United Way of Treasure Valley 2020 COMMUNITY ASSESSMENT Introduction Acknowledgements United Way of Treasure Valley would like to thank the following partners and agencies for their 2 participation in the 2020 Community Assessment. Sponsors: Saint Alphonsus Health System, Trinity Health Transforming Communities Initiative, and JPMorgan Chase & Co.
Advisory Committee: United Way of Treasure Valley Idaho Suicide Prevention Hotline, Rhiannon Avery, City of Boise Business Partners John Reusser Kelli Badesheim, Valley Regional Transit Idaho Community Health Workers Association International Rescue Committee, Toni Richardson Joyce Bailey, United Way of Treasure Valley CATCH Jesse Tree of Idaho, Ali Rabe Josh Campbell, Genesis Community Health Jesse Tree of Idaho Southwest District Health, Cristina Froude Tracy DeMarcus, Women’s and Children’s Boise School District Speedy Foundation, Shannon Decker Alliance Sacajawea Elementary Valley Regional Transit, Kelli Badesheim Karen Douglass, Southwest District Health Genesis Community Health Patient Western Idaho Community Health Tony Fisk, Saint Alphonsus Health System Advisory Board Collaborative, Alexis Pickering Cristina Froude, Southwest District Health Gem County Community Health Action Team WICAP Headstart, staff Bessie Katsilometes, AARP-Idaho LBGTQIA+ Volunteers Women’s and Children’s Alliance, Samantha Kenney, United Way of Mercy Housing Senior Amy Howard, Deborah DeSousa, and Treasure Valley Community Leader Interview Participants: Erin Vlamis Erik Kingston, Idaho Housing and Wyakin Foundation, George Nickel Ada County Paramedics, Steve Boyenger and Finance Association Mark Babson Rebecca Lemmons, Saint Alphonsus Special thanks to the following individuals who Ada County Commissioner, Diana Lachiondo Health System Allies Linked for the Prevention of HIV and helped facilitate/document Focus Groups and Hailey Michalk, Idaho Association for the AIDS, Chris Bidiman Key Informant Interviews: Education of Young Children Boise School District, Stacey Roth Allyson Auerbach, Health Resources in Action Jean Mutchie, St. Luke’s Boise State University, Lauren Oe Joyce Bailey, United Way of Treasure Valley Alexis Pickering, Western Idaho Community Boys & Girls Clubs Ada, Joey Schueler Tracy DeMarcus, Women’s and Health Collaborative Boys & Girls Clubs Nampa, Melissa Gentry Children’s Alliance Sasha Pierson, Idaho Voices for Children Caldwell Housing Authority, Marisela Pesina Carly Doud, Central District Health Ericka Rupp, Idaho Department of Health Cristina Froude, Southwest District Health and Welfare CATCH, Stephanie Day Tony Fisk, Saint Alphonsus Health System Christa Rowland, United Way of Treasure Valley City of Boise, Wyatt Schroeder Sarah Gibbs, Genesis Community Health Gregory Smith, JPMorgan Chase & Co. City of Caldwell, Mayor Garret Nancolas Economic Opportunity, Jannus, Kate Nelson Hortensia Hernandez, United Way of Caile Spear, Boise State University Elmore County Commissioners, Bud Corbus, Treasure Valley Jennifer Wheeler, Idaho Oral Health Alliance Wes Wootan, and Al Hofer Samantha Kenney, United Way of Chelsea Wilson, City of Caldwell Genesis Community Health, Josh Campbell Treasure Valley Jennifer Zielinksi, Idaho Anti-Trafficking Glenns Ferry, Bob Pattison, Shirley Lisle, and Claudia LeBlanc, United Way of Coalition Christy Acord Treasure Valley Focus Group Hosts: Idaho Anti-Trafficking Coalition, Mariana Loya, Intern with United Way of Life’s Kitchen Jennifer Zielinski and Kevin Zielinski Treasure Valley Notus Elementary Idaho Association for the Education of Young Claudia Ornelas, Southwest District Health Elmore County Health Coalition Children, Hailey Michalk and Allison Maier Alexis Pickering, Western Idaho Community Health Collaborative International Rescue Committee Idaho Business for Education, Rod Gramer Brittany Rosenthal, United Way of Central District Health Youth Idaho Commission on Aging, Judy Taylor Treasure Valley Behavioral Committee Idaho Foodbank, Kimberley Empey and Christa Rowland, United Way of Western Idaho Community Action Jackie Yarbrough Treasure Valley Partnership, Inc. Idaho Housing and Finance Association, Mayowa Sanusi, Health Resources in Action Owyhee Community Health Action Team Erik Kingston Idaho Oral Health Alliance, Jennifer Wheeler, Ed Schultz, United Way of Treasure Valley Samantha Kenney, and Susan Ellis
Acknowledgements United Way of Treasure Valley 2020 Community Assessment Introduction
Table of 3 Contents
Acknowledgments...... 2 Suicide...... 55 Substance Use...... 56 Table of Contents...... 3 Tobacco Use...... 59 Message from United Way of Treasure Valley...... 4 Healthy Weight: Physical Activity, Active Background...... 5 Transportation, Nutrition, and Food Security...... 60 Approach...... 6 Childhood Obesity...... 61 Social Influencers of Health Framework...... 6 Physical Activity...... 62 Health Equity Framework...... 7 Active Transportation...... 63 Scope and Strategy of This Report...... 7 Nutrition...... 64 Strategies that Maximize Impact...... 7 Hunger and Food Insecurity...... 65 Scope: The Treasure Valley...... 8 School Meals...... 66 Assessment Methods...... 9 Food Deserts...... 67 A Guide to Using the 2020 Community Safety...... 68 Assessment...... 10 Solutions: Policy, Systems, and Environmental Solutions: Policy, Systems, and Environmental (PSE) Changes...... 70 (PSE) Changes...... 11 Education...... 72 Demographics and Characteristics of the Early Childhood Education and School Treasure Valley...... 12 Readiness...... 72 Financial Stability...... 21 K-12 Education...... 75 Poverty and ALICE...... 21 Funding for Education and Education Quality.. 76 Children and Poverty...... 23 Poverty and Education...... 77 Employment and Economic Security...... 24 Chronic Absence...... 78 Meeting Basic Needs...... 27 Reading and Math Proficiency...... 78 Educational Attainment and Finance...... 28 High School Graduation Rates...... 82 Housing and Homelessness...... 30 Educational Enrichment...... 83 Home Values...... 30 Community School Strategy...... 83 Rental Availability...... 32 Out-of-School Time Programs...... 83 Housing Cost Burden...... 33 Postsecondary Education...... 84 Housing Stability and Housing Conditions...... 34 Solutions: Policy, Systems, and Environmental Homelessness...... 36 (PSE) Changes...... 86 Risk Factors for Homelessness...... 38 Community Strengths and Resources...... 88 Children Experiencing Homelessness...... 39 Appendices...... 90 Transportation...... 40 Appendix A. Focus Group Discussion Guide...... 90 Solutions: Policy, Systems, and Environmental Appendix B. Key Informant Interview Discussion (PSE) Changes...... 43 Guide...... 93 Health...... 45 Appendix C. Community Survey Instrument...... 96 General Health and Well-Being...... 45 Appendix D. Demographics/Descriptive Data Health Care: Access and Affordability...... 46 about Community Survey Participants...... 102 Insurance...... 49 Appendix E. Community Survey Respondent Oral Health...... 51 Ratings of Their Concern for Specific Community Behavioral Health: Mental Health and Issues...... 105 Substance Use...... 53 Appendix F. Additional Findings...... 107 Mental Health...... 53 Appendix G. Saint Alphonsus Addendum...... 126
United Way of Treasure Valley 2020 Community Assessment Introduction Introduction
Message 4 from United Way of Treasure Valley
Every community assessment, by its very This is the fourth of an ongoing series of data nature, represents a moment in time. to help us identify, rally, unite, and advance That has never been more true that this success for our community. Every three years, Treasure Valley Community Assessment. United Way of Treasure Valley, in partnership This document was created during the with Saint Alphonsus Health System, Trinity Coronavirus COVID-19 Pandemic of 2020. Health, and other community organizations, As I write this introduction, a significant takes a deep and comprehensive look at the portion of our low-wage earners are health, education, and financial stability of wondering what their job prospects will be the greater Treasure Valley. In this document in the days and weeks ahead. Families are you will find trends, observations and facts worried about their ability to pay rent or about the conditions in Ada, Canyon, Gem, a mortgage, and children are not likely to Owyhee, and Elmore Counties. Together this return to the classroom for many months. represents more than 40% of the population The repercussions on the health, financial of the State of Idaho. stability, and educational success of our I invite you to give time and attention to community are yet to be known. the “Policy, Systems, and Environmental What we do know; and what the information change” recommendations throughout within this report shows us, is how important this document. Data by itself does little. it is for us to use data as a beacon to make Data combined with the action of caring our policies, systems, and environments individuals and collaborative partners can much stronger, more resilient, and better change the life success of entire populations. adapted to support success in the 21st Find the actions and activities that compel Century. you and join us in fighting for the health, education, and financial stability of every I hope, dear reader, that you will take the person in every community. knowledge of context you have gained post- pandemic and layer it with the information Our deepest appreciation is given to the here to advance success for our children, community leaders and organizations who families, and hardworking, low-wage earning joined in presenting the 2020 United Way friends and neighbors. Community Assessment.
Nora J. Carpenter President and CEO United Way of Treasure Valley
Introduction United Way of Treasure Valley 2020 Community Assessment Introduction 5
BACKGROUND United Way of Treasure Valley (UWTV) fights corporations, and financial institutions; hospitals for the health, education, and financial stability and health care organizations; and faith-based of every person in every community in the organizations, civic groups, governments, non- Treasure Valley. Our community wins when we profits, and volunteers to confront the socio- unite and work together. Saint Alphonsus Health economic challenges in the Treasure Valley. System is a mission-driven, innovative health For the 2020 Community Assessment, UWTV organization that strives to become the national is working in partnership with Saint Alphonsus leader in improving the health of communities Health System to carry out the Community and each person served (see Appendix G Assessment. To date, UWTV’s work has identified for more information about Saint Alphonsus and focused on the three most critical building Health System). To those ends, UWTV and blocks for a stable life for Treasure Valley Saint Alphonsus Health System both provide residents: health, education, and financial leadership in understanding and addressing stability. These building blocks make up the two the common threats to the well-being of the foundational levels of Maslow’s Hierarchy (Figure Treasure Valley’s communities and residents. 1), and represent our most basic human needs. Every three years, UWTV conducts a community The 2020 Community Assessment validates this assessment that helps define the most pressing approach and demonstrates that continued human needs. This information guides the focus on these building blocks will make the alignment of resources and implementation biggest difference in the lives of local children, of needs-driven, evidence-based solutions. individuals, and families. UWTV convenes community partners, including small- and medium-sized businesses, major
Figure 1 Maslow’s Hierarchy of Needs
DATA SOURCE: Maslow, A.H. (1943). A Theory of Human Motivation. Psychological Review, 50, 370-396.
United Way of Treasure Valley 2020 Community Assessment Introduction Introduction 6
APPROACH Social Influencers of Health Framework It is important to recognize that multiple factors Health Organization further defines the Social Community Feedback on have an impact on health and well-being. There Influencers/Determinants of Health as “the Health Equity: is a dynamic relationship between community conditions in which people are born, grow, “Social service members and the environment in which they live, work, and age. These circumstances are systems live. The following diagram provides a visual shaped by the distribution of money, power, are hard to representation of this relationship. The World and resources.” navigate, you feel like you’re “chasing your tail” going back and forth Figure 2 Social Influencers of Health Equity Framework to different agencies for help.” Housing Stability Economic Community and – Community and Housing Education Food Health Care System Stability Conditions Social Context Member “Information sharing in Employment Housing Literacy Hunger Social Health Care and Food Integration Access and programs and Income Transportation Language Insecurity Affordability services seems Support Expenses Safety Early exclusionary. Nutrition Systems Provider Childhood Those that Debt Parks Linguistic Education Community are in the and Cultural Medical Bills Playgrounds Engagement situations aren’t Career/ Competency Support Walkability Technical Discrimination included in Quality of Education conversations Educational Zip Code/ Stress Care with those Attainment Geography Postsecondary making Education decisions.” – K-12 Parent and Community Member
Health Outcomes Mortality, Morbidity, Life Expectancy, Health Care Expenditures, Health Status, Functional Limitations
Braveman PA, Kumanyika S, Fielding J, et al. Health disparities and health equity: the issue is justice. Am J Public Health. 2011;101(suppl 1):S149-S155.
Introduction United Way of Treasure Valley 2020 Community Assessment Introduction
Health Equity Framework Health equity means that every person has a fair • The job they have and just opportunity to achieve optimal health • The neighborhood they live in regardless of: • Whether or not they have a disability1 7 • Their age Health equity is fundamental to having a • The color of their skin healthy community. Where possible, this report • Level of education incorporates data that highlight disparities in • Gender identity opportunities and equity and the impact this has • Sexual orientation on the health of populations.
Figure 3 The Health Impact Pyramid
Increasing Increasing Population Individual Impact Effort Needed Health Equity: “The attainment of the Counseling highest level of health and Education for all people. Achieving health equity requires Clinical valuing everyone equally Interventions with focused and ongoing societal efforts Long-Lasting to address avoidable Protective Interventions inequalities, historical and contemporary injustices, and the Changing the Context to elimination of health and Make Individuals’ Default Decisions Healthy health care disparities.” – Healthy People Socioeconomic Factors 2020, Office of Disease Prevention and Health Promotion DATA SOURCE: Frieden, TR, American Jounal of Public Health 2010; 100(4), 590-5
Scope and Strategy of This Report Strategies that Maximize Impact In 2010, Dr. Thomas Frieden, the Director of the Centers health or social services (2) pursue educational or for Disease Control and Prevention (CDC), offered a professional opportunities and (3) benefit from exposure tiered model of strategic interventions that has been to positive environmental factors such as clean air proven to improve health in populations where these and water, safe housing, and adequate sanitation. strategies have been implemented. The next layer up focuses on changing the context of the places where people are born, grow, live, work, The pyramid shows that strategies with the greatest and age to make the healthy choice the easy choice. potential to impact the Social Influencers of Health and These approaches center on Policy, Systems, and health equity are those that reach the most people and Environmental changes (PSE) which will be further require the fewest resources. The foundation of the explained in the PSE section of the report on page 11. pyramid points to the impact of socioeconomic factors in determining one’s ability to: (1) access necessary
1 Braveman PA, Kumanyika S, Fielding J, et al. Health disparities and health equity: the issue is justice. Am J Public Health. 2011; 101 (suppl 1): S149-S155.
United Way of Treasure Valley 2020 Community Assessment Introduction Introduction 8
Scope: The Treasure Valley The 2017 Treasure Valley Community Assessment ADA COUNTY included data for Ada, Canyon, and Gem With just over 480,000 residents, Ada County is Community Counties. With population growth in the region Idaho’s most populous and home to 27% of the Feedback on and residents being pushed further outside of state’s population. Its most populated cities are the Treasure Boise and Meridian with populations of 228,959 the Valley’s urban areas due to cost of living Valley: and 114,161, respectively. “Neighbors increases, UWTV determined that the 2020 are close and Community Assessment would expand its trusting.” geographic reach to include Elmore and Owyhee – Rural CANYON COUNTY Counties. Together, these five counties make up Canyon County’s population of over 229,000 Community 43% of the state’s population. residents makes it Idaho’s second most populated Member county with 12.9% of the state’s residents. The most “It is a very populated cities in Canyon County are Nampa and family-friendly Figure 4 Assessment Region Caldwell, which are home to 99,277 and 58,481 community; it is residents, respectively. safe. You may not agree with your neighbor but they will ELMORE COUNTY give you their At 27,511, the population of Elmore County makes shirt off their up 1.5% of the state’s population. Mountain Home, back if you with a population of 14,562, is the largest city in need help.” Elmore County. – Rural Community Member GEM COUNTY “The community Gem County is the second least populous county has a ‘it takes in the Treasure Valley Community Assessment with a village’ 18,112 residents or 1% of the state’s population. Its mentality.” largest city is Emmett with a population of 7,054. – Rural Community Member OWYHEE COUNTY Owyhee County is the least populated county in the Treasure Valley Community Assessment with 11,823 residents or .7% of the state’s population. Homedale is its largest city with a population of approximately 2,600.
DATA SOURCE: U.S. Census Bureau, American Community Survey 5-Year NOTE: Numbers reflect population in 2019 Estimates, 2014-2018; and U.S. Census Bureau, Quick Facts, 2019
Introduction United Way of Treasure Valley 2020 Community Assessment Introduction 9
ASSESSMENT METHODS This Community Assessment aims to identify In addition to an online and paper community the Ada, Canyon, Elmore, Gem, and Owyhee survey that engaged over 2,100 residents, Counties through a Social Influencers of Health approximately 165 individuals from multi- Assessment framework, which defines health in the broadest sector organizations, residents, and community Oversight: This committee sense and recognizes numerous factors – from stakeholders participated in focus groups and was comprised employment to housing to access to health interviews to gather feedback on community of 25 members care – that have an impact on the community’s strengths, challenges, and priority health representing health. Social, educational, economic, and concerns. Through the process of compiling, UWTV, Saint health data were drawn from existing data analyzing, and synthesizing quantitative and Alphonsus Health System, sources such as the U.S. Census, Idaho qualitative data, a list of key themes emerged. community Department of Health and Welfare, and Idaho This list was then prioritized by key stakeholders, health State Department of Education, among others. resulting in the following six priorities: centers, local public health departments, housing and Top Six Significant Community Priorities community development organizations, • Affordable, safe housing, • Mental health and well- educational 1 and homelessness being and substance use 4 institutions, and other health and human service The prioritized • Wages and job • Access to affordable organizations. availability key themes are healthcare, including 2 presented in behavioral and dental health 5 rank order • Cost of living: e.g., • Education, including high- 3 housing, transportation, quality early childhood child care, etc. education 6
A more detailed description of the Community Assessment methods can be found in Appendix G.
United Way of Treasure Valley 2020 Community Assessment Introduction Introduction
COVID-19 Pandemic Idaho’s first case of Coronavirus, or COVID-19, causing loss of income during the pandemic. was reported on March 13, 2020, although many Those that are essential workers are more likely 10 experts believe that the contagion was present to contract the contagion yet less likely to have in the state before this date. Governor Brad the resources to recover from Coronavirus; Little issued a statewide Stay-at-Home Order they are less likely to have adequate health on March 25, 2020, to help flatten the epidemic insurance and paid sick leave.2 Children from curve and allow hospitals the resources and low-income households are less likely to have capacity to respond to the illness. The Stay-at- the technology, parental support, and academic Home order effectively closed all businesses enrichment opportunities necessary to continue except those deemed “essential” with a plan to educational gains during school closures.3 reopen the economy in phases. Idaho’s economy While the data included in this report is is expected to fully reopen in early July 2020. preliminary to the Coronavirus pandemic, it Families from lower-income households are is important to note some of the predicted predicted to be disproportionately impacted by impacts of the pandemic on Idaho’s economy the pandemic. These families are more likely to and residents. Issues of health equity are be living paycheck to paycheck with little to no highlighted throughout this report, and it is savings to weather the pandemic, resulting in predicted that health equity and academic compounding bills. They are also less likely to achievement gaps will continue to widen after have jobs that allow them to work from home, the pandemic. A GUIDE TO USING THE 2020 COMMUNITY ASSESSMENT The 2020 Treasure Valley Community • A comparative source to examine what might Assessment is designed to provide businesses, have changed over time – what has improved, government, health care, schools, and other what has not, and where there are new areas agencies and organizations in the public and that need engagement private sectors with timely and credible data • A resource for identifying potential partners and evidence-based Policy, Systems, and and implementing effective, high impact Environmental (PSE) solutions to community strategies for population-level changes problems. It is recommended that the 2020 Treasure Valley Community Assessment be used as: • A data source that provides reliable and objective information about the characteristics of life in the Treasure Valley • A source of contextual data gathered from interviews and focus groups with community members, service providers, community leaders, and other key stakeholders whose voices provide crucial information for understanding the needs of the community
2 Fisher, Max, and Emma Bubola. “As Coronavirus Deepens Inequality, Inequality Worsens Its Spread.” The New York Times, The New York Times, 15 Mar. 2020, www.nytimes.com/2020/03/15/world/europe/coronavirus-inequality.html. 3 Fink, Jenni. “School Closures Due to Coronavirus Could Widen Educational Inequality among Students.” Newsweek, 25 Mar. 2020, www.newsweek.com/school- closures-coronavirus-inequality-education-gap-widens-1494303.
Introduction United Way of Treasure Valley 2020 Community Assessment Introduction Solutions: Policy, Systems, and Environmental (PSE) Changes The combination of quantitative data betterment of all who (numbers) and qualitative data (stories and interface with the environment. observations) helps to develop a consistent and 11 Leveraging existing comprehensive picture of the issues faced by partnerships and community resources is Treasure Valley residents. In order to achieve the critical for successfully implementing the highest impact in addressing these issues, the PSE solutions proposed in the 2020 Treasure United Way of Treasure Valley commits resources Valley Community Assessment. The strategies to PSE strategies. described in each section are suggested Policy change strategies include policies evidence-based recommendations from top implemented at the organizational, municipal, national sources such as the Centers for Disease and state or legislative levels. Such changes may Control and Prevention (CDC), U.S. Department include creating new or amending existing rules, of Education, and the Corporation for Enterprise policy and procedures, ordinances, resolutions, Development, as well as from residents and mandates, and regulations. community leaders who participated in the assessment’s focus groups and interviews. Systems change strategies include making By providing these strategies, UWTV hopes changes to rules and ways of doing business to inspire and create change in the lives of within or across organizations. individuals, within the organizations in which Environmental change strategies focus on they work and participate, and within their changing the physical environment for the communities.
A PROGRAMMATIC APPROACH VS. A PSE CHANGE APPROACH
Hosting a community Implementing nutrition standards for the bike ride. food and beverages provided to children in licensed child care homes and facilities.
Having an “open gym Alignment of the timing of College night” at a local school. Application Week with the Idaho Opportunity Scholarship application deadlines and the Idaho State Department of Education’s direct admissions process to Working with a provide a seamless, integrated experience corner store to r oc for students and families. roduc become a designated Healthy Market. Providing wayfinding signage to help people in neighborhoods identify safe walking paths. Opening and maintaining a community garden. Building more affordable housing units.
DATA SOURCE: Massachusetts Health Promotion Clearinghouse, Mass In Motion
United Way of Treasure Valley 2020 Community Assessment Introduction Introduction DEMOGRAPHICS AND CHARACTERISTICS OF THE TREASURE VALLEY Population Change, 2010 to 2018 According to the U.S. Census, Figure 5 between July 1, 2017 and July 12 1, 2018, Idaho tied Nevada as 17.2% having the highest percentage 16.1% of population growth in the nation with 2.1% growth during the one-year period.4 10.6% The population in Idaho overall increased by 10.6% from 2010 1.6% to 2018. Within the Treasure -.9% .6% Valley area, Ada County had the Community Ada Canyon Elmore Gem Owyhee Idaho largest percentage of growth County County County County County Feedback on Growth in (Figure 5). DATA SOURCE: ACS Housing and Demographic Estimates 2010 and 2018 the Treasure Valley Residents participating in focus groups and residence within a one-year period. Of the “We’re having growing pains, interviews stated that sizeable population 705,596 persons residing in the Treasure Valley, [but I’d] rather growth in the Valley has had both positive and an estimated 7.6% relocated to the area, have that than negative impacts on residents. Impacts include according to the latest American Community no growth.” school overcrowding, more businesses, influx of Survey five-year estimates. Persons who moved – Community talent from different areas of the country, growth to a new household from outside of their current Member of the refugee community, rise in housing costs, county of residence, from outside their state of “The community displacement of people from their communities, residence, or from abroad are considered part is divided. There is a side and longer commute time. of the in-migrated population. Persons who moved to a new household from a different that doesn’t Figure 6 provides information about population support growth household within their current county of “in-migration” by assessing changes in and are happy residence are not included. with how things are, but the In-Migration Population other side Figure 6 wants to grow and ‘step up 11.9% the game’.” 11.1% – Rural Community 8.1% Member 8.1% 6.9% 7.2% 6.2%
Ada Canyon Elmore Gem Owyhee Idaho U.S. County County County County County
DATA SOURCE: U.S. Census Bureau, American Community Survey 5-Year Estimates, as cited by Trinity Health Data Hub, 2014-2018
4 U.S. Census Bureau. (2018, December 20). Nevada and Idaho Are the Nation’s Fastest-Growing States. Retrieved May 26, 2020, from https://www.census.gov/ newsroom/press-releases/2018/estimates-national-state.html?CID=CBSM+POP18
Introduction United Way of Treasure Valley 2020 Community Assessment Introduction
In 2019, focus group and interview participants described the population growth as businesses move to Boise. This growth, they reported, has led to new people coming to the area, which 13 they noted adds diversity but may also change the culture of the Treasure Valley.
Table 1 Demographics Statewide and by County
Ada Canyon Elmore Gem Owyhee County County County County County Idaho U.S.
Population, 2018 446,052 212,230 26,433 17,052 11,455 1,687,809 322,903,030
Percentage of Total Population
White, Non-Hispanic 84.9% 70.6% 73% 87.9% 68.2% 82.2% 61.1%
Black or African American 1.4% 0.3% 2.6% 0% 0.4% 0.7% 12.7%
Hispanic or Latino 8% 25.1% 16.7% 8.3% 26.6% 12.4% 17.8%
Under 18 Years of Age 24.5% 28.9% 25.6% 23.3% 26.4% 26.1% 15.7%
Aged 65 Years and Older 13.5% 13.2% 12.9% 21.3% 17.5% 15% 15.3%
No High School Diploma 4.9% 15.4% 10.6% 12.1% 25% 9.4% 12.3%
Bachelor’s Degree or Higher 37.8% 18.3% 16.4% 14.8% 11.2% 26.9% 31.5%
Foreign-born Population 5.8% 8.4% 8.9% 3% 10.3% 6% 13.5%
Veterans 8.8% 8.9% 23.6% 15.3% 9.1% 9.2% 7.5%
Individuals with Disability 10.2% 13.9% 14% 19.6% 16.6% 13.3% 12.6%
DATA SOURCE: U.S. Census Bureau, American Community Survey 5-Year Estimates, as cited by Trinity Health Data Hub, 2014-2018
United Way of Treasure Valley 2020 Community Assessment Introduction Introduction 14
Race and Ethnicity Consistent with the overall demographics of Elmore Counties have the highest percentage Idaho, the five counties in this report are home of foreign-born residents. They have become a Community to a majority White population; however, a major part of the workforce in some industries. Feedback on Race and substantial portion of the populations in Canyon They also reported that, although they like the Ethnicity: and Owyhee Counties are Hispanic/Latino (See Treasure Valley, they face discrimination and “The Latino Table 1 on page 13). Despite the large population access issues that other residents are not facing. community of Hispanic/Latino residents in the Valley, some For example, the availability of translation is not being focus group participants feel the needs of the services varies throughout the Treasure Valley. represented. Hispanic/Latino community are not being met. Our needs “People are not ready to meet foreigners. They are not being Immigrants and refugees from Burma, Nepal, say ‘hi,’ but they don’t keep the conversation listened to. Things are Iraq, Afghanistan, Japan, Sudan, the Congo, going. They still clutch their bags when an staying the Somalia, and Eastern Europe participated in African man is near and they aren’t ready to same.” the focus groups and stated that, although the receive foreigners. You feel bad when they give – Community Treasure Valley remains mostly White, there [you] fake smile and don’t want to really know Member are pockets of diversity from immigrants and you.” “About one- refugees coming to the area. Owyhee and – K-12 Parent, Refugee, and Community Member. third of my employees are Spanish Foreign Born Population speaking.” Figure 7 – Human Resources Professional 13.5% “There’s a long history of 10.3% diversity within these rural 8.4% 8.9% and remote communities.” 5.8% 6% – Refugee Resettlement Professional 3%
Ada Canyon Elmore Gem Owyhee Idaho U.S. County County County County County
DATA SOURCE: U.S. Census Bureau, American Community Survey 5-Year Estimates, as cited by Trinity Health Data Hub, 2014-2018
Introduction United Way of Treasure Valley 2020 Community Assessment Introduction 15
Age Within the Treasure Valley, the largest age concerns were a top health issue for themselves group is 5-17 years, representing 19.4% of the or someone in their family. Focus group and Community population (Figure 8). Gem County has the key informant interview participants believe that Feedback on highest concentration of seniors at 21%. seniors are having problems accessing services Aging: specific to them, especially when it comes Although seniors (age 65 and older) comprise “Social to behavioral health. Social isolation is also a isolation is a only 13.6% of the Treasure Valley population, concern among seniors. big worry. We 27.6% of respondents to the 2020 Community want to see Assessment survey reported that aging health all our seniors having daily, rich contact Treasure Valley Population, by Age Figure 8 with another human being and we know that is not 2018 Treasure Valley Population: 713,222 happening in many instances, and that leads to other issues.” – Senior Services Professional “There are no facilities for the elderly with mental health issues ... [existing facilities are] not focused
Total Population on the unique by Age needs of 89,373 82,691 64,393 46,742 99,332 95,223 97,107 the geriatric 138,361 community.” – Senior
% of Population Services by Age Professional 6.6% 19.4% 9% 13.9% 13.4% 12.5% 11.6% 13.6%
0-4 years 5-17 years 18-24 years 25-34 years 35-44 years 45-54 years 55-64 years 65+ years
DATA SOURCE: U.S. Census Bureau, American Community Survey 5-Year Estimates, as cited by Trinity Health Data Hub, 2014-2018
United Way of Treasure Valley 2020 Community Assessment Introduction Introduction
Veterans Over 49,000 veterans live in the Treasure Valley. of survey respondents. Participants in the focus At 23.6%, Elmore County is home to the largest group and interviews describe Idaho as veteran- 16 population of veterans (Figure 9). friendly and indicated that there are a lot of resources for veterans. However, they explained Veterans in the Treasure Valley tend to skew that veterans are not aware of these resources older, with 45.3% being 65+. The median and, even if they are, they do not know how to income for veterans living in Idaho is $35,518. navigate them. Those living in the Treasure Valley have median incomes that range from $25,813 in Owyhee Participants reported that veterans diagnosed County to over $40,000 in Ada and Elmore with Post-Traumatic Stress Disorder (PTSD) also Counties (Figure 103, Appendix). face stigma in the community. PTSD is difficult under any circumstance, but was described as Among the health issues included in the common and particularly hard for those veterans Community community survey, mental health and stress who are parents. Feedback among veterans was of high concern to 60.2% from the LGBTQIA+ Community: “Boise in Figure 9 Percentage of Veterans Among Total Population particular is embracing and accepting of the LGBTQIA+ 23.6% Community.” – LGBTQIA+ Community Member 15.3% “LGBTQIA+ population 8.8% 8.9% 9.1% 9.2% struggles to get complete care with comfort. Meaning that the population Ada Canyon Elmore Gem Owyhee Idaho does not County County County County County always even know the right DATA SOURCE: U.S. Census Bureau, American Community Survey 5-Year Estimates, as cited by questions to Trinity Health Data Hub, 2014-2018 ask so that their provider can give LGBTQIA+ them the correct care.” A small percentage of community survey that access to medications such as Pre- – LGBTQIA+ respondents identified as lesbian, gay, or exposure Prophylaxis (PreP) and Post-exposure Community bisexual (5.6%) compared to about two percent Prophylaxis (PeP) was limited in some areas of Member of the population statewide. People who the Treasure Valley. Participants shared that there identify as LGBTQIA+ participating in focus were very limited providers that understood the groups stated that they have had issues needs of LGBTQIA+ patients, but that Boise accessing appropriate services and have has more resources for and is more accepting faced discrimination. For example, they stated of LGBTQIA+ people than other places in the Treasure Valley.
Introduction United Way of Treasure Valley 2020 Community Assessment Introduction
Figure 10 Percentage of Population With a Disability, by Age
45.3% 46.3% 42% 17 34.7% 36% 35% 30.8%
4.8% 4.4% 3.4% 4.3% 4.2% 4.2% 4.2% Under 18 65 & Over Under 18 65 & Over Under 18 65 & Over Under 18 65 & Over Under 18 65 & Over Under 18 65 & Over Under 18 65 & Over Ada Canyon Elmore Gem Owyhee Idaho U.S. County County County County County
DATA SOURCE: U.S. Census Bureau, American Community Survey 5-Year Estimates, as cited by Trinity Health Data Hub, 2014-2018
Individuals with a Disability The Americans with Disabilities Act defines a disability Canyon, Elmore, Gem, and Owyhee Counties as a “physical or mental impairment that substantially have a higher proportion of residents who are living limits one or more major life activities.” Individuals with with a disability than elsewhere statewide and a disability may be unable to work and often face a nationally (Figure 10). This indicates a higher need higher rate of poverty. They are also at higher risk for for disability services in the more rural counties of mental health issues including anxiety and depression.5 the Treasure Valley.
Figure 11 Gender Distribution Gender The gender distribution in Idaho consists of 50.1% male and 49.9% 49.9% 50.6% 47.6% 51% 48.7% 49.9% 50.8% Female female. Treasure Valley communities share a similar gender distribution to that of the state, although Elmore County has the lowest proportion of women at 47.6% and the highest proportion of men at 50.1% 49.4% 52.4% 49% 51.3% 50.1% 49.2% Male 52.4% (Figure 11).
Ada Canyon Elmore Gem Owyhee Idaho U.S. County County County County County
DATA SOURCE: U.S. Census Bureau, American Community Survey 5-Year Estimates, as cited by Trinity Health Data Hub, 2014-2018
5 National Council on Disability. HIghlighting Disability/Poverty Connection. Retrieved on June 2, 2020 from https://ncd.gov/newsroom/2017
United Way of Treasure Valley 2020 Community Assessment Introduction Introduction 18
Percentage of Population Aged 5 Years and Over with Limited English English Proficiency Figure 12 In the Treasure Valley, Proficiency (LEP) Owyhee County has the highest percentage of 11.4% residents with Limited English Proficiency (LEP) – 8.5% defined as those who 7.1% speak English less than 5.9% “very well”. Elmore and Canyon Counties also 4% have higher percentages 3% 2.5% than Idaho overall (Figure 12). Combined with the data on other languages spoken at home (Figure Ada Canyon Elmore Gem Owyhee Idaho U.S. 13), this indicates a need County County County County County for information and DATA SOURCE: U.S. Census Bureau, American Community Survey 5-Year Estimates, as cited by services to be provided Trinity Health Data Hub, 2014-2018 in languages other than English to ensure residents have access Figure 13 Percent of Population Aged 5 Years and Over with Language Other to the information and Than English Spoken at Home services they need. 23.4%
18.5%
13.7% 10.8%
8.5% 7.9%
Ada Canyon Elmore Gem Owyhee Idaho County County County County County
DATA SOURCE: U.S. Census Bureau, American Community Survey 5-Year Estimates, 2014-2018
Introduction United Way of Treasure Valley 2020 Community Assessment Introduction
Educational Attainment The Education Section of this Community highest percentage of residents aged 25 and Assessment provides extensive detail on a over that have a Bachelor’s degree or higher and variety of topics; however, information on the lowest percentage of the population with no 19 educational attainment is provided here high school diploma. In contrast, approximately as background about the characteristics of one in four residents of Owyhee County does residents of the Treasure Valley. not have a high school diploma and less than one in ten has a Bachelor’s degree or higher. Within the Treasure Valley, Ada County has the
Figure 14 Educational Attainment for Population Aged 25 and Over
37.8%
26.9%
25%
18.3% 16.4% 15.4% 14.8% 12.1% 10.6% 11.2% 9.4%
4.9% Bachelor’s Bachelor’s Bachelor’s Bachelor’s Bachelor’s Bachelor’s Degree or No H.S. Degree or No H.S. Degree or No H.S. Degree or No H.S. Degree or No H.S. Degree or No H.S. Higher Diploma Higher Diploma Higher Diploma Higher Diploma Higher Diploma Higher Diploma Ada Canyon Elmore Gem Owyhee Idaho County County County County County
DATA SOURCE: U.S. Census Bureau, American Community Survey 5-Year Estimates, as cited by Trinity Health Data Hub, 2014-2018
Economic Status Statewide, the percentage of children living Indicators of poverty and financial stability are at or below 100% of the Federal Poverty Level detailed further in the Financial Stability section (FPL) has decreased since 2015. This data seems of this report. A snapshot of economic status to suggest that childhood poverty declined is provided here as background about the in Idaho. However, with the exception of Ada characteristics of residents of the Treasure Valley. County, nearly 1 in 2 households in the Treasure Valley is struggling financially to meet their basic needs.
Figure 15 Percent of Idaho Children At or Below 100% Federal Poverty Level (FPL)
20% 18% 18% 15% 14% 15%
10% 2015 2016 2017 2018
DATA SOURCE: U.S. Census Bureau, American Community Survey 1-Year Estimates, as cited by The Annie Casey Foundation, 2015-2018
United Way of Treasure Valley 2020 Community Assessment Introduction Introduction
Indicators of poverty Percent of Children At or Below 100% Federal Poverty Level (FPL) Figure 16 are addressed in more detail in the Financial 20 Stability section of this 32.3% report. Given the close relationship between 25.5% poverty and adverse health outcomes, as well 19.5% as poverty and lower 18.6% 19.3% 16.9% educational attainment
and opportunities, these 11.7% issues will be explored in all sections of this report.
Ada Canyon Elmore Gem Owyhee Idaho U.S. County County County County County
DATA SOURCE: U.S. Census Bureau, American Community Survey 5-Year Estimates, 2014-2018
Household Composition Household composition is important for understanding and living arrangements vary substantially across the factors associated with poverty, because poverty Treasure Valley. Household composition has remained rates vary by age, gender, and household status. consistent across the region over the past decade. Table 2 shows that the characteristics of households
Household Composition Table 2
DATA SOURCE: Ada Canyon Elmore Gem Owyhee County County County County County Idaho U.S.
Households 168,471 70,847 10,285 6,583 4,250 618,331 119,730,128 Average household size (# of people) 2.59 2.95 2.5 2.57 2.66 2.68 3.23
Percentage of all households Single householder 30.1% 24.4% 25.9% 28.3% 24.3% 26.5% 27.7% Families 63.2% 70% 68.6% 67.5% 71.6% 67.7% 65.7% Families, children under 18 28.2% 33.7% 31.1% 21.4% 31.1% 29.8% 27.9% Two-parent family, children under 18 21.1% 24.4% 22.1% 11.9% 22.4% 22% 19% Single-male parent, children under 18 2.4% 2.5% 3.4% 0.8% 3.6% 2.4% 2.3% Single-female parent, children under 18 4.8% 6.9% 5.6% 8.6% 5.1% 5.4% 6.7%
DATA SOURCE: U.S. Census Bureau, American Community Survey 5-Year Estimates, as cited by Trinity Health Data Hub, 2014-2018
Introduction United Way of Treasure Valley 2020 Community Assessment Financial Stability Financial 21 Stability
FINANCIAL STABILITY The financial stability of an individual influences necessities and the amount of income required his/her ability to access food, housing, for a bare minimum “survival budget” for each Community education, and health care and is a significant census tract. Feedback on Social Influencer of Health. The following section Poverty: The available poverty and ALICE data validate discusses financial stability and the impacts “... We are the perceptions of focus group and interview to residents of the Treasure Valley. Income terribly under- participants about concentrated areas of resourced. inequality, poverty, and ineligibility for benefit poverty and substantial working poor in the There are programs are some of the economic concerns of high levels of Treasure Valley, and tell a disconcerting story the Treasure Valley. poverty that about the economic situation experienced by exist that are its residents. As shown below, the percentage of unable to be Poverty and ALICE households living in poverty and ALICE varied supported.” Nationally, the United Way coined the term – Rural across the Treasure Valley. With the exception “ALICE” to refer to Asset Limited, Income Community of Ada County, nearly 1 in 2 households in Constrained, Employed individuals. The Member the Treasure Valley is struggling to meet basic calculation of ALICE levels takes into account “There is no needs. the localized costs for a variety of household guarantee of food the next day for Percent of Households in Poverty or ALICE children.” Figure 17 – Community Member “Poverty levels are not reflective of 60% need in the 56% 55% community.” – Early 50% 49% 47% Childhood 44% 42% Professional 41% 40% 38% 37%
30% 2010 2012 2014 2016 2018
Ada Canyon Elmore Gem Owyhee
Source: United Way Asset Limited, Income Constrained, Employed (ALICE) Project, 2020
United Way of Treasure Valley 2020 Community Assessment Financial Stability Financial Stability
The U.S. Federal Figure 18 Percentage of Households in Poverty Poverty Level (FPL) is a measure of 22 income issued every year to 25% determine eligibility for 20% certain programs 18.2% 17.4%
and benefits. 14.8% 14.7% 15% 14.4% Since a peak 14.3% 13.1% 13.8% 12.9% around the 2008 11.8% 11.7% 10% 11.5% Great Recession, 9.7% 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 federal poverty Community rates are declining Ada Canyon Elmore Gem Owyhee Idaho Feedback on in the Treasure U.S. Poverty: Valley and Idaho DATA SOURCE: U.S. Census Bureau, Small Area Income and Poverty Estimates, 2009-2018 “[We have] overall. higher wages than other Participants in focus groups and interviews food, health care, and transportation or are parts of the perceived that Socio-Economic Status (SES) one paycheck or disaster away from losing state, but they’re still not varies throughout the Treasure Valley with some these things. counties having higher concentrations of poverty sufficient.” Although the number of households in the – Nonprofit than others, such as Owyhee County. According Treasure Valley that fall below the FPL is Professional to these participants, those closer to Boise have alarming, the percentage of families who higher SES due to the opportunities present “Minimum wage struggle to make ends meet reveals a crisis is still too low in the Boise area, whereas, in rural areas, there situation. and needs is more poverty. As wages struggle to keep up Including both thresholds living at or to change to with the cost of living, participants described a below the FPL and ALICE thresholds, 106,801 keep up with households in the Treasure Valley struggle housing and lot of “working poor” across Treasure Valley, with financially every day, which threatens the cost of living.” people having to work multiple jobs just to meet economic sustainability of the region. – Community basic needs such as gas, food, rent/mortgage, Member and day-to-day living. Participants also pointed Idaho’s first case of the Coronavirus, or “The income out that wages were higher in Oregon than COVID-19, was detected on March 13, 2020, that workers in Idaho. This is in part due to a higher minimum and Governor Little issued a statewide Stay- the county get wage of at least $11.50 in Oregon as compared at-Home Order on March 25, 2020, effectively paid isn’t close to what 40 to $7.25 in Idaho. closing a large portion of Idaho’s economy. Many Idahoans suddenly faced layoffs in the first miles away While FPL is a useful indicator of individuals’ and is paying.” five weeks of the pandemic; more than 100,000 households’ ability to meet basic needs, it is not – Rural Idahoans filed a claim for unemployment.5 adjusted for region-specific variables, nor does it Community While the lasting economic impacts of the Member capture the full picture of financial stability. Many COVID-19 pandemic are unknown at this time, individuals and families that live above the FPL it is predicted those households that were are employed but still struggle financially. They struggling financially before the pandemic will make too much to qualify for public assistance continue to face greater financial hardship after programs or benefits, but not enough to make the pandemic. ends meet financially. As a result, they are often unable to afford necessities such as housing,
5 2 Idaho News. Idaho Department of Labor adjusts to waves of unemployed: ‘The phones blew up on us’. https://idahonews.com/news/coronavirus/idaho-labor- department-adjusts-to-waves-of-unemployed
Financial Stability United Way of Treasure Valley 2020 Community Assessment Financial Stability Children and Poverty Growing up in poverty can have immediate and Even when families are able to increase their long-term side effects on physical and mental total income, they are faced with challenges. health, educational attainment, and financial Sometimes a small increase in income can mean 23 stability. Living at or below twice the FPL (or that key benefits such as the Supplemental 200% of the Federal Poverty Level) generally Nutrition Assistance Program (SNAP) and child means families are stretched financially, having care assistance can go away. If a family has a to make choices about which basic necessities small increase in income and crosses the income they will do without. A family of four with a eligibility line for a specific benefit program household income of $50,200 in 2018 was living such as SNAP, they immediately lose that Dental EmergencyCar Repair Medical Bills at 200% of the FPL.7 A substantial proportion assistance. Yet a small increase in income may Rent Increase of Treasure Valley households live at or below not compensate for the total loss of the benefit 200% of the FPL (Figure 19). The percentage of program. This is referred to as the benefits cliff.8 children (under 18 years of age) in the Treasure The benefits cliff can cause families to fall Valley living at or below 200% of the FPL is even deeper into poverty, and some families may more troublesome. More than half the children avoid opportunities for income increases due living in Elmore, Gem, Canyon, and Owyhee to potential loss in key benefits.9 Counties live in households with incomes at or below 200% of the FPL.
Figure 19 Percent of Population At or Below 200% Federal Poverty Level (FPL), by Age
56.1% 54.9% 54.5% 54.7%
44.4% 44% 43.2% 42.3% 40.1%
35.5% 29.4% 26.2%
Under 18 Over 18 Under 18 Over 18 Under 18 Over 18 Under 18 Over 18 Under 18 Over 18 Under 18 Over 18
Ada Canyon Elmore Gem Owyhee Idaho County County County County County
DATA SOURCE: U.S. Census Bureau, American Community Survey 5-Year Estimates, as cited by Trinity Health Data Hub, 2014-2018
6 Logan, S. (2020, April 29). Idaho Department of Labor adjusts to waves of unemployed: ‘The phones blew up on us’. Retrieved May 26, 2020, from https:// idahonews.com/news/coronavirus/idaho-labor-department-adjusts-to-waves-of-unemployed 7 U.S. Department of Health & Human Services. 2018 Poverty Guidelines. Retrieved May 27, 2020. https://aspe.hhs.gov/2018-poverty-guidelines 8 McCann, M., & Kennedy, L. (2019, August 20). Addressing Benefits Cliffs. Retrieved May 26, 2020, from https://www.ncsl.org/research/human-services/ addressing-benefits-cliffs.aspx 9 Birken, B., Moriarty-Siler, E., & White, R. (2018, April 23). Reducing the Cliff Effect to Support Working Families. Retrieved May 26, 2020, from https://ascend. aspeninstitute.org/reducing-the-cliff-effect-to-support-working-families/
United Way of Treasure Valley 2020 Community Assessment Financial Stability Financial Stability
Income supports are critical for residents whose receiving Social Security while Owyhee County wages do not cover basic needs. Gem County has the highest percentage receiving SNAP has the highest percentage of the population benefits. 24 Percentage of Households with Income Supports Table 3
Ada Canyon Elmore Gem Owyhee County County County County County Idaho U.S.
Supplemental Nutrition 7.5% 15.6% 12.2% 13.4% 15.9% 10.6% 12.2% Assistance Program Social Security 25.5% 31.3% 31.1% 46.2% 34.5% 31.9% 30.9% Supplemental Security 3.4% 5.8% 4.7% 6.2% 6.3% 4.7% 5.4% Income Cash Public 2.3% 4.2% 3.5% 6% 3.7% 3% 2.5% Assistance Income
DATA SOURCE: U.S. Census Bureau, American Community Survey 5-Year Estimates, as cited by Trinity Health Data Hub, 2014-2018
Employment and Economic Stability Stable employment in well-paying jobs is key to unemployment claims were filed; this number is greater promoting economic stability. As is true for the than all unemployment claims filed in 2019. U.S., Idaho and local unemployment rates have The median annual family income in Idaho is $64,723. declined steadily since 2010. In 2019, unemployment However, in the Treasure Valley, median family income in the Treasure Valley ranged between 2.2% in Ada ranges from $49,872 in Owyhee County to $80,854 County and 3.5% in Owyhee County. While yearly in Ada County.10 unemployment rates for 2020 were unknown at the While unemployment is relatively time this report was published, in the first five weeks low, low wages in the Treasure Valley and income of the 2020 COVID-19 pandemic, more than 100,000 inequality continue to challenge households to meet basic needs. Median Income by Household Composition Table 4
Married- Married- Single- Single- Single- Single- Geography Couple Families Couple Families Males without Males Females without Females without Children with Children Children with Children Children with Children
Ada County $84,721 $100,423 $56,725 $53,121 $52,971 $28,357 Canyon County $63,968 $64,198 $57,262 $34,237 $45,526 $25,596 Elmore County $58,685 $60,441 $69,167 $38,347 $33,594 $18,051 Gem County $54,801 $61,955 $63,060 $14,866 $40,372 $22,182 Owyhee County $51,600 $63,021 No Data $27,411 $37,054 $20,357 Idaho $69,896 $76,840 $52,777 $38,473 $46,501 $24,208 U.S. $84,289 $95,854 $58,168 $42,637 $48,841 $27,335
DATA SOURCE: U.S. Census Bureau, American Community Survey 5-Year Estimates, as cited by Trinity Health Data Hub, 2014-2018
10 U.S. Census Bureau, American Community Survey 5-Year Estimates, as cited by Trinity Health Data Hub, 2014-2018
Financial Stability United Way of Treasure Valley 2020 Community Assessment Financial Stability
According to Table 5, in 2018 an Idaho family budget” with modest allowances for housing, with two adults, one infant, and one toddler child care, food, transportation, technology, with an annual household income of $63,384 taxes, and some miscellaneous expenses. was considered to have a “household survival 25 Household Survival Budget, Idaho Table 5
Idaho Average Percent Change (2018) from 2013 to 2018 Monthly Costs Single Adult 2 Adults, Single Adult 2 Adults, 1 Infant, 1 Infant, 1 Preschooler 1 Preschooler
Housing $542 $761 15% 16% Community Feedback on $-- $1,010 N/A 12% Child Care Poverty: Food $279 $846 46% 46% “People have to move out of Transportation $325 $794 -7% 13% [the Treasure] Valley because Health Care $171 $727 44% 53% they can’t keep up with Technology $55 $75 N/A N/A the cost of Miscellaneous $161 $480 28% 37% living.” – Nonprofit Taxes $240 $589 81% 215% Professional
Monthly Total $1,773 $5,282 28% 37% “Jobs closer to home would ANNUAL TOTAL $21,276 $63,384 28% 37% mean more time with $10.64 $31.69 28% 37% Hourly Wage** family. [They] **Wage working full-time required to support this budget would save money by less DATA SOURCE: U.S. Department of Housing and Urban Development, 2018; U.S. Department of Agriculture, 2018; Bureau of Labor Statistics, 2018; Internal Revenue Service; Tax Foundation; and Idaho Department of Health and Welfare, 2018; as cited by United Way’s 2020 ALICE Report gas expense and less day care hours.” – Refugee The cost of living associated with the household the hourly wage needed as of 2018 to meet the and Rural survival budget increased substantially from household survival budget statewide and by Community 2013 to 2018 (28% for single adults and 37% for county. In Idaho and across the Treasure Valley, Member families with two adults, one infant, and one the minimum wage is not enough for a single preschooler). The greatest increase in monthly adult to meet the household survival budget. costs were taxes, health care, and food. In a four-person household with an infant and preschooler, if both adults are earning minimum One factor that contributes to income inequality wage, their collective wages are less than half of in the state and in the Treasure Valley is the what they need to meet the household survival predominance of jobs that pay low wages. budget across all counties in the Treasure Valley Although Idaho adopted the federal minimum and statewide. wage of $7.25, the rate has not changed since 2009. The most recent ALICE report11 calculates
11 ALICE Report – Idaho 2018 State Overview. (2020, June). Retrieved May 26, 2020, from https://www.unitedforalice.org/idaho
United Way of Treasure Valley 2020 Community Assessment Financial Stability Financial Stability 26
Hourly Wage Required for Household Survival Budget (HSB) and Percent of HSB that Minimum Wage Table 6 (MW) Covers
Community Hourly Wage Required by Single Hourly Wage Required by Two Adults Feedback on Geography Adult to Meet HSB (percent of with One Infant and One Preschooler Poverty: what MW covers) to MEET HSB (percent of what MW provides with two MW earners) “If you go across the river, minimum wage Ada County $12.53 (57.9%) $37.43 (38.7%) is three to four $11.50 (63%) $33.67 (43%) dollars more an Canyon County hour.” Elmore County $10.60 (68.3%) $31.40 (46.2%) – Rural Community Gem County $10.31 (70.3%) $32.03 (45.3%) Member $10.72 (67.6%) $32.68 (44.4%) “Refugees can’t Owyhee County get to night Idaho $10.64 (68.1%) $31.69 (45.8%) jobs they have because of DATA SOURCE: U.S. Department of Housing and Urban Development, 2018; U.S. Department of Agriculture, 2018; Bureau of Labor Statistics, limited public 2018; Internal Revenue Service; Tax Foundation; and Idaho Department of Health and Welfare, 2018 as cited by United Way ALICE Report 2020 transportation service routes and times.” – Refugee Statewide and in the Treasure Valley, there is a Focus group and interview participants Resettlement predominance of jobs that pay less than a living described a lack of “high-quality” jobs. They Professional wage. Low-wage jobs dominate the landscape explained that, although there seem to be “Cost of in Idaho, with roughly 70% paying less than “enough” jobs in the area, wages vary across living is fairly $20 per hour and two-thirds paying less than the area and are often insufficient. They noted reasonable, $15 per hour. that the highest paying jobs tend to be in or but the wages near Boise. have not While more than half (53.2%) of survey caught up.” respondents indicated that the cost of living was Focus group and interview participants – Community a top health concern for themselves or someone explained how lack of access to well-paid jobs Member in their family, some focus group participants and the rising cost of living in the Treasure Valley believe wages are the problem. are influencing Treasure Valley residents to move away from their communities.
Financial Stability United Way of Treasure Valley 2020 Community Assessment Financial Stability
Minimum Wages of States Table 7 Neighboring Idaho Four of the six states that neighbor Idaho offer State State’s Minimum Hourly Wage higher minimum wages (Table 7), which may 27 contribute to out-migration of residents in Washington $13.50 search of higher paying jobs. Oregon $11.50 $13.50 $7.25 $8.65 Montana $8.65 $11.50 Nevada $8.25 $5.15* $7.25 Utah $8.25 $7.25 Idaho $7.25 Wyoming $5.15*
*Employers subject to the Fair Labor Standards Act must pay the current Federal minimum wage of $7.25 per hour. * NOTE: as of June 2020 Source: https://www.dol.gov/agencies/whd/minimum-wage/state
Meeting Basic Needs As Table 5 shows, household costs have increased across ineligible for assistance, such as SNAP, is 36% and the many categories of expenses, making it difficult for percentage of food insecure children ineligible for families to meet basic needs. Focus group and interview assistance is 35%. These families and children are in the participants believe families with low incomes are often eligibility gap when they are ineligible for assistance forced to choose between food and other basic needs but do not have enough income to meet their needs, such as housing, child care, transportation, and health and face hunger on a daily basis. Ada County has the care. highest proportion of food insecure residents that are ineligible for assistance at 46% of the total food insecure The necessary survival budget for food has increased population and 48% of food insecure children; rates that 12 In Idaho, the 46% between 2013 and 2018. are higher than both the state and nation (Figure 20). percentage of the food insecure population that is
Figure 20 Percent of Food Insecure Population Ineligble for Assistance
48% 46%
35% 36% 35% 35% 31% 32% 33% 28% 28% 22% 21% 17% Food insecure Food insecure population Food insecure children Food insecure population Food insecure children Food insecure population Food insecure children Food insecure population Food insecure children Food insecure population Food insecure children Food insecure population Food insecure children Food insecure population Food insecure children
Ada Canyon Elmore Gem Owyhee Idaho U.S. County County County County County Data Source: Feeding America. 2017. As cited by Trinity Health data hub.
12 DATA SOURCE: U.S. Department of Housing and Urban Development, 2018; U.S. Department of Agriculture, 2018; Bureau of Labor Statistics, 2018; Internal Revenue Service; Tax Foundation; and Idaho Department of Health and Welfare, 2018; as cited by United Way’s 2020 ALICE Report
United Way of Treasure Valley 2020 Community Assessment Financial Stability Financial Stability 28
Child care is another major expense for $7,400 for in-home care. While care for one many households, and one that is critical to child comprises at least 10% of income, different maintaining job security. In 2019, the average family structures and income levels can mean Community annual price of child care in Idaho was $8,600 some families pay as much as 60% of their Feedback on for infant care in a child care center and about . Child Care: income on child care “The cost of child care is a Percent of Income Spent on Child Care, Idaho huge barrier. Table 8 People are turning down jobs because Child Care Center In-Home it is cheaper for them to Infant child care – married couple family 11.8% 10.1% stay home and take care Two children – married couple family 22.4% 19.8% of children.” – Community Infant child care – single parent 36.8% 31.5% Member Two children – single parent 69.5% 61.5% “{The biggest issues are] Married family with two children 64.9% 57.5% ‘kitchen table at the poverty line issues’. The things people DATA SOURCE: Child Care Aware of America, 2019 budget for. Addressing housing, transport- Educational Attainment and Finance ation, with low wages. More education leads to better prospects for lowest median income, approximately 1 in 4 Throw in child employment, earnings, and financial stability. residents does not have a high school diploma care and a Within the Treasure Valley, Ada County has the and 1 in 10 has a Bachelor’s degree or higher.13 single budget highest percentage of the population aged 25 cannot make As shown in Table 9, statewide and within the and over that has a Bachelor’s degree or higher it work.” Treasure Valley, the racial group with the largest and the lowest percentage of the population – City Official percentage of adults with no high school with no high school diploma. Ada County is also diploma is the “some other race” group (at 44% the county with the highest median income in and 43.7%, respectively). the Treasure Valley. In Owyhee County, with the
13 DATA SOURCE: U.S. Census Bureau, American Community Survey 5-Year Estimates, as cited by Trinity Health Data Hub, 2014-2018
Financial Stability United Way of Treasure Valley 2020 Community Assessment Financial Stability
Percent of Adults with No High School Diploma, by Race Table 9
White Black Native Asian Native Some Multiple or African American/ Hawaiian/ Other Race 29 Geography American Alaska Pacific Race Native Islander
Treasure Valley 7.1% 3.6% 16.2% 12.4% 3.7% 43.7% 8.5% Ada County 4.2% 13.5% 7.8% 12.4% 0% 24.5% 4.9% Canyon County 12.8% 7% 23.8% 15.1% 16.2% 49.6% 11.6% Elmore County 9.9% 14.3% 28.2% 2.5% 0% 39.3% 5.2% Gem County 9.4% No Data 12.8% 22% 0% 81.4% 44% Owyhee County 20% 91.7% 18.3% 23% No Data 74.5% 31.7% Idaho 8.3% 11.8% 14.1% 11.5% 5.1% 44% 11% U.S. 10.4% 14.6% 20% 13.2% 13.1% 38.1% 12%
DATA SOURCE: U.S. Census Bureau, American Community Survey 5-Year Estimates, as cited by Trinity Health Data Hub, 2014-2018
Within the Treasure Valley, 33.8% of the the percentage of the non-Hispanic/Latino Hispanic/Latino population does not have population. a high school diploma, more than six times
Percent of Adults with No High School Diploma, by Ethnicity Figure 21
68.1% 65%
43.4%
37.7% 36.9% 33.8% 32.3%
16.9% 14.7% 8.6% 9% 8.9% 6.8% 6.6% 5.6% 4.1%
% % Not % % Not % % Not % % Not % % Not % % Not % % Not % % Not Hispanic/ Hispanic/ Hispanic/ Hispanic/ Hispanic/ Hispanic/ Hispanic/ Hispanic/ Hispanic/ Hispanic/ Hispanic/ Hispanic/ Hispanic/ Hispanic/ Hispanic/ Hispanic/ Latino Latino Latino Latino Latino Latino Latino Latino Latino Latino Latino Latino Latino Latino Latino Latino
Treasure Ada Canyon Elmore Gem Owyhee Idaho U.S. Valley County County County County County
DATA SOURCE: U.S. Census Bureau, American Community Survey 5-Year Estimates, as cited by Trinity Health Data Hub, 2014-2018
United Way of Treasure Valley 2020 Community Assessment Financial Stability Financial Stability
Percent of 16-19 Year Olds Not in School or Employed Within the Treasure Valley Figure 22 counties of Canyon, Gem, and Owyhee,
higher percentages of the 10.4% 10.3% 30 populations aged 16-19 are not in school and not 8.8% employed compared to 6.8% in Idaho overall. 6.8% These data are consistent with focus group and 5% interview participant perceptions that jobs are 2.8% scarcer in areas outside Community of Ada County, which Feedback on perpetuates the more rural Housing: poverty seen in the region. “Rent eats Ada Canyon Elmore Gem Owyhee Idaho County County County County County first. You have to shelter and families DATA SOURCE: U.S. Census Bureau, American Community Survey 5-Year Estimates, 2014-2018 are making really hard decisions with kids to keep Housing and Homelessness a roof over their head, so Affordability, quality, and stability are important Home Values if rent does characteristics that directly impact an individual’s For existing homeowners, rising home values indeed eat 14 ability to access safe and healthy housing. can be beneficial. However, the increasing costs first then that leads to some Unstable housing and homelessness can of home ownership stretch the budgets of those negative lead to stress, isolation, chronic disease (e.g., who are buying into the market while pushing consequences asthma), substance use, mental health issues, out many Treasure Valley residents entirely. The as to what and violence.15 For those with housing, the cost of housing in the Boise Metro area17 has they are affordability and quality of housing impact going to eat risen for the 8th consecutive year; in 2019 alone for the rest of health and well-being. Housing is often a the median single-family home price increased the month.” household’s single greatest expense. The cost of by 20%. The average rental has increased by – Nonprofit housing directly impacts an individual’s ability to 23% over the past three years.18 Professional afford housing, as well as how much money they In Idaho, renter-occupied households have a “We need a can use towards health care, food, child care, healthy mix and transportation.16 While housing itself is an median monthly housing cost of $825, whereas of [various important factor in an individual’s health, it can owner-occupied households with a mortgage types of] also be a cost burden and result in compromises have median monthly housing costs of $1,228 housing (Figure 23). develop- to health in other areas (i.e. foregoing ments.” prescription medications due to cost). – Nonprofit Professional
14 Shaw M. Housing and Public Health. Annual Review of Public Health. 2004; 25: 397-418. 15 Shaw M. Housing and Public Health. Annual Review of Public Health. 2004; 25: 397-418. 16 Maqbool N, Viveiros J, and Ault M. The Impacts of Affordable Housing on Health: A Research Summary. Center for Housing Policy. 2015. 17 Boise Metro area includes Ada, Boise, Canyon, Gem, and Owyhee counties 18 Kohl, L. (2020, March 11). Boise, Idaho Housing Markets Set New Records as Price Gains Lead Nation. Retrieved May 26, 2020, from https://www.weknowboise.com/blog/idaho-housing-market-leads-nation.html
Financial Stability United Way of Treasure Valley 2020 Community Assessment Financial Stability
Monthly Median Housing Cost Figure 23
$950 (Renter-Occupied) 31 Ada County $1,382 (Owner-Occupied)
$846 (Renter-Occupied) Canyon County $1,114 (Owner-Occupied)
$809 (Renter-Occupied) Elmore County $1,083 (Owner-Occupied)
$745 (Renter-Occupied) Gem County $1,090 (Owner-Occupied)
$704 (Renter-Occupied) Owyhee County $1,103 (Owner-Occupied)
$825 (Renter-Occupied) Idaho $1,228 (Owner-Occupied)
DATA SOURCE: U.S. Census Bureau, American Community Survey 5-Year Estimates, as cited by Trinity Health Data Hub, 2014-2018
As shown in Figure 24, most housing Figure 24 Percent of Households That are Renter- or Owner-Occupied in Idaho and the Treasure Valley is owner-occupied. However, the percentage of Treasure Valley residents who live in rental properties is higher than statewide. Elmore County has the highest percentage of renters at 41.9%. 68.4% 68.2% 58.1% 73.5% 70.6% 69.3% 63.8% Owner- Occupied A prominent theme in focus groups and interviews was the lack of affordable housing. Many said that Treasure Valley residents are being priced out of the market . They 31.6% 31.8% 41.9% 26.5% 29.4% 30.7% 36.2% Renter- in their own communities Occupied explained that while many families are moving further and further west Ada Canyon Elmore Gem Owyhee Idaho U.S. within the Treasure Valley, more and County County County County County more families are “doubling up” as overcrowding and homelessness DATA SOURCE: U.S. Census Bureau, American Community Survey 5-Year Estimates, as cited by Trinity Health Data Hub, 2014-2018 are on the rise in the area.
United Way of Treasure Valley 2020 Community Assessment Financial Stability Financial Stability 32
Rental Availability A healthy vacancy rate, the percent of available In Idaho, the number of affordable and available rental units, is between 7 to 8%,19 indicating homes varies by income (Figure 25). The Community Feedback on some extra rental supply compared to demand. Area Median Income (AMI) is a figure used to Housing: However, Boise Metro’s (Ada, Boise, Canyon, determine affordable housing eligibility across “Rental Gem, and Owyhee counties) rental vacancy the nation. This figure varies by area and is application rate for all property types was only 1.55% in calculated annually by the U.S. Department of fees are being .20 Focus group and interview participants Housing and Urban Development. Statewide in required. 2019 Seems like a explained that rental units are not as available 2018, 23% of renter households were extremely scam. [There’s as they once were in the Treasure Valley due low-income. For that cohort of extremely low- a] feeling of to population growth. Only those with higher income there were not enough affordable and making money on application incomes, they argued, are able to rent the available units; there were only 44 affordable and fees. The apartments that are available. Increasingly, they available units for every 100 such households. cost of the noted, application fees are required to secure As incomes increased, the opportunity to locate application fee an apartment, creating an additional obstacle affordable and available rental housing also is a tank of gas or food for for lower-income individuals/families looking to increased. For example, for renter households a week.” acquire housing. that earned AMI there were more affordable and – Preschool available units than households, there were 101 The participants described how the low Parent and affordable and available homes for every 100 Community inventory and high costs of housing are such households. Member contributing to homelessness in the region. “The volume Affordable and Available Homes per 100 Renter of individuals Figure 25 outweighs our Households, Idaho resources. There are currently 170 homeless At Extremely families on our Low-Income 44 waiting list [at (ELI) NOTE: Extremely Low-Income CATCH Housing (ELI) is defined as at or below the Agency] for At 50% of 61 poverty guideline or 30% of their services due to Area Median area median income (AMI). lack of housing Income (AMI) availability.” At 80% of – Housing 96 AMI Services 19 Florida, R. (2018, July 30). How Vacancy Professional Traumatizes Cities. Retrieved May 26, 2020, from At 100% of https://www.citylab.com/equity/2018/07/vacancy- americas-other-housing-crisis/565901/ AMI 101 20 Kohl, L. (2020, March 11). Boise, Idaho Housing Markets Set New Records as Price Gains Lead Nation. Retrieved May 26, 2020, from https:// DATA SOURCE: https://nlihc.org/housing-needs-by-state/idaho, 2018 www.weknowboise.com/rental-market-vacancy- rates.php
Financial Stability United Way of Treasure Valley 2020 Community Assessment Financial Stability
Housing Cost Burden The U.S. Department of Housing and Urban Housing cost-burden is higher among renters Development has deemed households that than owners (Figure 27). spend more than 30% of their income on rent Among survey respondents, approximately 33 or mortgage payments to be “cost-burdened.” one in three indicated that affordable housing Such households are considered to have was a top concern for themselves or their insufficient income for other essential expenses families. Focus group and interview participants such as food, transportation, and health care. shared that home prices and property taxes In the Treasure Valley, more than one in four have increased in the Treasure Valley such that households are cost-burdened due to their those with lower incomes are not able to afford (Figure 26). housing costs home ownership. Percentage of Households That are Cost-Burdened Figure 26 Community Feedback on 31.6% 30.4% Housing: 28% “Waitlists are 27% 27.2% 27% 25.1% years long, so homelessness is a real threat.” – Community Member “A home that costs $300,000 now was $150,000 Ada Canyon Elmore Gem Owyhee Idaho U.S. 10 years ago.” County County County County County – Community Member DATA SOURCE: U.S. Census Bureau, American Community Survey 5-Year Estimates, as cited by Trinity Health Data Hub, 2014-2018 “Somebody that is not Percentage of Households that are Cost-Burdened, Owner- and Renter-Occupied making at Figure 27 least $60,000 a year cannot buy a home 46.5% here.” 42.5% 42.1% 41% 42% – Community 38.5% Member 34% “People are being priced out of their houses because of 13.4% 13.7% the rise in 9.7% 9.5% 8% 7.8% property 6.4% taxes.” Renter- Owner- Renter- Owner- Renter- Owner- Renter- Owner- Renter- Owner- Renter- Owner- Renter- Owner- – Community Occupied Occupied Occupied Occupied Occupied Occupied Occupied Occupied Occupied Occupied Occupied Occupied Occupied Occupied Member Ada Canyon Elmore Gem Owyhee Idaho U.S. County County County County County
DATA SOURCE: U.S. Census Bureau, American Community Survey 5-Year Estimates, as cited by Trinity Health Data Hub, 2014-2018
United Way of Treasure Valley 2020 Community Assessment Financial Stability Financial Stability
They also reported that rental costs have Housing Conditions increased, especially in Ada County, due to The quality of housing includes everything from growth and the influx of new people to the the structure of the housing unit itself to the 34 Treasure Valley. They explained that many built environment around it. Indoor exposure residents, especially those earning at or near to lead paint, secondhand smoke, and mold the minimum wage, need supplemental income are all pollutants that can cause negative health to pay for housing costs, which causes some outcomes. The location of housing also has to work multiple jobs. Others commute long broad health implications – from access to distances in order to afford housing in the employment that provides health insurance, Treasure Valley. green spaces for physical activity, healthy food, and accessible transportation. Housing Stability Housing instability encompasses a number of Due to a limited rental market with few Community challenges, such as having trouble paying rent, affordable vacancies, people with the lowest Feedback on overcrowding, moving frequently, staying with incomes may be forced to rent substandard Housing: relatives, or spending the bulk of household housing. In Idaho, 28.1% of occupied housing “Housing income on housing. These experiences of units have at least one substandard condition, costs aren’t meaning it poses a risk to the physical and supported instability may negatively impact the financial by the job security, educational attainment, and health of mental health and well-being of occupants, opportunities household members of all ages. visitors, and neighbors. Conditions might and wages include vermin, mold, water leaks, inadequate offered here – As shown in Figure 28, 10.1% of survey heating or cooling systems, unsafe electricity, some families respondents indicated that they were worried lack of indoor plumbing, and no kitchen, among are supported about their housing status at the time they by out-of- others. In Canyon, Gem, and Owyhee Counties, state jobs and completed the survey. the proportion of occupied units with at least long-distance Most of the survey respondents (80.3%) one substandard condition is higher than commuting.” statewide (Figure 31). – Nonprofit indicated that they had not moved in the past Professional 12 months. However, among those that had The community survey inquired about a range moved, 14.9% moved once and 4.8% moved “People have of challenging, unsafe, or substandard housing to move out more than once. conditions people are experiencing in the to Canyon Treasure Valley. As shown in Figure 29, mold and County Figure 28 Respondent Housing Situation at the bug infestations were the issues most frequently because of Time of the Survey housing costs, selected, at 7.8% and 6.2%, respectively. but they need Conditions such as these are more likely to to access Ada make it difficult for people to maintain their County for health, especially if they have chronic conditions services and such as asthma, allergies, or compromised jobs.” – Community immune systems. Member In Idaho, 2.1% of housing units lack a complete kitchen (Figure 32). Lack of kitchen facilities makes it more difficult for individuals and families to prepare nutritious foods and maintain a healthy diet.
Financial Stability United Way of Treasure Valley 2020 Community Assessment Financial Stability
Reported Problems With the Place the Respondent Lives Figure 29
Mold 7.8% 35
Bug infestation 6.2%
Water leaks 5.3%
Inadequate heat 5.2%
No or not working 4.4% smoke detectors Community Landlord/tenant Feedback on 4% right issues Housing: *Respondents were “Housing Lead paint or pipes 3% permitted to select insecurity is more than one option, real. A 9% Oven or stove so percentages do not 2% increase in rent not working sum to 100% throughout the city in one
DATA SOURCE: Saint Alphonsus Health System & United Way of Treasure Valley 2020 Community Survey year, and more NOTE: These reported problems do not follow state or federal classifications, respondents self-reported whether they believed this was an issue. so in property taxes.” – Nonprofit Overcrowded Housing Units Professional Overcrowded housing Figure 30 conditions are almost “[We’re not doing] two times more enough common in Owyhee of what’s 7.3% and Canyon Counties working – than elsewhere in the prevention. People Keeping Treasure Valley. people who live in overcrowded 4.8% 4.4% housed is a housing are more likely lot simpler to contract and spread and cheaper.” communicable diseases 2.8% – City 2.2% and tend to experience 2% Professional 1.5% more respiratory illnesses (Figure 30).
Ada Canyon Elmore Gem Owyhee Idaho U.S. County County County County County
DATA SOURCE: U.S. Census Bureau, American Community Survey 5-Year Estimates, as cited by Trinity Health Data Hub, 2014-2018 NOTE: Overcrowded Housing Unit is defined as more than one persons-per-room in a dwelling unit.
United Way of Treasure Valley 2020 Community Assessment Financial Stability Financial Stability
Percentage of Population Occupying Housing Units with One or More Figure 31 Substandard Conditions
32.5% 36 31.3% 29.8% 30.6% 27.2% 27.2% 28.1%
Community NOTE: The U.S. Department of Ada Canyon Elmore Gem Owyhee Idaho U.S. Feedback on Housing and Urban Development County County County County County defines substandard housing as “A Homelessness: dwelling unit that is either dilapidated or unsafe, thus endangering the “There is a lot of DATA SOURCE: U.S. Census Bureau, American Community Survey 5-Year Estimates, as cited by health and safety of the occupant, homelessness Trinity Health Data Hub, 2014-2018 or that does not have adequate and a lot of plumbing or heating facilities.” people would still not say Percentage of Housing Units Lacking a Complete Kitchen they are in Figure 32 need because they are staying with other people.” 3.2% – Community 2.8% 2.8% Member 2.1% 1.5% 1.6% “Once you’re 1.2% homeless, it’s hard to get back out.” – Community Ada Canyon Elmore Gem Owyhee Idaho U.S. Member County County County County County
DATA SOURCE: U.S. Census Bureau, American Community Survey 5-Year Estimates, as cited by Trinity Health Data Hub, 2014-2018 NOTE: Lacking a Complete Kitchen is considered a substandard housing condition
Homelessness Homelessness can take many forms – from living According to the 2019 State of Homelessness on the streets, encampments, or shelters, to in Idaho report, there were 9,255 individuals, living in cars or couch-surfing with family and including children, who sought services for friends. Homelessness and housing instability homelessness in 2019.22 Of those, 38% were have many causes and consequences.21 disabled, 27% chronically homeless, 27% families with children, 14% victims of domestic violence, and 13% veterans.
21 Homelessness in America: An Overview of Data and Causes (January 2015). National Law Center on Homelessness and Poverty. Retrieved May 26, 2020 from https://nlchp.org/wp-content/uploads/2018/10/Homeless_Stats_Fact_Sheet.pdf 22 Idaho Housing and Finance Association. (2020). 2019 State of Homelessness in Idaho. Retrieved May 26, 2020, from https://www.idahohousing.com/ documents/2019-report-the-state-of-homelessness-in-idaho.pdf
Financial Stability United Way of Treasure Valley 2020 Community Assessment Financial Stability
Collecting reliable data Figure 33 Sheltered and Unsheltered Homeless Point-in-Time (PIT) Count, on homelessness is Treasure Valley challenging due to the mobility of the population 37 and varying data collection methods and definitions of homelessness. A commonly used metric is a Point-in- 621 Unsheltered Time (PIT) count.23 This is an 407 422 annual count of sheltered 167 372 and unsheltered homeless individuals on a single night in January and is helpful 639 650 740 740 777 Sheltered for looking at trends in homelessness. From 2015 to 2019, the number of individuals experiencing 2015 2016 2017 2018 2019 homelessness on the PIT DATA SOURCE: Balance of State COC Point-in-Time Count Report and Boise City Ada County count night increased Point-in-Time Count, 2019 steadily (Figure 33).
Sheltered and Unsheltered Homeless Point-in-Time (PIT) Count, Idaho Figure 34
The most recent statewide PIT count of 1,274 1,255 1,244 1,212 individuals experiencing 1,171 homelessness 985 (both sheltered and unsheltered) revealed that approximately 738 720 2,197 men, women, 639 and children were 469 experiencing homelessness on one night. This is a 16.2% increase over 2018 Sheltered Unsheltered Sheltered Unsheltered Sheltered Unsheltered Sheltered Unsheltered Sheltered Unsheltered (Figure 34). Homeless Homeless Homeless Homeless Homeless Homeless Homeless Homeless Homeless Homeless
2015 2016 2017 2018 2019
DATA SOURCE: Balance of State COC Point-in-Time Count Report, 2019 and Boise City Ada County Point-in-Time Count
23 PIT count provides a one-night “snapshot” of number of homeless persons who are either living on the streets, in places not meant for habitation, or are currently residing in emergency shelters or homeless transitional housing projects. Using HUD’s definition of homelessness for the PIT count, Continuums of Care (CoCs) are instructed to count all adults, children in households, and unaccompanied youth who, on the night of the count, reside in one of the places described below: An unsheltered homeless person resides in a place not meant for human habitation, a vehicle, or on the street; Included in this count are people in temporary tents, encampments, and warming centers; A sheltered homeless person resides in an emergency shelter, transitional housing, or supportive housing for homeless persons who originally came from the streets or emergency shelters.”
United Way of Treasure Valley 2020 Community Assessment Financial Stability Financial Stability
Episodes of Homelessness, Balance of State 2019 Among those who were Figure 35 included in the Balance of State 2019 PIT count, 37% 38 were experiencing their first 37% episode of homelessness, 26% and 26% were considered 20% chronically homelessness 17% (Figure 35). In the Region 7 (Ada County) 2019 PIT count, 32% of individuals experiencing First time More than 1 Chronic – more No response time but less than one year homelessness identified as than 4 times or 4 times in the chronically homeless. past 3 years Community DATA SOURCE: Balance of State COC Point-in-Time Count Report, 2019. Feedback on NOTE: Includes all Idaho counties except Ada Homelessness: “Because of waiting lists and lack of Risk Factors for Homelessness availability, There are numerous risk factors for According to the Boise City/Ada County people spend homelessness including job loss, illness, and Coordinated Entry program, for families with a long time on domestic violence. Among those included in children, domestic violence was the number the streets.” the Balance of State 2019 PIT count (which one reported cause for seeking assistance at – Nonprofit includes all Idaho counties except Ada County), 46% of participants. For adult only households, Professional lack of affordable housing was cited as both 27% identified disabling conditions, addiction, “Shelters are the primary cause of homelessness and or illness as the primary circumstance causing scary [places] the primary circumstance that prevented homelessness.24 to take your children; individuals/families from becoming re-housed sometimes it’s (Figure 36). safer to sleep on the street.” – Community Figure 36 Circumstances Causing Homelessness: Circumstances Preventing Being Housed: Member Canyon/Elmore/Gem/Owyhee Counties Canyon/Elmore/Gem/Owyhee Counties
187
149 129 122
63 55
Unable to find Unemployment Evicted/unable Unable to find Unemployment Bad credit affordable to pay rent affordable history/debt housing housing
NOTE: Does not include Ada County. Respondents may be NOTE: Does not include Ada County. Respondents may be experiencing more than one of these circumstances experiencing more than one of these circumstances DATA SOURCE: Balance of State COC Point-in-Time Count DATA SOURCE: Balance of State COC Point-in-Time Count Report, 2019 Report, 2019
24 Boise City/Ada County Coordinated Entry
Financial Stability United Way of Treasure Valley 2020 Community Assessment Financial Stability
Focus group participants described the Children Experiencing Homelessness conditions in which families who have been Homelessness has substantially adverse displaced from their homes experience in impacts on children. Immediate impacts the Treasure Valley, from multiple families include food insecurity, poor mental and 39 living in the same house or apartment to physical health, feeling unsafe, and educational varying conditions in shelters. Most agree that challenges. Lasting effects include negative homelessness is a difficult situation to overcome. impacts to cognitive, social, emotional, and 25 Although participants in the focus groups and physical growth and development. interviews believe that many individuals and The definition of homeless for school-aged families are becoming displaced from their children is different from the definition for adult/ homes due to an increased cost of housing, family homelessness. Homelessness among some also explained that domestic violence is school-aged children includes families doubled a major cause of homelessness. up (living with another family), children living in Almost 40% of survey respondents indicated inadequate facilities including homes without that domestic violence is of high concern water or utilities, as well as motels, shelters, or 26 to them. places not meant for extended habitation.
Figure 37 Number of Idaho Students Experiencing Homelessness
8,080 7,816 7,816 7,810 8,000 7,162
7,000
2014-15 2015-16 2016-17 2017-18 2018-19
DATA SOURCE: Idaho State Department of Education, Title IX-A Homelessness in Idaho, 2018-2019
Number of Students Experiencing Homelessness Figure 38
Nearly 8,000 Idaho students 7,810 were considered homeless in the 2018-19 school year, comprising 2.5% of the student population. This number has remained fairly steady over the past three 3,518 school years. The Treasure
Valley accounts for nearly half 1,584 1,697 of homeless students statewide. 134 41 62 32.5%
25 Effects of Poverty, Hunger and Homelessness on Ada Canyon Elmore Gem Owyhee Treasure Idaho Children and Youth (2009). Retrieved May 26, 2020, County County County County County Valley from https://www.apa.org/pi/families/poverty DATA SOURCE: Idaho State Department of Education, Title IX-A Homelessness in Idaho, 2018-2019 26 National Center for Homeless Education. (n.d.). NOTE: In order to protect student privacy, any cells that represent less than 5 students or where the difference McKinney-Vento Definition. Retrieved May 26, 2020, between the total of one or more cells of categorical data is less than 5 of the total student population is redacted. from https://nche.ed.gov/mckinney-vento-definition/
United Way of Treasure Valley 2020 Community Assessment Financial Stability Financial Stability Transportation Transportation is a critical factor in meeting basic are more cost-burdened than home owners, are needs. Transportation allows for access to goods less likely to have a motor vehicle. 40 and services as well as education and jobs. The yearly cost of owning a car in Idaho Statewide and within the Treasure Valley, the is approximately $2,792, which includes proportion of households without a motor gasoline, insurance, repairs, taxes, and fees.27 vehicle is roughly 4%; renters, who data show Households With No Motor Vehicle Table 10
Owner-Occupied Percentage of Renter-Occupied Percentage of Geography Households with Owner-Occupied Households with Renter-Occupied Community No Vehicle Households with No Vehicle Households with Feedback on No Vehicle No Vehicle Transportation: “Almost 100% Ada County 1,787 1.6% 4,644 4% [of residents] have their Canyon County 799 1.7% 1,811 3.8% own vehicles, 183 3.1% 308 5.2% whether or Elmore County not they’re Gem County 56 1.2% 280 5.8% running well is another Owyhee County 84 2.8% 88 2.9% story.” Idaho 7,248 1.7% 17,141 4% – Nonprofit Professional U.S. 2,430,345 3.2% 7,994,589 10.5% “People are having trouble DATA SOURCE: Trinity Health Data Hub. U.S. Census Bureau, American Community Survey 5-Year Estimates, as cited by Trinity Health Data Hub, commuting to 2014-2018 work outside of Boise.” – Community In 2018, about 79% of Percentage of Population Commuting Alone Member Figure 39 the population in Idaho (Workers Ages 16 and Over) “East/west and across the Treasure corridors are full Valley commuted and commuting 80.9% 80.7% is taking longer alone in a car, truck, 78.2% 78.6% and longer. I or van to work (Figure 76.4% 74.9% work later to 39). Commuting alone 72.4% avoid sitting on increases the number the freeway.” – Community of vehicles on the road, Member thereby increasing traffic congestion.
Ada Canyon Elmore Gem Owyhee Idaho U.S. County County County County County
DATA SOURCE: U.S. Census Bureau, American Community Survey 5-Year Estimates, 2014-2018
27 CNN. (2018). Car ownership costs by state. Retrieved May 26, 2020, from https://money.cnn.com/interactive/pf/autos/car-ownership-costs-by-state/
Financial Stability United Way of Treasure Valley 2020 Community Assessment Financial Stability
The consensus among interview and focus system. Participants indicated that major gaps in group participants was that the public transportation services exist in the area because transportation system within the Treasure there is no federal funding to support public Valley is severely limited and that people rely transportation in the state. Residents also stated on cars for transportation. In fact, that transportation presents a major barrier to 41 less than 1% of the population in Idaho uses public accessing services. They explained that, if a transportation to commute to work compared resident does not have a car and must rely on to 5% nationally (Figure 40). This is in large public transportation, given the problems with part due to limitations on public transportation the system, they have trouble accessing services. infrastructure in Idaho. Most communities Valley Regional Transit is the Regional Transit outside of Ada County don’t have a public bus Authority for Ada County and Canyon County. system, and many people have to rely on cabs However, due to lack of funding, services and shared ride systems, where available, to get are often limited in geography, hours, and to appointments in the community. frequency. Comments from a representative of Community Feedback on the Valley Regional Transit Authority support Idaho is one of two states in the nation with Transportation: no state funding to support public transit what other assessment participants said about “People are not options. The state also does not allow a local the Treasure Valley’s public transportation. able to option tax (unless in a resort town) for cities to get to any raise their own revenue to fund transit or other services infrastructure needs.28 because of transportation.” More than 45% of community survey “The amount of transportation that we’re able to – Community Member respondents indicated that the availability of fund is not meeting people’s transportation needs. We’re about four times behind in terms of service public transportation was of high concern, “Transportation we provide for a region this size. Transportation contributing to the previously mentioned cost problems becomes a limiting factor in people’s ability to lead to other of living concerns. Interview and focus group achieve the opportunity they’re looking for and it’s problems participants asserted that the availability of a funding issue. Transportation isn’t consistently because public transportation diminished the further available throughout the region. We have a people can’t concentration of services in Boise, but it’s still less access health away one gets from Boise. They explained that than what we should have. In Meridian there really within the Treasure Valley, there are limited services.” isn’t anything. In Canyon County we struggle – Nonprofit stops and the hours of operation vary and with having the adequate amount of public Professional are inconsistent. The bus is the only form of transportation. This is a funding issue.” public transportation that exists; there is no rail “There is not a good enough public transit Percent Population Using Transit for Commute to Work system; busses Figure 40 only run once an hour. Sometimes Treasure Valley...... 0.37% you can’t get 3% Ada County...... 0.4% to the places 4% Canyon County...... 0.3% you want to 2% Elmore County...... 0.5% go and if Gem County...... 0.1% appointments U.S. Owyhee County...... 0.3% run over, you 5% Idaho...... 0.7% 1% U.S...... 5% can’t get home.” DATA SOURCE: U.S. Census Bureau, American Community Survey. – Refugee and 2014-2018. Source geography: Tract Community Member 28 Carmel, M. (2019, April 17). Boise set to increase public transit funding with new funding formula. Retrieved May 26, 2020, from https://www.idahopress.com/news/ local/boise-set-to-increase-public-transit-funding-with-new-funding/article_8a904bae-3c36-5048-99e4-c64554790bb6.html
United Way of Treasure Valley 2020 Community Assessment Financial Stability Financial Stability
Focus group and interview participants More than one-fifth of residents of Idaho explained that increasingly, Treasure Valley commuted 30 minutes or more alone in 2017 adults are traveling longer and longer distances (Figure 41). Within Treasure Valley, just over 50% 42 between their homes and work, shopping, and of those living in Gem County commuted more health care. Transportation was described as than 30 minutes alone. a significant portion of a household budget Focus group and interview participants stated due to the lack of public transportation in the that lack of public transportation, the increased They noted that, for those who Treasure Valley. growth of the area, and need for a car have own automobiles, gas and maintenance costs caused problems for those commuting to work. are a significant part of household budgets. Traffic has increased which reduces time for other activities and/or causes commuters to change their work schedules.
Community Commute Over 30 Minutes Among Solo Car Commuters Feedback on Figure 41 Transportation: “Transportation is a barrier, especially in the rural 51.4% 50% communities,
for low-income 44.2%
families 40% 37.9% because they 35.8% 37.2% have to be able 34.3% 35.2% to afford the 30% gas to get into the nearest city 22.6% 21.5% 20.6% center to do 20% 19.6% more localized 15% 15.1% shopping, but also to get 10% access to their 2011-2015 2012-2016 2013-2017 health care needs.” Ada Canyon Elmore Gem Owyhee Idaho U.S. – Community Member Source: U.S. Census Bureau, American Community Survey 5-Year Estimates, 2013-2017 “Availability of bus routes is limiting if working swing shift, overnights, etc.” – Refugee Resettlement Professional
Financial Stability United Way of Treasure Valley 2020 Community Assessment Financial Stability Policy, Systems, and Environmental Change Recommendations Policy, Systems, and Environmental change Housing approaches seek to go beyond programming • Increase affordable housing and into the systems that create the structures in stock and innovative 43 which we work, live, and play. These approaches housing options. often work hand-in-hand where, for example, • Increase the variety of income-based housing an environmental change may be furthered by options through rent-controlled properties, a policy of systems change. Similarly, a policy properties accepting Housing Choice could be put in place that results in additional Vouchers, accessory dwelling units, and environmental changes. The process is not building higher-density housing. linear. At the end of the day, an effective PSE approach should seek to reach populations • Support and promote the Housing First and uncover strategies for impact that are model, which prioritizes helping an individual/ sustainable. Efforts may accelerate the adoption family become housed before attending to or implementation of effective interventions by other services needed. effectively integrating approaches into existing • Create a funding stream for the State Housing infrastructures. Such approaches often include Trust Fund. advocates, decision and policy makers.29 • Increase state and federal funding of the HOME Program and Low-Income Housing Tax Employment and Poverty Credits, which help fund affordable housing • Attract and incentivize business development developments. in the Treasure Valley that can offer living • Encourage the passage and adoption of wage, or higher wage, jobs such as recent inclusionary zoning ordinances/laws that efforts by Caldwell’s Economic Development require and/or incentivize the development of Department. affordable housing. • Expand access to the federal Earned Income • Support policies to limit rental application Tax Credit to include 21- to 24-year-olds and fees and require adequate notice of rent workers not raising children at home. increases for tenants. • Expand access to the federal Child Tax Credit (CTC) so the lowest income working families Transportation can receive the full refund. The CTC has been • Initiate municipal plans that require sidewalks linked to higher educational outcomes for be installed when new housing developments children and higher earning potential as these are built and require the construction of children enter the workforce as adults. sidewalks around all schools, making it safer • Expand programming that encourages for students to walk to schools and alleviating youth to go on to postsecondary education, congestion during school drop off and pick including career and technical education for up times. skilled careers, as recommended by the Idaho • Encourage all community and roadway State Board of Education, in order to keep up agencies to adopt and promote complete with the growing demand in Idaho for a skilled street policies and designs making it safer workforce. for active transportation, which can help with • Increase availability of affordable child care decreasing congestion. options for families so that families can afford Continued on child care and remain employed. Next Page
29 The Food Trust. (2012). What Is Policy, Systems, and Environmental (PSE) Change? Retrieved May 26, 2020, from http://healthtrust.org/wp-content/ uploads/2013/11/2012-12-28-Policy_Systems_and_Environmental_Change.pdf
United Way of Treasure Valley 2020 Community Assessment Financial Stability Financial Stability
• Support Safe Routes to School programs • Expand bussing hours to accommodate and built environment initiatives to improve residents with nontraditional working hours. walkability and bikeability for students and • Support and utilize public bike share and 44 families around schools. scooter programs as alternative modes • Collaborate with Valley Regional Transit to of transportation across Treasure Valley promote the employer pass program with communities. employers in the Treasure Valley. • Develop subsidy/scholarship initiatives to • Create a state funding mechanism to support support employees or those needing health the expansion of public transit services to care or public/social services to utilize for promote easier access to public transit. buses, cabs, or rideshares. • Increase city funding from all cities to support the expansion of public transit accessibility, specifically increasing access to public transit outside of the city center.
Financial Stability United Way of Treasure Valley 2020 Community Assessment Health Health 45
HEALTH There is strong evidence characterizing the Social Within the Treasure Valley, general health varies Influencers of Health (e.g., financial stability, widely. As seen in the County Health Rankings housing, education) and their relationship to in 2019, Ada County ranks 1st in the state, while health. While other sections of the Community Owyhee County ranks 42nd. Assessment speak specifically to those social Gallup Well-Being Index, Idaho and economic structural influencers, the Figure 42 following section details the individual health and well-being of residents in the Treasure Valley. From both statistics and stories, the top health concerns identified were access to Physical 32 affordable health care and mental health and Community 3 well-being. Financial 33 General Health and Well-Being 38 According to the Gallup Well-Being Index, Social which consists of scores for physical, community, Career 23 financial, social, and career wellness, Idaho ranked 8th in the nation on well-being overall in Well-Being Index 22 2017 and fell to 22nd in 2018 (Figure 42).
DATA SOURCE: Gallup Well-Being Index, 2018
Figure 43 Adults Self-Reporting “Fair” or “Poor” General Health
Approximately 16% of adults statewide 21.1% and 21% in Southwest District rated 15.9% 16.4% their general health as “fair” or “poor” 10.8% according to the 2016 Behavioral Health Risk Factor Survey (Figure 43).
Southwest Central District Idaho U.S. District Health Health (District 3)* (District 4)*
DATA SOURCE: Idaho Health Behaviors Report (Results from Idaho’s Behavioral Risk Factor * NOTE: Southwest District: Adams, Canyon, Gem, Owyhee, Surveillance System), 2016 Payette, and Washington County; Central District: Ada, Boise, Elmore, and Valley County
United Way of Treasure Valley 2020 Community Assessment Health Health 46
Health Care: Access and Affordability The National Academies of Sciences, Barriers to health care in the Treasure Valley Community Engineering, and Medicine define access to included limited services, lack of awareness of Feedback on health care as the “timely use of personal health services, cost, and insurance coverage. Health Care: services to achieve the best possible health “People don’t outcomes.”29 Many people face barriers that In Idaho, race and ethnicity are associated know where In prevent or limit access to needed health care with more limited access to primary care. to go for help 2017, 37.6% of Hispanic or Latino adults had no services, which may increase the risk of poor with health.” consistent source of primary care. – Community health outcomes and health disparities.30 Member “[We need more] mobile Figure 44 Percentage of Adults Without a Regular Healthcare health. Bring Provider, 2017 services to where people are.” – Community 25.2% 24.3% 23.9% Health 22.4% Professional “Health care is more expensive than housing in most cases.” – City Official
Southwest Central District Idaho U.S. District Health Health (District 3) (District 4)
DATA SOURCE: Get Health Idaho Report 2019 https://healthandwelfare.idaho.gov/ Portals/0/Health/GetHealthyIdahoV2019.pdf
29 Milliman M, editor. Access to health care in America. Institute of Medicine (U.S.) Committee on Monitoring Access to Personal Health Care. Washington (DC): National Academies Press (U.S.); 1993. 30 Institute of Medicine (U.S.) Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care. Smedley BD, Stith AY, Nelson AR, editors. Unequal treatment: confronting racial and ethnic disparities in health care. Washington (DC): National Academies Press (U.S.); 2002.
Health United Way of Treasure Valley 2020 Community Assessment Health
Figure 45 Respondent Reported Health and Social Services That are Currently Lacking in Their Community*
Affordable housing 71% 47 Mental health care services 51%
Affordable child care services 43.8%
Housing services 42%
Transportation services 38%
Services for youth 27.7%
Services for older adults 25%
Employment services 23.2%
Health care servcies 22.1%
Financial assistance services 21.6%
Substance use services 21.6%
Educational support services 20%
Exercise and physical activity opportunities 19.3%
Services for veterans 19.1%
Services for people with disabilities 16.7%
Services for new immigrants 16.2%
Family planning services 15.6%
Food services 13.8% *Respondents were I don’t know 10% permitted to select more than one option, Other 3.4% so percentages do not Oral health care services 1.8% sum to 100%
DATA SOURCE: Saint Alphonsus Health System & United Way of Treasure Valley 2020 Community Survey
In the Treasure Valley, Figure 46 Primary Care Physicians per 100,000 Population there are 73.1 primary care physicians for every 100,000 73.1 people. Ada County has the highest rate of primary 67.2 care providers at 93.7 for 57.7 every 100,000, and Owyhee County has the lowest at 8.6 65.9
93.7 per 100,000. In 2017, 96% 35 of Idaho was a federally- designated shortage area 31 in primary care. IdahoIdaho...... 65.9 8.6 OwyheeOwyhee County Count...... y 8.6 GemGem CountyCount...... y 57.7 31 Idaho Department of Health and Welfare, Division of ElmoElmorere County County...... 67.2 DATA SOURCE: U.S. Department Public Health. (2019). Get Healthy Idaho: Measuring CanyonCanyon County Count...... y 35 of Health & Human Services, and Improving Population Health. Retrieved May Health Resources and Services Ada County...... 93.7 Administration, Area Health Resource 26, 2020, from https://healthandwelfare.idaho.gov/ Ada County File. 2017 Portals/0/Health/GetHealthyIdahoV2019.pdf TrTreasureeasure Valley Valle...... y 73.1
United Way of Treasure Valley 2020 Community Assessment Health Health 48
According to 2018 data, in Idaho overall, Minority populations identified experiencing approximately 2 out of 3 adults had a routine additional challenges in accessing services. checkup in the past year. Nationally, the rate Focus group and interview participants who Community was 77% for 2018.32 There are many reasons identified as members of the LGBTQIA+ Feedback on individuals do not receive routine health care. community reported that they have had difficulty Health Care: Within the Treasure Valley, survey respondents accessing appropriate services and feel they “The language around most frequently selected cost of services face discrimination with very few providers insurance here (52.4%), insurance problems/lack of coverage/ understanding the needs of LGBTQIA+ patients. is foreign to not enough coverage (39.3%), and long waits for Some feel that members of the LGBTQIA+ many people, appointments (39.3%) as issues that have ever community also lack knowledge that would citizens or not. It’s made it more difficult for them to get the health help them to advocate for their own health. complicated. If or social services needed. Boise, they indicated, is more accepting of you don’t say the LGBTQIA+ population than elsewhere in Among the types of health-related services that the right words, Treasure Valley. e.g., wellness survey respondents indicated are lacking in their checks that community, mental health care services, general The bureaucracy of health insurance, and are free with health care services, and substance use services Medicaid in particular, were described as insurance, you will have to were the top three selected (Figure 45). Focus impeding access to services. One common pay or [you] group and interview participants described a insurance-related issue was confusion about won’t get the lack of mental health and behavioral health covered services related to new Medicaid right care.” providers in the area. regulations. The participants reported that, even – Community for those who have insurance, services are still Member Several focus group and interview participants too expensive, especially medication costs. “Finding mental indicated that many residents are not aware health care is of the different services that are available. From 2013 to 2018, health care costs even harder Further, if residents are aware of the available increased significantly. For single adults, there than finding services, they rarely know how to navigate them. was a 44% increase and for families consisting LGBTQIA+ Immigrants especially face a number of issues competent of two adults, one infant, and one preschooler, primary care. that further impede access to services. Focus there was a 53% increase. There is a short group and interview participants explained Focus group and interview participants talked list of folks that that those without legal status have difficulty about the costs associated with accessing are LGBTQIA+ accessing services due to fear, language and or LGBTQIA+ services (i.e. co-pays and prescription drug costs) literacy issues, a lack of understanding about the friendly/ and, how burdensome they can be. knowledge- resources available to them, and challenges in able.” navigating services. – LGBTQIA+ Services Professional 32 Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System Survey Data. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2018
Health United Way of Treasure Valley 2020 Community Assessment Health
Insurance Figure 47 Percent of Population Aged 18-65 Years With and Without Lack of health Medical Insurance insurance coverage is one of the largest 11.6% 22.2% 17.6% 19.5% 29.4% 16.3% 12.5% Without 49 barriers to health care Medical access, nationally Insurance and in Idaho, and the unequal distribution of coverage contributes to inequities in 88.4% 77.8% 82.4% 80.5% 70.6% 83.7% 87.5% With health.33 Within Medical Insurance the Treasure Valley, the percentage of Community population with Feedback on Health Care: medical insurance “People are ranged from 70.6% Ada Canyon Elmore Gem Owyhee Idaho U.S. afraid to County County County County County in Owyhee County to access services 88.4% in Ada County DATA SOURCE: U.S. Census Bureau, American Community Survey 5-Year Estimates, as cited by Trinity because of in 2018. Health Data Hub, 2014-2018 their legal status.” – Community Health Professional Percent of Hispanic/Latino Uninsured “The middle- Figure 48 aged working class struggles The Hispanic and health 43.3% or Latino care is a population in the huge burden. People come Treasure Valley is for indigent 34.8% disproportionately services uninsured. because the cost is so high and they 24% 22.8% 23.7% give up. The 20.5% lower-income 19.2% 19.2% people are also affected.” – County Official “[Medicaid] would be more effective if the state didn’t put so many Treasure Ada Canyon Elmore Gem Owyhee Idaho U.S. Valley County County County County County limitations on programs.”
DATA SOURCE: U.S. Census Bureau, American Community Survey 5-Year Estimates, as cited by Trinity Health – Community Data Hub, 2014-2018 Health Professional
33 Call K, McAlpine D, Garcia C, Shippee N, Beeba T, Adeniyi T, et al. Barriers to care in an ethnically diverse publicly insured population: is health care reform enough? Med Care. 2014; 52:720–27.
United Way of Treasure Valley 2020 Community Assessment Health Health
Percent of Insured Population Receiving Medicaid Of the insured population in Figure 49 the Treasure Valley, about 1 in 5 were receiving Medicaid
in 2018 (Figure 49). However, 29.2% 50 27.3% with the passage of Medicaid 26.3% Expansion in 2019, these rates will likely change. 22.4% With expanded coverage 19.2% beginning Jan. 1st, 2020, around 91,000 are expected to be covered statewide.34 So 12.9% far, Medicaid expansion has provided health coverage to over 67,000 Idahoans. These Idahoans are now able to see a doctor, get tested for coronavirus without financial Ada Canyon Elmore Gem Owyhee Idaho hardship, and get treatment if County County County County County they are sick. DATA SOURCE: U.S. Census Bureau, American Community Survey 5-Year Estimates, as cited by The majority of Treasure Trinity Health Data Hub, 2014-2018 Valley residents who receive Medicaid are under the age of 18 (Figure 50).
Figure 50 Percent of Insured Population Receiving Medicaid, by Age
52.5%
46.5% 42.5% 39% 38.3% 36.8% 34.9%
24.1% 22.2% 19.7% 14.7% 12.8% 14.01% 14% 14.3% 13.8% 11.3% 12.2% 11.1% 8.5% 9.4% 8.6% 9% 6.5%
Under Ages Ages Under Ages Ages Under Ages Ages Under Ages Ages Under Ages Ages Under Ages Ages Under Ages Ages Under Ages Ages 18 18-64 65+ 18 18-64 65+ 18 18-64 65+ 18 18-64 65+ 18 18-64 65+ 18 18-64 65+ 18 18-64 65+ 18 18-64 65+ Treasure Ada Canyon Elmore Gem Owyhee Idaho U.S. Valley County County County County County
DATA SOURCE: U.S. Census Bureau, American Community Survey 5-Year Estimates, as cited by Trinity Health Data Hub, 2014-2018
34 Norris, L. (2020, January 6). Idaho and the ACA’s Medicaid expansion: Eligibility, enrollment and benefits. Retrieved May 26, 2020, from https://www.healthinsurance.org/idaho-medicaid
Health United Way of Treasure Valley 2020 Community Assessment Health 51
Oral Health Figure 51 Access to Dentists per 100,000 Population by County Oral health is essential to overall health and well-being. However, Community many residents in the Treasure Feedback on Valley do not have access to oral 42.4% 53.4% Oral Health: health care. In 2017, 97% of “I’d like to see 64.2% medical teams Idaho was designated a dental 77.3% 79.2% consider oral health professional shortage area. health as a Statewide, there are 64.2 dentists part of what per 100,000 people, comparable they screen.” to the national average of 61.1 – Dental Health 17.7% Professional per 100,000. Within the Treasure Idaho...... 64.2% Valley, Ada County has the highest “Mental health Owyhee County....17.7% rate of dentists at 79.2 per 100,000 and dental Gem County...... 53.4% (health) seem population and Owyhee County Elmore County..... 77.3% to be the two has the lowest at 17.7 per 100,000 biggest areas Canyon County.....42.4% population. of need.” Ada County...... 79.2% – Community Member Figure 52 Adults Self-Reporting No Dental Visit in the Last 12 Months, 2016 Among adults in Idaho 42% in 2016, 36.7% reported 36.7% 33.6% no dental visit in the 30% last 12 months, which is the recommendation for frequency of dental visits. In the Southwest District (which includes Canyon, Gem, and Owyhee Counties), the rate of adults who did not have a dental Southwest Central District Idaho U.S. visit in the last 12 months District Health Health (District 3) (District 4) was higher than statewide at 42% (Figure 52). DATA SOURCE: Get Health Idaho Report 2019 https://healthandwelfare.idaho.gov/Portals/0/ Health/GetHealthyIdahoV2019.pdf
United Way of Treasure Valley 2020 Community Assessment Health Health 52
In the focus groups and interviews, Figure 53 Percent of Idaho Third-Grade Students with Active participants indicated that there is Tooth Decay by Public Health District a need for more oral health care Community services in the area. Participants Feedback on 17.1% expressed that access problems Oral Health: 14.7% related to oral health care were 14.5% “Dental care is hardly mainly due to inconvenient covered under appointment times and locations Medicaid.” and inadequate coverage for – Refugee dental care, especially in the Resettlement Professional Medicaid Program. “Times for Due in part to the lack of regular dental care, oral health care, many children such as in Idaho are experiencing oral Southwest Central District Idaho District Health Health weekends health issues, such as dental caries and evening (District 3) (District 4) appointments, (cavities) and active tooth decay DATA SOURCE: Idaho Smile Survey Report, 2017 are not (Figure 53 and Figure 54). available, and more barriers exist for rural communities.” Figure 54 Percent of Idaho Third-Grade Students with Caries (Cavities) Experience – Dental Health Professional
69.8% 67.1% 70 65.4% 65.6% 61.8%
60
50 43.6% 39.7% 36.4% 40 35.8% 33.9%
30
2000-01 2004-05 2008-09 2012-13 2016-17
Caries Experience Severe Caries Experience
DATA SOURCE: Idaho Smile Survey Report, 2017
Health United Way of Treasure Valley 2020 Community Assessment Health 53
Behavioral Health: Mental Health and Substance Use Behavioral health issues, such as anxiety, ability to participate in treatment and recovery.36 depression, and addiction, can arise from Behavioral health can also impact other areas of Community genetic factors and/or from a number of life, including attending and focusing at school, Feedback on individual and societal factors such as incidence obtaining and maintaining a job, finding and Mental Health: of trauma and financial or housing instability.35 keeping housing, and having relationships with “It’s hard to Behavioral health issues affect people’s ability to friends and family.37 find qualified providers, participate in health-promoting behaviors, and Mental Health especially in thus affect their ability to maintain good physical mental and health. Substance use and mental health go Mental health is critical to personal well- behavioral hand in hand, as addiction to substances being, interpersonal relationships with family health.” is a form of mental illness. The relationship and friends, and the ability to contribute to – City Official between behavioral health and physical health community. On average, adults in the Treasure “There is a is bidirectional. Issues with physical health, such Valley experience approximately 3.7 poor need for more as chronic diseases, can have serious impacts , compared to affordable, mental health days per month convenient, on behavioral health and decrease a person’s 3.8 statewide and 4 nationwide. and available mental health counseling, Average Poor Mental Health Days Per Month Figure 55 longer service times, and more locations.” 4.2% 4% 4% – Community 3.9% 3.8% Member 3.5%
Age 20+ Age 20+ Age 20+ Age 20+ Age 20+ Age 20+
Ada Canyon Elmore Gem Owyhee Idaho County County County County County
DATA SOURCE: Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System, accessed via County Health Rankings, as cited by Trinity Health Data Hub, 2018
35 Tulchinsky TH, et al. Editorial: Mental Health as a Public Health Issue. Public Health Reviews. 2012; 34, 2. 36 Lando J, Marshall Williams S, Sturgis S, et al. A logic model for the integration of mental health into chronic disease prevention and health promotion. Prev Chronic Dis. 2006 April; 3(2):A61. 37 Mental health and mental disorders. Healthy People 2020. Retrieved October 30, 2018, from https://www.healthypeople.gov/2020/topics-objectives/topic/mental- health-and-mental-disorders.
United Way of Treasure Valley 2020 Community Assessment Health Health
Mental health among youth is particularly Figure 56 Students Reporting Mental Health Issues important. ACEs, or Adverse Childhood Experiences, are traumatic events that 54 occur between the ages of 0 and 17 that 38.9% undermine a child’s sense of safety and
security. ACEs, which are preventable, have 31.5% been linked to chronic health problems, mental illness, and substance misuse in
adulthood as well as negatively impacting 21.6% educational and job opportunities.38 17.2% About one-fifth of children aged 0-17 years have experienced ACEs, both in Idaho 2019 U.S. 2017 Idaho 2019 U.S. 2017 Idaho and nationally. Economic hardship Community (27.4% in Idaho) and parent or guardian Feedback on divorce or separation (23.3%) are the most Mental Health: commonly cited ACEs among children in “[There Idaho and nationally (Figure 124, Appendix). Students who seriously Students who felt sad or are] more considered committing hopeless for two or resources and Idaho high school students grapple with suicide in the past year more weeks in a row the understanding mental health issues at a higher rate than past year around mental their peers nationwide. Idaho ranks high health. Not nationwide for mental illness and suicide DATA SOURCE: Idaho Youth Risk Behavior Survey Results, 2019 as tabooed rates.39 as before, especially in Mental Health Care Providers per 100,000 Population schools.” Figure 57 In the community survey, 38.4% of – Early respondents believed that mental Childhood health and stress were top health Professional Ada County...... 289.6 concerns for themselves or their “If you Canyon County.....157 families. Among focus group and don’t have Elmore County...139.4 interview participants, mental insurance, health was described as a major Terry Reilly Gem County...... 96.4 [Community Owyhee County...34.2 34.2 concern. Participants pointed to Health Center] Idaho...... 208.6 the stress that comes with the cost is about the of living in the area (e.g., housing, 96.4 only option transportation, medical bills, child for mental health, or 289.6 care) and the stressors children and you just don’t families face at home. receive care.” – Community The outbreak of Coronavirus 208.6 Member disease 2019 (COVID-19) has also 139.4 added stress in the community due to its impacts on health care, 157 education, and financial systems. Related to mental health, fear and anxiety about a disease can be overwhelming, and can exacerbate DATA SOURCE: University of Wisconsin Population Health Institute, County Health Rankings, as cited by Trinity Health Data Hub, 2019 existing health conditions.
38 U.S. Centers for Disease Control and Prevention. (2020, April 03). Preventing Adverse Childhood Experiences |Violence Prevention|Injury Center|CDC. Retrieved May 26, 2020, from https://www.cdc.gov/violenceprevention/childabuseandneglect/aces/fastfact.html 39 Mental Health America. (2020). Overall Ranking. Retrieved May 26, 2020, from https://www.mhanational.org/issues/ranking-states
Health United Way of Treasure Valley 2020 Community Assessment Health
Many mental health needs are unmet due to Suicide low numbers of facilities and providers. Within Idaho is consistently among the states with the the Treasure Valley, Ada County has the highest highest suicide rates in the nation. In 2017, rate of mental health care providers at 289.6 per Idaho had the fifth highest suicide rate in the 55 100,000 people, and Owyhee County has the U.S., with a rate of 23.2 per 100,000 people. lowest at 34.2 per 100,000 people (Figure 57). This is 64.8% higher than the national average. Focus group and interview participants In 2018, the suicide rate in Idaho rose to 24 described a lack of treatment providers in per 100,000 (Figure 57). Suicide is the second the region, although some believe the leading cause of death for Idaho residents ages 40 problem is that people don’t access the 15-34 and for males up to age 44. Males are providers that are available. Some participants more than three times more likely to die from indicated that stigma is a factor impacting suicide than females in Idaho (Figure 58). access to care. Participants also believe that As seen in Table 11, the Treasure Valley accounts Community complicated applications for services, work for many of the suicide deaths in Idaho. Feedback on obligations (i.e. not being able to get out of Mental Health: work to access services), and fees also interfere “It’s hard to with access to behavioral health services. find qualified According to participants, access is particularly providers, problematic for those living in rural areas mainly especially in mental and due to transportation issues. behavioral health.” Suicide Age-Adjusted Mortality Rate Deaths Due to Suicide, 2013-2017 Figure 58 Table 11 – City Official per 100,000 Population, by Gender “There are lots of requests Geography Number of Deaths from staff [at Due to Suicide 33.% the Boys & Girls Club] for Ada 407 help with kids Canyon 196 over social and emotional 21.2 Elmore 30 struggles. Most of our Gem 18 kids have Owyhee 15 ACEs.” 9.4 – Out-of- 5.9 Idaho 1,734 School Time Professional Idaho Idaho U.S. Male U.S. Male Female Female DATA SOURCE: Idaho Bureau of Vital Records and Health Statistics, Idaho Department of Health & Welfare; Centers for Idaho U.S. Disease Control and Prevention; State Department of Education as cited by Suicide Prevention Program Idaho Department of Health and Welfare, 2017 DATA SOURCE: Centers for Disease Control and Prevention, *NOTE: Rates are unreliable when the rate is calculated with a National Vital Statistics System, accessed via CDC WONDER, as numerator (number of deaths) of less than 20. cited by Trinity Health Data Hub, 2013-2017 NOTE: Age adjusting rates is a way to make fairer comparisons between groups with different age distributions. For example, a county having a higher percentage of elderly people may have a higher rate of death or hospitalization than a county with a younger population, merely because the elderly are more likely to die or be hospitalized. Age adjustment can make the different groups more comparable.
40 DATA SOURCE: Idaho Bureau of Vital Records and Health Statistics, Idaho Department of Health & Welfare; Centers for Disease Control and Prevention; State Department of Education as cited by Suicide Prevention Program Idaho Department of Health and Welfare, 2018
United Way of Treasure Valley 2020 Community Assessment Health Health
The number of deaths by suicide is greatest participants shared concerns about suicide and in Ada County (Table 11). Overall, rates in the access to services. In Idaho, the Idaho Suicide Treasure Valley and the state are well above the Prevention Hotline is a suicide hotline that fields 56 national average (Figure 59). calls related to suicide. A provider described those who use the hotline. Community survey, focus group, and interview
Suicide Age-Adjusted Mortality Rate per 100,000 Population Figure 59
23.4 21.2 20.2 “One-third of [suicide] Community 18.4 hotline users are ‘familiars’ Feedback on that call regularly and do Mental Health: not have services available 13.3 and need a place that “Behavioral they can check-in. Another health is third of hotline users are [the] biggest concerned parties calling concern about loved ones, and because of the the last third are in acute toxic stress in mental health crisis. All are low-income Suppressed* Suppressed* challenged in navigating households.” the mental health support – Behavioral Ada Canyon Elmore Gem Owyhee Idaho U.S. system.” Health County County County County County Professional – Behavioral Health DATA SOURCE: Centers for Disease Control and Prevention, National Vital Statistics System, Professional “The community accessed via CDC WONDER, as cited by Trinity Health Data Hub, 2013-2017 is loving/caring NOTE: * indicates a rate too small to report NOTE: Age adjusting rates is a way to make fairer comparisons between groups with different but lacks the age distributions. For example, a county having a higher percentage of elderly people may mental health have a higher rate of death or hospitalization than a county with a younger population, merely literacy needed because the elderly are more likely to die or be hospitalized. Age adjustment can make the different groups more comparable. to navigate the system. The community is willing to learn, Substance Use help and act.” – Behavioral Substance use and abuse is a critical public the chances of substance use and addiction.43 Health health issue that affects not only the individual, Individuals with substance use disorders can Professional but also has serious direct and indirect impacts experience negative health and social outcomes, on families, communities, and society as a including higher rates of infectious disease (e.g., whole. The causes of substance use disorders HIV, hepatitis), cancer, mental illness, domestic are multi-faceted and include biological, violence, crime, financial hardship, housing social, and environmental factors.42 Trauma and instability and homelessness, child-abuse, and Adverse Childhood Experiences (ACEs) increase overdose.44
42 U.S. Department of Health and Human Services, Office of the Surgeon General Facing Addiction in America; The Surgeon General’s Report on Alcohol, Drugs, and Health. 2016. 43 Felitti VJ, et al. Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults The Adverse Childhood Experiences (ACE) Study. American Journal of Preventative Medicine. 1998; 14(4): 245-258. 44 U.S. Department of Health and Human Services, Office of the Surgeon General. Facing Addiction in America The Surgeon General’s Report on Alcohol, Drugs, and Health. 2016.
Health United Way of Treasure Valley 2020 Community Assessment Health
Alcohol is the most prevalent substance used unintended pregnancy, fetal alcohol syndrome, nationwide and in Idaho. Excessive drinking, sudden infant death syndrome, suicide, defined as the percentage of the adult interpersonal violence, and motor vehicle population that reports binge or heavy drinking45 crashes. The percentage of adults reporting 57 in the past 30 days, is a risk factor for a number excessive drinking in Treasure Valley ranges of adverse health outcomes such as alcohol from 13.8% in Owyhee County to 17.9% in Ada poisoning, hypertension, acute myocardial County (Figure 60). infarction, sexually transmitted infections,
Percent of Adults Reporting Excessive Drinking Figure 60
17.9% 17.3% 16.6% 14.9% 13.9% 13.8%
Ada Canyon Elmore Gem Owyhee Idaho County County County County County
DATA SOURCE: University of Wisconsin Population Health Institute, County Health Rankings, as cited by Trinity Health Data Hub, 2017
Although the percentage of Students Reporting Substance Use Figure 61 Idaho students reporting that they drank alcohol or used marijuana one or more times in 29.8% the past 30 days was lower than 26.6% nationwide, the percentage 22.6% who were offered, sold, or 19.8% 19.8% given illegal drugs on school 16.9% property exceeded national 14.2% 14% rates in 2017 (Figure 61). Effective in 2019, the state of Oregon legalized recreational Idaho 2019 U.S. 2017 Idaho 2019 U.S. 2017 Idaho 2019 U.S. 20 17 Idaho 2019 U.S. 2017 marijuana use, which may have an impact on Idaho utilization rates over time. Rates for youth Drank alcohol on Used marijuana one Took prescription Were offered/sold/ in Idaho and the U.S. related one or more of the or more times during drugs without given illegal drug past 30 days the past 30 days permission on school property to taking prescription drugs (lifetime) during past year without permission in their lifetime were comparable. DATA SOURCE: Idaho Youth Risk Behavior Survey Results, 2019
45 Binge drinking is defined as a woman consuming more than four alcoholic drinks during a single occasion or a man consuming more than five alcoholic drinks during a single occasion. Heavy drinking is defined as a woman drinking more than one drink on average per day or a man drinking more than two drinks on average per day.
United Way of Treasure Valley 2020 Community Assessment Health Health
Looking at the effects of substance use, the opioids (Figure 64). Consistent with this finding, age-adjusted total drug overdose mortality community survey participants identified opiates rate 46 in Idaho overall has nearly doubled as the drug of greatest concern in the Treasure 58 since 2001, from 7.9 per 100,000 population in Valley. 2001 to 14.5 per 100,000 in 2018, largely due to
Figure 62 Drug Overdose Age-Adjusted Mortality Rate in Idaho, per 100,000 Population
15 14.5
13.5 9.9 Community 10
Feedback on 5.6 7.4 Substance 5 4.7 Use: 5 4.4 4 “Drugs and 1.9 3.7 substance use are large 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 issues. They impact all Total Drug Opioid Involvement Prescription Opioid Did not Specify generations Overdose Involvement and it’s really bad in the schools. The DATA SOURCE: Centers for Disease Control and Prevention, National Vital Statistics System, accessed via CDC WONDER, 2012-2017 drugs we see include meth, opioids, Drug Overdose Age-Adjusted Mortality Rate per 100,000 Figure 63 marijuana, Population etc.” – K12 Parent They also described 22% 21.7% and problems with access Community 18.9% to treatment services, Member 18.1% 15.8% including issues with “Meth used to 14.4% insurance which create be an issue but gaps in service. They now it’s heroin 11.4% and opiates.” noted that many – K12 Parent people don’t access and services until they are Community referred by the court Member system, which is too late according to many Ada Canyon Elmore Gem Owyhee Idaho U.S. participants. County County County County County
DATA SOURCE: Centers for Disease Control and Prevention, National Vital Statistics System, accessed via CDC WONDER, 2012-2017
46 Age adjusting rates is a way to make fairer comparisons between groups with different age distributions. For example, a county having a higher percentage of elderly people may have a higher rate of death or hospitalization than a county with a younger population, merely because the elderly are more likely to die or be hospitalized. Age adjustment can make the different groups more comparable.
Health United Way of Treasure Valley 2020 Community Assessment Health
Tobacco Use Tobacco use is the leading cause of preventable 13.9% of adults are current smokers (Figure death and disease in the U.S. and affects not 64). Except for Ada County, all counties in the only the user but also those who live with and Treasure Valley have higher rates of smoking 59 interact with users. In Idaho overall, about than statewide.
Percent of Adults Who are Current Smokers Figure 64 Tobacco use is initiated primarily during adolescence. Teens who use a vape or e-cigarette 15.7% 15.6% 15.5% are nearly three times more 14.1% 14.1% 13.9% likely to try cigarettes. Both
12% nationally and in Idaho, Community vaping and e-cigarette use Feedback on are higher than cigarette Substance smoking. While rates of Use: cigarette, cigar, and chewing “Behavioral tobacco use have declined health services are really dramatically in Idaho, more lacking. There than one in five Idaho high aren’t many school students report and they’re not close by for utilizing an e-cigarette or Ada Canyon Elmore Gem Owyhee Idaho U.S. rural residents. , County County County County County vape in the last 30 days The cost and which is much higher than the time really Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System, accessed the national average (13.2%) add up.” via County Health Rankings, as cited by Trinity Health Data Hub, 2017 in 2017. – Rural Community Member Figure 65 Students Reporting Smoking, Chewing Tobacco, and Vaping, Idaho “The problem is we are receiving this information
30 through the 26.1% 21.5% 24.8% 19.7% 21.5% drug court; we 17.4% 20 need these
14.5% resources 17.8% 14.3% 12.5% 10 14.3% sooner.” 12.2% 5.3% 9.7% 9.1% – Rural Community 2009 2011 2013 2015 2017 2019 Member
Smoked cigarettes, cigars, or Smoked a cigarette on one or more of Used an e-cigarette chewed tobacco in the past 30 days the past 30 days (e.g. current smoker) or vape in the past 30 days
DATA SOURCE: Idaho Youth Risk Behavior Survey Results, 2019
47 U.S. Department of Health and Human Services. The Health Consequences of Smoking – 50 Years of Progress. A Report of the Surgeon General. Atlanta: GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014. 48 Berry, K. M., Fetterman, J. L., & Benjamin, E. J. (2019, February 1). Association of Electronic Cigarette Use With Subsequent ... Retrieved May 26, 2020, from https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2723425
United Way of Treasure Valley 2020 Community Assessment Health Health
New Federal legislation in 2020 raised the United Way of Treasure Valley and Saint minimum sale age of all tobacco products Alphonsus Health System helped pass state (including vape and e-cigarette) to 21. State legislation in 2020 to bring uniformity to 60 legislation proposed in 2020 to raise Idaho’s the definition of tobacco products between minimum sale age of tobacco products to 21, e-cigarettes, vape products, and other tobacco and create consistency between federal and products. This legislation will ensure consistency state law, failed to pass. The lack of consistency between traditional tobacco retailers and between federal and state laws has not only e-cigarette and vape-only retailers for licensing created confusion for retailers, but Idaho also and enforcement. faces a loss of federal funds for cessation programming and enforcement as a result.49 Healthy Weight: Physical Activity, Active Transportation, Nutrition, and Community Food Security Feedback on Physical There is strong science supporting the health Overall, 29.1% of Idaho residents are obese; Activity: benefits of maintaining a healthy weight the rate is higher among males (30.2%) than “[Lack of] through physical activity and a healthy diet. females (28.1%).50 The problem of obesity is access to Obesity, defined as a Body Mass Index of 30 or particularly acute in the Treasure Valley where exercise opportunities more, is nationally the second leading cause of the percentage of adults who are obese exceeds and obesity preventable death and disease after tobacco the statewide rate of 29.1% in all of the counties are common use. Obesity has not only persisted in the except Ada County. The percent of obese adults issues for ranges from 25.3% in Ada County to 40% in adults.” Treasure Valley, it has increased over time, – Community from 22.1% of adults in 2004 to 28.5% in Owyhee County (Figure 66). Member 2016 (Figure 126, Appendix). “In Treasure Percentage Adults That are Obese Valley there is Figure 66 ready access to nature, plentiful gyms, 40% the greenbelt, 37.3% 35.3% and trail 34.8% systems.” 29.1% 28.8% – Community Member 25.3%
Ada Canyon Elmore Gem Owyhee Idaho U.S. County County County County County
DATA SOURCE: Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, as cited by Trinity Health Data Hub, 2016
49 Blake, R. (2020, February 27). Idaho will lose federal funds after Senate kills bill to raise Idaho’s legal tobacco age to 21. Retrieved May 26, 2020, from https://magicvalley.com/news/local/govt-and-politics/idaho-will-lose-federal-funds-after-senate-kills-bill-to-raise-idahos-legal-tobacco-age/article_c22961c0-90b6- 597a-968d-f084400bf8bb.html 50 DATA SOURCE: Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, as cited by Trinity Health Data Hub, 2016
Health United Way of Treasure Valley 2020 Community Assessment Health
Childhood Obesity Weight issues start early and compromise the was lower than the nationwide rate of 14.8%, health and well-being of young people, setting younger students had the highest rates of them up for lifelong health challenges. Although overweight and obesity among Idaho’s high 61 at 12.1%, the percentage of Idaho’s high school school students (Figure 67). students who were overweight or obese in 2019
Percentage of Idaho Students Who Were Overweight or Obese Figure 67
14.8% 14% 13% 12.1% 11.4% 9.9%
9th 10th 11th 12th 9th-12th 9th-12th Grade Grade Grade Grade Idaho U.S. Average Average
DATA SOURCE: Idaho Youth Risk Behavior Survey Results, 2019 NOTE: Obesity is at or above the 95th percentile for Body Mass Index
According to the 2019 Figure 68 Student Weight and Activity Youth Risk Behavior Survey (YRBS), 12.4% of Idaho high school youth are overweight and 44.7% Were overweight 12.4% are trying to lose weight (Figure 68). Were trying to lose weight 44.7% Self-reported obesity is lowest among Idaho Percentage of Idaho students who were physically children who are White, active for a total of at least 60 minutes per day on 47.6% non-Hispanic at 12%; five or more of the past seven days the rate among Hispanic children is double (24%) that of White children. Percentage of Idaho students who played video or computer games or used a computer (for 35.5% Those who identify as something that was not school work) three or Other, non-Hispanic have more hours per day on an average school day the highest rate of self- reported obesity at 33%.51 DATA SOURCE: Idaho Youth Risk Behavior Survey Results, 2019 NOTE: Overweight is at or above the 85th percentile but below the 95th percentile for Body Mass Index
51 DATA SOURCE: Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, as cited by Trinity Health Data Hub, 2016
United Way of Treasure Valley 2020 Community Assessment Health Health
Physical Activity Physical activity is essential to physical and over the past few years, though it is still below mental well-being and is fundamental to healthy the national average. weight. In 2018, the U.S. Department of Health 62 As shown in Figure 69, less than half (47.6%) and Human Services released its second edition of the Physical Activity Guidelines for Americans, of students participating in the 2019 YRBS which provides science-based guidance to help reported being physically active for at least people ages three years and older improve their 60 minutes per day on five or more days in . More than one-third (35.5%) health through participation in regular physical the past week reported playing video games or using a activity.52 The Guidelines call for youth, ages six computer for something not related to school to 17, to get one hour of moderate to vigorous work for three or more hours a day on an physical activity each day. Adults should get two average school day. According to recent studies, and a half to five hours per week of moderate- children who participate in two hours or more of Community intensity exercise, or 75 minutes to two and a screen time daily are at a higher risk for obesity.53 Feedback half hours per week of vigorous-intensity aerobic on Physical physical activity. These levels of physical activity Activity: Physical activity opportunities across the region “Outdoor are associated with improved weight status, vary widely. Within the Treasure Valley area, the recreation cognition, and bone health. percent of the population living within half a mile is very of a park ranges from 5.8% in Gem County to While data on physical activity among adults accessible, 35.2% in Ada County. In Idaho overall, 28.4% of across the Treasure Valley are not available, in and it doesn’t the population lives within 0.5 miles of a park, cost much Boise City it appears that the percentage of lower than the national rate of 38%.54 to access.” adults engaging in physical activity has increased – Community Member “The parks are Figure 69 Percentage of Adults with No Leisure Time Activity scary looking.” During the Past Month – Rural Community Member 28.8% 24%
18.3%
Southwest Central District Idaho District Health Health (District 3) (District 4)
DATA SOURCE: Get Healthy Idaho Report, 2019
52 HHS Office, & Council on Sports. (2019, February 01). Physical Activity Guidelines for Americans. Retrieved May 26, 2020, from https://www.hhs.gov/fitness/ be-active/physical-activity-guidelines-for-americans/index.html 53 DATA SOURCE: Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, as cited by Trinity Health Data Hub, 2016 53 Fang, K., Mu, M., Liu, K., & He, Y. (2019, September). Screen time and childhood overweight/obesity: A systematic review and meta-analysis. Retrieved May 26, 2020, from https://www.ncbi.nlm.nih.gov/pubmed/31270831 54 U.S. Census Bureau, Decennial Census. ESRI Map Gallery, as cited by Trinity Data Hub, 2013.
Health United Way of Treasure Valley 2020 Community Assessment Health 63
Some assessment participants described the on the number of pedestrians and cyclists in opportunities for exercise as inadequate in the specific areas of the Treasure Valley in 2019. In Treasure Valley. They explained that there are Boise (recorded at Anne Frank Memorial), the too few gyms and sidewalks, too few parks that daily average number of pedestrians was 643 Community Feedback are safe and inviting, and the reliance on cars and the daily number of cyclists was 857. In on Physical diminishes the amount of exercise residents get. Caldwell (recorded at Indian Creek), the daily Activity: average number of pedestrians was 594 and “It is a ‘vehicle- Active Transportation the daily number of cyclists was 19; in Nampa centric’ Modes of active transportation, such as (recorded at Wilson Pathway), the daily number community. walking and bicycling, offer many benefits, of pedestrians and cyclists were 213 and 39, We are trying 55 to make it including physical activity. To promote respectively. more walkable active transportation, safe, well-maintained, Active transportation to and from school and bikeable, connected travel routes are needed throughout but the can benefit students while also reducing communities. Such paths and trails are not only community congestion and auto emissions in and around useful for recreation, but they provide access to has a mindset school facilities.56 Nationally, rates of active that you critical resources and services in communities. transportation declined substantially over must drive.” – Community Permanently-installed bicycle and pedestrian the past 50 years. Healthy People 2020 offers Member counter stations have been distributed by two goals aimed at reversing this trend: (1) Community Planning Association of Southwest to increase the proportion of walking trips to Idaho (COMPASS) throughout the Treasure school of less than one mile and (2) to increase Valley to measure the number of bicyclists the proportion of bicycling trips to school of less and pedestrians 24 hours per day, every day than two miles.57 of the year. COMPASS has recorded data
55 Pucher, J., R. Buehler, D. R. Bassett and A. L. Dannenberg (2010). “Walking and cycling to health: a comparative analysis of city, state, and international data.” Am J Public Health 100(10): 1986-1992. 56 Larouche, R., Mammen, G., Rowe, D.A. et al. Effectiveness of active school transport interventions: a systematic review and update. BMC Public Health 18, 206 (2018). https://doi.org/10.1186/s12889-017-5005-1 57 United States Department of Health and Human Services, Office of Disease Prevention and Health Promotion. Healthy People 2020 Topics & Objectives. https:// www.healthypeople.gov/2020/topics-objectives/topic/physical-activity/objectives
United Way of Treasure Valley 2020 Community Assessment Health Health
Nutrition A nutritious diet is essential to prevent heart In Boise City, MSA (Ada, Boise, Canyon, Gem, disease, cancer, and obesity, the most common and Owyhee Counties), and nationally, adults 64 causes of death. Diets high in sugar, fat, and consumed more fruits and vegetables between sodium and low in fruits, vegetables, and whole 2015 and 2017 (Figure 70 and Figure 71). grains are commonplace in the U.S. Improving Approximately 15% of adults in Boise City, MSA the dietary habits of children and adults is critical reported consuming vegetables less than one to improving community health.58 time per day in 2017.
Figure 70 Adults Consuming Fruit Less Than One Time per Day
39.9% 39.7% Community 40% 39.2% Feedback on 38.7% 38% 39.4% Nutrition: 36.6% 35.4% “People don’t 35% know how to 33.2% eat healthy besides just 30% plain fruits and 2013 2015 2017 vegetables.” Boise Idaho U.S. – Community Member DATA SOURCE: Centers for Disease Control, Behavioral Risk Factor Surveillance System (BRFSS), 2013-2017 NOTE: Boise City, MSA includes Ada, Boise, Canyon, Gem, and Owyhee Counties “Fresh produce is an issue. It’s expensive and Adults Consuming Vegetables Less Than One Time per Day far.” Figure 71 – Community Member 22.1% “[It is] cheaper 22.9% 20.4% to get 20% 18.9% junk food/ 19.7% 18.1% 18.7% McDonalds 15.9% than healthy 15% foods, [but 14.6% you’re] not functioning 10% when you’re 2013 2015 2017 not able Boise Idaho U.S. to eat as healthy.” DATA SOURCE: Centers for Disease Control, Behavioral Risk Factor Surveillance System (BRFSS), 2013-2017 – Community Member However, in Idaho and in the U.S., fewer access to stores where they are sold were linked than one-fifth of adults report consuming the to poor diets. They also argued that a lack of recommended five or more servings of fruits knowledge about the importance of a healthy and vegetables a day (Figure 130, Appendix). diet puts Treasure Valley residents at risk for diet- related poor health outcomes. Focus group and interview participants believed that the high cost of fresh foods and limited
58 Dietary Guidelines 2015-2020. (n.d.). Nutrition and Health are Closely Related. Retrieved May 26, 2020, from https://health.gov/our-work/food-nutrition/2015-2020- dietary-guidelines/guidelines/introduction/nutrition-and-health-are-closely-related/
Health United Way of Treasure Valley 2020 Community Assessment Health
Hunger and Food Insecurity There are 83,400 residents of the Treasure percentage of food-insecure residents, and the Valley who are not certain where they will get highest percentage of children under 18 facing their next meal.59 These residents experience food insecurity reside in Owyhee County.60 Ada 65 food insecurity, meaning they do not have County has the greatest number of people enough food in their homes due to a lack of (52,080) who are food insecure. resources. Hunger often occurs because of food The Supplemental Nutrition Assistance insecurity, but the two concepts are not the Program, or SNAP, provides a monthly financial same. Hunger is a personal, physical discomfort supplement to eligible families to purchase or illness caused by an involuntary lack of food; nutritious foods. In 2017-2018, in order to be food insecurity is the lack of financial resources eligible for SNAP, a family of four could have to get enough food. In Idaho, food insecurity a gross household income of no more than affects 12.3% of the total population and $2,665 per month.61 Statewide, 10.6% of families 15.8% of those under the age of 18. Within the received SNAP benefits between 2014 and 2018 Treasure Valley, Gem County has the highest as shown below in Figure 72. Percent of Households Receiving SNAP Figure 72
15.6% 15.9% 13.4% 12.2% 12.2% 10.2% 10.6%
7.5%
Treasure Ada Canyon Elmore Gem Owyhee Idaho U.S. Valley County County County County County
DATA SOURCE: Centers for Disease Control and Prevention, National Vital Statistics System, accessed via CDC WONDER, Trinity Health Data Hub, 2014-2018
Figure 73 Percentage of Population Food-Insecure
19.5% 20% 16.6% 15.8% 14.4% 13.4% 13.1% 12.3% 12.3% 12.3% 12% 11.5%
Total Children Total Children Total Children Total Children Total Children Total Children Population 18 & Population 18 & Population 18 & Population 18 & Population 18 & Population 18 & Under Under Under Under Under Under
Ada Canyon Elmore Gem Owyhee Idaho County County County County County DATA SOURCE: U.S. Census Bureau, American Community Survey 5-Year Estimates, as cited by Trinity Health Data Hub, 2014-2018
59 Data SOURCE: U.S. Department of Agriculture, Economic Research Service, USDA – Food Access Research Atlas. 2015, Trinity Health Data Hub 60 DATA SOURCE: University of Wisconsin Population Health Institute, County Health Rankings, Trinity Health Data Hub, 2016 61 2016 – 2017 Food Stamp (SNAP) Income Eligibility Levels, Deductions and Benefit Allotment Payments. (2017, February 02). Retrieved May 26, 2020, from https://www.savingtoinvest.com/food-stamp-snap-income-eligibility-levels-deductions-and-benefit-allotment-payments/
United Way of Treasure Valley 2020 Community Assessment Health Health
School Meals Schools play an important role in the hunger Such programs are often the result of crucial safety net by providing free meals to students partnerships between schools, local agencies, 66 from families with incomes less than 130% of and businesses, and yield important benefits for the Federal Poverty Level (FPL) and reduced- local children and families. priced meals (.30 for breakfast and .40 for Food insecurity affects both adults and children, lunch) to those between 130% and <185% of but it is particularly dangerous for children the FPL. Several schools operate on the USDA’s whose physical, social, emotional, and cognitive “Community Eligibility Program,” which allows development are at risk. School-based food all students in high-poverty schools to eat free programs help students to stay focused and of charge without paperwork to prove their ready to learn. They contribute to important eligibility. Other school-based food programs health and academic outcomes such as obesity include backpack programs, fruit and vegetable prevention, improved attendance, and improved Community programs, and school-based pantry programs. Feedback test scores. on Food Percent of All Students Eligible for Free/Reduced Price Lunch, Insecurity: Figure 74 “Poor nutrition 2016-2017 is related to 66.9% In the Treasure Valley, the food insecurity. 61.6% proportion of students It’s easy to say 54.4% 49.2% ‘eat healthy’ 45.8% who qualified for free but there or reduced-price lunch 33.3% aren’t good exceeded the statewide options, just rate of 45.8% in all but high calorie, one county in the 2016-17 low nutrition foods. Our school year (Figure 74). communities Ada Canyon Elmore Gem Owyhee Idaho are eating County County County County County easy foods.” DATA SOURCE: National Center for Education Statistics, Common Core of Data, as cited by – Community Trinity Health Data Hub, 2016-2017: Idaho Department of Education, CNP Lunch Eligibility Reports 2019-2020 Member NOTE: More recent county level data was not available at the time this report was produced “[If health professionals] Percent of Idaho Students Eligible for Free/Reduced Price Lunch began asking Figure 75 the two food security The percent of screening Idaho students who 49.1% 49.3% 48.8% 48.7% questions, that 47% qualify for free or 45.3% could ensure 42.9% folks have reduced-price lunch access to the has remained fairly food that they consistent since need, which 2013, although can lower healthcare cost there were slight and problems decreases in 2018 down the and 2019 (Figure 75). 2013-14 2014-15 2015-16 2016-17 2017-18 2018-19 2019-20 road.” DATA SOURCE: Idaho Department of Education, CNP Lunch Eligibility Reports 2018-2019 – Nonprofit NOTE: Community Eligibility Provision (CEP) allows schools and local educational agencies (LEAs) to provide Professional free breakfast and lunch to students in high-poverty areas. CEP determines eligibility from programs such as the Supplemental Nutrition Assistance Program (SNAP) and the Temporary Assistance for Families in Idaho (TAFI) instead of relying on the collection of household applications.
Health United Way of Treasure Valley 2020 Community Assessment Health
Food Deserts Several areas in the Treasure Valley are food desert considers distance to stores and classified as “food deserts,” which are areas whether people need vehicles to reach those with limited access to places where individuals stores rather than being able to walk, ride a 67 and families can purchase foods (Figure 76). bike, or use public transportation. The map Food deserts, which typically occur in lower- below depicts food deserts in a census tract that income neighborhoods, might offer fast food includes Owyhee, Ada, Canyon, and Elmore establishments or convenience stores rather Counties; it also shows that most of Owyhee than grocery stores or farm stands with fresh County is classified as a food desert. fruits and vegetables. The classification of a
Figure 76 Food Desert
Focus group and interview participants Community Feedback frequently talked about food security issues. on Food They described “food deserts” and explained Insecurity: that transportation barriers complicate access “For individuals to grocery stores or other places that sell food. who are They reported that in many communities, struggling to there is no grocery store, which requires many put food on the table, they residents to travel to do their food shopping. are making Further, because of the high cost of living, choices all the participants shared that residents are often time in regard forced to choose between food and other to cheap food. Maybe [they . DATA SOURCE: U.S. Department of Agriculture, Economic Research Service, basic needs are choosing] USDA – Food Access Research Atlas. 2015. food that isn’t the most Access to fast food in the Treasure Valley varies As illustrated in Figure 77, the proportion of fast nutritious for by county. Ada County has the most fast food food restaurants per 100,000 population has them, but establishments (81.6 per 100,000 population) slightly increased from 2010 to 2016 within the it is filling. Some of their and Owyhee County has the fewest (44.4 per Treasure Valley, Idaho, and nationwide. Treasure food choices 100,000) (Figure 131, Appendix). Valley had 65.7 fast food restaurants per 100,000 could be population in 2010 and 77.9 per 100,000 in 2017. contributing to their health Figure 77 Rate of Fast Food Restaurants per issues.” 100,000 Population – Nonprofit Professional
81.3 “In a recent 80 survey that 77.9 73.7 Boise State 70.5 73 70 University 69.1 65.7 (BSU) did, 63.9 72.8 36% of their 60 students are showing signs of food 2010 2011 2012 2013 2014 2015 2016 2017 insecurity.” Treasure Valley Idaho U.S. – Nonprofit Professional DATA SOURCE: U.S. Census Bureau, County Business Patterns, additional data analysis by CARES, as cited by Trinity Health Data Hub, 2017
United Way of Treasure Valley 2020 Community Assessment Health Health Safety Injuries and violence are widespread in society. trick or force victims into providing commercial Unintentional injuries and those caused by sex, or manipulate or force victims into working 68 acts of violence are among the top causes in illegal or inhumane conditions. Human of mortality across all ages. Beyond their trafficking remains a highly under-reported immediate health consequences, injuries and crime.68 In 2017, the National Human Trafficking violence have a significant impact on the well- hotline received 14 reported cases of human being of individuals, families, and communities trafficking from Idaho. In 2018 that number by contributing to premature death, reduced nearly doubled to 26 cases.69 quality of life, mental illness, high health care Human error, fatigue, operator health, and risky costs, and lost productivity.63 Rates of violent behaviors are safety challenges in every form of crime, including murder, rape, robbery, and transportation.70 The most recent Idaho Youth aggravated assault, have remained relatively Risk Behavior Factor Survey showed that Community .64 Overall, survey almost Feedback on consistent since 2016 respondents and focus group participants half of students in Idaho reported texting or Safety: emailing while driving during the past 30 “[My reported that they feel safe in their communities. days, which is more than the national average. community is] While most residents feel safe in their In the 2020 legislative session, Idaho passed a friendly, the best place I community, reported cases of domestic violence “Hands-Free Law” that will prohibit the use of an ever dreamed are increasing, and some residents are not electronic mobile device while driving.71 to live in.” able to feel safe in their own homes. Domestic – Refugee and violence is the use of abusive behavior by a Students Reporting Safety Issues Community Figure 78 Member partner in any intimate relationship to gain or keep control over another partner. This type 48.1% “[Our biggest of violence can be physical, sexual, emotional, challenge is] 65 culture: belief economic, or psychological. There were 39.2% that it doesn’t 5,774 reported incidents of violence between happen spouses, ex-spouses, and those in dating here, from relationships in 2017. Seventeen Idahoans died community because of domestic violence incidents; the members, number of domestic violence related fatalities 16.5% state systems, 13.1% and legislators. has increased yearly since 2014. A rape occurs There’s not approximately every 15.4 hours in the state enough data Idaho U.S. 2017 Idaho U.S. 2017 of Idaho.67 2019 2019 currently to prove that Rode in a vehicle in the last 30 Texted or emailed while Human trafficking is a form of modern slavery, days driven by someone who driving in the last 30 days this [human and it is a problem in every state. Human had been drinking alcohol trafficking] happens in trafficking is a business of profiting from stealing DATA SOURCE: Idaho Youth Risk Behavior Survey Results, 2019 Idaho.” someone else’s freedom. Human traffickers – Nonprofit 63 Florence C, Simon T, Haegerich T, Luo F, & Zhou C. (2015). Estimated lifetime medical and work-loss costs of fatal injuries-United States, 2013. MMWR: Morbidity Professional and mortality weekly report, 64(38), 1074-1077. 64 America’s Health Rankings, United Health Foundation. (2020). Violent Crime. Retrieved May 26, 2020, from https://www.americashealthrankings.org/explore/ annual/measure/Crime/state/ID 65 Idaho Coalition Against Sexual & Domestic Violence. (2018). Idaho Domestic Violence Fact Sheet. Retrieved May 26, 2020, from https://idvsa.org/wp-content/ uploads/2018/10/2018-Idaho-DV-Factsheet.pdf 66 Women’s & Children’s Alliance. (2020). Statistics. Retrieved May 26, 2020, from http://www.wcaboise.org/about-us/statistics/ 67 Women’s & Children’s Alliance. (2020). Statistics. Retrieved May 26, 2020, from http://www.wcaboise.org/about-us/statistics/ 68 National Human Trafficking Hotline. (2019). Idaho. Retrieved May 26, 2020, from https://humantraffickinghotline.org/state/idaho 69 National Human Trafficking Hotline. (2019). Idaho. Retrieved May 26, 2020, from https://humantraffickinghotline.org/state/idaho 70 U.S. Department of Transportation. (2019). Safety and Health. Retrieved May 26, 2020, from https://www.transportation.gov/policy/transportation-policy/safety 71 Idaho Press. (2020, March 19). Senate passes statewide hands-free law for drivers on cell phones, sends to governor. Retrieved May 26, 2020, from https://www.idahopress.com/eyeonboise/senate-passes-statewide-hands-free-law-for-drivers-on-cell/article_bd695051-29c1-5ba6-8a8b-8fc9ac70e2fc.html
Health United Way of Treasure Valley 2020 Community Assessment Health
The age-adjusted72 motor vehicle accident Focus group participants explained that mortality rate, is consistently higher in Idaho increased growth in the Treasure Valley has compared to the United States overall (Figure resulted in traffic, described as being a safety 69 79). While rates in the U.S. and in Idaho declined risk. As one community member summarized, between 2004 and 2011, both rates increased “Lots of accidents occur due to traffic.” again between 2014 and 2016.
Figure 79 Age-Adjusted Motor Vehicle Accident Mortality Per 100,000 Population
17.1% Community Feedback on 15% 16.2% Safety:
10.9% “[Our biggest challenge 10% 10.3% 12.2% is] some 6.5% pockets of our community 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 who discriminate. Boise is still Idaho U.S. small, which is good and bad; DATA SOURCE: http://gethealthy.dhw.idaho.gov/index.php/home/get_dashboard/14#25 sometimes it makes it so people don’t seek [domestic abuse] services.” – Nonprofit Professional “[My] children like it, more peaceful and tranquil than where we came from.” – Refugee and Community Member
72 Age-adjusting rates is a way to make fairer comparisons between groups with different age distributions. For example, a county having a higher percentage of elderly people may have a higher rate of death or hospitalization than a county with a younger population, merely because the elderly are more likely to die or be hospitalized. (The same distortion can happen when comparing races, genders, or time periods.) Age adjustment can make the different groups more comparable.
United Way of Treasure Valley 2020 Community Assessment Health Health Policy, Systems, and Environmental Change Recommendations: Policy, Systems, and Environmental change domestic and sexual abuse approaches seek to go beyond programming and victims of human 70 and into the systems that create the structures in trafficking. which we work, live, and play. These approaches • Increase the implementation and provision of often work hand-in-hand where, for example, trauma-informed services and practices. and environmental change may be furthered by • Increase the provision of supportive and wrap- a policy of systems change. Similarly, a policy around services to residents of affordable could be put in place that results in additional housing developments. environmental changes. The process is not linear. At the end of the day, an effective PSE • Increase walkability/bikeability of local approach should seek to reach populations communities through city policies and street and uncover strategies for impact that are design guideline changes. sustainable. Efforts may accelerate the adoption or implementation of effective interventions by Health Care Access effectively integrating approaches into existing • Implement coordinated care among providers infrastructures. Such approaches often include and systems. advocates, and decision and policy makers.73 • Increase provision and utilization of health services through Telehealth systems. General Health and Well-Being • Increase availability of health care workforce • Provide the co-location of services to increase development programs that decrease accessibility of existing resources, such as the provider shortages such as Family Medicine Community School Strategy utilized by United Residency of Idaho’s Teaching Health Centers Way of Treasure Valley and at 30 schools in and Residency Programs, and recruiting southern Idaho. mid-level providers (e.g., physician assistants, • Provide integrated services where possible, nurse practitioners) to supplement care teams. such as behavioral health or dental health • Expand the use of multi-sector health integrated into medical practices, etc. collaboratives that advance population level • Support ongoing funding of Medicaid health outcomes such as the Western Idaho expansion, and explore waivers to provide Community Health Collaborative. reimbursement for high-need medical and • Increase the number of Community Health behavioral health services. Workers, Navigators, Peer Support Specialists, • Increase number of innovative programs and Community School Coordinators to that encourage healthy food consumption, connect individuals and families with existing such as the Terry Reilly Fruit and Vegetable community resources. Prescription Program which provides prescriptions for fruits and vegetables, and Behavioral Health Idaho Foodbank’s Cooking Matters, which • Increase access to Social Emotional Learning teaches food budgeting and preparation skills in school systems, which has proven to to help participants make positive changes in reduce learning barriers by enhancing school eating habits. attachment, reducing risky behaviors and • Increase availability of programs that provide promoting positive development, and thereby mental health treatment for victims of positively influencing academic achievement.
73 The Food Trust. (2012). What Is Policy, Systems, and Environmental (PSE) Change? Retrieved May 26, 2020, from http://healthtrust.org/wp-content/ uploads/2013/11/2012-12-28-Policy_Systems_and_Environmental_Change.pdf
Health United Way of Treasure Valley 2020 Community Assessment Health
• Establish more community-based coalitions Nutrition and work groups to address ACEs, such as • Provide affordable fresh fruit and vegetable 2C Kids Succeed in Canyon County. options at convenience stores and other • Increase access to school-based mental neighborhood retail outlets. 71 health services through innovative strategies • Attract and develop grocery stores and such as private mental health providers co- supermarkets in food deserts. locating at schools to provide individualized • Improve transportation access to grocery mental/behavioral health services. stores through innovative programs like the • Incentivize behavioral health providers to North Nampa Grocery Shuttle. practice in rural communities, or to work • Continue to support implementation of specifically with youth and adolescents. nutrition standards for meals and Smart • Increase the utilization of Telehealth systems Snacks, which make the healthy choice the for behavioral health and substance use easy choice for students. treatment providers. • Promote the development of Community • Implement city and statewide policies to limit Gardens. e-cigarette and vape access to youth. • Increase Supplemental Nutrition Assistance • Evaluate the opportunities to implement Program (SNAP) participation and promote flavor bans for e-cigarettes and vapes at the acceptance of SNAP at more local farmers city and state level. markets. • Implement e-cigarette and vape cessation programs specific to students who want or need to quit. • Increase the state tobacco sales tax.
United Way of Treasure Valley 2020 Community Assessment Health Education 72 Education
Education is an important issue facing Idahoans educational opportunities from early childhood and is a significant Social Influencer of Health. through postsecondary levels. There is a Yet Idaho’s average spending per pupil was the correlation between education and economic Community second lowest nationwide in 2017.74 Repeatedly status, and education is a foundational Feedback on mentioned by assessment participants was socioeconomic driver for the health and well- Education: “Child care the need for access to affordable, quality being of individuals, families, and communities. is really expensive. Sometimes, if you want Early Childhood Education and School Readiness both parents to work, one On average, the number of days between birth families (65%). In Idaho overall, 63% of mothers salary just goes and the first day of kindergarten for Treasure of young children participate in the workforce. to child care. Valley children is 1,825. Early childhood, during Many parents are struggling to find affordable It’s difficult these first five years of life, impacts long-term high-quality child care.77 and sad. If social, cognitive, emotional, physical, and you don’t Among the survey respondents, 39.4% indicated financial development.75, 76 Healthy development have support that affordable child care was a top concern for or money to in early childhood helps prepare children for members of their community. Focus group and pay for it, it’s kindergarten and beyond. difficult.” interview participants also described the lack – Community Idaho has a lack of affordable, high-quality of child care as a major issue in the Treasure Member early education and child care options. Child Valley. In some areas, they explained, there are a “It’s important care deserts are defined as any census tract limited number of child care providers, and child to focus on with more than 50 children under age five that care is often not offered at times convenient the early years. contains either no child care providers, or so for those with nontraditional work hours. Often, Having strong programs is few options that there are more than three they added, available child care is unaffordable, important times as many children as licensed child care forcing parents to choose between work and because the slots. In Idaho, 49% of people live in a child care child care. They explained that parents often first five years desert. Child care availability is especially low have to work multiple jobs or make the choice to are the most for Hispanic or Latino families (56%) and rural not work because of the cost of child care. important in a child’s education.” – Early Education Professional
74 Richert, K. Census Report: Idaho Ranks Next to Last in Per-Pupil Spending. Retrieved May 27, 2020, from https://www.idahoednews.org/kevins-blog/census-report- idaho-ranks-next-to-last-in-per-pupil-spending/ 75 Karoly LA, Kilburn MR, Cannon JS. Early childhood interventions: proven results, future promise. Santa Monica (CA); Rand Corporation; 2005. 76 Anderson LM, Shinn C, Fullilove MT, Scrimshaw SC, Fielding JE, Normand J; Task Force on Community Preventive Services. The effectiveness of early childhood development programs: a systematic review. Am J Prev Med. 2003;24(3):32-46. 77 DATA SOURCE: Center for American Progress, Child care Deserts, 2017
Education United Way of Treasure Valley 2020 Community Assessment Education
The percent of income spent Figure 80 Percent of Income Spent on Child Care on child care varies based on the type of family structure; single parents in Idaho with Center- two children spend over 60% of 11.8% Based Care 73 Infant Child Care – their income on child care each Married Couple In-Home 10.1% Care month (Figure 80). Family
The annual price of having an Two Children – 22.4% infant in center-based care in Married Couple 19.8% Idaho is $8,600 in a child care Family center, and about $7,400 for 36.8% in-home care. These costs are Infant Child Care – comparable to the average Single Parent 31.5% Community $7,590 annual tuition of a four- Feedback on 78 Two Children – year public university in Idaho. 69.5% Education: A recent study conducted by Single Parent 61.5% “Child care is the U.S. Chamber of Commerce expensive, and found that Idaho’s economy Married Family with families need 64.9% two incomes annually loses an estimated Two Children at the to pay for Poverty Line 57.5% $479 million due to child housing and care issues, including lost tax transportation, revenue, employee absences, let alone child care.” and employee turnover due to DATA SOURCE: Child Care Aware of America, 2019 unstable child care.79 – Community Member Early Childhood Enrollment Population Aged 3-4 years “Employees Figure 81 in businesses struggle to Given the lack of programs find child care. 47.9% 46% and the high cost of child [They are] care, the percentage of calling in and missing days 37.6% three- and four-year-old 33.7% 35% 34% of work due children enrolled in early to lack of child childhood programs is care.” 24.8% lower in the Treasure Valley – Nonprofit compared to the U.S. overall. Professional
Ada Canyon Elmore Gem Owyhee Idaho U.S. County County County County County
DATA SOURCE: U.S. Census Bureau, American Community Survey 5-Year Estimates, as cited by Trinity Health Data Hub, 2014-2018
78 Child Care Aware America. Price of Child Care in Idaho. https://info.childcareaware.org/hubfs/2019%20Price%20of%20Care%20State%20Sheets/Idaho.pdf?utm_ campaign=2019%20Cost%20of%20Care&utm_source=2019%20COC%20-%20ID 79 Burt, A. (2020, March 01). Idaho loses millions in potential revenue due to inadequate child care, study finds. Retrieved May 27, 2020, from https://idahoaeyc. org/news/2020/3/1/idaho-loses-millions-in-potential-revenue-due-to-inadequate-child-care-study-finds
United Way of Treasure Valley 2020 Community Assessment Education Education
Head Start programs are Head Start Programs, Rate per 10,000 Children Figure 82 federally funded programs for children ages birth to five from low-income families that 16 74 support the development of the whole child and promote school readiness.80 Owyhee 11.3 and Elmore Counties have the 9 highest percentage of Head Start programs in the Treasure Valley region (Figure 82). While 6.7 the Head Start program is 5.3 valuable to low-income families,
Community a large number of families who 1.8 Feedback on struggle financially are ineligible Education: for this program due to income “Kids need a requirements. Yet, these families good start so Ada Canyon Elmore Gem Owyhee Idaho still struggle to find affordable, County County County County County that they don’t high-quality early education get behind. DATA SOURCE: U.S. Department of Health & Human Services, Administration for Students won’t options. Children and Families, as cited by Trinity Health Data Hub, 2019 ever get ahead if they start behind.” Investment in Early Childhood Development Idaho is one of four – Early Figure 83 Education states where three- and Professional four-year-old children EARLY CHILDHOOD DEVELOPMENT IS A do not have access to “Head Start 81 is really state-funded preschool. helpful for the SMART INVESTMENT Participants identified lack students AND Prenatal programs of preschool access as the families.” having a negative impact – Preschool on school readiness. Parent and Programs targeted toward the earliest years Community Only 57% of Idaho Member Preschool programs kindergarteners entered school with grade level “[Our most Schooling 82 pressing reading skills in 2019. A 2017 study conducted by concerns Job training are] early the Idaho Association for education. the Education of Young Rate of Return to Investment in Human Capital Getting kids Children found that 76% from birth 0 to age five a Prenatal 0-3 4-5 School Post-School of Idaho voters support solid start in state investments in education.” IMAGE SOURCE: James Heckman, Nobel Laureate in Economics preschool.83 – Nonprofit Professional 80 U.S. Department of Health & Human Services, Administration for Children and Families, as cited by Trinity Health Data Hub, 2018 81 Richert, K. As 1 of only 4 states that doesn’t fund preschool, Idaho misses out on federal grants. Retrieved May 27, 2020, from https://www.idahostatesman.com/ news/local/education/article226491965.html 82 Corbin, C., & Education Budget. (2019, November 06). Despite data showing otherwise, legislator says all students are ready for kindergarten. Retrieved May 27, 2020, from https://www.idahoednews.org/news/despite-data-showing-otherwise-legislator-says-all-students-are-ready-for-kindergarten/ 83 Burt, A. (2018, January 10). Survey finds strong support for state investment in early childhood education. Retrieved May 27, 2020, from https://idahoaeyc.org/news/2018/1/10/survey-finds-strong-support-for-state-investment-in-early-childhood-education
Education United Way of Treasure Valley 2020 Community Assessment Education 75
Focus group and interview participants K-12 Education described the need for high-quality early Quality kindergarten – 12th grade (K-12) childhood education. They explained that some education is necessary to reinforce early Community of the options available do not provide high- childhood education and continue its positive quality education due to staff turnover and lack Feedback on effects over time. A strong public education Education: of state funding. They explained that due to the system is essential to individual and community “We offer four lack of openings in preschool, many children stability and success.86 The availability of sessions for are not receiving early childhood education equitable and high-quality public education pre-K and in a formal setting. Participants also called they’re already benefits the entire community and has long-term full with a for expanded hours of operation for some 8 impacts on health and financial stability. waiting list. preschool and kindergarten programs. They I get calls all reported that some programs are only half-day, the time for which does not work well for most working pre-K. It’s super parents, and are also less effective in preparing expensive students. Several of the focus group participants and we need more.” who are also parents said they fear that their – K-12 children may fall behind because of the barriers Professional to early childhood education. “[Lack of Child care licensing ensures child care providers affordable preschool] are meeting basic health and safety standards trickles down to protect the well-being of children. In Idaho, to math licensing standards have not been updated proficiency and since 2011, and state standards are now out of reading levels compliance with national child care licensing all the way to SAT/ACT standards. In 2020, legislation that would have scores and brought Idaho up to federal child care standards into workforce for health and safety was denied, and Idaho development.” continues to be out of compliance.85 – Nonprofit Professional
85 Dawson, J. Daycare Licensing Bill Falls in Idaho House Over Concerns About New Regulations. Accessed May 27, 2020, from https://www.boisestatepublicradio. org/post/daycare-licensing-bill-falls-idaho-house-over-concerns-about-new-regulations#stream/0 86 Cotterell, J. (n.d.). Explaining Why Idaho Doesn’t Have Public Preschool. Retrieved May 27, 2020, from https://www.boisestatepublicradio.org/topic/explaining- why-idaho-doesnt-have-public-preschool 87 Corbin, C., & Education Budget. (2019, November 06). Despite data showing otherwise, legislator says all students are ready for kindergarten. Retrieved May 27, 2020, from https://www.idahoednews.org/news/despite-data-showing-otherwise-legislator-says-all-students-are-ready-for-kindergarten/
United Way of Treasure Valley 2020 Community Assessment Education Education
Funding for Education and Education Quality While Idaho’s state budget for public education (Figure 84). However, Idaho ranks 41st nationally has increased since the Great Recession, Idaho for teacher pay.90 Research has found that still ranks 49th in annual per pupil spending better teacher pay leads to better educational 76 91 at $7,486 versus the national average of outcomes. 88 A recent study conducted by the $12,201. Participants explained that the lack of funding Learning Policy Institute discovered a significant for education has led to bigger classroom sizes relationship between student outcomes and and an overall poorer quality of education. state financial inputs in public education.89 They argued that students do not get enough Statewide, the average teacher salaries individualized attention from teachers which increased by 16.9% from the 2014-2015 school they believe was related to lower graduation year to the 2019-2020 school year. Teacher rates and poorer educational attainment overall. salaries also increased over that time period Community in each of the counties in the Treasure Valley Feedback on Education: “My husband Figure 84 Average Teacher Salaries, 2014-2015 and 2019-2020 is a special education teacher, but doesn’t teach because the $46,508 (2014-15) pay is awful.” Ada County – Community $54,842 (2019-20) Member $39,856 (2014-15) “Why would Canyon County I teach kids $49,549 (2019-20) for $9 when I could make $43,672 (2014-15) Elmore County $15 chucking $45,634 (2019-20) packages for Amazon?” $40,378 (2014-15) – Community Gem County Member $46,850 (2019-20)
“Look at $35,892 (2014-15) Ada County Owyhee County schools, they $45,421 (2019-20) are very nice and we can’t $44,205 (2014-15) Idaho get a square $51,691 (2019-20) box that won’t leak. It’s unfair when DATA SOURCE: Idaho State Department of Education, 2020 it is coming from the same source. There’s no equitable funding for education.” 88 Richert, K. Census Report: Idaho Ranks Next to Last in Per-Pupil Spending. Retrieved May 27, 2020, from https://www.idahoednews.org/kevins-blog/census-report- – County idaho-ranks-next-to-last-in-per-pupil-spending/ Official 89 Baker, B. D. (2017). How money matters for schools. Palo Alto, CA: Learning Policy Institute. 90 Richert, K. (2019, May 06). Idaho teacher salaries nudge upward in new national rankings. Retrieved May 27, 2020, from https://www.idahoednews.org/news/idaho- teacher-salaries-nudge-upward-in-national-rankings/ 91 Walker, T. (2014, November 21). International Study Links Higher Teacher Pay and Teacher Quality. Retrieved May 27, 2020, from http://neatoday.org/2012/01/04/ international-study-links-higher-teacher-pay-and-teacher-quality/
Education United Way of Treasure Valley 2020 Community Assessment Education
Statewide, more schools are shifting to a status, and many other factors that can make four-day school week, specifically in rural it difficult to succeed academically. Families communities. For Academic Year 2019-2020, 60 in the Treasure Valley are facing significant of Idaho’s school districts and charter schools economic hardship. The percentage of 77 planned to operate on a four-day school week households in the Treasure Valley’s counties with lengthened hours.92 Many districts shifted to living at the Federal Poverty and Asset Limited a four-day school week to save money and help Income Constrained Employed (ALICE) Levels with teacher recruitment.93 While this strategy ranges from 37% in Ada County to 56% in may increase teacher satisfaction and lessen Owyhee County. costs, impact on student outcomes is as yet Idaho’s Public Schools provide free and unknown, and this may have a negative financial reduced-price meals to students from eligible impact on parents who work and have to find low-income families. Statewide, 47% of students additional child care.94 were eligible for free or reduced-price lunch in Community 2016-17. In the Treasure Valley, the proportion Poverty and Education Feedback on of students eligible for free or reduced-price There is a well-known correlation between Education: 95 lunch exceeds the statewide rate in every county “[We have} poverty and educational attainment. Children except for Ada County. Owyhee County and no school on raised in poverty have heightened risk factors, Canyon County have the highest percentages Fridays, so including emotional and social instability, of eligible students at 66.9% and 61.6%, Fridays are a challenge for chronic stressors, unsafe neighborhood respectively. conditions, malnutrition, and poor health child care.” – K-12 Parent Percent of Students Eligible for Free/Reduced and Rural Figure 85 Community Cost Lunch Member “Even though 66.9% the numbers 61.6% are going 54.4% down [the Title 49.2% One numbers 47% are reducing but the divide 33.3% is bigger] so the poor are poorer and the middle is disappearing.” – K-12 Professional
Ada Canyon Elmore Gem Owyhee Idaho County County County County County
DATA SOURCE: U.S. Census Bureau, County Business Patterns, additional data analysis by CARES, as cited by Trinity Health Data Hub, 2017
92 Wood, D. (n.d.). Public School Finance at the Idaho State Department of Education prepares payments for districts and creates school district financial data reports. Retrieved May 27, 2020, from https://www.sde.idaho.gov/finance/ 93 Wallace, A. (2020, April 1). Four-Day School Week Overview. Retrieved May 27, 2020, from https://www.ncsl.org/research/education/school-calendar-four-day- school-week-overview.aspx 94 Hill, P., & Heyward, G. (2017, March 03). A troubling contagion: The rural 4-day school week. Retrieved May 27, 2020, from https://www.brookings.edu/blog/ brown-center-chalkboard/2017/03/03/a-troubling-contagion-the-rural-4-day-school-week/ 95 E. Jensen. Teaching with Poverty in Mind. Alexandria, VA: ASCD. Chapter 2. http://www.ascd.org/publications/books/109074/chapters/How-Poverty-Affects- Behavior-and-Academic-Performance.aspx
United Way of Treasure Valley 2020 Community Assessment Education Education
Percent of Students that are English English language learners (ELLs) are Figure 86 students who are unable to learn Language Learners and/or communicate effectively in 78 English. These students generally 13.7% come from non-English speaking homes and are developing their 10% English language skills. ELL students require specialized instruction in 7% 5.6% English and in other courses. As 4.5% shown in Figure 86, in the Treasure Valley Owyhee County has the highest percentage of public school students who are English language Ada Canyon Elmore Gem Owyhee County County County County County On Chronic learners at 13.7%. Absence: DATA SOURCE: National Center for Education Statistics, School District Profiles, 2018-2019 “While chronic absence presents academic Chronic Absence challenges health issues, food insecurity, and lack of reliable for students Across Idaho, 12.8% of students missed so not in class, much school that they were academically at transportation. If a student is chronically absent when it risk in 2016. This is an increase from 9.9% every year of their schooling, by the time they reaches high in 2014.96 “Chronic absence” is a term used reach 12th grade, they will have missed over a levels in a to describe a student missing 10% or more year of schooling. These students are less likely classroom to read at grade level by third grade, more likely or school, school days due to any absence. Children living all students in poverty are twice as likely to be chronically to fail subjects in sixth grade, and more likely to may suffer absent, often tied to health problems, mental drop out of school in ninth grade.97 because the resulting Weighted Average Percentage of Reading and Math Proficiency classroom Figure 87 churn Kindergarten Students Scoring At or The Idaho Reading Indicator (IRI) is used to hampers Above Grade Level on Idaho Reading determine a student’s reading instructional teachers’ Indicator (IRI) Composite Score needs, including their strengths and needs ability to related to word recognition and word engage all students and 46.9% meaning. Figure 87 shows that less than half meet their 42.3% of beginning kindergarteners in the Treasure learning Valley are scoring at or above their grade needs.” level, though the rate is slightly higher than – Attendance their peers statewide. It is important to note that Works organization students who start behind are more likely to stay behind in their academic career.98 Treasure Idaho Valley
DATA SOURCE: State Department of Education, Idaho Reading Indicator, 2019
96 U.S. Department of Education, U.S. Department of Education – Civil Rights Data Collection. 2015-16 97 The Problem – Attendance Works. (2018). Retrieved May 27, 2020, from https://www.attendanceworks.org/chronic-absence/the-problem/ 98 García, E., & Weiss, E. (2017, September 27). Education inequalities at the school starting gate: Gaps, trends, and strategies to address them. Retrieved May 27, 2020, from https://www.epi.org/publication/education-inequalities-at-the-school-starting-gate/
Education United Way of Treasure Valley 2020 Community Assessment Education
All counties were able to reduce the percentage described as “summer slide,” or the tendency of students scoring below grade level from for students to lose achievement gains they fall to spring within the 2018-19 school year, made during the school year if they don’t have demonstrating the impact schools and teachers access to educational opportunities over the are having on student growth and outcomes. summer months. This trend disproportionately 79 However, between spring 2019 and fall 2019, impacts students from lower-income many students fell behind again. This trend households.99 is similar to national outcomes, and has been
Figure 88 Weighted Average Percentage of Kindergarten Students Scoring At or Above Grade Level on Idaho Reading Indicator (IRI) Composite Score
64.3% 63.1% On Chronic 47.9% Absence: 44.9% 46.9% 42.3% “Chronic absence is one of the earliest indications we have that students are not on course. Treasure Idaho Treasure Idaho Treasure Idaho Valley Valley Valley By tracking the number Fall 2018-19 Spring 2018-19 Fall 2019-20 of absences a
DATA SOURCE: Idaho State Department of Education, Idaho Reading Indicator, Fall 2018-Fall 2019 student has, whether they are excused or unexcused, we Third grade reading Weighted Average Percentage of Third Grade Students Scoring At or Figure 89 can take action scores are an important Above Grade Level on Idaho Reading Indicator (IRI) Composite Score at a point in predictor of educational time when 100 prevention and life success. If a 74.4% 73.2% 68.4% interventions child is not reading well 63.4% 64% 61.2% are most likely by third grade, they are to succeed.” less likely to graduate – Every Student from high school, and Present less likely to enroll organization in college.101 Slightly more third graders in the Treasure Valley read at or above grade level Treasure Idaho Treasure Idaho Treasure Idaho Valley Valley Valley compared to statewide. Fall 2018-19 Spring 2018-19 Fall 2019-20
DATA SOURCE: Idaho State Department of Education, Idaho Reading Indicator, Fall 2018-Fall 2019
99 Colorado Department of Education. (n.d.). Summer Slide and the Importance of Reading over the Summer. Retrieved May 27, 2020, from https://www.cde.state.co.us/cdelib/summerslide 100 Fiester, L., & Smith, R. (2010). Early Warning! Why Reading by the end of Third Grade Matters. Retrieved May 27, 2020, from https://www.ccf.ny.gov/files/9013/8262/2751/AECFReporReadingGrade3.pdf 101 Goerge, R., Lesnick, J., & Smithgall, C. (2010). Third Grade Reading Level Predictive of Later Life Outcomes. Retrieved May 27, 2020, from https://www.chapinhall.org/research/third-grade-reading-level-predictive-of-later-life-outcomes/
United Way of Treasure Valley 2020 Community Assessment Education Education
The Idaho Standards Achievement Test (ISAT) ELA scores are generally trending up over the is the state achievement test for Idaho that past five years. Math scores are also trending determines if a student has achieved grade level up, though math proficiency is lower across the 80 standards. It is administered for reading, English state, especially among Treasure Valley eighth Language Arts (ELA), and mathematics in grades grade students. third through eighth and once in high school.
Figure 90 Weighted Average Percentage of Fourth Graders Scoring Advanced or Proficient in English Language Arts (ELA)
Community 53.5% 52.8% Feedback on Education: 49.8% 48.1% 50% “The top 5% 51.9% 50.5% and bottom 46.6% 49.2% 35% receive 48% 45% attention 46.4% in school. All the kids in between 2014-2015 2015-2016 2016-2017 2017-2018 2018-2019 don’t get the attention they Treasure Valley Idaho need.” – Community DATA SOURCE: Idaho State Department of Education, ISAT Scores, 2014-2019 Member “[We need more] trauma informed Figure 91 Weighted Average Percentage of Fourth Graders Scoring Advanced or Proficient in Math training in schools. Teachers need to know what trauma 50.9% is and how it 48.9% presents in the 50% 47.8% 46.6% classroom.” 45.7% 49.9% 48.2% – K-12 45% 47.1% Professional 46.3% “[Biggest 43.4% challenge is] 2014-2015 2015-2016 2016-2017 2017-2018 2018-2019 engaging our parents that Treasure Valley Idaho maybe didn’t have a good DATA SOURCE: Idaho State Department of Education, ISAT Scores, 2014-2019 relationship with school for whatever reason.” – K-12 Professional
Education United Way of Treasure Valley 2020 Community Assessment Education
Idaho’s 11th graders can take the national be successful in that related college course. Scholastic Aptitude Test (SAT) free of charge, For example a student meeting benchmark and about 95% of students choose to take the standards on the math portion of the SAT has SAT. 102 In 2019, 56% of 11th graders in Idaho a higher likelihood of being successful in a 104 81 met the benchmark of 480 for reading and college math course. SAT scores are also used writing, while 33% met the 530 benchmark by many postsecondary institutions to make for math.103 The SAT benchmark standards admissions decisions. are a predictor of a student’s likelihood to
Figure 92 Weighted Average Percentage of Eighth Graders Scoring Advanced or Proficient in ELA
Community 55.8% 55.5% Feedback on 55% Education: 52.30% “Our teachers 53.7% 53.1% 53.9% 53.5% do so much 50% outreach and
48.2 47.7% go above and 46.3% beyond.” 2014-2015 2015-2016 2016-2017 2017-2018 2018-2019 – Community Member
Treasure Valley Idaho “[At our alternative DATA SOURCE: Idaho State Department of Education, ISAT Scores, 2014-2019 high school] at any one time, a third of the kids are homeless. Figure 93 Weighted Average Percentage of Eighth Graders Scoring Advanced or Proficient in Math At our elementaries, we have high mobility of families due 41.1% 40.6% to housing needs. This 40% 37% 38.5% 38.7% impacts student 37.5% 35% achievement.” 36.1% 35.8% 35% 34.6% – K-12 Professional
2014-2015 2015-2016 2016-2017 2017-2018 2018-2019
Treasure Valley Idaho
DATA SOURCE: Idaho State Department of Education, ISAT Scores, 2014-2019
102 Edge, S. (2019, July 07). Idaho SAT scores continue to drop. Retrieved May 27, 2020, from https://www.idahoednews.org/news/idaho-sat-scores-continue-to-drop/ 103 Idaho Education News, EdTrends (Trends in Idaho Public Education) Report, 2020 104 K–12 Educator Brief The College and Career Readiness Benchmarks for the SAT® Suite of Assessments. (n.d.). Retrieved May 27, 2020, from https://collegereadiness.collegeboard.org/pdf/educator-benchmark-brief.pdf
United Way of Treasure Valley 2020 Community Assessment Education Education
High School Graduation Rates Graduation rates have remained fairly consistent since 2015. Idaho's graduation 82 rate in 2019 was 80.7%. Idaho ranked 43rd in graduation rates nationally in 2019. Graduation rates vary by district within the Treasure Valley (Figure 95).
Figure 94 Graduation Rates
Community Feedback on Graduation: “Some 85% 85.3% 85% 84.1% students are 85% 83.2% earning trade credentials and work 80% 80.6% 80.7% experience 78.9% 79.7% 79.7% while attending 2015 2016 2017 2018 2019 [high] school, this is giving students Idaho U.S. more than a diploma upon Idaho State Department of Education, Graduation Rates, 2014-2019 graduation.” – City Official “Our CTE Graduation Rates, Spring 2018 (Career and Figure 95 Technical Education) programs Percentage of Students Who Started Ninth Grade in Fall 2014 have a wait list. and Graduated in Spring 2018 We need to 83.6% expand these 80.6% Boise 81% Mountain Home 83.1% programs.” Kuna 85.4% Prairie N/A – K-12 West Ada 87.3% Emmett 81% Professional Melba 95.2% Bruneau-Grand View 75% Middleton 84.8% Homedale 98.9% “Anything we Nampa 81.7% Marsing 90.6% can dream, we can become.” Notus 97% Pleasant Valley N/A – Community Parma 94.8% Three Creek N/A Member Vallivue 80.7% Treasure Idaho Wilder 88.9% Valley Glenns Ferry 81.3% DATA SOURCE: Idaho Department of Education, 2018
Education United Way of Treasure Valley 2020 Community Assessment Education 83
Educational Enrichment Community School Strategy Out-of-School Time Programs The Community School Strategy helps children Out-of-school time programs can contribute Community be more successful and families more stable to academic success by providing more Feedback on by bringing the resources they need directly in educational opportunity time, and have been Educational Enrichment: to support the local school, where services are linked to better attendance, better grades, “Drug issues more easily accessed. Increasingly, students better graduation rates, and less substance are occurring are facing barriers outside the classroom that abuse. Over 20,000 Idaho students participate because make it difficult for them to be successful inside in an after-school program, yet for every there are no the classroom. By finding the right partners after-school student enrolled in an after-school program, programs. to collaboratively address these barriers, five more would participate if provided the There is no schools are ensuring children and their families opportunity. A majority of parents say after- money for are supported both inside and outside the school programming helps them keep their jobs, after-school classroom. With services like preschool, after- and over 80% of parents support public funding activities.” school programs, mentorship, flu shots, dental for after-school programming. Out-of-school – Community Member services, community gardens, adult education, time programming offered over the summer and parenting education, the Community months can also help lessen the “summer “We want to School Strategy is redefining local schools to be slide” trend where students lose academic do whatever it takes to help a community hub where the community unites achievement gains over the summer due to a these kids to help children and families succeed.105 The lack of educational opportunities.107 Focus group be successful United Way of Treasure Valley introduced this and interview participants discussed what they adults, keep them off the strategy to Idaho in 2015, and since then, over described as a lack of after-school programs street and 30 schools in southern Idaho have adopted in the Treasure Valley and the accompanying off ‘latch-key’ the Community School Strategy to better consequences. settings.” support students and families. This strategy – Out-of- has been used nationwide for decades. It is School Time a proven evidence-based strategy for school Professional improvement that leads to growth in student “Food pantry and school outcomes.106 and clothes are available. I’ve never seen a school take care of its kids so well.” – K-12 Parent and Rural 105 Coalition for Community Schools. (2020). About Community Schools. Retrieved May 27, 2020, from http://www.communityschools.org/aboutschools/about_ community_schools_.aspx Community 106 Oakes, J., Maier, A., & Daniel, J. (2017). Community Schools: An Evidence-Based Strategy for Member 107 Equitable School Improvement. Boulder, CO: National Education Policy Center. Retrieved May 27, 2020
United Way of Treasure Valley 2020 Community Assessment Education Education
Postsecondary Education Rates of students going on to postsecondary According to a 2018 Treasure Valley Senior Exit education have remained fairly flat since 2016. Survey developed by RISE: Treasure Valley’s 84 In 2018, only 48% of Idaho students started a Education Partnership and given to graduating postsecondary program in the fall immediately high school seniors, 70% of students surveyed after graduation. Economically-disadvantaged planned to complete either a Bachelor’s or students enroll at a much lower rate. Master’s degree in their lifetimes. Currently, only 26.9% of Idahoans aged 25+ hold a Bachelor’s degree or higher.
Idaho Postsecondary Enrollment Rate, Figure 96 Class of 2018
Community 54% Feedback on Education: “Traditional 36% students are struggling with stress and having the coping strategies to deal with Not Economically Economically stressful Disadvantaged Disadvantaged
situations.” DATA SOURCE: Idaho State Board of Education, The Facts – Postsecondary Report 2019 Professional NOTE: includes students who enrolled in fall immediately after graduation
Figure 97 Percentage of Idaho Students Enrolled in Postsecondary Education, by Graduating Class
70%
64% 63% 60% 64%
50% 49% 49% 48% 40%
2014 2015 2016
Enrolled in Fall Immediately After Enrolled within Three Years of High Graduation School Graduation
DATA SOURCE: Idaho State Board of Education, The Facts Report 2019 NOTE: Rates for enrolled within three years of high school graduation are not yet available for classes 2017 and 2018
Education United Way of Treasure Valley 2020 Community Assessment Education
Rising tuition has created a barrier to while students are facing steep increases in postsecondary enrollment for Idaho students, tuition and fees each year.108 As a result of and disproportionately impacts lower-income increasing tuition, postsecondary education students and students of color. Over time, is inaccessible for some students, many are the state’s investment in Idaho’s public four- 85 forced to take on increasing loads of student year postsecondary institutions has declined debt, and degree completion rates are relative to the cost of postsecondary education, impacted.
Annual Tuition and Fees by Institution, Inflation-Adjusted Table 12
1980 1990 2000 2010 2020
Lewis-Clark State College $1,125 $1,993 $3,206 $5,279 $6,982 Community Feedback on Idaho State University $1,398 $2,081 $3,488 $5,706 $7,872 Education: “[The biggest Boise State University $1,262 $2,137 $3,320 $5,587 $8,068 challenge] is culture around education University of Idaho $1,441 $2,104 $3,416 $5,665 $8,304 especially postsecondary State Average $1,306 $2,079 $3,358 $5,559 $7,807 education, [there is a] lack DATA SOURCE: Idaho Center for Fiscal Policy Analysis of Idaho State Board of Education Data of support for postsecondary education.” Funding for Public Four-Year Institutions, Focus group and interview Figure 98 – Nonprofit participants described how the Percentage from Tuition Versus State General Fund Professional costs of postsecondary education “What will threatens undergraduate retention. happen to A representative from an institution those kids who 88.1% FY 2008 of higher education explained that, can’t afford “Student retention suffers as students college?” – K-12 Parent, get closer to graduation. Financial Refugee, and struggles increase.” 50.6% Community 46.5%
72%
FY 1980 FY 2020
Funding from Funding from State General Fund Student Tuition
IMAGE CREDIT\: Image from Idaho State Board of Education, the Facts Report 2019
108 Idaho Center for Fiscal Policy. (2019). The Cost of College in Idaho (Issue brief).
United Way of Treasure Valley 2020 Community Assessment Education Education
Idaho Undergraduate Retention Rates of New Students In the 2018 #RealCollege Figure 99 Survey conducted of Boise State University students, 58% of respondents reported 70% 69% 69% 86 68% experiencing some sort of basic needs insecurity in the 66% past year, including food insecurity, housing insecurity, or homelessness.109 According to the Idaho State Board of Education, “In constant 2019 dollars, tuition and fees for public four-year postsecondary On Basic institutions have increased an Needs average of 47% since fiscal Insecurity in year 2008.”110 FY 2014 FY 2015 FY 2016 FY 2017 FY 2018 Postsecondary
Education: DATA SOURCE: Idaho State Board of Education, Statewide Dashboard, 2018 “[Addressing basic needs insecurities at postsecondary Policy, Systems, and Environmental Change Recommendations: institutions] promotes Policy, Systems, and Environmental change • Develop and promote retention approaches seek to go beyond programming innovative preschool and degree completion, and into the systems that create the structures in funding models such as helping the which we work, live, and play. These approaches the “Preschool the Idaho institution often work hand-in-hand where, for example, Way” Collaboratives, the Caldwell Preschool generate more an environmental change may be furthered by Collaborative (a partnership between Caldwell tuition dollars a policy of systems change. Similarly, a policy Schools/YMCA/United Way of Treasure and improving outcomes could be put in place that results in additional Valley), Boise School District, and Basin School about which environmental changes. The process is not District to help expand access to families. legislators linear. At the end of the day, an effective PSE • Adapt the state’s definition of “school age” care.” approach should seek to reach populations – The Hope from age five to age four. This will allow and uncover strategies for impact that are Center local control and discretion of state funds at sustainable. Efforts may accelerate the adoption the district level to support early childhood or implementation of effective interventions by education. School districts would have effectively integrating approaches into existing flexibility to offer early childhood education infrastructures. Such approaches often include programs, expanding access to families. advocates, and decision and policy makers.111 • Increase availability of programming for Early Childhood Education parents before children enter the public school system to help more children be • Increase state investment in high-quality prepared to enter kindergarten, such as preschool options to expand access for IAEYC’s Ready for Kindergarten program. families.
109 Jones, M. (2019, October 01). Get informed and take action: Addressing food and housing insecurity on campus. Retrieved May 27, 2020, from https://www.boisestate.edu/news/2019/10/01/get-informed-and-take-action-addressing-student-basic-needs-at-boise-state/ 110 Idaho State Board of Education. (2020, January 31). Fact Book – 2019. Retrieved May 27, 2020, from https://boardofed.idaho.gov/resources/fact-book/ 111 The Food Trust. (2012). What Is Policy, Systems, and Environmental (PSE) Change? Retrieved May 26, 2020, from http://healthtrust.org/wp-content/ uploads/2013/11/2012-12-28-Policy_Systems_and_Environmental_Change.pdf
Education United Way of Treasure Valley 2020 Community Assessment Education
• Establish state investment in full-day Opportunities Beyond High School kindergarten programs to provide more • Include in district curriculum education/ educational hours for young learners. career planning to families before eighth • Advocate for policies that support licensing grade through innovative programs like the 87 for child care providers to protect the health Advancement Via Individual Determination and safety of young children. programs in Boise and Vallivue School • Require participation in the IdahoSTARS Districts. professional development, quality rating, • Offer more career internships for high school and improvement system for child care students. providers to increase quality of child care programs. • Increase availability of dual-credit programs, allowing students to earn college credits • Increase the number of businesses offering through their high school coursework. on-site child care and preschool programs Community to increase access. • Increase availability of Career and Technical Feedback on • Provide flexibility in hours of child care to Education (CTE) during high school. Education: match varying work schedules so parents • Continue and increase state funding for the “Community with non-traditional work hours still have Schools are Idaho Opportunity Scholarship which makes working access to child care. postsecondary education more affordable really well, for students in need. having more K-12 Education Community • Increase state funding for school districts. • Increase state funding to Idaho institutions Schools as a of higher education. vehicle to find • Increase state K-3 literacy funding which more partners provides school districts with flexible • Increase programs that offer basic needs [for the support for current postsecondary students. schools] would funding to support strategies to increase be good.” third grade literacy. • Help postsecondary students build – K-12 Professional • Implement the Community School Strategy momentum during their first year by at high-need schools to address family and encouraging them to choose a field of “Community student barriers to success, such as United study, take 30 credits during their first year, Schools and complete gateway Math and English and AVID Way of Treasure Valley and Saint Alphonsus (Advance- Health System’s work at Sacajawea courses. ment Via Elementary in Caldwell; and Boise School Individual District’s Community Schools. Determination) have made an • Include chronic absenteeism as an indicator impact.” of student achievement and develop – Nonprofit Professional strategies for addressing chronic absence. • Increase resources to support Social Emotional Learning in school environments, such as Social-Emotional Learning curriculum and Positive Behavior Interventions, and Supports which can increase educational outcomes and social- emotional competence into adulthood. • Increase availability of after-school and out- of-school time programming.
United Way of Treasure Valley 2020 Community Assessment Education Community Resources Community Strengths and Resources Focus group and interview participants Boise. Some also felt that growth in the region identified a number of strengths associated brings positive influences and thus could be 88 with the Treasure Valley, including the natural considered a strength. However, negative environment, the “tight-knit” nature of the consequences were also associated with growth communities, services available for veterans, (e.g., increased cost of living, overcrowded safety, and ability to raise a family in prosperous schools). Several acknowledged growth as conditions. necessary for the Treasure Valley’s economic well-being. Education in some areas of the Treasure Valley was described as a strength, particularly in
Community Asset List – some identified community assets include, but are not limited to: Community Feedback on • New Path Housing • Terry Reilly Health Services • Ada County Commissioners Community • Allumbaugh House • SANE Solutions • Ada County Emergency Strengths: Medical Services “I’m originally • Ignite 208 (Recovery) • Life Church and strong, from California • Phoenix Multisport supportive faith communities • Treasure Valley School and mainly • Indian Creek Districts moved here • Idaho Foodbank – numerous because of local and school-based food • International Rescue • Boys & Girls Clubs the small pantries Committee • Caldwell Housing Authority community, safety, easier • Jacksons Food Store • Allies Linked For the • Idaho Association for the access to • Elmore County Health Prevention of HIV and AIDS Education of Young Children education and Coalition • Meals on Wheels • Idaho Anti-Human Trafficking sports, and the ability to get • Nampa Impact for Health • Family Medicine Residency Coalition to know your • Caldwell Health Coalition of Idaho • Idaho Business for Education neighbors.” – Community • 2C Kids Succeed Coalition • Veteran Affairs • Jannus Member • Western Idaho Community • Life’s Kitchen • United Way of Treasure “The treasure Health Collaborative • Idaho Department of Labor Valley of the Treasure • St. Luke’s Valley is the • Charitable Assistance to • Department of Child and focus on the Community’s Homeless Family Services • Saint Alphonsus Health outdoors.” (CATCH), Inc. • College of Western Idaho System – Community Member • The City of Mountain Home • Owyhee County Community • West Valley Medical Center • Gem County Community Health Action Team • Boise State University Health Action Team • Senior Centers • Idaho Housing and Finance • Genesis Community Health • Washington County Association • Head Start and Migrant Community Health Action • Jesse Tree of Idaho Head Start Team • State of Idaho District Health • YMCA • Caldwell Police Department Organizations • Salvation Army • Western Idaho Community • Idaho Oral Health Alliance • A Book and A Bite Action Partnership • Valley Regional Transit • Oasis Food Pantry • Weiser Recreational • Women’s and Children’s Department Alliance
Community Resources United Way of Treasure Valley 2020 Community Assessment Community Resources • Wyakin Foundation • AARP Idaho • Federally Qualified Health • Create Common Good • Law Enforcement Centers • Micron • Boise Rescue Mission • American Foundation for Suicide Prevention • Vineyard Church • Interfaith Sanctuary 89 • Idaho Office of Refugees • Urban Renewal • Emmett Valley Meal • Girl Scouts • Southwest District Health Coalition • Idaho Legal Aid • Neighborhood Associations • Agency for New Americans • Idaho Commission on Aging • Miles of Smiles • Idaho Alzheimer’s • Delta Dental Association
Community Feedback on Community Strengths: “Idaho and the Treasure Valley are “veteran- friendly” areas. We have many available resources.” – Veteran Services Professional “We don’t want to be a city, but we do need to grow. We need additional population to afford infrastructure. We need outside investors. We need to change.” – Community Member
United Way of Treasure Valley 2020 Community Assessment Community Resources Appendices
APPENDICES Appendix A. Focus Group Discussion Guide 90 Page 1
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Appendix A. Focus Group Discussion Guide Page 2 91
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Appendix A. Focus Group Discussion Guide 92 Page 3
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Appendix B. Key Informant Interview Discussion Guide Page 1 93
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Appendix B. Key Informant Interview Discussion Guide 94 Page 2
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Appendix B. Key Informant Interview Discussion Guide Page 3 95
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Appendix C. Community Survey Instrument 96 Page 1
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Appendix C. Community Survey Instrument Page 2 97
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Appendix C. Community Survey Instrument 98 Page 3
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Appendix C. Community Survey Instrument Page 4 99
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Appendix C. Community Survey Instrument 100 Page 5
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Appendix C. Community Survey Instrument Page 6 101
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Appendix D. Demographics/Descriptive Data about Community Survey Participants 102 Page 1
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Appendix D. Demographics/Descriptive Data about Community Survey Participants Page 2 103
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Appendix D. Demographics/Descriptive Data about Community Survey Participants 104 Page 3
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Appendix E. Community Survey Respondent Ratings of Their Concern for Specific Community Issues Page 1 105
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Appendix E. Community Survey Respondent Ratings of Their Concern for Specific Community Issues 106 Page 2
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Appendix F. Additional Findings Population Characteristics Population Density Figure 100 107 Population, Density (Persons per Sq. Mile) by County Lower than Idaho State Density
Higher than Idaho State Density
Ada County 424 Canyon County 361.5 Elmore County 8.6 Gem County 30.5 Owyhee County 1.5 Idaho 20.4 U.S. 91.4
DATA SOURCE: U.S. Census Bureau, American Community Survey 5-Year Estimates, as cited by Trinity Health Data Hub, 2014-2018.
Urban Population Figure101 Urban Population, Percent by County Lower than Idaho State %
Higher than Idaho State %
Ada County å94.5% Canyon County 80.1% Elmore County 73.1% Gem County 55.0% Owyhee County 22.7% Idaho 70.6%
DATA SOURCE: U.S. Census Bureau, American Community Survey 5-Year Estimates, as cited by Trinity Health Data Hub, 2013-2017
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Diversity Index Figure 102
108 0.39
.14 .05 .07 .04 .04 .02
Ada Canyon Elmore Gem Owyhee Idaho U.S. County County County County County
DATA SOURCE: University of Missouri, Center for Applied Research and Engagement Systems. U.S. Census Bureau, Decennial Census, as cited by Trinity Health Data Hub, 2010
Figure 103 Median Veteran Income, 2017
Ada County $40,575
Canyon County $31,833
Elmore County $40,386
Gem County $30,777
Owyhee County $25,813
Idaho $35,518
DATA SOURCE: U.S. Census Bureau, American Community Survey 5-Year Estimates, as cited by Trinity Health Data Hub, 2013-2017 Figure 107.
Natural Environment
Average Daily Ambient Particulate Matter 2.5, 2016 Figure104
8.3 7.8 8.2 7.6 7.1 5.5 5.8
Ada Canyon Elmore Gem Owyhee Idaho U.S. County County County County County
DATA SOURCE: Centers for Disease Control and Prevention, National Environmental Public Health Tracking Network, as cited by Trinity Health Data Hub, 2016
Appendices United Way of Treasure Valley 2020 Community Assessment Appendices
Number of Days Exceeding Emission Standards, 2012 Figure105
2.8
2 2 109 1.9 1.4
0.67 0.4
Ada Canyon Elmore Gem Owyhee Idaho U.S. County County County County County
DATA SOURCE: Centers for Disease Control and Prevention, National Environmental Public Health Tracking Network, as cited by Trinity Health Data Hub, 2012
Figure 106 Percentage of Days Particulate Matter 2.5 Exceeding NAAQ Standards, 2009-2016
1
.95%
.24% .11% .02% .23% .03%
2009 2010 2011 2012 2013 2014 2015 2016 Idaho U.S. DATA SOURCE: Centers for Disease Control and Prevention, National Environmental Public Health Tracking Network, as cited by Trinity Health Data Hub, 2012
Built Environment
Percentage of Population Potentially Exposed to Unsafe Figure107 Drinking Water
70.8%
9% 5.6% 0.2% 2% 0.3%
Ada Canyon Elmore Gem Owyhee Idaho County County County County County
DATA SOURCE: Centers for Disease Control and Prevention, National Environmental Public Health Tracking Network, as cited by Trinity Health Data Hub, 2012
United Way of Treasure Valley 2020 Community Assessment Appendices Appendices
Financial Stability Employment and Economic Security
Median Family Income 110 Figure 108
Ada County $80,854
Canyon County $57,022
Elmore County $53,929
Gem County $50,578
Owyhee County $49,872
Idaho $64,723$64,723
U.S. $73,965$73,965
DATA SOURCE: U.S. Census Bureau, American Community Survey 5-Year Estimates, as cited by Trinity Health Data Hub, 2014-2018
Gini Index Value Figure 109
0.48 0.48 0.47 0.45 0.41 0.41 0.42
Ada Canyon Elmore Gem Owyhee Idaho U.S. County County County County County
DATA SOURCE: U.S. Census Bureau, American Community Survey 5-Year Estimates, as cited by Trinity Health Data Hub, 2014-2018
Appendices United Way of Treasure Valley 2020 Community Assessment Appendices
Housing Living in Same House One Year Ago, Percent of Persons Age 1 year+ Figure 110 111 85.5% 85.3% 83.3% 82.6% 81.4% 77.3%
Ada Canyon Elmore Gem Owyhee Idaho County County County County County
DATA SOURCE: U.S. Census Bureau, American Community Survey 5-Year Estimates, as cited by Trinity Health Data Hub, 2014-2018
Transportation Households With No Motor Vehicle Figure 111
8.7%
4.8% 5.1% 4.0% 3.9% 3.8% 3.7%
Ada Canyon Elmore Gem Owyhee Idaho U.S. County County County County County
DATA SOURCE: U.S. Census Bureau, American Community Survey 5-Year Estimates, as cited by Trinity Health Data Hub, 2014-2018
Motor Vehicle Crash Age-Adjusted Mortality Rate per 100,000 Population Figure 112
16.7 14.3 13.8 11.5 8.2 NOTE: Age adjusting rates is a way to make fairer comparisons between groups with different age distributions. For example, a county having a higher Suppressed* Suppressed* percentage of elderly people may have a higher rate of death or hospitalization than a county with a younger population, Ada Canyon Elmore Gem Owyhee Idaho U.S. merely because the elderly are more County County County County County likely to die or be hospitalized. (The same distortion can happen when comparing DATA SOURCE: Centers for Disease Control and Prevention, National Vital Statistics System accessed via CDC races, genders, or time periods.) Age Wonder, as cited by Trinity Data Hub, 2013-17 adjustment can make the different groups more comparable.
United Way of Treasure Valley 2020 Community Assessment Appendices Appendices
Health Life Expectancy, Mortality Rates, and Potential Years of Life Lost
Median Life Expectancy, 2018 112 Figure 113
87.7 81.2 78.5 79.3
Southwest Central District Idaho U.S. District Health Health (District 3) (District 4)
DATA SOURCE: Idaho Vital Statistics, Mortality Report, 2018 NOTE: Southwest District: Adams, Canyon, Gem, Owyhee, Payette, and Washington County; Central District: Ada, Boise, Elmore, and Valley County
Life Expectancy Variance, 2010-2015 Figure 114
19.4
7.6 7.5 5.8 3.7
0.5
Treasure Ada Canyon Elmore Gem Owyhee Valley County County County County County
DATA SOURCE: Centers for Disease Control and Prevention and the National Center for Health Statistics, U.S. Small-Area Life Expectancy Estimates Project. As cited by Trinity Data Hub, 2010-2015 NOTE: More recent data at the county level was not available
Appendices United Way of Treasure Valley 2020 Community Assessment Appendices
Figure 115 Years of Potential Life Lost Rate per 100,000
Treasure Valley 5,574 113
Ada County 5,027
Canyon County 6,169
Elmore County 6,673
Gem County 7,629
Owyhee County 10,432
Idaho 6,947
U.S. 6,273
DATA SOURCE: University of Wisconsin Population Health Institute, County Health Rankings, as cited by Trinity Data Hub, 2015-17
Figure 116 Years of Potential Life Lost (YPLL), 1997-1999 to 2015-2017
8,000 7,705
6,901 7,000 6,829 6,251 6,381 6,000 5,558
1997-1999 2000-2002 2003-2005 2006-2008 2009-2011 2012-2014 2015-2017 Treasure Valley Idaho U.S.
DATA SOURCE: Centers for Disease Control and Prevention, National Vital Statistics System, accessed via CDC WONDER, as cited by Trinity Data Hub, 2013-17
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Figure 117 Premature Mortality Rate per 100,000 Population, by Race/ Ethnicity, Treasure Valley, 2013-2017
114 5,905 4,427
5,507
White, Black, Hispanic or Non-Hispanic Non-Hispanic Latino
DATA SOURCE: Centers for Disease Control and Prevention, National Vital Statistics System, accessed via CDC WONDER, as cited by Trinity Data Hub, 2013-2017
Prenatal Care and Birth Outcomes
Figure 118 Percentage of Low Weight Births
8.2%
7.6% 7.3% 7.2%
Southwest Central District Idaho U.S. District Health Health (District 3) (District 4)
DATA SOURCE: Idaho Vital Statistics, Mortality Report, 2018 NOTE: Southwest District: Adams, Canyon, Gem, Owyhee, Payette, and Washington County; Central District: Ada, Boise, Elmore, and Valley County
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Figure 119 Babies Born with Low Birth Weight 115
10 8% 8.2% 7.6% 7% 7.3% 6.5% 7.2% 5
2014 2015 2016 2017 2018 Southwest District Central District Idaho U.S. Health 3 Health 4 DATA SOURCE: Idaho Vital Statistics, Natality Reports, 2014 – 2018
Figure 120 Infant Mortality Rate per 1,000 Live Births
10 6% 5.8% 5.7% 5.5% 5.2% 5 5.1% 4.7% 3.7%
2014 2015 2016 2017 2018 Southwest District Central District Idaho U.S. Health 3 Health 4 DATA SOURCE: Idaho Vital Statistics, Natality Reports, 2014 – 2018
Health Care
Rate of 30-Day Hospital Readmissions Among Medicare Beneficiaries Figure 121
14.9 12.6 12.3 12.5 10.6
No Data No Data
Ada Canyon Elmore Gem Owyhee Idaho U.S. County County County County County
DATA SOURCE: Dartmouth College Institute for Health Policy & Clinical Practice, Dartmouth Atlas of Health Care, as cited by Trinity Health data hub, 2015
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Figure 122 Preventable Hospital Events, Ambulatory Care Sensitive Condition Discharge Rate, Rate per 1,000 Beneficiaries
55 116 49.4 31.8 30.4 32.3 22.1 24.2
Ada Canyon Elmore Gem Owyhee Idaho U.S. County County County County County
DATA SOURCE: Dartmouth College Institute for Health Policy & Clinical Practice, Dartmouth Atlas of Health Care, as cited by Trinity Health Data Hub, 2015
Figure 123 Ambulatory Care Sensitive Condition Discharge Rate per 1,000 Medicare Part A Beneficiaries
68.2
60
50 49.5 45.4
40
32.3
2009 2010 2011 2012 2013 2014 2015 Idaho U.S.
DATA SOURCE: Dartmouth College Institute for Health Policy & Clinical Practice, Dartmouth Atlas of Health Care, as cited by Trinity Health Data Hub, 2015
Behavioral Health: Mental Health and Substance Use
Percentage of Children Aged 0-17 years who Figure 124 Experienced Two or More Adverse Childhood Experiences (ACEs), 2019
21.10% 20.50%
Idaho U.S.
DATA SOURCE: America’s Health Rankings analysis of U.S. HHS, HRSA, Maternal and Child Health Bureau (MCHB), Child and Adolescent Health Measurement Initiative (CAHMI), National Survey of Children’s Health Indicator Data Set, Data Resource Center for Child and Adolescent Health, United Health Foundation, 2019
Appendices United Way of Treasure Valley 2020 Community Assessment Appendices
Drug Poisoning Crude Mortality Rate per 100,000 Population, 2012-2016 Figure 125
15.6 14.2 13.2 13 117 10.2 7.7
Suppressed*
Ada Canyon Elmore Gem Owyhee Idaho U.S. County County County County County
DATA SOURCE: Centers for Disease Control and Prevention, National Vital Statistics System, accessed via CDC WONDER, as cited by Trinity Data Hub, 2012-2016
Healthy Weight: Physical Activity, Active Transportation, Nutrition, and Food Security
Figure 126 Percent of Adults That are Obese, Treasure Valley
28.5 25%
22.1% 20%
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
Treasure Valley
DATA SOURCE: Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, as cited by Trinity Health Data Hub, 2016
Percent of Population Living within 0.5 Miles of a Park, 2013 Figure 127
38% 35.2% 28.6% 28.4% 21.4% 17.3%
5.8%
Ada Canyon Elmore Gem Owyhee Idaho U.S. County County County County County
DATA SOURCE: U.S. Census Bureau, Decennial Census, ESRI Map Gallery, as cited by Trinity Health Data Hub, 2013
United Way of Treasure Valley 2020 Community Assessment Appendices Appendices
Physical Activity Establishments, Rate per 100,000 Figure 128 Population, 2016 118 17.9 13 10.1
7.4 5.3
No data
Ada Canyon Elmore Gem Owyhee Idaho County County County County County
DATA SOURCE: U.S. Census Bureau, County Business Patterns, additional data analysis by CARES, as cited by Trinity Health Data Hub, 2016
Figure 129 Physical Activity Establishment Rate per 100,000 Population
11.1 10 9.7 10.08 9.6
5
2010 2011 2012 2013 2014 2015 2016 Idaho U.S.
DATA SOURCE: U.S. Census Bureau, County Business Patterns, additional data analysis by CARES, as cited by Trinity Health Data Hub, 2016 NOTE: This U.S. industry comprises establishments primarily engaged in operating overnight recreational camps, such as children’s camps, family vacation camps, hunting and fishing camps, and outdoor adventure retreats that offer trail riding, white-water rafting, hiking, and similar activities. These establishments provide accommodation facilities, such as cabins and fixed campsites, and other amenities, such as food services, recreational facilities and equipment, and organized recreational activities.
Percentage of Adults Consuming Five or More Figure 130 Servings of Fruits & Vegetables a Day, 2017
18.5% 16.8%
Idaho U.S.
DATA SOURCE: Idaho Department of Health and Welfare, Division of Public Health Leading Health Indicators, 2017
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Fast Food Establishments Rate per 100,000 Population, 2016 Figure 131
81.6 69.1 119 57.7 59.8 52.1 44.4
Ada Canyon Elmore Gem Owyhee Idaho County County County County County
DATA SOURCE: U.S. Census Bureau, County Business Patterns, additional data analysis by CARES, as cited by Trinity Health Data Hub, 2016
Chronic Disease
Figure 132 Percent Adults with Diagnosed Diabetes, Treasure Valley
10% 8.2% 8.5% 6.4%
5%
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
Treasure Valley
DATA SOURCE: Center for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, as cited by Trinity Health Data Hub, 2016
Figure 133 Percent of Adults with High Blood Pressure
31.3% 29.5% 30% 29.4% 29.8% 30.1% 28.5% 29.4% 29.6%
25%
2011 2013 2015 2017
Boise Metropolitan Idaho Statistical Area DATA SOURCE: Center for Disease Control and Prevention, Behavioral Risk and Surveillance System Prevalence and Trends Data, 2011-2017 NOTE: Boise Metropolitan Statistical Area includes Ada, Boise, Canyon, Gem, and Owyhee Counties
United Way of Treasure Valley 2020 Community Assessment Appendices Appendices
Figure 134 Age-Adjusted Heart Disease Mortality per 100,000 Population
153.2 120 150 113.7
94.3 122.5 100
95.2 86
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 Idaho U.S. DATA SOURCE: Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System; Accessed via the Health Indicators Warehouse. U.S. Department of Health & Human Services, Health Indicators, as cited by Trinity Health Data Hub, 2004-2016 NOTE: Age-adjusting rates is a way to make fairer comparisons between groups with different age distributions. For example, a county having a higher percentage of elderly people may have a higher rate of death or hospitalization than a county with a younger population, merely because the elderly are more likely to die or be hospitalized. (The same distortion can happen when comparing races, genders, or time periods.) Age adjustment can make the different groups more comparable.
Figure 135 Percent of Adults with High Cholesterol
38.4% 38% 40% 38.5% 38.4% 33% 36.1% 36.3% 30.8% 30% 30.5%
2011 2013 2015 2017 Boise Metropolitan Idaho U.S. Statistical Area DATA SOURCE: Center for Disease Control and Prevention, Behavioral Risk and Surveillance System Prevalence and Trends Data, 2011-2017 Note: Boise Metropolitan Statistical Area includes Ada, Boise, Canyon, Gem, and Owyhee Counties
Figure 136 Cancer Screenings
77.6%
67.5% 62.4% 64.5%
Idaho U.S. 2017 Idaho U.S. 2017 2019 2019
Colorectal Cancer Female (50-75 years) Breast Cancer
DATA SOURCE: Idaho Department of Health and Welfare, Division of Public Health Leading Health Indicators, 2017
Appendices United Way of Treasure Valley 2020 Community Assessment Appendices
Figure 137 Crude Colon and Rectum Cancer Incidence Rate per 100,000 Population, 2012-2016 121 Treasure Valley 35.9
Ada County 33.7
Canyon County 38.8
Elmore County 42.8
Gem County 42.7
Owyhee County 40.3
Idaho 35.5
U.S. 38.7
DATA SOURCE: State Cancer Profiles, as cited by Trinity Health Data Hub, 2012-2016
Figure 138 Age-Adjusted Cancer Mortality Rate per 100,000 Population, 2013-2017
Ada County 150
Canyon County 155.3
Elmore County 187.4
Gem County 184.4
Owyhee County 145.1
Idaho 153.8
U.S. 158.1
DATA SOURCE: Centers for Disease Control and Prevention, National Vital Statistics System, accessed via CDC WONDER, as cited by Trinity Health Data Hub, 2013-2017 NOTE: Age-adjusting rates is a way to make fairer comparisons between groups with different age distributions. For example, a county having a higher percentage of elderly people may have a higher rate of death or hospitalization than a county with a younger population, merely because the elderly are more likely to die or be hospitalized. (The same distortion can happen when comparing races, genders, or time periods.) Age adjustment can make the different groups more comparable.
United Way of Treasure Valley 2020 Community Assessment Appendices Appendices
Figure 139 Age-Adjusted Cancer Mortality Rate per 100,000 Population, by Gender, 2013-2017 122 174.1 Male Ada County 131.4 Female
179 Male Canyon County 136.7 Female
234.3 Male Elmore County 150.5 Female
207.5 Male Gem County 162 Female
163.7 Male Owyhee County 136.9 Female
180 Male Idaho 132.9 Female
188.8 Male U.S. 135.7 Female
DATA SOURCE: Centers for Disease Control and Prevention, National Vital Statistics System, accessed via CDC WONDER, as cited by Trinity Health Data Hub, 2013-2017 NOTE: Age-adjusting rates is a way to make fairer comparisons between groups with different age distributions. For example, a county having a higher percentage of elderly people may have a higher rate of death or hospitalization than a county with a younger population, merely because the elderly are more likely to die or be hospitalized. (The same distortion can happen when comparing races, genders, or time periods.) Age adjustment can make the different groups more comparable.
Figure 140 Cancer Mortality, Age-Adjusted Rate per 100,000 Population
186.8 200
172.8
155.8 169.3 159.9 150 150.9 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 Idaho U.S.
DATA SOURCE: Centers for Disease Control and Prevention, National Vital Statistics System, accessed via CDC WONDER, as cited by Trinity Health Data Hub, 2013-2017 NOTE: Age-adjusting rates is a way to make fairer comparisons between groups with different age distributions. For example, a county having a higher percentage of elderly people may have a higher rate of death or hospitalization than a county with a younger population, merely because the elderly are more likely to die or be hospitalized. (The same distortion can happen when comparing races, genders, or time periods.) Age adjustment can make the different groups more comparable.
Appendices United Way of Treasure Valley 2020 Community Assessment Appendices
Figure 141 Lung Disease Age-Adjusted Mortality Rate per 100,000 Population, by Gender, 2013-2017
50.6% 123 47% 41.9% 43.3%
Male Female Male Female
Treasure Valley Idaho
DATA SOURCE: Centers for Disease Control and Prevention, National Vital Statistics System, accessed via CDC WONDER, as cited by Trinity Health data hub, 2013-2017 NOTE: Age-adjusting rates is a way to make fairer comparisons between groups with different age distributions. For example, a county having a higher percentage of elderly people may have a higher rate of death or hospitalization than a county with a younger population, merely because the elderly are more likely to die or be hospitalized. (The same distortion can happen when comparing races, genders, or time periods.) Age adjustment can make the different groups more comparable.
Figure 142 Lung Disease Age-Adjusted Mortality Rate per 100,000 Population, 2013-2017
65.3
53.7 51.5 43.9 42.9 46.3 41.1 38.6
Treasure Ada Canyon Elmore Gem Owyhee Idaho U.S. Valley County County County County County
DATA SOURCE: Centers for Disease Control and Prevention, National Vital Statistics System, accessed via CDC WONDER, as cited by Trinity Health data hub, 2013-2017 NOTE: Age-adjusting rates is a way to make fairer comparisons between groups with different age distributions. For example, a county having a higher percentage of elderly people may have a higher rate of death or hospitalization than a county with a younger population, merely because the elderly are more likely to die or be hospitalized. (The same distortion can happen when comparing races, genders, or time periods.) Age adjustment can make the different groups more comparable.
United Way of Treasure Valley 2020 Community Assessment Appendices Appendices
Safety
Students Reporting Bullying 124 Figure 143
19% 17% 14.9%
8.3%
Idaho U.S. 2017 Idaho U.S. 2017 2019 2019
Bullied on School Electronically Bullied Property Past Year Past Year
DATA SOURCE: Idaho Youth Risk Behavior Survey Results, 2019
Violent Crime Rate per 100,000 Population, 2019 Figure 144
385.6
263.4 230.6 217.9
181 183.4 183.4
Ada Canyon Elmore Gem Owyhee Idaho U.S. County County County County County
DATA SOURCE: Federal Bureau of Investigation, FBI Uniform Crime Reports. Additional analysis by the National Archive of Criminal Justice Data, Accessed via the Inter-university Consortium for Political and Social Research, as cited by Trinity Health Data Hub, 2019
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Age-Adjusted Mortality Due to Homicide, Rate per 100,000 People, Figure 145 2013-2017
5.7 125
3 2.28 1.9 1.4 No Data No Data No Data
Treasure Ada Canyon Elmore Gem Owyhee Idaho U.S. Valley County County County County County
DATA SOURCE: FCenters for Disease Control and Prevention, National Vital Statistics System, accessed via CDC WONDER, as cited by Trinity Health Data Hub, 2013-2017 NOTE: Age-adjusting rates is a way to make fairer comparisons between groups with different age distributions. For example, a county having a higher percentage of elderly people may have a higher rate of death or hospitalization than a county with a younger population, merely because the elderly are more likely to die or be hospitalized. (The same distortion can happen when comparing races, genders, or time periods.) Age adjustment can make the different groups more comparable.
Figure 146 Age-Adjusted Mortality Rate Due to Homicide, 2013-2017
10
5.9 6.2 5.3
5 2.2 1.5 2
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 Idaho U.S.
DATA SOURCE: Centers for Disease Control and Prevention, National Vital Statistics System, accessed via CDC WONDER, as cited by Trinity Health Data Hub, 2013-2017 NOTE: Age-adjusting rates is a way to make fairer comparisons between groups with different age distributions. For example, a county having a higher percentage of elderly people may have a higher rate of death or hospitalization than a county with a younger population, merely because the elderly are more likely to die or be hospitalized. (The same distortion can happen when comparing races, genders, or time periods.) Age adjustment can make the different groups more comparable.
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Appendix G. Assessments Methods
Treasure Valley Community Assessment Oversight Influencers of Health as well as health behavior UWTV assembled a Community Assessment and outcome data from various sources at 126 Steering Committee in 2019 to provide strategic national, state, regional, county, and local oversight of the Community Assessment levels. These data sources included but were process. This committee was comprised of 25 not limited to the Trinity Health Data Hub, members representing UWTV, Saint Alphonsus U.S. Census, Idaho Department of Health Health System (SAHS), community health and Welfare, and Idaho State Department centers, local public health departments, of Education. Data included self-report of housing and community development demographics, health behaviors, and outcomes organizations, educational institutions, and from large, population-based surveys such as other health and human service organizations. the Behavioral Risk Factor Surveillance System The committee provided guidance on each (BRFSS). For some indicators, the term “report component of the assessment, including location” is used, as autogenerated by the the Community Assessment methodology, Trinity Health Data Hub. “Report Location”, recommendation of secondary data sources, or Treasure Valley, refers to the five counties identification of key informants and focus group included in this assessment – Ada, Canyon, segments, dissemination of the community Elmore, Gem, and Owyhee Counties. The survey, and communication and dissemination Community Assessment Steering Committee throughout the Community Assessment participated in the selection of quantitative data process. The Steering Committee met monthly sources and indicators for the assessment. throughout the assessment process, from August 2019 to April 2020. Focus Groups In October through December 2019, UWTV UWTV, in partnership with SAHS, contracted and local partners conducted 16 focus groups with Health Resources in Action (HRiA) to with 120 individuals from across the assessment assist with the oversight and development of region. Focus groups were conducted with the 2020 Treasure Valley Community Health representatives of priority populations or Needs Assessment. HRiA provided project sectors, including immigrants and refugees, management and consultation, participated seniors, parents, LGBTQIA+, individuals in Steering Committee meetings, developed experiencing homelessness, employers, and the survey and trained partners to administer Community Health Workers. Focus group the survey, developed focus group and discussions explored participants’ perceptions interview questions and processes, facilitated of the community, priority health concerns, several focus groups, conducted data analysis, and suggestions for future programming and drafted the Community Health Needs and services to address these issues. A semi- Assessment report. HRiA also contracted with structured moderator’s guide was used across all SAHS to conduct the 2020 Ontario Community focus groups to ensure consistency in the topics Assessment utilizing the same processes to covered (APPENDIX A). Each focus group was allow for regional data comparison. facilitated by a trained moderator, and detailed In order to better understand the health of notes were taken during each discussion. On Ada, Canyon, Elmore, Gem, and Owyhee average, focus groups lasted 60 minutes and Counties, the following data collection methods included 6-10 participants. were used. Interviews Review of Secondary Data In October through December 2019, UWTV This assessment incorporated data on Social and local partners conducted 26 interviews
Appendices United Way of Treasure Valley 2020 Community Assessment Appendices with 37 community stakeholders to gauge for extracting main themes. While county their perceptions of the community, health differences are noted where appropriate, concerns, and what programming, services, analyses emphasized findings common across or initiatives are most needed to address the region. Selected paraphrased quotes – 127 these concerns. Interviews were conducted in without personal identifying information – are person with individuals representing a range of presented in the narrative of this report to sectors including elected officials, community further illustrate points within topic areas. development, education, housing, regional For the survey data, frequencies and cross- transit, food security, and health care, among tabulations by demographic characteristics were others. A semi-structured interview guide was conducted using SAS statistical software. In most used across all discussions to ensure consistency instances, response options from the survey in the topics covered (APPENDIX B). Each were collapsed for ease of interpretation. interview was facilitated by a trained moderator, and detailed notes were taken during Prioritization of Significant Health Needs conversations. On average, interviews lasted The Community Health Needs Assessment approximately 45 minutes. Steering Committee convened for a two-hour meeting on February 5th, 2020, to review and Community Survey discuss the preliminary results of the Treasure In October through December 2019, a Valley Community Health Needs Assessment community survey was developed and and identify and prioritize significant health distributed in both paper and electronic formats needs identified through the process. across the assessment region to broadly capture Participants received an overview of key themes and quantify the perspective of stakeholders that emerged in the collection of qualitative (Appendices C-E). Surveys were provided in (stories and observations) and quantitative English, Spanish, Arabic, Somali, and Swahili. (numbers) data. Each participant was asked to The survey focused on community members’ rank the significant health needs individually and providers’ perceptions of the community, while considering each theme in terms of top health concerns, and barriers to accessing impact, severity, magnitude, urgency, and the health and social services. The survey was overall concern of residents regarding the developed by HRiA in collaboration with the issue. The group then entered their prioritized Treasure Valley Community Assessment Steering significant health needs into a Menti.com group Committee and used both Likert-type scales poll to tabulate the collective significant health and closed-ended response categories. In total, needs. 2,198 people completed the survey. The top six significant community priorities are Data Analysis presented below in rank order. The secondary data, qualitative data from • Affordable, safe housing and homelessness interviews and focus groups, and survey data • Wages and job availability were synthesized and integrated into this • Cost of living: i.e. housing, transportation, community assessment report by HRIA. The child care, etc. collected qualitative information was coded and then analyzed thematically for main categories • Mental health and well-being and substance and sub-themes using NVivo, Version 12. Data use analysts identified key themes that emerged • Access to affordable health care, including across all discussions as well as the unique behavioral and dental health issues that were noted for specific populations. • Education, including high-quality early Frequency and intensity of discussions on childhood education a specific topic were key indicators used
United Way of Treasure Valley 2020 Community Assessment Appendices Appendices
Limitations accurately but remember incorrectly. In some As with all assessment efforts, there are some surveys, reporting and recall bias may differ information gaps related to the assessment according to a risk factor or health outcome 128 methods that should be acknowledged. First, of interest. Despite these limitations, most of for quantitative (secondary) data sources, most the self-report surveys analyzed in this Treasure data could not be provided at geographic levels Valley Community Health Needs Assessment smaller than county due to the small population benefit from large sample sizes and repeated size in the region. Similarly, there were limited administrations, enabling comparison over time. data available stratified by subgroup (age, Additionally, while the focus groups and race/ethnicity) for the area. It should be noted interviews conducted for this community that while comparisons are made between assessment provide valuable insights, results geographies and demographic groups, these are not statistically representative of a larger do not reflect tests of statistical significance. population due to non-random recruiting Additionally, most secondary data also have a techniques and a small sample size. Recruitment one – to three-year lag due to data collection for focus groups was conducted by community and reporting processes. While the qualitative organizations and participants were those data providing the community voice are current, individuals who were able to connect to these the quantitative data are a few years behind. community organizations. Because of this, it Data based on self-reports should be interpreted is possible that the responses received only with particular caution. In some instances, provide one perspective of the issues discussed. respondents may over – or underreport Lastly, it is important to note that data were behaviors and illnesses based on fear of social collected at one point in time, so findings, stigma or misunderstanding the question being while directional and descriptive, should not be asked. In addition, respondents may be prone to interpreted as definitive. recall bias – that is, they may attempt to answer
Appendices United Way of Treasure Valley 2020 Community Assessment Appendices
Appendix H. Saint Alphonsus Addendum underserved. Now referred to as Saint Alphonsus Saint Alphonsus Regional Medical Center-Boise, Saint Regional Medical Center, our licensed medical- Alphonsus Regional Rehabilitation Hospital, and Saint surgical/acute care 381-bed facility serves as Alphonsus Medical Center-Nampa the center for advanced medicine and is poised 129 to support the community well into the future. As a Catholic health system, Saint Alphonsus Saint Alphonsus also has an intricate system of is committed to advocacy for and service to health and wellness services that extend into the individuals whose social condition puts them at communities around our region. the margins of society. We are called to minister to those less fortunate and to ensure the dignity The Saint Alphonsus Regional Rehabilitation of all people. Hospital (SARRH), an affiliate of Encompass Health, is committed to helping patients regain Our Mission calls us to serve together with independence after a life-changing illness or Trinity Health, in the spirit of the Gospel as injury. SARRH is a 40-bed rehabilitation hospital a compassionate and transforming healing that opened in July 2019 across the street from presence within our communities. The the SARMC campus. It serves the Boise area Community Health Needs Assessments (CHNA) as a leading provider of inpatient rehabilitation allow Saint Alphonsus to be responsible for stroke, spinal cord injury, brain injury, and stewards of our resources and target our efforts other complex neurological and orthopedic and financial investments to where there is conditions. SARRH uses an interdisciplinary team the greatest need and increased potential for approach that includes physical, speech and effectiveness. occupational therapists, rehabilitation physicians, A Community Health Needs Assessment rehabilitation nurses, case managers, dietitians provides the opportunity to: and more, combined with our advanced » Gain insights into the needs and assets of the technology and expertise, to help patients communities served achieve their goals. Patients receive at least three hours of therapy five days per week while » Identify and address the needs of vulnerable under the constant care of registered nurses, populations within the community many of whom specialize in rehabilitation, and » Enhance relationships and opportunities for frequent independent private practice physician collaborative community action visits. » Provide information for community outreach The Saint Alphonsus Medical Center (SAMC-N) planning, evaluation, and assessment in Nampa, located at the corner of I-84 and Boise, Rehab, and Nampa Hospital Overviews Garrity Boulevard, offers state-of-the-art, best- Saint Alphonsus Regional Medical Center in-class health care to residents of Canyon (SARMC) in Boise, Idaho is dedicated to County. This 100-bed hospital that spans more delivering advanced medical services in a than 240,000 square feet, features a complete spiritual, healing environment throughout diagnostic center, six-suite surgical operating southwest Idaho, eastern Oregon and northern theatre, pre/post-operative holding and Nevada. Through innovative technologies, recovery rooms, 10-bed short stay observation compassionate staff, and warm, healing unit, spacious and private patient rooms, environments, Saint Alphonsus strives to provide and an 18-bed intensive care unit. Built with care that is focused on patients. preventive and ambulatory health in mind, the facility accommodates the latest information Founded in 1894 by the Sisters of the Holy technology, updated diagnostic and treatment Cross, SARMC was the first hospital established technology, and an environment proved to in Boise, bringing health care to the poor and reduce patient stress and recovery times.
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In addition to SARMC, SARRH, and SAMC-N, committee, as convened by the United Way the local Saint Alphonsus-owned facilities of Treasure Valley (UWTV), as the primary include Treasure Valley Lab, Saint Alphonsus method of gathering public input on the draft Health Alliance (clinically integrated network), reports between January and April 2017. The 130 and the Saint Alphonsus Medical Group. The community organizations that made up the 2017 Saint Alphonsus Medical Group is comprised of Committee were provided with drafts of the more than 80 clinics across southwestern Idaho assessment report and provided comments back and eastern Oregon, and more than 325 primary to UWTV for inclusion in the final document. care, pediatric, and specialty care physicians Additionally, the SARMC Mission Committee throughout the region that are focused on as well as the SARMC , SARRH, and SAMC-N keeping care close to home. Our Virtual Health Needs Community Hospital Boards Monitoring and Care initiatives use telemedicine were provided with drafts of the Community to reach out to patients who are homebound Assessment and contributed to the 2017 CHNA or in rural areas that lack mobility or access to priorities. health care centers and services. Through audio The 2014 CHNA and 2017 SARMC and SAMC-N and/or visual means, health care providers Community Health Needs Assessments can be are able to remotely assess, monitor, instruct, found online at: https://www.saintalphonsus.org/ educate, and treat patients who typically would about-us/community-benefit/community-needs- not be able to travel to receive services. These assessment/ community-based services, combined with the advanced critical care available at SARMC, The prior CHNA, completed in April 2017, SARRH, and SAMC-N, provide residents identified significant health needs within the with more comprehensive, convenient, and SARMC and SAMC-N community: accessible health and wellness care, and • Health Care Access, Including mental health support our mission to improve the health of our • Lack of health insurance coverage communities. • Lack of medical home Services offered by SARMC, SARRH, and • Lack of stable housing /experiencing SAMC-N include, but are not limited to: brain homelessness injury program, breast care, cardiology and vascular care, cancer care, diabetes care and • Suicides, attempts, and ideation education, emergency and trauma, endoscopy, • Poor mental health days hospitalists, infusion clinic, laboratory, Mako • Violence and bullying Robotic-Arm® Assisted Joint Replacement, • Vulnerable populations: immigrants, seniors, maternity services, neuroscience, nutrition, women, and children orthopedics, pain management, palliative care, pharmacy, physical therapy and rehabilitation, • Transportation barriers pulmonary diagnostics, radiology and medical imaging, research, sleep disorders, spine Nutrition, Physical Activity, and Healthy Weight Status care, stroke center, surgical services, including • Childhood and adult obesity prevalence Treasure Valley Surgery Center, telestroke, • Lack of participation in exercise/physical women’s and children’s services, and wound and activity hyperbaric. • Low daily fruit and vegetable consumption Prior Community Health Needs Assessment – 2017 • Hunger and food insecurity prevalence As with the 2020 Community Health Needs Harmful Substances Assessment, the prior 2017 Community Health Needs Assessment utilized an advisory • Tobacco usage • Vaping, e-cigarette usage, especially in youth
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• Prescription drug abuse and illicit drug use FY17 – 825 people served • Substance use often occurs with mental health FY18 – 3,457 people served needs FY19 – 3,543 people served 131 Oral Health • Safety Net: Supported other safety net • Adults seeing dentist in past year organizations in the community who provide health services, counseling, and oral health • Tobacco and sugary beverages worsen issues services for low-income and individuals The 2017 Community Health Needs Assessment experiencing homelessness. Also piloted was reviewed in detail within the Saint Community Health Workers to do outreach to Alphonsus Health System Community Health vulnerable patients. and Well-Being Department in partnership • Genesis Community Health is a key safety with UWTV and Health Resources in Action in net providing free services; Saint Alphonsus summer and fall 2019, prior to the development has provided $54K between FY17-19, and of the 2020 Community Health Needs also major in-kind support of Genesis Assessment processes and tools. services (Free Lab, Imaging, Other Support): Accomplishments from the 2017 Community Health Total Across Genesis Programs Needs Assessment FY17 – 3,618 Encounters, 900 Served SARMC, SARRH, and SAMC-N acknowledged FY18 – 4,665 encounters, 1,007 served the wide range of priority health issues that (some individuals receive multiple service emerged from the 2017 CHNA process, and types) determined that it could effectively focus on FY19 – 5,392 encounters, 1,148 served only those health needs which it deemed Medical most pressing, under-addressed, and within FY17 – 1,139 Encounters, 474 Served its ability to influence. SARMC and SAMC-N developed and/or supported initiatives to FY18 – 2,003 (this now includes our improve the health needs of health care access, medication assistance program #s as well), nutrition-physical activity-weight status (obesity 582 served prevention), and harmful substance use. FY19 – 2,206 encounters, 544 served
Health Care Access: SARMC and SAMC-N Dental worked to improve access to health care by FY17 – 666 Encounters, 285 Served removing barriers and providing services for the FY18 – 960 encounters, 367 served poor and underserved: FY19 – 763 encounters, 294 served • Advocacy: Participated/facilitated legislative activities between 2017-2019 that led to the Counseling adoption and funding of Medicaid Expansion FY17 – 198 Encounters, 53 Served in 2019. FY18 – 171 encounters, 22 served • Mobile Services: Established the Saint FY19 – 293 encounters, 25 served Alphonsus Mobile Clinic in 2018 to travel to Volunteer Physician Network (VPN) underserved communities in Canyon County to provide free medical, dental, and eye FY17 – 288 Referrals to specialty care, services to participants. Additionally, 30+ 95 Served community partners attend the mobile clinics FY18 – 528 encounters (started tracking to provide their services such as Terry Reilly differently in FY18), 151 served Health Services, Delta Dental, Idaho Dept of FY19 – 610 encounters, 136 served Labor, Idaho Foodbank, etc.
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Community Connectors (Community 2018-2019 school year – 521 students, 70 Health Workers) adults trained, eight students referred FY17 – 3,964 Referrals Total, 1,327 2019-2020 school year – 808 students, 123 132 Encounters, 475 Served adults trained, 13 students referred FY18 – 1,537 Referrals, 1,003 encounters, • Refugees: The Saint Alphonsus Center for 671 served Global Health and Healing, and the specialty FY19 – 2,384 Referrals, 1,520 encounters, CARE (Culturally Appropriate Resources and 694 served Education) Clinic for pregnant refugees/new refugee mothers and infants, provide trauma- • New Path Community Housing provides a informed care for this vulnerable population. site-based permanent supportive housing solution for individuals in the Boise area who • International Clinic (Family Practice): are experiencing homelessness. New Path is a Total visits by year: 40-apartment development providing housing FY17 – 5,447 and on-site services for the individuals and FY18 – 6,318 couples who live there. Since 2018, Saint Alphonsus has provided $100k annually for FY19 – 5,912 Terry Reilly Health Services to provide onsite • CARE Clinic (Maternal/Child Health) # of social services, medical services, and life skills women who went through prenatal care by training to support the individuals in their year: homes. Residents moved in November 2018. FY17 – 85 FY19: 50 individuals housed FY18 – 100 • Mental Health Programs: Supported FY19 – 83 Allumbaugh House, Suicide Hotline, Boise Rescue Mission, State Suicide Prevention • Program for Survivors of Torture: Council, telepsychiatry. Continued suicide FY17 – 54 prevention (SOS) programs in area FY18 – 53 schools. SARMC and SAMC-N continued FY19 – 60 collaborations in a community roundtable on mental health, including advocacy work in • Seniors: New senior services programming supporting and planning local crisis centers. and clinical services; Honoring Choices SARMC staff also serve on the Suicide advanced directive work continued and Prevention Action Network. completed. Hosted /sponsored Caregiver of • Suicide Hotline Calls/Contacts: the Year Awards, Caregiver Conference, JAVA Summit (Justice Alliance for Vulnerable Adults) FY17 – 9,531 inbound calls Health and Aging Expo, Santa For a Senior FY18 – 13,477 inbound calls program, Alzheimer’s Association Reason to FY19 – 13,794 inbound calls Hope Breakfast, Alzheimer’s Association Walk • Allumbaugh House: See below under to End Alzheimer’s, Alzheimer’s Memory Café, Harmful Substance Use along with a variety of smaller events. • SOS School Trainings: Signs of Suicide FY17 – 1311 seniors, family members, and Prevention & Awareness caregivers educated 2017-2018 school year – 744 students, 193 FY18 – 1691 seniors, family members, and adults, and 25 faith community nurses caregivers educated trained, six students referred FY19 – 1743 seniors, family members, and caregivers educated
Appendices United Way of Treasure Valley 2020 Community Assessment Appendices
Nutrition, Physical Activity, and Weight Status protection policy in 2018, passing multiple (Obesity Prevention): SARMC and SAMC-N municipal policies and procedures in the city expanded programs and promoted awareness of Caldwell to improve active transportation of nutrition and exercise opportunities under the complete streets concept, 133 to address health literacy around weight improved walkability and bikeability around management, active living, and healthy choices: Caldwell schools, helped establish a statewide Community School Strategy in more than • Funded GoNoodle to schools across southern 26 schools in nine districts, developed the Idaho and eastern Oregon, an activity Whole Child Initiative within the Caldwell program that promotes physical activity and School District to implement Positive Behavior mindfulness during class instruction time. Intervention and Supports in all 10 schools, School Year 2016-2017 – 21,727 Idaho and supported advocacy for statewide early students reached; 2,839,880 minutes of childhood education such as public Pre-K. student activity time • The Canyon County Grocery Shuttle was School Year 2017-2018 – 22,049 Idaho established to serve residents of a food students reached; 2,953,736 minutes of desert in North Nampa in 2018 whose last student activity time supermarket had shuttered. The shuttle picks School Year 2018-2019 – 23,334 Idaho up participants in residential locations and students reached; 3,628,986 minutes of runs an hourly route to WalMart and WinCo student activity time where participants can shop for groceries and prescriptions. Routes have been expanded to • Sponsored and hosted Meet Me Monday include the Nampa Farmer’s Market, and trips (MMM), an organized walking program to the Traveling Table to pick up food boxes. for individuals and families in Boise and Caldwell. MMM was expanded to four new FY18 – 1,042 riders sites between 2017-2019 until sunsetting the FY19 – 946 riders program and transitioning the materials to • SAMC-N serves as the Meals on Wheel the local communities in September 2019. provider for Nampa City, providing meals to A MMM toolkit was also developed for older adults who are often home bound and communities to establish their own walking cannot otherwise get out to obtain food. program. FY17 – 39,320 meals served FY18 – 1,000 people served FY18 – 33,626 meals served FY19 – 1,000 people served FY19 – 37,200 meals served • Provided education and outreach on healthy habits at community events, such as the Boise • SAMC-N, as a co-lead of the Healthy Impact downtown farmer’s market. Nampa Coalition, has been a partner in the development and implementation of the • Completed 90% of Baby Friendly hospital Traveling Table which started in January designation steps by the end of FY19. 2019. The Traveling Table is a mobile unit Baby-Friendly hospitals are recognized for that travels to a number of stops such as encouraging breastfeeding and mother/baby the Housing Authority and various housing bonding, which is known to provide health developments in Nampa to distribute free benefits for infants, children, and mothers and food boxes to those in need. The Traveling is a known effort for obesity prevention. Table is led by high school students of the • SAHS staff led the Transforming Communities Treasure Valley Learning Academy in Nampa, Initiative (TCI) grant work in partnership with with assistance from community volunteers. UWTV across Ada and Canyon Counties. This SAMC-N colleagues assist with the planning included passing a statewide breastfeeding
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of the table stops, tracking utilization, Prevention Week, West Ada School providing volunteers for food distribution, and District: 654 students contributing food from the SAMC-N cafeteria • Supported Allumbaugh House as key when specific items are in short supply from 134 community funder at $221K-$250K annually to the Idaho Foodbank. provide crisis mental health and detoxification FY19 – 1,351 people served services Harmful Substance Use: SARMC offered FY17 – 355 admissions from Saint new and expanded cessation programs, led Alphonsus statewide tobacco advocacy efforts, and FY18 – 321 admissions from Saint supported alcohol and drug use prevention and Alphonsus intervention programs. FY19 – 310 admissions from Saint • Took leadership roles within existing tobacco Alphonsus related coalitions and led the Idaho Tobacco 21 initiative, which aimed to raise the legal Conducting the 2020 Community Health Needs tobacco sales age to 21 by presenting Assessment legislation during the 2017, 2018 legislative Saint Alphonsus Regional Medical Center sessions, and conducted legislator education (SARMC) and the Saint Alphonsus Regional during the 2019 session. In FY20, SAHS led Rehabilitation Hospital (SARRH) in Boise, Idaho, work to pass tobacco parity legislation that and Saint Alphonsus Medical Center (SAMC-N) would include e-cigarettes in the statewide in Nampa, Idaho, completed a coordinated definition of tobacco and would establish a comprehensive Community Health Needs licensing protocol for e-cigarette retailers. Assessment that was adopted by the Boise, • Partnered with statewide Project Filter (from SARRH, and Nampa Community Hospital the Department of Health & Welfare) around Board of Directors on June 19, 2020. SARMC, new tobacco free campus and other public SARRH, and SAMC-N performed the CHNA in space signage to include e-cigarettes and adherence with certain federal requirements for vaping. not-for-profit hospitals set forth in the Affordable • Continued promotion of smoke-free movies Care Act and by the Internal Revenue Service. initiative to advocate for elimination of The assessment took into account input from tobacco products in film and/or to put an representatives of the community, community adult rating on movies portraying tobacco, members, and various community organizations. due to the bad influence on youth. It is available publicly online at https://www. • SAHS staff joined the Tobacco Free Idaho saintalphonsus.org/about-us/community- Alliance (TFIA) Advisory Board in 2020 benefit/community-needs-assessment/, or by • Saint Alphonsus Tobacco Free Living Program request from the Saint Alphonsus Health System offered comprehensive group and individual Community Health and Well-Being Department. tobacco cessation programming free to the The 2020 Community Health Needs Assessment public. was led by United Way of Treasure Valley FY17: with Health Resources in Action as a research Education for SAHS Providers and Staff – partner and Saint Alphonsus Health System, 759 attendees Trinity Health System, and JPMorgan Chase & Co. as funding partners. Five Counties: Ada, TFL Cessation Classes: Canyon, Owyhee, Elmore, and Gem were the August 2016–June 2017 – 143 attendees primary service areas studied, with analysis Community Events Targeting Tobacco and comparison of county/health district, Users – 415 individuals
Appendices United Way of Treasure Valley 2020 Community Assessment Appendices state, and national data wherever available. The Steering Committee initially identified These communities were selected for review as twelve categories of significant health needs, they comprise the primary service area where which were reduced to the top six. the bulk of SARMC, SARRH, and SAMC-N The 2020 Community Health Needs Assessment 135 patients draw from. The Trinity Health Data significant health needs are: Hub was utilized as the primary source for secondary data, in addition to localized data 1. Affordable, safe housing and homelessness sources provided by the Advisory Committee 2. Wages and job availability members. Additional duties of the Steering 3. Cost of living: i.e. housing, transportation, Committee, whose members are listed in child care, etc. the Acknowledgements, included selecting secondary data indicators, developing the 4. Mental health and well-being and substance community survey and focus group/interview use instruments, disseminating community surveys, 5. Access to affordable health care, including conducting and participating in focus groups behavioral and dental health and key informant interviews, selecting 6. Education, including high-quality early significant health needs, providing review and childhood education revision to the draft assessment report, and drafting the plan for communications and Comments dissemination of the completed assessment. Any additional comments on this report may be submitted to Rebecca Lemmons, Saint The detail processes for conducting community Alphonsus Health System Regional Manager surveys, focus groups, and key informant of Community Health and Well-Being at interviews is listed on page 90 of the 2020 [email protected]. Community Health Needs Assessment document. The 2020 Community Health Needs Assessment processes and drafts were presented to the SARMC Mission Committee on March 12, 2020, SARMC Community Hospital Board on April 9, 2020, the SAMC-N Community Hospital Board on April 24, 2020, and the SARRH Board on June 29, 2020. Each Board elected a designee to provide final adoption of the assessment. All approvals for adoption were received by June 19, 2020. Brief Overview of 2020 Significant Health Needs The 2020 Community Health Needs Assessment identified six significant health needs within the SARMC and SAMC-N communities. As described on page 9 of the 2020 Community Health Needs Assessment, the Steering Committee served as the external review committee to identify and prioritize significant health needs of the community, including Social Influencers of Health.
United Way of Treasure Valley 2020 Community Assessment Appendices unitedwaytv.org