New River Valley Implementation Strategy FY 2025-2027

New River Valley Community Health Assessment HEALTH IMPROVEMENT IMPLEMENTATION STRATEGY FY 2025-2027 NOVEMBER 30, 2024

Carilion New River Valley Medical Center CarilionClinic.org/community-health-assessments

Contents

Carilion New River Valley Medical Center Health Improvement Implementation Strategy .......... 3 Overview ................................................................................................................................ 3 Community Served ................................................................................................................. 3 Target Population ................................................................................................................... 4 Priority Health Needs.............................................................................................................. 4 Drivers of Priority Health Needs.............................................................................................. 4 Board Adoption....................................................................................................................... 4 Disclaimer .............................................................................................................................. 5 CNRV Action Plan ...................................................................................................................... 6 Access to Care ....................................................................................................................... 6 Community Partnerships ........................................................................................................ 6 Community Grants.................................................................................................................. 6 Carilion’s Mission and Health Equity ....................................................................................... 6 Priority Areas to Be Addressed .................................................................................................. 8 Chronic Disease ..................................................................................................................... 8 Mental Health/Substance Use ................................................................................................ 9 Injury/Violence .......................................................................................................................10 Dental Health.........................................................................................................................11 Strategies Impacting Multiple Priority Areas ..........................................................................12 Priority Areas Not Addressed ....................................................................................................12 About Us ...................................................................................................................................13 Appendices ...............................................................................................................................14 Appendix 1: Community Health Assessment Team............................................................14 Appendix 2: Community Health Need Prioritization Activity Table ......................................16

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Carilion New River Valley Medical Center 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 New River Valley 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 New River Valley Community Health Assessment (NRVCHA) 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, the New River Health District (NRHD) and the Community Health Center of the New River Valley (CHCNRV) partnered with existing community networks/coalitions to conduct the 2024 NRVCHA, forming the Community Health Assessment Team (CHAT). After review and discussion of the data collected, the 2024 NRVCHA led the CHAT to identify seven priority health issues in the community.

As a component of our systemwide Community Health and Equity Improvement and Investment Plan, this Implementation Strategy (IS) gives an overview of key components of the localized response to community needs within Carilion New River Valley Medical Center’s (CNRV) 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 CNRV Board of Directors twice yearly.

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

Community Served

Based on patient origin data, the service area for the 2024 NRVCHA included the counties of Montgomery, Pulaski, Floyd, and Wythe and the city of Radford, with secondary data included for Giles County. Giles County is also served by Carilion Giles Community Hospital (CGCH) located in Pearisburg, Virginia. CGCH conducted its own CHA of Giles County and Monroe County, West Virginia, concurrently therefore, Giles County is not included in the primary service area for the 2024 NRVCHA. Please note that while Wythe County is included in the service area, it is not traditionally considered part of the New River Valley.

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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 child-bearing 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 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 NRVCHA resulted in the following health priorities:

Chronic Disease

Overweight/Obesity Hypertension

Mental Health and Substance Use

Mental Health Challenges Substance Use

Injury/Violence

Interpersonal Violence

Dental Health

Dental Health

Sexual Health

Sexual Health

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 CNRV Board of Directors on November 26, 2024, and formally adopted as the 2024 New River Valley Community Health Assessment Health Improvement Implementation Strategy.

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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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CNRV 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 in order 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. 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 New River Valley, such as Healthy Roots NRV and Partnership for Access to Healthcare (PATH). Healthy Roots NRV works to improve well-being in the NRV by bringing together existing networks and organizations to develop and address shared goals. PATH is focused on rallying health and social service providers to increase access to care across the community. 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 and hypertension Goal: Improve health behaviors and outcomes for individuals with overweight/obesity and hypertension who are also experiencing health-related social needs Strategy

Metrics

Resources

Collaborators

Timeline

Implement a fruit and vegetable prescription program

• Number of participants • Value of prescriptions redeemed • Participant food insecurity, body weight and blood pressure

• Designated staff and department support • USDA grant

Carilion Community Health and Outreach, Carilion Family and Community Medicine, LEAP, Feeding SWVA, Radford University Carilion

FY25 – FY27

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, PATH NRV

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, Carilion Wellness, PATH NRV

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 evidence-based 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, Carilion Wellness

FY25 – FY27

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Injury/Violence

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

Metrics

Resources

Collaborators

Timeline

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

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

• Department support • Financial support to address SDOH needs

Women’s Resource Center of NRV, New River Valley Community Services, New River Valley Community Action

FY25 – FY27

Support the Resiliency Network of the NRV (Trauma-Informed Community Network) with Trauma Informed Basics and Resiliency Training (TIBR) implementation

• Number of Carilion staff • Designated staff trained as TIBR trainers and department support • Number of TIBR trainings • Number of TIBR participants • The percentage of trainings and participants trained with support from Carilion staff

Resiliency Network of the NRV, Carilion Community Health and Outreach, Carilion Community Impact

FY25FY27

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Dental Health Goal: Increase access to and capacity of affordable dental health care across the service area Strategy

Metrics

Resources

Collaborators

Timeline

Support collaborative, communityidentified efforts to increase access to dental care

• Number and types of organizations engaged during strategy development conversations

• Designated staff and leadership support

PATH NRV, CHCNRV

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

Explore pop-up clinic model for safety net partnerships

• Number of clinics held • Number of patients seen and types of services received

• Department leadership • Staff support • Clinical supplies

NRHD, Carilion Family and Community Medicine

FY25-27

Develop employee volunteer program to support the capacity of local organizations working to address CHA-identified needs

• Development of employee volunteer program • Number of employees engaged in volunteerism • Financial value of employee time supporting organizations addressing community health needs

• Department leadership • Staff support

Internal collaboration

FY25

Support New River Valley Housing Trust Fund to increase affordable housing across service area

• Number of affordable housing units created

• Financial support

New River Valley Regional Commission

FY25

Priority Areas Not Addressed

Many organizations across the NRV are currently working to address sexual health, including Planned Parenthood South Atlantic and the NRHD. We intend to support their work to the best of our ability and will partner to create pathways for community health workers to refer patients to sexual health services. While we commit to supporting them in their endeavors, we are not setting separate sexual health goals at this time due to resource constraints.

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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 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.

CNRV is an award-winning 146-bed acute care facility offering modern medical operating rooms, state of the art technology (advanced imaging and robotic surgery) and multiple surgical and medical specialties. We treat more than 30,000 cases per year in our Level III Trauma Center and designate 36 of our beds to mental health services. Our OB/GYN and midwifery program delivers nearly 80 babies each month at The Birthplace. Outpatient procedures include annual screenings and complex diagnostics, as well as support for rehabilitation and therapy programs. 1

1 https://www.carilionclinic.org/locations/carilion-new-river-valley-medical-center

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Appendices Appendix 1: Community Health Assessment Team Representative

Organization Type

Abby Ferguson

Healthcare

Alexandria Strickler

Local Government

Amanda Talbert Andi Golusky Ashley Hash Blake Hritz Brad St.Clair Caroline Ramirez Casey Edmonds Cayla Trueheart Debora Bratton Dee Frith Don Mankie

Public Health Department Medically Underserved Population* Healthcare Medically Underserved Population* Local Government Public Health Department Low-Income Population* Public Health Department Healthcare/Community Health Center Medically Underserved Population* Food Access

Emily Altizer

Local School District

Emily Gibson Erica Short Ginny Ayers Holly Lesko Holly Otsby Jenny Martin

Academic Expert Public Health Department Medically Underserved Population* Economic Development Healthcare Philanthropy

Jessica Wirgau

Philanthropy

Jill Maher Karen Jones

Local Government Minority Population*

Karim Khan

Local Community Spaces

Katie Boswell Kim Thurlow Kinsey Weaver Laura Groseclose Libby Pfaff

Labor/Workforce Local Government Economic Development Minority Population* Faith Community*

Margaret Hurst

Philanthropy

Marty Holliday

Labor/Workforce

Michelle Anderson

Older Adult Population*

Michelle Brauns

Healthcare/Community Health Center

Organization

Carilion Community Health and Outreach Montgomery County Department of Social Services VDH - New River Health District NRV Cares Carilion Community Benefit Literacy NRV Montgomery County Administration VDH - New River Health District New River Community Action VDH - New River Health District Tri-Area Community Health New River Valley Community Services Feeding Southwest Virginia Montgomery County Public School System Virginia Tech VDH - New River Health District Literacy NRV NRV Regional Commission Carilion Community Benefit Virginia Foundation for Healthy Youth Community Foundation of the New River Valley Town of Blacksburg NAACP Mont-Rad-Floyd Montgomery-Floyd Regional Library System Onward NRV Town of Blacksburg NRV Regional Commission Disability Resource Center Ninevah Community Foundation of the New River Valley New River/Mt. Rogers Workforce Development Board Wythe Hospice/Alzheimer’s Association Community Health Center of the New River Valley

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Representative Mike Wade Molly Roberts Mona DiGiulian Morris Fleischer

Organization Type

Medically Underserved Population* Healthcare Medically Underserved Population* Faith Community*

Organization

New River Valley Community Services Carilion Community Benefit NRV Cares Giles Christian Mission Carilion Division of Equity and Nathaniel Bishop Healthcare Inclusion Nick Bilbro Healthcare Carilion Community Benefit Pam Ray Public Health Department VDH - New River Health District Rhonda Seltz Minority Population* Virginia Poverty Law Center Robert Graham Local School District Pulaski County Public School System Carilion Community Health and Sarah Frazier Healthcare Outreach Carilion New River Valley Medical Shana Murphy Healthcare Center Sherry W. Kramer Medically Underserved Population* Women's Resource Center of the NRV Sophie Wenzel Academic Expert Virginia Tech Teresa Thornton Healthcare HCA - LewisGale Terrie Sternberg Faith Community* HCA - LewisGale Tina King Older Adult Population* Agency on Aging Trina Porterfield Low-Income Population* New River Community Action Radford City Department of Social Victoria Collins Medically Underserved Population* Services Whitney Caton Philanthropy United Way SWVA *member of or individual/organization serving/representing the interest of this population

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Appendix 2: Community Health Need Prioritization Activity Table

Results

Method

Prioritization Survey

Dot Voting Activity

Group Discussion

Using their community knowledge, data Using the results of the Prioritization The group was asked to reflect on collectively reviewed, and additional data Survey, the group was asked to the results of the dot voting shared, CHAT members were asked to individually choose 5 topics to prioritize: exercise. The following points were complete an electronic survey to prioritize made during that discussion: • The CHAT facilitators hung pages community health topics: around the meeting room, each with • Mental Health vs. Substance one of the topics from the Use vs. Overdose • The survey matched the structure utilized o Mental Health should be Prioritization Survey results. during the data walk at CHAT Meeting 2 considered separately from • First prioritized broad categories, then • Each CHAT meeting attendee was Substance Use specific topics within those categories given 5 dot stickers and instructed to o Overdose should fall under place one sticker on each of the 5 • CHAT facilitators ranked the following to the category of Substance topics they felt were most important develop results: o Broad categories (resulting top 3 Use to address in the next three years. o Substance Use should indicated by bold type below) • After voting was completed, the CHAT o Topics within each of the 3 top broad include tobacco use, facilitators quickly tallied and ranked vaping categories the results. o Remaining topics • The CHAT was presented with the top • Heart Disease did not make the list—considering 5-7 topics, unranked. The number of • Results include: o Top 3 topics of each of the top 3 Overweight/obesity as a results presented depended on any contributing factor, no need to broad categories ties and how closely votes were o Top 5 topics of the remaining add/change distributed. If topics were additional (i.e. not in the true top 5), CHAT categories • Domestic Violence did not make the list but should be facilitators noted this to the group included and separated them visually on the screen.

• STIs & Teen Pregnancy o Sexual Health better fit— STIs and pregnancy planning across multiple populations Mental Health/Substance Use Top 5: Top 6: • Substance use • Substance use • Mental health • Mental health • Mental health • Substance use • Overdoses • Overdoses • Overweight/obesity Chronic Disease • Overweight/obesity • Dental health • Overweight/obesity • Poor dental health • Sexual health Additional: • Diabetes • Domestic violence/intimate partner violence • Poor dental health • STIs Maternal/Child Health • Teen pregnancy • Teen pregnancy • Infant mortality • Low birthweight Injury/Violence & Infectious/Communicable Disease • Firearm injuries/deaths • Domestic violence/intimate partner violence • Childhood injury • STIs • Hepatitis C

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