stronger, healthier, together. - cac.ihntogether.org · the chip addendum was finalized and adopted...

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Stronger, healthier, together.

Community Health Improvement PlanProgress Report – June 2016

InterCommunity Health Network CCO CHIP Progress Report 2016

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Table of Contents Introduction .................................................................................................................................... 1

Document Purpose ..................................................................................................................... 1

Data Availability .......................................................................................................................... 1

Data ................................................................................................................................................. 2

Access to Healthcare ................................................................................................................... 2

Behavioral Health ........................................................................................................................ 8

Child Health ............................................................................................................................... 14

Chronic Disease ......................................................................................................................... 19

Maternal Health ........................................................................................................................ 26

Appendix I: Acronyms ................................................................................................................... 30

Appendix II: Glossary of Terms ..................................................................................................... 31

Appendix III: References ............................................................................................................... 33


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Introduction NOTE: An acronyms list and a glossary of terms are listed starting on page 30.

Document Purpose This document serves as the Community Advisory Council’s (CAC) 2016 Community Health Improvement Plan (CHIP) Progress Report to the Oregon Health Authority. It includes all data currently available for the outcomes and indicators identified in the InterCommunity Health Network CCO (IHN-CCO) 2016 CHIP Addendum.i For a detailed description of how the CHIP Addendum was developed, please refer to that document.ii

Data Availability The CHIP Addendum was finalized and adopted by the CAC in January 2016 and approved by the IHN-CCO Board of Directors in February. In the two months since its approval, IHN-CCO; the Linn, Benton, and Lincoln Regional Health Assessment Team; the CAC Coordinator; and many community partners have collaborated to bring data together for this document. There is much data reported here. Through continued collaboration with community partners, and with feedback provided over time by the CAC and its local committees, even more and better data will be available. This will better position the CCO and the CAC to evaluate and report on CHIP progress.


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Data

Access to Healthcare

Outcome A1: Reduce days to first appointment.

Indicator a: Length of time from enrollment to first appointment

NEW MEMBER ACCESS

Table 1. Average Number of Days for New IHN-CCO Members to See a Provideriii

Year: 2014 2015 Number of new members 27,765 15,975 Number with first claim 19,211 10,872 Average number of days until first claim (any provider) 67.5 55.3 Average number of days until first PCP claim 87.8 72.3

Indicator b: Length of time from appointment request to appointment for behavioral, physical, and oral health services

Data is not currently available.

Indicator c: Trauma-informed care, such as Adverse Childhood Experiences (ACEs) and resiliency measures

• ACES: 213 IHN-CCO providers trained in 2015. • Transformation Pilot Project: A Child Abuse Prevention & Early Intervention Pilot project

with Family Tree Relief Nurseryiv is underway. This transformation pilot aims to increase collaboration between Family Tree’s Home-Based program, IHN-CCO medical providers, and the Department of Human Services Child Welfare. The project will increase access and transition for high-risk, OHP-served families using a blended service model of Family Tree’s Home-based Interventionist and a traditional healthcare worker as an innovative way to assist families by linking them to their medical home and additional services, and providing stabilizing support for increased outcomes for family health, stability and attachment. The contract for this pilot includes ACES and Resiliency measures.

• Continuing Medical Education (CME): In 2015, Samaritan Health sponsored the following trauma-informed care-related trainings (CMEs average 57 physician participants):v

o Eating Disorders: Best Practice Interventions o Adverse Childhood Experiences Study (ACES) o Hidden Stress and Unexplained Symptoms


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Indicator d: Appropriate preventive care for all ages

PREVENTATIVE HEALTH DATA:

Table 2. Preventative Health Quality Measures Data from OHAvi

Preventative Health Quality Measures Data from OHAvii

Current Rolling Rate 12/14–11/15

2015 IHN-CCO Improvement Target

Adolescent Well Care Visits 28.1% 27.9% Child Immunization Status 62.4% N/A Dental Sealants – All Age Groups 15.0% 12.9% Developmental Screening 34.6% 29.2% Effective Contraceptive Use – All Ages 35.6% N/A Well Child Visits in First 15 Months of Life 65.2% N/A

Outcome A2: Increase the percentage of members who receive care communicated in a way that ensures that they can understand and be understood by their care providers, and that they are effectively engaged in their care.

Indicator a: Percentage of members who report that they receive care communicated in a way that ensures that they can understand and be understood by their care providers, and that they are effectively engaged in their care

PROVIDER TRAININGS:

• Two Samaritan Health Primary Care Medical Home Health Literacy Educational sessions were delivered in 2015 (~120 total provider participants)viii

• Samaritan Health sponsored seven CME courses related to improved communication, comprehension, and empowerment (CMEs average 57 physician participants). The titles of the CMEs provided were:ix

o Motivational Interviewing in Medical Settings o Health Literacy and the Teach-Back Method o Geriatric Medication Management o Disclosure of Medical Errors o Confidence Crisis in the Medical Profession o Adverse Childhood Experiences Study (ACES) o Involving Patients in Shared Decision Making

Indicator b: Percentage of members who access user-friendly, certified language interpreter services



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Outcome A3: Increase the percentage of members who have safe, affordable housing.

Indicator a: Number of homeless persons

Table 3. One-night count homeless population figures, including students

Year: 2011 2015 County: Linn Benton Lincoln Region Linn Benton Lincoln Region

Total homeless count

135 107 41 283 246 131 47 424

Sheltered count

125 107 41 273 197 94 25 316

Unsheltered count

10 0 0 10 49 37 22 108

Male 84 71 16 * 171 * 123 88 23 234 Female 51 36 24 * 111 * 108 43 23 174 Individuals 109 81 23 75 186 110 29 325 Family members

26 26 18 208 60 21 18 99

Average months spent homeless (female / male)

13 / 22 18 / 43 7 / 20 13 / 30 No data

No data

No data

No data

Source: Oregon Housing and Community Services and Community Services Consortium *Counts do not sum to total


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Indicator b: Number of homeless students

Table 4. Homeless students grades K-12 in Linn, Benton, and Lincoln Counties, 2013-2014

Source: Oregon Department of Education, 2013-2014

Indicator c: Percentage of members who have stable housing upon discharge from hospital or emergency department visit


Indicator d: Percentage of residents with high housing costs

Data for Indicator A3d is from the 2015 Regional Health Assessment.x

HOUSING BURDEN DATA:

Figure 1 on the next page shows the similarities in housing affordability between Oregon and the region. Similar to Oregon, 57% of renters in the region spend 30% or more of household income on housing rent. Of homeowners with mortgages, 37% spend 30% or more of household income on housing, compared to 38% in Oregon. Of homeowners without mortgages, 14% spend 30% or more of household income on housing, compared to 16% in Oregon.

County N Homeless Student Numbers Grades K-12

Percent of Homeless to Total Enrollment

Linn 859 4 % Benton 228 3 % Lincoln 519 10 % Region 1,199 3 % Oregon -- 3 %


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Figure 1. Home owner and renter housing cost burden more than 30% of income, in the region and Oregon 2011-2013

Source: U.S. Census Bureau, 2011-2013 American Community Survey, Table DP04

The median home values of the region vary widely, from $170,000 in Linn County to $270,700 in Benton County. Lincoln County’s median home value of $218,900 is close to the state median of $228,700 (Figure 2).

0% 10% 20% 30% 40% 50% 60%

0% 10% 20% 30% 40% 50% 60%

Owner, no mortgageOwner, mortgage

Renter

Owner, no mortgageOwner, mortgage

Renter

Oreg

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Percent of residents who spend more than 30 percent of their income on housing


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Figure 2. Home owner and renter housing cost burden more than 30% of income for Linn, Benton, and Lincoln Counties, the region, and Oregon 2011-2013.

Source: U.S. Census Bureau, 2011-2013 American Community Survey

Indicator e: Percentage of members who have safe housing


0 0.1 0.2 0.3 0.4 0.5 0.6 0.7

0% 10% 20% 30% 40% 50% 60% 70%

RegionBenton

OregonLincoln

Linn

RegionBenton

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Percent of residents who spend more than 30% of their income on housing


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Behavioral Health

Outcome BH1: Increase community awareness that behavioral health issues are normal and widely experienced.

Indicator a: Exposure to behavioral health information and self-care skills in health services, schools, and after-school programs


Indicator b: Availability of programs to train primary care and other health care providers and community members to understand behavioral health


Indicator c: Efforts made to inform communities about behavioral health through media exposure and other information

MENTAL WELLNESS LITERACY CAMPAIGN – FINAL REPORT

This public awareness campaign started as an IHN-CCO transformation pilot project in Linn County, May 2014. Due to its success, the pilot was expanded to Benton and Lincoln counties.

The campaign strives to remove the stigma about mental health. It encourages local communities to accept a broader meaning of wellness. The slogan is, “Your wellness is more than physical.” The campaign describes eight aspects of wellness. They are body, mind, environment, spirit, community, emotions, finances and work. It explains that mental health is part of overall wellness. It shows that the eight wellness areas are connected.

• “Understanding Mental Illness” online training developed in 2015 • 100% of IHN-CCO Staff & PCPs are aware of the on-line resource

o Completion of training for PCPs was documented through reporting for online training system.

o IHN-CCO staff was presented live training during mandatory all-staff meeting. • Today I Am” Campaign

o Linn County English version launched May 2014, completed July 2014, (final reports for English and Latino campaigns available upon request). Post-survey completed Aug 2014 shows 65% familiarity with Wellness

Campaign (exceeding target of 35%). Latino post-survey Campaign shows 58% familiarity with Latino Wellness

Campaign.xi


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o Regional (Linn-Benton-Lincoln) Latino community education campaign launched June 2015. Latino focus groups completed November 2014 Used Spanish population research to adapt the English campaign to be

culturally appropriate. Developed marketing, public relations, and media plan for Spanish

campaign in Benton, Lincoln and Linn counties. Presented adapted campaign materials to two Latinofocus groups and

used feedback to fine-tune the messaging. The feedback was largely positive and very helpful in finalizing the campaign imagery and tone.

Developed campaign imagery, messaging, and public event schedule in consultation with Latino stakeholders and project team.

• Education Campaign o Partnered with local coalitions and youth organizations to develop prevention

and stigma reduction messages, in coordination with observance of Mental Health Month 2014 & 2015, Recovery Month 2014, and Mental Health Awareness Week 2014.

o Hosted community youth suicide prevention training, Taming the Epidemic of Youthanasia, Dr. Dennis Embry, May 14, 2014 (attendance 233). 100% of respondents in evaluation of Dr. Embry’s training rated quality of

information presented as excellent or good. Collaborative planning with Linn County Mental Health Advisory Board

o Provided both Adult and Youth Mental Health First Aid community training, and facilitated sustainable funding (See Indicator BH1c).

o STAND (Students Taking Action Not Drinking) youth council developed school-based mental health awareness campaign in seven local school districts. Activities included dissemination of student developed posters (in English & Spanish), video, and other promotional incentives (lanyards, activity cards, etc.) bringing awareness to the eight dimensions of wellness.

o Community and business distribution of table tents. • Coalition of Local Health Educators

o Coordination with Regional Healthy Communities Steering Committee for Mental Health Promotion & Prevention Grant, with common Linn County Steering Committee.

o Key partners identified and gathered for orientation meeting June 23, 2014. o Gathered and reviewed local data, assessed gaps and needs, and determined

focus on prevention strategies with grades K-14. o Solicited proposals & awarded funding to:

Botvin’s Life Skills Training universal prevention curriculum in additional 4 & 6 grades throughout Linn County), serving total of 1,823 students in Year 1 and 1,487 students in Year 2.


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Life Skills Training completed: 91% of 4th graders & 81% of 6th graders in 2013-14, and 91% of 4th graders & 84% of 6th graders in 2014-15, reported increase in decision-making skills.

Girls Circle/Boys Council prevention curriculum for identified at-risk youth in rural middle and high schools (Jackson Street Youth Shelter), serving 136 Benton County students in year two.

Girls Circle/Boys Council: Provided Girls Circle to 52 females and Boys Council to 84 males in Linn County. Identified 12 youth with suicidal ideation and referred them to services.”

2016 INTERCOMMUNITY HEALTH NETWORK CCO WELLNESS CAMPAIGN STATEMENT OF WORK

• Develop written and visual creative communication platform to support eight aspects of wellness.

• Examine extension aspects of the “Today I Am” campaign as influences. • Concept, write and design transit and billboard advertising art direction to attain visual

frequency with target audience. • Create media purchasing plan to support out-of-home campaign in CCO region. • Write, shoot, and edit eight 15-second television commercials to support emotional

connectivity. • Create media purchasing plan for broadcast and cable delivery solutions in CCO region. • Design, write, audition talent, record and produce eight radio commercial series to

attain top-of-mind awareness with target audiences’ caregivers/respondents. • Create a media purchasing plan for terrestrial and internet radio solutions. • Develop an organic and boosted social media plan to reach “look-alike” audience. • Write and photograph authentic content to deploy within the social media structure(s). • Design interface content to extend branded look for linked/clickable content - web ads,

click-through, blasts, etc.”xii

MENTAL HEALTH FIRST AID TRAININGxiii

Mental Health First Aid (MHFA) is an 8-hour course that teaches [lay-people and non-clinical staff] how to identify, understand, and respond to signs of mental illnesses and substance use disorders. The training gives [participants] the skills necessary to reach out and provide initial help and support to someone who may be developing a mental health or substance use problem or experiencing a crisis.xiv

Table 5. Mental Health First Aid: 2014 and 2015 Number of Trainings & Certified Participants.

County Number of Participants Certified 2014

Number of Participants Certified 2015

2014 MHFA Trainings

2015 MHFA Trainings

Benton 107 184 4 7 Lincoln 15 32 1 2 Linn 180 240 10 14


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Indicator d: Peer-delivered education about behavioral health

What is reported below is only a partial picture of the peer-delivered services occurring in the region. For future reporting, the work of the Oregon Family Support Network, CHANCE, and classes provided such as Living Well with Chronic Conditions will be included.

• Benton County Health Services employs eight Peer Support Specialists, each work .49 to .60 full-time equivalent.xv

• Lincoln County Health and Human Services employs two Peer Support Specialists, each work a .475 full-time equivalent.xvi

• Linn County Health Services employs three-and-a-half full-time equivalent Peer Support Specialists.xvii

Outcome BH2: Increase the expertise of primary care providers who work with people who may have behavioral health needs in order to reduce stigma and improve access and appropriate utilization of services.

Indicator a: Number of primary care providers who have exposure to behavioral health education, information, and Continuing Medical Education (CME)

Samaritan Health sponsored Continuing Medical Education (CME)xviii 2015 behavioral health related trainings (CMEs average 57 physician participants):

• Eating Disorders: Best Practice Interventions • Adverse Childhood Experiences Study (ACES) • Hidden Stress and Unexplained Symptoms • Addressing Adolescent Substance Use in Primary Care • When Antidepressants Don’t Work

Indicator b: Co-located primary care and behavioral health providersxix

The following primary care clinics in the IHN-CCO region have co-located behavioral health providers:

• Albany Internal Medicine • Calapooia Family Medicine • Community Health Centers of Benton and Linn Counties, including the Corvallis,

Lebanon, Lincoln, and Monroe Health Centers; Sweet Home Health Center (hiring stage).

• Geary Street Clinic • Mid-Valley Children’s Clinic • North Albany Medical Clinics


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• Samaritan Health Services Lebanon Primary Care Clinics • Samaritan Health Services Corvallis Primary Care • Samaritan Pacific Communities Hospital Clinics (3 of 5)

Indicator c: Percentage of members who receive behavioral health services, screenings, and referrals in primary care settings


Outcome BH3: Increase behavioral health screenings, services, referrals, and peer and parent support in schools and other community venues.

Indicator a: Percentage of members who receive behavioral health services, screenings, and referrals in venues other than traditional medical facilities.


Indicator b: Numbers of certified Peer Support Specialists accessible to members in venues other than traditional medical facilities.


Indicator c: Rate of suicidal ideation, attempts, suicide, and/or self-harming behavior

The data for Indicator BH3c is from the 2015 Regional Health Assessmentxx

• Some suicide-related data sets are too small to release publically, due to confidentiality. However, “Suicide rates were much higher in Lincoln County in 2013 compared to the other counties in the region, with 30 deaths per 100,000 residents of Lincoln County. For that same year, Linn County recorded 16 suicides per 100,000 residents, and Benton County recorded 14 suicides per 100,000 residents.” xxi

• “Among all age groups, the suicide rate in 2013 per 100,000 people was 19, 12, and 14 in Linn, Benton, and Lincoln Counties, respectively.”xxii

• The following table “highlights the percentage of 8th & 11th grader students in the region who self-reported that they had experienced depression, thought about suicide, or attempted suicide during 2015. The rate of attempted suicide is higher among 8th graders in the region that among 11th graders in the region.”


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Table 6. Percent of 8th and 11th grade students with self-reported depression, thoughts about suicide, or actually attempted suicide during the last 12 months, Linn, Benton, and Lincoln Counties, and Oregon, 2015

Grade Linn Benton Lincoln Oregon

Felt so sad or hopeless almost every day for two weeks or more in a row that they stopped doing some usual activities

8th 29% 26% 36% 27%

11th 30% 28% 28% 29%

Seriously considered attempting suicide

8th 18% 18% 19% 16%

11th 13% 14% 16% 16%

Attempted suicide at least once 8th 9% 7% 15% 8%

11th 5% 5% 5% 6%

Source: Oregon Healthy Teens Survey, 2015


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Child Health

Outcome CH1: Increase the percentage of children, and families—particularly those with identified risk factors—who are empowered in their health, who partner with their healthcare provider, and who set their goals and follow through on those goals.

Indicator a: Percentage of children ready to learn when they enter school

SCHOOL READINESS DATA

Table 7. Early Learning Hub of Linn, Benton, & Lincoln Counties Kindergarten Assessment results, 2015-2016xxiii

Approaches to Learning Average Rating (1-5)

Early Mathematics Average number Correct (0-16)

Early Literacy Average Number Correct (0-100)

Approaches to Learning

Self-Regulation

Inter-personal Skills

Numbers & Operations

English Letter Names

English Letter sounds

EL Hub Average

3.6 3.5 3.8 8.5 17.8 6.9

State Average

3.6 3.5 3.8 8.5 18.5 7.4


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Table 8 below displays Head Start enrollment numbers for 2013-2014. The Head Start Program is a federal program that promotes the school readiness of children from low-income families by enhancing their cognitive, social, and emotional development.

Table 8. Oregon Head Start Pre-K and Early Head Start (EHS) programs and enrollment by county, 2013-2014

OHS Pre-K and EHS program

County OHS Pre-K enrollment

EHS enrollment

Total enrollment

Kids and Company of Linn County (KidCo) Head Start

Linn and Benton

449 52 501

Oregon State University Child Development Center

Benton 75 -- 75

Community Services Consortium

Lincoln 154 -- 154

Siletz Tribal Head Start Lincoln 20 30 50 Total 698 82 780 Source: Oregon Department of Education, Early Learning Division, Oregon Head Start Prekindergarten Programs 2013-2014 directory

Outcome CH2: Decrease the rate of childhood injuries.

Indicator a: Rate of injuries and mortality attributable to inadequate medication safety


Indicator b: Proper use of child safety equipment such as car seats, seat belts, and safety helmets


Indicator c: Child abuse and neglect rates


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Data for Indicator CH2c is from the 2015 Regional Health Assessmentxxiv

In 2014, there were a total of 1,817 reports of child abuse or neglect in the region, of which, 420 (23%) were founded (determined to be abuse). Of these cases, Benton County comprised 15%, Lincoln County comprised 28%, and Linn County comprised 57% (Figure 3).

Figure 3. Founded abuse rate per 1,000 for children less than 18 years of age in Linn, Benton, and Lincoln Counties, and Oregon, 2010-2014

Source: Oregon Department of Human Services, Child Welfare Data Book 2011, 2012xxv, 2013, 2014, & 2015. Rates include neglect, physical abuse, and sexual abuse

Indicator d: Percentage of members with safe housing

Data for Indicator CH2d is from the 2015 Regional Health Assessmentxxvi

Data on the safety of housing is not available. A reasonable proxy for the safety level of a house is its age. Older houses are less likely to have modern safety features, more likely to suffer from mold or other health threats, and more likely to contain lead paint. The following charts show the age of housing in the region. Beginning in 1980, lead paint was outlawed in houses.


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Figure 4. Age of housing stock in Linn, Benton, and Lincoln Counties.

Outcome CH3: Increase breastfeeding rates.

Indicator a: Percentage of women who receive lactation counseling and support during pregnancy and following childbirth


Indicator b: Percentage of women breastfeeding at 6 and 12 months


Indicator d: Percentage of women who can conveniently pump breast milk at work


1980 or later 41%

1950 to 1979 43%

Before 1950 16%

Region

1980 or later 46%

1950 to 1979 40%

Before 1950 15%

Lincoln

1980 or later 40%

1950 to 1979 47%

Before 1950 12%

Benton

1980 or later 39%

1950 to 1979 42%

Before 1950 19%

Linn


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Indicator d: Number of certified Baby Friendly Hospitalsxxvii

None of the five hospitals in the IHN-CCO region are currently certified by the Baby Friendly Hospital Initiative.

Outcome CH4: Increase integration of behavioral health care as part of routine primary pediatric care.

Indicator a: Occurrence of care coordination between primary care and behavioral health providers when working with children, youth, and families, including consultations and referrals


Indicator b: Number of regular behavioral health screenings occurring for pediatric IHN-CCO members

This report is in development.xxviii

Indicator c: Utilization of trauma-informed care, such as Adverse Childhood Experiences (ACEs) and resiliency measures

• In 2015, 213 IHN-CCO providers were trained on ACES.xxix

• Child Abuse Prevention & Early Intervention transformation pilot with Family Tree Relief Nurseryxxx is underway (as described for Indicator A1c).

Indicator d: Oregon Psychiatric Access Line about Kids (OPAL-K) utilization

OPAL-K 2015xxxi

• Number of registered providers per county 2015: Benton 20, Lincoln 5, Linn 24

• Number of case consultations per county: Benton 5, Lincoln 4, Linn 3


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Chronic Disease

Outcome CD1: Increase the percentage of members who have their asthma under control.

Indicator a: Urgent care and emergency department visits, and hospitalizations for asthma (report in development, will be available for future CHIP progress reportsxxxii)

For 2015, there was a 39.5 % Adult Asthma Admission Rate, (State Performance Metric PQI 15) adult asthma per 100,000 member years (no target rate has been set)xxxiii.

Outcome CD2: Increase the percentage of members who are physically active and/or maintain a healthy diet.

Indicator a: Percentage of members who eat the recommended daily amount of fruits and vegetables

Data for Indicator CD1a is from the 2015 Regional Health Assessment. It is not IHN-CCO member specificxxxiv.


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ADULT FRUITS AND VEGETABLE CONSUMPTION

Figure 5. Percent of adults who consumed at least 5 servings of fruits and vegetables per day in Linn, Benton, and Lincoln Counties, and Oregon, 2010-2013.

Source: Oregon Health Authority, Health risk and protective factors among Oregon adults, by county, 2010-2013

Indicator b: Percentage of members who are obese or overweight

Data for Indicator CD1b is from the 2015 Regional Health Assessment, and is not IHN-CCO member specific.xxxv

YOUTH OBESE AND OVERWEIGHT PREVALENCE BY COUNTY

Table 9. Overweight and obesity prevalence in Linn, Benton, & Lincoln Counties & Oregon, 2015

Linn Benton Lincoln Region Oregon 8th grade overweight 15 % 14 % 20 % 16 % 15 % 8th grade obese 12 % 7 % 19 % 11 % 11 % 11th grade overweight 15 % 9 % 19 % 14 % 15 % 11th grade obese 17 % 7 % 10 % 12 % 13 % Source: Oregon Healthy Teens Survey, 2015

19% 22%

24% 22%

0%

5%

10%

15%

20%

25%

30%

Linn Benton Lincoln Oregon

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Table 10. Prevalence of overweight and obesity among adults in the region and Oregon, 2013

Region Oregon Overweight 35.7% 35.5% Obese 26.1% 24.8% Source: Oregon State Health Profile, 2013

Indicator c: Percentage of members who have Type II diabetes

Data for Indicator CD1c is from the 2015 Regional Health Assessment, and is not IHN-CCO member specific.xxxvi

DIABETES-RELATED HEALTH SCREENINGS

Table 11. Age-adjusted percent of adults with diabetes-related health screenings in Linn, Benton, and Lincoln Counties and Oregon, 2010-2013

Health Screening Practice Linn County Benton County Lincoln County Oregon

Blood sugar test within the past 3 years (45 years or older)

63.5% 68.3% 75.0% 63.0%

Cholesterol checked within the past 5 years

70.8% 71.6% 76.3% 70.8%

Source: Oregon Health Authority, Health screenings among Oregon adults, 2010-2013

Indicator d: Percentage of members getting the recommended amount of physical activity.

Information and data for Indicator CD2d is taken from the 2015 Linn, Benton, and Lincoln Regional Health Assessmentxxxvii.

YOUTH PHYSICAL ACTIVITY LEVELS

The Healthy People 2020 objective for physical activity aims to increase the proportion of adolescents who meet current national physical activity guidelines to 32%.xxxviii

xxxix

In Benton and Linn counties, 8th graders exceeded the Health People 2020 objective, while 8th graders in Lincoln County did not. Conversely, 11th graders in Lincoln County exceeded the Healthy 2020 objective, while 11th graders in Linn and Benton Counties did not. Overall, a larger percentage of youth in the region self-report exercising for the recommended amount of time compared to Oregon youth (Figure 6).


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Figure 6. Percent of youth meeting Healthy People (HP) 2020 recommendations for physical activity, by grade, Linn, Benton and Lincoln Counties and Oregon, 2015.


33% 36%

21%

32% 31%

25% 25%

33%

26% 24%

32%

0%

10%

20%

30%

40%

Linn Benton Lincoln Region Oregon

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8th grade

11th grade

HP 2020 benchmark


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Figure 7. Percent of youth meeting Healthy People 2020 recommendations for physical activity, by grade, Benton and Lincoln Counties and Oregon, 2015


ADULT PHYSICAL ACTIVITY LEVELS

The U.S. Center for Disease Control (CDC) recommends 30 minutes of moderate physical activity on five or more days per week. Overall, 22% of Linn County adults, 32% of Benton County adults in, and 18% of Lincoln County adults met the CDC guidelines for physical activity from 2010-2013, compared to 25% of adults in Oregon.

Figure 8 on the next page displays how, within the region, the percent of adults who report no physical activity outside of work ranges from 13% in Benton County to 22% in Linn County, compared to the Oregon average of 18%.

0 0.1 0.2 0.3 0.4 0.5 0.6 0.7

0% 10% 20% 30% 40% 50% 60% 70%

OregonRegionLincolnBenton

Linn


Linn


Linn

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Percent of residents who spend more than 30% of their income on housing


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Figure 8. Percent of adults who report no physical activity outside of work within past month in Linn, Benton, and Lincoln Counties, and Oregon, 2010-2013

Source: Oregon Health Authority, Health risk and protective factors among Oregon adults, by county, 2010-2013

Outcome CD3: Reduce the percentage of members who use and/or are exposed to tobacco. TRANSFORMATION PILOT PROJECT PRIORITIZATION

The IHN-CCO Delivery System Transformation Steering Committee, using the CAC’s 2016 CHIP Addendum, has selected this outcome as one of four priority targets for its first round of Requests for Applications (RFPs) for transformation pilot project funding. The CCO has already received, and is currently evaluating, several viable applications.

Indicator a: Tobacco prevalence (2016 Quality Incentive Metric), including tracking prevalence among members who are under age 18, pregnant, or who are a member of another at-risk group

Data for Indicator CD3a is taken from the 2015 Linn, Benton, and Lincoln Regional Health Assessment.xl

SMOKING DURING PREGNANCY

The percentage of mothers in the region who smoked during pregnancy varies, ranging from 8% in Benton County to 17% in Linn County and 19% in Lincoln County.

22%

13%

16% 18%

0%

5%

10%

15%

20%

25%

Linn Benton Lincoln Oregon

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Table 12. Smoking rates among pregnant females by age in the region and Oregon, 2011-2013

Population (by age) Region Oregon 15 to 17 19 % 13 % 18 to 19 30 % 18 % 20 to 24 23 % 18 % 25 to 29 13 % 10 % 30 to 34 9 % 6 % 35 to 39 8 % 5 % 40 to 44 9 % 4 % Total 15 % 11 % Source: Oregon Health Authority, Center for Vital Statistics, 2011-2013

YOUTH TOBACCO CONSUMPTION

Table 13. Percent of youth who reported tobacco use in the past 30 days in Linn, Benton, Lincoln Counties, region, and Oregon, 2015

Grade Linn Benton Lincoln Region Oregon Smoked cigarettes 8th 8 % 1 % 8 % 5 % 4 % 11th 11 % 7 % 7 % 9 % 9 % Used e-cigarettes 8th 14 % 5 % 10 % 10 % 9 % 11th 21 % 12 % 10 % 16 % 17 % Source: Oregon Healthy Teens Survey, 2015

ADULT SMOKING RATES

Table 14. Age-adjusted percent of adults who currently smoke cigarettes in Linn, Benton, and Lincoln Counties and Oregon, 2010-2013

Linn Benton Lincoln Oregon Smoking rates 21 % 14 % 33 % 19 % Source: Oregon Behavioral Risk Factor Surveillance System (BRFSS)xli, Table II: Prevalence of Modifiable Risk Factors among Adults, 2010-2013

Indicator b: Use of tobacco cessation resources and tools

Report in development.xlii


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Maternal Health

Outcome MH1: Reduce the rate of unplanned pregnancies.

TRANSFORMATION PILOT PROJECT PRIORITIZATION

The IHN-CCO Delivery System Transformation Steering Committee, using the CAC’s 2016 CHIP Addendum, has selected this outcome as one of four priority targets for its first round of Requests for Applications (RFPs) for Transformation Pilot Project Funding. The CCO has already received and is considering several viable applications.

Indicator a: Effective contraceptive use among women at risk of unintended pregnancy (Quality Incentive Metric)

Quality Metrics Data from OHA (current rolling rate: Dec 2014 – Nov 2015): • Effective Contraceptive Use – All Age Groups was 35.6% (No target set for this time

periodxliii)

Indicator b: Effective contraceptive use among men


Indicator c: Percentage of pregnancies that are unplanned, including data by age, ethnicity, and race

Data for this indicator is taken from the 2015 Linn, Benton, and Lincoln Regional Health Assessmentxliv.


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TEEN PREGNANCY RATES

Figure 9. Pregnancy rate per 1,000 girls, ages 15-17 years in the region and Oregon, 3 year moving average, 2008-2013

Source: Oregon Health Authority, Center for Health Statistics, Birth Certificate Data, 2008-2013

Indicator d: Use of the One Key Question (see glossary for definition)

Clinics using the One Key Questionxlvxlvi:

• Benton County Federally Qualified Health Center

• Lincoln County Primary Care Clinics

• Lincoln County School Based Health Centers

• Linn County Federally Qualified Health Center

• Samaritan Geary Street Family Medicine

Outcome MH2: Increase the percentage of women of childbearing age who receive early and adequate pre-conception and prenatal care and who connect with appropriate resources throughout their pregnancy.

Indicator a: Timeliness of prenatal care (Quality Incentive Metric), including oral health care (care initiated in first trimester)

• 26% of IHN-CCO pregnant members received oral health care in the first trimester of pregnancy.xlvii

• Quality Metrics Data from OHA (2014 final rate, 2015 rate not yet available)

0

5

10

15

20

25

2008 - 2010 2009 - 2011 2010 - 2012 2011 - 2013

Preg

nanc

ies

per

1,00

0 w

omen

Region

Oregon


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• Prenatal and Postpartum Care for IHN-CCO Members, Prenatal Care Rate: 76.0%xlviii

Indicator b: Behavioral health screenings and access to treatment with a behavioral health provider

• Quality Metrics Data from OHA (2014 final rate, 2015 rate not yet available)

o Depression Screening and Follow-Up Plan: 3.3%xlix

• Quality Metrics Data from OHA (current rolling rate: Dec 2014 – Nov 2015)

o Alcohol and Drug Misuse (SBIRT) – All Age Groups: 7.5%l

Indicator c: Percentage of pregnant members with a healthy weight gain during their pregnancies.


Indicator d: Percentage of infants with low birth weight or premature birth

Data for Indicator MH2d is taken from the Regional Health Assessment.li

LOW BIRTH RATE BY RACE/ETHNICITY

Table 15. Percent of infants born with low birth weight by race/ethnicity in the region and Oregon, 2011-2013

Region Oregon White, non-Hispanic (NH) 6.2% 5.9% Black/African American, NH 15.6%* 9.5%* American Indian/Native American, NH 6.8%* 8.1%* Asian & Pacific Islander, NH 5.8%* 7.7%* Hispanic/Latino 8.6% 6.2% All infants 6.6% 6.2% Source: Oregon Health Authority, Center for Health Statistics, Birth Certificate Data, 2011-2013

* This number may be statistically unreliable due to small numbers and should be interpreted with caution


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PREMATURE BIRTH RATES

Table 16. Percent of births that are premature in the region and Oregon, 2011-2013

Region Oregon White, non-Hispanic 7.3 7.3 Black/African American, non-Hispanic 24.4* 9.7*

American Indian/Alaska Native 5.1* 10.4*

Asian & Pacific Islander 6.6* 7.6* Hispanic/Latino 8.8 7.4 All births 7.5 7.5 Source: Oregon Health Authority, Center for Health Statistics, Birth Certificate Data, 2011-2013

* This number may be statistically unreliable due to small numbers and should be interpreted with caution

Indicator e: Utilization of traditional health worker services by pregnant women


Outcome MH3: Increase the percentage of women, infants, and families—particularly those with identified risk factors—who access postpartum care and support.

Indicator a: Percentage of women who attend postpartum follow-up visits


Indicator b: Percentage of women who receive preventive dental care postpartum


Indicator c: Percentage of postpartum members who receive a mental health and substance abuse screening and are referred to treatment if necessary


Indicator d: Percentage of postpartum members who are contacted by their provider if they do not attend a follow-up visit



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Appendix I: Acronyms ACE – Adverse Childhood Experiences

CAC – Community Advisory Council

CASA – Court Appointed Special Advocates

CDC – Center for Disease Control

CHA – Community Health Assessment

CHIP – Community Health Improvement Plan

CCO – Coordinated Care Organization

CME – Continuing Medical Education

DHS – Department of Human Services

EHS – Early Head Start

HIA – Health Impact Area

K-12 – Kindergarten through 12th grade

LGBTQIA – Lesbian, gay, bi-sexual, transgendered, questioning, intersex, or asexual

N/A – Not applicable (does not apply)

IHN-CCO – InterCommunity Health Network Coordinated Care Organization

OFSN – Oregon Family Support Network

OHA – Oregon Health Authority, the state agency responsible for OHP/Medicaid

OHP – Oregon Health Plan (Medicaid)

Opal-K – Oregon Psychiatric Access Line about Kids provides free, same-day child psychiatric phone consultation to primary care providers in Oregon

O&I – Outcomes and Indicators

RHA Team – Regional Health Assessment Team

SBIRT – Screening, brief Intervention, and referral to treatment


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Appendix II: Glossary of Terms Addendum – Something that is added to the main or original text.

At Risk – An individual or group who is more likely, than another individual or group, to experience a problem, such as an illness.

Baby Friendly Hospital – Baby Friendly is a World Health Organization and United Nations Children’s Fund initiative to improve breastfeeding support throughout the ward. Baby Friendly is based on The Ten Steps to Successful Breastfeeding. A certified Baby Friendly Hospital has successfully met the requirements and been approved by this initiative. lii

CASA – Court Appointed Special Advocates—empowered directly by the courts—offer judges the critical information they need to ensure that each child’s rights and needs are being attended to while in foster care.liii

CME – Continuing Medical Education training credits for physicians. One credit equals one hour of education in a certified training. All Oregon physicians must earn 60 CMEs every two years. liv

Epidemiologist – Someone who studies patterns, causes, and effects of health and disease conditions in defined populations and is knowledgeable about relevant data.

Health Disparity – A situation where a person or group is more likely (than another person or group) to get sick or have a health related problem because of where they live, or how much education they have, or what race or gender they are, etc.

Healthy People 2020 – This is the federal government's prevention agenda for building a healthier nation. It is a statement of national health objectives designed to identify the most significant preventable threats to health and to establish national goals to reduce these threats. The vision of Healthy People 2020 is to have a society in which all people live long, healthy lives. The overarching goals of Healthy People 2020 are to: attain high-quality, longer lives free of preventable disease, disability, injury, and premature death; achieve health equity, eliminate disparities, and improve the health of all groups; create social and physical environments that promote good health for all; and promote quality of life, healthy development, and healthy behaviors across all life stages. The plan contains 42 topic areas.” lv

Health Impact Area (HIA) – A priority health focus area identified in the CHIP.

Indicator – A measurement or data that provides evidence that a certain condition exists or certain results have or have not been achieved. Indicators measure the level of success or lack of success a program has had in achieving an outcome.

Mental Health Promotion & Prevention – An Adverse Childhood Experiences and Trauma-Informed Care awareness grant campaign organized by IHN-CCO in collaboration with Benton, Lincoln, and Linn County Health Departments.

Member – Any individual enrolled in the Oregon Health Plan whose care is the responsibility of IHN-CCO.


32

OFSN – Oregon Family Support Network is an organization with families and youth working together to promote mental, behavioral, and emotional wellness for other families and youth through education, support, and advocacylvi

OHA – Oregon Health Authority, the state agency responsible for Oregon Health Plan/Medicaid

OHA Innovator Agent – Innovator Agents help CCOs and OHA work together to achieve the goals of health system transformation: better care, better health, and lower costs.

One Key Question (Initiative) – An evidence-based practice to prevent unplanned pregnancies or provide preconception preventive care information to those who are planning to become pregnant in the next year.lvii

Opal-K – Oregon Psychiatric Access Line about Kids provides free, same-day child psychiatric phone consultation to primary care providers in Oregonlviii

Outcome – Results or changes that come about from a program, such as changes in knowledge, awareness, skills, attitudes, opinions, aspirations, motivation, behavior, practice, decision-making, policies, social action, condition, or status.

Family Tree Relief Nursery – Family Tree Relief Nursery is a child abuse and neglect prevention program offering free services to low-income families with children under the age of 6. They support family stability and work with children and parents to minimize the need for children to be removed from their home.lix

Resiliency – The ability to recover.

RHA Team – The Regional Health Assessment Team works to coordinate data collection and reporting across Benton, Lincoln, and Linn counties. They are working to create a central database for community partners to provide & share data to support the repeating cycles of community health assessment across the region.

Social Determinants of Health – Social determinants of health are conditions in the environments in which people are born, live, learn, work, play, and age that affect wellbeing.lx

Youth MOVE – A youth-led national organization devoted to improving services and systems that support positive growth and development. They achieve this by uniting the voices of individuals who have lived-experience in various systems, including mental health, juvenile justice, education, and child welfare.lxi


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Appendix III: References

i https://www.oregon.gov/oha/OHPB/CCOCHIP/IHN%20-%20Community%20Health%20Improvement%20Plan%20Addendum%20-%20Jan.%202016.pdf ii https://www.oregon.gov/oha/OHPB/CCOCHIP/IHN%20-%20Community%20Health%20Improvement%20Plan%20Addendum%20-%20Jan.%202016.pdf iii Information provided by IHN-CCO, April 22, 2016. iv http://www.familytreern.org/ v Good Samaritan Regional Medical Center data, April 12, 2016. vi OHA Quality Measures IHN-CCO (Current Rolling: Dec 2014 – Nov 2015) report. vii OHA Quality Measures IHN-CCO (Current Rolling: Dec 2014 – Nov 2015) report. viii IHN-CCO data, April 8, 2015. ix Good Samaritan Regional Medical Center data, April 12, 2016. x https://www.co.benton.or.us/health 2015 Regional Health Assessment, Ch. 7, p. 147. xi IHN-CCO Latino Campaign Awareness Poll Summary Report, November 2015. xii 2016 IHN-CCO Mental Health Awareness Campaign work plan, IHN-CCO, April 11, 2016. xiii Information provided by Linn County Health Department & CASA, April 6, 2015; May 10, 2016. xiv http://www.mentalhealthfirstaid.org/cs/about/, retrieved April 27, 2016. xv Information provided by Benton County Health Services xvi Information provided by Lincoln County Health & Human Services xvii Information provided by Linn County Health Services xviii Information provided by Good Samaritan Regional Medical Center, April 12, 2016. xix Information provided by IHN-CCO, April 8, 2016. xx https://www.co.benton.or.us/health 2015 Regional Health Assessment, Ch. 7, p. 147. xxi CHIP Progress Report Regional Health Assessment, April 11, 2016 xxii CHIP Progress Report Regional Health Assessment, April 11, 2016 xxiii Early Learning Hub of Linn, Benton, and Lincoln Oregon Kindergarten Assessment Results, information provided by IHN-CCO, April 6, 2016. xxiv https://www.co.benton.or.us/health 2015 Regional Health Assessment, Ch. 7, p. 147.

https://www.oregon.gov/oha/OHPB/CCOCHIP/IHN%20-%20Community%20Health%20Improvement%20Plan%20Addendum%20-%20Jan.%202016.pdf




http://www.familytreern.org/

https://www.co.benton.or.us/health

http://www.mentalhealthfirstaid.org/cs/about/




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xxv 2012 data is from the Portland State University Population Research Center. Beginning 2013, the population data is one year behind the year shown and is from Puzzanchera, Sladky, & Kang (2014). Easy Access to Juvenile Populations: 1990-2013. xxvi https://www.co.benton.or.us/health 2015 Regional Health Assessment, Ch. 7, p. 43. xxvii https://www.babyfriendlyusa.org/about-us/baby-friendly-hospital-initiative, retrieved December 28, 2015 xxviii Information provided by IHN-CCO, April 14, 2016. xxix Information provided by IHN-CCO, April 6, 2016 xxx http://www.familytreern.org/ xxxi Information provided by the Oregon Health Authority, April 6, 2016. xxxii Information provided by IHN-CCO, April 14, 2016. xxxiii OHA Quality Measures IHN-CCO (Current Rolling: Dec 2014 – Nov 2015) report. xxxiv https://www.co.benton.or.us/health 2015 Regional Health Assessment, Ch. 7, pp. 154-155; 166 xxxv https://www.co.benton.or.us/health 2015 Regional Health Assessment, Ch. 7, pp. 155-156; 166 xxxvi https://www.co.benton.or.us/health 2015 Regional Health Assessment, Ch. 6, pp. 114-115 xxxvii https://www.co.benton.or.us/health 2015 Regional Health Assessment, Ch. 7, pp. 152-154 & 164-166 xxxviii Healthy People 2020. (2015) Physical Activity: Objectives. Retrieved from http://www.healthypeople.gov/2020/topics-objectives/topic/physical-activity/objectives xxxix Healthy People 2020 (2015) Physical Activity: Objectives. Retrieved from http://www.healthypeople.gov/2020/topics-objectives/topic/physical-activity/objectives xl https://www.co.benton.or.us/health 2015 Regional Health Assessment, Ch. 7, pp. 137-138; 157-158; 169-171 xli https://public.health.oregon.gov/DataStatistics/Pages/index.aspx, retrieved April 25, 2016 xlii Information provided by IHN-CCO, April 14, 2016. xliii Information provided by IHN-CCO, April 14, 2016. xliv https://www.co.benton.or.us/health 2015 Regional Health Assessment, Ch. 7, pp. 139-141 xlv Information provided by IHN-CCO, April 8, 2016. xlvi Information provided by IHN-CCO, April 14, 2016 xlvii Information provided by IHN-CCO, April 6, 2016


https://www.babyfriendlyusa.org/about-us/baby-friendly-hospital-initiative

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xlviii Information provided by IHN-CCO, April 14, 2016 xlix Information provided by IHN-CCO, April 14, 2016 l Information provided by IHN-CCO, April 14, 2016 li https://www.co.benton.or.us/health 2015 Regional Health Assessment, Ch. 7, pp. 141-143 lii https://www.babyfriendlyusa.org/about-us/baby-friendly-hospital-initiative, retrieved December 28, 2015 liii http://www.casaforchildren.org/site/c.mtJSJ7MPIsE/b.5301295/k.BE9A/Home.htm, retrieved December 28, 2015 liv http://www.cmeweb.com/gstate_requirements.php retrieved December 28, 2015 lv http://www.cdc.gov/dhdsp/hp2020.htm, retrieved May 5, 2015 lvi http://ofsn.org/, retrieved December 28, 2015 lvii http://www.onekeyquestion.org/, retrieved December 30, 2015 lviii http://www.ohsu.edu/xd/education/schools/school-of-medicine/departments/clinical-departments/psychiatry/divisions-and-clinics/child-and-adolescent-psychiatry/opal-k/index.cfm, retrieved December 28, 2015 lix http://www.familytreern.org/about-us , retrieved April 25, 2016 lx http://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-health, retrieved January 7, 2016 lxi http://www.youthmovenational.org/Pages/mission-vision-purpose.html, retrieved December 28, 2015


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http://www.casaforchildren.org/site/c.mtJSJ7MPIsE/b.5301295/k.BE9A/Home.htm

http://www.cmeweb.com/gstate_requirements.php

http://www.cdc.gov/dhdsp/hp2020.htm

http://ofsn.org/

http://www.onekeyquestion.org/

http://www.ohsu.edu/xd/education/schools/school-of-medicine/departments/clinical-departments/psychiatry/divisions-and-clinics/child-and-adolescent-psychiatry/opal-k/index.cfm



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http://www.youthmovenational.org/Pages/mission-vision-purpose.html

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