2016-2019 Community Health Needs Assessment and … fol… · State, Regional and Community Partners PeaceHealth’s 2016 HNA process was undertaken in the context of other recent

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2016-2019

Community Health Needs Assessment and Implementation Plan

Adopted by Community Health Board: June 27, 2016

Community Health Needs Assessment | PeaceHealth Southwest Medical Center 1

Table of Contents

I. EXECUTIVE SUMMARY .......................................................................................................................... 2

II. OVERVIEW ............................................................................................................................................ 6

State, Regional and Community Partners ...................................................................................... 6

Community Health Framework ...................................................................................................... 8

III. 2013 CHNA REVIEW .............................................................................................................................. 9

IV. CLARK COUNTY DEMOGRAPHIC AND SOCIOECONOMIC PROFILE ..................................................... 12

V. KEY HEALTH INDICATORS .................................................................................................................... 15

Method ......................................................................................................................................... 15

Healthy, Active Living ................................................................................................................... 16

Child & Family Wellbeing ............................................................................................................. 20

Health Delivery Systems ............................................................................................................... 24

Equity ............................................................................................................................................ 29

VI. COMMUNITY CONVENING .................................................................................................................. 31

Method ......................................................................................................................................... 31

VII. IMPLEMENTATION PLAN .................................................................................................................... 36

Selected Strategies ....................................................................................................................... 36

Significant Health Needs Not Addressed by Implementation Plan .............................................. 38


I. EXECUTIVE SUMMARY

Overview

PeaceHealth Southwest Medical Center

PeaceHealth Southwest Medical Center (PeaceHealth Southwest) is one of ten hospitals within

PeaceHealth, an integrated, not-for-profit health system in the Pacific Northwest. Located in Vancouver,

Washington, the primary service area for PeaceHealth Southwest is Clark County, Washington.

Community Health Needs Assessment

PeaceHealth Southwest and partners conducted a Community Health Needs Assessment (CHNA), a

systematic process involving the community to understand community health needs in order to

prioritize, plan and outline solutions.

The 2016 CHNA was carried out with community input, including public health and nonprofit community

groups representing minority and low-income residents. Both primary and secondary data were

collected and incorporated. We also interviewed key informants and held a community forum in which

needs were affirmed and possible strategies to address the needs were identified.

Data and local perspectives are presented and analyzed according to a four-pillar structure of

community health: 1) Healthy, Active Living; 2) Child & Family Wellbeing; 3) Integrated Health Delivery

Systems (including medical dental and behavioral health services); and 4) Equity.

PeaceHealth Southwest conducted this CHNA in conjunction with state, regional, and local community

health planning in Washington, Southwest Washington, the Columbia-Willamette area, and Clark

County.

2013 CHNA

The problem of health care access and lack of insurance coverage was identified in all PeaceHealth

communities in 2013 as a major need and was therefore chosen as a major focus area in our 2013 CHNA

implementation plans. PeaceHealth worked as part of the community coalitions that were formed

across the state for the purpose of helping people sign up for commercial health insurance and Apple

Health, i.e. Medicaid. By any measure these efforts were successful.


Summary of the 2016 Community Health Needs Assessment

Demographic and Secondary Data

Clark County has about 440,000 residents. 28% are children 0-19 years old, 61.6% are adults age 18-64,

and the remaining 12.6% are seniors age 65+. Vancouver is the largest city in the county representing

nearly 37% of the county’s population. Approximately 33% of Clark County residents are either “Asset

Limited, Income Constrained, Employed” or live below the poverty line. 8.7% of the County’s population

is Hispanic.

Key health indicators were organized into the four community health pillars using primary data from

Robert Wood Johnson’s 2016 County Health Rankings and other state sources. Health outcomes gaps in

each area are summarized below.

HEALTHY, ACTIVE LIVING: Major issues identified include youth smoking and physical inactivity. The

county is below the state average for both these measures.

CHILD & FAMILY WELLBEING: Readiness to Learn among kindergarteners entering school and food

insecurity among children are major concerns for children in Clark County. While these measures are

similar to State of Washington rates, these are important factors to monitor to improve children’s lives.

HEALTH DELIVERY: Data show that there are significant differences in rates of being insured by

race/ethnicity, and racial/ethnic differences in the quality of preventive care received by Medicare

beneficiaries. Addressing these inequities is vital to the health of the community.

EQUITY: Affordable housing is a key component of financial wellbeing and stability, and forms the basis

of good health. There are many pockets of people in Clark County burdened by high housing

costs. Clark County has less income inequality than the majority of counties in Washington State, an

important marker of community health resilience.

Community Engagement and Local Perspectives

PeaceHealth Southwest interviewed 12 key informants from organizations throughout the County

representing public health and minority health to identify health gaps and possible health solutions.

The key informant interviews were conducted in advance of a convening that was held on May 11, 2016

wherein more than 50 community leaders from public health, health and social services, business,

schools, and government met to confirm, refine, and identify health needs/gaps and possible solutions.

Table 1 summarizes the results of the community stakeholder meeting. It should be noted that the lists

of gaps and strategies represented in the table were generated in two separate set of group

conversations, processes, i.e. the strategies were not necessarily identified as specific solutions to the

identified gaps.


Table 1. Results of the Community Stakeholder Meeting

Major Health Problems/Gaps Prioritized Evidence-Based Strategies

Healthy,

Active

Living

Adult and teen chronic diseases

Social isolation

Community Health Worker

programs

School nutrition programs

Child &

Family

Wellbeing

Housing affordability for homeless

and low income families

Maternal/child health

Financial literacy/independence

Postpartum depression

Health care for women in recovery

Prenatal and early childhood home

visiting programs

Preschool programs with family

support services

Health

Delivery

Systems

Health care still unaffordable for

many despite insured status

Poor outcomes for people who

have chronic mental illness

Lack of health care access for

people who are undocumented

Integration of behavioral health

and primary care

Supported housing programs

Equity

Mass incarceration

Cost-burdened housing

Poverty disparities by

race/ethnicity

School-based health centers

Expanded Housing First programs


Implementation Plan

The Implementation Plan strategies summarized below were extrapolated from the data and from

community input. Our plan is comprehensive in the sense that there are strategies that impact the focus

areas within each of the community health pillars (and a number of strategies cross pillars). The display

of strategies is not intended to be a complete listing of all the activities that PeaceHealth will undertake

with its community partners to affect the health status of the community. Rather, it is a statement of

our community health priorities.

PeaceHealth Southwest CHNA 2016 Priorities

Ensure effective information exchange and care coordination for select populations (e.g.

PeaceHealth Medical Group patients with complex health and psychosocial conditions who are

served by multiple organizations) through the PeaceHealth Transforming Clinical Practice

Initiative (TCPI) and other community collaborations.

Increase participation in the PeaceHealth employee wellness program, particularly for

caregivers at the lower end of the compensation scale.

As part of our ongoing efforts to create an inclusive organization that exercises cultural humility,

recruit for and support a workforce that reflects the changing ethnic, racial and cultural

diversity of the communities that we serve.

Develop a Community Health Worker initiative that empowers individuals within specific

communities to serve a liaison/linking/intermediary role between health/social services and the

community to facilitate access and improve the quality and cultural competence of service

delivery.

Partner with local agencies to ensure the ongoing availability and potential expansion of

prenatal and early childhood home visiting programs.

Advocate for and actively support the development of a comprehensive continuum of services

including integrated primary clinical and behavioral health, access to crisis stabilization,

transitional and long-term housing, substance abuse treatment and psychiatry services for all

ages.

Advocate for and actively support strategies that provide short and longer-term interventions

addressing homelessness and the affordable housing crisis in Vancouver.


“ ”

II. OVERVIEW

Founded by the Sisters of St. Joseph of Peace in 1890, PeaceHealth is a Catholic Healthcare Ministry

serving in the communities of Alaska, Washington and Oregon. Today, PeaceHealth is a 10 hospital

integrated not-for-profit health system that offers a full continuum of health and wellness services.

PeaceHealth’s mission is to carry on the healing mission of Jesus Christ by promoting personal and

community health, relieving pain and suffering, and treating each person in a loving and caring way. The

fulfillment of our Mission is our shared purpose. It drives all that we are and all that we do. We have

embraced the Community Health Needs Assessment (CHNA) process as a means of engaging and

partnering with the community in identifying disparities and prioritizing health needs, and importantly,

in aligning our work to address prioritized needs.

Caring for those in our community is not new to PeaceHealth; it’s been in practice since the Sisters of St.

Joseph of Peace arrived in Fairhaven, Washington to serve the needs of the loggers, mill workers,

fishermen and their families more than 125 years ago. Even then, they knew that strong, healthy

communities benefit individuals and society, and that social and economic factors can make some

community members especially vulnerable. The Sisters believed they had a responsibility to care for

them, and that ultimately, healthier communities enable all of us to rise to a better life. This philosophy

inspires us today and guides us toward the future.

State, Regional and Community Partners

PeaceHealth’s 2016 CHNA process was undertaken in the context of other recent or concurrent planning

activities in the State, region and County related to community health:

The Washington State Health Improvement Plan (2014-2017 Creating a Culture of Health in

Washington) provides a statewide framework for health improvement efforts.

Clark County Public Health Department publishes a periodic Community Health Assessment

which is developed in partnership with the community. Its most recent 2015 Community Health

Assessment identifies three community priorities: chronic disease prevention related to physical

activity and healthy eating; access to health care; and behavioral health, including mental health

and substance abuse.

Wellness is something we nurture, something we build into our policies,

something we come together to create as public health professionals,

doctors, nurses, lawyers, transportation planners, neighborhood

advocates and PTAs, and others.

John Wiesman, DrPH, MPH Washington State Secretary of Health

https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&cad=rja&uact=8&ved=0ahUKEwjC1NKc8p3NAhUT4GMKHZ2PCBoQFggcMAA&url=http%3A%2F%2Fwww.doh.wa.gov%2FPortals%2F1%2FDocuments%2FPubs%2F822-034_SHIPreport.pdf&usg=AFQjCNH_Y3wmgHYsAT4onrena-7iF1KQGQ&sig2=y4pqOzN_wcQZgrcXjdXwCw&bvm=bv.124272578,bs.2,d.cGc

https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&cad=rja&uact=8&ved=0ahUKEwjC1NKc8p3NAhUT4GMKHZ2PCBoQFggcMAA&url=http%3A%2F%2Fwww.doh.wa.gov%2FPortals%2F1%2FDocuments%2FPubs%2F822-034_SHIPreport.pdf&usg=AFQjCNH_Y3wmgHYsAT4onrena-7iF1KQGQ&sig2=y4pqOzN_wcQZgrcXjdXwCw&bvm=bv.124272578,bs.2,d.cGc

http://tinyurl.com/htonvyg

http://tinyurl.com/htonvyg


Southwest Washington Regional Health Alliance for Clark, Skamania counties is a non-profit

with the dual role of governing the area Accountable Community of Health (ACH) and the Early

Adopter Behavioral Health activities.

An Accountable Community of Health

(ACH) is a regional coalition consisting of

leaders from a variety of different sectors

working together to improve health in their

region. As part of the Healthier Washington

Initiative, nine ACHs began formally organizing

across Washington in 2015. They are intended

to strengthen collaboration, develop regional

health improvement plans and projects, and

provide feedback to state agencies about their

regions’ health needs and priorities. The Health

Care Authority (HCA) is supporting ACH

development through guidance, technical assistance (TA), and funding.

Healthy Living Collaborative of Southwest Washington (HLC) is an organization that focuses on

upstream solutions that support community-based initiatives to improve health and wellness.

With a strong commitment to health equity, HLC supports the development of a network of

community health workers and improving the health and stability of all residents in Southwest

Washington by incorporating health considerations into decision making across all sectors,

systems, and policy areas to prevent and mitigate chronic disease and poverty.

Map 1. Accountable Community of Health Regions

Source: Washington Health Care Authority

http://www.hca.wa.gov/hw/Pages/communities_of_health.aspx


Community Health Framework

Drawing from the CHNAs conducted by PeaceHealth hospitals in 2013, and after reviewing existing

community health improvement plans and collecting public data on health status and the social

determinants of health, a PeaceHealth Community Health Framework was developed. This four-pillar

framework, depicted below, was used to organize data and collect input from community stakeholders.

The subcategories, or “focus areas” were used as guideposts for considering community health

improvement strategies.

Figure 1. 2016 PeaceHealth Community Health Framework Pillars

Healthy,

Active Living

Child & Family

Wellbeing

Integrated Health

Delivery Systems Equity

Physical activity

Healthy Eating

Tobacco, alcohol

and other drug

prevention

Social engagement

Maternal-child

health

Adverse Childhood

Experiences (ACEs)

and family resiliency

Access to quality

and affordable

medical, behavioral

health and dental

services

Assistance for

people who are

homeless

Cultural humility

There are two terms that are used in the above table that perhaps need to be defined, and they are:

Adverse Childhood Experiences (or ACEs) are traumatic events that occur in childhood and

cause stress that changes a child’s brain development. Exposure to ACEs has been shown to

have a dose-response relationship with adverse health and social outcomes in adulthood,

including but not limited to depression, heart disease, COPD, risk for intimate partner violence,

and alcohol and drug abuse.

Cultural humility is a term used to describe a way of infusing multiculturalism into a workplace.

Replacing the idea of cultural competency, cultural humility is based on the idea of focusing on

self-reflection and lifelong learning.


III. 2013 CHNA REVIEW

During the 2012-2013 timeframe, PeaceHealth Southwest, in collaboration with Clark County Public

Health, the Healthy Columbia Willamette Collaborative and other community partners in Southwest

Washington and the greater Portland, OR metro area, conducted a comprehensive CHNA. The CHNA

described the health status of the entire region and recommended areas for improvement. The

PeaceHealth Southwest CHNA focused on the Clark County, WA data. The table below summarizes our

2013-2016 CHNA and includes available metrics which summarize measurable progress to date.

Table 2. 2013 CHNA Summary and Current Status

Objectives Strategies Outcomes

Baseline Current

Objective 1:

Increase Access

to Affordable

Care

Increase the number of children and adults with health insurance

Improve access to low-cost medical and dental services

Uninsured adults:

19%

Uninsured adults:

8%

Objective 2:

Improve Mental

Wellbeing

Increase screening for mental health

Increase awareness of mental health conditions

Increase access to mental health services

Suicide death rate:

17.7

(age-adjusted per

100,000 population,

2010)

Suicide death rate:

15.9

(age-adjusted per

100,000 population,

2012-2014)

Objective 3:

Reduce

Substance

Abuse

Early intervention for substance abuse

Social support for substance-free living

Increase access to substance abuse services

Screening and early detection

Adults who drink to

excess: 16%

Adults who drink to

excess*: 19%

Objective 4:

Improve Healthy

Habits

Increase physical activity

Increase consumption of healthy food

Increase the physical activity opportunities in neighborhoods

Increase access to healthy foods

Incorporate weight control into health care services

Enhance physical activity and nutrition promotion in the clinical setting

Adults who are

obese: 29%

Adults who report

no leisure time

physical activity:

19%

Adults who are

obese: 29%

Adults who report

no leisure time

physical activity:

19%

*data methods changed/can’t compare to prior years

Sources: Robert Wood Johnson County Health Rankings, Enroll America, Washington State Department of Health:

Center for Health Statistics, Washington State Behavioral Risk Factors Surveillance System


As we move forward in adopting the 2016 CHNA, we reflect on lessons learned and accomplishments of

our process, goals, and implementation of the previous (2013) CHNA:

Lessons Learned

While the 2013 PeaceHealth Southwest CHNA was a comprehensive assessment with extensive

community involvement and partnership, with the exception of increasing access to insurance,

our subsequent plan execution was not as robust as intended due to lack of sustained

leadership and funding. Going forward this has been addressed in a number of ways, including

with the hiring of a Community Benefit director (January 2016) who is charged with leading the

CHNA Implementation Plan in collaboration with our community partners.

The new PeaceHealth Director for Community Benefit will provide staff support for the newly

formed PeaceHealth Southwest Community Health Board. With a Community Collaboration

Committee that will include representatives from public health and other community-based

health and social services, it is expected that the Community Health Board will provide the

sustained community engagement at the leadership level necessary to advance the 2016 CHNA

implementation plan.

Accomplishments

The 2013 PeaceHealth Southwest CHNA identified the problem of health care access and lack of

insurance coverage as the one issue that we wanted to focus on across all of our communities.

PeaceHealth worked as part of the community coalitions that were formed across the state for

the purpose of helping people sign up for commercial health insurance and Apple Health, i.e.

Medicaid. By any measure these efforts were successful.

Between 2013 and 2014 there was nearly a 30% increase in Medicaid enrollment. Enrollment

continued to increase in 2015 but not at the pace of the initial increase. Adult enrollment rose

45% from 2013 to 2015 and child enrollment rose 44% over the same period. As a result,

uninsured adults in Clark County decreased from 14% in 2013 to 8% in 2015.

Figure 2. Medicaid Enrollment and Percent Uninsured, Clark County

80804 81617

105528

117992

2012 2013 2014 2015

14%

8%

2013 2015


Figure 3. Medicaid Enrollment by Adults and Children, Clark County, 2012-2015

Source: Health Care Authority, State of Washington. Children are defined as under age 19.

Access to behavioral health services was noted as a significant community need the 2013 CHNA.

As an early adapter of the State of Washington’s plan to fully integrate the delivery of primary

and behavioral health services by 2020, Clark County has taken significant steps to meet a

number of the behavioral health related issues in the CHNA. As of April 2016, Medicaid clients

now access a continuum of physical health, mental health and substance use disorder services

through a single integrated health plan, instead of navigating multiple systems to receive care.

While this step is significant, during our 2016 community convening, we heard that while

funding is now coordinated, more work needs to be done to assure that actual service provision

is coordinated.

43191 43051

5751262389

37613 38567

48016

55604

2012 2013 2014 2015Adults Children


IV. CLARK COUNTY DEMOGRAPHIC AND SOCIOECONOMIC PROFILE

PeaceHealth Southwest serves the Columbia-Willamette area of Oregon and

Washington, with Clark County being its primary service area, and the focus

of this CHNA1.

Map 2. Clark County

Current Profile

Clark County has about 440,000 residents

28,925 (6.6%) are preschoolers age 5 or younger

94,501 (21.5%) are 5-19 years old

269,859 (61.6%) are adults age 18-64

55,232 (12.6%) are seniors age 65+

39,617 (8.7%) are Hispanic, an 11.5% increase since 2010

1 All data in this section is from the American Community Survey (US Census Bureau) unless otherwise noted.

Of Note:

The 2015 United Ways of the Pacific Northwest ALICE report summarizes the status of ALICE families—an acronym that stands for Asset Limited, Income Constrained, Employed. These are families that work hard and earn above the Federal Poverty Level (FPL), but do not earn enough to afford a basic household budget of housing, child care, food, transportation, and health care. Most do not qualify for Medicaid coverage.

In Clark County, 33% of all households are either in poverty or are ALICE households. This is similar to Washington State overall, wherein 32% of all households are either ALICE or in poverty.


More than 37.8% of Clark County residents live in Vancouver proper. In terms of the socioeconomic

determinants, the County, as depicted in Table 3 is:

91% of adults have a high school diploma.

12% of individuals live below the Federal Poverty Level.

33% of all households are either in poverty or cannot afford basic household expenses

662 people are homeless in Clark County, both sheltered and unsheltered (Homelessness in

Washington State: 2015 Annual Report on the Homeless Grant Programs, Department of

Commerce).

In the Vancouver, WA school district, 830 children in grades k-12 are reported from homeless

families (248) or doubled up (living with other families) (582) (2014-2015 Homeless Student

Data Report, Office of Superintendent of Public Instruction).

Table 3. Clark County, WA Sociodemographic Profile

City High school diploma (%)

Individuals living below the FPL

(%)

Median Household Income

People over age 5 who are

linguistically isolated

Battle Ground 89.2% 12.2% $57,347 7.6%

Camas 95.4% 5.8% $84,643 3.1%

La Center 96.3% 5.2% $71,948 3.3%

Ridgefield 98.3% 5.8% $91,205 5.8%

Salmon Creek 91.7% 13.6% $68,231 4.5%

Vancouver 89.4% 15.7% $50,379 8.6%

Washougal 92.2% 10.9% $60,353 1.3%

Woodland 84.6% 23.4% $65,065 8.3%

Yacolt 89.6% 9.1% $58,462 1.0%

Clark County 91.2% 11.8% $59,551 6.0%

Washington State 90.2% 13.5% $60,294 7.8%


The Community Need Index, a tool created by Dignity Health, measures a community’s social and

economic health on five measures: income, cultural diversity, education level, unemployment and

health insurance, and housing. The CNI demonstrates that within Clark County, there are pockets of

higher and lower need:

Map 3. Clark County Community Need Index Map, 2015

Source: Dignity Health

Key Take-Aways

A third of all Clark County residents are either below the Federal Poverty Level (FPL), or do not earn

enough to afford a basic household budget of housing, child care, food, transportation, and health care.

Within Clark County, there are pockets of high poverty and low educational attainment, with

highest need areas concentrated in and around Vancouver


V. KEY HEALTH INDICATORS

Method

Data for each of the four PeaceHealth pillars is detailed on the following pages. For each pillar, we

provide a description, how the community compares to other Washington counties, provide a profile of

the community, identify important indicators and provide key takeaways.

PeaceHealth selected the most currently available data from publically available sources. Data elements

were selected that align with the focus of the CHNA. The goal was to identify metrics that could be

consistently measured, monitored and benchmarked for all PeaceHealth communities throughout the

Pacific Northwest.

Data from the Robert Wood Johnson Foundation (RWJF) was used as a primary source. RWJF’s county

health rankings data compare counties within each state on more than 30 factors. Counties in each of

the 50 states are ranked according to summaries of a variety of health measures. Counties are ranked

relative to the health of other counties in the same state. RWJF calculates and ranks four summary

composite scores used in this report:

Overall Health Outcomes

Overall Health Delivery Factors

Health Factors – Health behaviors

Health Factors – Social and economic factors

This is a nationally recognized data set for measuring key social determinates of health. RWJF is

committed to continually measuring these metrics.

Data in this evaluation is also supplemented with sources from state and local agencies in Washington.

Unless otherwise noted all data cited in this section is from RWJF or the following sources:

Behavioral Risk Factor Surveillance System; Washington Healthy Youth Survey; Washington Department

of Health, Vital Statistics; US Census Bureau; The University of Washington’s Alcohol and Drug Abuse

Institute; WA Office of the Superintendent for Public Instruction; Feeding America; Enroll America;

Centers for Medicare & Medicaid Services; Community Commons.

Next to each local indicator we've shown whether the local rate (percentage) is less than, greater than,

or equal to the state rate (percentage). With any indicator, there is a range of possible 'true' values

because data collection always entails some error. Often, percentages that appear different are rated as

'equal.' This is because, statistically speaking, there is a large chance that the 'true' value of the data at

the state and county level is equal, rather than different, due to error inherent in the data collection

process.


Healthy, Active Living: Clark County Health Indicators, 2016

What is Healthy, Active Living?

Healthy, Active Living is a key pillar of a healthy community. We envision a community where the

environment and resources of that community allow adults, teens, and children to be physically active,

to eat nutritious meals, to be free of the burdens of substance abuse and chronic disease, and to live

with an ample sense of wellbeing and connection to others.

How Does Clark County Compare to Other Counties?

Clark County is ranked 14 out of 39 Washington Counties for its food and physical activity environment,

as well as the adult behavioral health indicators like excessive drinking and smoking. This means we’re

doing well compared to over half of counties in the state.

Healthy, Active Living Profile

Adults:

Adult obesity: 30% (=WA: 27%)

Adult physical inactivity: 19% (=WA: 18%)

Adult diabetes: 8% (=WA: 9%)

Youth:

10th graders who are obese: 10.7% (=WA: 11.2%)

10th graders reporting physical inactivity: 13.4% of 10th graders (=WA: 12.0%)

Environment:

Reasonable access to exercise opportunities: 96% of residents (>WA: 88%)

Food environment index: 2016: 7.3 (=WA: 7.5)

Substance abuse:

Adult smoking: 14% (=WA: 15%)

10th graders smoking cigs in past 30 days: 10.2% (>WA: 7.9%)

Deaths attributed to any opiate: 7.9 per 100,000 population (=WA: 8.6 per 100,000 population)


Closer Look

Youth smoking

10th graders in Clark County are significantly more likely than 10th graders in

Washington State to report smoking cigarettes in the past 30 days. Cigarette

use leads to heart disease and cancer later in life, and is a major factor in

wellbeing.

Access to exercise opportunities and physical inactivity

Clark County has better access to exercise opportunities than the majority of

Washington counties, yet the percentage of adult and teen residents that

report not participating in any physical activity is equal to the average

Washington resident.

Figure 4. Percent of Residents That Have Access to Outdoor Physical

Activity Opportunities by County, Washington State, 2016

Growth in opiate use and abuse

The use and abuse of opiates in the form of heroin and prescription drugs has

increased dramatically in Washington state as a whole and Clark County in

particular. Deaths from any opiate have increased nearly 58% in Clark

County since 2002-2004, while increasing only 31% in Washington State

overall. The 2011-2013 rate of opiate-related deaths in Clark County was

similar to Washington State’s overall rate.

Of Note:

Caregiver Wellness As the largest employer in the community, PeaceHealth is working to support Active Healthy living in its workforce by offering an employee wellness program. Workplace wellness programs are evidence-based strategies to improve physical fitness and risk factors. At PeaceHealth, we can make an impact on community wellness by improving our employees’ wellness, but there are differences based on income levels:

63.8% of eligible PeaceHealth Southwest employees participate in a wellness program.

22.4% of eligible PeaceHealth Southwest employees earning $25,000 - $40,000 participate in a wellness program.

Participation by Income


Figure 5. Increase in Opiate-related Deaths by County, Washington State, 2002-2004 to 2011-2013

Source: Univ. of WA Alcohol & Drug Abuse Institute, “Opioid Trends Across Washington State,” April 2015)

Additional Indicators with Trend Data

The Behavioral Risk Factor Surveillance System is used to measure chronic diseases and health behaviors

among a population of adults in all 50 states at the county level. The Washington Healthy Youth Survey

measures health risk behaviors and outcomes among 6th, 8th, 10th, and 12th graders in Washington

State. The Washington Department of Vital Statistics measures causes of death and circumstances of

prenatality and birth. The Robert Wood Johnson Foundation County Health Rankings aggregates BRFSS,

Vital Statistics, US Census, and business data to provide an overview of measures that matter for health.

The University of Washington’s Alcohol and Drug Abuse Institute measures markers of opiate abuse over

time in Washington counties.

Table 4. Healthy, Active Living: Clark County Health Indicators vs. Washington State, 2016

Better Equal Worse Trend

Chronic Conditions

Adult diabetes ● **

Heart disease death rate ● **

Adult obesity ● **

Risk behaviors

Adult physical inactivity ● stasis

Excessive alcohol use ● **

Adult smoking ● **

Drug overdose death rate ● **

Deaths due to any opiate ● worsening

Suicide death rate ● **

Environment

Grocery availability & food insecurity ● worsening

Access to exercise opportunities ● improving

**can’t show trend over time due to change in data collection methods


Table 5. Healthy, Active Living: Clark County 10th Graders,

Health Indicators vs. Washington State, 2016 and Trend Since 2010


Chronic Conditions

Obesity ● stasis

Depression ● worsening

Risk behaviors

Smoking cigarettes ● improving

Drinking alcohol ● improving

Using marijuana/hashish ● stasis

Binge drinking ● improving

Eat 5+ fruits/vegetables per day* ● stasis

Consumed no sugar-sweetened beverages in past 7

days ● **

Reports no leisure-time physical activity for 60

min/day in past 7 days ● stasis

Reports ‘seriously considering suicide’ ● worsening

Environment

Bought sugar-sweetened beverages at school ● improving

*trend since 2012

**no trend data available due to methodology change

Key Take-Aways

The rate of deaths from opiate use in Clark County are similar to the Washington state rate

overall. The death rate from opiate use in Clark County has risen dramatically since 2002-2004

and calls for solutions to prescription drug and heroin abuse in Clark County.

Despite ample access to exercise opportunities and a food environment similar to Washington

overall, many Clark County adults and teens are physically inactive and obese.

Clark County teens are more likely to smoke cigarettes than Washington teens overall, but the

trend does not continue into adulthood.


Child & Family Wellbeing: Clark County Health Indicators, 2016

What is Child & Family Wellbeing?

Child & Family Wellbeing is a key pillar of a healthy community. Circumstances in pregnancy through

early childhood are key predictors of health and wellbeing later in life. We envision a community where

all pregnant women and families with children are well-fed, safe, and equipped with resources and

knowledge to succeed in school, from kindergarten to high school graduation.


In social and economic factors, including the percentage of adults who have completed high school and

have some college education, as well as the percentage of babies born to single mothers, Clark County is

ranked 10th of 39 counties in Washington.

Child & Family Wellbeing Profile

Percent of students who demonstrate expected skills in 6 of 6 domains: 39.0% (=WA: 39.5%).

Childhood food insecurity: 22.1% (=WA: 21.0%)

Graduation rate: 78.6% (=WA: 77.2%)

Maternal smoking in third trimester of pregnancy: 7.9% (=WA: 7.3%)

Low birth weight: 6% (=WA: 6%)

Prenatal care beginning in first trimester: 76% (=WA: 74.7%)

19-35-month olds up-to-date with vaccinations: 57% (=WA: 56%)

Teens up-to-date with vaccines: 30% (=WA: 34%)

WIC infants fully or partially breastfed: 43.1% (Sea Mar CHC) (=WA: 38.4%)

Closer Look

Readiness to Learn

In the Vancouver School District, as in Washington State, children from low-income families and children

with limited English are significantly less ready for kindergarten than their peers as measured by skills in

six domains of ability of average 5-year olds. These domains include social/emotional functioning,

physical functioning, language ability, and cognitive, literacy, and math abilities. These kindergarten

deficits are difficult to make up over time and can lead to lower levels of high school completion and a

host of vulnerabilities later in life.


Figure 6. Percentage of Entering Kindergarteners Demonstrating

Kindergarten-Level Skills in 6 of 6 Domains, 2014-2015

Adverse Childhood Experiences (ACEs)

Adverse Childhood Experiences, or ACEs, are traumatic events that occur in childhood and cause stress

that changes a child’s brain development. Exposure to ACEs has been shown to have a dose-response

relationship with adverse health and social outcomes in adulthood, including but not limited to

depression, heart disease, COPD, risk for intimate partner violence, and alcohol and drug abuse.

Adverse Childhood Experiences include emotional, physical, or sexual abuse, emotional or physical

neglect, seeing intimate partner violence inflicted on one’s parent, having mental illness or substance

abuse in a household, enduring a parental separation or divorce, or having an incarcerated member of

the household.

Figure 7. Association between ACEs and Negative Outcomes

Source: Centers for Disease Control & Prevention, "Association between ACEs and negative outcomes"

Of Note:

61% of kindergarteners entering school are not ready for kindergarten in at least one domain in Clark County.

70% of 10th graders in Clark County are not up-to-date with vaccinations.

Nearly a quarter of Clark County children lack access to adequate, nutritious food.

39%

26%

18%

40%

31%

21%

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

All Low Income Limited English

Vancouver School District Washington

https://www.cdc.gov/violenceprevention/acestudy/about_ace.html


We can examine ACEs reported by adults in Washington and see that many Clark County adults are

bearing childhood traumas that put them at risk for poor health and social outcomes in adulthood.

Figure 8. Adverse Childhood Experiences Reported by Adults

in Clark County and Washington State, 2011

Source: Washington State Behavioral Risk Factor Surveillance System

Child & Family Wellbeing Data Sources

The Washington Department of Vital Statistics measures causes of death and circumstances of

prenatally and birth. The Robert Wood Johnson Foundation County Health Rankings aggregates BRFSS,

Vital Statistics, US Census, and business data to provide an overview of measures that matter for health.

The Office of the Superintendent for Public Instruction measures “Readiness to Learn” among entering

kindergarteners in Washington State in 6 domains: social-emotional, physical, language, cognitive,

literacy, and math. The USDA Women, Infant, and Children nutrition program measures breastfeeding

among its program recipients by individual WIC site—the numbers for Clark County come from the Clark

County Sea Mar WIC site. Low birth weight is compiled in a seven-year period by RWJF County Health

Rankings from WA State Vital Statistics data (2007-2013). Childhood food insecurity is measured by the

USDA, and is characterized by a lack of consistent, sufficient, and varied nutrition. The Food Research &

Action Center publishes analyses demonstrating the connections between food insecurity and

overweight/obesity.

0%

10%

20%

30%

40%

50%

60%

70%

1+ ACEs 2+ ACEs 3+ ACEs 4+ACEs

WA State Clark County


*Data aggregated from 2007-2013

**no trend data available

Key Take-Aways

There are children in Clark County who are hungry, lack access to a variety of nourishing,

balanced foods, and not prepared for kindergarten.

Toddler vaccination rates are similar to Washington overall but teenage vaccination rates are

lower than the State.

On the positive side, and contributing to an overall healthy community the rates of timely

prenatal care, and breastfeeding are strong.

Over half of in Clark County endured at least one Adverse Childhood Experience that puts them

at greater risk of poor health outcomes, negative health behaviors, and poor social outcomes.

Table 6. Child & Family Wellbeing: Clark County Health Indicators vs. Washington State, 2016


Social Indicators

High school graduation rate ● worsening

Childhood food insecurity ● improving

Entering kindergarteners demonstrating Readiness

to Learn in 6 of 6 domains* ● worsening

Health Indicators

Prenatal care in 1st tri. of pregnancy ● worsening

Maternal smoking in 3rd tri. of pregnancy ● stasis

Low birth weight* ● *

WIC infants partially or fully breastfed ● **

Toddlers up-to-date with vaccines ● **

Teenagers up-to-date with vaccines ● **


Health Delivery Systems: Clark County Health Indicators, 2016

What are Health Delivery Systems?

Health Delivery Systems are a key pillar of a healthy community. Access to quality, affordable,

comprehensive care throughout the life course is an important facet of community wellness. We

envision a community where all people have access to quality, affordable preventive and acute care,

including mental health and dentistry, throughout the life course.


In health delivery factors including the ratio of physicians, dentists, and mental health providers to the

population, as well as certain measures of quality of care like the percentage of Medicare recipients that

receive mammograms and diabetic monitoring, Clark County ranks 24th out of 39 counties in

Washington—lower than the majority of Washington Counties.

Health Delivery Systems Profile

Ratio of residents to medical, dental, and mental health providers:

Primary care: 1,510:1 (>WA)

Dentists: 1,500:1 (>WA)

Mental health: 410:1 (>WA)

Uninsured rate among adults below age 65: 8% (=WA: 8%)

10th graders who saw a doctor for a physical in the past year: 62.7% (=WA: 66.1%)

10th graders who saw a dentist for a checkup, exam, teeth cleaning, or other dental work:

76.1% of 10th graders in 2014 (=WA: 79.0%)

Closer Look

Health Insurance Inequities

Though Clark County’s overall insurance rate is improving, there are significant inequities in health

insurance rate by race/ethnicity.


Figure 9. Uninsured Rate among Adults <65 years, 2015

Preventive Hospital Stays

Preventable Hospital Stays is the hospital discharge rate for ambulatory care-sensitive conditions per

1,000 fee-for-service Medicare enrollees. Ambulatory care-sensitive conditions include: convulsions,

chronic obstructive pulmonary disease, bacterial pneumonia, asthma, congestive heart failure,

hypertension, angina, cellulitis, diabetes, gastroenteritis, kidney/urinary infection, and dehydration. This

measure is age-adjusted.

Hospitalization for diagnoses treatable in outpatient services suggests that the quality of care provided

in the outpatient setting was less than ideal. The measure may also represent a tendency to overuse

hospitals as a main source of care.

Lower number on this measure are the goal. Clark County ranks below the nation, but above the State

of Washington average, and near the bottom of all Washington counties. The data suggest that there

are opportunities to better serve populations with improved primary care delivery.

Of Note:

Clark County Medicare beneficiaries have a rate of 51 preventable hospital stays per 1000 beneficiaries per year, higher than WA State (36 preventable hospital stays).

Racial/ethnic disparities in access to insurance and preventive care exist in Clark County.

8%7% 7%

12%

8%8% 8%7%

13%

8%

0%

2%

4%

6%

8%

10%

12%

14%

All Black White Hispanic orLatino

Asian

Clark County Washington State


Figure 10. Preventable Hospital Stays, Clark County, WA

Preventive care inequities among Medicare beneficiaries

The preventive care received by Black Medicare beneficiaries in Clark County is worse than the

preventive care received by White Medicare beneficiaries in Clark County.

High-quality preventive care, like seeing a primary care doctor frequently and monitoring one’s blood

sugar and blood pressure, can improve health outcomes. One way to look at possible differences in the

quality of care is to examine Medicare beneficiaries (people aged 65 years and older that have access to

government-sponsored health insurance) of different races and ethnicities, since they have the same

source of health insurance.

In order to understand if differences in quality of preventive care exist, we can look at the rate of short-

term complications from diabetes using a composite measurement called Prevention Quality Indicators

(PQI) among Hispanic and White Medicare beneficiaries by county in Washington State. Short-term

complications are adverse events that could be avoided with proper preventive care. The data in the

map below show that Clark County White Medicare beneficiaries have 93 PQIs per 100,000

beneficiaries, while Clark County Hispanic Medicare beneficiaries have 0 PQIs per 100,000 beneficiaries.

In Clark County, Hispanic Medicare beneficiaries are more likely to have short-term complications from

diabetes than White Medicare beneficiaries, despite having the same source of health insurance.

The preventive care received by Hispanic Medicare beneficiaries in Clark County is worse than the

preventive care received by White Medicare beneficiaries in Clark County and leads to higher rates of


short-term diabetes complications among Hispanic adults. Greater access to quality primary care

among minority communities is an important strategy to mitigate these unequal health outcomes.

Figure 11. Short-term Diabetes Complications,

Hispanic Vs. White Medicare Beneficiaries, Washington State, 2014

Source: Center for Medicare & Medicaid Office of Minority Health, “Disparities Mapping Tool”

Emergency Room Use

Treating patients with low-acuity conditions in the ED is an issue because it is not the best care setting

for those conditions, and it contributes to unnecessary overcrowding and cost. Approximately 8.3% of

emergency room visits to Southwest Medical Center could be considered avoidable given their low

acuity. When viewed by payer, Medicare patients have the lowest rate of these visits, representing

nearly 2.5% of all Medicare ED encounters. Medicaid patients have the highest rates, and in 2015

showed a large increase in visits that were considered low acuity (14.6%).

Figure 12. Low-Acuity ED Visits by Payer, Southwest Medical Center, 2013-2015

Source: PeaceHealth Internal Data

1.80%

2.00%2.50%

6.90%

7.10%

8.60%

6.40%

7.60%

14.60%

2013 2014 2015

Medicare Medicaid Commercial/All Other


Health Delivery Systems Data Sources:

The Washington Healthy Youth Survey measures health risk behaviors and outcomes among 6th, 8th,

10th, and 12th graders in Washington State, including health care access. The Robert Wood Johnson

Foundation County Health Rankings aggregates provider and US Census data to provide an overview

provider to resident ratios and overall clinical care relative measures. Enroll America aggregates

measures of insurance across all 50 states at the county and state level. The Centers for Medicare &

Medicaid Services Office of Minority Health Disparities Mapping Tool shows measures of health

inequities at the county level across the US for different health delivery indicators.

Table 7. Health Delivery Systems: Clark County Health Indicators vs. Washington State,

2016 and Local Trend since 2010


Primary Care Provider to resident ratio ● stasis

Dentists to resident ratio ● stasis

Mental Health Providers to resident ratio ● improving

Uninsured adults below age 65 ● improving

Saw a doctor for a physical in the past year (10th

graders) ● improving

Saw a dentist for checkup, cleaning, or other work

in past year (10th graders) ● stasis

Key Take-Aways

Poor access to primary care, dental care, and mental health care is a contributor to poor health

in Clark County.

Nearly half of Clark County 10th graders did not have a physical in the past year, and nearly a

quarter did not see the dentist.

Racial/ethnic minorities in Clark County have worse access to quality preventive care than white

residents of Clark County, even when controlling for health insurance access.


Equity: Clark County Health Indicators, 2016

What is Equity?

Equity is a key pillar of a healthy community. Health equity will be achieved when everyone is

given the opportunity to reach their full health potential. Affordable, safe housing, and employment

that allows sufficient resources to meet a household budget are important facets of equity.


In social and economic factors, including the percentage of children in poverty, violent crime, and

income inequality, Clark County is ranked 10th of 39 counties in Washington.

Equity Profile

Individuals living below FPG: 11.8% (=WA: 13.5%)

Linguistic isolation: 6.0% (=WA: 7.8%)

Households with ‘severe housing problems,’ including cost-burdened housing: 17% (=WA: 18%)

Unemployment rate: 10% (=WA: 8.8%)

Veteran population: 11% (=WA: 11%)

Income inequality (ratio of income at the 80th percentile to income at the 20th percentile): 3.9

(<WA: 4.5)

Closer Look


Affordable housing is a key component of financial wellbeing and stability, and forms the basis of good

health. There are many pockets of people in Clark County burdened by high housing costs that

undermine their health and wellbeing, particularly in the Vancouver area.

Figure 13. Percentage Households Where Housing Costs Exceed

30% Of Household Income, Clark County, 2010-2014

Source: Community Commons


Equity Data Sources

The US Census measures the percentages of individuals living in poverty, in

linguistic isolation, and adults who are unemployed. The Robert Wood

Johnson County Health Rankings provide estimates of individuals who have

‘severe housing problems,’ meaning individuals who live with at least 1 of 4

conditions: overcrowding, high housing costs relative to income, or lack of

kitchen or plumbing, as well as a measure of income inequality at the county

and state level, which is the ratio of household income at the 80th percentile

to income at the 20th percentile. Community Commons provides maps of

census-tract level data, including housing cost burden.

Key Take-Aways

Clark County is doing well on most measures of social equity and

wellbeing relative to Washington State.

Low levels of income inequality are a particular area of resilience and

should be maintained.

A high percentage of cost-burdened housing in certain areas of Clark

County imperils the wellbeing of affected households and the

community as a whole.

Table 8. Equity: Clark County Health Indicators vs. Washington State,

2016 and Local Trend since 2012


Individuals living below the poverty line ● stasis

Individuals over age 5 in linguistic isolation ● stasis

Households with ‘severe housing problems’ ● stasis*

Unemployment rate ● improving

Income inequality ● **

*baseline trend data aggregated from 2006-2010

**no trend data available

Of Note:

Changing demographics call for employers to monitor their workforce so that it reflects the composition and diversity of the community.

Increasing racial and ethnic diversity among licensed health professionals is particularly important because evidence indicates that among other benefits, it is associated with improved access for non-majority patient groups, increased patient satisfaction and an overall decrease in health care disparities.


VI. COMMUNITY CONVENING

Method

Key informant Interviews

PeaceHealth Southwest interviewed key informants from organizations throughout the County

representing perspectives from public health and medically underserved and vulnerable groups. The

interviews were conducted to elicit perspectives on the health needs and gaps of the community, to get

feedback on the continuing relevance of the 2013 CHNA priorities and health priorities found through

the secondary data gathering of the 2016 CHNA, and to understand possible solutions that local experts

support.

Table 9. Organizations to which key informants belong, 2016 CHNA

Organization Population Served

Clark County Public Health Department

All Clark County residents; 0-25 ages for individual services, medically underserved

Free Clinic of SW Washington

Medically underserved, homeless, immigrant, early childhood to senior groups

DSHS SW Area Agency on Aging and Disabilities

Seniors, disabled

Vancouver School District Children K-12, low-income families

Healthy Living Collaborative

Medically underserved, homeless, immigrant, children, families, and seniors

Community Convening

The key informant interviews were conducted in preparation for a community convening session that

was held on May 11, 2016. More than 50 community leaders from local and regional public health,

health and social services, business, schools, and government were convened for approximately three

hours.

Community convening participants were led through a two-part process to identify gaps and needs and

then to rank community health improvement strategies that were organized into the community health

pillars. The process was designed to build on the considerable amount of time and effort that the

County Health Department, PeaceHealth and others have put into health assessments over the last

several years and to focus more on what we can actually do together to address the problems.


Following an update regarding secondary data and key informant perspectives for each of the

community health pillars, participants were asked to identify health and social needs /gaps, and strategy

opportunities. There was repetition and overlap between the key informant and group process input,

with the community convening participants adding infill to the key informant perspectives.

Gaps and opportunities

Table 10. Summary of health and social gaps/needs and strategy opportunities according to key

informants and community convening participants, by community health pillar, May 2016

Healthy, Active Living Child & Family Wellbeing

Needs/Gaps Chronic disease prevention

Social isolation

Low graduation rates, particularly

among homeless and low-income

families

Maternal/child health, including

postpartum depression and women

in recovery

Financial literacy/independence

Strategic

Opportunities

Mental health and substance

abuse care for teens and adults

School & community programs

for mental health and nutrition

access

Improved care coordination and

follow-up for high-risk and/or

linguistically isolated women and

infants/children through home

visiting programs

Better understanding of ACEs

among providers; compassion

fatigue relief for providers

Affordable childcare

Support for same-sex couples


Table 11. Summary of health and social gaps/needs and strategy opportunities according to key

informants and community convening participants, by community health pillar, May 2016

Health Delivery Systems Equity

Needs/Gaps

Health care still unaffordable for

many despite insured status

Disorganization and lack of

integration between services


Poor outcomes for undocumented

and chronically mentally ill

Strategic

Opportunities

Access to health care:

More primary care providers

that accept Medicaid and

Medicare

Transportation to care, mobile

clinics, FQHCs for low-

income/immigrant groups

More culturally adapted health

care for immigrant groups

Care coordination:

In-home care and chronic

disease care coordination and

follow-up

Integration of primary, mental

health, and dental care,

accessible dental care

Community Health Workers

Elderly

Better dementia, end-of-life care

education

Home safety evaluations

Dental care for residents over 65

years of age

Substance Abuse

Medical detox, crisis stabilization

Chronic pain:

Non-opiate pain relief strategies

Housing:

Housing as Medicaid benefit

Continuum of supportive

housing

County housing policies;

Housing First policies

Homeless/Day Center one-stop shop

Criminal justice & health system

collaboration; interface with

Medicaid system

Mass incarceration & low-

income/mental health connection

Services for undocumented


Strategies for Consideration in Implementation Plan

In the third part of the Community Convening, participants were provided with a packet of evidence-

based intervention strategies for each of the four community health pillars. Given their understanding

of community needs, participants were asked to collectively discuss strategies and then individually

select up to three evidence-based strategies within each pillar or write in a preferred strategy based on

the following criteria:

Magnitude of need

Organizational capacity in the community to address

Realistic to implement

Personal interest and passion

Table 12. Top Evidence-based Strategy Solutions Identified at the Community Convening

Strategy Needs Addressed

Healthy,

Active

Living

Community Health Worker

programs

Social isolation, chronic diseases, poor health

outcomes for undocumented/vulnerable

groups, transportation to health care

appointments, chronic disease management

School nutrition programs Chronic disease, access to healthy foods

School-based early

intervention

Teen mental health and substance abuse

care

Child &

Family

Wellbeing

Prenatal and early childhood

home visiting programs

Care coordination for prenatal/postpartum

vulnerable mothers, infants, and children

Preschool programs with family

support services

Affordable childcare, follow-up for high-risk

mothers and children

‘Early Pathways’/home-based

mental health

Mental health services for families and

children, affordable childcare, follow-up for

high-risk mothers and children

Health

Delivery

Systems

Integration of behavioral

health and primary care

Behavioral health services for families and

children; interface between criminal justice

and Behavioral health systems

Supported housing programs Housing for homeless, integration between

primary care and mental health care

Substance abuse treatment Alternative chronic pain treatment,

residential substance abuse care


Strategy Needs Addressed

Equity

School based health centers

Access to health care for low-income teens,

care coordination for linguistically isolated

and vulnerable populations

Expanded Housing First

programs

Care for the chronically mentally ill and

homeless, interface between criminal justice

and health care systems

Patient navigators

Poor access to social and health services for

the undocumented, chronic disease care

coordination and follow-up


VII. IMPLEMENTATION PLAN

Selected Strategies

Adopted by our authorized body, the statement of strategies below will serve as the basis for a more

detailed CHNA implementation plan which will be published no later than November 30, 20162. The

Implementation Plan strategies summarized below were extrapolated from the data and from

community input. Our plan is comprehensive in the sense that there are strategies that impact the focus

areas within each of the community health pillars (and a number of strategies cross pillars). The display

of strategies is not intended to be a complete listing of all the activities that PeaceHealth will undertake

with its community partners to affect the health status of the community. Rather, it is a statement of

our community health priorities.

The PeaceHealth Southwest Community Health Board will approve an annual CHNA implementation

plan that includes tactics, timelines and metrics.

Table 13. 2016 PeaceHealth Southwest Implementation Plan Summary

Aims/ Strategies Target population Primary partners

1. Ensure effective information exchange

and care coordination for select

populations (e.g. PeaceHealth Medical

Group patients with complex health and

psychosocial conditions who are served

by multiple organizations) through the

PeaceHealth Transforming Clinical

Practice Initiative (TCPI) and other

community collaborations.

Children and adults who

receive Medicaid and have

particularly complex health

psychosocial conditions.

Local Community Health

Centers, behavioral health

organizations, Tribal health

clinics and others.

2. Increase participation in the PeaceHealth

employee wellness program, particularly

for caregivers at the lower end of the

compensation scale.

PeaceHealth Caregivers

PeaceHealth HR; potential

partners could include union

representatives

2The final IRS regulations (published in the Federal Register on December 31, 2014) provide hospital facilities

with an additional four and a half months to adopt the implementation strategy, specifically requiring an

authorized body of the hospital facility to adopt an implementation strategy to meet the health needs identified

through a CHNA on or before the 15th day of the fifth month after the end of the taxable year in which the

hospital facility finishes conducting the CHNA.

http://www.gpo.gov/fdsys/pkg/FR-2014-12-31/html/2014-30525.htm


Aims/ Strategies Target population Primary partners

3. As part of our ongoing efforts to create

an inclusive organization that exercises

cultural humility, recruit for and support

a workforce that reflects the changing

ethnic, racial and cultural diversity of

the communities that we serve.

Patients and users of health

and social services

Workforce development

Council; community and

Technical colleges; Tribal

health Centers and others

4. Develop a Community Health Worker

initiative that empowers individuals

within specific communities to serve a

liaison/linking/intermediary role

between health/social services and the

community to facilitate access and

improve the quality and cultural

competence of service delivery.

Specific target populations

to be determined Healthy Living Collaborative

5. Partner with local agencies to ensure the

ongoing availability and potential

expansion of prenatal and early

childhood home visiting programs.

Pregnant women, infants

and children

Nurse Family Partnership

Program with the Clark

County Public Health

Department

6. Advocate for and actively support the

development of a comprehensive

continuum of services including

integrated primary clinical and

behavioral health, access to crisis

stabilization, transitional and long-term

housing, substance abuse treatment and

psychiatry services for all ages.

Children and adults

experiencing mental health

conditions and/or

substance use disorders

particularly those who do

not have coordinated or

integrated primary and

behavioral health care.

PeaceHealth Medical Group

SW WA Regional Health

Alliance

7. Advocate for and actively support

strategies to that provide short and

longer-term interventions addressing

homelessness and the affordable

housing crisis in Vancouver.

Children and adults

experiencing homelessness

or families without

adequate long-term

housing.

Council for the Homeless

Bring Vancouver Home

Campaign


Significant Health Needs Not Addressed by Implementation Plan

PeaceHealth Southwest has expertise in providing primary, specialty and tertiary care for Clark County

residents. We are able to address care access and coordinaiton challenges for specific popualtions, as

well as employee wellness and cultural competnecy within our own organization. We look forward to

partnering with public health, local non-profit organizations and others to address the broader issues of

population and community health that are outlined in our preliminary plan.

The issues that we have prioritized with input from the community leverage our resources and expertise

and address signigicant community needs. In prioritizing some issues however, others are not directly

addressed. These include financial literacy, immunization rates, low graduation rates, mass

incarceration, and poverty disparities.