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Akron Children’s Hospital Mahoning ValleyBeeghly Campus6505 Market Street Boardman, Ohio 44512 www.akronchildrens.org
Community Health Needs Assessment2013
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!!& &
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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:!!
!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.! ! The! activities! undertaken! by! Akron!Children’s!Hospital!Mahoning!Valley!to!address!these!prioritized!health!needs!are!contained!in!the!“Implementation!Strategy,”!which!is!also!located!on!the!hospital’s!website.!
&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!
&
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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!non[profit!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.!!!!!!!!!!!
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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:[email protected]!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:[email protected]!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!
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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! Akron!Children's!Hospital!Mahoning!Valley!%!Mahoning!County! 55%!Trumbull!County! 20%!
Columbiana!County! 14%!All!Other! 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.!!
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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! Ohio!Total!population1! 207,406! 235,145! 106,507! 11,544,225!Percent!population!change2! [1.4%! [1.5%! [1.2%! 0.1%!Percent!under!18!years!old1! 21.5%! 20.9%! 21.2%! 23.1%!Percent!65!years!and!older1! 18.4%! 18.4%! 17.3%! 14.8%!Percent!female1! 51.4%! 51.5%! 49.7%! 51.1%!Percent!Black!or!African!American1! 8.4%! 16.0%! 2.4%! 12.5%!Percent!Hispanic!or!Latino1! 1.5%! 5.0%! 1.4%! 3.3%!Percent!with!high!school!diploma!or!higher3! 87.1%! 87.9%! 85.7%! 87.8%!Percent!with!bachelor’s!degree!or!higher3! 16.6%! 20.9%! 13.0%! 24.5%!Homeownership!rate4! 73.7%! 71.6%! 74.5%! 68.7%!Median!value!of!owner[occupied!housing!units4! $100,500! $97,800! $97,700! $135,600!Persons!per!household4! 2.39! 2.36! 2.46! 2.46!Annual!per!capita!income4!! $22,127! $23,261! $20,691! $25,618!Median!household!income4! $42,441! $40,570! $41,003! $48,071!Percent!living!below!poverty!level4! 16.4%! 17.1%! 15.9%! 14.8%!Notes:!!1!2012!estimate,!2!Since!2010,!3!persons!age!25+,!2007[2011,!4!2007[2011!Source:!!US!Census!Bureau!(http://quickfacts.census.gov/qfd/maps/ohio_map.html)!!
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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!Tri[County!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.!!
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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!county[
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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,! low[income! 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.!!!
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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!
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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!
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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! Percent!County!of!Residence! ! !!!!!!Trumbull!County! 41! 50.0%!!!!!!Mahoning!County! 26! 31.7%!!!!!!Columbiana!County! 15! 18.3%!
! ! !Number!of!Years!Lived!in!County!(average!and!SD)! 36.6! 21.0!! ! !Racial!Background! ! !!!!!!African!American!(or!Black)! 5! 6.1%!!!!!!Asian!American! 0! 0.0%!!!!!!Caucasian!(or!White)! 74! 90.2%!!!!!!Native!Hawaiian!or!Other!Pacific!Islander! 1! 1.2%!!!!!!American!Indian!or!Alaska!Native! 0! 0.0%!!!!!!Other/Missing! 2! 2.4%!! ! !Ethnic!Background! ! !!!!!!Hispanic!or!Latino/a! 2! 2.4%!!!!!!Not!Hispanic!or!Latino/a! 73! 89.0%!!!!!!Missing! 7! 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.!!!!!!!!!
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Table&3.&Household&Characteristics&of&Community&Resident&Focus&Group&Participants&(n=82)&
Characteristic! Number! Percent!Number!of!People!in!Home! ! !!!!!!One! 13! 15.9%!!!!!!Two! 27! 32.9%!!!!!!Three! 20! 24.4%!!!!!!Four! 13! 15.9%!!!!!!Five!or!More! 8! 9.8%!!!!!!Missing! ! !
! ! !Number!of!Children!in!the!Home! ! !!!!!!None! 54! 65.9%!!!!!!One! 7! 8.5%!!!!!!Two! 5! 6.1%!!!!!!Three!or!More! 6! 7.3%!!!!!!Missing! 10! 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! Percent!Total!Household!Monthly!Income! ! !!!!!!0[$999! 10! 12.2%!!!!!!$1,000
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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! Percent!Had!Someone!in!Home!Who!Did!Not!Receive!Health!Care!Due!to!Cost! 33! 40.2%!
! ! !Has!Someone!in!Home!With!a!Chronic!Disease! 35! 42.7%!
! ! !Times!Per!Year!That!Participant!Goes!To!a!Doctor! ! !!!!!!None! 6! 7.3%!!!!!!One! 10! 12.2%!!!!!!Two! 20! 24.4%!!!!!!Three! 8! 9.8%!!!!!!Four! 13! 15.9%!!!!!!Five!to!Nine! 9! 11.0%!!!!!!Ten!or!More! 7! 8.5%!!!!!!Missing! 9! 11.0%!! ! !Participant’s!Description!of!Current!Health!! ! !!!!!!Excellent! 10! 12.2%!!!!!!Very!Good! 30! 36.6%!!!!!!Good! 28! 34.1%!!!!!!Fair! 8! 9.8%!!!!!!Poor! 1! 1.2%!!!!!!Missing! 5! 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.”!!!!!!!!!
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Table&6.&Community&Health&Perceptions&of&Community&Resident&Focus&Group&Participants&(n=82)!! Number! Percent!Participant’s!Description!of!Current!Health!of!County!Adults! ! !!!!!!Excellent! 1! 1.2%!!!!!!Very!Good! 1! 1.2%!!!!!!Good! 27! 32.9%!!!!!!Fair! 45! 54.9%!!!!!!Poor! 4! 4.9%!!!!!!Missing! 4! 4.9%!
! ! !Participant’s!Description!of!Current!Health!of!County!Children! ! !!!!!!Excellent! 0! 0.0%!!!!!!Very!Good! 4! 4.9%!!!!!!Good! 41! 50.0%!!!!!!Fair! 29! 35.4%!!!!!!Poor! 3! 3.7%!!!!!!Missing! 5! 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!
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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!
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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!
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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!
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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!
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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! X! X! X!!!!!!Diabetes! X! X! X!! ! ! !Maternal&&&Infant&Health& ! ! !!!!!!Premature!Births! X! X! X!!!!!!Low!&!Very!Low!Birth!Weight! X! X! X!!!!!!Infant,!Neonatal,!&!Post[Neonatal!Mortality! X! X! X!! ! ! !Child&Lifestyle&Factors& ! ! !!!!!!Overweight!&!Obesity! X! X! X!!!!!!Exercise! X! X! X!!!!!!Nutrition! 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! X! X! X!!!!!!Access!to!Dental!Care! X! X! X!!!!!!Mental!Health!Insurance!Coverage! X! X! X!!!!!!Number!of!Pediatric!Specialists! X! X! X!! ! ! !Environmental&Factors& ! ! !!!!!!Access!to!Healthy!Food! X! X! X!!!!!& &
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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.!!&
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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.!!! !
Community&Health&Needs&Assessment& & &&
! ! 22!
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%%%Diana!M.!Kingsbury,!MA,!MPH!Graduate%Research%Assistant!!Joseph!Smith,!MPH!Graduate%Research%Assistant!!!
Ken!Slenkovich,!MA!Assistant%Dean%%Tegan!Anne!Beechey,!MPA!Graduate%Research%Assistant%!Olivia!Hartman,!BSPH!Graduate%Research%Assistant%!Patrick!Gorby,!BS!Graduate%Research%Assistant%
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