2013 Community Health Needs Assessment Report Our Mission We believe all children have unique needs and should grow up without illness or injury. With the support of the community and through our spirit of inquiry, we will prevent, treat and eliminate pediatric disease.
Our Vision We will be the best children’s hospital. • We will provide patients and their families excellent care with compassion and respect. • We will provide superior, accessible, cost-effective service. • We will attract and retain the best talent at all levels of the organization. • We will be one of the top five pediatric research institutions. • We will be the nation’s premier pediatric educators. • We will achieve worldwide prominence by integrating patient care, research, education and advocacy.
2 Community Health Needs Assessment Report 2013 Table of Contents
Introduction...... 4 King County Community Healthcare Access Strategies...... 27 Our Commitment to the Community...... 4 Children and Youth with Special Health Care Needs Methodology...... 5 (with Chronic Conditions)...... 29
Compiling Existing Data...... 5 An Overview of the Children and Youth with Chronic Conditions Population...... 29 Theoretical Models...... 6 Children with Complex Chronic Conditions...... 32 Gathering Community and Public Health Input...... 7 Adolescent Transition...... 32 Limitations...... 8 Asthma and Allergies...... 33 ...... 8 Our Community Cancer...... 37 Socioeconomic Indicators...... 8 Heart Disease...... 39 Washington State, King County and South King Transplant...... 40 County...... 8 Child Health and Development...... 41 Age...... 8 Obesity...... 41 Race and Ethnicity...... 8 Mental and Behavioral Health...... 45 Poverty...... 9 Injury...... 49 Employment...... 9 Adolescent Health...... 61 Education...... 10 Immunizations...... 66 Housing...... 11 Oral Health...... 68 Homelessness...... 12 Prematurity...... 71 Foster Care...... 13 Crime...... 14 What the Community Tells Us: Gathering Community and Public Health Input...... 74 Food Insecurity...... 15 Online Survey Key Findings...... 74 LGBTQ Youth...... 16 Interview Key Findings...... 77 Health Literacy and Health Disparities in Low Health Literacy Populations...... 16 Listening Group Key Findings...... 79 Socioeconomic Indicators: Seattle Children’s...... 18 Seattle Children’s Community Benefit Priorities...... 80 Health Needs of Our Community...... 18 General Health Indicators...... 18 Acknowledgements...... 82 Leading Causes of Death...... 18 Appendix: Figures, Graphs Inpatient Admission Rates and Diagnosis...... 19 and Charts...... 83 Infant Mortality Rates...... 19 Access to Quality Healthcare for All Children...... 20 The Uninsured...... 20 Access to Care for All Patients on Medicaid...... 21 Access to Care for Specific Populations...... 23 Access to Research...... 23 Seattle Children’s Healthcare Access Strategies...... 24
Community Health Needs Assessment Report 2013 3 Introduction Seattle Children’s delivers exceptional patient Through the collaboration of physicians in care, advances new discoveries and treatments nearly 60 pediatric subspecialties, Children’s through pediatric research, and serves as the Hospital provides inpatient, outpatient, pediatric and adolescent medical center for the diagnostic, surgical, rehabilitative, behavioral, largest landmass of any children’s hospital in emergency and outreach services. Children’s the country – Washington, Alaska, Montana and is internationally recognized for advancing Idaho (the WAMI region). Consistently ranked discoveries in cancer, genetics, immunology, as one of the best children’s hospitals in the pathology, infectious disease, injury prevention country by U.S. News & World Report magazine, and bioethics. Children’s also serves as the Children’s is made up of Seattle Children’s primary clinical, research and teaching site for Hospital, Seattle Children’s Research Institute the Department of Pediatrics at the University and Seattle Children’s Hospital Foundation. of Washington School of Medicine. Our Commitment to the Community Children’s is dedicated to addressing the health successful community projects, including the needs of children and families in the region Health Coalition for Children and Youth, Global and throughout the world. Our advocacy and Alliance to Prevent Prematurity and Stillbirth outreach efforts are based on the documented (GAPPS), Safe Kids, VAX Northwest and the needs of our patient population and of the Childhood Obesity Prevention Coalition. broader community. After this first thorough needs assessment, we Although this is our first comprehensive will conduct one every three years to: Community Health Needs Assessment (CHNA), • Understand health and safety issues facing we have been involved with smaller scale underserved populations who experience assessments over many years, including those health disparities, using existing data and the aimed at: perspectives of community stakeholders and • A specific disease, such as obesity families. • A particular population, such as homeless • Identify strengths, existing programs and families activities that are helping the community thrive. • A geographic area with significant health disparities, such as South King County • Inform our community benefit efforts by determining where the community needs • Preventable injuries, such as drowning align with Children’s strategic plan or areas in We work with many other organizations which we have significant expertise. to develop targeted interventions aimed The CNHA will help us focus our efforts on the at improving children’s health and safety. most urgent community health needs. It lays We collectively determine our partnership the foundation for our overarching Community and advocacy goals from a policy, resource, Benefit Plan, which will engage stakeholders, education and delivery standpoint, and we link to the hospital’s strategic plan, and support establish evaluation points to measure success. partnerships with community organizations and Children’s partners with other organizations other healthcare providers. and serves in a leadership role on a number of
4 Community Health Needs Assessment Report 2013 Methodology The CHNA was conducted by Children’s External and incorporated input from leaders and Affairs and Guest Services Department, with individuals within public health and community guidance from the hospital’s Community Benefit organizations. We gathered qualitative and and Advocacy Advisory Committee and support quantitative data, which included compiling from Children’s leadership, internal stakeholders, existing child and adolescent health data and community partners and family representatives. generating 24 topic-specific reports through Children and teens face health problems that secondary data collection. can require cultural and social intervention. *(See Appendix, Figure 1: Seattle Children’s To ensure we captured the complexities of Community Health Needs Assessment Development childhood health in the region, we elicited Process.) Compiling Existing Data Before we could begin collecting data, we had specifically King County, with a focus on South to define the scope of our community. Although King County due to its health disparities. In Children’s servesCommunity the entire WAMI Health region, Needs based Assessment addition, the Focus report Area provides a general overview on our patient population, for the purposes of the status of regional healthcare access of the CHNA we defined our community as issues. the children and youth in Washington state —
Community Health Needs Assessment Focus Area
Alaska Montana
South King County Seattle
White N Center Tukwila Burien King Renton County Washington Sea Tac
Kent Covington Des Moines Maple Valley
Black Federal Diamond Way Auburn Idaho Algona
Pacific
Enumclaw
Adapted from map created by King County. AdaptedSource: Kingfrom mapCounty created iMAP by - King County. County Districts Source:(http://www.metrokc.gov/GIS/iMAP). King County iMAP - King County DistrictsDate: 11/6/2012 (http://www.metrokc.gov/GIS/iMAP). Date: 11/6/2012
Community Health Needs Assessment Report 2013 5 To attain secondary data about health including asthma, autism, injuries, mental health, indicators, health risk factors and obesity, oral health, prematurity, access to care, demographics, we used a wide variety of local, and children with chronic conditions. To gather county, state, regional and national resources, background on each topic area, we used the including: social-ecological model and the Spectrum • Centers for Disease Control and Prevention of Prevention; these organizing tools identify multiple approaches — from the individual • U.S. Census Bureau to the societal — to addressing public health • U.S. Department of Health and Human needs. Services’ Healthy People 2020 • National Survey of Children with Special Health Care Needs – Data Resource Center Children’s Community Benefit and for Child & Adolescent Health Advocacy Advisory Committee • Kids Count Data Center (The Annie E. Casey The Children’s Advocacy Advisory Committee Foundation) serves as an ambassador for advocacy by carrying out the goals of the Advocacy • Washington State Department of Health Program: to advance child and family health • Health Information Program of the and wellness by promoting injury prevention Washington State Hospital Association and healthy child development, make sure all children have access to quality healthcare, and • Communities Count meet the healthcare needs of children with • Public Health Seattle & King County chronic conditions in their local communities. • Seattle Children’s Office of Knowledge The multidisciplinary committee is composed Management of clinicians, staff and family members working on government affairs, diversity After reviewing the data (including input from and health equity issues, child advocacy and Children’s physicians and staff leaders), we community outreach. narrowed our focus to 24 topic areas of need,
Theoretical models
The Social-Ecological Model definition of prevention as simply teaching Used by the Centers for Disease Control, the healthy behaviors. The model includes Social-Ecological Model considers the complex six interconnected levels to help develop interplay between individual, relationship, comprehensive prevention strategies. community and societal factors in gaining a By identifying activities that meet prevention better understanding of public health issues objectives at each level of the model, people and the effect of potential strategies. can achieve results in which the “whole is *(See Appendix, Figure 2: The Social-Ecological greater than the sum of its parts.” Meeting Model) objectives at one level of the model has interrelated and positive effects at other levels. The Spectrum of Prevention Model *(See Appendix, Figure 3: The Spectrum of Taking into consideration how prevention Prevention.) can have multiple points of impact within a community, the Spectrum of Prevention model pushes beyond the restricting
6 Community Health Needs Assessment Report 2013 Gathering community and public health input
We wanted our CHNA to go beyond simply 10 different organizations focused on diverse identifying problems. We invited community families, high-risk populations and children with stakeholders to be part of our research process special health care needs. About half of the to help us learn about and report on existing interviewees work for organizations serving community assets and strengths. the entire state of Washington. The remaining participants work for organizations serving Online survey a smaller geographic area within the state, During July, August and September of including the Yakima Valley, South King County 2011 we conducted an online survey (using and Seattle. SurveyMonkey®) to collect both qualitative The interviews were designed to gain a deeper and quantitative data. The survey made it understanding of the health and safety issues possible to include participants who were facing children, adolescents and families. We unable to do phone interviews. We sent it to sought input from organizations that serve 70 organizations around the state. Children’s traditionally underserved populations or groups staff sent introductory emails to probable experiencing health disparities, hoping to learn survey participants, explaining how Children’s ways to improve child health. planned to use the survey information. This Phone interviewees were asked to identify: personal approach ultimately led to higher than average participation—we received responses • Top health and safety concerns for children from 74 community leaders representing 57 and adolescents in the community they serve organizations for a response rate of 81%. • Healthcare access issues that face children The survey asked stakeholders to: and adolescents in the community they serve • Identify the most concerning health and • Groups that are experiencing health safety problems that impact children in the disparities or inequalities community they serve • Community resources that are available for • Assess accessibility to healthcare services for children and families children and youth • What can be done in the community to • Identify barriers that prevent families and benefit the health of children children from living healthy lives • Opportunities for Children’s to address their • Identify programs and initiatives that are top health and safety concerns currently working in the community Listening groups • Suggest possible improvements in the community Parents are key stakeholders in community health issues. To gain their perspective, we • Identify opportunities for Children’s to organized three parent listening groups, one address health and safety issues in their English-speaking, one Spanish-speaking, and community one with the hospital’s Family Advisory Council. All were existing groups that regularly provide Phone interviews hospital feedback. These parent groups helped In a follow-up to the survey, we conducted us identify key health and safety issues facing phone interviews with 10 people representing families, gauge the availability of community
Community Health Needs Assessment Report 2013 7 resources, and learn from personal stories so most of our respondents were from King regarding healthcare access. County. While we gathered a great deal of community input from a wide range of stakeholders, limited resources made it Limitations impossible to reach all of our constituents. All research efforts face limitations; this section For example, we held just three listening groups. calls out the most important ones we faced. We While our English-speaking group was diverse collected CHNA data from agencies that use in its makeup, we recognize the gap in holding varying data sets. A particular challenge was listening groups with African American, Native inconsistent age groupings in epidemiological American, Russian, Somalian, Vietnamese or and outcome data. Data were also inconsistent other stakeholder communities (the hospital in defining life-stage categories, such as when a provides interpreter services in more than 20 child is considered an adult. languages on a regular basis). We reached out Inconsistencies in terminology and definitions to South King County community leaders, but made it difficult to make side-by-side could not connect with a broad representation comparisons. For example, the definition of of families there. These limitations may “Hispanic” varies from one community to inadvertently reinforce health inequalities. another. The definition of “community” also If hospitals rely on the same list of stakeholders varies. Individuals participating in a CHNA for a variety of survey needs, engagement likely define their community differently; a fatigue may influence participation. The community can be a geographic area, a racial 2010 Affordable Care Act requires hospitals group, a school or a religious affiliation. This to complete a CHNA every three years; poses problems when analyzing interview and stakeholders may be less willing to be surveyed survey results. if they’re asked frequently for input or if they We had fewer connections to community don’t see their ideas being implemented. leaders in other areas of Washington state, Our Community Socioeconomic indicators Child and teen health are influenced by a variety King County has a slightly higher percentage of of environmental and social factors. Social risk residents who are 19 and younger than Seattle factors such as growing up in poverty, no health and the state as a whole do. insurance coverage and racial/ethnic minority * (See Appendix, Figure 4: Number of Children in the WAMI status are associated with poorer health Region; Figure 5: Washington State Age Demographics outcomes for children. 2010; and Figure 6: Age Demographics 2006-10: Washington State, King County and South King County.) Washington state, King County Race and ethnicity and South King County With a population of 700,000, South King Age County is comparable in size to Snohomish County, the state’s third largest county. It is the Of the more than 1.7 million people in Washington most diverse part of King County’s three major state, nearly 27% are under 20 years old. South subsections, with more than one-third persons-
8 Community Health Needs Assessment Report 2013 of-color. Nearly a quarter of the residents are level). In King County, 15% of children live in foreign-born, and more than 100 languages are poverty and 5% in extreme poverty. 1 spoken there. *(See Appendix, Figure 12: Children Living in Poverty in the State of Washington; Figure 13: Children Living in Extreme In the South King County city of Tukwila, 48% Poverty in the State of Washington; Figure 14: Children of families speak languages other than English Living in Poverty by Race; and Figure 15: Children Living in at home, followed by 40% in SeaTac, 36% in Poverty in King County (by Race/Ethnicity.) Renton and 35% in Kent. The language barrier Children living in poverty: South King County impacts residents’ ability to access healthcare, Over the past decade, South King County has seen education and other support services. In a marked increase in the number of households Tukwila, 39% of the population is foreign-born, facing challenges accessing housing, food, jobs as is 31% in SeaTac. and healthcare. The South King cities of Tukwila, The South King numbers are especially striking SeaTac, Kent, Federal Way, Auburn and Burien when compared to federal and state figures. In all have a greater percentage of families living in the U.S., 13% of the population is foreign-born poverty than King County or Washington state, and 20% speak a language other than English with nearly one out of four families in Tukwila 3 at home. Washington state data also shows 13% of living below the poverty level. the population as foreign-born, with 18% speaking *(See Appendix, Figure 16: Poverty Data for Washington, a language other than English at home. King County and South King County Cities.) *(See Appendix, Figure 7: Race/Ethnicity: Washington, King County and South King County 2010; Figure 8: Race/ Poverty and SSI Ethnicity South King County Cities: 2010; and Figure 9: More than half of Washington state families Foreign-Born and Language Other Than English National, Washington State, King County and South King County living at or below the poverty level who Cities, 2005-2010.) received Social Security Insurance and/or public Census data for 2010 show that over the assistance have a woman as head of household. previous decade, the percentage of minorities in Poverty by race and ethnicity South King County has increased dramatically. American Indian, Black or African American, The number of people who identified and Hispanic children make up the greatest themselves as either Asian, Hispanic, African percentage of children living in poverty in American, Native American or belonging to Washington state and King County. two or more races increased 66%. The Latino population contributed most to this increase, Employment with populations doubling or even tripling in 2 Washington state unemployment numbers grew some South King cities. from 4.9% in 2006 to 9.2% in 2011, and 50,000 *(See Appendix, Figure 10: Minority Population Growth 2000-2010, South King County Cities and Figure 11: People children live in homes with no working adults. Speaking a Language Other Than English at Home in The median income for Washington families 4 Southwest King County.) with children was $63,981 in 2010. In South King County cities, unemployment averaged 8.4% Poverty in 2011, compared to 7.2% in all of King County, 5 Children living in poverty: Washington and 6.6% in Seattle. state and King County 3 From “Access to Comprehensive Pediatric Resource for Low-income Families in S. King County”, Medical Legal Partnership, Odessa Brown In Washington state, 18% of children live in poverty, Children’s Clinic, Seattle Children’s Hospital. while 7% live in extreme poverty (in families with 4 Kids Count Data Center, July 2011 http://datacenter.kidscount.org/data/ bystate/stateprofile.aspx?state=WA&cat=2033&group=Category&loc= incomes less than 50% of the federal poverty 49&dt=1%2c3%2c2%2c4. 5 Numbers and rates are not seasonally adjusted. Margins of error for unemployment rate by city are large, so it is not appropriate to 1 King County Performance, Strategy and Budget Data, 2011. compare the rates between cities. http://data.bls.gov/pdq/querytool. 2 From Seattle Times, February 2011: http://seattletimes.nwsource.com/ jsp?survey=la. Accessed 3/2/2012 Produced by: Public Health - Seattle flatpages/local/censustableau.html. & King County; Assessment, Policy Development & Evaluation Unit.
Community Health Needs Assessment Report 2013 9 *(See Figure 17: Washington State and King County *(See Appendix, Figure 25: On-Time Graduation Rates by Unemployment; Figure 18: Washington State Median Race in Washington, 2005-2010.) Family Income; Figure 19: Median Household Income in King County and South King County; Figure 20: Median While King County’s education figures are Income by Race/Ethnicity King County, 2008-2010; and similar to those across the state, academic Figure 21: Washington State Children Living in Low-Income results in some areas of South King lag behind: Households Where No Adults Work.) • While 65% passed the math WASL Education (Washington Assessment of Student Learning) countywide, this was true for only Childhood health is influenced by social factors 8 30% in Tukwila and 42% in Enumclaw. including the education level attained by parents. School attendance is also a factor. • In writing, 67% of King County fourth graders met the standard; this was true for 58% in When children attend school regularly, they are 9 more likely to succeed academically and less South King. likely to engage in at-risk behaviors. *(See Appendix, Figure 26: King County High-School Graduation Rates by Race/Ethnicity 2005-2010 and Figure In general, Washington state education statistics 27: Percent of fourth grade public school students meeting are close to national averages. High school state standards in writing.) graduation rates are almost 80% for all students in Washington state. They are affected by: Educational attainment Across the state of Washington, 31% of the • Language: 66% of students with limited population ages 25 and older hold college English proficiency graduate 10 degrees. In King County, this is true for 45%. • Income: 71% of low-income students graduate South King County presents the lowest rate • Health challenges: 71% of children with of people over 25 with bachelor’s degree, 6 disabilities graduate graduate or professional degrees, falling below *(See Appendix, Figure 22: 2009 National Public High Washington state and national averages. School Graduation Rates; Figure 23: Public High School Graduation Rates in the State and Nation; and Figure 24: School engagement 2008-09 State High School Graduation Rates by Income, School engagement consists of beliefs and Language, Health and Migration.) behaviors that show students respect learning High school graduation (or equivalency) is inside the classroom. Engagement improves a necessary step in the transition to college. students’ academic performance, promotes Washington ranks 36th in the nation in public school attendance and inhibits risky adolescent school graduation rates and 46th in the number behavior. Low rates of graduation and high rates of high school graduates attending college of truancy mean low engagement. The statistics directly from high school. Out of every 100 ninth below show that engagement in high school is grade students in the state, four years later, 69 low but appears to be higher among children in will graduate from public high schools. Out of the earlier years of their education. 100 high school graduates (from either public As students advance in school, they are more 7 or private high schools), 51 enroll in college. likely to cut classes or skip school altogether. In 2010, this likelihood increased from 17% in sixth Since 2005, graduation rates have increased grade to 19% in eighth grade and from 21% in across all ethnicities in Washington state and 10th grade to 28% in 12th grade, according to King County. American Indian, Black and 11 the Washington State Healthy Youth Survey. Hispanic youth still have lower graduation rates than their Asian/Pacific Islander and White 8 Ibid. counterparts. 9 Ibid. 10 Washington Tracking Network, Washington State Department of 6 U.S. Department of Education, http://www.eddataexpress.ed.gov/state- Health, obtained from US Census American Community Survey, 2011, report.cfm?state=WA. https://fortress.wa.gov/doh/wtn/WTNPortal/Default.aspx. 7 National Information Center for Higher Education Policymaking and 11 Department of Health, http://www.hys.wa.gov/Reporting/ Analysis, http://www.higheredinfo.org/. AnalyticReport08.pdf.
10 Community Health Needs Assessment Report 2013 In addition, students seem to enjoy school less every week of the year. Put another way, a as they get older. In 2010, 32% of sixth graders, household must earn wages equivalent to two 20% of eighth graders, and 13% of 10th and full-time jobs at minimum wage. 12th graders reported “almost always enjoying *(See Appendix, Figure 28: Hours at Minimum Wage 12 school.” Needed to Afford Rent.) From 2008 to 2010, 6.2% of King County teens Very low-income households earned less than ages 16 to 19 (8.3% of Washington state) were 30% of the household median income ($20,000) not in school and not working. in 2010. These households could afford to pay only $496 per month in rent, considerably less Parents’ education than the average cost of the least-expensive Nearly 30% of Washington children live in (and smallest) available apartments. households where no one has education beyond high school, 38% live with at least one Public subsidy housing person who has attended but not completed In addition to rental housing available to the college, and 35% live with at least one college general public, approximately 65,250 King 13 graduate. County (including Seattle) rental units receive some form of public subsidy. About 62% of Housing these units provide housing for low- and very low-income households (those earning less than Housing affordability 40% of area median income, or AMI). Another In analyzing housing affordability, experts rely 22% support moderate-income households on the rule of thumb that renters should spend (those earning less than 50% of AMI). These no more than 30% of their before-tax income 14 subsidized rentals help reduce but do not on rent and utilities. In Washington state, the eliminate the low-income rental shortage. For median gross rent as a percentage of household 15 higher income families, available rentals meet or income is 30.6%. exceed countywide demand. The Urban Institute, a nonpartisan economic and *(See Appendix, Figure 29: King County Rental Unit Supply social policy research organization, publishes and Demand.) Metro Trends, which grades the nation’s 100 Calculation of the affordability gap assumes biggest metropolitan areas on different indicators. that a “reasonable” monthly payment is no The Seattle-Tacoma area received a “C” for its more than 25% of income for home buyers and housing cost burden — rent and house prices 30% of income for renters. For renters, housing compared to median family incomes. costs include monthly rent, utilities and fuel. The National Low Income Housing Coalition Across King County only South King meets the found a mismatch between the cost of living rental needs for those below 40% of AMI; the and the hourly wage of Washingtonians. The rest of the county lacks affordable low-income Fair Market Rent (FMR) of a two-bedroom housing. The county’s east side has the least apartment is $944. A minimum wage worker available housing for those 50% or below the earns $9.04 an hour. To afford a FMR two- median income. In 2008, South King median bedroom apartment — without paying more rents averaged $825 per month, compared to than 30% of income on housing — a minimum $930 in Seattle and Shoreline, and $1,156 in East wage employee must work 80 hours a week King communities. Rural area monthly rentals
12 Ibid. averaged $1,295, the highest in the county. 13 Robert Wood Johnson Foundation, Commission to Build *(See Appendix, Figure 30: King County Moderate and a Healthier America, http://www.rwjf.org/files/research/ commission2008washington.pdf. Low-Income Rental Availability and Figure 31: Housing 14 Rolf Pendall, Rental Affordability: Multiple Measures for a Complex Affordability in Seattle in 2011: Homeownership and Rental Concept, posted: March 5th, 2012. Market.) 15 U.S. Census Bureau, 2010 American Community Survey.
Community Health Needs Assessment Report 2013 11 The United Way reported increases in requests Health implications of homelessness for rent assistance in the first three quarters Without permanent homes, people are exposed of 2010, followed by a decrease in the fourth to disease, violence, unsanitary conditions, quarter and then moderately high levels of malnutrition, stress and addictive substances. assistance requests ever since. As many as Consequently, their rates of serious illnesses and half of those requesting rent assistance do not injuries are three to six times the rates of other 21 qualify for the King County Housing Stability people. Project because their incomes are insufficient 16 compared to their housing costs. The Health Care for the Homeless Clinicians’ Network has identified other health implications Home foreclosures continue to be recorded for homeless youth, including: at high rates in King County compared with those in the years before the recession; South • Homeless parents rate their children’s health King County is disproportionately affected by as fair or poor more often than those who are 17 foreclosures. poor but housed and the general population. • Homeless children are more likely to be seen Homelessness in an emergency department, be hospitalized From 2008 to 2009, family homelessness in and have multiple health problems. Washington state rose 9.2%, compared to a 18 • The living conditions of homeless families national increase of only 2.7%. An estimated (often crowded spaces and less safe 23,000 people are homeless on any given night environments) pose them at increased risk across the state of Washington. A January 2009 for injury and common infectious diseases survey identified 3,465 homeless families with such as upper respiratory infections, ear children, made up of 10,696 people. Of these infections and diarrhea. families, 385 had no shelter and the remaining 3,080 were using emergency or transition • Homeless children are more likely to come shelters. In addition, 211 unaccompanied youth from backgrounds of domestic violence, 19 were counted in state shelters. mental illness and substance abuse. In The 2010 King County One Night Count addition to homelessness and poverty, these stresses impact psychosocial well-being, identified 8,937 homeless people on one 22 January night. This included 6,178 people in which weakens normal development. emergency shelters and transitional housing School and homelessness programs. Among those counted in shelters The rate of student homelessness in and transitional housing, 55% were families with Washington rose by 29.7% between the 2006– children and less than 1% were unaccompanied 23 20 07 and 2009–10 academic years. In the 2007- youth. 2008 school year, 18,670 state schoolchildren *(See Appendix, Figure 32: One Night Count of People Who Are Homeless in King County) in kindergarten through 12th grade were living homeless with their families. Of these children, Organizations like Solid Ground, First Place 5,306 lived in shelters, 11,069 lived with others, 24 School, Morningside and YouthCare provide 1,268 lived in motels and 1,027 had no shelter. critical support to homeless families and youth.
21 National Health Care for the Homeless Council, 2010. 16 United Way of King County, http://www2.uwkc.org/kcca/BasicNeeds/ 22 Karr, Catherine, MD and the Health Care for the Homeless Clinicians’ BasicNeeds.asp. Network. Presentation: Homeless Children: What Every Health 17 Ibid. Care Provider Should Know. http://www.nhchc.org/wp-content/ 18 National Alliance to End Homelessness, 2011. http://www. uploads/2012/02/HomelessChildren_WhatEveryProviderShouldKnow. endhomelessness.org/content/article/detail/3658/. pdf. 19 Washington State Point in Time Count of Homeless Persons, Jan. 2009. 23 Office of Public Instruction, 2010. http://www.k12.wa.us/HomelessEd/ http://homeless.ehclients.com/images/uploads/Subpop_and_County_ Data.aspx. Summary_2009.pdf. 24 Washington State DOH Adolescent Needs Assessment Report, 20 Committee to End Homelessness, http://www.cehkc.org/scope/cost. Jan. 2010 http://www.doh.wa.gov/DataandStatisticalReports/ aspx. HealthBehaviors/AdolescentHealthAssessment.aspx.
12 Community Health Needs Assessment Report 2013 29 During the 2005-2006 school year, just over The Braam Settlement agreement 1,700 South King County school students were In August 1998, a lawsuit was filed in identified as being homeless. Because of the Washington state on behalf of a class of foster difficulties in reaching homeless people, this children who had had three or more placements number is thought to be lower than the actual while in foster care. The lawsuit alleged that total of homeless students. DSHS did not provide constitutionally required *(See Appendix, Figure 33: Homeless Students in King care to foster children. The parties reached an County.) agreement in November 2004 with the goal of improving the conditions and treatment Foster care of children in the custody of DSHS Children’s Foster placement services are provided when Administration. children need short-term or temporary protection According to the Braam Oversight Panel because they are abused, neglected or involved 30 summary report for 2011, the percentage of in family conflict. Of the approximately 1.5 million children and youth who received an annual children who live in Washington, 10,136 are mental health and substance abuse screening currently in foster care, 1,633 were adopted from went from 72% in 2010 to 91%. Visits (two foster care in the past year and 42,051 are being or more every month) from siblings placed raised by their grandparents. The greatest number apart went down from 50% in 2010 to 26%. of state foster children live in Pierce, Snohomish, 25 And only 57% of medically fragile children (a Spokane and King counties. About 400 children decrease from 91% in 2010) were reported by a year “age out” of foster care, meaning they their caregiver to be connected to ongoing turn 18 years old without having been adopted 26 and appropriate medical care and placed with or reunited with their birth families. caregivers who have specialized skills or receive African American and Native American children ongoing training. are overrepresented in the foster care system. In Impact of foster care on child health Washington, they make up 4.2% and 2% of the general population respectively, with 10.5% and Children in foster care have more serious and 27 complex physical health, mental health and 8.4% of children in foster care. In King County, 31 they represent 8% of the child population, developmental problems. but they account for one-half of children who While all foster children qualify for Medicaid and 28 remain in foster care for more than four years. have the same benefits and challenges related In 2005, more than one-third of children in to access to healthcare, coordination of care foster care had been there for longer than two may be an issue because often no single adult years. In 2007, more than 25% of foster children knows a foster child’s complete medical history. moved more than two times between foster A full medical evaluation is now required within homes. 72 hours of placement in foster care, thanks to the Braam Settlement. Organizations like Ryther, Mockingbird Society, Amara, Treehouse and Children’s Home Society Use of mental health services by children in advocate for and support the needs of foster foster care is 8 to 11 times greater than that children and youth. experienced by other low-income and generally
25 Children’s Alliance and Washington State Budget & Policy Center - Data Provided by: National KIDS COUNT Program http://datacenter. 29 DSHS Children’s Administration: http://www.dshs.wa.gov/ca/about/ kidscount.org/data/bystate/Rankings.aspx?state=WA&loct=5&by=a&or imp_settlement.asp. der=a&ind=5223&dtm=11702&tf=35. 30 “Executive Summary: Children’s Administration, Braam Settlement and 26 Washington Education Foundation, 2006. Exit Agreement Semi-Annual Performance Report”, DSHS Children’s 27 Children’s Administration, Washington Department of Social and Administration, March 30, 2012. Health Services, 2006; National Indian Child Welfare Association and 31 Leslie, LK et al. Comprehensive Assessments for Children Entering Kids Are Waiting, 2007. Foster Care: A National Perspective. Pediatrics. 2003 Jul;112(1 Pt 1):134- 28 King County Coalition on Racial Disproportionality, 2005. 42.
Community Health Needs Assessment Report 2013 13 32 high-risk children in the Medicaid program. explanation for the recent increase in gang 36 Children in foster care account for 25% to 41% activity. In 2008 in the state of Washington, of mental health expenditures for children there were 18 gang-related homicides; eight of 37 within the Medicaid program, although they those were juvenile gang killings. In 2010, there 33 38 represent less than 3% of all enrollees. were 33 gang-related homicides. Foster children are significantly more likely to be The King County Sheriff’s Office believes there prescribed antipsychotics than receive appropriate are more than 10,000 gang members among an nonpharmacologic therapy for behavioral issues. estimated 140 street gangs in King County. The National Survey of Child and Adolescent Gang-related crime has gone up 165% since 2005 Well-Being documented that 13.5% of children and has shifted from Seattle to South King County. in the child welfare system were using Gang-related violence has increased over psychotropic medication, two to three times the 34 the past three years. In 2008 and 2009, King rate of other children in the community. County averaged 29 gang-related homicides 39 Crime and reported 200 gang-related shootings. The overall crime rate in Washington state has In 2010, 5% to 7% of King County students in dropped steadily from a high of 52.9 offenses grades eight, 10 and 12 reported gang membership (per 1,000 citizens) in 2005 to 38.3 in 2011. within the past year; among these students *(See Appendix, Figure 34: Washington State Overall there were significant decreases in gang Crime Rate.) membership from 2008 to 2010. Eighth graders were more likely than 12th graders to have been Gang activity gang members within the past year, and boys 40 Nationwide, youth gangs are responsible for were more likely than girls to be in gangs. the majority of serious violent offenses. Gang activity in schools and neighborhoods creates a Weapons and school climate of fear and is associated with increases Though carrying a weapon alone is not a violent 35 in violence and criminal behavior. Within the behavior, it greatly increases the risk that an Northwest region comprising Washington, argument will result in death, disability or other Oregon, Idaho, Montana, Wyoming and Alaska, serious injury. In 2010, 10% to 11% of students gang activity occurs mainly in Washington in grades eight, 10 and 12 reported carrying and Oregon. Currently there are an estimated a weapon in the past 30 days “because they 2,093 gangs with more than 36,650 members might need it in a fight.” of all ages in the region. Juvenile arrests Current youth gang membership in the state In 2009, there were 29,187 juvenile arrests (ages of Washington is estimated to be around 10 to 17) reported. There were 41 arrests for 20,000, with another 20,000 youth considered every 1,000 juveniles in the state, a decrease gang “associates.” Several groups that from 47 in 2008. The 2009 juvenile arrest rate operate like gangs but do not officially call 36 Washington State Department of Health Adolescent themselves gangs are also active in Washington. Needs Assessment, January 2010, http://www.doh. wa.gov/DataandStatisticalReports/HealthBehaviors/ Nationwide, gangs are moving from urban areas AdolescentHealthAssessment.aspx. to suburban and rural areas, which may be one 37 Washington Association of Sheriffs and Police Chiefs. The Crime in Washington State: 2008 Annual Report http://www.waspc.org/index. php?c=Crime%20Statistics). 32 Harman J, Childs G, Kelleher K. Mental health care utilization and 38 KCTS 9, Gangs and guns in Washington state, February 4, 2011: expenditures by children in foster care. Arch Pediatr Adolesc Med http://kcts9.org/kcts-9-connects/gangs-and-guns-washington-state- 2000; 154(11):1114–7. february-4-2011. 33 MISSING TEXT - go back to original Word doc 39 King County, Press Release, Aug. 30, 2011, County leaders unite 34 Takayama J, Bergman A, Connell F. Children in foster care in the around Executive’s proposal for gang violence intervention and state of Washington. Health care utilization and expenditures. JAMA prevention, http://www.kingcounty.gov/exec/news/release/2011/ 1994;271(23):1850–5. August/30CJReserve.aspx. 35 Washington State Department of Health, Healthy Youth Survey 2010 40 Washington State Department of Health, Healthy Youth Survey 2010 Analytic Report. Analytic Report.
14 Community Health Needs Assessment Report 2013 was the lowest reported for Washington state • 21% of 10th graders (15% in 2004) since 1981. Juveniles composed approximately 45 41 • 20% of 12th graders (17% in 2004) 12% of the total number of arrests statewide. Non-Hispanic American Indian youth (about The racial distribution of state juvenile arrests 35%) were more likely than non-Hispanic White in 2009 was 83% White, 11% Black, 3% Native youth (about 19%) to report that their family American, and 3% Asian. These rates include skipped or reduced meals in the past year due 46 persons of Hispanic origin who can be of any race. to lack of money. There was a 24% increase in Black youth According to the Children’s Alliance, more arrests from 2000 to 2009, compared to a 1.5% than 367,000 households in Washington state decrease for White youth, an 11.8% decrease for struggled to put food on the table in 2009. Native American youth and a 19.4% decrease for 42 The same year, an average of 695,059 people Asian youth. (about 10% of the state population) participated Food insecurity in the state’s Basic Food Program (formerly food stamps) on a monthly basis. This reflected Food security means having enough food at all a 24% increase over the prior year. About 42% times to meet basic needs for an active, healthy of those participants were children, with an 47 life. To be food-secure, a family or individual average age of 7. needs to be able to get acceptable foods in 43 socially acceptable ways. Countywide, visits to food banks rose significantly during 2008 and have remained “Food insecurity” describes households at high levels. The average number of monthly financially stretched to the point where they visits to food banks was 44% higher than cannot be certain that all household members those recorded in 2007. Some individual food will not go hungry. “Very low food security” banks saw increases as high as 30% during describes households where at least one family some months in 2008 compared to the same member goes hungry at times because there is months in 2007. Seattle food banks reported not enough money for food. that the largest increase in their client base was Washington’s state ranking for food insecurity in children ages 0 to 2 years, followed by other for 2006 to 2008 was 17th out of 50, a children under 18. significant increase from 34 the prior year. The Applications for the Basic Food Program state’s ranking for hunger also rose, from 28th 44 increased steadily in late 2008 and early in 2008 to 13th in 2009. 2009. Approximately 10,000 King County The 2008 Washington Healthy Youth Survey residents apply to the program each month, (HYS) found an increase in the number of and one in 20 of these are then enrolled in it. students reporting that their family had cut The program’s caseload grew by nearly 150% back on or skipped meals in the prior year due between October 2007 and October 2011. Since to lack of money: 2009, new applicants remain at high levels, and people require food assistance for longer • 16% of eighth graders 48 periods.
41 Governor’s Juvenile Justice Advisory Committee (GJJAC) www. dshs.wa.gov/pdf/ojj/AnnualReport2010/15-JuvenileArrests.pdf) with 45 Washington State Department of Health, Healthy Youth Survey, April data provided by the Washington Uniform Crime Reporting (WUCR) 2010. program of the Washington Association of Sheriffs and Police Chiefs. 46 Washington State Department of Health, Maternal and Child Health 42 Ibid. (MCH) report, April 2010. 43 Household Food Security in the United States, 2005. Mark Nord, 47 Washington State Department of Health, Maternal and Child Margaret Andrews and Steven Carlson. USDA Economic Research Health (MCH) report, April 2010. http://www.doh.wa.gov/ Service, 2006. DataandStatisticalReports/HealthBehaviors/MaternalChildHealthData. 44 Hungry in Washington, Children’s Alliance, with data from the U.S. aspx. Department of Agriculture (USDA) 2009 Household Food Security 48 United Way of King County, http://www2.uwkc.org/kcca/BasicNeeds/ Survey: http://www.voaww.org/cahungerreport. BasicNeeds.asp.
Community Health Needs Assessment Report 2013 15 56 57 Organizations such as food banks, the suicide. LGBTQ youth who are bullied or 58, 59 Washington Food Coalition, Food Lifeline, Solid rejected by their families after coming out, Ground and Hopelink assist families who are are at even greater risk. Protective factors for struggling with food insecurity. LGBTQ youth include family connectedness, 60 caring adults and school safety. LGBTQ Youth • Significantly more likely to be homeless (20% 61 It is difficult to accurately estimate the number to 40% of homeless youth identify as LGBTQ). of lesbian, gay, bisexual, transgendered or • More likely to skip school, drop out of school questioning (LGBTQ) youth because most 62 and get poor grades. national, state and local surveys do not collect • Have increased rates of sexual intercourse, information on sexual orientation. Adding to 63 the complexity of gathering such data is the alcohol, tobacco and illicit drug use. lack of standardized measures to assess sexual • Report higher rates of verbal, physical and 64 orientation, societal stigmatization, and the sexual harassment and violence. fact that many adolescents are unsure of their sexual orientation. Health literacy and health disparities in low health literacy populations Some data on LGBTQ adults and youth is available: In the U.S. adult population, 3% to 10% Health literacy is “the degree to which 49 of people identify as gay, lesbian or bisexual. individuals have the capacity to obtain, process In a national, population-based survey of junior- and understand basic health information and services needed to make appropriate health high and high-school students, 7% reported 65 50 same-sex attractions or relationships. decisions.” Although the majority of research literature focuses on adults, the ability of a Health disparities among lesbian, gay, child’s caregivers to understand and act on bisexual, transgender and questioning health information is paramount to the safety 66 (LGBTQ) youth and well-being of children. Adolescents face many challenges during their transition into adulthood; LGBTQ youth face Over one in three people have limited health literacy. Approximately 36% of Americans have additional challenges due to social stigma, 67 which causes varying degrees of psychosocial basic or below-basic health literacy skills. 51 56 Ibid. stress. LGBTQ youth are: 57 Ibid. 58 Ryan C, et al. Family rejection as a predictor of negative health • Two to three times more likely to attempt outcomes in white and Latino lesbian, gay, and bisexual young adults. 52, 53, 54, 55 Pediatrics 2009;123:346-52. suicide. In one statewide representative 59 GLSEN (Gay, Lesbian & Straight Education Network), 2009 National survey of ninth to 12th graders, greater than School Climate Survey, http://www.glsen.org/cgi-bin/iowa/all/news/ record/2624.html. 30% of LGBTQ youth had attempted suicide 60 Bontempo DE, D’Augelli AR. Effects of at-school victimization and sexual orientation on lesbian, gay, or bisexual youths’ health risk within the past year; 50% had considered behavior. J Adolesc Health 2002;30:364-74. 61 Ray N. Lesbian, gay, bisexual and transgender youth: an epidemic of homelessness (2006). New York: National Gay and Lesbian Task Force Policy Institute and the National Coalition for the Homeless. 49 Allen LB et al. Adolescent health care experience of gay, lesbian, and 62 Ryan C, et al. Family rejection as a predictor of negative health bisexual young adults. J Adolesc Health 1998;23:212-220. outcomes in white and Latino lesbian, gay, and bisexual young adults. 50 Frankowski BL, Am Acad Ped Comm Adolesc. Sexual orientation and Pediatrics 2009;123:346-52. adolescents. Pediatrics 2004;113:1827-32. 63 Frankowski BL, Am Acad Ped Comm Adolesc. Sexual orientation and 51 Ibid. adolescents. Pediatrics 2004;113:1827-32. 52 Ibid 64 http://www.glsen.org/cgi-bin/iowa/all/news/record/2624.html. 53 Garofalo R, et al. Sexual orientation and risk of suicide attempts 65 U.S. Department of Health and Human Services. Healthy People 2010: among a representative sample of youth. Arch Pediatr Adolesc Med understanding and improving health (2nd edition) US Government 1999;153(5):487-93. Printing Office, Washington, DC (2000). 54 American Association of Suicidology. Suicidal Behavior Among 66 Abrams MA, P Klass, BP Dreyer. Health Literacy and Children: Lesbian, Gay, Bisexual, and Transgender Youth Fact Sheet (2010). Introduction. Pediatrics. 2009;124:S262. Based on 2007 national statistics. 67 Kutner M, Greenberg E, Jin Y, Paulsen C, White S. The health literacy of 55 Bontempo DE, D’Augelli AR. Effects of at-school victimization and America’s adults: results from the 2003 National Assessment of Adult sexual orientation on lesbian, gay, or bisexual youths’ health risk Literacy. Washington, DC: National Center for Education Statistics: US behavior. J Adolesc Health 2002;30:364-74. Department of Education, 2006.
16 Community Health Needs Assessment Report 2013 Those with limited health literacy are more likely • Teens have increased rates of obesity, to be low-income, from a minority group, 65 or substance abuse and school behavior 78 older, and more likely to require government problems. 68 assistance and have limited education. • Patients tend to present with advanced 79 The majority of health information for families stages of diseases such as cancer. far exceeds the average reading level. The • Children are less likely to have a medical 80, 81 average U.S. adult has a reading level of home or access to preventative health 82 eighth or ninth grade, yet over half of medical services. instructions are written at a 10th-grade level or 69 • Parents are less likely to use assistance higher. 83 programs (14% vs. 50%), and children are 84 Providers and patients alike have difficulty less likely to have insurance. gauging health literacy through observation 70 alone. Shame is a major limitation to • If their caregivers have low health literacy, disclosure; 67% of illiterate people had never children with asthma are likely to experience 71 more emergency room visits, hospitalizations told their spouses of their inability to read. The 85 Joint Commission recognizes health literacy as and missed days of school. All patients with 72 low health literacy are at a higher risk for an avenue for increased medication safety. 86 hospitalization. Due to low literacy: Organizations like Reach Out and Read, Thrive • Patients tend to poorly manage their chronic by Five and the Foundation for Early Learning diseases such as diabetes, hypertension and 73 help support literacy in young children and HIV, tend to be less likely to be compliant 74 families. with medications or understand indications and tend to be susceptible to increased medication-dosing error using a variety of 75 dosing instruments. • Mothers are less likely to breast-feed and understand the dangers of smoking during 76, 77 pregnancy.
68 Ibid. 69 HS Yin, SG Forbis, BP Deyer. Health Literacy and Pediatric Health. Curr Probl Pediatr Adolesc Health Care. 2007;37:258-286. 78 Yin H S, SG Forbis, BP Deyer. Health Literacy and Pediatric Health. Curr 70 Bass PF 3rd, Wilson JF, Griffith CH, Barnett DR. Residents’ ability to Probl Pediatr Adolesc Health Care. 2007;37:258-286. identify patients with poor literacy skills. Acad Med 2002;77(10):1039- 79 Bennett CL, Ferreira MR, Davis TC, Kaplan J, Weinberger M, Kuzel T, et 41. al. Relation between literacy, race, and stage of presentation among 71 Parikh NS, Parker RM, Nurss JR, Baker DW, Williams MV. Shame and low-income patients with prostate cancer. J Clin Oncol 1998;16(9):3101- health literacy: the unspoken connection. Department of Medicine, 4. Emory University School of Medicine, Atlanta, GA 30303, USA. 80 According to the Data Resource Center for Child & Adolescent Health 72 The Joint Commission. Improving Health Literacy to Protect Patient (http://childhealthdata.org/browse/medicalhome/portal_more), Safety: What did my doctor say? Another in the series of Health Care “medical home” includes having a personal doctor or nurse, having a at the Crossroads reports. 2007. usual source of care, receiving family-centered and culturally-sensitive care, receiving needed referrals to specialty care and getting care that 73 Yin H S, SG Forbis, BP Deyer. Health Literacy and Pediatric Health. Curr is coordinated across providers and services. Probl Pediatr Adolesc Health Care. 2007;37:258-286. 81 Sanders L, Brosco J. Low caregiver health literacy: a risk factor for child 74 Williams MV, Parker RM, Baker DW, Coates W, J Nurss. The impact of access to a medical home. Pediatr Acad Soc. 2005;57:2772. inadequate functional health literacy on patients’ understanding of diagnosis, prescribed medications, and compliance. Acad Emerg Med. 82 HS Yin, SG Forbis, Deyer BP. Health Literacy and Pediatric Health. Curr 1995;2:386. Probl Pediatr Adolesc Health Care. 2007;37:258-286. 75 Yin HS, Mendelsohn AL, Fierman A, van Schaick L, Bazan IS, Dreyer BP. 83 Sanders L, Zacur G. Parent health literacy: a predictor of child Use of a pictographic diagram to decrease parent dosing errors with healthcare utilization. Pediatr Acad Soc. 2003;53:1517. infant acetaminophen: a health literacy perspective. Acad Pediatr. 2011. 84 Sanders L, Brosco J. Low caregiver health literacy: a risk factor for child 11(1):50-7. access to a medical home. Pediatr Acad Soc. 2005;57:2772. 76 Arnold CL, Davis TC, Berkel HJ, Jackson RH, Nandy I, London S. 85 D. DeWalt, M. Dilling, M. Rosenthal, M. Pignone. Low parental literacy Smoking status, reading level, and knowledge of tobacco effects is associated with worse asthma care measures in children. Ambul among low-income pregnant women. Prev Med 2001;32(4):313-20. Pediatr, 7 (1) (2007), pp. 25–31. 77 Kaufman H, Skipper B, Small L, Terry T, McGrew M. Effect of literacy on 86 Baker DW, Parker RM, Williams MV, Clark WS. Health literacy and the breast-feeding outcomes. South Med J 2001; 94(3):293- risk of hospital admission. J Gen Intern Med 1998;13(12):791-8.
Community Health Needs Assessment Report 2013 17 Socioeconomic indicators: Health needs of our Seattle Children’s community Service region After providing an overview of community health Children’s serves as the pediatric and indicators, this section presents three major adolescent medical center for Washington, categories representing how we group Children’s Alaska, Montana and Idaho — the largest region advocacy work: Access to Quality Healthcare for of any children’s hospital in the country. All Children, Children with Chronic Conditions and In 2011, Seattle Children’s recorded 323,292 Child Health and Development. patient visits. This included 260,260 outpatient clinic visits, 36,200 Emergency Department General health indicators visits and 14,118 hospital admissions. The hospital reported a total of 75,412 inpatient Leading causes of death days, with an average length of stay of In 2009, unintentional injuries accounted for the 4.94 days per patient. greatest percentage of deaths to Washington *(See Appendix, Figure 36: Patient Hometown Demographics.) children and youth ages 1 to 21, followed by suicide, cancer, homicide and birth defects. Race, ethnicity and language of From 2006-2010, the leading causes of patients injury deaths were suffocation, homicide and Since 2007, Seattle Children’s has experienced motor vehicle crashes in children birth to 1 in significant growth in the number of patients Washington State. In children ages 1 to 4, the and families who speak languages other than leading causes of injury deaths were drowning, English. The ethnic/racial diversity of our homicide and motor vehicle crashes. In children patients reflects that of our region (see page 5 to 14, they were motor vehicle crashes and 8 for data on state and county ethnic/racial drowning. In teens ages 15 to 19, the leading diversity). causes of injury deaths were motor vehicle crashes, suicide, homicide and poisoning. When Children’s patients’ families are asked what language they speak at home or what Reducing adolescent deaths due to motor language they prefer to speak when receiving vehicle crashes, homicide and suicide are healthcare, 16% indicated a language other included in the 21 Critical Health Objectives for than English. Children’s asks these questions Adolescents and Youth Adults from the U.S. to identify families likely to need a hospital Department of Health and Human Services, interpreter, provided free of charge. Centers for Disease Control. Languages spoken by Children’s patients who Washington state American Indian/Alaska are non-native English speakers include: Native youth ages 15 to 19 had nearly three times the injury death rate of White, Black or • Spanish: 58.1% Asian/Pacific Islander youth. The unintentional • Somali: 6.2% injury death rate for American Indian/Alaska • Vietnamese: 5.4% Native youth is 85.07 compared to 26.21 for 88 • Russian: 4.4% White youth (per 100,000). 87 *(See Appendix, Figure 40: Leading Causes and Total • Other: 25.9% 5-Year Incidence of Injury Deaths by Age Group, *(See Appendix Figure 37: Seattle Children’s Patients by Washington, 2004-2008 and Figure 41: 10 Leading Causes Race and Figure 38: Growth Rate of Seattle Children’s of Death in King County Children, 2003–2007.) Patient Population by Race and Ethnicity.) 88 Source: Critical Health Objectives for Adolescents and Young Adults. http://www.cdc.gov/HealthyYouth/AdolescentHealth/NationalInitiative/ 87 Seattle Children’s patient data, 2011. pdf/21objectives.pdf.
18 Community Health Needs Assessment Report 2013 Inpatient admission rates and Infant mortality rates diagnosis In 2009, the three leading causes of infant Seattle Children’s 10 top reasons for inpatient death in Washington state were birth defects admission reflect the state’s top categories. (23%), sudden infant death syndrome (SIDS) Of the Washington state top 20 inpatient (14%), and short gestation/low birth weight diagnoses, Children’s shares the following (11%). Infants born to African American and eight: asthma, bronchiolitis, seizures, bacterial American Indian/Alaska Native women have pneumonia, cellulitis, diabetic complications, two to three times higher infant mortality rates acute gastroenteritis and acute appendicitis. than those born to White and Asian women. *(See Appendix, Figure 42: Washington State Inpatient South King County has a higher infant mortality Pediatric Discharges by Diagnosis Related Group (DRG) rate than the rest of the county. (ages 0 to 17) July 2009–June 2010.) *(See Appendix, Figure 43: State and King County Infant Mortality Rates and Figure 44: King County and Seattle
Figure 39: 10 Leading Causes89 of Death in Infant Mortality Rates by Mother’s Race/Ethnicity.) Washington Children, 2009
RANK < 1 1-4 5-9 10-14 15-21
Congenital Unintentional Unintentional injuries Malignant neoplasms Unintentional injury 1 anomalies injury 23 11 15 101 156 Congenital SIDS Unintentional injury Malignant neoplasms Suicide 2 anomalies 60 10 13 72 ––– Short gestation Heart disease Homicide Congenital Homicide 3 45 ––– ––– anomalies 27 Maternal pregnancy Malignant Homicide Benign neoplasms Homicide 4 complications neoplasms ––– ––– ––– 27 22 Unintentional injury Malignant neoplasms Diabetes mellitus Suicide Heart disease 5 27 ––– ––– ––– ––– Placenta cord Chronic lower Influenza and Diseases of Congenital 6 membranes respiratory disease pneumonia appendix anomalies 25 ––– ––– ––– ––– Influenza and Bacterial sepsis Heart disease Septicemia 7 pneumonia ––– 12 ––– ––– ––– Circulatory system Chronic lower Septicemia Anemias 8 disease ––– respiratory disease ––– ––– 11 ––– Necrotizing Influenza and Septicemia 9 enterocolitis ––– ––– pneumonia ––– ––– ––– Diarrhea Three tied 10 ––– ––– ––– ––– ––– Note: For leading cause categories in this state-level chart, counts of less than 10 deaths have been suppressed (---).
89 Washington State Department of Health, Maternal Child Health Report, Feb 2011. http://www.doh.wa.gov/DataandStatisticalReports/ HealthBehaviors/MaternalChildHealthData.aspx.
Community Health Needs Assessment Report 2013 19 Access to quality healthcare for South King County Health Indicator Fast Facts all children Compared to other regions of King County, The uninsured 90, 91, 92, 93 South King has the highest rates of: Researchers have found a clear association • Uninsured children birth to 17: 4.6% in South between a lack of health insurance and the King County vs. 1.6% in Seattle following behaviors or consequences: • Poor maternal and child health - Late or no prenatal care • Delaying medical care - Births in 15- to 17-year-olds • Not obtaining appropriate screenings - Smoking during pregnancy - Preterm births, low birth weight infants • Not managing chronic disease - Infant mortality • Increased risk of poor health, hospitalization • Hospitalization for children ages 0 to 17 and premature death injured by motor vehicle crashes, firearms (unintentional and assault), poisoning, falls, Uninsured: nationally and suffocation. Overall, the number of uninsured people in the 94 • Teen obesity and risk of overweight United States is on the rise. (lowest rates of meeting physical activity recommendations) According to 2010 U.S. Census data, an The following positive health outcomes are estimated 49.9 million Americans are uninsured. found in South King County compared to the Throughout the country, uninsured children and rest of the county: adults are more likely to be poor, Hispanic, and • Longer life expectancy: Burien, Des Moines/ foreign-born, with 35% of noncitizen children Normandy Park being uninsured. In Washington state, between • Lower rates of low birth weight: Auburn 5% and 6% of children under 18 are uninsured, • Lower rates of adolescent birthrate: Covington about half the national average rate. • Lower rates of excessive alcohol intake: Burien, *(See Appendix, Figure 45: National Uninsured.) Renton, Federal Way and East Federal Way, Auburn* Uninsured: WAMI (Washington, Alaska, • Lower rates of infant mortality: Burien, East Montana and Idaho) region Federal Way, Des Moines/Normandy Park* • Lower rates of car crashes: Kent, Renton, Free or low-cost insurance options vary among Federal Way, Covington* WAMI states. The number of uninsured children • Lower rates of suicide: Renton, East Federal is decreasing nationally and in all WAMI states Way, Covington* except Alaska. • Higher rates of dental visits: Renton, East *(See Appendix, Figure 46: Children without Insurance, Federal Way, Covington* 1990-2009, WAMI and United States and Figure 47: Types • Lower rates of low birth weight: Federal Way, of Insurance Coverage in the WAMI Region.) East Federal Way* *Outcomes are not statistically significant but Uninsured: Washington state better than rest of the county. Approximately 97% of Washington children are privately insured or covered by Apple Health for Kids, the federal-state partnership that provides 90 Executive Summary. Health of King County Report, 2006. Retrieved free or low-cost health insurance to kids who November 2011 from: http://www.kingcounty.gov/healthservices/ health/data/hokc.aspx. qualify for Medicaid and other public insurance 91 Communities Count. Social and Health Indicators Across King County. Retrieved November 2011 from: http://www.communitiescount.org/ programs. Apple Health for Kids has been hailed index.php?page=report_page&pageid=98§ionid=30&year=. as a national model. 92 Washington State Department of Health, Center for Health Statistics, Birth Certificate Data http://www.kingcounty.gov/healthservices/ 94 DeNavas-Walt, Carmen, Bernadette D. Proctor, and Jessica C. Smith. health/data/chi2009/AccessPrenatalCare.aspx. U.S. Census Bureau, Current Population Reports, P60-239. Income, 93 Inside the ER: Is Trauma a Part of Being Poor? http://mynorthwest. Poverty, and Health Insurance Coverage in the United States: 2010. U.S. com/?nid=189&sid=512994. Government Printing Office, Washington, DC, 2011.
20 Community Health Needs Assessment Report 2013 Approximately 14% of noncitizen children in Figure: No Health Insurance Among King County Children100 Washington are uninsured. Children in families Ages 0-17 by Region, 2004, 2006, 2008 Combined earning less than 300% of the federal poverty level are more likely to be uninsured compared to families earning over this mark (4.6% versus 95 1.9%). The region with the highest uninsured rate among children, 6.6%, was Puget Metro, 96 which includes Kitsap and Thurston Counties. The number of American Indian/Native American children who are uninsured is much higher than any other group. About one in five American Indian/Native American children in Washington state (22%) had no health insurance in 2008, compared to 18% of Hispanic children, 9% of Asian children, 8% of black children and 6% of white children. Many children in the state’s 29 federally recognized tribes are Note: The lines extending from the bars are “error bars” eligible for Apple Health for Kids, but parents and represent the upper and lower 95% confidence 97 are often unaware their kids are eligible. intervals. The confidence interval is a statistical measure of the amount of random variation expected in percentage Uninsured: King County/South King County calculations. It means that if one analyzes the same group 100 times, naturally expecting some variation, 95% of the About 17,000 (4.3%) of King County children time the percentage will fall within the lower and upper ages 0 to 17 did not have health insurance in bound of the confidence interval. All of the confidence 98 2008. South King County has the greatest intervals in this chart overlap each other so none are statistically different from the others. percentage of children without health insurance. African American and Hispanic/Latino children Access to care for all patients on are most likely to lack adequate health Medicaid insurance coverage, as well as children in homes where family income is less than 300% of the Providers accepting Medicaid 99 federal poverty level. Medicaid patients, both adults and children, frequently have difficulty finding a primary care physician. Nationwide, physicians have been reluctant to serve these patients due to low Medicaid reimbursements. In a 2012 survey of pediatricians in Washington State, 47.9% reported accepting all new Medicaid patients. Low provider payment was the number one barrier to participation in Medicaid. (Ref: American Academy of Pediatrics. Pediatrician Participation in Medicaid, CHIP and VFC: Washington; 2011/12 AAP Member Survey.
95 US Census, http://factfinder2.census.gov. 9/12/2012.) 96 Office of Financial Management. *(See Appendix, Figure 49: Washington State and King 97 Children’s Alliance, http://www.childrensalliance.org/no-kidding-blog/ native-american-children-lead-ranks-uninsured-wa, with data from County Physician Medicaid Acceptance.) Washington Kids Count. 98 State Population Survey, Washington State Office of Financial Management http://www.ofm.wa.gov/sps/default.asp. 100 State Population Survey, 2004, 2006, 2008. Produced by: Assessment, 99 Communitiescount.org and Washington State Population Survey (SPS), Policy Development & Evaluation, Public Health – Seattle & King Washington State Office of Financial Managemente, 2002, 2004, 2006. County, 5/09.
Community Health Needs Assessment Report 2013 21 Barriers to enrolling in Medicaid/finding a In King County, 48% of Medicaid-insured primary care provider children under age 20 received dental services. In Seattle there is a high density of community For children under age 6, only 43% received health centers and a well-developed mass dental care. transportation system, making it easier for Children of color, from low-income families, patients to see their doctors. South King County and those who do not speak English are almost residents face other health access barriers twice as likely to have untreated tooth decay including transportation challenges, language, (20%, 23% and 23% respectively). Compared to culture, and fear of punitive legal consequences other areas of the state, King County children among undocumented people. are more likely to have no tooth decay and Access to dental care fewer fillings. In King County, 60% of elementary school children have no decay compared to 51% Three of the top 10 emergency room diagnoses of children statewide. Eighty percent of King for uninsured King County patients are 101 County residents have access to fluoridated emergency dental conditions. There are no water, which likely contributes to children available county-wide data regarding dental having healthier teeth and less decay than in insurance rates for children. 105 other parts of the state. Though reimbursement levels for dental service Dentists committed to working with low-income are generally low (rates for children under 6 are individuals and families are in particularly higher) there are many dentists in Washington short supply. By 2013, half of Washington state state who accept children that are Medicaid dentists are expected to retire, and not all those insured. Over the last 10 years, the rate of 106 who retire are being replaced. Medicaid insured children receiving dental services has nearly doubled, from 22% to 43%. Access to subspecialists The challenge remains, however, in helping According to a 2009 Children’s Hospital parents get connected to dental resources in Association (formerly National Association of their community to get their children into care. Children’s Hospital and Related Institutions or 107 The Access to Baby Child Dentistry (ABCD) NACHRI) survey, shortages of the following program is available in 37 of 39 counties to pediatric subspecialists have the greatest provide outreach so families with Medicaid- impact on a provider’s ability to deliver care: insured children can get connected to dental 102 • Pediatric neurologists care in their community. • Developmental behavioral pediatricians While there have been improvements in access to dental care for young children in King County • Pediatric gastroenterologists (increase from 30% to 48% in the last 7 years), • Pediatric general surgeons 103 still over 50% do not access care. Certain areas • Pediatric pulmonologists within King County have more limited access, and some populations experience higher levels *(See Appendix, Figure 52: Existing Pediatric Care Centers 104 in Washington State, Figure 53: Pediatric Subspecialists of oral disease. Lacking in WAMI States and Figure 54: Certified Pediatric Specialists—WAMI and National.)
101 King County Public Health Report: Access to Healthcare in King County for the Uninsured, Underinsured, and Medicaid Populations, 105 Ibid. 2008. 106 King County Public Health Report: Access to Healthcare in King 102 E-mail consultation with Sylvia Gil, Policy Analyst, Washington Dental County for the Uninsured, Underinsured, and Medicaid Populations, Service Foundation, July 24, 2012. 2008. 103 Ibid. 107 2009 NACHRI (National Association of Children’s Hospital and Related 104 WA State DOH Smile Survey 2010, http://www.doh.wa.gov/Portals/1/ Institutions) Child Health Policy Research & Analytics Pediatric Documents/Pubs/160-099_SmileSurvey2010.pdf. Subspecialty Physician Survey.
22 Community Health Needs Assessment Report 2013 Access to care for specific Children with chronic conditions populations Children with special health care needs are less 112 Mental health care likely to meet all criteria for a medical home, less likely to have easy access to obtaining Nationwide, the leading reason for visiting a needed referrals, and less likely to have health center is mental health and substance 108 adequate insurance to meet their healthcare abuse care combined. According to the Health 109 needs. Read more on page 29. Tracking Physician Survey, psychiatrists across the nation were much less likely to accept Access to research new patients, regardless of insurance type. Research changes lives, the way illness is treated, Approximately 41% of psychiatric providers and the way healthcare is practiced. Finding reported accepting all or most new Medicaid 110 new ways to treat and prevent the illnesses of patients, while 46% accepted none. childhood and young adulthood is the driving If they meet certain statewide access to care force behind Seattle Children’s increasing standards, low-income children and adults in emphasis on pediatric medical research. King County may qualify for publicly funded 111 In keeping with our dedication to family- mental health services. In general, only those centered care, we involve families throughout diagnosed with serious mental and emotional the research process. Hospital research-and- disorders qualify for publicly funded services. family liaisons work with families and research Eligible participants are enrolled in the mental teams to encourage clear communication, health managed care plan called the Regional provide information about the research process, Support Network (RSN), which coordinates care and assist families in deciding whether they through local community-based mental health want to be part of a clinical trial or not. By agencies. Washington state contracts with King demystifying the research process for families County Department of Community and Human and helping researchers communicate clearly, Services to manage the King County RSN. these liaisons help Children’s uphold the highest Obesity possible research ethical standards. In Washington state, while dietician visits for Our goals include: kids are covered under the Early Periodic • Ensure that research benefits every patient at Screening, Diagnosis, and Treatment (EPSDT) Children’s whether they directly participate or Program (the child health component of simply benefit from an advance in care made Medicaid), generally, obesity-related medical possible by research services are covered only if there are other diagnoses such as acanthosis nigricans, • Ensure that every patient and family hypertension or sleep apnea. There is also a understands the research process and its lack of access to affordable nutrition and fitness value to patient care programs, as well as social work services. Read • Offer every patient the opportunity to more on page 41. participate in safe, high-quality research *(See Appendix Figure 55 Medicaid Fee-for-Service studies Treatment of Obesity Interventions: Washington state.) The Center for Clinical and Translational
108 2003 Uniform Data System, cited in “Health Centers’ Role in Research (CCTR) is developing plans for Addressing the Behavioral Health Needs of Medically Underserved.” September 2004 Issue Brief from National Assoc. of Community integrating research programs within the Health Centers. hospital and the research institute. 109 http://www.rwjf.org/files/research/hscbulletin35sept2009.pdf. 110 Ibid. 111 Adult data; from the King County Public Health Report: Access to Healthcare in King County for the Uninsured, Underinsured, and 112 CHAMI (2007) 2007 NSCH Child Health and System Performance Medicaid Populations, 2008. Profile.
Community Health Needs Assessment Report 2013 23 Seattle Children’s healthcare access uncompensated care program made up the strategies difference — with a total of $103.1 million helping to fund the underpayment from the Advocacy Apple Health for Kids Program. Another $10.6 Healthcare for children is an affordable million went to families with no ability to pay for investment with a great payoff. Regular their children’s care. healthcare, immunizations and early diagnosis reduce the likelihood of costly, disabling or Seattle Children’s financial assistance programs life-threatening conditions. Paying the long- cover all expenses for families earning less than term healthcare costs associated with a lack 400% of the federal poverty level (FPL), which of regular healthcare is more expensive than in 2012 was $92,200 annually for a family of paying for children’s healthcare up front. 4. Families whose income exceeds 400% FPL Research shows that regular, preventive care and who have incurred significant account for children enrolled in Medicaid decreases balances and are not eligible for funding from otherwise avoidable emergency room use and other sources may receive Children’s deductible hospitalizations. financial assistance, where they pay a portion of their bill and financial assistance pays the rest. Seattle Children’s is a powerful advocate for healthcare for children and families. We are Financial assistance program a founding member and active partner in Whether they come to Children’s for an the Health Coalition for Children and Youth inpatient stay, clinic visit, surgery or through (HCCY), which advocates for state and federal the emergency department, information about policies to help children get the healthcare and the Financial Assistance Program is made preventive services they need. available to every family that visits the hospital. HCCY is a comprehensive coalition of over Financial assistance signage is posted in the 40 organizations in Washington state that hospital’s four primary patient languages: work to meet the health needs of children and English, Spanish, Russian and Vietnamese; youth, including medical, dental and mental and application forms are available in both health care. Members of HCCY include hospital English and Spanish. In-person interpreters associations, medical, dental, and mental health provide information to families with limited care providers, faith-based organizations, English proficiency. Many families also access a labor unions and public health organizations, Children’s Financial Assistance application form including government public health agencies. online. The coalition successfully championed Children’s financial counselors meet with Washington State’s 2007 Cover All Kids law, families to help define possible financial support which expanded access to health coverage for sources, including Apple Health for Kids, and to children and launched Apple Health for Kids. help them complete and submit forms. Social workers screen families for possible financial Financial services need and, when applicable, refer them to Seattle Children’s provides necessary medical Children’s financial counselors. care to all children in our region, regardless Children’s provides a standard 25% discount of a family’s ability to pay. In 2012, Children’s on healthcare services to uninsured patient provided $113.7 million in uncompensated care. families. Additionally, the hospital works to Nearly half of Children’s patients were covered accommodate U.S. families with reasonable by the Apple Health for Kids Program, but payment plans. the program reimbursed Children’s for just 68% of the real cost of treatment. Children’s
24 Community Health Needs Assessment Report 2013 Table 28: Seattle Children’s Fiscal-Year 2011 Payor Mix Children’s Clinic and the Harborview Children and Teens’ Clinic. The MLPC was launched in Type of Coverage Percent 2008 with a Robert Wood Johnson Foundation Medicaid 44 start-up grant. The organization addresses Other Government 6 unmet legal needs by: Insurance and Managed Care 49 Other 1 • Training healthcare workers and other stakeholders to handle advocacy issues Source: Children’s Facts and Stats, Fiscal Year 2012, affecting vulnerable families Seattle Children’s Hospital • Enabling constituents to identify potential Access to primary care legal issues and offering referrals Seattle Children’s provides medical, dental • Providing case consultation to providers and mental healthcare for babies, children and and direct legal services to pediatric patient teens, and legal services to patient families families (up to and including full-court through Odessa Brown Children’s Clinic and representation when indicated) several other programs. • Participating in systemic advocacy efforts Odessa Brown Children’s Clinic that promote child health and well-being Odessa Brown Children’s Clinic (OBCC), a MLPC offers trainings for more than 260 Seattle Children’s community clinic located in healthcare staff on topics including social Seattle’s Central District, was established in security applications and appeals, education, 1970. Serving an urban, predominantly African Medicaid, legal issues affecting adolescents, American population insured primarily by and landlord-tenant laws. These trainings Apple Health for Kids, OBCC’s staff members have improved patient advocacy by doctors, are strong advocates for multicultural families. residents and social workers, who help patients OBCC’s mission is to be an enduring community and families gain access to the services and partner dedicated to promoting culturally programs they need to meet their basic needs. relevant quality pediatric care, family advocacy, health collaboration, mentoring and education. Families most frequently requested legal The clinic provides medical, dental, and mental assistance with housing, public benefits, health services at one site, in addition to school- education, family, enrolling in Medicaid and based services. With 30,000 annual visits, immigration. OBCC predominantly serves Seattle Central MLPC advocacy efforts include mapping District residents and an increasing number healthcare disparities in South King County; of South King County residents who have improving benefits for families applying for relocated from the Central District. state support for developmentally disabled children; and supporting state legislation Medical-legal partnership for children that institutes protections for students with The Medical Legal Partnership for Children disabilities, limited English proficiency, and (MLPC) is a collaboration of pediatric clinicians, those experiencing bullying and harassment. social workers and attorneys who address the unmet legal needs of patients and families. Country Doctor Youth Clinic While this program model has been used in The Country Doctor Youth Clinic provides free more than 30 states and 160 hospitals and primary care to Seattle homeless people ages clinics, MLPC is the first partnership of its kind 13 to 23 two nights a week. As part of their in the Pacific Northwest. The program serves Adolescent Medicine rotation, Seattle Children’s children and families from Odessa Brown pediatric residents provide medical care at the
Community Health Needs Assessment Report 2013 25 clinic for homeless youth, increasing their skills • The Dental Surgery Center at the Center for in working with both youth and the homeless. Pediatric Dentistry Juvenile Detention Center and school-based • Odessa Brown Children’s Clinic (OBCC) clinics Dental Clinic Children’s Adolescent Medicine doctors, nurse • Children’s Dental Clinic on the main hospital practitioners, fellows and pediatric residents campus provide medical services at the King County Children’s is also a partner in operating the Juvenile Detention Center. Providers are on SmileMobile, a three-chair mobile dental office call seven days a week and provide care at the offering oral health services to low-income health clinic five days a week. They offer acute children with limited access to a dentist. Since care, Early and Periodic Screening, Diagnosis, 1995, the mobile clinic has treated more than and Treatment (EPSDT) physical exams, 25,000 children throughout Washington. In 2011, immunizations, tuberculin skin test screenings, the SmileMobile served 2,000 children, and with reproductive healthcare services and sexually the help of 51 dentists, 20 hygienists and 45 transmitted disease screenings. assistants, provided 4,563 preventive and 1,240 Children’s also provides school-based care at treatment services. Garfield High School. The school-based and Access to subspecialty care school-linked health center model is nationally recognized as one of the best ways to provide Seattle Children’s Outreach Clinics effective, efficient and appropriate healthcare At select WAMI regional hospitals and clinics, services to adolescents. School-based and Seattle Children’s specialists are available for school-linked health centers are comprehensive in-person patient visits and are available to take primary care clinics that provide medical and calls or speak directly with providers about mental health screening and treatment for patient care issues. Close to 300 outreach young people on or near school grounds. clinics are held across the WAMI region, The clinics are staffed by experienced health bringing specialty care closer to home for many professionals specially trained to work with patients. 114 adolescents. This clinic model effectively breaks Telemedicine down barriers that can discourage adolescents Seattle Children’s Telemedicine Program uses from accessing health services, including lack videoconferencing to connect remote patients of confidentiality, inconvenient appointment and families with healthcare team members times, prohibitive costs and apprehension about at the hospital in Seattle. Clinics throughout discussing personal health problems. Washington, Alaska, Montana and Idaho are The centers target adolescents who are equipped with cameras, microphones and TV uninsured and underinsured — those who monitors that allow each family to consult with have nowhere else to go for medical care Children’s experts in real time, without the and counseling. They also serve youth with expense and stress of traveling far from home. health insurance who desire confidential care Departments using telemedicine include: 113 and advice. • Psychiatry — for a wide variety of consultative, clinical and research purposes Dental care • Cardiology —to improve prenatal diagnoses Children’s provides dental services at three of congenital heart disease with prenatal Seattle locations (more on page 68): echocardiograms
113 King County Public Health: “What is a school-based or linked teen health center?” http://www.kingcounty.gov/healthservices/health/ 114 Personal Communication with Yolanda Evans, Department of child/yhs/thc.aspx. Adolescent Medicine. 3/21/12.
26 Community Health Needs Assessment Report 2013 Many other departments and individual Children’s Alliance advocates for affordable providers can increase the scope of their health insurance for children and families. practices with telemedicine technology. It also Children’s financial counselors work with enables primary care providers to more easily families to identify and sign up for healthcare participate in discharge planning and care coverage. conferences. Providers in different locations can Access to primary care participate in educational and administrative meetings and conferences. The hospital also Core safety net medical providers uses videoconferencing to help patients Core health safety net medical providers are connect with friends and family back home. community health centers, public health centers
115 Training and education and other clinics with a primary mission to serve patients regardless of their health insurance The University of Washington School of status. This includes clients with no health Medicine Pediatric Residency is the only insurance coverage, with Medicaid or other pediatric residency program in the Washington, publicly sponsored coverage, and with sporadic Alaska, Montana and Idaho (WAMI) region. coverage. Many of these providers receive In 2010, 732 residents from throughout the federal, state and local financial assistance to Northwest completed Children’s rotations. help pay for care for the uninsured and clients The hospital offers fellowships in more than with limited public coverage. 30 specialty areas. In 2010, 43 physicians completed subspecialty fellowships. More than These providers target low-income populations half of all Children’s-affiliated graduates practice including recent immigrants, public housing in the Pacific Northwest after completing their residents, and homeless individuals and families. training. Resident programs include: In addition, a number of community health centers target their services to specific ethnic • WAMI Rotation: Every pediatric resident 116 and racial groups. spends two months of their training in a rural primary-care setting. There are nine core Safety Net Providers in King County of which seven are Federally Qualified • Pathway program: Eight residents per year Health Centers (FQHC): participate in the Community Health and Global Health Pathways, which provides • Community Health Centers of King County public health, clinical and research experience • Country Doctor Community Health Centers to understand and influence determinants • Harborview Medical Center’s primary care of child health and health disparities at the clinics, including their children’s clinic (not a community level. FQHC) • Alaska Track: Four residents per year with a • International Community Health Services primary-care focus spend one-third of their training in Alaska. • Odessa Brown Children’s Clinics (not a FQHC) • Public Health–Seattle & King County (Public King County community healthcare Health Centers) access strategies • Puget Sound Neighborhood Health Centers Access to affordable health coverage • Sea Mar Community Health Centers WithinReach connects families in Washington to resources and information such as low-cost • Seattle Indian Health Board insurance and Women, Infants and Children
(WIC) through programs such as Parenthelp123, 116 Public Health- Seattle & King County: Access for Uninsured, 115 Seattle Children’s Community Benefit Report 2010. Underinsured, and Medicaid 2/5/2008.
Community Health Needs Assessment Report 2013 27 By law, FQHCs provide primary care and other services for King County youth include: services to medically underserved populations, Children’s Crisis Outreach Response System must offer a sliding fee scale, and cannot deny (CCORS) services due to an individual’s inability to pay. They must also have patient majority boards. Provides crisis services to children, youth and families who are not enrolled in the publicly Other King County providers with large funded King County Mental Health Plan Medicaid client caseloads include Highline Medical Group Roxbury Clinic and Burien Consejo Counseling & Referral Family Medicine, Valley Medical Center Valley A mental health counseling program Family Medicine, Northwest Physicians Network, specializing in serving the Latino and Spanish- Multicare Medical Group, UW Physicians speaking population by providing bilingual Network, Pediatric Associates and Swedish services. They offer behavioral health services Physicians Providence Clinic. (group and individual therapy) and youth Teen Clinics outpatient substance abuse treatment. • Teen Health Clinics offered through Public Valley Cities Health–Seattle & King County provide teens Provides mental health counseling and family under 21 of any sexual orientation with a support therapy for residents of South King safe, friendly and confidential place to get County at clinics in Auburn, Federal Way, Kent help and education. Services include free or and Renton. low-cost birth control, STD and HIV tests, pregnancy tests and information about sexual Care coordination health. Teen clinics are located in Auburn, The following are some of the organizations South and North Seattle, Factoria, Federal that provide care coordination services for Way, Renton and White Center. families of King County children and teens: • The 45th Street Homeless Youth Clinic • The Maternal-Child Health Bureau Program serves youth ages 12 to 23 who are currently offered through Public Health–Seattle & King homeless or who have been homeless in County, this program provides coordination the last 12 months. They provide medical of services to children with special needs, as and dental care, mental health counseling, well as limited medical services and supplies drug and alcohol counseling, HIV counseling, based on financial eligibility. acupuncture, yoga classes, naturopathy, meditation, massage, health education, social • The Center for Children with Special Health service referrals and outreach. Care Needs, in partnership with Seattle Children’s and the Washington State • The Country Doctor Youth Clinic or Country Department of Health, provides information Doctor Teen Clinic provides free and to the families of and professionals who work confidential medical care to street youth with children who have chronic physical, ages 13 to 23. Services include general developmental, behavioral or emotional medical exams, STD and HIV texting and counseling, pregnancy testing and referral, conditions such as asthma, cancer, autism or birth control, TB testing, massage therapy cerebral palsy. and acupuncture, as well as dental, vision and • The Division of Developmental Disabilities mental health referrals. helps children with developmental disabilities and their families obtain services and support Mental health based on individual preference, capabilities Organizations that provide mental health and needs, to promote everyday activities,
28 Community Health Needs Assessment Report 2013 routines and relationships. Their services than children without special needs. They are include the Medically Intensive Children’s also less likely to have adequate insurance to Program providing in-home nursing for meet their healthcare needs. Strategies for children with medically intensive needs, and addressing these issues include promoting the Individual and Family Services Program adequate reimbursement, working with families providing support for families who are caring to assure insurance coverage, training providers for a child at home, with a goal of sustaining in how to care for patients with special needs, care in the home setting. and encouraging medical homes. Nationally, 13.9% of children have special health Maternity support services 117 118 care needs, compared to 14.3% in the state Women, Infants and Children (WIC) provides of Washington. Approximately 85% of CSHCN counseling and education from nutritionists, experience one or more functional difficulty, and social workers and nurses to support pregnant/ 119 28% have four or more functional difficulties. breastfeeding women and children younger than While 27.2% of these children have health 5. Services are available through public health conditions that consistently greatly affect their centers in Auburn, Columbia City (South Seattle), 120 daily activities, 9.1% experienced a period of Federal Way, Kent, Renton and White Center. time without insurance at some point during 121 Other important community assets include the past year. Of CSHCN families, 11.7% pay 122 school districts and school-based clinics and $1,000 or more in medical expenses per year, programs, GED/Job Training programs, and and 20.4% reported one or more unmet needs 123 parent support and classes. for specific healthcare services. Of CSHCN families, 12.6% spend 11 or more hours per week Children and youth with special providing and/or coordinating healthcare for 124 health care needs (chronic their child. conditions) In the state of Washington, 47.1% of CSHCN We use two phrases interchangeably to reported that they received effective care describe children with complex chronic coordination compared to 75.2% of non- 125 conditions: children and youth with chronic CSHCN children. Of youth 12 to 17 years conditions, and children with special health old with special needs, only half received care needs (CSHCN). In this section, we provide services needed for transition to adult life, a general overview of the group of children adult healthcare, work and independence. An who have special health care needs, including estimated 24% of 10th grade youth have a 126 those with complex chronic conditions and physical, emotional or learning disability. patients transitioning out of adolescent care Access to services into adult care settings. Subsequent sections Several factors restrict access to primary cover specific chronic conditions: asthma and care for children with chronic conditions and allergies, cancer, heart disease and transplant. 117 Nation Survey of Children with Special Health Care Needs. U.S. Dept. of Health and Human Services HRSA. Retrieved December 17, 2010 from: An overview of the children and http://mchb.hrsa.gov/chscn/pages/prevalence.htm. 118 Washington State Department of Health, July 2009, Children with youth with chronic conditions Special Health Care Needs. 119 Ibid. population 120 Children and Youth with Special Health Care Needs (2005) Washington State Dept or Health. Washington state has more children with 121 Ibid. special health care needs than the national 122 Ibid. 123 Ibid. average. These children are more likely to have 124 Ibid. difficulty meeting the criteria for care for a 125 CHAMI (2007) 2007 NSCH Child Health and System Performance Profile. medical home and obtaining needed referrals 126 2005-2006 National Survey of Children with Special Health Care Needs.
Community Health Needs Assessment Report 2013 29 special needs, including lack of reimbursement special needs children. In addition, fewer than for required paperwork and documentation half of CSHCN receive services for transition to 133 for Medicaid patients, and lack of adequate adult care. reimbursement for the care of young Community assets and strengths adults with special needs, particularly those with Medicaid. These children also lack Washington State Children with Special Health transportation to and from appointments, Care Needs Program community resources and a medical home. Washington State Department of Health Children with special health care needs are less Children with Special Health Care Needs 127 likely to meet all criteria for a medical home, Program promotes integrated systems of care less likely to have easy access to obtaining that assure children with special health care needed referrals, and less likely to have needs the opportunity to achieve the healthiest adequate insurance to meet their healthcare lives possible and develop to their fullest needs. Children with chronic health conditions potential. The program provides and promotes represent less than 2% of the population but family-centered, community-based and can consume more than half of available coordinated care for children with special health 128 children’s hospital resources. Nationally, 13.2% care needs, and helps develop community- of CSHCN went with an unmet need in the based service systems for these children and past 12 months for any of 15 specific healthcare their families. 129 services or equipment. The program evaluates its progress using six 134 Children with special health care needs National Performance Measures: who have a medical home experience fewer 1. Families of children and youth with special hospitalizations and fewer trips to the health care needs are partners in decision emergency department. When their child has a making at all levels and are satisfied with the medical home, families of CSHCN report better services they receive. 130 care delivery and fewer missed work days. 2. Children and youth with special health Approximately 55% of Washington children care needs receive coordinated ongoing ages 12 to 17 get their care in a medical home 131 comprehensive care within a medical home. compared to 53% nationally. In Washington state, 47.1% of CSHCN reported that they 3. Families of children with special health care received effective care coordination compared needs have adequate private and/or public 132 to 75.2% of non-CSHCN children. insurance to pay for the services they need. CSHCN families are also affected by a lack 4. Children are screened early and continuously of respite for parents, government cuts to for special health care needs. essential programs, and lack of child care for 5. Community-based services for children and 127 CHAMI (2007) 2007 NSCH Child Health and System Performance youth with special health care needs are Profile. 128 New Study Takes First Steps to Improve the Quality of Health Care for organized so families can use them easily. Chronically Ill Children (2010). Retrieved at http://www.healthcanal. com/child-health/12482-New-Study-Takes-First-Steps-Improve-the- 6. Youth with special health care needs receive Quality-Health-Care-for-Chronically-Ill-Children.html. Last viewed 11/17. 129 National Survey of Children with Special Health Care Needs. NS- the services necessary to make transitions to CSHCN 2005/06. Data query from the Child and Adolescent Health Measurement Initiative, Data Resource Center for Child and Adolescent all aspects of adult life, including healthcare, Health website. Retrieved [08/2011] from www.childhealthdata.org. work and independence. 130 The Health of Washington State, Health Care Services, 2007, Washington State DOH. 131 Washington State Department of Health Adolescent Needs 133 Youth in Transition: Changing Tracks to Successful Adult Lives. Assessment Report, Jan 2010. Northwest Bulletin: Family and Child Health Vol. 23 (2) 2009. Retrieved 132 CHAMI (2007) 2007 NSCH Child Health and System Performance December 17, 2010 from: http://depts.washington.edu/nwbfch. Profile. (Family received all care coordination wanted and is satisfied 134 Washington State Children with Special Health Care Needs Program with communication among providers (children who used 2+ types of Retrieved December 17, 2010 from: http://www.doh.wa.gov/cfh/mch/ health service in past 12 months, age 0 to 17 years). cshcnhome2.htm.
30 Community Health Needs Assessment Report 2013 *(See Appendix, Figure 56: Washington vs. United States Sibshops for Siblings of Children with Special Transition Data.) Health and Developmental Needs King County Children with Special Health Care Seattle Children’s Sibshops are award-winning Needs Program workshops that provide support and guidance King County Children with Special Health Care to siblings of children with special medical Needs, a federally and state funded Title V or developmental needs. The Sibshop model Maternal-Child Health Bureau program offered mixes information and discussion activities with through Seattle and King County Public Health, games and special guests. There are currently provides linkage and coordination of services more than 200 Sibshops across the United to all children with special needs. The program States, Canada and elsewhere. provides limited direct medical services, and equipment and supplies to families that Recommended strategies 135 meet financial and other program eligibility Healthy People 2020 requirements. Healthy People 2020 objectives related to The program also offers public-health-nurse children with special health care needs include: case-coordination services via home visits or • Increase the proportion of children with by phone to families in King County, regardless special health care needs who have access to of income. Nurses support families by offering a medical home medical screenings, referrals, healthcare consultation, help with transitions, and care • Increase the proportion of children with coordination among different providers. special health care needs who receive their care in family-centered, comprehensive, Seattle Children’s assets and strengths coordinated systems.
The Center for Children with Special Needs 136 Reimbursement Through grants and contracts, the Center for A major barrier for providers caring for Children with Special Needs (CCSN) works to Medicaid patients are the low reimbursement improve care and increase access to health rate and non-reimbursed time. The Department education materials and community resources of Health and partners are working to address in the WAMI region. this by interviewing providers about their needs; The CCSN’s mission is to improve and promote supporting legislation that assures coverage the health and well-being of children with for more children and young adults and more special health care needs and their families, billable components of services; and providing with a special focus on providing information information to young adults and families about to families and healthcare professionals. The insurance options. center focuses on policy development, quality 137 of care, education and family partnerships in Provider training healthcare. Providers report training is helpful in caring for Through its website, the CCSN provides tools patients with special needs. The Washington for care management and information about State Department of Health and the University available resources to help families manage of Washington Center on Human Development their children’s healthcare and connect with and Disability continues to make available web- community-wide resources and services. based information for providers and families 135 Healthy People 2020 Retrieved December 17, 2010 from: http:// healthypeople.gov/2020. 136 Fact Sheet. (2009) National Performance Measures Overview. Washington State Department of Health Children with Special Health Care Needs Program. 137 Ibid.
Community Health Needs Assessment Report 2013 31 originally developed for the Adolescent Health with community providers, which is generally Transition Project, which ended in 2011. The unreimbursed. Center for Children with Special Needs also Community assets and strengths offers care plans and transition resources for teens. Catholic Community Services 138 Offer programs serving children and youth, Medical home including adoption, foster care, child care, youth One of the Federal Maternal and Child Health tutoring, mental health services, counseling and Bureau National Performance Measures emergency services. for children with special health care needs is that they receive coordinated ongoing King County Children with Special Health Care comprehensive care in a medical home. Having Needs Program (CSHCN) a medical home is shown to help ease the The program provides coordination of services adolescent transition to adult healthcare. to all children with special needs. See page 30 Legislation passed in 2008 supports enrolling for more information. primary care providers in learning collaboratives Parent to Parent (P2P) Programs that bring together hospital or clinic teams for learning how to become a medical home. Support and information for families of children with developmental disabilities. Care coordination study WithinReach Through the most comprehensive study of its 139 kind, Seattle Children’s is examining how to Helps families connect with insurance services improve care coordination for patients with and community resources. lifelong chronic conditions, decrease their need Child development centers for hospitalization and improve their quality These centers offer rehabilitation and physical of life. The study is following approximately therapy, early learning, and neurodevelopmental 600 medically complex patients for two years services. Examples include: in a clinic that works with patients’ primary care providers to develop care plans and other • Boyer Children’s Clinic in Seattle interventions to improve their care and reduce • Kindering Center in Bellevue the need for hospitalization. Seattle Children’s PlayGarden Children with complex chronic A Seattle outdoor play space where children of conditions all abilities can play. Children with complex chronic conditions Summer camps have lifelong progressive chronic conditions A directory of Washington state summer camps and/or significant chronic conditions in two for children with special needs. or more body systems. This group of children represents 1% to 2% of the general pediatric Adolescent transition patient population and 25% of Seattle Children’s Of Washington children ages 0 to 17, 14% patient population, occupying more than half of to 17% have special health care needs, the hospital’s total patient bed days. Children including chronic childhood onset diseases with complex chronic conditions require or developmental disabilities. Over 90% of intensive clinical care as well as coordination 140 these children live past 21 years of age, 138 Ibid. 139 Neff JM, Clifton H, Park KJ, Goldenberg C, opaliskyP J, Stout JW, Danielson BS. (Nov-Dec 2010). Identifying Children with Lifelong 140 TeKolste, K. A. (Summer, 2009). Crossing the health care chasm: Chronic Conditions for Care Coordination Using Hospital Discharge Transitioning adolescents with special health care needs to adult health Data. Academic Pediatrics, vol 10, No. 6, pages 417-23. care settings. Northwest bulletin: Family and child health, vol. 23, No. 2.
32 Community Health Needs Assessment Report 2013 yet most providers of adult healthcare are Asthma and allergies unfamiliar with how to care for individuals Asthma is one of the most common chronic with a broad spectrum of chronic childhood- childhood conditions. Although we have limited onset conditions. The adult-oriented healthcare data on the prevalence of asthma in children, system is fragmented, built on expectations an estimated one in 12 Washington youth had of independence, and has few systems for 144 current asthma in 2006. Nationally, food coordinated care. Less than half of children with allergies are increasingly common among special health care needs in the WAMI region 141 children. Children with food allergies are likely receive services for transition to adult care. to have related conditions such as asthma and Community assets and strengths other allergies. Seattle Children’s Center for Children with Air quality Special Needs provides teen-specific web- Air pollution is a major public health concern based resources including care plans, checklists, because it can affect large portions of the tips for how to communicate with care population who have no choice but to be providers and how to share information with exposed to it. Most air quality problems in friends and family. The Adolescent Health Washington state are caused by local sources Transition Project website is a resource for teens of air pollution such as cars, diesel vehicles, and young adults with special health care needs. wood stoves, fireplaces, outdoor burning, 142, 143 Recommended strategies wildfires and industry. Cars and trucks are the A successful transition process is all-encompassing, largest source of air pollution, accounting for focusing on patients and their families, all of nearly 60% of the state’s air pollution. People the patient’s pediatric providers, and the adult living closer to sources of air pollution are likely healthcare system the patient is entering. to have higher exposures to pollutants than Children’s hospitals that report high healthcare those who live farther away. State air quality is transition success have developed centralized worse during the winter months. Some regions systems to support clinical departments, of the state have higher levels of air pollution divisions and clinics by providing education and 144 Washington Healthy Youth Survey, 2006. tools for clinicians, patients and families, as well as resources for adult care providers receiving Examples of Washington State the patients. These systems may include: Children with Special Health Care • Support for families in helping their Needs Program Projects adolescent navigate transition planning • Autism Grant • A teaching physical exam to inform the • Epilepsia en Washington patient about their physical status, special • Washington Integrated Services Enhancement problems and care needs (WISE for CSHCN) • A health history and transfer summary for the • Medical Home Leadership Network patient • Children with Special Health Care Needs • Referral to patient support groups Assessment • An adolescent transition program that • Birth Defects Surveillance integrates and spans clinical areas by • Nutrition Services providing education and tools for all involved • Feeding Team Services 141 Ibid. 142 Ibid. • Adolescent Health Transition Project 143 NACHRI. (Fall, 2010). Ready or not, moving to adult care. Children’s hospitals today.
Community Health Needs Assessment Report 2013 33 154 than other regions. Infants and children, the Asthma in Washington state elderly, and people with lung or cardiovascular Facts about Washington state children with disease or diabetes are especially sensitive to 145 asthma: air pollution. • According to the Centers for Disease Control, *(See Appendix, Figure 57: King County Air Quality.) Washington state has one of the highest rates Asthma and allergies in the United States of asthma in the nation. Asthma is one of the most common chronic • In 2006, one in 12 youth had current asthma. childhood diseases, affecting an estimated six 146 • Black youth were about 30% more likely to million children in the country. According to have current asthma than White youth. the 2005-2006 National Survey of Children with Special Health Care Needs, 53% of children with • One in nine households with asthma had at special health care needs have asthma, and 53% least one child with current asthma. 147 have allergies. • Youth who smoked cigarettes were about Allergic rhinitis affects as many as 40% of 30% more likely to have asthma than 148 children. About 27% of children who have a nonsmokers. 149 food allergy also have eczema or a skin allergy. • Of 12th graders with asthma, about one in Atopic dermatitis affects between 10% and 20% five smoked cigarettes. 150 of children. • One in three youth with current asthma missed In 2007, approximately three million children one or more school days due to asthma. under the age of 18 reported a food or digestive 151 • Asthma hospitalizations for children younger allergy in the previous 12 months. Children with than 5 years old dropped from 376 to 277 per food allergies are two to four times more likely 100,000 population. If this trend continues, to have conditions such as asthma and other 152 allergies. The prevalence of food allergies 154 Washington State Department of Health, Washington Asthma Program (September 2008). 2008 Update Report: The Burden among children under the age of 18 increased of Asthma in Washington State. Retrieved October 15, 2010 from 153 http://www.doh.wa.gov/portals/1/Documents/Pubs/345-240- 18% from 1997 to 2007. 2008AsthmaBurdenReport.pdf.
Examples of Center for Children with Special Needs Projects • CSHCN.org website • Online Video Library for Professionals
145 The Health of Washington State, 2007 8.5.1 Outdoor (Ambient) Air • Care Planning Tools Quality Washington State Department of Health updated: 07/02/2008. http://www.doh.wa.gov/Portals/1/Documents/5500/EH-AQ2007.pdf. • Searchable Directory of Resources in the 146 The National Institutes of Health’s Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma. October 2007. WAMI Region 147 Maternal and Child Health Bureau (MCHB), Health Resources and Services Administration, U.S. Department of Health and Human • Provider Training Services. National Survey of Children With Special Health Care Needs, (2006). • Family Leadership Training 148 The Diagnosis and Management of Rhinitis: An Updated Practice Parameter. Joint Task Force on Practice Parameters. J Allergy Clin Immunol. 2008; 122: s1-284. • Summer Camp Directory for Children with 149 Branum AM, Lukacs, SL. Food allergy among U.S. children: Trends in Special Health Care Needs prevalence and hospitalizations. NCHS data brief, no 10. Hyattsville, MD: National Center for Health Statistics. 2008. • Community Resource Guides 150 Disease Management of atopic dermatitis: An updated practice parameter. Ann Allergy Asthma Immunol. 2004; 93: s1-s21. • Linkages Newsletter for Washington State 151 Branum AM, Lukacs, SL. Food allergy among U.S. children: Trends in prevalence and hospitalizations. NCHS data brief, no 10. Hyattsville, MD: Professionals Who Care for Children with National Center for Health Statistics. 2008. 152 Ibid. Special Health Care Needs 153 Ibid.
34 Community Health Needs Assessment Report 2013 Washington should meet the Healthy People Seattle Children’s Food Allergy Initiative 2020 target of 250 for this age group. In partnership with the Food Allergy Initiative • Of youth with current asthma, 21% had one or (FAI) – Northwest, Seattle Children’s Food more asthma-related emergency department Allergy Community Health Education Program visits in 2006. works to prevent adverse food allergy reactions
155 • Of children with asthma, 80% have allergies. through education and to provide tools that communities need to manage food allergies • Asthma was the number one reason for and assure children’s safety. The Initiative Seattle Children’s inpatient admission in 156 offers educational seminars to those caring for 2009, with 542 admissions. children with food allergies, including teachers, Asthma in King County summer camp staff, licensed child care centers, Asthma is the most common reason for children parent groups and school nurses. More than 157 to be admitted to the hospital in King County, 3,500 people have attended 160 food allergy where an estimated 23,000 children under the management presentations since the inception 158 age of 18 have asthma. of the program. The group also creates food- allergies standards with oversight from a *(See Appendix, Figure 58: King County Asthma Hospitalizations, 2003-07; Figure 59: Current Asthma community and family advisory board. Among King County Children, 2004-08; and Figure 60: Asthma Hospitalizations in Children by Poverty Level, Individual and patient education 2003-07.) Asthma is the most common medical diagnosis Seattle Children’s assets and strengths among children admitted to Children’s. The Pulmonary Department treats babies, children Odessa Brown Children’s Clinic (OBCC) Asthma and teens with asthma. Patients and families Clinic seen in Seattle Children’s Pulmonary Clinic Initiated in 1994 with a grant from the American receive a copy of the book, Living with Asthma, Lung Association, the OBCC Asthma Clinic available in English and Spanish. The hospital was created to empower and educate families website also provides pulmonary resources for to successfully manage their child’s asthma, families and children with asthma. increase successful primary care management of asthma in children, and improve access to Provider education both community and specialty-based care. Seattle Children’s Pulmonary Clinic provides The clinic also works to educate families about expertise to local, regional and national environmental triggers to asthma. programs that focus on children with special The program offers care provider spirometry pulmonary healthcare needs. Services trainings to expand their knowledge, skill include consultation, research and education and confidence with spirometry use and test to community agencies and professional interpretation. This training is offered regionally, organizations. The clinic also provides nationally and internationally, with a focus on telemedicine consultations to providers in rural safety-net hospitals. communities. Research Researchers at Children’s are looking at Web- 155 Northwest Asthma and Allergies. Retrieved October 29, 2010 from: http://www.nwasthma.com. and mobile phone-based tools to help parents 156 Seattle Children’s (2009), Facts and Stats. Retrieved December 2, 2010 from: www.seattlechildrens.org/about/history/facts-and-stats. improve their children’s asthma treatment. 157 Public Health – Seattle & King County, http://www.kingcounty.gov/ In one study, parents used a website that healthservices/health/chronic.aspx. 158 Washington State Department of Health, http://www.doh.wa.gov/ provided feedback on their child’s asthma DataandStatisticalReports/DiseasesandChronicConditions/ AsthmaData.aspx. symptoms and allowed them to set treatment
Community Health Needs Assessment Report 2013 35 goals. The website gathered information • Reduce hospital emergency department from parents about asthma severity, home visits for asthma care practices and parental beliefs related to • Reduce activity limitations among persons administration of medicines. In another study, with current asthma pulmonary specialists at Children’s worked with University of Washington researchers to • Reduce the proportion of persons with develop a smartphone app that could ease asthma who miss school or work days home monitoring of lung diseases. While • Reduce the proportion of children ages 5 to current smartphones can’t do all the needed 17 years with asthma who miss school days analysis in real time, researchers foresee future • Increase the proportion of persons with phones will. current asthma who receive formal patient Community assets and strengths education Some community organizations that work on • Increase the proportion of persons with asthma and food allergies include: current asthma who receive appropriate • ALA Washington Master Home asthma care according to National Asthma Environmentalist Program: Free Education and Prevention Program (NAEPP) environmental home health assessments. guidelines • The Northwest Asthma and Allergy Center U.S. Preventive Services Task Force provides diagnostic testing and treatment of The U.S. Preventive Services Task Force asthma, inhalant allergies and food reactions, recommends asthma home visits for children as well as occupational and environmental with asthma. Home visits are a cost-effective 160 reactions and eczema. way to improve asthma control when they: • Food Allergy Initiative (FAI) – Northwest • Identify asthma triggers in the home. supports food allergy research, clinical • Address more than one asthma trigger. programs, public policy and education. • Use multiple strategies to reduce triggers. • Spirometry 360 provides online information and classes about how to use the spirometry • Provide education on reducing triggers and method to measure lung function. controlling asthma. • The Medical-Legal Partnership for Children American Lung Association state and 161 brings together medical providers, social community level public policy agenda workers and lawyers to help meet the legal • Every state should have an adopted and needs of patients and families. The team has adequately funded comprehensive state plan provided medical and legal counseling to to reduce asthma morbidity and mortality. families whose housing conditions aggravate • Every state should have an adequately their child’s asthma. funded statewide asthma program. Recommended strategies • All healthcare systems, including public and 159 Healthy People 2020 private providers, purchasers and payers, Healthy People 2020 objectives that relate to should deliver services and medications asthma include: consistent with National Asthma Education and Prevention Program guidelines. • Reduce asthma deaths • Reduce hospitalizations for asthma 160 The Community Guide. Retrieved October 29, 2010 from: http://www. thecommunityguide.org/asthma/multicomponent.html. 159 Healthy People 2020, Retrieved December 15, 2010 from: www. 161 American Lung Association, Asthma Advocacy, Retrieved October 29, healthypeople.gov/2020/topicsobjectives2020/default.aspx. 2010 from: http://www.lungusa.org/lung-disease/asthma/advocacy.
36 Community Health Needs Assessment Report 2013 Cancer systems for treating pediatric cancer patients’ reproductive issues. Data shows that fertility Cancer incidence in children birth to 20 years preservation improves hope and resilience in Washington state is 17.9 per 100,000 (U.S. among cancer therapy patients. incidence is 16.9 per 100,000). Thurston and Cowlitz counties have the highest cancer Recommended strategies 162 incidence rates at 23.2 per 100,000. On 165 Cancer survivorship average, there are 304 cases of childhood 163 cancer per year in the state. • Ensure that all cancer survivors have
164 adequate access to high-quality treatment Teens and young adults with cancer and other post-treatment services. Teens and young adults with cancer have • Establish or maintain training for healthcare different needs and different treatment professionals to improve delivery of services challenges than children or older adults. Many and increase awareness of issues faced by teens fall into a gap between cancer treatment cancer survivors. programs designed for children and those created for adults, increasing the time it takes • Identify appropriate mechanisms and for diagnosis and treatment. Teens and young resources for ongoing surveillance of people adults are much less likely than children to get living with, through and beyond cancer. the most advanced treatments by taking part • Increase awareness among the general public, in research studies. Because of this, cancer policy makers, survivors, providers and others survival rates for teens and young adults have of cancer survivorship and its impact. not improved since the 1970s. For certain 166 Healthy People 2020 cancers, teens and young adults have much better results when they are treated at a Healthy People 2020 objectives related to pediatric hospital. cancer are: Children who survive cancer need careful attention • Reduce the overall cancer death rate. Target: for the rest of their lives. Up to two-thirds of 160.6 deaths per 100,000 population. childhood cancer survivors have treatment- Baseline: 178.4 cancer deaths per 100,000 related side effects months or even years later. population occurred in 2007. These include organ damage, second cancers, • Increase the proportion of cancer survivors and problems with mental tasks that can impact who are living five years or longer after school and work performance. diagnosis. Target: 72.8%. Baseline: 66.2% of Teachers and future employers may not persons with cancer were living five years or understand the unique needs of childhood longer after diagnosis in 2007. cancer survivors, or may have misconceptions • Increase the mental and physical health- about survivors’ abilities. Community physicians related quality of life of cancer survivors. may also have limited knowledge of cancer Community assets and strengths survivors’ needs. Seattle Cancer Care Alliance Children who have had cancer may experience decreased fertility as a result of their treatment. Seattle Cancer Care Alliance (SCCA) brings We lack resources, treatment guidelines and together Fred Hutchinson Cancer Research 165 Centers for Disease Control and Prevention (2004). A National Action 162 National Cancer Institute (2010). State Cancer Profiles. Retrieved Plan for Cancer Survivorship: Advancing Public Health Strategies. December 2, 2010 from: http://statecancerprofiles.cancer.gov/ Retrieved December 1, 2010, from: http://www.cdc.gov/cancer/ incidencerates/index.php. survivorship/pdf/plan.pdf. 163 Ibid. 166 U.S. Department of Health and Human Services. (2020).Healthy people 164 Seattle Children’s Hospital (2010). Childhood Cancer and Blood 2020, injury and violence prevention. Retrieved December 13, 2010 Disorders Program. Retrieved November 29, 2010, from: http://www. from: http://www.healthypeople.gov/2020/topicsobjectives2020/ seattlechildrens.org/clinics-programs/cancer. default.aspx.
Community Health Needs Assessment Report 2013 37 Center, University of Washington Medicine and • Promoting community education regarding Seattle Children’s. Through the SCCA partnership, Gardasil vaccine and skin cancer Children’s cares for more than 200 new pediatric • Addressing myths associated with sperm cancer patients each year. Research has found banking that teenagers with cancer do better if they are given treatment plans designed for children. • Providing web-based education to any Through SCCA, teenagers can continue to be cancer patient with materials such as: Fertility treated as they enter adulthood. and Cancer, fertility preservation information video for girls and Having a Life With Cancer. Fred Hutchinson Cancer and Research Center • Using social media for patient education and The Fred Hutchinson Cancer and Research support Center conducts research to improve prevention and treatment of cancer and related diseases. Children’s providers: The Hutchinson Center pioneered bone marrow • Share practice guidelines, resources and transplantation procedures. systems with other healthcare institutions regarding fertility preservation and University of Washington reproductive services for cancer patients. University of Washington Medical Center provides care for patients from Washington, • Provide consultation and share expertise, Wyoming, Alaska, Montana and Idaho. The UW resources and guidelines through School of Medicine has been ranked the best Continuing Medical Education to community primary-care medical school in the country practitioners about adolescent and young by U.S. News & World Report magazine for adult oncology, fertility preservation and 18 years. other topics. Seattle Children’s assets and strengths Adolescent and Young Adults with Cancer (AYA) program Seattle Children’s Cancer and Blood Disorders This program provides expert medical care Center and support for teens and young adults with Seattle Children’s comprehensive, most forms of cancer into their late 20s. They multidisciplinary team of pediatric cancer sponsor a weekly Teen Hangout staffed by experts treats 230 children newly diagnosed a hematology/oncology social worker where with cancer every year — more than any other young people with cancer can meet peers and institution in the region — and provides follow- address their psychosocial needs. The AYA is up care to more than 3,000 children and open to anyone in the community. The group adolescents. In outpatient clinics and in the partners with other community organizations 33-bed inpatient unit, children receive advanced that provide support for young adult patients diagnosis and treatments, participate in state- and survivors. of-the-art research studies and get specialized care. Seattle Children’s Cancer Survivor Program Seattle Children’s is specifically: Seattle Children’s Cancer Survivor Program is a follow-up program for childhood cancer • Implementing health awareness efforts survivors, whether they were treated at targeting secondary cancer prevention Seattle Children’s or elsewhere. It aims to keep (testicular, breast and skin cancers) survivors healthy throughout their lives by • Working to increase awareness and health providing care and education about their health promotion for Gardasil vaccine (for boys and risks. About 80% of children who have cancer girls) survive their disease. The Cancer Survivor
38 Community Health Needs Assessment Report 2013 Program was designed to meet the unique Recommended strategies needs of survivors treated during childhood. 171 Transition and lifelong care goals The program serves survivors who are still children, as well as adults who were treated for In early adolescence, CHD survivors needing cancer during childhood. It also gives survivors lifelong congenital heart care should begin to the chance to take part in research studies so transition to appropriate adult congenital heart disease care. CHD survivors should be educated we can learn more about the best ways to keep on how to choose adult congenital heart care, survivors well. and be made aware of care guidelines and Fertility preservation the benefits of cardiac heart surveillance. A Children’s is a regional and national leader in successful transition will include: fertility preservation services and education. • Obtaining health insurance In response to patient and family requests and • Selecting an adult care physician to provide community need, Children’s Cancer Center and coordinate comprehensive care developed the fertility preservation program, • Receiving reproductive, genetic and career providing fertility counseling and reproductive counseling services for cancer patients. Children’s offers a standard process for sperm banking to all at- • Educating adult care health providers about risk boys older than 12. the patient’s congenital heart disease • Maintaining communication between 172 Heart disease patients, families and healthcare providers
Congenital heart disease (CHD) is the most 173 Cardiovascular screening in athletes common birth defect. This chronic disorder requires lifelong ongoing heart care with a high The goal of performing cardiovascular screening 167 risk of additional problems. The majority of of young athletes is to reduce sudden cardiac children born with a congenital heart defect death through early detection and appropriate survive into adulthood, yet many require medical interventions, activity modification or 168 specialized and ongoing medical treatment. withdrawal from athletic participation. In early adolescence, patients with congenital Community assets and strengths heart disease should start preparing for the American Heart Association transition from pediatric to adult medical care. The American Heart Association’s mission is to Sudden cardiac arrest (SCA) is the leading build healthier lives free of cardiovascular diseases cause of sudden death in young athletes and stroke through advocacy, research and during sports participation and typically the educational resources for healthcare providers, result of undiagnosed structural or electrical 169 patients and families, and the community. cardiovascular disease. SCA is the first clinical manifestation of cardiac disease in up to 80% of Stanley Stamm Camp 170 athletes who suffer sudden death. Stanley Stamm Camp provides a medically supported one-week overnight camp experience in an outdoor wilderness setting for children ages 6 to 14 with terminal or chronic illnesses. The camp is free to all who attend. 167 Children’s Heart Foundation. Transition and Lifelong Care Goals. Retrieved November 29, 2010 from http://www. 171 Ibid. childrensheartfoundation.org/advocacy/transition-and-lifelong-care. 172 American Heart Association. Adult care for congenital heart disease 168 American Heart Association, news release, Feb. 28, 2011. patients should begin in adolescence. News release, Feb. 28, 2011. 169 Nick of Time Foundation. Cardiovascular Screening Program in Retrieved from http://newsroom.heart.org/pr/aha/1278.aspx. Children and Young Adults. Retrieved November 20, 2010 from http:// 173 Nick of Time Foundation. Cardiovascular Screening Program in www.nickoftimefoundation.org. Children and Young Adults. Retrieved November 20, 2010 from http:// 170 Ibid. www.nickoftimefoundation.org.
Community Health Needs Assessment Report 2013 39 Seattle Children’s assets and strengths (UNOS). UNOS manages a computerized Seattle Children’s Heart Center is working on network that impartially matches organ donors the following goals to improve heart health in with potential transplant recipients. Transplant the community: centers and organ recovery organizations across the country are part of this national network. • Create a Heart Center family advisory group. • Build a stronger relationship with the Heart- Transplant in the Northwest to-Heart Congenital Heart Defects group. More than 3,200 people in the Northwest • Address the need for heart services for Latino (UNOS region 6: Washington, Alaska, Idaho, Montana, Oregon and Hawaii) are currently in families from Central Washington. 174 need of life-saving organ transplants. • Provide pediatric heart-healthy-behavior *(See Appendix, Figure 61: Children and Youth on Waitlist community education. for Organ Transplant in Washington State as of 07/13/12.)
The Heart Center promotes education through 175 several programs, including: Recommended strategies • Heart-to-Heart, a monthly support group for Healthy People 2020 families who are dealing with CHD, illness- Healthy People 2020 objectives related to related heart conditions or heart transplant. transplant include: • An adolescent transplant support group • Increase the proportion of dialysis patients where teens can share concerns and wait-listed and/or receiving a deceased donor providers can address noncompliance issues. kidney transplant within one year of end- • Free, in-school cardiovascular screenings and stage renal disease start (among patients electrocardiograms (ECGs) (in partnership under 70 years of age). with the Nick of Time Foundation) for • Increase the proportion of patients with student athletes — conducted every treated chronic kidney failure who receive a two months during the school year by transplant within three years of registration volunteer physicians, ECG technicians and on the waiting list. echocardiographers, with cardiologist referrals provided as needed. Community strategies The Heart Center also promotes provider • Continue to raise awareness about organ education such as conferences for donation and encourage people to become community primary-care providers about new donors; the recipient need is larger than the developments in diagnosis. number of available organs. • Seattle Children’s must continue to act as Transplant a regional expert and partner resource for More than 110,000 people in the nation are waiting pediatric transplants. for a life-saving organ transplant. An average of 18 people — both children and adults — die each Community assets and strengths day from the lack of available transplant organs. Washington State Medical Association: Organ Every 10 minutes another person is added to donation the national organ transplant wait list. Washington State Medical Association offers All patients waiting for a deceased-donor information to inspire and facilitate organ transplant in the United State have equal access donation. to donated organs. Potential recipients who are 174 HRSA Organ Procurement and Transplantation Network, Retrieved July waiting for a deceased donor organ are listed 13, 2012 from: http://optn.transplant.hrsa.gov. 175 Healthy People 2020, Retrieved December 15, 2010 from: http:// with the United Network for Organ Sharing www.healthypeople.gov/2020/topicsobjectives2020/overview. aspx?topicid=6.
40 Community Health Needs Assessment Report 2013 LifeCenter Northwest • Among 10th graders, Hispanics, Non-Hispanic LifeCenter Northwest is the organ and tissue Pacific Islanders and Blacks were more likely program that services Alaska, Montana, North than Non-Hispanic Whites to be obese. Idaho and Washington. • From 2002-2008, obesity increased significantly for 12th graders, but remained Seattle Children’s assets and strengths consistent for eighth- and 10th-grade Seattle Children’s Transplant Center is the students during the same years. largest and only pediatric transplant center serving United Network for Organ Sharing • Among 10th graders, obesity and overweight (UNOS) Region 6, which includes Washington, rates were significantly higher in Garfield, Oregon, Montana, Idaho, Alaska and Hawaii. Grant, Mason, Okanogan and Yakima counties Children’s delivers world-class care to patients compared to counties in the rest of the state. These rates were significantly lower in with end-stage diseases of the kidneys, heart, 182 liver and intestine and has been transplanting Klickitat and Island counties. organs for more than 25 years. The center • Of Washington schools, 39% reported focuses on patient care, provider education, that students can purchase soda or fruit community partnerships and advocacy. drinks that are not 100% juice from vending 183 machines or school stores. Child health and development • In 2008, about 68% of eighth graders, 75% Obesity of 10th graders and 69% of 12th graders reported that they had drunk nondiet soda, Healthcare providers need resources to help sports drinks and other sweetened drinks at them better communicate with families facing 184 school at least once in the past week. overweight and obesity issues. They lack training and efficient systems and tracking tools Obesity in King County to support their efforts in treating overweight 176, 177, 178 • Of high-school students in King County, 9% patients and their families. are obese, 21% are overweight and 86% do Obesity in Washington state not meet physical activity recommendations. Facts about obesity and Washington youth: In addition, 72% have inadequate fruit and vegetable consumption, and 35% reported • Of high school students across the state, 11% 179 having one or more sodas yesterday. are obese and 14%-16% are overweight. • Youth in South King County are more likely • From 40%-60% of Washington youth do not 180 to be overweight or at risk of becoming 185 meet recommendations for physical activity. overweight. Asian, Latino and multiracial youth are least 181 *(See Appendix, Figure 62: Obesity Among King County likely to meet these guidelines. Students in Grades 8, 10 and 12, 2010 and Figure 63: Obesity Among King County Students in Grades 8, 10 and 176 Institute of Medicine, ed. (2005). Preventing childhood obesity: Health 12 by Region.) in the balance. Washington, DC: National Academies Press. 177 Jelalian, E., Boergers, J., Alday, C.S., & Frank, R. (2003). Survey of physician attitudes and practices related to pediatric obesity. Clin Pediatr, Apr;42(3):235-45. 178 Seattle Children’s Obesity Program. (July, 2003). Summary report: Development of family and community based resources to provide clinical guidance for children with obesity. 182 MCH Data Report Washington State DOH 160-015- April 2010, 179 Washington State Department of Health. (2010). Washington State http://www.doh.wa.gov/Portals/1/Documents/Pubs/160-015_ healthy youth survey, analytic report. Retrieved October, 2010 MCHDataReportChildWeight.pdf. from: http://www.doh.wa.gov/Portals/1/Documents/Pubs/210-084_ 183 Washington State Department of Health, Adolescent Needs WashingtonStateHYS2010.pdf. Assessment, January 2010. 180 Ibid. 184 Ibid. 181 Seattle King County Public Health (2008). Communities count: social & 185 Seattle King County Public Health (2008). Communities count: social & health indicators across King county 2008 report. Physical activity and health indicators across King county 2008 report. Physical activity and weight. Retrieved October, 2010 from: http://www.communitiescount. weight. Retrieved October, 2010 from: http://www.communitiescount. org. org.
Community Health Needs Assessment Report 2013 41 190 Obesity in Seattle Children’s patients Healthy People 2020 Seattle Children’s subspecialty clinic patient The following Healthy People 2020 objectives data shows that over 30% of the hospital’s relate to overweight and obesity in children and patient population is obese or overweight, adolescents: refecting national percentages. Of Odessa • Reduce the proportion of children and Brown Children’s Clinic (OBCC) patients 10 and adolescents who are considered obese. older, 40% are overweight or obese (25% are obese). Of OBCC patients 2 to 9 years old, 34% • Children aged 2 to 5 years—Target: 9.6%. are overweight or obese (17% are obese). Baseline: 10.7% of children aged 2 to 5 years were considered obese in 2005–08. *(See Appendix, Figure 64: Seattle Children’s Subspecialty Clinic Patient Data 2005-2007.) • Children aged 6 to 11 years—Target: 15.7%. Recommended strategies Baseline: 17.4% of children aged 6 to 11 years were considered obese in 2005–08. • Encourage healthcare professionals and organizations to participate in community • Adolescents aged 12 to 19 years—Target: 16.1%. 186 coalitions or partnerships to address obesity. Baseline: 17.9% of adolescents aged 12 to 19 years were considered obese in 2005–08. • Help communities increase opportunities for extracurricular physical activity and improve Community assets and strengths 187 access to outdoor recreational facilities. Coalitions and initiatives dedicated to obesity • Support health professional organizations in prevention and treatment include: creating and disseminating evidence-based National clinical guidelines and other educational • Childhood Obesity Action Network from the materials on childhood obesity prevention and in advocating for childhood-obesity prevention National Initiative for Children’s Healthcare 188 initiatives through coordinated efforts. Quality (NICHQ) • Have healthcare organizations advocate • Congressional Task Force on Childhood for improved access to fresh fruits and Obesity Prevention vegetables and for safe physical activity in • Children’s Hospital Association (formerly 189 communities and schools. known as NACHRI): Focus on a Fitter Future • Promote healthy eating and active living — collaboration with 25 children’s hospitals through community-wide campaigns to further define the role of children’s with messages that motivate families to hospitals in pediatric obesity management reduce children’s TV and screen time (as and prevention to advance progress toward recommended in King County’s Overweight lowering obesity rates. Prevention Initiative 10 Point Plan). • Executive Committee for the National • Improve reimbursement/payment for obesity American Academy of Pediatrics Provisional treatment services. Section on Obesity State 186 Department of Health and Human Services, CDC. (July, 24, 2009). • Washington State Childhood Obesity Recommended community strategies and measurements to prevent obesity in the United States. MMWR, Vol. 58/ No. RR-7. Retrieved Prevention Coalition promotes policy changes October 2010, from: http://www.cdc.gov/mmwR/PDF/rr/rr5807.pdf. 187 Ibid. such as enhanced nutritional standards in 188 Institute of Medicine Fact Sheet. (September, 2004). The Health-Care Sector and Providers Can Play a Role in Preventing Childhood Obesity. schools and child care programs, physical 189 National Initiative for Children’s Healthcare Quality. NICHQ. (2007). Expert committee recommendations on the assessment, prevention 190 U.S. Department of Health and Human Services.(2020). Healthy people and treatment 2020, injury and violence prevention. Retrieved December 13, 2010 of child and adolescent overweight and obesity. Childhood Obesity from: http://www.healthypeople.gov/2020/topicsobjectives2020/ Action Network. overview.aspx?topicid=24.
42 Community Health Needs Assessment Report 2013 education requirements in schools, and a • Public Health – Seattle & King County has a tax policy that discourages child and youth goal to protect and improve the health and consumption of foods and drinks of negative well-being of all people in King County, as nutritional value. defined by each individual’s “healthy years • Washington Action for Healthy Kids supports lived.” schools and communities in their efforts to Others organizations focused on obesity be places where students can be physically prevention include the American Heart active and choose healthy foods. Association (AHA), Boys and Girls Clubs, Girls on the Run of Puget Sound, School of County Acrobatics and New Circus Arts and Treeswing. • Communities Putting Prevention to Work and Community Transformation Grant initiatives Seattle Children’s assets and strengths aim at improving access to healthy eating, Seattle Children’s is a local, regional and active living and tobacco-free environments. national leader and advocate for reducing pediatric overweight and obesity. Seattle • Healthy Kids, Healthy Communities is working Community and individual education to improve healthy lifestyles for families in • Children’s provides children and teens with low-income housing. age-specific healthy eating and physical activity education. A number of community organizations are involved with obesity prevention programs for • In partnership with the YMCA of Greater children and families. They include: Seattle we offer ACT! (Actively Changing Together), a three-month nutrition, physical • YMCA’s ACT! (Actively Changing Together) is activity and self-empowerment program for a 12-week healthy lifestyle program for youth youth ages 8 to 14 who are overweight and ages 8 to 14 with a body mass index greater their parents. Active in 14 YMCAs in three than the 85th percentile. A physical activity counties. coach and nutritionist lead each session. • Families from Odessa Brown Children’s Clinic • The Austin Foundation is an organization (OBCC) and a local Boys & Girls Club work with that provides free fitness and nutrition an OBCC nutritionist to maintain seven raised education for Seattle and King County youth, garden beds at New Hope Baptist Church ages 5 to 25. across the street from the clinic. Families and • Seattle Parks and Recreation promotes children enjoy using the vegetables and herbs physical activity and wellness programs they grow in monthly nutrition and cooking through events, after-school activities, classes classes, and benefit from physical activity and more. classes offered at OBCC. • King County Food and Fitness Initiative, • Fit 4 You: A wellness program based at OBCC located in Delridge and White Center (Seattle), brings together providers and a nutritionist works to offer fresh produce at local corner to offer nutrition classes (e.g., community grocers, engage youth in leading change, kitchens and cooking and grocery shopping promote school-based efforts such as school classes) and provides individual consultations gardens, and enhance the physical environment with patients and their families. with projects like completed sidewalks. Advocacy • Let’s Do This is a campaign to inspire King • In 2009 we co-sponsored the first Statewide County residents to work together for Obesity Summit on prevention and policy healthier places to live, learn, work and play.
Community Health Needs Assessment Report 2013 43 (through partnership with the American Organization and community change Heart Association). We were also a key • Children’s committed $2 million to bicycle partner in the 2011 summit. and pedestrian improvements that link • Children’s is a member of the Childhood hospital and surrounding communities Obesity Prevention Coalition, a statewide to larger walk and bike networks. These coalition working on encouraging local and improvements will make biking and walking state policy change to prevent obesity. safer and more attractive for people of all ages and abilities (with Seattle • We have conducted provider advocacy Transportation). training independently and as part of trainings for providers on obesity prevention • The Seattle Children’s Hospital Wellness and management. Initiative is a comprehensive employee wellness program. • We were awarded $180,000 Communities Putting Prevention to Work grant from the • Our healthy hospital work includes food/ Department of Health and Human Services beverage changes in cafeteria, vending and Public Health – Seattle & King County machines and patient menus. We have been for “Everyone Swims.” This program leads recognized for healthy hospital efforts by the changes in Parks and Recreation, YMCAs American Heart Association. and community clinics in King County to Education, training and resources for healthcare improve access to swimming, water exercise providers and water recreation among low-income and • We consulted with primary care practices on culturally diverse families. quality improvement activities to promote • Worked with the Healthy Kids, Healthy an integrated approach to the prevention, Communities program (funded by the Robert assessment, identification and management Wood Johnson Foundation and run by of pediatric obesity within their clinics. Small the Seattle Housing Authority) to increase Steps to Health Pediatric Obesity Toolkit was access to healthy eating options and physical helpful in implementing the American Medical activity in underserved/under-resourced Association recommendations. (Partners communities within four low-income housing include the Washington State Department of sites in Seattle. Health, Public Health–Seattle & King County, National Initiative for Children’s Healthcare • Children’s worked with the King County Food Quality and payers.) and Fitness Initiative to improve healthy eating and active living in the White Center • Our obesity education kits help healthcare and Delridge neighborhoods and community providers discuss and treat obesity concerns by targeting schools, healthy retail, active with patients and their families (partnership environment and youth leadership. with the American Heart Association). • Children’s, Public Health - Seattle & King County • We have trained primary care providers in and Healthy King County Coalition were how to treat overweight and obese children awarded $3.6 million Community Transformation and communicate with parents — 245 Grant from the U.S. Department of Health primary care providers attended workshops and Human Services (HHS). This collaborative held at Children’s Hospital main campus in effort aims to change systems so all residents Seattle, and in Burien, Tukwila and Spokane. can be physically active, have access to • The Children’s Nutrition Symposium is offered healthy foods and drinks and live in tobacco- every other year. free environments.
44 Community Health Needs Assessment Report 2013 Mental and behavioral health If they meet certain statewide access to care In the United States, mental health issues affect standards, low-income children and adults in approximately six million to nine million children King County may qualify for publicly funded 191 and adolescents. By age 18, 20% of the mental health services. In general, only those population has had an episode of depression, diagnosed with serious mental and emotional 199 while 65% of adolescents report transient or disorders qualify for publicly funded services. 192 less severe depressive symptoms. In the U.S., Eligible participants are enrolled in the mental an average of one youth dies by suicide nearly health managed-care plan called the Regional 193 every two hours. In Washington state, an Support Network (RSN), which coordinates care estimated 7.4% of children experience multiple through local community-based mental health 194 symptoms of mental conditions and an agencies. Washington state contracts with King average of two youth between the ages of 10 County Department of Community and Human 195 and 24, die by suicide each week. Services to manage the King County RSN. The need for mental health services is In addition to the lack of access to mental significant. However, fewer than 20% of children health service, awareness and acceptance 196 who need mental health services receive them. that mental health illnesses are treatable and A recent study led by Dr. Carolyn McCarty diagnosable continue to limit treatment. suggests suicidal teens aren’t getting the *(See Appendix, Figure 65: The Mental Health of Children: mental health services they need. McCarty A Portrait of Washington State and the Nation, 2007.) and her co-investigators from the University of Access to mental health inpatient services Washington (UW) and Group Health Research Across the state, community hospital beds Institute found that only 13% of teens ages 13 to available to admit acutely ill mental health 18 with suicidal thoughts visited a mental health patients are on the decline. The state is also professional through their healthcare network suffering a critical shortage of involuntary- and only 16% received services the year after. commitment beds. Of Washington’s 39 The shortage of outpatient treatment, counties, 25 have no community hospital or continuum of care and inpatient beds continues freestanding evaluation-and-treatment facility statewide. According to the Health Tracking 200 197 beds. Physician Survey, psychiatrists across the nation were much less likely to accept Autism new patients, regardless of insurance type. Autism is a complex neurological disorder that Approximately 41% of psychiatric providers impacts brain development in social interaction, reported accepting all or most new Medicaid communication and repetitive behaviors. 198 patients, while 46% accepted none. The definition of autism has broadened to be defined as a spectrum disorder that includes 191 Centers for Disease Control, Healthy Youth! Mental Health (June, 2010). Retrieved November 5, 2010, from: http://www.cdc.gov/mentalhealth. the disorders of autism, Asperger disorder 192 Lewinsohn PM, Hops H, Roberts RE, Seeley JR, Andrews JA. Adolescent Psychopathology: I. Prevalence and incidence of and pervasive developmental disorder–not depression and other DSM iii-R disorders in high school students. Journal of Abnormal Psychology, otherwise specified (PDD-NOS). According 1993; 102(1):133-144. to the Centers for Disease Control, one in 110 193 American Association of Suicidology. National Suicide Statistics (2007). Retrieved May 6, 2011 from http://www.suicidology.org/web/ children in the nation has an autism spectrum guest/stats-and-tools/statistics. 201 194 Brandon, R., Hill, S., Mandell, D.J., Carter, L. Family Matters: Mental disorder (ASD). The Washington State Health of Children and Parents Washington Kids Count. Human Services Policy Center, Department of Health estimates that ASDs Evans School of Public Affairs, University of Washington, 2003. 199 Adult data; from the King County Public Health Report: Access to 195 Youth Suicide Prevention Program. Statistics About Youth Suicide. Healthcare in King County for the Uninsured, Underinsured, and Retrieved May 6, 2011 from http://yspp.org/about_suicide/statistics.htm. Medicaid Populations. 196 Ibid. 200 Ibid. 197 http://www.rwjf.org/files/research/hscbulletin35sept2009.pdf. 201 Centers for Disease Control, Autism Spectrum Disorders, Retrieved 198 Ibid. October 16, 2010 from http://www.cdc.gov/ncbddd/autism/index.html.
Community Health Needs Assessment Report 2013 45 affect from 8,000 to 12,000 children and youth homicide. Suicide is the fourth leading cause of 207 in the state. In some Puget Sound region school death in youth ages 10 to 14. Among all states, 208 districts, autism rates are estimated as high as Washington ranked 17th in youth suicide. 202 one in 50. Youth at increased risk for suicide include The National Survey of Children with Special American Indians/Alaska Natives (AI/AN); Health Care Needs (NC-CSHCN) found that, those who identify as lesbian, gay, bisexual or compared with all families of children with transgender (LGBT); and victims of bullying 209 special health care needs, ASD families were (and the perpetrators). Girls and young less likely to participate in decision-making women attempt suicide much more often than with their providers and be satisfied with the boys and young men, but males are three times services they receive, less likely to have a more likely to die by suicide. medical home, and less likely to find it easy to 203 In 2006, the suicides of 120 Washington youth use community-based service systems. ages 10 to 24 cost an estimated $231 million in Depression medical costs and lost future productivity. The Nationally, only 2.1% of adolescents ages 12 to 892 hospitalizations due to attempted suicides cost $18 million in medical care and lost short- 17 were screened for depression during primary 210 care physician office visits between 2005 and term productivity. 204 2007. The NSCH found that one out of three Recommended strategies youth ages 12 to 17 years (and up to one out of 211 Healthy People 2020 two Hispanic youth) who needed mental health services did not receive them. Washington state Related Healthy People 2020 objectives include: 205 had similar results. The 2010 Washington State • Mental health status improvement Healthy Youth Survey found that 25% of eighth - Reduce suicide rate by 10%. graders, 30% of 10th graders and 28% of 12th 206 - Reduce suicide attempts by adolescents graders reported having depressive feelings. by 10%. Depressed youth are at higher risk of substance - Reduce the proportion of persons who abuse (including nicotine dependence), legal experience major depressive episode (MDE) problems, poor physical health, early pregnancy, by 10%. and suicide as well as poor academic, work and • Treatment expansion psychosocial functioning. - Increase the proportion of children with Suicide mental health problems who receive Nationally, suicide is the third leading cause of treatment by 10%. death for youth ages 10 to 24. In Washington state, it is the second leading cause of death 207 Centers for Disease Control and Prevention, Injury Prevention and Control: Data and Statistics (WISQARS) (2003-2007). Retrieved May 7, in youth ages 15 to 19 and ages 20 to 24, with 2011 from http://www.cdc.gov/injury/wisqars/index.html. 208 American Association of Suicidology. National Suicide Statistics twice as many youth dying by suicide than (2007). Retrieved May 6, 2011 from http://www.suicidology.org/web/ guest/stats-and-tools/statistics. 202 Seattle Children’s autism case for support. 209 (HYS, YSPP) & (YSPP & Kim, Young Shin & Leventhal, Bennett. (2008). 203 Washington State Department of Health, Autism Awareness Fact Bullying and Suicide: a review. International Journal of Adolescent Sheet, January 2009. Medicine and Health 20(2), 133-154.) & Jennifer Wyatt Kaminski, 204 Centers for Disease Control, National Center for Health Statistics, Xiangming Fang, Victimization by Peers and Adolescent Suicide in Health Indicators Warehouse, 2007. Retrieved May 6, 2011 from http:// Three US Samples, The Journal of Pediatrics, In Press, Corrected www.healthindicators.gov. Proof, Available online 19 July 2009, ISSN 0022-3476, DOI: 10.1016/j. 205 U.S. Department of Health and Human Services (2007). National jpeds.2009.04.061. Survey of Children’s Health. Centers for Disease Control and 210 Children’s Safety Network, Economics and Data Analysis Resource Prevention, National Center for Health Statistics and Maternal and Child Center, Pacific Institute for Research and Evaluation, MD, 2008. Health. Retrieved May 6, 2011 from http://www.nschdata.org/Content/ Retrieved May 10, 2011 from Washington State’s Plan for Youth Suicide Default.aspx#. Prevention 2009 at http://here.doh.wa.gov/materials/washington- 206 Washington State Department of Health. (2010). Washington State states-plan-for-youth-suicide-prevention-2009/33_SuicPlan_E11L.pdf. Healthy Youth Survey, analytic report. Retrieved October, 2010 from: 211 Healthy People 2010. Retrieved December 15, 2010 from: http://www. http://www.hys.wa.gov/Reporting/AnalyticReport08.pdf. healthypeople.gov/2020/topicsobjectives2020/default.aspx.
46 Community Health Needs Assessment Report 2013 213 - Increase depression screening by primary Autism A.L.A.R.M guidelines care providers. Adapted from policies developed by American - Increase the proportion of primary care Academy of Pediatrics and American Academy physician office visits that screen adults ages of Neurology to help physicians assure that 19 years and older for depression. children receive routine and appropriate - Increase the proportion of primary care screenings and timely interventions, the physician office visits that screen youth ages A.L.A.R.M. guidelines are: Autism is prevalent, 12 to 18 years for depression. Listen to parents, Act early, Refer and Monitor. - Increase the proportion of juvenile residential Community assets and strengths facilities that screen admissions for mental There are several community mental health health problems. resources supported by the Department of - Increase the proportion of persons with Social and Health Services (DSHS), including co-occurring substance abuse and mental the National Suicide Prevention Lifeline, the disorders who receive treatment for both Washington Recovery Help Line, Crisis Lines in disorders. 40 counties and 13 Regional Support Networks - Increase depression screening by primary (RSN) that provide public mental health care providers. services such as crisis intervention, community • Autism spectrum dsorders mental health treatment and support services. - Increase the proportion of young children There are also a number of community-based with Autism Spectrum Disorders and other and private organizations that provide awareness, developmental delays who are screened, treatment and education to children, teens, evaluated and enrolled in early intervention parents and the community, including: services in a timely manner. - Increase the proportion of children with • Autism Outreach Project – Provides special health care needs who receive their program development, placement and staff care in family-centered, comprehensive, development activities for school districts, coordinated systems. parents, agencies and students with autism spectrum disorders. Washington Autism Task Force priority 212 recommendations • FEAT of Washington – Provides hope and guidance to families of children with autism, The task force recommends that individuals helping these children reach their full with autism spectrum disorders stay in their potential. communities, receive a wide range of healthcare services, obtain ongoing suitable treatments, • Youth Suicide Prevention Program (YSPP) – and receive: Focuses on public awareness, training and community organization around suicide • Evidence-based multidisciplinary interventions prevention. YSPP is a private nonprofit that that are timely and individualized is supported by both public (Department of • Culturally effective, family-centered support Health) and private funding. • Legally required services Seattle Children’s assets and strengths The Department of Psychiatry and Behavioral Medicine team diagnoses, treats and prevents problems with emotions and behavior. Services
212 Washington State Department of Health, Autism Task Force, Retrieved 213 Center for Disease Control, Autism Guidelines, retrieved November 1, November 5, 2010, from: http://www.doh.wa.gov/YouandYourFamily/ 2010 from: http://www.cdc.gov/ncbddd/autism/hcp-recommendations. IllnessandDisease/Autism/AutismTaskForce.aspx. html.
Community Health Needs Assessment Report 2013 47 include outpatient mental health services, providers in the community and patients with inpatient hospital stay, neuropsychology complex conditions: services and eating disorder services. • Disruptive Behavior Disorders – This Through a contract and in partnership with area represents 30% to 40% of inpatient DSHS, we provide primary care provider admissions to the hospital Inpatient consultations via the Partnership Access Line Psychiatry Unit and 40% of outpatient (PAL). Our other services include: evaluations and treatment. The goal is to • Telepsychiatry service, giving children strengthen the hospital’s ability to assist in underserved communities access to in continuum of care by partnering with psychiatrists community providers to identify resources in the community and to make sure that the • Mental-health-care-provider trainings care patients receive is evidence-based. • Patient and community education • Mood Disorders, including depression, The department’s vision and goals are to: be a bipolar and other mood disorders. leader in empirically based psychiatric assessment • Pediatric Psychology – This center treats and treatment interventions; enhance access to the mental health component of Children’s services and the community’s capacity to serve patients with medical health conditions. families through education, training and research; establish research across priority areas; retain and • Autism Center – Children’s Autism Center recruit the best people; sustain nationally ranked provides assessment, diagnosis, treatment Child and Adolescent Psychiatry and Psychology and support for autism spectrum disorders. training programs; and be a local and national Its clinicians provide medical, psychiatric, resource, advocating for and empowering families behavioral and speech services for babies, affected by mental illness. children and young adults. Approximately 45% of families seeking autism services at Following are some of the ways we are working Children’s lack adequate insurance coverage to meet these goals. for their child’s care. The Autism Center offers Bed design and expansion provider and community education, as well as individual patient and family education. The As part of the strategic planning process, the center offers monthly support groups and Department of Psychiatry and Behavioral Health community classes for parents and caregivers met with many community providers to try to of children with autism on a variety of topics. improve the referral and care process. These Classes are available statewide through community providers include Sound Mental Children’s video and teleconferencing Health (King County), Catholic Community outreach program. Services (Pierce County), Compass Community Health (Snohomish and Island Counties), Valley Changing organizational practices Community Mental Health (South King County) Emergency department mental health and Navos (King County). The community centers identified a lack of pediatric inpatient The Department of Psychiatry’s crisis response psychiatric beds as the biggest gap in care. As team expanded its role to provide support a result, Children’s is increasing inpatient beds for emergency department (ED) staff and from 20 to 26-31 in 2014 and to 41 in 2015. psychiatry residents 24 hours a day, seven days a week. A mental health evaluator and Centers of Excellence a pediatric mental health specialist assess At Children’s we are focusing our efforts in four children in the ED and work with the child and Centers of Excellence that will serve healthcare the family to create a plan on how to take care
48 Community Health Needs Assessment Report 2013 of the child until their outpatient appointment. Children’s, the PAL program provides free They also help ED staff follow the required steps child mental health consultation services to admit patients in the Inpatient Psychiatric to all primary care providers in the state of Unit when there is a medical necessity. Washington. It serves around 400 community physicians in Washington. PAL also offers a Community education and services downloadable mental healthcare resource Telemental Health (TMH) for doctors, Primary Care Principles for Child Videoconferencing allows children with mental Mental Health. health care needs in underserved communities Pastoral and spiritual care to talk with a psychiatrist in a distant center. The Community Mental Health Council is TMH provides services through Seattle working to educate and prepare pastors and Children’s Tri-Cities Clinic, a small mental health spiritual leaders to support individuals with clinic in north-central Oregon, and at the Alaska mental health issues. Psychiatric Institute in Anchorage to provide services to Alaska Native youth in remote areas Community outreach lectures for physicians of western Alaska. Children’s experts speak about mental health Education via media issues in the WAMI region and beyond. Children’s provides behavioral health education Developmental Pathways Research Program through media outlets such as network TV, local (DPRP) radio and online. Children’s partners with Seattle Public Schools Individual education to improve the recognition and management of mental health problems for middle school and The education services Children’s offers to high school students. The program includes families include: training and consultation for 17 school-based • Meal support classes for parents with children mental healthcare providers in assessment and or teens who have eating disorders management of mental health concerns. • Support groups for deaf and hard-of-hearing Middle-School Support Project (MSSP) teens and preteens who have mental illness Launched in partnership with the Nesholm • Support groups for parents of children Family Foundation and Sound Mental Health, who are going through dialectical behavior the goal of this program is to develop a school- therapy or who have children on the autism based initiative to support students’ academic spectrum success by integrating behavioral health • The Shared Resources Line (SRL), which services into the schools’ existing student provides family support through phone calls, support systems. The MSSP provides full-time school visits and team reviews outside of mental health professionals in schools with high outpatient visit. Families can call the SRL and levels of poverty and low student performance. speak with someone to get help with a crisis The program offers crisis intervention, or question. screening and referral, care management and comprehensive care. Community partnerships and provider education Injury Partnership Access Line (PAL) In the state of Washington, injury is the leading A partnership between the Department cause of death for children over 1 year old. The of Social and Health Services and Seattle leading injury-related hospitalizations are for falls, poisonings and motor vehicle crashes. The
Community Health Needs Assessment Report 2013 49 leading unintentional injury–related deaths are In 2006, 41,455 children were referred to motor vehicle crashes, drowning and poisoning. Washington state’s Child Protective Services Substantial disparities exist for childhood injury; (CPS); that is 26.8 per 1,000 children under age 217 there are higher injury rates for: 18. Across the state, children from 0 to 3 years • Infants and teens 15 to 17 years old old are at the greatest risk of any abuse. They have the highest abuse and neglect rates, and they are • Boys the most likely to experience recurrence of abuse 218 • African Americans and to die from abuse and neglect. • Native Americans Neglect is defined as “a failure to provide the • Alaskan Natives basic needs required to sustain and promote 219 • Children living in rural areas of the state a child’s health, safety and well-being.” Neglect accounts for 70% of validated child • Children living in areas with higher rates maltreatment cases in the state. of poverty and lower rates of educational 214 attainment Recommended strategies In South King County, rates of hospitalization • Provide support programs for parents from injuries are higher than state rates for falls, (especially first-time parents). Train parents motor vehicle accidents, pedestrian/vehicle in promoting positive child and youth 220 accidents, burns, cuts and drowning. development. • Provide public education about what abuse is Injury and children and youth with special 221 needs and how to recognize and report it. Youth in Washington with disabilities are more • Support efforts to educate and prevent 222 likely than youth without disabilities to be at Shaken Baby Syndrome. risk for unintentional injury. Compared to 10th • Teach parents positive child-rearing and grade youth without disabilities, Washington management skills, and safe and nurturing 10th graders with disabilities are more likely to 223 strategies. never or rarely wear seatbelts and to drive after drinking alcohol. Similar results were found for • Provide services that target primary prevention eighth graders and 12th graders. programs (for the general public), secondary prevention programs (targeted to high-risk *(See Appendix, Figure 40: Leading Causes and Total 5-Year Incidence of Injury Deaths by Age Group, families), and tertiary programs targeting 224 Washington, 2004-2008 and Figure 66: Hospitalizations families where abuse has occurred. Due to Injury: 0-17, South King County 2005-2009.) 217 Washington State Department of Health Injury Prevention Program. Child maltreatment (2004). Washington State childhood injury report (DOH Publication No. 341-012). Olympia, WA. One in five U.S. children experience some form 218 Ibid. 215 219 Rivara, F., McCormick, E., Jenkins, C., & Christakis, D. (2010). The of child maltreatment. As the affected child potential role of Seattle Children’s in preventing child maltreatment and optimizing parenting in Washington State. Report presented at the grows older, child abuse and neglect increase the Advocacy Advisory Council, Seattle Children’s Hospital. risk of delinquency, substance abuse, adolescent 220 Ibid. 221 Washington State Department of Health Injury Prevention Program. pregnancy, adverse health behaviors, suicide (2004). Washington State childhood injury report (DOH Publication 216 No. 341-012). Olympia, WA. attempts and HIV-risk behaviors. 222 Ibid. 223 Centers for Disease Control and Prevention. (2009). Strategic direction 214 Washington State Childhood Injury Report, Washington State DOH, for child maltreatment prevention: Preventing child maltreatment Injury Prevention Program September 2004. through the promotion of safe, stable, and nurturing relationships 215 U.S. Department of Health and Human Services, Administration between children and caregivers. Retrieved September, 2010 from: on Children, Youth and Families (2010). Child maltreatment 2008. http://www.cdc.gov/ViolencePrevention/pdf/CM_Strategic_Direction-- Retrieved October, 2010, from: http://www.acf.hhs.gov. Long-a.pdf. 216 Washington State Department of Health. (June, 2008). Washington 224 U.S. DHHS Administration for Children and Families, Child Welfare State injury and violence prevention guide. Retrieved October, 2010 Information Gateway (n.d.). Framework for prevention of child from: www.doh.wa.gov/Portals/1/Documents/2900/InjuryReportFinal. maltreatment. Retrieved September, 2010 from: http://www. pdf. childwelfare.gov/preventing/overview/framework.cfm.
50 Community Health Needs Assessment Report 2013 • Promote protective factors in support Seattle Children’s assets and strengths programs and services. The following The complex medical, legal, social and protective factors are linked to a lower psychiatric problems involved in every case of incidence of child abuse and neglect: suspected child abuse and neglect require the - Parent-child nurturing and attachment help of knowledgeable and skilled professionals. - Parenting knowledge of child and youth The Seattle Children’s Protection Program development assists hospital staff and community physicians - Parental resilience in assessing whether reasonable cause for action exists and helps them determine the - Social connections appropriate course of action. - Concrete support for parents (such as basic resources, connection to support services, The Protection Program is conducting a drug and alcohol treatment, and counseling statewide assessment of parenting programs 225 and public benefits) to understand needs and gaps in the state. This 226 will help define what greater role Children’s Healthy People 2020 might play regarding community advocacy and Healthy People 2020 objectives related to prevention of child maltreatment. maltreatment include: Education and Outreach • Reduce child maltreatment victims from 9.4 in 2008 to 8.5 per 1,000 children under 18 in The Protection Program offers educational 2020. resources for parents, caregivers and healthcare providers. It distributes educational • Reduce child maltreatment fatalities from 2.4 materials about healthy and safe parenting in 2008 to 2.0 per 100,000 children under 18 skills, including the Have a Plan video created in 2020. in partnership with Strengthening Families Community assets and strengths Washington and Conscious Fathering. • Strengthening Families Washington (formerly Other materials the program distributes are Council for Children & Families), an initiative aimed at abusive head trauma awareness and of the Department of Early Learning, that prevention, stress management, discipline focuses on helping families strengthen family and keeping families safe. The program offers bonds, understand child development and information about and access to community develop positive parenting skills. agencies and services that protect and help children and families. It educates Children’s • Parent Trust for Washington Children, which staff and the community in identifying and promotes health and safety in families and responding appropriately to family violence, communities by offering free or low-cost child abuse and neglect. classes, workshops, educational campaigns The Protection Program also promotes the and coaching for families. Period of PURPLE Crying Approach to Shaken • Childhaven, a therapeutic nursery serving Baby Prevention and hosts a statewide children who have experienced abuse and taskforce to disseminate this information neglect. through state hospitals, clinics and agencies that have contact with pregnant women and their partners, as well as to parents and 225 The U.S. Department of Health and Human Services’ Children’s Bureau, caregivers of newborns. Office on Child Abuse and Neglect.(2009). Strengthening Families and Communities. 226 U.S. Department of Health and Human Services..(2020). Healthy people 2020, injury and violence prevention. Retrieved December 13, 2010 from: http://www.healthypeople.gov/2020/topicsobjectives2020/ overview.aspx?topicid=24.
Community Health Needs Assessment Report 2013 51 Head injuries and bike helmets • Provide bicycle helmets to families in need, Head injury is the most common cause of death and provide education to families about how bicycle helmets can prevent bicycle-related and serious disability in bicycle crashes. A 232 correctly worn bicycle helmet reduces the risk Injuries. 227 of a head injury by nearly 85%. In a national • Provide education for the whole family on study by Safe Kids, 41% of children observed proper fit and use of helmets. Educational were wearing a helmet while participating in and promotional campaigns for bicycle wheeled sports. More than a third of child riders helmet use are most effective when 228 233 wearing helmets wore them improperly. There conducted at the local level. is a need for adolescent helmet education and Community assets and strengths awareness programs. By 12th grade, only 13% of students report wearing a bike helmet always Some community assets around bike safety or most of the time. In 2006, 45% of eighth include: graders, 27% of 10th graders and 30% of 12th • Safe Kids is a nationwide network working graders who rode a bicycle in the past year to prevent unintentional childhood injury by 229 wore a helmet most of the time or always. educating the community, providing safety Bicycle injuries among Washington children 0 to devices to families, and advocating for laws 17 years old account for an annual average of to keep children safe. Safe Kids has several three deaths, 206 hospitalizations, and about coalitions in Washington state, including 6,800 visits to hospital emergency rooms. Washington State Safe Kids, Safe Kids Seattle Bicycle hospitalization rates were highest in and Safe Kids South King. the 10 to 14 age group. Bicycle injuries are the • Cascade Bicycle Club provides education, second leading cause of injury hospitalization consulting services and helmet fitting, and for Washington children ages 5 to 14 years. low-cost sale events in Seattle and King Though bike helmets are required by law in County with the goal of creating a better Seattle and King County, many children do not community through bicycling. wear helmets when they ride. Many families • City and county bike helmet laws: Since 1994, cannot afford bike helmets and are unaware of King County has required all bicyclists to the importance of wearing them. On average, wear a helmet. In 2003 the law was expanded a $12 bike helmet for children ages 3 to 14 to include Seattle, where bicyclists may be 230 generates $580 in benefits to society. cited and fined for not wearing helmets. Recommended strategies • Harborview Injury Prevention & Research • Increase availability and accessibility of Center (HIPRC) led a statewide community 231 helmets. campaign to promote the importance of wearing bicycle helmets. • Kohl’s Through the Care for Kids program 227 Centers for Disease Control and Prevention (1995). Injury-control recommendations: bicycle helmets. MMWR;44, (No. RR-1). supports kids’ health and education initiatives 228 Cody BE, Quraishi AY, Mickalide AD.(2004). Headed for injury: An in communities nationwide. It focuses observational survey of helmet use among children ages 5 to 14 participating in wheeled sports.. National SAFE KIDS Campaign, primarily on injury prevention, immunization Washington DC. 229 Washington State Department of Health (2006). Washington State and nutrition programs. healthy youth survey. Retrieved from: http://www.doh.wa.gov/ Portals/1/Documents/Pubs/WashingtonStateHYS2006.pdf. 232 Washington State Department of Health, Injury Prevention 230 Health Resources and Services Administration’s Maternal and Child Program. (September 2004). Washington State childhood injury Health Bureau-Children’s Safety Network (2010). Injury prevention: report. Retrieved from: http://www.childdeathreview.org/reports/ what works? A summary of cost-outcome analysis for injury prevention WashingtonStateChildhoodInjuryReport.pdf. programs. 233 Centers for Disease Control and Prevention. Healthy people 231 Washington State Department of Health (2004). Health of 2020: Injury and violence prevention. Retrieved from: http:// Washington State. Retrieved from: http://www.doh.wa.gov/ www.healthypeople.gov/2020/topicsobjectives2020/overview. DataandStatisticalReports/HealthofWashingtonStateReport.aspx. aspx?topicid=24.
52 Community Health Needs Assessment Report 2013 • Washington Bike Alliance advocates for misused in a way that could increase a child’s 237 bicyclists and a bike-friendly Washington risk of injury during a crash. through legislation, research, education and Motor vehicle crashes remain the leading cause the built environment. of injury and death for children and young 238 Seattle Children’s assets and strengths adults in the state. A risk factor for most causes of injury is drug or alcohol impairment in Children’s has helped spearhead a statewide supervising adults and older children. More than community education effort promoting the two-thirds of fatally injured children were killed 239 importance of wearing bicycle helmets. We while riding with a drinking driver. About 45% have reached out to underserved communities of Washington children and teens who died in across the state with the Kohl’s Health and crashes were unrestrained by a child safety seat 240 Safety Van program. Children’s staff conducted or seatbelt. Motor vehicle occupant injuries helmet fittings and low-cost helmet sales for among Washington children 0 to 17 years old low-income and underserved families in the account for an annual average of 64 deaths, greater Seattle/King County region. Children’s is 355 hospitalizations and an estimated 10,600 241 also a sponsor of Bike to Work Day. visits to hospital emergency departments. Of the 22 children 4 to 8 years old who died in car In partnership with Harborview Injury 242 Prevention and Research Center, Cascade crashes, only one (5%) was in a booster seat. Bicycle Club, Washington Bike Alliance, local elected officials and government agencies, Children’s designed and implemented a community intervention to increase bicycle helmet use. The bicycle helmet program has been widely cited as a national model. The Odessa Brown Children’s Clinic Bike Helmet Program educates the community on the importance of wearing bike helmets, and it distributes and fits children with bike helmets. Child passenger safety Nationally, 43% of children ages 4 to 7 years 234 are restrained in booster seats. Child safety seats reduce the risk of death in passenger cars by 71% for infants and by 54% for children 235 ages 1 to 4 years. For children ages 4 to 7 years, booster seats reduce injury risk by 59% 236 compared to seat belts alone.
Child-restraint systems are often used 237 National Highway Traffic Safety Administration. (2006). Department of Transportation (US), National Highway Traffic Safety Administration incorrectly. One study found that 72% of nearly (NHTSA), Traffic Safety Facts Research Note 2005: Misuse of Child Restraints: Results of a Workshop to Review Field Data Results. 3,500 observed car and booster seats were Washington (DC). Retrieved October 2010, from: http://www.nhtsa.dot. gov/people/injury/research/TSF_MisuseChildRetraints/images/809851. pdf. 234 U.S. Department of Health and Human Services. (2010). Healthy people 238 Washington State Department of Health Injury Prevention Program. 2020, Injury and violence prevention. Retrieved December 13, 2010, (2004). Washington State childhood injury report (DOH Publication from: http://www.healthypeople.gov/2020/default.aspx. No. 341-012). Olympia, WA. 235 Harborview Medical Center, Seattle Children’s Hospital, Public Health 239 Shults, R.A. (2004). Child passenger deaths involving drinking Seattle & King County. (2004-2006). Injury Free Coalition for Kids drivers—United States, 1997−2002 MMWR, 53(4):77–9. Seattle. Report to the Community. 240 Ibid. 236 Durbin, D.R, Elliott, M.R., & Winston, F.K. (2003). Belt-positioning booster seats and reduction in risk of injury among children in vehicle 241 Ibid. crashes. JAMA, 289(14):2835–40. 242 Ibid.
Community Health Needs Assessment Report 2013 53 • A study of booster seat use among Latino Washington State Passenger children found they were one-third less likely Safety Facts to use a booster seat than were non-Latino children. They were also more likely to be • Teens ages 15 to 17 have the highest rate 249 completely unrestrained. of motor vehicle occupant deaths and 243 hospitalizations. • No retail stores in Central and Southeast Seattle report carrying car or booster • Hospitalizations for child motor vehicle 250 seats. A lack of access to safety seats and occupants are more likely to occur in rural economic resources make families in Central areas. and Southeast Seattle less likely to use these • Data show lower safety restraint use among safety devices. children killed in motor vehicle crashes in • Individuals with few economic resources or rural parts of Washington state compared to 244 little formal education are less likely to use urban areas. safety devices due to lack of money. They are • Compared to 10th grade youth without more likely to lack transportation to a store disabilities, Washington 10th graders with where they could purchase safety devices, to disabilities are more likely to never or rarely lack control over housing conditions, and to 251, 252 wear seatbelts and to drive after drinking believe that injuries are preventable. alcohol. Similar results were found for eighth 245 Recommended strategies and 12th graders. Child safety seat distribution and education programs are effective in increasing child 253 Racial and ethnic subgroups safety-seat use. On average, a $35 booster There are significant disparities in unintentional seat generates $2,500 in benefits to society, and child safety seats yield an estimated cost injury rates among racial and ethnic population savings of $2,200 for an average cost of only subgroups. In Washington state and nationally, 254 $52. These strategies could help increase injury death rates increase as poverty increases 246 safety-seat use: and as educational attainment decreases. Injury disproportionally affects children of • Increase the availability and accessibility of 255 Southeast and Central Seattle, the city’s multi- car seats and education to parents. ethnic core. The rate of hospitalization due to • Provide education along with child safety unintentional injury is greater for children in seats and booster seats to low-income these areas than for children in King County 247 249 Stehr D., & Lovrich NP. (August, 2002). An assessment of child as a whole. The following disparities relate to booster seat usage in the state of Washington: Results of a statewide 248 observational study. Pullman: Washington State University. safety restraints: 250 Seattle Children’s Hospital and Harborview Injury Prevention and Research Center Booster Seat Study. (n.d.). Observations survey of 243 Washington State Department of Health Injury Prevention Program. safety seat use in the central district of Seattle: May-September 2003. (2004). Washington State childhood injury report (DOH Publication 251 10 National SAFE KIDS Campaign (NSKC). (2004). Children at risk fact No. 341-012). sheet. Washington (DC): NSKC. Olympia, WA. 252 11 Cubbin C, Smith GS.(2002). Socioeconomic inequalities in injury: 244 Ibid. critical issues in design and analysis. Annu Rev Public Health, 23:349- 245 Washington State Department of Health, Office of Maternal and Child 75. Health. (October 2009). Youth with disabilities risk factors for injury 253 Zaza, S., Sleet D.A., Thompson R.S, Sosin D.M., & Bolen, J.C. (2001). data monograph. Task force on community preventive services. Reviews of evidence 246 Washington Department of Health (September, 2004). The health regarding interventions to increase the use of child safety seats. of Washington State 2004 Supplement: A statewide assessment American Journal of Preventive Medicine , 21 (4S), 31-47. addressing health disparities by race, ethnic group, poverty and 254 Health Resources and Services Administration’s Maternal and Child education. Retrieved October, 2010, from: http://www.doh.wa.gov/ Health Bureau-Children’s Safety Network. (2010).Injury prevention: DataandStatisticalReports/HealthofWashingtonStateReport.aspx. what works? A summary of cost-outcome analysis for injury prevention 247 Harborview Medical Center, Seattle Children’s Hospital, Public Health programs. Seattle & King County. (2004-2006). Injury Free Coalition for Kids 255 Washington State Department of Health Injury Prevention Program. Seattle. Report to the Community. (2004). Washington State childhood injury report (DOH Publication 248 Doll, L., Bonzo, S., Sleet, D., Mercy, J., & Haas, E.N. (Eds.) (2007). No. 341-012). Handbook of injury and violence prevention. Springer. Olympia, WA.
54 Community Health Needs Assessment Report 2013 parents through low-cost seat sales, • Harborview Injury Prevention and Research 256 giveaways or short-term loans. Center (HIPRC) co-sponsored with Children’s • Train Spanish-speaking car-seat technicians. the Latino child-passenger safety campaign to serve minority populations in Western and • Increase number of car-seat-check events Eastern Washington. and car-seat education programs in Seattle and Southeast King County. • www.Boosterseat.org, a website maintained
257 by HIPRC and created by the Washington Healthy People 2020 State Booster Seat Coalition. The following Healthy People 2020 objectives • Safe Kids works with local organizations and relate to child passenger safety: families to prevent unintentional injuries, • Reduce motor vehicle crash-related deaths. including promoting child passenger safety. • Reduce nonfatal motor vehicle crash-related • Washington Traffic Safety Commission injuries. coordinates Washington’s traffic safety • Increase age-appropriate vehicle restraint efforts by working with communities to system use in children: identify and help resolve traffic safety issues, analyzing data, distributing state and - Birth to 12 months. Target: 95%. Baseline: 86% federal traffic safety funds, and conducting of children ages 0 to 12 months were restrained education campaigns. in rear-facing child safety seats in 2008. • Allstate Foundation, Schuck’s Auto Supply - Children ages 1 to 3 years. Target: 79%. and the Seattle Mariners, among others, have Baseline: 72% of children ages 1 to 3 years provided funding for community car seat were restrained in front-facing child safety programs. seats in 2008. Seattle Children’s assets and strengths - Children ages 4 to 7 years. Target: 47%. Baseline: 43% of children ages 4 to 7 years For the past decade, Seattle Children’s has were restrained in booster seats in 2008. been a strong child passenger safety advocate, with a focus on promoting booster seat use in - Children ages 8 to 12 years. Target: 86 %. children between 4 and 8 years old. Children’s Baseline: 78% of children ages 8 to 12 years developed and instigated an award-winning used safety belts in 2008. community intervention campaign, the Community assets and strengths Campaign to Promote Booster Seat Usage in • The Safety Restraint Coalition collaborates Targeted Communities. The Latino version of with families, law enforcement, healthcare this program, Coalición por la Seguridad Vial providers, government agencies and de los Niños y Niñas en Washington, serves advocates to promote seat belt and car seat minority populations in Western and Eastern use. Washington and is a national injury prevention model. • Car-seat checks offered at hospitals in Seattle and South King County. Children’s and Odessa Brown Children’s Clinic provide low-cost car seats and booster seats • Strong laws supporting child passenger to patients and the community. Children’s staff safety in Washington state: the child members hold car seat safety checks at the passenger restraint law and the seat belt law. hospital and conduct educational programs
256 Ibid. and low-cost seat sales in partnership with 257 U.S. Department of Health and Human Services. (2010). Healthy people 2020, Injury and violence prevention. Retrieved December 13, 2010, Seattle Head Start programs. In 2000, Seattle from: http://www.healthypeople.gov/2020/topicsobjectives2020/ Children’s worked to promote and pass the overview.aspx?topicid=24.
Community Health Needs Assessment Report 2013 55 Washington state primary child safety seat law, • Buckle Up! Your Bundles of Love (car seat the first booster seat law in the nation. class for expectant parents) Community and individual education Drowning prevention • Provides low-cost booster and car seats to Drowning is the second leading cause of injury hospital patient and Emergency Department death for Washington children ages 1 to 17 families (25% of these seats are given to years. Among children in the state, drowning non-English-speaking families), and teaches accounts for an annual average of 27 deaths, parents how to use them correctly. 30 hospitalizations and about 110 visits to a • Co-sponsored the Latino child-passenger hospital emergency department. Drowning safety campaign with Harborview Injury death rates are highest in children 1 to 4 years Prevention and Research Center to serve old and in adolescents 15 to 17 years old. Most drowning in the state occurs in open water like minority populations in Western and Eastern 258 Washington. lakes or rivers. 259 • Provides low-cost or free booster seats to Key state drowning findings include: children and their families at Seattle Head • Infants are most likely to drown in a bathtub. Start locations, reaching underserved, • Children 1 to 4 years old most often drown minority and low-income families in King in open water; most of the swimming-pool County (in partnership with Odessa Brown deaths occurred in this age group. Children’s Clinic, Schuck’s and PEMCO). • None of the private pools or hot tubs • Provides on-site quarterly public car-seat- involved in a child drowning had a locked check events to review individual car seats gate. for proper installation and to educate parents. Children’s is the only Seattle organization • A lifeguard was present in only three of the providing regular free car-seat checks and 58 drowning deaths that occurred in open targeting culturally diverse and underserved water or in a pool. families. • 89% of children birth to 5 years, 80% of children 6 to 12 years and 50% of youth 13 to • Provides technicians trained in how to fit and 260 use car seats for children with special health 17 years wear life jackets in boats. care needs. • In a review of child and youth drowning • Sponsors an infant car-seat class for from 1999-2003, the Washington State Child expectant parents four times a year. The class Death Review determined that 85% were is taught by a certified child-passenger safety preventable. Interventions such as life jackets, learning to swim and lifeguards could have expert who shows parents-to-be how to 261 install their baby’s car seat and safely secure prevented deaths. the baby in the seat. • The risk for drowning increases among • Children’s Center for Diversity and Health individuals with less formal education and 258 Washington State Department of Health, Injury Prevention Program Equity provides car and booster seat (September 2004). Washington State childhood injury report. education Retrieved October 2010, from: http://www.doh.wa.gov/hsqa/ emstrauma/injury/pubs/wscir. 259 Washington State Department of Health, Maternal and Child Health Educational resources Assessment. Washington State child death review database. Includes deaths reviewed as of June 2006. • Booster Seat Education (easy-to-read flyer in 260 Seattle Children’s Hospital and Harborview Injury Prevention and Research Center. Washington State Boating Personal Flotation Device 14 languages) (PDF) Use Report, 2011. www.seattlechildrens.org/dp. 261 Washington State Department of Health (June 2004). Child death review state committee recommendations on child drowning prevention. Retrieved October 2010, from: http://www.doh.wa.gov/cfh/ mch/documents/Child_Drowning_Prevention.pdf.
56 Community Health Needs Assessment Report 2013 higher poverty rates and disproportionally • Increase life-jacket use in boats and while 262, 263 affects minorities. swimming in open water where no lifeguard 270 • Compared to 10th graders without is present. disabilities, Washington 10th graders with • Increase access to free and low-cost life 271 disabilities are less likely to use a life vest jackets for both children and adults. 264 when in a small boat. • Develop and implement culturally competent • Persons with a seizure disorder have a higher water safety education campaigns to reach 272 risk of drowning. Children and adolescents ethnically and racially diverse populations. with a history of seizure disorder are at • Increase access to swimming lessons for low- particular risk and need close monitoring and income and culturally diverse children, youth 273 supervision when bathing and when in or and families. near the water. Of the child drowning deaths reviewed, seven of the children (10%) either Community assets and strengths had a history of seizure disorder or seizure Community assets include: 265 was listed on the death certificate. • Parks departments, YMCAs and other Recommended strategies organizations that provide swimming lessons, 266 single gender swims and lifeguarded pools Healthy People 2020 objectives and beaches. • Reduce drowning deaths. Target: 1.1 • Washington State Parks Boating Program drownings per 100,000 population. Baseline: helps coordinate and set up boating safety 1.2 drownings per 100,000 population and life jacket loaner programs. occurred in 2007 (ages adjusted to the year • Public Health Seattle & King County tracks 2000 standard population). drowning deaths and has water safety State drowning prevention recommendations information on their website. • Provide education and awareness programs • Safe Kids helps to coordinate life jacket 267 for children and adults. loaner programs at the county and state level. 268 • Encourage policies and regulations. • Seattle Parks and Recreation Department • Provide parent education focused on supports water safety efforts by teaching supervision, safety issues for open water, and parent child swim lessons and selling low- 269 life-jacket use. cost life jackets. • U.S. Coast Guard develops and maintains national and international lifesaving standards for commercial ships and recreational 262 Ibid. 263 Washington State Department of Health (2004). The health of boats and works to minimize the loss of Washington State 2004 supplement: A statewide assessment addressing health disparities by race, ethnic group, poverty and life, personal injury, property damage and education. Retrieved October 2010, from: , http://www.doh.wa.gov/ HWS/doc/HWS2004Supp.pdf. environmental impact associated with the use 264 Washington State Department of Health, Office of Maternal and Child of recreational boats through prevention. Health (October 2009). Youth with disabilities risk factors for injury data monograph. Retrieved October 2010, from: http://www.doh. 270 Ibid. wa.gov/cfh/mch/documents/Injymonograph09.pdf. 271 Washington State Department of Health (2004). The health of 265 Washington State Department of Health (June, 2004). Child death Washington state 2004 supplement: A statewide assessment review state committee recommendations on child drowning addressing health disparities by race, ethnic group, poverty and prevention. Retrieved October 2010, from: http://www.doh.wa.gov/cfh/ education. Retrieved October 2010 from: http://www.doh.wa.gov/ mch/documents/Child_Drowning_Prevention.pdf. HWS/doc/HWS2004Supp.pdf. 266 Centers for Disease Control and Prevention (2010). Injury and 272 Washington State Department of Health (2004). Child Death Review violence prevention. Retrieved December 13, 2010 from: http://www. State Committee Recommendations on Child Drowning Prevention. healthypeople.gov/2020/topicsobjectives2020/default.aspx. Retrieved October 2010 from, http://www.doh.wa.gov/cfh/mch/ 267 Washington State Department of Health, Injury Prevention Program documents/Child_Drowning_Prevention.pdf. (September 2004). Washington state childhood injury report. 273 Seattle Children’s Hospital and Washington State Department of 268 Ibid. Health. (2010). Washington state open water drowning prevention: 269 Ibid. policy strategies for children and youth 2011-2016.
Community Health Needs Assessment Report 2013 57 • Washington Department of Health Office of Seattle Children’s drowning-prevention goals Emergency Medical and Trauma Prevention are to: goals include injury and illness prevention, • Serve as a local, state, national and including coordination of a Centers for international leader in drowning prevention. Disease Control drowning prevention grant in • Identify and promote the use of effective partnership with Seattle Children’s. data collection, surveillance and community • Washington State Drowning Prevention outreach for drowning prevention. Network provides a forum for organizations • Develop and advocate for effective drowning to work together on drowning prevention. prevention policy and systems. Seattle Children’s assets and strengths • Increase access to and use of life jackets. Children’s is recognized locally, nationally and • Increase awareness of drowning risk and internationally for its work on drowning risk prevention, particularly in open water. and prevention, with a particular focus on open • Increase capacity and coordination for drowning water. Children’s work is considered a national prevention in Washington state and nationally. model for bringing diverse groups together. • Increase drowning prevention among Comprehensive community campaigns have culturally diverse communities. resulted in the increased use of life jackets and a reduction in drownings among young children Sports injuries and concussions and teens. The Washington State Drowning Nationally, about 38 million children and Prevention Network is co-led by Seattle adolescents participate in organized sports, Children’s, Public Health Seattle & King County, and about one in 10 receives medical treatment 274, 275 Department of Health, Safe Kids Washington for a sports injury. Half of the injuries and Washington State Parks Boating Program. sustained by youth while playing sports are 276 We are currently focused on a statewide likely preventable. Each year, U.S. emergency open-water drowning-prevention policy departments treat an estimated 135,000 sports- strategy; disseminating best practice open- and recreation-related traumatic brain injuries water drowning-prevention messages with (TBIs), including concussions, among children 277 an international taskforce; developing obesity ages 5 to 18. Increased awareness of TBI prevention policies and system changes to risks, prevention strategies and the importance increase access to swimming lessons for of timely identification and management are children; creating a data tool and tracking essential for reducing the incidence, severity system; fostering state leadership in drowning and long-term negative health effects of this 278 prevention; and reaching out to ethnically type of injury. Athletes who have had a diverse families. Ongoing activities include a concussion are at increased risk for another life jacket loan program at all lifeguarded city concussion, and children and teens are more beaches in partnership with Seattle Parks; low- likely to get a concussion and take longer to 279 cost life jacket sales with Seattle ParksandUS recover than adults. Parents, players and Coast Guard Auxiliary; and making information 274 http://www.safekids.org/assets/docs/ourwork/research/sports.pdf. available in multiple languages. Children’s co- 275 http://www.niams.nih.gov/Health_Info/Sports_Injuries/child_sports_ sponsors community events such as April Pools injuries.asp. 276 The prevention of sport injuries of children and adolescents. (1993) Day and Summer Splashtacular. We also host a Medicine & Science in Sports & Exercise. Aug;25(8 Suppl):1-7. 277 Centers for Disease Control and Prevention. (July, 2007). Nonfatal drowning prevention and water safety website, traumatic brain injuries from sports and recreation activities -United a state and national resource with information States, 2001-2005. MMWR, 56(29);733-737. 278 Ibid. for families, educators and others. 279 Centers for Disease Control and Prevention (n.d.). Injury prevention and control-Traumatic brain injury. Recommendations for preventing concussions in sports. Retrieved October, 2010, from: http://www.cdc. gov/concussion/sports/index.html.
58 Community Health Needs Assessment Report 2013 coaches lack training, skills and knowledge Community assets and strengths in sports injury and concussion prevention. Community assets regarding sports injuries Nearly 18% of athletic injuries treated by Seattle include: Children’s athletic trainers in the Seattle public 280 • Brain Injury Association of Washington schools are concussions. (BIAWA) works to prevent brain injury and Recommended strategies increase awareness, support and hope • Players, parents and coaches need to learn for those affected by brain injury through the signs and symptoms of TBIs, including education, assistance and advocacy. concussion, and take appropriate action • Safe Kids goals are to prevent unintentional 281 when they suspect such an injury. childhood injuries, including brain injury. • Education and recognition remain the Seattle Children’s assets and strengths most important components of improving Seattle Children’s assets include the the care of athletes with concussions. Key Orthopedics and Sports Medicine Department, targets include parents, coaches, school which has developed an advocacy and administrators, athletic directors, teachers, outreach model for sending athletic trainers to athletic trainers, physicians and other 282, 283 work with young athletes in Seattle-area high healthcare providers.
284 schools. Children’s is also involved in ongoing Healthy People 2020 community education and outreach through Healthy People 2020 objectives that relate to programs focused on ski-helmet safety and sport injuries include: concussion prevention. • Reduce fatal traumatic brain injuries. Individual, community and provider education • Reduce hospitalization for nonfatal traumatic Children’s provides education and training brain injuries. on sports injury, concussion prevention and • Reduce emergency department visits for nutrition to more than 460 coaches, parents, nonfatal traumatic brain injuries. athletic trainers, student athletes and school nurses. As part of this outreach effort, we have: • Reduce sports and recreation injuries. Target: 41.0 injuries per 1,000 population. Baseline: • Provided sports participation exams to youth 45.6 per 1,000 population (2008). athletes in South Seattle. • Increase the proportion of public and private • Presented injury prevention and stretching schools that require students to wear techniques to new coaches in the Girls on the appropriate protective gear when engaged in Run program. school-sponsored physical activities. • Attended community and school health fairs to share information about how to prevent 280 Seattle Athletic Trainer’s Program. (2009). Injury statistics report: Active athletes 2008-2010. Sportware. head and other sports injuries. 281 Centers for Disease Control and Prevention. (July, 2007). Nonfatal traumatic brain injuries from sports and recreation activities -United • Co-created a concussion video developed for States, 2001-2005. MMWR, 56(29);733-737. coaches to help them identify concussions in 282 Halstead, M., Walter, K., & The Council on Sports Medicine and Fitness. (September, 2010). Sport-related concussions in children and youth athletes and understand the Lystedt Law. adolescents, Pediatrics Volume 126, Number 3, September 2010. 2010- 2005. 283 American College of Sports Medicine. (November, 2007). Selected • Provided community education via events, Issues in Injury and Illness Prevention and the Team Physician: A web materials and seminars in partnership Consensus Statement. Medicine & Science in Sports & Exercise. Retrieved October, 2010, from: http://stopsportsinjuries.reingoldweb. with Seattle Safe Kids. Events included com/files/pdf/Injury-Prevention.pdf. 284 U.S. Department of Health and Human Services (2020). Healthy people hosting sports safety booths and a 2020, injury and violence prevention. Retrieved December 13, 2010 from: http://www.healthypeople.gov/2020/topicsobjectives2020/ Harborview concussion-prevention clinic. overview.aspx?topicid=24.
Community Health Needs Assessment Report 2013 59 • Provided training to Seattle school nurses on • Enhance community infrastructure to support 288 head injuries and sports injuries. walking. • Helped develop concussion care and • Increase the number of active community 289 treatment guidelines and the return-to-play environments in Washington. criteria for treatment centers. Children’s is • Both Federal Highway Administration and the one of three hospitals in the Seattle area that Washington State Department of Transportation can treat concussions and determine if an require that bicycle and pedestrian athlete is ready to return to play. facilities be part of new construction and • Helped create standards for tracking (and reconstruction projects in all urban areas, managing) students with injuries and absent exceptional circumstances.
290 concussions to improve safety and reduce Healthy People 2020 risk liability for the region’s high school student athletes. Healthy People 2020 objectives relating to pedestrian safety: • Helped develop the Washington state Lystedt Law (requiring all school districts to • Reduce pedestrian deaths on public roads. develop guidelines and informational forms Target: 1.3 deaths per 100,000 population. to educate coaches, youth athletes and Baseline: 1.4 pedestrian deaths per 100,000 their parents about the nature and risk of population occurred on public roads in 2008. concussion and head injury). • Reduce nonfatal pedestrian injuries on public roads. Target: 20.3 injuries per 100,000 Pedestrian safety population. Baseline: 22.6 nonfatal pedestrian Pedestrian injuries are the third leading cause injuries per 100,000 population occurred on of injury death for Washington children ages 1 public roads in 2008. to 9. Statewide, pedestrian injuries in children 0 to 17 years old account for an annual average Community assets and strengths of 13 deaths, 116 hospitalizations and about • Feet First advocates for safe walking in 1,240 hospital visits. Pedestrian death rates neighborhoods and cities, and raises concerns were highest in children ages 0 to 4 and 15 to of pedestrians in conversations with 17. The majority of these deaths occurred on government agencies and community groups. a driveway or city street and involved motor • Seattle Community Council Federation is a vehicles; three of the deaths involved trains. coalition of neighborhood groups working Recommended strategies together to educate one another about issues affecting different communities in the Seattle • Educate and train parents and their children 285 area and to identify ways to address them. about safe pedestrian skills. • Transportation Choices Coalition believes • Advocate for enforcement of state and local 286 the current transportation system is laws. environmentally, economically and • Advocate for funds dedicated to safer socially unsustainable and encourages walking environments (e.g., more pedestrian 288 Department of Health and Human Services Centers for Disease Control bridges, streetlights, playgrounds, sidewalks, and Prevention. (July 24, 2009 ). Recommended community strategies and measurements to prevent obesity in the United States. MMWR paths and trails) at the federal, state and local Recommendations and Reports ,Vol. 58 / No. RR-7. http://www.cdc. 287 gov/mmwR/PDF/rr/rr5807.pdf. levels. 289 Washington State Department of Health.(July, 2008). Nutrition & physical activity plan. Washington State policy & environmental 285 Washington State Department of Health, Injury Prevention Program. approaches. Retrieved October, 2010, from: http://depts.washington. (September, 2004). Washington State childhood injury report. edu/waaction/plan/pa3/index.html. Retrieved October 2010, from: http://www.doh.wa.gov/hsqa/ 290 U.S. Department of Health and Human Services. (2010). Healthy people emstrauma/injury/pubs/wscir. 2020, Injury and violence prevention. Retrieved December 13, 2010, 286 Ibid. from: http://www.healthypeople.gov/2020/topicsobjectives2020/ 287 Ibid. overview.aspx?topicid=24.
60 Community Health Needs Assessment Report 2013 Washingtonians to make alternate use. High school dropout rates are also highest transportation choices like taking a bus or in this group of adolescents, which contributes train, riding a bike or walking. to a lifetime of lowered health status and poverty. The majority of youth ages 12 to 19 report that Seattle Children’s assets and strengths they wish they had waited longer to have sex, Until funding ended in 2011, Children’s was a and nearly 70% of surveyed Washington new partner of the Injury Free Coalition–Seattle, mothers younger than 20 years old reported which sponsored a “walking school bus” to their pregnancies were unintended. encourage urban kids to exercise safely. In the While there have been some recent national program, parent volunteers walk groups of and state decreases noted, alcohol abuse and children to school, stopping at set spots along underage drinking continue to be the state’s the way to collect more kids. The program biggest drug problem. One-fifth of Washington started at one elementary school in 2005 and high school seniors reported being drunk or expanded to four others. The coalition included high at school in the past year. Among youth, Seattle Public Schools, Feet First and Public alcohol use has been linked to unintentional Health–Seattle & King County. injuries, physical fights, academic and Seattle Children’s current efforts related to occupational problems and illegal behavior. pedestrian safety are part of the hospital’s Marijuana continues to be the drug of choice in comprehensive transportation plan, which Washington state for adolescents who undergo includes significant investments in capital projects drug treatment. Over 39% of high school youth that support biking and walking in northeast report ever abusing marijuana, and about one in Seattle. Changes will connect schools and parks eight seniors used prescription pain relievers to with the Burke-Gilman Trail and encourage get high in the past year. people of all ages and abilities to bike and While the rate is lower than that of many states, walk. Strategies include linking the hospital and almost 10% of Washington state youth ages 12 surrounding community to larger walking and to 17 smoke tobacco. Both binge drinking and biking networks and hosting community events tobacco use are listed in the 21 National Critical that promote pedestrian safety. Health Objectives for Adolescents and Young Children’s researchers are conducting studies on Adults. the epidemiology and prevention of pedestrian injuries, environmental influences on physical Adolescent reproductive health activity and eating behaviors, and on the Sexual activity and teenage pregnancy psychosocial factors that influence individual • According to the 2011 Youth Risk Behavioral choice for weight-related behaviors. This work Surveillance Survey, about 48% of high school includes examining how the neighborhood students in the United States had ever had 291 environment impacts weight, physical activity sexual intercourse. The 2010 Healthy Youth and dietary behaviors across the life span. Survey reports that about 31% of 10th graders and 53% of 12th graders in Washington state Adolescent health 292 had ever had sexual intercourse. Sexual activity, school achievement, obesity and eating disorders, and tobacco, alcohol and drug • About 18% of currently sexually active youth use continue to be the areas of most concern reported using birth control pills to prevent regarding adolescent health. pregnancy. Birth control pill use was highest Adolescents with behavioral and mental health 291 Youth Risk Behavior Surveillance, United States 2011, Youth Online: High School YRBS. issues are more likely to be sexually active and 292 Washington State Healthy Youth Survey, http://www. doh.wa.gov/Portals/1/Documents/Pubs/160-196_ engage in other risky behaviors such as drug YouthSexualBehaviorFactSheet2010.pdf, retrieved Aug. 17, 2012.
Community Health Needs Assessment Report 2013 61 among white students (24%), girls (23%), and olds significantly increased from 1998 to 293 12th graders (25%). 2008. This may be due to improved testing • Sexually active teens are more likely to methods, more screenings and improved engage in other risky behaviors such as surveillance, in addition to a possible increase 294 smoking, drinking and illegal drug use. in risky sexual behaviors. • In 2007, the rate of gonorrhea per 100,000 • About 67% of youth ages 12 to 14 and 57% 301 of youth ages 15 to 19 wish they had waited people was 74.7 for 10- to 19-year-olds. 295 longer to have sex. • Despite a lack of data on race/ethnicity, there • From 2005-2007, 68% of surveyed Washington is a disparity in gonorrhea infections between 302 new mothers younger than 20 years old black adolescents and all other races. 296 reported their pregnancies were unintended. • In 2008, 47% of girls in Washington had been • In 2007, birth rates in 15- to 17-year-olds were vaccinated against HPV, compared to 37% 303 higher among teens living in rural areas of the nationally. state. Birth rates were higher among Hispanic, • Between 2004-2008, there were about nine Non-Hispanic Black and Non-Hispanic new HIV cases per year among youth ages 10 304 American Indian teens, and significantly lower to 19. among Non-Hispanic Asian/Pacific Islander *(See Appendix, Figure 69: Sexually Transmitted Disease teens compared to Non-Hispanic White (STD) Infection Incidence Rates in Washington State.) 297 teens. *(See Appendix, Figure 67: King County Birth Rates Recommended strategies 305 Among Girls Ages 15 to 17, 2004-06 and Figure 68: King Healthy People 2020 County Adolescent Pregnancy, 2007.) Healthy People 2020 objectives relating to Sexually transmitted diseases (STDs) STDs, including HIV, are: • Chlamydia is the most commonly reported • Reduce the proportion of adolescents and STD, and gonorrhea is the second most young adults with Chlamydia trachomatis commonly reported STD in both Washington 298 infections. state and the nation. • Increase the proportion of sexually active • Nationally, HPV infection is more prevalent females ages 24 years and under who are among women living below the poverty screened for genital Chlamydia infections line, Black or Hispanic women, and during the measurement year. 299 unmarried women. • Reduce the proportion of females ages 15 to • Among Washington teens ages 15 to 19, 44 years who have ever required treatment reported chlamydia rates are nearly six times for pelvic inflammatory disease (PID). 300 higher in females compared to males. • Reduce the proportion of young adults • Chlamydia rates among 15- to 19-year- with genital herpes infection due to herpes simplex type 2. 293 Youth Risk Behavior Surveillance, United States 2011, Youth Online: High School YRBS. 294 National Campaign to Prevent Teen Pregnancy, The Sexual Behavior of • Reduce the number of new HIV diagnoses Young Adolescents Fact Sheet: http://www.thenationalcampaign.org/ and infections among adolescents and adults. resources/pdf/ss/ss3_YoungAdols.pdf. 295 Ibid. 296 Washington Pregnancy Risk Assessment Monitoring System (PRAMS), 2005-2007. Washington State Department of Health, 2009. 297 Washington State Department of Health Adolescent Needs 301 Ibid. Assessment, Sexual Health, January 2010. 302 Ibid. 298 Ibid. 303 State Department of Health Adolescent Needs Assessment, Sexual 299 Kahn, JA, Dongmei, L, Kahn, RS. Sociodemographic factors Health, January 2010. associated with high-risk human papillomavirus infection. Obstetrics & 304 Ibid. Gynecology. 2007:110 (1): 87-95. 305 Retrieved on December 15, 2010 from http://www.healthypeople. 300 Ibid. gov/2020/topicsobjectives2020/default.aspx.
62 Community Health Needs Assessment Report 2013 • Reduce the rate of HIV transmission among and occupational problems, and illegal 306 adolescents and adults. behavior. Almost 10% of Washington state 307 • Reduce the number of new AIDS cases youth ages 12 to 17 smoke tobacco. among adolescents and adults. • Since 2008, there are 11,000 fewer youth 308 • Increase the proportion of HIV-infected drinking alcohol in Washington state. adolescents and adults who receive HIV • In 2010, 16% of 10th graders and 19% of 12th care and treatment consistent with current graders reported being drunk or high at 309 standards. school in the past year. • Increase the proportion of sexually active • Since 1990, 8th graders are drinking less: 310 persons who use condoms. from 29% to 14% in 2010. Seattle Children’s assets and strengths • About 22% of 10th graders and 23% of 12th graders rode in a vehicle with a driver who • Children’s holds a weekly clinic at Youth had been drinking. 7% of 10th graders and Care’s Orion Center, a multi-service facility 311 12% of 12th graders drove after drinking. open to homeless youth ages 13 to 22 that • In 2010, 8% of 12th graders abused provides a range of services, from meals to 312 case management. prescription drugs (down from 12% in 2008). • Children’s acts as a medical resource for • In 2010, 12.7% of 10th graders and 19.6% of Ryther Child Center, a 24/7 treatment facility 12th graders reported cigarette use in the past 30 days, similar to the smoking rate in for children ages 6 to 12 with significant 313 histories of abuse and neglect and resultant 2008 (14.4% and 20% respectively). behavioral and emotional challenges. • More than 15,000 students (including 1 in 4 Ryther brings children to Children’s for STD 12th graders) used cigarettes or other 314 screening and testing, as well as general tobacco products in the past month. healthcare needs. *(See Appendix, Figure 70: Percent of Public School • Children’s provides medical coverage at Students Who Used Tobacco in the Past 30 Days, By Grade, King County, 2010; Figure 71: Current Youth Cigarette Seattle Children’s Home, an organization that Smoking by Grade, Washington State, 2010; Figure 72: serves the mental health needs of children Current Youth Cigarette Smoking by Grade and Figure 73: and their families throughout Seattle, King Illicit Drug Use by Washington 10th Graders, 2008.) County and Washington state. Recommended strategies 315 • Doctors, nurses and other staff regularly Healthy People 2020 speak in schools and community settings Binge drinking is one of the 21 National Critical on adolescent sexual health for males and Health Objectives for Adolescents and Young females. The For Boys Only: The Joys and Challenges of Growing Up and For Girls Only: 306 Centers for Disease Control Alcohol and Drug Use Healthy Topics, retrieved October 2010: http://www.cdc.gov/HealthyYouth/ A Heart-to-Heart Talk on Growing Up classes, alcoholdrug. 307 Centers for Disease Control and Prevention, www.cdc.gov/tobacco/ taught by experts in adolescent medicine and data_statistics/state_data/state_highlights/2010/states/washington/ index.htm. sponsored by Children’s, teach thousands 308 Washington State Healthy Youth Survey, 2010 http://www.doh.wa.gov/ of youth each year about body changes, DataandStatisticalReports/HealthBehaviors/HealthyYouthSurvey/ Reports/Factsheets.aspx. puberty, sexuality and social issues. 309 Ibid. 310 Ibid. Substance and tobacco use 311 Ibid. 312 Ibid. Alcohol is used by more young people in the 313 Ibid. 314 Public Health Data Watch: Tobacco Use in King County, retrieved Aug. United States than tobacco or illicit drugs. 17, 2012 from http://www.kingcounty.gov/healthservices/health/data/ Among youth, alcohol use has been linked to datawatch/Volume1102.aspx. 315 Retrieved December 15, 2010 from http://www.healthypeople. unintentional injuries, physical fights, academic gov/2020/topicsobjectives2020/default.aspx. Community Health Needs Assessment Report 2013 63 Adults. The Healthy People 2020 objective is to • Legislative advocacy to ensure that current decrease binge drinking among 12- to 17-year- and proposed laws and policies support olds in the past 30 days to no more than 2%. healthy and safe youth development. Tobacco use is also one of the 21 National The Prevention WINS Coalition has implemented Critical Health Objectives for Adolescents the following prevention programs and strategies: and Young Adults. The Healthy People 2020 • Guiding Good Choices parenting workshops objective is to reduce current smoking in grades offered in partnership with University Family nine through 12 to no more than 16%. Additional YMCA, Seattle Children’s and Seattle Public related Healthy People 2020 objectives related Schools. to illegal drug, alcohol and tobacco use are: • Life Skills Training curriculum put into • Reduce the proportion of adolescents who practice at Eckstein Middle School. have been offered, sold or given an illegal drug on school property. • Drug Free Homes Parent Pledge and Parent Resource Guide distributed to Eckstein • Increase the proportion of adolescents never Middle School parents/guardians. using substances and who disapprove of substance abuse. • Enforcement & Consequences Roundtable: During these regular meetings, • Increase the proportion of adolescents who representatives from the Seattle Police perceive great risk associated with substance Department, Seattle City Attorney’s Office, abuse. King County Juvenile Court Services, • Reduce tobacco use, steroid use and inhalant Washington State Liquor Control Board, use among adolescents. and others who work with law enforcement • Reduce the past-year nonmedical use of work on how to improve communication and prescription drugs. cooperation. • Reduce the initiation of tobacco use among Prevention Wins is in part credited with a children, adolescents and young adults. greater than expected decrease of underage drinking in northeast Seattle . • Increase smoking cessation attempts by adolescent smokers. Country Doctor Homeless Teen Clinic Since the 1970s, Country Doctor has provided Community assets and strengths medical and social services to street-involved Prevention WINS Coalition youth ages 12 to 23. Through a Drug Free Communities grant New Traditions from the Substance Abuse and Mental Health New Traditions is a Seattle-based nonprofit Services Administration, the Prevention WINS organization that works with low-income women Coalition, in partnership with Children’s, is and mothers to prevent chemical dependency. working to reduce alcohol and marijuana use among students at Eckstein Middle School and Auburn Youth Resources (AYR) Roosevelt and Nathan Hale High Schools in AYR is a private, nonprofit organization that Seattle. Strategies include: focuses on drug abuse prevention, intervention • Alcohol purchase surveys to reduce retail and treatment. sales of alcohol to minors. YouthCare • A social norms marketing campaign YouthCare has been working for nearly 40 years reflecting the true anti-drug norms among with Seattle’s homeless youth, many of whom parents in northeast Seattle. struggle with drug and alcohol addiction.
64 Community Health Needs Assessment Report 2013 Collaborative School-based Mental Health and programs, family planning, HIV, immunization Substance Abuse Services Project and infectious disease, injury and violence Children’s and Eckstein Middle School have prevention, mental health and mental disorders, partnered to provide a full-time chemical sexually transmitted diseases, nutrition, dependency counselor who screens for substance substance abuse and tobacco use. Healthy use, provides brief intervention and year-long People 2020 objectives include: educational offerings for family and students. • Increase the number of population-based The project is funded by a Mental Illness and data systems used to monitor Healthy People Drug Dependency grant from King County. 2020 objectives that include in their core a Seattle Children’s assets and strengths standardized set of questions that identify lesbian, gay, transgender and bisexual Adolescent Substance Abuse Program populations. This Children’s outpatient clinic cares for teens • Increase the number of population-based and young adults up to 20 years old who use data systems used to monitor Healthy People alcohol, drugs, tobacco or other substances in 2020 objectives that include in their core a ways that are harmful to their health. It partners standardized set of questions that identify with Children’s Psychiatry and Behavioral transgender populations. Medicine program, Harborview Medical Center’s substance abuse program and the Washington AAP Clinical Report: Guidance for the Clinician in Department of Social and Health Services’ Rendering Pediatric Care, Statement on Sexual Orientation and Adolescents (2004) Division of Alcohol and Substance Abuse. 318 The AAP “Office Practice Guidelines” state Healthcare of LGBTQ youth that physicians are responsible for ensuring Several organizations recommend that a safe and supportive environment and preventive healthcare visits for all adolescents offering comprehensive healthcare to all include private, confidential and nonjudgmental adolescents. This includes appropriate medical discussions of sexuality and sexual orientation. care and anticipatory guidance, connecting Despite these recommendations, studies the adolescent to appropriate community consistently demonstrate low rates of disclosure support services, assuring the patient of his of sexual orientation to providers, primarily or her confidentiality, and offering additional because providers simply do not ask. Most screening and education as indicated for each physicians do not regularly discuss sex, adolescent’s sexual activity. sexuality or sexual orientation with adolescent 316 patients. In general, LGBTQ adolescents will Seattle Children’s assets and strengths not initiate a discussion about sexual orientation The following Seattle Children’s departments with their providers. and materials provide support to LGBTQ youth and their families: Recommended strategies • Adolescent Medicine Healthy People 2020 • Psychiatry and Behavioral Medicine Sexual orientation is included in 19 Healthy 317 • Teenology 101 (blog) People 2020 objectives spanning 13 focus areas, including access to care, educational • Sexual Attraction and Orientation (for youth) • Sexual Attraction and Orientation (for parents) 316 Coker, et al. Health and healthcare for lesbian, gay, bisexual, and transgender youth: reducing disparities through research, education and practice (editorial). J Adolesc Health 2009;45:213-215. 318 American Academy of Pediatrics Clinical Report, Guidance for the 317 Healthy People 2020. Retrieved May 15, 2011 from http://www. Clinician in Rendering Pediatric Care, Barbara L. Frankowski, MD, MPH; healthypeople.gov/2020/topicsobjectives2020/overview. and the Committee on Adolescence, http://pediatrics.uchicago.edu/ aspx?topicid=25. chiefs/adolescent/documents/SexualOrientation.pdf.
Community Health Needs Assessment Report 2013 65 Community assets and strengths vaccinations required for school entry. This The following are some of the community leaves infants and toddlers unprotected when they are at greater risk for complications from organizations that provide support to LGBTQ 319 youth and their families: vaccine-preventable diseases. • The Youth Suicide Prevention Program is a In the National Immunization Survey, lower private, nonprofit organization dedicated to immunization rates occur among children reducing youth suicide attempts and deaths with family incomes that are categorized as in Washington state. negative/poor, near poor/low, and middle compared to children with family incomes that • The Trevor Project is dedicated to ending 320 are categorized as high. suicide among LGBTQ youth. It offers a nationwide 24/7 crisis-intervention lifeline, and guidance and resources for youth, parents and educators. • There is a high number of parents in Washington state who are vaccine hesitant. • www.StopBullying.gov provides information on how kids, teens, young adults, parents, The 2009-10 school entry exemption rate educators and others in the community can (6.2%) doubled over the past 10 years and recognize and prevent or stop bullying. was the highest in the nation. Some counties experience greater than 10% exemption 321 • The It Gets Better Project was created to rates. reach out to and support LGBT youth who • Outbreaks of vaccine-preventable disease are being bullied, let them know they are are often traced to susceptible children not alone, and reassure them that if they are whose parents have claimed an exemption able to get through this tough time, it will get from school or child care immunization better. 322 regulations. • Gay-Straight Alliance (GSA) Network • Providers report that they lack adequate empowers youth activists to help fight school knowledge and resources to address parental discrimination, harassment and violence concerns and want tools to help them related to sexual orientation and gender communicate with parents. identity. • Washington state rates for the 4:3:1:3:3:1 • YouthCare provides a wide range of services vaccination series is 66% among children 19 to homeless youth in Seattle including to 35 months old (lower than the national outreach, basic services, emergency rate of 76%). The Healthy People 2020 shelter, housing, counseling, education and 323 objective for this vaccination series is 80%. employment training. • Immunization rates in school-age children Immunizations have declined over the past eight years. Immunizations for healthy children and adults Contributing to this decline may be growing provide protection to the person receiving them 319 Washington State Department of Health (2007). The health of Washington State. Retrieved from: www.doh.wa.gov/hws/doc/ID/ and to children who are too young, have special ID_IMM2007.pdf. 320 The Centers for Disease Control. National Immunization Survey. health care needs or who are immunocompromised Retrieved from: http://www.cdc.gov/vaccines/stats-surv/imz-coverage. and may not be able to receive vaccinations. htm#nis. 321 Washington State Department of Health (2013). http://www.doh.wa.gov/ Children who receive their first immunizations Portals/1/Documents/Pubs/348-324-KindergartenExemptGraph.pdf 322 Opel, D., Diekema, D.S., Lee, N.R. & Marcuse, E. (2009). Social after three months of age are more likely to marketing as a strategy to increase immunization rates. Arch Pediatr remain under-immunized by 24 months. Many Adolesc Med;163(5), 432-437. 323 Washington State Department of Health (2007). The health of children remain unprotected until they receive Washington State. Retrieved October 2010, from:. www.doh.wa.gov/ hws/doc/ID/ID_IMM2007.pdf.
66 Community Health Needs Assessment Report 2013 anti-immunization sentiment as well as (Continue to support Washington State 324 additional vaccine requirements. Immunization Information System – formerly 330, 331, 332 CHILD Profile.) Vaccine hesitancy and provider needs A 2009 survey of vaccine-hesitant Washington • Target communication and social marketing to make “the right immunizations at the right mothers showed that they are influenced 333 by high-profile anti-vaccine messages that time” a cultural norm. present misinformation about vaccine dangers. • Develop clinic and community assessments The survey also showed that parents want to measure rates, provide feedback and 334 open discussion with their providers about promote best practices. the pros and cons of vaccines and that they • Tighten exemption requirements in schools 335 felt providers lacked the latest research on and child care centers. immunizations and seemed unprepared or 325 336 unwilling to respond to their questions. Healthy People 2020 Healthcare providers across the state report a Health People 2020 objectives related to growing number of parents are hesitant to fully vaccination/immunization include: vaccinate. Negotiating or delaying an infant’s • Reduce, eliminate or maintain elimination of immunization schedule is fast becoming more cases of vaccine-preventable diseases. 326 common behavior. Providers report that • Achieve and maintain effective vaccination they lack adequate knowledge and resources coverage levels for universally recommended to address parental concerns, are limited by vaccines among young children. time constraints, and want tools to help them 327 communicate more effectively with parents. In • Increase the proportion of children ages 19 focus groups conducted with parents who had to 35 months who receive the recommended fully vaccinated their children, findings suggest doses of DTaP, polio, MMR, Hib, hepatitis B, parents who immunize their children, when varicella and PCV vaccines. Target: 80%. educated about community immunity and local • Increase routine vaccination coverage levels immunization rates, become concerned about 328 for adolescents: others opting out. - One dose of tetanus-diphtheria-acellular Recommended strategies pertussis (Tdap) booster vaccine by 13 to 15 • Encourage healthcare providers to solicit years. Target: 80%. questions, build trusting relationships and - Three doses human papillomavirus vaccine provide educational materials to vaccine- (HPV) for females by age 13 to 15 years. 329 hesitant parents. Target: 80%. • Continue support for an immunization • Increase the proportion of children and adults registry. This gives providers a tool to support who are vaccinated annually against seasonal clinical decision-making for individual influenza. patients, and to provide community 330 U.S. Centers for Disease Control and Prevention. (n.d.). Guide to and statewide coverage data to drive Community Preventive Services, Vaccines. Retrieved from http://www. thecommunityguide.org/vaccines/index.html. interventions and support outbreak response. 331 Szilagyi, P., Vann, J., Bordley, C., Chelminski, A., Kraus, R., Margolis, P., & 324 Ibid. Rodewald, L. (2002). Interventions aimed at improving immunization 325 Vax Northwest (2009). Online survey of parents. Unpublished rates. In: The Cochrane Library, Issue 3, 2003. qualitative data. 332 Immunization Action Coalition of Washington (2010). Seven essential 326 Ibid. components to achieving high immunization rates. 327 Ibid. 333 Ibid. 328 Vax Northwest (June 2010). Focus Group Data conducted by Porer 334 Ibid. Novelli. Unpublished data. 335 Ibid. 329 Gust, D.A., Darling, N., Kennedy, A., Schwartz, B.(2008). Parents 336 U.S. Department of Health and Human Services. (2010). Healthy people with doubts about vaccines: Which vaccines and reasons why. 2020. Retrieved December 13, 2010 from: http://www.healthypeople. Pediatrics,122,718-725. gov/2020/topicsobjectives2020/default.aspx.
Community Health Needs Assessment Report 2013 67 Community assets and strengths and in implementing community and provider education. Community education efforts include Immunization Action Coalition of Washington Seattle Mama Doc blog entries on immunization The Immunization Action Coalition of issues and fact sheets for families in target Washington works to increase immunization populations. knowledge and rates in Washington state, Children’s offers the influenza vaccination to including: any patient ever seen at Children’s and to adult • Increasing and sustaining public awareness household members free of charge. about the importance of immunizations across the life span in preventing disease, Oral health disability and death. Rates of tooth decay in Washington state • Promoting optimal immunization of adults, children are higher today than in 1994 and teens and all children, especially those under 2000. Significant oral health disparities exist 2 years old and in areas where there is most for minority, low-income, non-English-speaking need based on current epidemiology. children, and children with special health care • Assuring improved timely access to needs. These groups have the highest levels of immunizations for infants, children, dental disease and the lowest levels of access adolescents and adults. to preventive and restorative services. Tooth decay in children leads to an increase in missed VAX Northwest school, pain, discomfort and difficulty with daily VAX Northwest is a partnership of Seattle activities. Children’s, Group Health Foundation, Within National Reach, Community Pediatric Foundation • Dental disease was called the “silent of Washington and the Washington State epidemic” by the U.S. Surgeon General Department of Health. The goal is to increase in 2000, and it remains one of the most timely immunizations in children from birth to common diseases of childhood. It is five times 24 months by: as common as asthma and seven times more 337 • Addressing parental hesitancy by focusing common than hay fever. on the provider-parent interaction by helping • Children and adolescents living in poverty are providers more effectively address parents’ twice as likely to suffer from tooth decay as immunization concerns. their more affluent peers, and their disease is 338 • Reinforcing the pediatric care provider as the more likely to go untreated. principle immunization resource for parents. • More than 51 million school hours are lost 339 • Establishing a new social norm and parent each year due to dental-related illness. advocates supporting full immunizations in 340 Washington target communities. • Of Washington third graders, 58% have tooth Seattle Children’s assets and strengths decay in primary and permanent teeth. Children’s provides expert consultation to state, • Nearly 40% of Washington children start national and international clinical guideline and kindergarten with tooth decay and nearly 15% immunization advisory committees. Children’s is have rampant decay. working to extend best practice guidelines for 337 U.S. Department of Health and Human Services. (2000) Oral Health in tracking seasonal influenza and pneumococcal America: A report of the Surgeon General. vaccinations in patients. We will also continue to 338 Ibid. 339 Ibid. provide expertise and leadership in developing 340 Washington State Department of Health (April, 2011). Smile Survey (2010) The Oral Health of Washington’s Children. http://doh.wa.gov/ clinical guidelines (at national and state levels) cfh/oralhealth/docs/datapubs/SmileSurvey.pdf.
68 Community Health Needs Assessment Report 2013 • Children from low-income families are • Increase the proportion of children, more likely to have more decay experience, adolescents and adults who used the oral rampant decay, and treatment needs than health care system in the past year. those from families with higher incomes. • Increase the proportion of low-income • Children who are Hispanic and speak another children and adolescents who received any language at home (especially Spanish) are preventive dental service during the past second most likely to have more decay year. experience, rampant decay and treatment • Increase the proportion of school-based needs. health centers with an oral health component.
Dental care access 346 Washington state oral health plan strategies • Only 31% of King County children under 6 with 341 For individuals, families and caregivers: Medicaid received any dental services in 2004. • Provide information that is supportive of • About 30% of Washington dentists are healthy lifestyle choices made at the home Medicaid providers, with the majority of and community levels. them seeing only a small number of Medicaid 342 patients annually. • Educate people about the links between oral and general health, and help them find and • Two state mobile dental services help use dental care. improve access to dental care in rural and 343 underserved areas. For system infrastructure: • There are about 62 safety-net dental clinics • Share relevant populations’ oral health status (including community health centers, free information with decision makers. clinics, and Seattle–King County Public • Increase the number of community groups Health clinics) in the state. There are also 22 and services related to oral health. tribal dental clinics and 10 dental clinics in 344 • Promote preventive activities, such as water correctional facilities. fluoridation, sealants, fluorides, oral health Recommended strategies education, tobacco cessation, healthy 345 Healthy People 2020 nutrition and oral-cancer screenings. Healthy People 2020 objectives related to • Rebuild capacity in dental public health at the dental care include: local, regional and state levels. • Increase public-private partnerships to • Reduce the proportion of children and mobilize resources to sustain these strategies. adolescents who have dental cavity experience in their primary or permanent Community assets and strengths teeth and untreated dental decay. Center for Pediatric Dentistry • Increase the proportion of children and The Center for Pediatric Dentistry is a adolescents who have received dental partnership between Children’s, the University of sealants on their molar teeth. Washington School of Dentistry, Washington Dental Service and the Washington Dental Service 341 Public Health Seattle & King County (February, 2008). Access to health care in King County for the uninsured, underinsured and Medicaid Foundation. It serves the combined needs of populations. 342 Ibid. Seattle Children’s Department of Dentistry and 343 Washington State Department of Health (2007). The Impact of Oral Disease on the Lives of Washingtonians. the University of Washington’s Department of 344 Ibid. Pediatric Dentistry. The patient base includes 345 Healthy People 2020, Retrieved February 15, 2010 from: http:// www.healthypeople.gov/2020/topicsobjectives2020/objectiveslist. 346 Washington State Oral Health Plan. (2009-2014). www.ws-ohc.org/ aspx?topicid=32. plan.htm.
Community Health Needs Assessment Report 2013 69 children across the state with a specific focus children and children with special health care 347 on children with special health care needs. needs. The four key areas of interest for the Center The Dental Surgery Center at the Center for for Pediatric Dentistry are research, teaching, Pediatric Dentistry at Magnuson Park healthcare delivery systems and public policy/ The Dental Surgery Center is a day surgery advocacy efforts. center that provides dental and oral surgery The Center for Pediatric Dentistry conducts a and recovery for patients over 3 years old. variety of community outreach events that focus Services include implants, biopsies, fracture on the importance of early childhood oral health: and dislocation treatment, removal of impacted teeth and other minor surgeries. Housed in Washington Dental Service (WDS) the Center for Pediatric Dentistry, the Dental WDS is the state’s leading dental benefits Surgery Center has three operating rooms company. WDS created the Washington staffed and operated by Children’s. Dental Service Foundation, which works with partner organizations to develop programs and Odessa Brown Children’s Clinic Dental Clinic public policies to improve the oral health of OBCC Dental Clinic offers dental exams, Washington’s residents. preventive services and treatment for children ages 12 months to 15 years, including exams for Washington State Department of Health, Oral Health Program children in Head Start programs. Over 80% of patients treated at the OBCC Dental Clinic are This department works to prevent dental covered under the state’s Medicaid program. disease and promote good oral health among Some highlights of the OBCC Dental Clinic’s Washingtonians. accomplishments include: Washington’s ABCD Program • OBCC produced a dental-care video, “Making This nationally recognized program is a Healthy Smiles for a Lifetime,” to help partnership of dentists, educators, public prepare parents for their child’s first dental health agencies, Medicaid representatives and appointment. OBCC staff works with local philanthropic leaders working to better inform Head Start and Early Childhood Education parents about oral health issues and to increase Centers, providing classroom education as the number of dental offices prepared for and well as staff and parent training upon request. willing to care for Medicaid-eligible children Members of the OBCC dental staff serve on 348 under 6 years old. Health Advisory Committees for several Head Start or ECEAP programs in Seattle. Seattle Children’s assets and strengths • The American Academy of Pediatric Dentistry Children’s Department of Dentistry has three and Head Start are partnering with dentists locations: The Center for Pediatric Dentistry, to provide Head Start children with dental Odessa Brown Children’s Clinic (OBCC) and homes. OBCC Serves 300 children through the Dental Clinic at Seattle Children’s. Through Seattle Public School Head Start programs clinical outreach, community and provider and 400 in other Head Start programs. education, Children’s is increasing awareness about oral health issues and working to improve • OBCC helps train medical healthcare access to oral health services for low-income providers to screen infants and children for early signs of poor oral health with 347 Sidekick Magazine (n.d) Retrieved October 25, 2010, from http:// sidekickmag.com/office_design/articles-office-design/dr-joel-berg- the hope of preventing decay. As a result, the-center-for-pediatric-dentistry-university-of-washington-seattle- washington_1291.html. these medical providers can play an integral 348 Washington’s ABCD Program, Improving Dental Care for Medicaid- role in improving the oral health of their Insured Children, The Pew Center on the States, June 2010.
70 Community Health Needs Assessment Report 2013 young patients. OBCC is a training site for • The SmileMobile, a three-chair dental office the Access to Baby and Child Dentistry on wheels, brings dental services to children (ABCD) program, which conducts trainings around the state. The mobile clinic has treated for general dentists who wish to practice more than 25,000 children since 1995. The pediatric dentistry. Children’s medical mobile is powered by a partnership between students and pediatric residents attend Oral Children’s, Washington Dental Service and Health 101 at OBCC one day a year. Washington Dental Service Foundation. • OBCC is a member of the Dental Society Prematurity Access Committee, the State of Washington Oral Health Plan and Oral Health Coalition Preterm birth is now the leading cause of death and the Head Start Preschool Program in the first month of life and the second leading cause of death in children up to age 5 around Advisory Board. the world. Even in the U.S., almost one in eight The Dental Clinic at Seattle Children’s Hospital babies is born preterm — before 37 completed Children’s Dental Clinic on the main hospital weeks of pregnancy. Prematurity rates among campus sees patients referred from other Blacks and Native Americans are nearly twice hospital clinics such as Craniofacial, Autism, as high as those for Whites or Asian Americans. Hematology/Oncology and Transplant. It also At $26 billion annually, preterm birth is a sees urgent cases from Children’s Emergency leading U.S. healthcare expenditure and the largest contribution to pediatric hospital-based Department. Some highlights of the clinic’s 349 community education and outreach efforts expenses. include: In addition to an increased risk of death in • Children’s is one of more than 132 members the neonatal period, prematurity is associated 350 of the Watch Your Mouth Campaign, funded with short-term and long-term morbidity. by the Washington Dental Foundation. This Short-term medical problems faced by these campaign works to raise awareness about infants include respiratory distress, necrotizing enterocolitis and increased risk of bacterial children’s oral health by promoting these issues: sepsis. Longer-term challenges include seizure • Dental Camp is an oral health-career disorders and brain damage, chronic lung awareness program for middle-school- diseases, learning disabilities and Attention 351 age youth from across the state. Target Deficit Hyperactivity Disorder. Treatment of participants include racial and ethnic these long-term effects is a major contributor to groups underrepresented in the oral the economic burden of health care. health workforce, and students from While treatment of infants born prematurely has under-resourced school districts. Program improved, a fundamental lack of knowledge of partners include Children’s, University of the causes and mechanisms of preterm birth Washington’s School of Dentistry, Seattle inhibits the ability to develop interventions that Central Community College’s Dental Hygiene will prevent it. Program and Seattle Vocational Institute’s Dental Assisting Program. • Children’s completed the Healthy Smiles Project (funded by the Washington Dental Service
Foundation), to engage pediatricians and family 349 GAPPS: Overview fact sheet, http://gapps.org/docs/GAPPS_Overview. physicians in providing oral health prevention pdf. 350 Institute of Medicine (US) Committee on Understanding Premature services. Healthy Smiles increased access to Birth and Assuring Healthy Outcomes; Behrman RE, Butler AS, editors. Preterm Birth: Causes, Consequences, and Prevention. Washington oral health services in areas of great need. (DC): National Academies Press (US); 2007. 351 Ibid.
Community Health Needs Assessment Report 2013 71 Washington State 2002, 26% were due to prematurity compared to 360 In 2010, there were 8,572 preterm births in 17% for Non-Hispanic Whites. 352 Washington state out of 86,480 total births. There are also geographic differences within State costs related to prematurity exceeded King County. Looking at 2003-2007 combined $400 million in 2005 for medical care, delivery, data, South King recorded 10% of live births before 37 weeks gestation, compared to 9% in and lost labor and productivity. This economic 361 burden is shouldered by the government, East King. During the same time period, women businesses, communities and families receiving late or no prenatal care represented 6.6% of live births in South King compared to 3.1% in and cannot reflect the personal suffering 362 353 experienced by families. East King and 2.9% in North King. *(See Appendix, Figure 74: Washington Singleton Preterm Disparities persist for Black and Native Deliveries by Maternal Race/Ethnicity, 2006-08; Figure American women who are more than twice 75: Pre-Term Births by Region-King County 2003-2007; 354 as likely to deliver prematurely as Whites. Figure 76: Singleton Preterm Medicaid Deliveries, 2006- 08; Figure 77: Late or No Prenatal Care by Region, King Washington’s average rates of preterm birth County, 2003-07; and Figure 78: Late or No Prenatal Care vary by race and ethnicity: Native Americans Comparing State, King County and Similar U.S. Counties) (14.8%), Blacks (13.4%), Whites and Asian Americans (10.4%). The causes of preterm birth Recommended strategies differ by ethnicity, environment and gestational Smoking cessation for all pregnant women and age. Black infants born preterm are nearly twice progesterone therapy for women with prior 355 preterm deliveries are the two best studied as likely to die as White or Hispanic infants. 363 interventions proven to prevent preterm birth. By maternal age, the highest preterm birth rates Additionally, a reduction in provider-initiated in the state are among the 45 to 49 (12.5%) 356 elective cesarean deliveries before 39 weeks and 15 to 17 (18.4%) age groups. Women on would impact the rate of preterm births. The Medicaid who received cash assistance also had trend toward elective cesarean section deliveries a significantly higher rate of singleton preterm contributes to preterm births, given the possibility delivery than other women (Medicaid and non- 357 of inaccurate dating. Assisted reproductive Medicaid). technology, or ART, (in vitro fertilization, ovulation King County induction, etc.) also contributes to preterm births by increasing the risk of having twins or In 2010, there were 2,287 preterm births in 358 higher-order multiples such as triplets. Limiting King County out of a total of 24,514 births. embryo transfers to a single embryo during IVF Preliminary 2010 race/ethnicity rates show 10.78 for most patients has been demonstrated to per 100 live births in non-Hispanic Whites, 17.15 reduce the risks of a multiple pregnancy. in non-Hispanic Blacks, 13.60 in the American A commitment to biomedical research into the Indian or Alaskan Native population, 10.69 in causes and mechanisms of preterm birth is Asian or Pacific islanders and 11.79 in the Hispanic essential to develop new strategies for prevention 359 population. In a county report looking at causes of preterm birth and improved care for the of African American infant deaths from 2000- 360 Public Health-Seattle and King County. “Racial Disparities in Infant Mortality: An Update King County 1980-2002” Public Health Data 352 Washington State Department of Health, Center for Birth Statistics. Watch. Volume 1, Number 1, October, 2004. http://www.doh.wa.gov/ehsphl/CHS/chs-data/birth/htmltables/d8.htm. 361 Public Health- Seattle and King County. Indicator: Preterm Births, 353 Ibid. King County. http://www.kingcounty.gov/healthservices/health/data/ chi2009/ 354 Ibid. HealthOutcomesPretermBirths.aspx. 355 Ibid. 362 Washington State Department of Health, Center for Health Statistics, 356 Ibid. Birth Certificates, 2003-07. 357 Washington State Department of Health “Preterm delivery for 363 Global report on preterm birth and stillbirth: evidence for effectiveness Singleton Births.” MCH Data Report, DOH 160-015-June 2010. of interventions. Fernando C Barros, Zulfiqar Ahmed Bhutta, Maneesh 358 Ibid. Batra, Thomas N Hansen, Cesar G Victora, Craig E Rubens and the 359 Ibid. GAPPS Review Group.
72 Community Health Needs Assessment Report 2013 preterm infant. The strength of local efforts lies in First Steps biomedical research, support of high-risk mothers First Steps offers a variety of services for low- and appropriate neonatal care for preterm babies. income pregnant women and their infants, Healthy People 2020 including: The Healthy People 2020 objective for the • Maternity Support Services: education, preterm birth rate was set at 11.4%, a 10% nutritional counseling and case management 364 improvement from the 2007 rate of 12.7%. for women at risk for poor infant outcomes due Although Washington state has already to socioeconomic status or other risk factors. reached this goal, future work needs to • Infant Case Management: available for high- address significant racial, geographic and risk women and infants. socioeconomic disparities. • The Nurse Family Partnership: connects first- Community assets and strengths time mothers with registered nurses for the duration of the pregnancy and the first two Equal Start Community Coalition 366 years of the infant’s life. This advocacy and service organization provides outreach workers to seek out women Seattle Children’s assets and strengths who would otherwise fall between the cracks Children’s works to prevent prematurity and of perinatal care. Members advocate for stillbirth through local, national and international recognition of institutionalized racism as a initiatives including: 365 factor in infant mortality. Global Alliance to Prevent Prematurity and Public Health Seattle & King County Stillbirth (GAPPS) The Public Health Department collects and An initiative of Seattle Children’s, GAPPS is evaluates state and county prematurity rates dedicated to improving understanding of and supports data analysis by race/ethnicity, the causes of prematurity and stillbirth, as a foundation for developing successful prevention socioeconomic status and location. 367 and treatment strategies. GAPPS is home Open Arms Perinatal Services to a large repository of specimens collected Open Arms Perinatal Services is a nonprofit from a large and diverse group of pregnant organization that provides community-based women. These specimens are available to support for women through pregnancy, birth and investigators worldwide who aim to understand postpartum and up to two years after the baby is the biological mechanisms of prematurity and 368 born. They provide services in 17 languages. stillbirth. GAPPS stewards the Preventing Preterm Birth initiative, a Grand Challenge in University of Washington Division of Global Health from the Bill & Melinda Gates Neonatology Foundation, designed to unite the scientific The Neonatal Perinatal Database within community to combat and prevent prematurity. the University of Washington Division of The Perinatal Interventions Program (PIP) will Neonatology supports review of morbidity, improve survival and reduce disability of newborns mortality and trends over time. This data allows and mothers by standardizing the care of preterm for longitudinal research, which could be used infants and improving maternal conditions that to educate and inform practices to reduce short lead to preterm birth, stillbirth and other life and long-term morbidity. threatening and disabling conditions. 364 HealthyPeople.gov. http://www.healthypeople.gov/2020/ topicsobjectives2020/objectiveslist.aspx?topicId=26Healthy People. 366 Washington State Health Care Authority, Medicaid. http://hrsa.dshs. gov. wa.gov/firststeps/. March 2012. 365 Conversation with Maria Carlos Program Manager, Infant Mortality 367 Global Alliance to Prevent Prematurity and Stillbirth. http://gapps.org/ Prevention Program, Seattle, King County Public Health on March 19, index.php/research/our_approach. 2012. 368 Ibid.
Community Health Needs Assessment Report 2013 73 Children’s Center for Childhood Infections and Prematurity Research What the This research center investigates mechanisms of infection-related premature birth and the Community Tells Us: multidisciplinary factors that predispose women 369 Gathering to preterm labor and delivery. Center for Developmental Therapeutics Community and The center identifies and develops new drugs Public Health Input and treatments that will be safer and more In keeping with Seattle Children’s mission, effective for children. Its Neonatal Respiratory our community benefit priorities are guided Support Technologies (NeoRest) team is not only by statistics, but by the communities developing affordable, easy-to-use and easy-to- maintain respiratory support solutions that can and families we serve. Children’s CHNA team be used in developing countries. These include gathered information from community leaders respiratory support devices such as the Hansen representing a wide range of interests, with an Ventilator and the bubble Sea-Pap, and artificial emphasis on organizations with public health pulmonary surfactant (a surface-tension- expertise. Families, community members and lowering fluid that coats the inside of a patient’s organizations shared their perspectives on key lungs and permits efficient gas exchange). health and safety issues that impact children The team is also working to improve antenatal through an online survey, phone interviews and corticosteroids therapy, which accelerates lung listening groups. development prior to birth in premature infants. High Risk Infant Follow-Up Clinic in Seattle Online survey key Children’s Division of Developmental Medicine findings The High Risk Infant Follow-Up Clinic in Seattle Children’s Division of Developmental Medicine We gathered input from 74 community leaders is a multidisciplinary clinic that follows children representing 57 organizations through an online after discharge from the Neonatal Intensive survey. Over half of the survey respondents Care Unit. Infants and children are seen at 4, selected poverty, mental health, obesity and 12, 24, 36 and 54 months and at 6 years and lack of parent education as top health and 8 years; 600 patients are seen each year. The safety issues in their communities: clinic helps coordinate patient services and • Poverty was identified by 65.7% in “select all measures longitudinal outcome variables. The top issues”; 37.9% in “choose two top issues” Division of Neonatology has focused research 370 efforts on neurodevelopmental outcomes. • Mental health was chosen by 62.7% in “select all”; 22.7% in “choose two” • Obesity was chosen by 55.2% in “select all”; 19.7% in “choose two” *(See Appendix, Figure 79: Top Statewide Health Issue Concerns.) Opportunities for improvement Stakeholders identified the following 369 Seattle Children’s. http://www.seattlechildrens.org/research/childhood- infections-and-prematurity. opportunities for improvement: 370 University of Washington Department of Pediatrics. http://www. washington.edu/medicine/pediatrics/specialties/neonatology.
74 Community Health Needs Assessment Report 2013 In the community 43% of participants “strongly disagreed” and “disagreed” with this statement. • Educate parents, kids, community and healthcare providers *(See Appendix, Figure 81: Responses to “It is easy for children, adolescents and families to get information on • Add community clinics and increase their how to be healthy and safe.”) hours The final access statement addressed • Provide assistance for immigrants/refugees immunizations (Figure 82); 65% of respondents such as translations, explaining the healthcare “agreed” and “strongly agreed” that it is easy to system and culturally relevant services access immunizations for children and teens. • Provide mobile health units to serve schools *(See Appendix, Figure 82: Responses to “It is easy to get immunizations and vaccinations for children and and churches, for example adolescents.”) Seattle Children’s Possible solutions • Education programs for teachers, health The final four questions were open-ended. The providers, parents and children first one asked what participants believed to • Provide more services in schools (such as be the largest barrier or challenge to accessing health clinics in high schools) healthcare for children, adolescents and • Hold community outreach fairs to families. Some of the key ideas that emerged communicate about available resources include: and to make sure eligible children apply for • Poverty Medicaid • Lack of Medicaid coverage/high cost without • Improve communication with community obtaining coverage organizations via website and listservs • Language issues • Create substance abuse programs for teens, • Lack of culturally sensitive programs possibly in a community setting (go to them) • Not understanding how to access healthcare/ Access to services and information healthcare system is complex We presented a series of statements focused • Parents don’t know where to find resources on family access to health services for children • Lack of transportation and teens. Respondents were asked to agree or disagree with each statement; options ranged • Appointments conflict with parents’ work from “strongly agree” to “strongly disagree.” schedules Participants could also choose to answer “not • High mobility of families/not having a medical sure” and add their written comments. home A large number of participants responded that The next question asked for ideas about what for children/teens, there is a lack of access to could be done in the community to benefit enough doctors who accept Medicaid and to children or adolescents with chronic conditions pediatric specialists, mental health providers, or special health care needs. The answers dental care and emergency care. centered around these themes: *(See Appendix, Figure 80: Lack of Access to Pediatric • Increase coverage for kids that receive care Care.) through Medicaid When respondents were asked to respond to • Develop more low-cost or free community the statement that it is easy to get information clinics on how to be healthy and safe (Figure 81),
Community Health Needs Assessment Report 2013 75 • Provide effective patient care coordinators to immigrants and economically challenged link community resources, the health facility families and the family • Develop sex education programs • Educate parents about available resources • School nurses • Offer transportation or pay for gas costs • Community centers, schools and churches to • Educate the community about chronic bring providers into the community through conditions to reduce stigmatization mobile healthcare • Develop student leaders to serve as peer • Sponsor and attend community outreach fairs educators • Local media organizations to develop media • Develop obesity prevention programs campaigns to educate the community about • Provide safe places to be physically active health issues • Increase primary care clinic hours of • School districts, especially regarding mental operation health, immunizations, dental care and educating parents about how to access • Help educate immigrant families about the resources healthcare system Finally, respondents were asked what Seattle • Educate parents, teens and children about Children’s can do to address the top health how to prevent chronic diseases concerns. The answers can be grouped into • Have mobile healthcare units visit several shared themes: neighborhoods and schools • Enhance culturally relevant programs, • Improve communication between providers, including more translated materials families and schools • Develop better communication with primary • Ensure that children are enrolled in health care clinics, focusing on better follow-up, insurance programs updates and records • Enhance and develop culturally relevant care • Develop parent education programs about • Offer resources in languages in addition to resource access and how to prevent chronic English disease The final two questions addressed what Seattle • Provide more support groups for parents of Children’s can do to make children and families children with special health concerns healthier. First, respondents offered ideas for • Participate more in the community through possible hospital partnerships: partnerships with organizations and nonprofits • Primary care facilities • Expand services into rural areas of • Local businesses to give discounts for safety Washington items such as bike helmets • Collaborate with schools to give families • Organizations that serve sexual, racial and consistent information ethnic minority children to develop trainings • Develop programs to education children for physicians about how to better help these about the importance of good nutrition and children physical activity • Community organizations to get materials • Make the Seattle Children’s website easier to out to communities that currently are use for community organizations, healthcare unaware of the resources, including facilities and families
76 Community Health Needs Assessment Report 2013 • Emphasize not only the child’s health but also several jobs both day and night, limiting their the parent’s health ability to bring children to clinic appointments. • Offer free immunizations around Washington Many interviewees said children of families with incomes just above the poverty level (“the • Expand youth substance abuse prevention, working poor”) are at a significant disadvantage intervention and treatment services because they don’t qualify for many social safety-net programs. One individual stated, Interview key findings “Many of the key health and safety problems stem from the conditions the families live in; Public health experts and community leaders there is not much the health centers can do in expanded on important health and safety that sense.” issues identified in the survey though a series Related to poverty is access to needed health of telephone interviews. We asked participants services. One concern is that families are priced what is needed to improve health and quality of out of necessary services, especially those life for children and families, and what Children’s not covered by Medicaid. For families without can do to address unmet needs. Nine themes employer-based insurance, there are many emerged from these interviews: restrictions on coverage, and they cannot afford • Poverty is a barrier to good health. to pay out-of-pocket for additional services. In • Access to services can be a challenge. some situations, the perceived cost discourages • Communication between providers, schools families from seeking care. In some areas of and families is often inadequate. Washington, healthcare services (such as mental health) are not available. • Rural and South King County are underserved geographic areas. Another barrier to access is the distance between available health services and the • Obesity is a major health concern. families who need them. Many families struggle • Mental health care is limited. with transportation to clinics, especially in low- • Parents have many questions about their income neighborhoods, South King County and child’s health. rural Washington. The public transportation • Adolescents lack services, both perceived system can be unreliable, inconvenient or and real. difficult to understand. • Refugees and immigrant families are A need for better especially underserved. communication pathways and Barriers to accessing healthcare care coordination All interviewees suggested that poverty Several interviewees mentioned the need for played a major role in families’ ability to improved communication between various access services. For example, many healthcare providers, parents and schools, saying that providers do not accept new children on community organizations don’t know about Medicaid, and this limits the types and range all of the services available. Since these of services a child can receive. Poverty is organizations generally disseminate health also associated with obesity, poor housing, information to the community, families may be stress, limited transportation and unsafe uninformed. Those interviewed also mentioned neighborhoods, all of which can directly and a need for improved communication between indirectly impact children’s health. Parents community clinics and Seattle Children’s; in low-income households may be working several referred to “silos” (working in isolation)
Community Health Needs Assessment Report 2013 77 both within Seattle Children’s and between the Parent health education lacking hospital and other organizations. Several people Another concern for interviewees is that interviewed said it was difficult for families to parents don’t have the information and manage their children’s health history records education they need about their child’s health. since so many children lack a primary care Parents face challenges with navigating the provider. healthcare system. One interviewee said that South King County and rural Washington are parents aren’t sure when to go to urgent care, considered notably underserved geographic primary care or the dentist. Parents also are locations. According to one interviewee, there unaware of available healthcare services. There is no health center in Tukwila, so residents is a healthcare knowledge gap between what must travel to SeaTac, Renton or White Center researchers and professionals know, and what for health services. Both South King County families receive. Several interviewees expressed and rural Washington have limited public the need for new parent-education programs, transportation options, making it difficult to get especially those focused on how to prevent to appointments. Interviewees also noted safety chronic disease and navigate the healthcare concerns related to limited transportation; one system, as well as those that teach skills like interviewee stated, “Many young people must healthy cooking. walk one to two miles to school or take Metro; Several interviewees focused on the health there are a variety of safety issues there.” needs of adolescents. Specifically, they were concerned about LGBTQ, racial minority and Obesity is a shared concern homeless youth. Cost and prior bad experiences Most interviewees were concerned about with doctors are barriers to youth accessing widespread obesity, noting factors contributing available healthcare services. Other areas of concern include treatment for chemical abuse to this problem such as unhealthy foods and mental health issues. They felt like some in schools, limited school-based physical unique health concerns facing teens are not education, neighborhoods that are not currently being addressed, including unsafe conducive to physical activity, a lack of healthy relationships, unsafe sex, bullying, low self- foods in local stores, and the high cost of sports esteem and physical violence. and recreation opportunities. A related concern is that families and children need information, Refugee and immigrant support and skills related to eating healthy foods and being physically active. populations at risk Most interviewees expressed concern for Access to mental health the health of refugee, immigrant and non- services is lacking English speaking families. While all families face challenges in navigating the healthcare Mental health care was frequently mentioned as system, families who do not speak English have either insufficient or nonexistent. Mental health significantly more difficulty. This is magnified services are not locally available, cost too much when they come from countries where there money or are difficult to find. In addition, mental are very few health services. Information about health services may not be culturally relevant available services is not reaching refugee and for many populations. Several interviewees immigrant communities, and culturally relevant mentioned that individuals do not seek services are lacking. mental health services because of the stigma associated with mental illness. Many immigrant groups don’t have mental health services in their home countries and are unfamiliar with the concept, and some cultures
78 Community Health Needs Assessment Report 2013 view mental health differently. Some immigrant had to search extensively to obtain relevant groups, especially undocumented individuals, information and it was hard to identify good are afraid to seek out services. Families either sources of information on the Internet. believe their child needs to be a U.S. citizen to These parents were concerned about receive care, or they’re worried about being grandparents as caregivers, saying there are few reported to immigration. In general, immigrant resources geared toward grandparents. Parents and refugee families lack culturally relevant felt that grandparents tend to use “outdated services and interpreted materials. information” and are reluctant to change, despite updated guidelines. This parent group said their children do have access to areas in Listening group key which be physically active, healthy foods and findings safety items such as car seats. This group expressed concerns about these Parent listening groups helped us better health and safety issues in their communities: understand current health and safety issues for children and teens in our communities. Seven • Lack of healthy food at schools themes emerged from these groups: • Distracted driving • Mental health services are difficult to find • Allergies and food allergies • Parent education is inadequate • Grandparents as caregivers • Grandparents lack resources to be caregivers • Immunizations/community immunity • Providers sometimes don’t accept Medicaid • Bullying • High cost of recreational activities is • Healthcare access prohibitive - Mental health services not covered by • Limited English skills are a barrier for seeking insurance health services - Providers not accepting Medicaid and not • Junk food is easily available outside the home paying for interpreters - Lack of a helpful nurse advice line English-Speaking parent listening group key findings Spanish-speaking parent This group’s primary concerns were access to listening group key findings mental health services and parent education. This group echoed the English-speaking One parent recalled a situation when she parents’ concern about lack of health needed to find mental health services for information. They said language was a barrier her son. While she did have employer-based in obtaining information about how to keep insurance, the process of finding a mental their children safe and healthy. These parents health provider to meet her son’s needs was also said it was unclear to them what services complicated and time consuming. She felt the are available for individuals who are not U.S. situation would be exacerbated if her family did citizens. Citizen status was a perceived barrier not have insurance, or if their insurance did not for a wide range of services and activities. have mental health coverage. Several parents also expressed concern about Parent/caregiver education was another the law that limits visits to the emergency concern for parents who feel information is not room for children with Medicaid. Recreation readily available to them about how to keep and sports activity costs are also prohibitive for their children safe and healthy. They said they these families.
Community Health Needs Assessment Report 2013 79 This group identified the following health and • Health Equity and Access in South King safety issues in their communities: County • Lack of information • Obesity • Easy availability of junk food, video games • Mental and Behavioral Health and TV We will also be sustaining four other community • Don’t know how to access free or low-cost benefit programs: activities • Adolescent Health • Language barrier • Injury Prevention (intentional and unintentional) • Low use of bike helmets (high use of car • Services for Children with Special Needs seats) • Parent/Family Education and Resources • Insurance limits visit to ER We will continue to encourage community • Need for more ways to share or find support benefit programs at all levels of the organization. We developed a framework to Family Advisory Committee help us make progress on our community The Family Advisory Committee validated the benefit priorities, so that they are: issues identified. • Linked to Seattle Children’s mission, vision, strategic plan and Continuous Improvement philosophy Seattle Children’s • Accomplished through strategic partnerships • Focused on addressing health disparities Community Benefit and identified gaps (geographic, population, Priorities literacy and topic specific) • Integrated into our clinical care, community Children’s conducted this assessment to ensure programs, research and education that patients receive exceptional service and equal access to high-quality care and to address • Meant to empower children, teens, families, child healthcare needs in the communities we healthcare providers, communities and the serve. Given the complexity of community government needs and the finite resources available to meet • Set to optimize our role as advocates, them, we are met with difficult choices. This educators and experts assessment has helped us hone in on the areas These priorities have been approved by the of greatest need, as defined by the communities board of trustees (the ultimate governing board we serve. of the organization) and will be incorporated The CHNA research results have validated our into the hospital’s operating and strategic existing work and have helped us prioritize initiatives. where and how to focus our community As we conclude the CHNA process, we are now benefit priorities. As part of Seattle Children’s drafting our community benefit implementation Community Benefit Priorities three-year plan, plan (CBIP). The CBIP will include a definition of we have identified five focus areas: the priority community benefit areas, a plan for • Access to Quality Healthcare for All Children addressing them, metrics to track progress, and • Coordination of Care for Children and Teens an explanation of why the hospital will not be with Chronic Conditions addressing other identified needs.
80 Community Health Needs Assessment Report 2013 Seattle Children’s 2013-2016 Community Benefit Priorities
Value Statement: Ensure patients have exceptional service and equal access to high quality care while addressing identified child health needs in the community
Framing Guidelines
Accomplished Focused on: Integrated in: Linked to: Meant to empower: Set to optimize our through: role as: Addressing health Clinical Care Mission Children Strategic disparities and Community Vision Teens Advocates Partnerships identified gaps programs Strategic Plan Families Educators (geographic, Research Experts population and CPI Philosophy Healthcare topic-specific) Education providers Communities Government
Community Benefit Priorities
Coordinated Care for Health Equity and Access to High Quality Mental and Behavioral Children and Teens with Access in South King Obesity Healthcare Health Chronic Conditions County
Sustained Community Benefit Programs
Injury Prevention Parent and Family Programs and Services for Adolescent Health Intentional and Education and Children with Special Needs Unintentional Resources
Community Health Needs Assessment Report 2013 81 Acknowledgements
Our thanks to the many people and community partners who made this report possible. They include: Asian Counseling and Referral Service (ACRS) Program for Early Parent Support (PEPS) Auburn Food Bank Public Health - Seattle & King County Auburn Head Start Renton School District Bellevue Schools Foundation Ryan Educational Resources Benton-Franklin Health District Safe Kids Washington Catholic Community Services of Western Safe Schools Coalition Washington Sarah Wandler, MSW Center for Pediatric Dentistry Sea Mar Community Health Centers Children’s Alliance Seattle Indian Health Board Community Schools Collaboration Seattle Parks and Recreation Country Doctor Community Health Centers Seattle School District Foundation for Early Learning Seattle Women’s Commission Girls on the Run of Puget Sound Seattle Young People’s Project Harborview Injury Prevention and Research Somali Community Services Coalition Center Teen Feed Harborview Medical Center Pediatric Clinic, Injury Center The American Indian Health Commission for Washington State Human Services Council University Congregational United Church of International Community Health Services (ICHS) Christ Julia Acheson, Parent University of Washington Madison Middle School, Seattle Public Schools UW Institute of Translational Health Sciences Meredith Mathews YMCA Washington Dental Service Foundation Muckleshoot Indian Tribe Washington State Department of Health Native American Women’s Dialog on Infant Washington State University Extension 4-H Mortality Youth Development Program Northwest Harvest Wellspring Family Services Northwest Immigrant Rights Project WithinReach Olga Owens, Parent Yakama Nation Women, Infant, Children Program Parent Trust for Washington Children Yakima Valley Farm Workers Clinic ParentMap Yakima Valley Memorial Hospital Pediatric Clinics at Harborview Medical Center YMCA of Greater Seattle People for People Youth in Focus Prevention Works in Seattle YouthCare
82 Community Health Needs Assessment Report 2013 Appendix: Figures, Graphs and Charts
CHNA Methodology 372 Figure 1: Seattle Children’s Community Health Needs Figure 3: The Spectrum of Prevention Assessment Development Process
371 Figure 2: The Social-Ecological Model
371 Centers for Disease Controls and Prevention, www.cdc.gov. 372 The Prevention Institute, www.preventioninstitute.org.
Community Health Needs Assessment Report 2013 83 Socioeconomic Indicators Age 373 Figure 6: Age Demographics 2006-10: 375 Figure 4: Number of Children in the WAMI Region Washington State, King County and South King County
State % Children Under 20 Number 2006-2010 American Community Survey Washington 26.7% 1,721,457 5-Year Estimates Geographic Total Under 5 5 to 9 10 to 14 15 to 19 Alaska 29.3% 207,840 Area population years years years years 25.3% 251,036 Montana United 303,965,272 6.6% 6.6% 6.8% 7.3% Idaho 30.4% 475,281 States Washington 6,561,297 6.5% 6.4% 6.6% 7.0% State 374 Figure 5: Washington State Age Demographics 2010 King 1,879,189 6.2% 5.8% 5.8% 6.2% County Seattle 595,240 5.1% 4.1% 3.6% 5.5% South King 454,553 7.3% 6.6% 6.6% 7% County*
*South King represents the average of the following cities: Auburn, Burien, Covington, Des Moines, Federal Way, Kent, Renton, SeaTac and Tukwila
375 U.S. Census Bureau http://factfinder2.census.gov, http://factfinder2.census. 373 U.S. Census Bureau, 2010 American Community Survey. gov/faces/tableservices/jsf/pages/productview.xhtml?pid=ACS_10_5YR_ 374 U.S. Census Bureau, 2010 American Community Survey. S0101&prodType=table.
84 Community Health Needs Assessment Report 2013 Race and Ethnicity 376 Figure 7: Race/Ethnicity: Washington, King County and South King County 2010
% Native Other % Hispanic Geographic Area % White % Black % AI/AN % Asian Hawaiian/OPI Race or Latino National 74.8 13.6 1.7 5.6 0.4 7.0 16.3 Washington State 81.4 4.8 3.0 9.0 1.0 6.0 11.2 King County 72.9 7.7 2.0 17.1 1.2 4.7 8.9 Seattle 73.9 9.5 2.1 16.5 0.8 3.0 6.6 South King County 62.5 12.1 2.8 16 2.7 9.3 15.8
377 Figure 8: Race/Ethnicity South King County Cities: 2010
% Native Other % Hispanic Geographic Area % White % Black % AI/AN % Asian Hawaiian/OPI Race or Latino Auburn 75 6.7 3.8 10.9 2.3 7.2 12.9 Burien 68.4 7.7 3.3 12.1 2.5 12.8 20.7 Covington 81.3 5.9 2.4 11 1.1 4.8 9.3 Des Moines 68.1 10.9 2.5 12.9 3.1 8.8 13.1 Federal Way 62.9 12.4 2.5 16.8 3.6 9.5 16.2 Kent 60.9 13.7 2.6 17.7 2.7 9.7 16.6 Renton 59.4 12.9 1.9 23.8 1.3 7.3 13.1 SeaTac 50.7 18.7 3.1 16.9 4.3 13 20.3 Tukwila 48.3 20.2 2.8 21.3 3.5 10.6 17.5
Figure 9: Foreign-Born and Language Other Than English National, 378 Washington State, King County and South King County Cities, 2005-2010
376 Race Alone or in Combination: 2010 and Race and Hispanic or Latino Origin: 2010, US Census Bureau http://factfinder2.census.gov 377 Ibid. 378 U.S. Census Bureau, 2006-2010 American Community Survey.
Community Health Needs Assessment Report 2013 85 379 Figure 10: Minority Population Growth 2000-2010, South King County Cities
380 Figure 11: Percent Speak Language Other than English at Home, by Census Tract, with Cities
Percent Speak Language Lake Forest Park BothellWoodinville Shoreline Kenmore Other Than English at Home Duvall by Census Tract, with Cities,
King County, Washington, Kirkland 5-year Average 2006-2010 Redmond
Yarrow Point Legend Hunts Point Carnation Clyde Hill Medina King County border Seattle
Cities Sammamish Bellevue Water Beaux Arts Percent Population Ages 5+ Mercer Island 0% - 13.6% Issaquah Newcastle Snoqualmie 13.7% - 22.8%
22.9% - 32.5% North Bend Renton 32.6% - 45.8% Burien Tukwila 45.9% - 70% SeaTac Normandy Park
01 2 4 6 8 Des Moines Kent Miles Ü Covington Maple Valley
Federal Way Black Diamond Data Source: US Census Bureau, 2006-2010 American Auburn Community Survey Produced by: Public Health - Seattle & King County; Assessment, Algona Policy Development & Evaluation Unit, 6/26/2012 Milton Pacific
Enumclaw
379 Seattle Times, February, 2011 http://seattletimes.nwsource.com/flatpages/local/censustableau.html. 380 Public Health – Seattle & King County, March 2012, http://www.kingcounty.gov/healthservices/health/data/maps.aspx.
86 Community Health Needs Assessment Report 2013 Poverty 381 Figure 12: Children Living in Poverty in the State of Washington, 2006 to 2010
382 Figure 13: Children Living in Extreme Poverty* in the State of Washington
2005-2007 2006-2008 2007-2009 2008-2010 6.6% 6.5% 6.7% 7.1% 99,179 97,960 102,356 109,144
*Extreme poverty indicates those with incomes less than 50% of the federal poverty level.
383 Figure 14: Washington Children in Poverty by Race (average of 2008-2010)
White
Two or More Races
Total
Some Other Race
Non-Hispanic White Non-Hispanic Native Hawaiian and Other Pacific Islander Non-Hispanic Black
Asian Non-Hispanic American Indian and Alaska Native Hispanic or Latino 0% 5% 10% 15% 20% 25% 30% 35% 40% 45%
381 The Annie E. Casey Foundation, KIDS COUNT Data Center, www.kidscount.org/datacenter. 382 Ibid. 383 Washington Kids Count is a joint effort of the Children’s Alliance and Washington State Budget & Policy Center, http://datacenter.kidscount.org/data/ bystate/Rankings.aspx?state=WA&ind=4748.
Community Health Needs Assessment Report 2013 87 384 Figure 15: Children Living Under Poverty Level in King County (by Race/Ethnicity) Children (birth to 17 years of age), living in households with income below the Federal Poverty Level by Race and Ethnicity, King County, 2006-2010
Children in Poverty Approx. Number Percent African American alone 11,734 38.10% Other race alone 5,373 29.30% American Indian, Alaska Native alone 972 29.10% Native Hawaiian, Pacific Islander alone 1,080 27.40% Two or more races 4,586 11.90% Asian alone 5,458 9.70% White alone 20,780 8.40% Hispanic/Latino ethnicity, any race 13,555 25.90%
Notes: In 2010, the national poverty threshold for a family of four including two related children was an annual household income of less than $22,113.
385 Figure 16: Poverty Data for Washington, King County and South King County Cities POVERTY STATUS IN THE PAST 12 MONTHS 2006-2010 American Community Survey 5-Year Estimates
384 American Community Survey, 2006-2010, U.S. Census. Produced by: Public Health - Seattle & King County; Assessment, Policy Development & Evaluation Unit 3/2012. 385 U.S. Census Bureau, 2006-2010 American Community Survey http://www.factfinder.census.gov.
88 Community Health Needs Assessment Report 2013 Employment 386 Figure 17: Unemployment in Washington State and King County, 2007 to 2011
387 Figure 18: WA State Median family income for families with children (Currency) 2005 2006 2007 2008 2009 2010 $56,462 $60,821 $62,363 $66,818 $64,206 $63,981
388 Figure 19: Median Household Income in King County and South King County Median Household Income for King County, Seattle and Selected South King County Cities 2008-2010
Median Income in Dollars 90% Margin of Error King County 67,711 +/-735 Seattle 60,619 +/-893 Auburn 52,164 +/-3,117 Burien 51,440 +/-3,809 Des Moines 61,613 +/-2,505 Federal Way 56,259 +/-2,505 Kent 52,704 +/-2,505 Renton 62,949 +/-2,763 SeaTac 46,595 +/-4,153
386 The Annie E. Casey Foundation, KIDS COUNT Data Center, www.kidscount.org/datacenter. 387 Ibid. 388 American Community Survey, 2008-2010. Produced by: Public Health - Seattle & King County; Assessment, Policy Development & Evaluation Unit 3/2012.
Community Health Needs Assessment Report 2013 89 389 Figure 20: Median Income by Race/Ethnicity King County, 2008-2010
390 Figure 21: Washington State Children Living in Low-Income Households Where No Adults Work
389 Ibid. 390 Ibid.
90 Community Health Needs Assessment Report 2013 Education 391 Figure 22: Public High School Graduation Rates – 2009
392 Figure 23: Public High School Graduation Rates in the State and Nation
391 National Information Center for Higher Education Policymaking and Analysis, http://www.higheredinfo.org. 392 Ibid.
Community Health Needs Assessment Report 2013 91 393 Figure 24: 2008-09 State High School Graduation Rates by Income, Language, Health and Migration
394 Figure 25: On-Time Graduation Rates by Race in Washington, 2005-2010
393 U.S. Department of Education. 394 Washington KIDS COUNT, http://datacenter.kidscount.org/data/bystate/stateprofile.aspx?state=WA&loc=49.
92 Community Health Needs Assessment Report 2013 395 Figure 26: King County High School Graduation Rates by Race/Ethnicity 2005-2010
396 Figure 27: Percent of Fourth-grade Public School Students Meeting State Standards in Writing
395 Education for King County from Kids Count http://datacenter.kidscount.org/data/bystate/stateprofile.aspx?state=WA&loc=6963. 396 King County, http://your.kingcounty.gov/aimshigh/search2.asp?EVAcademicAchieve.
Community Health Needs Assessment Report 2013 93 Housing 397 Figure 28: Hours at Minimum Wage Needed to Afford Rent In no state can a minimum-wage worker afford a two-bedroom unit at Fair Market Rent, working a standard 40-hour work week.
398 Figure 29: King County Rental Unit Supply and Demand
397 National Low Income Housing Coalition, Out of Reach* 2012 Report, www.nlihc.org. 398 Dupre + Scott and ACS 2010. Data on the housing affordability gap and affordable rental housing stock are from AIMS High 2009, the October 2010 Dupre + Scott Apartment Vacancy Report, the Washington Center for Real Estate Research (WCRER) and the 2011 Draft Technical Appendix B, King County Comprehensive Plan for Housing 2009-2012. Income range and housing cost data about owners and renters in unaffordable housing are from the 2010 American Community Survey. Prepared for Communities Count.
94 Community Health Needs Assessment Report 2013 399 Figure 30: King County Moderate- and Low-Income Rental Availability
Percent of Rental Housing Affordable to Moderate and Low Income Households Estimated Total Percent Affordable by Income Category Estimated Median Jurisdiction Number of <80% <50% <40% Rent Rental Units East $1,156 56,768 74.3% 7.4% 0.7% Rural Cities $1,295 4,062 51.5% 24.2% 2.8% South $825 86,318 96.4% 51.1% 14.0% Seashore $930 160,552 82.8% 34.6% 7.7% Uninc. King County $980 26,545 85.6% 25.1% 5.5% TOTALS $940 334,245 85.4% 33.8% 8.3%
400 Figure 31: Housing Affordability in Seattle in 2011: Homeownership and Rental Market
399 Consolidated Housing and Community Development Plan 2010–2012, Department of Community and Human Services, King County. http://www.kingcounty.gov/socialservices/Housing/PlansAndReports/HCD_Plans/ConsolidatedPlan.aspx. 400 Paycheck to Paycheck report, 2011 Third Quarter Findings, Center for Housing Policy, www.nhc.org. Announced on December 15, 2011.
Community Health Needs Assessment Report 2013 95 Homelessness
401 Figure 32: One Night Count of People Who Are Homeless in King County
402 Figure 33: Homeless Students in King County School Districts 2005-2006 School Year
401 Seattle King County Coalition for the Homeless, 2010. 402 OSPI. South King County Response to Homelessness: A Call for Action, 2008. Committee to End Homelessness in King County, http://www.cehkc.org/ DOC_reports/SouthKingCounty.pdf.
96 Community Health Needs Assessment Report 2013 Crime 403 Figure 34: Washington State Overall Crime Rate
Socioeconomic Indicators: Seattle Children’s Figure 36: Patient Hometown Demographics: Where Our Patients Come From (2011)
Figure 37: Seattle Children’s Patients by Race
403 Washington Association of Sheriffs & Police Chiefs, http://www.waspc.org/index.php?c=Crime%20Statistics.
Community Health Needs Assessment Report 2013 97 Figure 38: Growth Rate of Seattle Children’s Patient Population by Race and Ethnicity
General Health Indicators 404 Figure 40: Leading Causes and Total 5-Year Incidence of Injury Deaths by Age Group, Washington, 2004-2008
Note: All mechanisms of suicide and homicide were combined according to intent. Each listed mechanism is unintentional except those otherwise noted. **** indicates that the cell values range from 1-10 and are suppressed for data confidentiality purposes.
404 National Center for Health Statistics (NCHS), National Vital Statistics System. Produced by: Office of Statistics and Programming, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Web-based Injury Statistics Query and Reporting System http://www.cdc. gov/nchs/nvss.htm.
98 Community Health Needs Assessment Report 2013 405 Figure 41: 10 Leading Causes of Death in King County Children, 2003–2007
Rank Age <1 Age 1-14 Age 15-24 1 Perinatal Conditions Unintentional Injury Unintentional Injury Avg. 47.8 Avg. 10.6 Avg. 59.6
2 Congenital Malformations Cancer Suicide Avg. 26.6 Avg. 6.4 Avg. 22.8
3 Heart Disease Congenital Malformations Homicide Avg. 2.2 Avg. 3.4 Avg. 17.2
4 Homicide Homicide Cancer Avg. 2.0 Avg. 3.0 Avg. 8.8
5 Septicemia Heart Disease Heart Disease Avg. 1.2 Avg. 1.6 Avg. 3.2
6 Unintentional Injury Influenza & Pneumonia Congenital Malformations Avg. 1.2 Avg. 1.2 Avg. 3.0
7 ------Stroke Avg. 1.0
8 ------Influenza & Pneumonia Avg. 0
9 ------Pregnancy/Childbirth
10 ------
405 Death Certificate Data, Washington State Department of Health, Center for Health Statistics, http://www.kingcounty.gov/healthservices/health/data/ chi2009/HealthOutcomesCauseofDeath/age.aspx.
Community Health Needs Assessment Report 2013 99 Figure 42: Washington406 State Inpatient Pediatric Discharges by Diagnosis-Related Group (DRG) (ages 0 to 17) July 2009-June 2010
DRG DRG Description Discharges Patient Days Mean LOS 795 Normal newborn 59,387 99,162 1.670 794 Neonate w other significant problems 13,397 28,479 2.126 792 Prematurity w/o major problems 3,589 23,030 6.417 793 Full term neonate w major problems 3,516 19,699 5.603 203 Bronchitis & asthma w/o CC/MCC 2,869 5,746 2.003 791 Prematurity w major problems 1,539 27,005 17.547 343 Appendectomy w/o complicated principal diag w/o CC/MCC 1,431 1,963 1.372 790 Extreme immaturity or respiratory distress syndrome, neonate 1,233 45,377 36.802 775 Vaginal delivery w/o complicating diagnoses 1,220 2,467 2.022 195 Simple pneumonia & pleurisy w/o CC/MCC 1,190 2,596 2.182 885 Psychoses 1,094 11,487 10.500 392 Esophagitis, gastroent & misc digest disorders w/o MCC 1,092 2,936 2.689 202 Bronchitis & asthma w CC/MCC 1,074 3,498 3.257 789 Neonates, died or transferred to another acute care facility 1,062 6,532 6.151 101 Seizures w/o MCC 931 1,907 2.048 153 Otitis media & URI w/o MCC 919 1,797 1.955 194 Simple pneumonia & pleurisy w CC 857 2,737 3.194 641 Nutritional & misc metabolic disorders w/o MCC 849 2,309 2.720 690 Kidney & urinary tract infections w/o MCC 711 1,931 2.716 603 Cellulitis w/o MCC 700 1,776 2.537 639 Diabetes w/o CC/MCC 571 1,427 2.499 134 Other ear, nose, mouth & throat O.R. procedures w/o CC/MCC 568 859 1.512 847 Chemotherapy w/o acute leukemia as secondary diagnosis w CC 513 1,487 2.899 918 Poisoning & toxic effects of drugs w/o MCC 387 604 1.561 494 Lower extrem & humer proc except hip, foot, femur w/o CC/MCC 364 597 1.640 340 Appendectomy w complicated principal diag w/o CC/MCC 347 1,398 4.029 866 Viral illness w/o MCC 316 786 2.487
407 Figure 43: Washington State and King County Infant Mortality Rates
Location Infant Mortality Rate (per 1,000 live births) 5 yr average 2003–2007 Healthy People 2010 Objective 4.5 (2007 only) Washington 4.8 (2007 only) King County 4.5 Seattle 4.5 South King County 5.5 East King County 2.8 North King County 3.8
406 Washington State Hospital Association-Health Information Program, HIP-Enhanced CHARS January-December 2009 and January-June 2010 Inpatient Discharge Files Statewide Inpatient Pediatric Discharges by DRG (age 0-17). July 2009-June 2010 Discharges. 407 Public Health Seattle-King County, King County Community Health Indicators, http://www.kingcounty.gov/healthservices/health/data/chi2009/ HealthOutcomesInfantMortality.aspx.
100 Community Health Needs Assessment Report 2013 408 Figure 44: King County and Seattle Infant Mortality Rates by Mother’s Race/Ethnicity
Mother’s Race/Ethnicity Seattle and King County Infant Mortality Rate (per 1,000 live births) 5 yr average 2003–2007 African American 8.6 American Indian/AN 13.7 Asian/PI 3.8 Hispanic/Latina 4.2 White 3.8
Access to Healthcare 409 Figure 45: National Uninsured, 1987 to 2011
410 Figure 46: Children without Insurance, 1990-2009, WAMI and United States
408 Ibid. 409 DeNavas-Walt, Carmen, Bernadette D. Proctor, and Jessica C. Smith. U.S. Census Bureau, Current Population Reports, P60-239. Income, Poverty, and Health Insurance Coverage in the United States: 2010. U.S. Government Printing Office, Washington, DC, 2011, page 23. 410 KIDS Count Data Center, kidscount.org/datacenter.
Community Health Needs Assessment Report 2013 101 411 Figure 47: Types of Insurance Coverage in the WAMI Region
Population* Alaska Idaho Montana Washington Total Population 678,081 1,584,985 957,586 6,546,149 Under 18 years: 183,261 418,172 220,411 1,569,540 With private health insurance 56% (104,393) 58% (244,530) 58% (128,716) 59% (937,795) coverage only Type of Insurance Coverage* With public health coverage only 25% (45,225) 26% (111,235) 25% (56,895) 28.9% (454,026) With both private and public 4.7% (8,650) 3.6 % (15,436) 2% (6,330) 4% (70,179) health coverage No health insurance coverage 13.6 % (24,993) 11% (46,971) 12.9% (28,470) 6.8 % (107,540)
412 Figure 48: No Health Insurance Among King County Children Ages 0-17, by Region, 2004, 2006, 2008 Combined
413 Figure 49: Washington State and King County Physician Medicaid Acceptance
Geographic Area Percent Accepting New Percent Not Accepting Medicaid Patients New Medicaid Patients Washington State 55% 39% (Minus King County) King County 56% 43% National Data* 53% (all providers) 28% (all providers) *(different data source) 57% (pediatricians) 18% (pediatricians)
411 U.S. Census Bureau, 2009 American Community Survey. 412 State Population Survey, 2004, 2006, 2008. Produced by: Assessment, Policy Development & Evaluation, Public Health – Seattle & King County, 5/09. 413 Washington data: WCAAP Medicaid Survey 12/09, National Data: Center for Studying Health System Change 9/09. http://www.rwjf.org/files/research/ hscbulletin35sept2009.pdf.
102 Community Health Needs Assessment Report 2013 Figure 52: Existing Pediatric Care Centers in Washington State Gray’s Harbor Community Hospital - Aberdeen, WA Olympic Medical Center - Port Angeles, WA Island Hospital - Anacortes, WA Jefferson Healthcare - Port Townsend, WA Cascade Valley Hospital - Arlington, WA Prosser Memorial Hospital - Prosser, WA Auburn Regional Medical Center - Auburn, WA Pullman Regional Hospital - Pullman, WA Overlake Hospital Medical Center - Bellevue, WA MultiCare Good Samaritan Hospital - Puyallup, WA PeaceHealth St. Joseph Medical Center - Bellingham, WA Quincy Valley Medical Center - Quincy, WA Harrison Medical Center - Bremerton, WA Valley Medical Center - Renton, WA Okanogan Douglas District Hospital - Brewster, WA Ferry County Memorial Hospital - Republic, WA Highline Medical Center - Burien, WA Kadlec Regional Medical Center - Richland, WA Providence Centralia Hospital - Centralia, WA East Adams Rural Hospital - Ritzville, WA Lake Chelan Community Hospital - Chelan, WA Fred Hutchinson Cancer Research Center - Seattle, WA Providence St. Joseph’s Hospital - Chewelah, WA Harborview Medical Center - Seattle, WA Tri-State Memorial Hospital - Clarkston, WA Navos - Seattle, WA Whitman Hospital and Medical Center - Colfax, WA Northwest Hospital & Medical Center - Seattle, WA Providence Mount Carmel Hospital - Colville, WA Puget Sound Blood Center - Seattle, WA Whidbey General Hospital - Coupeville, WA Seattle Cancer Care Alliance - Seattle, WA Lincoln Hospital - Davenport, WA Swedish Medical Center - Seattle, WA Dayton General Hospital - Dayton, WA University of Washington Medical Center - Seattle, WA Kittitas Valley Community Hospital - Ellensburg, WA Virginia Mason Hospital - Seattle, WA St. Elizabeth Hospital - Enumclaw, WA Mason General Hospital - Shelton, WA Columbia Basin Hospital - Ephrata, WA Snoqualmie Valley Hospital - Snoqualmie, WA Providence Regional Medical Center - Everett, WA Willapa Harbor Hospital - South Bend, WA St. Francis Hospital - Federal Way, WA Deaconess Medical Center - Spokane, WA Forks Community Hospital - Forks, WA Providence Holy Family Hospital - Spokane, WA St. Anthony Hospital - Gig Harbor, WA Providence Sacred Heart Medical Center - Spokane, WA Klickitat Valley Health - Goldendale, WA Providence Sacred Heart Children’s Hospital - Spokane, WA Coulee Medical Center - Grand Coulee, WA • Shriners Hospital for Children - Spokane, WA Ocean Beach Hospital - Ilwaco, WA St. Luke’s Rehabilitation Institute - Spokane, WA Kennewick General Hospital - Kennewick, WA Valley Hospital and Medical Center - Spokane Valley, WA Evergreen Hospital Medical Center - Kirkland, WA Sunnyside Community Hospital - Sunnyside, WA Fairfax Hospital - Kirkland, WA Madigan Army Medical Center - Tacoma, WA St. Clare Hospital - Lakewood, WA MultiCare Allenmore Hospital - Tacoma, WA Cascade Medical Center - Leavenworth, WA MultiCare Mary Bridge Children’s Hospital and Health Center PeaceHealth St. John Medical Center - Longview, WA - Tacoma, WA Mark Reed Health Care District - McCleary, WA MultiCare Tacoma General Hospital - Tacoma, WA Valley General Hospital - Monroe, WA St. Joseph Medical Center - Tacoma, WA Morton General Hospital - Morton, WA North Valley Hospital - Tonasket, WA Samaritan Healthcare - Moses Lake, WA Toppenish Community Hospital - Toppenish, WA Skagit Valley Hospital - Mount Vernon, WA Legacy Salmon Creek Medical Center - Vancouver, WA Newport Hospital & Health Services - Newport, WA PeaceHealth Southwest Medical Center - Vancouver, WA Odessa Memorial Healthcare Center - Odessa, WA Providence St. Mary Medical Center - Walla Walla, WA Capital Medical Center - Olympia, WA Walla Walla General Hospital - Walla Walla, WA Providence St. Peter Hospital - Olympia, WA Central Washington Hospital - Wenatchee, WA Mid-Valley Hospital - Omak, WA Wenatchee Valley Hospital - Wenatchee, WA Othello Community Hospital - Othello, WA Skyline Hospital - White Salmon, WA Lourdes Medical Center - Pasco, WA Yakima Regional Medical and Cardiac Center - Yakima, WA Garfield County Public Hospital District - Pomeroy, WA Yakima Valley Memorial Hospital - Yakima, WA
Community Health Needs Assessment Report 2013 103 Figure 53: Pediatric Subspecialists Lacking in WAMI States
Alaska Idaho Montana Alaska Idaho Montana Adolescent Medicine x x Hematology-Oncology
Cardiology Infectious Diseases x x
Critical Care Neonatal-Perinatology
Developmental-Behavioral X Nephrology x
Emergency Medicine x x Pulmonology x x
Endocrinology x x Rheumatology x x x
Gastroenterology
Includes ABP-certified diplomats, as of December 2011, under 66-years-old with a known address in that state
414 Figure 54: Certified Pediatric Specialists—WAMI and National: Number of ABP Pediatric Specialists (ever certified)
IDAHO MONTANA WASHINGTON NATIONAL Number 1 0 17 496 Adolescent Medicine Ratio 429,437 n/a 93,138 149,588 Number 3 3 32 1677 Cardiology Ratio 143,146 74,498 49,480 44,243 Number 1 1 4 237 Child Abuse Ratio 429,437 223,493 395,838 313,062 Number 5 2 39 1687 Critical Care Ratio 85,887 111,747 40,599 43,981 Number 2 1 18 551 Developmental-Behavioral Ratio 214,719 223,493 87,964 134,657 Number 1 0 47 1648 Emergency Ratio 429,437 n/a 33,688 45,022 Number 0 0 15 1054 Endocrinology Ratio n/a n/a 105,557 70,395 Number 4 1 16 1089 Gastroenterology Ratio 107,359 223,493 98,960 68,132 Number 4 1 37 1750 Hematology-Oncology Ratio 107,359 223,493 42,793 42,398 Number 2 0 26 1067 Infectious Diseases Ratio 214,719 n/a 60,898 69,537 Number 10 9 62 3852 Neonatal-Perinatal Medicine Ratio 42,944 24,833 25,538 19,262 Number 1 0 17 451 Nephrology Ratio 429,437 n/a 93,138 164,514 Number 1 0 18 825 Pulmonology Ratio 429,437 n/a 87,964 89,934 Number 0 0 12 264 Rheumatology Ratio n/a n/a 131,946 281,045
414 American Board of Pediatrics Workforce Databook, 2010.
104 Community Health Needs Assessment Report 2013 415 Figure 55: Medicaid Fee-for-Service Treatment of Obesity Interventions: Washington State
Washington State Department of Social and Health Services Preventive Preventive Preventive Coverage: Coverage Related to Pharmaceutical Surgical Coverage Coverage: Coverage: Children Under Age 21 Co-Morbidities Coverage Adults Pregnant Women Weight Loss Prenatal Care: EPSDT: EPSDT services Disease Management Weight Loss Covered Procedures: Services: Extended include nutritional Services: Provided Drugs: No Covers all medically Washington services for counseling. Screenings through opt-in to coverage of necessary bariatric surgery Medicaid may pregnant women must include a certain populations, drugs when for eligible clients: pay for an include maternity comprehensive health including but not used for weight 1) age of 21-59; outpatient support services and development limited to those loss. 2) BMI ≥ 35 and a specified weight loss such as nutrition history, a nutritional with diabetes, heart co-morbid condition such program only assessment and/ assessment, a health failure, coronary as diabetes; when provided or counseling evaluation, and artery disease, and 3) Patients must engage through an visit by a counseing. If an EPSDT asthma. Includes all in a weight loss program outpatient state-certified screening provides Medicaid State Plan prior to surgery and weight dietitian, as well suspects or establishes services, plus disease must achieve at least five los facility as a community a medical need for management services percent weight loss to approved by health worker medical nutrition and assistance in demonstrate adherence to the Medical visit by therapy, eligible clients locating a primary care diet and lifestyl changes Assistance community may be referred to a provider for clients in required after bariatric Administration. health educators. certified dietitian to the high-risk group. surgery. receive outpatient Disease management
medical nutrition services include a EPSDT Bariatric Surgery: If bariatric surgery therapy. nurse advice line and is requested under education and disease the EPSDT program, Nutrition Services: management services. Outpatient nutrition the service must be services are provided to Diabetes Education: medically necessary, safe patients who are obese Covers outpatient and effective, and not and under the age hospital diabetes experimental. of 20 with an EPSDT education when referral to a certified referred by a licensed dietitian. healthcare provider.
Children with Chronic Conditions 416 Figure 56: Washington vs. United States Transition Data
Transition to Community- Early & Continuous Adequate Health Medical Home Family Professional Adult Care Based Services Screening Insurance Partnership WA 47% 85% 69% 65% 48% 56% US 41% 89% 64% 62% 47% 57%
NOTE: Washington rates of early and continuous screening and youth transition to adult services are statistically higher than the national rate. All other Washington National Performance Measure data are similar to national data.
415 George Washington University Department of Health Policy, Medicaid Fee-for-Service Treatment of Obesity Interventions. 50 State & District of Columbia Survey, page 64. 2010 416 Fact Sheet (2009) National Performance Measures Overview. Washington State Department of Health Children with Special Health Care Needs Program.
Community Health Needs Assessment Report 2013 105 Asthma 417 Figure 57: King County Air Quality Figure 59: Current Asthma Among 419 King County Children Aged 0 to 17, 2009-2010
Figure 58: Asthma Hospitalizations in 418 Children Under 18 in King County, 2003-07
Figure 60: Asthma Hospitalizations in 420 Children Under 18 by Poverty Level, 2003-07
417 Communities Count: http://www.communitiescount.org. 418 Washington State Department of Health, Office of Hospital and Patient 419 http://www.kingcounty.gov/healthservices/health/data/chi2009/ Data. Produced by: Public Health – Seattle & King County; Assessment, PEChildAsthmaPrevalence.aspx. Policy & Evaluation, 7/09. 420 Ibid.
106 Community Health Needs Assessment Report 2013 Transplant 421 Figure 61: Children and Youth on Wait List for Organ Transplant in Washington State as of 07/13/12
All Organs Kidney Liver Pancreas Kidney/ Heart Lung Heart/ Intestine Pancreas Lung < 1 year 5 0 3 0 2 0 0 0 1-5 years 16 1 6 0 0 3 0 0 6 6-10 years 7 5 1 0 0 0 0 0 1 11-17 years 14 9 3 0 0 2 0 0 0
Obesity 422 Figure 62: Obesity Among King County Students by Race/Ethnicity in Grades 8, 10 and 12, 2010
423 Figure 63: Obesity Among King County Students in Grades 8, 10 and 12 by Region, 2010
421 HRSA Organ Procurement and Transplantation Network, Retrieved July 13, 2012 from: http://optn.transplant.hrsa.gov/latestData/rptData.asp. 422 King County: http://www.kingcounty.gov/healthservices/health/data/chi2009/RiskYouthObese.aspx. 423 Ibid.
Community Health Needs Assessment Report 2013 107 Figure 64: Seattle Children’s Subspecialty Clinic Patient Data 2005-2007 All Heme/ Cardiac Surgery Oncology Neurology Pulmonary Adolescent Nephrology Orthopedics Endocrynology Otolaryngology
108 Community Health Needs Assessment Report 2013 Mental Health 424 Figure 65: The Mental Health of Children: A Portrait of Washington State and the Nation, 2007
State % National % Children aged 2-17 years who have one or more emotional, behavioral or developmental conditions 12.2 11.3
Prevalence by Age
Age 6-11 years 12.7 12.1
Age 12-17 years 15.7 14.9
Prevalence by Sex
Male 16.1 14.5
Female 8.2 7.9
Prevalence by Poverty Level
100-199% FPL 13 13.1
200-399% FPL 13.7 10
400% FPL or more 9.8 9.5
Prevalence by Insurance Type
Public 15.9 17.5
Private 10.5 9
Children aged 2-17 years with emotional, behavioral, or developmental conditions
Who have two or more conditions 43.1 40.3
Who received coordinated, ongoing, comprehensive care within a medical home 35.1 40.2
Whose health insurance is adequate to meet their needs 63 70.6
Who received mental health treatment or counseling in the past year 51.5 45.6
424 U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau. The Mental and Emotional Well-Being of Children: A Portrait of States and the Nation 2007. Rockville, Maryland: U.S. Department of Health and Human Services.
Community Health Needs Assessment Report 2013 109 Injury Figure 66: Hospitalizations Due to Injury: Figure 68: King County and Washington State 425 427 0-17, South King County 2005-2009 Adolescent Pregnancy, 2007
South King County: Injury Number Rate (%) Falls 588 69.03 Motor Vehicle-Traffic 241 28.29 Fire/Burn 148 17.38 MV-Occupant 145 17.02 Poisoning 114 13.38 MV-Pedestrian 61 7.16 Natural Environment 54 6.34 Cut/Pierce 37 4.34 Suffocation 20 2.35
Adolescent Health
Figure 67: King County Birth Rates Among Girls 426 Ages 15 to 17 by Region and School District, 2004-2006
Figure 69: Sexually Transmitted Disease (STD) Infection 428 Incidence Rates (per 100,000) in Washington State
* Incidence of gonorrhea has decreased significantly in Washington tates since 2006. ** Incidence of syphilis has decreased significantly in Washington since 2008.
425 Hospitalization discharge data: CHARS, Washington State DOH, Center 427 Public Health – Seattle & King County, http://www. for Health Statistics. Assessment, Policy Development & Evaluation, kingcounty.gov/healthservices/health/data/chi2009/ Public Health-Seattle & King County, 1/2011. HealthOutcomesAdolescentPregnancy/CD.aspx. 426 Public Health – Seattle & King County, http://www. 428 Washington State 2009 Sexually Transmitted Infections Annual Report, kingcounty.gov/healthservices/health/data/chi2009/ Washington State Department of Health, Oct 2010, King County HealthOutcomesAdolescentPregnancy/CD.aspx. (chlamydia, gonorrhea, syphilis).
110 Community Health Needs Assessment Report 2013 431
Figure 70: Public School Students Who Used 429 Figure 72: Current Youth Cigarette Smoking by Grade Tobacco in the Past 30 Days, By Grade. King County, 2010
Figure 73: Illicit Drug Use by 432 Washington 10th Graders, 2008 Data Source: Washington State Healthy Youth Survey. Produced by: Public Health-Seattle & King County; Assessment, Policy Development & Lifetime (ever Past 30 Days WA Evaluation Unit, 5/2012 Type of Drug used) WA % (± % (± margin of margin of error) error)
Figure 71: Current Youth Cigarette 430 Marijuana 31% (± 2) 19% (± 1) Smoking by Grade, Washington State, 2010 Methamphetamine 5% (± 1) 4% (± 1) Inhalants 9% (± 1) 6% (± 1) Cocaine/Crack 7% (± 1) * Pain killers to get * 9% (± 1) high Ritalin * 5% (± 1)
NH = non-Hispanic. Data Source: Washington State Healthy Youth Survey. Produced by: Public Health-Seattle & King County; Assessment, Policy Development & Evaluation Unit, 5/2012
429 http://www.doh.wa.gov/Portals/1/Documents/Pubs/160-197_ YouthTobaccoFactSheet2010.pdf. 431 Ibid. 430 http://www.kingcounty.gov/healthservices/health/data/datawatch/ 432 Washington State Department of Health Adolescent Needs Volume1102.aspx. Assessment.
Community Health Needs Assessment Report 2013 111 Prematurity Figure 74: Singleton Preterm Deliveries by Maternal Figure 76: Singleton Preterm Medicaid Deliveries,435 Race/Ethnicity,433 Washington State Birth Certificate Data, Washington First Steps Database, 2006-2008 2006-2008
Figure 77: Late or No Prenatal Care by Region, King Figure 75: Preterm Births by Region - 434 County, 2003-2007 King County 2003-2007
Data Source: Washington State Department of Health, Center for Health Data Source: Washington State Department of Health, Center for Health Statistics, Birth Certificates. Produced by Public Health-Seattle & King Statistics, Birth Certificates. Produced by Public Health-Seattle & King County: Assessment, Policy Development & Evaluation, 5/09 County: Assessment, Policy Development & Evaluation, 5/09
433 Washington State Department of Health, Preterm Delivery for Singleton Births, http://www.doh.wa.gov/Portals/1/Documents/ Pubs/160-015_MCHDataReportPrenatalDeliv.pdf. 434 Washington State Department of Health, Center for Health Statistics, 435 Washington State Department of Health, Preterm Delivery for Birth Certificate Data, http://www.kingcounty.gov/healthservices/ Singleton Births, http://www.doh.wa.gov/Portals/1/Documents/ health/data/chi2009/HealthOutcomesPretermBirths.aspx. Pubs/160-015_MCHDataReportPrenatalDeliv.pdf.
112 Community Health Needs Assessment Report 2013 Figure 78: Late or No Prenatal Care Comparing Wshington State (2007), King County (2007), and Similar U.S. Counties (2005)
Data Sources: UW National Center for Health Statistics, UW Office of Disease Prevention and Health Promotion and WA State Department of Health. Produced by Public Health-Seattle & King County: Assessment, Policy Development & Evaluation, 5/09
Community and Public Health Input Figure 79: Top Statewide Health Issue Concerns – Community Survey and Interviews
Community Health Needs Assessment Report 2013 113 Figure 80: Lack of Access to Pediatric Care
Figure 81: Responses to “It is easy for children, Figure 82: Responses to “It is easy to get immunizations adolescents and families to get information on how to and vaccinations for children and adolescents.” be healthy and safe.”
114 Community Health Needs Assessment Report 2013 4800 Sand Point Way NE Seattle, Washington 98105-0371 206-987-2000 (V), 206-987-2280 (TTY) www.seattlechildrens.org
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