Pend Oreille County Health Risks

A Community Health Improvement Opportunity

Map source: http://pendoreilleco.org/photos/map.gif

Some Background On Pend Oreille (pronounced pahn-duh-RAY) County

• Population of about 12,000.• Area of 1,425 miles.• Rich in natural beauty, wildlife.• Largest community (Newport)

has population of roughly 2000.• Only one major highway (State

Road 20) which parallels the Pend Oreille River.

• All the larger towns follow this river road.

A River Runs Through It…

And

So

Does

A

Road.

Rural It Is

Communities In The County

Images copyright of the Kalispel Tribe

Some Statistics of Importance

•Median household income: $39,352 (national average: $55,628).•15.9% of county residents below poverty level.•83.3% of families with a female householder with no husband are below poverty level.•Unemployment 6th highest in the state.

What it means…

Poverty is an issue that will affect health.

Particularly for women and children.

Children & Child Abuse

• Every third household has a child.• Child abuse is 2.5 X higher than similar

counties. • Childhood unintentional injuries 33% higher

than state levels.• “Poverty, lack of social support, social

isolation, unemployment and high stress levels” are all factors that increase the risk of child abuse within the home setting per the Office of Child Abuse & Neglect.

• Poverty and high stress become a truly significant concern that requires addressing within this county when 25% of two parent families and 83% of female parent families with children under 5 years of age living below the poverty line (654 families in 1998)

Health Insurance• 13.1% of residents have no

health insurance.• Female head of households

have nearly double the uninsured rate (21%) than traditional households (11.4%).

Significance: Uninsured tend to die sooner, get too little care too late and get poorer quality care when the do get care.

The Statistics onOther Common Health Issues

Statistics as Compared to State & U.S. Averages

Comparable Higher Lower

Obesity Maternal Smoking(2.5 X State & U.S. levels)

Teen Pregnancy

Fruit/ Vegetable consumption

Physical Activity Alcohol

Binge drinking Crime

Diabetes

Mental health

Access To Healthcare• Access low• One 74 bed hospital in SE

corner of the county• Two smaller hospitals in

neighboring Stevens county (also serve middle & south end)

• Only basic prenatal & neonatal care available

• 2/3 of county have >30 minute drive to nearest acute care hospital

Indicators of Health Care Needs

Optimal Cover-

ageMUA HPSA for

the county

HPSA for Kalspie Tribe

0102030405060708090

100

Primary CareMental Health

Dental Care

Primary CareMental HealthDental Care

MUA score of 62.0 or less qualifies for designation as an MUA.

Summary of Health Issues for Pend Oreille County

• Low income • Unemployment• Poverty, especially

female head of households with children

• Isolation/ distance from health care services

• Low education • Child abuse • Lack of health insurance • Maternal smoking • Isolated elderly• Lack of primary and

specialty care providers

How Can The

Problem Of

Child Abuse Be Resolved?

Positive Parenting Program(Triple P)

A CDC funded evidence and population based model that has a successful track record.

Their goal is “to prevent behavioral, emotional and developmental problems in children by enhancing the

knowledge, skills and confidence of parents”.

Provides professional training to health care providers and also uses the media to communicate teaching.

Positive Parenting Program (Triple P)Why Use It?

• Populations used were statistically very similar to Pend Oreille county.• Program uses existing in-place systems/ services/ providers.• Had good measurable track-able quantifiers.• Attempted to rule out any pre-study trends over the five years prior to

the interventions to validate results.• Large statistically significant outcomes.• Monitored child injuries in addition to confirmed reports of child abuse.• Affects key points of intervention opportunities

(hospital, ERs, ambulance workers, schools).• Uses a variety of methods to disseminate information useful to rural

communities.

Why Use This System for Pend Oreille?

Makes use of existing health care systems

Low resource expenditureMaximal community contactReduces community costs (unpaid

medical bills, law enforcement/ judicial, mental health)

Reduces child-out-of-home placements

Healthier long term communityLong term multigenerational

benefits

Questions?

Some Interesting Resources• Children’s Bureau, U. S. Department of Health and Human Services – Ample information here from

the government.• Child Welfare League of America – Mission: CWLA will lead the nation in building public will to ensure

safety, permanence, and well-being of children, youth, and their families by advancing public policy, defining and promoting practice excellence and delivering superior membership services. Vision: Our vision is that every child will grow up in a safe, loving, and stable family. Focus: Our focus is children and youth who may have experienced abuse, neglect, family disruption, or a range of other factors that jeopardize their safety, permanence, or well-being. CWLA also focuses on the families, caregivers, and the communities that care for and support these children.

• Circle of Parents – Mission Statement: Prevent child abuse and neglect and strengthen families through mutual self-help parent support groups.

• Council for Children & Families Washington (also called the Washington Council for Prevention of Child Abuse and Neglect) – A federally based grant program. Our Mission: To promote the optimal development of children and families by leading Washington state in its efforts to prevent child abuse and neglect.

• Friends: National Resource Center for Community-Based Child Abuse Prevention – A good source of training material. Provides monthly teleconferences, data archives, grant seeking advice and .

• Healthy Families America – A program that focuses on getting trained staff into homes for home visits that focus on teaching families parenting skills. Has good success statistics.

• National Alliance of Children’s Trust and Prevention Funds – Mission: Initiate and engage in national efforts that help State Children’s Trust and Prevention Funds in strengthening families to prevent child abuse and neglect. Promote and support a system of services, laws, practices and attitudes that supports families by enabling them to provide their children with safe, healthy and nurturing childhoods.

Report Suspected Child Or Elder Adult Abuse.

References• 1) Washington State Department of Health, (2007, July 10). Rural and Urban Commuting Areas,

2006. Retrieved July 12, 2009, from DOH, Division of Resource Management, Geographic Information Systems Web site: http://ww4.doh.wa.gov/gis/pdf/ruca_zip_06.pdf

• 2) U. S. Census Bureau; DP-1 Profile of General Demographic Characteristics: 2000 http://factfinder.census.govbf/_lang=en_vt_name=DEC_2000_SF1_U_DP1_geo_id=05000US53051.html

• 3) Washington State Local Public Health Indicators, NE Tri-County Health District, Prevention and Health Promotion http://www.doh.wa.gov/phip/khi/lphi/lhj/ne-tri/hp.htm

• 4) U.S. Census Bureau; DP-5 Housing Characteristics: 1990 http://factfinder.census.gov/servlet/BasicFactsTable?_lang=en&_vt_name=DEC_1990_STF3_DP5&_geo_id=05000US53051

• 5) U.S. Census Bureau; DP-2 Profile of Selected Social Characteristics: 2000 http://factfinder.census.gov/servlet/QTTable?_bm=y&-qr_name=DEC_2000_SF3_U_DP2&-ds_name=DEC_2000_SF3_U&-_lang=en&-_sse=on&-geo_id=05000US53051

• 6) U.S. Census Bureau; DP-3 Profile of Selected Economic Characteristics: 2000 http://factfinder.census.gov/servlet/QTTable?_bm=y&-qr_name=DEC_2000_SF3_U_DP3&-ds_name=DEC_2000_SF3_U&-_lang=en&-_sse=on&-geo_id=05000US53051

• 7) U.S. Census Bureau; State & County Quick Facts, Pend Oreille County, Washington http://quickfacts.census.gov/qfd/states/53/53051.html

• 8) Risk and Protection Profile for Substance Abuse Prevention in Pend Oreille County http://www.dshs.wa.gov/excel/ms/rda/4.47/updated/pendoreille.xls

• 9) Washington State Local Public Health Indicators, NE Tri-County Health District, Access to Care http://www.doh.wa.gov/phip/khi/lphi/lhj/ne-tri/access.htm

• 10) Washington State Local Public Health Indicators, NE Tri-County Health District, Maternal and Child Health http://www.doh.wa.gov/phip/khi/lphi/lhj/ne-tri/mch.htm

• 11) Washington Department of Health, Geographic Information Systems, Access to Hospital-Based Perinatal and Neonatal Care, 2006 http://ww4.doh.wa.gov/gis/pdf/neon_tt.pdf

• 12) Washington Department of Health, Geographic Information Systems, 30 Min. Drive Times from Acute Care Hospitals http://ww4.doh.wa.gov/gis/pdf/acute_tt.pdf

• 13) Washington Department of Health, Geographic Information Systems, Mental Health Care Shortage Areas http://ww4.doh.wa.gov/gis/pdf/primary.pdf, http://ww4.doh.wa.gov/gis/pdf/mental.pdf,

• 14) Washington Department of Health, Geographic Information Systems, Physician Scarcity Areas http://ww4.doh.wa.gov/gis/pdf/PSA.pdf

• 15) Washington Department of Health, Geographic Information Systems, Critical Access Hospitals and Bed Capacity http://ww4.doh.wa.gov/gis/pdf/hosp_list.pdf

• 16) Washington Department of Health, Geographic Information Systems, Local Health Jurisdictions and Indian Reservations http://ww4.doh.wa.gov/gis/pdf/lhj-ind.pdf

• 17 ) Kalispel Tribe of Indians home page http://www.kalispeltribe.com/camas-center-medical-dental-services/

• 18) U.S. Department of Health and Human Services, Child Welfare Information Gateway http://www.childwelfare.gov/pubs/usermanuals/foundation/foundatione.cfm

• 19) U.S. Department of Health and Human Services, Find Shortage Areas: HPSA by State & County http://hpsafind.hrsa.gov/

• 20) U.S. Census Bureau; State & County Quick Facts, Washington by County http://factfinder.census.gov/servlet/GCTTable?-geo_id=04000US53&-mt_name=DEC_2000_SF3_U_GCTP12_ST2&-ds_name=DEC_2000_SF3_U

• 21) State of Washington Department of Ecology, http://www.ecy.wa.gov/programs/wq/tmdl /pendoreille/wqissues.html

• 22) Bench, Dan W. (2002, October 30). PCBS, Mining, And Water Pollution. http://gsa.confex.com/gsa/2002AM/finalprogram/abstract_45204.htm

• 23) Washington State Population Survey 2008 http://wa-state-ofm.us/SPSOnline/index.cfm • 24) Care Without Coverage: Too Little, Too Late,

http://www.iom.edu/Object.File/Master/4/160/0.pdf • Institute of Medicine, May 2002. • 25) Pend Oreille County web page http://pendoreilleco.org/about/ • 26) Washington State Department of Health (2009). Rural Health Programs: health professional

shortage areas and medically underserved areas. Retrieved [July 7,2009]: http://www.doh.wa.gov/hsqa/ocrh/HPSA/hpsa1.htm

• 27) Newport Health and Hospital Services http://www.phd1.org/Services.htm