By Lake Tahoe News staff

Mental health, substance abuse and access to healthcare services are the main concerns of people on the South Shore, according to Barton Health’s 2015 Community Health Needs Assessment.

Other issues to be addressed include: Alzheimer’s disease, cancer, heart disease and stroke, infant health, injury and violence, nutrition and weight, oral health, and tobacco use.

The Affordable Care Act mandates these studies be done every three years, with this being the second one for Barton. The information was collected from community members, health professionals, and national Census data.

Assessment highlights:

·      Substance abuse ranked as the No. 1 major problem.

·      The ratio of primary care doctors to patients in the region is less than the California or U.S. proportion. In the past year, 20 percent of patients had difficulty finding a physician and 25 percent struggled to schedule a physician visit. More than 25 percent of survey responders reported not having a specific source for ongoing care.

·      Responders indicated mental health as a major problem. Nearly 30 percent of responders showed signs of chronic depression for more than two years and only half have been diagnosed with depression.

·      Suicide rates are above the state and national average.

·      Seventeen percent reported experiencing emotional abuse in the past or present.

·      Deaths from liver disease and drug use increased from the 2012 assessment and remain above California and national levels. One third of responders reported being excessive drinkers and 7 percent admitted to drinking and driving within the past month. Five percent had sought help for an alcohol or drug problem.

·      The majority of survey responders met physical activity guidelines, and 41 percent of adults and 72 percent of children identified as a healthy weight. Fewer adults and children were overweight or obese compared to California, Nevada, or national levels.

·      Violent crime and homicide rates were both low.

·      Teen pregnancy rates were half the national average.

Lake Tahoe News asked Leanne Wagoner, Barton community relations manager, a few questions about the assessment:

LTN: What steps did Barton take three years ago to deal with top needs in the assessment?

Wagoner: Barton Health staff has worked with numerous community partners, including the Community Health Advisory Committee and Lake Tahoe Collaborative, to create and implement more than 20 action items to address the top health concerns in the community.

Between 2012 and 2014, Barton Health awarded $25,000 each year in community health grants to organizations with projects that addressed the top three health priorities: mental health, substance abuse and access to healthcare. In 2015, Barton Health doubled the amount and will award $50,000.

Barton Health has provided volunteers and financial support for community-based initiatives, including the Drug Store Project, Every 15 Minutes, Sober Grad Nights, and educational classes such as Mental Health First Aid. To assist community members with finding the appropriate community resources, Barton Health now annually creates a “Health and Wellness Directory,” a free community resource guide comprised of local health and wellness resources. In addition, the top health issues are woven into free wellness lectures conducted by Barton physicians and clinicians, articles in submissions to local media and every Health & Life magazine, and a poster and advertisement series.

Barton Health continues to expand services for mental health. Staff has contracted with a second psychiatrist at Barton Psychiatry and hired a full time clinical social worker at Barton Community Health Center. The demand for counseling services and social service guidance is high and Barton is currently in the process of hiring an additional social worker. Because services are often restricted to a county or state, Barton Health collaborated with mental health agencies to create a process for Legal 2000, the ability to transfer mental health patients across state lines, which increases Barton’s ability to place patients in need of in-patient psychiatric care from five to nine facilities, improving access and expediting appropriate care. Barton Health hosted two well-attended mental health forums with partners and agencies in the fall of 2013 and spring of 2015, and formed a Mental Health Cooperative to address mental health issues. From the 2015 forum, a six-month action plan was developed identifying the following priorities: development of transitional housing, expand the health resource guide, implement coping skills programs for fifth-graders, attain local representation for NAMI, and launch a Mental Health Awareness campaign in May. All have been completed or are on target for completion this year.

Barton Health has implemented programs and protocols to address substance abuse. Physicians have received training in chronic pain management and an integrated pain management task force continues to help the program evolve. A Barton Health staff member chaired the Drug Free Coalition for a year and now leads the Reducing Access workgroup. In the fall, Barton Hospital’s Emergency Department will start implementing an Alcohol Brief Intervention Program to assess trauma patients for alcohol abuse and provide counseling services.

To improve access to health care, Barton expanded the Community Health Center by 3,000 square feet.  Barton added new specialties and telemedicine services for underserved community members, including those uninsured, underinsured, and Medi-Cal patients. With implementation of the Affordable Care Act, more than a dozen certified employees helped community members enroll in a health plan.  They hosted eight enrollment events, created a website link and telephone line to answer questions, and provided private appointments.

New services were also added. Additional service lines include Urology, Sleep Medicine, and Robotic Surgery. Barton expanded telemedicine services and created new partnerships with Tahoe Forest Cancer Center as well as a free Cancer Wellness Program. Transitions in Care was started to help patients being discharged from the hospital with chronic conditions, such as congestive heart failure, manage their conditions successfully at home to reduce the risk of readmission. Launched in spring 2015, Barton now offers a price estimator tool for certain procedures allowing patients to understand and plan for medical expenses, including a cost reduction program for MRI services.

LTN: With the data similar to what it was three years ago, it would seem like whatever was implemented didn’t really work. Can you speak to that?

Wagoner: Significant progress has been made. In 2012, access to care referred to the number of uninsured in our community. In less than three years, the uninsured population has reduced from 26.2 percent to 14.7 percent.  Barton Health’s certified enrollment counselors helped nearly 600 South Lake Tahoe residents navigate the insurance market and get the coverage they need. The 2015 Assessment shows new access to care hurdles that reflect demands from newly insured residents, which will be addressed in the 2015-2018 Action Plan.

With other results, we are seeing progress, but know it takes time and resources to see change. Mental health issues can be life long and difficult to diagnose and treat. Within the mental health category, Barton Health has expanded the telemedicine psychiatry services and has hired an additional psychiatrist and licensed social worker at the Community Health Center. This spring, Barton developed a Mental Health Cooperative with other agencies to implement a mental health action plan and has received a rural health grant to implement preventative and action measures to address mental health issues. The South Lake Tahoe community has also seen an investment from the school district with the allocation of increased counseling resources at the middle and high school.

To help address substance abuse, Barton plays an active role in the South Tahoe Drug Free Coalition which has had a number of successes including the new Brief Intervention program at the high school. A permanent drug take-back bin is now located at the police department and this school year a Friday Night Live program will launch at the high school. Barton’s integrated pain management group will continue to work on protocols to responsibly address acute and chronic pain patients throughout our health system. The California Healthy Kids Survey is a survey administered by LTUSD illustrating perceptions and usage around substance abuse in addition to other behavioral health measures. Improvement occurred in certain categories such as: there was a decrease in frequency of alcohol use among three age categories for kids in the 2014-15 school year as compared to 2011-12; across all grade levels more teenagers now perceive marijuana use as harmful.

Mental health, substance abuse, and access to healthcare are almost always listed as “Areas of Opportunity” among other Community Health Assessments and fairly frequently end up as priorities for both rural and urban communities alike. Mental health and substance abuse cannot be solved by one entity and require time and collaboration between social service agencies and the individuals as well as community support.

LTN: Is Barton required by law to create a three-year action plan, or is this something you are doing on your own? How will the outcomes be measured?

Wagoner: Barton Health has gone above and beyond the Affordable Care Act requirement that nonprofit hospitals conduct a Community Health Needs Assessment and Action Plan. Barton Health has maintained Community Health as a strategic plan priority for the organization and has hired a community outreach liaison to oversee the Action Plan and strengthen community partnerships. Barton Health has donated funds for community projects that address community health needs and successfully acquired additional partnerships and funding sources to support the action plan.

Outcomes can be measured by community data such as the California Healthy Kids Survey, county public health data, results from the Community Health Needs Assessment, and law enforcement reports. Hospital data provides valuable insight into our patients and their care.  Barton has expanded services and hired new clinicians and primary care providers. The community resource guide is widely distributed and has expanded to include mental health services. Find Barton’s community investments highlighted in the Community Benefit Report.

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Notes:

·      The 2015 Community Health Needs Assessment results and summary are online.