Licking County, Ohio Community Health Improvement Plan 2018 - … · 2020. 12. 15. · Licking...

Licking County, Ohio

Community Health Improvement Plan

2018 - 2021

Top Priorities as identified the Licking County Community Health Improvement Committee:

1.Behavioral Health

2.Chronic Disease

3.Access to Care

Licking County, Ohio | 2018 - 2021




IntroductionThe Licking County Community Health Improvement Committee (CHIC) was formed in April, 2010 and developed Licking County’s first Community Health Improvement Plan (CHIP) in 2011. The committee is comprised of over 20 local agencies working collaboratively to address the most prominent public health issues facing Licking County.

This is the third edition of the county’s CHIP, and as the committee has worked on this process over the past eight years, it has continued to learn and understand the process better, which has led to improved work being produced by the committee. CHIC members are aware that developing the plan is the easiest portion of the work, and the real work lies within actually accomplishing the goals contained in this plan.

CHIC members have adopted the Mobilizing for Partnerships through Planning and Partnerships (MAPP) process to develop all three versions of CHIPs. The process allows committee members to focus on data and make informed decisions based on the most pressing issues in the county. Every entity is strapped for resources and conducting the four assessments contained in the MAPP process provides the opportunity to combine resources and make the biggest impact possible. CHIC members completed the final MAPP assessment in 2018, and data from each of the four assessments was used to develop the priorities and associated goals and objectives contained in this document.

The public health system in Licking County is a robust network of entities striving to care for their customers and improve their quality of life. Having representatives from these organizations as members of the CHIC provides an excellent opportunity to capitalize on the expertise and passion of the individuals analyzing data and providing input related to items to be addressed in the CHIP.





Member OrganizationsLicking County Health Department | Joe Ebel, Chad Brown, Greg Chumney, Kari KennedyLicking County Board of Health | Neisha GrubaughLicking Memorial Hospital | Jeanne Emmons, Brian Thatcher, Rebecca LayPathways of Central Ohio/211 | Kristin McCloudHeath City Schools | Dr. Trevor ThomasCanal Market District | Jazz GlastraLicking County Job and Family Services | Nathan KeirnsMental Health America of Licking County | Penny SitlerMental Health Recovery for Knox and Licking Counties | Kay Spergel Ohio State University | Shari GallupUnited Way of Licking County | Deb DingusPublic at Large | Paddy KutzLicking County Children and Families First Council | Sylvia FrielLicking County Infant Mortality Taskforce | Joe EbelLicking County Diabetes Forum | Shari Gallup, Diane Kintner

Licking County Wellness Coalition | Carrie McKeeTobacco Use Reduction Network of Licking County | Chris SaylorFood Pantry Network of Licking County | Chuck MooreHospice of Central Ohio | Melissa OwensLicking County Healthcare Disaster Planning Coalition | Adam MastersLicking County Prevention Partnership | Olivia BiggsLicking County Addiction Taskforce | Kay Spergel Prescription Drug Overdose Prevention Coalition | Todd Kirkpatrick





Overview of Licking CountyLicking County is located in central Ohio and is just east of Columbus, the state capital. The county was established on January 30, 1808, and it is named after the Licking River. There are 39 political subdivisions in Licking County, three cities (Newark, Pataskala, and Heath), 11 villages, and 25 townships. The county’s population as of July 2017 according to the US Census was 173,448 people. The majority of the county is considered rural; however, the western portion of the county is experiencing an increase in development due to the expansion of State Route 161. Newark is the county seat, with a population of just over 49,000 people.

The major provider of healthcare services to the county’s population Licking Memorial Hospital, and it is also the largest employer in the county. Other major employers in Licking County include Owens Corning, State Farm, Park National Bank and Englefield Oil Company. Licking County has several institutions of higher learning including Denison University, the Ohio State University-Newark Campus, Mt. Vernon Nazarene University, Central Ohio Technical College. Additionally, the county has several unique attractions, namely the Newark Earthworks, which the largest complex of earthen enclosures in the world that were constructed by Native Americans . The county is also home to the Longaberger Basket Building, which is a seven-story building that is a replica of one of the company’s famous baskets.

Licking County has been experiencing a growth in population over the past several years, and this trend is expected to continue. With the expansion of the major highway leading to Columbus, additional commercial and residential development is expected to occur not only in the western portion of the county, but also extending into the central and eastern regions of the county as well. While development and growth can be a positive for a community, they can also present challenges regarding health concerns. CHIC members have recognized this potential concern and will remain vigilant to ensure that all of the public health needs of county residents are met.





Social Determinants of HealthSocial determinants of health are conditions in the environments in which people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks. Individuals can experience lower health outcomes based on where they live, their socio-economical status, and having a physical disability. These individuals have difficulty accessing the resources they need to lead healthy lives, and as a result, are less likely to seek or access preventive care necessary to prevent potential catastrophic health events.

CHIC members are dedicated to developing not only physical environments where people can thrive in Licking County, but social environments as well. This will mean tackling this sometimes-complicated issue to help ensure these individuals have the best chance possible to lead healthy lives. Examples of social determinants that CHIC members will attempt to address include: improving access to healthcare when it is needed, reducing and ultimately eliminating transportation barriers, and addressing mental health concerns related to poverty and the resulting stress. These conditions can lead to increased disease rates (both chronic and infectious) that result in poorer health outcomes.

If an individual cannot access preventative care or see a medical professional when they have an illness, there is a greater chance that they will face health consequences and even a shorter lifespan. Additionally, if pregnant mothers cannot access prenatal care, there is a higher likelihood that their children may not be carried to term or face serious health issues as a result.

These issues persist in many if not all communities in the country, and it’s the public health system’s responsibility to work to address them. There is not an overnight solution to addressing social determinants of health, however ignoring this issue is not an option. During the prioritization process CHIC members were cognizant of the possible influences social determinants may have on the items that were considered priorities, and that they would likely need to be addressed in order to achieve positive outcomes. Individuals experiencing lessor health outcomes due to these items are often left behind, however CHIC members were clear during their deliberations regarding this plan that this would not be the case in Licking County.





Policy and System Changes for Alleviation of Health Inequity Health inequities are systematic differences in the health status of different population groups. Tremendous evidence exists showing that social factors such as educational status, income level, ethnicity and gender all play a role in the health of an individual. This is the case in countries throughout the world regardless if the countries are rich or poor. An individual’s life expectancy can vary by wide margins based on where they live.

Health inequities can cause a significant financial burden as well due to the fact that minor health conditions are ignored and allowed to grow and become significant issues that are costlier to treat. The need to address these issues is high and they must be addressed at the public health system level in order for the change to be successful.

CHIC members discussed these issues during their prioritization process as well. Providing services and increasing the quality of life for individuals experiencing inequities was prevalent during each prioritization session. As indicated later in this plan, one objective the committee agreed on was not only increasing the number of tobacco cessation options for adults, but developing a referral network so that individuals can access these services when they are ready to quit using tobacco products.

However, the most significant issue regarding system level changes the committee agreed on is the need to address mental health in our community. This is the first time mental health has risen to the level of becoming a priority, and members of the CHIC other than mental health providers have realized its importance to public health. This is a dramatic systematic change that will ideally result in this issue being addressed and understood throughout the county.





MAPP ProcessCHIC members have been using the MAPP process to develop the county’s CHIP since 2010. The MAPP process was developed by the National Association of County and City Health Officials and is a nationally recognized framework for community health improvement. MAPP is designed to conduct assessments at a public health system level and allow for the evaluation of data from across the system to effectively determine the public health priorities within a community. CHIC members have completed all four MAPP assessments, and data from each assessment was reviewed during the prioritization process.

The Community Health Assessment includes relevant primary and secondary data collected in a scientific manner that provide an accurate depiction of public health concerns in the county. However, the Community Themes and Strengths Assessment contains qualitative data that was captured during focus groups and community discussions that provide insight as to what the public thinks the problems are in the county. If these, two datasets do not match, it’s indicative of a communication issue or potentially an emerging concern that needs to be investigated more closely.

Data from the Local Public Health System Assessment evaluates how the system as a whole performs in regard to a wide variety of metrics. The assessment also provides an avenue to compare the Licking County Public Health System with others from across Ohio and the country and identify gaps in services that need to be offered to best serve county residents.

Finally, the Forces of Change Assessment serves as a vehicle to review and identify possible issues that are going to impact public health within the county. The forces identified could make a positive or negative impact and identifying them allows for the necessary plans to be developed and resources to be identified. CHIC members actively conducted all four assessments, and the group continues to embrace the MAPP process as a viable tool for developing its CHIP.





Prioritization ProcessAs the CHIC discussed the development of the county’s new CHIP, it became apparent to the members that determining the priorities for the plan was extremely important to the group. The priorities make a clear statement about what the experts and decision makers within the public health system think are the biggest concerns to health in our community. Coming to an agreement on the priorities and agreeing as a group was important so that the committee could speak with one voice about how to best improve public health in the county. This is a powerful message that will provide credibility to the plan, and more importantly, the initiatives that are designed to address the priorities.

The prioritization process began in early 2017 after the county’s CHA was published with updated data. CHIC members met to review the data in comparison to the data contained in the previous assessment. During this evaluation process, discussions about new priorities for the updated CHIP were held. At this time, the group began to look at data trends that both confirmed existing problems and shed light on new ones.

After this discussion took place, CHIC members met to review data from all four MAPP assessments the group had conducted. The data was compared to past MAPP assessments, and the most recent assessments were also compared to identify common themes. A document containing the themes was developed and distributed to CHIC members to review prior to a final prioritization meeting, and a survey was developed and distributed to CHIC members. The survey was designed to allow members to rate priorities based on the evaluation of data from the four MAPP assessments. CHIC members met to review the survey data, and to once again compare it to the data from the MAPP assessments. Once this evaluation was complete, the decision was made to include three priorities in the updated CHIP.





PrioritiesThe finalized priorities include:

Access to Care is the only priority to be carried forward from the past CHIPs. It was also the only item mentioned as a priority in each of the four MAPP assessments. Chronic Disease was included as a priority in the second version of the county’s CHIP, and it will contain goals and objectives regarding a variety of issues related to chronic diseases and health behaviors that influence chronic diseases. This is the first time Behavioral Health has been included as a priority in the CHIP. Its inclusion is indicative of an emerging issue coming to the forefront as a result of conducting the four MAPP assessments.

Data from the assessments gave a clear indication that this is a core issue that is the root cause of several considerable public health concerns in the county. Taking on this issue provides an insight as to how the CHIC operates. The committee adopted a nationally renown methodology, implemented it as designed, collected accurate data, and used the data to make informed decisions regarding the priorities, goals and objectives contained in this plan. CHIC members have the best interest of the people of Licking County in mind, and their actions in developing this plan is proof of their commitment.

Goals and ObjectivesCHIC members developed goals and objectives designed to address each of the priorities listed above. They are all associated with either the Ohio State Health Improvement Plan (SHIP) or a national initiative. The targets for the objectives were also taken from the SHIP or a national initiative. The CHIC wanted to insure the plan is not only tied to these initiatives, but also relevant in terms of accurately addressing public health concerns. The goals and objectives are contained in the CHIP Action Plan and can be found in Appendix A of this document.

1.Behavioral Health

2.Chronic Disease

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erfo

rman

ce

Ind

icat

ors

Co

nn

ectio

nO

utc

om

es

By D

ecem

ber 3

1, 2

020,

Incr

ease

the

nu

mbe

r of

preg

nan

t wom

en

enro

lled

in to

bacc

o co

un

selin

g b

y 20

%

Con

duct

ou

trea

ch

to p

reg

nan

t wom

en

thro

ug

h O

B/G

YN o

ffice

sEn

roll

preg

nan

t wom

en in

co

un

selin

g

Toba

cco

Use

Red

uct

ion

N

etw

ork

of L

icki

ng

C

oun

ty (T

URN

)

Nu

mbe

r of w

omen

en

rolle

dN

atio

nal

Pre

ven

tion

St

rate

gy,

HP

2020

By D

ecem

ber 3

1, 2

020,

in

crea

se th

e n

um

ber o

f ad

ults

en

rolle

d in

ces

sa-

tion

cou

nse

ling

by

25%

Impl

emen

t ou

trea

ch

cam

paig

n u

sing

CH

IC

mem

bers

an

d pr

imar

y ph

ysic

ian

offi

ces,

Enro

ll pa

tien

ts in

co

un

selin

g

TURN

Nu

mbe

r of a

dults

en

rolle

dN

atio

nal

Pre

ven

tion

St

rate

gy,

HP

2020

By D

ecem

ber 3

1, 2

020,

re

duce

the

perc

eptio

n o

f E-

Cig

aret

tes

as a

saf

e al

ter-

nat

ive

to c

igar

ette

s in

hig

h

sch

ool s

tude

nts

by

20%

Wor

k w

ith y

outh

gro

ups

re

gar

din

g th

e h

ealth

ef

fect

s of

e-c

igar

ette

s, C

ondu

ct o

utr

each

re

gar

din

g th

e h

ealth

ef

fect

s of

e-c

igar

ette

s

TURN

Perc

ent o

f stu

den

ts

impa

cted

PRID

E Su

rvey

, CH

A

Lick

ing

Co

un

ty, O

hio

Co

mm

un

ity H

ealth

Imp

rove

men

t Pl

an

Ap

pen

dix

A |

CH

IP A

ctio

n P

lan

- Pa

ge

4

Just

ifica

tion

: Con

cern

s re

late

d to

Ch

ron

ic D

iseas

e h

ave

been

incl

ude

d in

the

past

2 C

HIP

s, an

d so

me

of th

ese

issu

es c

ontin

ue

to b

e a

con

cern

. Iss

ues

rela

ted

to O

besit

y ar

e id

entif

ied

in th

e 20

17 C

omm

un

ity H

ealth

Ass

essm

ent (

CH

A) a

nd

the

Forc

es o

f Ch

ang

e A

sses

smen

t con

duct

ed

by C

HIC

mem

bers

. Add

ition

ally

, Can

cer w

as id

entif

ied

as a

con

cern

in th

e C

HA

. Tob

acco

Use

an

d th

e di

seas

es c

ause

d by

its

use

wer

e id

entif

ied

in

the

CH

A, a

s w

ell a

s th

e C

omm

un

ity T

hem

es a

nd

Stre

ng

ths

and

Forc

es o

f Ch

ang

e A

sses

smen

ts. C

hro

nic

Dise

ase

is al

so a

prio

rity

in th

e St

ate

Hea

lth

Impr

ovem

ent P

lan

an

d it

is co

nta

ined

in H

ealth

y Pe

ople

202

0 an

d th

e N

atio

nal

Pre

ven

tion

Str

ateg

y.

Go

al:

De

cre

ase

th

e b

urd

en

of

can

cer

in L

icki

ng

Co

un

ty.

2.C

hro

nic

Dis

ease

Ob

ject

ive

Act

iviti

esA

gen

cy R

esp

on

sib

leK

ey P

erfo

rman

ce

Ind

icat

ors

Co

nn

ectio

nO

utc

om

es

By D

ecem

ber 3

1,

2020

,En

gag

e in

a

can

cer i

niti

ativ

e w

ith

the

LMH

C

ompr

ehen

sive

Can

cer C

omm

ittee

App

oin

t a C

HIC

mem

ber

as li

aiso

n to

the

CC

C,

Revi

ew d

ata

sou

rces

from

C

CC

,D

evel

op in

itiat

ive

base

d on

dat

a co

llect

ed b

y C

CC

LCH

D, L

MH

CH

IC li

aiso

n a

ppoi

nte

d,In

itiat

ive

deve

lope

d,N

um

ber o

f peo

ple

serv

ed

by in

itiat

ive

Nat

ion

al P

reve

ntio

n

Stra

teg

y, H

P 20

20

By D

ecem

ber 3

1,

2019

, hol

d a

colo

rect

al

can

cer s

cree

nin

g e

ven

t se

rvin

g a

min

imu

m o

f 10

0 pe

ople

Iden

tify

test

ing

lo

catio

n,

Dev

elop

refe

rral

m

ech

anism

for

abn

orm

al te

st re

sults

LCH

D, L

MH

Nu

mbe

r of p

eopl

e se

rved

,N

um

ber o

f ref

erra

ls m

ade

HP

2020

Lick

ing

Co

un

ty, O

hio

Co

mm

un

ity H

ealth

Imp

rove

men

t Pl

an

Ap

pen

dix

A |

CH

IP A

ctio

n P

lan

- Pa

ge

5

Just

ifica

tion

: Acc

ess

to c

are

has

bee

n a

con

cern

sin

ce th

e C

HIC

was

form

ed in

201

0. H

owev

er, w

ith th

e ex

pan

sion

of M

edic

aid

in O

hio

, th

e n

um

ber o

f in

divi

dual

s w

ithou

t in

sura

nce

fell

dram

atic

ally

from

201

3 to

201

7. U

nfo

rtu

nat

ely,

the

nu

mbe

r of i

ndi

vidu

als

that

cou

ld n

ot u

se th

eir h

ealth

ca

re w

hen

nee

ded

rem

ain

ed s

tag

nan

t. A

cces

s to

car

e w

as th

e on

ly p

riorit

y to

be

iden

tifie

d as

a c

once

rn in

all

fou

r MA

PP a

sses

smen

ts. I

t is

also

lin

ked

to th

e SH

IP, N

atio

nal

Pre

ven

tion

Str

ateg

y an

d H

ealth

y Pe

ople

202

0.

Go

al:

Incr

ea

se a

ffo

rda

ble

he

alt

h c

are

op

tio

ns

for

Lick

ing

Co

un

ty r

esi

de

nts

.

3.A

cces

s to

Car

e

Ob

ject

ive

Act

iviti

esA

gen

cy R

esp

on

sib

leK

ey P

erfo

rman

ce

Ind

icat

ors

Co

nn

ectio

nO

utc

om

es

By D

ecem

ber 3

1, 2

019,

co

ndu

ct a

n a

sses

smen

t of

data

from

hea

lth c

are

prov

ider

s to

det

erm

ine

the

mos

t pre

vale

nt

prev

enta

ble

con

ditio

ns

Revi

ew d

ata

from

ERs

, u

rgen

t car

es, L

ook

Up

Cen

ter,

and

oth

er

prov

ider

s, D

evel

op a

n a

sses

smen

t of

prev

enta

tive

con

ditio

ns

LCH

D, L

MH

, Pat

hw

ays

of

Cen

tral

Oh

io (P

CO

)A

sses

smen

t dev

elop

edSH

IP, N

atio

nal

Pre

ven

tion

St

rate

gy,

HP

2020

By D

ecem

ber 3

1, 2

020,

de

velo

p an

inte

rven

tion

ba

sed

on a

sses

smen

t re

sults

Dev

elop

an

d de

liver

in

itiat

ive

LCH

D, L

MH

, PC

ON

um

ber o

f peo

ple

serv

ed

by in

itiat

ive

SHIP

, Nat

ion

al P

reve

ntio

n

Stra

teg

y, H

P 20

20

By D

ecem

ber 3

1, 2

020,

co

ndu

ct a

hea

lth im

pact

as

sess

men

t to

dete

rmin

e th

e n

eed

for p

reve

nta

tive

adu

lt de

nta

l car

e

Col

lect

dat

a fro

m a

dult

den

tal p

rovi

ders

,D

evel

op H

IA,

Repo

rt re

sults

of H

IA to

C

HIC

an

d th

e pu

blic

LCH

D, L

MH

, PC

OH

IA d

evel

oped

,Re

sults

repo

rted

SHIP

, Nat

ion

al P

reve

ntio

n

Stra

teg

y, H

P 20

20



Appendix B | ReferencesHealthy People 2020 (May 2018). Social Determinants of Health. https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-of-health, Accessed on May 29, 2018.

Licking County Chamber of Commerce (January 2018), Business Directory. http://lickingcountychamber.chambermaster.com/list, Accessed May 22, 2018.

Longaberger (January 2014). About our Company. http://www.longaberger.com/about-longaberger/, Accessed on May 22, 2018.

National Association of County and City Health Officials (January 2018). Mobilizing for Action Through Planning and Partnerships. https://www.naccho.org/programs/public-health-infrastructure/performance-improvement/community-health-assessment/mapp, Accessed on May 22, 2018.

Ohio Historical Society (January 2018). Newark Earthworks. https://www.ohiohistory.org/visit/museum-and-site-locator/newark-earthworks, Accessed on May 22, 2018

Ohio Historical Society (April 2016). Licking County. http://www.ohiohistorycentral.org/w/Licking_County, Accessed on May 23, 2018.

World Health Organization (April 2017). 10 Facts on Health Inequity and Their Cause. http://www.who.int/features/factfiles/health_inequities/en/, Accessed on May 29, 2018.

https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-of-health

https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-of-health

http://lickingcountychamber.chambermaster.com/list

http://lickingcountychamber.chambermaster.com/list

http://www.longaberger.com/about-longaberger/

http://www.longaberger.com/about-longaberger/

https://www.naccho.org/programs/public-health-infrastructure/performance-improvement/community-health-assessment/mapp

https://www.naccho.org/programs/public-health-infrastructure/performance-improvement/community-health-assessment/mapp

https://www.ohiohistory.org/visit/museum-and-site-locator/newark-earthworks

https://www.ohiohistory.org/visit/museum-and-site-locator/newark-earthworks

http://www.ohiohistorycentral.org/w/Licking_County

http://www.ohiohistorycentral.org/w/Licking_County

http://www.who.int/features/factfiles/health_inequities/en/

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