COMMUNITY CONVERSATIONS ON...

COMMUNITY CONVERSATIONS

ON HEALTHCARE

A Report on the Conversation in Ajo, AZ

Tuesday, October 9, 2012 By

J. Hospodar, M. Jewett, N. MacKinnon, F. Driver, A. Bergen, and D. Stoh

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Table of Contents

Introduction………………………………………………………………………………………..3

The Conversation………………………………………………………………………………….4

Next Steps……………………………………………………………………………………........7

Acknowledgements………………………………………………………………………………..8

Appendix A………………………………………………………………………………………..9

Flyer for Ajo Community Conversation on Healthcare

Appendix B………………………………………………………………………………………11

Tables presented by Alan Bergen, Pima County Community Health Assessment

Handout from Alan Bergen, Ajo Primary Care Area (PCA), Statistical Profile – 2011

Handout from Alan Bergen, How to Find the Pima County Health Assessments On-line

Appendix C………………………………………………………………………………………28

Handout from David Stoh, Behavioral Health Services in Ajo

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INTRODUCTION

On October 9, 2012, a community conversation on healthcare was held at the Ajo Ambulance Training Station in Ajo, Ariz. The meeting was hosted by the Children’s Action Alliance in collaboration with Desert Senita Community Health Center and the University of Arizona’s Center for Rural Health at the Mel and Enid Zuckerman College of Public Health.

Ajo and the surrounding area is a community of approximately 3,500 residents, located in a geographically-isolated area roughly 2/3 the size of the state of Connecticut and surrounded on all sides by federal lands. Desert Senita Community Health Center, the sole provider of primary health and dental services in this rural, frontier area, became a Federally Qualified Health Center in 2001.

The format for the Ajo Community Conversation on Healthcare followed having

key speakers from Pima County who talked about current efforts that will impact Ajo. Those who attended the event either asked questions to each of the speakers during their brief presentations or wrote down on a card what key health needs are important and necessary for the community going forward.

Conversation Facilitator, Speakers, and Attendees

Matt Jewett, Health Policy Director at Children’s Action Alliance, facilitated the conversation. Fran Diver, CEO of Desert Senita Community Health Center, welcomed those attending and gave an update on the current plans going forward for the Center. Alan Bergen, Senior Program Manager at the Pima County Health Department, Community Surveillance and Investigation Division, gave a brief overview of the recently completed county-wide Community Health Assessment emphasizing the specific findings for Ajo. The University of Arizona Center for Rural Health Director, Dr. Neil MacKinnon, reflected on changes coming to healthcare and how the needs of a rural community might be impacted. David Stoh, Adult Services Specialist with the Community Partnership of Southern Arizona (Regional Behavioral Health Authority), discussed the current services offered by the agency and those scheduled to be provided. Joyce Hospodar, Manager, Health Systems Development at the Center for Rural Health, took notes and is the principal author of this report.

Approximately 30 people attended the event either representing themselves or were from the Garden Club, the Health District, the Library, the Pharmacy, and the media.

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THE CONVERSATION

The Conversation began with Matt Jewett welcoming everyone, introducing himself as the facilitator for the evening, and providing a brief overview of the Children’s Action Alliance and its commitment to hear from the state’s rural residents about their specific healthcare needs. Matt then introduced Fran Driver, who, too, welcomed everyone and reviewed the evening agenda.

Alan Bergen, Senior Program Manager at the Pima County Health Department, was the first to present. He provided information about the comprehensive Pima County Community Health Assessment completed in 2011. Alan briefly talked about the process used in conducting the assessment and emphasized that, in moving forward, it is vital to have Ajo representation in developing a county-wide action and implementation plan.

Alan presented selected health data from the comprehensive community health assessment that profiled Ajo compared to Pima County (see Appendix B). The ethnicity and race distribution of Ajo is similar to that of Pima County but unemployment is higher, household income is lower and the number of residents on AHCCCS is higher. Ajo has almost twice the population to provider ratio than Pima County, 885:1 versus 404:1, respectively. Other figures presented included a comparison of the health status of residents in Ajo and Pima County.

From community member and stakeholder surveys and group discussions conducted as part of the Pima County Community Health Assessment, five key factors were identified that impact the health of Pima County residents. These include: access to health care, the economy, health education and literacy, quality of care, and obesity. As a result, five health priorities were identified for Pima County.

A community taskforce reviewed the data collected during the community health assessment and identified five health priorities to focus on in Pima County:

• Establish easier access to resources that support healthier lifestyles • Engage and coordinate community resources to improve the community’s health status

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• Develop a community-wide data collection, analysis, and dissemination system to help track and monitor determinants of health

• Promote health education and health literacy, especially among populations of need • Identify public policies negatively impacting community health, and work together to

advocate for policy change

Dr. Neil MacKinnon, Director of the Center for Rural Health, discussed challenges and opportunities in rural health in Arizona. Next, he spoke about the role of the Center for Rural Health at the University of Arizona, which houses the State Office of Rural Health for Arizona. This Center has a mandate to work with rural communities across Arizona such as Ajo to improve health care. He also reviewed how barriers to change in healthcare can be overcome, by providing several real-world examples. Finally, he suggested that in life, other timing is a critical element and now with the implementation of the Affordable Care Act and government focus on healthcare, the timing is right for new approaches to the delivery of healthcare in Arizona.

David Stoh, Adult Services Specialist at the Community Partnership of Southern Arizona (CPSA), reviewed the current behavioral health services in Ajo, including those at Desert Senita and PPEP Services. There is currently only one therapist at PPEP but more are needed. David emphasized the difficulty in getting providers to serve Ajo.

David then reviewed the “perceived” behavioral health services lacking in Ajo and the proposed initiatives planned by CPSA. These initiatives involve focusing on the integration of health care, providing more robust children’s services, and using telepsychiatry to address medication use and the need for crisis psychiatric services (see Appendix C). David also noted that CPSA can bring training specialists to Ajo and other resources including possibly training online.

Fran Driver, CEO at Desert Senita Community Health Center, responded to numerous questions from attendees throughout the 90 minute meeting. In response to one of David’s comments, Fran discussed the planned expansion of behavioral health services at Desert Senita by hiring two additional licensed therapists. Further, Desert Senita is developing a Healing Garden and an art therapy program, both concepts being used around the country to help people with substance abuse, mental health

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issues, etc. A physician with psychiatric training is expected to come to Ajo soon but getting another psychiatrist continues to be a challenge. However, providing telepsychiatry is one of the key goals outlined in the strategic plan currently being developed by Deseret Senita.

Other key strategies Desert Senita is looking to implement include the following: focusing on the integration of healthcare including the application of an electronic medical record; looking off-site to expand selective services, e.g., Pharmacy; expanding Center service hours to 7:00 pm daily and short Saturday hours; offering wound care; continuing the Healthy Steps Program that focuses on educating parents as to whether their baby is developmentally stable; and, providing nutrition education and diabetic classes.

Needs Identified by Attendees

Audience participants were given note cards at the beginning of the meeting to encourage writing down specific healthcare needs they think are necessary in Ajo and the surrounding area. Below are the specific recommendations that were submitted:

• Need for a Physical Therapist to support, for example, those having a knee replacement

• Need for Home Health Care/Home Health Aide/Care Giver: “Sometimes a sick person prefers to stay home –sometimes a person cannot afford full-fledged assisted living. There is Arizona Long Term Care but to qualify depends on income.”

• Need to expand telemedicine opportunities to augment healthcare provided in a rural community

• Need to work with the University of Arizona College of Medicine to get interns/nurses to do their rotation in Ajo

• Need to collaborate with the Tohono O’odham Nation on diabetic education and other strategies

• Need to specifically include representatives from Ajo and the surrounding area in planning and developing strategies for the county, region, and the University of Arizona

• Need for Hospice but rules are strict that this service can only be provided within 50 miles from a hospital: “People have moved out of Ajo because of the need for Hospice.”

• Need for a Dermatologist plus the use of teledermatology

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• Need to consider heating the community pool and the need for qualified staff to keep the pool open all year

• Need to partner with the library to form a wellness group

NEXT STEPS

The next steps identified by each of the participating organizations are as follows:

Children’s Action Alliance

• Help distribute the summary report statewide to relevant stakeholders

Desert Senita Community Health Center

• Distribute the summary report to key stakeholders in the community • Attend the upcoming meetings supporting the development and implementation of the

Pima County Community Health Improvement Plan

Pima County Health Department

• Assist, facilitate, and support the development and implementation of a community health improvement plan for Pima County

• Recruit community members and stakeholders, including Ajo representatives, Desert Senita Community Health Center, and the Center for Rural Health, to participate in this initiative

Community Partnership of Southern Arizona

• Hold discussions between La Frontera, who currently subcontracts with PPEP to provide behavioral health services in Ajo, and Desert Senita, who is not contracted with CPSA, as to how CPSA can provide the following services in Ajo:

o children and families services o telepsychiatry services o integrating primary medical health care with behavioral health care.

Center for Rural Health

• Write up the summary report of the Ajo Community Conversation on Healthcare and distribute it to interested parties and place on the CRH website

• Attend the upcoming meetings supporting the development and implementation of the Pima County Community Health Improvement Plan

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ACKNOWLEDGMENTS

Thank you to the organizations who organized, facilitated, and contributed to the Community Conversation, especially Matt Jewett from the Children’s Action Alliance, and Fran Driver, from Desert Senita Community Health Center. Other contributors included Alan Bergen from the Pima County Health Department, David Stoh from the Community Partnership of Southern Arizona, and Dr. Neil MacKinnon and Joyce Hospodar from the Center for Rural Health at the University of Arizona. Finally, appreciation is given to the Ajo Ambulance Training Station for providing the space for the meeting.

Appendix A

Ajo Community Conversation on Healthcare

JOIN US:

COMMUNITY CONVERSATION ON HEALTHCARE

Share your story and ideas about healthcare priorities in your

family and community.

Explore what has happened in Arizona healthcare and what the

future holds.

A variety of healthcare providers, experts and policy makers will

be on hand to listen and share information.

Tuesday, October 9 from 5:30 p.m. to 7:00 p.m.

Ajo Ambulance Training Station

Refreshments will be served

Event is free and open to the public

For more information, contact Matt Jewett 602-266-0707 x212, [email protected]

PRESENTED BY :

Appendix B Pima County Community Health Assessment

Statistical Profile 2011

Instructions to Online Health Assessment

1

Pima County Community Health Assessment

Alan Bergen

Community Surveillance and Investigation Division

Ajo Community Conversation on Healthcare 10.9.12

2

Developing the Pima County Community Health Assessment (CHA)

� Convened Steering Committee and developed an action plan

� Collected and analyzed data

� Facilitated group discussions

� Recruited and launched the Community Health Assessment Taskforce (CHAT)

� Shared community health data

� Facilitated a workshop to identify health priorities

� Developed steps for addressing health priorities

� Drafted Community Health Assessment report

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Summary of Health Status

Ajo and Pima County Statistical Profile Comparison, 2011

Demographics Ajo Pima County

Population size 3,540 986,081

Race/ethnicity

White 77.3% 77.2%

Hispanic 37.5% 34.5%

Native American 9.3% 3.4%

Income

Population below 100% FPL 20.5% 16.4%

Population below 200% FPL 55.0% 37.1%

Unemployment rate 14.3% 8.3%

AHCCCS enrollees 30.3% 22.0%

Transportation score* 146 95

*Transportation score is the availability of or access to transportation to health

care services. The higher the score, the less adequate or greater the need for

transportation (based on the Primary Care Index).

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Resources Ajo Pima County

General hospitals 0 8

Medical providers

Primary care providers 4 2,443

Nurse practitioners 1 822

Physician assistants 1 157

Registered nurses 8 10,755

Dentists 2 541

Population to provider ratio 885:1 404:1

Inpatient hospitalization days/1,000 residents 973 612

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Health Status Ajo Pima County

Infant mortality rate No data 7.4

Low-weight births/1,000 live births 75.8 73.1

Teen births/1,000 females 14-19 years old 83.6 45.7

Prenatal care beginning in first trimester 64.6% 71.7%

Leading causes of death in Ajo

Motor/non-motor vehicle accidents (20-44 year olds)

Cardiovascular disease (45-85+ year olds)

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Leading Causes of Death in Pima County, 2010

Rank Cause of death Rate*

1 Cardiovascular disease 191.8

2 Cancer 156.1

3 Accident (unintentional injuries) 42.8

4 Chronic lower respiratory diseases 43.9

5 Cerebrovascular disease (stroke) 34.0

6 Drug-induced deaths 21.4

7 Diabetes 20.2

8 Alzheimer’s disease 19.3

9 Intentional self-harm (suicide) 16.9

10 Injury by firearms 16.9

*per 100,000 individuals

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Community Member and Stakeholder Surveys and Group Discussions

� Key factors that impact the health of Pima County residents

� Access to health care

� Economy

� Health education & literacy

�Quality of care

�Obesity

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Identifying Health Priorities

� The Five Health Priorities� Establish easier access to resources that support healthier lifestyles

� Engage and coordinate community resources to improve the community’s health status

� Develop a community-wide data collection, analysis, and dissemination system to help track and monitor determinants of health

� Promote health education and health literacy, especially among populations of need

� Identify public policies negatively impacting community health, and work together to advocate for policy change

9

What’s Next

� Assisting, facilitating, and supporting the development and implementation a Community Health Improvement Plan (CHIP) for Pima County that includes:

� Recruiting community members and stakeholders

� Developing the plan

� Identifying action and implementation groups

� Implementing the plan

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How to Find the Pima County Community Health Assessments Online

� Pima County Health Department (2011 report)� http://www.pimahealth.org/docs/CHA_Final_Report_8-27-12.pdf

� Pima County’s Non-profit Hospitals (2012 report)� http://www.carondelet.org/home/community-benefit-program/reports.aspx

� https://www.tmcaz.com/TMCHealthcare/CHNA

� http://uahealth.com/about-us/community-involvement/community-report

STATISTICAL PROFILE - 2011

DESCRIPTIONOF AREA

PCA NumberMajor Population CenterCountyHealth Planning Region

19201Ajo

Primary Care ScoreSpecial Tax District?

PIMA254B

State House Legislative District 04Designated as AzMUA? NoDesignated as Primary Care HPSA No

Designated as Federal MUA/P 54.40, MUA, (Ajo)

Next Nearest Provider Gila Bend2nd Nearest Provider SellsTravel Time to Next Nearest Provider 41 to 60 minutesTravel Time to 2nd Nearest Provider more than 80 minutes

Ajo Primary Care Area (PCA)

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For definitions and sources of data used in these profiles, see: http://www.azdhs.gov/hsd/profiles/datadocu.pdf

2011

9/19/2012

Page 1 of 4

BUREAU OF HEALTH SYSTEMS DEVELOPMENT, Arizona Department of Health Services

Primary Care Area # 19201 Ajo

DEMOGRAPHICSPOPULATION 3,540

Ajo COUNTY

HEALTHPLANNING

REGION ARIZONA

Population DensityPersons By Age

0-1415-1920-4445-6465-8485 +

Race/EthnicityWhiteAmerican IndianBlackAsian/Pacific IslanderOtherHispanic

GenderFemalesMales

Single Parent FamiliesFemale Headed Households

INCOMEPopulation below 100% FPLPopulation below 200% FPLMedian Household IncomeChildren <12 in Poverty

EDUCATIONLess Than 9th Grade Education9th-12th Grade, No DiplomaHigh School GraduateSome CollegeCollege or Professional Degree Holder

NON-RESIDENTMigrant, Agricultural WorkersTouristsWinter Residents

MISCELLANEOUSUnemployed"Uninsured" BirthsAHCCCS EnrolleesKidsCare EnrolleesMedicare BeneficiariesTransportation Score

2.3

542155

1,176932991

96

77.3%9.3%0.8%1.1%

11.5%37.5%

50.0%50.0%25.1%

5.7%

20.5%55.0%

$36,67833.1%

9.2%17.2%30.4%18.9%21.1%

617,618

26

14.3%6.0%

146

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....

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N/A

30.3%0.9%

986,081

187,573

3.4%77.2%

71,749446,159255,372132,173

20,000

3.6%2.8%

13.0%34.5%

50.9%49.1%28.9%

6.4%

16.4%37.1%

$55,36423.1%

5.2%7.7%

23.1%25.2%36.9%

1,6464,902,038

7,160

8.3%3.6%

22.0%0.8%

16.8%95

107.31,210,796

235,392

3.4%77.5%

88,984542,072312,761162,762

23,534

3.5%2.6%

13.0%36.1%

50.6%49.4%28.4%

6.5%

16.6%37.7%

$54,17923.4%

5.8%8.1%

23.9%25.2%35.1%

4,4926,411,947

9,510

8.7%3.9%

22.5%0.8%

16.8%116

52.36,438,178

1,369,009

4.7%75.5%

465,0733,001,2751,579,214

783,015103,911

4.2%3.0%

12.6%29.6%

50.3%49.7%27.3%

6.2%

15.3%35.0%

$59,15421.9%

24.4%24.9%33.4%

67,70432,200,000

75,670

9.2%3.9%

21.6%0.8%

14.4%135

56.5

6.4%8.2%

2011

9/19/2012

Page 2 of 4



RESOURCESFACILITIES

Ajo COUNTY

HEALTHPLANNING

REGION ARIZONA

General Hospitals

Designated as Sole Community Provider?Specialty BedsSkilled Nursing FacilitiesNursing Beds

SERVICESLicensed Home Health AgenciesAmbulatory Care Sites TypeLicensed PharmaciesCertified Ambulance Services

PERSONNELPrimary Care Providers

Ratio-Population:ProviderNurse Practitioners

Registered NursesMidwivesDentistsEmergency Medical

UTILIZATIONAMBULATORY CARE SENSITIVE CONDITIONS

ACSs/1000 Residents Age <65Points Above/Below (-) Statewide Average

HOSPITALIZATIONInpatient Days/1000 ResidentsInpatient Days/1000 by Age Group:

0-14 yrs15-19 yrs20-44 yrs45-64 yrs65-84 yrs85+ yrs

Leading DiagnosisLeading Procedure

(Non-maternity related)

No

No000

0A

1

4.0885

1

802

49

33.6-11.1

973

438494760

1,0341,3921,667

RESP SYS/CHEST SYMP NEC1 INT MAM-COR ART BYPASS

Hospital Beds/1000 Residents 0.0

2

:1

Physician Assistants 1

*** Not Applicable, ++ Insufficient Data, ## Not Available

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2

11191

29622

2,727

A, B, C, D, E30

2,443404

822157

10,75553

5412,959

42.3-2.4

612

377230431627

1,2892,389

82.8

:1

9

26231

29629

3,304

A, B, C, D, E35

2,738442

942193

12,16960

6123,793

43.8-0.9

607

374232419617

1,3092,452

152.5

:1

36

951,242

2,644145

16,329

162

13,7464684,2501,752

61,306224

3,62617,134

44.7

558

357217375582

1,3172,405

682.1

:1

***

A,B,C,D,E

2011

9/19/2012

Page 3 of 4



HEALTH STATUSINFANT MORTALITY RATE

Ajo COUNTY

HEALTHPLANNING

REGION ARIZONA

MORTALITY, LEADING CAUSE OF DEATH

Child (1-14)Adolescent (15-19)Young Adult (20-44)Mid Age (45-64)Elderly (65-84)Aged (85+)

PERCENT PREMATURE MORTALITYNATALITY

Fertility Rate/1000 Females 15-44 yrsBirth Rate/1000 Residents0-4 Prenatal Care Visits/1000 BirthsPrenatal Care Began:

None

Trimester TwoTrimester ThreeUnknown

Low-weight Births/1000 Live BirthsTeen Births/1000 Females 14-19 yrs

Block groups (2010) in area:

++

++++Motor- or nonmotor-vehicle accident, type of vehiclChronic ischaemic heart disease Chronic ischaemic heart disease Chronic ischaemic heart disease

112.5

127.0

3.5%

22.2%9.5%0.2%75.8

Infant ++

55.9%

Trimester One 64.6%

Other Places in area:

13.2

83.6

*** Not Applicable, ++ Insufficient Data, ## Not Available

194704.001, 194704.002, 194704.003, 194704.004

Ajo, Chico Shunie, Childs, Gibson, Gunsight, John The Baptist, Lukeville, Mexican Town, Quitobaquito, Rowood, The Adobe, Why

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13.676.2

49.5%

3.1%71.7%19.3%

5.5%0.4%

73.145.7

7.4

77.313.878.3

50.3%

3.0%71.9%19.1%

5.4%0.6%

73.747.1

7.5

80.515.486.2

51.5%

2.3%77.8%15.7%

3.9%0.3%

70.751.6

6.6

62.1

2011

9/19/2012

Page 4 of 4


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Care Area

MajorRoads

Minor Roads

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Appendix C Behavioral Health Services in Ajo

Behavioral Health Services in Ajo

PPEP Services (basement of the Ajo Justice Courthouse on La Mina Avenue)

• One non-Licensed Therapist providing all services • Takes AHCCCS clients and non-AHCCS Seriously Mentally Ill clients • Currently runs 6 groups

o Anger Management/Domestic Violence Group (2) Monday and Thursday o Substance Use Group (2) Tuesday and Wednesday o Parenting Group – Tuesday o Healthy Relationship Group

• 3 groups available, but not currently active o Adult Civic Responsibility o DUI Education o Teen Group

• Psychiatric and case Management Services for 17 SMI clients • Individual Counseling • Substance Abuse Evaluations (once a month) • Arizona Families First Substance Abuse Services

Desert Senita Services

• Two Licensed Therapists provide behavioral health services to No-AHCCCS clients • Case Management • Individual Therapy • Group Therapy

o Mothers, Maids, and Wives group; o Grief and Loss group; o Chronic Disease group; o Teen Girls group; o Resiliency group; o Self-Care group; o Expressive Arts group; o Budgeting group

Other “Perceived” Behavioral Health Services Lacking in Ajo

• Children’s Services o Psychiatric/Medication Management o Intakes o Individual therapy o Intensive In-Home therapy

• Family Support Services o Multi-Family Therapy Groups

• More frequent adult medication management/psychiatric services • Substance Abuse Evaluation and Treatment Services • Crisis Services – Psychiatric and Substance Abuse • Recover Home/Transitional Housing

CPSA Initiatives

• Integrated Health Care • Availability of More Robust Children’s Services • Telepsychiatric Services – Addresses Medication and Crisis Psychiatric Services

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