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Community Health Improvement Plan MADISON COUNTY

Prepared by: HealtheConnectionsHealthPlanning November 2013 Community Health Improvement Plan |

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Community Health Improvement Plan TABLE OF CONTENTS Background ............................................................................................................................ 1 Introduction ............................................................................................................................. 1 Process ..................................................................................................................................... 2 Steering Committee Member ............................................................................................. 4 Priorities Framework ............................................................................................................... 4 Tier I Priorities Prevent Chronic Disease: Promote the prevention of chronic disease through healthy eating and physical activity ............................................................................ 6 Promote Mental Health and Prevent Substance Abuse: Increase access to and awareness of mental health services ............................. 11 Tier II Priority Promote Healthy Women, Infants and Children: Increase the percent of births with adequate prenatal care ............................... 16 Tier III Priorities Promote Access to Primary and Preventive Services: Implement strategies and policies that promote access to primary and preventive services ................................................................................ 19 Promote Access to Long Term Care Services: Increase availability of long-term care options ........................................................ 22 Promote a Healthy and Safe Environment: Implement initiatives that promote health and wellness within work, home and community environments................................................... 24

Community Health Improvement Plan Participants ....................................................... 27

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BACKGROUND The Prevention Agenda 2013-17 is New York State's health improvement plan for 2013 through 2017, developed by the New York State Public Health and Health Planning Council (PHHPC) at the request of the Department of Health. This five-year plan was designed to demonstrate how communities across the state can work together to improve the health and quality of life for all New Yorkers. This serves as a guide for mandated Community Health Assessments and Community Health Improvement Plans. The Agenda features five priority areas: Prevent chronic diseases Promote healthy and safe environments Promote healthy women, infants and children Promote mental health and prevent substance abuse Prevent HIV, sexually transmitted diseases, vaccine-preventable diseases and healthcareassociated Infections The Prevention Agenda established goals for each priority area and defines indicators to measure progress toward achieving these goals. NYSDOH identified interventions shown to be effective to reach each goal. These interventions are displayed by stakeholder groups so that each sector can identify evidence-based or promising practices they can adapt for implementation to address the specific health issues in their communities and reduce health disparities. County Health Departments are required to respond to the State with a plan to address at least two of these priorities. It is a call to action for local health care providers, health plans, schools, employers, governmental and non-governmental agencies and business to collaborate at a community level to identify local health priorities and plan and implement a strategy for local health improvement that will enhance health status through increased emphasis on prevention.

INTRODUCTION The Community Health Improvement Plan is a long-term, systematic effort to address public health issues in Madison County. The plan is based on the results of a Community Health Assessment, and is foundational to the community’s health improvement process. Madison County engaged a broad spectrum of representatives from other community agencies who played an integral role in the development of the plan goals and strategies. A complete list of community participants is at the end of this document. This document provides guidance to all who live and work in Madison County for improving the health of the population and communities. The plan is fundamental for developing policies and defining actions to target efforts that promote health. Government agencies, including those related to health, human services, and education, use the Community Health Improvement Plan in collaboration with community partners to set priorities, implement initiatives, and coordinate and target resources. The Community Health Improvement Plan is the culmination of a year-long collaborative effort between healthcare and health-related organizations that serve Madison County. This planning effort involved accessing and analyzing various data, conducting expert review, and reaching consensus on priority health issues and strategies. Members of the partnership included individuals who provide a broad range of perspectives, representing various groups and sectors within the community, and bring the necessary resources and enthusiasm to the table. Broad community participation via focus groups, and other mechanisms, was employed to ensure that the process resulted in a community-driven and owned Community Health Improvement Plan.

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PROCESS The Madison County Board of Health established three overarching Strategic Health Directives that work together to prioritize prevention across multiple settings and advance our efforts to build a healthier Madison County: Healthy Care, Healthy Behaviors and Healthy Environment (Figure 1). The three directives were used to frame our health assessment activities as we evaluated health issues across each life stage of life; infants & toddlers, children, adolescents, adults, and older adults. The goals of Healthy Care are to ensure access to and receipt of recommended quality effective evidence preventive and health care services and information including dental and mental health care for individuals at each life stage, and provide local sustainable access to primary and preventive health care that is economically beneficial to our network of providers and our community in general. The goal of Healthy Behaviors is to support individuals at each life stage in making healthy choices. The goal of Healthy Environments is to create and sustain social and physical environments that are accessible; that support health, safety, and quality of life and that promote healthy behaviors for individuals at each stage of life. A steering committee comprised of community leaders convened on October 2012 to: (1) review the process and progress of the 2009 Community Health Assessment and Community Health Improvement Plan (CHA/ CHIP), which followed a community health improvement planning model adapted from the National Association of County and City Health Officials and the Centers for Disease Control and Prevention, called Mobilizing for Action through Planning and Partnerships (MAPP); and (2) establish a framework to guide the 2013-2017 CHA/CHIP. The community leaders represented government, community-based organizations, and the health care system. The mission of the steering committee was to develop and oversee the implementation of a plan to promote health across the life stages using the three overarching Strategic Health Directives. Madison County is presenting their 2014-2017 Plan using a life stage framework. The life stages are: infants and toddlers ages 0-3 years; children ages 4-11; adolescents ages 12-19; Adults ages 20-49; and older adults ages 50 and over. The steering committee met every other month during 2013 to monitor the progress of community focus groups, review current data, and define the priority areas to be addressed. Four community focus groups were held in February/March 2013. The groups were comprised of topical and programmatic experts working with the following age cohorts: infant/toddlers (ages 0-3), children/adolescents (ages 4-20), adults (ages 21-49), and older adults (ages 50+). The goals of the meetings were to discuss the data, areas of concern, and local, state and national initiatives that would inform the Community Health Assessment and Community Health Improvement Plan, and align the County’s priorities with the NYSDOH 20142017 Prevention Agenda. Participants discussed areas of importance and issues anecdotally identified by those working in the field. A fifth group met regarding health care and economic development. The five groups convened in June to review the data from the Community Health Assessment and determine priority focus areas by life stage. The groups identified strategies and key stakeholders who should be involved with the successful implementation of the strategies. Topic specific work groups met in July 2013 to finalize goals and strategies within each priority area.

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Figure 1: Strategic Health Directive Model

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STEERING COMMITTEE MEMBERS Cheryl Geiler, Madison County Department of Health Denise Hummer, Steering Committee Chairperson, Community Memorial Hospital Elizabeth Crockett, REACH CNY Eric Faisst, Madison County Department of Health Eve Van de Wal, Excellus Blue Cross Blue Shield Gene Morreale, Oneida Healthcare Geoffrey Snyder, Madison County Department of Health Julie Dale, Community Action Partnership for Madison County Joanne Eddy, Madison County Youth Bureau John Endres, Madison County Board of Health Judy Daniel, HCR Home Care Kara Williams, Health Foundation for Western and Central New York Lorraine Kinney-Kitchen, Child Care Council of Cornell Cooperative Extension

Marguerite Lynch, Excellus Blue Cross Blue Shield Mike Fitzgerald, Madison County Department of Social Services Mike Healy, Oneida Healthcare Ray Lewandowski, Madison Cortland ARC Rosanne Lewis, Madison County Department of Health Sam Barr, Madison County Board of Health Sara Wall Bollinger, HealtheConnections Health Planning Scott Ingmire, Madison County Planning Department Sean Fadale, Community Memorial Hospital Susan Jenkins, BRiDGES Stephen Wu, Hamilton College Teisha Cook, Madison County Mental Health Department Theresa Davis, Madison County Office for the Aging

PRIORITIES FRAMEWORK The health priorities for Madison County are organized into a three-tier framework: Tier I priorities represent the highest priorities for the community focus groups and the Steering Committee. Determination was based on data, anecdotal knowledge of the issue, current community resources available to address the issue, and the community’s ability to make an impact and “move the needle” during the next four years. Additional criteria used to select the top tier priorities were areas of focus that spanned the life stages. The Tier II priority was selected because of the correlation between adequate prenatal care and both shortterm health outcomes and long- term health outcomes that span the life stage. Additionally, supporting preconception and intra-conception is important in keeping those individuals of child bearing age healthy. Tier III priorities emerged from the discussions of the health care economic development Advisory Group and healthy environment related issues that were confirmed by the Steering Committee as important issues to include in the Community Health Improvement Plan. Tier III priorities include a description of overarching goals, lead agencies, and strategies.

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Goal 1.1

(ages 0-3)

Goal 4.1 Improve access to dental services for individuals with Medicaid*

Goal 2.2 Reduce youth use and abuse of drugs, alcohol and tobacco

Goal 2.1 Increase access to and awareness of mental health services

Decrease stroke related mortality

Older Adult (ages 50+)

Reach and Maintain a Healthy Weight

Adult (ages 19-49) Goal 1.3

(ages 13-18)

Goal 1.2

Children (ages 4-12)

Adolescent

Goal 6.3 Promote and implement Smart Growth approaches in Madison County and its municipalities.

Goal 6.2 Launch Healthy Home initiative

Increase availability of long term care options* Goal 6.1 Launch a Workforce Health & Productivity Management Initiative.

Goal 5

Goal 4.2 Improve access to health and wellness services through increased transportation options and awareness *

Increase the percent of births with adequate prenatal care in Madison County

Goal 3.1

Promotion of Breastfeeding

* Economic development priority area † Not a NYS Prevention Agenda priority area

Promote a Healthy and Safe Environment

Promote access to long term care† Strategic Issue 6

Promote access to primary and preventive services† Strategic Issue 5

Tier III Priorities Strategic Issue 4

Promote Healthy Women, Infants and Children

Tier II Priorities Strategic Issue 3

Promote Mental Health and Prevent Substance Abuse

Promote the prevention of Chronic Disease through Healthy Eating and Physical Activity Strategic Issue 2

Tier I Priorities Strategic Issue 1

Infant/Toddler

Priorities for the Madison County Community Health Improvement Plan 2013-2017


PREVENT CHRONIC DISEASE

Tier I

STRATEGIC ISSUE 1: PROMOTE THE PREVENTION OF CHRONIC DISEASE THROUGH HEALTHY EATING AND PHYSICAL ACTIVITY Goal 1.1: PROMOTION OF BREASTFEEDING Key Results Area: Increase the percent of (Women, Infant and Children) WIC infants that are breastfed for at least 6 months by 5%. The strategies focus on the entire population of those with live births; however, due to lack of data the indicator that will be tracked relates specifically to WIC. Lead Agencies: Madison County Department of Health, WIC, Community Memorial, and Oneida Healthcare Strategies: Utilize the Healthy Start Partnership that addresses environmental interventions through community-based partnerships to reduce obesity in childbearing women and their infants. The goal of the Healthy Start Partnership is to promote and support healthy lifestyles for women and their children by: (1) increasing physical activity, (2) creating community supports for healthy behaviors, and (3) influencing local policy to enhance existing programs. The rationale for this approach is that rural women, especially those of lower education and income levels, have a higher prevalence of being overweight and obese and have not been reached by obesity prevention programs. The Madison County Healthy Start Partnership meets monthly to promote healthy weight in women of childbearing age. Members include Community Action Partnership, Madison County Health Department, Madison-Herkimer WIC, and Oneida Healthcare Center.

CURRENT SITUATION: The nation benefits overall when mothers breastfeed. Recent research shows that if 90% of families breastfed exclusively for 6 months, nearly 1,000 deaths among infants could be prevented. The United States would also save $13 billion per year — medical care costs are lower for fully breastbreastfed infants than never-breastfed infants. Breastfed infants typically need fewer sick care visits, prescriptions, and hospitalizations. Breastfeeding also contributes to a more productive workforce since mothers miss less work to care for sick infants and employer medical costs are also lower. The percentage of WIC mothers who were breastfeeding at 6 months in Madison County decreased between 2004-2006 and 2008-2010 from 21.9% to 20.8% which is less than for NYS as a whole during the same timeframe (38.6% to 38.8%). The New York State Public Health Council set an objective to increase the percent of infants exclusively breastfed in the hospital to 48.1 % and increase the percent of WIC mothers breastfeeding at 6 months to 50.0%.

Breastfeeding is a consistent, evidence-based approach to beginning healthy eating in infants/children. The partnership works to: Increase access to comfortable places to breastfeed or use a breast pump. Increase local media promotion of breastfeeding to encourage a more accepting societal attitude Create a system that better aligns new moms with breastfeeding support services Provide more flexible working arrangements that allow for breastfeeding/breast pumps Support and promote WIC's breastfeeding services that are especially designed to give the support needed to breastfeed successfully at home, in public or at the work place. Services include: (1) BreastBreastfeeding-friendly clinics staffed with trained breastfeeding counselors; (2) A food package with additional nutritious foods especially for breastfeeding mothers; (3) Mother-to-mother support through its peer counselor program; (4) Experienced staff and peer counselors at WIC who understand the needs of breastfeeding mothers; (5) Breast pumps based on individual assessments, and (6) Linking information to the breastfeeding connections peer network groups with lactation counselors throughout the county.

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Support and promote Oneida Healthcare Center’s comprehensive breastfeeding program to support women who deliver at their facility. Oneida Healthcare encourages immediate breastfeeding when a baby is born so mothers and babies can begin to physically bond the moment they meet. Oneida Healthcare has two part-time certified lactation consultants on staff to assist mothers with pointers and help them troubleshoot. Breast pumps are available for purchase or to rent by the month at Oneida Healthcare. One of the lactation consultants will show women how to use it properly. If women already have a pump, they are encouraged to bring it to the hospital so staff can help them become familiar with using it. A complimentary piece would be to encourage management to provide opportunities for increased education of nursing staff to become peer counselors, community breastfeeding educators and/or certified lactation counselors. Oneida Healthcare provides a weighing station free of charge that mothers may visit as often as they would like to ensure their baby is growing as he or she should. If there is any reason for concern, lactation consultants are available to help. Implement the Business Case for Breastfeeding at work sites in Madison County. The Business Case for Breastfeeding is a comprehensive program designed to educate employers about the value of supporting breastfeeding employees in the workplace. The program highlights how such support contributes to the success of the entire business. The Business Case for Breastfeeding offers tools to help employers provide worksite lactation support and privacy for breastfeeding mothers to express milk. The program also offers guidance to employees on breastfeeding and working. Research shows that providing a lactation support program is not only highly desired by breastfeeding employees who return to work after childbirth, it can also improve a company’s return on investment (ROI) by saving money in health care and employee expenses. The Business Case for Breastfeeding demonstrates to corporate executives and others interested in improving employee services how a lactation support program can: Lower medical costs and health insurance claims for breastfeeding employees and their infants (up to three times less for breastfeeding employees) Reduce turnover rates (86-92 percent of breastfeeding employees returning to work after childbirth when a lactation support program is provided compared to the national average of 59 percent) Lower absenteeism rates (up to half the number of 1 day absences) Improve productivity Raise employee morale and loyalty to the company Implement the NYSDOH Great Beginnings initiative in Oneida Healthcare and Community Memorial Hospitals. The goal of Great Beginnings NY is to increase hospitals’ support of mothers who want to exclusively breastfeed during their hospital stay and after discharge. The initiative recommends four evidencebased strategies for hospitals to put into place within their facilities. They include: Ensure breastfeeding infants do not receive supplementation (infant formula, water, glucose water) unless medically indicated or at the request of the mother, and documented in the infant’s medical chart; Educate mothers on the impact of non-medically indicated supplementation on breastfeeding success; Discontinue the distribution of free infant formula including discharge packs, and the provision of infant formula promotional materials in any hospital location and as part of patient education; and Provide all breastfeeding mothers with post-discharge lactation support and referrals that include Home visiting nurses, Community Breastfeeding Educators and certified lactation Counselors and information about the Breastfeeding connections peer support groups.

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Goal 1.2: REACH AND MAINTAIN A HEALTHY WEIGHT FOR CHILDREN/ADOLESCENTS AGES 4-18 Key Results Area: Reduce the percent of children that are overweight or obese by 5% by 2017. This is equivalent to 68 children going from overweight or obese to a healthy weight. Lead Agencies: Oneida Healthcare, Oneida Family YMCA, Madison County Department of Health, Upstate Institute at Colgate University, Madison County Board of Health, BOCES, and Cornell Cooperative Extension of Madison County Strategies: Establish a Committee on Health and Physical Fitness within the Madison County Rural Health Council. The mission would be to promote physical fitness, nutrition, and health throughout the County by implementing programs, fostering communication and cooperation, and developing countywide support that will help the citizens of Madison County develop and maintain healthier lifestyles. Expand Fit Kids of Madison County pilot program. Fit Kids is a collaborative program of fitness and nutritional education for middle school aged children. Spearheaded by Oneida Healthcare and the Oneida Family YMCA, Fit Kids is a 16 week program for middle school aged children identified and referred to the program by their pediatrician or family practitioner. The participants engage with a professionally-administered fitness exam that consists of five components: strength, flexibility, endurance, blood pressure screening, and body fat analysis pre-program, mid-program, and post-program. Oneida Healthcare clinical staff provides nutritional counseling and educational seminars for the program participants and their families. Oneida Family Y’s Certified Personal Trainer works closely with Oneida Healthcare to design a series of workouts, classes, and other rigorous physical activity. The program’s current capacity is ten (10) children. Explore the possibility of utilizing students and facilities at Morrisville State College to expand Fit Kids of Madison County to southern part of the County. Expand the Healthy Schools New York (HSNY) initiative to all schools in Madison County. The goal of the Healthy Schools New York (HSNY) Program is to increase the number of schools that effectively implement policy, systems and environmental changes that promote the consumption of healthy foods and beverages, comply with state physical education regulations and expand opportunities to be physically active. Comprehensive school health policies can impact

CURRENT SITUATION: Regular participation in physical activity has benefits throughout the life of an individual. Engaging in activities such as dance, martial arts, and sports is associated with lower rates of obesity and depression, improved sleep patterns among other positive outcomes. Youth that establish active lifestyles are more likely to continue those healthy habits throughout adulthood. The US Department of Health and Human Services recommends that adolescents participate in five hours of exercise or physical activity weekly. The Madison County Youth Bureau Teen Assessment Project (TAP) 2010, found that roughly half of the teens surveyed in the county were engaging in only one hour or less of unstructured physical activity per week, falling far below national guidelines. However, students involved in organized sports tend to exercise a minimum of 2 hours per week, with over 20% engaging in at least eleven hours of exercise per week. Maintaining a healthy weight is essential to preventing chronic diseases such as cardiovascular disease, diabetes, and cancer. Unfortunately, childhood and adolescent obesity have sky rocketed nationwide. According to Ogden and Carroll (as cited by the CDC 2013) obesity has more than doubled in children and tripled in adolescents during the last three decades. New York State has not escaped this epidemic. Over one third of Madison County and New York State 7-12th grade youth are overweight or obese (37.9% and 34.9% respectively). In Madison County two-thirds of all the 7th-12th grade adolescents classified as obese or overweight are obese.

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student behaviors and lead to lifestyle changes that reach beyond the classroom. HSNY is a grant initiative funded through the NYS Department of Health that provides technical assistance to school districts. Explore the feasibility of a “Food Hubs and Farm to School” program. This program has been very successful at getting good, healthy, local, whole foods to our nation's students. Schools and districts find that their school food service professionals, who already have so many responsibilities, have limited time and resources for managing food aggregation logistics. Food hubs hold great promise to help. Food Hubs can offer convenient online ordering for schools either on a monthly or daily basis, that offer healthy, sustainable, local food sourced from many different area suppliers. Promote Cornell Cooperative Extensions’ Eat Smart New York program. This is a free nutrition education program designed exclusively for individuals or families who receive SNAP, WIC, SSI or who have children in Head Start. Participants enjoy practical, interactive, hands-on lessons presented in a group setting. These lessons are to meet their needs and to focus on healthy eating, stretching food dollars and keeping food safe to eat. The goal is to improve the health and wellbeing of families with limited resources.

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Goal 1.3: REDUCE STROKE-RELATED MORTALITY Key Results Area: Reduce stroke-related mortality by 10% by 2017. Lead Agencies: Oneida Healthcare, Community Memorial Hospital, Madison County Rural Health Council, and Madison County Department of Health Strategies: Establish a subgroup within the Committee on Health and Physical Fitness (see Strategy 1.2.1) to address the high rates of strokerelated mortality in Madison County. The work group will include government, healthcare organizations and community-based organizations and meet on a regular basis to identify and implement actions to reduce stroke-related mortality in Madison County. Work with primary care providers to raise patient awareness of the symptoms of a stroke. Primary care providers can educate patients on risk factors, and early signs of a stroke, and what patients should do if they believe that they are having a stroke. Oneida Healthcare and Community Memorial can assist in implementing this initiative with the primary care providers that are working in their clinics. Implement a public awareness campaign about the signs of a stroke and where to go for help. The National Stroke Foundation’s Stroke Awareness EKit contains the tools needed to reach others with important stroke education. All materials are free to use and available on their website. Materials include: stroke awareness sample email, flier, paycheck and bag stuffer, stroke awareness social media posts, stroke awareness resources for healthcare professionals, e-cards, Newsletter , Press Release, stroke 101 fact sheet, stroke symptoms poster, and FAST wallet card. The National Stroke Foundation stroke awareness campaign occurs during Stroke Week held annually in September.

CURRENT SITUATION: Cerebrovascular disease (commonly referred to as stroke) relates to blood vessels supplying the brain. Hypertension (high blood pressure) is a leading contributor as it causes damage to the blood vessel linings. Sustained hypertension permanently damages blood vessels making them more vulnerable to changes in blood pressure. Cerebrovascular disease primarily affects people the elderly or those with a history of diabetes, smoking, or ischemic heart disease. The previous Prevention Agenda (2008-2012) set the goal of reducing Cerebrovascular Disease mortality from 32.6 (based on 2003-2005 Vital Statistics) to 24.0 deaths per 100,000. There is evidence of decline in mortality on a state level, but rates in Madison County rates remain high. The County’s stroke mortality is almost double the state average (43.7 vs. 27.5 per 100,000). Healthy People 2020 have set the objective of reducing stroke deaths from 42.2 to 33.8 per 100,000.

Implement a campaign to reduce sodium consumption. Excessive sodium consumption is associated with elevated blood pressure levels and increased risk for heart attack or stroke. Presently, most of the sodium that Americans consume comes from processed and restaurant foods. Even a modest, long-term reduction in sodium consumption can have a beneficial impact on blood pressure and lead to the reduction of preventable cardiovascular events. The Centers for Disease Control and Prevention Sodium Reduction Toolkit contains materials to support the campaign. Campaign strategies could include: Encourage or require restaurants to gradually lower the amount of sodium in the menu items Hospitals, local food programs, institutions and employers should adopt nutrition standards, including sodium limits, on food purchased, served or sold. Public health and nutrition educators should encourage consumers to request lower sodium foods. Food outlets, including supermarkets and restaurants, should make it easy for consumers to identify lower sodium food choices.

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PROMOTE MENTAL HEALTH AND PREVENT SUBSTANCE ABUSE

TIER I

STRATEGIC ISSUE 2.1: INCREASE ACCESS TO AND AWARENESS OF MENTAL HEALTH SERVICES Goal 2.1.1: INCREASE THE NUMBER OF SERVICE VENUES AVAILABLE TO MEET CLIENT NEEDS Key Results Areas: Increase the number of unduplicated clients served and number of visits to licensed agencies in Madison County by 20%. This is equivalent to an additional 339 individuals making approximately 673 visits. Increase in the number of locations in Madison County where mental health services are provided. Lead Agencies: Director of Community Mental Health Service (County Mental Health Department), Hamilton-Bassett-Crouse Health Network, Inc., and Madison County Rural Health Council. Strategies: Support location of new sites and providers. Two agencies (Family Services of Cortland and Liberty Resources) have pending licenses with OMH. Family Services of Cortland is exploring the possibility of placing therapists/counselors in schools in Madison County. An additional agency is in the planning phase of expanding their OMH and/or OASAS license to include services in Madison County. New providers should be encouraged to become part of the Madison County Rural Health Council. Implement a school-based counseling program in southern part of Madison County. This effort is being led by the Hamilton-BassettCrouse Health Network, Inc. and Community Memorial Hospital in partnership with Hamilton School District. Provide outpatient substance abuse services in Madison County. Work with our network of providers to determine the feasibility of and implementation plan for providing services in Madison County. Support the integrated model of care (behavioral health as a part of primary care practices). Mental Health professional will be encouraged to explore co-location options with primary care practicPilot a Community Schools model for providing behavioral and physical health services in at least two rural school districts within Madison County. The Madison County Department of Health and the Madison County Rural Health Council should pursue grant funding from the NYS Health Foundation and the federal Health Resource Service Agency (HRSA) to support the pilot project. The project would target three areas: (1) development and implementation of a student evaluation tool to gauge need for behavioral health services; (2) development and implementation of behavioral

CURRENT SITUATION: According to Madison County Mental Health Department (MCMH) internal data, 9.9% of those receiving services are between the ages of 6 to 10 years, and 14.1% are between the ages of 11 to 14 years. The agency reported that 1 out of 4 of clients seen in the year 2012 were adolescents. The adolescent age range exceeded all others. In 2012, MCMH provided outpatient services to 852 unduplicated adults (20-50 years). Data suggests that mental health issues are a significant issue for adults In Madison County as evidenced by higher than average percentage of adults with activity limitations because of physical, mental or emotional problems and higher suicide mortality rates. Currently, there are limited treatment options for adults suffering from mental health issues in Madison County. MCMH provides the majority of mental health services supplemented only by a few local practitioners. In 2012, 50% of MCMH patients were insured through a Medicaid plan making it their largest payer. Commercial Insurance was the next largest payer at 19.2% followed by a combination of Medicaid and Medicare (12.7%) and self-pay (11%). A majority of adults receiving care from MCMH (18.9%) have been diagnosed with Depressive Disorder, and another 12.5% with major depression.

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health services within the school district; and (3) development of a community school service delivery model that can be replicated in school districts throughout the county, and serve as a model for the delivery of other services including medical and dental care. Goal 2.1.2: INCREASE THE FULL-TIME EQUIVILANT (FTE) OF PSYCHIATRISTS SERVING MADISON COUNTY RESIDENTS Key Results Areas: Increase the number of FTE Psychiatrists serving Madison County resident from a baseline of less than 3.0 FTE. Lead Agencies: Madison County Rural Health Council, Oneida Healthcare, Hamilton-Bassett-Crouse Health Network, Inc., and Madison County Department of Mental Health Strategies: Support the development of a short-stay mental health inpatient unit for seniors operated by Oneida Healthcare. Oneida Healthcare is in the planning stages of this initiative and as of September 2013 is exploring the feasibility of such an inpatient unit. Preliminary analysis anticipates that individuals up to 3 hours away would utilize the inpatient unit. Implement a telemedicine psychiatry program to bring child, adolescent and geriatric psychiatric consultation to primary care providers and diagnosed patients. Work with our network of providers (e.g., St. Joseph’s Hospital, Upstate Medical, Crouse Hospital) to identify and implement tele-psych opportunities in the county and serve as a resource for other providers in the area interested in telemedicine services. The Madison County Rural Health Council should take the lead in coordinating and facilitating this effort. Provide practice- and competency-based educational experiences for the future mental health workforce (e.g., psychiatric nurse practitioner, physician assistant and social worker student interns). Local mental and behavioral health service providers should serve as hosts for student and professional internships. Interns provide beneficial assistance to local providers that in many times are at little to no cost to the provider. Additionally, through this experience, students may desire to work in Madison County upon completion of their schooling. Internships can serve as a pipeline for recruiting potential providers. Goal 2.1.3: INCREASE PUBLIC AWARENESS OF NEW AND EXISTING SERVICES IN MADISON COUNTY Key Results Area: demonstrated increase in public awareness of available services including: web site activity, inquiries for service, articles and press releases, and consumer surveys. Lead Agencies: Madison County Rural Health Council, Madison County Mental Health Department Strategies: Explore the feasibility of 211 and/or a centralized database of community resources in Madison County. 2-1-1 connects people in need with services designed to address that need by providing a central telephone information service, chat line, and maintaining a data base of community information. Callers are referred to service providers according to their situation. 2-1-1 could maintain a comprehensive Directory of Services for Madison County on the Web. 2-1-1 can provide supportive services for organizations such as answering basic information calls, pre-screening for program eligibility and gathering survey data. Types of Referrals Offered by 2-1-1 include: Basic Human Needs Resources; Physical and Mental Health Resources; Work Support; Support for Elderly and the Disabled, Children, Youth, and Family Support; and Volunteer Opportunities and Donations. Community Health Improvement Plan |

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Encourage supporting agencies to add links to known services on their websites. Madison County Mental Health Department should host information about behavioral health issues and links to services available in Madison County. Service agencies and organizations should link to the Madison County Mental Health Department and other agency sites. Utilize media, including social media (Facebook, Twitter, etc.) to create awareness of mental health issues and service available for Madison County residents. Providers should be encouraged to submit articles, on an ongoing basis, to local media pertaining to various behavioral health topics that are applicable to Madison County, to increase community awareness of issues and services that are available. The messages and the means of delivering these messages should be strategically determined to have the greatest impact or benefit. For example, a European study found that texting health warnings and cessation information worked better among lower socioeconomic groups.

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STRATEGIC ISSUE 2.2: REDUCE USE AND ABUSE OF DRUGS, ALCOHOL AND TOBACCO Goal 2.2.1: REDUCE YOUTH USE AND ABUSE OF DRUGS, ALCOHOL, AND TOBACCO Key Results Area: Decrease past 30 day use of alcohol, marijuana, cigarettes, and prescription drugs by 10% for each grade cohort and each substance by 2017. Past 30 Day Use of Substances, 2012 7th grade

8th grade

9th grade

10th grade

11th grade

12th grade

Alcohol

3.7

5.2

15.6

22.4

36.5

42.8

Marijuana

1.7

4.0

12.2

15.7

24.1

26.0

Cigarette Prescription drugs

2.0

4.0

11.2

14.3

16.8

20.3

3.0

2.1

4.4

5.7

7.4

8.1

Source: BRiDGES 2012

Lead Agencies: BRiDGES Strategies: Support and promote The Choices and Consequences Program: a drug and alcohol prevention program designed to work with youth up to age 18 on an individual basis. Schools, probation or courts in Madison County may refer a youth to the program if they are at risk for, or are using drugs or alcohol or are facing consequences as a result of being caught with drugs or alcohol. Parents may also refer their son/daughter if drug or alcohol use is a concern. The program requires 5 hours of commitment consisting of a one-hour assessment with a parent and 2, two-hour program sessions. Each youth is required to complete the program within two months from the referral date. During the assessment appointment the needs of the youth are determined and the program format and content is designed to meet the needs of each youth. Depending on the assessment results, and age of the youth, one of two evidence based programs will be implemented; Teen Intervene or Prime for Life. Teen Intervene (TI): An evidence based program for teenagers suspected of experiencing mild or moderate problems associated with alcohol or other drug use. TI integrates stages of change theory, cognitive-behavioral therapy and motivational interviewing into its program. Prime for Life: An evidence based risk reduction program. The first goal of the program is to help each participant in the program reduce risk for any type of alcohol or drug problem. The second focuses on self-assessment to help people understand and accept the need to make changes to protect the things that are most valuable in their lives.

CURRENT SITUATION: As adolescents age they are exposed to alcohol and other drugs at an increased rate. With less supervision and more opportunities to earn income, it is easier to gain access to substances. Underage drinking and use of illicit drugs continue to be major concerns in Madison County. Between 2007 and 2011 the rate of youth ages 16-21 arrested for drug use, possession and/or sale increased from 27.6 per 10,000 to 33.6 per 10,000. The incarceration rate is below the 2007 and 2010 New York State rates of 215.4 and 202.8 respectively. The county has experienced success in lowering the DWI arrest rate; however, county rates continue to exceed state rates. Furthermore, the increase in drug sale, use, and possession highlights the possibility that young people may not be decreasing their use of substances, but making the healthier decision to not drive under the influence. The 2012 Pride Survey found that over 40% percent of 12th graders questioned consumed alcohol during the previous month. Between grades 7 and 12 the use of all drugs increased steadily. The risk perception of cigarettes and prescription drugs consistently exceeds the perception of risk of alcohol and marijuana. The perception of risk associated with marijuana decreased steadily between 7th graders and 12th graders, which coincides with the increase of marijuana use as the grade level increases. Despite the seemingly consistent moderate to high risk perception of alcohol, consumption increased as students aged.

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Support and promote the INROADS (INformation and Referral On Alcohol and other Drugs for Schools) program: an in school student assistance program funded in part by New York State Office of Alcoholism and Substance Abuse and the Madison County Youth Bureau that provides: Information, assessment and referral services Workshops for parents and teachers Collaboration with other school based prevention programs Collaboration with community based prevention programs Consultation with parents and school personnel regarding substance issues Class presentations including evidence-based curriculum, Life Skills Training program, Project ALERT Videos, pamphlets, books, activity sheets and other resources for teens, parents and school personnel Support and promote the Reality Check Program: a youth action movement in New York State with a strong presence in Central New York. Teens in Reality Check work to expose the manipulative marketing tactics of the tobacco companies and mobilize their communities to protect future generations from being targeted by Big Tobacco. Teens focus their efforts on raising awareness of how the tobacco industry markets their products in the stores they shop in, getting smoking and tobacco imagery out of G, PG, and PG-13 movies, and raising community awareness about the deceptive practices of the tobacco industry. Support and promote Botvin’s Life Skills Program: a science and research-based program that has been shown to cut tobacco, alcohol and marijuana use by up to 75%, and increase healthy decision making skills, with lasting effects for the youth involved. The program was developed by Dr. Gilbert Botvin through his work at the Cornell University Medical College. Program topics range from self-image and selfimprovement, decision making, and advertising, to communication skills, and lessons on tobacco, alcohol and other drugs. Program topics are aimed at strengthening the “life skills” that play into healthy decisionmaking. The middle school program is universal and meant to reach all youth in 6th or 7th grade. Through a partnership with schools, BRiDGES is able to provide a prevention education specialist to teach the program in a set classroom within the school. Program length typically runs 14 sessions. Support and promote Class Action: an eight to ten session classroom based program for high school students, and has been delivered by BRiDGES staff to students in 9th-12th grade since 2010. The goal of the Class Action program is to change student, parent and community norms and expectations about adolescent alcohol use because it is the most widely used drug among teens in the United States. This model was developed over a ten year period at the University of Minnesota through research into alcohol prevention studies and other studies related to the health and safety of youth (including cigarette use, drug use, unhealthy eating patterns and sedentary behavior). Students are given the opportunity to debate the legal aspects of alcohol related cases involving teens. Underage drinking is presented as a community wide problem, emphasizing the focus on the social and legal aspects of the problems rather than the usual sole focus of individual responsibility. The classroom is divided into six legal teams who learn hypothetical civil cases. The cases involve personal injury which occurs as a result of underage alcohol use. Support and promote Project Alert: Project Alert is an evidenced-based school prevention for grades 7 and 8; a group vulnerable to social influences but typically not yet heavy users of alcohol, tobacco and other drugs. Project ALERT is an eleven week program, taught once a week by a BRiDGES Prevention Education Specialist. The goal of Project ALERT is to reduce the use of those dangerous substances by keeping nonusers from trying them and by preventing nonusers and experimenters from becoming regular users. It places its emphasis on helping students identify internal as well as external pressures to use drugs and utilizes various activities to help students learn techniques for resisting them. The program encourages Resistance Self – Efficacy, active student involvement, goals setting, parent involvement and teacher modelin an effort to help students develop the knowledge and skills such that each he or she will be equipped to make positive and healthy choices.

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PROMOTE HEALTHY WOMEN, INFANTS AND CHILDREN

TIER II

STRATEGIC ISSUE 3: INCREASE THE PERCENT OF BIRTHS WITH ADEQUATE PRENATAL CARE IN MADISON COUNTY Goal 3.1: IMPROVE COORDINATION AMONG THE COUNTY OB/GYN REFERRAL NETWORK

CURRENT SITUATION:

Key Results Area: Increase the percent of births with adequate prenatal care in Madison County to 78.8% by 2017. This was the percentage in 2004-2008. Lead Agency: Madison County Department of Health, Oneida Healthcare OB/GYN services Strategies: Development of a checklist or tool for those agencies that are referring pregnant women for prenatal services. Market the tool adapted from the Bassett system that highlights potential risk factors that would benefit from home visiting nurses providing health education, linking to community based agencies and ongoing mental health supports. Provide face to face outreach to providers and Community based organizations with education on the risk, tool advantages and use of the tool for referral services. Provide promotional flyers and posters for consumers in locations that are easily accessible about risk factors and the benefits of community based agency and home visiting nursing services. Utilize WIC and other community partners to help enroll pregnant women in prenatal care. Market use of the Navigators presently in Madison County 5 days a week. Work with Navigator lead agencies to set up access sites such as WIC, the OB clinic site and other key locations to increase access and decrease barriers to health insurance for the pregnant women and her family members. Provide face to face outreach to providers and Community based organizations with information promoting the Navigator services and options. Provide promotional flyers and posters for consumers in locations that are easily accessible with Navigator information and options. Start a local list-serve for updates when changes occur, new information is released, and announcements of trainings and events.

Early, high-quality prenatal care can help to prevent poor birth outcomes by enabling early identification and, where possible, treatment of health problems. Such care can also provide an opportunity to educate or counsel pregnant women about the adverse effects of behaviors that increase their risk of poor outcomes for their baby. Receiving late or no prenatal care during a pregnancy can result in negative health outcomes for both mother and child. Women who receive late or no prenatal care are at a significantly higher risk of bearing children who are of low birth weight, stillborn, or die within the first year of life. Teenagers are especially at risk. The percent of births with adequate prenatal care in Madison County has decreased from 78.8% between 20042006 to 66.0% between 2008-2010 whereas New York State had an increase from 63.0% to 80.1% during the same timeframe. The percentage of pregnant women in WIC, of low socioeconomic status, with first trimester prenatal care increased in Madison County from 80.0% in 20042006 to 86.9% in 2008-2010 which is a greater increase than New York State as a whole (84.0% to 85.6%) during the same timeframe. The percentage of women delivering live births that received no prenatal care increased from 4.5% in 2004-2006 to 5.9% in 2008-2010 whereas New York State had a slight decrease from 5.0% to 4.7% during the same timeframe.

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Goal 3.2: INCREASE EDUCATIONAL OPPORTUNITIES FOR PROVIDERS Strategies: Offer 2-4 health department and/or provider breakfasts incorporating a theme of “Grand Rounds” per year for program updates and education. Engage members of the community medical staff and regional medical experts (regional perinatal center) on various topics such as perinatal statistics, perinatal substance abuse, community health agencies and best practices. Link to the Regional Perinatal Center outreach visits topics to increase valued attendance. If providers are unable to attend, provide DVD taping/ webinar recordings and link to access. Utilize home visiting nurses and health educators to facilitate face-to-face education with provider offices. During Public health detailing visits promote the Bassett risk tool to providers with benefits of home visiting programs and linkages to community agencies to benefit client’s compliance and health. Implement train-the-trainer opportunities. Topics may include: helping agencies to properly refer; nutrition; gestational diabetes; and smoking, opioid and marijuana cessation. Provide training on evidence based strategies through ACOG, Regional Perinatal Center and AWHONN and WIC for training to medical staff and community based agencies for the management of gestational diabetes. Link with WIC to provide RD or Nutritionist trainings that include strategies for improved nutrition prior, during and post prenatal period. Provide training through Bridges for tobacco and substance abuse issues. Goal 3.3: INCREASE EDUCATIONAL OPPORTUNITIES FOR WOMEN DURING PREGNANCY AND PRECONCEPTION/INTRA-CONCEPTION Strategies: Implement “Ask Me 3” campaign county-wide. Provide promotional flyers and posters for consumers in locations that are easily accessible. This evidence based strategy, licensed through the National Client Safety Foundation, is designed to improve communication between patients and health care providers, encourage patients to become active members of their health care team, and promote improved health outcomes. The campaign shows that people who understand health instructions and improve their health and wellness. This program is also available in Spanish. Promote Text4Baby to pregnant women using Oneida Healthcare OB services. Provide Text 4 baby promotional flyers and posters for consumers in locations that are easily accessible. Provide training on the Text $ Baby campaign, instructions to access application and encourage clients while in provider visits to activate. Provide training to Community Based agencies and LHD on use of application and instructions; have Community Based workers and Public health nurses demonstrate and advocate with clients at encounter to activate application. Pilot a program to have information in pharmacy where people buy pregnancy tests to let them know what they should do if there test comes back positive. Provide flyers , telephone ‘tear offs’ and posters for consumers to reach community based services such as WIC, Home Visiting, Community Action, navigators locations and hours of operation that are easily accessible. Provide training to providers on intra/pre-conception health tool kit (train the trainer). Use REACH CNY tool kit or similar kit for trained Health Educator from MCDOH to provide training to provider, agency, and community partners to promote preconception health discussions. Provide access to toolkit online in provider section of county DOH website.

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Maximize care provided during the postpartum visit. Work with providers to review normal routines for post-partum visits. Provide training for Public health nurses and Community Based workers on postpartum visit routines, provide information to clients (include compliance and preconception messages). Incorporate postpartum purpose and visits routine in every prenatal visit with providers; reinforcement will be provided by Home Visiting Nurses and Community Based Agencies. Use existing public health programs serving women in the postpartum period, to link them to other sources of interventions (e.g. Family Planning, home visiting, WIC).

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PROMOTE ACCESS TO PRIMARY AND PREVENTIVE SERVICES

TIER III

STRATEGIC ISSUE 4: IMPLEMENT STRATEGIES AND POLICIES THAT PROMOTE ACCESS TO PRIMARY AND PREVENTIVE SERVICES. Goal 4.1: IMPROVE ACCESS TO DENTAL SERVICES FOR INDIVIDUALS WITH MEDICAID Lead Agencies: Madison County Department of Health and Madison County Rural Health Council, M-O and O-H-M BOCES. Strategy: Explore the possibility of a multi-county (Madison, Oneida, Lewis and Herkimer) mobile dental service program with Oneonta-based American Mobile Dental. CNY dental service hosted in Madison County, to serve people located at county jails, nursing homes, juvenile detention and foster care facilities, schools, day care centers, Head Start, MH/DD/ CD group residences, senior day programs and community centers. American Mobile Dental will allocate time to general community outreach at senior centers, fire stations, pre-schools and schools as long as their basic business model is covered by ‘institutional’ clients with reliable billing. American Mobile Dental has an office in Cayuga County providing these types of services. They accept Medicaid, Medicare, commercial insurance and self-pay. Partner with a College of Dentistry to implement an Oral Health Intervention Program. The intention of the program is to reduce dental caries in children from kindergarten through sixth grade. Example: The New York State Health Foundation awarded New York University College of Dentistry (NYUCD) a one-year grant to cover the start-up costs of the program. NYUCD supplied the requisite dental supplies, equipment, clinical resources, and administration, while its faculty, postgraduate pediatric dentistry residents, and graduating dental and dental hygiene students served patients. This program was found to be successful. For instance, caries prevalence was 58.8% among five-year-olds at their first visit in February 2010. Of the same children presenting in June 2011, the incidence of new decay was zero. This suggests that decay was prevented in the newly erupted first permanent molars. Implement the Health Foundation for Western and Central New York’s CHOMPERS! Initiative. CHOMPERS! is designed to improve oral health of young children by bringing dental education, prevention, and treatment to places they already go (e.g., Head Start). The Foundation advances two proven strategies in the CHOMPERS! Program: Educate children and families about good dental health and the importance of preventive care by implementing Cavity Free Kids (CFK), a best practice oral health curriculum, in early childhood programs.

CURRENT SITUATION: Although Madison County is not designated as a shortage area, there is a shortage of dentists for the Medicaid community. Few dentists take Medicaid-insured patients, an issue that has been anecdotally attributed to cumbersome paperwork and poor and untimely reimbursement. Recently, Medicaid has moved to a ‘managed care’ approach, so that the paperwork related to the ‘feefor-service’ billing system is less of an issue. Most Medicaid-insured patients present with an insurance card from a commercial insurance carrier such as Excellus, United Health Care or Fidelis Care. Only 25.7% of Medicaid recipients utilized a dental service in 2012 (Medicaid Datamart). Dental providers tend to locate in areas of high population density and relative affluence. The Economic Development Advisory Group suggested that recruitment of a private dentist to serve low income and Medicaid-insured residents is unlikely to be successful. Access to dental care has been identified as a cross-cutting issue in the Community Health Assessment and effects members of each Life Stage.

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Provide restorative and preventive treatment to young children by bringing portable dental care to children where they already gather, e.g., preschools and community centers. This model helps safety net dental clinics develop a new, sustainable line of business; improves access to high-quality dental services; and creates a permanent dental home for young children and their families. Implement a preventative dental care program for elementary school aged children similar to the Seal a Smile Oral Health Services initiative in the NY Capital District. Seal a Smile is a program designed to provide preventative dental care to elementary school aged children in schools where over 35% of the children are eligible for the federal free lunch program. The program provides school-based preventive dental services such as screenings, cleanings, fluoride and sealants. In addition, staff help children needing restorative dental services access necessary care. Seal a Smile refers all uninsured children to their facilitated enrollment program for assistance applying for Child Health Plus. Implement a school-based dental sealant delivery program. School based dental sealant programs demonstrate strong evidence of effectiveness in preventing tooth decay among children. Madison County Department of Health once employed a dental hygienist that provided sealants to children in county schools. The President of the Madison County Dental Society served as the supervising dentist for the sealant program. The County should hire a dental hygienist and revitalize this program. Develop and implement a business plan for the Madison County Rural Health Council to provide Medicaid billing support services to local dentists. Local dentists indicated that the amount of paperwork they are required to complete for a Medicaid client is substantial and inclines dentists to shy away from taking on Medicaid clients. The MCRHC could assist dentists with the Medicaid paperwork, thereby unburdening limited dentist staff and facilitating Medicaid clients receiving dental care. This could also become a sustainable service for MCRHC through possible fees collected from dentists.

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Goal 4.2: INCREASE ACCESS TO HEALTH AND WELLNESS SERVICES THROUGH INCREASE TRANSPORTATION OPTIONS AND AWARENESS Lead Agencies: Madison County Coordinated Transportation Steering Committee, Madison County Rural Health Council. Strategies: Increase awareness of transportation options within Madison County. Recent changes to the transportation system in Madison County include the loss of county funds for Madison County Transit, and the State assuming a transportation coordination role for Medicaid transportation through a contract with Medical Answering Services and Maria’s Ontime Medicar Service (MOMS), has created uncertainty as to what transportation services exist in the County. The MCCTSC should coordinate the development and implementation of a marketing campaign to promote the transportation options available in Madison County. Determine the feasibility of the Madison County Rural Health Council becoming a Mobility Manager for Madison County. The Alleghany -Western Steuben Rural Health Network (AWSRH) serves as the mobility manager for their area in western NY. AWSRH is contracted through the local government that is responsible for mobility management. AWSRH was able to leverage funds through NYSDOT for an improved transit system for both older adults, those seeking employment or further education, community-at-large, and our nonemergency Medicaid population.

CURRENT SITUATION: It was feared that the Madison Transit System (MTS) would not exist beyond May 31, 2013, however as a result of collaboration with Birnie Bus, Madison County, Heritage Farms, and the New York State Department of Transportation, the Madison Transit System is able to continue limited service to select areas of Madison County. Through the coordination of shared service routes and hours of operation, MTS will continue service 5 days a week with service in Oneida, Wampsville, Bouckville, Canastota, Chittenango, Hamilton, Morrisville, Cazenovia, Earlville, and more. Though limited in scope and frequency, this service will provide options for some of the most heavily traveled areas of the County, in addition to some of the outlying villages and hamlets. The Coordinated Transportation Steering Committee continues to meet as transportation is a major barrier for residents.

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PROMOTE ACCESS TO LONG TERM CARE SERVICES

TIER III

STRATEGIC ISSUE 5: INCREASE AVAILABILITY OF LONG-TERM CARE OPTIONS (INCLUDING INCREASED ACCESS TO NON-MEDICAL SUPPORTIVE SERVICES FOR NON-MEDICAID ELIGIBLE INDIVIDUALS) Goal 5.1: EXPAND HOME AND COMMUNITY-BASED SUPPORTS AND SERVICES TO PREPARE FOR AN AGING POPULATION Lead Agencies: Local Municipalities, Hamilton-Bassett-Crouse Network, and the Madison County Office for the Aging, and Madison County Rural Health Council Strategies: Advocate with the New York State Department of Health for the Hamilton Manor to be approved for conversion of some beds from Adult Home to Medicaid Assisted Living Program (ALP). ALP funding is better than the Adult Home funding. This will immediately add new jobs providing assistance to seniors, and improve the quality of care available to residents of the Hamilton Manor. Encourage a real estate developer to build new, or renovate existing buildings, to create subsidized and non-subsidized physically accessible senior housing with supports such as housekeeping, transportation, day activities, medication monitoring, meal delivery and socialization. These should be located in villages such as Hamilton, Morrisville, Canastota, Chittenango and/or Cazenovia, close to shops and services. Encourage Crouse Community Center, Hamilton Senior Housing and/or Stonehedge Health and Rehabilitation Center to develop an Assisted Living facility to provide a higher level of support than senior apartments, but not as much care as is provided at the skilled nursing level. Members of the Advisory Group observed that Assisted Living is a financially challenging model of service. It was suggested that they can be financially successful if private-pay residents who can fully cover costs are attracted to live there. An alternative approach is to obtain grant funding to lower up- front and mortgage expenses, such as Regional Economic Development Council funding. A likely business model would be composed of 25% ALP apartments and 75% private pay. People with the ability to pay may be choosy about the housing location and the services offered, so it will be important to plan carefully. It is difficult to support people who are cognitively impaired at this level of care, yet they generally do not qualify for skilled nursing placement. It would be wise for the entity that develops this new facility to have ‘memory care’ placement opportunities prepared to accept individuals who have been living in the Assisted Living apartments when they are no longer safe living independently.

CURRENT SITUATION: The composition of Madison County’s older adult population is similar to state and regional patterns. About 13.8% of the county is over the age of 65, and 1.7% is over the age of 85. The majority of the area’s older adult population lives at home (67.2%), about a quarter (25.4%) lives alone, and 3.7% live in skilled nursing facilities. The percentage of older adults living alone is slightly lower than that of the state (29.0%), and like the state and nation, women are living longer. There are more elder women that live alone or reside in skilled nursing facilities in the county. Fewer older adults are disabled in Madison County than the national average (26.2% versus 37.9%). Madison County older adults have more financial resources than their national counterparts. The percentage living below 100% of the poverty level is lower in the county than in the state (7.0% versus 9.4%). More Madison County elders receive income from retirement (54.4% versus 49.0%), earnings (36.2% versus 34.2%) and social security (96.6% versus 91.9%) than their national counterparts. Madison County has an adequate supply of skilled nursing beds (nursing homes) but a relatively low supply of Adult Care Facilities (ACF) and similar facilities such as Assisted Living. In addition to providing additional long term care adult facilities, taking advantage of incorporating telecommunications into healthcare was proposed as a means to engage seniors in remote areas as well as to provide employment opportunities.

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Goal 5.2: PROMOTE POLICIES AND PROGRAMS THAT KEEP INDIVIDUALS ACTIVE AND HEALTHY WHILE THEY AGE. Strategies: VNA Options is a local Medicaid managed care plan currently developing its network in Madison County. Patients keep their own primary care doctor, but the rest of their care is coordinated by a Care Manager. This will reduce errors and improve continuity of care. This is a new business and will bring some new jobs to Madison County. Promote Cornell Cooperative Extensions’ Eat Smart New York program. This is a free nutrition education program designed exclusively for individuals or families who receive SNAP, WIC, SSI or who have children in Head Start. Participants enjoy practical, interactive, hands-on lessons presented in a group setting. These lessons are to meet their needs and to focus on healthy eating, stretching food dollars and keeping food safe to eat. The goal is to improve the health and wellbeing of families with limited resources. Promote and support the nutritional programs operated by Madison County Office of the Aging (OFA). The current program includes nutrition counseling with a registered dietitian that evaluates nutritional needs, develops and implements a nutrition counseling plan, evaluates the outcome, maintains documentation and distributes appropriate literature. They also offer a congregate, noon day meal and a home delivered meals programs that provides hot nutritionally balanced meals to Madison County residents who are 60 years of age or older. The OFA has opened an emergency food cupboard for Madison County residents aged 60+. In addition, OFA staff will counsel seniors on additional programs and services that many help them budget their limited income so that they can better afford their necessities. They operate the Senior Farmers' Market Nutrition Program (SFMNP) administered by The United States Department of Agriculture provides coupons to be used at local farmers markets.

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PROMOTE A HEALTHY AND SAFE ENVIRONMENT

TIER III

STRATEGIC ISSUE 6: IMPLEMENT INITIATIVES THAT PROMOTE HEALTH AND WELLNESS WITHIN WORK, HOME AND COMMUNITY ENVIRONMENTS. Goal 6.1: LAUNCH A WORKFORCE HEALTH & PRODUCTIVTY MANAGEMENT INITIATIVE. Lead Agencies: Madison County Department of Health, Madison County Chambers of Commerce, and Madison County Rural Health Council, Madison County Planning Department

CURRENT SITUATION:

Strategies: Promote best practice and wellness initiatives for small businesses (those with 100 or less employees). Develop and disseminate information via web, e-newsletter, and Chamber meetings to present information on initiatives, programs, and best practices that have positive impacts on both employee health and business activity.

At the level of a single company, investments in the health of the workforce, just as in new information systems and advanced production technology, can lead to substantial returns to the bottom line. Illness impacts businesses by increasing employee benefit costs, increasing absenteeism, reducing productivity at work (that is, increasing presenteeism), and increasing employee turnover rates.

Conduct a study of the health issues challenging small businesses in Madison County and use this information to identify and establish appropriate work site wellness activities that are affordable, comprehensive, effective, and sustainable. The Madison County Health Department should coordinate the implementation of the study in collaboration with academia and local business groups (e.g., Chambers of Commerce). Funding will need to be identified to support the study effort. The NYS Health Foundation has funded similar projects in St. Lawrence County.

The quality and duration of life directly impact a person's ability to generate income. Improved health that prolongs working years promotes income growth by extending the duration of economic productivity. Better health with better quality of life may increase economic value by raising the economic output of each year of life that is, increasing productivity.

Evaluate the effectiveness of the pilot to determine next phase of the Health & Productivity Management initiative. Results of the study should be presented to the business community and other relevant stakeholders. As part of that discussion, action items and next steps should be identified. The Madison County Health Department or the Madison County Rural Health Council could coordinate these discussions and future activities.

Approximately 94% of employers in Madison County have 10 employees or less. Madison County has: 1191 Employers with 0 to 10 Employees; 20 Employers with 11 to 49 Employees; and 50 Employers with 50+ employees. Businesses are only counted if they have one or more employee who is covered by unemployment insurance. This employment base, with its dependence on small businesses, has significant implications for the health of our workers. Many small businesses are challenged to provide health benefits for their employees.

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Goal 6.2: LAUNCH HEALTHY HOME INITIATIVE. Lead Agencies: Madison County Department of Health, Madison County Department of Planning Strategies: Develop a “toolbox” intended to expand on the connection between health and housing, to raise greater awareness of hazards in the home environment and compile resources intended to assist in eliminating such hazards. DOH Environmental Health Division will develop the toolbox work by working with housing stakeholders to identify information needs and potential tool kit uses. Host training courses, such as Essentials for Healthy Homes Practitioners Course, for residents, contractors, planners, etc. Trainings should focus on such topics as the root causes of health problems in a home with links to the seven principals of healthy housing. The Madison County Department of Health’s Environmental Health Division has experience coordinating similar types of training activities (e.g., wastewater operators, animal control officers). Create or otherwise identify guidance documents pertinent to addressing housing hazards including lead based paint, radon, moisture intrusion and mold, insects and pests, asbestos, drinking water, wastewater disposal, energy deficiencies, trip / fall hazards, adapting for aging in home, housing maintenance and code compliance, etc. Identify and compile a Directory of Resources that identifies service providers, sampling and laboratory services, specialized contractors and professionals with capabilities needed to identify, educate homeowners, mitigate or otherwise eliminate hazards effecting habitability. Directory should be housed on the County Health Department’s web site and provide links to the various resources. Create a Healthy Home By Design Guide specific for Madison County that identifies specific housing risks such as areas of elevated radon levels, housing stock likely to contain lead paint hazards, aquifers identified as exhibiting elevated contaminants such as nitrate, coliform bacteria, arsenic; hazardous waste site locations, areas of risk associated with industrial, agricultural use or gas & mineral extraction, etc.; healthy opportunities such as areas served with fluoridated water supplies, ready access to recreational activities, etc. This Guide will incorporate smart growth principles to encourage healthy housing development as well as the healthy home principles identified above.

CURRENT SITUATION: The design of communities can directly impact public health. Many diseases are caused or exacerbated by elements of the built environment including cancer, heart disease, asthma, birth defects, behavioral disorders, infertility, and obesity. Many of the homes in Madison County are older and therefore increase the risk of lead poisoning in children. There are a higher number of children with elevated blood lead levels in the county (25.0 vs 15.0 per 1,000 in NYS) which could be linked to building materials used in homes built before 1950. Elevated radon levels have emerged as a concern in Madison County and have been identified in homes that have been built recently. Elevated levels are a result of the emission of radon gas linked to penetration of shale layers during the construction of building foundations. Prolonged exposure to radon has serious health implications and has been cited as the number one cause of lung cancer in non-smokers. Higher than average levels of radon could be linked to the higher rates of lung cancer experienced in the county.

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Goal 6.3: PROMOTE AND IMPLEMENT SMART GROWTH APPROACHES IN MADISON COUNTY AND ITS MUNICIPALITIES. Lead Agencies: Madison County Department of Health and Madison County Department of Planning Strategies: Use the Madison County’s Smart Growth Policy and Code Audit Tool for Rural Communities tool in at least 3 municipalities within the next year. The county worked with the Environmental Protection Agency (EPA) to develop an audit tool that is applicable in rural communities and small towns of various sizes, and with differing levels of smart growth knowledge and implementation. The audit tool, which should be finalized by the end of 2013, was beta tested in the City of Oneida, Village of Chittenango, and Town of Brookfield during its development. Once finalized the MCDOH and MC Planning Department staff will meet with these three communities to conduct the audit using the final tool. As part of this effort, the County will need to develop and implement a mechanism to evaluate the effectiveness, usefulness, and acceptance or integration of the tool in local planning activities. Disseminate the tool and provide education on the tool to all municipalities in Madison County. Madison County Planning Department could disseminate copies of the tool to local planners through via electronic means and make copies available at their two training workshops provided to local planners each year. Establish and provide technical assistance services to for the Tool through the County Planning Department. With the introduction of the tool to the community we should anticipate, at least initially, that local planners and individuals interested in using the tool will have questions. The Planning Department has indicated that they could provide technical assistance to the local municipalities to address questions they may have. Create a web-based version of the tool. Provide a web based version of the tool on the County Planning Department’s web site. Develop a baseline measurement and system of community indicators to better assess the current state of the natural and built environments and create community goals for improvement. The system should consider the following resources in its development: San Francisco Health Department’s Sustainable Communities Index, CDC and State Environmental Public Health Tracking Systems, Madison County Community Health Assessment and Health Improvement Plans, Madison Vitals Report (Colgate Upstate Institute) STAR Communities Initiative, Partner with Academia (Colgate, Syracuse, Univ. of Rochester)

CURRENT SITUATION: As part of the 2009 Community Health Improvement Planning process, Madison County Department of Health and Madison County Department of Planning joined forces to create a plan for the integration of SMART growth principles into county growth and development initiatives. The 10 Smart Growth Principles were developed by the Smart Growth Institute to help communities get the results they want from growth and development. These principles were based on the best practices and key policies identified in an analysis of communities across the country. The Environmental Protection Agency (EPA) worked with Madison County through its Smart Growth Implementation Assistance program. The Madison County Departments of Health and Planning requested that EPA, through this technical assistance program, help them create and apply a policy and code audit tool. Through several years of information gathering, research, and public engagement, the County has concluded that implementing smart growth approaches to development would help to address their health, economic, and environmental challenges and support their stated vision of “a place of natural beauty where families and individuals thrive.”

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ACKNOWLEDGEMENT Madison County Department of Health would like to thank the individuals and organizations who donated their time to make the community health planning initiative a success, and one which will benefit the health of Madison County residents. The following individuals participated in the planning: Arlene Brouillette, Mid York CCC/Day Care Autumn Elliott, ARISE Bernadette Chapman, Madison-Oneida BOCES Betsy Harvey-Minutti, CABVI Betty Lyboult, Hazel L. Carpenter Home, Inc. Beverly Lawton, Loretto Lifeline Bonnie Crolick, Madison County Department of Social Services Brenda Chapman, WIC Bryan Ehlinger, Oneida Healthcare Extended Care Facility Carol Tytler, CNY AHEC Danielle Licitra, Madison County Mental Health Department David Bottar, CNY Regional Planning & Development Board Debbie SeGuin, Cornell Cooperative Extension Deborah Streiff, Madison-Oneida BOCES Adult Education Denise Hummer, Community Memorial Hospital Edward Weeks, Long-Term Care Consultant Eileen Augstyn, CABVI Eve VandeWal, Excellus Blue Cross Blue Shield Gene Morreale, Oneida Healthcare Gerry Edwards, MD, Heritage Family Medicine Heather Anderson, Crouse Community Center Jeff Jenkins, HCR Homecare Jessica Prievo, Madison County Department of Social Services Jessica Sudol, ARISE Jim Raulli, Town of Sullivan Parks & Recreation Jim Simmons, Heritage Farms Joan Nicholson, Morrisville College Joanne Eddy, Madison County Youth Bureau John Endres, DVM, Madison County Board of Health John Salka, Brookfield Town Supervisor Judy Daniel, HCR Homecare Karen Bright, Madison County Department of Social Services

Karen Romano, HealtheConnections RHIO Kathleen Hayden, REACH CNY Kathy Campbell, Madison-Cortland ARC Kathy Same, Cazenovia College Katie Schneider, Madison County Department of Social Services Kipp Hicks, Madison County Industrial Development Agency Kristen Mucitelli Heath, St. Joseph’s Health Center Kris Willey, Oneida Healthcare Center-Women's Health Associates Leonard Argentine, MD, Oneida Healthcare Linda Gaut, Madison County Department of Social Services Linda Khan, Madison County Department of Social Services Liz Crockett, REACH CNY Liz Crofut, Head Start Lorraine Kinney Kitchen, Child Care Council of Cornell Cooperative Extension Lynne Bird, VNA Options Marcie Soule, Madison County Department of Social Services Marguerite Lynch, Excellus Blue Cross Blue Shield Mark Duheme, HCR Homecare MaryJo Hojohn, Madison-Oneida BOCES Michael Healy, Oneida Healthcare Nancy Zlomek, Morrisville College Nate Philo, Madison County Mental Health Department Neil Wakeman, Hamilton Manor Home for Adults Pam Heintz, Madison County Department of Social Services Pat Baron, City of Oneida Code Enforcement Patty Edwards, Madison County Office for the Aging Patty Gorman, Oneida Healthcare Paul Scopac, Oneida Healthcare Peg Buzzard, Gorman Foundation Ralph Monforte, Cazenovia Town Supervisor Community Health Improvement Plan |

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Robert Kohlbrenner, PhD, Canastota Psychologist Robert Martiniano, Center for Health Workforce Studies Robin McCombie, Town of Sullivan Parks & Recreation Sam Barr, DMD, Madison County Board of Health Sandy Eaton, Madison County Department of Social Services Scott Ingmire, Madison County Planning Department Sean Fadale, Community Memorial Hospital Sherry Allen, Stoneleigh Apartments Stephanie Manion, Tri-Valley YMCA Steven Wu, Hamilton College Sue McSweeney, Hamilton Manor Home for Adults

Susan Berger, Cazenovia College Susan Colandra, Madison-Oneida BOCES Susan Healy-Kribs, United Healthcare Susan Jenkins, BRiDGES Tara Truett, Madison County Reads Ahead Teisha Cook, Madison County Mental Health Department Terry Van Dyke, St. Joseph’s Health Center Theresa Davis, Madison County Office for the Aging Tina Lewis, Madison County Youth Bureau Tom Dennison, Syracuse University Tracy McGraw, Liberty Resources Virginia Whitford-Anken, Liberty Resources

Health Department Staff that worked to make this a success: Aaron Lazzara, Environmental Health Christine Coe, Health Administration Chrystal Johnson, Health Promotion Jennifer McGowan, Health Promotion Virginia Zombek, Health Promotion

The Madison County Community Health Improvement Plan was facilitated and written by HealtheConnections. Staff include: Kate Warner MaNtsetse Kgama Patricia McMahon Sara Wall Bollinger

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For Report Information please contact: Madison County Department of Health www.healthymadisoncounty.org © 2013 For Report Information please contact: Madison County Department of Health www.healthymadisoncounty.org © 2013 Madison County Department of Health Madison County Department of Health PO Box 605 • Wampsville, NY 13163 PO315‐366‐2361 Box 605 • Wampsville, NY 13163 Tel: • Fax: 315‐366‐2697 Tel:health@madisoncounty.ny.gov 315‐366‐2361 • Fax: 315‐366‐2697 health@madisoncounty.ny.gov

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9 - Madison County 2013 CHIP  

Madison County Community Health Improvement Plan 2013-2017

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