Southeastern Community 2019

SOUTHEASTERN PENNSYLVANIA COMMUNITY HEALTH NEEDS ASSESSMENT HEALTH NEEDS ASSESSMENT

Partnering Hospitals

• Abington Hospital • Abington Lansdale Hospital • Chester County Hospital • Children’s Hospital of • Einstein Medical Center Montgomery • Einstein Medical Center Philadelphia • Einstein Medical Center Elkins Park • Grand View Hospital • Holy Redeemer Hospital • Jefferson Bucks Hospital • Jefferson Frankford Hospital • Jefferson Torresdale Hospital • Thomas Jefferson University Hospital • Jefferson Hospital for Neuroscience • Jefferson Methodist Hospital • Hospital of the University of Pennsylvania • Pennsylvania Hospital • Penn Presbyterian Medical Center

TABLE OF CONTENTS

Executive Summary...... 2 Philadelphia County, PA...... 127 1. Center City...... 128 Partners ...... 13 2. Far ...... 130 1. Introduction...... 13 3. Far ...... 134 2. Participating Hospitals and Health Systems.....14 4. Lower Northeast Philadelphia...... 138 a. Hospital Profiles 5. North Philadelphia – East...... 142 i. Overview of Hospital 6. North Philadelphia – West...... 146 ii. Past CHNA and Community 7. ...... 150 Benefit Impact Statements 8. River Wards Plus...... 154 iii. Target Community Benefit 9. – East...... 158 Service Areas and Demographics 10. South Philadelphia – West...... 162 3. Partner Organizations...... 58 11. ...... 166 4. Our Collaborative Approach...... 60 12. ...... 170

Bucks County, PA...... 69 Populations of Special Interest...... 174 1. Central/Lower Bucks...... 70 1. African-American communities...... 174 2. Perkasie/Sellersville/Indian Valley...... 74 2. Hispanic/Latino communities...... 178 3. Quakertown/Pennsburg...... 78 3. Immigrant and refugee communities...... 182 4. Individuals experiencing homelessness...... 184 Chester County, PA...... 81 5. Individuals with behavioral/ 1. Honey Brook...... 82 mental health conditions...... 188 2. Kennett...... 86 5. Individuals experiencing housing insecurity...... 197 3. Northeast Chester...... 88 7. Individuals with disabilities...... 200 4. Northwest Chester...... 90 8. LGBTQ+ communities...... 202 5. Oxford/West Grove...... 92 9. Prenatal/postpartum women...... 204 6. West Chester...... 94 10. Youth and adolescents...... 206

Montgomery County, PA...... 99 Community Health Needs...... 209 1. Blue Bell...... 100 2. Collegeville...... 102 Resources ...... 226 3. Conshohocken...... 104 1. Local Health Resources and Services...... 226 4. Greater Abington...... 106 2. References and Data Sources...... 227 5. King of Prussia...... 108 3. Online Appendix...... 228 6. Lower Eastern...... 110 7. Norristown...... 112 8. North Penn/Lansdale...... 116 9. Upper Dublin...... 120 10. Willow Grove...... 122

Community Health Needs Assessment | 1 Health is influenced by many factors, including social Partnering Hospitals and economic conditions, the built environment, • Abington Hospital accessibility of healthy products, the behavioral choices • Abington Lansdale Hospital people make, and access to and quality of the medical • Chester County Hospital care system. Hospitals play a unique role addressing • Children’s Hospital of Philadelphia many of these factors both in providing medical care and investing in initiatives to improve the health and well-being • Einstein Medical Center Montgomery of communities they serve. • Einstein Medical Center Philadelphia • Einstein Medical Center Elkins Park The Affordable Care Act (ACA) mandates that, every • Grand View Hospital three years, tax-exempt hospitals conduct a Community • Holy Redeemer Hospital Health Needs Assessment (CHNA). By determining and • Jefferson Bucks Hospital examining the health needs and gaps in communities, • Jefferson Frankford Hospital these assessments drive hospitals’ planning and • Jefferson Torresdale Hospital implementation of initiatives to improve community • Thomas Jefferson University Hospital health. • Jefferson Hospital for Neuroscience • Jefferson Methodist Hospital Recognizing that hospitals and health systems often EXECUTIVE SUMMARY EXECUTIVE mutually serve the same communities, a group of local • Hospital of the University of Pennsylvania hospitals and health systems convened to develop this • Pennsylvania Hospital first-ever Southeastern PA (SEPA) Regional CHNA, with • Penn Presbyterian Medical Center specific focus on Bucks, Chester, Montgomery, and Philadelphia counties.

This collaborative CHNA offered: » Increased collaboration among local hospitals/health systems serving this region » Reduced duplication of activities and community burden from participation in multiple community meetings » Reduced hospital/health system costs in CHNA report development » Opportunities for shared learning » Establishment of a strong foundation for coordinated efforts to address highest priority community needs

2 | Community Health Needs Assessment OUR COLLABORATIVE APPROACH

Hospitals and health systems and supporting partners collaboratively developed the CHNA that outlines health priorities for the region. The hospitals and health systems will produce implementation plans that may involve further collaboration to address shared priorities.

October 2018 to June 2019 June 2019 to November 2019

HEALTH INDICATORS PRIORITIZE PLANNING Philadelphia Department of Public Health & REPORT FOR ACTION (PDPH) led collection of a variety of quantitative indicators of health outcomes and factors influencing health from a variety of data sources.

REGIONAL HOSPITAL/ COMMUNITY HEALTH HEALTH SYSTEM NEEDS ASSESSMENT IMPLEMENTATION PLANS DATA COLLECTION PDPH synthesized findings of high priority areas; priorities Plans developed by hospitals/ were ranked using a modified health systems based on Hanlon method. findings from CHNA.

COMMUNITY/ STAKEHOLDER INPUT

Community meetings were coordinated by Health Care Improvement Foundation (HCIF) and Philadelphia Association of Community Development Corporations (PACDCD) and facilitated by qualitative experts from participating hospitals/health systems. Stakeholder focus groups were conducted by HCIF.

Community Health Needs Assessment | 3 In partnership with the Steering Committee of representatives from the partnering hospitals and health systems, the Philadelphia Department of Public Health (PDPH) and Health Care Improvement Foundation (HCIF) developed a collaborative, community-engaged approach that involved collecting and analyzing quantitative and qualitative data and aggregating data from a variety of secondary sources to comprehensively assess the health status of the region. The assessment resulted in a list of priority health needs that will be used by the participating hospitals and health systems to develop “implementation plans” outlining how they will address these needs individually and in collaboration with other partners.

SEPA REGIONAL CHNA STEERING COMMITTEE

Consensus-driven governance to provide oversight and direction; met once or twice monthly to review findings and set priorities. .

QUALITATIVE Chester County Health Department TEAM Mongomery County Office of Public Health

Led the quantitative Overall project Served as a Team of qualitative Supported analyses, synthesis, management and lead organizer research experts community meetings and prioritization of qualitative support for the community from hospitals who and quantitative community health for the regional meetings. moderated, analyzed, analyses. needs, and report community health and summarized development. needs assessment findings from effort. community meetings.

PDPH led the collection of quantitative indicators of Data were acquired from local, state and federal health for the region, with support from the Chester sources and focused on indicators that were uniformly County Health Department and Montgomery County available at the ZIP code level across the region. PDPH Office of Public Health. partnered with HealthShare Exchange, the local health information exchange, to analyze key hospital-based indicators of health.

4 | Community Health Needs Assessment HCIF coordinated the qualitative components of the assessment which included:

» 19 Community Meetings that were organized All data were synthesized by PDPH staff and a list of 16 by PACDC and facilitated by the Qualitative Team, community health priorities was presented to the Steering made up of experts from Children’s Hospital of Committee. Using a modified Hanlon ranking method, Philadelphia (CHOP), Jefferson Health, Penn Medicine, each participating hospital and health system rated the Holy Redeemer Health System, Grand View Health, priorities. An average rating was calculated, and the and Chester County Hospital. Analysis of findings community health priorities were organized in priority from these meetings was done by experts from CHOP, order based on: Jefferson, and Penn Medicine. • Size of health problem • Importance to community » 9 Key Stakeholder Focus Groups about steering • Capacity of hospitals/health systems to address committee-selected populations of special interest, • Alignment with mission and strategic direction including African American and Hispanic/Latino • Availability of existing collaborative efforts communities; individuals experiencing homelessness and housing insecurity; prenatal and postpartum women; and individuals with behavioral/mental Potential solutions for each of the community health health conditions. priorities, based on findings from the community meetings, stakeholder focus groups, and key informant » 12 Key Informant Interviews with leadership interviews, were also included. and staff at Federally Qualified Health Centers (FQHCs), conducted by Health Federation of Philadelphia.

» Additional Key Informant Interviews with hospital patient advisory groups, employees, and other stakeholders conducted by hospitals and health systems.

Community Health Needs Assessment | 5 COMMUNITY HEALTH PRIORITIES

COMMUNITY KEY POTENTIAL HEALTH PRIORITIES FINDINGS SOLUTIONS

» Drug overdose deaths have tripled » Reduce the number of people who

1. are the leading cause of death become addicted to opioids by reducing SUBSTANCE/ among young adults (ages 18 – 34) over-prescribing of opioids OPIOID USE in the region » Integrate Medication-Assisted Treatment AND ABUSE » Increases in infectious illnesses into ambulatory care and initiate like HIV and Hepatitis C, neonatal Medication-Assisted Treatment in abstinence, and homelessness emergency departments » Geographic disparities across the » Develop warm handoff projects with region external organizations. » Expand distribution of naloxone and other harm reduction resources. » Increase school- and community-based anti-drug education and awareness. » Expand medical respite for individuals with substance use disorder. » Increase medical outreach and care for individuals living with homelessness and substance use disorders. » Expand drug take-back safe disposal programs.

» 1 in 5 adults has a depressive » Expand use of telemedicine and mobile

2. disorder. care for counseling, therapy and other BEHAVIORAL HEALTH treatment for behavioral health conditions. » Undiagnosed and untreated DIAGNOSIS AND conditions like depression, anxiety, » Co-locate physical and behavioral health TREATMENT and trauma-related conditions and social services. result in: » Institute trauma-informed care/counseling • High utilization of emergency training for people working with youth. departments, particularly among youth, for mood and depressive disorders • Persisting rates of suicide, particularly among men • Substance use and abuse » Significant lack of community- based, integrated, and/or mobile behavioral health services » Vulnerable populations: individuals living in poverty, and those experiencing homeless or housing insecurity; youth and young adults; older adults; racial and ethnic minorities, immigrants and refugees; and LGBTQ+ people

6 | Community Health Needs Assessment COMMUNITY KEY POTENTIAL HEALTH PRIORITIES FINDINGS SOLUTIONS

» High supply of primary care » Expand primary care locations in

3. providers across the region, but neighborhoods with low access. ACCESS TO long wait times in some areas and » Support transportation assistance. AFFORDABLE PRIMARY/ Medicaid acceptance variable » Expand appointment availability and hours PREVENTIVE CARE » Low access to primary care in low access areas. providers for some vulnerable populations and communities due » Develop health promotion campaigns and to: initiatives to raise awareness. • Lack of providers » Provide samples/discounts on medications and enroll patients in • Affordability: Uninsured (no prescription assistance programs. safety net providers) and low- income with high co-payments/ » Use technology/telehealth to increase deductibles access to health information. • Language/cultural accessibility for immigrant/non-English speaking communities » Vulnerable populations: uninsured, working poor, immigrants

» Navigating healthcare services » Increase access to healthcare navigators,

4. and other health resources, like community health workers and patient HEALTHCARE AND enrollment in public benefits and advocates. HEALTH RESOURCES programs, remains a challenge » Develop community health resource due to: NAVIGATION directories, bulletins or newsletters. • General lack of awareness » Create permanent social service hubs and • Fragmented systems resource fairs. • Resource restraints » Encourage bi-directional integration of data between health and community- » Financial costs and logistics based organizations. associated with transportation can be a barrier to accessing healthcare » Develop school-based health and health and health resources resources navigation, like Community Schools. » Vulnerable populations: uninsured people, low-income » Provide information regarding available individuals/families, immigrants transportation services and facilitate the process for accessing these services. » Create accessible healthcare offices and access to preventive care and health screening for persons with disabilities.

Community Health Needs Assessment | 7 COMMUNITY KEY POTENTIAL HEALTH PRIORITIES FINDINGS SOLUTIONS

» Financial and logistical barriers to » Provide telehealth services.

5. specialty care for uninsured people » Co-locate primary and specialty care. ACCESS TO AFFORDABLE and those with high co-pays and SPECIALTY CARE deductibles » Provide care navigation and coordination. » Referrals from safety net providers » Schedule appointments with outside (e.g. FQHCs) are challenging providers at discharge. » Lack of care coordination, » Provide information regarding available affordability, and appointment transportation services and facilitate the availability (e.g. long wait times) process for accessing these services. result in patients not seeking » Create accessible healthcare offices for needed specialty care and use persons with disabilities. of emergency departments for acute needs

» Overall rates of cardiovascular » Initiate health education and promotion in

6. disease (CVD)-related chronic natural community hubs, such as beauty CHRONIC DISEASE disease continue to rise salons/barbershops and faith-based PREVENTION institutions. » Premature CVD deaths are 2-3 times higher in Philadelphia – » Support media campaigns that encourage related to higher rates of smoking, smoking cessation. obesity, and hypertension largely » Create opportunities for physical activity driven by higher rates of poverty like community walks, group fitness » Smoking rates in Philadelphia classes, or fitness vouchers. are far higher than the national » Continue expansion and marketing of average. wellness programs. » Vulnerable populations: » Centralize health and social services African-American, Latino, resources information. immigrant and socioeconomically disadvantaged » Use technology for health education and support.

» Access to and affordability of » Create additional food access via farmers’

7. healthy foods is a driver of poor markets, summer feeding programs, and FOOD ACCESS AND health in many communities food pantries. AFFORDABILITY » Low access is largely driven by » Support corner store redesign to poor food environments which lack accommodate healthier food supply. grocery stores or other sources of » Require screening and referral for food fresh food and produce, and are insecurity. saturated with fast food outlets, convenience and corner stores, and » Provide transportation to supermarkets other sources of unhealthy, often and other food distribution sites less expensive, food options » Provide medical-legal partnership » In communities where food services. insecurity is highest, the food environment is the poorest

8 | Community Health Needs Assessment COMMUNITY KEY POTENTIAL HEALTH PRIORITIES FINDINGS SOLUTIONS

» Excessive housing cost is as high » Develop new affordable housing units.

8. as 50% in some communities » Invest in cooperative young adult and AFFORDABLE AND across the region senior housing. HEALTHY HOUSING » Poor housing conditions like old » Provide home repairs and remediation lead paint, asbestos, bad hygiene, for high risk youth (e.g. with asthma) and infestations, lack of running older adults. water or HVAC, and damaged infrastructure, impact health: » Require screening for housing insecurity. • Poor childhood health (e.g. » Develop medical-legal partnerships. lead poisoning, asthma » Provide low-cost housing interventions like hospitalizations, injuries) smoke and carbon monoxide detectors. • Mental distress and trauma » Support rent subsidies. • Poor older adult health (e.g. falls, » Provide assistance in identifying and disability) accessing the waiting lists for accessible » Forgoing care, food and other housing. necessities due to financial strain » Advocate for and implement responsible » Rapid gentrification of some and equitable neighborhood development historically low-income that avoids displacement and segregation. neighborhoods creates risk » Raise awareness of available resources of displacement and housing for housing repair assistance. insecurity, and further segregation » Enforce lead abatement program policies. » Vulnerable populations: low-income individuals/families, » Invest in respite housing. persons with disabilities

» Teen births have declined » Provide free comprehensive sexual

9. substantially over the last education and family planning services SEXUAL AND decade, but are 2 times higher in for youth REPRODUCTIVE HEALTH Philadelphia and 4 times higher among Latina women » Sexually transmitted infection rates are rising among: • HIV: young MSM of color, PWID, high risk heterosexuals • Syphilis: young MSM of color in Philadelphia • Gonorrhea/Chlamydia: young females • Philadelphia’s overall rate is 6 times higher compared to suburban counties » Lack of comprehensive sexual education in some public schools

Community Health Needs Assessment | 9 COMMUNITY KEY POTENTIAL HEALTH PRIORITIES FINDINGS SOLUTIONS

» About 12 percent of the population » Implicit bias, cultural competence, and

10. across the 4 counties was not born trauma-informed care competencies for LINGUISTICALLY- in the U.S. As much as 26 percent healthcare providers, with focus on care AND CULTURALLY- of some neighborhoods do not for vulnerable communities like people APPROPRIATE speak English very well. living in poverty, LGBTQ+ people and individuals experiencing homelessness, HEALTHCARE » Cultural and religious norms and people living with addiction. influence individual beliefs about health » Provide multi-lingual health care access. » Recruit and retain a diverse healthcare workforce. » Develop low-literacy, culturally relevant, multi-lingual health education materials.

» Late access or inadequate access » Provide prenatal, rather than postpartum,

11. to prenatal care is 2 times higher linkages to community-based services. MATERNAL MORBIDITY in lower-income communities, up » Co-locate obstetric, primary, and pediatric AND MORTALITY to 50% of pregnancies in some care along with lab and imaging services. communities » Raise awareness of and increase options » Often related to pre-existing chronic for low-cost transportation. conditions including obesity, hypertension, diabetes, and CVD » Create direct linkages to substance use treatment during prenatal and postpartum » African-American mothers are periods. 3 times more likely to die from pregnancy-related complications » Fatal drug overdoses have caused a spike in maternal deaths not related to pregnancy

» Individuals living at or near poverty » Screen for socioeconomic disadvantage

12. levels have higher rates of adverse and establish systems for linkage to SOCIOECONOMIC health behaviors and outcomes community resources to address needs. DISADVANTAGE » Poverty is the underlying » Provide education and training (INCOME, EDUCATION, determinant for many racial/ethnic opportunities for low-income individuals AND EMPLOYMENT) health disparities » Employ and train returning citizens. » Inadequate education and training » Advocate for improvements to the and unemployment are key drivers disability system, so that people with of poverty disabilities are able to work without losing » Poverty among children and adults the attendant care services. tends to cluster in communities; » Provide workforce development/pipeline these communities collectively programs with schools. experience lower life expectancy, access to healthcare and health » Increase access to STEM education for resources, and greater exposure to youth. unhealthy living environments

10 | Community Health Needs Assessment COMMUNITY KEY POTENTIAL HEALTH PRIORITIES FINDINGS SOLUTIONS

» Community violence is largely » Support and hire returning citizens.

13. driven by community disadvantage » Create school and community-based COMMUNITY VIOLENCE and disproportionately impacts mentor programs. Philadelphia » Expand gun safety efforts like lock box » Gun violence primarily involves distribution and provide educational young Black males (>75%), many materials. disconnected from school and employment » Provide bullying prevention programs in school and in after school programs. » Women, immigrant youth, and LGBT+ people at higher risk for other interpersonal violence » Negative interactions and bullying are prevalent among youth

» Bias and discrimination » Create opportunities for medical

14. experienced by individuals due to professionals and communities to interact RACISM AND their race/ethnicity, immigration outside of the healthcare setting. DISCRIMINATION status, sexuality, adverse social » Establish systems of ongoing community experiences, and homelessness IN HEALTHCARE engagement beyond CHNA process. SETTINGS remain a challenge » Offer implicit bias, cultural competence, » Such experiences can result in and trauma-informed care competencies further mistrust of healthcare for healthcare providers, with focus on providers and institutions and can care for vulnerable communities like lead to forgoing care and increased people living in poverty, LGBTQ+ people, morbidity individuals experience homelessness, and people living with addiction. » Recruit and retain diverse healthcare workforce.

Community Health Needs Assessment | 11 COMMUNITY KEY POTENTIAL HEALTH PRIORITIES FINDINGS SOLUTIONS

» Access to safe outdoor and » Develop new affordable housing units.

15. recreational spaces for physical » Support neighborhood remediation and NEIGHBORHOOD activity and active transit (e.g. clean-up activities. CONDITIONS walking and biking) is a significant (E.G. BLIGHT, health priority, particularly for youth » Invest in infrastructure improvements to GREENSPACE, PARKS/ and young adults support active transit near hospitals. RECREATION, ETC.) » Extreme neighborhood blight, » Improve vacant lots by developing including abandoned homes, gardens and spaces for socialization and vacant lots and extreme amounts physical activity. of litter and trash, impacts communities socially and has been associated with poorer overall health and increased violence. » Lack of maintenance of public spaces, like schools, libraries and recreational facilities create additional health hazards.

» Individuals experiencing » Create medical respites for individuals in

16. homelessness are more likely to: urgent need of transitional housing. HOMELESSNESS • Be racial/ethnic minorities » Develop medical-legal partnerships. • Have mental health and » Develop new affordable housing units. substance use disorders » Co-locate health and social services. • Seek care at emergency departments/hospitals and be high-utilizers • Experience discrimination and bias in healthcare settings » Inadequate temporary shelters, transitional housing, and affordable housing options exist for individuals experiencing homelessness throughout the region

12 | Community Health Needs Assessment