2019 community health needs assessment implementation …

2019 Community Health Needs AssessmentImplementation Strategy

Valley Hospital

VALLEY-2019_IMPLEMENTATION_Strategy-3.indd 1VALLEY-2019_IMPLEMENTATION_Strategy-3.indd 1 11/18/19 3:18 PM11/18/19 3:18 PM

Executive Summary MultiCare Health System is a not-for-profit

health care organization with over 18,000 team members, including employees, providers and volunteers. MultiCare’s integrated community-based system of health includes primary, specialty and urgent care services, in addition to a wide range of community outreach programs. MultiCare is the largest community-based, locally governed health system in the state of Washington.

PRIORITY HEALTH NEEDS

In 2018, MultiCare partnered with the Spokane Regional Health District to conduct a comprehensive Community Health Needs Assessment (CHNA) for the MultiCare Valley Hospital service area. This is the first CHNA ever completed by Valley Hospital.

This CHNA draws on a recently completed community assessment, sponsored by Priority Spokane and the Community Health Assessment Board, that includes extensive community stakeholder input. In addition, the health district analyzed approximately 60 health indicators and implemented three community focus groups to further identify and prioritize this hospital service area’s needs. The resulting report features a wide-ranging set of quantitative and qualitative findings.

Based on the results of the assessment and specific selection criteria, the health district identified the following priority health needs:

■ Diabetes

■ Mental health

■ Obesity

■ Poverty

■ Suicide

THREE-YEAR FOCUS

MultiCare convened meetings with Inland Northwest leaders and stakeholders to review the assessment. Based on CHNA data, available resources and existing programs, Valley Hospital selected the following health priorities as the focus of the next three-year implementation period:

■ Behavioral health (access)

■ Intentional injuries (suicide and violence)

■ Oral health care (poverty)MultiCare Valley Hospital Community Health Needs Assessment Implementation Strategies 2019

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Executive SummaryContinued

Due to limited resources and expertise, hospital leadership decided not to address diabetes and obesity at this time.

MultiCare Valley Hospital, in collaboration with MultiCare Deaconess Hospital and MultiCare Rockwood Clinic, developed its own implementation strategy and formed implementation teams composed of internal staff and community partners. This Community Health Needs Assessment implementation strategy describes how Valley Hospital will address the identified health care needs by:

■ Continuing and strengthening existing programs and services

■ Exploring the implementation of new strategies, programs or services

■ Collaborating with community organizations to implement evidence-based strategies across the service area

MultiCare’s implementation strategies will contribute to long-term, sustainable improvements in community health. Through coordinated efforts with community partners, MultiCare will use these strategies as a road map toward achieving better health outcomes.

MultiCare Valley Hospital Community Health Needs Assessment Implementation Strategies 2019

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Table of Contents

5 About MultiCare

6 Meeting Community Needs: Valley Hospital

7 CHNA Methodology

9 Priorities

10 Focus 1: Behavioral Health (Access)

12 Focus 2: Intentional Injuries (Suicide and Violence)

15 Focus 3: Oral Health Care (Poverty)

17 Conclusion


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MultiCare Health System is the largest community-based, locally governed health system in the state of Washington. Our comprehensive network of features numerous primary care, urgent care and specialty services — including Immediate Clinic, MultiCare Indigo Urgent Care, Pulse Heart Institute and MultiCare Rockwood Clinic, the largest multispecialty clinic in the Inland Northwest. Specialty services include a Level II adult and pediatric trauma center, a Level IV Neonatal Intensive Care Unit, the region's only Level I trauma rehabilitation center and an internationally renowned therapy unit for children with special needs. Through our affiliation with Navos and Greater Lakes Mental Health, we are the largest behavioral health provider in Washington state.

Serving individuals of all ages and life stages, MultiCare’s network includes the following hospitals:

• MultiCare Allenmore Hospital, Tacoma

• MultiCare Auburn Medical Center, Auburn

• MultiCare Covington Medical Center, Covington

• MultiCare Deaconess Hospital, Spokane

• MultiCare Good Samaritan Hospital, Puyallup

• Mary Bridge Children’s Hospital, Tacoma

• MultiCare Tacoma General Hospital, Tacoma

• MultiCare Valley Hospital, Spokane Valley

• Navos, Seattle*

• Wellfound Behavioral Health Hospital, Tacoma*

About MultiCare

* Independently operated affiliate


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MultiCare Valley Hospital Service Area

Meeting Community Needs

Valley Hospital is a 123-bed hospital located in Spokane, Washington. Its primary service area, shown in the figure above, represents 75 percent of inpatients served. Approximately 158,253 people live in the Valley Hospital service area.


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BACKGROUND AND PROCESS

MultiCare Health System worked with the Spokane Regional Health District to complete a comprehensive Community Health Needs Assessment (CHNA). The process featured input from multiple community leaders and residents of Spokane County representing many sectors and population groups, including low-income residents and others affected by health disparities. The assessment also included extensive analysis of recent community health data.

CRITERIA FOR PRIORITIZING HEALTH NEEDS

MultiCare and the health district developed the following three criteria to prioritize health needs:

■ Was a health concern or indicator significantly worse in the hospital service area than in the state?

■ Were relatively large numbers of people impacted by a health concern or indicator?

■ Was a health concern repeatedly voiced during the community engagement portion of the assessment (e.g., survey, focus groups or interviews)?

CHNA Methodology The health concerns or indicators that met most

criteria became the suggested priority health needs for the hospital service area. The resulting list of priority needs served as a starting point for discussion, rather than as a definitive short list requiring action.

PRIORITY HEALTH NEEDS IDENTIFIED BY SPOKANE REGIONAL HEALTH DISTRICT

The health district identified the following priority health needs for residents within the Valley Hospital service area:

■ Diabetes

■ Mental health

■ Obesity

■ Poverty

■ Suicide


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CHNA MethodologyContinued

MULTICARE’S PROCESS FOR SELECTING HEALTH CARE PRIORITIES

MultiCare convened stakeholder meetings to review the assessment, consider community health needs and select system-wide priorities. The Valley internal stakeholder group included executive, physician, nurse, clinic and outpatient leaders. The group chose to focus on the following priority health needs over the next three-year period:

■ Behavioral health (access)

■ Intentional injuries (suicide and violence)

■ Oral health care (poverty)

Due to limited resources and expertise, hospital leadership decided not to address diabetes and obesity at this time.

Both MultiCare and community leaders worked to create implementation strategies, metrics and a resource inventory of existing programs and services offered by MultiCare and partner organizations that address the identified needs. The Spokane Health District convened community leaders in this process using a Results-Based Accountability™ framework.

MULTICARE VALLEY HOSPITAL IMPLEMENTATION STRATEGY

Valley Hospital’s implementation plan, outlined on the following pages, describes how the hospital will address the identified health care needs by:

■ Continuing and strengthening existing programs and services

■ Exploring the implementation of new strategies, programs or services

■ Collaborating with community organizations to implement evidence-based strategies across the service area


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MultiCare Valley Hospital Priorities

1. Behavioral Health (Access)

• Develop a survey tool to assess behavioral health resources among community partners.

• Develop a system to share behavioral health resources in the community.

• Identify gaps in care and connect clients to coordinated resources by fostering contractual relationships, shared knowledge and training among the Emergency Department and community partners.

2. Intentional Injuries (Suicide and Violence)

• Screen every new mother after delivery and prior to discharge for safety at home.

• Develop a comprehensive screening tool for suicide and violence to be used within MultiCare.

• Provide violence prevention training for staff that addresses topics such as intergenerational cycles of violence and referral protocols for survivors and victims.

3. Oral Health Care (Poverty)

• Collaborate with area partners to educate the public about the extent and impact of oral health problems on individuals and families; work with our partners to improve access to oral health services and resources for low-income and underserved populations.

• Facilitate continuous quality improvement and practice coaching to support medical-dental integration in pediatric clinics by partnering with Smile Spokane.

• Integrate oral health care into screening, discharge, training and learning support for mother, newborn and pediatric services.

G O A L S

S T R AT E G I E S

9 Valley Hospital Community Health Needs Assessment Implementation Strategies 2019


Focus 1: Behavioral Health (Access)

Our goal is to improve behavioral health outcomes in the Valley Hospital community.

Our goal is to improve mental health and substance use disorder outcomes for those living in the Valley Hospital community using the following strategies:

■ Develop a survey tool to assess behavioral health resources among community partners.

■ Develop a system to share behavioral health resources in the community.

■ Identify gaps in care and connect clients to coordinated resources by fostering contractual relationships, shared knowledge and training among the Emergency Department and community partners.

ANTICIPATED OUTCOMES

Anticipated outcomes related to these strategies include:

• Completed assessment of behavioral health community resources

• At least one contractual relationship between the Emergency Department and community partners

Behavioral health is directly tied to overall well-being and the ability to live a full, productive life. According to CHNA health indicator data and stakeholder input, substance use and poor mental health are top concerns in the Valley community.

In the Valley Hospital service area, 23.6 percent of adults reported having depression, which is higher than the state percentage of adults who report experiencing depression. Women (29.4 percent) were significantly more depressed than men (16.9 percent). In addition, approximately 11 percent of 10th grade students in the Spokane County community reported binge drinking in the past 30 days. Community focus group participants expressed concern about prescribing practices and the widespread use of opiates. They discussed opportunities such as the need for more counseling and treatment services, support for those who are struggling with addiction and depression, and education about the addictiveness of prescription drugs for both youth and adults.


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INTERNAL RESOURCES

As a not-for-profit health care system, MultiCare offers programs that increase access to behavioral health care. Examples of these programs and services include the following:

MultiCare Rockwood Behavioral Health Center offers mental health treatment for children, adolescents, adults and families. The conditions and problems addressed include depressive disorders, developmental delays, grief and loss, learning disabilities, mood and thought disorders, parenting issues, and post-traumatic stress disorder. Services include assistance coping with physical and mental illness and developmental disorders, academic and career counseling, diagnostic assessment, and pharmacological management of stress and anxiety during life transitions.

COMMUNITY RESOURCES

In addition to the MultiCare programs and services, we also partner with community organizations to improve behavioral health outcomes. Examples include the following:

Excelsior Wellness Center features a specialty medical clinic with integrated behavioral health providers, care coordinators, peer support specialists, family response specialists and a variety of direct support specialists.

Services include hospital diversion programs, co-occurring enhanced outpatient and residential services, an on-site fully accredited middle school and high school, nutrition services, and therapeutic recreation.

Inland Northwest Behavioral Health provides comprehensive assessment, diagnosis and treatment for individuals struggling with emotional or behavioral health issues, such as mood disorders, anxiety disorders or trauma. Offerings include individual, group and recreational therapies.

Frontier Behavioral Health is a trauma-informed organization providing clinically and culturally appropriate behavioral health care to individuals of all ages and families. The organization focuses on caring for high-risk or high-need populations as well as those receiving public funds. Frontier Behavioral Health believes evidenced-based practice, recovery, reintegration, support, open access and community education are all vital elements of responsive, comprehensive mental health care.

Pioneer Human Services helps individuals who have been incarcerated or who are in recovery from substance use access treatment, housing, job training and employment.

Focus 1: Behavioral Health (Access)Continued


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https://www.multicare.org/rockwood-clinic-services-behavioral-health/

https://www.excelsiorwellness.org/

https://inlandnorthwestbh.com/

https://fbhwa.org/

https://pioneerhumanservices.org/

Focus 2: Intentional Injuries (Suicide and Violence)

Our goal is to reduce intentional injury hospitalizations.

Our goal is to reduce the amount of intentional injury hospitalizations and the suicide rate, using the following strategies:

■ Screen every new mother after delivery and prior to discharge for safety at home.

■ Develop a comprehensive screening tool for suicide and violence to be used within MultiCare.

■ Provide violence-prevention training for staff that addresses topics such as intergenerational cycles of violence and referral protocols for survivors and victims.


Anticipated outcomes based on the strategies above include:

■ An increase in safety screenings for new mothers

■ Creation of a suicide and violence screening tool

■ An increase in violence awareness among staff

Intentional injuries result from purposeful human action, and can be physical or emotional in nature. These injuries commonly result from attempted suicides and assaults. In the Valley Hospital Service area, the rate of intentional injury hospitalizations was 75.9 cases per 100,000 people, which is higher than the state rate of 69.8 cases per 100,000 people. In addition, the suicide rate in this community was 15.9 cases per 100,000 people, which is also higher than the state’s suicide rate. Stakeholders who participated in community focus groups voiced concerns about assault and harassment in their neighborhoods. Particular concerns included child abuse and neglect, domestic violence, bullying, violence witnessed by youth, and firearm injuries and deaths.


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INTERNAL RESOURCES

MultiCare offers injury prevention and trauma services that assist individuals and families. Programs include the following:

MultiCare Rockwood Behavioral Health Center offers mental health treatment for children, adolescents, adults and families. The conditions and problems addressed include depressive disorders, developmental delays, grief and loss, learning disabilities, mood and thought disorders, parenting issues, and post-traumatic stress disorder. Services include assistance coping with physical and mental illness and developmental disorders, academic and career counseling, diagnostic assessment, and pharmacological management of stress and anxiety during life transitions.

Sexual Assault Services offers care to patients following a sexual assault by examining injuries, collecting evidence and connecting victims to support services, among other types of assistance. Nurse examiners are registered nurses who have completed specialized clinical training in forensic care.

COMMUNITY RESOURCES

In addition to the MultiCare programs and services, we also partner with community organizations to reduce the rate of violence. Examples include the following:

YWCA Spokane offers an anonymous, 24-hour domestic violence hotline at 509-326-2255. Offerings for domestic violence survivors include safety planning, counseling, housing and legal services. The YWCA also provides economic advancement through skill building, financial education, job readiness, employment support and clothing resources. Children’s services include early education, outreach and trauma support.

Partners with Families & Children prevents, interrupts and repairs cycles of abuse and neglect within families. The organization provides a social safety net for abused and neglected children by offering holistic support, evaluation and treatment services to families across the Inland Northwest.

Lutheran Community Services Northwest supports families beset by trauma and poverty. This organization assists refugees, finds foster homes for neglected children, works with families to keep at-risk teens from being removed from their homes, helps seniors and people with disabilities remain independent, and stands up for crime victims.

Focus 2: Intentional Injuries (Suicide and Violence)Continued


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https://www.multicare.org/rockwood-clinic-services-behavioral-health/

https://www.multicare.org/sexual-assault-services/

https://ywcaspokane.org/

https://www.partnerswithfamilies.org/

https://lcsnw.org/

End the Violence is a Spokane County-campaign to prevent domestic violence and support survivors. Domestic violence can include dating violence, sexual assault, child abuse and stalking.

Prevent Suicide Coalition is engaged in a strategic initiative to address suicide rates in Spokane County. The coalition intends to expand inclusion and reach, enhancing community competence around prevention and strengthening the safety nets available to reduce the upward trend of suicide attempts and deaths.

Vanessa Behan Crisis Nursery provides help for parents who may be experiencing substance abuse, domestic violence, homelessness or burnout from the demands of parenting by offering 24-hour child care for infants and children under the age of seven. This organization also offers parent education, crisis counseling and assistance with referrals to community agencies.

Focus 2: Intentional Injuries (Suicide and Violence)Continued


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https://endtheviolencespokane.org/

https://www.vanessabehan.org/

Focus 3: Oral Health Care (Poverty)

Our goal is to improve health outcomes – particularly oral health outcomes – for those living in poverty.

■ Facilitate continuous quality improvement and practice coaching to support medical-dental integration in pediatric clinics by partnering with Smile Spokane.

■ Integrate oral health care into screening, discharge, training, and learning supports for mother, newborn and pediatric services.


Anticipated outcomes based on the strategies above include:

■ An increase in the number of low-income individuals who receive dental care

■ An increase in awareness of oral health issues and resources among community partners

■ The integration of oral health screenings into mother, newborn and pediatric services

As the CHNA indicates, poverty affects many residents of the Valley Hospital community. Thirty-three percent of residents live at or below 200 percent of the federal poverty level. Poverty rates varied by zip code, ranging from 5.6 percent in the 99019 zip code to 21.7 percent in the 99217 zip code. In addition, the Valley Hospital community has a shortage of oral health care providers for low-income populations. Community members echoed concerns about the lack of dentists in this area who accept Medicaid patients.

Our goal is to improve oral health and other outcomes for low-income individuals through the following strategies and activities:

■ Collaborate with area partners to educate the public about the extent and impact of oral health problems on individuals and families; work with our partners to improve access to oral health services and resources for low-income and underserved populations.


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INTERNAL RESOURCES

MultiCare offers many services and programs to assist low-income individuals and families. Examples include the following:

Charity care is offered at no cost to children and families with incomes at or below 300 percent of the federal poverty level (FPL, which is $70,650 for a family of four. For persons between 300 percent and 500 percent of the FPL, there are sliding scale fees available to help offset the cost of care. In addition to charity care, MultiCare provides no-interest payment plans, flexible payment schedules, discounted services and assistance with qualifying for state-sponsored health plans.

MultiCare Rockwood Pediatric Clinic offers oral health screenings, education and fluoride varnish to all pediatric patients.

COMMUNITY RESOURCES

In addition to the MultiCare programs and services, we also partner with community organizations to improve oral health outcomes for people living in poverty. Examples include the following:

Arcora Foundation works to create lasting improvements in oral health care through disease prevention, increased access to care and transformation of health care systems.

CHAS Health provides medical, dental, pharmacy, behavioral health, pregnancy and pediatric services to low-income individuals at multiple locations throughout Spokane County.

Smile Spokane is a partnership of community leaders and agencies with a comprehensive plan to reduce oral health disparities through seven strategies: improving community care coordination, reducing opioid-related mortality, integrating oral health into primary care, increasing access to dental services for adults and seniors on Medicaid, promoting school-based sealant programs, and supporting community education.

Eastern Washington University Department of Dental Hygiene aims to improve the oral health of at-risk and underserved populations through oral health education, increased access to care, preventive fluoride treatments, dental sealants and oral cancer screenings. The department also provides assistance in establishing a dental home and navigating dental appointments.

Focus 3: Oral Health Care (Poverty)Continued


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https://www.multicare.org/financial-assistance/

https://www.multicare.org/rockwood-clinic-services-pediatrics/

https://arcorafoundation.org/

https://chas.org/

http://www.smilespokane.org/

https://www.ewu.edu/chsph/dental-hygiene/

https://www.ewu.edu/chsph/dental-hygiene/

ConclusionAs a leading regional health care system, MultiCare is committed to improving the health of the people and communities we serve. The process of conducting a Community Health Needs Assessment and developing implementation strategies helps us better understand the health care needs of our communities and the significant role we play in addressing those needs. In addition, this process has fostered greater collaboration among the many organizations that share our goal of improving the health of all people in our communities.

Alex Jackson, Chief Operating Officer, Rockwood Clinic

Bryan Mueller, President, Rockwood Clinic

Laureen Driscoll, President, Deaconess Hospital

Christopher Wherity, Community Outreach Director, Inland Northwest Region

Chuck Henke, Social Work Supervisor, Deaconess Hospital

David Chen, MD, Chief Medical Officer, Valley and Deaconess Hospitals

David Martin, Chief Operating Officer, Valley Hospital

David O’ Brien, MD, Senior Vice President, MultiCare Inland Northwest Region

Deborah Schroetlin, Case Management Director, Deaconess Hospital

Gail Callas, Patient Care Services Director, Rockwood Clinic

Gary Knox, MD, Chief Medical Officer, Rockwood Clinic

Greg Repetti, President, Valley Hospital

Heather Coleman, Chief Nurse Executive, Deaconess Hospital

Heather Crownhart, Rockwood Clinic Pediatrics Manager

Jamilia Sherls-Jones, DNP, MPH, RN, Director-Health Equity, Center for Health Equity & Wellness

Kate Jansen, Behavioral Health Clinic Supervisor, Rockwood Clinic

Kevin Maloney, Media Relations & Marketing Specialist, Inland Northwest Region

Kristin Gilman, MSW, Community Benefit Specialist, Center for Health Equity & Wellness

Louella Freeman, Emergency Department Director, Deaconess Hospital

Mary Quinlan, MS, Executive Director, Center for Health Equity & Wellness

Nancy Hughes, Transition Care Coordinator, Valley Hospital

Shannon Holland, Chief Nurse Executive, Valley Hospital

Wade Hunt, Chief Operating Officer, Deaconess Hospital

The MultiCare leaders and staff involved in developing the regional

implementation strategies for both Deaconess and Valley Hospitals include:


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ConclusionContinued

Ashley Beck, Spokane Regional Health District

Anthony Beam, Intern, Eastern Washington University

Amy Riffe, Spokane Regional Health District

Sarah Bolig Dorn, Better Health Together

Jan Dobbs, Chief Operating Officer, Frontier Behavioral Health

Maureen Finneran, ARCORA Foundation

Ryan Kiely, Excelsior Wellness Center

Joe Ader, Family Promise of Spokane

Sara Clements-Sampson, Community Benefit Manager, Providence Health System

Stacy Wenzl, Data Center Program Manager, Spokane Regional Health District

Steven Smith, Spokane Regional Health District

Heather Gallagher, Spokane Regional Health District

Shannon Emory, Intern, Gonzaga University

The community stakeholders involved in the development of the regional

implementation strategies for Deaconess and Valley Hospitals include:


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