2016 COMMUNITY HEALTH NEEDS ASSESSMENT · 2019. 7. 14. · 2016 Community Health Needs Assessment . Essentia Health St. Mary’s . Progress to Date on 2013 Community Health Needs

2016 COMMUNITY HEALTH NEEDS ASSESSMENT

St. Mary's Detroit Lakes

West Region

Essentia Health St. Mary’s-Detroit Lakes 1027 Washington Avenue Detroit Lakes, Minnesota 56501

EH St. Mary’s-Detroit Lakes is an 87-bed acute care facility in

Detroit Lakes, Minn. It is part of Essentia Health, a nonprofit

integrated health system caring for patients in Minnesota,

Wisconsin, North Dakota and Idaho. Headquartered in Duluth,

Minnesota, Essentia Health combines the strengths and talents of

14,000 employees, who serve our patients and communities

through the mission of being called to make a healthy difference

in people’s lives.

EH St. Mary’s-Detroit Lakes has been providing health care to the

community since 1886 when Dr. L.C. Weeks set up the first clinic.

While part of Essentia Health, St. Mary’s retains its Benedictine

alignment and Catholic heritage, which began in 1939.

EH St. Mary’s-Detroit Lakes provides both primary and select

secondary patient services, including a 12-bed women’s unit with

four birthing rooms, three operating rooms and full imaging and

laboratory services. Outpatient and Urgent Care services are

provided in our new clinic adjacent to the hospital. Additional

satellite clinics are located in Pelican Rapids, Park Rapids,

Menahga, Frazee, Mahnomen, and Lake Park. St. Mary’s Therapy

Center offers physical, occupational and speech therapy services

to all ages and includes a pediatric and outpatient gym, kitchen

and sleep center.

In providing the full spectrum of care, EH St. Mary’s-Detroit Lakes

also has Home Health, senior living, assisted living as well as

transitional and long-term care services in a close-knit

community.

EH St. Mary’s-Detroit Lakes has a Level III Trauma designation, is a

Primary Stroke Center hospital and has been awarded the Gold

Seal of Approval by JCAHO for demonstrated commitment to

standards of performance.

2016 Community Health Needs Assessment Essentia Health St. Mary’s

LEAD PARTIES ON THE ASSESSMENT

Peter Jacobson, Senior Vice President of Primary Care and Administrator

Karen Crabtree, Community Health Program Manager

Ann Malmberg, Regional Director of Community Health, West Region

TABLE OF CONTENTS 2...........................................................................

Essentia Health: Here With You ......................... 2

Executive Summary ........................................... 3

Caring for our Community ................................ 3.

Progress to Date on 2013 Community Health Needs Assessment ............................................. 4

2016 Community Health Needs Assessment ..... 6

Objectives .......................................................... 6

Description of Community Served by Essentia Health St. Mary’s ............................................... 6

Process Overview ............................................... 9

Assessment Process ......................................... 12

Phase 1: Assessment .................................... 12

Phase 2: Prioritization ................................ 12..

Phase 3: Design of Strategy and Implementation Plan ................................ 13 ...

Conclusion ....................................................... 15

Appendix A: Essentia Health St. Mary’s --- Top 80 percent of 2015 discharges by ZIP code .......... 16

Appendix B: Methodology

Appendix C: Stakeholder Meetings

Appendix D: Asset Map

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Essentia Health: Here With You At Essentia Health, our mission and values guide us every day. Together, we deliver on our promise to be here with our patients and members of our communities from the beginning to the end of life, both in our facilities and where they live, work and play. As a Catholic facility sponsored by the Benedictine Sisters of the St. Scholastica Monastery, Essentia Health St. Mary’s- Detroit Lakes promotes Christ’s ministry of holistic healing for all human life with special concern for the poor and powerless.

Mission

We are called to make a healthy difference in people's lives.

Vision Essentia Health will be a national leader in providing high quality, cost effective, integrated health care services.

Values

• Quality • Hospitality • Respect • Justice • Stewardship • Teamwork

Belief Statements

• Our highest priority is the people we serve. • We believe that the highest quality health care requires a regard for both the soul and science of healing

and a focus on continuous improvement. • We believe in the synergy of sponsorship among faith-based and secular organizations. • We believe in the value of integrated health care services. • We believe in having a meaningful presence in the communities we serve.

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Executive Summary

The 2016-2019 Becker County Community Health Needs Assessment was conducted as a partnership between EH St. Mary’s-Detroit Lakes with Sanford Health, Becker County Public Health and Partnership 4 Health. The goal was to identify primary health issues, current health status and needs. The results enable community members to strategically establish priorities, develop interventions and direct resources to improve the health of the people living in the community.

The CHNA survey was completed in late 2015. In early 2016, a Community Health steering committee developed “Becker County Energize” as a means to create a united approach to improve health and wellness in the community. The steering committee consists of a representative from all the major health organizations; representatives from non-profit, for-profit, and private organizations; local business representatives; local government and representatives from the state health improvement initiative. EH St. Mary’s-Detroit Lakes and Partnership 4 Health leaders co-facilitate the steering committee.

After prioritizing, the steering committee revealed 12 distinct issues in Becker County and developed three goal groups to address the top issues in the community. The Goal Groups are:

1. Healthier choices 2. Mental fitness 3. Community connections

Methodology, Prioritization Process and Action Planning

Participatory Action Research is a best practice used to facilitate the group work of the Becker County Energize steering committee. The committee used a group exercise to update an asset inventory of the service area that will be utilized for a community event for Becker County Energize. The committee also identified liabilities, potential funding sources, processes to keep citizens engaged in feedback and considerations for branding and marketing. Leadership and facilitation training to support committee members was given.

The Becker County Energize community event will further engage residents in facilitated discussion around the three focus groups to build community strategies to address them. The full three-year implementation plan will be completed by November 1, 2016.

Caring for our Community Our commitment to community health and wellness goes well beyond the work of the Community Health Needs Assessment. Through donations of funds, along with employees’ time and talents, Essentia Health invests in a variety of programs and outreach efforts. Across the organization, we support community coalitions, housing, food shelves, mental health, congregational outreach, community infrastructure, public health, education, safety and other nonprofit organizations. These investments are designed to promote better health, help lessen inequities in our communities, improve access to health care and strengthen relationships with those we serve.

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Progress to Date on 2013 Community Health Needs Assessment

EH St. Mary’s-Detroit Lakes initially partnered with the University of Minnesota, which provided a National Diabetes Prevention Program (NDPP) lifestyle coach. This best-practice program from the Centers for Disease Control and Prevention is evidence-based and has measurable outcomes. In 2015, the hospital hired a community health facilitator to teach NDPP classes. The first class is underway and 32 participants had lost more than 200 pounds by week 10 of the program.

Additional Accomplishments:

Stakeholder Engagement EH St. Mary’s-Detroit Lakes conducted stakeholder interviews with approximately 30 key community members to gain a better understanding of the community’s definition of community health, identify community assets, develop a list of priorities and define the community’s health-related issues. This resulted in the overarching development of a work plan surrounding the following five areas:

• Chronic disease prevention • Senior health and wellness • Mental health • Worksite wellness • Primary care integration

Preventative Care EH St. Mary’s-Detroit Lakes developed several additional classes targeting chronic disease prevention and management for adults and youth. Four classes have been completed, including diabetes prevention, diabetes self-management and chronic disease management. Additional community outreach and chronic disease prevention actions are being considered and developed. This includes a “Go Wild” youth nutrition class in the school district and a “Cooking Matters” course for adults.

Senior Health and Wellness EH St. Mary’s-Detroit Lakes has shifted focus to become more proactive and preventative in the area of senior health. The community paramedic program is in the final stages of implementation. The hospital has partnered with Ecumen, a local health organization with services for seniors, to be a Dementia Capable Care Community. The hospital organized and led a community conference for senior health and wellness on May 7, 2015, to identify innovative solutions to address the needs of the senior population. The EH St. Mary’s-Detroit Lakes Clinic opened a memory clinic one day per week to improve services for those suffering from any stage of memory loss. This has also resulted in three groups working on the priorities of advanced care planning, volunteerism, and education and advocacy.

Mental Health EH St. Mary’s-Detroit Lakes was selected as a national finalist for the Jackson Healthcare Community Health Award for integrating a mental health crisis team in the health system and across the community in 2014 and 2015. Staff has been trained in utilization of the mental health crisis team. The hospital hosted a conference in May 2015 with law enforcement, county and tribal entities, schools, mental health agencies and community partners to create solutions to improve mental health awareness and prevention services in our community. EH St. Mary’s-Detroit Lakes also expanded community education on mental health.

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Worksite Wellness The hospital’s worksite wellness initiatives are directed to improve eating habits and increase physical activity. Initiatives include removing beverages containing sugar from the hospital cafeteria and offering healthy choices in vending machines. EH St. Mary’s-Detroit Lakes is partnering to provide a weekly farmers’ market on campus in the summer and participating in community-supported agriculture (CSA) to enable employees to gain easy access to healthy foods. The hospital also has a healthy choice cafeteria system to promote eating well and participates in a local food hub.

Primary Care Integration EH St. Mary’s-Detroit Lakes is looking to improve patient and family wellness by increasing access to mental health for community members. It is in the process of integrating a licensed social worker into the primary care clinic. This will allow a focus on advanced care planning, immediate addressing of psychosocial need and child protection.

Reduction of Excessive/Binge Drinking The hospital has worked with community partners to increase the stop points for alcohol testing on county highways by law enforcement. A community chemical dependency committee meets quarterly to improve communication and coordination across agencies to improve efforts against alcohol and drugs.

Immunizations The hospital worked with its clinic to increase the percentage of immunizations provided.

Access to Healthcare EH St. Mary’s-Detroit Lakes collaborated with its clinic to increase the number of medical professionals available to individuals in the service area. It has also worked to decrease the number of uninsured patients in the community. The hospital has increased access to mental health with the mobile crisis team policy. The hospital has created a memory care clinic, rehabilitation care for Parkinson’s disease and stroke as well as an optometry clinic. The hospital is partnering with Appletree Dental to provide an outpatient dental clinic.

Tobacco Use The hospital has increased the number of inpatients provided with tobacco-cessation counseling during the past fiscal year. Outpatient tobacco-cessation counseling in collaboration with the Minnesota Quit Plan is also offered.

Secondary Prevention/Screening The hospital worked collaboratively with community members to conduct the annual Rotary Club Blood Screening event. This event reached more than 2,400 people.

Our CHNA activities are available on the website with updates reported annually. No written comments have been submitted at the time of this report.

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2016 Community Health Needs Assessment

Objectives Essentia Health is called to make a healthy difference in people’s lives. To fulfill that mission, we seek opportunities to both enhance the care we provide and improve the health of our communities. In conducting the Community Health Needs Assessment, Essentia Health has collaborated with community partners to embrace these guiding principles:

• Seek to create and sustain a united approach to improving health and wellness in our community

and surrounding area; • Seek collaboration towards solutions with multiple stakeholders (e.g. schools, work sites, medical

centers, public health) to improve engagement and commitment focused on improving community health; and

• Seek to prioritize evidence-based efforts around the greatest community good that can be achieved through our available resources.

The goals of the 2016 Community Health Needs Assessment were to:

1. Assess the health needs, disparities, assets and forces of change in Essentia Health St. Mary’s service area.

2. Prioritize health needs based on community input and feedback. 3. Design an implementation strategy to reflect the optimal usage of resources in our community. 4. Engage our community partners and stakeholders in all aspects of the Community Health Needs

Assessment process.

Description of Community Served by Essentia Health St. Mary’s The community served by EH St. Mary’s-Detroit Lakes includes Becker, Otter Tail and Hubbard counties. Discharge information shows that these are the home locations for more than 80 percent of patients discharged (See Appendix A). A primary barrier to care in the region is high poverty levels, particularly in Becker County. The region’s rates of unemployment also are higher than the state. There is an aging population. Diversity, based on the American Indian population, is noted in both Becker and Hubbard counties.

Poverty, education, age and race are all factors contributing to the inequitable health outcomes in this community. According to the Minnesota Department of Health’s White Paper on Income and Health, “Poverty in Minnesota is not evenly distributed across racial/ethnic groups, ages or educational levels. Poverty is concentrated among populations of color, children, people with less education, female headed households and rural Minnesotans.” 1

People in Minnesota with lower incomes are more likely to:

1 Minnesota Department of Health, White Paper on Income and Health, March 3, 2014 https://www.health.state.mn.us/data/legislative/docs/2014incomeandhealth.pdf

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https://www.health.state.mn.us/data/legislative/docs/2014incomeandhealth.pdf

• Have an infant die in the first year of life • Report that their health is fair or poor • Report having diabetes


• Report having seriously considered attempting suicide2

With a section of the White Earth Indian Reservation in Becker County, the health needs of the American Indian population are an important aspect of this assessment. As reported by the Indian Health Service, “The American Indian and Alaska Native people have long experienced lower health status when compared with other Americans. Lower life expectancy and the disproportionate disease burden exist perhaps because of inadequate education, disproportionate poverty, discrimination in the delivery of health services, and cultural differences. These are broad quality of life issues rooted in economic adversity and poor social conditions.

• Diseases of the heart, malignant neoplasm, unintentional injuries, and diabetes are leading causes of American Indian and Alaska Native deaths (2007-2009).

• American Indians and Alaska Natives born today have a life expectancy that is 4.4 years less than the U.S. all races population (73.7 years to 78.1 years, respectively).

• American Indians and Alaska Natives continue to die at higher rates than other Americans in many categories, including chronic liver disease and cirrhosis, diabetes mellitus, unintentional injuries, assault/homicide, intentional self-harm/suicide, and chronic lower respiratory diseases.”3

2 Minnesota Department of Health, White Paper on Income and Health, March 3, 2014 https://www.health.state.mn.us/data/legislative/docs/2014incomeandhealth.pdf 3 U.S. Department of Health and Human Services, Indian Health Service, Indian Health Disparities https://www.ihs.gov/newsroom/factsheets/disparities/

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https://www.health.state.mn.us/data/legislative/docs/2014incomeandhealth.pdf

https://www.ihs.gov/newsroom/factsheets/disparities/


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Becker Hubbard Otter Tail Minn. Est. July 2015

Population 33,386 20,655 57,716 5,489,594 Diversity White 87.7 % 94.8 % 96.2 % 85.7 % Black 0.6 % 0.4 % 1.1 % 5.9 %American Indian 7.9 % 2.5 % 0.7 % 1.3 % Asian 0.5 % 0.4 % 0.6 % 4.7 % Hispanic or Latino 1.8 % 0.4 % 0.6 % 5.1 %

Unemployment 6.4 % 6.8 % 6.2 % 3.7 %

Median household Income in 2014 dollars, 2010-2014

$51,470 $46,412 $50,914 $60,828

Persons in poverty 14.6 % 12.2 % 11.2 % 11.5 %

High School graduate or higher

90.5 % 92.2 % 90.7 % 92.3 %

Bachelor’s degree or higher

21.6 % 24.3 % 23.6 % 33.2 %

Persons under age 5 6.3 % 5.7 % 5.8 % 6.4 % Persons under age 18 24.6 % 21 % 21.4 %

Persons age 65 and over

19.3 % 23.6 % 22.5 % 14.3 %

Data from US Census Bureau: http://quickfacts.census.gov/qfd/states/27000.html Unemployment from MN Department of Employment and Economic Development (March, 2016 not seasonally adjusted): http://mn.gov/deed/data/current-econ-highlights/county-unemployment.jsp

http://quickfacts.census.gov/qfd/states/27000.html

http://mn.gov/deed/data/current-econ-highlights/county-unemployment.jsp


Health disparities were also identified by responses to the survey: (Full survey results in Appendix B)

Becker, Clay, Otter Tail, Wilkin responses 2015

Overweight or obese 66.7 % Identify they are in good, very good or excellent health 91.6 % Indicate no physical activity in the past month 15.1 % Indicate they ate five or more servings of fruit and vegetables yesterday

34.9 %

Diabetes 8.9 % Informed by a healthcare professional they have high blood pressure

33.6 %

Smoke (Minnesota average is 14.4%) 13.0 % Any binge drinking 31.7 % Informed they have depression 20.6 % Informed they have anxiety 17.2 % Becker,Clay,Otter Tail, Wilkin survey frequencies (Appendix)

Process Overview Essentia Health’s Community Health Committee developed a shared plan for the 15 hospitals within the system to conduct their 2016 Community Health Needs Assessments (CHNA). This plan was based on best practices from the Catholic Health Association and lessons learned from the completion of Essentia’s first CHNAs in 2013. This process was designed to:

• Incorporate community surveys and existing public data. • Directly engage community stakeholders. • Collaborate with local public health and other healthcare providers.

From there, each of Essentia’s three regions was responsible for adapting and carrying out the plan within their communities and hospital service areas. EH St. Mary’s-Detroit Lakes collaborated with Partnership 4 Health to have the Minnesota Department of Health conduct a survey of Becker, Clay, Otter Tail and Wilkin counties. Survey questions included the Behavior Risk Factor Surveillance System (BRFSS) survey from the Minnesota Department of Health Center. The vendor for the survey was Survey Systems, Inc. of New Brighton, Minnesota. The initial survey was sent to 1,600 households per county. A reminder postcard followed 10 days later. Becker County had a 22.9 percent response rate and Otter Tail County had a 27.3 percent response (methodology and survey response Appendix B). Survey Systems returned the responses in November.

EH St. Mary’s-Detroit Lakes and Partnership 4 Health convened three successive stakeholder groups that included the hospital, Partnership 4 Health, Mahube-Otwa Community Action Partnership, Becker County Chamber of Commerce, Aging Services, Boys and Girls Club and others. (See attendance and results, Appendix C). The American Indian population was represented by Becker County Public Health and Mahube-Otwa. The White Earth Indian Reservation public health nurse attended one meeting and

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agreed to work with the group going forward. This group represents strong, engaged community resources to assist in driving improvement in community health.

EH St. Mary’s-Detroit Lakes planning was conducted in four stages: assessment, prioritization, design and finalization. The process began in August 2015 and was completed in May 2016 with the final presentation of the Community Health Needs Assessment to leadership and the Board of Directors on May 9, 2016 and the West Region Board of Directors on May 17, 2016.

The following describes the assessment steps and timeline.

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ASSESS (April -

October 2015)

Define Service Area

Service Area Demographics

Analyze Secondary Data

Gather Community Input

Conduct Asset Mapping of

Available Community Resources

Evaluate Progress on 2013 CHNA

Priorities

PRIORITIZE (December 2015

- April 2016)

Set Criteria for Prioritized Needs

Choose Prioritization

Method

Choose Needs to Address

DESIGN (March - April

2016) Goal Setting

Identify the "team" for each

strategy

Determine strategy options

Choose Strategies/Progra

ms Set SMART

Objectives

Design Implementation

Plan and Evaluation Framework

FINALIZE (May 2016)

Review with key stakeholders for

final feedback

Present to EH-St. Mary's Board for

Approval May 9th, 2016

Present to West Region Board May 17,2016


Assessment Process

Phase 1: Assessment

EH St. Mary’s-Detroit Lakes collaborated with Partnership 4 Health to conduct a survey of Becker, Clay, Otter Tail and Wilkin Counties. White Earth Indian Reservation conducted a separate survey but was unable to share results at the time of this report. That information will be incorporated into the implementation strategy where possible.

As discussed in the overview, EH St. Mary’s-Detroit Lakes engaged a broad group of community representatives that included Becker, Hubbard and Otter Tail counties. White Earth Public Health was at one meeting and has agreed to represent the American Indian population. Public Health, Mahube-Otwa, the Boys and Girls Clubs, and Aging Services all work with diverse and underserved populations and represented those interests at the meetings.

The stakeholder groups reviewed the survey results, previous community health initiatives and assessed progress and opportunities for the future.

One limitation of the community survey was that Hubbard County was not included. However, stakeholders who can represent Hubbard County were at the meetings.

No comments were received from the 2013 Community Health Needs Assessment. Any comments received would have been reviewed, evaluated and taken into consideration when preparing the 2016 Community Health Needs Assessment.

Phase 2: Prioritization Needs identified by the survey were identified and placed on the Prioritization Worksheet. Criteria to identify the priority problems were discussed including cost, availability of solutions, impact of the problem, availability of resources, urgency and size. The criteria to identify interventions included expertise, return on investment, effectiveness of the solution, ease of implementation and maintenance, potential negative consequences, legal consideration, impact on systems of health, and feasibility of intervention.

The results of the meeting were brought to the first stakeholder group on February 25 to discuss findings and priorities. Meetings on March 10 and March 22 identified the top three priorities. A broader stakeholder group was convened on May 13 to begin the full three-year implementation plan that will be completed by November 1, 2016. The three priorities are:

1. Improve nutrition and increase activity across the lifespan (Healthy Choices). 2. Improve collaboration between partners in providing mental health services (Mental Fitness).

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3. Improve coalition partnerships that include underserved and minorities (Community Connections). Categorize health needs into goal areas (Healthy Choices, Mental Fitness, Workplace Wellness and Community Connections).

The hospital will partner with community partners but not take the lead or devote resources in those areas that are not within our expertise. For example, we support increasing the number of insured, the availability of affordable housing, the cost of public transportation, and air quality but don’t have the resources or expertise to specifically drive these areas. We work with programs to improve dental access but don’t provide dental services at Essentia Health St. Mary’s.

Phase 3: Design of Strategy and Implementation Plan

SUMMARY OF COMMUNITY DEFINED PRIORITIES/STRATEGIES:

The full three-year implementation plan will be completed by November 1, 2016. The stakeholder group has determined priorities and goals with strategies as listed below. These will be further developed over the next five months. Several partners have been identified for each priority and include public health and other representatives for the underserved and the American Indian population. Additional partners will continue to be added as the planning unfolds.

PRIORITY AREA GOALS Healthier Choices 1. Improve nutrition and increase activity across

the lifespan.

STRATEGIES FOR EACH PRIORITY

Priority: Healthier Choices Goal: National Diabetes Prevention Program Partners: Mahube/Otwa, Land of the Dancing Sky

Strategy 1: Increase both class numbers and locations.

Measure: BMI and physical activity from classes

Goal: Infant Health

Strategy 2: Increase access to healthy foods. Measure: Number of community gardens, number of people participating in WIC

Measure: Survey perception of wellness, number of fruits and vegetables, percent of residents with no physical activity annually.

PRIORITY AREA GOALS Mental Fitness 1. Improve collaboration between partners in

providing mental health services

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Priority: Mental Fitness Goal: Improve crisis intervention Partners: Sheriff’s Department, local police and fire

department, Wellness in the Woods, Becker County Mental Health, White Earth Mental Health, Willow Tree Crisis Bed, Stellher Human Services, Solutions Inc., Lakeland Mental Health, MNState, Detroit Lakes Schools, Lake Park/Audubon Schools, City of Detroit Lakes officials.

Strategy 1: Provide public education about services

Measure: Increase number of people trained in Question, Persuade and Refer (suicide awareness training) and mental health first aid

Strategy 2: Increase collaboration between Emergency Department, Emergency Medical Services, hospitalists, sheriff’s departments, police, and social services.

1. Reduce number of mental health emergency holds in the Emergency Department

Strategy 3: Continue “Stomp the Stigma” team 1. Number of participants in event 2. Increase funding for local mental health

initiatives

PRIORITY AREA GOALS Community Connections 1. Improve coalition partnerships that include

underserved and minorities


Priority: Community Connections Goal: Improve coalition partnerships that include underserved and minorities

Partners: Partnership 4 Health, White Earth Public Health, Aging Services, Mahube/OTWA CAP, Chamber of Commerce

Measure: Strategy 1: Collaborate on one event to improve health for an underserved population.

1. Host event with MN Flyers to focus on addressing barriers for special needs children

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Conclusion


As part of a nonprofit health system, EH St. Mary’s-Detroit Lakes is called to make a healthy difference in people’s lives. This needs assessment and implementation plan illustrates the importance of collaboration between our hospital and its community partners. By working collaboratively, we can have a positive impact on the identified health needs of our community during Fiscal Years 2017-2019. There are other ways in which EH St. Mary’s-Detroit Lakes will indirectly address local health needs, including the provision of charity care, the support of Medicare and Medicaid programs, discounts to the uninsured and others. Over the next three years, we will continue to work with the community to ensure that this implementation plan is relevant and effective and to make modifications as needed.

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Appendix A: Essentia Health St. Mary’s Detroit Lakes- Top 80 percent of 2015 discharges by ZIP code

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Zip Code

City

County

Discharges

Percentage

Cumulative Percentage

56501 Detroit Lakes Becker 2,974 38.2% 38.2% Becker 56544 Frazee Becker 711 9.1% 47.4% Becker 56470 Park Rapids Hubbard 383 4.9% 52.3% Hubbard 56557 Mahnomen Mahnomen 331 4.3% 56.5% Mahnomen 56572 Pelican Rapids Otter Tail 321 4.1% 60.7% 56589 Waubun Mahnomen 321 4.1% 64.8% Mahnomen 56554 Lake Park Becker 299 3.8% 68.6% Becker 56569 Ogema Becker 278 3.6% 72.2% Becker 56464 Menahga Wadena 241 3.1% 75.3% Wadena 56511 Audubon Becker 206 2.6% 78.0% Becker 56575 Ponsford Becker 181 2.3% 80.3% Becker

Survey Methodology

Survey Instrument

Staff from the public health agencies of Becker, Clay, Otter Tail and Wilkin counties in Minnesota developed the questions for the survey instrument with technical assistance from the Minnesota Department of Health Center for Health Statistics. Existing items from the Behavior Risk Factor Surveillance System (BRFSS) survey and from recent county-level surveys in Minnesota were used to design some of the items on the survey instrument. The survey was formatted by the survey vendor, Survey Systems, Inc. of New Brighton, MN, as a scannable, self- administered English-language questionnaire.

Sample

A two-stage sampling strategy was used for obtaining probability samples of adults living in each of the five counties. A separate sample was drawn for each county. For the first stage of sampling, a random sample of county residential addresses was purchased from a national sampling vendor (Marketing Systems Group of Horsham, PA). Address-based sampling was used so that all households would have an equal chance of being sampled for the survey. Marketing Systems Group obtained the list of addresses from the U.S. Postal Service. For the second stage of sampling, the “most recent birthday” method of within-household respondent selection was used to specify one adult from each selected household to complete the survey.

Survey Administration

An initial survey packet that included a cover letter, the survey instrument, and a postage-paid return envelope was mailed August 19-20, 2015, to 1600 sampled households in each of the five counties. About 10 days after the first survey packets were mailed (September 1), a reminder postcard was sent to all sampled households, reminding those who had not yet returned a survey to do so, and thanking those who had already responded. Two weeks after the reminder postcards were mailed (September 11 and 14), another full survey packet was sent to all households that still had not returned the survey. The remaining completed surveys were received over the next six weeks, with the final date for the receipt of surveys being October 21, 2015.

Completed Surveys and Response Rate

Completed surveys were received from 1920 adult residents of the five counties; thus, the overall response rate was 24.0% (1920/8000). County-specific response rates can be found on the next page.

Data Entry and Weighting

The responses from the completed surveys were scanned into an electronic file by Survey Systems, Inc.

To ensure that the survey results are representative of the adult population of each of the five counties, the data were weighted when analyzed. The weighting accounts for the sample design by adjusting for the number of adults living in each sampled household. The weighting also includes a post-stratification adjustment so that the gender and age distribution of the survey respondents mirrors the gender and age distribution of the adult populations of the five counties, according to U.S. Census Bureau 2010 estimates.

County

Response Rate

BECKER, MN 22.9% CLAY, MN 21.6% OTTER TAIL, MN 27.3% WILKIN, MN 26.3% RICHLAND, ND 21.9%

2015 CHS Assessment Summary of Survey Findings

Conducted in partnership with Essentia Hospital- Detroit Lakes, Lake Region Healthcare-Fergus Falls, Perham Health- Perham, St. Francis Hospital-Breckenridge

P4H CHB worked with Minnesota Department of Health (MDH) Center for Health Statistics to conduct a mailing to a random sample of households in Becker, Clay, Otter, Tail, Wilkin counties in MN and Richland county in North Dakota. Each hospital paid $4,000 toward the cost of the assessment. Funding from the State Health Improvement Program (SHIP) paid for the costs incurred by the counties. The survey instrument was created in Clay County in partnership with Sanford Health, Essentia, and Cass County PH in North Dakota. The survey was then modified with the assistance of MDH to capture the required questions to comply with SHIP funding requirements.

A total of 1600 households per county received the initial mailing. A total of 1,920 surveys were received for an overall response rate of 24.0%. To ensure that the survey results are representative of the adult population of each of the five counties, the data were weighted when analyzed. The weighting accounts for the sample design by adjusting for the number of adults living in each sampled household. The weighting also includes a post- stratification adjustment so that the gender and age distribution of the survey respondents mirrors the gender and age distribution of the adult populations of the five counties, according to U.S. Census Bureau 2010 estimates.

County Response

Rate Gender Age

groups Race

Nonwhite Education

<HS Grad

Income <$40,000

Unemployed or Disabled

BECKER, MN 22.9%

50-50 10.6%- 19.8%

3.9 % 2.2% 30.9% 1%-5%

CLAY, MN 21.6%

49-51 7.6%- 40.1%

3.2% 3.4% 28.8% 2.6%-4.7%

OTTER TAIL, MN 27.3%

50-50 12.9%- 21.0%

1.4% 5.7% 28.5% 0.8%-5.2%

WILKIN, MN 26.3%

50-50 10.7%- 22.9%

1.2% 2.2% 28.9% 4.9%-5.5%

RICHLAND, ND 21.9%

48-52 8.9%- 30.2%

1.8% 3.4% 19.7% 2.0%-3.1%

Self-reported Chronic Health Conditions

% reporting 40% 35% 30% 25% 20% 15% 10%

5% 0%

Self-reported Mental Health Status

Self-reported Healthy Behaviors

Priorities in our 2015-2019 Community Health Improvement Plan related to survey results

1. Healthy Lifestyle Behaviors 2. Mental Health

Priorities in our 2015-2019 Community Health Improvement Plan related to Health Statistics results

1. Adverse Childhood Experiences

Feeling down, depressed, hopeless

Little interest in doing things Mental Health not good

60% 40% 20%

0%

Mental Health

Healthy Behaviors 50% 45% 40% 35% 30% 25% 20% 15% 10%

5% 0%

Becker, Clay, Otter Tail, Wilkin CHB (n=1539)

General health status

Valid Percent

Valid Poor 1.8 Fair 6.6 Good 35.2 Very good 42.7 Excellent 13.6 Total 100.0 Missing Missing

Total

High blood pressure or pre-hypertension

Valid Percent

Valid No 66.4 Yes 33.6 Total 100.0 Missing Missing Missing Total

Total

Diabetes

Valid Percent

Valid No 91.1 Yes 8.9 Total 100.0 Missing Missing Missing Total

Total

Cancer

Valid Percent

Valid No 91.8 Yes 8.2 Total 100.0 Missing Missing

Total

Chronic lung disease

Valid Percent


Total

Heart trouble or angina

Valid Percent


Total

Stroke or stroke-related health problems

Valid Percent


Total

PAD or claudication

Valid Percent


Total

High cholesterol or triglycerides

Valid Percent

Valid No 69.3 Yes 30.7 Total 100.0

Missing Missing Total

Asthma

Valid Percent

Valid No 89.9 Yes 10.1Total 100.0


Arthritis

Valid Percent


Total

Depression

Valid Percent


Total

Anxiety

Valid Percent


Total

Panic attacks

Valid Percent


Total

Alzheimer's disease

Valid Percent

Valid No 99.3 Yes .7 Total 100.0 Missing Missing

Total

Other mental health problems

Valid Percent

Valid No 95.6 Yes 4.4 Total 100.0


Last routine checkup

Valid Percent

Valid Within the past year 75.0 Within the past 2 years 13.6 Within the past 5 years 4.8 5 or more years ago 6.5 Never .1 Total 100.0 Missing Missing

Total

Personal doctor

Valid Percent

Valid Yes, only one person 60.1 Yes, more than one person

23.3 No 16.6 Total 100.0 Missing Missing

Total

Usual place for care: Physician's office

Valid Percent

Valid Not checked 27.9 Checked 72.1 Total 100.0


Usual place for care: Public health department or clinic

Valid Percent

Valid Not checked 92.5 Checked 7.5 Total 100.0 Missing Missing

Total

Usual place for care: Some other free or discounted clinic

Valid Percent


Total

Usual place for care: Hospital emergency room

Valid Percent


Total

Usual place for care: Urgent care clinic

Valid Percent


Total

Usual place for care: No usual place

Valid Percent


Total

Usual place for care: Other place

Valid Percent


Total

Dental exam or cleaning

Valid Percent

Valid Within the past year 77.8 Within the past 2 years 8.5 Within the past 5 years 5.0 5 or more years ago 8.6 Never .1 Total 100.0 Missing Missing

Total

Where get most health-related information: Government websites

Valid Percent


Where get most health-related information: Non-government websites

Valid Percent


Where get most health-related information: Television

Valid Percent


Where get most health-related information: Magazine, newspapers, books

Valid Percent


Where get most health-related information: Doctor or other healthcare professional

Valid Percent


Where get most health-related information: Fanily or friends

Valid Percent


Where get most health-related information: Telephone helpline

Valid Percent


Where get most health-related information: Other

Valid Percent


Best way to access technology for health information: Personal conputer or tablet

Valid Percent


Best way to access technology for health information: Public computer

Valid Percent


Best way to access technology for health information: Smart phone

Valid Percent


Best way to access technology for health information: Other

Valid Percent


Best way to access technology for health information: None

Valid Percent


Calculated variable: Current insurance status

Valid Percent

Valid Currently uninsured 3.0 Currently insured 97.0 Total 100.0 Missing Missing

Total

Dental or oral health insurance

Valid Percent

Valid Yes 60.0 No 36.4 Don't know 3.6 Total 100.0 Missing Missing

Total

Days mental health not good

Valid Percent

Valid 0 days 56.5 1-9 days 32.4 10-19 days 7.3 20-29 days 2.1 All 30 days 1.7 Total 100.0 Missing Missing

Total

Little interest or pleasure in doing things past 2 weeks

Valid Percent

Valid Not at all 78.9 Several days 17.4 More than half the days 1.9 Nearly every day 1.8 Total 100.0 Missing Missing

Total

Feeling down, depressed, hopeless past 2 weeks

Valid Percent

Valid Not at all 80.0 Several days 17.4 More than half the days 1.5 Nearly every day 1.0 Total 100.0 Missing Missing

Total

Number of vegetables yesterday

Valid Percent

Valid 0 servings 11.7 1-2 servings 61.0 3-4 servings 20.7 5 or more servings 6.7 Total 100.0


Number of solid fruits yesterday

Valid Percent

Valid 0 servings 19.5 1-2 servings 58.7 3-4 servings 17.8 5 or more servings 4.0 Total 100.0 Missing Missing

Total

Number of fruit juice servings yesterday

Valid Percent

Valid 0 servings 61.3 1-2 servings 34.5 3-4 servings 2.5 5 or more servings 1.6 Total 100.0 Missing Missing

Total

Calculated variable: Number of fruits and vegetables yesterday

Valid Percent

Valid 0 servings 4.6 1-2 servings 24.5 3-4 servings 29.5 5-9 servings 34.9 10 or more servings 6.5 Total 100.0 Missing Missing

Total

Past month participate in any physical activities or exercise

Valid Percent

Valid Yes 84.9 No 15.1 Total 100.0 Missing Missing

Total

Moderate excercise 5+ days per week

Valid Percent

Valid 0-4 days per week 69.2

5-7 days per week 30.8 Total 100.0 Missing Missing

Total

Vigorous excercise 3+ days per week

Valid Percent

Valid 0-2 days per week 71.0 3-7 days 29.0 Total 100.0 Missing Missing

Total

Blood pressure screening past 12 months

Valid Percent

Valid Yes 81.9

No 18.1 Total 100.0 Missing Missing

Total

Blood sugar screening past 12 months

Valid Percent

Valid Yes 58.2


Total

Bone density test past 12 months

Valid Percent

Valid Yes 10.8


Total

Cardiovascular screening past 12 months

Valid Percent

Valid Yes 24.6

No 75.4 Total


100.0

Cholesterol screening past 12 months

Valid Percent

Valid Yes 60.4

No 39.6 Total


100.0

Dental screening and X-rays past 12 months

Valid Percent

Valid Yes 72.6

No 27.4 Total


100.0

Flu shot past 12 months

Valid Percent

Valid Yes 55.9

No 44.1 Total


100.0

Glaucoma test past 12 months

Valid Percent

Valid Yes 40.5

No 59.5 Total 100.0


Hearing screening past 12 months

Valid Percent

Valid Yes 19.4


Total

Immunizations past 12 months

Valid Percent

Valid Yes 26.0


Total

STD screening past 12 months

Valid Percent

Valid Yes 7.7


Total

Vascular screening past 12 months

Valid Percent

Valid Yes 9.2


Total

Colorectal cancer screening past 12 months

Valid Percent

Valid Yes 16.9

No 83.1 Total


100.0

Skin cancer screening past 12 months

Valid Percent

Valid Yes 17.3

No 82.7 Total


100.0

Pelvic exam past 12 months (female only)

Valid Percent

Valid Yes 58.9

No 41.1 Total


100.0

Breast cancer screening past 12 months (female only)

Valid Percent

Valid Yes 58.2

No 41.8 Total


100.0

Cervical cancer screening past 12 months (female only)

Valid Percent

Valid Yes 46.0

No 54.0 Total


100.0

apsara

Cross-Out

Prostate cancer screening past 12 months (male only)

Valid Percent

Valid Yes 29.1

No 70.9 Total


100.0

Calculated variable: Smoking status

Valid Percent

Valid Current smoker 13.0 Former smoker 28.1 Never smoked 58.9 Total 100.0 Missing Missing

Total

Calculated variable: Smokeless status

Valid Percent

Valid Non-user 96.6 Current user 3.4 Total 100.0 Missing Missing

Total

Among those who currently smoke or use smokeless tobacco:

Where would go first for help to quit tobacco: Telephone quitline

Valid Percent


Total

Where would go first for help to quit tobacco: Doctor or other healthcare professional

Valid Percent

Valid Not checked 66.7

Checked 33.3 Total 100.0 Missing Missing

Total

Where would go first for help to quit tobacco: Pharmacy

Valid Percent


Total

Where would go first for help to quit tobacco: Private counselor/therapist

Valid Percent

Valid Not checked Missing Missing Total

100.0

Where would go first for help to quit tobacco: Public health department or clinic

Valid Percent


Total

Where would go first for help to quit tobacco: Don't know

Valid Percent


Total

Where would go first for help to quit tobacco: I don't want to quit

Valid Percent


Total

Where would go first for help to quit tobacco: Other

Valid Percent

Valid Not checked 89.1Checked 10.9Total 100.0


Any alcohol drinking in past 30 days

Valid Percent

Valid No drinking 25.9 Any drinking 74.1 Total 100.0 Missing Missing

Total

Calculated variable: Heavy drinking

Valid Percent

Valid No drinking or not heavy 88.1 Heavy drinking 11.9 Total 100.0 Missing Missing

Total

Calculated variable: Binge drinking

Valid Percent

Valid No drinking or no binge 68.3 Any binge drinking 31.7 Total 100.0 Missing Missing

Total

Ever had a problem with alcohol use

Valid Percent


Total

Ever had a problem with Rx or non-Rx drug use

Valid Percent


Total

Has alcohol had harmful effects in past 2 years

Valid Percent


Total

Has drug abuse had harmful effects past 2 years

Valid Percent


Total

Calculated variable: Weight status according to BMI

Valid Percent

Valid Not overweight 33.3 Overweight but not obese 38.8 Obese 27.8 Total 100.0 Missing Unknown weight and/or height

Total

Number of children under 18 living in household

Valid Percent

Valid None 60.2 1 to 2 29.2 3 to 5 10.3 6 or more .3 Total 100.0 Missing Missing

Total

Availabilty of affordable housing

Valid Percent

Valid Not at all concerned 33.9 Not very concerned 22.1 Somewhat concerned 32.1

Very concerned 11.8 Total 100.0 Missing Missing

Total

Homelessness

Valid Percent

Valid Not at all concerned 34.6 Not very concerned 25.8 Somewhat concerned 29.7 Very concerned 9.9 Total 100.0 Missing Missing

Total

Hunger

Valid Percent


Total

Availability of public transportation

Valid Percent


Total

Cost of public transportation

Valid Percent

Valid Not at all concerned 44.2 Not very concerned 30.2 Somewhat concerned 18.8 Very concerned 6.8 Total 100.0


Driving habits

Valid Percent


Total

Availability of good walking or biking options

Valid Percent


Total

Water quality

Valid Percent


Total

Air quality

Valid Percent


Total

Home septic Missings

Valid Percent

Valid Not at all concerned 43.4

Not very concerned 31.4 Somewhat concerned 17.5 Very concerned 7.7 Total 100.0


Hazardous waste

Valid Percent


Total

Availability of services for at-risk youth

Valid Percent


Total

Cost of services for at-risk youth

Valid Percent


Total

Youth crime

Valid Percent


Total

School dropout rates

Valid Percent

Valid Not at all concerned 23.7Not very concerned 36.9Somewhat concerned 27.2Very concerned 12.2Total 100.0


School absenteeism

Valid Percent


Total

Teen pregnancy

Valid Percent


Total

Bullying

Valid Percent


Total

Availbility of activities for children and youth

Valid Percent


Total

Cost of activities for children and youth

Valid Percent


Total

Availability of quality child care

Valid Percent


Total

Cost of quality child care

Valid Percent

Valid Not at all concerned Not very concerned

22.4 22.3

Somewhat concerned 29.5 Very concerned 25.8 Total 100.0 Missing Missing

Total

Availability of quality infant care

Valid Percent


Total

Cost of quality infant care

Valid Percent


Total

Availability of activities for seniors

Valid Percent


Total

Cost of activities for seniors

Valid Percent

Valid Not at all concerned 28.1 Not very concerned 33.4 Somewhat concerned 26.4 Very concerned 12.1

Total 100.0 Missing Missing Total

Availability of resources to help the elderly stay safe in their homes

Valid Percent


Total

Availability of resources for family/friends caring for and making decisions for elders

Valid Percent


Total

Availability of resources for grandparents caring for grandchildren

Valid Percent


Total

Availability of long term care

Valid Percent


Total

Cost of long term care

Valid Percent


Total

Availability of memory care

Valid Percent


Total

Child abuse and neglect

Valid Percent


Total

Elder abuse

Valid Percent


Total

Domestic violence

Valid Percent


Total

Presence of street drugs, Rx drugs and alcohol in the community

Valid Percent


Total

Presence of drug dealers in the community

Valid Percent


Total

Presence of gang activity

Valid Percent


Total

Crime

Valid Percent


Total

Sex trafficking

Valid Percent


Total

Access to affordable health care

Valid Percent


Total

Access to affordable Rx drugs

Valid Percent


Total

Access to affordable health insurance

Valid Percent

apsara

Cross-Out


Total

Cost of affordable vision insurance

Valid Percent


Total

Cost of affordable dental insurance coverage

Valid Percent


Total

Distance to health care services

Valid Percent


Total

Providers not taking new patients

Valid Percent


27.1 29.4

Somewhat concerned 25.2 Very concerned 18.3

Total 100.0 Missing Missing

Total

Coordination of care between providers and services

Valid Percent


Total

Availability of non-traditional hours

Valid Percent


Total

Availability of transportation

Valid Percent


Total

Use of emergency room services for primary health care

Valid Percent


Total Missing Missing Total

100.0

Timely access to vision care providers

Valid Percent


Total

Timely access to dental care providers

Valid Percent


Total

Timely access to prevention programs and services

Valid Percent


Total

Timely access to bilingual providers and/or translators

Valid Percent


Total

Timely access to transportation

Valid Percent


Total

Timely access to doctors, physician assistants or nurse practitioners

Valid Percent


Total

Timely access to physician specialists

Valid Percent


Total

Timely access to registered dietitians

Valid Percent


Total

Timely access to exercise specialists or personal trainers

Valid Percent

Valid Not at all concerned 43.8 Not very concerned 39.7


Total

Timely access to mental health providers

Valid Percent


Total

Timely access to substance abuse providers

Valid Percent


Total

Obesity

Valid Percent


Total

Poor nutrition and eating habits

Valid Percent


Total

Inactivity and lack of exercise

Valid Percent


Total

Cancer

Valid Percent


Total

Chronic disease (e.g. diabetes, heart disease, multiple sclerosis)

Valid Percent


Total

Sexually transmitted diseases (e.g. AIDS, HIV, chlamydia)

Valid Percent


Total

Infectious diseases such as the flu

Valid Percent


Total

Dementia and Alzheimer's disease

Valid Percent


Total

Depression

Valid Percent


Total

Stress

Valid Percent


19.7 25.9


Total

Suicide

Valid Percent


Total

Other psychiatric diagnoses

Valid Percent


Total

Alcohol use and abuse

Valid Percent


Total

Drug use and abuse

Valid Percent


Total Missing Missing Total

100.0

Underage drinking

Valid Percent


Total

Underage drug use and abuse

Valid Percent


Total

Smoking and tobacco use

Valid Percent


Total

Exposure to second-hand smoke

Valid Percent


Total

Not necessary Doctor hasn't suggested

Why n Cost/no insurance/ insurance does not cover

58.9 18.4 6.1 →


Why n

Cost/no insurance/ insurance does not cover

→ 61.9 26.8 4.3


Why n


→ 52.3 38.3 2.6



→ 47.9 41.7 3.4


Why n


→ 50.1 33.7 4.5


Why n


→ 42.5 3.9 22.5


Why n


→ 47.4 7.4 3.1


Why n


→ 54.8 29.0 3.5



→ 59.8 28.9 3.5


Why n


→ 65.0 22.1 1.9


Why n


→ 77.0 12.0 2.4


Why n


→ 56.5 33.6 2.9

Why n



→ 53.7 28.7 2.9


Why n


→ 43.9 40.5 2.0


Why n


→ 50.6 22.8 4.3


Why n


→ 54.0 25.4 2.8


Why n


→ 56.3 20.3 2.7



→ 47.2 35.4 4.9

→ Past 12 months stopped smoking 1+ days trying to quit Valid Percent

Valid Yes 54.7 No 45.3 Total 100.0 Missing Missing Total

→ Did you get the help you needed (alcohol) Valid Percent

Valid Yes 67.3 No 11.9

Didn't need help 20.8 Total 100.0 Missing Missing

Total

→ Did you get the help you needed (drug) Valid Percent

Valid Yes 54.0 No 25.9 Didn't need help 20.1 Total 100.0

Usual place for child's care: Physician's office

→ Valid Percent


Total

Usual place for child's care: Public health department or clinic

Valid Percent


Total

Usual place for child's care: Some other free or discounted clinic

Valid Percent

Valid Not checked 99.2 Checked .8 Total 100.0 Missing Missing

Total

Usual place for child's care: Hospital emergency room

Valid Percent


Total

Usual place for child's care: Urgent care clinic

Valid Percent


Total

Usual place for child's care:

Valid Percent


Total

Usual place for child's care: Other place

Valid Percent


Total

Are all chldren up to date in immunizations

Valid Percent

Valid Yes, all children 91.9 No, not all children 7.4 Don't know .7 Total 100.0 Missing Missing

Total

Do all children get flu vaccine every year Valid Percent

Valid Yes 49.4 No 45.2 Don't know 2.0 Not applicable 3.4 Total 100.0 Missing Missing

Total

ot in the past 12 months Fear of procedure or results

Transportation problems/ can't get appointment

No providers offer this procedure or screening Other reason

0.4 0.4 0.0 12.8




0.4 0.2 0.5 7.6




0.1 0.3 0.5 5.6




0.2 0.1 0.5 5.3




0.6 0.1 0.1 8.7




2.1 0.4 1.3 17.0




3.4 0.1 0.0 33.7




0.1 0.2 0.2 9.1




0.1 0.1 0.3 5.5




0.5 0.1 0.1 5.9




0.2 0.1 0.1 3.6




0.1 0.1 0.2 3.6

ot in the past 12 months

Fear of procedure or results



1.7 0.1 0.1 10.1




0.9 0.1 0.1 6.0




1.7 0.1 0.1 13.6




1.0 0.1 0.0 12.4




0.7 0.0 0.2 12.2




0.7 0.1 0.0 10.0

CNHA meeting, February 25, 12-2 pm, Essentia

In attendance: Karen Crabtree, Ann Malmberg and Peter Jacobson, Essentia Anna Muzik and Taressa Strand, Sanford Ronda Stock, Becker County Public Health Karen Lenius, Mahube Otwa Community Action Council Jason Bergstrand and Karen Nitzkorski, PartnerSHIP 4 Health

Goal of Process: Creating Better Health in the Community by engaging the community in a process that allows ownership and partnership

• Request from group to compare State statistics and local trends to help prioritize community needs o Resources could include:

Children’s Defense Fund MN Youth Survey Hunger – Food Pantry (Jack Rentz) Affordable Housing – Mahube Otwa, Guy Fischer w/County Robert Wood Johnson funded report: Community Health Rankings and Roadmap White Earth Tribal Health – Pat Butler (or possibly LaVonne Larson with Senior

Nutrition) DL Police Dept. County Commissioner – Don Skaare

• Who should be at the table that isn’t? o Law Enforcement (Karen N will ask police, Karen C will ask sheriff) o White Earth (Ann will ask) o Medical Provider (Karen C will ask) o Pastor Ryan from Harvest Community Church in Frazee (Karen C will ask) o DL School Guidance Counselor: Sarah, Alex (Anna Muzic will ask) o Amy from the DLCCC (no one assigned to ask)

Becker, Clay, Otter Tail, Wilkin Data, the highlighted were identified as a starting place:

Results of Health condition questions:

Greater than 10% Yes 1. High blood pressure or pre-hypertension 33.6 2. Asthma 10.1 3. High cholesterol or triglycerides 30.7 4. Arthritis 20.8 5. Depression 20.6 6. Anxiety 17.2 Results of Health care questions:

1. Dental within the last year 77.8% 2. Currently insured 97% 3. Dental insurance 36.4% 4. Mental health not good 10-30 days/month 11.1% 5. Little interest in doing things the past 2 weeks (> not at all) 21.1%

these two highlighted items are considered one item Karen C will refer to past survey

1

6. Feeling down, depressed, hopeless the past 2 weeks (> not at all) 19.9% 7. No physical activity in the past month 15.1% 8. BP check in the last year 81.9% 9. Blood sugar/yr. 41.8% 10. Flu shot past 12 mo. 55.9 11. Current smoker 13.0% (Tried to stop smoking 1+ days-54.7%) 12. Smokeless tobacco 3.4% 13. Any alcohol drinking in the last 30 days 74.1% 14. Heavy drinking 11.9% 15. Binge drinking 31.7% 16. Ever had a problem with alcohol 8.3% 17. Ever had a problem with RX or non-RX drug use 1.8% 18. Has alcohol had harmful effects/past 2 years 15.7% 19. Has drug use had harmful effects/ past 2 years 6.6% 20. Weight status by BMI: Overweight but not obese 38.8, Obese 27.8

Lifestyle: (percent somewhat or very concerned) Affordable housing 43.9 Karen N will reach out to Guy Fischer at County, Karen C will look at past

survey 1. Homelessness 39.6 2. Hunger 45.3 Karen L will reach out to Food Pantry and Mahube data 3. Available public transportation 28.2 4. Cost of public transportation 25.6 5. Driving habits 42.3 6. Available good walking or biking options 35.8 7. Water quality 30.9 8. Air quality 32.5 9. Home septic 25.2 10. Hazardous waste 31.2

Aging: (percent somewhat or very concerned)

1. Available activities for seniors 38.5 2. Cost of activities for seniors 38.5 3. Available resources to help elderly stay safe in homes 47.8 4. Available resources for family/friends caring for elders 48.4 Karen L will follow up 5. Available long term care 50.6 6. Cost of long term care 67.3% 7. Available memory care 52.9

Other discussion about cost of long term care but we decided we couldn’t influence it; also transportation was mentioned

Children and Youth: (percent somewhat or very concerned)

1. Underage drinking 52.8 2. Underage drug use and abuse 58.2 Jason will follow up with MN Youth Survey 11. Services for at risk youth 46.1% 12. Cost for youth services 42.6 13. School dropout rates 39.4 14. School absenteeism 36.4 15. Teen pregnancy 46.6 Ronda will follow up 16. Bullying 61.2 Jason will follow up with MN Youth Survey

2

17. Availability of activities for children and youth 48.3 18. Cost of activities for children and youth 52 19. Available quality child care 48.4 20. Cost of quality child care 55.3 21. Available quality infant care 49.5 22. Cost of quality infant care 51.7 23. Available resources for grandparents caring for grandchildren 39.3

Decided to take cost of quality child care off the list

Safety: (percent somewhat or very concerned)

1. Youth crime 53 2. Child abuse and neglect 59.2 Ronda will follow up 3. Elder abuse 45.3 4. Domestic violence 57.8 5. Presence of street drugs, RX, alcohol in the community 67.8 Karen N will follow up with Police

Karen C will follow up with Sheriff 6. Drug dealers in the community 61.7 7. Gangs 46.3 8. Crime 59.8 9. Sex Trafficking 39.3

Health Care: (percent somewhat or very concerned)

1. Access to affordable health care 66.7 Karen C will follow up with both, compare past data 2. Access to affordable Rx 63.6 3. Access to affordable health insurance 69.7 4. Cost of affordable vision insurance 60.9 5. Cost of affordable dental insurance 65.1 6. Distance to health care services 33 7. Providers not taking new patients 43.5 8. Coordination of care between providers 43.5 9. Availability of non-traditional hours 36.7 10. Availability of transportation 25.2 11. Use of ED for primary care 45.9 12. Timely access to vision care providers 22.6 13. Timely access to dental care providers 30.8 14. Timely access to preventative services 25 15. Timely access to bilingual providers/translators 15.6 16. Timely access to transportation 20.1 17. Timely access to doctors, APCs 39.3 18. Timely access to physician specialists 39.3 19. Timely access to dieticians 16.8 20. Timely access to exercise specialists 16.5 21. Timely access to mental health providers 31.4 22. Timely access to substance abuse providers 26.4

Physical Health: (percent somewhat or very concerned)

1. Obesity 59 Karen C will look at Community Health Rankings for these two items 2. Poor nutrition and eating habits 54.3 3. Inactivity/lack of exercise 57.1

3

4. Cancer 60.9 5. Chronic disease 52.2 6. STDs 29.8 7. Infectious diseases such as the flu 43.5 8. Dementia/Alzheimer’s 50.1 9. Smoking and tobacco use 51.5 10. Exposure to second hand smoke 47.3

Mental Health: (percent somewhat or very concerned)

1. Depression 49.9 Karen C will follow up 2. Stress 54.4 3. Suicide 44 4. Other psychiatric DX 37.6 5. Alcohol use and abuse 52.1 6. Drug use and abuse 53.3

4

Community Health Needs Assessment Planning Team Meeting

Essentia Health, Detroit Lakes Thursday, March 10th, 12noon-1:30pm

In attendance: PartnerSHIP 4 Health: Jason Bergstrand and Karen Nitzkorski

Boys & Girls Club: Tami Skinner White Earth: Cyndy Rastadt Public Health: Ronda Stock Public Health Essentia: Karen Crabtree, Jackie Buboltz, LeAnn Mouw, Ann Malmberg, Peter Jacobson, Clarissa Dumdei, Dan Johnson

Background Information Jason Bergstrand summarized that today’s focus will use CHNA survey results to set priorities and goals Goal: create a grassroots effort focused on evidenced based strategies that lead to improved community health

Peter Jacobson, Senior VP West Region Essentia & CEO of Essentia Detroit Lakes Institute of Medicine Triple Aim Focus: Improve Health of Population, Enhance patient Experience, Lower per Capita Costs Need to impact sickest 10 % who account for 64 % of expenses; high cost of Medicare patients

Karen Crabtree: Introduction to Crow Wing Energized creating a united approach to improving health and wellness in our community and surrounding area prioritizing evidence based practices Note: Crow Wing’s Summary Results would be a great Executive summary to share with community. Community puts together funding and resources.

Essentia Health has asked that this process use these four categories as driving the process:

• Workplace Wellness • Community Connections • Healthy Choices • Mental Fitness

$ would come from Essentia but also other key partners, examples could be Sanford, DMF, United Way

Narrow our priority list (Handout- 12 areas, listed below) Goal: create a more manageable list to present to the community Discuss the additional research completed by core group reps

1) Lifestyle – Community Connections • Affordable housing –

o DL workforce summit is addressing this issue o Shortfall of 650 units for people less than the median income

2) Aging: Strengthening Family/Community Connections • Available resources for family/friends caring for elders

o % of resources is high that’s needed

• Available memory care o Advanced care planning opportunity o ACT on Alzheimer’s o Results from Mahube Otwa survey: Almost every day I need help with shopping, driving,

cleaning house, paying bills, medications, staying safe; self-reporting percentages: 56 % to 89%; o significant amount of senior citizens and baby boom bubble, 9.2 % of seniors in Community are

in poverty

3) Children and Youth (From MN Youth Survey: Jason found that Becker County’s data is lower than the state in this area in drug and bullying); Healthy Choices/ Mental Fitness

• Underage drug use and abuse (School addresses this with resources) • Teen pregnancy; Ronda: 35 in Becker County, 24 per county in the state – so higher than average • Bullying - lower than state rate, school and Boys & Girls Club are actively addressing • Child out of home placements – high: 272 in 2015

4) Physical Health – Healthy Choices • Obesity - 5% higher than state average • Cancer • High blood pressure or pre-hypertension & high cholesterol - Becker County is same as state average • Hunger –

o food insecurity - 10 % is BECKER COUNTY, 11 % is state o Adult Drinking 23 % BECKER COUNTY versus 19%; 45 % deaths by drunk driving o Limited access to healthy foods, 14 % compared to 6% at State

5) Mental Health - Becker County has the highest of mental health intake in the state – Mental Fitness • Stress – higher than state average • Depression • Family and children – Wilder Report

How can we address these collectively and comprehensively?

Start the planning process for April Community Kickoff Meeting When & where to have the event: Choices: Wednesday April 13, 8 am – 1 pm or Friday April 15, 8am – 1 pm Outcome for community meeting is to choose two goals, priorities and measures.

Didn’t have time to discuss these:

o How to best engage the community Effective marketing

o Identify possible leaders for Goal Groups o What other organizations might we partner with to leverage additional funding

and resources

Next Steps Follow up meetings to be held on Tuesday March 15 at 1:00 pm and Tuesday March 22 at 9:00 am

Becker County Energize Planning Meeting, March 22, 2016. 9:00 am, Essentia EMS conference room

In attendance: Facilitators: Karen Crabtree, Essentia; Jason Bergstrand and Karen Nitzkorski, PartnerSHIP 4 Health Attendees: Karen Lenius and Debra Skjonsberg, Mahube-Otwa, Carrie Johnston, Chamber; LaVerne Moltzan, Midwest Bank; Don Skarie, Becker County Commissioner; Ronda Stock, Becker Public Health; Anna Muzik, Sanford; Guy Fischer, Becker County EDA; Danica Robson and Mark Tysver, Land of Dancing Sky- West Central Area Agency on Aging; Clarissa Dumdei, LeAnn Mouw, Tiffany Hagen, Essentia; Tami Skinner, Boys & Girls Club.

Overview by Jason Bergstrand about the Community Health Needs Assessment, County-wide effort, engaging the community in a citizen-driven wellness movement.

Event location, date and time: to be determinedApril 13, May 13, 8 am – 12 noon, breakfast provided, Ecumen in Detroit Lakes Due to feedback at this meeting, this date will probably change

• Invited MN Commissioner of Health to be keynote speaker • Divide into four goals groups: Healthier Choices, Mental Fitness, Workforce Wellness, Community

Connections • What should the work of these four groups be?

Goal and objectives to be accomplished at the event:

• Goal of 60 attendees • Identify priorities of group • Karen Crabtree shared the tree analogy handout • Karen also shared mental health example that showcased how partners came together and impacted

delivery methods o development of a crisis team, increasing access, services and follow up o Health providers and staff were kept in communication loop o Outcomes, data: 22% decrease in emergency room holds, decrease amount of commitments

from 33 to 11, cost savings: $550,000 per year by implementing process change • Policy and system driven

Karen C asked participants to divide into the four focus groups, using trunk handout as guide,

• Participants through participatory action research voted on priorities • Map community resources • Identify and list potential financial and in-kind resources • List potential venues to keep citizens engaged in providing on-going feedback • Considerations for branding and marketing your initiative partners

Notes from group discussion

- Priorities by vote are: 1. Healthy Choices 2. Mental Health 3. Worksite Wellness

• Worksite Wellness Group

o How would health concerns fit into this group; is it a square peg in a round hole? o Propose to eliminate this group and go with other three groups since their focus would be

better suited to impacting the health concerns from the survey

o Could re-visit this in a year o Meld the leadership from this group into one of the others o Could impact smaller employers better through the work of one of the other groups o Less is more

• Mental Health Group o Financial Resources

Grant Writing for County and state funding, consider local matching funds United Way, Dakota Medical Foundation, Robert Wood Johnson, West Central Initiative

o Potential Engagement Strategies Ask what are you doing to be intentional? Use intended audiences for the work.

o Marketing Explore Social media use County Fair booth Communicate with County constituencies Use Essentia for marketing support through flyer and web site development

• Healthy Choices Group Discussed how to provide more activity and affordable options for healthy foods and active living programming

o Identified many assets in the community o Financial Resources: depends on direction of goals o Consider sub-categories within a goal group; e.g. could include worksite wellness o Marketing: Have a presence at events such as the water carnival

• Community Connections Group Focused on affordable housing and its workforce connection Discussed senior pieces – connecting the community with resources, focus on programming for older adults, provide dementia education, and transportation and access for older adults

o Financial Resources Bremer Foundation United Way Alzheimer’s Association

o Marketing Tie into ACT community efforts Senior events

Next Meeting: Friday April 8, 2:00 pm, EMS Conference Room

Trade/Title Organization/Business phone Community Health Assets

email LEGAL Chief of Police DL Police 846-3203 [email protected] County Sheriff Becker County Sheriff County Attorney [email protected] Public Defenders County Administrator Jailor

Local Media/Newspaper DL Online, The Record

SCHOOL Superintendent Superintendent Principle Principle School Board Member HEALTH/WELLNESS CEO/ED of org CFO of org Community Relations Manager of Public Health worker WIC Health Providers EMS/Paramedics clinic hospital senior care Veteran Service Officer

mailto:[email protected]


COUNTY County Commissioner County Commissioner Chamber of Commerce Board Member NATURAL RESOURCE DNR Soil & Water Conservation

FINANCIAL Banker

MMCDC

White Earth Tribal College

MH Ombudsman Becker

Group Contact Person Passion/interests email Phone

Rotary Jaycees Kiwanis Lions

VFW AM Vets Legion Women's Auxillary

PTO/PTA

Red Hat Ladies Senior Citizen Club Parish Nurses

Volunteer Fire Dept Community Club Faith Community - Adult Youth Groups

Girl Scouts Boy Scouts FFA Youth Program

Community Ed Chamber of Commerce

Internal Assets

Culture of Essentia Talented Individuals

value driven process improvement Essentia structure- standard Religious org

employee satisfaction Board & PFAC

Organization Contact info Services Mahube/OTWA 847-1385 human service programs volunteer coordination Financial support Ministerial Association internal funding for public vouchers

Becker County Human Service 847-5628 x 5360 emergency aid food child care DLCCC 844-4221 exercise Child care café? Veterans Service Officers 846-7312 housing/funding long term care medical care Aging Services/Senior Linkage 218-739-4617 Advocacy Pre-admission telephonic counseling Home Instead 877-558-0429 free education webinars/ CEU's direct care Hospice 846-1446 end of life care education bereavement Neighbor to Neighbor 334-3559 volunteer chore service transportation Meals on Wheels/ Senior nutri 847-5823 food prep & delivery regional coverage area Mom's Meals online website home delivered multi-state Lakeland outpatient mental health meds & counseling Stellher 218-841-4717 children mental health CTSS Solutions CTSS counseling Mental Health Crisis Team 218-329-6691 Community MH collaboration crisis assessment & inter

ACP online website telehealth counseling via skype Lakes Counseling 847-0696 CD treatment oupatient day program Drake Counseling 844-5191 inpatient youth day programs outpatient A place to belong 846-9022 community activities low income population Lakes Crisis Centter 847-7446 domestic violence services kinship program housing women & childr

Freedom Resource Center 844-5880 disability advocacy & applicat education service referral Lutheran Social Services 847-0629 caregiver coaching outpatient therapy guardianship Pelican Oaks volunteer program block nurse transportation Caring Hands/Hearts voluntee 238-5737 chores transportation Communities for a Lifetime policy & structural planning Rural MN CEP 846-7377

Churches First Lutheran clothing distribution preschool?

Adventist Church thrift store Holy Rosary preschool

Transportation EMS x5000 Medivan 847-1729 People's Express 800-450-0123 WE Transit 983-6317 Becker County Transit 847-1674

Health & Family Plannin Daycare/ Senior Program

thrift store

Mental Health WIC Chemical Dependency Public Health classes large geographic population equipment advocacy referral education 1:1 counseling referrals advisory council IADL support wrap up service

on site or in home Senior Nutrition

diagnostic assessment adult and child counseling outpatient

vention Crisis Bed/Willow Tree IRTS

elder abuse education & outreach emergency services

chores

Group Passion/interests email Phone Healthy eating, health habits, access

Partnership 4 Health to health

Mahube/OTWA Senior and youth health initiatives Food Systems Initiative Becker County/White Earth MHCT mental health BCOW mental health Mstate Ministerial Association Alzheimers Association dementia care & services

Elected Officials State Pep Dist. 2B Rebpublican

DFL- LTC funding / H&HS finance State Senator committee State Pep Dist. 4B DFL- Education, Ag Policy County Commissioner Auditor/Treasurer County Recorder County Sheriff County Attorney

Mayor of Audubon Mayor of Callaway

Mayor of Frazee Mayor of Lake Park

outdoor trails, access to services, poverty

Contact Person

Elected Officials State Senator Al Franken State Representative Amy Klobuchar State Representative Collin Peterson Governor Mark Dayton

Coalitions Childrens Defense Fund Elaine Cunningham [email protected] MN Homeless Coalition Liz Kuoppela 218-248-5963 Women's Foundation of Minnesota Victoria Mcwayne Creek MN Coalition for Battered Women Liz Richards 651-646-6177


EssentiaHealth.org

https://www.essentiahealth.org/

2016 COMMUNITY HEALTH NEEDS ASSESSMENT · 2019. 7. 14. · 2016 Community Health Needs Assessment . Essentia Health St. Mary’s . Progress to Date on 2013 Community Health Needs

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