2024 Omaha Child & Adolescent Community Health Needs Assessment
What is the Pediatric Community Health Needs Assessment (CHNA)?
All tax-exempt health care institutions must conduct a CHNA every three years
The CHNA must
Define the community it serves
Assess the health needs of that community
Obtain stakeholder input
Document and publish the findings in a widely available format
Identify the significant health need(s) the health care institution will work to address over the next three years
How is community defined?
Our community is defined as the Omaha Metro
This includes the following counties:
Cass County, NE
Douglas County, NE
Sarpy County, NE
Pottawattamie County, IA
Location Definitions
Data from the parent survey is available by geographic location
Geographic locations include:
NE Omaha - North and East of 72nd and Dodge in Douglas County
SE Omaha - South and East of 72nd and Dodge in Douglas County
NW Omaha - North and West of 72nd and Dodge in Douglas County
SW Omaha - South and West of 72nd and Dodge in Douglas County
Western Douglas County - Rural West of Douglas County, approximately West of 204th St
Cass County, Nebraska
Sarpy County, Nebraska
Pottawattamie County, Iowa
Income Definitions
Data from the parent survey is available by family income
Incomes include:
Very Low Income: <100% Federal Poverty Level
Low Income: <200% Federal Poverty Level
Mid/High Income: ≥200% Federal Poverty Level
Who works on the CHNA?
Children's Nebraska and Boys Town National
Research Hospital partner to produce the report
Additional support and guidance from:
Building Healthy Futures
Charles Drew Health Center, Inc.
Creighton's Institute for Population Health
Douglas County Health Department
Lozier Foundation
OneWorld Community Health Center
Sarpy/Cass Health Department
How is data gathered?
Parent survey
1,100 parents across our community
Phone survey with ~110 questions
Conducted in English and Spanish
Stakeholder survey
~500 Omaha stakeholders including physicians, other health care providers, elected officials, community leaders, and social service providers
Listening sessions
Conducted by Creighton's Institute for Population Health
Learn more from specific Omaha populations that are traditionally missed in a phone survey or have needs that are not well suited to collect from a phone survey.
Immigrants
and Refugees
Those involved in the foster care system
Those that identify as LGBTQ+ Homeless and Housing insecure (conducted in partnership with CHI Health)
Race/Ethnicity Definitions
Data from the parent survey is available by race.
Races include: Black Hispanic White
Diverse Races (Those that do not fit into one of the other three groups The sample size prevents further disaggregation.)
Access to Care
Access to Care
92%
Children visited a physician for a routine check-up in the past year
This has increased from a stagnant 84% in 2012-2021. While improving overall, children in Cass county (86%), children over 5 years of age (90%) and those of diverse races (88%) are not improving at the same rate as their peers.
Children lacking health insurance coverage at some point in the last year
The number of children who went without health insurance at some point in the last year increased from 9% in 2021 to 12% in 2024. This is likely due to the unwinding of the temporarily expanded Medicaid services as a result of the COVID public health emergency
27%
Very low-income families could have used help coordinating their child's health care services or providers
This is dramatically higher than the average of 14%. Other significant disparities include parents of Black children (26%), those in Northeast Omaha (22%) and Pottawattamie county (20%).
The rate of parents feeling that their child's health care experiences were worse based on race:
1%
This rate has not changed significantly from 2021 That year's data indicated a significant disparity with Black families stating that their health care experiences were worse based on race 8% of the time, but this has improved to 4% in the past three years. 2024's data reflects no statistically significant differences based on race.
When asked the question "If you had a new baby, would you want to get all of the recommended vaccines?," 15% of parents responded no.
1 in 8 (13%)
Children used the emergency room more than once in the past year
This has more than doubled from 2021 (6.2%). Children in Northeast Omaha (23%), very low income children (22%) and those of diverse races (22%) were more likely to use the emergency room more than once The most common reason for usage other than an emergency and doctor's recommendation was it being after hours or a weekend.
Vaccine hesitancy is highest in Northeast(17%) and Southwest(16%) Omaha, and in Sarpy (17%), Cass (17%), and Pottawattamie (21%) counties. The most frequently cited reasons for not getting all recommended vaccines are safety concerns (47%), perceiving the vaccines as unnecessary (34%), and personal reasons (7%)
Access to Care
15%
Parents had difficulty getting a doctor's appointment 15%
Parents
Parents said cost of a doctor's visit prevented their child's medical care
1
Parents
Parents
Access to Care
[Immigrants and refugees] are very conscious of how they speak, because they're not able to be understood, they're not able to understand. And even myself, I have called on behalf of my clients, and the receptionist, to schedule an appointment, they're not very welcoming. So just imagine somebody who is intimidated, doesn't know the language, and you're just throwing words at them basically, because they don't understand it, they cannot retain it, and moving fast...So training people who are interacting with [immigrants and refugees] firsthand on recognizing when to bring an interpreter, ask for help, that's going to make it very easy for some of them. —
Immigrant/Refugee Listening Session Attendee
Access to a pediatric practitioner that knows the family and child, uses screening and conversation to identify needs for referral, follows up on environmental risks and trauma, and provides a safe space for child health and well-being. Many families do not have regular providers and use alternative systems (e.g. emergency room) for health care. Relatedly, many families do not have or do not know how to access medical insurance. – Community Leader
Health disparity, health systems fee-forservice structures and access to care issues make connections to care fragmented and too complex. There is limited lived experience data from a family perspective to help understand what and why challenges exist. This limits the ability to create solutions. Need broader population perspective and upstream approaches. – Other Health Provider
The same for our community, most of us go to Charles Drew because of the interpretation available there... Even though it's far up north, a lot of people are buying houses nowadays towards the West… [Charles Drew] is more convenient because of the language barriers. My mom would rather do that when I'm not available, she would go to Charles Drew and she would drive 30 minutes to come over here and get her checkup and everything with a reliable translator, everything. But some people that are in the Northwest area, they've been going to CHI Immanuel, even though they're no translators or interpreters there, they rely on their kids, or some of them in their 30s, who has limited English, they try their best to go there. And so maybe have more interpretation available on hand or something.
— Immigrant/Refugee Listening Session Attendee
Minority children and adolescents may be more likely to be uninsured or underinsured, which can limit their access to preventive services, primary care, and specialty care. Many families in North Omaha have low income, which can limit their ability to afford health care services or health insurance. This can result in delayed or foregone medical care. There is a shortage of health care providers, including pediatricians and mental health professionals, in North Omaha. This can lead to long wait times for appointments and reduced availability of services. Minority children and adolescents may face disparities in health outcomes and may experience discrimination within the health care system, which can affect their willingness to seek care and their overall health. A historical mistrust of the health care system. – Public Health Representative
Mental Health
Mental Health
8%
School-age children felt sad or hopeless almost everyday for two weeks
This means the child's feelings of sadness or hopelessness almost every day for two or more weeks caused them to stop doing their usual activities This was more often true for girls (11%), Northeast Omaha children (12%), and children in very low-income families (14%)
School-age children diagnosed with depression
Both parents and stakeholders identified mental health as the top health concern for children and adolescents
29% Parents Stakeholders
49%
Stakeholders also rated Maternal/Prenatal/Infant Health and Sexual Health in the top three Parents named Obesity/Nutrition/Exercise and Cold/Flu as the second and third health issues Stakeholders included physicians, public health representatives, other health professionals, social service providers and community leaders who have the ability to identify primary concerns for those they serve
Parents who indicate that their school-age child worries a lot, a sign of anxiety:
36%
This rate has increased from 22%
School-age children diagnosed with anxiety
1 in 9 (11%)
Omaha children experience "fair" or "poor" mental health
This has increased from 10% in 2024, and 6% in 2018. Dramatic disparities exist with 25% of very low-income children, 16% of Southwest Omaha children and 14% of Northeast Omaha children, girls and Pottawattamie county children experiencing "fair' or "poor" mental health
School-age children in Northeast Omaha (34%), Northwest Omaha (28%), girls (28%), and those in very low-income families (31%) suffer the worst disparities in anxiety diagnosis
Mental Health
School-age children were bullied in the past year, online or in person
22%
Children have ever lived with someone who had serious mental health issues
According to Mental Health America, children whose parents have mental illness are at risk of developing social, emotional, and/or behavioral problems. The percent has increased from 13% in 2018. The largest disparities are seen among Northeast Omaha children (32%), low-income children (27%), Black children (24%), and Pottawattamie county children (23%).
Children are currently receiving mental health treatment
Parent awareness of mental health resources in the community 1 in 12 (8%)
Child has difficulties sleeping
The percent of school-age children with difficulty falling asleep or sleeping through the night has risen over 150% since 2012.
School-age children with 2+ hours of screen time per weekday
Douglas county children (10%), Black children (12%), and children from very lowincome families were least likely to get their needed mental health services (10%).
School-age children in Northeast Omaha (75%), Pottawattamie county (73%), boys (74%), those in very low-income families (75%), and Black children (79%) report the highest rates of high screen time.
Mental Health
This issue has finally gotten more awareness but has significantly compounded since 2020. Schools lack resources for mental and behavioral support. Often, children with high needs are sent home when schools can't meet their needs, which creates a bigger issue for working parents. The community needs more options for families prior to crisis situations. –Social Services Provider
Though the amount of resources for mental and behavioral health is growing, there is still a big need for parents, caregivers, and people who are in contact with children to receive these types of resources. Many families, especially refugee or immigrant families, carry a stigma on mental and behavioral health, other families get overwhelmed with caring for a child that is dealing with a condition and may not know where to turn to or lose hope on the child. Treating and caring for children with various mental or behavioral health conditions can be expensive, limiting access to medications and treatments. – Public Health Representative
Especially when I compare myself with my kid, they’re growing as a king and queen, because I grew up in a refugee camp, very limited food, education, everything. When I compare, even the house, I used to live in a bamboo house. So comparatively how they stay, the food that they eat, the clothes that they wear, everything is so in a high level. So the parents are like, "Oh, okay, they're okay," but they don't know what’s going on. — Immigrant/Refugee Listening Session Attendee
Mental health is a big issue...With the young folks, what we're seeing actually, we're seeing a spike in terms of suicide ideation, substance abuse, and dependency. — Immigrant/Refugee
Listening Session Attendee
We can see our children when they get sick, physical[ly], but we can't see when our kids are having mental sickness. That's kind of challenging, because parents, they are not able to differentiate their kids how they're doing. [B]ecause of their busy schedule...parents [are] not able to know when the kids are having all those symptoms building…and it's very hard unless they really give their time and focus to the kid. I think that's the biggest issue happening, because you know when the child is having fever or stomach ache or something, but you never know how the child is growing mentally, and if they're having any kind of mental sickness like depression, or anxiety. — Immigrant/Refugee Listening Session Attendee
Social Determinants of Health
Social Determinants of Health
Children in Low-Income Households
Low-income is defined as households living below 200% of the Federal Poverty Line. This amount reflects the need for assistance and support to make ends meet. 12% of children are living in very low income households.
Stakeholder ratings of contributors to health problems among children and youth
Key stakeholders (n=220) in Omaha were asked to rank the most important Social Determinants of Health contributors to health problems among local children and youth. The chart below shows the top contributors.
Families Experiencing Food Insecurity
These families state that food has run out in the past year and/or they have been worried about running out of food before they can buy more. The rate of food security is significantly higher for certain Omaha populations
Families do not have enough cash on hand to cover a $400 emergency expense
Emergencies happen and for families without a small emergency fund, one surprise expense could send them into a cycle of debt.
1 in 4 (24%)
Children living in Northeast Omaha lived in unhealthy or unsafe housing conditions in the past year
This is more than double the average (10%) 22% of very low income children and 24% of Black children also lived in unhealthy or unsafe housing conditions in the past year
Social Determinants of Health
30%
Families find it difficult to buy affordable fresh produce
This has increased from 17% in 2021 and dramatic disparities existing in Northeast and Southeast Omaha (39% and 38%) and in low and very low income families (44% and 40%).
Families sharing 7+ meals together in the past week
Frequent family meals are linked with several protective factors influencing the lifelong health of children. They are inversely associated with disordered eating, substance abuse, violent behavior, depression and suicidal ideation. 46% of Omaha families shared 7 or more meals together in the past week.
Northeast Omaha families live in neighborhoods with rundown housing and signs of vandalism
This is dramatically higher than the average of 11%. According to the Center for Community Progress living in areas of rundown housing and vandalism contributes to health problems caused by exposure to toxins, harms mental health, and harms individual financial stability. Violent crime has been shown to increase in disinvested neighborhoods.
The rate of parents perceiving their neighborhood to be slightly/not at all safe dropped over 3% since 2021 to:
9%
3 in 10 (29%)
Children "sometimes" or "never" use neighborhood playgrounds and parks
41% of Northeast Omaha parents and 43% of Southeast Omaha parents report that children sometimes or never use their neighborhood playgrounds and parks. There is also a dramatic disparity by income with 49% of very low income parents report that children only sometimes or never using their neighborhood playgrounds and parks.
Children missing school in the past year due to feeling unsafe
10% of Omaha children missed school in 2024 due to feeling unsafe. Significant disparities exist for children in very low income and low income households (17% and 15%) and those in Northeast Omaha (15%)
Social Determinants of Health
Due to today's economy and workforce challenges, families are struggling to provide basic necessities, and our community resources are stretched very thin. Referrals to agencies that provided support in the past are no longer taking new clients, so families are going without. Need is far exceeding the amount of support our social support agencies can provide, thereby creating even greater strain on families. – Public Health Representative
It's a major problem for families in general, especially in areas of the county where the built environment has not been designed to accommodate safe spaces. For instance, there is not a lot of walking/running space in North Omaha, and the areas marked as "trails" are next to dangerously busy streets (i.e., trail off Sorenson Parkway), which can make it unsafe for children and adolescents interested in using the trail. In addition, most of the healthy activities cost money, which not all families can afford, especially if their focus is on basic needs (which are barely met). Therefore, the city should consider offering more programs that are free for lowincome families OR free in general for all families to participate in. The promotion of these programs will need to be enhanced, as I hear many times from community residents that they "didn't know" about a program or event to promote health and well-being, mainly because it was poorly promoted. – Public Health Representative
Housing, housing, housing … we have a big gap in healthy housing options for families, and our children are suffering as a result. Without stable, healthy housing options, children will continue to experience trauma related to frequent upheaval from school and family environments, and many of their health conditions will worsen due to living in aging homes that expose them to pollutants, bed bugs, and mold. The cumulative effect are unhealthy children that lack connection to community, children that become disengaged in school, and children experiencing illnesses over and over. – Public Health Representative
The workload, I think is something that hampers the health of the refugee children and all refugees themselves, even if they're adults. So they work a lot, and they're going to not find enough time to give it to their children, to go to hospitals for their general checkup, even if there not a bigger issue. And that small issue can lead to the bigger one, but they will ignore it because they can't take their work and they cannot find time — Immigrant/Refugee Listening Session Attendee
The challenges that we are seeing is that as immigrants, we are not raised to go for yearly checkups, so vaccines. So when parents come over here, that is something that's very new to them. So with education and having health fairs, bringing service providers to them, that does make it easier for them to understand the importance of either vaccines or yearly checkups, or dental appointments like every six weeks, all those kinds of stuff, it comes with education. So the other thing is when parents come, they're focused on survival. So with work schedule, juggling the kids, sometimes it's a one-income household, so all their energy goes to providing those things. If we are looking at Maslow's hierarchy of needs, the basics, that's what they're focused on. So as you go up, "Do I go to work, or do I take time off unpaid just to take a child who's not sick to the doctor?" To them it makes more sense to go to work and get paid than take a well child to the doctor. — Immigrant/Refugee Listening Session Attendee
