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Pacific County Rural Health Project, University of WA Coursework, Summer 2010
   To understand key, high -
    level county background
    information
   To identify and prioritize
    county health issues
   To identify additional
    questions for community
    leaders and stakeholder
   To explore strategies for one   (VisitEveryCityinWashingtonState.com)

    key county health
    improvement issue
   Located in SE portion of Washington State,
    population 20,900
    (U.S. Bureau of the Census, 2010)
   Four incorporated cities
    › Raymond, South Bend, Long Beach, Ilwaco
    › Populations from 945 to 2,985
       (U.S. Bureau of the Census, 2010)
   One primary route of three connecting
    highways
    › Rural winding roads, majority of county remote to
       healthcare access
(www.co.pacific.wa.us)
Economic Indicator                      Pacific      WA State
                                                            County
2009 unemployment rates                                   10.2 – 14.3%     8.9%
(U.S. Department of Labor, 2010)

Children living in poverty                                    23%          15%
(County Health Rankings, 2010)

Families living below the poverty level                       9%           7%
(U.S. Bureau of the Census, 2000)

Median household income                                     $31,209      $45,776
(U.S. Bureau of the Census, 2000)

Population with Medicaid coverage                            22.9%        33.1%
(WA State Department of Social & Health Services, 2010)
   Classifications:
    › RUCA code: Small Town and Isolated Rural
      (Department of Health, 2001)
    › Medically Underserved Area
      (U.S. Department of Human and Health Services, 2010)
    › Health Professional Shortage Area
       Primary Care
       Mental Health
      (U.S. Department of Human and Health Services, 2010)
   Willapa Harbor Hospital, South Bend
    › Level 5 Trauma Designation
    › Critical Access
   Ocean Beach Hospital, Ilwaco
    › No trauma designation
    › Critical Access
 Neither hospital offer obstetric service,
  closest obstetric services in adjacent Lewis
  and Aberdeen counties
 50% of county more than 30 minutes from
  acute care facility
(WA State Dept. of Health, 2006)
   Community Health Clinics
    (Community Health Service, 2010)
    › Cowlitz Family Health Center, Ocean Park
      (Medical/Dental)
    › Shoalwater Bay Indian Tribe, Tokeland
      (Medical/Dental)
   Rural Health Clinics (WA State Dept of Health, 2009)
    ›   Ocean Beach Medical Center, Ilwaco
    ›   Naselle Clinic, Naselle
    ›   Riverview Health Center, Raymond
    ›   Pacific Family Health Center, South Bend
Shoalwater Bay      Riverview
Indian              Health Center
Tribe,(Medical/De   (Medical)
ntal)
                    Pacific Family
                    Health Center
                    (Medical)




Cowlitz Family
Health Center
(Medical/Dental)




                    Naselle Clinic
                    (Medical)
Ocean Beach
Medical Center
(Medical)
   Willapa Behavioral Health
    (WA State Department of Social and Health Services, 2010)

   Two locations:
    › North county: Raymond
    › South County: Long Beach
   University of Washington Telehealth
    Services:
    › Ocean Beach Hospital, Ilwaco
    › Willapa Harbor Hospital, South Bend,
    › Shoalwater Bay Tribe, Tokeland
   Rural telehealth services included:
    › Surgical telementoring
    › Medicine and cardiology grand rounds and
      nursing video teleconferences
      (University of Washington, 2005)
Health Indicator                      Pacific County           WA State

Reported Chlamydia infectionsᵃ         1385/100,000       2277/100,000
Adult binge drinkingᵃ                      15%                   16%
Violent crime rateͨ                    179/100,000         342/100,000
Access to healthy foodsͨ                   50%                   47%
Food service safetyᵃ                      100%                   93%
Reported child immunizationsᵃ              47%                   42%
Children with health insuranceᵃ            96%                   95%
Note:    ᵃ Washington State Department of Health (2009)
         ᵃ Washington State Department of Health (2006)
         ͨCounty Health Rankings (2010)
          ᵃU.S. Department of Health & Human Services (2009)
          * Peer County Range
Health Indicator            Pacific County   WA State
Adult physical activityᵃ        27%            51%
Teen physical activityᵃ         42%            42%
Adult overweight/obeseᵃ         63%            61%
Teen overweightᵃ                33%            25%
Obesityᵃ                        37.8%          24.2%
Adult cigarette smokingᵃ        27%            16%
Teen cigarette smokingᵃ         21%            15%
Teen alcohol useᵃ               40%            33%
Adult poor mental healthᵃ       16%            10%
Suicideᵃ                         34.3        13.9-34.5*
Health Indicator                               Pacific County    WA State
Motor vehicle crash death rateͨ                 27/100,000      12/100,000
Child unintentional injury hospitalizationsᵃ    326/100,000     205/100,000
Mortality from unintentional injuryᵃ                54.1        30.2-58.1*
Influenza Vaccination (65 yrs or older)ᵃ           71%             72%
Infant mortalityᵃ                                  6.5%          3.3-9.5*
Post-neonatal infant mortalityᵃ                    3.0%         0.0-5.0%*
Adults with unmet medical needᵃ                    16%             14%
Adults with personal healthcare providerᵃ          76%             79%
Adult dental careᵃ                                 63%             74%
Adult with health insuranceᵃ                       72%             84%
Adult and teen obesity


Adult and teen physical activity


Adult access to dental care
   Obesity/Physical Activities
    › What types of outdoor activities are available?
    › What programs exist to encourage physical
        activity?
    ›   What healthy food education or programs are
        available or of interest to the community?
    ›   What types of resources are desired by the
        community to promote physical activity and
        health foods?
    ›   What existing resources can be strengthened or
        advanced?
    ›   What resources are need to build on existing
        strengths, address barriers, or develop new
        programs?
   Adult Dental Access
    › What are the local resources for adult dental
        care?
    ›   What are your non-dental and emergency care
        providers observing in adult dental issues?
    ›   What are the known barriers to adult dental
        care access?
    ›   What resources are needed to increase adult
        dental care access?
    ›   If additional dental providers were available,
        how could services be offered to increase
        access?
Pacific County Rural Health Project, University of WA Coursework, Summer 2010
   “Fit and Fun” model
    (Rural Healthy People 2010 Project, Southwest Rural Health
    Research Center, 2010)
  School and community-based fitness and
  nutrition strategy
 Initially implemented in Gowanda, New
  York in 1999
 Community collaboration with state rural
  health network organization and five
  community partners.
   Program Components
    › Healthy Snack Taste Testing
    › Healthy Choices Sticker Program
    › Fitness Bucks
    › Fit & Fun Relay Night
    › Family Fit & Fun Night
   Recommended staffing:
    › Part-time paid program
      coordinator, public relations
      coordinator, finance staff person
      and clerical support (part-time).
    › Volunteer program support
   Funding required
    › Initial five-year foundation or other grant
     funding recommended
   Program effectiveness
    › Student selection of new foods, amount and
     frequency of student daily physical activity,
     and number of students and adults receiving
     information/education and participating in
     activities.
   Work with community to identify additional
    environmental infrastructure to support and
    encourage physical activity such as:
    › Walking paths, bicycling paths, beach routes
   Identify and obtain foundation/grant funding
    for completion of paved trails in north and
    south county regions
(Pacific County Economic Development Council, 2009)
 Protocol for Assessing Community
  Excellence in Environmental Health
  (PACE-EH)
 Four major components with 13 subtasks
    › Assess the community
    › Define the Problem
    › Take action
    › Evaluation
     (National Association of County and City Health Officials)
 Pacific County is a rural county with
  majority of health indicators performing
  worse than WA State comparison
 Selected Priority health issue: Adult and
  teen obesity
 Recommended intervention: “Fit and
  Fun” model (Southwest Rural Health
  Research Center)
Community Health Services (2010). Health care authority funded community clinics in Washington State.
   Retrieved from www.chs.hca.wa.gov/clinics.html

County Health Rankings (2010). Snapshot 2010: Pacific. Retrieved from http://
   www.countyhealthrankings.corg/print/washington/pacific

Mapquest (2010). Pacific County, Washington. Retrieved from
   http://www.mapquest.com/maps?city=Willapa&state=WA&country=US&latitude=46.674999&l
   ongitude=-123.665001&geocode=CITY

Pacific County Economic Development Council (2009). Comprehensive development strategy for
     Pacific County. Retrieved from http://www.pacificedc.org/Business/ 2009%20PCCEDS1.pdf

Southwest Rural Health Research Center (2010). Models for practice focus area: Educational and
    community-based programs. Rural Healthy People 2010. Retrieved from
    http://srph.tamhsc.edu/centers/rhp2010/html/education/fitfun.htm

University of Washington (2005). Telehealth services at the University of Washington: Current
    telehealth activities and partner. Retrieved from http://depts.washington.edu/uwths/home
    /present.php

U.S. Census Bureau (2000). Profile of General Demographic Characteristics. Retrieved from
     http://factfinder.census.gov

U.S. Department of Labor, Bureau of Labor Statistics (2010). Local Area Unemployment Statistics.
     Retrieved from http://data.bls.gov/PDQ/servlet/SurveyOutputServlet
U.S. Department of Health & Human Services (2009). Community Health Status Indicators. Retrieved
     from http://communityhealth.hhs.gov

U.S. Department of Labor, Bureau of Labor Statistics (2010). Local Area Unemployment Statistics.
     Retrieved from http://data.bls.gov/PDQ/servlet/SurveyOutputServlet

U.S Bureau of the Census (2010). http://quickfacts.census.gov/qfd/states/53/53049.html

Washington State Department of Health (2006). Access to Hospital-based Perinatal and Neonatal
    Care. Retrieved from http://ww4.doh.wa.gov/gis/pdf/neon_tt.pdf

Washington State Department of Health, Rural Health Programs (2009). Federally Designated Rural
    Health Clinics by County as of July 1, 2009. Retrieved from www.doh.gov/hsqa/ocrh/RHC
    /Fed_DesignRHCs.pdf

Washington State Department of Social & Health Services (2007). DSHS Client Services, July 2006 –
    June 2007). Retrieved from http://clientdata..rda.dshs.wa.gov

Washington State Department of Health (2009). Pacific County Public Health and Human Services
    Department. Retrieved from http://www.doh.wa.gov/phip/khi/lphi/lhj/
    pacific/access/access1.htm
Washington State Department of Social & Health Services (2010). Authorized community mental
    health agencies. Retrieved from www.dshs.wa.gov/mentalhealth/timberlands.shtml

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Pacific County Rural Health Project, University of WA Coursework, Summer 2010

  • 2. To understand key, high - level county background information  To identify and prioritize county health issues  To identify additional questions for community leaders and stakeholder  To explore strategies for one (VisitEveryCityinWashingtonState.com) key county health improvement issue
  • 3. Located in SE portion of Washington State, population 20,900 (U.S. Bureau of the Census, 2010)  Four incorporated cities › Raymond, South Bend, Long Beach, Ilwaco › Populations from 945 to 2,985 (U.S. Bureau of the Census, 2010)  One primary route of three connecting highways › Rural winding roads, majority of county remote to healthcare access
  • 5. Economic Indicator Pacific WA State County 2009 unemployment rates 10.2 – 14.3% 8.9% (U.S. Department of Labor, 2010) Children living in poverty 23% 15% (County Health Rankings, 2010) Families living below the poverty level 9% 7% (U.S. Bureau of the Census, 2000) Median household income $31,209 $45,776 (U.S. Bureau of the Census, 2000) Population with Medicaid coverage 22.9% 33.1% (WA State Department of Social & Health Services, 2010)
  • 6. Classifications: › RUCA code: Small Town and Isolated Rural (Department of Health, 2001) › Medically Underserved Area (U.S. Department of Human and Health Services, 2010) › Health Professional Shortage Area  Primary Care  Mental Health (U.S. Department of Human and Health Services, 2010)
  • 7. Willapa Harbor Hospital, South Bend › Level 5 Trauma Designation › Critical Access  Ocean Beach Hospital, Ilwaco › No trauma designation › Critical Access  Neither hospital offer obstetric service, closest obstetric services in adjacent Lewis and Aberdeen counties  50% of county more than 30 minutes from acute care facility
  • 8. (WA State Dept. of Health, 2006)
  • 9. Community Health Clinics (Community Health Service, 2010) › Cowlitz Family Health Center, Ocean Park (Medical/Dental) › Shoalwater Bay Indian Tribe, Tokeland (Medical/Dental)  Rural Health Clinics (WA State Dept of Health, 2009) › Ocean Beach Medical Center, Ilwaco › Naselle Clinic, Naselle › Riverview Health Center, Raymond › Pacific Family Health Center, South Bend
  • 10. Shoalwater Bay Riverview Indian Health Center Tribe,(Medical/De (Medical) ntal) Pacific Family Health Center (Medical) Cowlitz Family Health Center (Medical/Dental) Naselle Clinic (Medical) Ocean Beach Medical Center (Medical)
  • 11. Willapa Behavioral Health (WA State Department of Social and Health Services, 2010)  Two locations: › North county: Raymond › South County: Long Beach
  • 12. University of Washington Telehealth Services: › Ocean Beach Hospital, Ilwaco › Willapa Harbor Hospital, South Bend, › Shoalwater Bay Tribe, Tokeland  Rural telehealth services included: › Surgical telementoring › Medicine and cardiology grand rounds and nursing video teleconferences (University of Washington, 2005)
  • 13. Health Indicator Pacific County WA State Reported Chlamydia infectionsᵃ 1385/100,000 2277/100,000 Adult binge drinkingᵃ 15% 16% Violent crime rateͨ 179/100,000 342/100,000 Access to healthy foodsͨ 50% 47% Food service safetyᵃ 100% 93% Reported child immunizationsᵃ 47% 42% Children with health insuranceᵃ 96% 95% Note: ᵃ Washington State Department of Health (2009) ᵃ Washington State Department of Health (2006) ͨCounty Health Rankings (2010) ᵃU.S. Department of Health & Human Services (2009) * Peer County Range
  • 14. Health Indicator Pacific County WA State Adult physical activityᵃ 27% 51% Teen physical activityᵃ 42% 42% Adult overweight/obeseᵃ 63% 61% Teen overweightᵃ 33% 25% Obesityᵃ 37.8% 24.2% Adult cigarette smokingᵃ 27% 16% Teen cigarette smokingᵃ 21% 15% Teen alcohol useᵃ 40% 33% Adult poor mental healthᵃ 16% 10% Suicideᵃ 34.3 13.9-34.5*
  • 15. Health Indicator Pacific County WA State Motor vehicle crash death rateͨ 27/100,000 12/100,000 Child unintentional injury hospitalizationsᵃ 326/100,000 205/100,000 Mortality from unintentional injuryᵃ 54.1 30.2-58.1* Influenza Vaccination (65 yrs or older)ᵃ 71% 72% Infant mortalityᵃ 6.5% 3.3-9.5* Post-neonatal infant mortalityᵃ 3.0% 0.0-5.0%* Adults with unmet medical needᵃ 16% 14% Adults with personal healthcare providerᵃ 76% 79% Adult dental careᵃ 63% 74% Adult with health insuranceᵃ 72% 84%
  • 16. Adult and teen obesity Adult and teen physical activity Adult access to dental care
  • 17. Obesity/Physical Activities › What types of outdoor activities are available? › What programs exist to encourage physical activity? › What healthy food education or programs are available or of interest to the community? › What types of resources are desired by the community to promote physical activity and health foods? › What existing resources can be strengthened or advanced? › What resources are need to build on existing strengths, address barriers, or develop new programs?
  • 18. Adult Dental Access › What are the local resources for adult dental care? › What are your non-dental and emergency care providers observing in adult dental issues? › What are the known barriers to adult dental care access? › What resources are needed to increase adult dental care access? › If additional dental providers were available, how could services be offered to increase access?
  • 20. “Fit and Fun” model (Rural Healthy People 2010 Project, Southwest Rural Health Research Center, 2010)  School and community-based fitness and nutrition strategy  Initially implemented in Gowanda, New York in 1999  Community collaboration with state rural health network organization and five community partners.
  • 21. Program Components › Healthy Snack Taste Testing › Healthy Choices Sticker Program › Fitness Bucks › Fit & Fun Relay Night › Family Fit & Fun Night  Recommended staffing: › Part-time paid program coordinator, public relations coordinator, finance staff person and clerical support (part-time). › Volunteer program support
  • 22. Funding required › Initial five-year foundation or other grant funding recommended  Program effectiveness › Student selection of new foods, amount and frequency of student daily physical activity, and number of students and adults receiving information/education and participating in activities.
  • 23. Work with community to identify additional environmental infrastructure to support and encourage physical activity such as: › Walking paths, bicycling paths, beach routes  Identify and obtain foundation/grant funding for completion of paved trails in north and south county regions (Pacific County Economic Development Council, 2009)
  • 24.  Protocol for Assessing Community Excellence in Environmental Health (PACE-EH)  Four major components with 13 subtasks › Assess the community › Define the Problem › Take action › Evaluation (National Association of County and City Health Officials)
  • 25.  Pacific County is a rural county with majority of health indicators performing worse than WA State comparison  Selected Priority health issue: Adult and teen obesity  Recommended intervention: “Fit and Fun” model (Southwest Rural Health Research Center)
  • 26. Community Health Services (2010). Health care authority funded community clinics in Washington State. Retrieved from www.chs.hca.wa.gov/clinics.html County Health Rankings (2010). Snapshot 2010: Pacific. Retrieved from http:// www.countyhealthrankings.corg/print/washington/pacific Mapquest (2010). Pacific County, Washington. Retrieved from http://www.mapquest.com/maps?city=Willapa&state=WA&country=US&latitude=46.674999&l ongitude=-123.665001&geocode=CITY Pacific County Economic Development Council (2009). Comprehensive development strategy for Pacific County. Retrieved from http://www.pacificedc.org/Business/ 2009%20PCCEDS1.pdf Southwest Rural Health Research Center (2010). Models for practice focus area: Educational and community-based programs. Rural Healthy People 2010. Retrieved from http://srph.tamhsc.edu/centers/rhp2010/html/education/fitfun.htm University of Washington (2005). Telehealth services at the University of Washington: Current telehealth activities and partner. Retrieved from http://depts.washington.edu/uwths/home /present.php U.S. Census Bureau (2000). Profile of General Demographic Characteristics. Retrieved from http://factfinder.census.gov U.S. Department of Labor, Bureau of Labor Statistics (2010). Local Area Unemployment Statistics. Retrieved from http://data.bls.gov/PDQ/servlet/SurveyOutputServlet
  • 27. U.S. Department of Health & Human Services (2009). Community Health Status Indicators. Retrieved from http://communityhealth.hhs.gov U.S. Department of Labor, Bureau of Labor Statistics (2010). Local Area Unemployment Statistics. Retrieved from http://data.bls.gov/PDQ/servlet/SurveyOutputServlet U.S Bureau of the Census (2010). http://quickfacts.census.gov/qfd/states/53/53049.html Washington State Department of Health (2006). Access to Hospital-based Perinatal and Neonatal Care. Retrieved from http://ww4.doh.wa.gov/gis/pdf/neon_tt.pdf Washington State Department of Health, Rural Health Programs (2009). Federally Designated Rural Health Clinics by County as of July 1, 2009. Retrieved from www.doh.gov/hsqa/ocrh/RHC /Fed_DesignRHCs.pdf Washington State Department of Social & Health Services (2007). DSHS Client Services, July 2006 – June 2007). Retrieved from http://clientdata..rda.dshs.wa.gov Washington State Department of Health (2009). Pacific County Public Health and Human Services Department. Retrieved from http://www.doh.wa.gov/phip/khi/lphi/lhj/ pacific/access/access1.htm Washington State Department of Social & Health Services (2010). Authorized community mental health agencies. Retrieved from www.dshs.wa.gov/mentalhealth/timberlands.shtml