Franklin County Area Implementation Strategy FY 2025-2027

Franklin County Area Community Health Assessment HEALTH IMPROVEMENT IMPLEMENTATION STRATEGY FY 2025-2027 NOVEMBER 30, 2024

Carilion Franklin Memorial Hospital CarilionClinic.org/community-health-assessments

Contents

Carilion Franklin Memorial Hospital Health Improvement Implementation Strategy .................... 3 Overview ................................................................................................................................ 3 Community Served ................................................................................................................. 3 Target Population ................................................................................................................... 3 Priority Health Needs.............................................................................................................. 4 Drivers of Priority Health Needs.............................................................................................. 4 Board Adoption....................................................................................................................... 4 Disclaimer .............................................................................................................................. 4 CFMH Action Plan ..................................................................................................................... 5 Access to Care ....................................................................................................................... 5 Community Partnerships ........................................................................................................ 5 Community Grants.................................................................................................................. 5 Carilion’s Mission and Health Equity ....................................................................................... 5 Priority Areas to Be Addressed .................................................................................................. 7 Chronic Disease ..................................................................................................................... 7 Mental Health/Substance Use ................................................................................................ 8 Injury/Violence ........................................................................................................................ 9 Strategies Impacting Multiple Priority Areas ..........................................................................10 About Us ...................................................................................................................................11 Appendices ...............................................................................................................................12 Appendix 1: Community Health Assessment Team............................................................12 Appendix 2: Community Health Need Prioritization Activity Table ......................................14

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Carilion Franklin Memorial Hospital Health Improvement Implementation Strategy Overview

Carilion Clinic is committed to joining with our partners to pursue the essential work of improving and maintaining the health of the Franklin County Area in accordance with our mission.

Periodically assessing the health concerns of each community is a key component of addressing community needs. Every three years, the Franklin County Area Community Health Assessment (FCACHA) aims to uncover issues, indicate where improvement is needed and track and promote progress in key areas so that there is demonstrated, ongoing change. The CHA process and the public availability of its findings enable and empower our community to effectively improve and maintain health.

Carilion, Healthy Franklin County (HFC) and the West Piedmont Health District collaborated to conduct the 2024 FCACHA alongside additional community partners, the Community Health Assessment Team (CHAT). After review and discussion of the data collected, the 2024 FCACHA led the CHAT to identify six priority health issues in the community.

As a component of our systemwide Community Health and Equity Improvement and Investment Plan, this Implementation Strategy gives an overview of key components of the localized response to community needs within Carilion Franklin Memorial Hospital’s (CFMH) service area.

This plan applies to fiscal years 2025-2027 and will be updated as appropriate with the identification of new programs and strategy updates. Progress on initiatives described in this document will be reported to the CFMH Board of Directors twice yearly.

Please visit https://carilionclinic.org/community-health-assessments to review the full 2024 FCACHA.

Community Served In fiscal year 2023, CFMH served 24,883 unique patients. Patient origin data revealed that during this year, 92% of patients served by CFMH lived in Franklin County (64%) and Henry County (28%). Thus, the service area for the 2024 FCACHA included Franklin County and Henry County.

Target Population

The target population for Carilion’s CHA projects consists of underserved/vulnerable populations disproportionately impacted by the social determinants of health (SDOH), including poverty, race/ethnicity, age, education, access and/or lack of insurance. Strategies are implemented to impact specific populations and life-stages, including parents of young children and adolescents, women of childbearing age, adults and the elderly. Other considerations include race, ethnicity and income levels. Distinct efforts were taken to ensure the CHA reflects those residing in Medically Underserved Areas and 3

Health Professional Shortage Areas, and all patients were considered in the assessment regardless of insurance status or financial assistance eligibility.

Priority Health Needs

In collaboration with the CHAT, we identified key health needs to align resources and other efforts for the following three years. The CHAT reviewed extensive data, asked questions and participated in a consensus-building prioritization process. The 2024 FCACHA resulted in the following health priorities:

Chronic Disease

Overweight/Obesity Hypertension Diabetes

Mental Health and Substance Use

Mental Health Challenges Substance Use

Injury/Violence

Interpersonal Violence

Drivers of Priority Health Needs

The CHA process focused on prioritizing health conditions and outcomes, rather than a broader focus on their root causes. We recognize that access to healthcare and other services and the SDOH are key facilitators of good health and well-being. As such, we focused on those and other health factors as a strategic component of action planning. Some strategies included in this plan are intended to impact the root causes of health.

Board Adoption

This document was approved by the CFMH Board of Directors on November 25, 2024, and formally adopted as the 2024 Franklin County Area Community Health Assessment Health Improvement Implementation Strategy.

Disclaimer

Carilion began conducting CHAs prior to the IRS adoption of the 501(r)(3) standard which requires not-for-profit hospitals to conduct a Community Health Needs Assessment (CHNA) every three years. While meeting the CHNA requirement, Carilion maintains the longstanding formal name—Community Health Assessment—for our process and reports.

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CFMH Action Plan

While the focus of this plan is on new and innovative programs and initiatives, we will continue to respond to community health needs through ongoing efforts, including: • • • •

Ensuring access to state-of-the-art healthcare close to home, Working with other organizations on community-wide strategies to reduce barriers, coordinate resources and enhance community strengths, Providing community-based health and wellness programming, and Providing targeted grants for community health improvement.

Access to Care

We address access to care in numerous ways to ensure our patients can access the type of care they need, when and how they need it. We do this by expanding our services and updating our facilities, such as recent renovations to add a second ultrasound room, a second echocardiogram machine, DaVinci robotics surgery, and an additional Fast Track room for the Emergency Department. We have also brought new services to our facility such as Neurosurgery and telemedicine services (dermatology, wound care and rheumatology). We focus on giving patients more choices about how they receive care and communicate with their providers by utilizing digital health initiatives and other advancements. Through projects that look at internal efficiencies, we are making it easier for patients to get appointments and be proactive about their health.

Community Partnerships

Carilion believes in the power of collaboration and understands that area health issues must be addressed together, with the community. To ensure lasting impact from the health assessment and community health improvement process, Carilion provides support to health coalitions that address needs in the Franklin County Area, such as HFC. HFC is an initiative that seeks to improve health by mobilizing time, talent and financial resources to promote healthier lifestyles.

In addition, Carilion partners with multiple organizations and coalitions on initiatives to improve health, wellness and address SDOH.

Community Grants

Carilion’s community grants help build and sustain community health improvement programs through partner organizations. Each year, Carilion provides funding and community health sponsorships to help local charitable organizations fulfill their missions as they relate to the health and well-being of our communities. Community grant dollars are allocated across Carilion’s entire service area based on requests that align with CHA priorities, with particular focus on helping members of underserved communities with little access to services.

Carilion’s Mission and Health Equity

Our mission—improving the health of the communities we serve—calls for us to meaningfully address health inequities and disparities. Equity is a key lens for the CHA process, guiding our actions as we seek to understand community health needs. Community heath improvement strategies are focused on identifying and serving those who need it most, seeking to broaden the potential for everyone across our communities to thrive.

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The Vital Conditions for Health and Well-Being is a widely adopted framework that asserts that there are two ways to safeguard the health and well-being of a community:

Image source: https://rippel.org/vital-conditions/

This framework provides an important lens for assessing opportunities to respond to health inequities. Its balanced approach helps people facing adversity today (urgent services) while also addressing conditions that reduce the number of people who need crisis services (vital conditions). As we seek to improve the health of the community, we are mindful of this balance to encourage thriving communities.

In addition to focusing on the community at-large, we also consider how we can support health equity for our employees. One mechanism by which we support our employees is through our employee benefits program with tiered premiums corresponding to employee salary ranges.

Other examples include financial support for dependent care and a robust employee wellness program which provides regular programming to improve both physical and mental health and well-being. Additionally, employees can participate in programs such as evidence-based health education and work with community health workers to navigate SDOH needs. We also have an employee emergency fund to help fill gaps in times of need. Through other programs such as YES and Grow Our Own, we provide opportunities for entry-level employees to gain skills and education leading to higher pay careers at little-to-no-cost to the employee. We continue to seek innovative ways to support employee health, well-being and ability to thrive.

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Priority Areas to Be Addressed Chronic Disease

Overweight/obesity, hypertension and diabetes Goal: Improve health behaviors and outcomes for individuals with overweight/obesity, hypertension and diabetes who are also experiencing health-related social needs Strategy Metrics Resources Collaborators Timeline Implement a fruit • Number of • Designated staff Carilion Community FY25 – FY27 and vegetable participants and department Health and prescription Outreach, Carilion support • Value of program Family and prescriptions • USDA grant Community redeemed Medicine, Feeding • Participant food SWVA, Radford insecurity, body University Carilion, weight and blood Healthy Franklin pressure County

Implement Healthy Heart Ambassadors program

• Number of participants • Participant blood pressure

• Designated staff and department support • CDC grant via VHHA Foundation

Carilion Community Health and Outreach, Carilion Family and Community Medicine, VDH, VHHA Foundation, Roanoke Virginia Healthy Hearts Initiative

FY25 – FY27

Implement evidence-based health and nutrition education programs

• Number of participants • Participant dietary behaviors and physical activity frequency

• Designated staff and department support

Carilion Community Health and Outreach, Carilion Family and Community Medicine, Healthy Franklin County, Carilion Wellness

FY25 – FY27

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Mental Health/Substance Use

Mental health challenges and substance use Goal: Increase access to and capacity of mental health and substance use services for lowincome individuals Strategy Metrics Resources Collaborators Timeline Expand Carilion’s peer support specialist workforce

• Number of staff across service area • Number of referrals and consults

• Staff and department leadership

Carilion Community Health and Outreach, Carilion Mental Health, Carilion Women’s, other internal departments as applicable

FY25 – FY27

Implement evidencebased mental health education and wellbeing programs

• Number of participants • Participant stress management skills, anxiety and depression symptom frequency and resilience indicators

• Designated staff and department support

Carilion Community Health and Outreach, Carilion Mental Health, Carilion Women’s, Healthy Franklin County, Carilion Wellness

FY25 – FY27

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Injury/Violence

Interpersonal violence Goal: Decrease the prevalence of interpersonal violence across the service area.

Strategy Work with forensic nursing program to identify opportunities and fill gaps in transitioning patients from acute care to the community

Metrics • Number of patients seen • Number of patients referred to community organizations • Number and types of resources provided

Resources • Department support • Financial support to address SDOH needs

Collaborators Franklin County Family Resource Center, Southern VA Child Advocacy Center

Timeline FY25 – FY27

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Strategies Impacting Multiple Priority Areas Goal: Create a system of care that addresses health-related social needs within the community and clinical services Strategy Metrics Resources Collaborators Timeline Implement Healthy Franklin FY25 • Number of clinics held • Department pop-up clinic County leadership • Number of patients seen model for and types of services • Staff support safety net received • Clinical partnerships supplies Expand Carilion Community FY25 – • Number of staff across • Staff and Carilion’s Health and FY27 service area department community Outreach, other leadership • Number of referrals and health worker internal consults workforce departments as applicable Develop Internal FY25 • Development of employee • Department employee collaboration volunteer program leadership volunteer • Number of employees • Staff support program to engaged in volunteerism support the • Financial value of capacity of employee time supporting local organizations addressing organizations community health needs working to address CHAidentified needs Support and FY25 • Established framework • Staff support Healthy Franklin participate in County FY27 • Possible further metrics to development be determined of communitywide strategic framework to further address community health needs

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About Us

Carilion Clinic is a not-for-profit, integrated healthcare system located among the Blue Ridge Mountains. Carilion provides quality care for nearly one million individuals through a comprehensive network of hospitals, primary and specialty physician practices, wellness centers and other complementary services. Our roots go back more than a century when a group of dedicated citizens came together and built a hospital to meet the community’s healthcare needs. Today, Carilion is a vital anchor institution focused on healthcare and dedicated to our mission of improving the health of the communities we serve.

With an enduring commitment to our region’s health, we advance advanced through clinical services, medical education, research and community health investments. Carilion believes in service, collaboration and caring for all. We invest in discovering and responding to local and regional health needs, understanding that we must involve additional stakeholders to address community health issues and create change effectively.

Carilion recognizes the impact the environment has on the health of our communities. Efforts continue to make our hospitals and other facilities more energy-efficient, increase recycling and use of recyclable or bio-degradable materials, reduce waste materials and serve local, sustainable foods to patients and in our cafeterias. Carilion has an office of sustainability which leads these efforts and empowers employees to be involved in environmental health related projects.

CFMH provides a full range of top-quality inpatient and outpatient care for Franklin County Area residents. The facility includes an inpatient hospital and medical offices for acute and specialty care. For inpatient care, CFMH physicians diagnose and treat illnesses, anticipate problems and rapidly respond to changes in patient conditions. Emergency services are onsite 24/7 and CFMH offers direct access to Carilion’s Level 1 Trauma Center if an advanced level of care is needed. Other onsite services include imaging services, inpatient and outpatient surgical services, therapy services and laboratory.

CFMH serves all patients regardless of their ability to pay. The hospital’s governing board members are elected annually and reside in the region. The majority of members are neither hospital employees nor contractors. Medical staff privileges are extended to qualified providers.

Surplus funds are reinvested in new technology, clinical initiatives, education and charitable efforts. Reinvestments include providing free, discounted and subsidized care and critical medical services not otherwise offered in our region. 1

1 https://www.carilionclinic.org/locations/carilion-franklin-memorial-hospital

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Appendices Appendix 1: Community Health Assessment Team Name Organization Type or Sector Organization Name A.W. Frith

Mental Health/Substance Use

Piedmont Community Services

Abby White

Mental Health/Substance Use

Piedmont Community Services

Alex Watkins

Substance Use

Virginia Harm Reduction Coalition

Alison Cronk

Healthcare

Carilion Clinic

Amanda Smith

Healthcare

Carilion Clinic

Annie Morgan

Social Support

United Way of Roanoke Valley

Ariel Johnson

Substance Use

Virginia Harm Reduction Coalition

Bethany Philpott

Health District

West Piedmont Health District

Carl Cline

Healthcare

Carilion Franklin Memorial Hospital

Carol Tuning

Disability Services

Disability Rights & Resource Center

Catina Wright

Substance Use

Virginia Harm Reduction Coalition

Cheryl Mosley

Social Support

United Way of Roanoke Valley

Christine Arena

Library

Franklin County Public Library

Ellen Holland

Free Clinic

Bernard Healthcare Center / Free Clinic of Franklin Co.

Emily Waller

Healthcare

Carilion Family Medicine

Florence Brown

Senior Services

Essig Center, Office on Aging

Heidi Morris

Healthcare

Carilion Hospice

Holly Ostby

Healthcare

Carilion Clinic

Joshua Ball

Public Safety

Franklin County Department of Public Safety

Joshua Martin

Mental Health/Substance Use

Piedmont Community Services

Joyce Moran

Child Advocacy

Southern VA Child Advocacy Center

Kat Heredia

Mental Health/Substance Use

Piedmont Community Services

Kim Mason

Senior Services

Southern Area Agency on Aging

Lashara Wade

Social Support

United Way of Roanoke Valley

Leslie Clark

Social Support

United Way of Roanoke Valley

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Lisa Lietz

Academic, Enrichment and Food Programs

SML Good Neighbors

Lucas Tuning

Social Support

United Way of Roanoke Valley

Lucille Bowing

Community Advocate

Community Member

Marcie Altice

School Representative

Franklin County Public Schools

Molly Roberts

Healthcare

Carilion Clinic

Nancy Bell

Health District

West Piedmont Health District

Nancy Oltara Tompkins

Food Access

Gardeners Association

Nick Bilbro

Healthcare

Carilion Clinic

Nicky Hale

Federally Qualified Health Center

Tri Area Community Health Center

Pam Chitwood

Public Health

West Piedmont Health District

Paul Chapman

Parks and Recreation

Franklin County Parks and Recreation

Regina Clark

Mental Health/Substance Use

Piedmont Community Services

Rita Pruitt

Food Access

Feeding Southwest Virginia

Ryan King

Public Safety

Rocky Mount Police Department

Sharon Tyree

Disability Services

Disability Rights & Resource Center

Sheila Overstreet

Housing

Franklin County Habitat for Humanity

Shirley Holland

Healthcare

Carilion Clinic

Shirley Sorrentino

Transportation

Franklin County NETS

Stephanie Hackett

Social Support

United Way of Roanoke Valley

Sue Turner

Federally Qualified Health Center

Tri Area Community Health Center

Teresa Fontaine

Senior Services

Southern Area Agency on Aging

Tim Radford

Public Safety

Franklin County Public Safety

Tracy McCown

Healthcare

Carilion Franklin Memorial Hospital

Brandon Stephens

Mental Health/Substance Use

Piedmont Community Services

Don Mankie

Food Access

Feeding Southwest Virginia

Becky Ayers

Public Safety

Franklin County Public Safety

Samantha Turner

Mental Health/Substance Use

Piedmont Community Services

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Appendix 2: Community Health Need Prioritization Activity Table Activity Prioritization Survey Dot Voting Activity Group Discussion Method Using their community Using the results of the The group was asked to knowledge, data Prioritization Survey, the reflect on the results of the collectively reviewed, and group was asked to dot voting exercise. The additional data shared, individually choose 5 topics to following points were made CHAT members were prioritize: during that discussion: asked to complete an • The CHAT facilitators hung • Poor mental health vs. electronic survey to Substance use vs. pages around the meeting prioritize community Overdose room, each with one of the health topics: topics from the o Poor mental health Prioritization Survey should be considered • The survey matched results. separately from the structure utilized Substance use during the data walk at • Each CHAT meeting attendee was given 5 dot CHAT Meeting 2 o There were differing stickers and instructed to opinions on whether • First prioritized broad place one sticker on each overdoses should be categories, then of the 5 topics they felt included with specific topics within were most important to substance use. They those categories address in the next three could be combined as • CHAT facilitators one category with ranked the following to years. separate develop results: • After voting was goals/objectives completed, the CHAT o Broad categories developed during the facilitators quickly tallied (resulting top 3 strategic planning and ranked the results. indicated by bold phase. type below) • The CHAT was presented with the top 5-7 topics, o Topics within each o Substance Use should unranked. The number of include tobacco use, of the 3 top broad results presented vaping and both youth categories depended on any ties and and adults. o Remaining topics how closely votes were • Results include: • Overweight/obesity, distributed. If topics were diabetes and high blood o Top 3 topics of additional (i.e. not in the pressure could be each of the top 3 true top 5-6), CHAT combined into one broad categories category titled Metabolic o Top 4 topics of the facilitators noted this to the Syndrome. remaining group and separated them categories visually on the screen.

Results* Mental Health/Substance Use • Substance use • Poor mental health • Overdoses Chronic Disease • Overweight/obesity • Diabetes • High blood pressure Injury/Violence

Top 6: Top 6: • Substance use • Domestic violence/intimate partner • Poor mental health violence • Overdoses • Overweight/obesity • Overweight/obesity • Domestic • Diabetes violence/intimate partner • High blood pressure violence • Substance Use (ATOD, youth and adult, • Diabetes overdoses) 14

Additional: • Poor mental health violence/intimate • High blood pressure partner violence • Motor vehicle crashes • Childhood injury Maternal/Child Health & Infectious/ Communicable Disease • Teen pregnancy • Infant mortality • STIs • Hepatitis C *Results are not presented in any ranked order.

• Domestic

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