CommunityHealth

Pickens County, South Carolina

NeedsAssessment 2013

TABLE OF CONTENTS

445

56

89

1213162021

Purpose

Description of Community

Methodology / Assessment Partners

Secondary / Qualitative Statistical Data Sources

Primary / Qualitative Data

1. Surveys

2. Focus Groups

3. Forums

4. Partners

Summary

Supporting Statistical Data

Limitations

Existing Healthcare Resources

Recommendation

Reference

Appendix

A. Community Leader Input / Expertise

B. Needs Assessment Survey

C. Implementation Matrix

DATA COLLECTION

4

BAPTIST EASLEY & CANNON MEMORIAL HOSPITALSCOMMUNITY HEALTH NEEDS ASSESSMENT (CHNA)

The resulting CHNA will be used to document community needs, link those needs to community benefit efforts, and assist the two hospitals in planning and prioritizing community benefit investments.

COMMUNITY SERVED-PICKENS COUNTY

The population identified as Pickens County encompasses the following eight cities and zip codes: Pickens (29671), Easley (29640, 29641, 29642), Liberty (29657), Central (29630), Clemson (29631, 29632, 29633, 2934), Norris (29667), Six Mile (29682) and Sunset (29685). These zip codes represent the primary market for both hospitals. The following map (fig. 1) identifies the targeted areas in the county for this assessment.

MAJOR HEATLH CONCERNSQUALITATIVE DATA

PURPOSE

In compliance with the provisions of the Health Care Bill, Baptist Easley (BE) and Cannon Memorial Hospital (CMH) partnered to conduct a Community Health Needs Assessment (CHNA) during FY2012 and FY2013. The results of the assessment will be filed on the 2013 IRS form 990.

The one survey meets the requirement for both BE and CMH and is conducted every three years. The results of the survey are made available on both hospital websites.

Baptist Easley www.baptisteasley.orgCannon Memorial Hospital www.cannonhospital.org

The assessment has three main objectives:

1. Assess/Identify top health-related needs/ issues in the community.

2. Assess the underlying factors of these identified top related health needs/issues in the community.

3. Assess resources available in the community to address these issues with possible solutions.

FIG. 1

COMMUNITY SERVED PICKENS

COUNTY MAP

Central

Liberty

Clemson

Easley

Norris

Pickens

Six Mile

Sunset

As of 2010, the total Pickens County population totaled 119,224 (fig. 2), which has grown 7.64% since 2000. The population growth rate is much lower than the state average rate of 15.29% and is lower than the national average rate of 9.71%. Pickens County median household income was $41,898 in 2006-2010 and has grown by 15.70% since 2000.

The income growth rate is higher than the state average rate of 13.31% and is lower than the national average rate of 19.17%. Pickens

County median house value was $123,500 in 2006-2010 and has grown by 28.51% since 2000. The house value growth rate is much lower than the state average rate of 45.52% and is much lower than the national average rate of 50.42%. As a reference, the national Consumer Price Index (CPI) inflation rate for the same period is 26.63% (U.S. Census, 2012).

Pickens County, South Carolina - Overview Total Population

Population by RaceAmerican Indian and Alaska Native alone

Asian alone

Black or African American alone

Native Hawaiian and Other Pacific Native alone

Some other race alone

Two or more races

White alone

Population by Hispanic or Latino Origin (of any race)

Persons of Hispanic or Latino Origin

Persons Not of Hispanic or Latino Origin

2010 Census Counts119, 224

230

1,913

7,854

14

1,690

1,776

105,747

3,743

115,481

100.00%

0.19%

1.60%

6.59%

0.01%

1.42%

1.49%

88.70%

3.14%

96.86%

FIG. 2

6

METHODOLOGY

Baptist Easley Hospital (BE) conducted the assessment in conjunction with Cannon Memorial Hospital (CMH). Both systems serve the same population and are in close geographic proximity of approximately seven miles. Because of this factor, and a long history of partnerships between both hospitals as well as all Health and Human Service (HHS) agencies in the county, the decision was made to partner in the CHNA. Input from the various HHS agencies provided vital information for the assessment. Historically all of the stakeholders mentioned above have worked closely to develop and implement previous CHNA’s and other community initiatives. This partnership will conserve resources, increase efficiency, and promote optimal outcomes in community benefits. Both hospital’s administration and Board of Directors (BOD) were in agreement with the partnership.

A community-based approach was taken to complete the community health needs assessment. A collaborative partnership already in existence as described above, and with much input from local and regional Public Health professionals, community leaders, and community boards facilitated the process (see appendix A for list).

Efforts were made to ensure that research was conducted in a manner representative of the communities within the primary service area of both hospitals. National, state, regional, and county-specific data was collected from a broad set of data sources. Primary and secondary research was gathered from various sources including statistical data collected by the State of South Carolina.

Research methods were conducted in an approach that incorporated both quantifiable and qualitative data to obtain a well-rounded view of the state of the community’s health.

1) Collection of statistical (secondary, quantitative) data at national, state, regional and local levels—key data sources included Pickens County Health Partners, Vision 2025, Pickens County Access Health, County Health Rankings, National Health Indicators Warehouse, CDC and South Carolina DHEC biostatistics, and hospital discharge data. Dates of data collected ranged from 2000– 2011. For each indicator, data was obtained for the most recent year available. In addition, data was obtained, when available, from previous years to assess progress and identify trends.

2) Collection of qualitative data through a variety of community and stakeholder focus groups and surveys.

The qualitative portion of the CHNA consisted of surveys and focus groups to obtain input from community leaders and stakeholders, as well as general community populations. The collection of surveys began July 2012 and continued through October 2012 (see appendix B for survey).

A total of 1328 surveys were administered to the general population. Surveys were collected at church congregations, physician offices, YMCA programs, random community surveys, Samaritan’s Health Clinic, United Christian Ministries, two community church food pantries, Centering Pregnancy programs, chronic disease management classes, and community health education programs. Seven of the survey sites provide programs for uninsured/underinsured persons. Survey results were broken down into age categories and payment source for healthcare services (fig. 3 & 4).

Forums were also conducted simultaneously with general population groups to confirm the information gathered from written surveys. The groups identified to participate in the forums included two Centering Pregnancy groups, SHINE soup kitchen, and chronic disease management classes.

Community leaders were encouraged to participate in the survey. One hundred and sixty-five surveys were collected from key leaders representing the following: Behavioral Health Services, United Way Staff and Board, Samaritan Health Clinic, United Christian Ministries, School District of Pickens County School Nurses, Pickens County Health

18-35

36-50

51-62

62+

26

2725

22

PVT Insurance

Medicare

Medicaid

Uninsured

31

2217

30

FIG. 3

FIG. 4

AGE OF PARTICIPANTSQUALITATIVE DATA

UNINSURED VS. INSURED QUALITATIVE DATA

8

Department, First Steps Board and Staff, Rape Crisis, BEH Community Services Staff, BEH Voice of the Customer Board, BEH Board of Directors, Abundant Living pastors, parish nurses and lay health leaders, Joseph Sullivan Center, and City Council Members. The Pickens County School District school nurses were surveyed in a forum setting and input was obtained from local and regional Public Health officials and community health experts (see appendix A).

RESULTS/SUMMARYThe purpose of the surveys and forums was to determine the general perception of Pickens County and leaders of community organizations’ perception of the top health concerns for the area.

Top Health Concerns Concluded from Surveys and Focus Groups (fig. 5)

1. Cardiovascular Diseases (includes stroke)2. Diabetes3. Obesity4. Cancer (all types)5. Hypertension

Participants were also queried on barriers to accessing healthcare services and suggestions for meeting both the health and system needs which they identified.

Top System Concerns Concluded from Surveys and Focus Groups

1. Transportation2. Affordable Healthcare/gaps for under

and uninsured3. Education and Awareness

The top five health concerns identified in the survey and focus group process mirrors the statistical data described below. While there is no statistical data available to support the top three system issues concluded from the survey and focus groups, the identified issues are common knowledge among all health and human service agencies in the county. In the collaborative partnership described earlier, the decision was made to address the top five identified health needs and the health education and awareness system needs identified by the community. The collaborative partnership has the capacity to directly impact these issues individually and collectively.

FIG.5

32

25

16

14

13

Cardiovascular Disease

Diabetes

Obesity

Cancer

High Blood Pressure

MAJOR HEATLH CONCERNSQUALITATIVE DATA

SUPPORTING STATISTICAL DATA

In 2007 a community health needs assessment identified a need to preserve healthy lifestyles, grow healthcare resources, work to guarantee affordable healthcare, and increase affordable dental care (Pickens County Vision 20/25, 2007). Again, five years later and now 10 years after the initial CHNA (PCHP, 2003) we see a common thread in Pickens County that mirrors state and national statistics in access to care and increasing healthy lifestyles. Statistics in the original assessment and the recent assessment reveal cardiovascular disease (CVD) as the number one cause of death and morbidity in Pickens County for individuals over 65 years of age. It is the 2nd leading

cause of death in residents 45-65 years of age (fig. 6). Heart disease diagnoses also make up the top inpatient chronic conditions for both CMH and BE. Of those individuals surveyed, 32% responded they thought cardiovascular disease was the top health problem in our community (SCDHEC, 2012).

HEART DISEASE COUNTY

Total Blacks Whites Males Females

STATE

Number of hospitalizations

Crude rate of hospitalization (per 100,00)

Median age of hospitalized patients

Total cost of hospitalizations ($)

Average length of hospital stay (days)

Number of ER visits

Crude rate of ER visits (per 100,000)

Median age of ER patients

Total cost of ER visits ($)

Number of deaths

Age-adjusted death rate (per 100,000)

1,860

1,574

68

93,632,500

4

670

567

63

3,507,700

236

189.7

113

1,040

60

4,268,100

4

59

543

61

258,600

15

209.6

1,719

1,601

68

87,861,600

4

598

557

63

3,195,700

220

188.4

1,112

1,875

66

60,872,200

4

362

610

62

1,855,500

113

165.3

748

1,217

70

32,760,300

4

308

524

65

1,652,200

123

165.3

55,893

1,225

67

2,767,780,900

5

16,905

371

63

91,625,400

9,253

188.9

FIG. 6

10

COUNTYSTROKE

Total Blacks Whites Males Females

STATE

Number of hospitalizations

Crude rate of hospitalization (per 100,00)

Median age of hospitalized patients

Total cost of hospitalizations ($)

Average length of hospital stay (days)

Number of ER visits

Crude rate of ER visits (per 100,000)

Median age of ER patients

Total cost of ER visits ($)

Number of deaths

Age-adjusted death rate (per 100,000)

369

312

70

12,050,100

4

137

116

66

1,244,400

56

45.7

33

304

61

1,278,100

5

3

28

65

28,400

5

67.3

332

309

71

10,427,100

4

134

125

66

1,216,000

50

43.5

181

305

68

6,241,800

4

67

113

63

584,700

27

52.4

188

320

73

5,808,300

4

70

119

73

659,700

29

38.7

14,471

317

69

539,875,300

5

4,283

94

67

31,243,700

2,285

47.7

OBESITY

When adults in Pickens County were asked to rate their overall health as part of the 2010 South Carolina Behavioral Risk Factor Surveillance System (BRFSS), 86% reported having excellent, very good, or good health compared to the SC total of 82%. However, 57% of Pickens County residents are considered overweight or obese compared to South Carolina’s 67%. When surveyed,

16% of our response group felt that obesity was one of the major health concerns for our community. Obesity is one of the leading risk factors related to morbidity and mortality in South Carolina. Contributing factors to the obesity rate in our county is the percentage of adults not meeting the recommended physical activity and fruits and vegetables intake (SCDHEC/BRFFS, 2012).

FIG. 6

IMPACT OF DIABETES IN THE SOUTH CAROLINA AND THE UNITED STATES

Diabetes affects 25.8 million Americans and contributes to approximately 231,000 deaths each year. Approximately 371,476 adults in South Carolina are diagnosed with Diabetes. Diabetes is the seventh leading cause of death in South Carolina, claiming 1,114 lives in 2009. African Americans have nearly twice the prevalence as Whites. The direct and indirect costs of Diabetes in the U.S. were nearly $174 billion in 2007.

DIABETES IN PICKENS COUNTY

Twenty-five percent of our survey group felt that diabetes was one of the top health concerns for our community. The following points verify this perception:

• An estimated 7,180 adults (7.9% of adults) in Pickens County suffer annually from Diabetes.

• In 2010, there were 153 hospitalizations for Diabetes in Pickens County for all ages.

• There were an additional 2,522 hospital discharges with Diabetes-related conditions in Pickens County.

• The total direct costs of hospitalizations and emergency room visits were over $4.1 billion in 2010.

• In 2010, there were 296 emergency room (ER) visits for Diabetes as the primary diagnosis, among which 53 (18%) were by African American patients.

• A total of 31 people in Pickens Countydied of Diabetes in 2009

• The following graph compares national, state, and local data (fig. 7).

(SCDHEC, 2012).

US SC Pickens

PREVALENCE OF SELF-REPORTEDDIABETES AMONG ADULTS

2001

0

2

4

6

8

10

12

2002 2003 2004 2005 2006 2007 2008 2009 2010

FIG. 7

% o

f Pop

ulat

ion

12

• Hospitalization and ER data for individuals diagnosed with diabetes indicate that 50% are at least 62 years old. This is consistent with state and national data reporting seniors are at greater risk for chronic diseases such as Diabetes (fig. 8)

CANCER IN PICKENS COUNTY

Lung cancer is one of the most prevalent types of cancer in Pickens County and caused approximately one third of all cancerdeaths in 2011. The number of hospitalizations related to lung cancer and colorectal cancer far outweighs the number of all other cancers combined during this same time frame. In 2011 the percentage of Pickens County residents admittedly smoking cigarettes was slightly higher than the state average of 23.14% (SCDHEC, 2012).

The American Lung Association and other national health authorities have identified tobacco use and as the number one risk factor for lung cancer. Second-hand smoke also poses a major health risk.

LIMITATIONS

The primary research for the community at large was based on surveys and group forums. We realize this limits participation from those community members who were not part of the targeted groups; however, surveys were made available to any public member who utilized Cannon Memorial Hospital, any of its practices, and by community random sampling. The assessment did not conduct town hall meetings in the community. The expectation was each community was well represented by the community leaders identified.

The appending table (fig. 10) is a list of organizations and existing healthcare facilities available in Pickens County with assets for meeting collaborative CHNA implementation strategies. There may be others inadvertently omitted who provide some form of healthcare service to our community.

50

733

9

FIG. 8

Medicare

Medicaid

PVT Ins

DIABETES ER & HOSPITALIZATION

CHARGES, PICKENS COUNTY,

2010

Self/ Indigent

FIG. 9EXISTING HEALTHCARE FACILITIES & OTHER RESOURCES

AnMed Women’s Care, Liberty

Behavioral Health Services

Clemson Community Care

Clemson Free Medical Clinic

Foothills Community Health Center

Clemson University Joseph Sullivan Center

DESCRIPTION & ASSETS TOWARD IMPLEMENTATION STRATEGIES FOR TOP FIVE IDENTIFIED NEEDS:

Obstetrical and gynecological services regardless of payer source.CVD / DM / CA / OB / HTN

BHS of Pickens County is a non-profit organization that focuses on prevention, intervention, and treatment of drug, alcohol, and other addictive substances. CVD / DM / CA / OB / HTN

Provides assistance for food, heat, and rent. This agency also provides referral and support services.

Provides healthcare and prescriptions, at no cost, to residents who have no insurance and who cannot pay for services. CVD / DM / CA / OB / HTN

Federal grant funding received, but not currently operational at this time. Once the clinic is operational, efforts will be made to collaborate with this community partner. The clinic will provide healthcare, on a sliding scale fee, to residents who meet specified criteria based on income. CVD / DM / CA / OB / HTN

Provides comprehensive healthcare for faculty members and community residents. Also seeks to bring healthcare to underserved populations thru partnerships and grant funded initiatives. CVD / DM / CA / OB / HTN

Cardiovascular Disease

Diabetes Mellitus

Cancer

Obesity

Hypertension

CVD

DM

CA

OB

HTN

LEGEND

14

Mountain View OB/GYN/Centering Pregnancy Program

Parish Nurse Program

Pickens County Health Department

Pickens County Mental Health Center

Pickens County School Nurse Programs

Samaritan Health Clinic

Provides comprehensive obstetrical care for residents regardless of payer source. This program includes a nationally recognized Centering Pregnancy program which improves immediate and long-term outcomes for women and infants. CVD / DM / CA / OB / HTN

Baptist Easley and area churches partner to provide health education and wellness programs to congregants and surrounding neighborhoods. CVD / DM / CA / OB / HTN

Provides both adult and child health services. The health department also seeks to improve safety, quality of life, and empower residents to improve health/wellbeing. CVD / DM / CA / OB / HTN

Provides Mental Health services to the residents of Pickens County based on identified needs and state mandates. Referral.

Each school in Pickens County has a minimum of one nurse on staff. Nurses dispense medications to children while at school, become a referral source forparents/children, provide support services, and have the ability to bill Medicaid for specific services. CVD / DM / CA / OB / HTN

Provides healthcare and prescription, at no cost, to residents who have no insurance and cannot pay for services. CVD / DM / CA / OB / HTN

United Christian Ministries

United Way of Pickens County

Baptist Easley Hospital Wellness Programs

Cannon Memorial HospitalWellness Programs

YMCA

Provides assistance for food, heat, and rent. This agency also provides referral and support services. Referral.

The United Way partners with every agency in Pickens County to provide grant funding and/or support services. The United Way currently has grant funding to assist individuals with prescription assistance, hunger, and homeless issues. One of the largest initiatives in 2012 is the Hunger/Homeless Coalition. This coalition is well underway to establishing a comprehensive and structured system to ensure family units are empowered and assisted in life-sustaining needs, education, and gainful employment. Referral.

Baptist Easley provides free/ low-cost wellness screenings and education targeting cardiovascular disease, Diabetes, and other identified health concerns. Evidence-based chronic disease management classes are also offered free of charge. CVD / DM / CA / OB / HTN

Cannon Memorial provides free/ low-cost wellness screenings and education targeting cardiovascular disease, Diabetes, and other identified health concerns. CVD / DM / CA / OB / HTN

Provides physical fitness and healthy lifestyle programs in a wholistic approach of mind, body, and soul for all age groups. CVD / DM / CA / OB / HTN

Cardiovascular Disease

Diabetes Mellitus

Cancer

Obesity

Hypertension

CVD

DM

CA

OB

HTN

LEGEND

16

RECOMMENDATION

BE recognizes the devastating burden of Chronic Disease in Pickens County and across the nation. Cardiovascular Disease (CVD) and Diabetes are now considered co-morbidities and the top two identified health concerns in Pickens County. With this in mind, BE made the decision to combine health education and awareness efforts to maximize positive outcomes as described below.

BE will implement six initiatives for education and risk reduction in CVD, Diabetes, and cancer. All six of these initiatives are immediate for FY2013 with plans to expand and enhance strategies in subsequent years.

Targeting risk reduction provides an avenue for addressing the top five and several other identified health concerns on the survey, because the same risk factors are common to most chronic health issues. For example, obesity and tobacco use are risk factors for CVD, Diabetes, and cancer. Hypertension is a risk factor for CVD and Diabetes. The education in the following initiatives will focus on all common risk factors and provide the community with information on access to available services.

Initiative 1: Increase knowledge in CVD and decrease risk factors BE has designed a standardized curriculum for use in community forums and train-the-trainer options for replication in various settings. Participants in each session will be surveyed after the presentation to determine if knowledge was increased and/or a commitment was made to reduce oneCVD risk factor. This initiative teaches risk reduction and goal setting around heart healthy numbers, hypertension, weight control, nutrition, tobacco reduction, and physical activity. Therefore this initiative will address the top five health concerns identified in the assessment.

Initiative 2: Decrease Diabetes risk factors

BE initiated the Start Now program. This is a standardized program taught by Diabetes Educators and focused on risk factor reduction. By the end of each session participants contemplate and report willingness to reduce at least one risk factor and incorporate lifestyle changes. This initiative teaches risk reduction and goal setting around consistent blood sugar numbers, heart healthy numbers, hypertension, weight control, nutrition, tobacco use, and physical activity. Therefore this initiative will address the top five health concerns identified in the assessment.

Initiative 3: Increase knowledge and self-efficacy in Diabetics and their caregivers

BE initiated the Diabetic Maps program. This is an interactive standardized program facilitated by healthcare providers and lay health advocates. Small group sessions are conducive for participation in hands on activities and learning scenarios. At the end of each session, participants take away knowledge and skills for increased Diabetes self-management. This initiative teaches risk reduction and goal setting around nutrition, consistent blood sugar numbers, hypertension, weight control, and physical activity. Therefore this initiative will address four of the five health concerns identified in the assessment.

Initiative 4: Increase knowledge of harmful effects of tobacco and increase the number of tobacco-free Church campuses

BE was awarded a Healthy South Carolina grant to fund this initiative. BE designed a standardized curriculum and provided train-the-trainer sessions for Parish Nurses in 25 churches committed to partner in the grant process. The commitment includes providing educational sessions for both adult and youth congregants, developing and implementing a tobacco-free campus policy, and posting tobacco-free campus signs. Many of the churches are also committed to opening the

educational components to the community as well. At the end of each educational session, individuals are more aware of harmful effects of tobacco and informed about the new items on the market which contain nicotine. This initiative will meet the identified health concern of cancer and address the increased incidence of lung cancer deaths in Pickens County. Reduced tobacco use and avoiding second-hand smoke will also reduce the risk for other identified health needs such as CVD, Diabetes, and hypertension.

Initiative 5: Reduce tobacco use

BE provides Fresh Start classes free of charge for the community. This standardized curriculum focuses on benefits of being tobacco-free and offers suggestions in tobacco cessation. During the four week session, participants are asked to start reducing the amount of daily tobacco consumed using the techniques and strategies learned in class. By the end of the fourth week, participants are asked to select a quit date and determine to become tobacco-free. This initiative will meet the identified health concern of cancer and address the increased incidence of lung cancer deaths in Pickens County. Reduced tobacco use will also reduce the risk for other identified health needs such as CVD, Diabetes, and hypertension.

18

Initiative 6: Increase self management skills in individuals diagnosed with chronic disease

BE designed a standardized curriculum to assist individuals and their caregivers to navigate the numerous issues in dealing with any chronic illness. This curriculum focuses on several issues that are common to all chronic illnesses such as fatigue, pain, difficult emotions, and the disease process. The curriculum also instills hope and encouragement by advocating for action plans and goal setting. At the end of each session participants learn skills and techniques to improve self-management. Chronic disease includes but is not limited to, CVD, Diabetes, cancer, and hypertension. Therefore this initiative will address four of the five health concerns identified in the assessment.

During FY2013 BE will engage community partners in meeting the six initiatives described above. These initiatives will address six of the top ten identified health concerns. The FY2014 plan is a continuation of these initiatives with expansion and enhancement of the strategies and partner involvement which will drive positive outcomes. Obesity, one of the top five identified needs will be addressed and integrated into the initiatives for CVD, Diabetes, and chronic disease management described above. On a broader

scale, childhood obesity is already addressed in collaboration with the Pickens County School District, Clemson University Department of Agriculture, Zest Quest, Youth Learning Institute, and SCDHEC Farm to School initiatives. The United Way, Leadership Pickens County, YMCA, BE, CMH, City of Easley, City of Pickens, and City of Liberty have initiated the following to increase physical activity opportunities: Initiating and refurbishing walking and bike trails, providing safe bike and walking areas downtown, and sponsoring family fun events that highlight physical activity. Pickens County is a rural area with a large number of farms which produce fresh fruit and vegetable options during the Spring, Summer, and Fall. BE currently supports the local Farmers Market with Registered Dieticians providing healthy cooking demonstrations and recipes for fresh fruits and vegetables. BE also advocates Farm to Table activities and educates food pantries in economical options for providing fresh fruits and vegetables for clients. BE employees serve on the Hunger Coalition for Pickens County, educate underserved populations in healthy eating options, and advocates resource awareness to meet this need. BE is also leading the way in healthy workplace initiatives by providing healthy meal and snack machine options as well as promoting physical activity options for employees. In FY2011, 2012 and 2013, BE was awarded the American Heart

Association Gold Fit Friendly Worksite award. BE strives to lead the way in worksite health and wellness with a desire to be a model for the community.

Three of the top 10 identified health issues in the assessment will not be addressed at this time by BE. However, county-wide partnerships are in place to continue analyzing options to meet these needs and BE will continue to serve as leaders and team players. These include access to dental care for uninsured citizens, access to mental health care, and substance abuse issues. Funding is the main barrier in moving forward with these particular identified health needs. Budget cuts for the Medicaid program in the area of dental care and federal cuts in the area of mental health are crippling at this time. However, the newly formed, Pickens County Drug Task Force is focusing on prescription narcotic drug abuse. This is a collaboration between Pickens County School District, Law Enforcement, Behavioral Health Services, BE and CMH. Recent data indicates that Pickens County has a higher than average incidence of teen and young adult deaths attributed to prescription drug overdose. Pickens County was also identified as a Red Zone for the number of narcotics prescribed for Medicaid recipients. Public awareness campaigns, rallies for youth and young adults, and prescription drug take-back days are coordinated through

this task force (personal interview, Cliif Collie, PharmD-Task Force Member). In addition, the top two non-medical system issues identified in this assessment will not be addressed at this time by BE. These include Healthcare cost/gaps for underinsured and uninsured, and transportation issues. However, at this time BE is working internally and with other health systems to reduce healthcare costs especially in the area of purchasing. BE continues to find ways to provide services for the underinsured and uninsured. Charity care and community benefit resources continue to increase each year. Transportation is a long standing issue with little opportunity for change because of funding. County government and county-wide partnerships continue to seek and review opportunities to improve the need for transportation. Currently, Seniors Unlimited provides transportation to Medicare and Medicaid recipients for medical appointments. BE is seeking partnerships with local private transportation companies to assist with medical follow-up after patients are discharged. BE is also working in partnerships to provide chronic disease management courses at senior housing centers and other strategic places in the community to decrease transportation issues, decrease readmissions, and improve outcomes.

20

REFERENCE

Pickens County Vision 20/25. (2007). Retrieved from http://pickenscountyvision2025.org

Pickens Health Partners. (2003). Retrieved from http://pchp.org

South Carolina Department of Health and Environmental Control. (2012). Retrieved from http://www.scdhec.gov

South Carolina Department of Health and Environmental Control. (2012). Retrieved from http://www.scdhec/BRFFS.gov

U.S. Department of Health and Human Services. (2012). Retrieved from http://www.cdc.gov

U.S. Census Bureau. (2012). Retrieved from http://www.census.gov

Broad Interest IntervieweesAlex Levy, Director, Rape Crisis CouncilAmanda Dow, Cannon Memorial Hospital, Manager Community ServicesAngela Reid, Baptist Easley Hospital, Manager Community ServicesBob Hiott, Director, Behavioral Health ServicesCarol Cinnamon, Director of Health and Counseling Services, Southern Wesleyan UniversityCathy Breazeale, Youth Services Director, Behavioral Health ServicesGeorge Sutter, MD, Samaritan Health ClinicJulie Capauldi, Director, United WayNikki Dunn, Assistant Director, Samaritan Health ClinicParish Nurses—total of 42Pickens County School District, 26 School Nurses and First Steps Board MembersRegina Reece, Director, Samaritan Health ClinicTeresa Nash, Director, United Christian MinistriesLocal Pastors—Total of 23 pastors from all denominations and faith backgrounds representing:

Congregants from disparate to affluent populations; Caucasian, African American, and Latino races.

BEH Board of DirectorsBEH Voice of the Customer Board Members—comprised of 15 community representatives

Individuals with special knowledge or expertise in Public Health Jane Yates, Region 2 DHEC, County Nurse Manager, Pickens County Health Department, Lilly Hall, Region 2 DHEC, Public Health/CHNA LiaisonKathleen Meyer, Clemson University, Professor, Department of Public Health SciencesDr. Paula Watt, Clemson University, Director, Joseph Sullivan Center/

Community Health Initiatives

Representative IntervieweesRepresentative David HiottSenator Larry MartinLiza Holder, Pickens Chamber of Commerce Board MemberTiffany Martin, Easley Chamber of Commerce Board Member

APPENDIX A | COMMUNITY LEADER INPUT/EXPERTISE

22

COMMUNITY HEALTH NEEDS ASSESSMENT SURVEY

Please feel free to write comments on the back if additional space is needed.

Age

Payment Source for Health Care Services:○ Medicare ○ Medicaid ○ Private Insurance ○ Self Pay ○ None

1. What are the major health concerns in our county?

2. Are services available in Pickens County to address these concerns?

3. Do you have problems accessing services?

4. Do you have suggestions in addressing these issues?

APPENDIX B | SURVEY

24

Com

mun

ity R

esou

rce

/Rol

e

FY 2

013

Bapt

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asle

y H

ospi

tal—

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tate

Phy

sicia

n--r

efer

Can

non

Mem

oria

l Hos

pita

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fer

Beha

vior

al H

ealth

Ser

vice

s--r

efer

Cle

mso

n C

omm

unity

Car

e--r

efer

Cle

mso

n Fr

ee M

edic

al C

linic

--re

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Cle

mso

n U

nive

rsity

Jose

ph S

ulliv

an C

ente

r--r

efer

Foot

hills

Com

mun

ity H

ealth

Cen

ter-

-ref

erPa

rish

Nur

se P

rogr

am--

teac

hPi

cken

s Cou

nty

Hea

lth D

epar

tmen

t--re

fer

Pick

ens C

ount

y Sc

hool

Hea

lth N

urse

s--r

efer

Pick

ens C

ount

y YM

CA-

-ref

erSa

mar

itan

Hea

lth C

linic

--re

fer

Uni

ted

Chr

istia

n M

inist

ries-

-ref

erU

nite

d W

ay o

f Pic

kens

Cou

nty-

-ref

er

FY20

14Ad

d th

e fo

llow

ing

addi

tiona

l tea

chin

g sit

esBu

sines

s & In

dustr

y—ho

st te

achi

ng si

tes

Can

non

Mem

oria

l--te

ach

Jose

ph S

ulliv

an C

ente

r--te

ach

Foot

hills

Com

mun

ity H

ealth

Cen

ter-

-teac

hPi

cken

s Cou

nty

Libr

ary—

host

teac

hing

site

Pick

ens C

ount

y YM

CA—

host

teac

hing

site

Sam

arita

n H

ealth

Clin

ic—

host

teac

hing

site

FY20

15To

be

asse

ssed

and

des

igne

d in

201

4

Impl

emen

tatio

n St

rate

gies

• D

esig

n a

stand

ardi

zed

curr

icul

um

cond

uciv

e to

teac

h/re

plic

ate

in

mul

tiple

setti

ngs i

n th

e co

mm

unity

• S

olic

it co

mm

unity

par

tner

s to

teac

h cu

rric

ulum

in o

rgan

izatio

nal

setti

ngs

• D

esig

nate

hos

pita

l sta

ff fo

r Sp

eake

r Bur

eau

in v

ario

us

com

mun

ity se

tting

s

• P

rovi

de tr

ain-

the-

trai

ner s

essio

ns in

sta

ndar

dize

d cu

rric

ulum

• S

olic

it pa

rtne

rs n

ot te

achi

ng th

e cu

rric

ulum

for r

efer

ral o

f in

divi

dual

s int

o co

mm

unity

cla

sses

• I

nitia

te e

duca

tiona

l pre

sent

atio

n

• A

sses

s pro

gram

fide

lity

and

revi

ew

part

icip

ant s

urve

ys m

onth

ly

• R

evise

cur

ricul

um/p

roce

ss

as in

dica

ted

Goa

l

Redu

ce ri

sk fa

ctor

s fo

r Car

diov

ascu

lar

Dise

ase

Incr

ease

kno

wle

dge

and

awar

enes

s in

Car

diov

ascu

lar

Dise

ase

Eval

uatio

n M

etho

d

Surv

ey u

pon

com

plet

ion

of

educ

atio

nal

pres

enta

tion

Mea

sure

men

t

• %

of a

ttend

ees

repo

rtin

g a

com

mitm

ent t

o de

crea

se a

t lea

st on

e ris

k fa

ctor

• %

of a

ttend

ees

repo

rtin

g in

crea

se

in k

now

ledg

e

Initi

ativ

e 1

APPENDIX C | IMPLEMENTATION MATRIX

26

Com

mun

ity R

esou

rce

/Rol

e

FY 2

013

Bapt

ist E

asle

y H

ospi

tal—

teac

hBa

ptist

Ups

tate

Phy

sicia

n--r

efer

Can

non

Mem

oria

l Hos

pita

l--re

fer

Beha

vior

al H

ealth

Ser

vice

s--r

efer

Cle

mso

n C

omm

unity

Car

e--r

efer

Cle

mso

n Fr

ee M

edic

al C

linic

--re

fer

Cle

mso

n U

nive

rsity

Jose

ph S

ulliv

an C

ente

r--r

efer

Foot

hills

Com

mun

ity H

ealth

Cen

ter-

-ref

erPa

rish

Nur

se P

rogr

am--

refe

rPi

cken

s Cou

nty

Hea

lth D

epar

tmen

t--re

fer

Pick

ens C

ount

y Sc

hool

Hea

lth N

urse

s--r

efer

Pick

ens C

ount

y YM

CA-

-ref

erSa

mar

itan

Hea

lth C

linic

--re

fer

Uni

ted

Chr

istia

n M

inist

ries-

-ref

erU

nite

d W

ay o

f Pic

kens

Cou

nty—

refe

r

2014

Add

the

follo

win

g ad

ditio

nal t

each

ing

sites

Busin

ess &

Indu

stry—

host

teac

hing

site

sC

anno

n M

emor

ial--

teac

hFo

othi

lls C

omm

unity

Hea

lth C

ente

r—ho

st sit

ePi

cken

s Cou

nty

Libr

ary—

host

teac

hing

site

Pick

ens C

ount

y YM

CA—

host

teac

hing

site

Sam

arita

n H

ealth

Clin

ic—

host

teac

hing

site

FY20

15To

be

asse

ssed

and

des

igne

d in

201

4

Impl

emen

tatio

n St

rate

gies

• I

nitia

te S

tart

Now

pro

gram

sta

ndar

dize

d cu

rric

ulum

• T

augh

t by

cert

ified

D

iabe

tes E

duca

tor

• S

olic

it pa

rtne

rs fo

r ref

erra

l of

indi

vidu

als i

nto

com

mun

ity c

lass

es

• I

nitia

te e

duca

tiona

l pre

sent

atio

n

• A

sses

s pro

gram

fide

lity

and

revi

ew

part

icip

ant s

urve

ys m

onth

ly

• R

evise

cur

ricul

um/p

roce

ss

as in

dica

ted

Goa

l

Dec

reas

e D

iabe

tes

risk

by c

hang

ing

lifes

tyle

beh

avio

r

Eval

uatio

n M

etho

d

Surv

ey u

pon

com

plet

ion

of

educ

atio

nal

pres

enta

tion

Mea

sure

men

t

• %

of a

ttend

ees

repo

rtin

g in

crea

se in

kn

owle

dge

• N

umbe

r of

Chu

rche

s co

mm

ittin

g to

a

toba

cco-

free

cam

pus

with

doc

umen

ted

polic

y.

Initi

ativ

e 2

Com

mun

ity R

esou

rce

/Rol

e

FY20

13Ba

ptist

Eas

ley

Hos

pita

lPa

rish

Nur

ses

FY20

14Pa

rtne

r with

follo

win

g to

teac

h cu

rric

ulum

Can

non

Mem

oria

l Hos

pita

lFo

othi

lls C

omm

unity

Hea

lth C

ente

rSa

mar

itan

Hea

lth C

linic

FY20

15To

be

asse

ssed

and

des

igne

d in

201

4

Impl

emen

tatio

n St

rate

gies

• I

nitia

te D

iabe

tes M

aps p

rogr

am

stand

ardi

zed

curr

icul

um

• S

olic

it Pa

rish

Nur

ses t

o te

ach

curr

icul

um in

con

greg

atio

nal

setti

ngs

• P

rovi

de tr

ain-

the-

trai

ner s

essio

ns in

sta

ndar

dize

d cu

rric

ulum

• I

nitia

te e

duca

tiona

l pre

sent

atio

n

• A

sses

s pro

gram

fide

lity

and

revi

ew p

artic

ipan

t sur

veys

mon

thly

• R

evise

cur

ricul

um/p

roce

ss

as in

dica

ted

Goa

l

Incr

ease

kno

wle

dge

and

awar

enes

s in

Dia

bete

s

Incr

ease

in se

lf-m

anag

emen

t ski

lls

Eval

uatio

n M

etho

d

Surv

ey u

pon

com

plet

ion

of

educ

atio

nal

pres

enta

tion

Mea

sure

men

t

• %

of a

ttend

ees

repo

rtin

g in

crea

se

in k

now

ledg

e

• %

of a

ttend

ees

repo

rtin

g an

in

crea

se in

se

lf-effi

cacy

Initi

ativ

e 3

28

Com

mun

ity R

esou

rce

/Rol

e

FY20

13Ba

ptist

Eas

ley

Gra

nt sp

ecifi

c to

Chu

rch

Cam

puse

sPa

rish

Nur

ses—

teac

hC

hurc

h Ad

min

istra

tion

–Dev

elop

Tob

acco

Fre

e C

ampu

s Pol

icy

FY20

14Pa

rtne

r with

follo

win

g to

teac

h cu

rric

ulum

Can

non

Mem

oria

l Hos

pita

lBe

havi

oral

Hea

lth S

ervi

ces

Foot

hills

Com

mun

ity H

ealth

Cen

ter

FY20

15To

be

asse

ssed

and

des

igne

d in

201

4

Impl

emen

tatio

n St

rate

gies

• D

esig

n a

stand

ardi

zed

curr

icul

um

cond

uciv

e to

teac

h/re

plic

ate

in

mul

tiple

setti

ngs i

n th

e co

mm

unity

• S

olic

it Pa

rish

Nur

ses w

ho w

ill te

ach

curr

icul

um in

con

greg

atio

nal

setti

ngs

• P

rovi

de tr

ain-

the-

trai

ner s

essio

ns in

sta

ndar

dize

d cu

rric

ulum

• I

nitia

te e

duca

tiona

l pre

sent

atio

n

• A

sses

s pro

gram

fide

lity

and

revi

ew

part

icip

ant s

urve

ys m

onth

ly

• R

evise

cur

ricul

um/p

roce

ss

as in

dica

ted

Goa

l

Incr

ease

kno

wle

dge

and

awar

enes

s in

harm

ful e

ffect

s of

toba

cco

Incr

ease

num

ber o

f to

bacc

o-fre

e ch

urch

ca

mpu

ses

Eval

uatio

n M

etho

d

Surv

ey u

pon

com

plet

ion

of

educ

atio

nal

pres

enta

tion

Mea

sure

men

t

• %

of a

ttend

ees

repo

rtin

g in

crea

se in

kn

owle

dge

• N

umbe

r of

Chu

rche

s co

mm

ittin

g to

a

toba

cco-

free

cam

pus

with

doc

umen

ted

polic

y.

Initi

ativ

e 4

Com

mun

ity R

esou

rce

/Rol

e

FY20

13Ba

ptist

Eas

ley

Hos

pita

l—te

ach

smok

ing

cess

atio

n cl

asse

sBa

ptist

Eas

ley

Gra

nt sp

ecifi

c to

Phy

sicia

n O

ffice

s-Ba

ptist

Ups

tate

Phy

sicia

ns—

refe

r to

SC Q

uit L

ine

FY20

14Pa

rtne

r with

follo

win

g to

teac

h cu

rric

ulum

Beha

vior

al H

ealth

par

tner

ship

Busin

ess &

Indu

stry

Can

non

Mem

oria

l Hos

pita

lFo

othi

lls C

omm

unity

Hea

lth C

ente

r

FY20

15To

be

asse

ssed

and

des

igne

d in

201

4

Impl

emen

tatio

n St

rate

gies

Initi

ate

two

stand

ardi

zed

toba

cco

cess

atio

n pr

ogra

ms

1. T

obac

co c

essa

tion

clas

ses

• S

tand

ardi

zed

curr

icul

um f

or

toba

cco

cess

atio

n ta

ught

by

Amer

ican

Can

cer S

ocie

ty

cert

ified

trai

ner

• S

olic

it pa

rtne

rs f

or re

ferr

al o

f in

divi

dual

s to

clas

ses

• In

itiat

e ed

ucat

iona

l pre

sent

atio

n•

Ass

ess p

rogr

am fi

delit

y an

d re

view

pa

rtic

ipan

t sur

veys

qua

rter

ly•

Rev

ise c

urric

ulum

/pro

cess

as

indi

cate

d

2. P

hysic

ian

office

refe

rral

to S

C

Q

uit L

ine

• S

olic

it Ph

ysic

ians

and

offi

ce

man

ager

s to

part

icip

ate

• P

rovi

de tr

ain-

the-

trai

ner s

essio

ns

in st

anda

rdize

d cu

rric

ulum

•

Initi

ate

refe

rral

syste

m•

Ass

ess p

rogr

am fi

delit

y an

d re

view

pa

rtic

ipan

t num

bers

eac

h m

onth

• R

evise

cur

ricul

um/p

roce

ss

as in

dica

ted

Goa

l

Redu

ce to

bacc

o us

e

Eval

uatio

n M

etho

d

Reco

rd #

peo

ple

atte

ndin

g Ba

ptist

Ea

sley

smok

ing

cess

atio

n cl

asse

s Su

rvey

pre

an

d po

st

cess

atio

n cl

ass t

o ob

tain

cur

rent

to

bacc

o us

e

Obt

ain

num

ber

of re

ferr

ed

indi

vidu

als w

ho

cont

act t

he S

C

Qui

t lin

e

Mea

sure

men

t

• #

indi

vidu

als

acce

ssin

g lo

cal

avai

labl

e re

sour

ces

for T

obac

co

Ces

satio

n

• %

of i

ndiv

idua

ls re

port

ing

cess

atio

n

or re

duce

d to

bacc

o us

e a

fter a

cces

sing

lo

cal t

obac

co

cess

atio

n cl

asse

s

• #

refe

rral

s to

SC

Qui

t Lin

e

Initi

ativ

e 5

30

Com

mun

ity R

esou

rce

/Rol

e

FY20

13Ba

ptist

Eas

ley

Hos

pita

l—te

ach

Bapt

ist U

psta

te P

hysic

ian-

-ref

erC

anno

n M

emor

ial H

ospi

tal--

refe

rBe

havi

oral

Hea

lth S

ervi

ces-

-ref

erC

lem

son

Com

mun

ity C

are-

-ref

erC

lem

son

Free

Med

ical

Clin

ic--

refe

rC

lem

son

Uni

vers

ity Jo

seph

Sul

livan

Cen

ter-

-ref

erFo

othi

lls C

omm

unity

Hea

lth C

ente

r--r

efer

Paris

h N

urse

Pro

gram

--te

ach

Pick

ens C

ount

y H

ealth

Dep

artm

ent--

refe

rPi

cken

s Cou

nty

Scho

ol H

ealth

Nur

ses-

-ref

erPi

cken

s Cou

nty

YMC

A--r

efer

Sam

arita

n H

ealth

Clin

ic--

refe

rU

nite

d C

hrist

ian

Min

istrie

s--r

efer

Uni

ted

Way

of P

icke

ns C

ount

y--r

efer

FY20

14Ad

d th

e fo

llow

ing

addi

tiona

l tea

chin

g sit

esBu

sines

s & In

dustr

y—ho

st te

achi

ng si

tes

Can

non

Mem

oria

l--te

ach

Jose

ph S

ulliv

an C

ente

r--te

ach

Foot

hills

Com

mun

ity H

ealth

Cen

ter-

-teac

hPi

cken

s Cou

nty

Libr

ary—

host

teac

hing

site

Pick

ens C

ount

y YM

CA—

host

teac

hing

site

Sam

arita

n H

ealth

Clin

ic—

host

teac

hing

site

FY20

15To

be

asse

ssed

and

des

igne

d in

201

4

Impl

emen

tatio

n St

rate

gies

• D

esig

n a

stand

ardi

zed

curr

icul

um

cond

uciv

e to

teac

h/re

plic

ate

in

mul

tiple

setti

ngs i

n th

e co

mm

unity

• S

olic

it Pa

rish

Nur

ses t

o te

ach

curr

icul

um in

con

greg

atio

nal

setti

ngs

• P

rovi

de tr

ain-

the-

trai

ner s

essio

ns

in st

anda

rdize

d cu

rric

ulum

• I

nitia

te e

duca

tiona

l pre

sent

atio

n

• A

sses

s pro

gram

fide

lity

and

revi

ew p

artic

ipan

t sur

veys

mon

thly

• R

evise

cur

ricul

um/p

roce

ss a

s in

dica

ted

Goa

l

Incr

ease

self-

man

agem

ent s

kills

in

indi

vidu

als w

ith

diag

nose

d C

hron

ic

Dise

ase

Eval

uatio

n M

etho

d

Surv

ey u

pon

com

plet

ion

of

educ

atio

nal

pres

enta

tion

Mea

sure

men

t

• %

of a

ttend

ees

repo

rtin

g an

in

crea

se in

se

lf-effi

cacy

Initi

ativ

e 6

32

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