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Community Health Needs Assessment 2013 Contents Introduction ................................................................................................................................ 4 Background and Purpose.................................................................................................... 4 Service Area ....................................................................................................................... 5 Hospital Service Area Map .................................................................................................. 6 Consultants ......................................................................................................................... 6 Organizations and Partners ................................................................................................ 7 Methods ..................................................................................................................................... 7 Secondary Data Collection .................................................................................................. 7 Input from Persons who Represent the Community ............................................................ 8 Information Gaps ................................................................................................................ 8 Health Care Facilities and Community Resources .............................................................. 8 Identification and Prioritization of Health Needs ........................................................................10 Priority Health Needs .........................................................................................................10 Demographics ...........................................................................................................................12 Population ..........................................................................................................................12 Gender...............................................................................................................................13 Race/Ethnicity ....................................................................................................................13 Citizenship .........................................................................................................................14 Language ...........................................................................................................................14 Veterans ............................................................................................................................15 Social and Economic Factors ....................................................................................................16 Social and Economic Factors Ranking ...............................................................................16 Poverty ..............................................................................................................................16 Households ........................................................................................................................17 Free or Reduced Price Meals.............................................................................................18 Unemployment ...................................................................................................................19 Educational Attainment ......................................................................................................19 Homelessness ...................................................................................................................20 Crime and Violence ............................................................................................................21 Health Access ...........................................................................................................................22 Health Insurance Coverage ...............................................................................................22 Sources of Care .................................................................................................................23 1 Use of the Emergency Room .............................................................................................24 Access to Primary Care Community Clinics .......................................................................25 Underserved Areas ............................................................................................................26 Dental Care........................................................................................................................26 Birth Characteristics ..................................................................................................................27 Births .................................................................................................................................27 Teen Birth Rate ..................................................................................................................27 Prenatal Care.....................................................................................................................27 Low Birth Weight ................................................................................................................28 Infant Mortality ...................................................................................................................28 Breastfeeding.....................................................................................................................29 Mortality/Leading Causes of Death ...........................................................................................30 Mortality Rates ...................................................................................................................30 Leading Causes of Premature Death .................................................................................31 Chronic Disease........................................................................................................................32 Health Status .....................................................................................................................32 Diabetes ............................................................................................................................32 Heart Disease ....................................................................................................................33 High Blood Pressure ..........................................................................................................33 Cancer ...............................................................................................................................34 Asthma ..............................................................................................................................34 Disability ............................................................................................................................35 Health Behaviors.......................................................................................................................36 Health Behaviors Ranking ..................................................................................................36 Overweight and Obesity .....................................................................................................36 Fast Food...........................................................................................................................37 Soda Consumption ............................................................................................................38 Fresh Fruits and Vegetables ..............................................................................................38 Physical Activity .................................................................................................................38 Community Walkability .......................................................................................................40 HIV/AIDS ...........................................................................................................................40 Sexually Transmitted Diseases ..........................................................................................41 Teen Sexual History ...........................................................................................................41 2 Cigarette Smoking .............................................................................................................41 Alcohol and Drug Use ........................................................................................................41 Mental Health .....................................................................................................................42 Immunization of Children ...................................................................................................43 Flu and Pneumonia Vaccines.............................................................................................44 Mammograms and Pap Smears .........................................................................................44 Colorectal Cancer Screening .............................................................................................45 Community Input .......................................................................................................................46 Attachment 1. Benchmark Comparisons ...................................................................................63 Attachment 2: Community Stakeholders ..................................................................................64 3 Introduction Background and Purpose Henry Mayo Newhall Memorial Hospital (Henry Mayo) is a 238-bed nonprofit hospital that serves the community of Santa Clarita, California. The mission of the hospital is to improve the health of our community through compassion and excellence in health care services. Founded in 1975, Henry Mayo is a fully-accredited, acute care hospital facility and Level II trauma center that provides inpatient and outpatient services. Services include a nationally recognized Advanced Primary Stroke Center, the Sheila R. Veloz Breast Imaging Center, a behavioral health unit, outpatient wound care, maternity, neonatal intensive care unit, cancer, comprehensive cardiovascular care, and infusion center. Henry Mayo has seen the Santa Clarita Valley experience tremendous growth and an aging population. As a result, the need for expanded health care services has dramatically increased. To grow with the community, the hospital has embarked on a major long-term planning project which includes the construction of a new inpatient hospital building that will add up to 120 new beds, new medical office buildings designed to support hospital programs and services, a new central plant, new parking structures and a life-saving helipad. Currently under construction is an education center and medical office building. Recent improvements include a newly-renovated intensive care unit (ICU), a new neonatal intensive care unit (NICU), a new operating room, new infusion center, and expanded cardiovascular services. In the last five years, the hospital also expanded and updated its entire emergency and imaging departments, adding new and replacement technologies to improve the quality of care. Henry Mayo is in the top 5% of the country with the latest advancement in electronic health records, and is recognized as one of the “Most Wired” hospitals in the nation. Henry Mayo has undertaken a Community Health Needs Assessment (CHNA) as required by state and federal law. California Senate Bill 697 and the Patient Protection and Affordable Care Act and IRS section 501(r)(3) direct tax exempt hospitals to conduct a Community Health Needs Assessment and develop an Implementation Strategy every three years. The Community Health Needs Assessment is a primary tool used by the hospital to determine its community benefit plan, which outlines how it will give back to the community in the form of health care and other community services to address unmet community health needs. This assessment incorporates components of primary data collection and secondary data analysis that focus on the health and social needs of the service area. 4 Service Area Henry Mayo Newhall Memorial Hospital is located at 23845 McBean Parkway, Valencia, California. The hospital’s service area is Canyon Country, Castaic, Newhall, Santa Clarita, Stevenson Ranch and Valencia. FY12 hospital inpatient admissions data indicate that 78% of patients originate from the following zip codes. This area is located in the Santa Clarita Valley, which is in north Los Angeles County within Service Planning Area 2 (SPA 2). Henry Mayo Newhall Memorial Hospital Service Area City Canyon Country Castaic Newhall Santa Clarita Stevenson Ranch Valencia Zip Code 91351, 91387 91384 91321 91350, 91390 91381 91354, 91355 5 Hospital Service Area Map Source: HealthyCity.org Consultants The Community Health Needs Assessment has been conducted as a collaborative effort between The Identity Group and Melissa Biel of Biel Consulting, Inc. The Identity Group is a strategic health care consulting firm that was founded in 1989. The firm specializes in working with community, non-profit hospitals, foundations and health plans. Biel Consulting, Inc. is an independent consulting firm that works with hospitals, clinics and community-based nonprofit organizations. Dr. Biel has over 10 years of experience conducting hospital Community Health Needs Assessments and working with hospitals on developing, implementing, and evaluating community benefit programs. 6 Organizations and Partners A number of organizations and agencies contributed time and resources to assist with the conduct of this needs assessment. We acknowledge the following organizations and agencies: Action Family Counseling Alzheimer’s Association American Cancer Society, California Division American Diabetes Association Boys & Girls Club of Santa Clarita Valley Child & Family Center City of Santa Clarita, Newhall Community Center College of the Canyons Domestic Violence Center of Santa Clarita Valley Help the Children Henry Mayo Newhall Memorial Hospital Behavioral Health Unit Los Angeles County, Department of Public Health Los Angeles County Department of Mental Health - Santa Clarita Valley Mental Health Center Los Angeles Residential Community (LARC) LARC Ranch Northeast Valley Health Corporation (NEVHC) Northeast Valley Health Corporation – WIC Program Samuel Dixon Family Health Centers, Inc. Santa Clarita Adult Day Health Care Santa Clarita Valley Central Office of Alcoholics Anonymous Santa Clarita Valley Senior Center Single Mothers Outreach Methods Secondary Data Collection Secondary data were collected from a variety of local, county, and state sources to present the hospital service area demographics, social and economic factors, health access, birth characteristics, leading causes of death, chronic disease, and health behaviors. Analyses were conducted at the most local level possible for the Hospital service area, given the availability of the data. For example, demographic data, birth and death data are based on zip codes. Economic indicators are available by city. Other data are only 7 available at the county level. Sources of data include the U.S. Census American Community Survey, California Department of Public Health, California Employment Development Department, California Department of Education, California Department of Justice, California Health Interview Survey, County Health Rankings, Los Angeles Homeless Services Authority, Los Angeles County Public Health, Uniform Data Set, and others. When pertinent, these data sets are presented in the context of the state. The report includes benchmark comparison data that measures Henry Mayo Newhall Memorial Hospital’s community data findings with Healthy People 2020 objectives (Attachment 1). Healthy People 2020 objectives are a national initiative to improve the public’s health by providing measurable objectives and goals that are applicable at national, state, and local levels. Input from Persons who represent the Community Targeted interviews were used to gather information and opinions from persons who represent the broad interests of the community served by the hospital. Twenty-four interviews were completed during August, 2013. For the interviews, community stakeholders identified by Henry Mayo were contacted and asked to participate in the needs assessment. Interviewees included individuals who are leaders and representatives of medically underserved, low-income, minority and chronic disease populations, or regional, State or local health or other departments or agencies that have “current data or other information relevant to the health needs of the community served by the hospital facility.” A list of the stakeholder interview respondents, their titles, organizations and leadership roles are in Attachment 2. Information Gaps Information gaps that impact the ability to assess health needs were identified. Most notably, some data are only available at the county level, which make it difficult to identify health needs at the local level. Also, data were not always collected on a yearly basis, meaning that some data were several years old. Health Care Facilities and Community Resources Hospitals Henry Mayo Newhall Memorial Hospital Kaiser Foundation Hospital – Panorama City Northridge Hospital Medical Center Providence Holy Cross Medical Center Valley Presbyterian Hospital Clinics Asian Pacific Health Care Venture Comprehensive Community Health Center, Inc. 8 El Proyecto Del Barrio, Inc. Mission City Community Network, Inc. Northeast Valley Health Corporation Samuel Dixon Family Health Centers, Inc. Valley Community Clinic Other Community Resources A list of resources within the community that are available to meet identified community health needs can be accessed at: Los Angeles County Information and Referral Line www.211la.org Los Angeles County Department of Mental Health http://dmh.lacounty.gov/wps/portal/dmh/our_services Healthy City www.healthycity.org/c/service 9 Identification and Prioritization of Health Needs Based on the results of the primary and secondary data collection, health needs were identified. Each health need was confirmed by more than one indicator or data source (i.e., the health need was suggested by more than one source of secondary or primary data). In addition, the health needs were based on the size of the problem (relative portion of population afflicted by the problem); or the seriousness of the problem (impact at individual, family, and community levels). To determine size or seriousness of a problem, the health need indicators identified in the secondary data were measured against benchmark data, specifically California state rates or Healthy People 2020 objectives. Indicators related to the health needs that performed poorly against these benchmarks were considered to have met the size or seriousness criteria. Additionally, primary data sources were asked to identify community and health issues based on the perceived size or seriousness of a problem. The identified health needs included: Access to care Alcohol and drugs Asthma Cardiovascular disease Community safety and violence Dental health Diabetes Homelessness Mental health Overweight and obesity Smoking Priority Health Needs Priority setting is a required step in the community benefit planning process. The Community Health Needs Assessment must provide a prioritized description of the community health needs identified through the CHNA, and include a description of the process and criteria used in prioritizing the health needs. Henry Mayo engaged an internal leadership group that included the: CEO, CFO, COO, CFO, CMO, Director Planning, Director Decision Support, Director Outpatient Services, and the Managed Care Contract Specialist. This leadership team met in September, 2013 to review the identified community health needs. The group prioritized the health needs ranking them based on criteria that included: the size of the issue, impact on community health and quality of life, and availability of internal and external resources to meet the need. For each of the health needs, the criteria were rated using a matrix to 10 assign points from 1-5, where a 1 rating was equivalent to a low criteria score and a 5 score was a high criteria score. The rating points were then tallied for a total score. The health needs were ranked in the following priority order from highest to lowest score. Rank-Ordered Priority Health Needs Access to Care Diabetes Asthma Cardiovascular Disease Obesity Mental Health Alcohol/Drugs Homelessness Dental Health Violence Smoking 11 Demographics Population According to the American Community Survey (averaged across five years, 2007 to 2011), the population for the Henry Mayo Newhall Memorial Hospital primary service area was 266,980. Children and youth, ages 0-17 make up 26.8% of the population; 10.1% are 18-24 years of age; 29.0% are 25-44; 25.9% are 45-64; and 8.1% of the population are seniors, 65 years of age and older. The area has higher percentages of youth aged 5-17, and adults ages 45-64, and lower rates of children 0-4, young adults aged 18-24, and seniors, than found in Los Angeles County and the state. Population by Age Henry Mayo Hospital Service Area Number Percent Age 0-4 Age 5-17 Age 18-24 Age 25-44 Age 45-64 Age 65+ Total 16,683 55,090 27,083 77,487 69,072 21,565 266,980 Los Angeles County Number 6.2% 20.6% 10.1% 29.0% 25.9% 8.1% 100% Percent 654,277 1,773,554 1,041,611 2,929,277 2,340,034 1,048,994 9,787,747 6.7% 18.1% 10.6% 29.9% 23.9% 10.7% 100% California Number 2,545,224 6,758,294 3,867,838 10,522,270 9,107,741 4,167,833 36,969,200 Percent 6.9% 18.3% 10.5% 28.5% 24.6% 11.3% 100.0% Source: American Community Survey, 2007-2011 When the population is examined by place, Stevenson Ranch notably has the highest concentration of children 0-17 (32.6%), and the lowest concentration of adults 18-64 (60.9%), in the hospital service area. The lowest concentration of children 0-17 (21.9%), and the lowest concentration of seniors 65+ (4.1%) can be found in Castaic. The highest concentration of seniors is found in Newhall (12.1%). Population by Age and Zip Code Geographic Area Zip Code Canyon Country 91351 Canyon Country 91387 Castaic 91384 Newhall 91321 Santa Clarita 91350 Santa Clarita 91390 Stevenson Ranch 91381 Valencia 91354 Valencia 91355 Henry Mayo Hospital Service Area L.A. County Ages 0-17 27.0% 28.3% 21.9% 25.5% 28.3% 27.8% 32.6% 29.7% 23.4% 26.9% 24.8% Ages 18-64 65.3% 64.9% 74.1% 62.4% 63.3% 65.0% 60.9% 63.1% 65.5% 65.0% 64.5% Ages 65+ Total Pop. Median age 7.7% 6.9% 4.1% 12.1% 8.4% 7.2% 6.6% 7.2% 11.1% 8.1% 10.7% 31,596 39,991 29,617 34,948 32,449 19,348 18,597 28,330 32,104 266,980 9,787,747 35.2 33.0 31.9 33.7 35.1 40.2 37.2 37.0 36.8 35.2 34.6 Source: American Community Survey, 2007-2011 12 Gender Of the area population, 51.6% are male and 48.4% are female, which is a higher ratio of men to women than found in the county or the state. Population by Gender Gender Male Henry Mayo Hospital Service Area 51.6% Los Angeles County 49.3% 48.4% 50.7% Female California 49.7% 50.3% Source: American Community Survey, 2007-2011 Race/Ethnicity The population of the service area consists primarily of White/Caucasians (52.5%) and Latinos (28.8%). Asian/Pacific Islanders comprise 10.3% of the population, and African Americans, Native Americans, those of mixed race, and all other races combined total 8.2% of the population. The area has a notably larger percentage of Whites, and a smaller percentage of Latinos when compared to Los Angeles County or California. Race/Ethnicity Henry Mayo Hospital Service Area Number Percent White Hispanic or Latino Asian Black or African American American Indian/AK Native Native HI / Pacific Islander Other or Multiple 140,292 76,924 27,298 9,968 377 245 11,876 52.5% 28.8% 10.2% 3.7% 0.1% 0.1% 4.4% Los Angeles County Number Percent 2,749,159 4,644,328 1,331,809 816,625 17,324 23,979 204,523 28.1% 47.5% 13.6% 8.3% 0.2% 0.2% 2.1% California Number 15,028,200 13,752,743 4,760,615 2,159,863 151,324 132,395 984,060 Percent 40.7% 37.2% 12.9% 5.8% 0.4% 0.4% 2.7% Source: American Community Survey, 2007-2011 When examined by place, Newhall was the highest concentration of Latinos (46.1%) in the service area, Stevenson Ranch the highest concentration of Asians (23.7%), and Castaic the highest concentration of African Americans (10.7%). Population by Race and Ethnicity and Zip Code Geographic Area Zip Code Canyon Country Canyon Country Castaic Newhall Santa Clarita Santa Clarita Stevenson Ranch Valencia Valencia 91351 91387 91384 91321 91350 91390 91381 91354 91355 White 45.4% 45.7% 46.2% 42.5% 57.1% 69.5% 56.5% 55.0% 65.7% Asian 7.0% 12.0% 4.6% 4.8% 9.9% 6.2% 23.7% 18.0% 10.4% Hispanic/Latino 40.7% 31.5% 33.6% 46.1% 25.5% 18.4% 13.8% 17.7% 18.7% Black 2.0% 5.0% 10.7% 3.0% 2.6% 2.0% 2.7% 3.9% 1.0% 13 Henry Mayo Hospital Service Area Los Angeles County 52.5% 28.1% 10.2% 13.6% 28.8% 47.5% 3.7% 8.3% Source: American Community Survey, 2007-2011 Citizenship In the hospital service area, 20.7% of the overall population are foreign born and 9.5% are not citizens. The highest concentration of foreign-born residents (29%) and the highest concentration of non-citizens are found in Newhall. Foreign Born Residents and Citizenship Geographic Area Canyon Country Canyon Country Castaic Newhall Santa Clarita Santa Clarita Stevenson Ranch Valencia Valencia Henry Mayo Hospital Service Area Los Angeles County Zip Code 91351 91387 91384 91321 91350 91390 91381 91354 91355 Foreign Born 25.4% 22.5% 16.0% 29.0% 16.6% 10.4% 23.1% 21.0% 17.5% 20.7% 35.6% Not a U.S. Citizen 11.3% 10.7% 8.1% 20.7% 5.5% 2.2% 8.3% 7.0% 6.2% 9.5% 19.4% Source: American Community Survey, 2007-2011 Language In the hospital service area, 68.9% of residents speak only English in their homes. Spanish is spoken in 19.4% of the homes; this is less than the number of Spanish speaking households in the county (39.4%) and the state (28.6%). The service area has noticeably fewer households that speak Asian/Pacific Island languages (6.9%) or other Indo-European languages (3.7%) than speak Spanish or English. Language Spoken at Home, Population 5 Years and Older Henry Mayo Hospital Service Area Speaks Only English Speaks Spanish Speaks Asian/PI Language Speak Indo-European Language Speaks Other Language 68.9% 19.4% 6.9% 3.7% 1.1% Los Angeles County 43.4% 39.4% 10.8% 5.4% 1.0% California 56.8% 28.6% 9.5% 4.3% 0.9% Source: American Community Survey, 2007-2011 When communities are examined by language spoken in the home, Newhall has the highest concentration of Spanish-speakers (35.9%). Stevenson Ranch has the highest concentration of Asian/Pacific Islander languages (18.6%). 14 Language Spoken at Home Geographic Area Zip Code Canyon Country Canyon Country Castaic Newhall Santa Clarita Santa Clarita Stevenson Ranch Valencia Valencia Henry Mayo Hospital Service Area Los Angeles County English 91351 91387 91384 91321 91350 91390 91381 91354 91355 59.5% 65.0% 68.8% 57.7% 75.7% 82.2% 67.4% 72.7% 77.6% 68.9% 43.4% Spanish 30.7% 21.6% 24.9% 35.9% 13.4% 9.6% 7.9% 9.1% 9.9% 19.4% 39.4% Asian/PI 4.6% 7.8% 3.5% 3.1% 6.5% 3.6% 18.6% 11.9% 6.9% 6.9% 10.8% Indo European 3.6% 3.7% 2.0% 2.8% 3.7% 3.6% 5.2% 5.2% 4.5% 3.7% 5.4% Source: American Community Survey, 2007-2011 In the school districts in the service area 36.3% of students in the Newhall School District are English learners, and 33.2% of Sulphur Springs Union District students are English learners, compared with 19.2% of Saugus Union District students and 17.1% of Castaic Union Elementary District students. The rates in all of the area's school districts are lower than found among students in Los Angeles County as a whole. English Learners and 'Fluent English Proficient' Students School District Acton-Agua Dulce Unified District Castaic Union Elementary District Newhall District Saugus Union District Sulphur Springs Union District William S. Hart Union High District Los Angeles County Percent 21.8% 17.1% 36.3% 19.2% 33.2% 23.4% 52.5% Source: California Department of Education DataQuest, 2012-2013 Veterans In the Henry Mayo Hospital service area, 6.7% of the population 18 years and older are veterans. This is slightly lower than the percentage of veterans found in California, but higher than that of Los Angeles County. Veterans Veteran Status Henry Mayo Hospital Service Area Los Angeles County California 6.7% 4.8% 7.3% Source: American Community Survey, 2007-2011 15 Social and Economic Factors Social and Economic Factors Ranking The County Health Rankings ranks counties according to health factors data. Social and economic indicators are examined as a contributor to the health of a county’s residents. California’s 58 counties are ranked according to social and economic factors with 1 being the county with the best factors to 58 for that county with the poorest factors. This ranking examines: high school graduation rates, unemployment, children in poverty, social support, and others. Los Angeles County is ranked as a 41, in bottom of the third quartile of all California counties according to social and economic factors. Social and Economic Factors Ranking County Ranking (out of 58) Los Angeles County 41 Source: County Health Rankings, 2013 Poverty Poverty thresholds are used for calculating all official poverty population statistics. They are updated each year by the Census Bureau. For 2011, the federal poverty level (FPL) for one person was $10,890 and for a family of four $22,350. Among the residents in the Henry Mayo service area, 7.3% are below 100% of the federal poverty level (FPL) and 19.1% are below 200% of FPL. These rates of poverty are not as high as those found in the county where 16.3% of residents are at poverty level and 38.4% are below 200% of FPL. Newhall, however, has rates of poverty similar to those found at the county level. Ratio of Income to Poverty Level Geographic Area Zip Code Canyon Country Canyon Country Castaic Newhall Santa Clarita Santa Clarita Stevenson Ranch Valencia Valencia Henry Mayo Hospital Service Area Los Angeles County California 91351 91387 91384 91321 91350 91390 91381 91354 91355 Below 100% Poverty 6.7% 9.2% 6.7% 16.9% 3.9% 3.2% 5.2% 3.2% 6.0% 7.3% 16.3% 14.4% Below 200% Poverty 28.2% 20.6% 17.7% 38.7% 13.1% 9.3% 9.4% 10.0% 14.2% 19.1% 38.4% 33.9% Source: American Community Survey, 2007-2011 16 Examining poverty levels by community and type of household paints an important picture of the population within the hospital service area. Newhall has the highest levels of poverty in the service area, across all household types. Overall children tend to suffer at higher rates of poverty (9.1%) as compared to seniors (5.9%), and 22.1% of all households with a female head-of-household and children, live in poverty. Poverty Levels of Children, Seniors, and Female Head of Households with Children Geographic Area Zip Code Canyon Country Canyon Country Castaic Newhall Santa Clarita Santa Clarita Stevenson Ranch Valencia Valencia Henry Mayo Hospital Service Area Los Angeles County California 91351 91387 91384 91321 91350 91390 91381 91354 91355 Children Under 18 Years Old 10.6% 12.5% 8.1% 23.7% 4.4% 3.2% 6.2% 3.0% 5.3% 9.1% 23.1% 19.9% Seniors 5.4% 5.1% 2.2% 11.1% 4.6% 0.0% 5.4% 4.2% 6.7% 5.9% 11.7% 9.1% Female HoH with Children 21.5% 31.9% 7.7% 37.3% 12.8% 19.5% 30.5% 9.3% 13.2% 22.1% 35.8% 34.1% Source: American Community Survey, 2007-2011 Households The median household income in the area ranges from $58,130 in Newhall to $113,537 in Santa Clarita (91390). The communities in the service area, including Newhall, have median household incomes that are higher than the county median household income. Median Household Income Geographic Area Canyon Country Canyon Country Castaic Newhall Santa Clarita Santa Clarita Stevenson Ranch Valencia Valencia Henry Mayo Hospital Service Area Los Angeles County Zip Code 91351 91387 91384 91321 91350 91390 91381 91354 91355 Median Household Income $74,649 $83,102 $98,330 $58,130 $99,876 $113,537 $112,399 $104,574 $86,721 $89,361 $56,266 Source: American Community Survey, 2007-2011 In the service area there are 85,135 households. The percentage of 3-person households (18.6%), 4-person households (20.3%), and 5-person households (9.5%) exceeds the county and state rates for these size households. 17 Household Size Household Size 1 Person Households 2 Person Households 3 Person Households 4 Person Households 5 Person Households 6 Person Households 7+ Person Households Henry Mayo Hospital Service Area 17.7% 27.3% 18.6% 20.3% 9.5% 3.9% 2.6% Los Angeles County 24.2% 26.3% 16.3% 15.0% 8.7% 4.5% 5.0% California 23.3% 29.1% 16.2% 15.0% 8.3% 4.0% 4.1% Source: U.S. Census Bureau, 2010 In the hospital service area, residents have lower rates of supportive benefits than found in the county: 2.7% of service area residents receive SSI benefits, 1.6% receive cash public assistance income and, 2.4% of residents receive food stamp benefits. Despite this, 30% of area households living in poverty report experiencing food insecurity, with 11.7% reporting food insecurity with hunger. Household Supportive Benefits Households Supplemental Security Income (SSI) Public Assistance Food Stamps/SNAP Henry Mayo Hospital Service Area 85,135 2.7% 1.6% 2.4% Los Angeles County 3,218,518 5.8% 3.9% 6.2% Source: American Community Survey, 2007-2011, by ZCTA Food Insecurity SPA 2 Households below 100% FPL Reporting Food Insecurity (based on a series of 5 questions) without Hunger Households below 100% FPL Reporting Food Insecurity with Hunger 18.3% 11.7% Los Angeles County 17.9% 12.8% Source: L.A. County Department of Public Health, 2011 LA County Health Survey Free or Reduced Price Meals The number of students eligible for the free and reduced price meal program is one indicator of the socioeconomic status of a school district’s student population. In the Sulphur Springs Union District, nearly half (45.5%) of the children are eligible for the program. In Acton-Agua Dulce Unified, 37.2% of children meet program eligibility requirements, while in Saugus Union District, the lowest concentration, only 18.2% of the students are eligible. All of the area's districts have a smaller percentage of lowincome eligible students than the county or state. It is important to note that while examining District totals provides an overview of the student population; this is an average among all the schools. Within the District there are a number of schools with 18 higher and lower rates of eligible low-income children. Students Eligible for Free or Reduced Price Meal Program School District Acton-Agua Dulce Unified District Castaic Union Elementary District Newhall District Saugus Union District Sulphur Springs Union District William S. Hart Union High District Los Angeles County California Students eligible for Free and Reduced Price Meal Program 37.2% 24.3% 35.0% 18.2% 45.5% 20.5% 66.6% 57.5% Source: California Department of Education DataQuest, 2011-2012 Unemployment Santa Clarita has a relatively low unemployment rate of 6.7% when compared to the county and the state. Unemployment Rate, 2012 Average Geographic Area Unemployment Rate Santa Clarita City Los Angeles County 6.7% 11.0% California 10.5% Source: California Employment Development Department, Labor Market Information, 2012 Educational Attainment In the 2011/12 school year, 93% of 12th graders graduated from William S. Hart Union High District, and 80.8% from Acton-Agua Dulce Unified District, both were higher than the Los Angeles County rate of 75% and the state rate of 78.7%. School District Acton-Agua Dulce Unified District William S. Hart Union High District Los Angeles County California Percent of 12th Grade Students Graduating with their Cohort 80.8% 93.0% 75.0% 78.7% Source: California Department of Education DataQuest, 2011-2012 Of the population age 25 and over, 11.9% have less than a high school diploma, which is better than county and state completion rates. 19 Population, 25 Years and Older, with No High School Diploma Henry Mayo Hospital Service Area 11.9% Los Angeles County California 23.8% 18.9% Source: American Community Survey, 2007-2011, by ZCTA 19.6% of service area adults are high school graduates and 33% are college graduates. In Los Angeles County 20.8% of residents are high school graduates and 29.2% are college graduates. Educational Attainment of Adults, 25 Years and Older Population 25 years and older th Less than 9 Grade Some High School, No Diploma High School Graduate Some College, No Degree Associate Degree Bachelor Degree Graduate or Professional Degree Henry Mayo Hospital Service Area 168,124 4.8% 7.1% 19.6% 26.1% 9.3% 22.6% 10.4% Los Angeles County 6,318,305 13.8% 10.1% 20.8% 19.2% 6.8% 19.1% 10.1% California 23,797,884 10.4% 8.8% 21.1% 21.8% 7.7% 19.3% 11.0% Source: American Community Survey, 2007-2011, by ZCTA Homelessness The Los Angeles Homeless Services Authority (LAHSA) conducts the biennial Greater Los Angeles Homeless Count, for the Los Angeles Continuum of Care (LA CoC); it includes all of LA County except for the cities of Glendale, Pasadena and Long Beach, who conduct their own homeless counts. Comparing the homeless counts from 2009 and 2011, there was a significant increase in the number of homeless in SPA 2. Homeless Census and Annual Estimate, 2009 and 2011 SPA 2 Los Angeles County Total Homeless 2009 2011 3,753 4,727 53,046 51,340 Sheltered Unsheltered 2011 2011 N/A N/A 38% 62% Source: Los Angeles Homeless Services Authority, 2009 and 2011 Los Angeles Homeless Count Sheltered vs. Unsheltered for 2009 was not included as it covered different geographic areas than 2011. The majority of homeless continue to be adult males. However, SPA 2 has a noticeably higher percentage of homeless who are seniors, and lower percentages of other measured subgroups, as compared to the county. 20 Homeless Population, by percentages Geographic Area Youth 18-24 1.9% 7.7% Seniors SPA 2 Los Angeles County 11.2% 7.2% Children under 18 Family Members 11.7% 13.4% Women 18% 20% N/A 28% Source: Los Angeles Homeless Services Authority, 2011 Los Angeles Homeless Count Crime and Violence Calls for domestic violence are categorized as with our without a weapon. In the city of Santa Clarita there were 399 domestic violence calls in 2011. Only 20.8% of the calls did not involve a weapon. Reports of domestic violence in Santa Clarita are 25% more likely to involve a weapon than at the county level, and more than twice as likely as at the state level. Domestic Violence Calls, 2011 Geographic Area Santa Clarita City Los Angeles County California Total 399 39,817 158,547 Without Weapon 20.8% 37.9% 60.9% With Weapon 79.2% 62.1% 39.1% Source: California Department of Justice, Office of the Attorney General, 2011 15.6% of adults in SPA 2 indicated they had experienced physical or sexual violence by an intimate partner since the age of 18, and 5.3% had been the victims of intimate partner violence in the past year. These rates are higher than those found at both the county and state levels. Experienced Physical or Sexual Violence SPA 2 By Intimate Partner Since Age 18 By Intimate Partner in Past Year 15.6% 5.3% Los Angeles County 12.7% 3.1% California 14.8% 3.5% Source: California Health Interview Survey, 2009 21 Health Access Health Insurance Coverage Health insurance coverage is considered a key component to accessing health care. In SPA 2, adults ages 18-64 have the lowest rates of health insurance at 73%, children have rates of 95.8%, and essentially zero seniors reported being without health insurance. Rates of insurance coverage in the service area exceed county rates. Compared to the county, more adults and children in SPA 2 were covered by private insurance. Children were slightly more likely to be covered by Healthy Families than at the county level, and children, adults, and seniors were all less likely to be covered by Medi-Cal. As expected, a large proportion of seniors (92.6%) have Medicare coverage in some form, which is higher than the 88.2% found among county seniors. Currently insured children and adults were both less likely to have spent time uninsured within the past year. Insurance Coverage for Children, 0-17 SPA 2 Healthy Families Medi-Cal Healthy Kids Private Insurance No Insurance Spent some time without Insurance in the past year Los Angeles County 13.9% 23.8% 2.3% 55.7% 4.2% 12.0% 34.4% 2.2% 46.4% 5.0% 5.4% 6.4% Source: L.A. County Department of Public Health, 2011 LA County Health Survey Insurance Coverage for Adults, 18-64 SPA 2 Medi-Cal Medicare Private No Insurance Spent some time without Insurance in the past year Los Angeles County 14.4% 0.8% 57.9% 27.0% 17.3% 1.4% 52.9% 28.5% 8.4% 9.1% Source: L.A. County Department of Public Health, 2011 LA County Health Survey 22 Insurance Coverage for Adults 65+ SPA 2 Medi-Medi Medicare & Private Medicare Only Medi-Cal (w/o Medicare) Private No Insurance Los Angeles County 24.2% 28.0% 40.4% 0.0% 5.9% 0.0% 25.9% 25.4% 36.9% 3.4% 6.4% 2.1% Source: L.A. County Department of Public Health, 2011 LA County Health Survey Sources of Care Residents who have a medical home and access to a primary care provider improve continuity of care and decrease unnecessary ER visits. 96.2% of children in SPA 2 have a usual source of care, versus 95.2% for Los Angeles County. Among adults, 77.4% of adults in SPA 2 and 76.6% in L.A. County have a usual source of care. No Usual Source of Care SPA 2 Children with No Usual Source of Care Adults with No Usual Source of Care 3.8% 22.6% Los Angeles County 4.8% 23.4% Source: L.A. County Department of Public Health, 2011 LA County Health Survey When looked at by race or ethnicity, African Americans, Latinos and Asians in SPA 2 are less likely to have a usual source of care than at the county or state level. No Usual Source of Care by Race/Ethnicity SPA 2 African American Latino Asian White Los Angeles County 13.3% 25.1% 22.5% 10.0% 10.1% 20.7% 19.3% 10.4% California 11.0% 19.3% 14.4% 10.0% Source: California Health Interview Survey, 2011-2012 The source of care for 56.6% of SPA 2 residents is a doctor’s office, HMO, or Kaiser. Clinics and community hospitals are the source of care for 23.1%. The ER is a source of care for a small percentage of area residents (0.9%). 18.5% of SPA 2 residents have no source of care; this is higher than the state rate of 14.3%. 23 Sources of Care 56.6% Los Angeles County 56.7% 23.1% 24.6% 23.3% 0.9% 0.8% 18.5% 1.1% 0.9% 16.7% 1.1% 0.8% 14.3% SPA 2 Dr. Office/HMO/Kaiser Permanente Community clinic/Government clinic/ Community hospital ER/Urgent Care Other No source of care California 60.5% Source: California Health Interview Survey, 2011-2012 Caregivers of children in SPA 2 reported that 9.6% of area children have difficulty accessing medical care, 4.8% were unable to afford to see a doctor for a physical exam or check-up in the past year, 3.5% were unable to afford to see a doctor when they had an illness or health problem, and 4.1% were unable to afford needed prescription medications. These percentages are all lower than those seen at the county level. The numbers for adults were much higher, with 28.9% of adults in SPA 2 reporting that obtaining needed medical care is either somewhat or very difficult, 16.8% could not afford to see a doctor when they needed to in the past year, and 15.8% could not afford needed prescription medications. The percentages who could not afford medical care or prescriptions were, unexpectedly, slightly higher in SPA 2 than at the county level. Health Care Barriers 9.6% Los Angeles County 12.3% 4.8% 6.4% 3.5% 6.1% 4.1% 5.7% 28.9% 31.7% 16.8% 16.0% 15.8% 15.4% SPA 2 Children Who Have Difficulty Accessing Medical Care Children Who Were Unable to Afford to See a Doctor for a Physical Exam or Check-up in the Past Year Children Who Were Unable to Afford to See a Doctor for an Illness or Other Health Problem in the Past Year Children Who Were Unable to Afford Prescription Medicines in the Past Year Adults Who Reported That Obtaining Needed Medical Care When Needed is Somewhat or Very Difficult Adults Who Did Not See a Doctor When Needed in the Past Year Because They Could Not Afford It Adults Who Reported They Could Not Afford Prescription Medication When Needed, in the Past Year Source: L.A. County Department of Public Health, 2011 LA County Health Survey Use of the Emergency Room An examination of ER use can lead to improvements in providing community-based prevention and primary care. 19.5% of SPA 2 residents visited an ER over the period of a year, which is slightly higher than at the county or state levels. Indeed, all sectors of the population of SPA 2 utilize the ER at levels higher than the state, and most at levels 24 higher than the county. Seniors visit the ER at the highest rates of any age category at the state and county level, but in SPA 2, children 0-17 are the highest utilizers. Use of Emergency Room SPA 2 Visited ER in last 12 months 19.5% Los Angeles County 18.2% California 17.9% 0-17 years old 18-64 years old 65 and older 23.9% 17.8% 20.0% 20.2% 16.9% 21.1% 19.1% 17.0% 19.7% <100% of poverty level <200% of poverty level 21.6% 20.4% 20.2% 21.1% 21.3% 19.1% Source: California Health Interview Survey, 2011-2012 Access to Primary Care Community Clinics Community clinics provide primary care (including medical, dental and mental health services) for uninsured and medically underserved populations. Using ZCTA (ZIP Code Tabulation Area) data for the Henry Mayo Newhall Memorial Hospital service area and information from the Uniform Data System (UDS)1, 18.1% of the population in the service area is categorized as low-income (200% of Federal Poverty Level) and 7.1% of the population are living in poverty. There are a number of Section 330 funded grantees (Federally Qualified Health Centers – FQHCs and FQHC Look-Alikes) that serve the area, although the vast majority of patients in all ZCTA's are served by Northeast Valley Health Corporation. Other clinics include: Comprehensive Community Health Center, Inc., Valley Community Clinic, El Proyecto Del Barrio, Inc., Asian Pacific Health Care Venture, and Mission City Community Network, Inc. Even with Section 330 funded Community Health Centers serving the area, there are a significant number of low-income residents who are not served by one of these clinic providers. The FQHCs have a total of 11,821 patients in the service area, which equates to 24.9% penetration among low-income patients and 4.3% penetration among the total population. From 2010-2011 the CHC providers increased their number of patients for a 15.6% increase in patients served by Community Health Centers in the service area. However, there remain 35,740 lowincome residents, approximately 75% of the population at or below 200% FPL that are not served by a Section 330-funded grantee. 1 The UDS is an annual reporting requirement for grantees of HRSA primary care programs: • Community Health Center, Section 330 (e) • Migrant Health Center, Section 330 (g) • Health Care for the Homeless, Section 330 (h) • Public Housing Primary Care, Section 330 (i) 25 Low-Income Patients Served and Not Served by FQHCs Geographic Area ZCTA Canyon Country 91351 Canyon Country 91387 Castaic 91384 Newhall 91321 Santa Clarita 91350 Santa Clarita 91390 Stevenson Ranch 91381 Valencia 91354 Valencia 91355 Henry Mayo Service Area LowIncome Population 7,658 7,819 3,939 13,035 3,366 2,103 1,921 2,972 4,742 47,561 Patients served by Section 330 Grantees In Service Area 2,767 2,081 775 3,907 783 311 253 351 593 11,821 Penetration among Low-Income Patients Penetration of Total Population 36.1% 26.6% 19.7% 30.0% 23.3% 14.8% 13.2% 11.8% 12.5% 24.9% 8.9% 5.2% 2.6% 11.2% 2.3% 1.6% 1.3% 1.2% 1.8% 4.3% Low-Income Not Served Number Percent 4,891 5,738 3,164 9,128 2,583 1,792 1,668 2,621 4,149 35,740 63.9% 73.4% 80.3% 70.0% 76.7% 85.2% 86.8% 88.2% 87.5% 75.1% Source: UDS Mapper, 2011 Underserved Areas The northern part of the service area, including most of Castaic, part of Valencia (sections of 91354 and 91355) and part of the 91390 area of Santa Clarita, is designated as a Health Professionals Shortage Area (HPSA) based on geographic area. Dental Care 22% of the children in SPA 2 do not have dental insurance, which is comparable to the rate for L.A. County. 9.6% of SPA 2 children were unable to obtain dental care (including checkups) in the past year, because they could not afford it, which is better than the county's 12.6% rate. 29.8% of SPA 2's adults were unable to obtain dental care (including checkups) in the past year because they could not afford it, which is similar to L.A. County. Dental Care Children Who Do Not Have Dental Insurance Children Unable to Obtain Dental Care (including check-ups) in the Past Year, Because They Could Not Afford It Adults Unable to Obtain Dental Care (including check-ups) in the Past Year, Because They Could Not Afford It SPA 2 Los Angeles County 22.0% 21.8% 9.6% 12.6% 29.8% 30.3% Source: L.A. County Department of Public Health, 2011 LA County Health Survey 26 Birth Characteristics Births In 2011, there were 2,986 births in the service area. The majority of the births were to mothers who are White (36.8%) and Latino (34.3%). However, in Newhall 57.5% of births were to Latina mothers and 20.5% were to White mothers. In Canyon Country, 43.3% of births were to Latinas and 29.8% of births were to White mothers. Teen Birth Rate In 2011, teen pregnancy rates occurred at a rate of 45.2 per 1,000 births (or 4.5% of total births). This rate is considerably less than the teen pregnancy rate found in the county and the state. The rates for Newhall, Castaic, and Canyon Country were higher than for the other zip codes in the service area. Births to Teenage Mothers (Under Age 20) Geographic Area Zip Code Canyon Country Canyon Country Castaic Newhall Santa Clarita Santa Clarita Stevenson Ranch Valencia Valencia Henry Mayo Hospital Service Area Los Angeles County California 91351 91387 91384 91321 91350 91390 91381 91354 91355 Births to Teen Live Births Mothers 30 422 30 575 14 226 33 435 4 366 6 157 4 178 6 315 8 312 135 2,986 10,480 130,312 38,834 503,856 Rate per 1,000 Live Births 71.1 52.2 61.9 75.9 10.9 38.2 22.5 19.0 25.6 45.2 80.4 77.1 Source: California Department of Public Health, 2011 Prenatal Care In 2011, pregnant women in the service area entered prenatal care late - after the first trimester - at a rate of 110.5 per 1,000 live births. This rate of late entry into prenatal care translates to 89% of women entering prenatal care within the first trimester. It is lower in Newhall and Canyon Country, where 85% and 86.4% of women, respectively, entered early into prenatal care. The area rate of early entry into prenatal care does meet the Healthy People 2010 benchmark of 77.9% of women entering prenatal care in the first trimester. Late Entry Into Prenatal Care (After First Trimester) Geographic Area Canyon Country Zip Code 91351 Late Prenatal Care 60 Live Births* 417 Rate 143.9 27 Canyon Country Castaic Newhall Santa Clarita Santa Clarita Stevenson Ranch Valencia Valencia Henry Mayo Hospital Service Area Los Angeles County California 91387 91384 91321 91350 91390 91381 91354 91355 74 22 63 30 9 19 19 29 325 18,232 81,140 568 222 420 363 157 175 311 309 2,942 124,538 492,832 130.3 99.1 150.0 82.6 57.3 108.6 61.1 93.9 110.5 146.4 164.6 Source: California Department of Public Health, 2011 *Births in which the first month of prenatal care is unknown are not included in the tabulation. Low Birth Weight Low birth weight is a negative birth indicator. Babies born at a low birth weight are at higher risk for disease, disability and possibly death. The Henry Mayo Newhall Memorial Hospital service area has a lower rate of low birth weight babies (65.6 per 1,000 live births) when compared to the county (83.2 per 1,000 live births) and the state (67.8 per 1,000 live births). The rate of low birth weight in the service area (6.6%) is also lower than the Healthy People 2020 objective of 7.8% of births being low birth weight. (When examining geographic areas with a small occurrence it is important to use caution when drawing conclusions from data as small occurrences may result in high rates.) Low Birth Weight (Under 2,500 g) Geographic Area Canyon Country Canyon Country Castaic Newhall Santa Clarita Santa Clarita Stevenson Ranch Valencia Valencia Henry Mayo Hospital Service Area Los Angeles County California Zip Code 91351 91387 91384 91321 91350 91390 91381 91354 91355 Low Birth Rate per 1,000 Live Births Weight Live Births 28 422 66.4 35 575 60.9 14 226 62.0 18 435 41.4 34 366 92.9 9 157 57.3 14 178 78.7 19 315 60.3 25 312 80.1 196 2,986 65.6 10,844 130,312 83.2 34,159 503,856 67.8 Source: California Department of Public Health, 2011 Infant Mortality Infant deaths are under one year of age. The infant death rate in the service area is 5.4 per 1,000 live births. In comparison, the infant death rate in the county is 4.8 and the 28 state is 4.7 deaths per 1,000 live births. The infant death rate in the service area is less than the Healthy People 2020 objective of 6.0 deaths per 1,000 live births. (When examining geographic areas with a small occurrence it is important to use caution when drawing conclusions from data as small occurrences may result in high rates.) Infant Mortality Rate, 2010 Geographic Area Canyon Country Canyon Country Castaic Newhall Santa Clarita Santa Clarita Stevenson Ranch Valencia Valencia Henry Mayo Hospital Service Area Los Angeles County California Zip Code 91351 91387 91384 91321 91350 91390 91381 91354 91355 Infant Deaths Live Births 4 428 4 564 2 250 3 493 2 406 0 175 0 193 1 336 1 329 17 3,174 619 130,312 2,419 509,979 Death Rate 9.3 7.1 8.0 6.1 4.9 0.0 0.0 3.0 3.0 5.4 4.8 4.7 Source: California Department of Public Health, 2010 Breastfeeding Breastfeeding has been proven to have considerable benefits to baby and mother. The California Department of Public Health (CDPH) highly recommends babies be fed only breast milk for the first six months of life. Data on breastfeeding are collected by hospitals on the Newborn Screening Test Form. At Henry Mayo Newhall Memorial Hospital 94.2% of women use some breastfeeding and 68% exclusively breastfeed their infants, which is higher than rates for the county and the state. In-Hospital Breastfeeding Henry Mayo Hospital Los Angeles County Hospitals California Any Breastfeeding Number Percent 1,065 94.2% 109,686 90.9% 481,183 91.7% Exclusive Breastfeeding Number Percent 768 68.0% 56,478 46.8% 264,377 60.4% Source: California Department of Public Health, Breastfeeding Hospital of Occurrence, 2011 29 Mortality/Leading Causes of Death Mortality Rates The three leading causes of death in the Hospital service area are heart disease, cancer, and stroke. The crude death rate is a ratio of the number of deaths to the entire population. The heart disease mortality rate in the service area is 110.9 per 100,000 persons, which is lower than the 160.7 seen at the county level, but still exceeds the Healthy People 2020 objective of 100.8 deaths per 100,000 persons. The death rates for the remaining top ten causes of death in the service area are lower than the rates for the county, and also lower than the Healthy People 2020 objectives, where applicable. Mortality Rates, per 100,000 Persons, 2010 Heart Disease Cancer Stroke Alzheimer’s Disease Chronic Lower Respiratory Disease Unintentional Injuries Influenza and Pneumonia Diabetes Liver Disease Suicide Henry Mayo Hospital Service Area Number Rate 296 110.9 290 108.6 71 26.6 56 21.0 55 20.6 44 16.5 30 11.2 29 10.9 19 7.1 18 6.7 Los Angeles County Rate 160.7 141.2 33.4 22.8 28.1 19.5 20.0 19.3 11.9 8.1 HP 2020 Rate 100.8 160.6 33.8 No Objective 98.5 36.0 No Objective 65.8 No Objective 10.2 Source: California Department of Public Health, 2010 The five year average, age-adjusted cancer mortality rate for all cancer sites in Los Angeles County was 158.6. Mortality from digestive system and respiratory system cancers occurs at the highest rates. Cancer Mortality Rates, per 100,000 Persons, Age-Adjusted, 2005-2009 Los Angeles County Cancer, all sites Digestive system Respiratory system Male genital Female genital Breast Urinary system Leukemia Brain and Nervous system Number 68,315 19,366 15,402 3,929 4,145 5,639 3,167 2,859 1,850 Rate 158.6 44.9 36.6 23.8 17.0 12.7 7.4 6.6 4.1 California Rate 162.7 42.7 41.0 23.7 15.4 12.3 7.9 6.7 4.3 Source: California Cancer Registry (CCR), Cancer Surveillance Section, Cancer Surveillance and Research Branch, California Department of Public Health, 2005-2009 30 Leading Causes of Premature Death A premature death is one in which someone dies before age 75 (under age 1 is not included). With 75 years set as a cut-off date, everyone who dies between the ages of 1-74 is considered to have died prematurely. Coronary heart, suicide and drug overdose are the top three causes of premature death in SPA 2. Leading Causes of Premature Death SPA 2 Los Angeles County #1 Cause Coronary Heart Disease Coronary Heart Disease #2 Cause Suicide Homicide #3 Cause #4 Cause Drug Motor Vehicle Overdose Crash Motor Vehicle Liver Disease Crash #5 Cause Liver Disease Suicide Source: L.A. County Department of Public Health, Office of Health Assessment and Epidemiology. Mortality in Los Angeles County 2009: Leading Causes of death and premature death with trends for 2000-2009, October 2012. Mortality rates are age-adjusted based on the 2000 Standard Population using the methods approved by the CDC. 31 Chronic Disease Health Status Among the residents in SPA 2, 4.7% of children were described by their caretakers as being in fair or poor health, and 18.5% of SPA 2 adults described themselves in those terms. These percentages are slightly lower than those found at the county level. Adults in SPA 2 reported having 5.8 unhealthy days (either mental or physical) in the past 30 days, and 2.5 days of the past 30 during which their activities were limited due to poor physical and/or mental health. These are slightly higher rates than those seen at the county level. Health Status, Fair or Poor Health SPA 2 Children with Fair or Poor Health Adults with Fair or Poor Health 4.7% 18.5% Los Angeles County 5.8% 20.7% Source: L.A. County Department of Public Health, 2011 LA County Health Survey Unhealthy Days, Adults 18+ SPA 2 Average Number of Unhealthy Days (Mental and/or Physical) in the past 30 days Average Number of Days in the past 30 Days that Activities Were Limited Due to Poor Physical and/or Mental Health. Los Angeles County 5.8 days 5.4 days 2.5 days 2.1 days Source: L.A. County Department of Public Health, 2011 LA County Health Survey Diabetes Diabetes is a growing concern in the community. In SPA 2 8.5% of the population has been diagnosed as pre-diabetic, and 7.2% of adults have been diagnosed with diabetes. For adults with diabetes, 50.5% were very confident they can control their diabetes, which is lower than the levels found in the county and the state. 65.2% take oral hypoglycemic mediations and 66.7% had a diabetes management care plan, both of which are also lower than the levels found county and state-wide. 25.9% had never had a foot exam, and 8.2% said that they had never had an HgA1c test. 32 Adult Diabetes Diagnosed Pre/Borderline Diabetic 8.5% Los Angeles County 7.1% Diagnosed with Diabetes Very confident to Control Diabetes Somewhat confident Not confident 7.2% 50.5% 37.2% 12.3% 10.9% 60.9% 30.6% 8.5% 8.5% 58.6% 32.6% 8.8% Takes oral hypoglycemic medications Has a diabetic management care plan Has never had a foot exam 65.2% 66.7% 25.9% 73.7% 77.8% 25.7% 72.0% 78.0% 27.8% Never heard of the HgA1c test Never had the HgA1c test 17.2% 8.2% 19.5% 9.3% 14.5% 10.6% SPA 2 California 8.0% Source: California Health Interview Survey, 2011-2012 (Lines 1-5) and 2009 (Lines 6-10) When examined over time, it is clear that while the rate of diabetes in SPA 2 is lower than that found in Los Angeles County as a whole, it is rising more than the county rate. Adults Diagnosed with Diabetes, 2005-2011 Service Planning Area 2 Los Angeles County 2005 6.3% 8.6% 2007 7.0% 9.1% 2011 Change 2005-2011 9.6% 52.4% 9.9% 15.1% Source: L.A. County Department of Public Health, 2012 Heart Disease For adults in SPA 2, 5.3% have been diagnosed with heart disease. This is lower than state and county rates. Among these adults, 56.5% are very confident they can manage their condition, which is a higher level of confidence than that seen at the county or state level. 77.0% of adults in SPA 2 have a management care plan developed by a health care professional. Adult Heart Disease 5.3% Los Angeles County 5.6% Very Confident to Control Condition Somewhat Confident to Control Condition Not Confident to Control Condition 56.5% 36.6% 6.9% 49.5% 41.7% 8.8% 55.3% 35.3% 9.4% Has a management care plan 77.0% 73.3% 74.1% SPA 2 Diagnosed with heart disease California 6.3% Source: California Health Interview Survey, 2011-2012 High Blood Pressure Hypertension (high blood pressure) and high cholesterol are co-morbidity factors for diabetes and heart disease. In SPA 2, 23.9% of adults have been diagnosed with high blood pressure, and 28.4% with high cholesterol. High cholesterol is found more often in SPA 2 residents than in county residents as a whole. 33 High Blood Pressure SPA 2 Ever Diagnosed with Hypertension 23.9% Los Angeles County 24.0% 28.4% Los Angeles County 25.6% Source: L.A. County Department of Public Health, 2011 LA County Health Survey High Cholesterol SPA 2 Ever Diagnosed with High Cholesterol Source: L.A. County Department of Public Health, 2011 LA County Health Survey Cancer In Los Angeles County, the age-adjusted cancer incidence rate is 451.9 per 100,000 persons. Digestive system cancers (92.5), female genital cancers (54.0) and leukemia (12.1) occur at rates higher than the state rates for these types of cancer. Cancer Incidence, per 100,000 Persons, Age Adjusted, 2005-2009 All sites Male genital Breast Digestive system Female genital Respiratory system Urinary system Leukemia Brain and nervous system Los Angeles County 451.9 146.0 78.0 92.5 54.0 49.4 31.7 12.1 5.6 California 474.7 150.1 81.5 87.9 51.6 56.2 34.0 11.9 6.2 Source: California Cancer Registry (CCR), Cancer Surveillance Section, Cancer Surveillance and Research Branch, California Department of Public Health Asthma The population diagnosed with asthma in SPA 2 is 13.5%. 47.9% of asthmatics take medication to control their symptoms, which is a higher rate than for state or county residents. Among youth, 18.8% have been diagnosed with asthma, and 24.8% of them visited the ER during the past year due to asthma, which are both higher percentages than those seen at the county or state level. 71% of asthmatics are very confident that they can control and manage their asthma, which is less confidence than expressed at the county and state levels. 34 Asthma 13.5% 18.8% Los Angeles County 12.7% 14.5% 14.4% 14.4% 13.7% 24.8% 22.8% 21.2% 47.9% 46.7% 44.1% 42.6% 46.6% 39.6% 71.0% 26.2% 2.8% 73.4% 22.9% 3.7% 76.9% 19.8% 3.3% SPA 2 Diagnosed with Asthma, Total Population Diagnosed with Asthma, 0-17 Years Old ER Visit in Past Year Due to Asthma, Total Population ER Visit in Past Year Due to Asthma, 0-17 Years Old Takes Daily Medication to Control Asthma, Total Population Takes Daily Medication to Control Asthma, 0-17 Years Old Very Confident to Control and Manage Asthma Confident to Control and Manage Asthma Not Confident to Control and Manage Asthma California 14.1% 15.4% Source: California Health Interview Survey, 2011-2012, except for confidence levels, which are 2009 Disability In SPA 2, 28.1% of adults had a physical, mental or emotional disability. The rate of disability in the state was 29.9%. The percent of adults who couldn't work for at least one year due to their disability (3.6%) was also lower than the state or county rates. Population with a Disability SPA 2 Adults with a disability Couldn’t work for at least one year, due to impairment Los Angeles County California 28.1% 29.8% 29.9% 3.6% 6.0% 5.8% Source: California Health Interview Survey, 2011-2012 35 Health Behaviors Health Behaviors Ranking County Health Rankings examines healthy behaviors and ranks counties according to health behavior data. California’s 58 counties are ranked from 1 (healthiest) to 58 (least healthy) based on a number of indicators that include: adult smoking, obesity, physical inactivity, excessive drinking, sexually transmitted infections, and others. A ranking of 18 puts Los Angeles County in the top third of California counties for health behaviors. Health Behaviors Ranking Los Angeles County County Ranking (out of 58) 18 Source: County Health Rankings, 2013 Overweight and Obesity Over half (55.6%) of adults are overweight or obese in SPA 2, a rate lower than that seen on the county or state level. Children, too, tend to be less overweight and obese in SPA 2 than in the larger populations. When looked at over time, however, obesity among adults is rising in SPA 2 at a faster rate than in the county. Overweight or Obese SPA 2 Adult Teen Child 55.6% 16.6% 9.6% Los Angeles County 58.9% 17.1% 13.3% California 59.8% 15.8% 12.6% Source: California Health Interview Survey, 2011-2012 Adult Obesity 2005 Service Planning Area 2 Los Angeles County 17.0% 20.9% 2007 17.1% 22.2% 2011 21.1% 23.6% Change 2005-2011 24.1% 12.9% Source: L.A. County Department of Public Health, 2012 Rates of obesity among African Americans and Latinos in SPA 2 are lower than rates seen at the county and state levels, but remain higher than those seen among Whites and Asians. Asians and Whites in SPA 2 show slightly higher rates of obesity than seen at the county level, but lower than state levels. Asians are far less likely to be obese when compared to other races. 36 Adult Overweight and Obesity by Race/Ethnicity SPA 2 African American Asian Latino White 65.9% 35.3% 62.3% 55.5% Los Angeles County 71.6% 34.9% 68.9% 52.7% California 72.4% 37.1% 70.7% 57.2% Source: California Health Interview Survey, 2011-2012 The physical fitness test (PFT) for students in California schools is the FitnessGram®. One of the components of the PFT is measurement of body composition (measured by skinfold measurement, BMI, or bioelectric impedance). Children who do not meet the “Healthy Fitness Zone” criteria for body composition are categorized as needing improvement or at high risk (overweight/obese). Among 5th graders, between 24.5% (in the Saugus Union District) and 34.1% (in the Sulphur Springs Union District) of the service area's 5th graders need improvement or are at high risk. This compares favorably with the 51.4% seen at the county levels. Ninth graders also compare well, with 21% of Acton-Agua Dulce and 19.7% of William S. Hart District's students needing improvement or being at high risk, compared to the county's 44.1%. 5th and 9th Graders, Body Composition, Needs Improvement + High Risk School District Acton-Agua Dulce Unified District Castaic Union Elementary District Newhall District Saugus Union District Sulphur Springs Union District William S. Hart Union High District Los Angeles County Fifth Grade 33.0% 28.6% 26.1% 24.5% 34.1% N/A 51.4% Ninth Grade 21.0% N/A N/A N/A N/A 19.7% 44.1% Source: California Department of Education, Fitnessgram Physical Fitness Testing Results, 2011-2012 Fast Food 44.4% of children and 37.9% of adults in SPA 2 eat fast food at least once per week. These rates are lower than those seen in L.A. County. Fast Food Consumption SPA 2 Children Who Were Reported to Eat Fast Food at Least Once a Week Adults Who Reported Eating Fast Food at Least Once a Week Los Angeles County 44.4% 50.5% 37.9% 40.0% Source: L.A. County Department of Public Health, 2011 LA County Health Survey 37 Soda Consumption 33.5% of children and 31.6% of adults in SPA 2 drink at least one soda or sweetened drink per day, which are lower rates than seen at the county level. Soda or Sweetened Drink Consumption Los Angeles County SPA 2 Children Reported to Drink At Least One Soda or Sweetened Drink a Day Adults Who Reported Drinking At Least One Soda or Sweetened Drink a Day 33.5% 38.3% 31.6% 35.5% Source: L.A. County Department of Public Health, 2011 LA County Health Survey Fresh Fruits and Vegetables 90% of SPA 2 adults find accessing fresh produce (fruits and vegetable) to be somewhat or very easy. That number is slightly lower for those adults who are caretakers of children 0-17 (88.1% said access was somewhat or very easy). Despite the ease of access, only 17.1% of SPA 2 adults reported eating the recommended 5 or more servings of fruit and vegetables in the previous day. Access to and Consumption of Fresh Fruits and Vegetables, Adults Los Angeles County SPA 2 Adults Who Reported That Accessing Fresh Produce (Fruits and Vegetables) was Very or Somewhat Easy Caretakers of Children, 0-17, That Reported Community Access to Fresh Produce (Fruits and Vegetables) was Good or Excellent Adults Who Reported Eating 5 or More Servings of Fruit/Vegetables in the Past Day 90.0% 89.7% 88.1% 81.9% 17.1% 16.2% Source: L.A. County Department of Public Health, 2011 LA County Health Survey Physical Activity For school-aged children in SPA 2, 29.6% engage in physical activity for at least one hour a day, 7 days a week. An additional 59.4% participate in physical activities regularly, and 11% do not participate in any physical activity. Physical activities include walking, biking, or skateboarding to/from school; participating in team sports; bicycling, rollerblading, or skateboarding for fun; physically interactive games such as DDR / Wii Sports / Wii Fit; and/or Gymnastic, Dance or Karate Classes. Physical Activity, Children 6-17 SPA 2 One hour or more per day, 7 days per week Participates Does not Participate 29.6% 59.4% 11.0% Los Angeles County 28.7% 60.3% 10.9% Source: L.A. County Department of Public Health, 2011 LA County Health Survey 38 61.3% of SPA 2 adults meet aerobic activity guidelines (vigorous activity for 75 minutes a week or moderate activity for 150 minutes a week) and 36.3% meet muscle strengthening guidelines (at least two days per week of muscle strengthening); only 28.4% meet both guidelines; 12.8% of SPA 2 adults engage in no aerobic activity weekly, and 11.2% engage in neither aerobic nor strengthening activities. 48.9% of SPA 2's adults utilize neighborhood walking paths, parks, playgrounds or sports fields. 35.2% do not, and an additional 16% report that their neighborhood does not have any of the above, which is higher than the 14.2% for Los Angeles County. Physical Activity, Adults SPA 2 Meet Aerobic Activity Guidelines (Vigorous activity for 75 minutes a week or Moderate activity for 150 minutes a week) Meet Muscle Strengthening Guidelines (at least 2 days/week of muscle strengthening). Meet Both Aerobic and Strengthening Guidelines Engage in No Aerobic Activity Weekly Engage in No Aerobic or Strengthening Activities Use Walking Paths, Parks, Playgrounds or Sports Fields in Their Neighborhood Do Not Use Neighborhood Paths, Parks, Playgrounds or Fields Report Their Neighborhood Does Not Have Any of the Above Los Angeles County 61.3% 61.8% 36.3% 37.1% 28.4% 12.8% 11.2% 29.7% 12.0% 10.2% 48.9% 51.5% 35.2% 16.0% 34.3% 14.2% Source: L.A. County Department of Public Health, 2011 LA County Health Survey One of the components of the physical fitness test (PFT) for students in schools is measurement of aerobic capacity through run and walk tests. Children who meet the established standards for aerobic capacity are categorized in the Healthy Fitness Zone. Between 59.8% (Acton-Agua Dulce Unified) and 79.7% (Saugus Union) of area fifth graders meet the Healthy Fitness Zone standards for aerobic capacity. Among ninth graders, 72.4% of Acton-Agua Dulce Unified, and 75.4% of William S. Hart Union District's ninth graders meet the standards. All of the above rates compare favorably with rates seen at the county level. 5th and 9th Grade Students, Aerobic Capacity, Healthy Fitness Zone School District Acton-Agua Dulce Unified District Castaic Union Elementary District Newhall District Saugus Union District Sulphur Springs Union District William S. Hart Union High District Los Angeles County Fifth Grade 59.8% 75.2% 78.9% 79.7% 66.6% N/A 58.8% Ninth Grade 72.4% N/A N/A N/A N/A 75.4% 57.6% Source: California Department of Education, Fitnessgram Physical Fitness Testing Results, 2011-2012 39 Community Walkability WalkScore.com ranks over 2,500 cities with a walk score. The walk score for a location is determined by its access to amenities. Many locations are sampled within each city and an overall score is issued for the walkability of that city. A higher score indicates an area is more accessible to walking while a lower score indicates a more vehicle dependent location. WalkScore.com has established the range of scores as follows: 0-24: Car Dependent (Almost all errands require a car) 25-49: Car Dependent (A few amenities within walking distance) 50-69: Somewhat Walkable (Some amenities within walking distance) 70-89: Very Walkable (Most errands can be accomplished on foot) 90-100: Walker's Paradise (Daily errands do not require a car) Based on this scoring method, all of the zip codes in the service area were rated "Car Dependent". Walkability Geographic Area Walk Score 91355 - Valencia 91350 - Santa Clarita 91354 - Valencia 91387 - Canyon Country 91351 - Canyon Country 91321 - Newhall 91381 - Stevenson Ranch 91384 - Castaic 91390 - Santa Clarita 43 40 29 20 15 11 8 0 0 Source: WalkScore.com, 2012 HIV/AIDS The number of cases of HIV/AIDS diagnosed in SPA 2 and L.A. County dropped from 2010 to 2011. SPA 2 shows a lower rate of infection than does Los Angeles County. HIV/AIDS Diagnoses, 2010 - 2011 2010 SPA 2 Los Angeles County Number 240 2,065 2011 Rate 11 20 Number 250 1,880 Rate 11 18 Source: County of Los Angeles, Public Health, 2011 Annual HIV Surveillance Report 40 Sexually Transmitted Diseases Rates of Chlamydia, gonorrhea and syphilis (both primary/secondary and early latent) are all lower for SPA 2 than for Los Angeles County. STD Cases, Rate per 100,000 Persons, 2010 SPA 2 Chlamydia Gonorrhea Primary & Secondary Syphilis Early Latent Syphilis 295.0 52.1 4.8 5.2 Los Angeles County 455.1 96.8 6.5 9.2 Source: County of Los Angeles, Public Health, Sexually Transmitted Disease Morbidity Report, 2010 Teen Sexual History 85.6% of SPA 2 teens indicated they have never had sex, 11.4% that they had their first sexual encounter after the age of 15, and 3% that they had had a sexual encounter when they were younger than 15. Of those youth who had sex, 65.7% had been tested for an STD within the previous year. Teen Sexual History Never Had Sex First Encounter Under 15 Years Old First Encounter Over 15 Years Old 85.6% 3.0% 11.4% Los Angeles County 79.7% 11.1% 9.2% If Had Sex, Tested for STD in Past Year 65.7% 46.6% SPA 2 California 81.7% 7.6% 10.7% 32.2% Source: California Health Interview Survey, 2011-2012 Cigarette Smoking In SPA 2, 13.8% of adults are current smokers, with an additional 1% who smoke, but 'not regularly'; 20.6% of residents are former smokers, and 64.6% identify as nonsmokers. Cigarette Smoking, Adults SPA 2 Current smoker Non-Regular Smoker Former Smoker Non-Smoker Los Angeles County 13.8% 1.0% 20.6% 64.6% 13.1% 1.5% 19.5% 66.0% Source: L.A. County Department of Public Health, 2011 LA County Health Survey Alcohol and Drug Use 54.7% of adults in SPA 2 reported drinking in the past month. Heavy drinking is defined as more than 30 drinks for women and more than 60 drinks for men. 3.8% of adults in SPA 2 reported heavy drinking in the past month. Binge drinking is defined as consuming a certain amount of alcohol within a set period of time. For males this is five 41 or more drinks per occasion and for females it is four or more drinks per occasion. Among adults, 14.9% in SPA 2 had engaged in binge drinking in the past year. Alcohol Consumption and Binge Drinking, Adult SPA 2 Reported Drinking Alcohol in the Past Month. Reported Heavy Drinking in the Past Month Reported Binge Drinking in the Past Month 54.7% 3.8% 14.9% Los Angeles County 51.9% 3.5% 15.4% Source: L.A. County Department of Public Health, 2011 LA County Health Survey 3.4% of SPA 2 adults reported having used methamphetamines, cocaine or Ecstasy in the past year, which is higher than the 2.3% reported in L.A. County. Only 4.4% reported misusing prescription drugs within the past year, compared to 5.2% of L.A. County residents. Drug overdose was listed as the third leading cause of premature death in SPA 2 for 2009, the last year for which data was made available. Adult Illegal Drug Use SPA 2 Reported Using Methamphetamines, Cocaine or Ecstasy in the Past Year. Reported Misusing Any Form of Prescription Drugs in the Past Year. Los Angeles County 3.4% 2.3% 4.4% 5.2% Source: L.A. County Department of Public Health, 2011 LA County Health Survey Among teens in SPA 2, 9.2% have tried drugs and 5% have used marijuana in the past year. These rates are lower than found in the county. Teen Illegal Drug Use SPA 2 Ever tried marijuana, cocaine, sniffing glue, other drugs Marijuana use in past year 9.2% 5.0% Los Angeles County 14.6% 10.2% Source: California Interview Health Survey, 2011-2012 Mental Health 63.5% of SPA 2 adults reported receiving sufficient social and emotional support. 8.8% of SPA 2 residents tried to access mental health care in the prior 12 months, and 7.2% of area residents stated that they were unable to receive mental health care or counseling when they needed it during the prior year because they could not afford it. 12.5% of SPA 2 residents have been diagnosed with anxiety, and 7.2% of residents are either currently being treated or are having symptoms of anxiety. 13.9% had been diagnosed with depression, and 8.9% of SPA 2 residents were either being currently 42 treated or experiencing symptoms of depression. 12% were considered to be at risk for major depression, and 8.5% were both at risk for major depression and were primary caregivers for a child 0-17. Mental Health Indicators, Adults SPA 2 Reported Receiving Sufficient (Always/Usually) Social and Emotional Support. Los Angeles County 63.5% 64.0% 8.8% 7.5% 7.2% 6.1% Ever Diagnosed with Anxiety Ever Diagnosed with Anxiety and Either Currently Being Treated For Anxiety or Currently Having Symptoms of Anxiety. 12.5% 11.3% 7.2% 6.4% Ever Diagnosed with Depression Ever Diagnosed with Depression and Either Currently Being Treated For Anxiety or Currently Having Symptoms of Depression. At Risk for Major Depression At Risk for Major Depression AND Primary Caretaker of a Child 0-17 13.9% 12.2% 8.9% 8.3% 12.0% 8.5% 10.4% 9.2% Reported They Tried to Access Mental Health Care in the Past 12 Months. Unable to Receive Mental Health Care or Counseling When Needed (in the past year) Because They Could Not Afford It. Source: L.A. County Department of Public Health, 2011 LA County Health Survey 7.7% of respondents in SPA 2 reported that they had tried to access mental health care for a child/children between the ages of 3 and 17 within the past year. 3% of children in SPA 2 were reported to have been unable to afford mental health care or counseling within the prior year, just slightly higher than the 2.6% seen county-wide. Mental Health Access, Children 3-17 SPA 2 Respondents Who Reported They Tried to Access Mental Health Care for Children in the Past Year Children Reported as Unable to Afford Mental Health Care or Counseling in the Past Year Los Angeles County 7.7% 7.8% 3.0% 2.6% Source: L.A. County Department of Public Health, 2011 LA County Health Survey Immunization of Children Rates of compliance with childhood immunizations upon entry into kindergarten vary among area school districts. The overall rate of immunization for the Henry Mayo Newhall Memorial Hospital service area is 86.5%, which is lower than the rate for Los Angeles County, and lower than the state rate. William S. Hart Union High District has a rate of 60%, but this represents only one school: Santa Clarita Valley International School. Immunization rates in other area districts range between 73% (Acton-Agua Dulce Unified) and 93.8% (Castaic Union Elementary District), with only Castaic and Newhall Districts having rates higher than the Los Angeles County rate. 43 Up-to-Date Immunization Rates of Children Entering Kindergarten, 2011-2012 School District Acton-Agua Dulce Unified District Castaic Union Elementary District Newhall District Saugus Union District Sulphur Springs Union District William S. Hart Union High District (Santa Clarita Valley International School) Henry Mayo Service Area Los Angeles County California Immunization Rate 73.0% 93.8% 90.9% 86.6% 80.7% 60.0% 86.5% 89.2% 91.0% Source: California Department of Public Health, Immunization Branch, 2011-2012 Flu and Pneumonia Vaccines 36.4% of SPA 2 adults and 47.5% of children received a flu shot in the prior 12 months. Among seniors, 65.4% of SPA 2 residents received the flu shot, and 64.3% reported ever having received a pneumonia vaccination. All three rates are slightly higher than county rates. Flu Vaccine, Past 12 months SPA 2 Received Flu Vaccine, 65+ Years Old Received Flu Vaccine, 18+ 65.4% 36.4% Los Angeles County 64.2% 33.7% Source: L.A. County Department of Public Health, 2011 LA County Health Survey Flu Vaccine, Past 12 months, Children 0-17 SPA 2 Received Flu Vaccine 47.5% Los Angeles County 45.4% Source: California Health Interview Survey, 2009 Pneumonia Vaccine, 65+ SPA 2 Adults 65+ Who Reported Ever Having a Pneumonia Vaccination. 64.3% Los Angeles County 61.3% Source: L.A. County Department of Public Health, 2011 LA County Health Survey Mammograms and Pap Smears The Healthy People 2020 objective for mammograms is 81% of women 40+ years have a mammogram in the past two years. In SPA 2, women have met that objective with 82.8% of women 50-74 obtaining mammograms. The Healthy People 2020 objective for Pap smears in the past three years is 93%. In SPA 2, 84% of women had a Pap smear in the past three years. Both rates are higher than county rates. 44 Women Mammograms and Pap Smears SPA 2 Women 50-74 Who Reported Having a Mammogram in the Past 2 Years. Women 18-65 Who Reported Having a Pap Smear within the Past 3 Years. Los Angeles County 82.8% 79.8% 84.0% 82.8% Source: L.A. County Department of Public Health, 2011 LA County Health Survey Colorectal Cancer Screening In SPA 2, 75.8% of adults over 50 received colorectal cancer screenings. Of those adults advised to obtain screening, 67% were compliant at the time of the recommendation. Colorectal Cancer Screening, Adults 50+ SPA 2 Screening Sigmoidoscopy, Colonoscopy or Fecal Occult Blood Test Compliant with Screening at Time of Recommendation Los Angeles County 75.8% 75.7% 67.0% 66.5% Source: California Health Interview Survey, 2009 45 Community Input Introduction Twenty-four telephone interviews were conducted for the Henry Mayo Newhall Memorial Hospital (Henry Mayo) Community Health Needs Assessment in August 2013. Interview participants included mental health and substance abuse agencies; community clinics/health centers; public health and WIC; City of Santa Clarita community services; a community advocate representing senior citizen issues; and a number of agencies focused on specific issues and/or vulnerable populations, including Alzheimer’s disease, cancer, children, single mothers, the developmentally disabled, and services for seniors. The interviewees spoke to issues and needs in the area surrounding the hospital. Attachment 2 lists the interview participants and their organizational affiliations. Interview Topics Interview participants were asked to share their perspectives on a number of topics, including: Biggest issues or concerns facing the community Existing and needed actions/activities to address community issues Health problems impacting people in the community Challenges faced in obtaining primary care and specialty care, mental/behavioral health services and social services, and suggested strategies to facilitate access Barriers to obtaining prevention and treatment services for chronic diseases and resources used for education and for chronic disease self-management Reasons for emergency room use for non-emergency care and recommendations to address this Recommended roles for hospitals and healthcare providers in addressing community health needs Other notes and comments Biggest Issues or Concerns in the Community A number of interview participants reflected that the Santa Clarita Valley is viewed by many of its residents as an affluent area, and that the existence and needs of lowerincome, uninsured, and homeless individuals and families who live in the “pockets of poverty” are often overlooked or ignored. One participant noted that, “there is so much need in the San Fernando Valley that the Santa Clarita Valley gets forgotten.” The biggest issues and concerns in the community were identified to include: The economy, jobs, and financial struggles among many families who are having difficulty making ends meet. Many people have lost jobs, are running out of unemployment, are underemployed, or can only find low-wage jobs. 46 Difficulty in accessing health care (including medications) due to lack of coverage and/or cost and shortage of Medi-Cal providers in the area for both primary care and specialty care services. Substance abuse overall, but particularly drug use among youth, high-school age through mid-20s, including heroin use (mentioned numerous times), methamphetamines, marijuana and prescription drugs. There have been a number of heroin-related deaths within this age group in the past several years. Lack of housing and other social services to meet the needs of the homeless, especially when the winter shelter is closed. Shortage of mental health services and long waits for services coupled with mental health needs among area residents, including the homeless mentally ill and those suffering from depression, anxiety and despair due to difficult or changing life circumstances. Domestic violence. Lack of services for seniors and their caregivers, including affordable or subsidized respite care, access to a quality skilled nursing facility in the Santa Clarita Valley, adult day services, services for monolingual seniors speaking Spanish, Tagalog and other Asian languages, and outreach to isolated, homebound seniors. Lack of access to affordable dental care. Lack of coordination among health care and mental health providers, often due to HIPAA restrictions, that negatively impacts both medical and mental health outcomes for patients. Lack of public health services in the area since the Los Angeles County Valencia Health Center closed down and area residents are required to go to Pacoima for public health services such as immunizations, TB, flu shots, etc. Lack of local Los Angeles County Department of Health Services (DHS) in the area, with the closest DHS services located in the Antelope Valley. Other concerns also identified: Questions and concerns regarding the Affordable Care Act (ACA), including: o Whether it will be effective in increasing coverage and access to care; o What will occur with the residually uninsured after the ACA is in effect (including the undocumented and those who chose to pay the penalty rather than get coverage); and o How the ACA will affect access to mental health services for families in the Santa Clarita Valley. Transportation. Affordable housing. 47 Homelessness and mental health concerns among the community college student population. Lack of support groups and transportation to medical services for cancer patients, especially problematic for those needing to travel great distances for daily radiation treatments. Lack of a pediatric endocrinologist at Mayo or elsewhere in the Santa Clarita Valley. Physician and hospital staff training relative to patients with dementia and development disabilities, and how to work with these patients in outpatient and inpatient settings. Food security/hunger. Causes for these issues were thought to include: Stress and lack of resources (e.g., income, insurance) among many victims of domestic violence. Lack of support experienced by single mothers. Lack of knowledge of the affordable services and resources that are available. Risk factors for drug and alcohol use among youth, including latch-key kids who are not participating in after-school activities, easy accessibility, curiosity, boredom, first time users getting hooked, lack of parental supervision or engagement, the perception that marijuana is “okay,” and alcoholism in the family. Concern that the ACA will be too expensive, and people will choose the penalty over purchasing coverage. Lack of new funding for affordable housing. Difficulty in accessing and using transportation for seniors. Lack of preparation within the area for the population boom among the ethnic communities who are monolingual. Lack of support groups for cancer patients (other than breast cancer groups) and lack of reliable transportation options for patients needing daily radiation treatment. HIPAA can inhibit communication across medical providers and systems. Disabled population is living longer due to medical advancements, but now experiencing more issues of aging. Education and language barriers can be challenges to accessing health care and other services. Lack of funding to meet the mental health service needs of the indigent, undocumented and others with limited means. 48 Lack of integration among the hospital and other service agencies to most fully address the needs of patients – noted as an issue for those with dementia, developmentally disabled, mentally ill, and among mothers/families with young children where there may be post-partum depression. Existing and Needed Actions/Activities to Address Community Issues The interview participants identified a number of local strategies that are working to address community issues and concerns, including some programs that the interview participants are involved in. Several of the efforts around drug and alcohol prevention were identified to include: Annual Heroin Kills symposium, led by the Mayor’s Blue Ribbon Task Force/City of Santa Clarita, to educate the community about local drug use and provide information on local initiatives to address the problem as well as on available resources. Local nonprofits such as the Boys & Girls Club, and others, promote attendance at the event, and the City’s cable television station tapes and broadcasts it a number of times to promote exposure to the content. The Mayor’s Blue Ribbon Task Force meets monthly to develop prevention strategies. It includes the city, school district, police department and other providers. The school district takes education for students around the dangers of drunk driving seriously, including innovative programs such as reminding students every 15 minutes one day of the year that teens are killed by drunk drivers every 15 minutes and bringing cars that have been in alcohol-related accidents onto the school site for viewing. Parent education provided by the Boys & Girls Club and other agencies related to the importance of parenting teens, including issues such as text messaging and bullying. The Drug Free Youth In Town (DEFY IT) program is a collaboration of the city, school district and county to establish voluntary clubs at schools to develop drugfree messaging and programming, including providing education at 6 th grade assemblies. Efforts focused on community outreach and services were identified to include: City of Santa Clarita Human Services Department provides families with information on city programs and services, and also has an Outreach Neighborhood Services (ONS) program targeted to hard-to-reach families to provide information, materials and resources. Help the Children accepts donations (e.g., food, clothing) and then redirects the donations to other human service agencies that provide the direct services. 49 Several churches have programs to help meet the needs of the area’s lowincome and homeless, including Real Life Church, which helped to establish a community outreach/resource center in Newhall called Savia, and Church of Hope, which provides assistance to homeless living in the wash. Henry Mayo conducts health fairs in Valencia, Canyon Country and Newhall, which are helpful and important. The Santa Clarita Valley Senior Center provides a meal program and a food pantry to provide food resources. Efforts focused on improving access to and/or coordination of care and services were identified to include: A Mental Health Consortium has been established that includes a number of mental health organizations, domestic violence services and a few health providers (including Mayo’s Behavioral Health Unit) to identify, discuss and address gaps in services. The Consortium has written a grant to support their collaborative process. Henry Mayo provides charity care to help uninsured and under-insured people. The ACA will increase the number of people eligible for Medi-Cal and make health insurance premiums more affordable for many others. The ACA has also prompted Los Angeles County to move in the direction of Patient-Centered Medical Homes, which will facilitate more communication between providers to address a patient’s full spectrum of needs. The Santa Clarita Valley Mental Health Center works to get releases from patients to allow providers to talk with each other across systems. Additional activities occurring to help address identified needs include: Breast cancer support group has been in place for many years as a partnership between the American Cancer Society (ACS) and Henry Mayo Hospital. ACS tried to fill the need for additional support groups by providing online support groups and also offers minimal transportation assistance with volunteer drivers. WeSPARK offers additional services in the San Fernando Valley, which some patients are willing to drive to for access. Dial-A-Ride provides transportation to seniors to hospital/medical appointments. Both the Alzheimer’s Association and LARC Ranch offer training for hospital staff on addressing the needs of their respective patient populations (i.e., patients with dementia and developmentally disabled people). LARC Ranch has trained staff at Henry Mayo. The City of Santa Clarita is working on developing a healthy built environment to increase access to physical activity. Several area nonprofit organizations provide substance abuse and mental health services, including Action, the Henry Mayo BHU, Child & Family Center, and the 50 Santa Clarita Valley Mental Health Center, which is a Los Angeles County Department of Mental Health facility. There are also a number of 12-step programs in the area, including Alcoholics Anonymous (AA), Overeaters Anonymous (OA), ALAnon, TeenGroup and Narcotics Anonymous (NA). In response to the question of what else needs to be done, or what some possible solutions to the issues/concerns facing the community might be, interviewees suggested the following: More coordination needed among nonprofits to facilitate networking and problem solving and to reduce competition for dollars. The Mental Health Consortium needs funding to collaborate more effectively to address gaps. More organization needed to facilitate communication and relationship building between mental health and medical providers so that partnerships will be in place when the ACA takes effect and these relationships are mandated. A pediatric endocrinologist is needed to serve the Santa Clarita Valley. Reduce the stigma associated with domestic violence and sexual assault. Educate teens about healthy relationships and with anti-bullying programs. Support groups are needed for single mothers to help reduce their isolation and stress. Translations and services are needed for the many monolingual populations in the area, including Spanish-speaking, Koreans and a growing Middle Eastern population. Constant acknowledgement and messaging will be needed to reduce the drug problem among youth. Give parents a chance to meet and form supportive networks with other parents via churches, nonprofits, schools, etc. Affordable or subsidized respite care for caregivers for the elderly and the chronically ill. Ongoing training for staff at Henry Mayo to work with special need populations, such as the developmentally disabled and people with dementia. Promote access to specialty care and to medications. Address the housing situation for homeless and also create sober living housing – both of which will have to combat neighborhood opposition. Create centralized place for information on local services/resources. Health Problems Impacting People in the Community Several health problems that are impacting the community were identified. Most of these have been persistent over time, while others are showing an increase. The health problems identified most frequently included: 51 Drug use among youth, especially heroin, but also methamphetamines, marijuana and prescription painkillers. Mental health problems, particularly depression and anxiety. Health problems associated with aging, most notably Alzheimer’s disease and other forms of dementia. It was noted that as the baby boomers age, the incidence of dementias are increasing. Vascular dementia, which leads to ministrokes and other symptoms similar to dementia, was identified as the second leading type of dementia. Other health issues associated with aging, including: o Chronic diseases (e.g., diabetes, hypertension, COPD, Congestive Heart Failure) o Mobility problems (e.g., knees, hips, balance/falls, difficult time walking) Co-morbidities; i.e., people with Alzheimer’s disease, developmental disabilities or mental health problems also dealing with chronic disease or other medical problems. Treatment for the medical problems is complicated by the presence of the other issue. Overweight and obesity among children and adults, and related complications (e.g., hypertension and a high prevalence of Type 1 Diabetes among children). Reasons posited for the obesity epidemic included: Lack of access to fruits and vegetables. Carbohydrates are less expensive and easy to access. Interrelated with poor self-esteem; people self-medicate with food. Cultural issues and family-wide obesity. Kids given unhealthy snacks for school and after-school activities. Other health problems also identified included: Among the college-age population - Women’s health issues, sexually transmitted infections, acne, chronic urinary tract infections, mental health problems and dental health problems. Alcoholism. Lack of Medi-Cal physicians in the Santa Clarita Valley, necessitating that people drive to the San Fernando Valley for services, which presents transportation challenges. Autism. Challenges Faced in Obtaining Primary Care, Specialty Care, Mental/Behavioral Health Services and Social Services, and Suggested Strategies to Facilitate Access 52 Interview respondents were asked about the problems and challenges children and families face in obtaining several different types of services, and what might make it easier for them to access these services. Primary Care and Specialty Care Services The most frequently identified challenges in obtaining primary care were lack of insurance and cost. Additional challenges included: Difficulties experienced by people with jobs who do not qualify for Medi-Cal but cannot afford insurance, including affording care and taking time off work for medical appointments. Lack of services for the uninsured. The local community health centers have reached capacity for seeing new uninsured patients and there are no Los Angeles County Public Health or Department of Health Services (DHS) clinics in the area. Northeast Valley Health Corporation noted that they only opened their Santa Clarita Valley clinic three years ago, but they have already exceeded capacity and do not have enough resources (i.e., funding, exam rooms, doctors) to see new uninsured adults. Student Health Center at College of the Canyons cannot manage students with chronic diseases and so has to refer out to other clinics. However, the other clinics may not be accepting new patients. Transportation, especially for the elderly, disabled and lower-income families. This is particularly a problem when the only available appointments are in the San Fernando Valley. As noted above, transportation is also a hardship for cancer patients traveling to the Santa Clarita Valley for daily radiation treatments over 6-8 weeks from areas including Bakersfield and the Antelope Valley. Language barriers to informational materials and to communication with health care professionals. There is a shortage of providers who speak Spanish and the other languages spoken in the area. Shortage of physicians who accept Medi-Cal and of Primary Care Physicians (PCPs) overall, as many graduating physicians opt to specialize rather than provide primary care. Difficulty recruiting doctors to the Santa Clarita Valley, as the commute to the area is seen as too long. Documentation status. Lack of understanding of local resources and how to access them. Lack of coordination of medical services for the homeless. Cost of medications and diabetic testing strips, resulting in people not complying with medication recommendations or testing for diabetes as often as they should. 53 Lack of training/awareness among primary care providers about treating people with mental illness, Alzheimer’s disease, or developmental disabilities. Not many specialists in private practice have an interest in providing low-cost services. Suggestions for what would make it easier to obtain primary care and specialty care included: More resources for primary care and specialty care for the uninsured. More people will qualify for Medi-Cal under the ACA, but increased capacity for seeing these patients will be needed via existing or new clinics (i.e., exam rooms, physicians). Increased presence of Los Angeles County Public Health and DHS services. Increased language capacity. Transportation assistance/alternatives. Partnerships between primary care providers, hospitals and relevant agencies for serving patients with special needs (e.g., mentally ill, developmentally disabled, patients with dementia). Los Angeles County Department of Mental Health, Alzheimer’s Association and LARC Ranch all expressed interest in participating in these partnerships. Hopes for the potential of the ACA to provide affordable coverage for more individuals and families, but also concerns whether it will really make a difference – and who will get left behind. Mental Health and Behavioral Health Services The problems and challenges in obtaining mental health services included: Shortage of mental health providers and long waits for services, especially for those who are un/under-insured. Services are insufficient for both chronically mentally ill and for those suffering from anxiety or depression. Limited funding/resources at local agencies such as the Child & Family Center and the Santa Clarita Valley Mental Health Center (a Los Angeles County Department of Mental Health clinic) means that these agencies have to triage patients and only serve those with the most severe and acute needs, leaving many people unserved and without service options. Santa Clarita Valley Mental Health Center clinic only serves adults at this point. People with mental health problems often present in the emergency room, likely indicating lack of access to other resources. Transitional care is no longer available in our community. Skilled nursing resources are inadequate for the growing need. Growing need for local services for veterans returning from recent wars with a variety of problems (e.g., PTSD, traumatic brain injury, family problems). Due to 54 insufficient resources in the Santa Clarita Valley and specialized insurance coverage that many local agencies cannot accept, veterans often have to travel to the San Fernando Valley Veteran’s Administration for services. Lack of a comprehensive adult day care center that includes counseling and psychiatric services. Need for dementia care services. Families cannot afford the needed home care. Lack of knowledge among families about mental health resources or where to get this information, as many families are not linked to the community centers that can provide referrals and do not have internet access. Some sub-populations that face greater risk for depression and anxiety include caregivers of people with Alzheimer’s disease, domestic violence victims and single mothers. In addition, Samuel Dixon Health Center estimates that one-third of their patients have a mental health diagnosis in addition to their medical condition. While medication can be provided, counseling to help address underlying stressors is hard to access. Suggestions for improving access to mental health services included: Increase the availability/capacity of low-cost/free services for people who need counseling for anxiety and depression at local mental health providers such as Child & Family Center and the Santa Clarita Valley Mental Health Center. Expand services at the Mental Health Center to also include children. Expand services in different languages as needed. Outreach to neighborhoods regarding available services, including door-to-door outreach and flyers. Provide outreach and materials in the appropriate languages. Implement the Mental Health Consortium’s collaboration grant. Several service providers expressed interest in knowing more about what is happening at other agencies to facilitate better patient referrals for needed services. Create a larger network of local nonprofits that includes health care providers, mental health providers, city services and other social/human service organizations. Recruit psychiatrists and geropsychiatrists to the Santa Clarita Valley. Social Services Problems and challenges to obtaining social services were identified as: Lack of knowledge about available services or where to get this information. Community Centers, Single Mothers Outreach, the WIC program and Alcoholics Anonymous are good sources of referrals for the people they serve, but this is still a limited population. 55 Transportation was identified numerous times relative to the size of the Santa Clarita Valley, the distance to Los Angeles or the San Fernando Valley, and the inadequacy of the local bus system. Needs of the homeless were also mentioned several times. The homeless population is growing but is mostly ignored. The only resource is the Winter Shelter, which only serves men and only for a limited time during the year. Needs of the college-age student population were identified to include homelessness, victimization of domestic violence and sexual assault, and need for access to food and clothing. Lack of affordable or subsidized respite services for caregivers. Several respondents noted that Henry Mayo does a good job of linking patients to services; however, when the closest services are in the San Fernando Valley, there are often transportation barriers. Suggestions for making it easier to obtain social services included: A nonprofit health organization, called Health Leads, is working to improve access to services through volunteer patient advocates who link clients with services. A community resource guide is needed. Not everyone has access to the Internet. We need to communicate better about the existing services available. Outreach to neighborhoods regarding available services, including door-to-door outreach and flyers. Provide outreach and materials in the appropriate languages. Boys & Girls Club offers affordable recreational activities. College of the Canyons is starting a food pantry and community garden to help address the food need among students. They are also starting a program to give out clothes from their Lost and Found. Educate people on how to use the Internet and create better access to the Internet. Provide information on community resources at primary care sites. Create and share a resource guide with local service providers. Expand basic need services (e.g., housing, food, clothing) from Los Angeles into the Santa Clarita Valley to better meet the local need. More outreach to increase awareness of local 12-step programs and more awareness overall between local providers of available services. Barriers to Obtaining Prevention and Treatment Services for Chronic Diseases and Resources used for Education and for Chronic Disease Self-Management Many of the barriers to obtaining prevention and treatment services for chronic diseases are those mentioned previously; i.e., lack of insurance, cost, language barriers, 56 documentation status, and transportation barriers to obtaining services not available in the Santa Clarita Valley, especially for the elderly and lower-income families. Other barriers noted by the respondents included: Lack of a diabetes clinic or Congestive Heart Failure clinic in the area to help provide ongoing monitoring for disease management and to prevent unneeded emergency room visits. Personal barriers and resistance to engaging in prevention activities. Stigma and potential loss of treatment/care opportunities when physicians do not take symptoms of dementia seriously and do not offer access to available resources. There is no pediatric endocrinologist in the Santa Clarita Valley, necessitating families to travel outside the area for this service. Patients with mental health problems require additional coaching and support to foster compliance with medications or other chronic disease management recommendations. It was noted that many people do not learn about or manage their chronic diseases due to cost, competing priorities in their lives, and/or lack of capability to do so. The health care services, education programs and materials people use to learn more about their chronic diseases and to care for themselves were identified to include: Henry Mayo Hospital offers a number of opportunities, including: o Health fairs, including health screenings (e.g., Body Composition Index, cholesterol, blood pressure), at community centers in neighborhoods with large low-income, Latino populations. o New, interventional cardiovascular services previously not available in the area, such as stents, balloons and surgeries. o Hospital-sponsored education programs in the community, often at no charge (e.g., spine education, CPR training, tobacco cessation). Information provided by community health centers (i.e., Northeast Valley Health Corporation and Samuel Dixon) either directly or through other nonprofits (e.g., Newhall Community Center). The community health centers also offer patient education provided by nurse practitioners, medical assistants, and dieticians. Santa Clarita Valley Senior Center provides weekly blood pressure readings and a dietician on a monthly basis who provides blood sugar readings. They also provide many exercise classes and health education classes. College of the Canyons Student Health Center offers two wellness events per year focused on high-risk behaviors such as alcohol use, drug use and stress management. They indicated a need for assistance to offer more prevention resources to students. 57 Internet research for those who have access to the Internet and ability to use it. Many older adults have never learned to use the internet. Alzheimer’s Association provides educational materials, but is limited by funding on the extent of education provided. American Diabetes Association (ADA) and American Cancer Society also provide information on their websites and offer printed materials to the extent that they can. The ADA also offers assistance to families through their Safe at School initiative to provide the school guidance, based on physician recommendations, on how to manage a child’s diabetes during the school day. Several recommendations were made to facilitate access to information about chronic disease management, including: Media outreach and use of social media are important strategies for reaching younger audiences. Visual information (i.e., videos) is more helpful than written materials. A walk-in clinic for chronic disease management would be helpful. Reasons for Emergency Room Use for Non-Emergency Care and Recommendations to Address This The majority of the interview participants said they are aware of people using the emergency room for non-emergency purposes. The primary reasons identified for this included lack of insurance and a regular source of care. Additional reasons included: Knowing they will be treated regardless of insurance status or ability to pay. Cost of services prohibitive at urgent care or a physician’s office, and payment not required up front in the emergency room. Some people never expect to pay the bill and are not concerned about the impact on their credit. Convenient hours and accessibility; no appointment is needed and services are available in the evenings and on weekends when most other clinics or provider offices are closed. Lack of awareness of low-cost options, such as community clinics. Lack of capacity at local community health centers/clinics to provide medical homes for new, uninsured patients due to lack of exam rooms and funding. Emergency room seen as a safe place for the undocumented. Use by Medi-Cal Managed Care patients who do not have access to covered services in the Santa Clarita Valley, and so use the emergency room rather than travel to the San Fernando Valley. Attempts to access pain medications. People with mental illness and have chaotic lives often do not engage in preventive behaviors or manage their chronic diseases, and so end up with conditions requiring emergency care. 58 Recommendations for how to address the use of the emergency room for nonemergency care included: Utilize mobile health clinics to serve the homeless and provide prevention and primary care services. Case management and assistance to foster education and jobs. Health care coverage, as may be more available through the ACA. More low-cost health care clinics and affordable urgent care, open during hours that are convenient for people on various work schedules. Educate students and community members about the ACA and also about appropriate emergency room use. Develop a diversion program with the local community health centers to help prevent inappropriate emergency room use. Co-locate community health center services on the Hospital campus and/or assist in funding more exam rooms. Hospital may wish to consider accepting Medi-Cal to better serve these patients who live in the area. Provide wellness coaches or educators to patients at discharge to help prevent readmission. These coaches/educators need to speak the languages of the population and have cultural sensitivity. Address alcoholism and substance abuse issues to foster healthier people who can access jobs and hopefully insurance. Recommended Roles for Hospitals and Health Care Providers in Addressing Community Health Needs Although this question was not framed relative to Henry Mayo, many of the respondents reflected on how the hospital supports the community now and how it could further address community needs. Some of the current activities that Henry Mayo and other local agencies participate in that address health needs were identified to include: Health fairs sponsored by Henry Mayo at the Newhall Community Center. Santa Clarita Valley Senior Center offers weekly blood pressure screenings and monthly opportunities for blood sugar screenings and to meet with a dietician. Henry Mayo provides agencies with flu vaccines for seniors. Suggestions for how Henry Mayo Hospital and other health care providers can help to more effectively address community health needs included: A number of interviewees noted the need for more collaboration among local health, mental health, substance abuse and social service providers. An agency needs to take the lead to convene this type of collaborative group on a quarterly basis to share information, network, reduce competition for dollars, and identify 59 opportunities for coordinated strategies to address gaps in services. It was noted that this leadership would create more visibility for Henry Mayo in the community and also create deeper relationships between the Hospital and community agencies, as the Hospital is seen somewhat as operating by itself rather than as integrated within the community. Several interviewees also noted the value of building partnerships with large institutions that serve many people (i.e., schools, City Parks & Recreation programs, colleges, faith organizations) and then leveraging those partnerships to conduct outreach and education related to prevention, screenings and access to affordable primary care services. It was noted that people need continuous reminders of the low-cost health care options. Foster integration between health care and mental health services to achieve better health outcomes. The needs of Spanish-speaking people need to be better addressed via information, signage, and services available by Spanish-speaking providers. This is also true for other major languages spoken in the community, such as Korean. Hospital and urgent care services that can accept Medi-Cal for payment. Expand health fairs to other community sites to reach additional people. Conduct outreach to homeless people in the wash and in other places they live. Go to them versus expecting them to come to community agencies. The staff of the Santa Clarita Valley Mental Health Center knows where the homeless are located and can help develop effective outreach strategies. Utilize media channels such as the AARP newsletter to conduct outreach and education. Reminders for patients about needed screenings are helpful. More direct chronic disease management is needed to better control chronic diseases and prevent unneeded emergency room visits and hospitalizations. A follow-up phone call program was suggested. Outreach is needed for isolated, home-bound elderly people to identify their needs, assure they are taking their medications and have sufficient food, etc. Affordable or subsidized respite care is needed for caregivers of the elderly and of people with chronic diseases. A larger staff of geriatric physicians is needed to better serve the health needs of older adults in the area, including a neurologic clinic to help diagnose and treat dementia and Alzheimer’s disease. Evaluate the need for a pediatric endocrinologist to serve the needs of children with diabetes. A nonprofit skilled nursing facility, possibly run in partnership with the hospital. Simple education about the ACA is needed to review employer responsibilities, coverage options and eligibility, including Medi-Cal and Medicare. 60 Any service for which people have to travel to the San Fernando Valley is a need. An expansion of non-pharmaceutical, holistic alternatives to drug therapy is needed. Comments/Other At the close of the interview, participants were given an opportunity to share any final thoughts or comments. Several participants expressed their support for the Hospital’s participation in the needs assessment process and their hopes that it will improve the health of the community. Other comments included: Appreciation about the Hospital, including that it: o Is a “good presence” and “good community partner.” o Has a senior management team that is progressive and trying to build a community hospital that meets the needs of the community. It was noted that the Hospital is constantly upgrading its facilities (including the parking lot), is increasing its bed-count capacity, and is building a new facility for training and continuing education. o Has a volunteer Auxiliary that conducts food drives and fundraisers. o Recently opened a NICU, meeting an important community need. Interest in learning more about the needs assessment, getting involved and working with the Hospital. Interest in working the Hospital more closely on the issue of drug use in the community; i.e., to develop parent education strategies and have more discussion of the issue. The Hospital could be more proactive in addressing the needs of special needs patients, such as those who are hearing impaired. There are opportunities for the Hospital to work more closely with a number of community agencies as well as the public health department. There is interest among many community agencies in partnering more closely with the Hospital to better serve the populations they specialize in, including the lowincome/uninsured, developmentally disabled, college students, mentally ill patients, substance abuse population, patients with Alzheimer’s disease and other cognitive impairments, homeless, WIC patients and others. There is an opportunity for the Hospital to improve its cultural competency, and better serve Spanish-speaking and lower-income populations, bring Spanishspeaking staff into the Hospital, and to offer many more services in Spanish. Northeast Valley Community Health Center would like to work together with Henry Mayo to develop contracts that would allow Medi-Cal deliveries to occur at the Hospital, in the community where the women live. 61 62 Attachment 1. Benchmark Comparisons Where data were available, health and social indicators in the Henry Mayo Newhall Memorial Hospital service area were compared to Healthy People 2020 objectives. The bolded items are indicators that do not meet established objectives; non-bolded items meet or exceed benchmarks. Service Area Data High school graduation rate 88.1% Child health insurance rate 95.8% Adult health insurance rate 73.0% Heart disease deaths 110.9 per 100,000 Cancer deaths 108.6 per 100,000 Stroke deaths 26.6 per 100,000 Suicides 6.7 per 100,000 Diabetes deaths 10.9 per 100,000 Unintentional injury deaths 16.5 per 100,000 Breast cancer incidence 78.0 per 100,000 Early prenatal care 89% of women Low birth weight infants 6.6% of live births Infant death rate 5.4 per 1,000 live births Breastfeeding (any) 94.2% Adults with an ongoing source of care 77.4% Adult obese 21.1% Diabetic annual foot exam 74.1% Adults engaging in binge drinking 14.9% Cigarette smoking by adults 13.8% Senior flu vaccine 65.4% Childhood flu vaccine 47.5% Adults 50+ colorectal cancer screening 75.8% Adult women who have had a Pap smear 84.0% Women over 50 who have had a mammogram 82.8% Healthy People 2020 Objectives High school graduation rate 84% Child health insurance rate 100% Adult health insurance rate 100% Heart disease deaths 100.8 per 100,000 Cancer deaths 160.6 per 100,000 Stroke deaths 33.8 per 100,000 Suicides 10.2 per 100,000 Diabetes deaths 65.8 per 100,000 Unintentional injury deaths 36.0 per 100,000 Breast cancer incidence 20.6 per 100,000 Early prenatal care 77.9% of women Low birth weight infants 7.8% of live births Infant death rate 6.0 per 1,000 live births Breastfeeding (any) 81.9% Adults with an ongoing source of care 89.4% Adult obese 30.6% Diabetic annual foot exam 74.8% Adults engaging in binge drinking 24.4% Cigarette smoking by adults 12% Senior flu vaccine 90% Childhood flu vaccine 80% Adults 50+ colorectal cancer screening 70.5% Adult women who have had a Pap smear 93% Women who have had a mammogram 81.1% 63 Attachment 2: Community Stakeholders Name Title 1 Nancy Agosto Director 2 Frank Alvarez, MD, MPH 3 Amy Anneberg 4 Lori Blumenthal Area Health Officer, SPA 1 and SPA 2 Director of Healthcare Corporate Initiatives Manager, Step Out Walk 5 Julie Calderon Human Services Supervisor 6 Elizabeth Cravitz Director, Case Management & Social Services 7 Linda Davies Executive Director 8 Christine Goulet 9 Robert Hill 10 Cathy Ladd WIC Area Manager Community Member, Representing Seniors Vice President of Programs 11 Cheryl Laymon Chief Operating Officer 12 Michelle Majors Mental Health Clinical Program Head 13 Myles McNamara Past President 14 Joanne Melton Manager, Central Office Suzann Nelsen & Linda Lieblang Teresa (Missy) Nitescu Director of Support Services Associate Executive Director 17 Jeanine Prado Human Services Administrator 18 19 20 Cary Quashen Colleen Reeves, NP Michael Santomauro 21 Larry Schallert 22 DaAnne Smith Kathleen Sturkey & Chris Bratzel Founder Director, Student Health Ctr. Director Director of Program Development Executive Director Executive Director & Executive Officer Jim Ventress Executive Director 15 16 23 24 Chief Operating Officer Organization Santa Clarita Adult Day Health Care Los Angeles County Department of Public Health American Cancer Society, California Division American Diabetes Association City of Santa Clarita, Newhall Community Center Henry Mayo Hospital Domestic Violence Center of Santa Clarita Valley NEVHC – WIC Program N/A Alzheimer’s Association Samuel Dixon Family Health Centers, Inc. Los Angeles County Department of Mental Health - Santa Clarita Valley Mental Health Center SCV Senior Center Foundation Santa Clarita Valley Central Office of Alcoholics Anonymous Santa Clarita Valley Senior Center Northeast Valley Health Corporation (NEVHC) Newhall Community Center City of Santa Clarita Action Family Counseling College of the Canyons Help the Children Child & Family Center Single Mothers Outreach Los Angeles Residential Community (LARC) LARC Ranch Boys & Girls Club of Santa Clarita Valley 64