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PROUD HERITAGE HEALTHY FUTURE STRENGTHENING THE TIES THAT BIND

The Results of the Trinity-Conception Community Health Needs Assessment


PROUD HERITAGE, HEALTHY FUTURE: STRENGTHENING THE TIES THAT BIND The Results of the Trinity-Conception Community Health Needs Assessment, 2012


ACKNOWLEDGEMENTS Advisory Committee (Community Members): Gina Bishop, Kim Crane, Dale Decker, David Fowlow, Gillian Janes (Project Lead, Eastern Health), Pat March, Jonathan Neil, Joyce Petten, Rachelle Porter (Steering Committee Liaison, Eastern Health), Kelly Sheppard, Rosalind Snow, Reginald Stanford, Denise Strong Steering Committee (Eastern Health Employees): Cindy Clarke, RenĂŠe Dobbin, Gail Downing, Mary Harris, Gillian Janes (Project Lead), Joy Loveys, Sharon Metcalfe, Cal Morgan (retired), Wayne Miller (Executive Sponsor), Lilly Mulrooney, Patricia Noonan, Maxine Paul, Colleen Piercey, Rachelle Porter, Joanne Stares, Wynn Anne Warren Primary Research: Participants of the telephone survey, focus groups, key informant interviews, public submissions, and all those who helped to recruit participants Secondary Research: Jordan Pike, Librarian, Eastern Health; individuals who provided reports and data on the Trinity-Conception region; Newfoundland Labrador Housing; Newfoundland and Labrador Statistics Agency Administrative Support: Patricia Rideout and Pauline Chatman, Eastern Health Communications: Deborah Collins and Angela Lawrence, Eastern Health Photography: Cindy Clarke, Gail Downing, Gillian Janes, Robyn Lush, Maxine Paul, Patricia Rideout, and Robert Shannahan.

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EXECUTIVE SUMMARY EASTERN HEALTH Eastern Health is the largest integrated health authority in Newfoundland and Labrador, serving a regional population of approximately 300,000. It provides the full continuum of health and community services, including public health, hospital care and long-term care, as well as some provincial responsibilities (e.g., Cancer Care, Cardiac/Critical Care). The organization has approximately 13,000 employees, 720 members of medical staff and 1,500 volunteers.

COMMUNITY HEALTH NEEDS ASSESSMENT Since Eastern Health was established in 2005, needs assessments have been a priority for its Board of Trustees as well as a requirement under the Regional Health Authorities Act (2004). The purpose of a community health needs assessment is to gather information about the health of an area based on diverse perspectives.

THE DETERMINANTS OF HEALTH The determinants of health are all of the factors that interact to affect the health of individuals and communities; they provide the “lens” through which we view our communities. Some examples include income and social status, education and literacy, and healthy child development.

THE TRINITYCONCEPTION AREA The backdrop for this needs assessment is a rugged yet breathtaking environment that has dominantly influenced its residents for centuries. The Trinity-Conception area still has obvious ties to the sea and the fishery despite major industrial changes, and there remains a strong sense of community throughout the area that has lasted for generations. The Trinity-Conception Community Health Needs Assessment was launched in July 2011. Throughout the needs assessment process, it was obvious that people of Trinity-Conception are proud of their culture and traditions; however, they are equally concerned about how to address concerns and ensure the viability of the region in the future.

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METHODS AND METHODOLOGY All of Eastern Health’s community health needs assessments have involved gathering information from the public in a variety of ways, or “mixed methods”: telephone surveys, one-on-one interviews with key informants, focus groups, and written/oral/electronic submissions from the public. Social media (i.e., Facebook and Twitter) also provided opportunities to interact with the public. Secondary research included data and reports specific to the Trinity-Conception area, with provincial and national comparisons where possible. Getting input from numerous sources enables us to “triangulate” data, which means that if a theme emerges from several different research methods, then it most likely is a pressing issue in the area.

SUMMARY OF FINDINGS The wealth of information from the primary and secondary research was organized into themes to identify the issues that were mentioned most frequently throughout the region. These key themes are: (1) Preventive Approaches and Education: In general, people want to see an emphasis on the preventive aspects of health, such as education and awareness about the benefits of nutrition, physical activity and healthy lifestyles. (2) Health Services: Three main aspects of health services identified are: mental health and addictions, family doctors and satisfaction with services. Transportation was mentioned repeatedly in the focus groups and interviews as a barrier to access throughout the region, particularly given the geographic dispersion, the lack of public transportation and the limited availability of private transportation. (3) Social Supports/Community-Based Supports: Social support networks and communitybased services are strong in the Trinity-Conception area. While the level of commitment to supporting each other and our communities is commendable, there is a strong sense that more could be done to identify and meet needs at the local level and promote regional cooperation. (4) Communication and Awareness: It is important for programs and services to be well communicated in Trinity-Conception so that people are aware of and knowledgeable about what is available and how to gain access. (5) Housing: Housing and rental prices in many areas have increased while an already limited availability of rental properties has further decreased due to rising demand. There is also a need for suitable housing supports for vulnerable residents, particularly those with complex mental health issues or seniors living alone in older homes.

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RECOMMENDATIONS The recommendations of this needs assessment involve maximizing resources, working with community partners, and linking with existing initiatives within Eastern Health. A summary of the recommendations are as follows: 1. Expand Eastern Health’s Chronic Disease Self-Management Workshops to the TrinityConception area. 2. Approach Trinity-Conception local media to collaborate with Eastern Health on various topics related to prevention, health promotion and overall healthy living specific to the area. This would help expand on existing initiatives throughout Eastern Health, particularly through the work of the Health Promotion division and Wellness Coalitions. 3. Explore new models of care delivery that involve a “hub” or group of physicians in a larger area, such as Carbonear, with outreach and mobile services to other communities throughout the Trinity-Conception area. 4. Investigate options to expand the role of other health professionals in the TrinityConception area. In particular: a. Review the allocation and roles of Nurse Practitioners (NPs) within Eastern Health to determine opportunities for rural communities. b. Submit information from this needs assessment to the upcoming provincial review of road and air ambulance services. This submission would include considering opportunities for the role of paramedics to be expanded to focus on preventive aspects of health in rural communities. 5. Develop a proposal to expand the use of Telehealth or other distance technologies to advance patient care in Mental Health and Addictions Services, which will build on the recent Telehealth installation for the Mental Health program in Carbonear General Hospital. 6. Develop a local community advisory committee to review identified mental health issues and develop an action plan to addresses these issues.

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7. Work with partner groups to expand peer support initiatives, including: a. Explore options to expand the Peer Support Training Program developed by the Consumers’ Health Awareness Network Newfoundland and Labrador (CHANNAL) in the Trinity-Conception area. b. Explore opportunities to expand the Friendship Corner, which is a community support group for consumers of mental health services facilitated by Eastern Health staff based in Harbour Grace. 8. Include contact information (e.g., phone numbers) of key health services available to residents in Trinity-Conception area in the needs assessment summary brochure that will be distributed to each mailbox in the region. 9. Expand on the ongoing re-development and maintenance of Eastern Health’s website, www.easternhealth.ca. This includes: a. Providing up-to-date information on every Eastern Health program and service for easy access to information. b. Providing answers to frequently asked questions to help guide the public, such as contact numbers and hours of operation. 10. Establish an Eastern Health Working Group to identify the best way to build and maintain an inventory of community-based organizations and resources throughout the region. This will enable easier access to contact information and increase opportunities for collaboration with community partners. 11. Host a forum within two years between the Mental Health and Addictions program and its referral sources (especially school districts and family doctors) to develop broader awareness of each others’ roles, discuss referral and prioritization processes, discuss how to increase peer support in the area and other related topics. 12. Develop a semi-annual forum for dialogue between Eastern Health and community family doctors to share information about health services. 13. Host a professional development session whereby Eastern Health staff, in partnership with the Baccalieu Advisory Board on Housing and Homelessness, learn about the impact of housing on health and opportunities for collaboration.

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CONCLUSION This assessment links with and builds on numerous existing initiatives within Eastern Health, including the Health Promotion Plan, the Wellness Coalitions and the 2011-14 operational plans within each program of Eastern Health. Most notably, the needs assessments completed by Eastern Health to date have helped to shape our strategic plan 2011-14, Together We Can, and its four main priority areas: Quality & Safety, Access, Sustainability and Population Health.

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TABLE OF CONTENTS Eastern Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1 Community Health Needs Assessments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3 The Determinants of Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5 Income and Social Status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Education and Literacy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Employment and Working Conditions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Social Environments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Social Support Networks. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Physical Environments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Healthy Child Development . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Biology and Genetic Endowment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Health Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Culture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Gender . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Personal Health Practices and Coping Skills. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Background: The Trinity-Conception Area . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8 Profile of the Area: The Facts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10 Methods and Methodology: How Did We Get Information? . . . . . . . . . . . . . . . . . . . . . .14 Primary Research. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 Secondary Research. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

Summary of Findings: What Did We Hear? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17 What We Heard: Preventive Approaches and Education . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 Recommendations Related to Preventive Approachesand Education . . . . . . . . . . . . . . . . . . . 20 What We Heard: Health Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 Recommendations Related to Health Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 What We Heard: Social Supports/Community-Based Supports . . . . . . . . . . . . . . . . . . . . . . . 27 Recommendation Related to Social Supports/Community-Based Supports. . . . . . . . . . . . . . 28 What We Heard: Communication and Awareness. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 Recommendations Related to Communications and Awareness. . . . . . . . . . . . . . . . . . . . . . . 30

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What We Heard: Housing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 Recommendation Related to Housing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33

Summary of Eastern Health’s Community Health Needs Assessments . . . . . . . . . . . . .34 Linking Recommendations to Other Initiatives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .36 Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .38 Appendix I: Telephone Survey Executive Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . .40 Appendix II: List of Key Informants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45 Appendix III: Key Informant Interview Guide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .46 Appendix IV: List of Focus Groups . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .48 Appendix V: Focus Group Question Guide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .49 Appendix VI: Written and Oral Submissions Received . . . . . . . . . . . . . . . . . . . . . . . . . .50 Appendix VII: Secondary Sources (Literature Review and Data Sources) . . . . . . . . . . .51

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TABLE OF FIGURES Figure 1:

Map of Eastern Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2

Figure 2:

Map of Trinity-Conception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11

Figure 3:

Percentage of Population aged 25-54 with Bachelor’s Degree or Higher (2006) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13

Figure 4:

Rate of Smoking (Canadian Community Health Survey, 2009-10) . . . . .19

Figure 5:

Rate of Alcohol Consumption (Canadian Community Health Survey, 2009-10) . . . . . . . . . . . . . . . . . . .19

Figure 6:

Access to Family Doctors in Trinity-Conception . . . . . . . . . . . . . . . . . .22

Figure 7:

People Reporting Having a Family Doctor by Needs Assessment . . . . . .23

Figure 8:

Wait Times for Family Physician Appointments and Satisfaction Levels (Very Satisfied or Satisfied) by Needs Assessment . . . . . . . . . . . . . . . . .23

Figure 9:

Satisfaction with Health and Community Services . . . . . . . . . . . . . . . . .24

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TABLE OF TABLES

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Table 1:

% Population Increases from 2006-2011 Census . . . . . . . . . . . . . . . . . . .12

Table 2:

Population Decreases from 2006-2011 Census . . . . . . . . . . . . . . . . . . . .13

Table 3:

Summary of Primary Research . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15

Table 4:

Waitlist for Mental Health Services and Addictions Services in TrinityConception (November 2011) and Discovery Region (November 2010) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21

Table 5:

Waitlist Data for NL Housing in Trinity-Conception (as of February 17, 2012) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .32


THE RESULTS OF THE TRINITYďšşCONCEPTION COMMUNITY HEALTH NEEDS ASSESSMENT

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Eastern Health

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Eastern Health is the largest integrated health authority in Newfoundland and Labrador, serving a regional population of approximately 300,000. Its boundaries extend from Port Blandford east to St. John’s and include all communities on the Bonavista, Burin and Avalon peninsulas. The organization provides the full continuum of health and community services, including public

health, hospital care and long-term care. Services are offered in 30 communities, through community-based offices, clinics, hospitals and nursing homes. Eastern Health has approximately 13,000 employees, 720 members of medical staff and 1,500 volunteers. In addition to its regional responsibilities, Eastern Health is responsible for provincial tertiary level health services through its academic healthcare facilities, such as pediatrics and cardiac/critical care. The


PROUD HERITAGE, HEALTHY FUTURE: STRENGTHENING THE TIES THAT BIND

organization also administers numerous provincial programs and services to other areas of the province, such as Cancer Care, Provincial Genetics, Organ Procurement and Stem Cell Transplantation. Eastern Health partners with a

FIGURE 1:

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MAP OF EASTERN HEALTH

number of organizations – particularly Memorial University of Newfoundland and College of the North Atlantic – to educate the next generation of health professionals, conduct research and improve patient, client and resident care.


THE RESULTS OF THE TRINITYCONCEPTION COMMUNITY HEALTH NEEDS ASSESSMENT

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Community Health Needs Assessments

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Since Eastern Health was established in 2005, needs assessments have been a priority for its Board of Trustees as well as a requirement under the Regional Health Authorities Act (2004). Eastern Health has conducted community health needs assessments on the Burin Peninsula (2006),

the Southern Avalon (2007), the Northeast Avalon (2010) and the Discovery Zone (Bonavista to Port Blandford to Swift Current to Chapel Arm, 2011). In addition, two of the legacy organizations of Eastern Health (i.e., the Healthcare Corporation of St. John’s and Health and Community Services - St. John’s) partnered with the Bell Island Health and Wellness Committee to undertake a community health needs assessment, which was released in 2006.


PROUD HERITAGE, HEALTHY FUTURE: STRENGTHENING THE TIES THAT BIND

The purpose of a community health needs assessment is to gather information about the health of an area based on diverse perspectives. These assessments help to facilitate dialogue with individuals and groups in the area, increase public participation concerning the health of communities, identify issues as well as recommend actions to address the issues (Cavanagh & Chadwick, 2005). Steering committees comprised of Eastern Health employees oversee each needs assessment process. Advisory committees, comprised of community members who respond to a public call, provide support and guidance to the process as well.

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A significant aspect of needs assessments involves asking people their opinions. For the Trinity-Conception assessment, a telephone survey, key informant interviews, focus groups, and public submissions provided these opinions and are summarized in subsequent sections of this report. Additionally, social media (i.e., Facebook and Twitter) provided further opportunities for interaction and promotion of the needs assessment. Secondary research, including a literature review and data analysis, was also used to validate findings. Eastern Health has conducted its needs assessments with two key underlying beliefs in mind: 1. Communities have the strengths, knowledge and skills necessary to originate programs which influence the determinants of health and which promote overall health and well-being; 2. Individuals have an important role to play in making communities a healthier place to live. A significant aspect of Eastern Health’s needs assessments has been the participation of

community members who sit on the advisory committees. These committees provide Eastern Health with important insights directly from area residents from all walks of life, while at the same time offering each committee member unique opportunities and experiences to work together to achieve common goals. Some of the advisory committee members from Trinity-Conception provide their perspective on this experience in the following quotations: “…(S)erving on the committee gave me an opportunity to see what others struggle with re: health care. It is difficult to see beyond our own experiences at times and see the world through someone else’s. It gives you a new perspective and sometimes even a new appreciation for the struggles of others. Professionally, it also opened my eyes to the struggles of others (re: health care), but it also broadened my network of community members and service providers to call upon for information to move my work forward, guidance and fresh perspectives.” —Kim Crane, Tilton “It has been a privilege and quite the learning experience for me being a part of the Community Health Needs Assessment Committee for the Trinity-Conception Region of Eastern Health.” —Dave Fowlow, Heart’s Delight-Islington “…My experience with the process has been positive…Many of these issues are complex and will take time and effort to solve. However, the first step in any process is to critically analyze the past and present to see what lessons we can learn. The future is where we try to put in place the plans to deal with these issues. Hopefully, the process we have started will lead to improvements that can be further built on in the years to come.” —Reg Stanford, Blaketown


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The Determinants of Health

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Throughout all of the community health needs assessments conducted by Eastern Health the determinants of health have provided the “lens” through which we view our communities. The determinants of health are, in short, all of the factors that interact to affect the health of individuals and communities. The Public Health Agency of Canada (2003) provides a description of each of these 12 determinants.

Income and Social Status Higher income affects living conditions such as safe housing and the ability to buy sufficient food. Research indicates that the healthiest populations are those in societies that are prosperous and that have an equitable distribution of wealth: large gaps in income distribution amongst a population lead to increases in social problems and poorer health among the population as a whole.


PROUD HERITAGE, HEALTHY FUTURE: STRENGTHENING THE TIES THAT BIND

Education and Literacy

Physical Environments

Health status improves with education level. Canadians with low literacy skills are more likely to be unemployed and poor, to suffer poorer health and to die earlier than Canadians with high levels of literacy.

Contaminants in our air, water, food and soil can cause a variety of adverse health effects. Likewise, factors related to housing, indoor air quality, and the design of communities and transportation systems can significantly influence our physical and psychological well-being.

Employment and Working Conditions 6

Unemployment, underemployment, stressful or unsafe work are associated with poorer health. Paid work provides not only money, but also a sense of identity and purpose, social contacts and opportunities for personal growth. Conditions at work can also have a profound effect on health and emotional well-being.

Social Environments

Healthy Child Development Experiences from conception to age six have the most important influence on brain development. There is a wealth of evidence indicating that positive stimulation early in life improves learning, behaviour and health into adulthood.

Biology and Genetic Endowment

The importance of social support extends to the broader community. Values and norms such as safety within a society influence the health of individuals and populations.

The basic biology of the human body is a fundamental determinant of health. Genetic endowment appears to predispose certain individuals to particular diseases or health problems.

Social Support Networks

Health Services

Support, caring and respect from family members, friends and communities is linked to better health. For example, research suggests that the more social contacts people have, the lower their premature death rates.

Health services, particularly those designed to maintain and promote health, help to prevent disease, to restore health and to contribute to population health. For the most part, Canadians have access to universal health care; however,


THE RESULTS OF THE TRINITYďšşCONCEPTION COMMUNITY HEALTH NEEDS ASSESSMENT

many low- and moderate-income Canadians have limited or no access to some health services such as eye care, dentistry, mental health counselling and prescription drugs.

Culture Some persons or groups may face additional health risks due to their socio-economic environment, which is largely determined by dominant cultural values that contribute to the perpetuation of conditions such as marginalization, stigmatization, loss or devaluation of language and culture and lack of access to culturally appropriate health care and services. For example, suicide rates have been higher amongst Canada’s First Nations compared with other populations within Canada.

Gender Gender refers to roles, attitudes, behaviours, values, relative power and influence that society places differently on both sexes. For example, statistics show that men are more likely to die prematurely than women, mainly as a result of heart disease, injuries, cancer and suicide. While women live longer than men, they are more likely to suffer depression, stress overload (often due to efforts to balance work and family life), chronic conditions such as arthritis and allergies, and injuries and death resulting from family violence.

Personal Health Practices and Coping Skills Personal health practices and coping skills refer to ways individuals can prevent diseases and promote self-care, cope with challenges, develop self-reliance, solve problems and make choices that enhance health. For instance, smoking and the use of alcohol have major impacts on health.

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PROUD HERITAGE, HEALTHY FUTURE: STRENGTHENING THE TIES THAT BIND

Background: The TrinityConception Area

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“It took the sea a thousand years, A thousand years to trace The granite features of this cliff, In crag and scarp and base.” This excerpt from E. J. Pratt’s poem “Erosion” could have been written about any of the shores of this province; however since this prolific writer was originally from Western Bay, the poem’s imagery is certainly fitting as the setting

for the Trinity-Conception Community Health Needs Assessment. From “Mad Rock” and “Old Harry” in Conception Bay, “Shag Rock” in Trinity Bay, the Baccalieu Island Ecological Site to the fossil sites in Spaniard's Bay, Bishop’s Cove, and Upper Island Cove, the backdrop for this needs assessment is a rugged yet breathtaking environment that has dominantly influenced its residents for centuries. The Trinity-Conception area (also known as the Baccalieu Trail, the Mariner Resource


THE RESULTS OF THE TRINITYCONCEPTION COMMUNITY HEALTH NEEDS ASSESSMENT

“YOU CAN STILL SEE EVERY STAR IN THE SKY, EVERY RIPPLE IN THE OCEAN.” FOCUS GROUP PARTICIPANT DESCRIBING THE VIEW FROM HIS HOME

Opportunities Network and Economic Zone 17) holds a wealth of history, adventure and intrigue of which its residents are fiercely proud. The recognition of Cupids as the birthplace of English Canada in 1610, the legend of pirates like Peter Easton, the legacy of Princess Sheila NaGeira, the development of technology at the Heart’s Content Cable Station, Amelia Earhart’s aviation history in Harbour Grace and the settlement of Whitbourne as the province’s first inland community are but a few examples of this rich history. The ties to the sea and the fishery are still obvious despite major industrial changes and there remains a strong sense of community throughout the area that has lasted for generations. This sense of community was evident from the onset of this needs assessment. The public launch of the assessment in Carbonear, Old Perlican and Dildo was well attended by individuals and community groups. Residents from a wide range of backgrounds participated in focus groups and interviews and many community representatives offered freely of their time to host events or actively recruit attendees. There was also an excellent response to public calls to sit on the Advisory Committee and to provide written, oral or electronic submissions. Lively and passionate discussions took place throughout the region as participants shared their views on what is working well in their communities and what they feel needs improvement. Throughout the entire process, it was obvious that people of Trinity-Conception are proud of their culture and traditions; however,

they are equally concerned about how to address concerns and ensure the viability of the region in future. This report outlines how information was gathered during this need assessment, the major themes that were brought forward as well as a number of proposed recommendations for action for Eastern Health to undertake along with its community partners. As the title of this report— Proud Heritage, Healthy Future: Strengthening the Ties that Bind—suggests, we hope readers will find this to be a concise and practical document that will be used for planning and prioritizing with community groups and service providers throughout the Trinity-Conception region.

FAST FACT In the 2009-10 version of Statistics Canada’s Canadian Community Health Survey, 84.7% of respondents of the Trinity-Conception area identified themselves as having a “very strong or somewhat strong sense of belonging to a community”. Source: www.communityaccounts.ca

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PROUD HERITAGE, HEALTHY FUTURE: STRENGTHENING THE TIES THAT BIND

Profile of the Area: The Facts

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As indicated in Figure 2, the Trinity-Conception region (i.e., Economic Zone 17) includes the northwest portion of the Avalon Peninsula. Starting with Brigus Junction, the zone includes all communities in Conception Bay North, the North Shore of Conception and Trinity Bays, Lower Trinity South and Whitbourne. Socioeconomic data from a number of sources provide

more details on the Trinity-Conception area. Notably, at the time of writing this report, data from the 2011 Census was just becoming available (i.e., community-level population counts only); hence 2006 Census data was mainly used for this profile, along with data from the Newfoundland and Labrador Statistics agency through Community Accounts www.communityaccounts.ca. Complete data sources used for this profile are listed under Appendix VII, Secondary Sources.


THE RESULTS OF THE TRINITYCONCEPTION COMMUNITY HEALTH NEEDS ASSESSMENT

Like many rural parts of the province of Newfoundland and Labrador, the TrinityConception area has pockets of growth – mostly in the service centres – with many smaller

communities exhibiting sharp population declines and an aging population. The population of the area (Census 2006) is 39,850, a decline of 2.7% from the 2001 Census.

Grates Cove

FIGURE 2:

MAP OF TRINITYCONCEPTION

Red Head Cove Old Perlican Bay de Verde

New Chelsea-New MelbourneBrownsdale-Sibleys Cove-Lead Cove

Low Point Caplin Cove

Hant’s Harbour

Lower Island Cove Job’s Cove Burnt Point-Gull Island-Northern Bay

Winterton Turks Cove

Ochre Pit Cove

New Perlican

Western Bay Small Point-Broad Cove-Blackhead-Adams Cove

Heart’s Content Heart’s Desire

Kingston Perry’s Cove Salmon Cove Victoria Freshwater Carbonear Harbour Grace Bryant’s Cove Upper Island Cove Bishop’s Cove Spaniard’s Bay Bay Roberts Port de Grave Bareneed Clarke’s Beach Cupids North River South River Brigus Georgetown Makinsons

Heart’s Delight-Islington Cavendish Whiteway Green’s Harbour Hopeall New Harbour Dildo Old Shop South Dildo Blaketown

Whitbourne

Roaches Line Ocean Pond Brigus Junction

11


PROUD HERITAGE, HEALTHY FUTURE: STRENGTHENING THE TIES THAT BIND

TABLE 1:

% POPULATION INCREASES FROM 2006 2011 CENSUS

COMMUNITY

12

% POPULATION INCREASE FROM 2006 TO 2011 CENSUS

POPULATION 2011 CENSUS

Whteway

33.2%

293

New Perlican

11.7%

210

Clarke’s Beach

8.3%

1,396

Bay Roberts

7.5%

5,818

Whitbourne

7.1%

916

Heart’s Delight-Islington

6.2%

704

Spaniard’s Bay

3.2%

2,622

Harbour Grace

1.9%

3,131

North River

0.9%

562

South River

0.9%

655

Carbonear

0.3%

4,739

Preliminary data available from the 2011 Census in Table 1 indicated that the following municipalities had increases in their population as compared with 2006.

of the population received Income Support Assistance at some point, which was similar to the provincial average of 10.0%. According to the Canadian Community Health Survey (2009-10), 12.3% of individuals age 12 and over in Trinity-Conception rated their health status as “excellent” and another 44.1% rated as “very good”; for the province, the rates were 16.2% and 43.9%, respectively. The highest percentage of hospital morbidity/separations during 2006-07 was due to diseases of the circulatory system, at 15.1%. Diseases of the circulatory system were also highest for the province, at 13.2%. The median age for people with this diagnosis in TrinityConception was 70 years. The top five cases of death by selected chronic disease in Trinity-Conception were malignant neoplasms (i.e., cancer), ischaemic heart disease, cerebrovascular disease (e.g., stroke), diabetes and chronic lower respiratory disease.

FAST FACTS

The 2011 Census showed that a number of municipalities had decreases in their population as compared with 2006 as indicated in Table 2. In the Trinity-Conception area, the employment picture is diverse with many residents working in the services sector (particularly health, education and retail), processing and manufacturing, primary industries, and construction. The incidence of employment insurance in 2009 was 47.5% in the area compared with 34.4% for Newfoundland and Labrador. The gross income (i.e., gross personal income per capita) for every man, woman and child in 2007 was $21,100; for the province it was $24,900. During 2008, 10.8%

The median age of the Trinity-Conception area in 2006 was 44; for the province it was 42. In 2010 there were 325 births, which was a 1.5% decrease over 2009 in the TrinityConception area. The 2009 birth rate (i.e., the ratio of live births to the population expressed per 1,000) was 8 for Trinity-Conception area; for the province it was 10.


THE RESULTS OF THE TRINITYCONCEPTION COMMUNITY HEALTH NEEDS ASSESSMENT

TABLE 2:

POPULATION DECREASES FROM 2006 2011 CENSUS

COMMUNITY

% POPULATION DECREASE FROM 2006 TO 2011 CENSUS

PERCENTAGE OF POPULATION AGED 25 54 WITH BACHELOR’S DEGREE OR HIGHER 2006

POPULATION 2011 CENSUS

Bishop’s Cove

-16.4%

275

Bay de Verde

-15.3%

398

-13.7

346

Small Point-Adam’s Cove-Blackhead-Broad Cove

-11.2%

389

Heart’s Content

-10.3%

375

Winterton

-6.6%

484

Brigus

-5.5%

750

Bryant’s Cove

-5.0%

396

Upper Island Cove

-4.4%

1,594

Cupids

-3.7%

761

Old Perlican

-2.2%

661

Heart’s Desire

-1.3%

223

Victoria

-0.3%

1,764

Hant’s Harbour

FIGURE 3:

Education levels in the Trinity-Conception area are similar to those of the province. Twentyseven per cent (27%) of people aged 18-64 do not have a high school diploma, as compared with 25.1% for Newfoundland and Labrador (2006). Figure 3 shows that in 2006, 9.5% of people aged 25 to 54 in Trinity-Conception had a Bachelor’s Degree or higher as compared to 15.1% for the province overall.

15.1% 9.50%

 Trinity-Conception Area  Province

FAST FACT In 2008, the Low Income Incidence (based on the NL Market Basket Measure) was 15.3% in Trinity-Conception; this was the same as the provincial rate for that same year.

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PROUD HERITAGE, HEALTHY FUTURE: STRENGTHENING THE TIES THAT BIND

Methods and Methodology: How Did We Get Information?

6

14

All of Eastern Health’s community health needs assessments have involved gathering information from the public in a variety of ways. This “mixed methods” approach included: telephone surveys, one-on-one interviews with key informants, focus groups, and written/oral/electronic submissions from the public.

Getting input from numerous sources enables us to “triangulate” data, which means that if a theme emerges from several different research methods, then it most likely is a pressing issue in the area. The Trinity-Conception Community Health Needs Assessment was publicly launched in July 2011 in three communities throughout the region: Carbonear in Conception Bay North, Old Perlican on the North Shore and Dildo in Trinity South. Community groups, elected officials and the general public were invited to attend the launch to find out more about the needs


THE RESULTS OF THE TRINITYCONCEPTION COMMUNITY HEALTH NEEDS ASSESSMENT

assessment process and how to get involved. Immediately after the event, Eastern Health began to gather information from area residents, as outlined below.

Primary Research

The Trinity-Conception telephone survey was conducted with a random sample of 603 individuals aged 19 or older in each of the three aforementioned areas. A statistically reliable sample was used in each area and the overall margin of error was approximately + 3.97 (at the 95% confidence level).

A summary of the level of participation in the primary research is provided in Table 3. The subsequent paragraphs provide a description of each of the methods.

In terms of the demographic profile of the survey respondents, approximately 32% were age 31-49, 62% were age 50 or older and 58% were female.

(a) Telephone Survey A telephone survey was conducted on Eastern Health’s behalf by MarketQuest-Omnifacts during July and August 2011. This survey was based on previous telephone surveys completed for needs assessments within other areas of Eastern Health’s boundaries, with minor changes for the target geography of Trinity-Conception. The survey compared three areas within TrinityConception: Conception Bay North (from Brigus to Kingston), the North Shore (from Small Point to Heart’s Content) and Trinity South (from Heart’s Desire to Whitbourne).

TABLE 3:

SUMMARY OF PRIMARY RESEARCH

RESEARCH METHOD

NUMBER OF PARTICIPANTS

(a)

Telephone Survey 603 Surveys in Total

• • •

Conception Bay North Area: 201 North Shore Area: 200 Trinity South Area: 202

(b)

Key Informant Interviews 30 Interviews in Total

• •

26 Different Organizations 42 Participants

(c)

Focus Groups 26 Focus Groups in Total

• •

23 Different Organizations 178 Participants

(d)

Public Submissions 19 Submissions in Total

8 Oral Submissions (i.e., by telephone) 10 Electronic Submissions (i.e., by email and fax) 1 Written Submission (i.e., letter)

• •

TOTAL:

842 PARTICIPANTS

The Executive Summary of the telephone survey is provided in Appendix I. The full telephone survey report, including the questionnaire and report of results from 603 respondents, is available to the public on Eastern Health’s website www.easternhealth.ca. (b) Key Informant Interviews Between July 2011 and January 2012, 30 interviews were completed with a wide range of participants: from individuals with an interest in the assessment process to regional and provincial service providers and elected officials. Interviews ranged from approximately 30-120 minutes, some of which involved interviewing several people at the same time, and were completed in all areas of the region. Interviewees were identified in a variety of ways, such as calling representatives of local community-based groups, consulting committee members for suggested names and asking who else should be contacted at the end of each individual interview (i.e., “snowball sampling”). A list of all organizations who participated in the interviews is provided in Appendix II and the interview questions are included in Appendix III. (c) Focus Groups Twenty-six focus groups were completed between August and December 2011. These sessions also included a wide variety of participants, from secondary school students to seniors living in long-term care. The sessions

15


PROUD HERITAGE, HEALTHY FUTURE: STRENGTHENING THE TIES THAT BIND

lasted between approximately 30 and 120 minutes and were conducted throughout the region. A variety of recruitment methods were used, including electronic invitations via email, posting flyers in public places and meeting with existing community-based groups during their regularly-scheduled times. The number of participants during the sessions ranged from two to 12. A list of focus groups completed is available in Appendix IV and the focus group questions are listed in Appendix V.

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(d) Written/Oral/Electronic Submissions from the Public Nineteen submissions were made either by email, telephone, letter or fax from individuals and community groups. The call for public submissions was widely advertised (e.g., the Compass, cable channel, email distribution list, social media, through committee members). Submission topics ranged from community health concerns for one particular agency to regional issues affecting all residents. Appendix VI includes a list of public submissions received.

Secondary Research Additional information was provided through a literature review and analysis of data from within Eastern Health, provincial sources (e.g., Community Accounts) as well as national sources (e.g., Census 2011, Canadian Institute for Health Information). A complete list of reports and data sources is available in Appendix VII.


THE RESULTS OF THE TRINITYďšşCONCEPTION COMMUNITY HEALTH NEEDS ASSESSMENT

7

Summary of Findings: What Did We Hear?

17

A wealth of information was provided through both the primary and secondary research.



Preventive Approaches and Education



Health Services

This information was organized into themes to identify the issues that were mentioned most frequently throughout the region. These key themes are:



Social Supports/Community-based Supports



Communication and Awareness



Housing


PROUD HERITAGE, HEALTHY FUTURE: STRENGTHENING THE TIES THAT BIND

What We Heard: Preventive Approaches and Education Focusing on prevention was a strong theme that emerged through the primary research. In general, people want to see an emphasis on the preventive aspects of health, such as education and awareness about the benefits of nutrition, physical activity and healthy lifestyles. People also understand that education about healthy lifestyles needs to begin at an early age and needs to be promoted at all stages of life.

18

Indeed, there appears to be a firm understanding in the region that an emphasis on prevention generally means there will be less need for treatment later in life; that preventive measures should result in less strain on the health system over the long term by reducing the need for treatment. There is also a wide recognition that preventive approaches require a long-term commitment because we may not see the benefits of our efforts for years to come. For instance, the efforts currently put into promoting nutrition and healthy living with school-aged children will not demonstrate results such as reduced rates of obesity or Type 2 Diabetes until those children reach adulthood. While this focus on education and awareness was brought forward as important to ensure people

i

know the benefits of healthy living, another key message was also brought forward: people need support for how to have a healthy lifestyle, not just education about what a healthy lifestyle is. In other words, while messages about the benefits of healthy living, physical activity, recreation and nutrition are getting through, we must also recognize that many people still face barriers to practising a healthy lifestyle. As mentioned in one focus group, “People know they need to eat healthy – the message is there and awareness is there but people can’t afford fresh produce and milk, especially young families and older people on a fixed income.” It was also pointed out how prevention and education continue to be important because there are so many issues to address. Violence prevention is one example whereby education and awareness on issues like bullying have increased in recent years, and there is an understanding that various communication methods are needed for various target audiences, from pre-schoolers to the elderly. While people recognize that there are numerous ongoing initiatives that involve health promotion, prevention and early intervention – particularly through partnerships with the Wellness Coalitions, schools, and healthy aging initiatives – they understand that enormous efforts are required from all sectors of society about attitudinal and behavioural changes to focus on the preventive aspects of health.

he Lower Trinity South Regional Development Association (LTSRDA) and the Eastern School District have received national recognition for their partnerships with a number of regional agencies and funding sources for the St. Francis School Greenhouse project. This initiative targets both children and older workers who learn how to plant, harvest and prepare local fruits and vegetables as well as learn about the “relationship between agriculture and food on the table.” This program has helped publicize “the healthy living aspect of local agriculture – something that has all but fallen off the map for many people in the region, especially kids.” Source: Bringing Health to the Planning Table: A Profile of Promising Practices in Canada and Abroad (n.d.), pp. 51-52

T


THE RESULTS OF THE TRINITYCONCEPTION COMMUNITY HEALTH NEEDS ASSESSMENT

FIGURE 4:

RATE OF SMOKING CANADIAN COMMUNITY HEALTH SURVEY, 200910

21.2%

18.6%

FIGURE 5:

RATE OF ALCOHOL CONSUMPTION CANADIAN COMMUNITY HEALTH SURVEY, 200910

37.9%

32.9%

 Trinity-Conception Area  Province  Trinity-Conception Area  Province

“IT’S HARD TO BE HEALTHY IF YOU CAN ONLY AFFORD MACARONI.”

FAST FACTS

KEY INFORMANT

19 In 2010, the breastfeeding initiation rate in Carbonear was 48.7%, compared to 46.4% in Burin, 51.7% in Clarenville and 73.4% in St. John’s (Provincial Perinatal Database). The percentage of people who were overweight or obese (i.e., adult body mass index of 25 or greater) among those 18 years of age and older was 68.6%; the provincial rate was 63.5%. (Canadian Community Health Survey, 2009-10). The prevalence of diabetes (age 12+) was 8.5%; the province was 8.1% and Canada was 6.1% (Canadian Community Health Survey, 2009-10). According to The Cost of Healthy Eating in Eastern Health Region – Rural Avalon and Peninsulas (2010), the average weekly cost of the Nutritious Food Basket is $169.23 for a “reference family” of four: a man and woman aged 25-49 years, a boy 13-15 years and a girl 7-9 years.


PROUD HERITAGE, HEALTHY FUTURE: STRENGTHENING THE TIES THAT BIND

Recommendations Related to Preventive Approaches and Education



Expand Eastern Health’s Chronic Disease Self-Management Workshops to the Trinity-Conception area. a. Eastern Health’s Chronic Disease Prevention and Management Strategy is scheduled for formal release to the public during 2012. One of the components of the strategy that has already begun implementation is SelfManagement Workshops. These workshops are six-week programs offered once a week for approximately two and a half hours and are designed for people living with chronic conditions. The program is peer-led and can help individuals deal with such issues as managing fatigue or tiredness, learning how to eat healthier and/or dealing with frustration, depression, pain or isolation. b. Workshops are already planned to begin in the Trinity Conception area in the coming months and training to equip individuals to lead the workshops will also be offered in the area during 2012.



Approach Trinity-Conception local media to collaborate with Eastern Health on various topics related to prevention, health promotion and overall healthy living specific to the area. This would help expand on existing initiatives throughout Eastern Health, particularly through the work of the Health Promotion division and Wellness Coalitions.

20

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he health sector can treat the costly consequences of obesity, tobacco use, the harmful use of alcohol and unintentional injuries, including those arising from road traffic crashes. But prevention – which is by far the better option – depends on action in other sectors, whether involving trade agreements, food production and marketing policies, road design, or regulations and their enforcement. Health programmes do not need to invest in these other sectors, but they do need to work with them to realize shared benefits in a whole-of-government approach to health. Source: World Health Organization, 2010, pp.1-2

T


THE RESULTS OF THE TRINITYCONCEPTION COMMUNITY HEALTH NEEDS ASSESSMENT

What We Heard: Health Services Several aspects of health services have been combined in one common theme based on feedback gathered during the assessment. The three main aspects are: mental health and addictions services, family doctors and satisfaction with services. Each of these is described in more detail below. (a) Mental Health and Addictions Services The importance of mental health was widely acknowledged during the course of this assessment. Mental health was often referenced as a key aspect of health and there appears to be a strong will to de-stigmatize mental health issues. Mental health and addictions services were often cited when discussing access issues, as people want to see reduced wait times in this area. Similarly, the need for increased community support for people dealing with mental health and addictions issues was also widely recognized. While people gratefully acknowledge the additional resources that have been put into the area for mental health and addictions in recent years, such as the U-Turn Drop-In Centre in Carbonear and the recent announcement of an addictions treatment centre to be built in Harbour Grace, many people believe that the demand is still high, there are long waitlists for some services and we need to ensure we are meeting identified needs. For example, in terms of stigma, it was mentioned that in a smaller community some people might be reluctant to see a mental health and addictions professional for fear of how others in the community would view this. People also discussed the need to use resources efficiently, such as considering

alternate ways of providing outreach and followup for clients in need. Internal to Eastern Health, clients who are referred to community Mental Health and Addictions services are assessed within 30 days (unless they have been released from an institution where an assessment has already been completed). Based on clinical judgment, clients are categorized into one of three different waitlists: Priority 1: within 30 days; Priority 2: within 3 months; and Priority 3: within 6 months. As indicated in Table 4, there were 129 people on the waitlist for community mental health services in the Trinity-Conception area in November 2011 compared with 113 in the previous needs assessment in the Discovery Region (BonavistaClarenville-Arnold’s Cove). For addictions services, 23 people were on the waitlist in November 2011 for Trinity-Conception compared with 21 in the Discovery Region. Both the Trinity-Conception area and the Discovery Zone are used for comparison purposes since both have a very similar population and the Discovery Zone assessment was the most recent assessment completed prior to TrinityConception.

TABLE 4:

WAITLIST FOR MENTAL HEALTH SERVICES AND ADDICTIONS SERVICES IN TRINITYCONCEPTION NOVEMBER 2011 AND DISCOVERY REGION NOVEMBER 2010 TRINITYCONCEPTION NOVEMBER 2011

DISCOVERY REGION NOVEMBER 2010

Mental Health (adults and children)

129 clients

113 clients

Addictions (adults and children)

23 clients

21 clients

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PROUD HERITAGE, HEALTHY FUTURE: STRENGTHENING THE TIES THAT BIND

(b) Family Doctors The telephone survey indicated that access to family doctors is very good in the TrinityConception area: 95% of respondents report having a regular family doctor. Figure 6 below shows that residents in Conception Bay North are more likely to have a family doctor: 98% of respondents, versus 89% on the North Shore and 90% in Trinity South.

FIGURE 6:

ACCESS TO FAMILY DOCTORS IN TRINITY CONCEPTION

98%

89%

FOCUS GROUP PARTICIPANT

FAST FACT

90%

 Conception Bay North  North Shore  Trinity South

22 Such access to family doctors is consistent with the other needs assessments that Eastern Health has undertaken, as indicated in Figure 7.

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“THERE CAN BE LONG WAITS FOR MENTAL HEALTH SERVICES BUT IF YOU HAVE A PROBLEM IT’S HARD TO WAIT IF YOU HAVE A HARD DAY OR ISSUE.”

Statistic Canada’s Canadian Community Health Survey, 2008-09, indicated that 45.4% of survey respondents in the Trinity-Conception area rated their mental health as “excellent” and 38.3% rated it as “very good”.

In the Trinity-Conception area, Eastern Health employs the following Mental Health and Addictions staff as of March 2012: • 4 Community Health Nurses (1 of which is located within the hospital setting) • 8 Social Workers (includes 3 Addictions Counsellors, 1 Addictions Prevention Consultant 1 Intake Worker and 1 specific to Adolescents) • 1 Occupational Therapist • 1 Psychologist


THE RESULTS OF THE TRINITYCONCEPTION COMMUNITY HEALTH NEEDS ASSESSMENT

Like many rural parts of the province of Newfoundland and Labrador, the TrinityConception area has pockets of growth – mostly in the service centres – with many smaller

FIGURE 2:

communities exhibiting sharp population declines and an aging population. The population of the area (Census 2006) is 39,850, a decline of 2.7% from the 2001 Census.

MAP OF TRINITYCONCEPTION

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PROUD HERITAGE, HEALTHY FUTURE: STRENGTHENING THE TIES THAT BIND

FIGURE 9:

SATISFACTION WITH HEALTH AND COMMUNITY SERVICES

59%

75%

65%

 Trinity-Conception  Discovery Zone  Northeast Avalon

24

While the telephone survey indicates that access to family doctors is quite good in the TrinityConception area, there was concern mentioned throughout the focus groups, interviews and public submissions that access to family doctors will not be as high in the next two to five years as doctors in the area draw closer to retirement. Recruitment and retention of family doctors is a concern for many residents, particularly on the Trinity Bay side of the peninsula. Residents are worried that they will be without a family doctor, will have to travel further, or that there could be a high turnover of family doctors that would negatively impact on continuity of care. All of these concerns are heightened given the aging population and transportation barriers in most communities. (c) Satisfaction/Dissatisfaction Levels The telephone survey highlighted areas of greatest satisfaction and dissatisfaction with health and community services in TrinityConception. Fifty-nine percent (59%) of telephone survey respondents rated their satisfaction level with health and community services in general as a 4 or 5 out of 5, with 5 being “very satisfied”. Despite excellent access to family physicians, the overall level of satisfaction is lower than the two most recent needs assessments completed by Eastern Health, as indicated in Figure 9.1

The telephone survey also indicated that there was strong satisfaction with family doctors and that the most dissatisfaction was with the Emergency Department. Wait time was the most common reason given for this dissatisfaction. Of the 40% of telephone survey respondents who had visited the Emergency Department in the last 12 months, 35% provided a rating of 1 or 2 out of 5, which indicates a high level of dissatisfaction. “Long wait times” were cited as the main reason for their dissatisfaction. While Emergency Department wait times did come up during focus groups and interviews, it was not one of the more frequent issues identified in the region.

FAST FACTS In terms of national comparisons, the Canadian Community Health Survey (2011) reports that 84.8% of the Canadian population age 12 and over has a regular medical doctor, which ranges from a low of 13.2% in Nunavut to 93.6% in Nova Scotia. According to the Canadian Institute for Health Information (CIHI), the number of family medicine physicians per 100,000 population in Canada (2009) was approximately 100, for a ratio of approximately 1:1000. At the time of this report, there were 38 family doctors/general practitioners for a population of approximately 39,850 (2006 Census) in Trinity-Conception, for a ratio of approximately 1:1049.

_________________________________________________________________ 1 Questions on satisfaction/dissatisfaction levels with health and community services were not asked the same way in the Burin Peninsula and Southern Avalon reports; therefore, comparisons cannot be made with those areas on this particular question.


THE RESULTS OF THE TRINITYCONCEPTION COMMUNITY HEALTH NEEDS ASSESSMENT

“IF PEOPLE CAN’T COME TO YOU, YOU HAVE TO GET TO THEM.” “IF YOU HAVE PROGRAMS BUT PEOPLE CAN’T ACCESS THEM, IT’S JUST AS WELL THE PROGRAMS WEREN’T THERE.” FOCUS GROUP PARTICIPANTS

Transportation was mentioned repeatedly in the focus groups and interviews as a barrier to access throughout the region. For the most part, the Trinity-Conception area is geographically dispersed. There is no public transportation system throughout the area and while there are a limited number of private transportation operators in some communities (i.e., mostly in the larger communities of Bay Roberts, Harbour Grace, and Carbonear) it can be costly due to the distance between communities. This issue of transportation as a barrier has been researched by a number of groups in recent years, including the Mariner Resource Opportunities Network (2006) and the Eastern Region Mental Health Steering Committee (2004). Key informants and focus group participants discussed passionately how the cost of transportation affects all areas of health, such as social supports, medical appointments and employment opportunities. The added challenges of an aging population and risks associated with driving during winter months increase the likelihood of isolation and negative impacts on mental health. The telephone survey reported that 43% of respondents had to travel outside of the TrinityConception area over the last 12 months to access a health service, test, treatment or medical advice.

This compares with the Discovery Zone where 51% of telephone survey respondents travelled outside of their area for health services. The vast majority of the Trinity-Conception respondents (74%) cited their reason for travelling was due to the service not being available in their area; however, when survey respondents were asked to identify if there had been a barrier to prevent them from receiving health care, community services or medical advice, the vast majority (96%) said “no”.

25


PROUD HERITAGE, HEALTHY FUTURE: STRENGTHENING THE TIES THAT BIND

Recommendations Related to Health Services Explore new models of care delivery that involve a “hub� or group of physicians in a larger area, such as Carbonear, with outreach and mobile services to other communities throughout the Trinity-Conception area. Such models would be based on current research that identifies key factors for successful recruitment and retention of physicians, such as providing a group-style practice rather than solo practice.



26

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Investigate options to expand the role of other health professionals in the TrinityConception area. In particular: a. Review the allocation and roles of Nurse Practitioners (NPs) within Eastern Health to determine opportunities for rural communities. b. Submit information from this needs assessment to the upcoming provincial review of road and air ambulance services. This submission would include considering opportunities for the role of paramedics to be expanded to focus on preventive aspects of health in rural communities. For example, providing support in a community-based setting would enable area residents to manage some chronic conditions closer to their homes. This would also require working with post secondary institutions who train paramedics for long-term workforce planning.



Develop a proposal to expand the use of Telehealth or other distance technologies to advance patient care in Mental Health and Addictions Services, which will build on the recent Telehealth installation for the Mental Health program in Carbonear General Hospital. Alternative methods of delivery that require the development of new or expanded information technology will require the development of an information management proposal.



Develop a local community advisory committee to review identified mental health issues and develop an action plan to address these issues.

he challenge of having access to affordable transportation was well illustrated by a woman from a small community on the North Shore. She heard about one of our focus groups through an organization she is involved with and wanted to attend the session scheduled for Harbour Grace. While she wanted to participate in person, she had no access to transportation and there is no public transportation service in her area. A taxi firm in Harbour Grace was willing to provide transportation; however the cost of a round trip would have been $154.

T


THE RESULTS OF THE TRINITYCONCEPTION COMMUNITY HEALTH NEEDS ASSESSMENT

What We Heard: Social Supports/Community-Based Supports As mentioned throughout this report, social support networks and communitybased services are strong in the Trinity-Conception area. It is widely recognized that there is a lot that we do well in this province when it comes to looking after fellow residents and there were many positive comments made about the sense of community as a strength of the TrinityConception area. Likewise, there is a lot that we do well in terms of outreach and sharing resources. For example, churches continue to be quite involved in addressing identified needs such as organizing food banks or providing space for community groups to meet. A number of examples were also provided whereby “grassroots” community groups were formed based on an identified need for social support and interaction, particularly in smaller communities. Partnerships and collaboration are also strong in Trinity-Conception. For example, a partnership between Baccalieu Trail Seniors Outreach Services and Eastern School District enables seniors to learn technology skills from high school students while the high school students gain community service credits required for graduation – a “win-win” situation for both parties. As well, the Carbonear Campus of College of the North Atlantic and Eastern Health have partnered to develop a network of contacts to support students with mental health challenges and, vice versa, to help clients of mental health services who may want to return to school. While the level of commitment to supporting each other and our communities is commendable,

it was also recognized that there is still more that could be done to reinforce and even expand our social support networks. There is a strong sense that more could be done to identify and meet needs at the local level and promote regional cooperation rather than territoriality. Throughout the primary research process, participants recognized the links between employment and income as determinants of health and how these impact on the health of individuals and communities. Indeed, income affects all aspects of health and overlaps with other areas identified, such as transportation and nutrition. While the employment situation, in general, has improved in Trinity-Conception in recent years – reportedly due in large part to major industrial projects – employment remains a major issue, especially for those communities that are farther away from the new industries. In particular, both fishing and tourism are seasonal, thus opportunities for full-time, year-round work can be limited in communities that rely heavily on these industries. At the same time, research indicates that labour shortages (both skilled and unskilled) in the area are increasingly having a negative effect on local businesses in terms of maintaining or expanding their operations (Mariner Resource Opportunities Network, 200809). In addition, many people in Trinity-Conception commute for work to other parts of the Avalon Peninsula or even outside the province, which impacts on family and community life.

“WE HAVE TO REACH OUT TO OTHERS. WE’RE ALL IN THIS TOGETHER. IN UNITY WE RISE.” FOCUS GROUP PARTICIPANTS

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PROUD HERITAGE, HEALTHY FUTURE: STRENGTHENING THE TIES THAT BIND

Recommendation Related to Social Supports/CommunityBased Supports Work with partner groups to expand peer support initiatives, including: a. Explore options to expand the Peer Support Training Program developed by the Consumers’ Health Awareness Network Newfoundland and Labrador (CHANNAL) in the Trinity-Conception area. CHANNAL is a provincial organization that has developed a self-help network among individuals living with mental health issues. b. Explore opportunities to expand the Friendship Corner, which is a community support group for consumers of mental health services facilitated by Eastern Health staff based in Harbour Grace.



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any positive comments about the strengths of the area were provided during focus groups and key informant interviews, particularly about the people and their sense of community. Comments such as these were heard repeatedly: “Friendly people…Everybody knows everybody” “If you need anything they’d help you.” “Can count on neighbours” “Sense of community is huge…don’t see elsewhere”

M


THE RESULTS OF THE TRINITYCONCEPTION COMMUNITY HEALTH NEEDS ASSESSMENT

What We Heard: Communication and Awareness Communication and awareness have been grouped into one theme since they overlap based on the comments that were shared throughout the needs assessment process. In short, participants articulated the importance of various programs and services being well communicated in TrinityConception for residents to be aware of and knowledgeable about what is available and “what communities have to offer”. It was repeatedly mentioned that for a community to be healthy, its residents must be aware of what services are available, what various agencies’ mandates are, and how to access funding when needed. Likewise, it was often mentioned that people working in either the public, private or voluntary/community-based sector also need to be aware of what is available in communities. Although there is generally a strong level of commitment to collaboration and partnership amongst various agencies, it was recognized that strong professional networks need to be maintained across the region, particularly in the face of challenges such as staff turnover, competition for funding and/or legislative changes. For instance, some representatives mentioned the need to be better educated on each others’ roles, to provide better “wraparound” (i.e., interdisciplinary, client-centred) services to shared clients and to keep updated on systemic issues. Others mentioned the need to share services based on dwindling populations in some communities. Communication and awareness also relate to the issue of being able to navigate various health and community services. Focus group participants and key informants from various agencies posed

similar questions during sessions: “If we don’t know what services are out there, and we work with systems every day, how can the average person know where to go to get services?” This issue also relates to information from the telephone survey whereby 40% of survey respondents identified family doctors as their main source of information about health services, followed by a hospital/clinic at 21% and the Internet at 20%. Notably, use of the Internet as a source of information was higher among respondents ages 19-30, at 41%.

“THERE NEEDS TO BE COMMUNICATION BETWEEN GROUPS FOR THINGS LIKE SCHEDULING SO THAT WE ARE NOT DUPLICATING.” FOCUS GROUP PARTICIPANT

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PROUD HERITAGE, HEALTHY FUTURE: STRENGTHENING THE TIES THAT BIND

Recommendations Related to Communications and Awareness 

Include contact information (e.g., phone numbers) of key health services available to residents in Trinity-Conception area in the needs assessment summary brochure that will be distributed to each mailbox in the region.



Expand on the ongoing re-development and maintenance of Eastern Health’s website, www.easternhealth.ca. This includes: a. Providing up-to-date information on every Eastern Health program and service for easy access to information. b. Providing answers to frequently asked questions to help guide the public, such as contact numbers and hours of operation.



Establish an Eastern Health Working Group to identify the best way to build and maintain an inventory of community-based organizations and resources throughout the region. This will enable easier access to contact information and increase opportunities for collaboration with community partners. The main action items of the Working Group will be to: a. Outline a structure to identify how to get the needed data, where to keep the data, how to enter the data and how to sustain the data over the long term. b. Identify the information to be included in this inventory (e.g. organization, contact name, email, website, geography, area of interest, etc.) c. Submit the necessary information management proposals and, if required, the appropriate budget or program realignment options within Eastern Health.



Host a forum within two years between the Mental Health and Addictions program and its referral sources (especially school districts and family doctors) to develop broader awareness of each others’ roles, discuss referral and prioritization processes, discuss how to increase peer support in the area and other related topics.



Develop a semi-annual forum for dialogue between Eastern Health and community family doctors to share information about health services. The primary goal is to help community physicians develop a stronger understanding of the services and initiatives ongoing in Eastern Health and provide an opportunity for community physicians to identify systems challenges that affect patient care.

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THE RESULTS OF THE TRINITYCONCEPTION COMMUNITY HEALTH NEEDS ASSESSMENT

What We Heard: Housing While the increase in economic activity on the Avalon Peninsula is welcomed and appreciated, area residents are concerned with the impact such activity has on the availability of affordable housing in the area. Housing prices in many areas have increased while an already limited availability of rental properties has further decreased due to rising demand. A number of examples were provided whereby renters in the Trinity South and Conception Bay North areas, in particular, have seen their rents double or nearly triple recently due to growing demand. Unfortunately, the housing situation is causing some people to be “squeezed out” of affordable housing, particularly those with low incomes. There was also considerable discussion about the need for suitable housing supports for vulnerable residents, particularly those with complex mental health issues or seniors living alone in older homes. Participants recognize that it is “cheaper on the system” for people to live in their own homes as long as possible; however, it can be difficult – if not impossible – for people with special needs to maintain their own residence without supports in place. Indeed, housing and upkeep can deplete personal income as people struggle to pay bills, which often affects their health: some people are forced to make hard choices between paying for medications, buying groceries, heating their homes, or paying for shelter. Homelessness in the Trinity-Conception area has also been growing as an area of concern in recent years. Participants point out that while there may not be obvious signs of homelessness in the area, as may be seen in larger centres, there are increasing reports of people with no long-term, suitable housing. For example, the term “couch

surfer” was used to describe some individuals who rely on friends and family while they search for longer-term housing. The culture of the province, in general, and the Trinity-Conception area, specifically, was also mentioned: our sense of community can mean that individuals rely on family and friends rather than be on the street; however, it is widely recognized that longer-term solutions to housing are needed in the area. Although there is limited data available on housing needs in the Trinity-Conception area, we do know that as of February 17, 2012, there were 30 applicants on the rental housing waitlist for Newfoundland Labrador Housing. This waitlist contains applicants for public rental housing (i.e., Newfoundland Labrador Housing’s owned and operated units) and the rent supplement program. Table 5 provides a breakdown of the 30 applications for the Trinity-Conception area, which represents 6% of the overall waitlist for the Avalon region.

FAST FACT In 2006, the average owner’s major shelterrelated payments in Trinity-Conception were $510 per month; the provincial average was $645. The average rent was in the area was $540, while the provincial average was $570. Eastern Health participates on the Baccalieu Advisory Board on Housing and Homelessness and will continue to work with that group to understand issues related to housing and homelessness and their impact on health.

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PROUD HERITAGE, HEALTHY FUTURE: STRENGTHENING THE TIES THAT BIND

TABLE 5:

WAITLIST DATA FOR NL HOUSING IN TRINITYCONCEPTION AS OF FEBRUARY 17, 2012 AREA B: NORTH SHORE

AREA A: CONCEPTION BAY NORTH

AREA C: TRINITY SOUTH

COMMUNITY

# OF APPLICATIONS

COMMUNITY

# OF APPLICATIONS

COMMUNITY

# OF APPLICATIONS

Clarke’s Beach

2

Ochre Pit Cove

1

Heart’s Desire

1

South River

1

Burnt Point

2

New Harbour

2

Cupids

1

TOTAL AREA B

3

TOTAL AREA C

3

Bay Roberts

2

Spaniard’s Bay

1

Harbour Grace

2

Carbonear

14

Salmon Cove

1

TOTAL AREA A

24

TOTAL ALL AREAS OF TRINITYCONCEPTION:30

32

i

hrough the course of this study, it has become increasingly apparent that the region’s housing stock is not adequate to address the needs of many residents. Unfortunately, at the time of writing, there are no reliable statistics regarding the exact scope and magnitude of homelessness in the Baccalieu Trail region. That said through the course of the consultations with service providers in the region it has been reiterated repeatedly that lack of access to safe, affordable and appropriate housing is a common concern of many residents in the region….For instance, one service provider with Human Resources Labour and Employment stated that in the past two years, twenty-five clients out of a total caseload of thirty (or approximately 83%) have experienced acute housing issues. Similarly, one social worker with Eastern Health’s Community Support Program stated that, in the past year, she is aware of fourteen clients in their programme who have experienced significant difficulty in accessing safe, affordable and appropriate housing. Similar figures have been reported by other service providers through the course of the consultations; with reports of 70 to 80% of their clients having experienced acute housing needs. Source: Mariner Resource Opportunities Network report, 2010, p. 47

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THE RESULTS OF THE TRINITYCONCEPTION COMMUNITY HEALTH NEEDS ASSESSMENT

Recommendation Related to Housing 

Host a professional development session whereby Eastern Health staff, in partnership with the Baccalieu Advisory Board on Housing and Homelessness, learn about the impact of housing on health and opportunities for collaboration.

33

acancy rates are available for Census Metropolitan Areas (CMAs) through the Canada Mortgage and Housing Corporation (CMHC). According to their statistics released in the fall of 2011, the CMA of Bay Roberts had a vacancy rate of 3.6 %. While this was higher than other CMAs in the province, it was noted that Bay Roberts had “very few vacancies in a market with a limited supply of rental units” (p. 2). The average rent for a two bedroom unit in Bay Roberts was $561.

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PROUD HERITAGE, HEALTHY FUTURE: STRENGTHENING THE TIES THAT BIND

Summary of Eastern Health’s Community Health Needs Assessments

8

34

Trinity-Conception has been the final geographical area within Eastern Health’s boundaries to undergo the Community Health Needs Assessment process. Eastern Health is now well positioned to compare and contrast the entire region and identify common themes, while at the same time respect the uniqueness and strengths of different approaches in various areas.

While each needs assessment has had its own findings, there have been similar themes throughout all of the reports. Eastern Health has learned that people appreciate health care providers and all of the work they do. They want to see more of a focus on health promotion, intervention, and prevention activities, especially amongst the school age population. People are concerned about access to primary care, particularly family doctors. They want to see improved access to priority services and a


THE RESULTS OF THE TRINITYCONCEPTION COMMUNITY HEALTH NEEDS ASSESSMENT

“DISEASE: THE VERY SPELLING OF THE WORD INDICATES THAT OUR BODIES ARE ILL AT EASE, EITHER MENTALLY OR PHYSICALLY.” PORTION OF WRITTEN SUBMISSION FROM AN AREA RESIDENT greater focus on mental health and addictions services, both in terms of promoting their importance to overall health as well as timely access to services. People also recognize that more support and awareness is needed for people struggling with mental health and addictions issues to reduce stigma and increase social networks in their communities. The needs assessments have also emphasized people’s frustration with the barriers to navigating the health care system. Many of these barriers are directly and indirectly related to the determinants of health, including income, employment and transportation. Input from participants throughout the region has underscored the importance of identifying and reducing these barriers. As well, needs related to increased awareness of programs, services and contact information are aspects of navigation that have been mentioned repeatedly. The findings of each community health needs assessment completed to date have resulted in a number of recommendations to address the issues identified. The reports of the assessments have already resulted in many positive enhancements to various communities, such as the establishment of a Community Development Fund for community groups, an increased focus on mental health issues in the Placentia-St. Mary’s Bay areas, a review of long-term care needs and seniors’ care on the Southern Avalon

and an emphasis on improving access in Northeast Avalon, to name a few. The reports have also been used by community groups as they undertake their own planning activities. Most notably, the needs assessments completed by Eastern Health to date have helped to shape our strategic plan. Eastern Health’s strategic plan 2011-14, Together We Can, has four main priority areas: Quality & Safety, Access, Sustainability and Population Health. The findings from the Trinity-Conception Community Health Needs Assessment process have been consistent with this plan, as indicated in the recommendations outlined.

35


PROUD HERITAGE, HEALTHY FUTURE: STRENGTHENING THE TIES THAT BIND

Linking Recommendations to Other Initiatives

9

36

From the onset of the TrinityConception Community Health Needs Assessment there has been a strong commitment to having a reasonable number of actionable recommendations that can be carried out by Eastern Health. Maximizing our resources is an essential aspect of such recommendations, as we want to ensure

that we are working as efficiently and as effectively as possible to meet our many competing demands. Working with community partners is an equally important aspect of any recommendations as we work collaboratively to respond to the needs of our residents and continuously improve the overall health of the region we share. We want to emphasize what we do well through our sense of community, cooperation and collaboration: these are strengths on which to build as we work toward common goals. As mentioned, the needs assessments


THE RESULTS OF THE TRINITYCONCEPTION COMMUNITY HEALTH NEEDS ASSESSMENT

“YOU DON’T HAVE TO BE THE MOST EDUCATED TO BE AN INITIATOR OF CHANGE.” KEY INFORMANT INTERVIEWEE

completed by Eastern Health to date have helped to shape our strategic plan. Likewise, the priorities of the strategic plan are consistent with many of the issues brought forward in TrinityConception. Additionally, the recommendations from this assessment should link with and build on existing initiatives within Eastern Health, including: • Health Promotion Plan; •

Chronic Disease Prevention and Management Strategy;

Wellness Coalitions;

The Client-Centred Waitlist Management Strategy;

2011-14 operational plans within each program of Eastern Health.

Furthermore, it must be reiterated there has been a great deal of overlap in the key issues and recommendations in all of the community health needs assessments completed by Eastern Health to date. As well, findings from focus groups conducted during development of the Chronic Disease Prevention and Management Strategy were consistent with information in the needs assessments. While the recommendations outlined previously under each section of “what we heard” are specific to Trinity-Conception, they must be considered in the context of all the needs assessments and the broader, long-term approach to improving the health of communities throughout the Eastern Health region.

37 This is their culture, this – their master passion Of giving shelter and of sharing bread, Of answering rocket signals in the fashion Of losing life to save it. —Excerpt from “Newfoundland Seamen” E. J. Pratt

astern Health’s Wellness Coalitions (Eastern Regional and Avalon East) have a combined membership of approximately 400. The diverse membership is comprised of a wide range of community-based groups, including seniors groups, family resource centres, youth groups, schools, and municipalities.

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PROUD HERITAGE, HEALTHY FUTURE: STRENGTHENING THE TIES THAT BIND

Conclusion

10

38

The Trinity-Conception Community Health Needs Assessment is the fifth such assessment completed by Eastern Health. Many of the issues brought forward in TrinityConception are similar to those we have heard in other parts of the region and the recommendations are consistent with ongoing initiatives within Eastern Health to help us reach our vision of Healthy People, Healthy

Communities. We must continue to build on the strengths of our communities and work with our many partners to achieve this vision over the long term. Many people shared in the development of this report and its recommendations. It is clear that there is a strong level of commitment to work on the challenges we face, while at the same time celebrating the positive aspects in our communities.


THE RESULTS OF THE TRINITYCONCEPTION COMMUNITY HEALTH NEEDS ASSESSMENT

‘Cape Bonavista’ – Cabot’s hail! Secure The Matthew would ride out the gale that night. This chiming name was just the overture To Heart’s Content, Bonne Bay, and Heart’s Delight. What psalm made luminous the captain’s face When double-reefed his ship made Harbour Grace? —Excerpt from “Newfoundland Calling”, E. J. Pratt

39

These sentiments are reflected in the title of this report; Proud Heritage, Healthy Future: Strengthening the Ties that Bind. In addition to this report, each household in the Trinity-Conception area will receive a summary brochure which outlines these findings and the

recommendations. Eastern Health will provide six-month progress updates on the recommendations to its Board of Trustees and will report back to the public within two years.


Appendix I: Telephone Survey Executive Summary

40


             

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  &   .  I       =41A?     !          <   .     &       8        

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  4A   F* - :    &          !     8                              .  0    $     <<    !           +      !           &        !    ! !  : =   4 A   & /  1    !?                         (      ! !      + 8       &             <  .    ! .              !  4  2  2<     &  F     *  2  F    *        !     ! !    !  . 5 =0 ?

2


Appendix II: List of Key Informants Key Informant Interviews: • Baccalieu Advisory Board (2 interviews)

Member of the House of Assembly – Port de Grave: Glenn Littlejohn

Member of the House of Assembly – Trinity-Bay de Verde and Minister of Child, Youth and Family Services: Charlene Johnson

Baccalieu Trail Seniors Outreach Services

Baccalieu Trail Youth Employment Centre

College of the North Atlantic – Carbonear Campus

Mr. and Mrs. Fred and Belinda Cramm, Old Perlican

O’Shaughnessy House

• •

Community Youth Network – SPLASH Centre (2 interviews)

Royal Canadian Mounted Police (RCMP)

Credit Counseling Service NL

Department of Advanced Education and Skills (formerly Department of Human Resources, Labour and Employment)

Single Parents Association of Newfoundland and Labrador

Trinity-Conception Family Resource Centre (2 interviews)

U-Turn

Department of Child, Youth and Family Services

Western Avalon Communities Against Violence Committee

Department of Justice

Eastern Health: Psychiatry

Whitbourne Family Resource Centre

Eastern Health: Long-term Care

Eastern School District (2 interviews)

Women Interested in Successful Employment (WISE)

Employment Assistance Services (Old Perlican Site)

Lower Trinity South Regional Development Association

Mariner Resource Opportunities Network (MRON)

Member of the House of Assembly – Bellevue: Calvin Peach

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Appendix III: Key Informant Interview Guide Background The Board of Trustees of Eastern Health identified needs assessments as a priority for the organization, and the Regional Health Authorities Act states that health authorities must assess the needs of its population. In order to get opinions from residents of the Trinity-Conception Area (Economic Zone 17), we will be conducting a telephone survey, focus groups and key informant interviews. The Determinants of Health During the needs assessment process, we speak a lot about the determinants of health. A 1986 report, Achieving Health for All: A Framework for Health Promotion, helped to focus society on the underlying prerequisites or determinants of health and illness. It suggested that a number of influences and their interaction had major impacts on the health and well-being of a population. Factors such as social, economic, cultural and physical environment play a role - for better or worse - in the health of a community. This means that making improvements in the health and well-being of Canadians must go beyond delivery of health care services and include action on the broad determinants of health. The key determinants of health are: 1. Income and Social Status 2. Social Support Networks 3. Education and Literacy 4. Employment/Working Conditions 5. Social Environments 6. Physical Environments 7. Personal Health Practices and Coping Skills 8. Healthy Child Development 9. Biology and Genetic Endowment 10. Health Services 11. Gender 12. Culture

46


Interview Guide I will use the following questions as a guide during our conversation. 1. Who does your organization represent? (demographics of clientele, geographic region, scope, etc.) 2. In your opinion, what health issues are affecting the people and communities in the Trinity-Conception area? 3. There are many factors that influence our health (sometimes known as the determinants of health). Which factors do you feel most influence the health of the people and communities in the Trinity-Conception area? 4. What could/should be done to improve the health of the people and communities in the Trinity-Conception area? 5. From your organizationâ&#x20AC;&#x2122;s perspective, what are the strengths of the health and community services system in the Trinity-Conception area? 6. From your organizationâ&#x20AC;&#x2122;s perspective, what are the challenges of the health and community services system in the Trinity-Conception area? What could be done to address these challenges? 7. What do you think the Trinity-Conception area will look like in 10-15 years from now? 8. Have we missed anything that you would like to comment on? 9. Is there a particular person or group that you feel I should consult during the needs assessment?

47


Appendix IV: List of Focus Groups

48

Advisory Committee – Trinity Conception Community Health Needs Assessment

College of the North Atlantic Community Studies Program

Community Youth Network – SPLASH Centre

Con-Tri Retired Teachers Association

Crescent Collegiate – Allied Youth Post 1163 (2 sessions)

Eastern Health Employees (3 sessions): Carbonear, Whitbourne, Old Perlican

Eastern Health Physicians

Friendship Corner, Harbour Grace

Friendship Group, Old Perlican

General Practitioners and Emergency Responders

General Public, Bay de Verde

General Public and Church Leaders

General Public, Community-Based Groups and Municipal Leaders

General Public and Community-Based Groups (in partnership with Single Parents Association of NL)

General Public and School Principals

Health Professionals and Community-Based Groups

Island Harbour and Cavendish 50+ Clubs, Heart’s Delight-Islington

Long-term Care Family Council – Eastern Health

Long-term Care Residents – Eastern Health

Lower Trinity South Regional Development Association – Targeted Initiative for Older Workers

Mariner Resource Opportunities Network (MRON)

Rural Secretariat

Women Interested In Successful Employment


Appendix V: Focus Group Question Guide Community Questions 1. What are some of the main strengths of your community/area? 2. What are some of the main challenges for your community/area?

Health Questions 3. What makes a community healthy? 4. What are the main health concerns in your community? 5. How do you think these concerns can be reduced or eliminated?

Health and Community Services Questions 6. What issues or barriers do people in this area experience in accessing heath and community services? 7. What opportunities do you see to improving health and community services in your community? 8. How can community resources be better utilized to improve the health and well-being of people in the area?

Summary 9. Thinking of all the concerns that have been discussed today that related to health and well-being, what one issue is the most important to discuss? 10. What other comments do you have to make about any issue related to the communityâ&#x20AC;&#x2122;s health and wellness that we havenâ&#x20AC;&#x2122;t covered in todayâ&#x20AC;&#x2122;s session, but which you feel is important to mention? 11. Is there a particular person or group that you feel I should consult during the needs assessment?

49


Appendix VI: Written and Oral Submissions Received •

Association for Youth and Leisure (AYAL, North Shore)

Department of Advanced Education and Skills (formerly Department of Human Resources, Labour and Employment)

Eastern School District – Coley’s Point Primary School

Eastern School District – Immaculate Conception School

Health Professionals Submissions (2)

Homecare Agency Submission

Individual Submission: advocacy and support for Lesbian, Gay, Bisexual, Transgendered and Queer (LGBTQ) community

Individual Submission: Autism support

Individual Submissions (2): North Shore issues

Individual Submission: prevention, education, physical and mental health

Individual Submission: suggestions to improve privacy/confidentiality, safety, physical access and mental health in long-term care

Individual Submission: Trinity South, access

Joint Councils of Conception Bay North

Lower Trinity South Regional Development Association

NL Youth Centre

North Shore Regional Development Association

Parkinson Society of Newfoundland and Labrador

Social Media Facebook: www.facebook.com/TCHealthAssessment Twitter: www.twitter.com/TC_Health

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Appendix VII: Secondary Sources (Literature Review and Data Sources) Avalon Sport Complex Inc. (n.d.) Building Healthy Lifestyles in Trinity South Blaketown, Old Shop, South Dildo Sport Field Renovation Proposal: Author. Baccalieu Trail Seniors Outreach Services SRC NL. (2011, June). Activity Report: Author. Blas, E., & Sivasankara Kurup, A. (Eds). (2010). Equity, social determinants and public health programmes. Geneva: World Health Organization. Boland, B., Earle, A., McConnell, S., Brothers, D., & McConnell, S. (2008). Navigators and Networks: Harnessing resources and meeting the needs of individuals with complex needs. St. John’s, NL. Canada Mortgage and Housing Corporation. (2011, Fall). Rental Market Report: Newfoundland and Labrador Highlights: Author. Canadian Institute for Health Information. (2010). Retrieved February 2, 2012, from http://www.cihi.ca/CIHI-ext-portal/pdf/internet/RELEASE_02DEC10_FIG1_EN Cavanagh, S., & Chadwick, K. (2005). Summary: Health Needs Assessments at a Glance: Health Development Agency. Retrieved January 28, 2010, from http://www.nice.org.uk/media/150/35/Health_Needs_Assessment_A_Practical_Guide.pdf Community Accounts. (2012). Economic Zone 17 – Mariner Resource Opportunities Network Inc. Profile. Retrieved March 8, 2012, from http://nl.communityaccounts.ca/profiles.asp?_=vb7En4WVgb2uzqVjXA__ Community Accounts. (2012). Indicators of Well Being. Retrieved March 8, 2012, from http://nl.communityaccounts.ca/indicators.asp?_=f4GHZpqLaqauzbaTkXDazKafg3k_ Community Accounts. (2012). Well Being Summary Indicator Table. Retrieved March 8, 2012, from http://nl.communityaccounts.ca/WBsummary.asp?_=vcTKnZOWgWm2yKmVjZTDwKx3yaefkrO8s pWtgJCzldC0mG7UyMiLcWaEl8uvu8.Ow42TwKiTfKa6xdapoqaLabyKocumwQ__ Djwa, S., & Moyles, R. G. (Eds). (1989). E. J. PRATT Complete Poems Part 1. Toronto: University of Toronto Press.

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Djwa, S., & Moyles, R. G. (Eds). (1989). E. J. PRATT Complete Poems Part 2. Toronto: University of Toronto Press. Eastern Health. (2010, June). The Cost of Healthy Eating in Eastern Health Region – Rural Avalon and Peninsulas, 2010 results: Author. Eastern Health. (2011, July). Chronic Disease Status in Eastern Health – Presented by the Chronic Disease Prevention and Management Division: Author. Eastern Health Rural Avalon Occupational Therapy Services. (2010, October). Community OT Services: Author. Eastern Region Mental Health Steering Committee. (2004, July). A Collaborative Project: Networking to Build the Future in Mental Health for Eastern Newfoundland: Author. Harris Centre (The) Memorial University. (2008, November). Summary Report: Harris Centre Regional Workshop – Memorial University partnering with the Mariner Resource Opportunities Network (MRON), Zone 17: Author. Integrated Community Sustainability Plan for the Municipality of Small Point-Broad CoveBlackhead-Adam’s Cove. (2010, March). Retrieved February 20, 2012, from http://www.municipalitiesnl.com/userfiles/files/Small%20PointAdam's%20Cove%20Intergrated%20Community%20Sustainability%20Plan.pdf Integrated Community Sustainability Plan for the Municipality of Whiteway. (2010, March). Retrieved February 15, 2012, from http://www.municipalitiesnl.ca/userfiles/files/Whiteway%20ICSP%20.pdf Mariner Resource Opportunities Network Inc. (2006, June). Executive Summary, June 2006 Transportation Survey Results: Author. Mariner Resource Opportunities Network Inc. (2008). Strategic Economic Plan, Zone 17, 2008-2011: Author. Mariner Resource Opportunities Network Inc. (2009, September). Labour Market and Human Resource Analysis 2008-09: An Overview of the Current Labour Market Conditions in the Baccalieu Trail Region: Author. Mariner Resource Opportunities Network Inc. (2010, January). An Assessment of the Infrastructure and Service Requirements of Homeless Individuals in the Baccalieu Trail Region, 2009-10: Author Mathews, M. (n.d.). Attracting and keeping physicians in Newfoundland and Labrador. PowerPoint presentation. St. John’s, NL

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PROUD HERITAGE HEALTHY FUTURE STRENGTHENING THE TIES THAT BIND www.easternhealth.ca

Trinity-Conception Community Health Needs Assessment  

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