Community Health Needs Assessment 2013 Akron Children’s Hospital Beeghly Campus

Community Health Needs Assessment
2013
Akron Children’s Hospital
Beeghly Campus
6505 Market St.
Boardman, OH 44512
www.akronchildrens.org
Table of Contents
Executive Summary......................................................................................................................... 2
Background
Purpose ............................................................................................................................... 3
Request Copies and More Information .............................................................................. 4
Description of Hospital Facility ........................................................................................... 4
Description of Community Served ...................................................................................... 5
Methodology
Approach ............................................................................................................................. 7
Epidemiologic Data ............................................................................................................. 8
Community Leader Interviews ............................................................................................ 9
Community Resident Focus Groups.................................................................................. 10
Other Community Health Needs Assessments ................................................................. 14
Prioritization Process ........................................................................................................ 15
Community Resources .................................................................................................................. 16
Summary of Results ...................................................................................................................... 19
Conclusions ................................................................................................................................... 20
Acknowledgements....................................................................................................................... 22
Community Health Needs Assessment
EXECUTIVE SUMMARY
Akron Children’s Hospital operates two hospitals: one at its Akron campus and one at its
Beeghly campus in Boardman, Ohio in Mahoning County. The area’s only pediatric hospital,
Akron Children’s Hospital Mahoning Valley opened in December 2008. This non-profit, 32-bed
pediatric hospital offers a full range of pediatric services to the children of the Mahoning Valley
and surrounding areas, including access to a 24/7 emergency department, laboratory,
radiology, outpatient surgical center, endocrinology, rehabilitation and EEG/ECHO/EKG
services, as well as a hematology/oncology clinic and infusion center and child advocacy center.
In 2013, Akron Children’s Hospital Mahoning Valley partnered with Kent State University to
conduct a Community Health Needs Assessment (CHNA). During the CHNA process,
epidemiologic data were reviewed and compared to the rates for Trumbull, Mahoning, and
Columbiana Counties to two peer counties, the state, the nation, and Healthy People 2020
objectives. Input was also obtained from community leaders and community residents and
CHNAs conducted by other community groups were consulted. All of this information was used
to develop a list of prioritized health needs for children in Trumbull, Mahoning, and Columbiana
Counties.
The unranked list of prioritized health needs for children that were identified across all three
counties were:
Chronic Diseases
• Asthma
• Diabetes
Maternal & Infant Health
• Premature Births
• Low & Very Low Birth Weight
• Infant, Neonatal, & Post-Neonatal Mortality
Child Lifestyle Factors
• Overweight & Obesity
• Exercise
• Nutrition
Mental Health
Substance Abuse
• Opioid Drug Abuse
Sexually Transmitted Diseases
• Adolescent Gonorrhea
Access to Health Care
• Health Insurance Coverage
• Access to Dental Care
• Mental Health Insurance Coverage
• Number of Pediatric Specialists
Environmental Factors
• Access to Healthy Food
These prioritized health needs are being used by Akron Children’s Hospital Mahoning Valley to
guide intervention and outreach efforts aimed at improving community health.
Background information on the CHNA, the methodology used to conduct the CHNA, and the
results of the analysis are contained in this report.
2
Community Health Needs Assessment
BACKGROUND
Purpose
In keeping with Akron Children’s Hospital’s mission, relationships have been established with
various community and professional organizations who share common goals for the delivery of
services to children and families with a focus on access and improvement of health outcomes.
To better identify the health needs of the community, Akron Children’s Hospital Mahoning
Valley engaged in a more formalized process with Kent State University to provide a Community
Health Needs Assessment to validate and prioritize the needs of the community we serve.
In March 2010, the US Congress passed and President Obama signed the Patient Protection and
Affordable Care Act (ACA). The ACA contains numerous changes to the US health care system,
including requiring non-profit hospitals to conduct CHNAs every three years. The Internal
Revenue Service (IRS), the federal agency that is charged with enforcing these new
requirements, has issued regulations pertaining to these new reporting requirements of nonprofit hospitals. These regulations require CHNAs to include a description of:
• The community served and how it was defined;
• The process and methods used to conduct the assessment, including a description of the
sources and dates of the data and other information used in the assessment and the
analytical methods applied to identify community health needs;
• The information gaps that impact the ability to assess health needs;
• Collaborating hospitals and vendors used while conducting the CHNA;
• How input was received from persons who have expertise in public health and from
persons who represent the broad interests of the community, including a description of
when and how these persons were consulted;
• The prioritized community health needs, including a description of the process and
criteria used in prioritizing the health needs;
• Existing health care facilities and other resources within the community available to
meet the prioritized community health needs;
Akron Children’s Hospital Mahoning Valley has a long history of collaboration on a wide range
of projects aimed at improving community health. The results of this CHNA will help guide
these intervention efforts and will also act as a resource for other community groups working
toward improving the health of the community.
3
Community Health Needs Assessment
Request Copies and More Information
In addition to being publicly available on our website, a limited number of reports have been
printed. If you would like a copy of this report or if you have any questions about it, please
contact:
Heather Wuensch
Akron Children’s Hospital
One Perkins Square
Akron, OH 44308
Phone: 330-543-8130
Email: hwuensch@chmca.org
http://www.akronchildrens.org
Roseann Marsico
Akron Children’s Hospital Mahoning Valley
Beeghly Campus
6505 Market Street
Boardman, OH 44512
Phone: 330-746-8701
Email: rmarsico@chmca.org
http://www.akronchildrens.org/mv
Description of Hospital Facility
Akron Children’s Hospital operates two hospitals: one at its Akron campus and one at its
Beeghly campus in Boardman, Ohio in Mahoning County. The area’s only pediatric hospital,
Akron Children’s Hospital Mahoning Valley opened in December 2008. This non-profit, 32-bed
pediatric hospital offers a full range of pediatric services to the children of the Mahoning Valley
and surrounding areas. The hospital provides access to a 24/7 emergency department,
laboratory, radiology, outpatient surgical center, endocrinology, rehabilitation and
EEG/ECHO/EKG services, as well as a hematology/oncology clinic and infusion center and child
advocacy center. During calendar year 2012, the following patient encounters occurred on the
Beeghly campus: 1,739 inpatient and observation admissions, 27,774 emergency room visits,
and 22,528 specialty visits.
Akron Children’s also owns and operates a 19-bed Level II Special Care Nursery at the hospital’s
Beeghly campus and a 25-bed Level IIIB Neonatal Intensive Care Unit at St. Elizabeth Health
Center in Youngstown. Akron Children's neonatal team is committed to providing the most
effective and efficient care for our tiniest patients, as well as providing parents with the
emotional and educational support they need.
Also located in the Mahoning Valley is the Community Outreach, Education & Support Center,
which provides education and support for children and their families. These programs meet
specified criteria of nationally accredited disease management programs, as well as Akron
Children's criteria and monitoring requirements. Our community health outreach includes
asthma and diabetes education and support, school programs, disease-specific camps and
support groups, fitness programs, community events and educational programs that touched
more than 45,000 individuals in calendar year 2012.
In 2012, Akron Children’s Hospital was re-designated as a Magnet hospital by the American
Nurses Credentialing Center’s (ANCC) Magnet Recognition Program®. This is the highest
recognition granted by ANCC and recognizes the very best in nursing care. Ranked a Best
Children’s Hospital by US News & World Report, Akron Children’s Hospital is the largest
4
Community Health Needs Assessment
pediatric provider in northeast Ohio. Akron Children’s Hospital has been caring for children
since 1890 guided by three promises that we consider sacred: To care for all children as if they
were our own; to treat everyone the way we would want to be treated; and to turn no child
away for an inability to pay. For more information, visit www.akronchildrens.org/mv.
Description of Community Served
Akron Children’s Hospital Mahoning Valley has and continues to serve patients and families
from many communities across the region. Most people who receive services from the hospital
are located in Mahoning, Trumbull and Columbiana Counties. Thus, for the purposes of this
report, the community identified for this CHNA consists of those counties.
Akron Children's Hospital Mahoning Valley Community
Discharges from Akron Children's Hospital Mahoning Valley NICU,
Special Care Nursery and Pediatrics Unit (2012)
County Where Patients Reside
Mahoning County
Trumbull County
Columbiana County
All Other
Akron Children's Hospital Mahoning Valley %
55%
20%
14%
11%
Trumbull County
There are approximately 207,406 people living in Trumbull County, which is a decrease of 1.4%
since 2010. There are 7 cities and 5 villages in Trumbull County, with the county seat being
Warren. Compared to the State of Ohio, Trumbull County has a slightly smaller proportion of
children (under 18 years old) and a larger proportion of older adults (65 years and older).
Nearly 8% of the population in Trumbull County is Black or African American and 1.5% is
Hispanic or Latino compared to 12.5% and 3.3%, respectively, in the State of Ohio. Educational
attainment in Trumbull County is lower than the State of Ohio with 87.1% having a high school
diploma or higher and 16.6% having a bachelor’s degree or higher. Similarly, annual per capita
income in Trumbull County is lower than the State of Ohio and the percent of Trumbull County
residents living in poverty is higher than that of the State.
Mahoning County
There are approximately 235,145 people living in Mahoning County, which is a decrease of 1.5%
since 2010. There are 7 cities and 7 villages in Mahoning County, with the largest being
Youngstown. Compared to the State of Ohio, Mahoning County has a smaller proportion of
children (under 18 years old) and a higher proportion of older adults (65 years and older).
Sixteen percent of the population in Mahoning County is Black or African American and 5.0% is
Hispanic or Latino compared to 12.5% and 3.3%, respectively, in the State of Ohio. The percent
of Mahoning County residents with a high school diploma or higher is roughly the same as the
State of Ohio, but the percent with a bachelor’s degree or higher is lower than the State. The
annual per capita income in Mahoning County is lower than the State of Ohio and the percent
of Mahoning County residents living in poverty is higher than the State average.
5
Community Health Needs Assessment
Columbiana County
There are approximately 106,507 people living in Columbiana County, which is a decrease of
1.2% since 2010. There are 3 cities, 11 villages, and 18 townships in Columbiana County, with
the largest being Salem. Compared to the State of Ohio, Columbiana County has a smaller
proportion of children (under 18 years old) and a higher proportion of older adults (65 years
and older). Approximately 2.4% percent of the population in Columbiana County is Black or
African American and 1.4% is Hispanic or Latino compared to 12.5% and 3.3%, respectively, in
the State of Ohio. The percent of Columbiana County residents with a high school diploma or
higher is lower than the State of Ohio and the percent with a bachelor’s degree or higher is
nearly half of the State average (13.0% versus 24.5%). The annual per capita income in
Columbiana County is much lower than the State of Ohio and the percent of Columbiana
County residents living in poverty is higher than the State average.
Table 1. Demographic Characteristics of Communities Served and the State of Ohio
Trumbull
Mahoning
Columbiana
1
Total population
207,406
235,145
106,507
2
Percent population change
-1.4%
-1.5%
-1.2%
1
Percent under 18 years old
21.5%
20.9%
21.2%
1
Percent 65 years and older
18.4%
18.4%
17.3%
1
Percent female
51.4%
51.5%
49.7%
1
Percent Black or African American
8.4%
16.0%
2.4%
1
Percent Hispanic or Latino
1.5%
5.0%
1.4%
3
Percent with high school diploma or higher
87.1%
87.9%
85.7%
3
Percent with bachelor’s degree or higher
16.6%
20.9%
13.0%
4
Homeownership rate
73.7%
71.6%
74.5%
4
Median value of owner-occupied housing units
$100,500
$97,800
$97,700
4
Persons per household
2.39
2.36
2.46
4
Annual per capita income
$22,127
$23,261
$20,691
4
Median household income
$42,441
$40,570
$41,003
4
Percent living below poverty level
16.4%
17.1%
15.9%
1
2
3
4
Notes: 2012 estimate, Since 2010, persons age 25+, 2007-2011, 2007-2011
Source: US Census Bureau (http://quickfacts.census.gov/qfd/maps/ohio_map.html)
Ohio
11,544,225
0.1%
23.1%
14.8%
51.1%
12.5%
3.3%
87.8%
24.5%
68.7%
$135,600
2.46
$25,618
$48,071
14.8%
6
Community Health Needs Assessment
METHODOLOGY
Approach
To conduct the Community Health Needs Assessment, a modified version of a well-established
framework for strategic planning in public health called “Mobilizing for Action through Planning
and Partnerships” or MAPP process was followed. MAPP has been utilized by numerous public
health stakeholders to strengthen and improve local community health through collaborative
and methodical processes involving multiple stakeholders.
The MAPP process has six phases:
1. Organizing for success and
developing partnerships
2. Visioning
3. Conducting MAPP assessments
4. Identifying strategic issues and
prioritizing identified issues
5. Formulating goals and strategies
6. Taking action (planning,
implementing, and evaluating
programs/policies)
In the first phase, Akron Children’s Hospital
Mahoning Valley convened meetings and
discussed the new IRS requirements
pertaining to CHNAs, the resources needed to
conduct the CHNA, and the desire to hire a contractor to help facilitate the process. At the end
of the first phase, the hospital solicited a proposal from Kent State University College of Public
Health (KSU-CPH) and then hired KSU-CPH to facilitate the development of the CHNA.
In the second phase, meetings were held to identify a vision and process to conduct the CHNA,
which were determined primarily by the specific requirements of CHNAs mandated by the IRS.
A work plan with anticipated timelines was also created.
In the third phase, existing county-level epidemiologic data were gathered instead of collecting
data through a survey due to concerns of self-report bias with the latter approach. In addition,
interviews with community leaders and focus groups with community residents were
conducted. Some hospital-based data were also added to the analysis. A Local Public Health
System Assessment and a Forces of Change Assessment were not conducted because the TriCounty Community Health Assessment & Planning Initiative conducted them in 2011.
In the fourth phase, a series of meetings were held to identify the prioritized health needs
based on the epidemiologic data, the input from community leaders and residents, and other
CHNAs that had been previously been conducted. Health needs were prioritized for children
only.
7
Community Health Needs Assessment
In the fifth and six phases, Implementation Plans were developed that identified the strategies
the hospital will undertake to address some of the prioritized health needs identified in the
fourth phase.
The hospital’s Implementation Plans will be publicly available at
www.akronchildrens.org by Dec. 31, 2013.
Epidemiologic Data
The epidemiologic data used in this report were collected from a variety of sources that report
information at the county, state, and national levels. The epidemiologic data collected
represented a very wide range of factors that affect community health such as mortality rates,
health behaviors, environmental factors, and health care access issues.
County Health Rankings
The County Health Rankings & Roadmaps program is a collaboration between the Robert Wood
Johnson Foundation and the University of Wisconsin Population Health Institute. The program
collects information on mortality, morbidity, health behaviors, clinical care, social and economic
factors, and physical environment at a county-level for nearly all counties in the United States.
Some data reported are actual counts based on actual reports (i.e., reported disease
diagnoses), some data are estimated based on samples (i.e., the Behavioral Risk Factor Survey),
and some data are modeled to obtain a more current estimate (i.e., projected 2012 estimates
based on 2010 census data). For more information about the County Health Rankings program,
please visit: www.countyhealthrankings.org.
Community Health Status Indicators
The Community Health Status Indicators project is a partnership between the Centers for
Disease Control and Prevention, the National Institutes of Health/National Library of Medicine,
the Health Resources Services Administration, the Public Health Foundation, the Association of
State and Territorial Health Officials, the National Association of County and City Health
Officials, the National Association of Local Boards of Health, and the Johns Hopkins University
School of Public Health. Similar to the County Health Rankings project, the Community Health
Status Indicators project collects information on a variety of sources and generates county
profiles. Currently, most of the data are from 2009, however it does contain information that
the County Health Rankings does not. For more information about the Community Health
Status Indicators project, please visit: wwwn.cdc.gov/CommunityHealth/HomePage.aspx.
Community Health Needs Assessment Toolkit
The Community Health Needs Assessment Toolkit is a collaborative partnership between the
Kaiser Permanente; the Institute for People, Place, and Possibility (IP3); the Centers for Disease
Control and Prevention; and other partners that seek to make freely available data that can
assist hospitals, non-profit organizations, state and local health departments, financial
institutions, and other organizations seeking to better understand the needs and assets of their
communities and to collaborate to make measureable improvements in community health and
well-being. Similar to the County Health Rankings program, the Community Health Needs
Assessment Toolkit project collects information from a variety of sources and creates county8
Community Health Needs Assessment
level profiles for comparison purposes. For more information about the Community Health
Needs Assessment Toolkit, please visit: assessment.communitycommons.org.
Ohio Department of Health
The Ohio Department of Health is a cabinet-level agency that administers most of the state’s
state-level health programs including coordination of the activities for child and family health
services, health care quality improvement, services for children with medical handicaps,
nutrition services, licensure and regulation of long-term care facilities, environmental health,
prevention and control of injuries and diseases, and others. County-level data that could be
compared to national statistics were collected in a variety of areas and used in this CHNA. For
more information about the data available at the Ohio Department of Health, please visit:
www.odh.ohio.gov/healthstats/datastats.aspx
Annie E Casey Foundation
The Annie E Casey Foundation runs a program called KIDS COUNT®, which is a national and
state-by-state effort to track the wellbeing of children in the United States. KIDS COUNT®
collects and reports data at the county-level in a variety of areas related to child health
including demographics, education, economic well-being, health, safety and risky behaviors,
and other indicators. Most of the data in KIDS COUNT® for Ohio is supplied by Ohio’s Children’s
Defense Fund and is taken from a variety of sources, including the Ohio Department of Health.
For more information about KIDS COUNT®, please visit: datacenter.kidscount.org.
Ohio Hospital Association
Established in 1915, the Ohio Hospital Association is the nation’s first state-level hospital
association. OHA collaborates with member hospitals and health systems to meet the health
care needs of their communities and to create a vision for the future of Ohio’s health care
environment. OHA, in coordination with member hospitals, have developed new web based
software called “Insight” that allows hospitals to run customized and standard reports for
Marketing, Physician Recruiting, Business Development and Benchmarking purposes. Several
health indicators were drawn from OHA’s Insight system with their permission. For more
information about OHA Insight, please visit: http://www.ohanet.org/insight/
Community Leader Interviews
In addition to examining the county-level epidemiologic data, interviews were conducted with
community leaders in July – August 2013 to gain their insight on what they thought were the
significant health needs of children and adults in their communities, the factors that affect
those health needs, other existing community health needs assessments, possible collaboration
opportunities, and to get suggestions on what the hospitals can do to address the significant
health needs identified in the CHNA. These community leaders represent the broad interests of
the communities served by the hospital facility including the medically underserved, lowincome persons, minority groups, those with chronic disease needs, and leaders from local
public health agencies and departments who have special knowledge and expertise in public
health.
9
Community Health Needs Assessment
Leaders from the following community organizations were consulted during this CHNA:
• Youngstown City Health District, Acting Health Commissioner
• Youngstown/Warren Regional Chamber, President & Chief Executive Officer
• Pediatric Associates of Youngstown, Physician
• Mahoning County Children’s Services, Quality Improvement Supervisor
• Help Hotline Crisis Center, Chief Executive Officer
• Mahoning County District Board of Health, Health Commissioner
• Trumbull County Women, Infants, and Children (WIC) Program, Director
• Trumbull County Mental Health and Recovery Board, Director of Evaluation & Quality
Improvement
• Trumbull County Children’s Services, Executive Director
• St. Joseph Health Center, Chair of Pediatrics
• Columbiana County Mental Health and Recovery Services Board, Executive Director
• Portage/Columbiana Counties Women, Infants, and Children (WIC) Program, Director
• The Morning Journal, Editor
• Salem Community Hospital, Vice President for Medical Affairs
• Columbiana County Educational Service Center, Superintendent
• Columbiana County Department of Job and Family Services, Children’s Services
Administrator
• Coordinated Action for School Health (CASH) Coalition, Coordinator
• Columbiana County Health Department, Health Commissioner
Community Resident Focus Groups
In addition to the input from community leaders, focus groups were conducted with
community residents in August – September 2013 to get their input on what they thought were
the significant health needs of children and adults in their communities, the factors that affect
those needs, the solutions they thought would solve those needs, and what the hospitals and
other community groups could do to address those needs. Due to the observed information
gap in the epidemiologic data on the health of children, adult and child substance abuse issues,
and adult and child mental health issues, several questions were asked to probe more deeply
on these issues. In addition, a questionnaire was distributed to focus group participants to
gather demographic information and basic perceptions of community health. The discussion
guide, questionnaire, and protocol were reviewed and approved by the Kent State University
Institutional Review Board.
Recruitment
Community residents were recruited to participate in the focus groups by posting and
distributing flyers in the community. The sites where the community resident groups were held
were selected based on proximity to population areas, ease of access (including free parking
and bus lines), and recommendations from local community leaders. Community residents that
participated in the focus groups were given a $50 Visa gift card as a “thank you” and to
10
Community Health Needs Assessment
compensate them for their time and expense. A total of 82 people participated in the
Community Resident Focus Groups.
Characteristics of Participants
As noted in Table 2, participants were drawn from across the region and were diverse. Fifty
percent of participants were from Trumbull County, 31.7% from Mahoning County, and 18.3%
were from Columbiana County. The average number of years that participants lived in their
home county was 36.6 years. Six percent of participants were African American, 90.2% were
Caucasian, and 2.4% were Hispanic.
Table 2. Demographic Characteristics of Community Resident Focus Group Participants (n=82)
Characteristic
Number
County of Residence
Trumbull County
41
Mahoning County
26
Columbiana County
15
Number of Years Lived in County (average and SD)
Percent
50.0%
31.7%
18.3%
36.6
21.0
Racial Background
African American (or Black)
Asian American
Caucasian (or White)
Native Hawaiian or Other Pacific Islander
American Indian or Alaska Native
Other/Missing
5
0
74
1
0
2
6.1%
0.0%
90.2%
1.2%
0.0%
2.4%
Ethnic Background
Hispanic or Latino/a
Not Hispanic or Latino/a
Missing
2
73
7
2.4%
89.0%
8.5%
As noted in Table 3 (next page), participants had diverse household characteristics. Nearly 16%
percent of participants lived by themselves, 32.9% lived with one other person, 24.4% lived
with two other people, 15.9% lived with three other people, and 9.8% lived with four or more
people. Nearly 66% percent had no children in the home, 8.5% had one child, 6.1% had two
children, and 7.3% had three or more children in the home.
11
Community Health Needs Assessment
Table 3. Household Characteristics of Community Resident Focus Group Participants (n=82)
Characteristic
Number
Number of People in Home
One
13
Two
27
Three
20
Four
13
Five or More
8
Missing
Number of Children in the Home
None
One
Two
Three or More
Missing
54
7
5
6
10
Percent
15.9%
32.9%
24.4%
15.9%
9.8%
65.9%
8.5%
6.1%
7.3%
12.2%
As noted on Table 4, participants ranged in terms of their income and health insurance status.
Twelve percent of participants reported a monthly household income between $0-$999, 14.6%
between $1,000-$1,999, 11% between $2,000-$2,999, 17.1% between $3,000-$3,999, 6.1%
between $4,000-$4,999, and 22% reported monthly household income exceeding $5,000 per
month. In addition, 15.9% reported they had no health insurance, 39% had private health
insurance, 1.2% had health insurance as a veteran or member of the military, 24.4% had
Medicare, and 17.1% had Medicaid.
Table 4. Income and Insurance Status of Community Resident Focus Group Participants (n=82)
Number
Total Household Monthly Income
0-$999
10
$1,000 - $1,999
12
$2,000 - $2,999
9
$3,000 - $3,999
14
$4,000 - $4,999
5
$5,000 and Higher
18
Missing
14
Primary Type of Health Insurance
Uninsured
Private Health Insurance
Veterans/Military
Medicare
Medicaid
Other
Missing
13
32
1
20
14
0
2
Percent
12.2%
14.6%
11.0%
17.1%
6.1%
22.0%
17.1%
15.9%
39.0%
1.2%
24.4%
17.1%
0.0%
2.4%
12
Community Health Needs Assessment
As noted in Table 5, participants had diverse health care utilization experiences. Forty percent
stated that someone in their home did not receive health care due to the cost and that 42.7%
of them had someone in their home with a chronic disease or condition. Seven percent
reported that they usually don’t go to a doctor during the year, 12.2% go once per year, 24.4%
go twice per year, 9.8% go three times per year, 15.9% go four times per year, 11% go five to
nine times per year, and 8.5% go ten or more times per year.
Table 5. Health Care Status and Utilization of Community Resident Focus Group Participants (n=82)
Number
Had Someone in Home Who Did Not Receive Health Care Due to Cost
33
Percent
40.2%
Has Someone in Home With a Chronic Disease
35
42.7%
Times Per Year That Participant Goes To a Doctor
None
One
Two
Three
Four
Five to Nine
Ten or More
Missing
6
10
20
8
13
9
7
9
7.3%
12.2%
24.4%
9.8%
15.9%
11.0%
8.5%
11.0%
Participant’s Description of Current Health
Excellent
Very Good
Good
Fair
Poor
Missing
10
30
28
8
1
5
12.2%
36.6%
34.1%
9.8%
1.2%
6.1%
Lastly, as noted in Table 6 (next page), participants reported fairly diverse views of the health of
adults and children in their county. One percent of participants described the current health
status of adults in their county as “excellent,” 1.2% described it as “very good,” 32.9% described
it as “good,” 54.9% described it as “fair,” and 4.9% described the current health status of adults
in their county as “poor.” Participants rated the current health status of children in their
County slightly higher. None described it as “excellent,” 4.9% described it as “very good,” 50%
described it as “good,” 35.4% described it as “fair,” and 3.7% described the current health
status of children in their county as “poor.”
13
Community Health Needs Assessment
Table 6. Community Health Perceptions of Community Resident Focus Group Participants (n=82)
Number
Participant’s Description of Current Health of County Adults
Excellent
1
Very Good
1
Good
27
Fair
45
Poor
4
Missing
4
Participant’s Description of Current Health of County Children
Excellent
Very Good
Good
Fair
Poor
Missing
0
4
41
29
3
5
Percent
1.2%
1.2%
32.9%
54.9%
4.9%
4.9%
0.0%
4.9%
50.0%
35.4%
3.7%
6.1%
Other Community Health Needs Assessments
Lastly, prior community health needs assessments that were conducted in the region were also
reviewed and helped to inform this CHNA. Some of these CHNAs were known to the Steering
Committee, some were found using Internet searches, and some were sent to us by Community
Leaders.
The other CHNAs that were reviewed during the preparation of this CHNA included:
• Humility of Mary Health Partners, St. Elizabeth Health Center
• Tri-County Community Health Assessment & Planning Initiative
• East Liverpool City Hospital and Salem Community Hospital CHNA
• Humility of Mary Health Partners, St. Joseph Health Center
14
Community Health Needs Assessment
Prioritization Process
As mentioned previously, epidemiologic data for children were collected from a variety of
sources. To prioritize these health indicators, the data from Trumbull, Mahoning, and
Columbiana Counties were compared to their two peer counties in Ohio that were
demographically similar, the state and US averages, and the Healthy People 2020 target, if one
was available. To aid the prioritization process, the indicators were plotted on matrices.
Indicators listed on the left-hand side of the
matrix compared unfavorably to the two
comparison counties, the state, and the US.
Indicators on the right-hand side of the matrix
compared favorably to those benchmarks. In
addition, on each side of the matrix, it was noted
if the indicators were higher/lower than 2, 3, or 4
of the benchmarks. For example, indicators in
the upper left box of the matrix (shaded in red)
were “worse” in Mahoning County compared to
the two comparison counties, the State, and the
US. Indicators in the bottom right (shaded in
blue) were “better” in Mahoning County
compared to these benchmarks. The use of
these matrices helped the Steering Committee
quickly compare the vast amount of data to key
benchmarks and identify the prioritized health
needs based on the epidemiologic data.
The list of prioritized health needs resulting from the epidemiologic analysis was then
supplemented with additional health needs identified by community leaders and community
residents. A content analysis was conducted on the notes and transcripts of community leader
interviews and community resident focus groups to identify themes that consistently emerged.
The health areas listed below were the health needs identified for children by community
leaders and residents that were added to the list.
Community Leaders
• Nutrition
• Physical activity
• Obesity
• Mental health
• Substance abuse
• Number of pediatric specialists
Community Residents
• Obesity
• Mental health
• Diabetes
• Sexually transmitted diseases
15
Community Health Needs Assessment
COMMUNITY RESOURCES
There are a wide variety of resources in the community that can help address the prioritized
health needs identified in this CHNA.
Trumbull County
• Access Health Mahoning Valley
• Belmont Pines
• Child and Family Solutions
• Children's Rehabilitation Center of Warren, Ohio
• Churchill Counseling
• Coleman Professional Services
• Comprehensive Psych Services
• Easter Seals, Mahoning, Trumbull and Columbiana Counties
• Family and Children First Council
• Girl Scouts of Northeast Ohio
• H.C. Mines Intermediate School (Howland)
• Health Board: TCAP Head Start
• HMHP, St. Joseph Health Center
• Homes for Kids
• Kent State University
• Niles City Health Department
• One Health Ohio
• Potential Development
• PsyCare
• The Mayor Ralph A. Infante Wellness Center
• The Trumbull County Mental Health and Recovery Board
• Trumbull County Career and Technical Center (TCCTC)
• Trumbull County Children's Services
• Trumbull County Educational Service Center
• Trumbull County Health Dept
• Trumbull County Juvenile Justice Center
• United Methodist Community Ceter
• Valley Care, Hillside Rehabilitation Hospital
• Valley Care, Trumbull Memorial Hospital
• Warren City Health Department
• Warren City Schools
• WIC, Trumbull County
16
Community Health Needs Assessment
Mahoning County
• Access Health Mahoning Valley
• Beatitude House
• Central YMCA, Youngstown, Ohio
• Comprehensive Psych
• D&E Counseling
• Davis Family YMCA, Boardman, Ohio
• Easter Seals, Mahoning, Trumbull and Columbiana Counties
• Help Hotline Crisis Center, Inc.
• HMHP, St. Elizabeth Health Center
• Jewish Community Center of Youngstown
• Mahoning County Board of Health
• Mahoning County Children's Services
• Mahoning County Educational Service Center
• Mahoning County Juvenile Justice Center
• Mahoning County Mental Health Board
• Mahoning Youngstown Community Action Partnership
• One Health Ohio
• Pediatric Associates Of Youngstown
• Pioneering Healthier Communities; Youngstown
• Potential Development
• Second Harvest Food Bank of the Mahoning Valley
• Sojourner House
• The Mahoning County Board of Developmental Disabilities
• The Rich Center for Autism
• United Methodist Community Center
• United Way of Youngstown and the Mahoning Valley
• Valley Care Health System, Northside Medical Center
• Valley Counseling
• WIC, Mahoning County
• Youngstown City Health Department
• Youngstown City Schools
• Youngstown Hearing and Speech
• Youngstown State University
17
Community Health Needs Assessment
Columbiana County
• Columbiana County Career and Technical Center (CCCTC)
• Columbiana County Community Action Agency (Head Start)
• Columbiana County Dept of Job and Family Services
• Columbiana County Educational Service Center
• Columbiana County Health Dept
• Columbiana County Juvenile Court
• Columbiana County MHRS Board
• Columbiana County MRDD
• Damascus Elementary
• East Liverpool City Hospital
• Easter Seals, Mahoning, Trumbull and Columbiana Counties
• Hannah Mullins School of Practical Nursing
• Salem Community Center
• Salem Community Hospital
• Salem YMCA
• WIC, Columbiana County
National Organizations
• American Association of Pediatrics, Ohio Chapter
• American Diabetes Association
• American Lung Association
• Children's Hospital Association
18
Community Health Needs Assessment
SUMMARY OF RESULTS
The final list of prioritized health needs for children (based on the epidemiologic data and input
from community leaders and community residents) were then grouped into broad categories
representing the type of health indicator:
Table 9. Prioritized Health Needs By County for Children
Trumbull
Mahoning
Columbiana
Chronic Diseases
Asthma
Diabetes
X
X
X
X
X
X
Maternal & Infant Health
Premature Births
Low & Very Low Birth Weight
Infant, Neonatal, & Post-Neonatal Mortality
X
X
X
X
X
X
X
X
X
Child Lifestyle Factors
Overweight & Obesity
Exercise
Nutrition
X
X
X
X
X
X
X
X
X
Mental Health
X
X
X
Substance Abuse
Opioid Drug Abuse
X
X
X
Sexually Transmitted Diseases
Adolescent Gonorrhea
X
X
Access to Health Care
Health Insurance Coverage
Access to Dental Care
Mental Health Insurance Coverage
Number of Pediatric Specialists
X
X
X
X
X
X
X
X
X
X
X
X
Environmental Factors
Access to Healthy Food
X
X
X
19
Community Health Needs Assessment
CONCLUSIONS
Our analysis of the epidemiologic data, the input received from community leaders and
community residents, and our review of other CHNAs identified a broad range of prioritized
health needs for children in our community. These include physical, mental, and environmental
health outcomes as well as risk factors for diseases or conditions.
Chronic Diseases
Chronic diseases are a type of disease where the person can live with the disease for a long
time, sometimes indefinitely. People with chronic diseases usually need to see their doctors on
a regular basis to monitor the progression of their disease and get treatment. The prioritized
chronic disease health needs for children in our community include asthma and diabetes.
Maternal & Infant Health
Maternal and infant health is a broad category of factors that affect pregnancy and childbirth.
The prioritized maternal and infant health needs for children in our community include
premature births; low and very low birth weight; and infant, neonatal, and post-neonatal
mortality.
Child Lifestyle Factors
Lifestyle risk factors are “everyday” behaviors that children engage in that can negatively
impact their health. Children that engage in these lifestyle risk factors are at higher risk for a
large number of chronic diseases such as heart disease, diabetes, and cancer. The prioritized
lifestyle factors for children in our community are overweight and obesity, exercise, and
nutrition.
Mental Health
Mental health refers to the successful performance of mental function, resulting in productive
activities, fulfilling relationships with other people, and the ability to adapt to change and cope
with adversity. Mental health is particularly important for children since it can affect
psychological and emotional development, school performance, family and peer relationships,
and physical health. For this reason, all mental health conditions were identified as prioritized
community health needs for children in our community.
Substance Abuse
Substance abuse refers to a set of conditions associated with the consumption of mind- and
behavior-altering substances that have negative behavioral and health outcomes. The impact
of substance abuse on the bodies of growing children is a very serious concern since it can have
lasting negative effects. The prioritized substance abuse issue for children in our community is
opioid drug abuse.
20
Community Health Needs Assessment
Sexually Transmitted Diseases
Sexually transmitted diseases are spread through unprotected sex and can result in significant
health problems, including infertility. The sexually transmitted disease identified as a
prioritized health need for children in our community is adolescent gonorrhea.
Access to Health Care
Access to health care is a broad term used to describe the availability, acceptability,
affordability, and accessibility of health care systems and providers. Among kids, lack of access
to health care means that children can’t get the immunizations and screenings they need,
which can increase their risk for disease and poor development. The prioritized access to care
needs for children in our community are health insurance coverage, access to dental care, and
mental health insurance coverage, and number of pediatric specialists.
Environmental Factors
Environmental risk factors are a broad category of external conditions that can negatively affect
health outcomes. The prioritized environmental factor for children in our community is access
to healthy food.
For detailed charts and data on these prioritized health needs for every county in our
community, please see the Detailed Data Appendix.
21
Community Health Needs Assessment
ACKNOWLEDGEMENTS
The Kent State University College of Public Health (KSU-CPH) was hired to conduct this
Community Health Needs Assessment under the direction of a Steering Committee that was
comprised of representatives from Akron Children’s Hospital Mahoning Valley and Akron
Children’s Hospital in Akron. The Steering Committee Members are:
Akron Children’s Hospital Mahoning Valley
Sharon A. Hrina, MSN, RN, NE-BC
Vice President, Akron Children’s Hospital
Mahoning Valley
Lisa Taafe, MSN, RN, CNP
Clinical Administrative Director, Akron
Children’s Hospital Mahoning Valley
Roseann Marsico, BA
Executive Secretary
Akron Children’s Hospital in Akron
Bernett L. Williams, MPA
Vice President, External Affairs
Michael Wellendorf, MPA
Government Relations Liaison
Heather Wuensch
Director of Community Benefit, Advocacy and
Outreach
The KSU-CPH authors of this report were:
Willie H. Oglesby, PhD, MSPH, FACHE
Assistant Professor of Health Policy &
Management and
Assistant Director, Office of Public Health
Practice and Partnerships
Ken Slenkovich, MA
Assistant Dean
Diana M. Kingsbury, MA, MPH
Graduate Research Assistant
Olivia Hartman, BSPH
Graduate Research Assistant
Joseph Smith, MPH
Graduate Research Assistant
Patrick Gorby, BS
Graduate Research Assistant
Tegan Anne Beechey, MPA
Graduate Research Assistant
22