___________________________________________________
2016-2019
Community Health Needs Assessment and Implementation Plan
Adopted by Community Health Board: June 28, 2016
Table of Contents
I.
EXECUTIVE SUMMARY.................................................................................................................2
II.
OVERVIEW..................................................................................................................................6
State, Regional and Community Partners................................................................................6
Community Health Framework ..............................................................................................8
III. 2013 CHNA REVIEW ....................................................................................................................9
IV. COWLITZ COUNTY DEMOGRAPHIC AND SOCIOECONOMIC PROFILE ............................................. 13
V.
KEY HEALTH INDICATORS......................................................................................................... 166
Method ............................................................................................................................ 166
Healthy, Active Living ........................................................................................................ 177
Child & Family Wellbeing..................................................................................................... 22
Health Delivery Systems .................................................................................................... 266
Equity............................................................................................................................... 311
VI. COMMUNITY CONVENING....................................................................................................... 344
Method .............................................................................................................................. 34
VII. IMPLEMENTATION PLAN ........................................................................................................... 39
Introduction ....................................................................................................................... 39
Needs Not Addressed.......................................................................................................... 42
Appendix 1: Organizations Participating in Community Convening..................................................... 433
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I.
EXECUTIVE SUMMARY
Overview
PeaceHealth St. John Medical Center
PeaceHealth St. John Medical Center (PeaceHealth St. John) is one of ten hospitals within PeaceHealth,
an integrated, not-for-profit health system in the Pacific Northwest. Located in Longview, Washington,
the primary service area for PeaceHealth St. John is Cowlitz County, Washington.
Community Health Needs Assessment
PeaceHealth St. John and partners conducted a Community Health Needs Assessment (CHNA), a
systematic process involving the community to understand community health needs in order to
prioritize, plan and outline solutions.
The 2016 CHNA was carried out with community input, including public health and nonprofit community
groups representing minority and low-income residents. Both primary and secondary data were
collected and incorporated. We also interviewed key informants and held a community forum in which
needs were affirmed and possible strategies to address the needs were identified.
Data and local perspectives are presented and analyzed according to a four-pillar structure of
community health: 1) Healthy, Active Living; 2) Child & Family Wellbeing; 3) Integrated Health Delivery
Systems (including medical dental and behavioral health services); and 4) Equity.
PeaceHealth St. John conducted this CHNA in conjunction with state, regional, and local community
health planning in Washington, Southwest Washington, and Cowlitz County.
2013 CHNA
The problem of health care access and lack of insurance coverage was identified in all PeaceHealth
communities in 2013 as a major need and was therefore chosen as a major focus area in our 2013 CHNA
implementation plans. PeaceHealth worked as part of the community coalitions that were formed
across the state for the purpose of helping people sign up for commercial health insurance and Apple
Health, i.e. Medicaid. By any measure these efforts were successful.
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Summary of the 2016 Community Health Needs Assessment
Demographic and Secondary Data
Cowlitz County has about 102,000 residents. 26% are children 0-19 years old, 60% are adults age 18-64,
and the remaining 14% are seniors age 65+. Longview is the largest city in the county representing
nearly 36% of the county’s population. Approximately 34% of Cowlitz County residents are either Asset
Limited, Income Constrained, Employed or live below the poverty line. 8.1% of the County’s population
is Hispanic.
Key health indicators were organized into the four community health pillars using primary data from
Robert Wood Johnson’s 2016 County Health Rankings and other state sources. Health outcomes gaps in
each area are summarized below.
HEALTHY, ACTIVE LIVING: Cowlitz County has the highest death rate related to opiate use in Washington,
and opiate abuse is a major public health issue in Cowlitz County. Adult obesity and related chronic
diseases are also major drivers of poor health in Cowlitz County.
CHILD & FAMILY WELLBEING: Critical indicators of need in Cowlitz County include higher rates of low
birth weight, childhood food-insecurity, and maternal smoking relative to Washington State.
HEALTH DELIVERY: Data show that there are significant differences in rates of being insured by
race/ethnicity, and racial/ethnic differences in the quality of preventive care received by Medicare
beneficiaries. Addressing these inequities is vital to the health of the community.
EQUITY: Affordable housing is a key component of financial wellbeing and stability, and forms the basis
of good health. There are many pockets of people in Cowlitz County burdened by high housing
costs. Lack of affordable housing and a high percentage of households that are Asset Limited, Income
Constrained, Employed (ALICE) or in poverty mean that over a third of Cowlitz residents cannot afford a
basic household stability budget.
Community Engagement and Local Perspectives
PeaceHealth St. John interviewed key informants from five organizations throughout the County
representing public health and minority health to identify health gaps and possible health solutions.
The key informant interviews were conducted in advance of a convening that was held on May 10, 2016
wherein 18 community leaders from public health, health and social services, business, schools, and law
enforcement met to confirm, refine, and identify health needs/gaps and possible solutions.
Table 1 summarizes the results of the community stakeholder meeting. It should be noted that the lists
of gaps and strategies represented in the table were generated in two separate set of group
conversations, processes, i.e. the strategies were not necessarily identified as specific solutions to the
identified gaps.
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Table 1. Results of the Community Stakeholder Meeting
Major Health Problems/Gaps
Healthy,
Active
Living




Maternal smoking during
pregnancy
Care coordination for
prenatal/postpartum vulnerable
mothers, infants, and children
ACEs



Health care access inequities
Substance abuse care
Crisis/triage care


High housing costs
Culturally integrated businesses,
health care, and government
Access to health care for
vulnerable and rural populations

Child &
Family
Wellbeing
Health
Delivery
Systems
Adult and teen chronic diseases
Adult and teen substance
use/abuse
Lack of access to healthy food

Equity

Prioritized Evidence-Based Strategies




Community Health Worker
programs
School nutrition programs
Prenatal and early childhood
home visiting programs
Preschool programs with family
support services

Integration of behavioral health
and primary care
Detox/sobering centers


Systems/patient navigators
School-based health centers

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Implementation Plan
The Implementation Plan strategies summarized below were extrapolated from the data and from
community input. Our plan is comprehensive in the sense that there are strategies that impact the focus
areas within each of the community health pillars (and a number of strategies cross pillars). The display
of strategies is not intended to be a complete listing of all the activities that PeaceHealth will undertake
with its community partners to affect the health status of the community. Rather, it is a statement of
our community health priorities.
PeaceHealth St. John CHNA 2016 Priorities
1. Ensure effective information exchange and care coordination for select populations (e.g.
PeaceHealth Medical Group patients with complex health and psychosocial conditions who are
served by multiple organizations) as part of PeaceHealth Transforming Clinical Practice Initiative
(TCPI) and other community collaborations.
2. Increase participation in the PeaceHealth employee wellness program, particularly for
caregivers at the lower end of the compensation scale.
3. As part of our ongoing effort to create an inclusive organization that exercises cultural humility,
recruit for and support a workforce that reflects the changing ethnic, racial and cultural
diversity of the communities that we serve.
4. Advocate for public policy and support community efforts to improve public infrastructure that
supports active lifestyles.
5. Advocate for and support programs geared to promoting healthy nutrition, for school aged
children and their families.
6. Further develop and expand Community Health Worker initiatives that empowers
individuals within specific communities to serve a liaison/linking/intermediary role
between health/social services and the community.
7. Increase PeaceHealth St. John caregiver awareness of ACEs including trauma informed care and
resilience.
8. Advocate for and actively support the development of a comprehensive continuum of services
that includes integrated primary care and behavioral health services, transitional programs and
substance abuse treatment programs.
9. Advocate for and actively support collaborative strategies that provide short and longer-term
interventions addressing homelessness.
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II.
OVERVIEW
Founded by the Sisters of St. Joseph of Peace in 1890, PeaceHealth is a Catholic Healthcare Ministry
serving in the communities of Alaska, Washington and Oregon. Today, PeaceHealth is a 10 hospital
integrated not-for-profit health system that offers a full continuum of health and wellness services.
PeaceHealth’s mission is to carry on the healing mission of Jesus Christ by promoting personal and
community health, relieving pain and suffering, and treating each person in a loving and caring way. The
fulfillment of our Mission is our shared purpose. It drives all that we are and all that we do. We have
embraced the Community Health Needs Assessment (CHNA) process as a means of engaging and
partnering with the community in identifying disparities and prioritizing health needs, and importantly,
in aligning our work to address prioritized needs.
Caring for those in our community is not new to PeaceHealth; it’s been in practice since the Sisters of St.
Joseph of Peace arrived in Fairhaven, Washington to serve the needs of the loggers, mill workers,
fishermen and their families more than 125 years ago. Even then, they knew that strong, healthy
communities benefit individuals and society, and that social and economic factors can make some
community members especially vulnerable. The Sisters believed they had a responsibility to care for
them, and that ultimately, healthier communities enable all of us to rise to a better life. This philosophy
inspires us today and guides us toward the future.
State, Regional and Community Partners
PeaceHealth St. John’s 2016 CHNA process was undertaken in the context of other recent or concurrent
planning activities in the State, region and County related to community health:

The Washington State Health Improvement Plan (2014-2017 Creating a Culture of Health in
Washington) provides a statewide framework for health improvement efforts.

Cowlitz County Public Health Department publishes a periodic Community Health Assessment
which is developed in partnership with the community. Its most recent 2014 Community Health
Assessment identifies three program objectives: strengthen the system of care for mothers and
children; foster Community Health Worker (CHW) expansion; run an annual health
improvement agenda, and one process objective: increase community coordination.
“
Wellness is something we nurture, something we build into our policies,
something we come together to create as public health professionals,
doctors, nurses, lawyers, transportation planners, neighborhood
advocates and PTAs, and others.
John Wi esman, DrPH, MPH
Wa s hington State Secretary of Health
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
Cascade Pacific Action Alliance is the Accountable Community of Health (ACH) for the central
western Washington region.
An ACH is a regional coalition consisting
Map 1. Accountable Community of Health Regions
of leaders from a variety of different
sectors working together to improve health in
their region. As part of the Healthier
Washington Initiative, nine ACHs began
formally organizing across Washington in 2015.
They are intended to strengthen collaboration,
develop regional health improvement plans and
projects, and provide feedback to state
agencies about their regions’ health needs and
priorities. The Health Care Authority (HCA) is
Source: Washington Health Care Authority
supporting ACH development through
guidance, technical assistance (TA), and funding.

Healthy Living Collaborative of Southwest Washington (HLC) is an organization that focuses on
upstream solutions that support community-based initiatives to improve health and wellness.
With a strong commitment to health equity, HLC supports the development of a network of
community health workers and improving the health and stability of all residents in Southwest
Washington by incorporating health considerations into decision making across all sectors,
systems, and policy areas to prevent and mitigate chronic disease and poverty.

Pathways 2020 is a non-profit coalition of business and civic organizations dedicated to making
Cowlitz County a better place to live. Since 1997, the organization has produced a Community
Report Card. It’s most recent 2015 Report Card includes data on social cohesion, economic
measures, education, overall health, housing, and access to healthy food in the County.
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Community Health Framework
Drawing from the CHNAs conducted by PeaceHealth hospitals in 2013, and after reviewing existing
community health improvement plans and collecting public data on health status and the social
determinants of health, a PeaceHealth Community Health Framework was developed. This four-pillar
framework, depicted below, was used to organize data and collect input from community stakeholders.
The subcategories, or “focus areas” were used as guideposts for considering community health
improvement strategies.
Figure 1. 2016 PeaceHealth Community Health Framework Pillars
Healthy,
Active Living
 Physical activity
 Healthy Eating
 Tobacco, alcohol
and other drug
prevention
Child & Family
Wellbeing
 Maternal-child
health
 Adverse Childhood
Experiences (ACEs)
and family resiliency
Integrated Health
Delivery Systems
 Access to quality
and affordable
medical, behavioral
health and dental
services
Equity
 Assistance for
people who are
homeless
 Cultural humility
 Social engagement
There are two terms that are used in the above table that perhaps need to be defined, and they are:

Adverse Childhood Experiences (or ACEs) are traumatic events that occur in childhood and
cause stress that changes a child’s brain development. Exposure to ACEs has been shown to
have a dose-response relationship with adverse health and social outcomes in adulthood,
including but not limited to depression, heart disease, COPD, risk for intimate partner violence,
and alcohol and drug abuse.

Cultural humility is a term used to describe a way of infusing multiculturalism into a workplace.
Replacing the idea of cultural competency, cultural humility is based on the idea of focusing on
self-reflection and lifelong learning.
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III. 2013 CHNA REVIEW
During the 2012-2013 timeframe, PeaceHealth St. John, in collaboration with the Cowlitz County Public
Health Department, Lower Columbia Head Start, Pathways 2020, and other community partners in
Southwest Washington conducted a comprehensive CHNA. The CHNA described the health status of the
entire region and recommended areas for improvement. The PeaceHealth St. John CHNA focused on the
Cowlitz County, WA data. The table below summarizes our 2013-2016 CHNA and includes available
metrics which summarize measurable progress to date.
Table 2. 2013 CHNA Summary and Current Status
Objectives
Objective 1:
Increase Access
to Affordable
Care
Outcomes
Strategies
Increase the number of children and adults
with health insurance
Recruit and retain primary care providers
Support community health partner
programs
Baseline
Current
Uninsured adults:
17%
Uninsured adults:
10%
Adults who smoke:
24%
Adults who smoke:
17%*
Adults who are
obese: 37%
Adults who are
obese: 32%
Adult physical
inactivity: 23%
Adult physical
inactivity: 22%
Provide maternal smoking interventions
Objective 2:
Reduce tobacco
use
Increase number of smoke-free
environments/PSE approach
Enhance tobacco use interventions in
primary care settings
Improve access to healthy foods
Objective 3:
Reduce obesity
Improve access to recreational facilities
Enhance physical activity and nutrition
promotion in the clinical setting
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Objectives
Objective 4:
Increase number
of healthy
newborns and
infants
Objective 5:
Promote
workplace
wellness at St.
John
Outcomes
Strategies
Baseline
Reduce the use of tobacco and drugs in
pregnant women
Increase immunization rates
Support appropriate maternity screenings
Increase availability of healthy foods at St.
John
Increase opportunity for physical activity
for caregivers
*data methods changed/can’t compare to prior years
Current
Low birth weight
rate: 7%**
Low birth weight
rate: 7%**
Maternal smoking
rate: 21%
Maternal smoking
rate: 16%
Toddler
immunization rate:
no data
Toddler
immunization rate:
56%
Pregnant women
receiving prenatal
care in the first
trimester: 81%
Pregnant women
receiving prenatal
care in the first
trimester: 79%
No data
Participation in
PeaceHealth
wellness program:
51% of eligible
caregivers
**data spans 2007-2013
Sources: Robert Wood Johnson County Health Rankings, Enroll America, Washington State Department of Health:
Center for Health Statistics, Washington State Behavioral Risk Factors Surveillance System, PeaceHealth internal data
As we move forward in adopting the 2016 CHNA, we reflect on lessons learned and accomplishments of
our process, goals, and implementation of the previous (2013) CHNA:
Accomplishments

The 2013 PeaceHealth CHNA identified the problem of health care access and lack of insurance
coverage as the one issue that we wanted to focus on across all of our communities.
PeaceHealth worked as part of the community coalitions that were formed across the State for
the purpose of helping people sign up for commercial health insurance and Apple Health, i.e.
Medicaid. By any measure these efforts were successful.
Between 2013 and 2014 there was more than a 34% increase in Medicaid enrollment.
Enrollment continued to increase in 2015 but not at the pace of the initial increase. Adult
enrollment rose 44% from 2013 to 2015 and child enrollment rose 54% over the same period.
As a result, uninsured adults in Cowlitz County decreased from 17% in 2013 to 10% in 2015.
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Figure 2. Medicaid Enrollment and Percent Uninsured, Cowlitz County
17%
37233
33837
25243
10%
24243
2012
2013
2014
2013
2015
2015
Figure 3: Medicaid Enrollment by Adults and Children, Cowlitz County, 2012-2015
24,622
16,165
15,377
8,866
2012
23,295
13,938
9,215
9,078
2013
2014
Children
2015
Adults
Source: Health Care Authority, State of Washington. Children are defined as under age 19.

Reducing tobacco use was noted as a significant community need in the 2013 CHNA.
PeaceHealth supports the Tobacco Free Coalition that is currently working with Cowlitz on the
Move, the State Department of Health, Youth and Family Link and the Healthy Living
Collaborative to expand the tobacco free ordinances in the cities of Longview, Kelso and the
County to include the prohibition of e-cigarettes and vaping in public areas. PeaceHealth has
already adopted this policy for all properties owned and operated by PeaceHealth St. John. The
Family Health Center has also adopted a tobacco free policy since the initiation of the CHNA in
2013. All of the local schools have tobacco free campuses and have policies that include vaping
and e-cigarettes.
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
Reducing obesity was also identified as a focus area in the 2013 CHNA. The employee wellness
program at St. John partners with a local organic farm to provide access to a community
supported agriculture program. Since 2013, a minimum of 50 employees have purchased shares
in the program each year, providing each caregiver and their family with fresh produce and
increasing the consumption of foods that promote health.
Through a partnership with Cowlitz on the Move, Pathways 2020, Longview Parks and
Recreation and Cowlitz County we distributed Cowlitz County trail maps to primary care
providers to use when counseling patients and family about free opportunities for physical
activity in our community.
PeaceHealth supports the Lower Columbia School Gardens program through board
membership, in kind volunteer hours to support programs, availability of Registered Dietitians
for health education, and financial funding. PeaceHealth has provided $52,300 as financial and
in kind support since 2013.

Another priority identified in the 2013 CHNA was increasing the number of healthy newborns
and infants. PeaceHealth is a charter member of the Cowlitz Health and Safety Network, formed
in 2015 to increase resources and education to help at-risk youth and families. In collaboration
with the Cowlitz County Health Department Office of Healthy Communities, Youth and Family
Link, Pathways 2020 and other health, education and social service providers, the Network has
provided community-wide education about Adverse Childhood Experiences (ACES).

The 2013 CHNA described PeaceHealth St. John’s commitment to promoting workplace
wellness. In addition to the community supported agriculture program described above, the
cafeteria at St. John has changed the types of food provided for caregivers, patients and hospital
visitors. In 2013, 70% of the foods produced and sold in the Cafeteria and served to patients in
the hospital were pre-packaged products. Now, in 2016 90% of foods produced for the patients
in the hospital and sold in the cafeteria are made from scratch, on site. Additionally, the general
patient menu for hospital patients meets the heart healthy diet guidelines of the American
Heart Association, further increasing the access to healthy foods for members of our
community.
The vending machines within our facilities have transitioned to offer more low fat, high fiber,
and limited high fructose corn syrup options to further support our efforts to increase the health
of food options available on-site.
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IV.
COWLITZ COUNTY DEMOGRAPHIC AND
SOCIOECONOMIC PROFILE
PeaceHealth St. John serves Southwest Washington, with Cowlitz County
being its primary service area, and the focus of this CHNA 1.
Map 2, Cowlitz County, WA
Current Profile
Cowlitz County has about 102,000 residents.






1
Of Note:
The 2015 United Ways of
the Pacific Northwest ALICE
report summarizes the
status of ALICE families—an
acronym that stands for
Asset Limited, Income
Constrained, Employed.
These are families that
work hard and earn above
the Federal Poverty Level
(FPL), but do not earn
enough to afford a basic
household budget of
housing, child care, food,
transportation, and health
care. Most do not qualify
for Medicaid coverage.
In Cowlitz County, 34% of
all households are either in
poverty or are ALICE
households. This is similar
to Washington State
overall, wherein 32% of all
households are either ALICE
or in poverty.
6,273 (6%) are preschoolers under 5 years old
20,029 (20%) are 5-19 years old
60,985 (60%) are adults age 18-64
17,135 (17%) are seniors age 65+
8,285 (8%) are Hispanic or Latino (slight growth in population since 2010)
3,608 (4%) are American Indian and Alaska Native (stasis in population since 2010)
All data in this section is from the American Community Survey (US Census Bureau) unless otherwise noted.
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The largest population center is Longview, home to more than 35% of Cowlitz County residents. This is
followed by the geographically adjacent city of Kelso, where about 12% of the County’s residents live. In
terms of the socioeconomic determinants, the County, as depicted in Table 3 is:

87% of adults have a high school diploma.

18% of individuals live below the Federal Poverty Level.

34% of all households are either in poverty or cannot afford basic household expenses

341 people are homeless in Cowlitz County, both sheltered and unsheltered (Source: Homelessness
in Washington State: 2015 Annual Report on the Homelessness Grant Programs, Department of Commerce).

In the Longview, WA school district, 430 children in grades K-12 are reported from homeless
families (96) or doubled up (living with other families) (334) (Source: 2014-2015 Homeless Student Data
Report, Office of Superintendent of Public Instruction).
Table 3. Cowlitz County, WA Sociodemographic Profile
High school
diploma (%)
Individuals living
below the FPL
(%)
Median
Household Income
People over age 5
who are
linguistically isolated
Kelso
79.8%
32.1%
$33,492
5.5%
Longview
86.7%
22.8%
$37,827
3.2%
Woodland
84.6%
23.4%
$33,492
8.3%
Cowlitz County
87.2%
18.4%
$46,571
3.0%
Washington State
90.2%
13.5%
$60,294
7.8%
City
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The Community Need Index (CNI), a tool created by Dignity Health, measures a community’s social and
economic health on five measures: income, cultural diversity, education level, unemployment and
health insurance, and housing. The CNI demonstrates that within Cowlitz County, there are pockets of
higher and lower need:
Map 3. Cowlitz County, WA Community Need Index Map, 2015
Source: Dignity Health
Key Take-Aways

Over a third of all Cowlitz County residents are either below the Federal Poverty Level (FPL), or,
if above, but do not earn enough to afford a basic household budget of housing, child care, food,
transportation, and health care.

Within Cowlitz County, there are pockets of high poverty and low educational attainment, with
highest need areas concentrated in and around Longview.
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V.
KEY HEALTH INDICATORS
Method
Data for each of the four PeaceHealth pillars is detailed on the following pages. For each pillar, we
provide a description, how the community compares to other Washington counties, provide a profile of
the community, identify important indicators and provide key takeaways.
PeaceHealth selected the most currently available data from publically available sources. Data elements
were selected that align with the focus of the CHNA. The goal was to identify metrics that could be
consistently measured, monitored and benchmarked for all PeaceHealth communities throughout the
Pacific Northwest.
Data from the Robert Wood Johnson Foundation (RWJF) was used as a primary source. RWJF’s county
health rankings data compare counties within each state on more than 30 factors. Counties in each of
the 50 states are ranked according to summaries of a variety of health measures. Counties are ranked
relative to the health of other counties in the same state. RWJF calculates and ranks four summary
composite scores used in this report:




Overall Health Outcomes
Overall Health Delivery Factors
Health Factors – Health behaviors
Health Factors – Social and economic factors
This is a nationally recognized data set for measuring key social determinates of health. RWJF is
committed to continually measuring these metrics.
Data in this evaluation is also supplemented with sources from state and local agencies in Washington.
Unless otherwise noted all data cited in this section is from RWJF or the following sources:
Behavioral Risk Factor Surveillance System; Washington Healthy Youth Survey; Washington Department
of Health, Vital Statistics; US Census Bureau; The University of Washington’s Alcohol and Drug Abuse
Institute; Cowlitz Family Health Center WIC; WA Office of the Superintendent for Public Instruction;
Feeding America; Enroll America; Centers for Medicare & Medicaid Services; Community Commons.
Next to each local indicator we've shown whether the local rate (percentage) is less than, greater than,
or equal to the state rate (percentage). With any indicator, there is a range of possible 'true' values
because data collection always entails some error. Often, percentages that appear different are rated as
'equal.' This is because, statistically speaking, there is a large chance that the 'true' value of the data at
the state and county level is equal, rather than different, due to error inherent in the data collection
process.
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Healthy, Active Living: Cowlitz County Health Indicators, 2016
What is Healthy, Active Living?
Healthy, Active Living is a key pillar of a healthy community. We envision a community where the
environment and resources of that community allow adults, teens, and children to be physically active,
to eat nutritious meals, to be free of the burdens of substance abuse and chronic disease, and to live
with an ample sense of wellbeing and connection to others.
How Does Cowlitz County Compare to Other Counties?
Cowlitz County is ranked 35 out of 39 Washington counties for its food and physical activity
environment, as well as the adult behavioral health indicators like excessive drinking and smoking. This
means we’re doing poorly compared to other counties in Washington.
Healthy, Active Living Profile
Adults:



Adult obesity: 32% (>WA: 27%)
Adult physical inactivity: 22% (=WA: 18%)
Adult diabetes: 13% (>WA: 9%)
Youth:


10th graders who are obese: 15.4% (=WA: 11.2%)
10th graders reporting physical inactivity: 9.5%(=WA: 12.0%)
Environment:


Reasonable access to exercise opportunities: 79% of residents (<WA: 88%)
Food environment index: 2016: 6.5 (<WA: 7.5)
Substance Abuse:



Adult smoking: 17% (=WA: 15%)
10th graders smoking cigs in past 30 days: 9.1% (=WA: 7.9%)
Deaths attributed to any opiate: 17.9 per 100,000 population (>WA: 8.6 per 100,000 population;
highest of any county in Washington)
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Closer Look
Growth of Opiate Abuse
Cowlitz County has the highest opiate death rate of all counties in
Washington at 17.9 deaths per 100,000 population, appearing nearly
double the overall rate of deaths from opiates in Washington State as a
whole (8.6 deaths per 100,000 population). The death rate from opiates
in Cowlitz County has grown 74% from 2002-2004 to 2011-2013, as shown
in Figure 4.
Figure 4. Rate of Deaths Attributed to any Opiate by County, WA State
Source: Univ. of Washington Alcohol & Drug Abuse Institute
Accordingly, there is a high rate of opiate-related crime in Cowlitz County.
Unfortunately, residents of Cowlitz County have lower rates of treatment
for opiate abuse, despite the high rate of deaths from opiates.
Figure 5. Rate of Opiate-Related Crime and
Rate of Treatment for Opiate Abuse by County, WA State
Of Note:
Caregiver Wellness
As one of the largest
employers in the
community, PeaceHealth is
working to support Active
Healthy living in its
workforce by offering an
employee wellness program.
Workplace wellness
programs are evidencebased strategies to improve
physical fitness and risk
factors. At PeaceHealth, we
can make an impact on
community wellness by
improving our employees’
wellness, but there are
differences based on income
levels:
51% of eligible PeaceHealth
St. John employees
participate in a wellness
program.
37% of eligible PeaceHealth
St. John employees earning
$25,000 - $40,000
participate in a wellness
program.
Participation by Income
Source: Univ. of Washington Alcohol & Drug Abuse Institute
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Opiate use in Cowlitz County is a public health emergency and a high priority among all health issues
facing our community.
Obesity and Related Chronic Diseases
Nearly a third of Cowlitz County adults are obese, and 13% of Cowlitz County adults have diabetes, a
rate higher than in Washington state overall. Obesity and diabetes imperil the health of Cowlitz County
residents, lower their life span, and put enormous pressure on families to care for aging relatives with
avoidable chronic disease. Resulting partly from high obesity rates, the rate of heart disease among
Cowlitz County adults is much higher than Washington State, at 202.7 per 100,000 population vs. 138.3
per 100,000 population.
Figure 6. Percent of Adult Residents that are Obese by County, WA State, 2016
Source: Robert Wood Johnson County Health Rankings
Additional Indicators with Trend Data
The Behavioral Risk Factor Surveillance System is used to measure chronic diseases and health behaviors
among a population of adults in all 50 states at the county level. The Washington Healthy Youth Survey
measures health risk behaviors and outcomes among 6th, 8th, 10th, and 12th graders in Washington
State. The Washington Department of Vital Statistics measures causes of death prenatally and at birth.
The Robert Wood Johnson Foundation County Health Rankings aggregates BRFSS, Vital Statistics, US
Census, and business data to provide an overview of measures that matter for health. The University of
Washington’s Alcohol and Drug Abuse Institute measures markers of opiate abuse over time in
Washington counties.
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Table 4. Healthy, Active Living: Cowlitz County Health Indicators vs. Washington State, 2016
Better
Equal
Worse
Chronic Conditions
Adult diabetes
●
Heart disease death rate
●
Adult obesity
●
Risk behaviors
Adult physical inactivity
●
Excessive alcohol use
●
Adult smoking
●
Drug overdose death rate
●
Deaths due to any opiate
●
Suicide death rate
●
Environment
Grocery availability & food insecurity
●
Access to exercise opportunities
●
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Table 5. Healthy, Active Living: Cowlitz County 10th Graders,
Health Indicators vs. Washington State, 2016 and Trend Since 2010
Better
Equal
Worse
Trend
Chronic Conditions
Obesity
●
stasis
Depression
●
worsening
Smoking cigarettes
●
improving
Drinking alcohol
●
improving
Using marijuana/hashish
●
stasis
Binge drinking
●
improving
Risk behaviors
Eat 5+ fruits/vegetables per day*
Consumed no sugar-sweetened beverages
in past 7 days
Reports no leisure-time physical activity
for 60 min/day in past 7 days
Reports ‘seriously considering suicide’
Environment
Bought sugar-sweetened beverages at
school
*trend since 2012
●
stasis
**
●
●
stasis
●
stasis
●
improving
**no trend data available due to methodology change
Key Take-Aways

Deaths from opiates are a public health crisis in Cowlitz County, with a higher death rate from
opiates than anywhere else in Washington State.

Obesity, diabetes, and heart disease among Cowlitz County adults are major public health issues
with negative consequences for Cowlitz County’s aging population.

Physical inactivity among young adults appears to be uncommon and is a particular area of
health resilience that should be maintained.
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Child & Family Wellbeing: Cowlitz County Health Indicators, 2016
What is Child & Family Wellbeing?
Child & Family Wellbeing is a key pillar of a healthy community. Circumstances in pregnancy through
early childhood are key predictors of health and wellbeing later in life. We envision a community where
all pregnant women and families with children are well-fed, safe, and equipped with resources and
knowledge to succeed in school, from kindergarten to high school graduation.
How Does Cowlitz County Compare to Other Counties?
In social and economic factors, including the percentage of adults who have completed high school and
have some college education, as well as the percentage of babies born to single mothers, Cowlitz County
is ranked 28th of 39 counties in Washington.
Child & Family Wellbeing Profile









Percent of students who demonstrate expected skills in 6 of 6 domains: 28 % (<WA: 39.5%)
Childhood food insecurity: 28% (>WA: 21.0%)
Graduation rate: 79% (=WA: 77.2%)
Maternal smoking in third trimester of pregnancy: 16% (>WA: 7.3%)
Low birth weight: 7% (>WA: 6%)
Prenatal care beginning in first trimester: 79% (>WA: 74.7%)
19-35-month olds up-to-date with vaccinations: 56% (=WA: 56%)
Teens up-to-date with vaccines: 33% (=WA: 34%)
WIC infants fully or partially breastfed: 27% (Cowlitz Family Health Center) (<WA: 38.4%)
Closer Look
Adverse Childhood Experiences (ACEs)
Adverse Childhood Experiences, or ACEs, are traumatic events that occur in childhood and cause stress
that changes a child’s brain development. Exposure to ACEs has been shown to have a dose-response
relationship with adverse health and social outcomes in adulthood, including but not limited to
depression, heart disease, COPD, risk for intimate partner violence, and alcohol and drug abuse.
Adverse Childhood Experiences include emotional, physical, or sexual abuse, emotional or physical
neglect, seeing intimate partner violence inflicted on one’s parent, having mental illness or substance
abuse in a household, enduring a parental separation or divorce, or having an incarcerated member of
the household.
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Of Note:
Figure 7. Association between ACEs and Negative Outcomes
Adults in Cowlitz County
report high rates of Adverse
Childhood Experiences
(ACEs) that contribute to
poor health and social
outcomes throughout the
life course.
A high rate of babies are
born at low birth weight in
Cowlitz County relative to
the Washington State.
Over a quarter of Cowlitz
County children lack access
to adequate, nutritious
food.
Source: Centers for Disease Control & Prevention,
"Association between ACEs and negative outcomes"
We can examine ACEs reported by adults in Washington and see that adults in Cowlitz County are more
likely to have endured ACEs that put them at risk for poor health and social outcomes throughout the
life course than adults in Washington State overall.
Figure 8. ACEs Reported by Adults in Cowlitz County and WA State, 2011
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
1+ ACEs
2+ ACEs
Cowlitz County
3+ ACEs
4+ACEs
WA State
Source: Washington State Behavioral Risk Factor Surveillance System
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High rate of maternal smoking during pregnancy and low birth rate
Pregnant women in Cowlitz County are nearly twice as likely as pregnant women in Washington overall
to smoke during pregnancy, despite being just as likely to receive appropriate prenatal care in the first
trimester of pregnancy. Smoking during pregnancy imperils the health of women and babies alike, and
contributes to the high rate of babies born at low birth weight in Cowlitz County. The percentage of live
births with low birth weight (<2500 grams) is a key indicator of maternal-child health and wellbeing
because it indicates long-term developmental health and wellbeing. The rate of low birth weight in
Cowlitz County is higher than many other Washington counties and higher than Washington State
overall, making it a particularly urgent area of need.
Figure 9. Rate of Low Birth Weight by County, WA, 2007-2013
Source: Robert Wood Johnson County Health Rankings
Child & Family Wellbeing Data Sources
The Washington Department of Vital Statistics measures causes of death prenatally and at birth. The
Washington Department of Health conducts the Behavioral Risk Factor Surveillance System (BRFSS) that
compiles ACEs data on adults. The Robert Wood Johnson Foundation County Health Rankings
aggregates BRFSS, Vital Statistics, US Census, and business data to provide an overview of measures that
matter for health. The Office of the Superintendent for Public Instruction measures “Readiness to
Learn” among entering kindergarteners in Washington State in 6 domains: social-emotional, physical,
language, cognitive, literacy, and math. The USDA Women, Infant, and Children nutrition program
measures breastfeeding among its program recipients by individual WIC site—the numbers for Cowlitz
County come from the Cowlitz Family Health Center WIC site. Low birth weight is compiled in a sevenyear period by RWJF County Health Rankings from WA State Vital Statistics data (2007-2013). Childhood
food insecurity is measured by the USDA and Feeding America, and is characterized by a lack of
consistent, sufficient, and varied nutrition.
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Table 6. Child & Family Wellbeing: Cowlitz County Health Indicators vs. Washington State, 2016
Better
Equal
Worse
Trend
Social Indicators
High school graduation rate
stasis
●
Childhood food insecurity
Entering kindergarteners demonstrating
Readiness to Learn in 6 of 6 domains
Health Indicators
●
stasis
●
worsening
stasis
●
Prenatal care in 1st tri. of pregnancy
Maternal smoking in 3rd tri. of pregnancy
●
improving
Low birth weight*
●
*
WIC infants partially or fully breastfed
●
**
Toddlers up-to-date with vaccines
●
**
Teenagers up-to-date with vaccines
●
**
*Data aggregated from 2007-2013
**no trend data available
Key Take-Aways

Many Cowlitz County children are food-insecure—over a quarter of children in Cowlitz County-and not fully prepared for kindergarten; because so many Cowlitz County residents are in
poverty or Asset-Limited, Income Constrained, Employed (ALICE), there may be a dearth of
food/nutrition and quality, affordable child care that affects children’s wellbeing.

Adults in Cowlitz County report high rates of Adverse Childhood Experiences (ACEs) that
contribute to poor health and social outcomes throughout the life course.

The high rates of maternal smoking during pregnancy contribute to high rates of low birth
weight in Cowlitz County; being born at low birth weight imperils the health and wellbeing of
children across the life course and puts Cowlitz children at risk for development delays that will
alter their ability to thrive in school and in the community.
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Health Delivery Systems:
Cowlitz County Health Indicators, 2016
What are Health Delivery Systems?
Health Delivery Systems are a key pillar of a healthy community. Access to quality, affordable,
comprehensive care throughout the life course is an important facet of community wellness. We
envision a community where all people have access to quality, affordable preventive and acute care,
including mental health and dentistry, throughout the life course.
How Does Cowlitz County Compare to Other Counties?
In health delivery factors including the ratio of physicians, dentists, and mental health providers to the
population, as well as certain measures of quality of care like the percentage of Medicare recipients that
receive mammograms and diabetic monitoring, Cowlitz County ranks 20th out of 39 counties in
Washington—in the bottom half of Washington counties.
Health Delivery Systems Profile





Ratio of care providers to residents:
 Primary care: 1,540:1 (>WA: 1,190:1)
 Dentists: 1,820:1 (>WA: 1,290:1)
 Mental health: 530:1 (>WA: 380:1)
Uninsured rate among adults below age 65: 10% (>WA: 8%)
10th graders who saw a doctor for a physical in the past year: 64% (=WA: 66.1%)
10th graders who saw a dentist for a checkup, exam, teeth cleaning, or other dental work: 73%
(<WA: 79.0%)
Preventable hospital stays among Medicare beneficiaries: 38 per 1,000 beneficiaries (=WA: 36
per 1,000 beneficiaries)
Closer Look
Health Insurance Inequities
Though Cowlitz County’s overall insurance rate is improving, there are significant inequities in health
insurance rate by race/ethnicity, as depicted in Figure 10 below.
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Figure 10. Uninsured Rate among Adults <65 Years, 2015
Of Note:
18%
16%
16%
13%
14%
12%
10%
8%
10%
10%
8%
Cowlitz County has fewer
primary care, dental, and
mental health care
providers per resident than
Washington state overall.
12%
10%
8%
8%
7%
6%
4%
2%
0%
All
Black
White
Cowlitz County
Hispanic or
Latino
WA State
Asian
A greater proportion of
Cowlitz County adults are
uninsured relative to
Washington State adults.
Racial/ethnic disparities in
access to insurance and
preventive care exist in
Cowlitz County.
Preventive Hospital Stays
Preventable Hospital Stays is the hospital discharge rate for ambulatory care-sensitive conditions per
1,000 fee-for-service Medicare enrollees. Ambulatory care-sensitive conditions include: convulsions,
chronic obstructive pulmonary disease, bacterial pneumonia, asthma, congestive heart failure,
hypertension, angina, cellulitis, diabetes, gastroenteritis, kidney/urinary infection, and dehydration. This
measure is age-adjusted.
Hospitalization for diagnoses treatable in outpatient services suggests that the quality of care provided
in the outpatient setting was less than ideal. The measure may also represent a tendency to overuse
hospitals as a main source of care.
Lower numbers on this measure are the goal. Cowlitz County ranks well below the nation, but above
the Washington State average. Recent data suggests the trend is improving.
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Figure 11. Preventable Hospital Stays, Cowlitz County, WA
Preventive care inequities among Medicare beneficiaries
High-quality preventive care, like seeing a primary care doctor frequently and monitoring one’s blood
sugar and blood pressure, can improve health outcomes. One way to look at possible differences in the
quality of preventive care is to examine the health outcomes of Medicare beneficiaries (people aged 65
years and older that have access to government-sponsored health insurance) of different races and
ethnicities, since they have the same source of health insurance. In examining the quality of care of
diabetes care (called Prevention Quality Indicators) among White and Hispanic Medicare beneficiaries
by county in Washington State, we see that Cowlitz County has some of the state’s most glaring
inequities in long-term complications of diabetes by race/ethnicity. White Medicare beneficiaries 219
have PQIs per 100,000 beneficiaries, while Hispanic Medicare beneficiaries have 0 PQIs per 100,000
beneficiaries.
The preventive care received by Hispanic Medicare beneficiaries in Cowlitz County is worse than the
preventive care received by White Medicare beneficiaries in Cowlitz County and results in worse
outcomes for diabetes.
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Figure 12. Age-adjusted Prevention Quality Indicators for
Long-Term Complications of Diabetes, Medicare Beneficiaries, 2014
Source: Center for Medicare & Medicaid Office of Minority Health, “Disparities Mapping Tool”
Emergency Room Use
Treating patients with low-acuity conditions in the ED is an issue because it is not the best care setting
for those conditions and it contributes to unnecessary overcrowding and expense. Approximately 11%
of emergency room visits to St. John Medical Center could be considered avoidable given their low
acuity. When viewed by payer, Medicare patients have the lowest rate of these visits, representing
4.4% of all Medicare ED encounters. Medicaid patients have the highest rates, 16%. In general, the
percent of low acuity visits appear to be flat or trending slightly downward for all payer types.
Figure 13. Low-Acuity ED Visits by Payer, St. John Medical Center, 2013-2015
17.6…
15.90%
16.00%
12.60%
12.20%
10.80%
4.40%
4.50%
4.40%
2013
Medicare
2014
Medicaid
2015
Commercial/All Other
Source: PeaceHealth Internal Data
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Health Delivery Systems Data Sources:
The Washington Healthy Youth Survey measures health risk behaviors and outcomes among 6th, 8th,
10th, and 12th graders in Washington State, including health care access. The Robert Wood Johnson
Foundation County Health Rankings aggregates provider and US Census data to provide an overview
provider to resident ratios and overall clinical care relative measures, and shows preventable
hospitalization rates. Enroll America aggregates measures of insurance across all 50 states at the county
and state level. The Centers for Medicare & Medicaid Services Office of Minority Health Disparities
Mapping Tool shows measures of health inequities at the county level across the US for different health
delivery indicators.
Table 7. Health Delivery Systems: Cowlitz County Health
Indicators vs. Washington State, 2016 and Local Trend since 2010
Better
Equal
Worse
Trend
Primary Care Provider to resident ratio
●
stasis
Dentists to resident ratio
●
stasis
Mental Health Providers to resident ratio
●
improving
Uninsured adults below age 65
●
improving
Saw a doctor for a physical in the past year (10th
graders)
Saw a dentist for checkup, cleaning, or other work in
past year (10th graders)
improving
●
●
stasis
Key Take-Aways

Poor access to primary care, dental care, and mental health care is a contributor to poor health
in Cowlitz County.

Over a third of 10th graders did not have a physical in the past year, and over a quarter did not
see the dentist.

Significant racial/ethnic disparities in access to preventive care exist in Cowlitz County.
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Equity: Cowlitz County Health Indicators, 2016
What is Equity?
Equity is a key pillar of a healthy community. Health equity will be achieved when everyone is
given the opportunity to reach their full health potential. Affordable, safe housing, and employment
that allows sufficient resources to meet a household budget are important facets of equity.
How Does Cowlitz County Compare to Other Counties?
In social and economic factors, including the percentage of children in poverty, violent crime, and
income inequality, Cowlitz County is ranked 28th of 39 counties in Washington, meaning that Cowlitz
County faces greater obstacles to social and economic wellbeing than other counties in Washington.
Equity Profile









Individuals living in poverty: 18% (>WA: 13.5%)
Households that are Asset Limited, Income Constrained, Employed or in poverty: 34% (=WA:
32%)
Linguistic isolation: 3% (<WA: 7.8%)
Households with ‘severe housing problems,’ including cost-burdened housing: 19% (=WA: 18%)
Unemployment rate: 13.5% (>WA: 8.8%)
Veteran population: 13.4% (=WA: 11%)
Income inequality (ratio of income at the 80th percentile to income at the 20th percentile):
4.6(=WA: 4.5)
341 people are homeless in Cowlitz County, both sheltered and unsheltered
In the Longview, WA school district, 430 children in grades k-12 are reported from homeless
families (96) or doubled up (living with other families) (334)
Closer Look
Cost-burdened housing
Affordable housing is a key component of financial wellbeing and stability, and forms the basis of good
health. There are many pockets of people in Cowlitz County burdened by high housing costs that
undermine their health and wellbeing, particularly in the Longview area.
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Figure 14. Percentage Households Where Housing Costs Exceed
30% Of Household Income, Cowlitz County, WA 2010-2014
Source: Community Commons
Of Note:
Changing demographics call
for employers to monitor
their workforce so that it
reflects the composition
and diversity of the
community. Increasing
racial and ethnic diversity
among licensed health
professionals is particularly
important because evidence
indicates that among other
benefits, it is associated
with improved access for
non-majority patient
groups, increased patient
satisfaction and an overall
decrease in health care
disparities.
Poverty and Asset Limited, Income Constrained, Employed
Household Inequities
Asset Limited, Income Constrained, Employed households are those that are employed and living above
the poverty line, but cannot afford a stable household budget of housing, food, transportation, health
care, and childcare.
When this group of households is combined with those in poverty, we see that over 34% of households
in Cowlitz cannot afford a liveable monthly budget. Furthermore, there are significant differences by
race/ethnicity, with younger households and non-white households having higher rates of poverty and
ALICE (see Figure 15 below).
Figure 15. Households Below the ALICE Threshold by Race/Ethnicity and Age, 2013
60%
50%
40%
30%
20%
10%
0%
Asian
Black
Hispanic
White
Seniors
Source: United Way ALICE Report, Pacific Northwest
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Equity Data Sources
The US Census measures the percentages of individuals living in poverty, in linguistic isolation, and
adults who are unemployed. The Robert Wood Johnson County Health Rankings provide estimates of
individuals who have ‘severe housing problems,’ meaning individuals who live with at least 1 of 4
conditions: overcrowding, high housing costs relative to income, or lack of kitchen or plumbing, as well
as a measure of income inequality at the county and state level, which is the ratio of household income
at the 80th percentile to income at the 20th percentile. Community Commons provides maps of censustract level data, including housing cost burden. The United Way Pacific Northwest ALICE report provides
county-level estimates of ALICE households and households in poverty.
Table 8. Equity: Cowlitz County Health
Indicators vs. Washington State, 2016 and Local Trend since 2012
Better
Equal
Worse
Individuals living below the poverty line
Individuals over age 5 in linguistic isolation
●
stasis*
●
Unemployment rate
Income inequality
stasis
stasis
●
Households with ‘severe housing problems’
Trend
●
stasis
●
**
*baseline trend data aggregated from 2006-2010
**no trend data available
Key Take-Aways

A high percentage of cost-burdened housing in certain areas of Longview and other areas of
Cowlitz County imperils the wellbeing of affected households and the community as a whole.

Over a third of Cowlitz households cannot afford a livable monthly budget; households
struggling to make ends meet are more likely to be non-seniors and non-white.

Homelessness affects Cowlitz County residents and should be addressed by community
strategies.
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VI.
COMMUNITY CONVENING
Method
Key informant Interviews
PeaceHealth St. John interviewed key informants from organizations throughout the County
representing perspectives from public health and medically underserved and vulnerable groups. The
interviews were conducted to elicit perspectives on the health needs and gaps of the community, to get
feedback on the continuing relevance of the 2013 CHNA priorities and health priorities found through
the secondary data gathering of the 2016 CHNA, and to understand possible solutions that local experts
support.
Table 9. Organizations to which Key Informants Belong, 2016 CHNA
Organization
Population Served
Cowlitz County Health
Department
All Cowlitz County residents; 0-25 ages for individual
services, medically underserved
Pathways 2020
Medically underserved, homeless, immigrant, early
childhood to senior groups
Cowlitz Family Health Center
Medically underserved, homeless, immigrant, early
childhood to senior groups
Youth and Family Link
Healthy Living Collaborative
Children 0-5, children K-12, low-income families,
immigrant and medically underserved groups
Medically underserved, homeless, immigrant, children,
families, and seniors
Community Convening
The key informant interviews were conducted in preparation for a community convening session that
was held on May 10, 2016. Eighteen community leaders from local and regional public health, health
and social services, business, schools, and law enforcement were convened for approximately three
hours.
Community convening participants were led through a two-part process to identify gaps and needs and
then to rank community health improvement strategies that were organized into the community health
pillars. The process was designed to build on the considerable amount of time and effort that the
County Health Department, PeaceHealth and others have put into health assessments over the last
several years and to focus more on what we can actually do together to address the problems.
Following an update regarding secondary data and key informant perspectives for each of the
community health pillars, participants were asked to identify health and social needs/gaps, and strategy
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opportunities. There was repetition and overlap between the key informant and group process input,
with the community convening participants adding infill to the key informant perspectives.
Gaps and opportunities
Table 10. Summary of Health and Social Gaps/Needs and Strategy Opportunities According to Key
Informants and Community Convening Participants, by Community Health Pillar, May 2016
Healthy, Active Living

Needs/Gaps


Adult and teen chronic
diseases
Adult and teen substance
use/abuse
Lack of access to healthy food
Community solutions for physical
activity
 Community gardens
 Places for physical activity: bike
paths, parks and rec programs,
transportation policies
Family engagement policies
 Neighborhood watch programs
 Low cost family activities
Strategy
 Community kitchens/healthy
Opportunities
eating programs
Child & Family Wellbeing

Maternal smoking during
pregnancy
Education system

Early childhood education and
health programs; expand Head
Start, Early Head Start

Anti-bullying programs

Mentorship programs
Prevention and health promotion for young
parents

WIC

Breastfeeding promotion
 Substance abuse and suicide
Mental health and substance abuse
prevention
care for teens and adults
 Enhanced behavioral health
Training for professionals
and substance abuse treatment
 ACEs training

Developmental screening

Community Health Workers
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Health Delivery Systems
Needs/Gaps
Equity

High housing costs

Culturally integrated businesses,
health care, and government
Care coordination

Health literacy training and supports

Systems navigation/health
literacy support for low-resource
and immigrant groups

Ways for marginalized groups to
have input in the policy process

Integrated
primary/behavioral/dental health
care
Healthy, safe, affordable housing


Coordinated reentry programs for
ex-offenders and those released
from behavioral health treatment

Hospital transitions


Improved access to primary,
urgent, and specialty care
Community Health Workers for
linguistically/culturally isolated
groups

Use CHWs

Community-based activities

Need more MDs and mid-level
providers

Big Brothers/Big Sisters program

Concern: providers are leaving,
PeaceHealth isn’t committed to
town
Block parties


Community garden

Community leadership

Diversity training for employers

PeaceHealth commitment to the
community/reduction in workforce
concerns

Lack of government leadership
regarding issues of diversity

Housing

More affordable housing

Policy debate: ‘Housing First’ vs.
‘shelter in accordance to personal
responsibility’ approaches

Health care access inequities

Strategy
Opportunities

Mental health and substance
abuse care for youth and adults

Need more triage and detox beds
for SA patients

Dental care

School-based programs

Access for low-income
adults/Medicaid

Geriatric services

Home health services for aging
populations

Training for providers

Better access for frail elderly
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Strategies for Consideration in Implementation Plan
In the third part of the Community Convening, participants were provided with a packet of evidencebased intervention strategies for each of the four community health pillars. Given their understanding
of community needs, participants were asked to collectively discuss strategies and then individually
select up to three evidence-based strategies within each pillar or write in a preferred strategy based on
the following criteria:




Magnitude of need
Organizational capacity in the community to address
Realistic to implement
Personal interest and passion
Table 11. Top Evidence-Based Strategy Solutions Identified at the Community Convening
Strategy
Healthy,
Active
Living
Child &
Family
Wellbeing
Needs Addressed
 Community Health Worker
programs
Social isolation, chronic diseases, poor health
outcomes for undocumented/vulnerable
groups, transportation to health care
appointments, chronic disease management
 School nutrition programs
Chronic disease, access to healthy foods
 Community fitness programs
Obesity, elder isolation and health
 Prenatal and early childhood
home visiting programs
Care coordination for prenatal/postpartum
vulnerable mothers, infants, and children,
maternal smoking, ACEs
 Preschool programs with family
support services
Affordable childcare, early developmental
screening, ACEs
 ‘Early Pathways’/home-based
mental health
Mental health services for families and
children, affordable childcare, follow-up for
high-risk mothers and children
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Strategy
Health
Delivery
Systems
Equity
Needs Addressed
 Integration of behavioral
health and primary care
Substance abuse care, care coordination for
vulnerable populations, access to care
 Detox/sobering centers
Improved substance abuse care, improved
crisis/triage care
 Increasing access to dental care
providers that accept Medicaid
Dental care, health inequities
 Reduce opioid prescriptions in
ED and primary care settings
Chronic pain management, adult substance
abuse
 Systems/patient navigators
Access to health care for vulnerable groups
 School-based health centers
Access to health care for rural populations
 Increase mid-level scope of
practice
Access to health care for vulnerable and rural
populations
 Expand Housing First programs
Homelessness, chronically mentally ill
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VII.
IMPLEMENTATION PLAN
Introduction
The CHNA is a report based on epidemiological, qualitative and comparative methods that assesses the
health issues in a hospital organization’s community and that community’s access to services related to
those issues.
The Implementation Plan is a list of specific actions that demonstrate how PeaceHealth St. John plans to
meet the CHNA-identified health needs of the residents in the service area. This Implementation Strategy
was approved by the local PeaceHealth Community Health Board.
IRS Implementation Strategy Requirements
The Implementation Strategy which is developed and adopted by each hospital must address the
needs identified in the CHNA by either describing how the hospital plans to meet the need or
identifying it as a need not to be addressed by the hospital and why. Each need addressed must be
tailored to that hospital’s programs, resources, priorities, plans and/or collaboration with
governmental, non-profit or other health care organizations. If collaborating with other organizations
to develop the implementation strategy, the organizations must be identified.
PeaceHealth Process for Establishing Implementation Plan
In 2016, PeaceHealth reconfigured its ten local governing boards into “Community Health Boards” with
the dual responsibility of overseeing the quality of hospital care and furthering community health.
Accordingly, each board established two standing committees, one dedicated to monitoring and
improving quality and the other focused on local CHNA implementation.
When the CHNA was published in late June 2016, the document included a set of relatively high level
strategies for consideration by the CHNA committees. These committees were asked to consider the
identified CHNA strategies in relation to hospital competencies, community partnerships that would be
required and available resources, and to settle on a final set of strategies that would inform the
development of the CHNA implementation plan. This document outlines those final strategies 2.
Health Priorities and Implementation Plan Structure
The Implementation plan outlined below is for a three-year period and will guide the development of
an annual plan that operationalizes each initiative. The needs that are being addressed correspond to
the prioritized needs identified in the CHNA. For each need, a set of initiatives are noted, along with
the outcome measures, necessary community partners, and the degree of PeaceHealth engagement.
This section was amended on November 14, 2016 to replace the interim implementation strategies published with the CHNA
adopted in June 2016 with the final implementation strategies approved by the St. John Board in November 2016.
2
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It should be noted that the listing of community partners is not intended to imply firm organizational
commitment on behalf of those listed nor limit involvement by organizations not listed. The degree of
PeaceHealth engagement is framed in terms of “lead,” “co-lead” or “support.”
Table 12. 2016 PeaceHealth St. John CHNA Implementation Plan Overview
Focus Area
Needs
Prevalence of harm
from adverse
childhood events
Initiatives

Behavioral
Health

Prevalence of chemical
dependency among
youth

Care
Coordination
for Complex
Patients
Prevalence of
childhood inactivity
Children who lack a
primary care provider
and/or other needed
services
Promote and support educational
programs aimed at preventing
chemical dependency among
youth
Co-lead and/or participate in
selected programs providing
highest need children and their
families with physical activity
events such as the AHA Jump Rope
for Heart, Special Olympics, etc.

Support and promote a farm to
table experience for children
including:
 School Gardens
 Teaching Kitchen

Support development of
Community Health Worker
Project: Link to Health to address
identified disparities
Inadequate nutrition
among some school
age children
Maternal
Child Health
& Childhood
Development
Orient targeted clinical staff to the
effects of Adverse Childhood
Events (ACEs) to increase
awareness of and support for
those at risk
Community Health Needs Assessment | PeaceHealth St. John Medical Cen ter
Indicators/Measures

Childhood (toddler and
teen) immunization rates

% of children who
demonstrate readiness
skills for kindergarten in all
areas

Rate of ED visits that are
BH (psych and/or
substance abuse) related

10th graders who are
overweight > 85th
percentile

10th graders reporting no
leisure time physical
activity for 60 min/day in
the past 7 days

10th graders who reported
eating 5 or more servings
of fruits and vegetables
each day

Percent of infants and
children who have a
primary care provider

Childhood (toddler and
teen) immunization rates

% of children who
demonstrate readiness
skills for kindergarten in all
areas
40
Table 13. 2016 PeaceHealth St. John Initiatives
Initiatives
Behavioral Health
Target Population
Potential Partners
Emergency Support Shelter;
Vulnerable
populations at risk Cowlitz County Public Health
Dept.; Justice & Hope
for ACEs
Conference

Orient targeted clinical staff to
the effects of Adverse Childhood
Events (ACEs) to increase
awareness of and support for
those at risk

Promote and support educational
Youth at risk for
programs aimed at preventing
chemical
chemical dependency among
dependency
youth
Schools; Cowlitz County
Public Health Dept.
PeaceHealth
Engagement
Co-lead
Support
Maternal/Child Health & Childhood
Development

Co-lead and/or participate in
selected programs providing
highest need children and their
families with physical activity
events such as the AHA Jump Rope
for Heart, Special Olympics, etc.
School aged
children and
their families
American Heart
Association; Cowlitz Parks
and Recreation; YMCA;
Schools; Youth & Family
Link; Cowlitz County Public
Health Department
Co-lead/Support

Support and promote a farm to
table experience for children
including:
 School Gardens
 Teaching Kitchen
School aged
children and
their families
Youth and Family Link;
School Gardens; Dr. Robert
Ellis; Lower Columbia
Community Action; Altrusa
International
Support

Support development of
Community Health Worker Project:
Link to Health to address identified
disparities
Infants and
children
Youth & Family Link;
Cowlitz County Public
Health; Nurse Family
Partnership Program;
Healthy Living
Collaborative; Children
Protective Services
Support
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Needs Not Addressed
In this CHNA, PeaceHealth St. John addressed a significant number of health needs that were prioritized
with input from the community and where we were able to leverage our resources and expertise to
address these issues. However, in prioritizing some issues, others are not directly addressed. The issues
not addressed included preschool programs with family support services, prenatal and early childhood
home visiting programs, detox/sobering centers, community paramedic programs, short and longerterm interventions addressing homelessness and increased access to dental providers that accept
Medicaid. Though we recognize their importance and impact on the overall health of the community, in
most of these cases PeaceHealth St. John lacks the expertise to address these issues and we do not feel
we are in a position to deploy specific strategies around these broader socio-environmental issues. We
also feel these needs are being addressed by other facilities or organizations in the community.
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Appendix 1: Organizations Participating in Community
Convening
PeaceHealth St John Stakeholder Meeting May 10th, 2016







Longview Police Department
Weyerhaeuser
PeaceHealth
Cowlitz County Public Health
Department
Pathways 2020
Safe Kids Coalition
St John Foundation






Longview Fire Department
Healthy Living Collaborative
Cowlitz County Health and Human
Services
Cowlitz Family Health Center
City of Longview
Cowlitz Economic Development Council
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