LLCHC Service Area Needs Assessment

Final Report

Lower Lights Christian Health Center

Service Area Community Health

Assessment

Exploring Health Issues, Policies, Services and Citizen Involvement impacting residents of Franklinton, .

Created: October 21, 2013 Board Reviewed & Approved: November 05, 2013

by Cornerstone Management Wheelersburg, OH LLCHC Service Area Needs Assessment

INTRODUCTION

Medicine and medical care come to mind when discussing health issues. However, there are several factors which directly impact a person’s health which are not medical in nature. These broad health status indicators deal with poverty, housing, education, environment and more. It is these underlying causes of disease that is the focus of this project.

The health of the community concerns everyone. A healthy community is well equipped with active, productive, participating citizens who are free to use their energies toward the good of their employers, school systems, volunteer groups, and churches. The kind of community that successfully joins together for the common good is made up of clean neighborhoods of healthy families that support the mental and physical health of each individual. Few communities completely obtain this goal. Most are plagued to some degree by polluted streets, emotional health issues, excessive rates of preventable disease and death, increasing costs of medical care, and an overall decline in the quality of life. When citizens’ health is poor, productivity declines, employers are forced to deal with high rates of absenteeism, education suffers, and the pool of available volunteers decline. Prevention and early intervention are the keys to creating a healthy population living in healthy communities and so maximizing their ability to thrive. It is, therefore, of vital importance to assess the underlying causes of poor health and the availability of healthcare resources in the community in order to address the issues that are creating health problems.

This report contains a baseline of measurable data upon which to build. It lays the groundwork for developing a dynamic plan to continually assess and improve the health status of Franklinton residents. This project will guide the development of strategies to implement community health programs with an emphasis on prevention and provision of cost effective, high quality comprehensive early intervention health care for all.

BACKGROUND

In the rapidly changing world of health care in our nation and in our state, we must strive to keep current with changes that affect the health of the community. Health providers must become more versatile in providing programs that meet the changing needs of the public. The Nationally focused Healthy People 2020 Project and Ohio’s Public Health Plan have identified certain core functions which are necessary to effectively change the way health providers organize resources and programs. Community health needs assessment is identified as a strong tool by which a community can identify important health problems by both of those projects, and begin to aggressively address them. Health assessments include broad community representation that provides necessary input to a data-driven assessment of the current state of the community’s health.

LLCHC Service Area Needs Assessment

A review of the Lower Lights Christian Health Center programs precipitated the overall project. This was followed by an assessment of the Franklinton community’s health delivery system in order to determine, among other variables, the availability, accessibility, and quality of care being offered. While these two facets of the project were taking place, a survey of Franklinton residents was also implemented to obtain what “the people” considered their biggest health problems. Concurrently, our researchers performed a background secondary data analysis and review of historical data, conducted a series of interviews with health personnel and clientele, completed a telephone survey of healthcare providers, conducted a random telephone sampling of community members, and investigated similar sized systems for a comparative analysis. This sampling provided a true research based assessment of the problems affecting the health status of Franklinton residents.

SCOPE

This assessment is intended to provide insight into the community health status of Franklinton, a suburb of Columbus, Ohio. It seeks to discover perceived problems from the community at large and problems identified by those who work in the health professions. The core focus of the project considers the primary health care needs and barriers to care for the approximately 12,000 of Franklinton residents with incomes below 200% of federal poverty guidelines. Therefore, before further developing the descriptions of poverty and health concerns of Franklinton, it is important to understand the basis-for estimates of the statistics used to describe the target population.

Access Ohio notes that there is little health care data kept below the county level in Ohio. As Access says, "health status indicators are not available for many cities, townships, rural counties nor for specific population groups." Therefore, they conclude, most reliable information is available at the county level. Nonetheless, there are a number. of census statistics kept at the census tract level, (such as age, sex, race, poverty status, home ownership,) which impact health status and do provide some specific numbers with respect to the Franklinton population. In many cases, however, the best estimate of the degree of a problem in the target population is the same as the figure for Franklin County as a whole, unless there is some circumstance that makes it possible to conclude that the manifestations of the problem in the target population are greater or less than the manifestations of the problem county-wide.

Also, the under 200% of Poverty population is faced with significant health disparities as evidenced by characteristics developed by the National Center for Health Statistics. In every category, persons with low incomes fare significantly worse than persons with higher incomes: having health insurance rates are lower; doctor visits are lower; dental visits are lower; dental caries are higher; and routine cancer screening rates are lower. It is clear that health disparities exist in the lower income ranges.

Page 3 of 19 3 LLCHC Service Area Needs Assessment Table 1. Healthcare Disparities by Poverty Level Income below 100% of Incomes between Incomes Over 200% of the Federal Poverty 100% and 200% of the the Federal Poverty Level Federal Poverty Level Level % of children without a 13.5% 9.8% 3.8% usual source of health care % of children without a 17.2% 14.7% 10.1% healthcare visit in the last 12 months % of adults without a usual 27.5% 24.5% 12.6% source of healthcare % of persons without a 53.0% 48.1% 26.6% dental visit in the past year % of persons with untreated 33.8% 29.5% 12.7% dental caries Income below 100% of Income above 100% of the Federal Poverty the Federal Poverty Level Level % of women over 40 45.2% 27.9% without a mammography in the last two years % of women over 18 27.9% 13.8% without PAP in the last 3 years Income below 100% of Income between 100% Income between 150% Income over 200% of the Federal Poverty and 149% of the and 199% of the the Federal Poverty Level Federal Poverty Level Federal Poverty Level Level % of the population under 31.4% 32.8% 25.6% 10.9% 65 with no health care insurance % of the population under 26.7% 39.2% 56.6% 83.9% 65 with private health care insurance Source: National Center for Health Statistics

Page 4 of 19 4 LLCHC Service Area Needs Assessment METHODOLOGY

Cornerstone Management, with significant input from the Lower Lights Christian Health Center staff, collected, organized and analyzed the health assessment data from a number of major sources. Sources include the US Census Bureau, Ohio Department of Health, Ohio Department of Development, US Department of Health and Human Services, and the National Center for Health Statistics. An external resource assessment was also completed in conjunction with the Franklin County and Columbus City Health Departments. Questions centered on leadership, community, public perceptions, professional staff, and additional resources their clinics offer.

This health assessment provides an understanding of not only the community’s health status but also the internal strengths and limitations of the Franklinton health delivery system. Its design also assists in determining residents’ perceptions of health issues and healthcare providers. To increase the quality of responses, personal interview methodology was employed as often as possible.

The statistical sampling included:  Fifty (50) randomly selected Franklinton households, contacted by telephone for a general health and needs assessment. This provided an initial identification of health issues, attitudes, and service and provider utilization by community members. Approximately 30 of the 50 households contacted agreed to complete the survey for a response rate of 60%. Of those declining to participate, about 60% pleaded time constraints, 37% simply declined or seemed fearful of providing information and 3% were unable to understand the purpose of the survey.  Primary care physicians were polled as to available services. There were 3.9 physicians providing services in 2 locations. Some respondents were unable or unwilling to answer all the questions. None, other than Lower Lights, accepted new Medicaid patients or provided income based sliding fee discounts.  Secondary data analysis on existing state and federal demographic, health, social and economic reports (as well as information secured from local sources) was compiled and examined for contextual placement.  Interviews with community leaders, social service providers, and governmental entities serving the Franklinton area were employed as an additional method of gathering information and community thought patterns in target areas of the assessment. Community and health representatives provided input in this process.  In late 2012 LLCHC participated as a member of the Franklin County Community Health Needs Assessment Steering Committee to provide the residents of central Ohio with a comprehensive summary of the larger community’s health status and needs. That report, Franklin County Healthmap 2013, was issued in January 2013 and is included as an attachment to this report

Page 5 of 19 5 LLCHC Service Area Needs Assessment REPORT ORGANIZATION

This community health assessment covers five main areas:

I. Profile of Franklinton. II. Assessment of community health status. III. Survey of available health services IV. Community perceptions V. Conclusions and Recommendations

I - PROFILE OF FRANKLINTON

Franklinton, one of the first villages in the Northwest Territory and the oldest community in Central Ohio, was founded at the confluence of the Scioto and the Olentangy rivers in 1797. The community became known as “The Bottoms” since it was located in a flood plain. In fact, over 90 people died in the 1913 flood, thousands of people were left homeless, and many industries were irreparably damaged and left the area. That event marked the beginning of Franklinton’s decay as many residents relocated to the nearby community. As a result, property values dropped as much as 50% resulting in a large influx of low-income families to move to the area.

During the 1960s through 1980s period, construction of the Interstate Highway system delivered another negative blow to Franklinton. The Columbus inner belt construction removed several blocks of buildings along Sandusky Street, lowered property values and drove out of East Franklinton most of the remaining stable families. This out-migration was once again followed by an influx of low income families.

In addition to the land use and population changes that occurred, the inner belt formed a barrier which sealed off the only side of East Franklinton that was not bordered by the . This isolation was further reinforced with the construction of West I-70. Franklinton is now surrounded by highways, railroads and a river. This physical separation from the rest of the city has created a unique and easily defined community.

The Franklinton area is generally bound by the Scioto River on the north, the first set of railroad tracks west of Starling Street on the east, Greenlawn Avenue/City of Columbus corporate limits/Mound Street on the south, and Central Avenue/I-70 on the west. It also includes an area between the Scioto River and the first set of railroad tracks west of Starling Street. This area is commonly referred to as the Scioto Peninsula.

Franklinton is roughly composed of census tracts 30, 32, 40, 42, 43, 50 and 51. These census tracts contain an area that has been designated as a Medically Underserved Area (MUA) by the Bureau of Primary Health Care (#02682), and that has been designated as a Health Professional Shortage Area (HPSA). Page 6 of 19 6 LLCHC Service Area Needs Assessment

Table 2. HPSA/MUA Census Tract MUA Medical HPSA Dental HPSA 30 x x x 32 x x x 40 x x x 42 x x x 43 x x x 50 x x x 51 x x x Source HRSA

Unfortunately, Franklinton’s isolation and appellation as “The Bottoms” continues to connote the poor economic conditions of its citizenry.

General economic issues demonstrate the pervasive poverty of the area:  41% of families live at or below federal poverty guidelines, and this number jumps to 63% of families with children of less than five years of age. This is the highest poverty rate within the City of Columbus.  In 2011, at least 5000 of Franklinton’s 20,000 residents had no health insurance coverage.  The median income is $23,102 as compared to Columbus at $55,039.

Page 7 of 19 7 LLCHC Service Area Needs Assessment  The estimated unemployment rate for Franklinton in September 2012 was 14% for males and 10% for females, compared to 9.1% and 9.0% respectively for Columbus.  45.5% of the population does not have a high school diploma.  40.9% of the total population is under 100% of poverty, and another 18% are under 200% of poverty. 22% of all housing in Franklinton is unoccupied, and only 33% is owner occupied.  The racial composition of Franklinton population is 76% White, 15% Black, 2% Hispanic, 2% Asian, and 5% unknown.  There have been no unusual changes in the demographic composition of the community in several years.

Table 3. Economic Indicator Comparison, Service Area/Columbus Indicator Franklinton Columbus Single Mother Households 14.3% 7.5% Less than a high school education 45.5% 14.2% College Graduates 15.3% 29.1% Household <$10K 25.9% 8.1% Household <$15K 36.4% 13.5% Household <$25K 54.7% 25.3% Family Median $23,102 $55,039 Poverty Families w/Children (n=1781) 45.5% 10.6% Source: US Census ACS 2011 (Franklinton): Tables

Franklinton leaders believe that the physical and mental health of its residents directly affects the economic health of the area. That a healthy, better educated, more reliable work force, which is attractive to business and industry, will allow Franklinton residents to begin their escape from the shrouds of poverty.

II – ASSESSMENT OF COMMUNITY HEALTH STATUS

The seven census tracts that generally conform to Franklinton community boundaries contain both a designation as a Medically Underserved Area (MUA), and a Health Professional Shortage Area (HPSA).

The pervasive poverty in Franklinton has contributed to significant health care disparities in the service area and target population. Research of data from several sources identified many healthcare disparities and these disparities have been organized by the five (5) Lifecycles for this report and are as follows:

Page 8 of 19 8 LLCHC Service Area Needs Assessment PERINATAL

 The percentage of pregnant women with no prenatal care in the first trimester is 35.0% which far exceeds averages for both Franklin County (18.2%) and the State overall (16.7%). [Source: Ohio Department of Health]  The perinatal mortality rate in Franklin County (2006-2008) is 8.8 per 1000 live births as compared to the Ohio rate of 7.7 for the same period. [Source: Ohio Department of Health]  The rate of low birth weight babies for the same three year period is 1.9% of all births compared to the State of Ohio rate of 1.5%. Furthermore only 49.3% of the VLBW infants were delivered at Level III facilities as compared to 71.2% in the State of Ohio. It is estimated that this rate is even lower among the target population. [Source: Ohio Department of Health 2008]

PEDIATRIC

 The infant mortality rates for Franklinton is 15.0 per 1000 live births as compared to Franklin County (8.8 per 1000 live births), and Ohio (7.9 per 1000 live births). [Source: Ohio Department of Health]  The neonatal mortality rate for Franklin County is 5.9 per 1000 live births (3 year average) as compared to the State of Ohio at 5.2 per 1000 live births. Exact data is not available for the target population. [Source: Ohio Department of Health]  The leading causes of death for Franklinton children between the ages of 1 and 14 include accidents, homicides, and suicides with a crude (not age adjusted) death rate of 23.3 per 100,000 deaths as compared to a rate of 22.8 (2008) for the State of Ohio. [Source: Ohio Department of Health]  Only 28% of Columbus children in 1st through 3rd grades have preventive dental sealants on their permanent teeth compared to Healthy People 2020 goal of 50%; 29% of these same children have untreated dental caries or decayed teeth; 5% of these children are in need of immediate dental care; 25% of this group of children (1st through 3rd grade) have not had a dental visit within the past year, and 3% have never had a visit (2002 Franklin County Health Assessment updated 2008). This problem is worse among lower-income children.

ADOLESCENT

 Drug use among Franklinton youth is pervasive but no solid data is available to document the level of the problem.  The teen pregnancy rate in Franklinton is more than double the rate for Franklin County as a whole: 7.6% vs. 3.5% (averages for the period 2006-2008 – Columbus Department of Health).

Page 9 of 19 9 LLCHC Service Area Needs Assessment  According to the Columbus Health Department, the number of new cases of HIV reported in Franklinton has risen dramatically over the past ten years in this age group. No comparative data is available.  The incidence of sexually transmitted diseases among this age cohort in Franklin County per 100,000 population is much higher than the incidence in the United States according to the 2002 Franklin County Health Assessment Updated 2008.

ADULT AND GERIATRIC

The health care problems among the target population and the Franklin County area are similar for both life cycles.

 8.1% of Franklin County residents have been diagnosed with diabetes/high blood sugar as compared to 5.4% in the US according to the 2010 County Health Rankings Franklin County. Furthermore, deaths per 100,000 persons attributable to diabetes are 34 as compared to 25.2 in the US according to this same study. Not surprisingly this assessment found that 61.7% of Franklin County residents are overweight compared to 56.5% of US residents. The assessment also found that 25.8% of Franklin County residents were obese as compared to only 19.1% in the US. In Franklinton 70.3% of residents have a BMI of 25 or higher compared to 56.3 for Franklin County.

According to the Ohio Hospital Association during 2008, fifty-nine (59) adults from Franklinton were hospitalized for diabetic crises.

 Deaths from lung cancer per 100,000 (age adjusted) is 67 in Franklin County as compared to 58 in the US. According to the 2002 Franklin County Health Assessment updated 2010, Health Department statistics estimate that 55.3% of Franklinton residents are current smokers compared to 26.6% of Franklin County residents.  Deaths from stroke per 100,000 (age adjusted) in Franklin County is 48.1 in Franklin County compared to the national benchmark of 41.4. Contributing factors include the fact that 26.9% of Franklinton residents have been diagnosed with high blood pressure as compared to 23.4% in the US.  Deaths from breast cancer per 100,000 (age adjusted) in Franklin County is 31.3 compared to 27 in the US according to the Ohio Department of Health 2008.

o Dental care is a problem for all lifecycles in the target population, especially for low-income residents. Franklin County Health Department survey results indicated that 33.7% of adults in Franklin County had not visited a dentist in the past year, and 27.6% of adults had no dental insurance.

Health status indicators for mortality & chronic and infectious diseases prevalence and incidence within the community and target population with comparisons are shown in the following tables: Page 10 of 19 10 LLCHC Service Area Needs Assessment

Table 4. Health Status Indicators: Service Area/Columbus City/State/HP2020 Rates

Indicator Service Columbus State of HP Area City Ohio 2010 Infant Mortality 11.0 8.4 7.8 4.5 per 1,000 live births Low Birth 8.6% na 8.0% 5.0% Weight Births Late Prenatal 30.9% 18.5% 14.0% 12% Care Births to 26.3% na 18.9% na Women who smoked Teen Pregnancy 42.4 39.9 33.6 na per 1,000 females age 10- 19 Coronary Heart 201.7 na 174.7 166 Disease Cancer 227.8 209.0 200.2 159.9 Stroke 55.9 * na 51.4 48 Diabetes 30.2 * na 29.7 CLRD 53.2 * na 50.1 Source: Health Statistics, ODH 2008 * For some indicators data specific to the targeted population is not readily available but for those indicators the overall Franklin County indicators were worse than State rates.

The first five (5) indicators can be categorized as Maternal and Child Health indicators. All 5 categories are consistently higher than the State of Ohio. Except for a few areas, the other Maternal and Child Health indicators appear to be in line with the State of Ohio rates. The last five (5) indicators on Table 5 are more disease related mortality rates. On these Health Status Indicators, the target population does not fair as well. The service area had a higher average incidence rate per 100,000 populations than the State of Ohio in all of the five (5) categories.

Target population data for communicable disease rates compared to the State of Ohio is not favorable and well above both State and HP 2020 rates. Residents of Franklinton tend to maintain certain attitudes and values that drive unhealthy behaviors which impact access to and inappropriate use of the health care system. Preventative health care or health maintenance is not valued by most of the population. The lack of value is probably most pronounced in low income families where substance abuse, violence, appointment no-show, unprotected sex, poor diet, etc., abound. The general attitude is to classify health habits as personal issues, guarded by self-reliance, stoicism, and personal privacy. Often, care for a health care problem is not sought unless it is perceived to be life- threatening.

Page 11 of 19 11 LLCHC Service Area Needs Assessment

Table 5. Communicable Diseases: Service Area/State Rates

Service State of HP 2020 Disease Area Ohio HIV/AIDS 235.8 124.8 na Chlamydia 447.4 315.1 na Gonorrhea 335.4 184.2 19.0 Syphilis 4.7 2.0 0.02 Source: Health Statistics, ODH 2008

Table 6: Behavioral Risk Factor Indicators: County/State Rates

Service State of HP Indicator Area Ohio 2020 Current 34.1% 26.6% 12% Smokers Mammogram 67.2% 77% 70% 40+, last 2 yrs. Sigmoid 50+ 31.1% 46% 50% last 5 yrs. Overweight 61.7% 58.8% 15% BM>25 Pap Smear 80.6% 86.6% 90% 18+ last 2 yrs. Binge 28.9% 15.9% 20% Drinking Source: Health Statistics, ODH 2008

Page 12 of 19 12 LLCHC Service Area Needs Assessment II – A REVIEW OF COMMUNITY RESOURCES

This section outlines views on the Franklinton community resources in context with their health delivery system and service availability.

Leadership in Franklinton appears to be stronger in some areas than others. Everyone agreed that the leaders of their community work well together, generally taking a long term view and giving programs time to develop into assets. Most felt that while there is leadership from many areas of the community, gaps exist in the areas of business and industry of which the notable exception is Mt Carmel Medical Center which is providing outstanding support to the community.

Government responsiveness is thought to be good, but more involvement in community matters would be desirable. Community needs are positively addressed, but there is room for improvement in this area. Specifically, closer ties are needed between government, business, and the non-profit sector. Community leaders do not regularly attend meetings that relate to the area’s health services. For the most part, neither private industry nor the local media have joined with the community to promote public health awareness. The community does have a strategic plan but it is only directed at recruiting new industry. Problems within the community are often not addressed until they become crises.

There is no local foundation specifically committed to the improvement of the community. There are however, several local civic organizations devoted to the betterment of the community, most notably, the Kiwanis, Rotary, and Lions Club.

The community agreed there are no ethnic or racial divisions posing problems. Generally groups work well together and the community is not dominated by any special interests. There is a shared sense of pride and vision for the community within the consortium.

Responses identified Mt Carmel Medical Center as a strong leader in health services. As an example, its cooperation with LLCHC in providing care to the underserved, Mt Carmel sets a fine example of partnering between quasi-government and the private sector. Respondents were disappointed that the same cooperation isn’t seen in other areas.

Page 13 of 19 13 LLCHC Service Area Needs Assessment III - SURVEY OF AVAILABLE SERVICES

All 3.5 primary care providers serving the Franklinton area were contacted.

The survey of primary care providers showed:

 The total number of primary care physicians in Franklinton providing services to the medically indigent is inadequate.

 None of the respondents other than LLCHC accepts new Medicaid patients or provides discounted fees for low income patients

 100 % of respondents had office hours Monday through Friday.

 In two of the offices, a physician was available only 4-5 hours per day.

Other health care providers that provide some level of care to the target population (most of which cooperate with LLCHC) include:

 Mt. Carmel West Hospital provides both diagnostic laboratory and radiologic services to LLCHC patients based on a sliding fee scale. Mt. Carmel also accepts LLCHC in its specialty clinics to include Obstetrics, Gynecology, Orthopedics, General Surgery and Cardiology, Gastroenterology, and Urology. Uninsured patients are accepted based on family size and income in accordance with the Hospital Care Assurance Program (HCAP). Mt. Carmel also assists with in-patient care for LLCHC patients. Mt. Carmel’s assistance greatly enhances LLCHC’s ability to provide comprehensive services.  A number of private practice medical specialists will accept uninsured and Medicaid eligible new patients referred by LLCHC. They will not accept any new patients not referred by LLCHC.  Lower Lights Ministries provides many varied services. These services include substance abuse programs, employment/educational counseling, food pantry, clothing pantry, housing assistance, transportation, and community outreach.  WIC services and nutritional counseling are available and a Franklin County WIC office located across the street from LLCHC.  The PRIDE Center, an arm of the Columbus Health Department, is also located across the street from LLCHC. Services provided include case management, eligibility assistance, discharge planning or home evaluation.  The Alpha Group, a private mental health/substance abuse agency will accept LLCHC referrals regardless of ability to pay but will not accept new patients not referred by LLCHC.  Netcare, a community mental health safety net agency accepts patients regardless of ability to pay.

Page 14 of 19 14 LLCHC Service Area Needs Assessment  The Columbus Health Department Dental Clinic accepts patients regardless of ability to pay. Services provided include fillings, exams, cleanings, extractions, and some root canals.  The East Central Health Center Dental Clinic also provides low cost dental care, and provides the same services as the Columbus Health Department. (Not in service area.)  The Family Practice on High Street – Dental Clinic provides limited dental services for adults and children based on a sliding fee scale. (Not in service area.)  The Vineyard Free Medical Clinic provides limited dental services on Fridays to include exams, fillings, and extractions. (Not in service area.)

IV- CLIENT AND COMMUNITY PERCEPTIONS

Client survey results of the Lower Lights Christian Health Center To obtain a sampling of attitudes toward current service delivery at the LLCHC clinic, random personal interviews with ten clinic clients provided the opportunity to ask open-ended questions that provided insight and answers inherently unobtainable in formal closed-ended surveys, and, that might not have been expressed among peers in a focus group setting. In this case, the interview guide was constructed to more fully gain an understanding of the deeper feelings and attitudes of the residents in Franklinton toward the clinic, its programs, and other community issues. The semi-structured interviews yielded a fairly tight set of results regarding opinions toward the clinic. It also provided very candid responses concerning sensitive and sometimes conflicting issues within the community. For example, most of respondents listed drug-abuse, drinking, and smoking at their top health concern while two respondents specified the need for universal health care.

The sampling provided a balanced group by family income status. Sixty percent of respondents’ household income fell between $10,000 and $15,000; thirty percent were below $10,000; and only one was over $25,000. Only twenty percent (20%) of respondents owned the homes they occupied. This compares to an owner occupied rate of sixty-three percent (63%) for Ohio and seventy-three percent (73%) nationally. Family members, co-workers, and friends provided an introduction to the clinic for most respondents. Sixty percent of the respondents visit a “family doctor” only one or two times per year; two persons indicated they “never” see a doctor. All respondents said the clinic provided the services they needed. None had trouble scheduling an appointment.

All (100%) of the respondents indicated they would still use the services of the clinic if given a choice among health care providers. Ninety percent rated the prenatal care a top ranking “5" and indicated they felt comfortable recommending it to a family member. All respondents said the health clinic workers informed them of “important health issues” and 90% said they “always” get clear directions concerning specific needs.

Page 15 of 19 15 LLCHC Service Area Needs Assessment Community Survey Results This section contains a summary of the primary data collected from telephone interviews conducted within the project area. Major findings are presented for comparison with secondary data. Not surprisingly, perceptions of respondents conflicted with actual services offered in a number of cases. This was especially evident in several “public awareness” or communicative issues regarding some health indicators.

Thirty-three of 46 respondents were familiar with the LLCHC clinic. Four were not sure if they knew specifically of the clinic, but thought they “might have heard of it.” The annual average number of physician encounters for respondents was three, with a standard deviation of +/- 4; however there were several responders indicating 20 to 24 visits per year. Such extreme numbers usually result from some type of special problem/need. Approximately seventy-five percent (75%) of respondents stated they were moderately to very conscious of their family’s health. Fifty-two percent use private insurance or cash to pay for medical care, while twenty-seven percent (27%) utilize Medicare and eight (18%) are enrolled in Medicaid. The average household size of respondents in the telephone survey was three. The minimum household size was one and the maximum was six. Incomes for households responding to the survey varied somewhat. Twenty-four percent were under $10,000, while three percent totaled over $45,000. The remaining respondents were evenly spaced between these two limits. Twenty-four percent (24%) of respondents in the telephone survey said they felt cancer was the number one health concern facing the community. Sixteen percent (16%) said pollution, which directly relates to increased cancer risks, was paramount. Fifteen percent (15%) of respondents stated that “all” of the problems listed were pressing issues and needed immediate attention. Fourteen percent (14%) listed drug abuse, ten percent said “colds and flu”, and nine percent (9%) said there were essentially “no problems” facing the community. Other problems cited by participants included alcohol, allergies, child abuse, lime disease, measles and transportation.

V - CONCLUSIONS

Community Perceptions Almost one third of survey respondents under age 60 were unfamiliar with the clinic. An outreach and education effort, especially in middle and high schools, could increase early clinic usage and could positively impact maternal health as well as the risk of low birth weight and infant mortality.

Franklinton citizens are concerned about a wide range of health issues according to survey results. Publicity and education could address many of these concerns, with a focus on cancer detection and prevention. Clean up campaigns targeting specific areas in one or two week blocks could involve civic groups, schools, businesses and citizens in an effort to eradicate rodent, tick, and mosquito breading areas, clean trash from roadways and streams, and beautify formerly unsightly areas. Drug abuse education and treatment options should be publicized, with law enforcement stepping up efforts at eradication.

Page 16 of 19 16 LLCHC Service Area Needs Assessment Education “Education and community based health promotion and disease prevention interventions are important in reducing illness, injury, disability, and premature death in Ohio.” (Healthy People Ohio 1997) Citizens must be educated about the need for prevention and early interventions. Community respondents were often unaware of services offered by LLCHC. Some were aware that services were available, but not sure if they would qualify or if specific services such as a dental clinic were offered. A focused media campaign involving radio, TV, and print media is recommended to inform people about Health Department clinics, education programs, and income guidelines.

Access Access to care within the area is a serious problem. If suitable space could be found, consideration should be given to relocating the clinic, thereby improving accessibility to clients.

The health of the community concerns everyone. If the Franklinton community is to move forward economically and educationally, its citizens must be mentally and physically up to the challenge. With the identification of problem areas, both real and perceived, steps may be taken to upgrade the health of individuals, families, and neighborhoods.

Franklinton’s economic woes are in some ways the cause of and caused by health problems. Pollution of air and water by industry in the past may have contributed to lung problems and cancer. Unemployment and underemployment worries contribute to or worsen emotional and physical diseases caused by stress, along with the social problems of alcoholism, drug abuse, and domestic violence. An unhealthy workforce brings problems with absenteeism, low productivity, and worker dissatisfaction. Improving the health of the community as a whole through clean-up projects, stress control education, and affordable, available health care would improve the health of industry already present in the community, and make Franklinton more attractive to new businesses.

Goals for continued improvement should focus on information, education, and access. If the community is informed about the availability of care, provided access to care through better affordability, and educated about the importance of good health practices and preventative care, Franklinton can realize the vision of a vibrant community, where every individual is fully equipped to live up to his potential to the benefit of everyone.

Page 17 of 19 17 LLCHC Service Area Needs Assessment Gaps in Service Health services (except those offered by the LLCHC) available to uninsured and under-insured citizens of Franklinton is virtually non existent. An effort should be made to attract more primary care physicians to the area, which would assure availability of care and increase the base of care available to Medicaid recipients. Physicians should be educated about the need for evening and Saturday hours, and encouraged to offer expanded hours at least one or two days a week (perhaps one evening and every other Saturday). Working parents were often unable to schedule appointments during non-working hours, a result borne out by the lack of evening and Saturday office hours found in the survey of primary care physicians

Physicians also need to be encouraged to allow uninsured or under-insured patients to pay on a sliding fee scale.” Working poor” who are unable to qualify for a medical card, and who have little or no discretionary income available to pay for office visits, often put off obtaining care. Also this barrier includes those with incomes in the $20,000 to $30,000 range who have private insurance which doesn’t pay for office visits, or whose deductibles are prohibitively high.

Oral health is also a serious problem for Franklinton residents. Dental services are not available to the vast majority of residents.

According to Ohio’s Public Health Plan: “Access to primary and preventive dental care, continues to be a problem for people without financial means.” Franklinton’s 12,000 people living below the 200% federal poverty level easily fall in the category of “people without financial means”.

Lower Lights Community Health Center The following outlines findings from an internal and external assessment of the Lower Lights Christian Health Center and its clinical program. This assessment was conducted via interviews with key personnel from LLCHC. Questions in the interviews were adapted from the Ohio Health Plan’s Guide for Community Assessment.

While the LLCHC has a strategic plan, it is not widely known to the employees. The mission statement does appear common to all those within the organization. The staff of the LLCHC feels that they are the ones primarily responsible to be good health advocates. LLCHC is the most vocal agency within the community on promoting the public health.

Communication within LLCHC is very good. All lines of communication are open within the chain of command. Staff meetings are held weekly with supervisors. Employees expressed an atmosphere conducive to sharing ideas and differing perspectives. This is strength of the organization. A leadership role is taken by the CEO, who makes the final decision when a general consensus cannot be reached. Teamwork within the agency is an excellent indicator of quality care and service. The clinic is utilizing available technology via Internet access and Electronic Health Records systems.

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Board representation is good, with low income, clinic users and professional communities being well represented. Age, race, and gender are adequately diverse.

The Lower Lights Community Health Center internal and external assessment reveals an organization with the necessary resources to continually assess and provide for the health of the community. It has the capacity to fill important roles in the assessment and care delivery process. Those being: Leader, collaborating partner, and a source of technical assistance and data. The staff of the LLCHC works well together, and communication within the clinic is generally very good.

Continually updating the strategic plan and communicating it to the staff should be a priority. Yearly updates will ultimately save time and allow the clinic to be continually responsive to the community.

In summary, LLCHC and Mt Carmel are clearly leading the provision of health care services in Franklinton and providing the springboard from which to launch non healthcare redevelopment. An aggressive program of networking involving leadership in all segments of the community would benefit the area as a whole and create a cooperative atmosphere that is attractive to prospective industry. Many larger companies now understand that healthier, happier employees are more loyal and more productive. They are actively forming partnerships with local governments, schools, and non-profit organizations that encourage their employees to volunteer their time and talents. They also provide funding for many projects.

As stated earlier, LLCHC was a participant in developing the Franklin County Healthmap 2013. This report focuses on the LLCHC Franklinton service area, while the Healthmap 2013 provides an excellent overview of the entire Columbus MSA. Both reports should be used together to facilitate the development of LLCHC strategies to provide comprehensive, affordable, healthcare to the impoverished residents of its Franklinton service area.

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