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Catron County

               Health Plan

                           FY 2010
                 Community Health Improvement Plan 2009

                           Catron County, New Mexico

Table of Contents

Executive Summary………………………………………………………………………………… 2
       Purpose of the Plan…………………………………………………………………….. 4
       Brief Community Description………………………………………………………. 4
       Planning Process…………………………………………………………………………. 4
Vision Statement…………………………………………………………………………………….. 5
Community Health Assessment
       Summary of Catron County Health Profile 2009………………………….. 6
       Catron County Facts at a Glance………………………………………………….. 8
       Major Health Issues……………………………………………………………………… 9
Priority Areas
       Priority Selection and Rationale…………………………………………………… 9
       Problem Analyses
                 1. Inadequate number of health care providers and
                    maldistribution of existing services……………………………….13
                 2. Needs of seniors and others with disabling conditions
                    or chronic diseases…………………………………………………………14
                 3. Behavioral health including mental health and
                    Substance abuse……………………………………………………………15
                 4. Injury prevention………………………………………………………….16
Community Action Plan
       Health Priority One: Poor Distribution of Providers……………………….18
       Health Priority Two: Aging Issues and Needs………………………………….19
       Health Priority Three: Behavioral Health………………………………………..20
       Health Priority Four: Injury Prevention……………………………………………21

Executive Summary
        Catron County, New Mexico is the largest of the State’s 33 counties, covering almost
7,000 square miles. Much of the County is public land. The population is just over 3,500 people
giving a population density of 0.5 residents per square mile and a federal designation as a
frontier area. There is no population center and residents are scattered in small villages,
subdivisions, and isolated ranches. Most people are non-Hispanic Caucasian (78%) with the
remainder being almost exclusively Hispanic. The age distribution is different from much of
New Mexico with only 19.5% youth, 56.3% between ages 20 and 64, and 23.2% 65 and older.
Poverty is a serious problem and unemployment and underemployment are widespread. The
large area of the County creates serious transportation problems. Health care services consist of
a single Federally Qualified Health Center, a level 1 school-based health center, and minimal
behavioral health services. The Public Health Office is currently unstaffed, and social service
agencies do not have offices in the County.
        The Community Health Improvement Plan was developed in early 2009 to guide efforts
to improve health and wellness in the County over the next 5 years. Data from the Catron
County Health Profile 2009, key informant interviews, and Health Council focus groups in both
the northern and southern parts of the County were used to compile the Plan.
        Residents of Catron County are generally healthy. Those with significant medical needs
must leave the County for care, and all children are born outside the County. The birthrate is
half that of the New Mexico rate (7.0 vs14.5/1,000). Teen births also average less than half the
rate for New Mexico as a whole. Two school districts serve approximately 400 students, 77 of
whom are classified as having disabilities (19%). Major maternal and child health problems
include the lack of any prenatal care, WIC services in only one location, immunization rate at
age 2 of only 75%, no pediatrician or other medical specialists, poverty, low Medicaid
enrollment rate, minimal behavioral health services, lack of school-based health care in the
Reserve school district, and drug and alcohol use.
        In all but one of the last ten years, the age-adjusted death rate was lower in Catron
County than for the State of New Mexico as a whole. The leading causes of death in 2006 were
heart disease, cancer, accidents, chronic lung disease, and stroke.
        Violence, including accidents, suicide and homicide is a serious problem. Substance
abuse and especially alcohol related death is a major concern. The County has many factors
contributing to a high risk for behavioral health problems. These include isolation, poor social
supports, poverty and an increased number of senior citizens. The environment is generally a
healthy one, but there are areas with inadequate water supplies, particulate pollution due to wood
heat in homes and forest fires, and a crisis in dealing with solid waste disposal. Many homes are
substandard and there is little infrastructure (sidewalks, lighting, etc.).
        Access to health services is a significant problem for most County residents. What health
services that do exist are generally available only in Reserve, despite significant population
growth in other areas of the County, especially in the north. There is no public transportation to
allow access to care. Presbyterian Medical Services operates a clinic in Reserve with satellite
services one day per week in Quemado. There is a school-based health center in the Quemado
Independent School District but not in Reserve District. Two part-time family practitioners serve
the population (only 0.4 physicians/1000 residents). There are no night or weekend services, no
emergency department, no pharmacy, no home health care, no physical, occupational, or speech
therapy, no prenatal care and no medical specialists. Limited radiology and laboratory services
are available at the clinic and some pharmaceuticals are dispensed to clinic patients. Behavioral
health services are provided three days per month in Reserve and one day per week for students
in the Quemado schools.

       Major health issues include:
       1. Lack of health care providers of all types including physicians, nurses, emergency
           medical personnel, mental health counselors, drug and alcohol abuse counselors,
           physical therapists, occupational therapists, speech and language therapists,
           developmental specialists, health promotions specialists, health educators, dieticians,
           psychologists, etc. Location of the current providers poorly matches the distribution
           of the population.
       2. Behavioral health including mental health and substance abuse.
       3. High level of violence and excessive deaths from accidents, suicide, and homicide
       4. A lack of maternal and child health services
       5. Poor health literacy, communication, and health education
       6. Few wellness and health maintenance opportunities, nutrition education, or formal
           fitness programs.
       7. Cancer
       8. Diabetes
       9. Transportation
       10. Limited community involvement

The Health Council has chosen four priorities for the next five years, based on the first three of
these issues. These are summarized as 1) poor distribution of providers, 2) inadequate services
for the aged and those with disabling or chronic conditions, 3) behavioral health, and 4) injury
prevention. Strategies to address these priorities include resource development, training and
education, community assessment, community norm changes, and local government
involvement. Partners in addressing these problems may include Presbyterian Medical Services,
both school districts, Border Area Mental Health Services, Inc., County government, White
Mountain Regional Medical Center, Gila Regional Medical Center, New Mexico Department of
Health, State legislators, The Wellness Coalition, Local Collaborative 7, Socorro Mental Health
Foundation, social service agencies, Continuum of Care Coalition and Substance Abuse
Coalition, the DWI Council, law enforcement, extension services, Department of Fish and
Wildlife, New Mexico One Call, and the Department of Public Safety. By the end of five years
we hope to have health facilities in each quadrant of the County, a fully staffed Public Health
Office with outreach throughout the County and a variety of programs, ancillary health services
in the County, psychiatric telemedicine services, three behavioral health therapists, a Community
Wraparound Team, behavioral health support groups, a consumer-run warmline, a surveillance
system for accidents and an Injury Prevention Coalition.

Purpose of the Plan

       The Catron County Health Council (CCHC), established in 1991 to recruit and retain
       health care providers to the county, was expanded in 2007 to include a northern branch –
       the Northern Catron County Health Council (NCCHC). Working with the established
       council, the NCCHC has helped identify health care needs in the northern part of the
       county. Meetings in both the south and north have helped to identify health care needs
       and strengthen the desire county-wide to work together to meet targeted objectives over
       the next five (5) years.

Brief community description

       Catron County is the largest of New Mexico’s counties, covering almost 7,000 square
       miles. The county is the second least densely populated with 1 person per 2 square miles
       (U.S. Bureau of Census Population estimate 2006). It is designated a frontier county
       with the Village of Reserve as the county seat. The remaining population is divided
       among the communities of Datil, Glenwood, Pie Town, Quemado, Luna, and many
       smaller communities. Residents are scattered on isolated ranches, in established and new
       subdivisions, and small villages. Population growth is occurring as an increased number
       of early retirees and persons of retirement age make subdivisions in Catron County their
       permanent home or second home during the summer.               The area is economically
       depressed and poverty rates are high, especially for children. Medical, dental and mental
       health care is limited or non-existent in most areas of the county. Many residents are
       uninsured or have inadequate coverage. Often residents must travel over 20 miles by dirt
       road and then over an hour by paved road to receive limited health care. Specialty,
       hospital and emergency care requires several hours of travel to more urban areas.

       Catron County is home to several natural attractions that bring additional visitors to the
       county each year. Quemado Lake is a popular spot for fishing, boating, camping, and
       leisure activities. National Forest land is abundant in the county, including the Cat Walk
       in the southern portion of the county, and a popular rock climbing outcropping in the
       north. In the summer months, many travelers frequent the small communities of the
       county to enjoy the cooler temperatures and vast beauty that Catron County has to offer.
       During the fall and winter months, the excellent hunting opportunities draw people from
       throughout the United States to the breathtaking adventures of our county.

Description of the plan process and people involved

       The Community Health Improvement Plan was developed by the Catron County Health
       Council based on the 2009 Catron County Health Profile, key informant interviews and
       two regional focus groups. Meetings were held in various areas of the northern and
       southern portions of the county, and residents were asked to identify their major health
       concerns or concerns about health and wellness in the County. Four problem areas were
       identified as top priorities for health improvement. A small group of Health Council
       members and staff met with DOH health promotions staff and independently to establish
       goals in each area and to identify change strategies to use to reach specific objectives.

Vision Statement
    Health in its purest state is a condition of translucent radiance; unimpeded by the forces
    of disease, defect, pain and ignorance.

    It is a state of complete spiritual, mental, emotional, physical and
    environmental well-being.

    We envision a coherent and cohesive community; involved and dedicated to the
    improvement of the quality of life and the elimination of the barriers that separate us
    from each other; and from perfect health.

    Our distinct cultural differences, distant villages and persistent poverty will only serve to
    inspire the Catron County Health Council to continue its quest for a better and brighter

Community Health Assessment
Summary of the Profile

The Catron County Health Profile 2009 provides a snapshot of the County as of the beginning
of 2009, and is based on a revision of the 2008 Profile. Catron County is a frontier county
located in southwestern New Mexico and covering almost 7,000 square miles. The current
population is just over 3,500 people (UNM BBER 2006). The majority are non-Hispanic
Caucasians, with most of the remainder being Hispanic. Over 50% of the population is between
the ages of 20 and 64. There is a smaller proportion of children and youth (19.5%) than in the
state as a whole, and 23.2% of residents are 65 and older. Fewer than half the residents over the
age of 16 are employed (US Census Bureau, Employment Status by Sex, 2000) and 22.5% live
in poverty (45.3% of children). Very few residents receive food stamps (3%) or TANF (0.3%)
and the proportion of children enrolled in Medicaid is significantly less than in the rest of New
Mexico. About 20% of those who seek medical care are unfunded and there is no County
Indigent Fund.

Residents of Catron County are generally healthy. Those with significant medical needs must
leave the Country for care and all children are born outside the County. The birthrate is half that
of New Mexico as a whole at 7.0/1,000. This is an average of 24 births per year from 2000 to
2006. The teen birth rate (12.5) is also less than half that of the State (35.5), and births to single
mothers, about 75% of the State rate at 32%. Low birth weight approximates the State rate of

Catron County has two school districts serving approximately 400 students and a single Head
Start program serving only the Reserve area. There are a significant number of home-schooled
children. Seventy seven students are classified as having disabilities and are receiving special
education services. Only the Quemado School District has a school based health center (Level

In all but one of the last ten years, the age-adjusted death rate was lower in Catron County than
for the State of New Mexico. The leading causes of death in 2006 were heart disease, cancer,
accidents, chronic lung disease, and stroke, but each of these had an age adjusted death rate
lower than that for the State overall except for accidents.

Information about nonfatal illness is almost impossible to obtain and infectious diseases are more
common than reflected in DOH statistics. Violence, including accidents, suicide, and homicide
is a particularly serious problem. Substance abuse and especially alcohol related death is a major
concern for County residents. The County has many factors contributing to a high risk for
behavioral health problems including isolation, poor social supports, poverty, and an increased
number of senior citizens. The suicide rate for Catron County from 2000-2005 was twice the
New Mexico rate and four times the rate for the United States.

The environment of Catron County is generally healthy with no concerns about industrial
pollutants. Water is scarce, however, and many private wells have undesirable mineral
contaminants. Air quality is impacted by forest fires and the high number of homes that heat
with wood (46%). Solid waste disposal is a serious ongoing problem. Many homes are
substandard and infrastructure is minimal

Access to health services is a significant problem for County residents. The entire county is a
Health Professional Shortage Area for medical, dental and mental health professionals. The
County has a ―Medically Underserved Area‖ designation by the federal government. What
health services that do exist are generally available only in Reserve, the County seat. Only about
10% of the population lives in Reserve, and the major area of population growth is the northern
part of the County. Many parts of the County have no formal health services at all. There is no
public transportation and travel to obtain medical care is a significant problem. The major health
care provider is Presbyterian Medical Services who run a federally qualified health center in
Reserve and a satellite clinic and school based health center in Quemado (northwestern Catron
County). The clinic is open 4 ½ days per week in Reserve and 1 day each for general care and
students in Quemado. The clinic employs 1.4 FTE of physician services, 1.0 dentist (Reserve
only), and has 1.4 FTE nurses. There are no night or weekend services, no emergency
department, no pharmacy, no home health care, no prenatal care and no medical specialists.
Limited radiology and laboratory services are available and the clinic dispenses some
medications for their patients. The Public Health office is currently unstaffed. WIC services are
available one day per week only in Reserve and some public health services such as
immunizations are occasionally available. Emergency Medical Services exist on a volunteer
basis in six communities, but there are no paramedics. There is one chiropractor and several
alternative health practitioners in the County. Behavioral health services are provided three days
per month in Reserve and one day per week for students in Quemado. There are no
psychologists or psychiatrists, no face to face crisis services, and no comprehensive community
support services. The DWI Council conducts an after school program in Reserve for youth from
4th-12th grades as well as other prevention activities.

Senior citizens account for 23.2% of the County population. There are three Senior Centers, one
in Glenwood, one in Reserve, and one in Quemado. The Senior Centers provide recreation,
socialization, meals, and a number of home-based services as well as some transportation to
medical appointments and shopping. A senior health fair is held just prior to influenza season
each year and flu shots are available. The lack of home health care, including physical therapy,
occupational therapy, and speech therapy, is a particular problem for many seniors and their
families. Hospice care has recently become available throughout the County.

Social service agencies are nonexistent in the County. Coverage is expected to be provided from
neighboring counties, but personnel from these agencies are rarely present in the County. The
Children, Youth and Families Division recently began providing on site services twice a month.
Families must travel out of county to Socorro or Silver City for Income Support or other
programs. Presumptive eligibility for Medicaid is available through the Catron County Medical
Center (PMS).

Some pertinent statistics are shown on the accompanying page, “Catron County Facts at a

                                        Characteristics of the Population
Facts at a Glance
                                                19.5% under age 20
Geography                                       57.3% ages 20-64
                                                23.2% ages 65 and older
      7,000 square miles                       Majority is non-Hispanic
      3,500 people                              Caucasians; most of
      0.5 persons per square mile               remainder are Hispanic
      A ―frontier‖ county                      An increasing number of
                                                 part-time residents and
Maternal and Child Health 2000-                  seasonal visitors
                                        Leading Causes of Death/100,000
      7.0 births/1,000 population
      Teen birth rate 34.4/1000        Causes      1998-2004 2005 2006
      Births to single mothers—
       31.7%                             Heart       194.9     109.4 167.8
      Pregnant women who
                                         Cancer      126.5     147.6 153.7
      No prenatal care in County        Accidents     65.2    205.1    64.0
     Behavioral Health                  Chronic lung 26.2       47.5    46.2
(Individuals needing services)*
                                         Diabetes               24.7    27.5
  Mental Health      Substance Abuse
                                         Stroke         50.5    16.9    32.2
Youth 87 (12.9%)       12.6 (3.2%)
                                        Violent Deaths (1998-2007)
Adults 669 (23.9%)     227 (8.5%)
                                                Accidents     40
*Gaps Analysis 2002                             Suicide       15
9.3% of adults report frequent mental           Homicide       9
distress (BRFFS)
                                        Health Services
Behavioral Health (Youth)
                                                Clinics—Reserve and
      Depression            26.9%               satellite in Quemado
      Suicide attempt       11.7%              Doctors 1.4 (4/10,000)
      Drink currently       41.9%              Dentists 1.0
      Marijuana             20.2%              Nurses in clinics 1.4
      Cocaine               11.6%              Public health nurse—None
      Inhalants              4.8%              Mental health counselor—7
      Heroin                 8.7%
      Methamphetamine        7.2%

Major health issues or problems

              The major identified health issues can be divided into several categories as

       1. Maternal and child heath
       2. Health literacy and communication/education
       3. Wellness and health maintenance opportunities, nutrition and fitness
       4. Services for Senior Citizens and others with disabling conditions or chronic diseases
       5. Inadequate medical providers with poor distribution of services
       6. Violence
       7. Cancer
       8. Diabetes
       9. Behavioral health including substance abuse and mental health
       10. Accidental injuries
       11. Community involvement
       12. Transportation

Ranking of health issues or problems

       The top four health issues chosen by the community as a focus for action are:

       1. Inadequate number of health care providers and maldistribution of existing services
       2. Meeting the needs of senior citizens and others with disabling conditions or chronic
       3. Behavioral health including substance abuse and mental health
       4. Accidental injuries

Priority Areas

       Priority selection and rationale
          Four priority areas have been selected as described below.

          1.    Poor distribution of services—Catron County has an insufficient number of
               health care providers including doctors, nurses, mental health therapists,
               psychologists, health educators and health promotion specialists. Ancillary
               services such as occupational and physical therapy, speech and language therapy,
               laboratories and pharmacies do not exist. The services that do exist are located in
               Reserve, the County seat, which is in the southern part of the County. The major
               population growth in the County has been in the northern half thus leaving a
               sizeable number of residents with no local services. This is an increasing problem
               as more people move into the County. The County has only 1.4 FTE of physician
               time and additional hours are needed to provide services needed in the northwest,
               northeast, and southern parts of the County and to expand hours in Reserve. The
               only satellite clinic is the Quemado Clinic, which serves students one day per
               week and the entire population of the northwestern part of the County only one
               day per week. There is no clinic in the northeastern area, around Datil or in the
               Glenwood area. Glenwood residents often access care in Silver City or Cliff, but

     have repeatedly expressed interest in having a clinic in their area, as Silver City is
     a full hour away. Services from outside the County have been recently curtailed
     due to travel restrictions and financial difficulties. There is no staff in the Public
     Health Office, and even when a nurse and clerk were present, many programs
     provided in other counties were not offered in Catron County. Behavioral Health
     services have also been reduced drastically. There is a single part-time counselor
     working one day per week in the Quemado School Based Health Center and a
     family support worker also part-time in Quemado. An itinerant counselor comes
     to Reserve 3 days per month. There are no services in other communities and
     State cutbacks in funding restrain the local Community Mental Health Agency
     from providing needed services. There are no medical specialists even on an
     itinerant basis and no prenatal care. Recruiting health care providers is a
     significant problem and space to house services also limits expansion. All
     Emergency Medical Services are provided by volunteers and several communities
     are having difficulty recruiting individuals to staff their programs.

2.    Needs of seniors and others with disabling conditions and/or chronic disease--
     Although the Senior Centers provide congregate meals, socialization, recreation
     and some in home services for the elderly, there is no other source of home health
     and the ancillary services of physical therapy, occupational therapy, and speech
     therapy. The long distances between homes in the County create a barrier to
     delivering these services. Seniors find it difficult to access health care due to
     transportation issues. There are no services for Alzheimer’s Disease. The clinic
     does not have services in most of the geographic areas of the County and only
     limited services outside of Reserve (see above). Patients needing regular
     laboratory studies such as PT/INR must drive long distances frequently to obtain
     these. Access to medications is also limited with no County pharmacy. There are
     no long-term care facilities in the County and relatives must often be placed far
     away in Silver City or Socorro. Two home care agencies and the Agency on
     Aging provide housekeeping services to qualified individuals. A new hospice
     program has just started in the County. These access problems worsen as the
     population ages. Not only are the older individuals affected, but their entire
     family suffers. One recent development in this area was the opening of a new
     Senior Center in Glenwood. There is no Senior Center in the northeastern part of
     the County although residents are bussed to Quemado one day per week.

3. Behavioral health including substance abuse and mental health-- Catron County
   has many common risk factors for behavioral health problems. Drug and alcohol
   use is a major concern for local citizens and is felt to contribute to domestic
   violence, traffic fatalities, and other violent deaths. Depression is widespread and
   9.3% of adults responding to the BRFSS survey report frequent mental distress.
   The suicide rate is high (see above) and over a quarter of youth report suffering
   from depression. Prevention efforts address youth substance abuse but do not
   combat community norms that contribute to the problem. There is concern that
   law enforcement and the courts do not respond adequately to the challenge of
   drug and alcohol-related crimes. There are minimal services available to treat
   those affected. Behavioral health services have been recently curtailed.
   Attracting service providers to the area is difficult, and stigma creates a major

   barrier to accessing services. A group of local consumers of behavioral health
   services has recently organized to address many of these concerns.

4. Injury Prevention—In 2005, the death rate from accidents in Catron County was
   an astounding 205/100,000! Although this was probably a statistical artifact
   caused by the small number of total deaths each year in the County, the average
   age adjusted death rate from accidents between 1998 and 2004 was 96.9 (New
   Mexico Selected Health Statistics Annual Report, 2005). Only cancer and heart
   disease cause more deaths each year in the County, and for 2005, accidental
   injury was the leading cause of death! Although the rate for 2006 has dropped
   down to the overall state rate, it is still the third leading cause of death. No data
   exists to show the incidence of nonfatal injuries. It is estimated that for every
   injury death there are 10 hospitalizations and 141 emergency department visits. It
   is known that rural areas have higher rates of accidental death than more urban
   areas, but the rate in Catron County is unusually high even for rural areas. Many
   injuries are related to firearms, alcohol, and drug use.

Problem analyses
A force field analysis was conducted to analyze each of the four problems chosen as Health
Council priorities.

Force Field Analysis

Problem: Poor distribution of Services              Ideal State: Adequate health providers
                                                    throughout the County

     Driving Forces                      Restraining Forces

    increased morale                o    perception that Reserve is the “center” and largest population
    citizen perception of
     adequacy (days of               o    cost of malpractice insurance and overhead costs
                                     o    Single service provider-PMS
    increased energy efficiency
                                     o    No SBHC in Reserve
    county land development
     increasing                      o    Distances and lack of communication infrastructure

    need for prenatal care          o    Largeness of county-driving distances/condition of vehicles

    need for specialty care ( 1-2   o    Mindset of resistance to progress
     times per month specialty)
                                     o    Reactive as opposed to proactive mindset
     (pediatrician 1/ week)
                                     o    Recruitment difficulties-adequate housing, number of rentals,
    preference for
                                                isolation in living, salary, low state reimbursement rates,
     complementary medical
                                                poor license reciprocity, reputation of NM educational
    population growth
                                     o    Available office space (sq. footage and buildings)
    changing mindsets within
                                     o    Lack of public transportation
     the population
                                     o    Political philosophy that healthcare is not a government
    aging population requires                   responsibility.
     additional services

Discussion: The inadequate number and variety of health care providers and the distribution of
these providers exclusively in the Reserve area is a major priority due to unmet health care
needs of residents. Driving forces towards achieving the ideal state of having adequate health
providers throughout the County, include changing demographics and expectations, the need for
specialty care and the higher health care needs of elderly people. Restraining forces include
some issues that are beyond our control, but the Council has decided that they may be able to
counter the effects of a single health care provider in the County and the philosophical belief of
the County Commissioners that healthcare is not a government responsibility.

Force Field Analysis

Problem: Aging issues and needs                 Ideal State: Ancillary services provided
                                                throughout the county, such as Lab, Pharmacy,
                                                Home Health, Hospice, WIC

       Driving Forces                                       Restraining Forces

      Increased number of people with high                 Distance
       medical needs
                                                            Cost of provision
      Energy efficiency
                                                            Funding infrastructure (office space,
      Cost savings in long term                                  mobile services, etc.)

      Increased use of Senior transit services to          Lack of “outside the box” thinking
       bring people to local ancillary services ,                  concerning health services in this
       meals, etc.                                                 vast county

      Shorter hospital stays                               Absence of senior care facility, as well as
                                                                  general facilities- lab, pharmacy,

                                                            Mobile population, with people
                                                                  combining med. appointments
                                                                  with available shopping

Discussion: The second priority is closely related to Priority 1, but addresses ancillary services
rather than healthcare providers. Ideally we would like to see ancillary services, such as
laboratory testing, pharmacy services, home health and hospice care, available throughout the
County. This need is driven by an increasing need for these services due to the high proportion
of senior citizens and others with high medical needs, including Alzheimer’s disease and other
chronic conditions. Residents who are discharged from the hospital often need these ancillary
services on a temporary basis in order to be able to return to their homes. Restraining forces

seem almost insurmountable, leading to the choice of ―outside the box thinking‖ as a point of
intervention to achieve an increase in services.

Force Field Analysis

Problem : Behavioral       Health         Ideal State: Fewer County residents experience negative
                                          effects on their life from behavioral health challenges

       Driving Forces                                        Restraining Forces

      Work of the Health Council has become            o      Low access to services-limited services,
       more known over time                                       services are distant (transportation,
                                                                  vehicle quality and cost, childcare)
      Prevention efforts (DWI,SACAT)
                                                        o      Willingness of adults to provide minors
      New behavioral health grassroots group                      with alcohol and drugs of abuse
                                                        o      Weak communication system (lack of
      Depression noticed more in aging                           awareness of treatment
       population, not just youth                                 opportunities and treatability)

      Domestic Unity active                            o      Social stigma

      Border Area Mental Health presence               o      Lack of collaboration between
                                                                   prevention groups
      Coming telehealth
                                                        o      Cultural mindset (Turf protective,
      SBHC Quemado has mental health                              independent and individualism mind
       services, which includes telehealth                         set)
                                                        o      Community norms/culture
      Limited retail availability of alcohol
                                                        o      Inadequate number of law enforcement

                                                        o      Special treatment of certain citizens with
                                                                  respect to rules, policies and laws

                                                        o      Lack of community specific data

                                                        o      School district reluctance to track
                                                                  behavioral health data

                                                        o      Denial factor

                                                        o      State budget

                                                     o      No CYFD or YFS presence in County,
                                                               which leads to slow response or
                                                               insufficient response by tech.

                                                     o      State awareness of importance of this
                                                                issue, ex.: Health Promotion Team

                                                     o      Perception of distance as being “too far”
                                                                by tech. Assistance such as Value
                                                                Options, DOH, etc., as well as local
                                                                service providers

                                                     o      Perception that Catron County is not
                                                                worth it (population, numbers of
                                                                voters, etc.)

                                                     o      Aging technological infrastructure- over
                                                                committed and under built.

                                                     o      State behavioral health

                                                     o      State telehealth infrastructure does not
                                                                require to update in order to serve
                                                                areas such as Catron County

                                                     o      No SBHC in Reserve, which would
                                                                provide mental health services

                                                     o      Cultural mindset and fear of
                                                                governmental involvement. Citizens
                                                                do not tend to speak out for
                                                                legislative/policy etc. changes

                                                     o      General spirit of rejection of authority in

Discussion: Behavioral health, including substance abuse and mental health, was chosen as a
priority because of several factors. Data from the Profile demonstrates that this is a significant
concern. The State is embarking on a transformation of behavioral health services, and Border
Area Mental Health Services has recently reduced its offerings in the County due to difficulty
finding practitioners. A significant driving force is the recent establishment of a new Grassroots
Behavioral Health Group. Several areas seem to be possible points for change including
increasing awareness at a State level of the importance of this issue, hopefully leading to a health
promotions team member in the County, increasing collaboration among prevention groups,
limited services, and community norms.

Force Field Analysis

Problem: Injury   Prevention           Ideal State: Decrease in frequency of accidental injury.

       Driving Forces                              Restraining Forces

      Awareness of unsafe practices                 o   Increased number of elderly citizens

      Training                                      o   Agricultural machinery use (tractors,
      Upgrading of substandard housing
                                                     o   Lack of adequate firearm safety
      Improved infrastructure (sidewalks,
       lighting, etc.)                               o   Increased use of ATVs

                                                     o   Recreational and occupational use of

                                                     o   Alcohol and drug use

                                                     o   High frequency of lightning strikes

                                                     o   Long driving distances

                                                     o   Wildlife on roads

                                                     o   Outdoor recreation

                                                     o   Wildland fires

                                                     o   Prevalence of older or substandard

Discussion: Accidental injuries are the third leading cause of death in Catron County. While
heart disease and cancer are difficult to prevent in an older population, injury prevention efforts
could have dramatic and rapid beneficial effect. Awareness of unsafe practices and remedial
actions can be addressed by a volunteer coalition and does not require the professional services
unavailable in the County.

       1. Poor distribution of services

         a. Strategy 1. Local government involvement
         b. Strategy 2. Multiple service providers
         c. Strategy 3. Resource development
   2. Needs of seniors and others with disabling conditions and/or chronic diseases
         a. Strategy 1. Training and education
         b. Strategy 2. Community assessment
         c. Strategy 4. Resource development
   3. Behavioral health including substance abuse and mental health
         a. Strategy 1. Resource development
         b. Strategy 2. Training and education
   4. Injury prevention
         a. Strategy 1. Training and education
         b. Strategy 2. Community norm changes

1. Community action plan (Grid)—see attached.

        CHI PLAN : Community Action Plan Grid

Health Priority One: Poor Distribution of Providers

Goals                                 Objectives                           Community Partners/Resources     Health Status Outcomes/Indicators

Goal 1 : Medical clinics in each of 4 Objective1.1: Conduct needs                PMS                       Presence of operating clinics in Datil,
major communities- Datil,             assessment in 1 target area per            BAMHS                     Quemado, Reserve and Glenwood
Quemado, Reserve, and Glenwood. year.                                            Quemado Independent
                                                                                  School District #2
                                      Objective 1.2 Locate possible              Catron County
                                      providers for each target                   Government
                                      community by 2013.                         White Mountain Regional
                                                                                  Med. Center
                                                                                 NM Dept. of Health

   Goal 2 : Develop adequate          Objective 2.1: Have a 1.0 FTE              NM Dept. of Health        One day/week Public Health presence
   county-wide Public Health          Public Health Nurse by the end of          State legislators         in outlying areas.
   Presence and programs.             2011.                                      County government
                                                                                 Quemado Independent       Public Health office fully staffed in
                                                                                  School District #2        Reserve, including programs such as
                                      Objective 2.2 Locate Public Health
                                                                                                            5% increase in immunization rate by
                                      office space throughout the                                           2014.
                                      County by the end of 2011.
                                                                                                            Increase in flu vaccines given by 10%.

        CHI PLAN: Community Action Plan Grid

Health Priority Two: Aging Issues and Needs

Goals                                    Objectives                          Community Partners/Resources    Health Status Outcomes/Indicators

Goal 1 : Create ability to think         Objective 1.1 Provide paradigm                                      Have PT services available in the
“outside the box” in relation to         shift training to Health Council,                                   county.
ancillary services.                      county government, and other            To be identified
                                         interested community members,                                       Have OT services available in the
                                         county-wide, within 18 months.                                      county.

                                                                                                             Have Home Health care available to the
                                                                                                             entire county.

Goal 2 : Bring Home Health Care to all   Objective 2.1 Develop                     NM Dept. of Health       At least 3 unique ideas for meeting the
of Catron County.                        collaborative grant proposals to          The Wellness Coalition   county health care needs by 2013.
                                         raise up to $500,000.00 to                Web based training
                                         subsidize in-home services by FY

        CHI PLAN : Community Action Plan Grid

Health Priority Three: Behavioral Health

Goals                   Objectives                         Community Partners/Resources      Health Status Outcomes/ Indicators

Goal 1 : Develop a     Objective 1.1 Complete                    LC 7                      Reduce suicide rate by 25% by 2015.
system of care for     assessment to define services             BAMHS
Behavioral Health in   needed by June 30, 2011.                  Socorro Mental Health     Decrease incidents of depression on YRRS by 20% by 2015.
Catron County.                                                   CYFD
                       Objective 1.2 Have support                                           Have 3 behavioral health therapists operating in county by
                                                                 Youth and Family
                       groups for those with behavioral                                     2015.
                       health challenges in the 4 target
                                                                 Presbyterian Med.         Have telehealth medicine with psychiatrist by 2015.
                       communities by June 30, 2011.
                                                                 LifeQuest                 Establish warm line by 2012.
                       Objective 1.3 Train consumer
                       workforce on an ongoing basis.            La Familia
                                                                 Continuum of Care         Have AA groups throughout the county.
                       Objective 1.4 Add at least one             Coalition
                       new behavioral health service                                        Have community wrap around team in place by 2012.
                       per year to entire county.
                                                                                            Increase number of DWI arrests by 10%

                                                                 LC 7
Goal 2 : Increase      Objective 2.1 : Conduct anti-             BAMHS                     Increase in use of behavioral health services by 50% by
public awareness of    stigma campaign.                          Socorro Mental Health     2015.
behavioral health                                                CYFD
                       Objective 2.2 : Educate county            Youth & Family Services   Service at least 30 residents/ month with warm line by
                       citizens and lawmakers on                 Presby. Med. Services
                       severity of problem.                      LifeQuest
                                                                                            Implementation of community education program by 2012.
                                                                 La Familia
                                                                 Continuum of Care

        CHI PLAN : Community Action Plan Grid

Health Priority Four : Injury Prevention

Goals                  Objectives                             Community Partners/Resources                 Health Status Outcomes/Indicators

Goal 1 : Educate       Objective 1.1 Develop mechanism              NM Dept. of Health, Injury   Data collection system in place by 2012.
citizens and county    for collecting county-wide data on            Prevention Office
government about       both fatal and non-fatal injuries.           Law enforcement              Implementation of community education series on
the magnitude of the                                                NM dept. of Fish and         injuries by 2011.
problem.                                                             Wildlife

Goal 2 : Develop       Objective 2.1 : Create presentation          NM Fish and Wildlife         Implementation of injury prevention coalition by
collaboration with     about the high incidents of                  Law enforcement              2011.
other groups county-   unintentional injuries by December           DPS
wide.                  30, 2009.                                    Public Health Office
                                                                    Catron County Medical
                       Objective 2.2 : Take presentation to          Center
                       at least 4 collaborative groups
                                                                    County Extension services
                       throughout the county.

                       Objective 2.3 : Create community-
                       wide injury prevention coalition.

Goal 3 : Reduce risk   Objective 3.1 : Work with coalition          NM One Call                  Decrease in number of fatal accidents by 25% by
factors contributing   to create injury prevention program.         Public Health Office         2015.
to accidents.                                                       Dept. of Public Safety
                                                                                                  Inspection of homes of those desiring it, over 65
                                                                                                  years of age for safety risk factors


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Description: Catron County grassroots clinics