AN EQUITABLE, HEALTHY AND SAFE DALLAS COUNTY
COMMUNITY HEALTH NEEDS ASSESSMENT 2016
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CREDITS
This report would not have been possible without the support of many organizations and individuals throughout the Dallas area. Dallas County Health and Human Services and Parkland Health & Hospital System provided leadership throughout the process, most especially Sue Pickens, Gail Seaman, Chris Nwoko, Brad Walsh, Greg Eastin and Zach Thompson. The organizations that participated on the Community Health Needs Assessment PHI Workgroup for Dallas County included:
Adapt Community Solutions Dallas-Fort Worth Hospital Council North Dallas Shared Ministries
Dallas-Fort Worth Hospital Council AIDS Arms North Texas Food Bank Education and Research Foundation American Heart Association Dallas Independent School District Presbyterian Hospital Dallas Women’s Foundation Serve West Dallas Baylor Scott & White Health Desoto Independent School District Smiley Dentistry DFW Area Health Education Center Southern Methodist University Center buildingcommunityWORKSHOP (AHEC) for Research and Evaluation Children’s Health (including the Texas Department of State Health Health & Wellness Alliance for Environmental Protection Agency Services Children & Charting the Course) Texas HHSC – Center for Elimination of City of Dallas Housing Federal Reserve Bank of Dallas Disproportionality and Disparities City of Dallas WIC Program Foremost Family Health Centers Texas Health Resources City of Garland Health Department Green Oaks Texas Hunger Initiative CitySquare Hatcher Station COPC Advisory Board Texas Scottish Rite Hospital The Diabetes Health and Wellness CNM Connect Hispanic Chamber of Commerce Institute at Juanita J Craft Recreation Center Injury Prevention Center of Greater Community Council of Greater Dallas United Way of Metropolitan Dallas Dallas Commit2 Los Barrios Unidos Community Clinic University of North Texas University of Texas – Southwestern Dallas County Criminal Justice Methodist Dallas Medical Center Medical Center and University Hospital Dallas County Health & Human University of Texas at Dallas, Institute MetroCare Services for Population Research Urban Communities (formerly Urban Dallas County Medical Society Mission East FQHC League) Dallas County Sheriff’s Department National Kidney Foundation YMCA of Metropolitan Dallas
Research and Project Management provided by
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TABLE OF CONTENTS
Credits ...... 2 Table of Figures ...... 6 Table of Tables ...... 8 Executive Summary ...... 9 Background ...... 9 Vision ...... 9 Top Five Health Issues ...... 10 Call to Action: Goals and Strategies ...... 10 Introduction ...... 12 Methodology ...... 13 Partnership Development ...... 14 Dallas County and Its Communities ...... 14 Visioning Sessions ...... 16 Community Strengths and Themes Assessment ...... 18 Who is the Leader? ...... 18 Priority Health Issues ...... 18 Strengths ...... 18 Weaknesses ...... 19 Barriers ...... 19 Unmet Needs ...... 20 Leadership ...... 20 Innovative Approaches ...... 21 Community Health Status ...... 21 Immunizations ...... 39 Communicable Diseases...... 44 Asthma and Respiratory Diseases ...... 48 Cancer ...... 49 Diabetes ...... 53 Heart Disease and Stroke ...... 55 Preventable Hospitalizations ...... 57
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Maternal-Fetal Health ...... 58 Behavioral Health – Mental Health and Substance Use Disorders ...... 65 Violence and Injuries ...... 66 Environmental Health Factors ...... 68 Public Health System Assessment ...... 69 Comparison to Peer Counties ...... 70 Forces of Change ...... 72 Healthcare Coverage ...... 73 Poverty ...... 75 Economic Development in Traditionally Poverty-Stricken Communities ...... 76 1115 Waiver ...... 77 Behavioral Health System Changes ...... 77 Strategic Issues: Top 5 Health Issues Impacting Dallas County Residents ...... 78 Behavioral Health ...... 78 Why Behavioral Health? ...... 79 Health Access ...... 80 Why Health Access? ...... 80 Older Adults and Aging Population ...... 81 Why Older Adults and Aging Population? ...... 81 Community Coordination and Care Partners ...... 82 Why Community Coordination and Care Partners? ...... 82 Maternal, Infant and Child Health ...... 83 Why Maternal, Infant and Child Health? ...... 83 Call to Action...... 84 Goals ...... 84 Measuring for Success ...... 85 Strategies for Change ...... 86 Appendices ...... 87 Appendix 1 - Social Determinants of Health ...... 87 Appendix 2 - Cultural Competency ...... 92 Appendix 3 – Healthy People 2020 Dallas County Stop Lights ...... 93
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Appendix 4 - Healthy People 2020 Stop Lights by Region ...... 95 Appendix 5 - Assets and Resources ...... 100 Appendix 6 – Community Assets – Behavioral Health Outpatient Clinics ...... 100 Appendix 7 – Community Assets – Women’s Health Clinics ...... 103 Appendix 8 – Community Assets – Pediatric Clinics ...... 103 Appendix 9 – Community Assets – Dental Clinics ...... 105 Appendix 10 – Community Assets – Free-Standing Emergency Departments ...... 106 Appendix 11 – Community Assets – Retail Urgent Care & After Hours Clinics ...... 106 appendix 12 – Community Assets – Free and Low Cost Primary Care Clinics ...... 108 Appendix 13 – Community Assets – Substance Abuse CLinics ...... 111 Appendix 14 – Community Assets – Psychiatric Hospitals ...... 112 Appendix 15 – Community Assets – Faith-Based Substance Abuse Facilities ...... 112 Appendix 16 – Community Assets – Mental Health Resources ...... 113 Appendix 17 – Community Assets – Farmers Markets ...... 114 Appendix 18 – Community Assets – Recreation Centers ...... 114 Appendix 19 – Community Assets - Health Care Collaboratives Identified ...... 117 Appendix 20 – Community Assets – Parks and Trails in Dallas County ...... 117 Appendix 21 – Assessment Resources ...... 120 Appendix 22 – Key Informant Interview Discussion Guide ...... 121 Appendix 23 – Focus Group Discussion Guide ...... 122 Appendix 24 – Dallas County Boundary and zip Code Boundaries ...... 122 Appendix 25 - Dallas County Service Areas ...... 123 Appendix 26 – 2013 CHNA Implementation Plan Update - Parkland ...... 124
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TABLE OF FIGURES
Figure 1. Dallas County Service Areas and ZIP Codes ...... 15 Figure 2. Dallas County Population Estimate ...... 22 Figure 3. Dallas County Age Specific Birth Rate...... 22 Figure 4. Dallas County Birth Rate by Race-Ethnicity ...... 23 Figure 5. Dallas County 5 Year Race-Ethnicity Population Projection ...... 23 Figure 6. Dallas County Age Group Mix ...... 24 Figure 7. Dallas County Per Capita Income ...... 25 Figure 8. Dallas County Community Map ...... 26 Figure 9. 2015 Age ...... 27 Figure 10. 2015 Race/Ethnicity ...... 27 Figure 11. 2015 Educational Attainment ...... 28 Figure 12. Dallas County Children in Poverty ...... 33 Figure 13. Percent of Families in Poverty ...... 33 Figure 14. Community Need Index Map ...... 35 Figure 15. Years of Potential Life Lost Rate per 100,000, 2014 ...... 36 Figure 16. Access to Healthcare: Percent without Health Insurance, All Ages ...... 37 Figure 17. Primary Care Physicians per 100,000 ...... 38 Figure 18. Percent of Adults with a Primary Care Physician ...... 38 Figure 19. Adults 65+ who have had a Pneumonia Vaccine ...... 41 Figure 20. Dallas County Flu/Pneumonia Mortality Rate ...... 42 Figure 21. Texas Refugee Health Program Arrivals by Resettlement County, CY 2014 ...... 43 Figure 22. Texas Refugee Health Program Screening Rate by Resettlement County, CY2014 ...... 43 Figure 23. Tuberculosis Case Rate ...... 44 Figure 24. Dallas County New Chlamydia Cases per 100,000 Population ...... 45 Figure 25. Dallas County New Gonorrhea Cases per 100,000 Population ...... 46 Figure 26. Dallas County New Syphilis Cases per 100,000 Population ...... 46 Figure 27. Dallas County New HIV Cases per 100,000 Population ...... 47 Figure 28. Dallas County New AIDS Cases per 100,000 Population ...... 47 Figure 29. Estimated Asthma Prevalence Rate by ZIP Code, 2015 ...... 48 Figure 30. Pediatric Asthma and Chronic Pulmonary Disease Hospitalizations, 2014 ...... 49
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Figure 31. Pediatric Asthma and Chronic Pulmonary Disease Hospitalizations, 2014 ...... 49 Figure 32. Cancer Incidence and Mortality Rates for Top Four Tumor Sites, Dallas County, 2009-2013 . 50 Figure 33. Expected New Cancer and Cancer Deaths, Dallas County, 2015 ...... 50 Figure 34. Cancer Incidence and Mortality Rates by Race/Ethnicity, Dallas County, 2009-2013 ...... 51 Figure 35. Estimated Breast Cancer Prevalence, 2015 ...... 51 Figure 36. Estimated Colorectal Cancer Prevalence, 2015 ...... 52 Figure 37. Cancer Screening Test in Dallas County ...... 53 Figure 38. Estimated Diabetes Prevalence per 1,000 Population, 2015 ...... 54 Figure 39. Health Outcomes: Diabetes Mortality Rate per 100,000 Population ...... 55 Figure 40. Heart Disease Mortality Rates ...... 56 Figure 41. Age Adjusted Heart Disease Mortality Rate per 100,000 ...... 56 Figure 42. Preventable Hospitalization Rates by Service Area ...... 57 Figure 43. Health Outcomes: Birth Outcomes, Infant Mortality Rate per 1,000 Live Births, 2014 ...... 59 Figure 44. Infant Mortality Rate by Year, Dallas County ...... 59 Figure 45. Health Outcomes: Birth Outcomes, Very Low Birth Weight Rate, 2014 ...... 60 Figure 46. Percent of Dallas County Births with No Prenatal Care, 2006-2013 ...... 60 Figure 47. Dallas County Births with no Prenatal Care in the First Trimester ...... 61 Figure 48. Dallas County Teen Birth ...... 62 Figure 49. Dallas County Births to Women Age 15-19 per 1,000 Women Age 15-19, 2015 ...... 62 Figure 50. North Texas Alliance to Reduce Teen Pregnancy Target ZIP Codes ...... 63 Figure 51. State of Texas Maternal Mortality Rate ...... 64 Figure 52. Suicide Mortality Rates, Dallas County 2013 ...... 65 Figure 53. Alcohol-Attributable Death Rates by Zip Code, 2013 ...... 66 Figure 54. Health Outcomes: Homicide Rates ...... 67 Figure 55. Injury Related and Non-Injury Ed Visits by Dallas County Residents 2013-15 ...... 67 Figure 56. Rate of Deaths due to Falls, Dallas County Age 65+, 2008-14 ...... 68 Figure 57. Public Health System ...... 69 Figure 58. CDC's CHSI Profile for Dallas County ...... 71 Figure 59. Forces of Change Categories Examined ...... 72 Figure 60. Gaps in Coverage for Dallas County ...... 74 Figure 61. Comparison of Dallas to Other Texas Cities on Economic Measures ...... 75
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Figure 62. Years of Potential Life Lost Due to Select Causes, Dallas County 2013 ...... 78 Figure 63. Drug Attributable Mortality Rates, 2013 ...... 79 Figure 64. Framework for Social Determinants of Health...... 88 Figure 65. Dallas County Food Deserts ...... 89 Figure 66. Minimum Wage Hours Worked to Afford the Median Rent on a 2 Bedroom Dwelling, 2014 . 89 Figure 67. Single Parent Households ...... 90 Figure 68. Population Over 25 with no High School Diploma ...... 90 Figure 69. Average Weekly Wage ...... 91 Figure 70. Parks in City of Dallas...... 118 Figure 71. Trails in Dallas County ...... 119
TABLE OF TABLES
Table 1. SNAP Food Benefits Cases and Recipients by County, March 2016 Benefit Month ...... 34 Table 2. Zip Codes with Lowest Need Based on CNI Score ...... 34 Table 3. Zip Codes with Most Need Based on CNI Score ...... 35 Table 5. Primary Care Physicians per 100,000 Population ...... 39 Table 6. 2015/16 School Year Report TX Dept of State Health Services, Region 2/3 ...... 40 Table 7. 2013 Immunizations, Childcare Attendees Age 19-59 Months, Region 2/3 ...... 40 Table 8. Communicable Disease Rates, Cases per 100,000 Population, 2014 ...... 45 Table 8. Age- Adjusted Rates per 100,000 for Preventable Diabetes Hospitalizations, 2014 ...... 54 Table 9. Forces of Change Summary ...... 73
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EXECUTIVE SUMMARY
This report was commissioned by Parkland Health & Hospital System, in partnership with the Dallas County Health Department, to meet the requirements of Section 501 (r) of the Internal Revenue Service Code. The report was prepared by Germane Solutions and Parkland Health & Hospital System staff and is the work and opinions of the Community Health Needs Assessment Public Health Improvement (PHI) Workgroup, not of Parkland Health & Hospital System.
BACKGROUND In 2015, Parkland Hospital, in partnership with Dallas County Health and Human Services and many community partners, facilitated the creation of a Community Health Needs Assessment (CHNA) for Dallas County that reflects the diversity, strengths and challenges of the community. The community defined for this CHNA is Dallas County, Texas. Federal law requires that non-profit hospitals and health systems complete a CHNA every three years. This assessment is the second iteration of the Dallas County CHNA, the first being the 2013 Horizons document which can be found at the Dallas County Health and Human Services website (Horizons 2013).
This effort was supported by a CHNA PHI Workgroup that consisted of healthcare executives from the leading health systems in Dallas County as well as leadership from multiple school districts, health departments, civic organizations and representatives of the local university systems. The CHNA is designed to assist the local public health system in Dallas County in making progress to achieve its vision of an equitable, healthy and safe Dallas County.
VISION The vision statement developed by the CHNA PHI Workgroup encompasses a set of values making clear the concepts of equity, health and safety for all citizens of Dallas.
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TOP FIVE HEALTH ISSUES In the 2013 Horizons Assessment, the top five priorities were identified as:
Multiple Chronic Conditions Healthcare Access Health Disparities and Resource Deserts Infrastructure – Unifying Prevention Efforts and Maximizing Resources Behavioral Health
Progress has been made in these areas over the last three years, which led to this examination of the current status of health in Dallas County and, in consultation with the CHNA Public Health Improvement (PHI) Workgroup, development of a new set of five priorities for the next three years:
Behavioral Health – Mental Health and Substance Use Disorders Health Access – Insurance Coverage and Provider Shortages Maternal, Infant and Child Health Community Coordination and Care Partners Older Adults and Aging Population
CALL TO ACTION: GOALS AND STRATEGIES
Goal 1: Increase Goal 2: Increase Access to Health Access to Goal 5: Increase Goal 4: Increase Services for Preventive and Goal 3: Reduce capacity to address care coordination Individuals with Specialty Care, Infant Mortality in the health needs of and care Mental Health and particularly for Low Dallas County the aging partnerships Substance Use Income and Other population Disorders Underserved
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To positively impact the five priority areas a comprehensive approach should be developed to address each priority as well as the social determinants of health1 that will positively or negatively impact the county’s efforts to make progress in those areas. In addition, focusing on collaborative efforts among the existing healthcare delivery infrastructure and community based organizations to address inequities among socioeconomic groups will help set the foundation for a healthy community.
Engaging community partners with existing relationships to at risk populations is vital to progress on the five priorities over the next three years. To meet the needs of community members with mental health and substance use disorders, those with low incomes and the underserved, infants and pregnant women, and the elderly will require creative strategies, increased care coordination and partnerships.
1 Social determinants of health are “the structural determinants and conditions in which people are born, grow, live, work and age.” They include factors like socioeconomic status, education, the physical environment, employment and social support networks. Kaiser Family Foundation. Nov 04, 2015 Harry J. Heiman and Samantha Artiga. Beyond Health care: The Role of Social Determinants in Promoting Health and Health Equity. http://www.chicagoamwa.org/uploads/2/8/7/0/28704181/the_role-of-social-determinants.pdf
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INTRODUCTION
In 2015/16, Parkland Health & Hospital System, in partnership with Dallas County Health and Human Services and many community partners facilitated the creation of a Community Health Needs Assessment (CHNA) for Dallas County that reflects the diversity, strengths and challenges of the community. Parkland Hospital first opened its doors in 1894 and is now one of the largest public health systems in the country, averaging more than 1 million patient visits annually. Dallas County Health and Human Services protects the health of the citizens of Dallas County through disease prevention and intervention as well as promoting a healthy community and environment. The community defined for this CHNA is Dallas County, Texas.
This effort was supported by a CHNA PHI Workgroup that consisted of healthcare executives from the leading health systems in Dallas County as well as leadership from multiple school districts, health departments, civic organizations and representatives of the local university systems. The CHNA will assist the local public health system in Dallas County to make progress in achieving its vision of an equitable, healthy and safe Dallas County.
The CHNA and subsequent implementation plan will embody the first three elements of the Essential Public Health Services2. These include:
Assessments 1. Monitor Health 2. Diagnose and Investigate Health Problems/Hazards Policy Development 3. Inform, Educate, Empower 4. Mobilize Community Partnerships 5. Develop Policies and plans Assurance 6. Enforce Laws and regulations 7. Link people to health services 8. Assure Competent Work Force 9. Evaluate Health Services
10. Research and innovate
The aim of the recommendations and strategies outlined is to strive to improve each individual resident’s health with the ultimate goal of enhancing the health and quality of life throughout the Dallas County community.
2 Centers for Disease Control and Prevention. 10 Essential Public Health Services. National Public Health Performance Standards. Last modified May 29, 2014, http://www.cdc.gov/nphpsp/essentialservices.html
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METHODOLOGY
The CHNA is designed to document the health status of the community and support planning and policy initiatives to improve population health. Parkland Health & Hospital System, in partnership with the Dallas County Health Department, enlisted the services of Germane Solutions to assist the CHNA planning committee with conducting the CHNA. In conducting this CHNA, the project team utilized a community-driven strategic planning process for improving community health developed by the National Association of County & City Health Officials (NACCHO) called the Mobilizing for Action through Planning and Partnerships (MAPP) framework.3 MAPP is not an agency focused assessment process; it is an interactive process that can improve the efficiency, effectiveness and performance of local public health systems.
A series of key informant interviews, focus groups and work sessions with the committee were conducted along with significant work to collect and analyze the various health and social determinants of health data available for Dallas County. These activities were designed to allow for the most complete picture of health of Dallas County to be presented.
Primary qualitative data sources for this assessment included 55 key informant interviews, a focus group held at Los Barrios Unidos, a focus group of Community Oriented Primary Care (COPC) advisory board members held at Parkland and two focus groups held at the Dallas County Health and Human Services department in addition to seven monthly meetings of the CHNA PHI Workgroup. Secondary data sources are numerous in Dallas County. A variety of active healthcare, education, social service organizations and businesses provided leadership in collecting, organizing and vetting datasets that were utilized for this CHNA. Secondary data sources included but were not limited to:
U.S. Census Parkland Health & Hospital System Dashboards and Data Dallas-Fort Worth Hospital Council Foundation Healthy North Texas Dashboard and proprietary inpatient and outpatient data Dallas County Health and Human Services (DCHHS) Division Data summaries Texas Medical Association Texas Department of State Health Services, Bureau of Vital Statistics, Bureau of STD/HIV and BRFSS Office Dignity Health Community Need Index Nielson/Claritas Population Facts Truven Health Analytics
A draft of the Dallas County CHNA was posted on the Parkland Health & Hospital System website for public comments. The draft was also made available to the CHNA PHI Workgroup, shared with the Parkland Board of Managers and sent to participants in the key informant interviews and focus groups. Comments received were responded to in the format which they were received.
3 Mobilizing for Action through Planning and Partnerships. NACCHO. http://www.naccho.org/programs/public- health-infrastructure/mapp
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PARTNERSHIP DEVELOPMENT
During the first phase of the MAPP process, the project team organized the planning process and developed the planning partnership. The purpose of this phase is to build commitment, engage participants as active partners and ensure partners’ time is used well, resulting in a plan that can be implemented. Parkland Health and Hospital System, working with Dallas County Health and Human Services, assembled a group of stakeholders who have advised the development of the Dallas County Community Health Needs Assessment. Members of the CHNA PHI Workgroup include representatives from hospitals and health systems, schools, law enforcement, public health officials, community leaders, behavioral health providers, the Dallas County Medical Association and other professional associations. The PHI Workgroup met on a monthly basis from April 2015 through April 2016 to complete the CHNA. These meetings included presentations from many of the members of the PHI Workgroup and other community representatives on developments since the last CHNA in 2013 and included review activities and assessments that are part of the MAPP process.
DALLAS COUNTY AND ITS COMMUNITIES
The CHNA includes information about Dallas County, and its communities within the county. These communities are defined by contiguous U.S. postal ZIP codes. The community definitions have been used for health planning for many years and have been referred to as both “planning zones” and “service areas” in past studies. For the CHNA, they will be referred to as either communities or service areas.
Since the ZIP code boundaries do not exactly match county line boundaries, some differences in geographic coverage and population totals result. A map comparing the Dallas County boundaries with the communities’ ZIP code boundaries can be found in Appendix 18.
Service Area populations are based on 2014 or 2015 U.S. Census estimates. Service Area demographics are aggregated using U.S Census 2010 to 2015 five year averages for Dallas County ZIP Code Tabulation Area (ZCTA) data. ZCTAs are statistical geographic entities produced by the U.S. Census Bureau for tabulating higher level data summary statistics from the 2010 and annual Census estimates.
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Figure 1. Dallas County Service Areas and ZIP Codes
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VISIONING SESSIONS
Vision and values statements provide focus, purpose and direction to the community health needs assessment process. During a Visioning session, participants work together to achieve a shared vision of the future. Determining a vision for the future is one purpose of this assessment. The Dallas County PHI workgroup convened on January28, 2016 to hold a session on identifying a vision and setting values for this process. The session was attended by a diverse group of Dallas County stakeholders and many potential ideas and concepts were discussed.
POTENTIAL VISION BRAINSTORMING Improve Health & Well-Being Vitality Equitable Inclusive Safety Families Community Potential Statements like “Better Health across Dallas” and the Dallas County Health and Human Services Vision “Safe Families, Healthy Lives” were mentioned as possible themes to unite around.
In crafting a statement that encompasses the characteristics the group identified as important, the following vision statement was developed:
An Equitable, Healthy and Safe Dallas County
Values are the fundamental principles and beliefs that guide a community driven planning process. As the group moved into a discussion of values, many ideas and concepts were proposed that would contribute to a potential set of values for Dallas County in this process:
POTENTIAL VALUES BRAINSTORMING Dignity Resolve Purpose Determination Integrity Evidence-Based Innovative Positive Reinforcement Moving Toward Positive Outcomes Social Justice Social Determinants of Health Health Literacy Community Engagement (Civic & Advancing Excellence Compassion Individual) Sustainability Link to Economic Viability & Vitality Culturally Appropriate Anti-Stigma – HIV/AIDS, Behavioral Real Collaboration Effective Linkages Health Accessible Drive to Successful Outcomes Accountable to External Entities Responsible to Internal Resources Empowerment for Individuals Quality (Recognizing and Owning) People-Centric Include people served in the process Bring a structural lens to the system Anti-Racist Data-Driven Evaluation Qualitative Data Informed Balance to Systems Philanthropy/Giving Back Be Accountable to Community Align Priorities to Community Age-Inclusive/Life Cycle Developmental Lens Faith-Based (Building on trusted Make more a part of everyday life Make Being Healthy Easy relationships) Do No Harm See what others see Co-Creation of Solutions Political Will Engagement Advocacy Service of Excellence Protection of Environment
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These themes were organized in a comprehensive list that captures the thoughts of the PHI Workgroup as follows:
DIGNITY INTEGRITY PURPOSE EXCELLENCE CO-CREATION ACCOUNTABILITY INCLUSIVENESS People-Centric Accessible Philanthropy/ Evidence- Balance to Systems Responsible to Anti-stigma Giving Back Based Internal Resources Positive Quality Make Being Data Driven Link to Economic Bring a structural Priorities to Reinforcement Healthy Easier Viability & Vitality lens to the system community Empowerment See what Align Priorities Qualitative Effective Linkages Drive to successful Include People- others see to Community Data outcomes served in the Informed process Make Part of Do No Harm Collaboration Protection of Anti-racist Everyday Life environment Faith-Based Culturally Appropriate Political Will Engagement Social Justice
Dignity – The CHNA will be people-centric, emphasizing the worth and value of everyone in the community in everything we do and say. We will empower individuals to speak up for themselves and others.
Integrity – The CHNA will help to ensure that everything The Public Health Improvement Workgroup does stands up to the highest standards of quality, accessibility and transparency for the entire community.
Purpose – The CHNA will always reflect the reason why we do the work we do. The CHNA will help people have their voices heard with regard to important health issues and will make choosing to be healthy the easy choice.
Excellence – In order to make Dallas the outstanding community it can be, the CHNA will ensure decisions are data-informed, strategies are evidence-based and that the Public Health Workgroup will constantly be looking to improve efforts based on data feedback.
Co-Creation –The Public Health Improvement Workgroup recognizes the value of collaboration and linkages to bring additional resources to the challenges we face. The CHNA states that only through these collaborations can Dallas County residents achieve economic viability and vitality.
Accountability – The Public Health Improvement Workgroup recognizes the responsibility and the importance of being accountable to our community and is committed to developing strategies that protect a healthy environment.
Inclusiveness – The Public Health Improvement Workgroup will draw public health solutions from diverse constituencies in order to ensure all constituencies within our community have a voice on this important issue.
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COMMUNITY STRENGTHS AND THEMES ASSESSMENT
As part of the process for the Parkland/Dallas County Health and Human Services, Community Health Needs Assessment for Dallas County, a series of key informant interviews were was conducted, touching on various themes related to the health of Dallas County citizens and the public health infrastructure. A summary of those interviews by subject area is outlined here.
WHO IS THE LEADER? The first question that was asked of all key informants had to do with leadership in improving health in Dallas County. Many view Dallas County Health and Human Services and Parkland Health & Hospital System as the leaders for improving the overall health of Dallas County, particularly with regard to their services for indigent populations. Others put the responsibility of leadership on the Commissioners Court or other decision makers in the healthcare delivery system such as hospital executives. A significant number of respondents believe there is a shared responsibility for leadership among everyone in the community, particularly from educators, elected officials, health providers, business owners and social service organizations and that all entities should contribute in their own way and in their own space.
PRIORITY HEALTH ISSUES Respondents were given a list of health risk factors and asked to discuss what is most important to improve health outcomes in Dallas County. Health care access was of most concern to respondents. Many discussed the lack of Medicaid expansion in Texas as a key barrier to access, particularly for those lower on the income scale, but also for those who do have insurance, including Medicaid and CHIP. There is a perception that an increasing number of providers are not accepting Medicaid and CHIP coverage and therefore even many covered families are having a difficult time getting the preventive care they need.
Social determinants of health were also mentioned as a significant contributing factor to poor health in Dallas County and an area that needs to see more investment from partners in the community. Those who recognized the social determinants of health as an issue put them at the top of the list and saw addressing them as a key to improving overall health.
Several respondents identified inequities in wealth and income as impacting health and recognized the influence these economic inequities had on health disparities overall. There are certainly areas of Dallas County that have great wealth and the ability to address health concerns as they arise, as well as achieve good preventive care. However, there are also areas of Dallas County where there is great poverty and significant challenges in sustaining good health, including access to care when it is needed. Preventive care is severely lacking for too many in Dallas County.
STRENGTHS When asked about the strengths of the current health service delivery system, many respondents identified the expansion of primary care clinics in previously low access areas and the brand new
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Parkland Hospital. Respondents from across the county recognize that Dallas has some of the best providers and world-class facilities for those that have the means to access them. There is recognition of tremendous leadership in the medical and public health arenas. Health care quality in Dallas County is very high, with highly trained medical doctors and other medical personnel. Dallas has shown it can handle a significant public health emergency and acute care is provided at a very high level for everyone.
WEAKNESSES Dallas County has many challenges and these were raised by the key informants. The lack of behavioral health services and primary care for individuals who don’t have the means to pay is seen as a significant gap in the Dallas County health system. Specialty care was mentioned by many respondents as sparse outside of the hospital settings and difficult to access for low income individuals and families. Long wait times were often mentioned as a significant challenge to individuals attempting to access services. Respondents also noted that the health system is not always easy to navigate for patients. The disparities in location of services and hours of operation that contribute to access problems, were mentioned as a weakness by several respondents.
When asked which Dallas County population groups have the most challenges, the indigent was most often mentioned, followed by the South Dallas region and the African American and Hispanic communities as a whole. People with mental health and substance use disorders were also mentioned as a specific group in need of greater interventions. Concerns about access to dental and vision care were also raised.
BARRIERS The number one barrier mentioned by respondents is transportation, especially in South Dallas County. Transportation is a core component integral to healthcare access. As mentioned by the PHI Workgroup, key informants and within focus groups, many of the transportation routes travel directly to downtown with few cross county routes, making it necessary to change buses or light rail routes. Even when available, the cost for transportation is a barrier as well—it may come down to a choice between food, prescriptions or transportation to your health care provider. Public transit can cost as low as $1.25 for a 2 hour pass to $10 a day for a regional pass. Although the City of Dallas obtained federal grants for low- income elderly rides to appointments, the need greatly outweighs the available services and does not reach the one million plus population outside of the city. There are communities within Dallas County that do not participate in the Dallas Area Rapid Transit (DART), most notably Grand Prairie, Duncanville, and Mesquite. This may be especially problematic for residents of Grand Prairie, particularly because it is the fourth largest city in Dallas County and home to the most populous ZIP code in the county, 75052, with an estimated 100,611 residents.
Transportation was followed immediately by lack of insurance coverage. There was a great deal of unanimity that inability to access or afford primary care (and specialty care) is consistently a significant barrier for Dallas County citizens, which leads to continued reliance on emergency rooms as a major provider of care. The failure of Texas to expand Medicaid was repeatedly discussed as partly responsible for the lack of insurance coverage, however respondents acknowledged that the lack of
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expansion is only one piece of a broader issue for access. Even with Medicaid coverage, there would be no guarantees of available access to services.
Beyond healthcare, there were significant barriers in the public health realm mentioned, including health literacy, stigma, fear and trust. The messaging of public health and wellness will need to address the relative literacy of the population as well as the fear and mistrust of health systems and institutions that have developed over many generations. Dallas County residents do not always trust what they are told about their health, therefor rebuilding this trust should be a primary focus for health providers and community leaders.
UNMET NEEDS When asked to discuss unmet needs in Dallas County, mental health was the most frequently mentioned along with health care access. One respondent told a story regarding an individual well known to the medical community as a repeat visitor to the emergency rooms who committed a violent act and murdered an individual. The respondent was using the story to illustrate what can potentially be prevented with more accessible mental health services, even if only to the individuals who are well- known to medical providers.
There was some discussion of social determinants of health when addressing unmet needs, including access to fresh fruits and vegetables and other means of healthy eating. Many individuals were concerned with “one size fits all” methods of health service and the ignorance of cultural, economic, and sociological differences among communities in regards to public health. Dallas County is a diverse community with people who face different challenges and need tailored interventions. A lack of creativity must not be allowed to inhibit the development of strategies to address health challenges in our communities.
LEADERSHIP Respondents were asked to discuss ways in which the community can provide leadership to create a healthier environment in Dallas County. The answers ranged from political and social engagement (particularly around Medicaid expansion and other means of expanding coverage) to being more visible on health issues in general and acknowledging a correlation between population health and strong economic development. The consensus was that progress could be made if the community was more engaged in health issues and united in their efforts. Whether that shift originates from community leaders, businesses, or policy makers did not matter as long as the result was more engagement and visibility of the issues and challenges that face Dallas County. Most respondents believe that health professionals in Dallas County are competent in their fields and knowledgeable of the various approaches that can be used to enhance health outcomes. The challenge is building enough political and social support for taking action as well as recognizing and promoting the positive outcomes that can be achieved.
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INNOVATIVE APPROACHES Key informants were given the opportunity to brainstorm innovative approaches to enhance health outcomes in Dallas County. These included current strategies and programs that may need to be expanded to increase effectiveness. A number of approaches were discussed including:
Baylor Scott & White’s Diabetes Health and Wellness Center in South Dallas A State of the County Health Address annually by the Commissioners Court Children’s Health System asthma program Programs for the homeless in Fort Worth Corporate Wellness and Health Certification – recognition for employers that do great work Community Accountable Care Organization San Antonio’s Jail Diversion program Encourage exercise in place (e.g. parking further from the office building on purpose) A health care “think tank” to address specific problems Targeted placement of mobile health clinics in neighborhoods with high service utilization; screenings conducted by paramedics and nurses Free telehealth appointments or house calls for people who have barriers to attending their medical appointments
COMMUNITY HEALTH STATUS
The Community Health Status Assessment is designed to answer the question, “How healthy are the residents of Dallas County?” and “What does the health status of Dallas County look like?” The results of the Community Health Status Assessment form the qualitative, data-driven basis for the CHNA PHI Workgroup and key healthcare partners to ensure that the specific priority health status issues are addressed. A broad range of data serves as the foundation of this analysis while identifying community health issues and determining where the community stands in relation to peer communities, state and national benchmarks.
DALLAS COUNTY ECONOMIC AND SOCIODEMOGRAPHIC SUMMARY Dallas County has an estimated 2016 population of 2,621,108 and is expected to grow 6.7% to 2,796,325 by the year 2021. The Texas population has grown at a rate substantially outpacing that of the United States. Dallas County is the second most populous county in Texas and the ninth-most populous county in the country. The North Texas Population boom can be attributed to strong economic growth with incoming corporations in major industries such as manufacturing, technology, oil and gas, banking and financial services, food and health care services. For example, Toyota Motor Corporation, Active Network, Liberty Mutual Insurance, Jamba Juice, Occidental Petroleum and American Specialty Health Inc. have all relocated to North Texas in the last few years. North Texas in particular has benefited significantly from the migration of California based corporations. Nearly 70 California corporations have
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moved to the Dallas Fort-Worth region between 2008 and 2014.4 Dallas County’s unemployment rate in 2015 was 4.3%5.
Figure 2. Dallas County Population Estimate
Although Dallas County has experienced steady population growth in the midst of a recession, the birth rate declined dramatically. However, 2014 marked the first time in several years that the birth rate increased in Dallas County. Year 2015 preliminary data show a decline in the birth rate from 2014 and may suggest that the post-recession birth rate is here to stay for some time. The Hispanic population in Dallas County had the sharpest decrease in birth rates at 110.0 births per 1,000 women age 15 to 44 between the years 2007-2009 and 84.8 births between 2011-2013 in the same group.
Figure 3. Dallas County Age Specific Birth Rate6
4 Jean, S. (2015). Is Texas the new California? The Dallas Morning News. Retrieved August 18, 2016 from http://interactives.dallasnews.com/2015/ca-biz-relocation/ 5 United States Department of Labor, Bureau of Labor Statistics (http://data.bls.gov/map/MapToolServlet) 6 Texas Department of State Health Services. (2016). 2014 Texas vital statistics. Retrieved from http://www.dshs.texas.gov/chs/vstat/vs14/data.aspx#birth
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Figure 4. Dallas County Birth Rate by Race-Ethnicity7
Along with population growth, Dallas County is experiencing shifts in its demographic make-up. All race-ethnic groups are expected to increase except for the Caucasians population. The Asian population is expected to have the greatest growth. Although the 65+ Age Group has the smallest population, they are expected to have the greatest population increase, nearly 26%, in the next five years.
Figure 5. Dallas County 5 Year Race-Ethnicity Population Projection8
7 March of Dimes. (2016). Peristats. Retrieved from https://www.marchofdimes.org/Peristats/ 8 Truven Health Analytics, Market Expert Population Estimate
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Figure 6. Dallas County Age Group Mix9
9 Truven Health Analytics, Market Expert Population Estimate
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Although Dallas County is experiencing strong population growth, a booming housing market and in- migration of business, it is still plagued by poor income distribution and high rates of poverty. Over 19% of Dallas County residents live in poverty including 29% of children.10
Figure 7. Dallas County Per Capita Income
10 United States Census Bureau. (2016). QuickFacts – Dallas County, Texas. Retrieved August 20, 2016 from www.census.gov/quickfacts
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DALLAS COUNTY COMMUNITY HIGHLIGHTS
Dallas County has traditionally been divided into 13 geographic communities using U.S. postal ZIP codes. This CHNA uses these communities to more precisely target assets, issues, needs and gaps for each of these sub-sections of the county. Figure 8 presents an area map with the communities outlined.
Figure 8. Dallas County Community Map
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Figure 9. 2015 Age11
There are significant variations in the racial and ethnic makeup of various geographic areas in Dallas County. North Dallas, Northwest Dallas and the Outer Northeast area show the most significant percentage of White Non-Hispanic individuals. Areas like Southeast Dallas, Southwest Dallas, Grand Prairie and Irving see a significant percentage of Hispanic residents. African Americans make up a significant percentage of the population in South Dallas, Cedar Hill and Desoto Lancaster.
Figure 10. 2015 Race/Ethnicity12
11 Truven Health Analytics, Market Expert Population Estimate 12 Truven Health Analytics, Market Expert Population Estimate
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There is significant variation in educational attainment among the regions of the county with college educated individuals dominating areas like Cedar Hill, North Dallas, Northwest Dallas and the Outer Northeast while those with less than a high school education are more prominent in Southwest Dallas, Southeast Dallas and South Dallas.
Figure 11. 2015 Educational Attainment13
Cedar Hill
Considering population size, Cedar Hill is the second smallest community, with only 84,249 residents, or 3.3% of the Dallas County population. African-Americans make up 49% of the Cedar Hill population. Latinos are 24.7% and Caucasians are 22.1% of the population. Population age mirrors Dallas County overall. In 2015 the per capita income was $26,104, 7.5% were unemployed, and 11.3% were living in poverty. 83.8% of adults age 25 and older have graduated from high school. Cedar Hill has the second highest mortality rate for chronic obstructive pulmonary disease among Dallas County communities, 41.7/100,000, versus 35.5/100,000 for all of Dallas County.
Desoto/Lancaster
Desoto/Lancaster has the highest proportion of African American residents of any of the communities in Dallas County (70.0%, compared with 22.0% county-wide). Only 10.7% of the Desoto/Lancaster population age 25 and older did not finish high school, the 3rd lowest of the 13 communities. The community has the second highest mortality rates of all Dallas County communities for heart disease and cancer, after South Dallas, 21% and 16% higher than the overall county rate, respectively.
13 Nielson/Claritas Inc., Pop-Facts 2015 version
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Desoto/Lancaster had the highest rate of Very Low Birthweight Births (under 1500 grams) in 2014, 2.9%, compared with 1.8% for Dallas County as a whole.
Grand Prairie
Grand Prairie’s Race/Ethnicity mix is 45% Latino, 24% non-Hispanic White, 21% African American and 7% Asian-American. In the 2014 Economic Census, Grand Prairie had the lowest rate of liquor stores per capita of the 13 Dallas County communities, 0.5 stores per 100,000 populations. The overall Dallas County rate was 7.5 stores per 100,000. Grand Prairie had the lowest heart disease mortality rate of the 13 Dallas County communities in 2014 (117.6 per 100,000, versus 171.4 per 100,000 for Dallas County). The Grand Prairie community had the highest infant mortality rate of all Dallas County communities in 2014 (12.3 deaths/1,000 live births, versus 7.4 deaths/1,000 live births county-wide), even though the community had the lowest rate of Very Low Birth Weight births (0.94%, compared with 1.78% county-wide).
Irving
Irving is one of three Dallas County communities which are majority Hispanic (57.3%). Irving had the fifth highest rate of people lacking health insurance in 2016, at 18.1%. In 2014 the Irving community had the highest rates in Dallas County of hospitalizations for diabetes long-term complications (162.0 per 100,000) and diabetes lower extremity amputations (30.8 per 100,000). Irving had the second lowest rate of Very Low Birth Weight births (births under 1500 grams), at 1.3%.
North Dallas
North Dallas is the most affluent of the Dallas County communities, with a per capita income of $46,871 and an unemployment rate of 6.5% in 2015. The community is 64.2% White Non-Hispanic, 7.1% African American, 22.7% Hispanic and 4.0% Asian. In 2014 North Dallas had the lowest mortality rate for motor vehicle accidents (3.82 per 100,000), and the lowest infant mortality rate (4.99 per 1,000 live births). The North Dallas community had the lowest rates in the county for avoidable hospitalizations for diabetes short term complications (33.0 per 100,000), diabetes long term complications (59.4 per 100,000), congestive heart failure (211.9 per 100,000) and chronic obstructive pulmonary disease (121.0 per 100,000).
Northeast Dallas
The Northeast Dallas community is the third largest of the 13 Dallas County communities, with 261,743 residents.
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51.4% of the Northeast Dallas population age 25 and over have more than a high school education as compared 54.4% for the county. The community had one of the highest rates of ED visits for injuries in 2014, 66.4 per 1,000, compared to 58.2 per 1,000 for all of Dallas County. The Northeast Dallas community had the second highest rate of hospital admissions for pediatric asthma in 2014, at 195.7 cases per 100,000, compared to the Dallas County rate of 125.9 per 100,000.
Northwest Dallas
Northwest Dallas has the largest proportion of Asian-Americans of any Dallas County community, with 17.9% Asian American, 42.7% White Non-Hispanic, 12.6% African American and 24.1% Hispanic. The community has the highest proportion of its population age 25 and over with more than a high school diploma, 75.3%. The Dallas County overall proportion is 54.4% The community has the second-highest per capita income, $38,922, and the second lowest poverty rate, 7.4%. The Northwest Dallas community has the lowest mortality rates in the county for cancer (107.6 per 100,000), cerebrovascular disease/stroke (30.5 per 100,000) and diabetes (7.6 per 100,000). The Dallas County rates for these three causes of death, respectively, are 144.8, 46.0 and 17.1 per 100,000. Northwest Dallas had the lowest Years of Potential Life Lost rate, 3,744 YPLL’s per 100,000, in 2014, suggesting a low rate of mortality before age 75 in the community. The county- wide rate was 6,974 YPLL’s per 100,000.
Outer Northeast
The Outer Northeast community has the second largest population of the 13 communities, 271,292. Only 7.3% of households in the Outer Northeast community were below the poverty line in 2015, the lowest poverty rate in Dallas County. The county-wide rate is 15.8%. The community had the lowest incidence rates of chlamydia (269.5) and gonorrhea (80.4) of the Dallas County communities in 2013. Outer Northeast community had the highest suicide mortality rate in Dallas County, 13.5 deaths per 100,000, compared to a Dallas County rate of 9.3 per 100,000. It also had the lowest homicide mortality rate, at 3.3 deaths per 100,000, versus the county rate of 6.0 per 100,000.
South Dallas
The South Dallas community is the poorest of the 13 communities in Dallas County, with a per capita income of $13,660 (versus $25,108 across Dallas County). 29.2% of South Dallas households are below the poverty level, the highest rate in the county. 28.3% of South Dallas residents age 25 and over have less than a high school education, the fourth lowest rate of the 13 Dallas County communities.
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The community has the second highest proportion of African Americans in the population, 66.4%. Hispanics make up 28.1% of the community’s population. South Dallas has the highest mortality rates for the top three causes of death (heart disease, cancer and cerebrovascular disease/stroke) among the 13 communities. It also has the highest Years of Potential Life Lost rate, 13,829 YPLL’s per 100,000, compared with 6,974 YPLL’s per 100,000 for all of Dallas County. The community also has the highest homicide mortality rate, at 18.4 deaths per 100,000. The Dallas County overall rate is 6.0 per 100,000.
Southeast Dallas
The Southeast Dallas community is the most populous of the 13 communities, with 386,544 residents or 15.1% of the Dallas County population. Over half of the community’s residents are Latino, 52.4%. This represents 1/5 of all Hispanics in Dallas County. Southeast Dallas is the third poorest community in the county, with 22.9% of households in poverty (versus 15.8% county-wide) and a per capita income of $16,074 (versus $25,108 for all of Dallas County). The community has the second highest homicide mortality rate, at 10.4 deaths per 100,000.
Southwest Dallas
Latinos make up the largest race/ethnic group in the Southwest Dallas community, with 68.6%, while Non-Hispanic Whites make up 11.6% of the population and African Americans make up 17.4%. Southwest Dallas has the highest percentage of people age 25 and over without a high school diploma, 41.6%, compared with 22.4% for Dallas County. The Southwest Dallas community has one of the highest rates of births to girls ages 15-17, 27.8 births per 1,000 girls 15-17. It also has the second lowest infant mortality rate in the county, at 6.2 per 1,000 live births, compared to 7.4 for Dallas County overall. Southwest Dallas had the highest motor vehicle accident mortality rate in 2014, at 13.0 per 100,000 populations, compared with 7.8 per 100,000 for Dallas County.
Stemmons Corridor
About half of the population of Stemmons Corridor (50.0%) are Hispanic. 37.2% are White Non-Hispanic and 8.3% are African-American. The Stemmons Corridor has the highest rate of liquor stores per capita, at 28.4 per 100,000. Stemmons Corridor has the second highest drug-attributable death rate, at 19.5 deaths per 100,000, compared with 14.9 per 100,000 for all of Dallas County. The community had the highest HIV incidence rate in Dallas County in 2013, with 69.6 new HIV cases per 100,000. The county-wide rate was 31.0 per 100,000.
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Wilmer Hutchins Seagoville
The Wilmer Hutchins Seagoville community has the smallest population of the 13 Dallas County communities, with 78,171 residents. This is 3.0% of the county population. The population of the community is 40.1% Hispanic, 33.0% Non-Hispanic White, 22.9% African-American and 2.0% Asian-American. The Hispanic segment is growing, and recently became the largest race/ethnic group in the community. The Wilmer Hutchins Seagoville community has the lowest primary care physician-to- population ratio of any Dallas County community, with only 8.8 doctors per 100,000 populations. This suggests that access to medical care is more difficult for these residents, especially those without reliable transportation. In 2014 the community had the highest mortality rates of the Dallas County communities for diabetes (32.2 deaths/100,000) and chronic obstructive pulmonary disease (43.8 deaths/100,000), and the fourth highest mortality rate for heart disease (185.0 deaths/100,000).
POVERTY One of the most significant issues facing Dallas is poverty. The relationship between poverty and health is complex and different for every individual. Poverty is both a cause and a consequence of poor health. Poor health in turn traps communities in poverty14.
“Socioeconomic status is the most powerful predictor of disease, disorder, injury and mortality we have,” says Tom Boyce, MD, Chief of University of California San Francisco’s Division of Developmental Medicine within the Department of Pediatrics.
The predictive power of income is obvious when considering life expectancy. Impoverished adults live seven to eight years less than adults who have incomes four or more times the federal poverty level, which is $11,770 for a one-person household regardless of where they live.15
Dallas County has some of the highest poverty rates with 20% of the residents below the poverty line in 2014 and 30% residents below the age of 18 living below the poverty line. The population grew by 14% from 2000-2014; however, persons living in poverty grew by 65% for the same time period. The number of children living in poverty increased 77% from 2000 to 2014. (Dr. Tim Bray, Institute for Urban Policy Research, The University of Texas at Dallas, presentation to the Public Health Improvement Work Group, January, 2016)
14 The World Bank, Brief Poverty and Health August 25, 2014. http://www.worldbank.org/en/topic/health/brief/poverty-health 15 Conway, Claire. Poor Health: When Poverty Becomes Disease, UCSF News Center, January 06, 2016. https://www.ucsf.edu/news/2016/01/401251/poor-health
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Figure 12. Dallas County Children in Poverty16
Figure 13. Percent of Families in Poverty
16 2015 Beyond ABC: Assessing the Well-Being of Children in Dallas County and the North Texas corridor, Published by Children’s Medical Center.
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Many, though certainly not all, of Dallas’ neighborhoods in poverty are concentrated in the southern sector of the city. Additionally, there are nearly 400,000 Dallas County residents receiving Supplemental Nutrition Assistance Program (SNAP) benefits.
Table 1. SNAP Food Benefits Cases and Recipients by County, March 2016 Benefit Month17
Number Number of Recipients: Recipients: Recipients: Recipients: Recipients: Total FB Avg of Cases Recipients Ages < 5 Ages 5 - 17 Ages 18 - 59 Ages 60 - 64 Ages 65 + Payments Payment / Case 171,002 390,422 67,884 158,218 132,715 10,276 21,329 $45,670,687 $267
COMMUNITY NEED INDEX In 2004, Dignity Health and Truven Health Analytics collaborated to developed a Community Need Index (CNI) to assist in the process of gathering vital socio-economic factors including percent living in poverty, educational attainment, race and ethnicity, percent with limited English, unemployment, insurance status, and living in rental housing.18 Based on these statistics the CNI provides a score for every populated ZIP code in the United States on a scale of 1.0 to 5.0. A score of 1.0 indicates a ZIP code with the least need, while a score of 5.0 represents a ZIP code with the most need.
The weighted average score for Dallas County is 4.2, the median score is 4.4, and the scores range from a low of 2.2 to a high of 5.0.The national median is 3.0. The zip codes at the extremes in Dallas County are as follows:
Table 2. Zip Codes with Lowest Need Based on CNI Score
Zip Code CNI Score Population City 75048 2.2 22,711 Sachse 75088 2.2 25,253 Rowlett 75225 2.2 21,753 Dallas 75019 2.4 41,069 Coppell
17 Texas Health & Human Services Commission, Recipients by County by Month. http://www.hhsc.state.tx.us/research/tanf-snap-results.asp 18 “Community Need Index: Methodology and Source Notes”, 2015, Truven Health Analytics. http://cni.chw- interactive.org/Truven%20Health_2015%20Source%20Notes_Community%20Need%20Index.pdf
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Table 3. Zip Codes with Most Need Based on CNI Score
Zip Code CNI Score Population City 75203 5 16,637 Dallas 75210 5 7,388 Dallas 75212 5 27,684 Dallas 75215 5 14,768 Dallas 75216 5 50,248 Dallas 75217 5 84,271 Dallas 75220 5 43,140 Dallas 75223 5 14,022 Dallas 75224 5 35,550 Dallas 75228 5 68,880 Dallas 75231 5 38,290 Dallas 75235 5 17,531 Dallas 75240 5 26,385 Dallas 75246 5 2,677 Dallas 75247 5 748 Dallas
Figure 14. Community Need Index Map19
19 Dallas County Community Need Index Map, Dignity Health (formerly Catholic Health West), 2015. Retrieved August 19, 2016 from http://cni.chw-interactive.org
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PREMATURE DEATH Years of potential life lost (YPLL) is an estimate of the average years a person would have lived if he or she had not died prematurely (usually 75 years).20 High premature death rates are found in Dallas County service areas with socioeconomic indicators relating to low income, high unemployment, poverty, and percentage without a high school diploma.
Dallas County’s premature death rate of 6,794/100,000 is 7% lower than the state of Texas at 7,327/ 100,000. However, there are selected service areas with higher rates including South Dallas, Southwest Dallas, Southeast Dallas, and Desoto Lancaster. Figure 15. Years of Potential Life Lost Rate per 100,000, 201421
20 Dranger, Elizabeth, MA and Remington, Patrick, MD, MPH. YPLL: A Summary Measure of Premature Mortality Used in Measuring the Health of Communities. Wisconsin Public Health & Health Policy Institute, October 2004 21 Texas Department of State Health Services, Bureau of Vital Statistics; denominator population data from Claritas, Inc.
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HEALTHCARE ACCESS Although the State of Texas has not expanded Medicaid as part of the Affordable Care Act (ACA), progress has been made in reducing the percentage of Dallas County citizens who are without insurance. The percentage of uninsured in Dallas County has decreased from 31% in 2006 to 23% in 2014. However 38% of residents in South Dallas, 29% of residents in Southwest Dallas and 25% of residents in Southeast Dallas do not have health insurance. Also, several communities (i.e. Cedar Hill, Desoto Lancaster, Irving, North Dallas, Northeast Dallas, Northwest Dallas, and Outer Northeast) have actually experienced an increase in the percentage of uninsured.
In the 2015 edition of Beyond ABC: Assessing the Well Being of Children in Dallas County and the North Texas Corridor, it states that of the 659,187 children under age 18 living in Dallas County, nearly 19% live in poverty and 15.2% were uninsured in 2013. The number of uninsured children has declined in Dallas County by 7.5 percentage points from 2008 to 2013. While the decline in the uninsured rate for children is attributable in part of the ACA, these rates had been declining in the decade before the ACA became law.
The level of Medicaid physician payment has been shown to affect a physician’s willingness to accept Medicaid patients. According to a Texas Medical Association study conducted in 2012, only 31% of physicians said they accept all new Medicaid patients compared to 67% in 2000. Less than 30% of physicians in Dallas, Tarrant, Harris and Travis Counties said they accept all new Medicaid patients.22
Figure 16. Access to Healthcare: Percent without Health Insurance, All Ages23
22 Texas Medical Association, March 20112 Physician Survey. http://www.politifact.com/texas/statements/2013/jan/08/texas-medical-association/medical-group-says-31- percent-texas-doctors-accept/ 23 Data Source: Dallas Fort Worth Hospital Council Foundation, Data Initiative. Prepared by Parkland Health and Hospital System
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The percentage of Dallas County residents with a primary care physician (PCP) decreased from 69% in 2004 to 66% in 2014. This percentage is not only below the state and national averages, but 17.2 percentage points below the federal government’s Healthy People 2020 goal. Texas is ranked 43rd out of the 50 states in concentration of PCPs24. Dallas County has a maldistribution of PCPs, with the highest concentration of PCPs in the Stemmons community and the northern suburbs and the lowest in the southern regions of the County.
Figure 17. Primary Care Physicians per 100,00025
Figure 18. Percent of Adults with a Primary Care Physician26
24 http://www.americashealthrankings.org/ALL/PCP 25 Texas Medical Association Physician Practice Address files; denominator population data from Claritas, Inc., except 2010 from Nielson/Claritas, Inc. Pop Facts. Mid 2010 version. County and State source is Texas Bureau of Primary Care. http://www.dshs.texas.gov/chs/hprc/tables/2015/15PC.aspx 26 Texas Dept of State Health Services BRFSS personal communications for Dallas County Data.
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Table 4. Primary Care Physicians per 100,000 Population27
2013 2013 2015 2015 PCPs PCPs per PCPs PCPs per 100,000 100,000 Travis County 1,035 94.5 1,111 97.0 Dallas County 2,137 87.5 2,237 89.6 Harris County 3,514 81.4 3,831 85.7 Bexar County 1,433 78.9 1,529 81.2 Tarrant County 1,474 77.6 1,581 80.7
Nationally, PCPs are in short supply, and according to the Association of American Medical Colleges (AAMC) total physician demand is expected to increase 17% by 2025. A shortage is expected to persist under every likely scenario, resulting in increased use of advanced practice nurses, greater use of alternate settings such as retail clinics, delayed physician retirement, rapid changes in payment and delivery, and other modeled scenarios.28
IMMUNIZATIONS Healthy People 2020 goals call for increasing immunization rates and reducing preventable infectious diseases. Dallas County is working to support the nation’s public health goals that focus on reducing illness, hospitalization, and death from vaccine-preventable diseases and other infectious diseases.
CHILDHOOD IMMUNIZATIONS Dallas does not appear to have experienced the high rate of unvaccinated children for conscientious or religious beliefs that other parts of the country experience. An April 2016 review of vaccination data by the Dallas Morning News showed that out of the entire Dallas Independent School District student population of more than 160,000 students, only 486, less than one percent, were not vaccinated due to reasons of conscientious or religious belief.29 By the time the children reach school age, almost all are fully vaccinated except conscientious objectors (Table 6).
27 http://www.dshs.texas.gov/chs/hprc/tables/2015/15PC.aspx 28 https://www.aamc.org/download/426260/data/physiciansupplyanddemandthrough2025keyfindings.pdf 29 “Trend of No Vaccines Worries Doctors”. Dallas Morning News. April 14, 2016. http://interactives.dallasnews.com/2016/vaccinations/
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Table 5. 2015/16 School Year Report TX Dept of State Health Services, Region 2/330
Grade Vaccine Name % Kindergarten DTaP 93.7 Kindergarten Hepatitis A 97.0 Kindergarten Hepatitis B 98.0 Kindergarten MMR 2 97.7 Kindergarten Polio 97.6 Kindergarten Varicella 2 97.0 7th Grade Dtap 97.4 7th Grade Hepatitis B 98.6 7th Grade Meningococcal 97.6 7th Grade MMR2 98.7 7th Grade Polio 98.6 7th Grade Varicella 2 96.4
Table 6. 2013 Immunizations, Childcare Attendees Age 19-59 Months, Region 2/3
Vaccine Name % Vaccinated DTaP 88.0 Polio 97.5 MMR 93.4 Varicella 93.1 Hepatitis B 91.0 HIB 97.4 PCV 86.7 Hepatitis A 71.3 4:3:1:3:3:1:4^ 75.1
^≥4 doses of diphtheria and tetanus toxoids and acellular pertussis (DTaP) vaccine, ≥3 doses of poliovirus (Polio) vaccine, ≥1 dose of any measles-mumps-rubella (MMR) vaccine,≥3 doses of Haemophilus influenza (Hib) vaccine of any type, ≥3 doses of hepatitis B (HepB) vaccine, ≥1 dose of varicella (Var) vaccine, and ≥4 doses of pneumococcal conjugate vaccine (PCV).
Chickenpox cases in the United States dropped 84% between 2000 and 2012 following routine use of the varicella vaccine. Updated figures recently published by the CDC also show that in the four years after a two-dose vaccine was recommended for children in 2006, cases of chickenpox declined about 70%. The biggest drop occurred in children between the ages of 5 and 9 (Steele, 2012; CDC, 2015). However, increases in pertussis are blamed on unvaccinated and under vaccinated population.31
30 Ibid: Region 2/3 includes Dallas County and 47 other counties. 31 Phadke VK, Bednarczyk RA, Salmon DA, et al. Association between vaccine refusal and vaccine-preventable diseases in the United States: a review of measles and pertussis. JAMA 2016 Mar 15;315(11):1149-58
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ADULT IMMUNIZATIONS It is recommended that all adults age 18 and older receive an annual flu vaccine and adults age 65 and older receive one lifetime dose of pneumonia vaccine. From 2007 to 2014 in Dallas County, adults receiving the annual flu vaccine increased annually. The percentage receiving the pneumonia vaccine remained relatively stable with a slight increase from 70.3% in 2007 to 71.6% in 2014
MORTALITY DUE TO FLU/PNEUMONIA
The 2014 Dallas County age adjusted death rate due to flu/pneumonia was 14.55 per 100,000 population. The mortality rate ranged from 7.7 per 100,000 population in Cedar Hill to 25.4 per 100,000 population in South Dallas.32 Figure 21. Mortality Rates Due to Flu/Pneumonia
Figure 19. Adults 65+ who have had a Pneumonia Vaccine33
32 Texas Dept. of State Health Services Bureau of Vital Statistice, Death Record Database, Calculated by Parkland Health & Hospital System Population Medicine Dept. 33 Texas Dept of State Health Services BRFSS Survey prepared for Dallas County.
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Figure 20. Dallas County Flu/Pneumonia Mortality Rate
REFUGEE IMMUNIZATION Dallas County is a designated refugee resettlement site, where refugees and Dallas County residents have differing innate immunity and vaccination rates. Refugee immunizations serve to protect refugees from illnesses prevalent in the United States while protecting Dallas County residents from illnesses spread by refugees who may have innate immunity34.
Nineteen percent (19%) of refugees that resettled in Texas settled in Dallas County in 2014. Dallas County received 2,428 arrivals, a 5% increase form 2013. These refugees originated from 37 countries. The major countries of origin for Dallas County refugees are Burma, Iraq, Afghanistan, Bhutan, and Somalia. Dallas County had a lower percentage of refugees receiving health screenings at 75% compared to Harris County at 97%.
34 Immunization Report Card, 2010. Dallas County Health and Human Services – Preventative Division
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Figure 21. Texas Refugee Health Program Arrivals by Resettlement County, CY 201435
Figure 22. Texas Refugee Health Program Screening Rate by Resettlement County, CY2014
35 Texas Dept of State Health Services Refugee Health Program.
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Tuberculosis Between 2007 and 2014, the tuberculosis case rate in Dallas County has been consistently higher than found in Texas The number of annual TB cases decreased by 42% from 1993 to 2014 in Dallas County. The percentage of cases that are foreign born compared to U.S. born has increased from 1993 to 2014 The proportion of TB cases occurring in persons experiencing homelessness has decreased since 2012
Figure 23. Tuberculosis Case Rate36
COMMUNICABLE DISEASES The prevention and control of infectious diseases involves dealing with a variety of pathogens, each of which pose a specific threat to the health of Dallas County residents. The Centers for Disease Control and Prevention identify three critical elements for public health efforts to address communicable diseases: strong public health fundamentals, high-impact interventions and sound health policies.
When compared to Texas, Dallas County has lower incidence rates for four notifiable communicable diseases: campylobacteriosis, cryptosporidiosis, pertussis, and salmonellosis. Cryptosporidiosis is a bacterial intestinal parasite acquired through contaminated water or food. It typically runs its course over two weeks unless the patient is immuno-compromised, in which case it can be life threatening.
The following table presents incidence rates of select bacterial diseases and enteric diseases and zoonotic diseases in Dallas County for 2014.
36 Texas Dept of State Health Services 2014 Annual TB Report.
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Table 7. Communicable Disease Rates, Cases per 100,000 Population, 201437
Campylobacteriosis Cryptosporidiosis Pertussis Salmonellosis County Cases Rate Cases Rate Cases Rate Cases Rate Collin 76 7.5 14 1.4 145 14.2 94 9.2 Dallas 230 9.1 29 1.1 192 7.6 316 12.5 Denton 46 5.5 7 0.8 102 12.2 119 14.2 Ellis 14 7.6 0 0.0 15 8.2 25 13.6 Rockwall 8 7.2 2 1.8 16 14.4 13 11.7 Tarrant 214 10.6 37 1.8 467 23.1 351 17.3
SEXUALLY TRANSMITTED DISEASE IN DALLAS COUNTY
Chlamydia is the most commonly reported sexually transmitted disease in Dallas County with 15,341 cases diagnosed in 2015. Since 2008, there has been a 9% increase in reported chlamydial infections, which may be due to expanded and more sensitive diagnostics tests. The Dallas County rate of Chlamydia is 600.8 per 100,000 population, well above the State of Texas rate of 486.4 per 100,000.38
Figure 24. Dallas County New Chlamydia Cases per 100,000 Population
37 Texas Dept of State Health Services 2014 Annual Report 38 Texas STD Surveillance Report. 2015. Texas Department of State Health Services, TB/HIV/STD Epidemiology and Surveillance Branch. Retrieved from https://www.dshs.texas.gov/hivstd/reports/STDSurveillanceReport.pdf
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In 2015 there were 5,334 cases of Gonorrhea reported in Dallas County, a 1.4% increase from 2008. The Dallas County rate of Gonorrhea in 2015 was 208.9 per 100,000 population, greater than the Texas rate of 136.5 per 100,000.
Figure 25. Dallas County New Gonorrhea Cases per 100,000 Population
Between 2008 and 2015 Syphilis had a 29% increase in the number of reported cases. The Dallas County rate of Syphilis in 2015 was 62.3 per 100,000 population, greater than the Texas rate of 30.5 per 100,000. Syphilis symptoms in adults are divided into four stages; primary, secondary, latent, and late syphilis. In 2014, 89% of primary and secondary cases occurred in males.
Figure 26. Dallas County New Syphilis Cases per 100,000 Population
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In 2015, Dallas County had the second highest estimated number of residents living with HIV or AIDS in the State of Texas at 16,387, following Harris County at 23,846. Although new cases of HIV/AIDS have declined over the last ten years, incidence rates among African American men and women remain disproportionately higher in Dallas County, similar to trends observed larger urban areas in the U.S.39
Figure 27. Dallas County New HIV Cases per 100,000 Population
Figure 28. Dallas County New AIDS Cases per 100,000 Population
39 Texas HIV Surveillance Report. 2015. Texas Department of State Health Services, TB/HIV/STD Epidemiology and Surveillance Branch. Retrieved from https://www.dshs.texas.gov/hivstd/reports/HIVSurveillanceReport.pdf
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ASTHMA AND RESPIRATORY DISEASES Asthma is a chronic inflammatory disorder of the airways characterized by episodes of reversible breathing problems. These episodes can range in severity from mild to life threatening. In 2015 there were an estimated 217,879 Dallas County residents with asthma, accounting for over 14,000 emergency room visits and 25 deaths. COPD is a preventable and treatable disease characterized by airflow limitation that is not fully reversible. The airflow limitation is usually progressive and associated with an abnormal inflammatory response of the lung to noxious particles or gases (typically due to cigarette smoke).
Figure 29. Estimated Asthma Prevalence Rate by ZIP Code, 2015
The hospitalization data for both adult asthma and pediatric asthma reflect disparities in some communities in Dallas County. Although the County rate is 12 hospitalizations per 100,000 for adults the rates among Dallas County market segments range from 4.9 in Southwest Dallas to 28.0 in South Dallas. The Dallas County pediatric asthma rate is 125.9 per 100,000 with market segment rates ranging from a low of 50.9 in Grand Prairie to a high of 250 in South Dallas.
Hospitalization data for COPD also reflects differences between the County rate and the rates of some market segments. The County rate for COPD hospitalizations is 202.5 per 100,000 and market segment rates range from 128.6 in Cedar Hill to 328.8 per 100,000 sex-age adjusted discharges in South Dallas.
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Figure 30. Pediatric Asthma and Chronic Pulmonary Disease Hospitalizations, 2014
Figure 31. Pediatric Asthma and Chronic Pulmonary Disease Hospitalizations, 2014
CANCER Cancer mortality rates vary across the county, based on important factors such as stage at diagnosis, prevalence of risk factors, and race. Although the continual advances in research, detection and treatment of cancers continue to decrease national incidence rates, cancer remains a leading cause of death nationwide and in Dallas County.
Of the four most common types of cancer, prostate cancer had the highest five year aggregate incidence rate at 112.3 cases per 100,000 Dallas County residents between 2009 and 2013. The five year
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aggregate incidence rate for lung cancer was 56.0 per 100,000 residents but had the highest five year aggregate mortality rate at 42.7 per 100,000 residents.
Figure 32. Cancer Incidence and Mortality Rates for Top Four Tumor Sites, Dallas County, 2009-2013
The following chart illustrates a clearer picture of current cancer cases in Dallas County. The Texas Department of State Health Services expects 9,443 new cancer diagnoses in Dallas County for the year 2015.40 Breast cancer is expected to account for 15% of new cancer cases followed by prostate cancer and lung cancer at 12% each, and blood cancers at 10%. Although lung cancer will account for 12% of new cancers it is expected to be responsible for more than a quarter of all cancer deaths in the county.
Figure 33. Expected New Cancer and Cancer Deaths, Dallas County, 2015
40 Texas Department of State Health Services 2015, Texas Cancer Registry, 2015
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Between 2009 and 2013, Black men and women were more likely than other racial and ethnic groups to be diagnosed with one of the top four cancers and die as a result. This disparity is evident when comparing the incidence and mortality rates for prostate cancer, lung and colorectal cancer between Black men and women and other racial and ethnic groups. Figure 34. Cancer Incidence and Mortality Rates by Race/Ethnicity, Dallas County, 2009-2013
Figure 35. Estimated Breast Cancer Prevalence, 2015
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Figure 36. Estimated Colorectal Cancer Prevalence, 2015
As we continue to advance patient-centered care, efforts should be made to share the importance of cancer screenings. Research shows that a recommendation from a health care provider is the most important reason patients cite for having cancer screening tests.41
In Dallas County, the percentage of women age 40 and over who had mammograms in the past two years decreased from 2010 to 2014. Cervical cancer screening: The percentage of Dallas County women 18 years of age and older who had a Pap test in the past three years increased by 7.2 percentage points from 2010 and 2014 to 83.9%. Colorectal cancer screening: The percentage of Dallas County adults who have ever had this screening increased by 3.7 percentage points between 2010 and 2014.
41 Schueler KM, Chu PW, Smith-Bindman R. Factors associated with mammography utilization: A systematic quantitative review of the literature. J Women’s Health. 2008 Nov;17(9):1477–98.
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Figure 37. Cancer Screening Test in Dallas County
SUSAN G. KOMEN FOR THE CURE
Dallas County is the headquarters of the international breast cancer foundation, Susan G. Komen for the Cure. The 2010 Dallas County affiliate “Community Profile Report” provides insight into breast cancer incidence and mortality along with key priorities for increased screening and early detection, particularly in communities with high mortality rates. The Profile Report states,
“Komen Dallas County has a history of seeking to serve the residents of South Dallas through its community grants and outreach initiatives. In the last Affiliate Community Profile published in 2011, zip codes 75210, 75215, 75216, 75232, and 75241 were identified target areas for the Affiliate’s mission- based efforts. The most recent data available indicates that these five zip codes, in addition to the remaining areas in the community of South Dallas, continue to experience disparities related to breast cancer diagnosis and death.”
DIABETES The three main types of diabetes are Type 2, Type 1, and gestational diabetes. They affect thousands of Dallas County residents, are a significant cause of death (though Dallas County’s rate is below that of the state of Texas) and cause significant lifestyle challenges for many residents of the county. Diabetes is the 7th leading cause of death. Nearly 25% of Americans with diabetes are undiagnosed, and 57 million have blood glucose levels that increase the risk of developing this condition in the next few years. Diabetes lowers life expectancy by up to 15 years, increases the risk of heart disease by 2 to 4 times and is the leading cause of kidney failure, lower limb amputation, and adult onset blindness.42 Dallas County’s estimated diabetes prevalence is 11%, matching the State of Texas. In comparison, Bexar County’s diabetes prevalence rate sits at 13%, Harris County at 11%, Tarrant County at 10%, Travis County at 8%. In the State of Texas African Americans and Hispanics are twice as likely to die from diabetes related causes than Caucasians.
42 Office of Disease Prevention of Health Promotion. Healthy People 2020, Diabetes. Retrieved July 25, 2016.
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Figure 38. Estimated Diabetes Prevalence per 1,000 Population, 2015
Table 8. Age- Adjusted Rates per 100,000 for Preventable Diabetes Hospitalizations, 2014
Short Term Short Term Long Term Uncontrolled Lower Extremity Complications Complications Complications Amputation Among (Adult) (Ages 6-17) People with Diabetes
DALLAS COUNTY 76.24 36.03 118.87 13.13 14.38 White non-Hispanic 81.86 57.37 143.03 9.15 18.24 Black non-Hispanic 169.97 319.05 204.68 25.50 22.20 Hispanic 45.86 77.29 147.10 15.85 21.55
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The category of Diabetes Long Term Complications contains some of the most common causes of death due to diabetes, including diabetic kidney disease and heart disease related to or exacerbated by diabetes. Wilmer Hutchins Seagoville, South Dallas, and Southwest Dallas currently have some the highest mortality rates. In 2004, Cedar Hill had the highest diabetes mortality rate in the County and had the largest decrease - 18.2 points – over a ten year period.
Figure 39. Health Outcomes: Diabetes Mortality Rate per 100,000 Population
HEART DISEASE AND STROKE Heart disease is the leading cause of death in the United States. Stroke is the third leading cause of death in the United States. Although these two health challenges are among the most widespread and costly facing the nation as well as Dallas County, they are also among the most preventable. There are several controllable risk factors that contribute to cardiovascular disease:
High blood pressure/Hypertension High cholesterol Cigarette Smoking Diabetes Poor diet and physical inactivity Overweight and obesity
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Figure 40. Heart Disease Mortality Rates
Figure 41. Age Adjusted Heart Disease Mortality Rate per 100,000
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PREVENTABLE HOSPITALIZATIONS
Prevention quality indicators (PQI) identify hospitalizations that could have been prevented. They help identify populations with unchecked risk factors and barriers to treatment at the appropriate level. South Dallas has the highest Congestive Heart Failure PQI rate, 626.2 per 100,000. This is followed by Grand Prairie and South East Dallas. The service areas with the lowest PQI rates are North Dallas and North West Dallas. South Dallas has the highest Hypertension PQI rate, 147.2 per 100,000. This is followed by DeSoto Lancaster and North East Dallas. The service areas with the lowest PQI rates are Stemmons Corridor, and North Dallas. Grand Prairie has the highest Angina without procedure PQI rate, 13.0 per 100,000. This is followed by North East Dallas, Stemmons Corridor and Southwest Dallas. The service areas with the lowest PQI rates are North West Dallas and Outer North East Dallas.
Figure 42. Preventable Hospitalization Rates by Service Area
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MATERNAL-FETAL HEALTH Social determinants and inequities have an impact on the health of mothers and their children. Preconception health status, age, access to appropriate preconception and interconception health care, as well as the challenges of poverty, all play an important role in maternal, child and fetal health in Dallas County. The infant mortality rate in Dallas County increased in 2014 to 7.43. In comparison the 2013 national infant mortality rate was 5.96 and in 2012 the rate for the State of Texas was 5.8. The market segments with the highest rate of infant mortality in 2014 were South Dallas, Cedar Hill and Grand Prairie.43
43 Texas Department of State Health Services. (2016). 2014 Texas vital statistics. Retrieved from http://www.dshs.texas.gov/chs/vstat/vs14/data.aspx#birth
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Figure 43. Health Outcomes: Birth Outcomes, Infant Mortality Rate per 1,000 Live Births, 2014
Figure 44. Infant Mortality Rate by Year, Dallas County44
44 Texas Department of State Health Services. (2016). 2014 Texas vital statistics. Retrieved from http://www.dshs.texas.gov/chs/vstat/vs14/data.aspx#birth
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Figure 45. Health Outcomes: Birth Outcomes, Very Low Birth Weight Rate, 2014
Infants with a birth weight under 1,500 grams are at serious risk for complications, delayed development and death. Some causes of Very Low Birth Weight births can be addressed by early and frequent prenatal care.
Not only are babies born to teenaged mothers (age 15-19) more likely to have low birth weight, they are also at greater risk of living in poverty, family instability, having poor nutrition and lower lifetime family income.
Figure 46. Percent of Dallas County Births with No Prenatal Care, 2006-2013
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Timely and frequent prenatal care is necessary to detect and manage problems with pregnancies. The percentage of women who delivered a live birth in Dallas County without ever getting prenatal care has increased since 2006. The percentage of mothers had prenatal care in the first trimester increased slightly during the same time period.
Figure 47. Dallas County Births with no Prenatal Care in the First Trimester45
TEENAGE BIRTHS Teen birth rates in the U.S. have been in decline for decades and currently hold a rate of 27.0 per 1,000. Although all states have seen success in lowering this statistic, the State of Texas still has one of the highest teen birth rates in the country, at 41.0, falling only behind five other states; Arkansas – 43.5, New Mexico – 43.3, Oklahoma – 42.9, and Mississippi – 42.6.46 Although teenage pregnancy in Dallas County has been on the decline, the teen pregnancy rate of 50.5 per 1,000 women age fifteen to nineteen is still relatively high. Within Dallas County there are ZIP codes at both ends of the spectrum with areas in the City of Rowlett that have teen pregnancy rates as low as 7.0 and areas within the City of Dallas with rates as high as 113.0. Figure 48 illustrates a four year 30% decrease in teen births in Dallas County and Figure 49 highlights five ZIP codes with the highest teen pregnancy rates.
45 Texas Department of State Health Services. (2016). 2014 Texas vital statistics. Retrieved from http://www.dshs.texas.gov/chs/vstat/vs14/data.aspx#birth 46 Kaiser Family Foundation, 2014. Teen birth rate per 1,000 population ages 15-19. State Health Facts. Retrieved online from http://kff.org/other/state-indicator/teen-birth-rate-per-1000/
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Figure 48. Dallas County Teen Birth47
Figure 49. Dallas County Births to Women Age 15-19 per 1,000 Women Age 15-19, 2015
47 Dallas Fort-Worth Hospital Council, 2015. State reported inpatient data – Qlikview.
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NEW COALITION TARGETS TEENAGE PREGNANCY IN DALLAS A new coalition of researchers and nonprofits has vowed to address the problem of teen pregnancy. The North Texas Alliance to Reduce Teen Pregnancy plans to target five ZIP codes in Dallas County and is aiming to decrease the teen birth rate by 20% in the next five years. Texas Women’s University is helping to lead the coalition which received a $5 million grant from the U.S. Department of Health and Human Services. The five ZIP Codes that are being targeted, 75215, 75216, 75203, 75212, and 75220 have births rates of 113, 108, 96, 90, and 84, respectively.48 Figure 50. North Texas Alliance to Reduce Teen Pregnancy Target ZIP Codes
TEXAS TO OFFER FREE BIRTH CONTROL TO LOW INCOME TEENAGERS A new program from the Texas Health and Human Services Commission aims to consolidate programs that provide family planning, reproductive health care, and cancer screenings to low income teenagers in order to reduce the teen pregnancy rate. The new Healthy Texas Women program will expand access to 5,000 health providers and provide free birth control to low income teenagers with a family income less than 200% of the federal poverty level. Teenagers in the program must have parental consent to receive free birth control. It is worth noting that Texas teenagers enrolled in Medicaid can already get free birth control with no parental consent.
48 Hacker, H. (2015). Group targets 5 dallas zip codes with ‘alarming’ teen birth rates. The Dallas Morning News. Retrieved July 19, 2016 from http://www.dallasnews.com/news/metro/20150923-groups-target-5- dallas-zip-codes-with-alarming-teen-birth-rates1.ece
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The new program is likely to include long acting reversible contraception (LARC), such as intrauterine devices and hormonal implants. Although these methods are more expensive than traditional hormonal contraception, they are recommended by physician groups because they are highly effective, can last up to 12 years, remove human error, and are less costly in the long term. Some health insurance plans pay the full cost of LARC devices, while other women pay up to $1,000 out of pocket. In 2013, 93 federally funded clinics in Texas provided free or reduced cost contraception to teenagers without parental consent, and about 8% of teenagers chose a LARC device.49
TEXAS SEES DRAMATIC INCREASE IN PREGNANCY RELATED DEATHS Between 2010 and 2014 the rate of Texas women dying of pregnancy-related causes nearly doubled. Although the rest of the country experienced an increase, no other state has had as sharp an increase as Texas. From the year 2000 to 2010 Texas had a moderate increase in maternal mortality, followed by a doubling within a two year period between 2011 and 2012. Maternal mortality is considered rare in the U.S. however this sharp increase is alarming and health experts are not sure why it happened. A future study examining Texas data by race-ethnicity and detailed causes of death will help to understand this recent phenomenon.50
Figure 51. State of Texas Maternal Mortality Rate
49 Martin, B. 2015. State to offer free birth control to low-income teenagers. The Dallas Morning News. Retrieved online from http://www.dallasnews.com/news/state/headlines/20150924-state-to-offer-free-birth- control-to-low-income-teenagers.ece 50 MacDorman, M. (2016). Recent increases in the U.S. maternal mortality rate. Obstetrics and Gynecology.
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BEHAVIORAL HEALTH – MENTAL HEALTH AND SUBSTANCE USE DISORDERS Behavioral health disorders are among the most common causes of disability. Substance abuse has a major impact on individuals, families and Dallas County as a whole. The effects of substance use disorders are cumulative, significantly contributing to a variety of other problems including homelessness, HIV/AIDS, other STDs, domestic abuse, motor vehicle crashes, crime, homicide and suicide.
Figure 52. Suicide Mortality Rates, Dallas County 2013
The percentage of adolescents experiencing a major depressive episode in Texas increased from 8% (US = 8.1%) in 2010 to 11.2% (US = 11.0%) in 2014. Past-Year Serious Mental Illness for adults in Texas is on track to surpass the national average having increased from 3.4% (US = 3.9%) in 2010 to 4.1% (US = 4.1%) in 2013.51 Adult mental health patients reporting improved functioning from treatment received in the public mental health system was only 45.9% as opposed to a national average of 70.9%.
51 Texas Barometer 2015. SAMHSA.http://www.samhsa.gov/data/sites/default/files/2015_Texas_BHBarometer.pdf
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Figure 53. Alcohol-Attributable Death Rates by Zip Code, 2013
Alcohol-attributable deaths are also disparately spread throughout the county with a rate as high as 96.2 per 100,000 in the 75215 zip code to rates of 29 per 100,000 and below in Northeast Dallas and far north and west areas of the county.
VIOLENCE AND INJURIES Most events that result in injury, accidental disability or death are predictable and preventable. It is important to understand all the factors contributing to injury and violence to effectively gather information and understand the problem: Individual behaviors, physical environment, lack of access to services and the social environment are all factors that influence the risk of unintentional injury and violence.
Homicide rates are likely to be higher in geographies where there are greater socioeconomic disadvantages. Approaching homicide from the public health perspective and treating it as a preventable death allows for the development of strategies that influence the contributing factors.
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Figure 54. Health Outcomes: Homicide Rates
Figure 55. Injury Related and Non-Injury Ed Visits by Dallas County Residents 2013-15
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Even more than hospitalizations, Emergency Department visit data give us a picture of the burden of injury on Dallas County residents. Out of nearly ¾ million ED visits annually, around 20% are the result of injuries. Auto accidents, assaults, burns, falls, and poisonings are major contributors to this statistic. Fall injuries, in particular, can be directly attributed to death and diminished quality of life for seniors.
Figure 56. Rate of Deaths due to Falls, Dallas County Age 65+, 2008-14
ENVIRONMENTAL HEALTH FACTORS The Healthy People 2020 Environmental Health objectives focus on 6 themes, each of which highlights an element of environmental health:
1. Outdoor air quality 2. Surface and ground water quality 3. Toxic substances and hazardous wastes 4. Homes and communities 5. Infrastructure and surveillance 6. Global environmental health
Dallas has generally higher air and water quality than many communities around the country. There are pockets of challenges with toxic substances and hazardous wastes, but not out of the norm for similar communities. Indoor air pollution, high outdoor temperatures, inadequate sanitation, structural problems, fire hazards and hazards from lead-based paint all have been identified as challenges in Dallas County and should be addressed to improve health.
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PUBLIC HEALTH SYSTEM ASSESSMENT
The Local Public Health System Assessment (LPHSA) focuses on all of the organizations and entities that contribute to the public’s health. The LPHSA answers the questions, “What are the components, activities, competencies, and capacities of the Dallas County health system?” and “How are the Essential Services being provided to our community?” This public health system includes not only Dallas County Health and Human Services and Parkland Health & Hospital System, but other hospitals and healthcare providers as well as a variety of governmental and non-governmental entities that contribute to the system of care.
Figure 57. Public Health System
While Dallas has a large number of healthcare providers, ensuring that both primary care and specialty services (including behavioral health services) are available to individuals, access continues to be a challenge.
Health Professional Shortage Areas (HPSA) are designated by the Health Resources and Services Administration (HRSA) to identify areas where more healthcare professionals of a certain type are needed and to provide incentives for healthcare professionals to be hired in those areas. Dallas County has 35 HPSA designations: Primary Care (14), Mental Health (8) and Dental Health (13). These designations vary from needs based on geographic area to needs identified in federally qualified health centers, tribal populations, or correctional facilities.
Dallas County trains most of its own doctors with undergraduate and graduate medical education programs operating within the county. This bolsters efforts to increase access to qualified primary care providers, however, with an aging workforce and population growth, challenges remain with significant gaps in critical areas. Your health depends on where you live in Dallas County.
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COMPARISON TO PEER COUNTIES The CDC’s Community Health Status Indicator (CHSI) gives us a lens to look at the key health indicators in Dallas County and compare to other counties through the CHSI Summary Report. The only indicator listed in which Dallas performs in the top quartile of its peer counties in the country is the rate of adult binge drinking. On the majority of the indicators, Dallas performs in the middle two quartiles for its peer counties in the country. In each of the key areas (i.e. Mortality, Morbidity, Health Care Access and Quality, etc.), Dallas County has one or more indicators where it performs in the lowest quartile of its peer counties. Morbidity for adult diabetes, adult obesity, HIV, older adult asthma and older adult depression is are particularly stark, as are the cost barriers to care, primary care provider access and the high level of uninsured.
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Figure 58. CDC's CHSI Profile for Dallas County52
52 Dallas County Summary Comparison Report. http://wwwn.cdc.gov/CommunityHealth/profile/currentprofile/TX/Dallas/ CHSI. US Department of Health and Human Services, Centers for Disease Control and Prevention
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FORCES OF CHANGE
The Forces of Change Assessment identifies forces such as legislation, technology and other impending changes that affect the environment in which the community and its public health system operate. This assessment answers two primary questions:
1. What is occurring or might occur that affects the health of our community or the local public health system? 2. What specific threats or opportunities are generated by these occurrences?
On December 17, 2015 the Parkland/Dallas County Health Department Needs Assessment Workgroup held a work session to conduct a Forces of Change Assessment. Approximately 30 individuals participated, representing a wide cross-section of service providers and policy leaders. The following categories were examined and discussed:
Figure 59. Forces of Change Categories Examined
Social •Relationship between individuals and groups
•Resources Economic •Employment •Wealth/Funding
•Policies Political •Laws •Legislative Actions
•Built systems Environmental •Natural systems •Social systems
•Judicial/Justice System Legal •Norms •Values
Ethical •Rules and Standards for conduct and integrity
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Synthesizing and prioritizing these Forces of Change provides the following findings:
Table 9. Forces of Change Summary Forces (Trends, Events, Factors) Threats Posed Opportunities Created Healthcare Coverage - Few providers are taking new - Could be an opening for more patients who have Medicaid, federally qualified health CHIP or plans from the health centers insurance exchange - Many uninsured (falling in the Medicaid gap because Medicaid was not expanded) Income and Wealth Inequalities - Stresses and burdens this adds - The public health system is to an already stressed safety forced to act because of the net increasing inequities - Shrinking tax base to fund services that can address inequities Economic Development in - Are people in poverty being - Smart development efforts Traditionally Poverty-Stricken pushed to the suburbs of the could ensure that there is a Areas county or out of the county by diversity of individuals living in development efforts in their newly developed areas communities53 1115 Waiver - The Waiver has been extended - To establish continued for 15 months. Plans for innovation and benchmarked continuing this past this time programs to expand access period are critical to continue and improve quality for the to serve the poor and vulnerable populations uninsured
HEALTHCARE COVERAGE The Kaiser Family Foundation states that of the 3.1 million individuals nationwide who remain in the coverage gap created by the lack of Medicaid expansion in some states, 25% are in Texas.54 With its combination of a large uninsured population and one of the most limited set of Medicaid eligibility standards in the country Texas has 766,000 people in the coverage gap including 67% people of color, 66% adults without dependent children, 55% female and 69% members of a working family.
53 Kneebone, Elizabeth Brookings Institute. The Growth and Spread of Concentrated Poverty, 2000 to 2008-2012. http://www.brookings.edu/research/interactives/2014/concentrated-poverty#/M10420 54 Garfield, Rachel and Damico, Anthony. The Coverage Gap: Uninsured Poor Adults in States that Do Not Expand Medicaid – An Update. October 23, 2015. http://kff.org/health-reform/issue-brief/the-coverage-gap-uninsured- poor-adults-in-states-that-do-not-expand-medicaid-an-update/
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Figure 60. Gaps in Coverage for Dallas County
Dallas County has one of the largest populations of uninsured individuals in any county in the country at 572,664 (22.9%).
“Currently, in Dallas County, there are 133,000 people that would be Medicaid eligible if we would just take the federal government’s money. Economically, what that would mean to you, it would mean that $1.4 million would be running through medical systems every single day taking care of an additional 133,000 people. The economic impact would be hundreds of millions of dollars more right now just on the impact of those dollars for increased health and decreasing absenteeism, from people just having preventive healthcare”
Dallas County Judge Clay Jenkins
The majority of people in the coverage gap are poor working families. Either they or a family member is employed either part-time or full-time but still living below the poverty line. Any movement to close the coverage gap in Dallas County would not only be a significant force of change for access to care but also improving one of the potential influences of poverty, a significant social determinant of health. Medicaid expansion in any form would be a significant event that would impact the state and the county in a variety of ways and cause realignment of services and public health efforts across the county.
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POVERTY Research has shown a strong relationship between wealth and health. People at the bottom of the income distribution in the United States are over three times more likely to die before the age of 65 than those at the top. Each step down the income scale results in an increase in premature death. This pattern is called the “social gradient”.55 If these disparities continue to increase unabated in the coming years, they will have an increasing impact on the ability of Dallas County to make improvements in public health and population health.
Figure 61. Comparison of Dallas to Other Texas Cities on Economic Measures56
Dallas has a lower median income than San Antonio, Houston, Fort Worth and Austin. The poverty rate in Dallas is also significantly higher than other large cities in Texas. When Dallas Mayor Mike Rawlings launched the Mayor’s Task Force on Poverty in 2014 he said, “Dallas is the poorest rich city in the United States. Poverty is concentrated in this city in deep pockets, and it’s growing denser in those pockets.”
This growth in the density of poverty, concentrated in pockets of Dallas County is deeply concerning as a force of change for the health of Dallas County citizens. The impact that concentrated poverty has on health is well documented, with significant impacts due to unfavorable living and workplace conditions, stress and pollution that affect health across the course of life, including in-utero.
The Task Force on Poverty, with its array of community partners, has the potential to be a positive force for change over the next several years in helping to mobilize Dallas to combat the problem of poverty. Reversing the trend of increasing poverty and increasing concentration of poverty across the county could have a tremendous impact on health.
55 Social Determinants of Health. World Health Organization. http://www.who.int/social_determinants/thecommission/finalreport/key_concepts/en/ 56 Lindenberger, Michael. “How Dallas compares to other Texas cities in poverty, income and housing”. Dallas Morning News. Biz Beat Blog, January 19, 2016. http://bizbeatblog.dallasnews.com/2016/01/how-dallas- compares-to-texas-cities-in-poverty-income-and-housing.html/
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ECONOMIC DEVELOPMENT IN TRADITIONALLY POVERTY-STRICKEN COMMUNITIES Just as conditions in our homes impact our health, conditions in the neighborhoods that surround our homes also have major health influences. Social and economic features of neighborhoods have been linked with mortality, general health status, disability, birth outcomes, chronic conditions, health behaviors and other chronic disease risk factors, as well as mental health, injuries, violence and other important health indicators. A significant force of change in Dallas County in recent years has been the revitalization of poverty-stricken neighborhoods that brings in new business and housing. At the same time, this development displaces individuals who lived in the neighborhood previously to other areas of the city, county or other counties, changing the neighborhoods where they relocate.
“We are so excited to be in this facility. All of the hard work, all of the angst, all of the prayers; all of the financing, the re-financing, the praying for financing – everything that went into this process, father, we’re just so grateful. This neighborhood, this community is in need of a signal and I believe you are sending a signal today.”
A prayer led by the Rev. Donald Parish Jr. of the True Lee Missionary Baptist church during the opening celebration for Parkland’s newest clinic located in the Frazier Courts neighborhood of southeast Dallas
The Fair Park project is one recent example of efforts in Dallas to revitalize communities leading to questions about what happens to those displaced by the development and whether those most in need are being pushed further and further away from employment, services and transportation. The potential for similar projects to impact the overall health and welfare of Dallas County needs to be taken into consideration for public health efforts.
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1115 WAIVER The current Medicaid 1115 Transformation Waiver was set to expire on September 30, 2016. The State of Texas and the Centers for Medicare and Medicaid Services (CMS) struck a deal in May of 2016 to extend the existing waiver an additional 15 months while negotiations continue on the next version of the Waiver. The Regional Healthcare Partnership – Region 9 (RHP-9) is actively working with the Texas Health and Human Services Commission (HHSC) to assist the process. The transition plan was submitted to the (CMS) on March 23, 2015. The Delivery System Reform Incentive Payment (DSRIP) projects must mature beyond their implementation phase to demonstrate outcomes and evaluate which initiatives provide the most promising practices.
The RHP-9 covers three counties (Dallas, Denton & Kaufman) and a population of 3.1 million people, 40% of whom are low income. The projects in RHP-9 center on expanding access, patient impact, collaborations, workforce enhancement, chronic care management and patient navigation. There is great concern that if after the current 15-month extension expires, the waiver is not renewed for an additional five years it will have devastating consequences to the efforts that have been undertaken as part of this initiative. Whether or not the waiver is ultimately renewed after the current temporary extension, it will be a significant force of change for Dallas County and the State of Texas.
BEHAVIORAL HEALTH SYSTEM CHANGES The current mental health and substance abuse infrastructure in Dallas County and the 6 counties surrounding it are in the process of undergoing a major shift in funding and service alignment. Texas is moving from a coordinated Managed Care program for people under 200% of FPL, to an integrated Medicaid managed care program where behavioral health is a component of services offered for patients receiving Medicaid services. North STAR was the public mental health system for people with incomes below 200% FPL which blended mental health and substance abuse services and funding. The funds for Medicaid and Indigent patients needing mental health or substance abuse services as well as some re-entry funds were pulled together into a streamlined system. The transition from NorthSTAR to the integrated Medicaid program will split NorthSTAR into two systems, one system for Medicaid patient s and a separate system for indigent patients. Medicaid patients will be part of the existing Medicaid managed care network, and the Indigent population will be in a separate system managed by the North Texas Behavioral Health Authority. In an effort to coordinate this system, and separate the funding mechanisms, all current NorthSTAR Providers are being encouraged to be credentialed into the Medicaid program to help offset the cost of providing care to the indigent. This would help better allocate the Medicaid patients among current NorthSTAR providers, to assure more of these critical providers can continue to see low income behavioral health patients.
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STRATEGIC ISSUES: TOP 5 HEALTH ISSUES IMPACTING DALLAS COUNTY RESIDENTS
BEHAVIORAL HEALTH • One of the 2013 Horizon Priorities • One of the most discussed topics during key informant interviews • “The system is overwhelmed” • “There aren’t enough resources to meet the need” • “Mental health services are the #1 need by a large margin” • Data for Texas is disturbing • Percent of Adolescents experiencing a major depressive episode in Texas increased from 8% (US = 8.1%) in 2010 to 11.2% (US = 11.0%) in 2014 • Past-Year Serious Mental Illness for adults in Texas is on track to surpass the national average having increased from 3.4% (US = 3.9%) in 2010 to 3.8% (US = 4.2%) in 2014. • Mental health consumers reporting improved functioning from treatment received in the public mental health system was only 45.9% as opposed to a national average of 70.9% in 2014
Figure 62. Years of Potential Life Lost Due to Select Causes, Dallas County 2013
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Figure 63. Drug Attributable Mortality Rates, 2013
WHY BEHAVIORAL HEALTH? Improving behavioral health in Dallas County by helping individuals achieve recovery from mental health and substance use disorders continues to be a significant challenge. A consistent theme during key informant interviews and focus groups was the need for additional psychiatric and substance abuse treatment options for individuals who face these issues every day. Behavioral Risk Factor Surveillance System (BRFSS) data shows that 14 percent of Dallas County residents experienced five or more days of poor mental health in the past 30 days during 2014 and over 8 percent of county residents were taking medication(s) for a mental health or emotional condition.
Adopting behavioral health as a continuing priority for the health of Dallas County would focus attention on developing goals and strategies that will continue to improve community health.
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HEALTH ACCESS • Health care access is one of the most often mentioned items in key informant interviews, particularly with regard to Medicaid Expansion and adequate access to primary care doctors and specialists • Health Insurance coverage is a major determinant of access to health care • Uninsured children and nonelderly adults are substantially less likely to have a usual source of health care or a recent health care visit than their insured counterparts • Access to care is a critical component of the healthcare delivery system. Without an adequate supply of healthcare providers, the provision of care suffers.
WHY HEALTH ACCESS? Health insurance and the lack of healthcare coverage were among the most frequently identified barriers during the CHNA key informant interviews. As medical cost increase across the country, not only are people without health insurance unable to afford necessary medical treatments or prescription drugs, many individuals and families (e.g. those with high deductible plans) are also unable to afford adequate health care. They are also less likely to get routine checkups and regular screenings that allow healthcare providers to catch more serious issues earlier when they are less costly to treat.
Another component of access that is a significant concern is the ratio of primary care physicians and healthcare professionals to the county population, as well as access to certain types of specialty providers, particularly psychiatrists. Developing strategies that increase the number of available providers and grow the base of primary care is an important priority for improving health in Dallas.
Transportation was also identified as a barrier to access. Public transportation is available to most outpatient healthcare facilities. However, direct routes are not always available. For example, if a trip to Parkland Hospital by car is 23 minutes in usual traffic it would be 59 minutes by bus and 1 hour and 5 minutes by light rail. In addition many indigent patients cannot afford public transportation.
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OLDER ADULTS AND AGING POPULATION • The continued improvements in health and health care that lead to people living longer has several implications on public health • Good health is key if older people are to remain independent and play a part in family and community life • Life-long health promotion and disease prevention activities can prevent or delay the onset of non-communicable and chronic diseases, such as heart disease, stroke and cancer • Several key informants expressed concerns about the potential population shift of individuals over 65 in Dallas County who will not be Medicare-eligible. This could present unique challenges to the healthcare delivery system
WHY OLDER ADULTS AND AGING POPULATION? As with many communities around the country, Dallas County is experiencing growth in the aging population and the unique challenges that population presents. Many individuals in the key informant interviews discussed concerns about being able to meet the needs of this population and the planning that will need to be in place to ensure the system is prepared.
Dallas County is seeing a higher rate of chronic kidney disease, osteoporosis and asthma among the Medicare population than the nation at large. These challenges will only increase as the population ages. The system should begin looking at strategies to better manage the challenge.
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COMMUNITY COORDINATION AND CARE PARTNERS • Care coordination is identified by the Institute of Medicine as a key priority with the potential to improve the effectiveness, safety and efficiency of the health care system • Dallas has a wealth of care providers and organizations who support the health care continuum • Key informants often mentioned the potential of organizations in the healthcare system working better together to improve health outcomes for the community • Aligning key priorities and processes could bring significant improvements to the health of Dallas County citizens • Care coordination involves deliberately organizing patient care activities and sharing information among all of the participants concerned with a patient’s care • The main goal of care coordination is to the patient’s needs and preferences in the delivery of high-quality, high-value health care • This means the patient’s needs and preferences are known and communicated at the right time to the right people
WHY COMMUNITY COORDINATION AND CARE PARTNERS? Dallas has an abundance of resources focused on improving the health of the community. Many of the entities who work in healthcare have similar aims and work with similar populations. There have been a number of well-coordinated efforts that have had significant participation from a variety of community partners. Care coordination has long been recognized as an important aspect of high quality, patient- centered care. Much work remains to determine the best means to achieve coordinated care in Dallas County and how care coordination will improve health outcomes. There is a desire within the community of Dallas County to see more efforts at coordination, both in the provision of healthcare services and in the effort to improve population health. Better coordinated care and health improvement efforts could result in improvements in a number of important health metrics in the community and, just as importantly, instill confidence in the citizens of Dallas County that the healthcare system is working for them.
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MATERNAL, INFANT AND CHILD HEALTH • While there are many initiatives in Dallas to seek to reduce infant deaths, pre-term and low- weight births, this is still a critical area of concern • Dallas County has one of the worst infant mortality rates in the state • 45% of excess feto-infant deaths in Dallas County occurred in the Maternal Health/prematurity risk period • Improving the well-being of mothers, infants and children is a Healthy People 2020 objective and an important public health goal for the United States • Pregnancy provides an opportunity to identify existing health risks in women and to prevent future health problems for women and their children
WHY MATERNAL, INFANT AND CHILD HEALTH? Healthy children need healthy parents. The health of the mother – before, during and after pregnancy – has a direct impact on the health of the child. The risk of maternal and infant mortality and pregnancy- related complications can be reduced by increasing access to quality preconception (before pregnancy) and inter-conception (between pregnancies) care. Healthy birth outcomes and early identification and treatment of health conditions among infants can prevent death or disability and enable children to reach their full potential. Unintended pregnancy is also associated with a host of public health concerns. In response, preconception health initiatives have been aimed at improving the health of a woman before she becomes pregnant through a variety of evidence-based interventions.
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CALL TO ACTION
GOALS
Goal 1: Increase Goal 2: Increase Access to Health Goal 5: Increase Access to Preventive Services for Goal 3: Reduce Goal 4: Increase care capacity to address and Specialty Care, Individuals with Infant Mortality in coordination and the health needs of particularly for Low Mental Health and Dallas County care partnerships the aging Income and Other Substance Use population Underserved Disorders
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MEASURING FOR SUCCESS It is important for Dallas County to approach each of these goals in a way that makes measurable progress, below are suggested measures for partner organizations to use in meeting the goals outlined here.
Goal 1: Increase Access to Health Services for Individuals with Mental Illness and Substance Use Disorders - possible measuremnent startegies •Increase the screening and identification of individuals with mental illness and substance use disorders in primary care settings •Increase the number of individuals with mental illness and substance use disorders who are connected to a primary care provider •Increase the number of locations where individuals with mental illness and substance use disorders can access integrated care Goal 2: Increase Access to Preventive and Specialty Care, particularly for Low Income and Other Underserved - possible measuremnent startegies •Reduce wait times for appointments for speciality care •Increase the number of primary care providers who accept Medicaid patients •Increase the number of specialists who take referrals from Medicaid patients Goal 3: Reduce Infant Mortality in Dallas County - possible measuremnent startegies •Increase access and connection of women to clinical preventive services •Increase awareness and education of breastfeeding, family planning, immunizations, safe sleep and smoking cessation •Increase awareness of warning signs of pregnancy complications and infant risks Goal 4: Increase Care Coordination and Care Partnerships - possible measuremnent startegies •Increase number of entitities participating in coordination of care plans outside their entity •Increase the number of collective action partnerships currently acting on health issues Goal 5: Increase Capacity to Address the Health Needs of the Aging Population - possible measuremnent startegies •Increase the number of aging citizens who utilize preventive services •Increase screening of aging population for depression •Increase the number of interventions being used in Dallas County to specifically address the needs of aging citizens
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STRATEGIES FOR CHANGE
GOAL 1: INCREASE ACCESS TO HEALTH SERVICES FOR INDIVIDUALS WITH MENTAL ILLNESS AND SUBSTANCE USE DISORDERS Examples of possible strategies under this goal include:
Care coordinators for individuals with mental illness and substance use disorders Screening to identify individuals with mental health and substance use disorders early In-school training programs for teachers and staff regarding children with mental health diagnosis Faith-based training programs for faith leaders and staff regarding children with mental health diagnosis
GOAL 2: INCREASE ACCESS TO PREVENTIVE AND SPECIALTY CARE, PARTICULARLY FOR LOW INCOME AND OTHER UNDERSERVED Examples of possible strategies under this goal include:
Programs to increase connections to preventive services for the underserved Targeted interventions for populations that have identified barriers (ESL, LGBT, etc.) Address populations with low vaccination rates (i.e. homeless, recent immigrants and socially isolated adults) Address response to cancer diagnosis in high-risk communities
GOAL 3: REDUCE INFANT MORTALITY IN DALLAS COUNTY Early identification of pregnant women and follow-up to increase access to prenatal care Public education campaigns specifically tied to care for pregnant women and young parents Maternal and infant health community screenings
GOAL 4: INCREASE CARE COORDINATION AND CARE PARTNERSHIPS Develop alliances that address specific diseases and/or populations which involve many partners Additional Accountable Care Organizations (ACOs) and Accountable Health Communities (AHCs) Develop additional Clinically Integrated Networks
GOAL 5: INCREASE CAPACITY TO ADDRESS THE HEALTH NEEDS OF THE AGING POPULATION Invest in new or expanding programs to train providers in geriatric care Plans to increase the health workforce in areas that are particularly needed to care for the aged Make the Senior Connection more available – a multi-hospital collaborative effort to identify and connect senior adults to medical, social and transportation services
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APPENDICES
APPENDIX 1 - SOCIAL DETERMINANTS OF HEALTH
In order to achieve better health, it is imperative that Dallas County residents address the social and environmental factors that influence health. The social and environmental resources that affect health are not evenly distributed and impact different people in Dallas County differently. Changing these social determinants is not only an issue for the healthcare community; it is an issue for all citizens of Dallas County.
Engaging the entirety of Dallas County to address health issues is critical to achieving better health in Dallas County. To do so, stakeholders must engage the entirety of the community to define:
What kind of change is important and meaningful to the community What will work and why What won’t work and why
One aspect of the solution is health promotion in the workplace. Promoting workplace cultures that reduce stress, make nutritious food available in cafeterias, snack areas, vending machines and at meetings, promoting physical activity and other healthful behaviors, is one strategy that will create a culture of health within the workforce.
Throughout the process of developing the Dallas County Community Health Needs Assessment, the stakeholders repeatedly returned to the theme of equity and the key role it plays in health of the citizens of Dallas County. Health inequities are the differences in health that are unnecessary and avoidable which are also considered unfair and unjust. They are separate from health disparities, which are expected differences in health outcomes, disease or access. Often inequities are tied to factors much larger than healthcare itself—the social determinants of health.
Every individual in Dallas County should have a fair opportunity to live a long and healthy life. Health inequities are frequently rooted in historic injustices that make sub-populations more vulnerable to poor health than comparison groups. Addressing these issues from a broad community perspective is a significant challenge that must be undertaken to improve the overall health and well-being of citizens.
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Figure 64. Framework for Social Determinants of Health
57
Ensuring that the natural environment, the built environment, everyday activities, the local economy, the community and individual lifestyles are all contributing in a positive way to the health and well- being of individual citizens of Dallas County will help make significant progress in improving the health of everyone.
A separate section of this document has described poverty in Dallas County. Other social determinants of health include:
food deserts and the availability of healthy food the supply of affordable housing single parent households educational attainment having safe places to be physically active, and Employment and the availability of living wage jobs.
57 Barton, H. and Grant M. (2006). A health map for the local human habitat. The Journal for the Royal Society for the Promotion of Health, 126(6), pp 252-253. ISSN 1466-4240
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Figure 65. Dallas County Food Deserts
Figure 66. Minimum Wage Hours Worked to Afford the Median Rent on a 2 Bedroom Dwelling, 2014
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Figure 67. Single Parent Households
Figure 68. Population Over 25 with no High School Diploma
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Figure 69. Average Weekly Wage
Improving the health of Dallas County residents will include enhancing socioeconomic conditions, which is a greater task than any healthcare system or partner agency can take on. The healthcare community must partner with the political, educational, and business community in order to address these great challenges.
Another significant and relatively unique challenge that has been mentioned by many key informants, committee members and key stakeholders is the problem of stray dogs in specific neighborhoods in Dallas. According to the Dallas-Fort Worth Hospital Council, the number of dog bites treated at hospitals increased from around 5,000 in 2014 to around 6,000 in 2015. The challenge is that the stray dogs are not wild or feral. City officials estimate that 6 out of 7 dogs on the street belong to someone. A variety of approaches are being taken particularly because the concept of “catch and kill” has been shown to be ineffective since pet owners tend to get more animals. The health challenge that stray dogs create in many neighborhoods is fear or outdoor exercise, walking, running or biking. This is an example of a social determinant that cannot be solved by the health system alone. It needs a community-wide approach and will have a significant impact on the health of these neighborhoods if it can be addressed.
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APPENDIX 2 - CULTURAL COMPETENCY
In order to enhance health and social equity in Dallas County, we must understand and promote cultural competence. Cultural competence describes the ability of systems to provide care to patients with diverse values, beliefs and behaviors, including tailoring health delivery to meet patients’ social, cultural and linguistic needs. Cultural competence is both a vehicle to increase access to quality care and a business strategy to attract new patients to a care provider. There are many challenges that get in the way of culturally competent approaches to health-related issues, including lack of diversity amongst the teams who are planning interventions, systems of care that are poorly designed to meet the needs of diverse populations, and poor communication with individuals of different racial, ethnic or cultural backgrounds.
In terms of health care providers, there are national standards for culturally and linguistically appropriate services (CLAS) in health care. The CLAS standards were developed to help provide a common understanding of culturally and linguistically appropriate services. They were also proposed as one method of correcting inequities in the provision of health services and to make healthcare systems more responsive to the needs of every consumer.
Members of the LGBT population are approximately twice as likely to smoke as the general population; indeed, they have some of the highest smoking rates of any sub-population.58 In addition to tobacco use, alcohol and other drug abuse may be more common among LGBT than heterosexual men and women, although there are conflicting studies and some have been prone to problems with methodology. Texas is home to 600,000 LGBT adults and 46,000 same-sex couples; 38% are Latino, 46% are white and 15% are African American.59 It’s estimated that Dallas has 1.68 same-sex couples per 1,000 households.60 It’s important to understand that there are no LGBT-specific diseases, but the disparities that impact this population are significant, stemming from structural and legal factors, social discrimination and a lack of culturally competent healthcare.
58 Lee JGL, Griffin GK, Melvin CL. Tobacco use among sexual minorities in the USA, 1987 to May 2007: a systematic review. Tobacco Control. 2009;18:275-282. 59 LGBT People in Texas. The Williams Institute, UCLA. http://williamsinstitute.law.ucla.edu/wp- content/uploads/Texas-fact-sheet.pdf 60 Comparing LGBT Rankings by Metro Area: 1990 to 2014. The Williams Institute, UCLA. March 2015. http://williamsinstitute.law.ucla.edu/wp-content/uploads/Comparing-LGBT-Rankings-by-Metro-Area-1990- 2014.pdf
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APPENDIX 3 – HEALTHY PEOPLE 2020 DALLAS COUNTY STOP LIGHTS
Dallas County Most Recent Dallas County Compared With Most Recent Data Compared With Healthy People 2020 Goals Historical Data Percent Without
Health Insurance 23% (2014) Physician-to-
Population Ratio 89.6 per 100,000 No Goal (2015)
Hospitalizations for Adult Asthma, Ages 12.0 per 100,000 No goal based on this age range 18-39 Hospitalizations for Chronic Obstructive 202.5 per No goal based on this age range Pulmonary Disease, 100,000 Ages 40+ Hospitalizations for 125.9 per Pediatric Asthma, No goal based on this age range 100,000 Ages 2-17 Dallas County Most Recent Dallas County Compared With Most Recent Data Compared With Healthy People 2020 Goals Historical Data Adult Hospitalizations for 85.1 per 100,000 No goal based on this metric Diabetes Short-Term Complications Adult Hospitalizations for 153.1 per 100,000 No goal based on this metric Diabetes Long-Term Complications Diabetes Mortality 17.8 per 100,000 Rate
Current Smoking 14.6%
Hypertension 27.7% N/A Prevalence
Stroke Mortality Rate 46.1 per 100,000
Heart Disease 179.6 per Mortality Rate 100,000
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Very Low Birth Weight Rate (less 1.6 than 1500 g)
Suicide Mortality 10.0 per 100,000 Rate
Homicide Mortality 8.3 per 100,000 Rate
Motor Vehicle Accident Mortality 9.8 per 100,000 Rate
Rate of ED Visits for 59.5 per 100,000 Injuries
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APPENDIX 4 - HEALTHY PEOPLE 2020 STOP LIGHTS BY REGION Physician-to- Chlamydia Gonorrhea Primary and New HIV No Health Population Incidence Incidence Secondary Incidence Insurance Ratio Syphilis
Cedar Hill Service Area
DeSoto Lancaster Service Area
Grand Prairie Service Area
Irving Service Area
North Dallas Service Area
Northeast Dallas Service Area
Northwest Dallas Service Area
Outer Northeast Service Area
South Dallas Service Area
Southeast Dallas Service Area
Southwest Dallas Service Area
Stemmons Corridor Service Area
Wilmer Hutchins Service Area Stop Lights: Green = in first or second quartile among Dallas County service areas, Yellow = in third quartile among Dallas County service areas, Red = in bottom quartile among Dallas County service areas
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Hospitalizations Hospitalizations for Hospitalizations Overall Female for Adult Chronic Obstructive for Pediatric Cancer Breast
Asthma, Ages 18- Pulmonary Disease, Asthma, Ages 2- Mor- Cancer 39 Ages 40+ 17 tality Mortality
Cedar Hill Service Area
DeSoto Lancaster Service Area
Grand Prairie Service Area
Irving Service Area
North Dallas Service Area
Northeast Dallas Service Area
Northwest Dallas Service Area
Outer Northeast Service Area
South Dallas Service Area
Southeast Dallas Service Area
Southwest Dallas Service Area
Stemmons Corridor Service Area
Wilmer Hutchins Service Area Stop Lights: Green = in first or second quartile among Dallas County service areas, Yellow = in third quartile among Dallas County service areas, Red = in bottom quartile among Dallas County service areas
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Lung Colorectal Adult Hospitalizations Adult Hospitalizations Diabetes Cancer Cancer for Diabetes Short- for Diabetes Long- Mortality
Mortality Incidence Term Complications Term Complications Rate Rate Rate
Cedar Hill Service Area
DeSoto Lancaster Service Area
Grand Prairie Service Area
Irving Service Area
North Dallas Service Area
Northeast Dallas Service Area
Northwest Dallas Service Area
Outer Northeast Service Area
South Dallas Service Area
Southeast Dallas Service Area
Southwest Dallas Service Area
Stemmons Corridor Service Area
Wilmer Hutchins Service Area Stop Lights: Green = in first or second quartile among Dallas County service areas, Yellow = in third quartile among Dallas County service areas, Red = in bottom quartile among Dallas County service areas
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Stroke Heart Disease Infant Very Low Suicide Alcohol- Mortality Mortality Rate Mortality Birth Weight Mortality Attributable Rate Rate Rate Rate Death Rate
Cedar Hill Service Area
DeSoto Lancaster Service Area
Grand Prairie Service Area
Irving Service Area
North Dallas Service Area
Northeast Dallas Service Area
Northwest Dallas Service Area
Outer Northeast Service Area
South Dallas Service Area
Southeast Dallas Service Area
Southwest Dallas Service Area
Stemmons Corridor Service Area
Wilmer Hutchins Service Area Stop Lights: Green = in first or second quartile among Dallas County service areas, Yellow = in third quartile among Dallas County service areas, Red = in bottom quartile among Dallas County service areas
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Rate of ED Years of Drug- Homicide Motor Vehicle Visits for Potential Attributable Mortality Accident Injuries Life Lost Death Rate Rate Mortality Rate (75) Rate
Cedar Hill Service Area
DeSoto Lancaster Service Area
Grand Prairie Service Area
Irving Service Area
North Dallas Service Area
Northeast Dallas Service Area
Northwest Dallas Service Area
Outer Northeast Service Area
South Dallas Service Area
Southeast Dallas Service Area
Southwest Dallas Service Area
Stemmons Corridor Service Area
Wilmer Hutchins Service Area Stop Lights: Green = in first or second quartile among Dallas County service areas, Yellow = in third quartile among Dallas County service areas, Red = in bottom quartile among Dallas County service areas
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APPENDIX 5 - ASSETS AND RESOURCES
Dallas County has a diverse array of valuable assets to utilize in addressing the challenges of improving health for the entire community. From Dallas County Health and Human Services to the hospitals and health systems, to governmental entities and law enforcement, to community non-profits who focus on various aspects of the issues we have examined to every citizen of Dallas County. The amount of resources Dallas County is able to bring to bear to address these issues is substantial and varied. Understanding the variety of assets available is one component of being able to develop comprehensive strategies that encompass these partners and have the greatest potential of success.
In addition to the partners that were credited at the beginning of this assessment, identified here are a number of other assets and resources that could be marshalled to support the efforts of improving the health of Dallas County.
APPENDIX 6 – COMMUNITY ASSETS – BEHAVIORAL HEALTH OUTPATIENT CLINICS
Name City Zip Service Area A.B.O.D.E. Treatment, Inc. Dallas 75223 Southeast Dallas A.B.O.D.E. Treatment, Inc. Dallas 75215 South Dallas A.B.O.D.E. Treatment, Inc. Dallas 75223 Southeast Dallas ABC Behavioral Health Adult Dallas 75228 Southeast Altshuler Center for Education and Research Dallas 75247 Stemmons Corridor Answers of Hope Biblical Counseling Center Dallas 75225 North Dallas Brighter Tomorrow’s Irving 75061 Irving Center for Children with Autism Dallas 75240 North Dallas Center for Children with Autism — DeSoto (CCAM III) DeSoto 75115 DeSoto Lancaster Center for Children with Autism (CCAM I) Dallas 75247 Stemmons Corridor Centro de Mi Salud Dallas 75208 Southwest Dallas Chapel of Hope Ministries, Inc. Dallas 75248 Northwest Dallas Chapter House Counseling Services, LLC Richardson 75080 Outer Northeast Child and Family Guidance Center Dallas 75235 Stemmons Corridor Child and Family Guidance Center Mesquite 75149 Southeast Child and Family Guidance Center (Stephen J. McManus Dallas 75208 Southwest Dallas Family Mental Health Clinic / Oak Cliff) Christian Reform Alliance for Today's Youth (CRAFTY) Dallas 75241 South Dallas Christian Reform Alliance for Today's Youth (CRAFTY) Dallas 75241 South Dallas Concord Counseling Center/Concord Missionary Dallas 75237 South Dallas Crisis Assistance South Dallas After Hours clinic Dallas 75237 South Dallas DALLAS BEHAVIORAL HEALTHCARE HOSPITAL LLC DESOTO 75115 DeSoto Lancaster Dallas Challenge, Inc. Dallas 75208 Southwest Dallas Dallas Challenge, Inc. Dallas 75208 Southwest Dallas Dallas County Juvenile Probation Department Dallas 75212 Southwest Dallas
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DALLAS METROCARE SERVICES LANCASTER KIEST Dallas 75216 South Dallas DALLAS METROCARE SERVICES MIDWAY ADDISON 75001 Northwest Dallas DALLAS METROCARE SERVICES SKILLMAN Dallas 75243 Northeast Dallas DALLAS METROCARE SERVICES THE BRIDGE Dallas 75201 Stemmons Corridor Dallas Sigma Counseling Services, Inc. CARROLLTO 75006 Northwest Dallas N David P. Maida Dallas 75211 Southwest Dallas DSM Eastside Family Clinic Child 5+ / adol Dallas 75228 Southeast Enterhealth Outpatient Services, LLC Dallas 75225 North Dallas First Step Counseling ADDISON 75001 Northwest Dallas First Step Counseling Dallas 75208 Southwest Dallas GARLAND BEHAVIORAL HOSPITAL GARLAND 75042 Northeast Dallas Genesis Garland/Mesquite Dallas 75228 Southeast Dallas GENESIS OAK CLIFF Dallas 75208 Southwest Dallas Genesis Walnut Hill Dallas 75229 Stemmons Corridor Genesis Women's Shelter Dallas 75219 Northwest Dallas Green Oaks Hospital Dallas 75230 North Dallas GREEN OAKS HOSPITAL DALLAS 75251 North Dallas HICKORY TRAIL HOSPITAL DESOTO 75115 DeSoto Lancaster Hickory Trail Hospital, L.P. Dallas 75088 Outer Northeast Homeless Services at The Stew Pot Dallas 75201 Stemmons Corridor Homeward Bound, Inc. Dallas 75208 Southwest Dallas Homeward Bound, Inc. Dallas 75208 Southwest Dallas I360 TEXAS LLC Dallas 75240 North Dallas LifeNet Community Behavioral Healthcare Dallas 75243 Northeast Dallas LifeNet Community Behavioral Healthcare Dallas 75201 Stemmons Corridor Lifenet Texas — Center & Pharmacy Dallas 75234 Stemmons Corridor Local Intellectual Developmental Disabilities Authority Dallas 75247 Stemmons Corridor (LIDDA Memorial Hermann Prevention and Recovery Center ADDISON 75001 Northwest Dallas Mental Health America Dallas 75204 North Dallas Metro Haven of Love, Inc. Dallas 75215 South Dallas Metrocare at Grand Prairie — Center & Pharmacy Grand Prairie 75051 Grand Prairie Metrocare at Hillside Campus Dallas 75211 Southwest Dallas Metrocare at Midway — Center & Pharmacy Addison 75001 Northwest Dallas Metrocare at River Bend — (Pathways) Center and Dallas 75247 Stemmons Corridor Pharmacy Metrocare at Samuell - Center and Pharmacy Dallas 75228 Southeast Metrocare at Stemmons #151 Dallas 75207 Stemmons Corridor Metrocare at Westmoreland - Center and Pharmacy Dallas 75211 Southwest Dallas Metrocare Services Dallas 75247 Stemmons Corridor Mosaic Family Services Dallas 75204 North Dallas MULTICULTURAL RECOVERY CENTER INC Dallas 75240 North Dallas Name City Zip Service Area
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NAMI Dallas County Dallas 75204 North Dallas New Life Christian Counseling Ministry DALLAS, TX 75211 Southwest Dallas Nexus Recovery Center, Inc. Dallas 75228 Southeast Dallas Nexus Recovery Center, Inc. Dallas 75219 Stemmons Corridor North Texas Behavioral Health Authority Richardson 75080 Outer Northeast Obadiah Gang and Drug Program, Inc. DALLAS, 75230 North Dallas Opportunities Counseling Center, Inc. Dallas 75247 Stemmons Corridor Opportunities Counseling Center, Inc. Grand Prairie 75050 Grand Prairie Phoenix Houses of Texas, Inc. Dallas 75219 Stemmons Corridor Promise House Dallas 75208 Southwest Dallas Psychotherapeutic Services of America, LLC Dallas 75201 Stemmons Corridor Real People Ministries, Inc. DALLAS, 75223 Southeast Dallas Reconciliation Outreach Ministries DALLAS 75204 North Dallas Reconciliation Outreach Ministries DALLAS 75204 North Dallas Recovery Healthcare Corporation Dallas 75247 Stemmons Corridor Red Bird Education Programs, PLLC Dallas 75237 South Dallas RESOURCE CENTER OF DALLAS INC Dallas 75219 Stemmons Corridor Salvation Army, The DALLAS 75235 Stemmons Corridor Solace Counseling Associates PLLC Dallas 75235 Stemmons Corridor Solutions Outpatient Services Dallas 75209 North Dallas Special Needs Offender Program (SNOP Dallas 75216 South Dallas St. Francis Anglican Church, Inc. DALLAS 75214 North Dallas Suicide and Crisis Center Dallas 75204 North Dallas SUNDANCE HOSPITAL DALLAS GARLAND 75042 Northeast Dallas Teen Challenge of North Texas Dallas 75223 Southeast Dallas TEXAS HEALTH BEHAVIORAL HEALTH CENTER GLEN Dallas 75235 Stemmons Corridor LAKES The Addicare Group of Texas Garland 75041 Northeast Dallas The Family Place Dallas 75209 North Dallas THE MEN OF NEHEMIAH INC Dallas 75215 South Dallas The Salvation Army Dallas 75235 Stemmons Corridor The Steven A. Cohen Military Family Clinic at Metrocare Addison 75001 Northwest Dallas TIMBERLAWN MENTAL HEALTH SYSTEM DALLAS 75228 Southeast Dallas TRS BEHAVIORAL CARE INC CARROLLTO 75007 Northeast Dallas N TRS BEHAVIORAL CARE INC Dallas 75231 Northeast Dallas Turtle Creek Recovery Center Dallas 75201 Stemmons Corridor Veterans Affairs Dallas 75216 South Dallas Victim Relief Ministries Richardson 75081 Outer Northeast Violence Intervention and Prevention Program - Parkland Dallas 75235 Stemmons Corridor Hospital Waterford Academy, LLC Richardson 75081 Outer Northeast Wayside Educational and Counseling Center DALLAS 75216 South Dallas WINDHAVEN COUNSELING CENTER LLC ADDISON, 75001 Northwest Dallas
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APPENDIX 7 – COMMUNITY ASSETS – WOMEN’S HEALTH CLINICS Name City Zip Service Area DeHaro-Saldivar Women's Health Center Dallas 75211 Southwest Dallas Garland Women's Health Center Garland 75040 Northeast Dallas Golden Cross Academic Clinic with Methodist Dallas Dallas 75208 Southwest Dallas Grand Prairie Women's Health Center Grand Prairie 75051 Grand Prairie Irving Women's Health Center Irving 75061 Irving Maple Women's Health Center Dallas 75235 Stemmons Corridor Oakwest Women's Health Center Dallas 75224 Southwest Dallas Real Choices Pregnancy Resource Ctr Irving 75062 Irving Southeast Dallas Women's Health Center Dallas 75217 Southeast Dallas Hatcher Station Women's Health Center Dallas 75215 South Dallas Garland Women's Health Center Garland 75040 Northeast Dallas Grand Prairie Women's Health Center Grand Prairie 75051 Grand Prairie Irving Women's Health Center Irving 75061 Irving Lakewest Women's Health Center Dallas 75212 Southwest Dallas Maple Women's Health Center Dallas 75235 Stemmons Corridor Oakwest Women's Health Center Dallas 75216 South Dallas Southeast Dallas Women's Health Center Dallas 75217 Southeast Dallas Vickery Women's Health Center Dallas 75231 Northeast Dallas Women's Health Center Garland 75041 Northeast Dallas Addison Clinic Addison 75254 Northwest Dallas Cedar Hill Health Center Cedar Hill 75104 Cedar Hill Mesquite Clinic Mesquite 75150 Southeast Dallas North Dallas Shelburne Health Center Dallas 75231 Northeast Dallas South Dallas Surgical Health Services Center Dallas 75237 South Dallas BIRTH AND WOMENS CENTER INC DALLAS 75204 North Dallas DALLAS BIRTH CENTER DALLAS 75226 Southeast Dallas MADEWELL WOMAN DALLAS 75204 North Dallas FAMILY CENTERED MATERNITY CARE GARLAND 75041 Northeast Dallas FAMILY BIRTH SERVICES GP 75050 Grand Prairie SPECIAL BEGINNINGS PLLC GP 75050 Grand Prairie LOVERS LANE BIRTH CENTER INC RICHARDSON 75080 Outer Northeast Parkland Hospital Ob/Gyn ICC Dallas 75235 Stemmons Corridor White Rose Women's Center Dallas 75205 North Dallas White Rose Women's Center Dallas 75231 Northeast Dallas
APPENDIX 8 – COMMUNITY ASSETS – PEDIATRIC CLINICS Name City Zip Service Area Balch Springs Well Child Clinic (DCHHS) Balch Springs 75180 Southeast Dallas Center of Hope Women & Children’s Health Clinic Dallas 75235 Stemmons Corridor
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Name City Zip Service Area Children’s Medical Center Bachman Lake - Pediatric Group Dallas 75220 Stemmons Corridor Children’s Medical Center Carrollton - Pediatric Group Carrollton 75007 Northwest Dallas Children’s Medical Center Cedar Hill - Pediatric Group Cedar Hill 75104 Cedar Hill Children’s Medical Center Cockrell Hill -Pediatric Group Dallas 75211 Southwest Dallas Children’s Medical Center Desoto – Pediatric Group Desoto 75115 Desoto Lancaster Children’s Medical Center Garland -Pediatric Group Garland 75040 Northeast Dallas Children’s Medical Center Irving -Pediatric Group Irving 75062 Irving Children’s Medical Center Lake Highlands - Pediatric Group Dallas 75243 Northeast Dallas Children’s Medical Center Lancaster Kiest -Pediatric Group Dallas 75216 South Dallas Children’s Medical Center Mill City - Pediatric Group Dallas 75210 Southeast Dallas Children’s Medical Center Oak Cliff - Pediatric Group Dallas 75211 Southwest Dallas Children’s Medical Center Pediatric Group Medical District Dallas 75207 Stemmons Corridor Children’s Medical Center Pleasant Grove -Pediatric Group Dallas 75217 Southeast Dallas Children’s Medical Center St. Philip's -Pediatric Group Dallas 75215 South Dallas Cockrell Hill Well Child Clinic (DCHHS) Cockrell Hill 75211 Southwest Dallas DISD Parkland Balch Springs Youth & Family Health Center Dallas 75217 Southeast Dallas DISD Parkland Youth & Family - Adamson Dallas 75203 South Dallas DISD Parkland Youth & Family - Amelia Flores Dallas 75228 Southeast Dallas DISD Parkland Youth & Family – Balch Springs Balch Springs 75217 Southeast Dallas DISD Parkland Youth & Family - EBJ Dallas 75215 South Dallas DISD Parkland Youth & Family - Fair Oaks Dallas 75231 Northeast Dallas DISD Parkland Youth & Family - Kiosco Dallas 75229 Stemmons Corridor DISD Parkland Youth & Family - Redbird Dallas 75233 Southwest Dallas DISD Parkland Youth & Family - Seagoville Dallas 75253 Wilmer Hutchins Seagoville DISD Youth & Family - West Dallas Dallas 75212 Southwest Dallas DISD Youth & Family - Woodrow Dallas 75214 North Dallas Farmers Branch Well Child Clinic (DCHHS) Farmers Branch 75234 Stemmons Corridor Foremost Fam Hlth Ctrs/Balch Springs Balch Springs 75180 Southeast Dallas Foremost Fam Hlth Ctrs/Martin Luther King Jr. Family Clinic Dallas 75215 South Dallas Grand Prairie Well Child Clinic (DCHHS) Grand Prairie 75050 Grand Prairie Healing Hands Ministries Dallas 75243 Northeast Dallas Irving Well Child (DCHHS) Irving 75060 Irving John West Well Child (DCHHS) Dallas 75228 Southeast Lancaster Well Child (DCHHS) Lancaster 75134 DeSoto Lancaster Los Barrios Unidos Comm. Clinic - Grand Prairie Grand Prairie 75050 Grand Prairie Los Barrios Unidos Community Clinic, Inc. Dallas 75212 Southwest Dallas Mission East Dallas Dallas 75228 Southeast Dallas Network of Community Ministries Dallas 75081 Outer Northeast Oak Cliff Branch Immunization Clinic and Well Child Dallas 75208 Southwest Dallas
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Name City Zip Service Area Oak West Health Center Dallas 75224 Southwest Dallas Parkland Youth & Family - Vivian Field Farmers Branch 75234 Stemmons Corridor Pediamed Dallas 75217 Southeast Dallas Pediamed Garland 75042 Northeast Dallas Pediatric Primary Care Dallas 75235 Stemmons Corridor Pediatrics After Hours Dallas 75230 North Dallas PediPlace Location#2 Dallas 75248 Northwest Dallas QuestCare Dallas 75243 Northeast Dallas Seagoville Well Child (DCHHS) Seagoville 75159 Wilmer Hutchins Seagoville Vivian Field Family Health Center Farmers Branch 75234 Stemmons Corridor
APPENDIX 9 – COMMUNITY ASSETS – DENTAL CLINICS Name City Zip Service Area Baylor College of Dentistry Dallas 75246 Southeast Dallas Baylor College of Dentistry, Texas A&M Health Dallas 75246 Southeast Dallas Science Center MLK Jr. Family Clinic Dallas 75215 South Dallas Smiley Dental & Orthodontics Garland 75042 Northeast Dallas Smiley Dental & Orthodontics Garland 75043 Outer Northeast Smiley Dental & Orthodontics Irving 75060 Irving Smiley Dental & Orthodontics Mesquite 75150 Southeast Dallas Smiley Dental & Orthodontics Balch Springs 75218 North Dallas Smiley Dental & Orthodontics Dallas 75218 North Dallas Smiley Dental & Orthodontics Dallas 75220 Stemmons Corridor Smiley Dental & Orthodontics Dallas 75224 Southwest Dallas Smiley Dental & Orthodontics Dallas 75227 Southeast Dallas Smiley Dental & Orthodontics Dallas 75234 Stemmons Corridor Smiley Dental & Orthodontics Dallas 75249 Cedar Hill South Texas Dental Garland 75042 Northeast Dallas South Texas Dental Irving 75060 Irving South Texas Dental Dallas 75208 Southwest Dallas South Texas Dental Dallas 75211 Southwest Dallas South Texas Dental Dallas 75216 South Dallas South Texas Dental Dallas 75217 Southeast Dallas South Texas Dental Dallas 75220 Stemmons Corridor South Texas Dental Dallas 75228 Southeast Dallas South Texas Dental Dallas 75231 Northeast Dallas South Texas Dental Dallas 75237 South Dallas Community Dental Center Dallas 75204 North Dallas
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Name City Zip Service Area Community Dental Center Dallas 75231 Northeast Dallas Community Dental Center Farmers Branch 75234 Stemmons Corridor Los Barrios Unidos Community Clinic, Inc. Dallas 75212 Southwest Dallas Mission East Dallas Dallas 75228 Southeast Dallas Healing Hands Ministries Dallas 75243 Northeast Dallas
APPENDIX 10 – COMMUNITY ASSETS – FREE-STANDING EMERGENCY DEPARTMENTS Name City Zip Service Area Advance ER Dallas 75244 North Dallas Advance ER Dallas 75209 North Dallas Elite Care Emergency Center COPPELL 75019 Northwest Dallas Excellence ER Dallas 75206 North Dallas Excellence ER GARLAND 75044 Outer Northeast Highland Park Emergency Room Dallas 75209 North Dallas Irving Family 24-Hour ER + Urgent Care LLC Irving 75063 Northwest Dallas Legacy ER Coppell 75019 Northwest Dallas Physicians ER Oak Lawn Dallas 75219 Stemmons Corridor Preston Hollow Emergency Room Dallas 75231 Northeast Dallas
APPENDIX 11 – COMMUNITY ASSETS – RETAIL URGENT CARE & AFTER HOURS CLINICS Name City Zip Service Area
Addison Target Addison 75001 Northwest Dallas CareNow Dallas 75237 South Dallas CareNow Garland 75044 Outer Northeast CareNow Dallas 75254 Northwest Dallas CareNow Grand Prairie 75052 Grand Prairie CareNow Garland 75043 Outer Northeast
Cedar Hill SuperTarget Cedar Hill 75104 Cedar Hill
Cityplace Market Target Dallas 75204 North Dallas
Clinicas Mi Doctor Dallas 75211 Southwest Dallas
Clinicas Mi Doctor Dallas 75206 North Dallas
Clinicas Mi Doctor Dallas 75220 Stemmons Corridor
Clinicas Mi Doctor Dallas 75211 Southwest Dallas
Clinicas MI Doctor Dallas 75228 Southeast Dallas
Clinicas Mi Doctor Dallas 75240 North Dallas
Clinicas MI Doctor Dallas 75231 Northeast Dallas
Clinicas Mi Doctor Irving 75060 Irving
Clinicas Mi Doctor Grand Prairie 75051 Grand Prairie Concetnra Urgent care Garland 75042 Northeast Dallas
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Name City Zip Service Area Concetnra Urgent care Irving 75039 Northwest Dallas Concetnra Urgent care Dallas 75247 Stemmons Corridor Concetnra Urgent care Mesquite 75149 Southeast Dallas Concetnra Urgent care Dallas 75206 North Dallas Concetnra Urgent care Dallas 75237 South Dallas Concetnra Urgent care Addison 75001 Northwest Dallas
Dallas NE SuperTarget Dallas 75231 Northeast Dallas
Dallas South Target Dallas 75237 South Dallas DeHaro-Saldivar Health Center - COPC Dallas 75211 Southwest Dallas
Family Clinic Dallas 75227 Southeast Dallas
Family Medicine Clinic - COPC PHHS Dallas 75235 Stemmons Corridor
Garland East SuperTarget Garland 75040 Northeast Dallas Garland Health Center - COPC PHHS Garland 75040 Northeast Dallas
Grand Prairie S SuperTarget Grand Prairie 75052 Grand Prairie
Grand Prairie Target Grand Prairie 75052 Grand Prairie
Irving North Target Irving 75063 Northwest Dallas
Irving Target Irving 75062 Irving
MD Kids Pediatrics 75224 Southwest Dallas Dallas
MD Kids Pediatrics Garland 75041 Northeast Dallas MD Kids Pediatrics Dallas 75233 Southwest Dallas
Medallion Target Dallas+C83 75214 North Dallas Medspring Urgent Care Dallas 75205 North Dallas Medspring Urgent Care Dallas 75201 Stemmons Corridor
Mesquite Super Target Mesquite 75150 Southeast Dallas MinuteClinic Dallas 75214 North Dallas MinuteClinic Dallas 75225 North Dallas MinuteClinic Irving 75038 Northwest Dallas MinuteClinic Mesquite 75150 Southeast Dallas MinuteClinic Dallas 75230 North Dallas MinuteClinic Garland 75040 Northeast Dallas MinuteClinic Richardson 75080 Outer Northeast
North Dallas Coit Road Super Target Dallas 75248 Northwest Dallas
North Dallas Target Dallas 75240 North Dallas Pediamed Dallas 75217 Southeast Dallas Pediamed Garland 75042 Northeast Dallas
Richardson Sq Mall Super Target Richardson 75081 Outer Northeast
Target Garland 75043 Outer Northeast
Vickery Family Health Center - COPC PHHS Dallas 75231 Northeast Dallas Walmart Care Clinic Garland Garland 75043 Outer Northeast Care Club Medical Clinic-Urgent Care Richardson 75080 Outer Northeast CityDoc Urgent Care Dallas 75204 North Dallas Complete Med Care Dallas 75246 Southeast Dallas
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Name City Zip Service Area Grand Prairie Urgent Care & Family Grand Prairie 75052 Grand Prairie Medicine Healthcare Clinics Dallas 75206 North Dallas Easy Care Rowlett 75089 Outer Northeast Neighborhood Medical Center Dallas 75254 Northwest Dallas PrimaCare Medical Center Dallas 75243 Northeast Dallas PrimaCare Medical Center Dallas 75231 Northeast Dallas PrimaCare Medical Center Mesquite 75150 Southeast Dallas PrimaCare Medical Center Cedar Hill 75104 Cedar Hill PrimaCare Medical Center Dallas 75254 Northwest Dallas PrimaCare Medical Center Dallas 75214 North Dallas PrimaCare Medical Center Dallas 75234 Stemmons Corridor PrimaCare Medical Center Richardson 75081 Outer Northeast QuestCare Urgent Care: Urgent Care Walk Dallas 75205 North Dallas
In Clinic in Dallas Superior Healthcare Centre-Urgent Care Dallas 75247 Stemmons Corridor Pediatrics After Hours Dallas 75230 North Dallas
APPENDIX 12 – COMMUNITY ASSETS – FREE AND LOW COST PRIMARY CARE CLINICS Name City Zip Service Area Agape Clinic at Grace United Methodist Church Dallas 75246 Southeast Dallas AIDS ARMS Peabody Health Center, Inc Dallas 75215 South Dallas AIDS ARMS Trinity Health & Wellness Center, Inc Dallas 75208 Southwest Dallas Apex Clinic of TX, Inc. Carrollton 75007 #N/A Balch Springs Youth & Family Health Center Dallas 75217 Southeast Dallas Baylor Family Medicine at Garland Garland 75042 Northeast Dallas Baylor Family Medicine at Irving Irving 75061 Irving Baylor Family Medicine at North Garland Garland 75040 Northeast Dallas Baylor Family Medicine at Worth Street Dallas 75246 Southeast Dallas Baylor Garland Family Practice Garland 75044 Outer Northeast Baylor Geriatrics Center Dallas 75246 Southeast Dallas Baylor Medical Center at Irving Irving 75061 Irving Baylor Medical Center at Irving - Cancer Support Center Irving 75062 Irving Baylor Senior Health Center at Mesquite Mesquite 75150 Southeast Dallas Brother Bill's Helping Hand Dallas 75212 Southwest Dallas Center of Hope Women & Children’s Health Clinic Dallas 75235 Stemmons Corridor Children’s Medical Center Dallas 75217 Southeast Dallas Pleasant Grove -Pediatric Group Children’s Medical Center Bachman Lake - Pediatric Group Dallas 75220 Stemmons Corridor Children’s Medical Center Carrollton - Pediatric Group Carrollton 75007 #N/A
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Name City Zip Service Area Children’s Medical Center Cedar Hill - Pediatric Group Cedar Hill 75104 Cedar Hill Children’s Medical Center Cockrell Hill -Pediatric Group Dallas 75211 Southwest Dallas Children’s Medical Center Garland -Pediatric Group Garland 75040 Northeast Dallas Children’s Medical Center Irving -Pediatric Group Irving 75062 Irving Children’s Medical Center Lake Highlands - Pediatric Dallas 75243 Northeast Dallas Group Children’s Medical Center Lancaster Kiest -Pediatric Group Dallas 75216 South Dallas Children’s Medical Center Mill City - Pediatric Group Dallas 75210 Southeast Dallas Children’s Medical Center Oak Cliff - Pediatric Group Dallas 75211 Southwest Dallas Children’s Medical Center Pediatric Group Desoto Desoto 75115 DeSoto Lancaster Children’s Medical Center Pediatric Group Medical District Dallas 75207 Stemmons Corridor Children’s Medical Center St. Philip's -Pediatric Group Dallas 75215 South Dallas Christ’s Family Clinic University Park 75205 North Dallas CitySquare Health Dallas 75215 South Dallas CitySquare Opportunity Center Dallas 75215 South Dallas
Dallas Life Foundation Dallas 75215 South Dallas Dallas VA Medical Center Dallas 75216 South Dallas Diabetes Health & Wellness Institute Dallas 75210 Southeast Dallas DISD Refugee Support Services Dallas 75228 Southeast Dallas Easter Seals North Texas - Oak Cliff Center Dallas 75224 Southwest Dallas Employee Physician Office Dallas 75247 Stemmons Corridor Essilor Vision Foundation Dallas 75234 Stemmons Corridor Esters Family Clinic Irving 75061 Irving Foremost Fam Hlth Ctrs/Balch Springs Balch Springs 75180 Southeast Dallas Foremost Fam Hlth Ctrs/Martin Luther King Jr. Family Dallas 75215 South Dallas Clinic Healing Hands Ministries Dallas 75243 Northeast Dallas Hope Clinic of Garland Garland 75040 Northeast Dallas Irving Bible Church Irving 75063 Northwest Dallas Irving Interfaith Clinic Irving 75061 Irving Irving Interfaith Clinic Irving 75061 Irving Islamic Association of North Texas Clinic Richardson 75081 Outer Northeast Jackson Internal Medicine Clinic Dallas 75232 South Dallas Las Colinas Medical Center Irving 75039 Northwest Dallas Los Barrios Unidos Comm. Clinic - Grand Prairie Grand Prairie 75050 Grand Prairie Los Barrios Unidos Comm. Clinic-South Dallas Dallas 75211 Southwest Dallas Los Barrios Unidos Community Clinic, Inc. Dallas 75212 Southwest Dallas Medical City Dallas Hospital Dallas 75230 North Dallas Medical/Surgical Clinic of Irving Irving 75061 Irving Metrocrest Family Medical Clinic Dallas 75234 Stemmons Corridor Metrocrest Family Medical Clinic Farmers Branch 75234 Stemmons Corridor Mission East Dallas Dallas 75228 Southeast Dallas
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Name City Zip Service Area Molina Medical Surgical Center Irving 75060 Irving Neighbor Care Clinic Dallas 75212 Southwest Dallas Network of Community Ministries Richardson 75081 Outer Northeast North Dallas Shared Ministries Medical Clinic Dallas 75229 Stemmons Corridor Parkland Adamson Youth & Family Center Dallas 75203 South Dallas Parkland Amelia Flores/White Rock Y & F HC Dallas 75228 Southeast Dallas Parkland Balch Springs Youth & Family Center Balch Springs 75217 Southeast Dallas Parkland COPC DeHaro-Saldivar Health Center Dallas 75211 Southwest Dallas Parkland COPC Hatcher Station Dallas 75210 Southeast Dallas Parkland COPC Irving Health Center Irving 75061 Irving Parkland COPC Oak West Health Center Dallas 75224 Southwest Dallas Parkland COPC Parkland Center for Internal Medicine Dallas 75235 Stemmons Corridor Parkland COPC Bluitt-Flowers Health Center Dallas 75216 South Dallas Parkland COPC Employee Physician Office Dallas 75247 Stemmons Corridor Parkland COPC Family Medicine Clinic Dallas 75235 Stemmons Corridor Parkland COPC Garland Health Center Garland 75040 Northeast Dallas Parkland COPC Geriatric Center, Senior House Calls Dallas 75235 Stemmons Corridor Parkland COPC Grand Prairie Health Center Grand Prairie 75051 Grand Prairie Parkland COPC Southeast Dallas Health Center Dallas 75217 Southeast Dallas Parkland COPC Vickery Family Health Center Dallas 75231 Northeast Dallas Parkland Eddie Bernice Johnson Youth & Family Center Dallas 75215 South Dallas Parkland Fair Oaks Y & F Health Center Dallas 75231 Northeast Dallas Parkland HOMES The Stewpot Clinic Dallas 75201 Stemmons Corridor Parkland Kiosco Y & F Health Center Dallas 75229 Stemmons Corridor Parkland Red Bird Y & F Health Center Dallas 75233 Southwest Dallas Parkland Seagoville Y & F Health Center Dallas 75253 Wilmer Hutchins Seagoville Parkland Vivian Field Family Health Center Farmers Branch 75234 Stemmons Corridor Parkland West Dallas Y & F Health Center Dallas 75212 Southwest Dallas Parkland Wilmer-Hutchins Youth & Family Center Dallas 75241 South Dallas Parkland Woodrow Y & F Health Center Dallas 75214 North Dallas Pediamed Dallas 75217 Southeast Dallas Pediamed Garland 75042 Northeast Dallas Pediatric Primary Care Center Dallas 75235 Stemmons Corridor Pediatrics After Hours Dallas 75230 North Dallas PediPlace Location#2 Dallas 75248 Northwest Dallas Preventive Medicine Clinic Dallas 75220 Stemmons Corridor Primary Care Clinic of North Texas Plano 75075 #N/A QuestCare Dallas 75243 Northeast Dallas The Family Place (Family Violence Ctrs w limited medical Dallas 75209 North Dallas support) The Family Place (Family Violence Ctrs w limited medical Dallas 75209 North Dallas support)
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Name City Zip Service Area Urban Inter-Tribal Center of Texas Dallas 75235 Stemmons Corridor Veterans Affairs Department Dallas 75224 Southwest Dallas Veterans Affairs Department Dallas 75231 Northeast Dallas
APPENDIX 13 – COMMUNITY ASSETS – SUBSTANCE ABUSE CLINICS Name City Zip Service Area
A.B.O.D.E. Treatment, Inc. Dallas 75223 Southeast Dallas A.B.O.D.E. Treatment, Inc. Dallas 75215 South Dallas Chapter House Counseling Services, LLC Richardson 75080 Outer Northeast Dallas Challenge, Inc. Dallas 75208 Southwest Dallas Dallas County Juvenile Probation Department Dallas 75212 Southwest Dallas DALLAS METROCARE SERVICES LANCASTER KIEST Dallas 75216 South Dallas DALLAS METROCARE SERVICES MIDWAY ADDISON, 75001 Northwest Dallas DALLAS METROCARE SERVICES SKILLMAN Dallas 75243 Northeast Dallas DALLAS METROCARE SERVICES THE BRIDGE Dallas 75201 Stemmons Corridor Dallas Sigma Counseling Services, Inc. CARROLLTON 75006 Northwest Dallas David P. Maida Dallas 75211 Southwest Dallas Enterhealth Outpatient Services, LLC Dallas 75225 North Dallas First Step Counseling ADDISON, 75001 Northwest Dallas First Step Counseling Dallas 75208 Southwest Dallas Genesis Garland/Mesquite Dallas 75228 Southeast Dallas GENESIS OAK CLIFF Dallas 75208 Southwest Dallas Genesis Walnut Hill Dallas 75229 Stemmons Corridor Green Oaks Hospital Dallas 75230 North Dallas Hickory Trail Hospital, L.P. Dallas 75088 Outer Northeast Homeward Bound, Inc. Dallas 75208 Southwest Dallas Homeward Bound, Inc. Dallas 75208 Southwest Dallas I360 TEXAS LLC Dallas 75240 North Dallas LifeNet Community Behavioral Healthcare Dallas 75243 Northeast Dallas LifeNet Community Behavioral Healthcare Dallas 75201 Stemmons Corridor Memorial Hermann Prevention and Recovery Center ADDISON, 75001 Northwest Dallas MULTICULTURAL RECOVERY CENTER INC Dallas 75240 North Dallas Nexus Recovery Center, Inc. Dallas 75228 Southeast Dallas Nexus Recovery Center, Inc. Dallas 75219 Stemmons Corridor Opportunities Counseling Center, Inc. Dallas 75247 Stemmons Corridor Opportunities Counseling Center, Inc. Grand Prairie 75050 Grand Prairie Phoenix Houses of Texas, Inc. Dallas 75219 Stemmons Corridor Promise House Dallas 75208 Southwest Dallas Psychotherapeutic Services of America, LLC Dallas 75201 Stemmons Corridor Recovery Healthcare Corporation Dallas 75247 Stemmons Corridor
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Red Bird Education Programs, PLLC Dallas 75237 South Dallas RESOURCE CENTER OF DALLAS INC Dallas 75219 Stemmons Corridor Solace Counseling Associates PLLC Dallas 75235 Stemmons Corridor Solutions Outpatient Services Dallas 75209 North Dallas TEXAS HEALTH BEHAVIORAL HEALTH CENTER Dallas 75235 Stemmons Corridor GLEN LAKES The Addicare Group of Texas Garland 75041 Northeast Dallas The Salvation Army Dallas 75235 Stemmons Corridor TRS BEHAVIORAL CARE INC CARROLLTON 75007 Northeast Dallas TRS BEHAVIORAL CARE INC Dallas 75231 Northeast Dallas Turtle Creek Recovery Center Dallas 75201 Stemmons Corridor Waterford Academy, LLC Richardson 75081 Outer Northeast WINDHAVEN COUNSELING CENTER LLC ADDISON, 75001 Northwest Dallas
APPENDIX 14 – COMMUNITY ASSETS – PSYCHIATRIC HOSPITALS Name Zip Service Area DALLAS BEHAVIORAL HEALTHCARE HOSPITAL LLC 75115 DeSoto Lancaster GARLAND BEHAVIORAL HOSPITAL 75042 Northeast Dallas GREEN OAKS HOSPITAL 75251 North Dallas HICKORY TRAIL HOSPITAL 75115 DeSoto Lancaster SUNDANCE HOSPITAL DALLAS 75042 Northeast Dallas TIMBERLAWN MENTAL HEALTH SYSTEM 75228 Southeast Dallas
APPENDIX 15 – COMMUNITY ASSETS – FAITH-BASED SUBSTANCE ABUSE FACILITIES Provider Name City Zip Service Area
Answers of Hope Biblical Counseling Center Dallas 75225 North Dallas Christian Reform Alliance for Today's Youth (CRAFTY) Dallas 75241 South Dallas Chapel of Hope Ministries, Inc. Dallas 75248 Northwest Dallas Christian Reform Alliance for Today's Youth (CRAFTY) Dallas 75241 South Dallas Concord Counseling Center/Concord Missionary Dallas 75237 South Dallas Metro Haven of Love, Inc. Dallas 75215 South Dallas New Life Christian Counseling Ministry Dallas 75211 Southwest Dallas Obadiah Gang and Drug Program, Inc. Dallas 75230 North Dallas Real People Ministries, Inc. Dallas 75223 Southeast Dallas Reconciliation Outreach Ministries Dallas 75204 North Dallas Reconciliation Outreach Ministries Dallas 75204 North Dallas Salvation Army, The Dallas 75235 Stemmons Corridor St. Francis Anglican Church, Inc. Dallas 75214 North Dallas THE MEN OF NEHEMIAH INC Dallas 75215 South Dallas Wayside Educational and Counseling Center Dallas 75216 South Dallas
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APPENDIX 16 – COMMUNITY ASSETS – MENTAL HEALTH RESOURCES Name City Zip Service Area Child and Family Guidance Center Dallas 75235 Stemmons Corridor ABC Behavioral Health Adult Dallas 75228 Southeast Child and Family Guidance Center Mesquite 75149 Southeast Metrocare Services Dallas 75247 Stemmons Corridor Child and Family Guidance Center (Stephen J. McManus Dallas 75208 Southwest Dallas Family Mental Health Clinic / Oak Cliff) A.B.O.D.E. Treatment, Inc. Dallas 75223 Southeast Dallas Dallas Challenge, Inc. Dallas 75208 Southwest Dallas Metrocare at Samuell - Center and Pharmacy Dallas 75228 Southeast Metrocare at Westmoreland - Center and Pharmacy Dallas 75211 Southwest Dallas Metrocare at Hillside Campus Dallas 75211 Southwest Dallas Metrocare at River Bend — (Pathways) Center and Dallas 75247 Stemmons Corridor Pharmacy Metrocare at Grand Prairie — Center & Pharmacy Grand Prairie 75051 Grand Prairie Metrocare at Midway — Center & Pharmacy Addison 75001 Northwest Dallas Lifenet Texas — Center & Pharmacy Dallas 75234 Stemmons Corridor Metrocare at Stemmons #151 Dallas 75207 Stemmons Corridor Center for Children with Autism (CCAM I) Dallas 75247 Stemmons Corridor Center for Children with Autism Dallas 75240 North Dallas Center for Children with Autism — DeSoto (CCAM III) DeSoto 75115 DeSoto Lancaster Altshuler Center for Education and Research Dallas 75247 Stemmons Corridor Local Intellectual Developmental Disabilities Authority Dallas 75247 Stemmons Corridor (LIDDA Special Needs Offender Program (SNOP Dallas 75216 South Dallas Homeless Services at The Stew Pot Dallas 75201 Stemmons Corridor The Steven A. Cohen Military Family Clinic at Metrocare Addison 75001 Northwest Dallas Centro de Mi Salud Dallas 75208 Southwest Dallas DSM Eastside Family Clinic Child 5+ / adol Dallas 75228 Southeast Mosaic Family Services Dallas 75204 North Dallas Suicide and Crisis Center Dallas 75204 North Dallas Veterans Affairs Dallas 75216 South Dallas Victim Relief Ministries Richardson 75081 Outer Northeast Teen Challenge of North Texas Dallas 75223 Southeast Dallas Violence Intervention and Prevention Program - Parkland Dallas 75235 Stemmons Corridor Hospital Genesis Women's Shelter Dallas 75219 Northwest Dallas The Family Place Dallas 75209 North Dallas Brighter Tomorrows Irving 75061 Irving North Texas Behavioral Health Authority Richardson 75080 Outer Northeast Crisis Assistance South Dallas After hours clinic Dallas 75237 South Dallas Mental Health America Dallas 75204 North Dallas NAMI Dallas County Dallas 75204 North Dallas NAMI Southern Sector Dallas County Dallas
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APPENDIX 17 – COMMUNITY ASSETS – FARMERS MARKETS Name City Zip Service Area Dallas Farmers Market Dallas 75201 Stemmons Corridor Camden Farmers Market Dallas 75201 Stemmons Corridor Cox Farms Market - Dallas Dallas 75208 Southwest Dallas Sprouts Farmers Market Dallas 75206 North Dallas Southwest Farmers Market Garland 75042 Northeast Dallas Celebration Market Dallas 75209 North Dallas Alta Farmers Market Apartments Dallas 75201 Stemmons Corridor Grand Prairie Market Square Grand Prairie 75050 Grand Prairie Little D Farmers Market Dallas 75212 Southwest Dallas Broadstone Farmers Market Dallas 75201 Stemmons Corridor Sprouts Farmers Market Dallas 75229 Stemmons Corridor Sprouts Farmers Market Cedar hill 75104 Cedar Hill Sprouts Farmers Market Richardson 75080 Outer Northeast Cox Farms Market - Duncanville Duncanville 75137 Cedar Hill Bonton Farm-Works Dallas 75215 South Dallas Urban Farm Co. by Dallas Urban Farms Dallas 75224 Southwest Dallas Diabetes Health & Wellness Alliance Dallas 75215 South Dallas Lakewest Family YMCA Dallas 75212 Southwest Dallas
APPENDIX 18 – COMMUNITY ASSETS – RECREATION CENTERS Name Address City Zip Service Area Calumet Community Center 321A Calumet Ave Dallas 75211 Southwest Boys & Girls Clubs of Greater 2907 Linfield Rd Dallas 75216 South Dallas Dallas, Inc. Boys & Girls Club of America 1000 Enterprise St Grand Prairie 75051 Grand Prairie Boys & Girls Clubs of Greater 4869 Gus Thomasson Rd Mesquite 75150 Southeast Dallas Richardson Boys & Girls 1210 W Belt Line Rd Richardson 75080 Outer Northeast Cedar Springs Boys & Girls Club 4440 Brown St Dallas 75246 Southeast Dallas Maple Lawn Boys & Girls Club 3120 Inwood Rd Dallas 75235 Stemmons Corridor Cedar Springs Boys & Girls Club 4440 Brown St. Dallas 75219 Northwest Dallas Dade Boys & Girls Club 2801 Park Row Dallas 75215 South Dallas Dunbar Boys & Girls Club 4200 Metropolitan Ave Dallas 75210 Southeast Dallas Pinnacle Prep Boys & Girls Club 735 W. Illinois Ave. Dallas 75224 Southwest Dallas Lincoln Boys & Girls Club 2826 Hatcher St Dallas 75215 South Dallas Williams Prep Boys & Girls Club 1750 Viceroy Dr Dallas 75235 Stemmons Corridor Lipscomb Boys & Girls Club 5801 Worth St Dallas 75214 North Dallas Madison Boys & Girls Club 3000 Martin Luther King Jr. Dallas 75215 South Dallas Blvd Coppell Family YMCA 146 Town Center Blvd Coppell 75019 Northwest Dallas
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Garland Family YMCA 1709 N. Garland AVE Garland 75040 Northeast Dallas Grand Prairie Family YMCA 4556 S. Carrier PKWAY Grand Prairie 75052 Grand Prairie Irving Family YMCA 2200 W. Irving Blvd Irving 75061 Irving Lake Highlands Family YMCA 8920 Stults Road Dallas 75243 Northeast Dallas Lakewest Family YMCA 3737 Goldman Dallas 75212 Southwest Dallas Moorland Family YMCA 907 E. Ledbetter road Dallas 75216 South Dallas Oak Cliff Family YMCA 6701 S. Hampton Road Dallas 75232 South Dallas Park South Family YMCA 2500 Romine Ave Dallas 75215 South Dallas T. Boone Pickens YMCA 601 N. Akard Street Dallas 75201 Stemmons Corridor Town North Family YMCA 4332 Northaven Dallas 75229 Stemmons Corridor West Dallas Community Centers, 2828 Fishtrap Rd. Dallas 75212 Southwest Dallas Inc. YMCA at White Rock 7301 Gaston Avenue Dallas 75214 North Dallas Anita Martinez Recreation Center 3212 N. Winnetka Ave. Dallas 75212 Southwest Dallas Arcadia Recreation Center 5420 N Arcadia Dr. Dallas 75211 Southwest Arlington Park Recreation Center 1505 Record Crossing Dallas 75235 Stemmons Corridor Bachman Recreation Center 2750 Bachman Dr Dallas 75220 Stemmons Corridor Beckley Saner Recreation Center 114 W. Hobson Dallas 75224 Southwest Dallas Campbell Green Recreation Center 16600 Parkhill Dr. Dallas 75248 Northwest Dallas Churchill Recreation Center 6906 Churchilll Way Dallas 75230 North Dallas Cummings Recreation Center 2976 Cummings Dallas 75216 South Dallas Eloise Lundy Recreation Center 1229 Reverend CBT Smith St Dallas 75203 South Dallas Exall Recreation Center 1355 Adair Dallas 75204 North Dallas Exline Recreation Center 2525 Pine Dallas 75215 South Dallas Fireside Recreation Center 8601 Fireside Dallas 75217 Southeast Dallas Fruitdale Recreation Center 4408 Vandervort Dallas 75216 South Dallas Grauwyler Recreation Center 7780 Harry Hines Dallas 75235 Stemmons Corridor Harry Stone Recreation Center 2403 Millmar Dallas 75228 Southeast Dallas Janie C Turner Recreation Center 6424 Elam Dallas 75235 Stemmons Corridor Jaycee Zaragoza Recreation Center 3114 Clymer Dallas 75212 Southwest Dallas John C. Phelps Recreation Center 3030 Tips Blvd. Dallas 75216 South Dallas Juanita J. Craft Recreation Center 4500 Spring Ave Dallas 75210 Southeast Dallas K.B. Polk Recreation Center 6801 Roper Dallas 75209 Stemmons Corridor Kidd Springs Recreation Center 711 W. Canty Dallas 75208 Southwest Dallas Kiest Recreation Center 3081 S. Hampton Dallas 75224 Southwest Dallas Kleberg Rylie Recreation Center 1515 Edd Dallas 75253 Wilmer Hutchins Seagoville Lake Highlands North Recreation 9940 White Rock Trl Dallas 75238 Northeast Dallas Center Larry Johnson Recreation Center 3700 Dixon Ave Dallas 75210 Southeast Dallas Marcus Recreation Center 3003 Northaven Dallas 75229 Stemmons
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Corridor Marcus Annex Recreation Center 2910 Modella Dallas 75229 Stemmons Corridor M. L. King Jr Recreation Center 2922 MLK Blvd Dallas 75215 South Dallas Martin Weiss Recreation Center 1111 Martindell Ave Dallas 75211 Southwest Dallas Nash-Davis Recreation Center 3710 N. Hampton Dallas 75212 6801 Mt Creek Pkwy Park In The Woods Recreation 6801 Mt Creek Pkwy Dallas 75249 Cedar Hill Center Pleasant Oaks Recreation Center 8701 Greenmound Dallas 75227 Southeast Dallas Reverchon Recreation Center 3505 Maple Ave Dallas 75219 Stemmons Corridor Ridgewood/Belcher Recreation 6818 Fisher Dallas 75214 North Dallas Center Samuell Grand Recreation Center 6200 E. Grand Ave Dallas 75223 Southeast Dallas Singing Hills Recreation Center 1909 Crouch Road Dallas 75241 South Dallas Thurgood Marshall Rec Center 5150 Mark Trail Dallas 75232 South Dallas Tommie M. Allen Rec Center 7071 Bonnie View Road Dallas 75241 South Dallas Umphress Recreation Center 7616 Umphress Dallas 75217 Southeast Dallas Walnut Hill Recreation Center 10011 Midway Rd. Dallas 75229 Stemmons Corridor Willie B. Johnson Recreation Center 225 Willowdell Dallas 75243 Northeast Dallas Granger Recreation Center 1310 West Avenue F Garland 75040 Northeast Dallas Audubon Recreation Center 342 West Oates Road Garland 75043 Outer Northeast Bradfield Recreation Center 1146 Castle Drive Garland 75040 Northeast Dallas Fields Recreation Center 1701 Dairy Road Garland 75040 Northeast Dallas Holford Recreation Center 2314 Homestead Place Garland 75044 Outer Northeast Hollabaugh Recreation Center 3925 West Walnut Street Garland 75042 Northeast Dallas Tony Shotwell Life Center 2750 Graham St. Grand Prairie 75050 Grand Prairie Dalworth Recreation Center 2012 Spikes St. Grand Prairie 75051 Grand Prairie Mesquite Scott Dunford Center 1015 Green Canyon Drive Mesquite 75150 Southeast Dallas Rutherford Community Cnter 900 Rutherford Drive Mesquite 75149 Southeast Dallas Mesquite Emmitt Evans 1116 Hillcrest St. Mesquite 75149 Southeast Dallas Community Center Duncanville Recreation Center 201 James Collins Blvd Duncanville 75116 Southwest Dallas DeSoto Recreation Center 211 E. Pleasant Run Rd DeSoto 75115 DeSoto Lancaster Lancaster Recreation Center 1700 Veterans Memorial Pkwy Lancaster 75134 DeSoto Lancaster Alan E. Sims Recreation Center 310 E. Parkerville Rd. Cedar Hill 75104 Cedar Hill Senter Recreation Center 901 Senter Road Irving 75060 Irving The Core 234 East Parkway Boulevard Coppell 75019 Northwest Dallas Crosby Recreation Center 1610 E. Crosby Rd Carrollton 75006 Northwest Dallas Farmers Branch Community 14050 Heartside Place Farmers Branch 75234 Stemmons Recreation Center Corridor The Addison Athletic Club 3900 Beltway Drive Addison 75001 Northwest Dallas Huffhines Recreation Center 200 N. Plano Road Richardson 75081 Outer Northeast Heights Recreation Center 711 W. Arapaho Road Richardson 75080 Outer Northeast Rowlett Community Center 5300 Main St. Rowlett 75088 Outer Northeast
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APPENDIX 19 – COMMUNITY ASSETS - HEALTH CARE COLLABORATIVES IDENTIFIED During the Community Health Needs Assessment process the following collaboratives were identified as being active in the Dallas County area.
Dallas Faces Race RHP 9 Learning Collaborative North Texas Accountable Healthcare Partnership Texas Hunger Initiative – Dallas Region Health and Wellness Alliance for Children Dallas Coalition for Hunger Solutions Childhood Obesity Collaborative – Charting the Course Early Matters Dallas (now a part of the Alliance for Children’s Health) Commit! – Our Kids Our Tomorrow WINS – Working in Neighborhoods Strategically DFW Steering Committee for Child Health Promotion Children at Risk Immunization Collaborative Alliance on Underage Drinking CHIP and Medicaid Coalition – Community Council of Dallas Area Drug Prevention Partnership (DADPP) Greater Dallas Child Abuse Prevention DWI Task Force Anti-Poverty Coalition Tobacco-Free North Texas 0-5 Collaboration – Bachman Lake Community Literacy Coalition Building Community Workshop Dallas Regional Mobility Coalition DFW Hospital Council Community Health Collaborative Dallas Domestic Violence Awareness Coalition Health Industry Council Women’s Council of Dallas County, Health and Human Services Coalition Texas Disparities Advisory Board Dallas County Veteran’s Coalition Dallas Area Coalition to Prevent Childhood Obesity Interfaith Housing Coalition, Inc. Behavioral Health Leadership Team Homeless Coalition of Dallas NAMSI Coalition for Affordable Housing Pediatric Promise Dallas County Sexual Assault Coalition Community Action Network My Ride Dallas Coalition North Texas Association of Charitable Clinics
APPENDIX 20 – COMMUNITY ASSETS – PARKS AND TRAILS IN DALLAS COUNTY
The Dallas Park System is one of the largest municipal park systems in the nation. There are 380 parks, totaling over 23,470 acres of developed and undeveloped parkland including:
4,658 surface acres of water 18,641 acres of municipal tree canopy 143 miles of developed trails 4 dog parks Athletic fields, playgrounds, spray grounds, tennis, basketball and volleyball courts, picnic shelters
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Figure 70. Parks in City of Dallas
Over the past decade, trails have become one of the most popular recreational amenities in the U.S. Couples use them to take walks together, parents use them to teach their children how to ride a bicycle, and other use them to help lose weight, stay in shape, train for a race, or as a means by which they can get to work, to school, or to the store. Not surprisingly, studies have shown that trails enhance local property values and can do much to attract residents, tourists, and businesses; reduce traffic; and improve air quality. There are currently over 100 miles of major hard surface trails (i.e., trails with a
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width of at least eight feet and a length of at least 1.5 miles) and 7.5 miles of dedicated bike lanes in Dallas County. These trails and bike lanes are located in the cities of Dallas, Richardson, Irving, Grand Prairie, Carrollton, DeSoto, Lancaster, Mesquite, Addison, Farmers Branch, and Garland, and they already make it possible to reach major employment centers like Las Colinas and the Telecom Corridor, to connect with DART light rail stations, to enjoy views of White Rock Lake, Bachman Lake, and the Trinity River, to see concerts and sporting events at the American Airlines Center, to reach SMU or the University of Texas at Dallas, and to travel from beyond the County's border to downtown Dallas.
Figure 71. Trails in Dallas County
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APPENDIX 21 – ASSESSMENT RESOURCES The public health improvement workgroup identified these specialized health assessment resources, whose aggregate findings have been considered during CHNA development. For more detailed information on select topics, please review the following local resources:
. Beyond ABC: Assessing Children’s Health in Dallas County, Children’s Medical Center . Community Profile Report, Dallas County Affiliate of Susan G. Komen for the Cure . Comprehensive HIV Needs Assessment, Ryan White Planning Council of the Dallas Area . Regional Behavioral Health Needs Assessment, North Texas Behavioral Health Authority . Regional Health Partnership 9: Community Needs Assessment Report, Dallas Forth Worth Hospital Council, 2013 . United 2020, United Way of Metropolitan Dallas . The 2016 Metro Dallas Homeless Alliance Report – The Homeless in Dallas . State pf Texas Children 2016, Race and Equity in Dallas. Center for Public Policy Priorities, Texas Kids Count, April 2016 . Regional Needs Assessment, Region 3 Prevention Resource Center, 2016 . Healthy Garland Community Health Assessment MAPP Process, 2015
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APPENDIX 22 – KEY INFORMANT INTERVIEW DISCUSSION GUIDE
Thank you for participating in this brief Key Stakeholder Interview for the Parkland Hospital and Dallas County Health Department to help in formulating their Community Health Needs Assessment. Your input is critical to gather data that helps in developing recommendations to improve the quality and access of health care for citizens of Dallas County.
1) What of the following is most important in improving the health of Dallas County residents? Why? Healthcare Access Health Literacy Healthcare Organizations Partnership Infrastructure Improving Disease Risk Factors Promoting continued care of persons with a disease diagnosis
2) What do you see as the strengths of the health services available in Dallas County? What does Dallas County do well?
3) Which health services do you know are available in Dallas County, but are insufficient to meet the need?
4) What health services are needed by particular populations, but are not being provided in the county?
5) What do you see as barriers to accessing health care in Dallas County and who faces those barriers?
6) What is the biggest unmet need facing Dallas citizens in obtaining quality health care?
7) What other people or organizations do you collaborate with on health issues facing Dallas County?
8) How do you think the community of Dallas can take a leadership role in creating an environment of health?
9) What innovative approaches would you like to see adopted in Dallas County?
10) Who else should we be speaking with as part of this effort?
11) Do you have any suggestions to improve the needs assessment process?
SUPPLEMENTAL QUESTION 12 – What do you see as Parkland’s role in providing a leadership role in the Dallas healthcare community?
Thank you for your time and your insight concerning the purpose and future you envision for Dallas County. We greatly appreciate your comments.
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APPENDIX 23 – FOCUS GROUP DISCUSSION GUIDE
Thank you for participating in this Focus Group for the Parkland Health & Hospital System and Dallas County Health Department to help in completing their Community Health Needs Assessment. Your input is critical to gathering information that will help develop recommendations to improve the quality and access to health care for citizens in Dallas County.
1. What do you like about the health services you receive? What works well for you? 2. What do you not like about the health services you receive? What could be done better? 3. What health services do you need, but you cannot access? 4. Why do you go to the places you go for care? Who do you trust to provide the right care for you and your family? 5. What gets in the way of you being able to stay healthy? 6. What do you think is most important to improving your overall health?
APPENDIX 24 – DALLAS COUNTY BOUNDARY AND ZIP CODE BOUNDARIES
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APPENDIX 25 - DALLAS COUNTY SERVICE AREAS ZIP Service Area ZIP Service Area ZIP Service Area 75104 Cedar Hill 75050 Grand Prairie 75204 North Dallas 75137 Cedar Hill 75051 Grand Prairie 75205 North Dallas 75249 Cedar Hill 75052 Grand Prairie 75206 North Dallas 75209 North Dallas ZIP Service Area ZIP Service Area 75214 North Dallas
75115 DeSoto Lancaster 75060 Irving 75218 North Dallas
75134 DeSoto Lancaster 75061 Irving 75225 North Dallas
75146 DeSoto Lancaster 75062 Irving 75230 North Dallas
75240 North Dallas
ZIP Service Area ZIP Service Area 75244 North Dallas
75040 Northeast Dallas 75043 Outer Northeast 75251 North Dallas
75041 Northeast Dallas 75044 Outer Northeast
75042 Northeast Dallas 75048 Outer Northeast ZIP Service Area
75231 Northeast Dallas 75080 Outer Northeast 75203 South Dallas
75238 Northeast Dallas 75081 Outer Northeast 75215 South Dallas
75243 Northeast Dallas 75088 Outer Northeast 75216 South Dallas
75001 Northwest Dallas 75089 Outer Northeast 75232 South Dallas
75006 Northwest Dallas 75182 Outer Northeast 75237 South Dallas
75019 Northwest Dallas 75241 South Dallas
75038 Northwest Dallas ZIP Service Area
75039 Northwest Dallas 75149 Southeast Dallas ZIP Service Area
75063 Northwest Dallas 75150 Southeast Dallas 75141 Wilmer Hutchins Seagoville
75248 Northwest Dallas 75180 Southeast Dallas 75159 Wilmer Hutchins Seagoville
75254 Northwest Dallas 75210 Southeast Dallas 75172 Wilmer Hutchins Seagoville
75217 Southeast Dallas 75181 Wilmer Hutchins Seagoville
ZIP Service Area 75223 Southeast Dallas 75253 Wilmer Hutchins Seagoville
75201 Stemmons Corridor 75226 Southeast Dallas
75202 Stemmons Corridor 75227 Southeast Dallas ZIP Service Area
75207 Stemmons Corridor 75228 Southeast Dallas 75001 Northwest Dallas
75219 Stemmons Corridor 75246 Southeast Dallas 75006 Northwest Dallas
75220 Stemmons Corridor 75019 Northwest Dallas
75229 Stemmons Corridor ZIP Service Area 75038 Northwest Dallas
75234 Stemmons Corridor 75116 Southwest Dallas 75039 Northwest Dallas
75235 Stemmons Corridor 75208 Southwest Dallas 75063 Northwest Dallas
75247 Stemmons Corridor 75211 Southwest Dallas 75248 Northwest Dallas 75212 Southwest Dallas 75254 Northwest Dallas
75224 Southwest Dallas
75233 Southwest Dallas 75236 Southwest Dallas
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APPENDIX 26 – 2013 CHNA IMPLEMENTATION PLAN UPDATE - PARKLAND I. Multiple Chronic Conditions A. Implement a Chronic Disease Registry 1. 2014 – We successfully implemented and expanded the following functional chronic disease management registries to target clinics: Obesity, Diabetes, CKD, CHF and Asthma. 2. 2015 – We increased the percentage/unique individuals enrolled in the chronic disease registries. The goal for DY4 was to enroll at least 10,000 unique patients into the chronic care registries and at the end of the measurement period we reached over 98,000 unique patients. 3. 2016 – We increased the percentage/ unique individual enrolled in the chronic disease registries. The goal for DY5 was to enroll at least 25,000 unique patients into the chronic care registries and at the end of April we have already reached over 96,000 unique patients.
B. Implement a comprehensive, system-wide Chronic Disease Management Model 1. 2014 –We formalized multi-disciplinary teams consisting of Physicians, Midlevel’s, Clinical Pharmacist, Nursing Staff, Social Workers/Case Managers and Dietitians.to support the system-wide expansion of a chronic care model defined by Wagner Chronic Care Model in the primary care setting. 2. 2015- We developed a program to identify and manage chronic care patients needing further clinical intervention. Our program aimed at identifying and providing care at least 15,000 unique patients in DY4 affected by one or more chronic conditions. The screening process included the following: annual HbA1c annual lab testing to monitor ACE/ARBs (either K or BUN, or K and Creatinine) annual retina eye exam
At the end of the measurement year, 29,244 unique patients were successfully screened and treated.
3. 2016 – We continue to apply the Chronic Care Model to targeted chronic diseases, which are prevalent. Our program aimed at identifying and providing care at least 20,000 unique patients in DY5 affected by one or more chronic conditions. The screening process included the following: annual HbA1c annual lab testing to monitor ACE/ARBs (either K or BUN, or K and Creatinine) annual retina eye exam lipid Panel
At the end of April, 43,439 unique patients were successfully screened and treated.
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C. Enhance and Expand the application of the Patient Centered Medical Home Model to the Parkland system primary care clinics 1. 2013 – We put in place policies and systems to enhance patient access to the Medical Home in order to enhance access to care available through systems such as open scheduling, expanded hours and options for communication between patients, their personal physician and practice staff. We established criteria for Medical Home assignment for selected chronic care patients. 2. 2014 – We implemented patient tracking and identified current utilization rates of preventive services to targeted populations. We began tracking and assigning patients to patient care teams at the COPC’s, PCIM and Family Medicine clinics. Utilization reports for breast cancer, colorectal cancer and pediatric asthma screening were developed for COPC clinics. 3. 2015 – Based on the criteria we improved the number of eligible patients assigned to Medical Homes. The DY4 goal (ended October, 2015) for the COPC Project 2.1 was 37,500 individuals “enrolled in the medical home”. We exceeded the goal by enrolling 67,726 individuals. The goal for the PICM Project 2.11 in DY4 was 2,575 individuals. We exceeded the goal and 4,269 individuals were “enrolled in the medical home”. 4. 2016 – We improved and expanded the population health management by identifying and reaching out to patients who need to be brought in for preventive and ongoing care. We improved/expanded the assignment of patients to care teams and improved proactive communication and intervention with the Medical Home population. We identified patients in the patient centered medical home who were 65 and over and needed their pneumococcal vaccination. Letters were then sent to these patients reminding them to visit and receive this preventative service. Breast cancer and colorectal cancer screening utilization reports were developed for PCIM and Family Medicine clinics.
II. Health Care Access A. Expand Primary Care Services in Existing Community Clinics - (Grand Prairie) & (DeHaro, Garland, Vickery, Y& F – hours and providers). 1. 2013 – We increased access and capacity by expanding the clinic hours, increasing staff, and opening an additional Youth and Family clinic, resulting in an increase in primary care clinic volume of visits. Our DY2 goal was to reach 9389 visits and we finished the fiscal year at 12,684 visits. 2. 2014 – We hired/trained additional primary care provider teams in existing clinics, and expanded the DeHaro Clinic by 1100 square feet. Project 1.1 DY3 visit goal was 12,000 visit and we finished the fiscal year at 22,158. Project 1.2 DY3 visit goal was 7000 visits and we finished the fiscal year at 7,601 visits. 3. 2015 – We improved/increased the access and number of patient visits. Project 1.1 DY5 visit goal was 18,000 visit and we finished the fiscal year at 23,591 visits.
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Project 2.1 DY4 visit goal was 7000 visits and we finished the fiscal year at 18,868 visits. 4. 2016 – We continue to improved/increased the access and number of patient visits. Project 1.1 DY5 visit goal is to increase visits to 22.658, and project 1.2 goal is to increase to 7,601 visits.
B. Expand Specialty Care Services to address critical unmet demands. 1. 2014 – We performed a gap assessment and developed/ implemented a specialty care access plan to expand targeted specialty care access and we hired/trained provider teams required to implement the expansion (Diabetes, Cardiology, Neurology, and Smoking Cessation). 2. 2015- We improved access and increased specialty care clinic volumes of visits. Baseline visit volume was 68,945 with a goal to provide an additional 12,592 visits (encounters). In DY4 we provided a total of 83,329 visits. 3. 2016 – We will continue the expansion process with a goal of increasing the number of visits. Goal is to provide 15,390 additional visits (encounters) above baseline visit volume of 68,945 (Target total volume: 84,335). Current additional visits through August 2016 are 13,077. DY5 monthly average is above 7,000 visits, therefore projected to meet/exceed the goal.
C. Continue the completion of the construction, transition and opening of the replacement ambulatory clinic Hatcher Station. 1. 2014- We Expanded the hours of a primary care clinic services by 100 hours 2. 2015 – We increased the primary care clinic visit volume over the baseline of 44,217 patient visits. The DY4 goal (ended October, 2015) for Hatcher Station Project 1.100 was 46,717 patient visits. We exceeded the goal by completing 48,591 visits. We hired and trained two additional primary care providers/staff teams. We completed the construction of East Dallas replacement clinic, known as Hatcher Station in the spring of 2015, and began seeing patients on May 19, 2015. 3. 2016 – Our goal is to increase the primary care clinic volume of visits over the DY4 (FY15) baseline of 46, 717 patient visits by an additional 2,000 patient visits.
D. Opening of New Parkland acute care replacement hospital 1. Inpatient operations were moved to a new 2.5 million sq ft 862 bed replacement hospital in August of 2015. New hospital has all private rooms and was designed to be a healing environment. 2. New ambulatory specialty clinic facility adjacent to the new hospital will open in January of 2017.
III. Health Disparities and Resource Deserts A. Expand, enhance and tailor interpretation services to improve culturally competent care.
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1. 2013 – We implemented language access policies and procedures. We provided education system-wide through virtual learning and other media supports to increase awareness of the interpretation program. 2. 2014 – We utilized the Health Literacy Universal Precautions Toolkit to improve communications with patients as well as improve self-management and supportive systems for patients. As an outcome of this utilization, we rolled out training on teach back , a form of training that helps ensure patients of all health literacy levels and learning styles leave an interaction with a true understanding of the concepts and tools presented by the healthcare provider. 3. 2015 – We improved/increased the number of qualified health care interpreter encounters. The goal was 341,656 interpretations, Parkland achieved 824,947. 4. 2016- We will continue to increase the access and reduce the percentage of encounters in which patient wait time for an interpreter is greater than or equal to 15 minutes by implementing greater access to remote interpretation (video and voice) where access is on demand. Parkland rolled out 50 video units to inpatient units as well as 18 video units to outpatient clinics.
IV. Infrastructure – Unifying Efforts and Maximizing Resources A. Unify Efforts and Maximizing Resources. 1. 2013 – We established an office, hired and trained staff to collect, analyzes, manage real-time data and monitor the improvement trajectory and improvement activities. The office is known as “Quality Through Transformation Initiative” (QTTI). 2. 2014 – We lead and support 22 clinical transformational projects and provide tools to inform Parkland and regional audiences with respect to the performance of our transformational projects. We participate in statewide, and regional, learning collaborative to drive targeted quality improvements. 3. 2015 – We continued to participate and use regional and statewide improvement/learning collaboratives and concepts to drive successful outcomes associated with transformation. We created a quality dashboard to be shared with the organizational leadership and at all levels of the organization that include outcomes measures and patient satisfaction measures. 4. 2016 - We continue to participate and use regional and statewide improvement/learning collaboratives and concepts to drive successful outcomes associated with transformation and share patient impact and outcomes with the organization associated with transformation.
B. RHP 9 – Anchor/Regional Level
As the Anchor for The Regional Health Plan (RHP) 9, Parkland is the regional administrative contact with HHSC and the guiding entity for RHP9, which includes 25 providers and 129 intervention projects. Parkland reports regional progress, successes, and challenges to providers and other stakeholders in the form of anchor updates, learning collaborative
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events, biannual reporting period summaries, regional annual report, payment summary reporting, and periodic newsletters.
In 2014 & 2015 all providers had access to Performance Logic a project management tool. . The anchor tracked monthly project metrics. Guidance was offered to providers at risk for not meeting metrics.
As part of the 2014 RHP 9 Learning Collaborative Plan submitted to HHSC, the Anchor office conducts a minimum of 2 face-to-face regional level shared learning and experience events open to all providers and stakeholders. In 2015 and 2016, RHP 9 and RHP 10 collaborated to hold a two-day learning event that was attended by regional providers and stakeholders, statewide regional representation, and HHSC. In addition, RHP9 conducts 4 cohort-level learning collaborative events in the areas of readmissions, access, chronic disease, and behavioral health. The cohorts were selected based on the DSRIP project frequency and regional community health needs assessment. The cohorts met periodically to share the progress of their projects, best practices, lessons learned, and to collaborate and partner where there was opportunity. Ad-hoc learning collaborative activities included a process improvement cohort led by Parkland in collaboration with UTSW staff. RHP 9 Anchor office also coordinated RHP 9 roadshows which allowed the providers to tour and learn on an operational level. . This hands-on approach allowed providers to identify opportunities that they might take back to their own organizations to use. Two additional regional opportunities included the Speaker Series and the RHP 9 Give Back Campaign participation.
Fiscal 2014 Regional Events January 14, 2014: RHP 9 Learning Collaborative Kick-Off September 18, 2014: RHP 9 Learning Collaborative 2nd-Event
Cohort Events: January 14, 2014: RHP 9 Learning Collaborative Cohort – Kickoff February 26 & 27, 2014: RHP 9 Learning Collaborative Cohorts – Shared Implementation Learning March 26 & 27, 2014: RHP 9 Learning Collaborative Cohorts – Shared Implementation Learning May 13 & 14, 2014: RHP 9 Learning Collaborative Cohorts – Shared Implementation Learning August 12 & 13, 2014: RHP 9 Improvement Collaborative Cohorts – Improvement Collaboratives August 27, 2014: RHP 9 Process Improvement Cohort – Ad Hoc Learning Activities
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Speaker Series May 28, 2014: RHP 9 Speaker Series I
RHP 9 Give Back Campaign North Texas Food Bank: Donated over 279 lbs of food
Fiscal 2015 Regional Events May 27-28, 2015: RHP 9 & 10 Collaborative Connections – Impacting Care Learning Collaborative September 24, 2015: RHP 9 Regional Shared Experiences and Learning Event
Cohort Events: December 11, 2014: RHP 9 Improvement Collaborative Cohort – Improvement Collaboratives March 24 & 25, 2015: RHP 9 Improvement Collaborative Cohorts April 15, 2015: RHP 9 Process Improvement in Healthcare Cohort
Speaker Series November 11, 2014: RHP 9 Speaker Series II
Webinar February 25, 2015: RHP 9 PDSA Raise the Floor Webinar #1 June 10, 2015: RHP 9 PDSA Raise the Floor Webinar #2 August 2015: RHP 9 PDSA Raise the Floor Webinar #3
Road Shows January 20, 2015: Metrocare - Behavioral Health and Physical Care Needs All Under One Integrated Team February 18, 2015: Methodist Dallas Medical Center - Diabetes Management DSRIP Project March 18, 2015: Baylor Community Care Clinic in Irving April 6, 2015: Children’s Health: Complex Care Medical Services and Children’s Health Pediatric Group May 1, 2015: New Parkland Hospital Tour
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June 30, 2015: University of Texas Medical Center – Medication Management & Depression Screening July 15, 2015: Medical City Dallas (HCA) & Green Oaks Hospital Integrated Primary and Behavioral Health Clinic September 10, 2015: Texas A&M – Baylor College of Dentistry & North Dallas Shared Ministries
RHP 9 Give Back Campaign DFW Rescue Me – RHP 9 collected over 80- blankets for DFW Rescue Me a foster-based dog rescue group in the Dallas area.
Fiscal 2016 Regional Events Feb 9-10, 201: RHP 9 & 10 Collaborative Connections – Impacting Care Learning Collaborative July 21, 2016: RHP 9 Regional Shared Experiences and Learning Event
Cohort Events: May 19, 2016: RHP 9 Learning Collaborative Cohort Session (Combined Session)
Webinar June 16, 2016: RHP 9 PDSA Raise the Floor DY5 Webinar
RHP 9 Give Back Campaign Women’s Shelters in Dallas, Denton & Kaufman County –Toiletry and Personal Care Items collected
V. Behavioral Health A. Develop and implement a new patient navigation program targeted to assist Parkland patients with mental health disorders. 1. 2013 – We did assessments to determine the gap in services and service needs to identify, triage and manage the target population. 2. 2014- We completed the program design, hired and trained staffs to support our patient population who are most at risk of receiving disconnected/fragmented care including training programs, procedures, and continuing education.
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3. 2015 – We continued to refine the program based on our pilot phase learnings. We increased the number of unique patients enrolled in the program. We surpassed the goal of 1,800 unique patients with this project, by refining the referral process, and incorporating group activities on the psych unit. 4. 2016 – We continue to increase our access and number of unique individuals enrolled in the program. The DY5 (FY16) goal for this year is 2,400 individuals enrolled in the program.
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