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Pend Oreille County Health Risks Opportunity Map
- 1. Pend Oreille County Health Risks A Community Health Improvement Opportunity Map source: http://pendoreilleco.org/photos/map.gif
- 2. Some Background On Pend Oreille (pronounced pahn-duh-RAY) County • Population of about 12,000. • Area of 1,425 miles. • Rich in natural beauty, wildlife. • Largest community (Newport) has population of roughly 2000. • Only one major highway (State Road 20) which parallels the Pend Oreille River. • All the larger towns follow this river road.
- 3. A River Runs Through It… And So Does A Road.
- 4. Rural It Is
- 5. Communities In The County Images copyright of the Kalispel Tribe
- 6. Some Statistics of Importance •Median household income: $39,352 (national average: $55,628). •15.9% of county residents below poverty level. •83.3% of families with a female householder with no husband are below poverty level. •Unemployment 6th highest in the state. What it means… Poverty is an issue that will affect health. Particularly for women and children.
- 7. Children & Child Abuse • Every third household has a child. • Child abuse is 2.5 X higher than similar counties. • Childhood unintentional injuries 33% higher than state levels. • “Poverty, lack of social support, social isolation, unemployment and high stress levels” are all factors that increase the risk of child abuse within the home setting per the Office of Child Abuse & Neglect. • Poverty and high stress become a truly significant concern that requires addressing within this county when 25% of two parent families and 83% of female parent families with children under 5 years of age living below the poverty line (654 families in 1998)
- 8. Health Insurance • 13.1% of residents have no health insurance. • Female head of households have nearly double the uninsured rate (21%) than traditional households (11.4%). Significance: Uninsured tend to die sooner, get too little care too late and get poorer quality care when the do get care.
- 9. The Statistics on Other Common Health Issues Statistics as Compared to State & U.S. Averages Comparable Higher Lower Obesity Maternal Smoking (2.5 X State & U.S. levels) Teen Pregnancy Fruit/ Vegetable consumption Physical Activity Alcohol Binge drinking Crime Diabetes Mental health
- 10. Access To Healthcare • Access low • One 74 bed hospital in SE corner of the county • Two smaller hospitals in neighboring Stevens county (also serve middle & south end) • Only basic prenatal & neonatal care available • 2/3 of county have >30 minute drive to nearest acute care hospital
- 11. Indicators of Health Care Needs Primary Care Mental Health Dental Care 0 20 40 60 80 100 Primary Care Mental Health Dental Care MUA score of 62.0 or less qualifies for designation as an MUA.
- 12. Summary of Health Issues for Pend Oreille County • Low income • Unemployment • Poverty, especially female head of households with children • Isolation/ distance from health care services • Low education • Child abuse • Lack of health insurance • Maternal smoking • Isolated elderly • Lack of primary and specialty care providers
- 14. Positive Parenting Program (Triple P) A CDC funded evidence and population based model that has a successful track record. Their goal is “to prevent behavioral, emotional and developmental problems in children by enhancing the knowledge, skills and confidence of parents”. Provides professional training to health care providers and also uses the media to communicate teaching.
- 15. Positive Parenting Program (Triple P) Why Use It? • Populations used were statistically very similar to Pend Oreille county. • Program uses existing in-place systems/ services/ providers. • Had good measurable track-able quantifiers. • Attempted to rule out any pre-study trends over the five years prior to the interventions to validate results. • Large statistically significant outcomes. • Monitored child injuries in addition to confirmed reports of child abuse. • Affects key points of intervention opportunities (hospital, ERs, ambulance workers, schools). • Uses a variety of methods to disseminate information useful to rural communities.
- 16. Why Use This System for Pend Oreille? Makes use of existing health care systems Low resource expenditure Maximal community contact Reduces community costs (unpaid medical bills, law enforcement/ judicial, mental health) Reduces child-out-of-home placements Healthier long term community Long term multigenerational benefits
- 17. Questions?
- 18. Some Interesting Resources • Children’s Bureau, U. S. Department of Health and Human Services – Ample information here from the government. • Child Welfare League of America – Mission: CWLA will lead the nation in building public will to ensure safety, permanence, and well-being of children, youth, and their families by advancing public policy, defining and promoting practice excellence and delivering superior membership services. Vision: Our vision is that every child will grow up in a safe, loving, and stable family. Focus: Our focus is children and youth who may have experienced abuse, neglect, family disruption, or a range of other factors that jeopardize their safety, permanence, or well-being. CWLA also focuses on the families, caregivers, and the communities that care for and support these children. • Circle of Parents – Mission Statement: Prevent child abuse and neglect and strengthen families through mutual self-help parent support groups. • Council for Children & Families Washington (also called the Washington Council for Prevention of Child Abuse and Neglect) – A federally based grant program. Our Mission: To promote the optimal development of children and families by leading Washington state in its efforts to prevent child abuse and neglect. • Friends: National Resource Center for Community-Based Child Abuse Prevention – A good source of training material. Provides monthly teleconferences, data archives, grant seeking advice and . • Healthy Families America – A program that focuses on getting trained staff into homes for home visits that focus on teaching families parenting skills. Has good success statistics. • National Alliance of Children’s Trust and Prevention Funds – Mission: Initiate and engage in national efforts that help State Children’s Trust and Prevention Funds in strengthening families to prevent child abuse and neglect. Promote and support a system of services, laws, practices and attitudes that supports families by enabling them to provide their children with safe, healthy and nurturing childhoods.
- 19. Report Suspected Child Or Elder Adult Abuse.
- 20. References • 1) Washington State Department of Health, (2007, July 10). Rural and Urban Commuting Areas, 2006. Retrieved July 12, 2009, from DOH, Division of Resource Management, Geographic Information Systems Web site: http://ww4.doh.wa.gov/gis/pdf/ruca_zip_06.pdf • 2) U. S. Census Bureau; DP-1 Profile of General Demographic Characteristics: 2000 http://factfinder.census.govbf/_lang=en_vt_name=DEC_2000_SF1_U_DP1_geo_id=05000US 53051.html • 3) Washington State Local Public Health Indicators, NE Tri-County Health District, Prevention and Health Promotion http://www.doh.wa.gov/phip/khi/lphi/lhj/ne-tri/hp.htm • 4) U.S. Census Bureau; DP-5 Housing Characteristics: 1990 http://factfinder.census.gov/servlet/BasicFactsTable?_lang=en&_vt_name=DEC_1990_STF3_ DP5&_geo_id=05000US53051 • 5) U.S. Census Bureau; DP-2 Profile of Selected Social Characteristics: 2000 http://factfinder.census.gov/servlet/QTTable?_bm=y&-qr_name=DEC_2000_SF3_U_DP2&- ds_name=DEC_2000_SF3_U&-_lang=en&-_sse=on&-geo_id=05000US53051 • 6) U.S. Census Bureau; DP-3 Profile of Selected Economic Characteristics: 2000 http://factfinder.census.gov/servlet/QTTable?_bm=y&-qr_name=DEC_2000_SF3_U_DP3&- ds_name=DEC_2000_SF3_U&-_lang=en&-_sse=on&-geo_id=05000US53051 • 7) U.S. Census Bureau; State & County Quick Facts, Pend Oreille County, Washington http://quickfacts.census.gov/qfd/states/53/53051.html • 8) Risk and Protection Profile for Substance Abuse Prevention in Pend Oreille County http://www.dshs.wa.gov/excel/ms/rda/4.47/updated/pendoreille.xls
- 21. • 9) Washington State Local Public Health Indicators, NE Tri-County Health District, Access to Care http://www.doh.wa.gov/phip/khi/lphi/lhj/ne-tri/access.htm • 10) Washington State Local Public Health Indicators, NE Tri-County Health District, Maternal and Child Health http://www.doh.wa.gov/phip/khi/lphi/lhj/ne-tri/mch.htm • 11) Washington Department of Health, Geographic Information Systems, Access to Hospital- Based Perinatal and Neonatal Care, 2006 http://ww4.doh.wa.gov/gis/pdf/neon_tt.pdf • 12) Washington Department of Health, Geographic Information Systems, 30 Min. Drive Times from Acute Care Hospitals http://ww4.doh.wa.gov/gis/pdf/acute_tt.pdf • 13) Washington Department of Health, Geographic Information Systems, Mental Health Care Shortage Areas http://ww4.doh.wa.gov/gis/pdf/primary.pdf, http://ww4.doh.wa.gov/gis/pdf/mental.pdf, • 14) Washington Department of Health, Geographic Information Systems, Physician Scarcity Areas http://ww4.doh.wa.gov/gis/pdf/PSA.pdf • 15) Washington Department of Health, Geographic Information Systems, Critical Access Hospitals and Bed Capacity http://ww4.doh.wa.gov/gis/pdf/hosp_list.pdf • 16) Washington Department of Health, Geographic Information Systems, Local Health Jurisdictions and Indian Reservations http://ww4.doh.wa.gov/gis/pdf/lhj-ind.pdf • 17 ) Kalispel Tribe of Indians home page http://www.kalispeltribe.com/camas-center-medical- dental-services/ • 18) U.S. Department of Health and Human Services, Child Welfare Information Gateway http://www.childwelfare.gov/pubs/usermanuals/foundation/foundatione.cfm • 19) U.S. Department of Health and Human Services, Find Shortage Areas: HPSA by State & County http://hpsafind.hrsa.gov/
- 22. • 20) U.S. Census Bureau; State & County Quick Facts, Washington by County http://factfinder.census.gov/servlet/GCTTable?-geo_id=04000US53&- mt_name=DEC_2000_SF3_U_GCTP12_ST2&-ds_name=DEC_2000_SF3_U • 21) State of Washington Department of Ecology, http://www.ecy.wa.gov/programs/wq/tmdl /pendoreille/wqissues.html • 22) Bench, Dan W. (2002, October 30). PCBS, Mining, And Water Pollution. http://gsa.confex.com/gsa/2002AM/finalprogram/abstract_45204.htm • 23) Washington State Population Survey 2008 http://wa-state-ofm.us/SPSOnline/index.cfm • 24) Care Without Coverage: Too Little, Too Late, http://www.iom.edu/Object.File/Master/4/160/0.pdf • Institute of Medicine, May 2002. • 25) Pend Oreille County web page http://pendoreilleco.org/about/ • 26) Washington State Department of Health (2009). Rural Health Programs: health professional shortage areas and medically underserved areas. Retrieved [July 7,2009]: http://www.doh.wa.gov/hsqa/ocrh/HPSA/hpsa1.htm • 27) Newport Health and Hospital Services http://www.phd1.org/Services.htm
Editor's Notes
- Pend Oreille County (pronounced pahn-duh-RAY) has a population of about 12,000 people and covers an area of 1,425 miles of forest, tall mountains and valleys (25,7). The region is rich in natural wildlife and game. There are only 5 relatively small towns with populations of 150-450 people and one city in the county. The largest community within the county is the city of Newport located next to the Idaho border in the SE corner of the county with a population of roughly 2000 people (25). All of the towns sit along the Pend Oreille River and follow the only highway, State Road 20 which travels from Idaho in the SW corner of the county north to the Canadian border. Image source: http://icons-pe.wunderground.com/data/wximagenew/t/Tom1026/860.jpg
- Three larger towns, Metaline Falls (population 223), Metaline (population 162) and Ione (population 479), are in the northern end of the county and are separated from essentially everywhere else by Colville and Kaniksu National Forests, large mountains long distances to larger cities. It is a minimum of a 90 minute drive to the nearest large town with adequate medical services which would be Newport. The wood pulp, hay and cattle producing communities of Cusick and Usk have a combined population of 212 and share the area with the counties only Indian population, the Kalispel Tribe of Indians who raise buffalo as one of their industries (25). The city of Newport is home to the counties only hospital, the 74 bed Trauma Level IV Newport Community Hospital (27). There is also a 42 bed assisted living complex and a 50 bed skilled nursing facility in the city (27). There are two hospitals, Mount Carmel Hospital (33 bed) and Saint Joseph's Hospital (65 bed) in neighboring Stevens county to the West however they are equally or more distant and require travel over high mountains (15). All three hospitals provide only basic neonatal and prenatal care according to the Washington Department of Health (11).
- The county is designated primarily as “small town and isolated rural” per the Washington State Department of Health Dominant RUCA code while the southern one third is designated as “suburban” (1). Pend Oreille is part of the Northeast Tri County Health District which includes Ferry, Stevens and Pend Oreille counties (3). Health data is commonly combined for these three counties which can make it a challenge to separate the nuances to a specific county in some cases. The county has a predominantly Caucasian population (93.5%) with a median age of 41.9 years and a density of 8.4 people per square mile according to the U.S. Census Bureau 2000 survey (2, 7). A total of 16.2% of the population is over 65 years of age which compares to a national average of 12.4%. Image source: http://ww4.doh.wa.gov/gis/pdf/ruca_zip_06.pdf
- Within this county ethnicity does not appear to be an issue, at least as is reflected in the statistical and published information available. The opposite side of the coin could be that ethnic peoples are made so unwelcome that they do not stay but no substantiating or refuting information could be located. No reports of ethnic violence were found. There are very few ethnic minorities within the region with the exception of one local Indian tribe which make up 3% of the population (7). The only native Indian tribe in Pend Oreille is the Kalispel Tribe of Indians on the Kalispel reservation (16). There is a small Indian medical and dental clinic available to the tribe on the reservation 4 days a week for basic services but no emergency services (17). The Kalispel Tribe of Indians gains some of its support from the Northern Quest Resort and Casino outside the city of Spokane. They also have an industries that include the sale of buffalo meat, the manufacture of shotguns and specialty aluminum cases and Petroglyph Printing and Signs (18, 25).
- The median household income, at $39,352 is well below the national average and the state average of $55,628 (7). Furthermore 15.9 % of county residents are below the poverty level (7). One striking statistic is that 83.3% of families with a female householder and no husband present are below the poverty level (6). Unemployment is high (#6 highest) and above Washington state and almost all county averages (20). This data suggests that low income and poverty is an issue for many in the county particularly single women with children in the home. Even those who are working are not likely to be able to afford health insurance if it offered and as a result may not seek health care in a timely manner. Image source: http://www.cartoonstock.com/newscartoons/cartoonists/for/lowres/forn371l.jpg
- One third of the households have children in the home which make up 21% of the total county population (2, 7). Child abuse in homes is more than two and a half times higher compared to similar counties (8). Childhood Unintentional Injury hospitalizations is 33% higher compared to state levels (10). The U. S. Census Bureau reports that 5% of homes in the county have inadequate or absent kitchen, toileting or heating (4). A total of 81% of adults over 25 finished high school and 19% did not finish (5). Only 12.3% of the population obtained a bachelors degree or higher (5). The combination of very high child abuse statistics and high child injury/ hospitalizations indicate a substantial health and safety risk to the child in every third home. According to the Office on Child Abuse and Neglect, “poverty, lack of social support, social isolation, unemployment and high stress levels” are all factors that increase the risk of child abuse within the home setting (18chp5). Furthermore, child abuse is twice as likely in single parent households, particularly for younger children (18chp5). Poverty and high stress become a truly significant concern that requires addressing within this county when 25% of two parent families and 83% of female parent families with children under 5 years of age living below the poverty line (654 families in 1998) (6). Image source: http://media.photobucket.com/image/child+abuse/luckless15/movie1/domesticchildabuse6.jpg?o=100
- According to the Washington State Population Survey of 2008, 13.1% of Pend Oreille residents are without health insurance (23). The uninsured statistics can be broken down in various ways and results in some interesting variations. In husband – wife families the uninsured rate is 11.4% whereas in ‘other’ family households the rate was 21%. These numbers mean female head of households have nearly double the uninsured rate of traditional households. This is significant in that research shows that those who are uninsured tend to die sooner, get too little care too late, and get poorer quality care when they do get care (24). Furthermore, these are the same homes where high stress and poverty are causal factors in child abuse. Image source: http://www.flickr.com/photos/7904868@N07/1922023898/
- Smoking and physical activity are a little higher than Washington state and US averages but obesity, fruit/ vegetable consumption, binge drinking, diabetes and mental health are comparable to the rest of the state and US (3). DSHS statistics show that tobacco, alcohol, and crime are not significant issues overall compared to similar counties (8). Teen pregnancy was also low compared to the state and US levels (10). Maternal smoking is nearly 2.5 times the state and US averages (10). Maternal smoking and smoking within the household, especially by the father are issues that clearly affect the health of the coming baby in addition to the health of everyone within the home. The health risks of smoking are well documented. More education and research will be needed to address this health concern.
- Access to health care is a little low but fairly close to state and US averages according to the Washington State Department of Social and Health Services (9). There is one 74 bed hospital (Newport Community Hospital) in the south end of the county on the Border of Idaho. Two hospitals, Mount Camel (33 bed) and Saint Joseph’s (65 bed), are in neighboring Stevens county but they too serve the middle and south end of Stevens county (15). All three hospitals (Newport, Mt. Camel, & St. Joseph) provide only basic perinatal and neonatal care (11). Two thirds of the county has a >30 minute drive and three quarters of the county have a >20 minute drive to the nearest acute care hospital (12). Clearly, distance is an issue for a major portion of the county.
- All of Pend Oreille County is designated by the Washington Department of Health as ‘Geographic’ which means all county residents have trouble getting health care services (26). Pend Oreille is a federally designated Health Professional Shortage Area (HPSA) for Primary Care, Mental Health and Dental Care (13). Medically Underserved Area (MUA) scores of 15 for Primary Care, 11 for Mental Health Care and 10 for Dental Care are all very low on the 0-100 scale (13, 19). These scores implicate that the county is in need of more health care providers in all three areas due to the geographic limitations of isolation from any major metropolitan areas. The county is designated by the Washington State Department of Health as both a Physician Scarcity Area and a Specialty Scarcity Area by the Washington Department of Health (14). Both of these Scarcity Area types of rural designations implicate that the county has an inadequate number or physicians and specialists to meet the needs of the population.
- It appears that the most pressing issues for Pend Oreille that directly affect health and well being include lack of medical providers, unemployment, low incomes, child abuse in the homes and distance to/ lack of quality health care services. Low education levels, remoteness and lack of significant industry are likely contributing factors in the poor incomes within the county. The lack of inward migration of new business and people will also hinder the opportunities for economic growth and improved health opportunities. The shortage of primary, dental and mental health care providers in the area, particularly in the northern half of the county is unlikely to improve without assistance given the lack of growth within the county.
- The Positive Parenting Program (Triple P) an evidence-based program funded by the Centers for Disease Control and Prevention (CDC). This is a population based care model that has shown good effectiveness in its results. The goal of Triple P is “to prevent behavioral, emotional and developmental problems in children by enhancing the knowledge, skills and confidence of parents” (28). The basis for the Triple P program model is the study ‘Population-Based Prevention of Child Maltreatment: The U.S. Triple P System Population Trial’ which was published January 22, 2009 in the journal Prevention Science. This randomized study of 18 counties had a control group of status quo services and a group which received ‘dissemination’. Dissemination consisted of professional training to health care providers in addition to “universal media and communication strategies”. Because “this study is the first to randomize geographical areas and show preventive impact on child maltreatment at a population level using evidence-based parenting interventions” it has the best opportunity to demonstrate valid effectiveness of the interventions. Image source: http://www.triplep-america.com/pages/About_Us/index.html
- Poor financial resources limit the expenditure availability within the county. Making use of the limited medical resources already present would combine low resource expenditure with maximal community contact since alternate health care options are not readily available. A reduction in the large rates of abuse and injuries should result in a reduction in costs to the community in the form of unpaid medical bills, reduced law enforcement/ judicial system expenses, reduced mental health service needs, reduced child-out-of-home placements and a healthier long term community. With the well documented trend of abuse perpetuation within abusive homes, the long term benefits have the potential to be substantial and can readily justify the expense of implementing a program. Given the remoteness of the region, parental teaching programs for medical providers could be provided via the Internet, mailed CD materials, webcasts or teleconferencing. In house training could be supplied to large provider groups such as in the hospital and larger clinics.
- Questions?
- Image source: Washington State Department of Health.