Allegany County Department of Health CHA and CHIP for 2014-2017

Transcription

Allegany County Department of Health
Community Health Assessment 2014-2017
and
Community Health Improvement Plan
2014-2017
Lori Ballengee, M.S.
Public Health Director
Thomas E. Hull, M.S.
Deputy Public Health Director
Laurie Hennessy, RN, BSN
Director of Patient Services
The 2014-2017 Community Health Assessment
was compiled and written by
Theresa Moore
Supervising Public Health Educator
County Office Building
7 Court Street
Belmont, New York 14813
Tel: 716-268-9250
Fax: (716)-268-9264
1
Table of Contents
A. Community Health Assessment (CHA)
1. A description of Allegany County
a. Demographics of the population served
b. Health status of the population served
2. Main health challenges for Allegany County and contributing causes of
health challenges
3. Summary of assets and resources to address health issues
4. Process and methods used to conduct the assessment
B. Community Health Improvement Plan (CHIP)
1. Identification of priorities from the Prevention Agenda 2013
2-6 are included in CHIP grid
2. Goals and objectives
3. Individuals and organizations implementing strategies
4. Outcome and process measures
5. Description of strategies and best practice or evidence-based practices
6. Description of process for maintaining, tracking, and making changes to
CHIP
Attachments:
 Allegany County Community Health Assessment Survey
 Allegany County Integrated Health Plan 2013-2014 Report (summary of survey and
focus groups)
 Allegany County Data 2013-Community Health Assessment (Power point)
 Allegany County Obesity Related Services-provider survey results
 Allegany County Obesity tables
 Allegany County Child Psychiatric Services-Provider Survey results
 Allegany County Department of Health Organizational Chart
2
COVER PAGE
Local Health Department/Unit Address: Allegany County Health Department
7 Court Street, Belmont, New York 14813
Telephone: (585) 268-9250
Fax: (585) 268-9264
Submitted by: Theresa Moore
E-MAIL: mooretk@alleganyco.com
Prepared by: Theresa Moore, Supervising Public Health Educator
GENERAL COUNTY INFORMATION
Health Department Type (please check one):
XX
Full Service
Less than Full Service
Organization Type (please check one):
XX
Single Agency
(Health Only)
_____ Multiple Agency,
please list:
__________________________
Sources of Data Information on the demographic and population characteristics of Allegany
County were obtained from the following:
 2010 U.S. Census Data
 2007-2011 American Community Survey 5 year Estimates (U.S. Census)
 People Quick-facts for the U.S. Census
 New York State Vital Statistics
 New York State Expanded Behavioral Risk Factor Surveillance System (BRFSS) July
2008-June 2009
 New York State District Report Card Comprehensive Information Report
 National Center for children in Poverty
 New York Makes Work Pay (NYMWP) project
 United States Bureau of Labor
 Uniform Crime Reporting Program
 Allegany County Indicators for tracking Public Health Priority Areas, 2013-2017-various
data sources
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A. Community Health Assessment (CHA)
1.Description of Allegany County
Allegany County is a rural county located along the Southern Tier of Upstate New York, with an
Area of 1,030 square miles. It is bordered by Cattaraugus, Wyoming, Livingston, and Steuben
Counties in New York State, and by McKean and Potter counties in Pennsylvania.
a.Demographics of population served
The 2010 U.S. Census data shows Allegany County population at 48,949, a decrease of 1.96%
from the 2000 U.S. Census (see line graph below). The average births from 2008-2011 for
Allegany County was 511 per year. The population density is 47.6 people per square mile. The
county has 12 public school districts, 29 townships and 10 villages. Population concentrations
are in Wellsville, Alfred, Cuba, Bolivar and Andover.
Allegany County Population
* Census data ** Census estimate
55000
50000
45000
2012**
2010
2000
1990
1980
1970
1960
40000
4
Gender, Race and Age
The 2010 U.S. Census showed the median age of Allegany County residents to be 37.8 years,
with 50.5% male to 49.5% female ratio, slightly less than 1:1. Caucasians comprise the vast
majority of county residents, making up 96.2% of the population. African Americans, 1.1%;
American Native/Alaska Native, 0.2%; Asians, 0.9% and 1.2% other racial groups total the
remaining 3.8%.
Allegany County percentages of Racial group
Caucasian
Africian American
Asian
American Native/
Alaska Native
Other
Census data also shows that 27.71% of the population is 19 years of age or younger. From 1970
to present, there has been little change in the composition of this age group. A little over 57.09%
of the population is age 20-64 and 15.21% is age 65 or older. The data also indicate that the
county’s population is living longer. In 1970, the population age 65 and over totaled 5,113. By
1994, this number had increased 40%, to 7,159, in 2000 it increased to 7,000, and in 2010 it
increased to 7,443 (an increase of 6.3%) (See chart below)
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Age Distribution of Residents of Allegany County, New York: 2010 U.S. Census
Age Group
Number of
Percent of
Number of
Percent of
Difference
Persons
Population
persons 2000
Population
percentage
2010
2010
2000
of
population
< 5 years
2,667
5.4%
2,798
5.6%
-0.2
5-9 years
2,895
5.9%
3,267
6.5%
-0.6
10-14 years
3,048
6.2%
3,866
7.7%
-1.5
15-19 years
4,953
10.1%
5,250
10.5%
-0.4
20-24 years
4,761
9.7%
4,737
9.5%
+0.2
25-34 years
4,866
9.9%
5,040
10.1%
-0.2
35-44 years
5,203
10.6%
6,902
13.8%
-3.2
45-54 years
6,832
14%
6,505
13.0%
+1.0
55-59 years
3,295
6.7%
2,431
4.9%
+1.8
60-64 years
2,983
6.1%
2,131
4.3%
+1.8
65-74 years
3,931
8.0%
3,748
7.5%
+0.5
75-84 years
2,503
5.1%
2,328
4.7%
+0.4
>85 years
1,009
2.1%
924
1.9%
+0.2
Totals
48,946
100%
49,927
100%
-1.97%
Income
Income levels in Allegany County are among the lowest in the state. The 2010 census shows the
county’s per capita income as $26,953, with median household income at $41,900. The New
York State median household income was $56,951 in 2010, while the 2010 national figure was
$52,762.
2010 Median Household income
2010 Annual Per Capita Income
2007-2011 per capita money income (2011 dollars)
Allegany County New York State United States
$41,900
$56,951
$52,762
$26,953
$48,596
$39,937
$20,047
$31,796
$27,915
The 2010 percentage of residents living below 100% of poverty is 17.2%, up from 15.5% in the
2000 Census. A total of 15% of New Yorkers live at or below the poverty level while 15.3%
nationally live at or below poverty level.
In the table below the 2005-2007 estimates U.S. Census are compared to 2007-2011 estimates
U.S. Census for the numbers and percentage of Allegany County Residents living below the
Federal Poverty Level Standards. The 2007-2011 data shows Allegany County at 16.6% for all
persons living below poverty, a slight decrease from 2005-2007 and above NYS at 14.5%. In
2007-2011 the percentage of families with children under 5 years living in poverty is 22.6%, an
increase from 2005-2007 which was 21.3%. The 2007-2011 percentage families with a female
householder and no male present and related children under 5 years, living under poverty is
49.6% a decrease from 61.8% in 2005-2007.
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Population Group Allegany County
All persons
Persons 18 years and over
Persons 65 years and over
All Families
Families with children under 5 years of age
Female Head of Household Families
Female Head of Household families, no
male present and related children under age
5 years
Percent Below Poverty
Level 2005-2007
16.7
15.2
8.2
11.0
21.3
38.3
61.8
Percent Below Poverty
Level 2007-2011
16.6
14.7
9.3
11.6
22.6
37.3
49.6
The American Community Survey 5 year estimates of U.S. Census data provided the following
income data for Allegany County inflation adjusted dollars.
American Community Survey (U.S. Census)
% of households with income less than $10,000
% of households with income of $50,000+
% of households receiving public assistance
1998
17.2
13.7
10.2
2000
12.1
27.1
4.4
2007
8.8
36.5
3.4
2011
7.8
40.7
3.9
The National Center for Children in Poverty shows in 2011 40% of the children in New York
State were living in low-income families, 43% in rural areas. County specific percentages were
not available from this source, Allegany County falls into the rural percentages for New York
State with 43% rural low-income.
Income status of children under age 18, by residential area, 2011
50 state data 2011 American Community Survey
National
New York
Low income
43%
40%
Urban
Above low income
57%
60%
Low income
52%
43%
Rural
Above low income
48%
57%
Definitions:
Low Income-Families and children are defined as low income if the family income is less than twice the federal poverty threshold.
Poor-Families and children are defined as poor if family income is below the federal poverty threshold.
The federal poverty for a family of four with two children was $22,350 in 2011 and $22,050 in 2010.
Rural- An area that is not in a metropolitan statistical area (MSA), as defined by the U.S. Census Bureau.
According to the New York State Department of Health in 2011, Allegany County’s
Medicaid/Family Health Plus/Self-Pay Labor and Delivery rate continues to increase, 57.42%
and continues to be higher than the NYS rate of 50.21%. In 2007 Community Health Data Set,
our Medicaid and Self-pay Delivery rate was 46.7% while the NYS excluding NYC percent is
33.8.
According to the New York State District Report Card Comprehensive Information Report
Alfred-Almond also had the least number of children eligible for the Free Lunch Program in
7
2011-2012 with 21%, and 10% of their population received free lunches. In the same school
year Friendship School had the most students eligible for Free lunches at 61% of their
population, while only 10% of their students actually receive them. Please see Table below for a
complete listing of eligibility and usage by school district.
School District
%
Eligible
for Free
Lunch
Program
in 20092010
19
%
Receiving
Free/Reduce
Lunch
Program in
2009-2010
% Eligible
for Free
Lunch
Program in
2010-2011
%
Receiving
Free/Reduc
e Lunch
Program in
2010-2011
% Eligible
for Free
Lunch
Program in
2011-2012
% Receiving
Free/Reduce
Lunch Program
in 2011-2012
11
23
7
21
10
33
31
44
13
16
15
25
36
45
17
13
11
38
37
42
15
15
15
32
32
36
53
35
13
9
14
13
10
36
40
37
58
29
11
11
9
12
18
40
44
35
61
39
10
10
9
10
8
Scio
42
16
48
13
51
Wellsville
32
12
36
11
36
Whitesville
19
13
27
6
22
Source: New York State Education Department-NYS District Report Card
14
12
8
Alfred-Almond
Andover
Belfast
BolivarRichburg
Canaseraga
Cuba-Rushford
Fillmore
Friendship
Genesee Valley
Disabilities
According to the New York Makes Work Pay (NYMWP) project and the American Community
Survey (ACS) for 2008-2010 focusing on working-age population 18-64 years old, Allegany
County has 12% of women and 10.3% of men reporting a disability in comparison with 8.5%
and 8.6%, respectively, in New York State. The working-age population of Allegany County is
estimated to be 31,000 with 11.1%, 3,500 individuals having reported one or more disabilities.
The prevalence of disabilities in Allegany County is greater than the statewide average of 8.5%
and the national average of 10%. Allegany County ranked 27th highest in or disabilities
prevalence among the 60 counties in this report of New York State counties. Some estimates of
the “Disability and Employment Status Report for Allegany County” are based on data
specifically for Allegany County while others are based on a larger geographic area called a
Public Use Microdata Area (PUMA) which include Allegany and Cattaraugus County. In this
larger area PUMA Allegany County accounts for 38.8% of the working-age population.
Working people in the PUMA with Allegany County disability types are reported: 5.9%
ambulatory disability, 4.7% cognitive disability, 3.4% independent living disability, 1.7% self8
care disability, 1.9% visual disability and 2.6% hearing disability. 5.1% of individuals reported
two or more disabilities included in these six types. In the PUMA containing Allegany County,
there are 4,600 civilian veterans 18 years and older, 12.5% reported a service-connected
disability. The employment rate for working age individuals with disabilities is 27.4% and
72.2% for individuals without a disability. New York State’s employment rates, in comparison,
are 27.4% and 73.9%. In the larger PUMA area that contains Allegany County, working-age
individuals with disabilities that did not graduate from high school was 20.4% compared to 7.8%
of individuals without disabilities. In Allegany County 36.2% of working-age people with
disabilities live below the federal poverty level which is three times the poverty rate for people
without disabilities.
Mobility
Access Allegany has been working to improve transit service to the people of Allegany County
since 2007. The service area includes most of the communities in Allegany County. The bus
routes connect townships across the region, major employment centers, shopping areas, and
healthcare facility in the county. The service offers five bus routes, an express route in Wellsville
and seven supplemental flex routes. Allegany County residents have consistently increased their
ridership each year. Mass transit is not as accepted in rural Allegany County as in urban areas of
New York State. The 2007-2011 American Community Survey 5-year Estimates for Allegany
County workers 16 years and over total 20,851 and the table below is a breakdown of how they
commute to work. Their mean travel time to work is 21.3 minutes.
2007-2011 Allegany County Commute to work for
workers 16 years and over
worked at home
Other means
Walked
Public Transportation (Excluding taxicab)
Car, Truck, or van (carpooled)
Car, Truck or van (drove alone)
0
5,000 10,000 15,000 20,000
Educational attainment
The 2010 U.S. Census showed that 30,495 Allegany County residents 25 years of age and older
9
who had ever been enrolled in school (see table below) 8.6% have less than a high school
diploma or equivalency degree; 3.5% having less than a 9th grade education; and 41.4% have a
high school diploma or equivalency degree. 29.8% have an advanced degree with the following
breakdown, 12.4% have an Associate’s Degree, 8.7% have a Bachelor’s Degree and 8.7% hold a
Graduate or Professional Degree. In comparison the 2005-2007 U.S. Census showed that
educational attainment status was available on 30,010 people, 25 years and over, who had ever
been enrolled in school. Of these, 11.6% have less than a high school diploma or equivalency
degree, with 3.7% having less than a 9th grade education. Of those ever-enrolled in school,
31.2% have an advanced degree with the following breakdown, 12.6% have an Associate’s
Degree, 8.8% have a Bachelor’s Degree and 9.8% hold a Graduate or Professional Degree.
Allegany County residents 25 years of age and older who had ever been enrolled in school
2010 U. S. Census
8.7%
3.5%
8.6%
8.7%
< 9th Grade
Education
< High School
Diploma
High School
Graduate
2 Year Degree
12.4%
41.4%
4 Year Degree
Post-Graduate
Allegany County School Enrollment
Population 3 years & over enrolled in school
Preschool
Kindergarten through 12th grade
College
2007-2011 U.S. Census
14,815
3.65%
53.63%
42.74%
2005-2007 U.S. Census
14,727
4.4%
59.2%
40.8%
The New York State Department of Health reports the school dropout rate for Allegany County
over the three year period of 2008-2010 was 1.8 compared to New York State’s rate of 2.8 and
NYS excluding NYC’s rate of 2.0.
10
There are 12 Public School Districts in Allegany County. According to the New York State
District Report Card Comprehensive Information Report, 11 of the 12 districts are Category 4
Schools, which means they are rural schools with high student needs in relation to district
resource capacity. Only Alfred-Almond School District is a Category 5, which denotes average
student needs in relation to district resource capacity.
Home ownership
The People Quick-facts for the U.S. Census identified in 2010, 26,140, total housing units within
the county and 18,208 are occupied housing units. Of these housing units 41% were built before
1940. Of the 18,208 occupied housing units, .8% lack complete plumbing facilities, 1.4% lack
complete kitchen facilities, and 2.5% have no telephone service available. According to Allegany
County Environmental Health statistics for 2013, approximately 50% obtained their water from a
public water supply, while the remaining 50% had private water sources such as wells and
springs, while 35% were connected to a public sewer, with 65% having individual sewage
disposal systems, such as septic systems, cesspools, etc. Median monthly mortgage payments
for owner-occupied housing units (with a mortgage 7,476) were $1,007 (a 9% increase from
2005-2007), with 32.1% of homes valued at less than $50.000. Another 42.8% of these homes
are valued at $50,000 to $99,000, for a total of 79.9% of the homes in Allegany County valued at
less than $100,000. The median monthly rent for occupied units was $584 (38% increase from
2005-2007). In 2007-2011 the total number of households within the county, 18,936; 74.4% is
the homeownership rate; the average number of persons per household is 2.32; and the median
value of owner-occupied housing units is $66,800. Of these, 69.8% moved into their housing
unit in 1990 or later, 13.1% moved into their housing unit between 1980-1989, 8.5 % had moved
between 1970-1979, and 8.7% had moved in during 1969 or earlier. The 2007-2011 Census data
shows an average owner occupied household size is 2.39 (renter occupied units is 2.10) and the
average family size is 2.79. The majority of households in Allegany County (67%) are family
households, while 11.5% are householder 65 years and over. Additional data showed that 2.5%
of the occupied units had no telephone, 7.3% had no vehicle, and 92.8% had one or more
vehicles.
Employment status
According to the U.S. Census Bureau, 2007-2001 American Community Survey, Allegany
County had an estimated 21, 595 civilian employed population 16 years and over. Management,
professional and related occupations remains the number one occupational category and sales
and office occupations is still number two. Construction/extraction/maintenance occupations and
farming/forestry/fishing occupations were not in the top five occupations in 2007-201. Natural
resources/construction/maintenance moved into the top five in 2007-2011.
11
Occupational Status of Labor Force, by Percent,
Allegany County, New York: 2007-2011 U.S. Census
Occupational Category
Management, professional, and related
Occupations
Sales and Office Occupations
Service Occupations
Production, transportation and material moving
Occupations
Construction, extraction and maintenance
Occupations
Farming, Forestry, and Fishing Occupations
Natural resources, construction and maintenance
occupations
Percent of Labor
Force 2007-2011
31.7
Percent of Labor
Force 2005-2007
30.9
20.6
19.5
15.8
20.3
19.5
16.6
Not in top 5
10.8
Not in top 5
12.3
1.9
Not in top 6
For the industrial occupational status of the labor force by percentage, educational
services/health care/social assistance remains number one and manufacturing increases the
percentage and remains number two.
Industrial Occupational Status of Labor Force, by Percent,
Allegany County, New York: 2007-2011 U.S. Census
Rank
Industry
Estimated Percentage
Percentage
number
2007-2011
2005-2007
individuals
1
Educational services, and health care and social
7,481
34.65
34.8
assistance
2
Manufacturing
3,458
16.02
14.9
3
Retail Trade
2,231
10.34
9.7
4
Construction
1,590
7.37
7.7
5
Arts, entertainment and recreation, and
1,407
6.52
6.6
accommodation and food services
6
Other services, except public administration
949
4.40
4.3
7
Public Administration
919
4.26
3.6
8
Transportation and warehousing, and utilities
865
4.01
4.0
9
Professional, scientific, and health care and social
851
3.94
4.9
assistance
10
Agriculture, forestry, fishing and hunting, and
743
3.44
3.7
mining
11
Finance and insurance, and real estate and rental
465
2.16
2.2
and leasing
12
Wholesale trade
318
1.48
2.0
12
Information
318
1.48
1.6
12
TOTAL
21,595
100
100
According to the 1990 U.S. Census, Allegany County’s labor force population (individuals >
age 16) was 38,889. The 2000 US Census shows a slight increase to 39,335. The 2005-2007
census estimates show an increase to 40, 751. In the 2005-2007 census estimates, 25,102
(50.5%) represented the civilian labor force, of which 22,485 were employed. By worker class,
73.8% were private wage and salary workers, 18.4% were local, state, or federal government
workers, and 7.5% were self-employed. By occupational category, most employees worked in
professional specialty occupations, administrative support occupations, service occupations, or
sales and office occupations. By specific industrial category, educational, health and social
service workers comprised the largest group, followed by those manufacturing durable goods,
retail trade, construction, and arts, entertainment, recreation, accommodation and food services.
The county has few industrial employers of any size.
Allegany County Business
Dresser Rand Co.
Otis Easter, Inc
Allegany County
Alfred State College
Alfred University
Alstrom Power, Inc
Allegany ARC
Jones Memorial Hospital
Swain Ski and Snowboard Center
Houghton College
Friendship Dairies
Cuba Memorial Hospital
Empire Cheese
L.C. Whiford Co, Inc.
Location
Wellsville, NY
Wellsville, NY
Belmont, NY
Alfred, NY
Alfred, NY
Wellsville, NY
Wellsville, NY
Wellsville, NY
Swain, NY
Houghton, NY
Friendship, NY
Cuba, NY
Cuba, NY
Wellsville, NY
Product type
Steam Turbines, Generators
Pipe line Construction
Government
Education
Education
Air Heaters/Oxidizers
Services for Developmentally disabled
Medical Services
Ski Resort
Education
Dairy products
Medical Services
Cheese products
Construction
Number of employees
700
50 (NY) & 645 (NY & PA)
540
537
518
500
383
348
340 (winter)
300
265
222
220
200
According to the United States Bureau of Labor, the June 2013 unemployment rate (not seasonal
adjusted) for Allegany County was 7.8%, New York State’s rate was 7.6% and the national rate
was 7.8%. This is down from the June 2009 unemployment rate for Allegany County of 9.7%,
(New York State’s rate was 8.6% and the national rate was 9.5%). The 2005-2007 estimates for
the US Census shows an unemployment rate of 6.4% for Allegany County. The NYSDOH
County Health Indicator Profile (2004-2006) showed an unemployment rate of 5.7% for
Allegany County, while the state rate (excluding New York City) was 4.6%. Allegany County
consistently has unemployment rates higher than the state.
Health insurance status and Access to a regular source of care
The New York State (NYS) socio-economic status and general health indicators for Allegany
County for 2008-2010 show 93.8% of children ages less than 19 with health insurance in 2010
compared to NYS with 94.9 %. The same data set showed adults, ages 18-64 years with health
insurance in 2010 was 85.3% in comparison to NYS with 83.1 percent. This data also showed an
age-adjusted 13.3% of adults in Allegany County, 13.8 % in NYS and 12% in NYS excluding
13
New York City (NYC), who did not receive medical care because of the cost in 2008-2009. The
NYS data also showed age-adjusted 83.6% of adults with a regular health care provider in 20082009 in Allegany County, in NYS 83% and in NYS excluding NYC 87.1%. For the 3 year
period 2008-2010 the total emergency department visit rate per 10,000 for Allegany County was
3,660.2, NYS 3821.2 and NYS excluding NYC 3,544.4. In comparison the age adjusted total
emergency department visit rate per 10,000 was 3,716.4 for Allegany County, 3,8121.2 for NYS,
and 3,556.7 for NYS excluding NYC. The total hospitalization rate per 10,000 for Allegany
County was 1,196.1, for NYS 1,290.5 and NYS excluding NYC 1,223.2. Age adjusted total
hospitalization rates per 10,000 were 1,155.2 for Allegany County, 1,242.5 for NYS, and 1,167.6
for NYS excluding NYC.
In Allegany County the ratio of 18 physicians to population is physicians to 48,949 residents in
2010, 2,719.4 residents to each physician. In Allegany County the ratio of dentists to population
is 11 dentists to 48,949 residents in 2010, 4449.9 residents to each dentist.
New York State Expanded Behavioral Risk Factor Surveillance System in 2008-2009 reported
for Allegany County the:
 Age adjusted percentage of adults who did not receive medical care because of the cost in
2008-2009 was 13.3 compared to NYS at 13.8 and NYS excluding NYC at 12.
 Age adjusted percentage of adults with regular health care provider in 2008-2009 was
83.6, NYS 83 and NYS excluding NYC was 87.1
Vital Records NYSDOH Bureau of Biometrics and Health Statistics reports for Allegany County
in 2008-2010 the
 Age adjusted total emergency department visit rate per 10,000 is 3,716.4 compared to
NYS 3,819.5 and NYS excluding NYC is 3,556.7
 Age adjusted total hospitalization rate per 10,000 is 1,155.2 compared to NYS 1,242.5
and NYS excluding NYC is 1,167.6.
Immigrant/migrant status
According to the U.S. 2010 Census for Allegany County, 670 individuals or 1.4% reported they
were Hispanic or Latino. Immigrant, migrant residents or seasonal workers may not consistently
complete documents like the U. S. Census. Several agencies working within Allegany County
have reported in increase in the number of year round and seasonal migrant farm workers.
Statistics for either group is unavailable or unstable. Cornell Cooperative Extension of Allegany
and Cattaraugus Counties reported 12-15 year round immigrant employees on four farms in
Allegany County in the townships of Rushford, Angelica, Scio and Wellsville. They do not know
of any migrant, seasonal employees working in Allegany County for agricultural production.
Other Relevant Characteristics and Demographic Data
According to New York State Vital Statistics Data from 2009-2011, there were an average 264
marriages in Allegany County, which outweighed the 2009-2011 average of 166.67 for divorces.
Data collected for 2007, 2008, 2010, and 2011 by the FBI as part of the Uniform Crime
14
Reporting Program illustrates offenses reported to and arrests made by State and Local law
enforcement that report data to the FBI. These data do not include Federal law enforcement
activity. Data indicates that in 2011 69% of the reported crimes committed were larceny – thefts,
while 21% were burglaries and 5.26% were aggravated assaults.
Crime
Total
Murder
Rape
Robbery
Aggravated Assault
Burglary
Larceny-Theft
Motor vehicle thefts
2007
707
1
10
2
73
195
410
16
2008
649
0
10
4
77
174
366
18
2010
841
0
11
6
72
161
577
14
2011
895
0
13
4
47
190
621
20
According to 2012 Kid’s Well-Being Indicators Clearinghouse (KWIC) data, the rate of Persons
in Need of Supervision (PINS) cases opened in Allegany County was 10.2 per 1,000 7-17 year
olds compared to the base year of 2005 rate, 16.8 per 1,000.
According to New York State Department of Health Community Health Indicator Profile Data
for 2008-2010, the overall adolescent pregnancy rate for Allegany County is 17.5 per 1,000
females age 15-17 (in 2004-2006 the adolescent pregnancy rate for Allegany County was 24.8
per 1,000 females age 15-19, and the Western New York regional rate is 49.9) compared to 31.1
for New York State. Our adolescent pregnancy rates continue to be lower than New York State
and the Western New York region, as they have been for more than eleven years.
Total Births for the 29 townships and 11 villages in Allegany County using 2002-2011 New
York State Vital Statistics Live Births by Minor Civil Division Table 55 are in the table below.
The townships with the highest live birth averages are Wellsville, Cuba, Hume, Friendship, and
Bolivar. The Villages with the highest live birth averages are Wellsville, Cuba and Andover.
15
29 Townships
Total live births from
2002-2011
10 year
average
11 Villages
Total live births
from 2002-2011
10 year
average
Alfred
160
16
Alfred
50
5
Allen
41
4.1
Almond
49
4.9
Alma
97
9.7
Belmont
118
11.8
Almond
181
18.1
Andover
136
13.6
Amity
275
27.5
Angelica
114
11.4
Andover
250
25
Bolivar
150
15
Angelica
159
15.9
Richburg
36
3.6
Belfast
228
22.8
Canaseraga
59
5.9
Birdsall
25
2.5
Cuba
241
24.1
Bolivar
288
28.8
Wellsville
614
61.4
Burns
116
11.6
Richburg
52
5.2
Caneadea
187
18.7
Centerville
128
12.8
Clarksville
122
12.2
Cuba
348
34.8
Friendship
294
29.4
Genesee
176
17.6
Granger
45
4.5
Grove
40
4
Hume
298
29.8
Independence
154
15.4
New Hudson
106
10.6
Oil Springs
2
0.2
Rushford
120
12
Scio
186
18.6
Ward
33
3.3
Wellsville
896
89.6
West Almond
21
2.1
Willing
118
11.8
Wirt
128
12.8
Allegany County is an extremely poor county that is extremely rural. The county has a large
geographic area, but public transportation is limited, which can make it difficult to access
services. The county is one and a half to two and a half hours from a large, metropolitan area.
We have a high unemployment, high percentage of students eligible for free/reduced lunch and
high Medicaid/Family Health Plus/Self-pay delivery rate compared to the rest of the state. All of
these factors contribute to the poor health of Allegany County, and public health services are an
important part of the health of the county.
16
b. Health status of the population served
Information about the health status of the residents of Allegany County begins with a section
entitled Improve Health Status and Reduce Health Disparities. Other sections are organized
using the five prevention agenda priorities for 2013-2017: Prevent Chronic Diseases; Promote a
Healthy and Safe environment; Promote Healthy Women, Infants, and Children; Promote Mental
Health and Prevent Substance Abuse; and Prevent HIV, STDs, Vaccine Preventable Diseases
and Healthcare Associated Infections. The topics included in the five prevention agenda
priorities for 2013-2017 were included in the community assessment survey. See the attached
copy of the survey and the summary of the survey results. Also see the summary of the focus
group discussions in the attached document.
Improve health status and reduce health disparities
The health indicators for health status and disparities are shown in the table below. Allegany
County is not very racially diverse and premature death ratios showing black non-Hispanic and
white non-Hispanic are unstable. The disparities indicators for Allegany County are less than, in
line with or slightly above the New York State (NYS) rates.
Improve Health Status and Reduce Health
Disparities Indicators
Data
years
Allegany
County
New York
State
NYS 2017
Objective
% premature death (before age 65) 2008-2010
2008-10
19
24.2
21.8
Premature Death ratio black non-Hispanics to
white non-Hispanics
Premature Death ratio of Hispanics to white
non-Hispanics
Age adjusted preventable hospitalizations rate
per 10,000 ages 18+
ratio black non-Hispanics to white nonHispanics
ratio of Hispanics to White non-Hispanics
2008-10
Unstable*
2.12
1.87
2008-10
Unstable*
2.14
1.86
2008-10
151.6
155
133.3
2008-10
0.86
2.09
1.85
2008-10
0.1
1.5
1.38
2010
85.3
83
100
2008-09
83.6
83
90.8
% Adults with health insurance ages 18-64
Age adjusted % of adults who have a regular
health care provider, ages 18+
*Fewer than 10 events in one or both rate numerators, therefore the ratio is unstable
Promote a Healthy and Safe environment
The table below includes the indicators for a healthy and safe environment including fall injuries,
assault, occupational injuries and illness attributed to exposures at work, fluoridation of public
water supplies, access to grocery stores and transportation. To note fall hospitalization rate per
10,000 for children less than 10 years of age and 10-14 years were both higher than the NYS
17
excluding NYC rate, in the 4th quartile and statistically significant. The percentage of
commuters who use alternate modes of transportation is very low compared to NYS. This low
number may be attributed to the limited access to public transportation and lack of knowledge
and confidence in the new bus system. The percentage of residents served by community water
systems with optimally fluoridated water is very low compared to NYS. Fluoridation of the
community water supplies in Allegany County is in most cases not cost effective when
comparing the cost of the equipment and supplies with the number of residents using the water
supply. Allegany County has two public water supplies with fluoridation and about 50% of the
total county residents have private water sources.
In comparison to the data from 2006-2008 the rate of hospitalizations due to falls per 10,000
shows:
 Ages 65+ in 2008-2010 is 187.8 for AC and in 2006-2008 for ages 65-74 was 64.7, ages
75-84 was 253.6, and ages 85+ was 542.6. In AC, great strides have been made with fall
prevention in the elderly and was chosen a priority in the last CHA.
 Ages less than 10 years in 2008-2010 is 31.7 for AC and in 2006-2008 was 11.7 (unstable
number due to fewer than 20 events in the numerator)
 Ages 10-14 years in 2008-2010 is 31.3 and in 2006-2008 was 15.2 (unstable number due
to fewer than 20 events in the numerator)
Promote a Healthy
and Safe Environment
Indicators
Rate of hospitalizations due to falls per 10,000ages 65+ years
Rate of ED visits due to falls per 10,000-ages 14 years
Fall hospitalization rate per 10,000-less than 10
years
Data years
Alleg.
Co.
NYS
NYS
ex
NYC
Quartile
2008-10
187.8
204.6
2008-10
519.6
476.8
2008-10
31.7
26.2
22
4
Fall hospitalization rate per 10,000-10-14 years
2008-10
31.3
21.1
19.3
4
Assault-related hospitalization rate per 10,000
2008-10
1.1
4.8
Rate of occupational injures treated in ED per
10,000 adolescents-ages 15-19 years
2008-10
40.2
36.7
Work related hospitalizations per 100,000
employed persons ages 16 years and older
Elevated Blood Lead Levels per 100,000
employed persons ages 16 years and older
2008-10
278.4
168.4
210.9
2008-10
60.5
23.2
24
Hospitalization rate per 100,000 persons ages 15
years and older-Pneumoconiosis
Hospitalization rate per 100,000 persons ages 15
years and older-Asbestosis
2008-10
71.1
24.5
32.8
2008-10
57.5
22.2
36
% of commuters who use alternate modes of
transportation
2007-11
27.6
44.6
% of population with low-income and low
access to a supermarket or large grocery store
2010
2.9
2.5
Yes or No
Statistical
Significance
th
Yes-NYS excl
NYC
th
Yes-NYS excl
NYC
18
% of residents served by community water
systems with optimally fluoridated water
2012
22.5
71.4
Prevent Chronic Diseases
The following table gives the prevention of chronic diseases indicators for Allegany County
(AC) in comparison to New York State (NYS) and NYS excluding New York City (NYC); the
ranking quartile with the rest of New York State; and yes or no was it statistically significant in
comparison to NYS and NYS excluding NYC. The Age adjusted percentage of adults who were
obese (BMI of 30 or higher) was in the 4th quartile and statistically significant compared to NYS
(2008-2009 NYS Expanded Behavioral Risk Factor Surveillance System). The age-adjusted
percentage of adults who smoke cigarettes; The age-adjusted percentage of adults living in
homes where smoking is prohibited; and the age adjusted percentage of adults eating 5 or more
fruits or vegetables per day (2008-2009 NYS Expanded Behavioral Risk Factor Surveillance
System) were all in the 4th quartile and statistically significant compared to NYS and NYS
excluding NYC.
Prevention Chronic Diseases
Indicators
Data
years
Allegany
County
NYS
NYS
(ex
NYC)
Quartile Yes or No
Statistical
Significance
% of adults who are obese
Age adjusted % of adults obese (BMI 30
or higher)
% of children and adolescents who are
obese
% of cigarette smoking among adults
Age-Adjusted % of adults who smoke
cigarettes
Age-Adjusted % of adults living in
homes where smoking is prohibited
Age adjusted % of adults eating 5 or
more fruits or vegetables per day
% of children in WIC viewing TV 2
hours or less per day (ages 0-4 years)
2008-09
2008-09
29.9
30.5
23.2
23.1
2010-12
14.7
17.6
2008-09
2008-09
24.6
25.5
16.8
17
18.9
4
2008-09
71.2
80.9
79.3
4
th
24.3
4
th
th
2008-09
21.2
27.1
27.7
4th
2008-10
83.3
78.6
80.7
3
rd
Yes-NYS
Yes-NYS & NYS
excluding NYC
Yes-NYS & NYS
excluding NYC
Yes- NYS
excluding NYC
Yes-NYS
Incidence (morbidity) rates for 2008-2010 for pneumonia, chronic lower respiratory disease, and
asthma are AC in comparison to NYS and NYS excluding NYC are shown in the chart below.
The pneumonia hospitalizations per 10,000 for ages 0-4 years were in the 4th quartile and
statistically significant for AC compared to NYS and NYS excluding NYC. AC is 83.7, NYS is
44.6 and NYS excluding NYC is 37.5. The Chronic Lower Respiratory Disease CLRD)
hospitalization rate per 10,000-age adjusted is in the 3rd quartile and statically significant compared to
NYS excluding NYC, AC is 38.4, NYS is 37.5 and NYS excluding NYC is 31.7.
19
Incidence/Morbidity
Pneumonia, Chronic Lower
Respiratory Disease, Asthma
Pneumonia hospitalization rate per 10,000ages 0-4 years
Chronic Lower Respiratory Disease
Hospitalization rate per 10,000-age
adjusted
Asthma ED visit rate per 10,000
Data years
Allegany
County
NYS
Quartile
44.6
NYS
ex
NYC
37.5
2008-10
83.7
2008-10
38.4
37.5
31.7
3
2008-10
31.7
83.7
Asthma ED visit rate per 10,000-ages 0-4
years
Adults told by a healthcare provider they
have Asthma from BRFSS expanded
county data
ER visit rate due to Adult Asthma in all
ages from NYSDOH
Hospitalization rate due to Adult Asthma
per 10,000 in ages 18-64 from NYSDOH
Hospitalization rate due to Asthma per
10,000 from NYSDOH
Asthma hospitalization rate per 10,000ages 0-4 years
Rate of hospitalizations for short-term
complications of diabetes per 10,000ages 6-17 years
complications of diabetes per 10,000ages 18+ years
Department of Health and Human Services
CDC National Diabetes surveillance
system % adult population estimate
NYSDOH vital statistics Age Adjusted
death rate per 100,000,
BRFSS percentage age 18+ reported they
have diabetes
% Medicare enrollees receiving HbA1c
test (County Health Rankings)
2008-10
58.3
221.4
2008-09
16.1
15.2
2007-09
36.4
83.7
2007-09
7.6
14.8
2007-09
11.6
20.3
12.4
2008-10
29.2
58.8
36.1
2008-10
13.7
20.9
11.2
2008-10
15.6
29
16.1
2008-10
3.3
unstable
3.2
2008-10
5.6
5.6
2009
9.5%
8.9
2010
10.6
16.2
2004-10
12.4%
8.2
2003-06
85.9%
79.6
4
th
rh
Yes or No
Statistical
Significance
Yes-NYS & NYS
excluding NYC
Yes-NYS excluding
NYC
Incidence (morbidity) rates for 2008-2010 for diabetes are AC in comparison to NYS and NYS
excluding NYC are shown in the chart below. AC age adjusted diabetes hospitalization rate per
10,000 with diabetes as the primary diagnosis for the years 2008-2010 was 16.9. This is the 4th
quartile in comparison to NYS excluding NYC which is 14.3 and below the NYS rate of 19. AC
20
age adjusted diabetes hospitalization rate per 10,000 with any diagnosis for the years 2008-2010
was 228.2. This is in the 3rd quartile compared to NYS excluding NYC which is 198.2 and
above the NYS rate of 226.1.
In comparison to past indicators:
 Diabetes hospitalization rate per 10,000 (primary diagnosis)-age adj. in 2008-2010 is 16.9

and was 15.2 in 2004-06
Diabetes hospitalization rate per 10,000 (any diagnosis)-age adj. in 2008-2010 is 228.2 and
was 217.1 in 2004-06
Incidence/Morbidity
Diabetes
Data years
Allegany
County
NYS
NYS
ex
NYC
Quartile
2008-10
complications of diabetes per 10,000ages 6-17 years
2008-10
complications of diabetes per 10,000ages 18+ years
Department of Health and Human
2009
Services CDC National Diabetes
surveillance system % adult population
estimate
NYSDOH vital statistics Age Adjusted
2010
death rate per 100,000,
BRFSS percentage age 18+ reported they
2004-10
have diabetes
% Medicare enrollees receiving HbA1c
2003-06
test (County Health Rankings)
Diabetes hospitalization rate per 10,000 2008-10
(primary diagnosis)-age adj.
Diabetes hospitalization rate per 10,000 2008-10
(any diagnosis)-age adj.
3.3
unstable
3.2
5.6
5.6
9.5%
8.9%
10.6
16.2
12.4%
8.2%
85.9%
79.6
%
16.9
19
14.3
4
228.2
226.1
198.
2
3
Yes or No Statistical
Significance
th
Yes NYS excluding
NYC
rd
Yes NYS excluding
NYC
Incidence (morbidity) rates for 2008-2010 for cardiovascular disease, disease of the heart, and
coronary heart disease hospitalizations are in the 4th quartile and statistically significant when
comparing AC to NYS and NYS excluding NYC are shown in the chart below. Congestive heart
failure mortality, congestive heart failure and stroke pre transport mortality are in the 4th quartile
and statistically significant when comparing AC to NYS and NYS excluding NYC.
21
Incidence/Morbidity
Stroke, Heart Disease
Data years
Allegany
County
NYS
NYS ex
NYC
Quartile
Age adjusted heart attack
hospitalization rate per 10,000
Cardiovascular disease
hospitalization rate per 10,000age adjusted
Disease of the heart
hospitalization rate per 10,000 –
age adjusted
Heart Disease deaths per 100,000
from NVS
Coronary Heart Disease mortality
rate per 100,000- age adjusted
Coronary Heart Disease
hospitalization rate per 10,000age adjusted
Age Adjusted death rate per
100,000 from Coronary Heart
Disease from HIW
Coronary Health Disease Deaths
per 100,000 from NVS
Congestive heart failure mortality
rate per 100,000, crude
rate per 100,000, age adjusted
rate per 100,000- pre-transport
mortality
Congestive heart failure
hospitalization rate per 10,000 –
age adjusted
Stroke mortality rate per 100,000age adjusted
Stroke mortality rate per 100,000pre-transport mortality
Stroke Deaths per 100,000 from
NVS
Age Adjusted death rate per 100,000
from Cerebrovascular (stroke) from
Health Indicators Warehouse
2010
25.1
15.5
2008-10
173.4
165.6
157.5
4 , Y, Y
2008-10
129.7
113.3
109.2
2003-09
221.9
234.1
2008-10
148.3
169.4
2008-10
57.7
46.9
2008
149.5
193.4
2003-09
158
182.5
2008-10
28.4
2008-10
Yes or No Statistical
Significance
th
Yes-NYS & NYS
excluding NYC
4 , Y, Y
th
Yes-NYS & NYS
excluding NYC
145.1
3rd, Y, N
Yes-NYS
43.7
4 , Y, Y
13.3
19.8
4 , Y, Y
22.4
11.3
15.5
4 Y, N
2008-10
18.3
7.2
10.9
4 , Y, Y
2008-10
29.9
28.9
26.9
4 ,N, Y
2008-10
37.4
26.7
31.9
3 ,Y, N
2008-10
27.1
10.9
16.5
4 ,Y, Y
2003-09
41.1
30.1
2008
35
31.5
th
Yes-NYS & NYS
excluding NYC
th
Yes-NYS & NYS
excluding NYC
th
Yes-NYS
th
Yes-NYS & NYS
excluding NYC
th
Yes-NYS excluding
NYC
rd
Yes-NYS
th
Yes-NYS & NYS
excluding NYC
22
According to the NYS Vital Statistics for 2007-2009, the following are incidence rates (per
100,000 population and age adjusted incidence) for AC and NYS respectively. The data
illustrates that our lung and female breast cancer incidence rates are slightly higher than the state
rate and slightly below the NYS excluding NYC rate. Our female breast, colorectal and cervical
(although cervical is unstable due to low number of events) rates are elevated in comparison to
NYS and NYS excluding NYC. The colorectal and cervical rates may be attributed to the
increased activity of our Cancer Services Program of Allegany and Cattaraugus Counties; more
people are being screened now because of the education and screenings provided by this
program. AC’s melanoma Cancer incidence rates are above the NYS rate. Our overall cancer
incidence rate is in line with the NYS rate and below the NYS excluding NYC rate.
Cancer
incidence
Allegany County age
adjusted rate per
100,000
69.9
132.0
13.7*
54.5
15.6
New York State age
adjusted rate per
100,000
63.8
126.9
8.3
45.8
10.4
NYS excluding NYC
age adjusted rate per
100,000
72.2
136.1
7.4
46.2
10.8
Lung
Female Breast
Cervical
Colorectal
Lip, Oral,
Pharynx
Ovarian
12.8
12.9
Prostate
135.9
166.9
Melanoma
20.0
17.0
All Cancers
489.1
489.6
*Fewer than 10 events in the numerator, therefor the rate is unstable
13.5
171.3
520.0
Mortality
According to 2010 and 2011 New York State Vital Statistics, the leading causes of death in
Allegany County, and New York State, by rank and total number of deaths are in the below
chart. Heart disease was the leading cause of death in 2010 and 2011 for Allegany County and
New York State. Cancer is number two for both AC and NYS in 2010 and 2011. Stroke rates
are decreasing from 2010 to 2011 in AC and Chronic Lower Respiratory Disease (CLRD) rates
are increasing.
23
Select Causes
of Death
Allegany
County
2010
New
York
State
2010
Allegany
County
2011
New
York
State
2011
Rank for
AC for
# of deaths
in 2008-10
Cause of
premature death
in Allegany
County (number
of deaths)
Allegany
County deaths
2008-10
Premature
Death Rate
100,000
Heart Disease
Cancer
Stroke
Pneumonia
Chronic Lower
Respiratory D.
Total Accidents
Diabetes
Liver Disease
Suicide
235
190
51.1
34.7
67.4
229.9
181.1
31.6
23.6
35
272.7
217.3
32.8
45.1
75.9
225.9
180
31.6
24.7
35.5
1
2
160
107
448
229
4
33
60
49
14.3
14.3
4.1
24.4
18.6
7.3
7.8
43.1
36.9
8.2
10.3
27
20.1
7.6
8.3
3
5
5
5
34
15
15
15
78
44
34
34
The data illustrates that our lung cancer morbidity rate is slightly higher than the state rate and
below the NYS excluding NYC rate. Our female breast mortality rate is slightly elevated in
comparison to NYS and NYS excluding NYC. The Lip, Oral, Pharynx rates for Allegany County
are higher than the NYS and NYS excluding NYC rates.
Cancer
mortality
Allegany County age
adjusted rate per
100,000
44.0
23.9
2.4*
15.5
15.6
New York State age
adjusted rate per
100,000
42.8
21.7
2.3
15.7
10.4
NYS excluding NYC
age adjusted rate per
100,000
49.0
22.2
1.9
15.7
10.8
Lung
Female Breast
Cervical
Colorectal
Lip, Oral,
Pharynx
Ovarian
11.6
7.8
Prostate
17.8
21.6
Melanoma
1.3*
2.1
All cancers
175.9
163.0
*Fewer than 10 events in the numerator, therefor the rate is unstable
8.5
20.8
2.7
173.9
Chronic lower respiratory disease (CLRD) age adjusted mortality rate per 100,000 is in the 3rd
quartile and statistically significant compared to the NYS rate and the NYS excluding NYC rate.
Death rates due to pneumonia in 2010 and 2011 are slightly higher than the state rate.
24
Mortality
Pneumonia, Chronic Lower
Respiratory Disease
Age Adjusted death rate due
to Pneumonia per 100,000
from NYS vital statistics
Age Adjusted death rate due
to Pneumonia per 100,000
from NYS vital statistics
Chronic Lower Respiratory
Disease mortality rate per
100,000-age adjusted
Data
years
Allegany
County
NYS
2010
26
19.8
2011
34.9
20.3
2008-10
52.1
31.1
NYS ex Quartile
NYC
38.5
3
rd
Yes or No
Statistical
Significance
Yes-NYS &
NYS
excluding
NYC
For 2011, the Vital Statistics also revealed the following mortality data, by age group, for
Allegany County and the ranking for these deaths by age group for Allegany County and New
York State provided the following results:
Number of Deaths in 2011
189
125
67
53
20
14
10
3
2
2
Allegany County
85+
75-84
65-74
55-64
45-54
35-44
25-34
0-9
20-24
10-19
New York State
85+
75-84
65-74
55-64
45-54
35-44
25-34
0-9
20-24
10-19
The leading age group for death in Allegany County in 2007 was the same as 2011and the same
as NYS, age 85+. The rank order for Allegany County and New York State remains the same as
in 2007 and 2000. The ranking for deaths by age group for Allegany County was the same order
as New York State for the year 2007. This was not true in 2000, Allegany County’s top group
was 75-84 year olds and 0-9 year olds were 7th, 10-19 year olds were 8th, and 25-34 year olds
were last.
According to the New York State 2011 Vital Statistics compared to the 2007 NYS Vital
Statistics, the first and second leading causes of death for Caucasians in each age group in New
York State are as follows:
25
Age
Group
<1
Number 2 Cause
of Death 2011
Congenital
Anomalies
10-19
Number 1 Cause of
Death 2011
Conditions
Originating in the
Perinatal Period
Malignant
Neoplasms
Accidents
20-24
25-44
Accidents
Accidents
45-64
Malignant
Neoplasms
Diseases of the
Heart
Suicide
Malignant
Neoplasms
Diseases of the
Heart
Malignant
Neoplasms
1-9
65+
Accidents
Suicide
Number 1 Cause
of Death 2007
Conditions
Originating in the
Perinatal Period
Malignant
Neoplasms
Accidents
Accidents
Accidents
Malignant
Neoplasms
Diseases of the
Heart
Number 2 Cause
of Death 2007
Congenital
Anomalies
Accidents
Malignant
Neoplasms
Suicide
Malignant
Neoplasms
Diseases of the
Heart
Malignant
Neoplasms
Prevent HIV, STDs, Vaccine Preventable Diseases and Healthcare Associated Infections
The health indicators for this prevention agenda category are listed in the chart below. The
Allegany County pertussis incidence per 100,000 for the years 2008-2010 was in the 4th quartile
and statistically significant in comparison to New York State. Allegany County’s rate was 8.1
more than double the New York State rate at 3.0. The Allegany County pneumonia/flu
hospitalization rate (ages 65 years +) per 10,000 was 179.3, in the 3rd quartile and statistically
significant compared to NYS at 127.9 and NYS excluding NYC at 140.1.
According to the New York State Department of Health statistics for 2008-2010, most of the
communicable disease incidence (morbidity) rates per 100,000 population for Allegany County
are either non-existent, less than, or consistent with New York State (NYS) and NYS excluding
New York City (NYC). This is consistent with the last assessment from 2010-2013.
26
Vaccine Preventable Diseases
Data
and Healthcare-Associated
years
Infections Indicators
% of children with
2011
4:3:1:3:3:1:4 immunization
series-ages 19-35 months
Pertussis incidence per 100,000 2008-10
% of adolescent females with
3-dose HPV immunization –
ages 13-17 years
Age-adjusted % of adults with
flu immunization-ages 65+
years
Pneumonia/flu hospitalization
rate (ages 65 years +) per
10,000
H. influenza incidence per
100,000
Hepatitis A incidence per
100,00
Hepatitis B Acute incidence
per 100,000
Tuberculosis incidence per
100,000
E.Coli 0157 incidence per
100,000
Salmonella incidence per
100,000
Shigella incidence per 100,000
Allegany
County
NYS
NYS
ex
NYC
Quartile
4.3
4
3
60.4
47.6
8.1
3.0
2011
25.2
26
2008-09
70.7
75
2008-10
179.3
127.9
140.1
20082010
20082010
20082010
20082010
20082010
20082010
2008-10
0.7*
1.3
1.5
0.0*
0.8
0.5
0.0*
0.8
0.6
1.4*
5.4
2.4
2.0*
0.6
0.8
6.8
13.9
12.9
0.0*
4.4
3.2
th
rd
Yes or No
Statistical
Significance
Yes-NYS
Yes-NYS
and NYS
excl. NYC
Lyme disease incidence per
20089.5
42.4
66.2
100,000
2010
% of adults 65 years and older 200870.7
75.0
76.0
with flu shot in last year
2010
% of adults 65 years and older 200863.0
64.0
71.2
who ever received pneumonia
2010
shot
Mumps incidence per 100,000 2008-10 0.0*
5.5
4.0
Meningococcal incidence per
200863.0
64.7
71.2
100,000
2010
*Fewer than 10 events in the numerator, therefore the rate is unstable
27
Our AIDS case rate, per 100,000 population, for 2008-2010 is 2.7* and the New York State rate
is 17.6, and NYS excluding New York City is 5.6, according to the Bureau of HIV/AIDS
Epidemiology data. Incidence rates for Allegany County for HIV, syphilis, gonorrhea, and
chlamydia are so low they are unstable or below the NYS and NYS excluding NYC rates.
Prevent HIV/STDS
Indicators
Data
years
Allegany
County
NYS
NYS
ex
NYC
7.4
5.6
1.6
Quartile
Yes or No
Statistical
Significance
HIV case rate per 100,000
2008-10 2.0*
21.4
AIDS case rate per 100,000
2008-10 2.7*
17.6
AIDS age adjusted mortality
2008-10 0.0*
5.3
rate per 100,000
Primary and secondary syphilis 2010
0
11.2
case rate per 100,000 males
unstable
Primary and secondary syphilis 2010
0
0.5
case rate per 100,000 females
unstable
Syphilis Early
2008-10
1.4*
12.8
2.5
Gonorrhea case rate per
2008-10 5.4*
89.7
55.7
100,000 for all ages
2008-10 25.5*
335.5
210.3
100,000 for ages 15-19
2010
10.5
203.4
100,000 women – ages 15-44
unstable
years
2010
9.8
221.7
100,000 men – ages 15-44
unstable
years
Chlamydia case rate per
2008-10 65.8
305.1
178.9
100,000 males of all ages
2008-10 197.9
644.6
426.2
100,000 females of all ages
2010
523.8
1,619.8
100,000 women – ages 15-44
years
PID hospitalization rates per
2008-10
1.7*
3.7
10,000 females ages 15-44
*Fewer than 10 events in the numerator, therefore the rate is unstable
28
Promote Healthy Women, Infants, and Children
According to 2008-2010 New York State Vital Statistics, the pregnancies for Allegany County
females age 15-44 for 3 years total was 1,837, while there were 1,534 births. A cumulative rate
of pregnancies per 1,000 females age 15-44 for 2008-2010 for Allegany County is 61.0 while the
New York rate is 93.6. The cumulative birth rate per 1,000 females age 15-44 for Allegany
County from 2008-2010 is 50.9 while the New York birth rate is 60.9.
According to the New York State Department of Health in 2011, Allegany County’s
Medicaid/Family Health Plus/Self-Pay Labor and Delivery rate continues to increase, 57.42%
and continues to be higher than the NYS rate of 50.21%. In 2007 Community Health Data Set,
our Medicaid and Self-pay Delivery rate was 46.7% while the NYS excluding NYC percent is
33.8.
The indicators for the prevention agenda item Promote Healthy Women, Infants and Children
shows Allegany County is above NYS in the percentage of infants exclusively breastfed in the
hospital in 2008-2010. The percentage of children ages with the recommended number of well
child visits in government sponsored insurance programs is below the NYS percentage, as is the
percentage for each of the year categories (1-15 months, 3-6 years, 12-21 years). This shows the
lack of prevention knowledge, attitude and behavior of the parents to take their children to
regular physical appointments. Access to physician may also play a role in these numbers being
below the state percentages.
29
Promote Healthy Women, Infants, and Children
Indicators
Data
years
Alleg.
Co.
NYS
NYS
2017
Obj.
% of preterm births
2008-10
11.8
12
10.2
% of preterm births ratio of Medicaid births to nonMedicaid births
% of infants exclusively breastfed in the hospital
2008-10
1.18
1.10
1.00
2008-10
64.7
42.5
48.1
ratio of Black non-Hispanics to White nonHispanics
ratio of Hispanics to white non-Hispanics
ratio of Medicaid births to non-Medicaid births
2008-10
1.17
.5
(unstable)
.57
2008-10
1.24
.55
.64
2008-10
.72
.57
.66
Maternal mortality rate per 100,000 births
2008-10
Unstable
23.3
21
Medicaid/Family Health Plus/Self-Pay Labor and
Delivery rate continues to increase
% of children with recommended number of well
child visits in government sponsored insurance
programs
% of children ages 0-15 months who have had the
recommended number of well child visits in
government sponsored insurance programs
% of children ages 3-6 years with recommended
number of well child visits in government
sponsored insurance programs
% of children ages 12-21 years with recommended
number of well child visits in government
sponsored insurance programs
% of children with any kind of health insuranceages 0-19 years
2011
57.42
50.21
2011
52.4
69.9
76.9
2011
78.8
82.8
91.3
2011
65.7
82.8
91.3
2011
41.3
61
67.1
2010
93.8
94.9
100
The table below illustrates data on dental health for children and adults. From the 3rd grade study
children in Allegany County have more caries, evidence of untreated tooth decay, dental
sealants, at least one dental visit in the last year and take fluoride tablets than 3 rd graders in NYS
excluding NYC. For adults, the age adjusted percentage who had a dentist visit in the last year
was below the NYS and NYS excluding NYC percentages, ranking in the 4th quartile.
Emergency department visit rate per 10,000 was also in the 4th quartile and statistically
30
significant. These statistics show adults do not have the knowledge, attitudes or behaviors that
model good dental hygiene and preventative care. Parents have made positive changes from the
2002-2004 3rd grade study. A survey of third grade children in 6 schools in the county,
conducted in 2002-2004 and reported by the New York State Department of Health, reported a
rate of 64% of county third graders studied, had caries experience. Of those, 43.7% had
untreated caries. Only 36.3% had received dental sealants. An impressive 77.1% had a dental
visit within the last 12 months, while 63.2% are covered by dental insurance. Additionally,
44.6% of Allegany County third graders received fluoride supplements. Only 14% of the
Allegany County population on public water systems (approximately 50% of the homes are on a
public water supply) receives fluoridated water.
Promote Healthy Women, Infants, and
Children Indicators
Dental
Data
years
Alleg. NYS
Co.
NYS
ex
NYC
Quartile
rd
2009-11
51.7
NA
45.4
3
% of 3 grade children with evidence of
untreated tooth decay
rd
2009-11
25.4
NA
24
3
% of 3 grade children with dental sealants
rd
2009-11
53.6
NA
41.9
3
% of 3 grade children with at least one dental
visit in last year
rd
2009-11
87.8
NA
83.4
4
% of 3 grade children with reported taking
fluoride tablets regularly
Age adjusted % of adults who had a dentist visit
within the past year
Caries emergency department visit rate per
10,000
% Medicaid enrollees with at least one dental
visit within the last year
% Medicaid enrollees with at least one preventive
dental visit within the last year
% Medicaid enrollees (ages 2-20 years) who had
at least one dental visit within the last year
rd
2009-11
63.3
NA
41.9
3
2008-09
63
71.1
72.7
4
2008-10
280.6
65.8
69.9
4
2008-10
26.6
31.3
29.4
3
2008-10
19.9
25.9
23.4
3
2008-10
38
40.8
40.5
3
% of 3 grade children ratio of low –income
children to non-low income children
2009-11
1.2
2.5
% of 3 grade children with caries experience
rd
rd
rd
rd
th
Yes or No
Statistical
Significance
Yes-NYS
excluding NYC
Yes-NYS
excluding NYC
Yes-NYS
excluding NYC
Yes-NYS
excluding NYC
rd
Yes-NYS
excluding NYC
th
Yes-NYS &
NYS excl. NYC
th
Yes-NYS &
NYS excl. NYC
rd
Yes-NYS &
NYS excl. NYC
rd
Yes-NYS &
NYS excl. NYC
rd
Yes-NYS &
NYS excl. NYC
31
The following statistics include adolescent pregnancy rates, pregnancy data and lead screening.
The 2008-2010 adolescent pregnancy rates per 1,000 females ages 15-17 years is almost half the
NYS rate. The 2008-2010 percentage of births to teens ages 15-19 years is over the NYS and
NYS excluding NYC rates, in the 3rd quartile and statistically significant. The percentage of
unintended pregnancy among live births is above the state. The difference in the 15-17 and 1519 age ranges may be attributed to 18 and 19 year olds who were pregnant in 2008-2010. The
percentage of pregnant women in WIC who were pre-pregnancy obese (BMI 30 or higher) is in
the 3rd quartile (above the state). The percentage of births within 24 months of previous
pregnancy for Allegany County is 26.7 and NYS is 18, AC is in the 4th quartile. The percentage
of children born 2008 with a lead screening by 18 months and children born in 2008 with at least
two lead screenings by 36 months are both below the state. Children with at least two lead
screenings by 36 months, is in the 4th quartile. This may be attributed to physicians in Allegany
County completing the lead test by 18 months for the first year and not rescreening the child by
36 months for the second year. Many physicians do not see the large number of children with
extremely high blood lead levels and do not feel it is necessary to retest each child. The ACDOH
has been working with the physicians in Allegany County to have them test children at age one
and age two. Parents also do not feel it is necessary or convenient to take their child to the
laboratory after the doctor’s appointment to have blood drawn. ACDOH is working with
physicians to do lead testing in their offices to overcome this barrier.
32
Promote Healthy Women, Infants, and
Children Indicators (con.)
Data
years
Alleg.
Co.
NYS
NYS
ex
NYC
Quartile
6.8
3
Adolescent pregnancy rate per 1,000
females-ages 15-17 years
% of births to teens ages 15-19 years
2008-10
17.5
31.1
2008-10
9.2
6.6
% of unintended pregnancy among live
births
2011
35.2
26.7
births ratio of Black non-Hispanics to
White non-Hispanics
births ratio of Hispanics to White nonHispanics
births ratio of Medicaid births to nonMedicaid births
% of women with health coverage-ages 1864 yrs
% of live births that occur within 24
months of previous pregnancy
% of births to women 25 years & older
without a high school education
% of pregnant women in WIC who were
pre-pregnancy obese (BMI 30 or higher)
2011
2.19
2.09
(unstable)
2011
2.08
1.58
(unstable)
2011
1.62
1.69
2010
87.4
86.1
2008-10
26.7
18
2008-10
11.5
14.8
10.3
3
2008-10
29.4
23.4
26.7
3
% of WIC mothers breastfeeding at least 6
months
% of births delivered by cesarean section
2008-10
18.5
39.7
28.7
3
2008-10
33
34.4
36.1
3
% of births within 24 months of previous
pregnancy
2008-10
26.7
18
21.1
4
0.2
unstable
56.2
6.8
2.9
4
69.5
65.4
3
28.6
52.9
45.2
4
% children born in 2008 with lead
2008-10
screening by 9 months
% children born 2008 with a lead screening 2008-10
by 18 months
% children born in 2008 with at least two
2008-10
lead screenings by 36 months
Yes or No
Statistical
Significance
rd
Yes-NYS &
NYS exc NYC
rd
Yes-NYS
rd
Yes-NYS
rd
Yes-NYS &
NYS exc NYC
rd
Yes- NYS excl
NYC
th
Yes-NYS &
NYS excl
NYC
Yes-NYS &
NYS exc NYC
th
rd
Yes-NYS &
NYS exc NYC
th
Yes-NYS &
NYS exc NYC
33
Promote Mental Health and Prevent Substance Abuse
Alcohol related motor vehicle injuries and deaths per 100,000 for the 2008-2010 timeframe was
in the 4th quartile for Allegany County, more than two times the NYS percentage. The age
adjusted suicide death rate per 100,000 for AC is above the NYS rate. The numbers for mental
health consumers are below the NYS numbers. This may be attributed to the limited access to
mental health providers, lack of knowledge of the benefits of mental health services and lack of
insurances that pay for mental health services. Mental health outpatient services available in AC
are similar to the rest of NYS. Outpatient services are the primary source of services offered for
adults and children. Support is second for children in AC with no emergency, inpatient, or
residential services for children in AC. Residential is second and support is third for adults in AC
with not emergency or inpatient services.
In comparison to the previous indicators for AC
 Age-adjusted suicide death rate per 100,000 in 2008-10 is 11.5 and in 2006-08 was 15.5
 Alcohol related motor vehicle injuries and deaths per 100,000 in 2008-210 is 76.5 and in
2007-09 was 82.6
Promote Mental Health and
Prevention Substance Abuse
Indicators
Data
years
Alleg. Co.
Age-adjusted % of adults with poor
mental health for 14 or more days
in the last month
Age-Adjusted % adults binge
drinking during the past month
Alcohol related motor vehicle
injuries and deaths per 100,000
Age-adjusted suicide death rate per
100,000
Office of Mental Health-mental
health consumers
health consumers-youth (0-17)
2008-09
8.6
10.2
2008-09
19.4
18.1
2008-10
76.5
36.2
2008-10
11.5
7.1
2005-07
.84% (409)
2005-07
health consumers-adults (18-64)
2005-07
1.08% (124) %
of youth pop
30.3% of total
MHC
.89% (271) % of
adult pop
66.3% of total
MHC
.92%
(178,272)
20.6%
(36,739)
health consumers-adults (65+)
2005-07
.20 (14) % of
older adult pop
3.4% of total
MHC
NYS
NYS Quartile Yes or No
ex
Statistical
NYC
Significance
50.0
th
4
Yes-NYS &
NYS excl NYC
72.4%
(129,052)
7%
(12,413)
34
2. Main health challenges for Allegany County and contributing causes of health challenges
Allegany County has long had the designation as a Health Professional Shortage Area (HPSA)
for Dental, Mental Health and Primary Care. The extreme rural nature and poverty of the county
make it difficult to recruit and retain physicians and other health professionals. This contributes
to an inconsistency in health care as professionals come and go. Allegany County has an
increasingly aged population, as do most areas of the nation, yet there are no geriatric specialists
in Allegany County.
The geographic vastness of the county also makes health care difficult. The county is 1,030
square miles; it takes well over an hour to travel from one end of the county to the other by car.
With a population of 48,949 in 2010 U.S. Census, there are 47.6 people per square mile in the
county. There are several villages that have no physicians or health care facilities and there are
portions of the Northern Central County (Fillmore, Hume) that have a half-hour drive time to an
Emergency facility. Larger villages contain Ambulance Corps and/or Fire Departments that rely
largely on volunteers; the county is covered by a comprehensive 911 Emergency system located
just outside the Village of Belmont in the Town of Amity in the Allegany County Jail and Public
Safety Facility.
The social environment in Allegany County tends to be one of close-knit extended families that
typically stay within close proximity of the county. Residents, especially the elderly, are slow to
change, which makes the frequent change in health professionals, especially specialists, difficult.
Residents typically rely on family and close friends for medical and health care advice. This
stems from a lack of access to providers as well as the inability to afford health care.
Allegany County consistently ranks in the poorest counties in New York State with a
Medicaid/Family Health Plus and Self-Pay delivery rate that is higher than New York State. It is
a one and a half to two hour drive to the nearest Medical Centers and certain types of specialists.
Even if residents could afford the care, many are unable to access it due to the distance and/or
inability to travel, either locally or regionally. Another economic concern is the lack of
providers (especially specialists, such as dentists) that accept Medicaid. Medicaid is traditionally
a cumbersome system that offers substandard reimbursements for physicians.
Several problems in Allegany County impact negatively on the health of county residents by
serving as barriers to timely and affective health care. These barriers are primarily financial,
educational, transportation, and logistical in nature.
Families living at or below standardized poverty levels (11.6% of Allegany County), tend to
neglect or ignore health care because they lack the ability to pay for these services, or because
they do not recognize or understand the seriousness of problems for which they should seek
timely medical care for themselves or family members. In Allegany County, this problem is
compounded by the fact that a majority of dentists and some medical specialists in the county
will not accept Medicaid patients or allow patients to have time-based payment plans. In 2011,
the Medicaid/Family Health Plus and Self-Pay delivery rate in Allegany County (57.42%) was
more than the New York State rate (50.21%). Over half (57.42%) of deliveries were
35
Medicaid/Family Health Plus or Self-Pay. This tells us that almost half of county residents use
Medicaid or have no health insurance and must self-pay. Yet, with limited Medicaid providers,
this becomes a major barrier to access to care.
From a transportation standpoint, many low-income people cannot afford or do not have access
to a vehicle in which they could travel to receive needed medical care. The fact that the county
has a limited public transportation services greatly exacerbates this problem. County logistics
makes this problem even worse. The majority of health care providers and facilities are located
in the villages of Alfred, Cuba, or Wellsville, the three largest communities in the county.
However, a substantial number of residents are located across large sections of the county, and
accessing these areas for medical care can be extremely difficult as a result. An unfortunate
consequence of these factors is that by the time many county residents seek out and access health
care, it is often late in the course of their disease, when outcomes are less favorable and longer,
more costly care may be necessary.
Since more than 96.2% of Allegany County residents are white, English-speaking, there are few
cultural and/or linguistic barriers to health care. The small non-English speaking populations
exist primarily in the college/university areas. The county does have an Amish population, but
there is a physician in the county that they utilize for prenatal visits, deliveries, and pediatric
visits. They also attend immunization clinics at the LHU.
People of diminished means, particularly those living below established poverty levels, or of low
socioeconomic status, are more prone to engage in unhealthful habits such as excessive tobacco
and alcohol use. The county’s increased mortality rates for lung cancer and liver disease is
evidence of this. Their lack of resources also make it difficult for them to purchase and prepare
nutritionally sound meals that help to promote overall health and well-being, as our higher rates
of diabetes mortality and hospitalizations show. Information obtained from the 2009 Expanded
Behavioral Risk Factor Surveillance Surveys (BRFSS) showed that those people also typically
lead sedentary lifestyles in which they participate in little or no beneficial physical activity. As
mentioned previously, they also tend to neglect health care due to their inability to access and
pay for these services. As such, they are impacted to a greater degree than people of greater
economic means from the effects of acute and chronic disease conditions. Another key risk
factor is the choice not to access care for a variety of reasons including the belief that health care
is not important and/or will not affect significant change.
Because the county is so large geographically and public transportation is limited, residents must
travel, sometimes great distances, for services that urban areas take for granted. This fact
contributes to our increased motor vehicle accident and unintentional injury morbidity and
mortality rates. The Department of Motor Vehicles shows the rates per 100,000 populations for
2008-2010 for alcohol-related motor vehicle injuries and deaths are double the state rate
(36.2/100,000) at 76.5/100,000.
36
The above knowledge is important in an area such as Allegany County, which is one of the
poorest counties in the state, generally ranking somewhere in the top three. In 2010, 11.6% of
the county’s families were living below the federal poverty level. This signifies that 5,678
county residents are at high risk to poor health and the diminished quality of life that often
coincides with it.
In Allegany County the main health challenges facing this community are Chronic Disease and
Mental Health.
In the Chronic Disease priority, behavioral risk factors such as not eating 5 or more fruits or
vegetables per day; eating a diet high in fat and calories; and lack of daily physical activity
contribute to the level of obesity of Allegany County residents. The environmental risk factors
also contribute to Obesity, i.e. rural communities are more dangerous to walk or ride a bicycle
along road ways, have less outdoor space that is developed for physical exercise, less access to
gyms, etc. Socioeconomic factors include the cost of healthy foods; the community’s access to
stores with healthier options; lack of income to join a gym for physical exercise. In Allegany
County there is a lack of policy environments such as zoning for walkable communities and
menu labeling in restaurants, although Allegany County does have smoke free parks. In the
community survey, lack of motivation was mention as a reason why they did not exercise more
often. Allegany County does have 12 school districts, with exercise/weight rooms, hallways for
inside walking in winter weather, tennis courts, outdoor basketball courts, tracks and paved areas
for walking/running and some have swimming pools. There is a disconnect between the school
districts and county residents, they do not know how or when to access the facilities in their own
school district. Many communities have parks, playgrounds and a few have walking trails for
community members to access, although usage is low. Obesity is a risk factor for all chronic
diseases including diabetes, heart disease, stroke, and cancers.
In the Mental Health priority, behavioral risk factors include not accessing health care for
physical health, mental, emotional or behavioral health where problems can be identified and
managed. Additionally, Allegany County includes a population that does not have enough
knowledge or positive attitude about preventing/managing mental health problems to access
what assistance is available. Socioeconomic factors include lack of funds or insurance to access
services; high economic stresses including unemployment; difficulty in recruiting and retaining
mental health practitioners; lack of paid time from work to access needed services and lack of
transportation to services offering within Allegany County and in Western New York.
Allegany County is a very poor, rural county with many broad determinants of health including
behavioral risk factors, environmental risk factors, socioeconomic factors, policy environment
and other unique characteristics. All of these factors contribute to the health status of the
residents of this county, as well as the knowledge, attitudes and behaviors of the county residents
in working toward preventing the main health challenges surrounding preventing chronic
diseases and promoting better mental health.
37
3. Assets and Resources in Allegany County
There are 12 public school districts in Allegany County, two private schools, Immaculate
Conception School of Allegany County that educates students Pre-K through 8th grade and
Houghton Academy that educates students 6th through 12th grade, and includes the Cattaraugus
Allegany BOCES center at Belmont and a BOCES administered alternative school in Cuba.
The schools are mandated to provide health education and the health department is a part of that
education, to some degree, in most districts. Allegany County is home to Alfred State College,
Alfred University and Houghton College. The Health Department attends health fairs offered by
worksites, colleges and community agencies.
The Environmental Division of the Health Department addresses the physical environment and
issues that deal with indoor air, food, water and septic/sewer system safety, inspection and
installation. They are the regulatory agency for enforcement of public health laws and
regulations. The county has little or no incidence of food-borne diseases and very infrequent
outbreaks.
The following are media sources used by the Allegany County Department of Health for public
service announcements, clinic schedules, emergency notification to the public and
advertisements. Local media outlets include Wellsville Daily Reporter and Pennysaver;
Spectator Sunday paper from Hornell, NY; WLSV/WJQZ radio; WPIG/WHDL radio;
WMXO/WOEN radio; Time Warner TV community bill board; WZKZ radio; WDNY radio;
Patriot weekly paper; Alfred Sun weekly paper; Hornell Tribune daily paper; Olean Times
Herald daily paper; WKPQ/WHHO radio; Angelia Booster News monthly paper; college
newspapers Tor Echo and Fiat Lux; Pennysaver for Cuba/Franklinville; and WGRZ channel 2
Buffalo; WIVB channel 4 Buffalo and WKBW channel 7 Buffalo.
Health Department
The Allegany County Department of Health has been in operation since the early 1920's, when
home care services, well baby visits, and tuberculosis care were first provided. Since that time,
services were increased and expanded so that by 1975, the department functioned as a full
service health department, providing both public health nursing and environmental health
programs. The health department has approximately 36 people in its employ including
administrative staff, nursing, health educators, public health sanitarians, clerical support, and
grant funded subcontracted staff. A Board of Health that meets on a quarterly basis governs the
Health Department. There are Management level employees that provide oversight of staff and
programs and reports to board of health.
Administration and Management
Five employees of the health department serve in administrative or managerial capacities. This
includes the Public Health Director that holds a Master’s Degree in Public Health and Physical
Education, the Deputy Public Health Director who holds a Master’s Degree in Epidemiology, the
Director of Patient Services who holds a Bachelor’s Degree in Nursing, the Supervising Public
Health Educator who holds a Bachelor’s Degree in Community and School Health Education,
and Accountant who holds a bachelor’s degree in Business Administration with a concentration
in accounting.
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Nursing Services Division
The Nursing Division is comprised of a Director of Nursing, one Public Health Nurse, one
Registered Nurse and a Nurse Practitioner for the Family Planning Program. The Department of
Health also has responsibility for the provision of traditional Community Health Services to the
Allegany County residents. The services provided are inclusive of but certainly not limited to
the prevention of and follow up of communicable disease. We owe many of our successes in the
prevention of and follow up of communicable disease to the fine working relationship we enjoy
with our community partners. Direct clinic services are also provided under community Health.
A sample of the clinic services provided to the community is Family Planning, Immunization
and Blood Pressure Screening.
Children’s Services Division
This division oversees the administration of the Early Intervention Program (EIP), the Child Find
Program, the Physically Handicapped Children’s Program (PHCP), Preschool Special Education
Program and the Children with Special Health Care Needs Program. The Early Intervention
Service Coordinator who holds two Associate’s Degrees conducts day to day activity within the
EIP and Child Find. The PHCP and Children with Special Health Care Needs Program operate
under the direction of the Physically Handicapped Children’s Program Coordinator who also
holds a Bachelor’s Degree. The budget for the Children’s Services Division is adequate to meet
its needs. Funds are available as needed for any specialized care, medical supplies, or equipment
a child may require. The program coordinators have adequate clerical and billing support, and
each has their own computer.
Child Find Children between 0-3 years who are or may be at risk for developmental problems
are monitored at periodic intervals by the health department so that timely intervention strategies,
where needed, can be implemented.
Early Intervention Program (EIP)
A child between the ages of 0-3 diagnosed with a
developmental disorder or delay is determined eligible for EIP and if requested by parent, the
family will receive services in accordance with an Individualized Family Services Plan (IFSP).
EIP services are provided by NYSDOH approved providers the county’s EI official is
responsible to ensure that EIP services contained in the IFSP are provided.
Children with Special Health Care Needs (CSHCN) CSHCN is an informational, referral and
advocacy program for children from birth to 21 years of age who may require health or related
service of a type or amount beyond that typically required by children. This program
encompasses the Physically Handicapped Children’s Program and Preschool School Special
Education Program.
Preschool Special Education Program (PSEP) Children age 3-5 with disabilities may receive
special education services through the PSEP. In 2012, over 195, children were enrolled in this
program.
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Physically Handicapped Children’s Program (PHCP)
The PHCP provides financial
assistance and case management to children between the ages of 0-21 with handicapping
conditions that would otherwise be unable to afford such care. This program has a medical
treatment component, and an orthodontia component. As of August 2012 there are 17 children
currently receiving PHCP services.
Environmental Health Division
The Environmental Health Division (EHD) provides a full range of services focused on
community sanitation, food safety, and regulation of public water systems, disease control, and
correcting public health hazards. The division is composed of the Deputy Public Health
Director/Director for Environmental Health, four full-time public health sanitarians, and one
public health technician. The Deputy Public Health Director/Director of Environmental Health
holds a Master’s Degree in Environmental Health with a major in Epidemiology. Each of the
Public Health Sanitarians (PHS) holds a Bachelor’s Degree in a science or environmental health
related major, and one is also a registered nurse. The Public Health Technician (PHT) holds a
Bachelor of Arts Degree in Biology.
Each PHS is provided with a county vehicle to use on the job. Each PHS also “specializes” in at
least one or more environmental health program areas (e.g., public water supply, food safety,
children’s camps, and lead poisoning prevention).
In the general areas they all inspect the:
 Installation of new and replacement septic systems for compliance with State Rules and
Regulations.
 Inspect food service establishments, mobile home parks, campgrounds, hotels, motels,
swimming pools, bathing beaches for compliance with the New York State Sanitary Code
and advise operators on how to maintain compliance with Code requirements.
 Provide water sampling, inspections and oversight of over 100 public water systems
located within the county.
 Conduct compliance checks relative to the Adolescent Tobacco Use Prevention Act
(ATUPA) and investigate complaints regarding possible violations of the New York State
Clean Indoor Air Act (CIAA).
 Investigate nuisance complaints and determine if they constitute public health hazards,
then advise the responsible individual (landowner/facility owner or operator, etc.) on how
to correct the problem to protect the public health.
 Conduct sanitary surveys of private septic systems and water supplies as required at the
transfer of ownership of houses.
 Investigate animal bites to prevent the possibility of the patient from contracting rabies.
 Inspects children’s camps and reviews their safety plans.
 Conduct site visits at households of children with Elevated Blood Lead Levels 15 ug/dL
and above and conduct comprehensive lead assessment surveys of dwellings occupied by
children considered to be lead poisoned.
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All Environmental Health Division work is conducted by a small but well-trained staff. The
EHD budget has been sufficient to meet its needs, including the completion of routine work,
special or emergency studies (e.g., food or water testing in cases of possible contamination or
illness), vehicle maintenance, office and field supplies, conferences, training, and environmental
health related publications, subscriptions and memberships. Computer support to the division to
monitor program activity, track data, and generate reports, etc., has been adequate. There is no
supplemental funding for CIAA activities or enforcement, other than what is contained within
the annual ATUPA grant.
Health Education Division
The department has one full-time Supervising Public Health Educator (SPHE) who holds a
Bachelor’s degree and 21 years’ experience in health education at the health department. The
SPHE is the Public Information Officer for the health department, Program Director for the
CSPACC, writes grants for the health department, supervises the Community Health Educator
and the coordinator for the CSPACC, writes the Community Health Assessment, and the
Community Health Improvement Plan (CHIP). The Community Health Educator is a
subcontractor, holds a Master’s degree in Adult Education, provides education and outreach for
the Family Planning Program 70% of his time, education and outreach for the Lead Poisoning
Prevention Program 4% of time and provides general public health education program activities
including dental health, work with local coalitions on physical activity and nutrition for youth
and elderly; injury control; advertising and marketing for health department programs; and other
grants activities.
Clerical support within the health department includes the Secretary to the Public Health
Director, a Medical Records Computer Operator, a Clinic Secretary and a two typists (one acts as
receptionist). The number of clerical staff, when all positions are filled, is sufficient to meet
departmental needs. Cross training is conducted to allow continuation of support to all program
areas when clerical staff is deficient. Also, many perform the same general job duties despite
supporting separate areas of the department, so moving individuals as needed to cover personnel
shortfalls has generally not been a problem. Each clerical staff member has their own computer
and receives training on the software used in their primary program support areas.
Subcontracted Staff
WIC Program
WIC Program Director holds a Bachelor’s degree and is a registered nurse who is Internationally
Board Certified as a Lactation Consultant (IBCLC). She supervises one full-time registered
nurse, 1 nutritionist with BA in Nutrition and three full-time clerical and program support staff
that provide nutritional screening and education to pregnant, breastfeeding and postpartum
women, infants and children up to age five. She manages a client-driven budget that is currently
serving approximately 1250. The WIC Breastfeeding Coordinator has an Associate’s Degree in
Nursing from Alfred State and is a registered nurse who is a Certified Lactation Consultant
(CLC). In May 2007 she was promoted to Assistant Program Coordinator and in May 2008
became certified as lactation consultant. The Nutrition Coordinator has a Bachelor’s Degree in
Nutrition from Mansfield University. The Nutrition Educator and Outreach Coordinator have an
Associate’s Degree in Human Services and a BA in management. WIC Clinic Specialist and
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Vendor Manager has an Associate’s Degree and a certificate from BOCES for Medical Office
Assisting, certification as a Lactation Consultant and her postpartum Doula certificate. WIC
Administrative Assistant has a Bachelor’s Degree. She has a Certification as Lactation
consultant.
The Cancer Services Program of Allegany and Cattaraugus Counties (CSPACC) provides
comprehensive screening, case management, and diagnostic services with respect to colorectal,
breast and cervical cancers. Prostate cancer services are educational and Medicaid Treatment
Act only. The Medicaid Treatment Act provides Medicaid for breast, cervical, cervical precancerous, colorectal, and prostate cancer patients receiving treatment for cancer, once eligibility
is determined. The CSPACC now has three sub-contracted staff that works solely within this
program: a Coordinator who holds a Bachelor’s degree and is a registered nurse; a Data
Manager; and an Outreach Specialist who holds a Bachelor’s degree. The Supervising Public
Health Educator is Program Director of the CSPACC grant and provides grant management. The
screening numbers for the calendar year 2012 are: 375 mammograms, 323 clinical breast exams,
186 cervical screenings, and 144colorectal screening (FIT Kit). The grant in previous years has
been able to provide screenings to all those eligible for the CSPACC and recruited into the
partnership, due to budget cuts to the NYSDOH Cancer Services Program this grant must now
stay within the contracted amount for screenings and diagnostic services. Eligibility guidelines of
the program are women 40-64 without health insurance that pays for screenings are eligible for
cervical and breast screening and diagnostic testing; women and men 50-64 without health
insurance that pays for screenings are eligible for colorectal screening and diagnostic testing.
This grant is currently in an extension period and will be reapplying for an additional four years
at the end of 2013 or beginning of 2014.
Public Health Emergency Preparedness Coordinator has been with the health department for 7
years in this position. She prepares and monitors local emergency preparedness response plans
through collaborations with local, state, regional, and federal entities to build an "all-hazards"
approach to public health emergency response. She is responsible for the coordination of public
health related exercises to ensure compliance with CDC, and US DHS Homeland Security
Exercise and Evaluation Program (HSEEP) guidelines. She coordinates with local, state, and
federal entities to ensure activities for the federally funded public health emergency preparedness
initiatives comply with grant requirements.
Accounting
Accountant monitors effectiveness of departmental fiscal systems by developing, revising and
implementing accounting systems and procedures to provide complete and accurate accounting
for the agency's financial transactions. He is responsible for aiding an outside accounting firm in
completion of annual Medicaid and Medicare cost reports; prepares the annual State Aid
application and quarterly claims, and compiles the department’s annual budget and maintains
required financial records and reports throughout the year. He performs cost and budget
analyses, financial forecasting feasibility studies and other accounting tasks to aid in program
efficiency and effectiveness. He maintains ledger and journal accounts and balances and
reconciles with the County Treasurer's office; prepares periodic fiscal and statistical statements
and reports for agency use, and/or submission to State and/or Federal agencies; assists in the
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completion/preparation of grant applications by compiling and analyzing financial data; and
advises and consults with the County Treasurer and/or the Public Health Director and other staff
as appropriate on current fiscal reporting requirements and control of expenditures.
County Coroners
The county has four coroners who fall under the organizational umbrella of the health
department. These individuals are salaried through health department which provides them with
administrative support, along with needed supplies, reimbursement for travel, transportation, and
telephone use, other related expenses, etc. The coroners are now included in the county’s
Comprehensive Emergency Preparedness and Response Plan. Each coroner covers a general area
of the county. As needed, they help one another to ensure countywide coroner services are
available at all times. The coroners are assisted in simple cases by a doctor who acts as
“Coroner’s Physician”. The county does not have a medical examiner for postmortem
examinations in coroner case deaths. These services are obtained through contractual agreement
with the Monroe County Medical Examiner’s Office in Rochester.
Community Resources
A tremendous variety of community agencies serve as resources contributing to the social,
mental, and physical well-being of Allegany County residents. While the following list of these
agencies is quite comprehensive, it does not necessarily reflect all organizations that provide
services aimed at protecting and promoting health in Allegany County. See attached Allegany
County Obesity related services, Allegany County Child Psychiatric Services, and Allegany
County Obesity services table.
Mental, Emotional, Behavioral Health services complete list on www.networkofcare.org
(choose Mental Health/Behavioral Health then choose Allegany County)
Allegany County Mental Health Association
Provides day treatment for adults with developmental disabilities, mentoring programs, crisis
intervention and counseling services.
Milestone Psychiatric Services, Wellsville NY
Psychological Services, a Medical Group Practice
Allegany County Community Services, Wellsville NY
plans for, coordinates, provides services, and ensures quality of mental health, substance abuse,
and developmental disabilities for residents of Allegany County.
Allegany Rehabilitation Association, Inc
Offers mental health services, case management, chemical dependency, transportation, housing,
education, and social and vocational rehabilitation.
 PROS, Wellsville NY
 The Counseling Center (TCC), Wellsville, NY
 Senior Outreach Program
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
Behavioral Health Clinician in Allegany County Jail
Alfred University-Powell Family and Child Counseling Services
individual and family counseling for children, adolescents, and adults. We also offer
psychoeducational assessments for children and adolescents from age three (3) through age
twenty-one (21). The primary clinicians are advanced counseling and school psychology AU
graduate students, and all sessions and treatments are supervised and observed by doctoral-level
AU faculty psychologists.
ACCORD Adolescent and Youth Respite Program
Elmira Psychiatrist Center-outpatient Wellsville. NY
Youth for Christ-work with youth and families
Catholic Charities of Allegany & Cattaraugus County
Provides counseling services and anger management instruction.
Southern Tier Environments for Living (STEL Inc.)
Residential programs for adults with psychiatric illness. Programs provide rehabilitative services
to assist residents with acquiring skills to live in more independent settings. STEL provides three
levels of care in Wellsville. A 24 hour supervised group home setting scattered apartments with
two to three staff visits a week. Our last program is single room occupancy. STEL has two
locations in Wellsville, and individuals must possess independent living skills. This program is
considered permanent housing.
Allegany County Counsel on Alcoholism and Substance Abuse, Wellsville, NY
Allegany Council provides multidisciplinary treatment to any person either referred or selfdirected who meets admission criteria. This program is certified by the State of New York Office
of Alcoholism and Substance Abuse Services to deliver clinical treatment services to individuals
and families whose lives have been affected by the disease of addiction. Full-time counselors are
available to deliver a wide range of services. These include Information and Referrals,
Evaluation/Assessments, Medical Assessment, Individual and Group Counseling, Child and
Family Therapy, Family Intervention, Vocational/Educational Counseling, Clinical Consultation,
and Adult MICA Programs.
Allegany County Mental Health Association | Youth/Adult Compeer Program
Youth volunteer program designed to give adult role modeling to needy children. All volunteers
undergo extensive background check and training. Activities are chosen by youth and adult
jointly. In addition there are regularly scheduled outings for everyone involved in the program.
Alcohol Treatment Center, Buffalo, New York
The Alcohol Treatment Center provides regional coverage in offering care for individuals and
their families who are experiencing problems related to alcohol consumption and alcoholism.
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The Center has a 24-hour help line available for use in crisis situations for those needing
immediate intervention and treatment.
Allegany County School Districts
The school districts within Allegany County, including the Allegany County BOCES, offer their
students a vast array of health related programs, over and above the required school health
curriculum. Often, these subjects are provided, upon request, by health department staff, or other
individuals within the community. Topics presented include dental health, human sexuality,
contraception, family planning, parenting skills, “Baby Think it Over”, prenatal care, nutrition,
sexually transmitted disease, HIV/AIDS, alcohol and substance abuse, tobacco use, motor
vehicle safety, etc. Another program available to the schools, that serves to promote child
health include “Project KNOW”, a program designed to help prevent unplanned or unwanted
teenage pregnancies, targeting grades five through twelve. School districts employ psychologists
to work with children experiencing difficulties related to school, over concern for the mental
health of the individual. Teachers and school nurses are trained to notice behaviors indicative of
a child in need of help. As necessary, parents are advised of any problems, and referrals made to
outside agencies or health care providers for more definitive care. School districts foster
participation in physical activity programs at each grade level. Health classes and gym classes
promote physical fitness in students. Extracurricular activities such as interscholastic and
intramural sports also provide students the opportunity to participate in organized physical
activities. All schools within the county call for their students to be up-to-date on required
immunizations. Students are not allowed into school if they are not fully immunized. Students
in need of immunizations are referred to the health department, local health care providers, or
their personal physicians. County schools send letters home to parents when students are due for
immunizations.
Elm Street Academy is a BOCES Big Picture School Program located in Cuba, NY in Allegany
County and has students from Allegany, Cattaraugus and Steuben Counties. Big Picture Schools
were created to address the problem of students dropping out of school. Big Picture Schools
provide a unique learning opportunity for students who are at risk of dropping out of school. Under
the Big Picture concept, students become immersed in areas they are passionate about, in particular
through internships and real-world learning experiences.
Alzheimer’s Support Group of Allegany County, Wellsville, New York 14895
This group provides counseling and support to Alzheimer’s patient and their families, to help
them cope with the difficulties encountered when affected by this disease.
American Lung Association, Buffalo, New York 14228
The American Lung Association provides services for persons suffering from asthma and other
lung diseases, smoking cessation programs, and smoking prevention courses aimed at school
children.
Andover Historic Preservation Corporation, 4 Main Street/Box 713, Andover, New York
The Andover Historic Preservation Corporation provides affordable housing to low-income
county residents.
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Children’s Camps
Each year, there are several children’s camps in the county that provide participants the
opportunity to engage in various levels and types of physical activities. Several private camps
and camps sponsored by local colleges and universities are also available.
Child Health Plus
Child Health Plus is aimed at freeing children from common childhood diseases and protecting
them from serious health threats posed by untreated illnesses. The program protects children
with no health insurance or who are underinsured, through reduced rate or free medical care, by
covering primary, outpatient, and preventive health services for all children meeting income
guidelines.
Absolut Center for Nursing and Rehabilitation at Houghton; Houghton, New York 14744
The goal of this facility is to treat its patients with a focus on facilitating their return to home.
Services include a planned recovery program that may consist of physical therapy, speech
therapy, occupational therapy, nutrition, respiratory therapy, restorative nursing, case
management, and outcome measurement.
Alfred State College and Alfred University, Alfred, NY, Houghton College, Houghton, NY
Colleges and universities located within the county provide health related services to their
students. Depending on the program, faculty members and the general public may also make use
of these offerings. Various programs and services provided include treatment and counseling for
sexually transmitted disease, contraception, psychological counseling, and counseling and
referral for students experiencing problems related to drug and alcohol use. Facilities are set up
to handle minor health care problems on an outpatient basis (colds, flu, minor injuries, etc.),
followed by appropriate referral to higher-level care when warranted. To help control
communicable disease, each facility requires entering students to be screened for tuberculosis
and be up-to-date on all required immunizations before they can start classes. Students in need
of these services can receive them from their personal health care provider, the school health
center, or they may be referred to a local health care provider or the health department. Problems
with drug and alcohol abuse at universities around the country, some of which were highly
publicized, has led these facilities to develop harder stances on the use of drugs and alcohol by
students, whether on or off-campus. These efforts include notification of parents when an
underage student is caught drinking or drunk on campus, eliminating hazing activities involving
fraternities and sororities, suspending students who are repeat offenders, and offering alcohol and
drug-free social activities to their students. Alfred University has eliminated the Greek
organizations altogether. Students, faculty, and members of the community can take part in
exercise and physical activity through these schools. Houghton College, Alfred State College,
and Alfred University hold summer camps for children from throughout the area in sports such
as swimming, basketball, football, baseball, soccer, tennis, and horseback riding. Each facility
also offers a wide range of interscholastic and intramural sports their students can participate in,
and fitness centers and swimming pools for student, faculty, and community use.
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Community Groups/Volunteers
Community groups and individuals, who volunteer their time and effort as officials, coaches,
etc., help promote physical fitness through a wide variety of organized team sports. These
include participation in Little League baseball, tackle and flag football, golf, basketball, softball,
and soccer, etc.
Developmental Disabilities Prevention Program, Williamsville, New York 14231
This program provides services to individuals with developmental disabilities designed to
promote health practices and strategies that reduce the occurrence of mental retardation and
developmental disabilities.
Dog Control Officers
Most townships in the county have Dog Control Officers (DCO) who are responsible for
ensuring that the dogs within their township are licensed and properly immunized against rabies.
The DCOs assist the health department in locating and confining stray dogs involved in bite
incidents so the animals can be observed for signs/symptoms of rabies. They may also seize and
destroy, if necessary, dogs with multiple bite histories or those whose owners refuse to have
them vaccinated against rabies.
Farmers Markets in Wellsville, Alfred and Belmont once a week between May and October.
Family Court, 7 Court Street, Belmont, New York 14813
Family court handles domestic violence and abuse petitions filed by or on behalf of victims. The
Court adjudicates these cases to determine the appropriate course of action to take in resolving
each case.
Hillside Children’s Center, Western Region Office, Warsaw and Cuba, New York
The Hillside Children’s Center provides foster care for emotionally disturbed children in a home
environment, as opposed to an institution or group home. Children receive treatment primarily
within the foster home through social workers, sociotherapists, and education specialists. The
primary focus of this program, whenever possible, is to reunite the child with his or her natural
family.
Allegany County Sheriff’s Department, Belmont, New York 14813
New York State Police, Belmont, New York 14813
Local Town and Village Police
Law enforcement agencies provide training on highway traffic safety. Presentations are
available to all county residents, with focus on teenage drivers. The New York State Police are
involved in the Child Safety Seat Program. These agencies also respond to calls of domestic
violence and abuse, and alcohol and drug abuse, arresting and charging offenders while referring
victims to the appropriate care and support facilities.
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Randolph Children’s Home, Inc., 356 Main St. ER, Randolph, NY 14772
The Randolph Children’s Home provides supervision and confinement to children with
behavioral or other problems. Children live within the home located in Randolph and attend
school on the grounds at Randolph Academy. Individual foster homes are also available for the
placement of these children.
Allegany Western Steuben Rural Health Network, Wellsville, NY
This agency seeks to identify unmet health needs, develop and organize rural health delivery
systems, provide shared services and resources, develop wellness programs, identify financial
resources to support health services, identify strategies that focus on consumer health needs.
Southern Tier Health Care System, Inc., One Blue Bird Square, Olean, New York 14760
This agency seeks to identify unmet health needs, develop and organize rural health delivery
systems, provide shared services and resources, develop wellness programs, identify financial
resources to support health services, identify strategies that focus on consumer health needs.
Child advocacy center for sexual abuse in Wellsville, NY
WNY Regional Office of Mental Health
This office provides assistance to those in need of mental health services through counseling,
referral, and patient care through contact and affiliation with regional health care providers.
Western New York Emergency Medical System (WNY-EMS)
The WNY Emergency Medical System consists of 286 EMS agencies and 31 hospital-based
emergency medicine departments. The Allegany County Office of Emergency Services is part of
this system. The WNY-EMS is coordinated through the Western Region Emergency Medical
System (WREMS), which is responsible for the development of the EMS System, medical
control, quality improvement, education, and establishing regional communications. Services to
the community include the development and advancement of a Regional EMS System that
provides the emergency patient a continuum of care from an accident or injury scene, through
transport and treatment at a hospital emergency medicine department or trauma center.
Western New York Regional Trauma System (WNY-RTS)
The WNY-RTS is composed of two regional and one area trauma center. The Erie County
Medical Center (ECMC), Buffalo Children’s Hospital, and the Women’s Christian Association
Hospital provide regional trauma services to WNY, including helicopter support. WNY has
approximately 28 referring hospitals that provide specialty services that support trauma patients.
The activities of these facilities are as follows:
Regional Adult Trauma Center About 60% of trauma injuries in WNY are triaged to the
regional adult center. This center provides all patients with immediate intervention, evaluation
and care from pre-admission through home health and rehabilitation. The Trauma Center
accepts any patient with a traumatic injury, and has a policy of accepting all referred patients.
Patient care is provided by a multidisciplinary Trauma Team, assisted as necessary by consulting
specialty medical and support services.
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Regional Pediatric Trauma Center The Pediatric Trauma Center provides services similar to
the Adult Trauma Center. Cases are accepted by the Center, including those referred from other
facilities. A trauma team provides all patient care, with assistance from specialty medical and
support services as needed.
Area Adult Trauma Center This center provides trauma care similar to that of the regional and
pediatric trauma centers, with services managed by a Trauma Team, with assistance as needed
from specialty medical and support services.
WNY Community Hospitals All community hospitals within WNY have the capacity to
administer emergency and lifesaving procedures in the event of a trauma admission. Major
trauma patients that these hospitals cannot provide definitive care to are sent to a regional trauma
center for treatment.
Zafron Home for Parenting Teens
The Zafron Home for Parenting Teens serves pregnant and parenting teenage mothers from
Western and Central New York State. Residents are placed through their county’s DSS, or the
State Office of Children and Family Services, and must be in the custody of one of those
agencies. The home provides a supportive living arrangement for teenage mothers and their
children, and offers support and assistance designed to develop and improve independent living
skills. Eligibility requirements must be met in order to be placed in this facility.
Clinic Facilities
The following clinics are available through the Allegany County Department of Health. If no
insurance is available a sliding fee scale is available. These services afford the working poor and
Medicaid population health-related services they may otherwise neglect to get. There are Family
Planning/STD Clinics available in Wellsville, Alfred, and Belmont. These well utilized services
are offered by appointment and walk in and have a high participant satisfaction rate. There are
free blood pressure screenings open to the public held monthly in Alfred, Belmont, Fillmore,
Whitesville, Cuba, Wellsville, Canaseraga, Bolivar and Friendship. Immunization clinics are
open to the public several times a month by appointment in Belmont. There is a sliding scale fee
based on household income for all vaccines if no insurance coverage. Allegany County Health
Department continues to utilize the vaccine for children program. These clinics are very busy,
especially before the start of the school and college year and during influenza season.
The Health Department offers free rabies clinics for dogs, cats and ferrets at least once every
four months in accordance with New York Public Health Law and the New York State Sanitary
Code. These clinics are generally held on Saturday’s at various times throughout the year, most
often at the centrally-located County Office Building in Belmont, NY. These clinics are always
very well attended and busy and overall feedback from the public is very positive. If/when
enough funds are available; the Health Department also sponsors two-three additional free rabies
clinics for local townships, upon request.
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The WIC Program offers free services in Alfred Station, Angelica, Belfast, Bolivar, Canaseraga,
Cuba, Fillmore, Friendship and Wellsville for eligible residents. Several office clinics are also
held monthly in Wellsville for those who miss their appointments, are coming on new, and for
recently delivered babies. Evening and lunch clinic hours are available as needed. These office
clinics mean that participants do not wait for services. New participants typically receive an
appointment within 2-7 working days to insure timely use of services. The WIC Program also
has a free Electric Breast Pump Loaner Program for participants that wish to continue
breastfeeding upon returning to work/school or for those who are separated from their babies.
Hand and pedal pumps are also available upon request. Participants report staff to be extremely
friendly and helpful. Current caseload is 1,250.
The following physicians accept Medicaid patients and provide primary
obstetrical/gynecological, pediatric, ophthalmic and other services in Allegany County.
Dr. Kurt Benham, ophthalmic, Wellsville
Dr. David Brubaker, family medicine, Houghton
Dr. Gary Cook, optometry, Wellsville
Dr. James Rummel, family medicine, Andover
Dr. Osborn, family medicine, Bolivar
Dr. Leo Cusumano, pediatrics, Cuba
Dr. Depner, family medicine, Wellsville
Dr. Lu-Ann Kaye, family practice/OBG, Wellsville
Dr. Zahi Kassas, pediatrics, Wellsville
Dr. Kelvin Gold, family medicine, Cuba
Dr. Robert Maiden, psychology, Wellsville
Dr. F. Clifton Miller, obstetrics/gynecology and pediatrics, Wellsville
Dr. M. Raqib Raja, psychiatry, Wellsville
Dr. Calvin Schierer, family medicine, Houghton
Dr. Heather Lanphere, obstetrics/gynecology, Wellsville
Dr. Kenneth VanDine, ophthalmic, Wellsville
Dr. Reed Haag, Internal Medicine, Wellsville
Dr. Susan Mason, family practice, Alfred
Dr. Steven Collins, family practice, Belmont
Tri County Family Medicine, Canaseraga
Cuba Dental Clinic
Dr. Peter Hancher Dentist, Wellsville
Dr. Robert Riley, Dentist, Wellsville
care,
The Universal Primary Care: Southern Tier Community Health Center Network, Inc., a Federal
Qualified Health Care Center with locations in Cuba and Houghton. Established in 2004, UPC
specializes in family medicine, adult medicine, pediatrics, obstetrics and gynecology. Our
Medical Staff consists of five physicians, two certified nurse midwives, one nurse practitioner
and one physician assistant. As a teaching site of the Olean General Hospital/University of
Buffalo Family Medicine department, UPC is proud to train medical students and medical
residents in rural Family Medicine. UPC is a nationally designated Patient Centered Medical
Home. UPC is a Federally Qualified Health Center. The Jones Memorial Hospital offers clinics
50
in Belmont, Wellsville, and Alfred that accept Medicaid patients. The Olean Medical Group has
a satellite office in Cuba that accepts Medicaid patients for general practice and obstetrics and
gynecology. The Urgent Care Center at Cuba Memorial Hospital and Jones Memorial Hospital
Emergency Room in Wellsville also accept Medicaid patients.
As with many small rural counties in New York State, health resources and access to care in
Allegany County is often inadequate or lacking, particularly in the areas of dental care and
specialty medical services. Part of this stems from the fact that Allegany County has such a large
proportion of its population enrolled in Medicaid, or who are under insured or have no health
insurance at all. Few dentists in the county accept Medicaid patients due to the low
reimbursement rates they receive for services rendered. Specialty medical providers are
impacted by this same problem. Neither group recovers basic expenditures for the services they
provide to Medicaid patients, and are therefore reluctant to care for these people.
Cuba Memorial Hospital, located on the eastern side of Allegany County, offers a combined
urgent care, rehabilitation and long-term care facility. Jones Memorial Hospital, located on the
western side of Allegany County, is the only general hospital within the county’s borders. Jones
Memorial has a clinic centrally located in Belvidere and a Women’s Health Center in Wellsville.
Among the counties, which flank Allegany County, are several hospitals available to county
residents. These include Olean General Hospital (Cattaraugus County), St. James Hospital in
Hornell, and Ira Davenport Memorial Hospital in Bath (both in Steuben County), Noyes
Memorial Hospital in Dansville (Livingston County), Wyoming County Community Hospital in
Warsaw (Wyoming County), and Charles Cole Memorial Hospital in Coudersport, Pennsylvania
(Potter County). Specialty hospitalization or tertiary care is available through hospitals in
Buffalo (e.g., Buffalo General Hospital; Erie County Medical Center; Roswell Park Cancer
Institute), Rochester (Strong Memorial Hospital), and Sayre, Pennsylvania (Guthrie
Clinic/Robert Packer Memorial Hospital).
Primary and Specialty Health Services
Currently, there are approximately 12.5 primary care physicians providing adult and pediatric
services (general/family practice), and approximately 12 specialty care physicians, with practices
in Allegany County. Specialty physicians include obstetrician/gynecologists, internal medicine
physicians, general surgeons, pediatricians, ophthalmologists, and podiatrist. Access to these
physicians is limited to a degree for the following two reasons. First, the majority of them are
located in Alfred, Cuba, Houghton, and Wellsville. This leaves them geographically removed
from large segments of the county population. Also, many of these physicians only practice in
the county on a part-time basis, as they have their primary practices located in adjacent counties.
This further limits access to these individuals for county residents in need of medical care.
Aside from private practice physicians, there are also several clinics available to county residents
for receiving primary, specialty, or preventive health care. Jones Memorial Hospital operates
three satellite clinics in the county, with locations in Belvidere, a Veteran’s Health Care Center
in Wellsville and a Women’s Health Care Center in Wellsville. In Cuba, the West Main Medical
Center provides family practice and primary care services to its clientele. Also in Cuba, the UPC
(Southern Tier Community Health Center Network) is a Federally Qualified Health Care Center
51
and provides general practice and gynecological services. The Allegany County Department of
Health offers family planning clinics in 3 locations in Allegany County, blood pressure clinics in
9 locations in Allegany County, and immunization clinics at the Belmont site. However, despite
this fact, the extreme rural nature of the county, particularly in the northeastern, northwestern,
and south central portions of the county restricts easy access for a substantial proportion of the
county’s population.
Dental Health Care In 2013 there are 11 licensed dentists in Allegany County. Cuba Dental
Clinic is an Article 28 clinic is owned and operated by the Cuba Memorial Hospital. A two
dentist practice in Wellsville accepts Medicaid (Hancher and Riley). We currently have 2
orthodontists who practice at sites in several counties. There are four dental practices in
Wellsville, two and a dental clinic in Cuba, one in Alfred and two in Houghton. This leaves a
large area of the county with inadequate dental coverage, requiring many county residents to
travel significant distances for these services.
Cancer Treatment-Regional cancer treatment is available to patients through Southern Tier
Oncology in Hornell; Wilmont Cancer Center, Rochester General Breast Center, Strong
Memorial Hospital in Rochester, CCS Oncology Cancer Center of WNY and the Roswell Park
Memorial Cancer Institute in the Buffalo area, Southern Tier Cancer Care, Mildred Milliman
Radiation Center and Berry Street Health Center in Olean and Cancer Care of WNY in
Jamestown. Roswell Park Cancer Institute was recently identified as one of the top 10 cancer
centers in the United States. Patients may also receive care in the forms of surgery, radiation
therapy and chemotherapy through local physicians and area health care centers.
Rehabilitation Services-County residents have access to rehabilitation services through a
variety of sources including private contractors, therapist groups, clinics, and the health
department. Individual therapists or therapy groups often contract with the health department to
provide services to patients identified through the Children’s Services programs. These include
such specialty providers as physical therapists, occupational therapists, speech therapists, and
audiologists.
Nursing Homes, Geriatric Care Facilities, and Rest Homes There are several nursing home,
geriatric care facilities, and rest homes within the county including the following: CentervilleWolfer Family Type home for adults; Bolivar - Bolivar Manor; Cuba - Cuba Memorial Skilled
Nursing Facility; Houghton – Absolut at Houghton; Scio - Mater Dei Home for Adults;
Wellsville - Highland Health Care Center, Manor Hills, and the Wellsville Manor. Availability
of rooms at these locations is at a premium. The result is that many patients often end up in
facilities well away from their families, such as in Olean, New York, Hornell, New York, and
Coudersport, Pennsylvania, until a bed in a county home is available.
Helping to alleviate this problem WillCare offers long-term home health care to county residents
in their homes (“nursing home without walls”), as an alternative to nursing home placement. To
be considered for this program, a patient must be under the direct care of a licensed physician,
qualify for nursing home placement, and have only an informal support system at home.
52
4. Documentation on the process and methods used to conduct the assessment.
The process and methods of conducting the Community Health Assessment (CHA) included
researching the data, surveying the community and conducting focus groups in the community.
The key stakeholder core group is made up of representatives from the Allegany County
Department of Health, the Allegany Western Steuben Rural Health Network, the Cuba Memorial
Hospital and the Jones Memorial Hospital. This core group has been meeting since January
2013; attending the webinars from the New York State Department of Health on the Community
Health Assessment (CHA), the Community Health Improvement Plan (CHIP), and the
Community Service Plan (CSP); developing the survey for the community and the list of groups
that should be represented by the focus groups. The data that was researched included the 2010
U.S. Census, 2007-2011 American Community Survey 5 year Estimates (U.S. Census), People
Quick-facts for the U.S. Census, New York State Vital Statistics, New York State Expanded
Behavioral Risk Factor Surveillance System (BRFSS) July 2008-June 2009, National Center for
children in Poverty, New York State District Report Card Comprehensive Information Report,
New York Makes Work Pay (NYMWP) project, United States Bureau of Labor, Uniform Crime
Reporting Program, and Allegany County Indicators for tracking Public Health Priority Areas,
2013-2017-various data sources.
See the attachments: Allegany County Community Health Assessment Survey, Allegany County
Integrated Health Plan 2013-2017 Report, and Data 2013-Community Health Assessment
(power point) used at the stakeholders meeting.
The vision of this group is to collaboratively build the infrastructure and capacity of our local
healthcare delivery system to make Allegany County the healthiest community in New York
State. This group was guided through the MAPP (Mobilizing for Action through Planning and
Partnerships) process by the AWSRHN. MAPP is an evidence-based, community driven
strategic planning tool for improving community health. The elements of MAPP include: Build
LHD leadership, but also promote community responsibility for the health of the public; Assess
capacity of entire local public health system; Strategic planning; Focus on health status,
community perceptions, forces of change, and local public health system capacities; and
Strategically match needs, resources, ideas, and actions. The MAPP process in Allegany County
included: Identify Key Stakeholders-January 2013; Quantitative Data Gathering and AnalysisJanuary through August 2013; 8 Focus Groups- 101 Participants (March 25, 2013- 19 Teens,
April 10, 2013- 9 Faith Leaders, April 10, 2013- 7 Physicians, April 15, 2013- 7 Community
Nurses, April 22, 2013- 11 Community Health Educators, April 25, 2013- 23 Jones Memorial
Hospital Leadership Team, May 22, 2013- 10 Business Leaders, June 25, 2013- 15 Aging
Service Providers); Community Health Assessment Survey- 408 Participants-February –July
2013; and a Key Stakeholders meeting August 14, 2013 which included a power point
presentation of data, community survey, and focus groups and the exercise to choose priorities.
The priorities that were selected from the Allegany County Community Health Assessment for
the Allegany County Community Health Improvement Plan are:
 Priority #1: Prevent Chronic Disease
Reduce Obesity in Children and Adults
53

Disparity - Socioeconomic
Priority #2: Promote Mental Health and Prevent Substance Abuse
Promote Mental, Emotional and Behavioral Health
Disparity - Socioeconomic, Disability
54
B. Community Health Improvement Plan (CHIP)
1. Identification of priorities from the Prevention Agenda 2013
In January 2013, the Allegany County Department of Health (ACDOH),
Allegany/ Western Steuben Rural Health Network (AWSRHN), Cuba Memorial
Hospital (CMH), and Jones Memorial Hospital (JMH) started meeting to discuss
the Community Health Assessment (CHA), Community Health Improvement Plan
(CHIP), and hospital Community Service Plan (CSP). These meetings were
organized around the dates for the New York State Department of Health
(NYSDOH) webinars on CHA/CHIP/CSP. The vision of this group is to
collaboratively build the infrastructure and capacity of our local healthcare
delivery system to make Allegany County the healthiest community in New York
State. This group was guided through the MAPP (Mobilizing for Action through
Planning and Partnerships) process by the AWSRHN. MAPP is an evidencebased, community driven strategic planning tool for improving community health.
The elements of MAPP are:
• Build LHD leadership, but also promote community responsibility for the
health of the public
• Assess capacity of entire local public health system
• Strategic planning
• Focus on health status, community perceptions, forces of change, and
local public health system capacities
• Strategically match needs, resources, ideas, and actions
The MAPP process in Allegany County:
o Identify Key Stakeholders-January 2013
o Quantitative Data Gathering and Analysis-January through August 2013
o 8 Focus Groups- 101 Participants
o March 25, 2013- 19 Teens
o April 10, 2013- 9 Faith Leaders
o April 10, 2013- 7 Physicians
o April 15, 2013- 7 Community Nurses
o April 22, 2013- 11 Community Health Educators
o April 25, 2013- 23 Jones Memorial Hospital Leadership Team
o May 22, 2013- 10 Business Leaders
o June 25, 2013- 15 Aging Service Providers
o Community Health Assessment Survey- 408 Participants-February –July
2013
o Key Stakeholders met August 14, 2013o Power point presentation of data, community survey, and focus
groups (see attached power point)
o Exercise to choose priorities
55
Allegany County Community Health Assessment- Priority Scoring System from the
exercise to choose priorities from the key stakeholders meeting on August 14, 2013.
Attendance
Allegany/Western Steuben Rural Health Network, Inc.
Carrie Whitwood, Executive Director and Helen Evans, Associate Director
Allegany County Department of Health
Lori Ballengee, Public Health Director, Theresa Moore, Supervising Public Health
Educator, Linda Wilcox, Director Early Intervention, Madelyn Thornton, Coordinator
CSPACC, Lauri Smith, WIC Program Coordinator, Laurie Hennessy, Director of Patient
Services, Shaye Reagan, Intern with WIC Program, and Richard Reynolds, Children with
Special Health Care Needs
Jones Memorial Hospital
Eva Benedict, Chief Executive Officer, Tracy Gates, Chief Financial Officer, Donna
Bliven, Judy Burt, Julie Hart, Brenda Sobeck, and Brenda Szabo
Cuba Memorial Hospital
Norma Kerling, Director of Patient Services
Priorities
Priority #1: Prevent Chronic Disease
Reduce Obesity in Children and Adults- 30 Points
Promote Mental, Emotional and Behavioral Health- 24 Points
Priority #3: Prevent Chronic Disease
Increase Access to High Quality Chronic Disease Preventative Care and management
in Both
Clinical and Community Settings- 20 Points
Exercise Scoring
Promote Mental Health and Prevent Substance Abuse
Promote Mental, Emotional and Behavioral Health- 24 Points (4 Green * 3 = 12, 4 Pink * 2 =
8, 4 Yellow * 1 = 4)
Prevent Substance Abuse and Other Mental, Emotional and Behavioral Health Disorders- 4
Points (1 Yellow * 1 = 1)
Strengthen Infrastructure across Systems- 1 Point (1 Yellow * 1 = 1)
Promote Healthy Women, Infants and Children
Maternal and Infant Health- 0 Points
Child Health- 7 Points (1 Green * 3 = 3, 2 Pink * 2 = 4, 0 Yellow * 1 = 0)
Preconception and Reproductive Health- 0 Points
Prevent HIV, STDs, Vaccine Preventable Diseases and Healthcare Associated Infections
Vaccine Preventable Disease- 8 Points (1 Green * 3 = 3, 2 Pink * 2 = 4, 1 Yellow * 1 = 1)
HIV- 0 Points
Sexually Transmitted Disease- 0 Points
Hepatitis C Virus- 0 Points
Healthcare Associated Infections- 0 Points
Prevent Chronic Disease
Reduce Obesity in Children and Adults- 30 Points (8 Green * 3 = 24, 2 Pink * 2 = 4, 2 Yellow *
56
1 = 2)
Reduce Illness, Disability and Death Related to Tobacco Use and Second Hand Smoke
Exposure- 3 Points (0 Green * 3 = 0, 0 Pink * 2 = 0, 3 Yellow * 1 = 3)
Increase Access to High Quality Chronic Disease Preventative Care and management in Both
Clinical and Community Settings- 20 Points (2 Green * 3 = 6, 6 Pink * 2 = 12, 2 Yellow * 1 =
2)
Promote a Healthy and Safe Environment
Injury, Violence and Occupational Health- 2 Points (0 Green * 3 = 0, 0 Pink * 2 = 0, 2 Yellow *
1 = 2)
Outdoor Air Quality- 0 Points
Built Environment- 0 Points
Water Quality- 0 Points
Healthcare Disparities
Poverty
Entitlement
No Incentive to Improve Health
Pertussis- Babies and Children
Influenza- Decrease Hospitalizations in those >65 years of Age
(6) Obesity- Poverty Level
- Wellness Programs, Exercise Programs, Proper Food Choices, Culture Change toward
Improved Nutrition, Financial Means to Purchase Fresh Fruits and Vegetables, Increase Weight
Loss Opportunities among Low Income Women, Increase Nutrition Education among Children,
Increase Education among Parents, Promote Healthy Eating in Low Income Families, and
Increase Physical Activity in Low Income Families
Access to Mental Health Care- Children
Access to Mental Health Care- Adolescents
Dental Health in Children
- Early Education, including Parents, for Caries Prevention
Suicide Prevention- Youth
Access to High Quality Chronic Disease Prevention and Management- Poverty/Uninsured
- Increase In-County Access
The core committee of stakeholders continued to meet and discuss scoring and committees for
the CHA and CHIP. After the scoring for the key stakeholders was complete, two committees
were assembled one on obesity and one on mental health. The obesity committee has met four
times, completed a survey for an asset map, and determined the CHIP for obesity. The mental
health committee has met once with physical health providers to determine the asset map for
Allegany County and the gaps in services. The committee met a second time to determine the
CHIP for mental health. (see attached See the attachments: Allegany County Community Health
Assessment Survey, Allegany County Integrated Health Plan 2013-2017 Report, and Data 2013Community Health Assessment (power point) used at the stakeholders meeting)
The priorities that were selected from the Allegany County Community Health Assessment for
the Allegany County Community Health Improvement Plan are:
 Priority #1: Prevent Chronic Disease
57

Reduce Obesity in Children and Adults
Disparity - Socioeconomic
Promote Mental, Emotional and Behavioral Health
Disparity - Socioeconomic, Disability
2., 3., 4.,5., 6. Allegany County Community Health Improvement Plan
Date Created: November 5, 2013
Date Reviewed/Updated:
Prevention Agenda Priority for 2013-2017: Promote Mental Health and Prevent Substance Abuse
Focus Area: Strengthen Infrastructure Across Systems
GOAL: Strengthen infrastructure for MEB health promotion and MEB disorder prevention.
PERFORMANCE MEASURES
How We Will Know We are Making a Difference
Short Term Indicators
Source
Frequency
Identify and strengthen opportunities for sharing data on access to care, identifying
service gaps, studying cost-effectiveness strategies for integration and coordination,
and the impact of interventions.
Identify and strengthen opportunities for implementing MEB health promotion and
MEB disorder prevention with individuals.
Collaborate with the physical health community to identify opportunities to provide
cross systems training.
Utilization Data
Annual
Quarterly
Long Term Indicators
Suicide Prevention
Coalition
Utilization Data
# of PCPs Trained
# Positive Screens
# of Referrals
Source
Reduce the age-adjusted suicide death rate per 100,000 by 10% (Baseline: 11.5 per
100,000, Year: 2008-2010)
NYSDOH Vital
Statistics
Annual
Maintain the age-adjusted % of adults with poor mental health for 14 or more days in
the last month by 10% (Baseline: 8.6 per 100,000, Year: 2008-2010)
BRFSS
Annual
Quarterly
Frequency
OBJECTIVE #1: Identify and strengthen opportunities for sharing data on access to care, identifying service gaps,
studying cost-effectiveness strategies for integration and coordination, and the impact of interventions.
BACKGROUND ON STRATEGY
Source: Center for Integrated Health Solutions, 2013
Evidence Base: Model Program
Policy Change (Y/N): Y
Disparity (Y/N): Y, Socioeconomic, Disability
Improvement Strategies
Activity
Identify key leaders among BEM
Agencies in Allegany County to
form an Advisory Team, whose
Target
Date
Resources
Required
Lead Person/
Organization
Anticipated
Product or Result
Progress
Notes
3/2014
Key leaders
Helen Evans,
AWSRHN
Baseline data
Training schedule
Evidence Based
Key leader
group has
been
58
responsibilities are to prioritize
needs related to data, training,
and evidence based practices
that are necessary to promote
MEB health and prevent MEB
disorders.
Theresa Moore,
ACDOH
J. Hart, JMH
Facilitate quarterly Advisory
Team meetings to monitor and
evaluate system changes,
appropriateness of service
provisions and augment when
necessary.
Explore improving care
coordination for the Severely
Mentally Ill and/or Addicted by colocating Primary Care Services in
local Behavioral Health
Settings; including data collection
using a structured consumer
survey, research on state and
federal regulations, literature
reviews, and completing a
business feasibility plan.
Achieve regulatory requirements
necessary to implement a
integrated model system
Ongoing
12/2014
Implement in one (1) MEB setting
and monitor effectiveness for
potential spread into other
specialized populations
12/2015Ongoing
Site
M. Conklin, CMH
L. White, Community
Services
Participant BuyIn
6/2014
Article 28 Status
Improve care coordination
between Primary Care and MEB
Care via improved Health
Information Exchange; i.e.
integrated EMR exchange and/or
Regional Health Information
Organizations (RHIOs)
organized
and meet 2
times to
organize the
CHIP
Improved
Communication
Improved
Coordination of Care
J. Hart, JMH
W. Penman, ACASA
Define and monitor
consumer Quality
Indicators in the
target population
M. Damiano, ARA
L. White, Community
Services
Decrease NonEmergent ED
Utilization
Certificate of
Need
J. Hart
Certificate Of Need
Funding
J. Hart, JMH
Billing Services
W. Penman, ACASA
SMI and Addicted
Consumers will have
improved access to
primary care
Shared
Organizational
StructureClerical Support
M. Damiano, ARA
Exam RoomSpace
R. Anderson,
Community Services
L. White, Community
Services
Practitioner(s)
Improve access to MEB Health
Services for children and
adolescents through the
recruitment and retention of a
Child and Adolescent Psychiatrist
and/or expand Tele-psychiatry
Services.
Practices to be used
12/2015
12/2015
Tele-psychiatry
consultant
contract
(equipment
acquired
previously)
J. Hart, JMH
R. Anderson,
Community Services
M. Damiano,
ARA/ARC
Agency/Hospital
Cost-Sharing
Formula
IT Support
J. Hart
Process for
Consent
M. Damiano,
ARA/ACR
Movement toward
Level 6- Full
Collaboration in
Transformed/Merged
Integrated Practice
Six Levels of
Collaboration/
Integration
Tele-psychiatry
Services
Implemented
Improved Medication
Management and
Treatment for
Children and
Adolescents
Improve Care
Coordination via:
- Medication
Reconciliation
- Shared Case Notes
C. Murphy, TCC
W. Penman, ACASA
The Counseling Center
D. Lewis, ACASA
59
OBJECTIVE #2: Identify and strengthen opportunities for implementing MEB health promotion and MEB
disorder prevention with individuals.
Source: NYS Office of Mental Health, Suicide Prevention Center
Evidence Base: Yes
Policy Change (Y/N): No
ACTION PLAN
Activity
Target
Date
Resources
Required
Lead Person/
Organization
Anticipated
Product or
Result
Support the Allegany County
Suicide Prevention Coalition in its
efforts to improve mental health
awareness and acceptance through
a multipronged anti-stigma
campaign; addressing institutional
stigma, societal stigma and
individual stigma.
efforts to increase the number of
gatekeepers trained through the
evidence-based curriculum
SafeTALK (Talk, Ask, Listen and
Keep Safe)
3/2014
Expanded Grant
Funds; current
funds include
MHANYS and
AC United Way
Funds
Helen Evans,
Allegany/Western
Steuben Rural Health
Network, Inc.
Print Advertising
efforts to increase the number of
professionals trained through the
evidence-based curriculum ASIST
(Applied Suicide Intervention Skills
Training).
12/2014
12/2014
Expanded Grant
Funds; current
funds include
MHANYS and
AC United Way
Funds
Expanded Grant
Funds; current
funds include
MHANYS and
AC United Way
Funds
Lindy White, Allegany
County Community
Services
Helen Evans,
Allegany/Western
Network, Inc.
County Community
Services
Helen Evans,
Allegany/Western
Network, Inc.
Progress
Notes
Promotional Items
Radio Advertising
Increase Suicide
First Aid in
Community-AtLarge
Increase Suicide
Intervention Skills
in the Professional
Community
County Community
Services
OBJECTIVE #3: Collaborate with the physical health community to identify opportunities to provide cross systems
training
Source: Office of Alcohol and Substance Abuse (NYS OASAS) and Department of Health and Human Services
Evidence Base: Yes
Policy Change (Y/N): Yes
ACTION PLAN
Activity
Standardize substance use
screening in the Primary Care
Setting through the development of
protocols using the Screening,
Brief Intervention and Referral to
Treatment (SBIRT) approach.
Protocols will comply with AMA
and CMS Guidelines allow for
Target
Date
Resources
Required
Lead Person/
Organization
Anticipated
Product or
Result
12/2015
Professional
Development for
SBIRT for PCP’s
employed by
JMH
J. Hart, JMH will
mandate the training
after EMR is complete
in Summer of 2014
PCP’s trained to
use SBIRT
Progress
Notes
60
maximum billing under CPT codes
99408, 99409, CMS codes G0396,
G0397, and SBI codes H0049 and
0050.
Develop a Quick Reference Guide
to enhance referral strategies for
individuals screened positive in
Primary Care Settings using the
SBIRT.
Implement SBIRT in one (1) PCP
office for test-piloting with
anticipating spread to additional
sites.
Standardize adult depression
screening in the Primary Care
Setting through the development of
protocols using the PHQ9
Depression Screening Tool.
Protocols will comply with CMS
Guidelines to allow for maximum
billing under G0444 “Annual
depression screening, 15 minutes”
code.
Develop a Quick Reference Guide
to enhance referral strategies for
individuals screened positive in
Primary Care Settings using the
PHQ9 Depression Screening.
Implement PHQ-9 in one (1) PCP
office for test-piloting with
anticipating spread to additional
sites.
12/2015
Personnel
Printing/Copying
W. Penman, ACASA
Quick Reference
Guide
3/2015Ongoing
Integration of
SBIRT in EMR
J. Hart, JMH
Improve screening
and referral for
substance use in
the PCP setting
PCP’s trained to
use PHQ-9
M. Conklin
12/2014
Professional
Development for
PHQ-9 for PCP’s
employed by
JMH
J. Hart, JMH will
mandate the training
after EMR is complete
in Summer of 2014
12/2014
Personnel
Printing/Copying
T. Moore, ACDOH
MEB committee
Quick Reference
Guide
3/2014Ongoing
Integration of
PHQ-9 in EMR
J. Hart, JMH
Improve screening
and referral for
adult depression in
the PCP setting
M. Conklin, CMH
ALIGNMENT WITH STATE/NATIONAL PRIORITIES
Obj #
1
2
3
NYSDOH Prevention Agenda
2013-2017
Strengthen infrastructure for MEB
health promotion and MEB
disorder prevention.
Healthy People 2020
National Prevention Strategy
AHS-5.1 Increase the proportion of
adults age 18-64 who have a specific
source of ongoing care.
MHMD-1 Reduce the suicide rate.
3. Provide individuals and families
with the support necessary to
maintain positive mental well-being.
3.Provide individuals and families
with the support necessary to
maintain positive mental well-being.
SA-8 Increase the proportion of
persons who need alcohol and/or
illicit drug treatment and received
specialty treatment for abuse or
dependence in the past year)
4.Promote early identification of
mental health needs and access to
quality services
MHMD-11.1 Increase the proportion
of primary care physicians who
screen adults aged 19 years and
older for depression during office
visits.
61
DESCRIBE PLANS FOR SUSTAINING ACTION
The Mental, Emotional, and Behavioral Health Committee (MEB) will meet on a quarterly basis to plan, implement and
evaluate activities. Sustainment will be completed by tracking progress and making midcourse corrections as needed.
Obj. 1 & 3 Sustainment will be dependent upon maximizing billable services to support the cost of the primary care delivery
system.
Obj. 2: Sustainment will be by training gatekeepers and professionals to carry out suicide prevention, intervention, and
postvention strategies.
Prevention Agenda Priority for 2013-2017:
Focus Area: Reduce Obesity in Children and Adults
GOAL: Create community environments that promote and support healthy food and beverage choices and physical
activity.
PERFORMANCE MEASURES
How We Will Know We are Making a Difference
Short Term Indicators
Source
Frequency
OBJECTIVE #1: Improve “Girls on the Run” participants who demonstrate
favorable self-esteem, eating attitudes and behaviors, physical activity attitude, and
body size satisfaction as measured in the pre-posttest surveys results.
OBJECTIVE #2: Individuals living with chronic illness who participate in the
Chronic disease Self-Management (CDSM) Program will demonstrate significant
improvements in exercise, cognitive symptom management, communication with
physicians, self-reported general health, health distress, fatigue, disability, and
social/role activities limitations. Graduates will spend fewer days in the hospital and
decrease outpatient visits and hospitalizations.
OBJECTIVE #3: Individuals diagnosed as Pre-Diabetic will increase awareness and
knowledge of the seriousness of diabetes, its risk factors, and effective strategies for
(1) preventing complications associated with diabetes and (2) preventing type 2Diabetes. A minimum of 50% of DPP participants will increase and sustain effective
lifestyle changes to prevent diabetes; including losing 7% of body weight through
healthy eating and physical activity.
Long Term Indicators
Pre & Post Test
Before and
after every
cohort
Before and
after every
cohort
OBJECTIVE #1: Increasing the number of participants in the program; increase the
number of sites throughout Allegany County by 100% at the end of three years
OBJECTIVE #2: Decrease hospital readmission rates
OBJECTIVE #3: Maintain or decrease incidence of diabetes
Pre & Post Test
Pre & Post Test
Before and
after every
cohort
Source
Frequency
Girls on the Run
Council
JMH Data
Cuba Data
Department of
Health and Human
Services CDC
National Diabetes
surveillance system
% adult population
estimate
Annually
Annually
3 Years/as
available
62
OBJECTIVE #1: Improve “Girls on the Run” participants who demonstrate favorable self-esteem, eating attitudes
and behaviors, physical activity attitude, and body size satisfaction as measured in the pre-post test surveys results.
Source: Girls on the Run
Evidence Base: Y
Policy Change (Y/N): N
Disparity (Y/N): Y, Socioeconomic
Activity
Secure funding to establish an
Allegany County “Girls on the
Run” Council
Target
Date
Resources
Required
Lead Person/
Organization
Anticipated
Product or Result
6/2014
$7,500.00
H. Evans, AWSRHN
Council successfully
chartered
Progress
Notes
B. Szabo, JMH
M. Conklin, CMH
Continue to sponsor and support
the Wellsville Girls on the Run
Program
6/2014
Coaches
T. Moore, ACDOH
B. Szabo, JMH
Promote running as a
Life Skill
Grant Funding
Pre/Post Test
Safe Green Space
and/or Trail
Increase Self Esteem
Meeting Space
Expand reach annually with a
minimum of one new “Girls on the
Run” site/year
6/2015 –
Ongoing
Healthy Snack
Additional
Coaches
JMH has
graduated its
first Girls on
the Run
group;
11/2013
Improved Body
Image
B. Szabo, JMH
Promote running as a
Life Skill
T. Moore, ACDOH
Scholarship
Funds for Girls
Pre/Post Test
M. Conklin, CMH
Increase Self Esteem
Safe Green Space
and/or Trails
Improved Body
Image
Meeting Space
Monitor pre-post test results to
guide programming changes as
needed
11/2013Ongoing
Explore the potential expansion
to include “Girls on Track”
grades 6-8.
6/2015
Healthy Snack
Pre-Post Test
Analysis
Additional
Coaches
Additional
Funding
B. Szabo, JMH
Program evaluation
and outcomes
B. Szabo, JMH
T. Moore, ACDOH
H. Evans, AWSRHN
M. Conklin, CMH
Build on the age
continuum if
appropriate
63
OBJECTIVE #2: Individuals living with chronic illness who participate in the Chronic disease Self Management
(CDSM) Program will demonstrate significant improvements in exercise, cognitive symptom management,
communication with physicians, self-reported general health, health distress, fatigue, disability, and social/role
activities limitations. Graduates will spend fewer days in the hospital and decrease outpatient visits and
hospitalizations.
Source: Stanford School of Medicine- Stanford Patient Education Research Center
Evidence Base: Y
Activity
Coordinate Stanford University’s
Chronic Disease SelfManagement (CDSM) Program
marketing, registration and
planning targeting individuals and
caregivers living with a chronic
illness, healthcare professionals,
health and human service
organizations, media outlets, etc.
Expand the number of trained
local CDSM Leaders from the
current census of six (6) to ten
(10).
Target
Date
Resources
Required
Lead Person/
Organization
Anticipated
Product or Result
1/2014Ongoing
Print
AdvertisingFunding
H. Evans, AWSRHN
A minimum of ten
(10) registrations/
quarter.
Referrals (Selfreferrals/Medical
Referrals)
M. Conklin, CMH
6/2014
Outreach to
Healthcare
Providers
Volunteer
Leaders
J. Hart, JMH
Progress
Notes
T. Moore, ACDOH
H. Evans
10 CDSM Leaders
J. Hart, JMH
Master Trainers
M. Conklin, CMH
T. Moore, ACDOH
P2 Collaborative of
WNY
QTAC
Deliver quarterly Stanford
University’s Chronic Disease
Self-Management (CDSM)
Program workshops consisting of
two and a half hours, once a
week, for six weeks, in
community settings such as
senior centers, worksites,
churches, libraries and hospitals.
Monitor and evaluate the
effectiveness of CDSM in relation
to established Quality Indicators;
i.e. hospital admission rates, ER
utilization, self-reported chronic
illness indicators.
1/2014Ongoing
CDSM Trained
Leaders
H. Evans, AWSRHN
CDSM Leaders
Workshop Sites
QTAC
Workshop
Materials
3/2014Ongoing
Hospital-Based
data
H. Evans, AWSRHN
J. Hart, JMH
M. Conklin, CMH
QTAC
100 CDSM graduates
will demonstrate
significant
improvements in
chronic illness selfmanagement skills
Reduction in
readmissions;
graduates will
demonstrate
significant
improvements in
chronic illness selfmanagement skills
64
OBJECTIVE #3: Individuals diagnosed as Pre-Diabetic will increase awareness and knowledge of the seriousness of
diabetes, its risk factors, and effective strategies for (1) preventing complications associated with diabetes and (2)
preventing type 2-Diabetes. A minimum of 50% of DPP participants will increase and sustain effective lifestyle
changes to prevent diabetes; including losing 7% of body weight through healthy eating and physical activity.
Source: Center for Disease Control and National Institutes for Health
Evidence Base: Y
Activity
Complete DPP Recognition
Application with the Center for
Disease Control.
Coordinate the National Diabetes
Prevention Program for
individuals diagnosed as PreDiabetic, conducting outreach
and marketing to healthcare
professionals, health and human
service organizations, worksite
wellness programs, media
outlets, etc.
Attend community-based health
fairs and outreach events to
promote the American Diabetes
Association Type 2 Diabetes Risk
Test; enrolling anyone scoring atrisk or pre-diabetic into DPP.
Recruit and retain a minimum of
four (4) local DPP Volunteer
Lifestyle Coaches to deliver the
DPP Program.
Target
Date
Resources
Required
Lead Person/
Organization
Anticipated
Product or Result
3/2014
Application
H. Evans, AWSRHN
DPP Recognition
1/2014Ongoing
Print
AdvertisingFunding
H. Evans, AWSRHN
A minimum of ten
(10) registrations/
quarter.
K. Dahlgren, NDEP
Consultant
Referrals (Selfreferrals/Medical
Referrals)
1/2014Ongoing
3/2014
Outreach to
Healthcare
Providers and
Worksite
Wellness
Coordinators
Computer based
AMA Risk Test
or Paper Risk
Test
Volunteer
Leaders
Progress
Notes
AWSRHN
awarded a
grant via the
NYS Health
Foundation
to launch
DPP
K. Dahlgren
is currently a
DPP
Facilitator
H. Evans, AWSRHN
A minimum of five
(5) events
K. Dahlgren, NDEP
Consultant
H. Evans
J. Hart, JMH
Four (4) DPP
Volunteer Lifestyle
Coaches
P2 Collaborative
M. Conklin, CMH
NYS Health
Foundation
Stagger quarterly Diabetes
Prevention Program (DPP)
workshops in community settings
such as senior centers, worksites,
churches, libraries and hospitals.
Participants will work with a
lifestyle coach in a group setting
to receive a 1-year lifestyle
change program that includes 16
core sessions (usually 1 per
week) and 6 post-core sessions
(1 per month).
1/2014Ongoing
Monitor and evaluate the
effectiveness of DPP in relation to
3/2014Ongoing
DPP Lifestyle
Coaches
T. Moore, ACDOH
P2 Collaborative of
WNY
H. Evans, AWSRHN
DPP Lifestyle Coaches
Workshop Sites
Workshop
Materials
Hospital-Based
data
ACDOH
Allegany County OFA
H. Evans, AWSRHN
50 DPP graduates
will demonstrate
significant lifestyle
changes; i.e. weight
loss.
Improved Quality
Indicators
65
established Quality Indicators; i.e.
Glucose Levels, ER Utilizations,
In-Patient Visits, number of
participants, retention rates, etc.
J. Hart, JMH
M. Conklin, CMH
ALIGNMENT WITH STATE/NATIONAL PRIORITIES
NYSDOH Prevention Agenda
2013-2017
Create community environments
that promote and support healthy
food and beverage choices and
physical activity.
Healthy People 2020
National Prevention Strategy
PA-3 Increase the proportion of
adolescents who meet current
Federal physical activity guidelines
for aerobic physical activity and for
muscle-strengthening activity.
Improve health, fitness and quality of
life through daily physical activity.
Improve the health function and
quality of life and wellbeing for all
individuals.
Healthy Eating 4.Help people recognize and
make healthy food and beverage choices.
Active Living 2. Promote and strengthen
school and early learning policies and
programs that increase physical activity.
physical activity.
Promote health and reduce chronic
disease risk though the consumption
of helpful diets and achievement and
maintenance of healthy body weights.
Improve the health function and
quality of life in older adults.
Improve health related quality of life
and wellbeing for all individuals.
Healthy Eating 4.Help people recognize and
physical activity.
D-16 Increase prevention
behaviors in persons at high risk for
diabetes with pre-diabetes.
Improve health related quality of life
and wellbeing for all individuals.
Healthy Eating 4. Help people recognize and
DESCRIBE PLANS FOR SUSTAINING ACTION
Health and Wellness Committee will meet on a quarterly basis to plan, implement and evaluate activities. Sustainment will
be completed by tracking progress and making midcourse corrections as needed.
The Health and Wellness Committee will explore funding sources and use of trained volunteers wherever possible.
66

Allegany County Department of Health CHA and CHIP for 2014-2017

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