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MAPP Final Report

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MAPP Final Report Powered By Docstoc
					        Marshall County, KY
            2010/2011
    Community Health Assessment




            Prepared by:
Marshall County CHAT/MAPP Committee
                                      1
I. Introduction
Goal:

To partner with community members to provide a comprehensive and unbiased profile of Marshall County,
assess community health and risk factors, identify program gaps/duplication issues, and begin planning for
future collaborations as a community based on MAPP data results.




Participants:

The Marshall County Health Department initiated the MAPP process, however, the project was a true
partnership of multiple county agencies. A subcommittee was formed to organize root components of the
project. A larger group, made up of the entire public health system, was included in the overall MAPP
planning process.

Objectives:

       Identify local health/safety needs

       Determine priority health/safety needs for Marshall County

       Develop a coordinated strategic plan utilizing MAPP data

       Continue cyclical MAPP process by initiating and continuing agency discussions to insure goals and
        objectives outlined in community strategic plan are met.


                                                                                                             2
Survey Areas:

         Community Themes and Strengths Assessment

          Provides a deep understanding of the issues residents feel are important by answering the following
          questions: ―what is important to our community,‖ ―how is quality of life perceived in our
          community,‖ what assets do we have that can be used to improve community health?‖

         Public Health System Assessment

          A comprehensive assessment of all of the organizations and entities that contribute to the public’s
          health by answering the following questions: ―what are the activities, competencies, and capacities
          of our local public health system,‖ ―how are the essential services being provided to our
          community?‖

         Community Health Assessment

          Provides a deep understanding of the issues residents feel are important by answering the following
          questions: ―how healthy are our residents,‖ ―what does the health status of our community look
          like?‖

         Forces of Change Assessment

          Focuses on the identification of forces such as legislation, technology, and other issues that affect the
          context in which the community and its public health system operates by answering the following
          questions: ―what is occurring or might occur that affects the health of our community or the local
          public health system,‖ ―what specific threats or opportunities are generated by these occurrences?‖

  II. Methodology
  Sample

      The primary objective in survey distribution was to get a representation of the county’s residents as a
      whole while documenting for comparison results among separate communities in the county.
      Communities broken down in the Demographics section of the surveys were as follows:

      Calvert City             Possum Trot               Sharpe                    Benton

      Hardin                   Gilbertsville             Draffenville              Aurora

      Fairdealing              Oak Level                 Brewers                   Briensburg



                                                                                                                 3
  All surveys, with the exception of the Public Health System Assessment, were conducted in the
  following ways:

     Random distribution at local events

     Distribution at local agencies/businesses

     Random telephone interviews

     Online Surveys (promoted on MCPHD.org and MarshallCountyDaily.com)

  The Public Health System Assessment was conducted in a retreat format. County agency and private
  company leaders were invited to participate in a 2-day retreat. At the retreat, questions outlined in the
  NPHPSP Local Public Health System Performance Assessment Instrument were asked and recorded.
  Majority ruled on answers, and questions were discussed if a consensus was difficult to reach, or results
  were close. Answers were sent to NPHPSP for a full report, which has been utilized in the community’s
  strategic plan. Data was collected from August 2009-October 2010.

  A total of 644 participants completed surveys. Thirty-two agency/business leaders participated in the
  Public Health System Assessment. The Community Strengths and Themes Assessment yielded 260
  completed surveys, and the Community Health Assessment had 352 participants. Also, 15 people
  actively participated in the Forces of Change assessment.

  Telephone interviews were conducted by Murray State University nursing students. Dr. Dana Manley
  MRNP oversaw the process. It was conducted at a phone bank located at Murray State University.

  Survey instruments were based on samples found on the NACCHO MAPP Clearinghouse Website. The
  examples were analyzed by the MAPP/CHAT subcommittee and full committee. They were localized
  and edited to fit Marshall County. The Public Health System Assessment was not edited, but used as
  published by NPHPSP.

  Two Wal-Mart gift cards were given as incentives for those who completed written surveys. One was
  given as part of the Family Week community event, and one for those who completed surveys at the
  Marshall County Health Department.

III. Assessments
         1. Themes and Strengths Assessment Community Questions:




                                                                                                          4
                        Table 1.1:

   How Does Marshall County Rate as a Healthy County
   Excellent                               5%

   Very Good                              23.8%

     Good                                  45%

     Fair                                 23.5%

     Poor                                 2.7%



                        Table 1.2:

Would You Say the Healthcare System in Marshall County is:
   Excellent                              8.6%

   Very Good                               29.6

     Good                                 38.9%

     Fair                                  19.1

     Poor                                  3.9



                        Table 1.3:

     How Does Marshall County Rate as a Safe County
   Excellent                               9.2

   Very Good                               44.6

     Good                                  33.8

     Fair                                  11.2

     Poor                                  1.2


                                                             5
                                              Figure 1.1:

                          Do You Have Enough Money to Pay for Essentials




   *Always = 61.5%, Sometimes = 32.3%, No = 6.2%




                                              Figure 1.2:

                     Do You Feel There are Enough Jobs in Marshall County




*Yes = 8.6%, No = 91.4%


                                                                            6
                                           Figure 1.3:

                           Do You Feel There are Enough Jobs for Youth




*Yes = 20.4%, No = 29.6%

                                           Table 1.4:

                            How do You Rate Your Own Personal Health
                     Very Healthy                             17%

                       Healthy                               52.5%

                  Somewhat Healthy                           27.4%

                      Unhealthy                               3.1%



                                           Table 1.5:

                     Are you Satisfied with the Church and Faith Community
                       Always                                56.8%

                      Sometimes                              38.9%

                           No                                 4.3%

                                                                             7
                                          Figure 1.4:

                           Do you have a Sense of Community Pride




   *Always = 57.4%, Sometimes = 39.1%, No = 3.5%



                                           Table 1.6:

Are You Satisfied With the Level of Trust and Respect Between Community Partners
                 Always                                       31%

               Sometimes                                     58.1%

                   No                                        10.9%




                                                                                   8
                                          Table 1.7:

         Where do You Usually Go When You Are Sick or Need Health Care
               Public Health Clinic                        8.5%

         Hospital Outpatient Department                    7.3%

                 Doctors Office                           81.1%

         Hospital Emergency Department                    12.7%

             Outside Marshall County                      28.6%



                                            Table 1.8:

What do You Feel Are Barriers to Getting Health Care in Your Community
     Too Much Paper Work                                 15.7

              Cost                                       75.9

  Prescription/Medication Cost                           45.4

        No Transportation                                7.9

Doctors Don’t Speak My Language                          3.7

  Fear/Distrust of Health System                         21.3




                                                                         9
                                 Table 1.9:

               Where do You Get Information About Resources
                School                                  26.4

                Church                                  34.6

              Neighbors                                 46.5

                Family                                  43.7

                  TV                                    31.5

              Newspaper                                 53.1

                Radio                                   40.6

         Quick Reference Guide                          13.8



                                 Table 1.10:

Within the Past Year, What Mental Health Services Did You or a Family Member
                                   Need
                 None                                  83.3%

              Crisis Care                               1.9%

            Hospitalization                             8.9%

          Counseling/Therapy                           10.9%




                                                                           10
                                  Table 1.11:

  If You Needed Them, Were You Able to Get Mental Health Services in Marshall
                                  County
                    Yes                                   6%

                    No                                   13.3%

                    N/A                                  80.6%




                                  Figure 1.5:

Within the Past Year, Has Any Family/Friend Needed Long-Term Care Placement




*Yes = 10.5%, No = 89.5%




                                                                                11
                                         Figure 1.6:

 If You Needed Long-Term Care Placement, Was It Available in Marshall County




*Yes = 14.9%, No = 5.2%, N/A = 79.9%



                                         Table 1.12:

           Which of the Following Need Improvement in Marshall County
                   Schools                               28.4%

                 Family Life                             28.4%

             Parks and Recreation                         22%

              Clean Environment                           25%

             Affordable Housing                          40.7%

       Healthy Behavior and Lifestyles                   53.7%

           Arts and Cultural Events                      40.7%




                                                                           12
                                      Table 1.13:

   What are the 3 Most Important Health Problems in Marshall County
                Aging                                20%

      Heart Disease and Stroke                      37.7%

         Rape/Sexual Assault                         2.3%

               Cancer                               50.8%

         High Blood Pressure                        26.9%

       Respiratory/Lung Disease                     14.2%

         Child Abuse/Neglect                         20%

              Homicide                               1.5%

     Sexually Transmitted Disease                    6.9%

               Diabetes                             24.2%

             Infant Death                            3.5%

               Suicide                               3.5%

           Dental Problems                           8.5%

Infectious Disease (HIV/AIDS, TB, etc.)              0.4%

         Teenage Pregnancy                          32.3%

          Domestic Violence                         11.9%

            Mental Health                           10.4%

       Firearm Related Injuries                      1.2%

Motor Vehicle Related Crashes/Injuries              23.8%




                                                                      13
                                         Table 1.14:

  What 3 Behaviors Have the Most Negative Impact in Marshall County
         Being Overweight                              41.2%

       Dropping out of School                          28.5%

         Poor Eating Habits                            25.8%

            Divorce Rates                              18.1%

       Not Using Birth Control                         18.1%

Not Using Seat Belts/Child Restraints                  11.2%

          Lack of Exercise                             24.6%

               Racism                                  21.9%

             Unsafe Sex                                18.8%

Not Getting ―Shots‖ to Prevent Disease                 6.2%

          Substance Abuse                              56.9%

         Underage Drinking                             28.8%

                                         Table 1.15:

        What Substance is the Biggest Risk Risk to Marshall County
              Marijuana                                7.1%

          Prescription Drugs                           20.4%

               Cocaine                                 1.2%

               Alcohol                                 11.4%

               Tobacco                                 10.2%

         Methamphetamine                               47.2%

       Over the Counter Drugs                          2.7%



                                                                      14
                         Table 1.16:

         Where are the Places You Go For Recreation
        Parks                                  67.6%

  Swimming Pools                               14.5%

Live Theater/Concerts                           9.4%

Health/Fitness Centers                         17.2%

 Lake/LBL/Camping                              55.1%

    Sports Fields                              29.3%

       Church                                   52%

    Senior Center                               1.2%

       Library                                 28.5%




                                                       15
                                   Table 1.17:

What are the Most Important Neighborhood Issues in Marshall County
    Road Maintenance/Repair                                 34.1%

    Sewer Maintenance/Repair                                18.1%

   Lack of Public Transportation                            32.9%

        Lack of Sidewalks                                   27.3%

          Street Lighting                                   23.7%

             Speeding                                       37.8%

      Pedestrian Crosswalks                                 9.2%

            Bikeways                                        19.7%

      Lack of Walking Trails                                22.1%

Crime Patrols/Neighborhood Watch                            30.9%

    Law Enforcement Coverage                                32.9%



2. Themes and Strengths Assessment Demographic Questions:

                                   Table 2.1:

                               Age of Respondents
            25 or less                                      5.1%

              26-34                                         17.3%

              35-44                                         20%

              45-54                                         28.2%

              55-64                                         21.2%

             Over 65                                        8.2%



                                                                     16
                                           Figure 2.1:

                                             Gender




       *Females = 70%, Males = 30%

                                           Figure 2.2:

                             How Would You Describe Yourself




*African American/Black = 0.4%, Asian/Pacific Islander = 0.0%, Hispanic/Latino = 0.4%,

 Native American = 1.6%, White/Caucasian = 97.6%

                                                                                         17
                                         Figure 2.3:

                                        Marital Status




*Married or Partner = 76.5%, Divorced = 10%, Widowed = 3.6%, Single = 10%



                                          Table 2.2:

                                          Education
            Less Than High School                                    6.4%

         High School Diploma or GED                                  23.6%

                Some College                                         32%

           College Degree or Higher                                  38%




                                                                             18
                       Table 2.3:

                    Household Income
Less Than $20,000                      10%

$20,000-$29,999                        13.3%

$30,000-$49,999                        22.9%

  Over $50,000                         53.8%



                       Table 2.4:

                        Zip Code
     42025                              151

     42029                              32

     42066                               1

     42048                               7

     42044                              21

     42071                               4

     42036                               1

     42051                               1




                                               19
                              Table 2.5:

                   In What Community Do You Reside
      Calvert City                                     12.1%

     Possum Trot                                       3.1%

        Sharpe                                         3.6%

        Benton                                         36.6%

        Hardin                                         4.0%

      Gilbertsville                                    8.9%

      Draffenville                                     7.6%

      Fairdealing                                      11.2%

        Aurora                                         1.3%

       Oak Level                                       4.0%

        Brewers                                        3.6%

      Briensburg                                       4.0%



                              Table 2.6:

                  How Do You Pay for Your Healthcare
     No Insurance                                      9.1%

    Health Insurance                                   83.4%

       Medicaid                                        6.3%

       Medicare                                        8.7%

Veterans’ Administration                               2.0%




                                                               20
                           Table 2.7:

                 What is Your Employment Status
 Full Time Employed                                   74%

 Part Time Employed                               8.0%

   Self Employed                                  2.8%

    Unemployed                                    3.2%

    Homemaker                                     4.0%

       Student                                    0.8%

       Retired                                    7.2%



                           Table 2.8:

            If Not Working, What is the Main Reason
     Employed                                     83.6%

   Disabled or Ill                                2.7%

  Can’t Find Work                                 7.4%

Taking Care of Family                             5.5%

  Need Training                                   0.8%




                                                            21
     3. Community Health Assessment Community Questions:

                                      Table 3.1:

During the Past 30 Days, for About How Many Days Did Pain Make it Hard For You to
           do Your Usual Activities, Such as Self Care, Work, or Recreation
                  None                                     58.6%

                  1 to 2                                   14.9%

                  3 to 4                                   5.5%

                  5 to 6                                   6.9%

                 7 to 10                                   2.0%

                  11 +                                     12.1%



                                      Table 3.2:

Thinking About Your Mental Health, For How Many Days During the Past 30 Days Was
                          Your Mental Health Not Good
                  None                                     42.2%

                  1 to 2                                   23.3%

                  3 to 4                                   11.5%

                  5 to 6                                   8.0%

                 7 to 10                                   5.5%

                  11 +                                     9.5%




                                                                                22
                                     Figure 3.1:

            Because of Health Impairments, Do You Need the Help of Others




*Yes = 8.1%, No = 91.9%

                                     Figure 3.2:

                   Do You Use Any Device To Help You Get Around




*Yes = 5.5%, No = 94.5%
                                                                            23
                                         Table 3.3:

 How Many Days in the Past Month Were You Not Able to Work or do Daily Activities
                    Because of Poor Physical or Mental Health
                   None                                          79.0%

                   1 to 2                                        6.3%

                   3 to 4                                        2.6%

                   5 to 6                                        4.0%

                   7 to 10                                       1.7%

                    11 +                                         6.3%



                                         Figure 3.3:

                           Are You Currently Trying to Lose Weight




*Yes = 64.5%, No = 35.5%
                                                                                24
                           Table 3.4:

During the Past Month Did You Participate in Any Moderate Activity
         Yes                                       70.5%

          No                                       26.1%

       Not Sure                                     3.3%

                           Table 3.5:

How Many Days Per Week Do You Participate in Moderate Activities
       1-2 Days                                    34.8%

       3-4 Days                                    33.3%

       5-7 Days                                    20.0%

         None                                      11.8%

                           Table 3.6:

During the Past Month Did You Participate in Any Vigorous Activity
         Yes                                       35.2%

          No                                       61.5%

       Not Sure                                     3.4%

                           Table 3.7:

How Many Days Per Week Do You Participate in Vigorous Activities
       1-2 Days                                    29.4%

       3-4 Days                                    16.1%

       5-7 Days                                     5.6%

         None                                      48.9%




                                                                     25
                                        Table 3.8:
Has Your Healthcare Provider Ever Told You That You Have Any of the Following Health Problems

     Hypertension (Blood Pressure)                         40.1% (131)

                Angina                                      4.7% (15)

              Heart Attack                                  4.4% (14)

                 Stroke                                      2.5% (8)

            High Cholesterol                               40.7% (131)

              Overweight                                   51.2% (166)

              Skin Cancer                                   7.2% (23)

             Breast Cancer                                  3.1% (10)

            Cervical Cancer                                 4.1% (13)

           Colorectal Cancer                                 1.9% (6)

       Lung and Bronchus Cancer                              1.9% (6)

            Prostate Cancer                                  2.8% (9)

              Oral Cancer                                    1.6% (5)

         Other Cancer (not skin)                            3.2% (10)

                Asthma                                      11.3% (36)

    Emphysema or Chronic Bronchitis                         7.3% (23)

             Liver Disease                                   2.2% (7)

               Depression                                   26.9% (86)

        Mental Health Problems                              11.6% (36)

        Arthritis or Rheumatism                             27.6% (88)

                Diabetes                                    14.9% (48)

               HIV/AIDS                                      1.6% (5)

                                                                                            26
                                           Figure 3.4:

During the Past 30 Days, Did You Have at Least One Drink of Any Alcoholic Beverage




*Yes = 39.3%, No = 60.7%

                                           Figure 3.5:

                   How Many Alcoholic Drinks Do You Drink in a Week




*1 = 16.9%, 2 to 3 = 13.0%, 4 to 5 = 4.3%, 6 or more = 5.3%, None = 60.5%
                                                                                 27
                                     Table 3.9:

              Which of the Following Best Describes Your Smoking Status
                Never Smoke                                   54.0%

                Smoke Daily                                   16.2%

                Smoke Some                                    4.9%

               Former Smoker                                  25.0%



                                     Figure 3.6:

        Do You Use Pipes, Cigars, or Other Tobacco Products on a Regular Basis




*Yes = 17.5%, No = 82.5%




                                                                                 28
                                          Table 3.10:

       Which of the Following Best Describes How You Feel About Your Smoking
                 I Don’t Smoke                              (245)

     Not Quitting Within the Next 6 Months                   (29)

 Planning on Quitting Within the Next 6 Months               (20)

   Planning on Quitting Within the Next Month                (4)

            Currently Trying to Quit                         (19)

      Have Not Smoked in the Last Month                      (5)

     Have Not Smoked in the Last 6 Months                    (18)

*Total respondents = 319




                                          Table 3.11:

      How Often Do You Buckle Your Safety Belt When Driving or Riding in a Car
                     Never                                  1.2%

                     Rarely                                 2.4%

                     Some                                   4.3%

                Almost Always                               14.6%

                    Always                                  77.4%




                                                                                 29
                        Table 3.12:

    How Many Servings of Fruit Do You Eat Each Day
     None                                       9.8%

     1 to 2                                     61.6%

     3 to 4                                     18.9%

   5 or More                                    5.2%

  Not Sure                                      4.6%



                        Table 3.13:

 How Many Servings of Vegetables Do You Eat Each Day
     None                                       3.7%

     1 to 2                                     60.6%

     3 to 4                                     26.0%

   5 or More                                    7.6%

   Not Sure                                     2.1%



                        Table 3.14:

               How Often Do You Use Sunscreen
    Never                                       24.1%

    Rarely                                      41.7%

50% of the Time                                 20.1%

  Most Days                                     9.0%

    Always                                      5.2%


                                                        30
                                             Table 3.15:

                       Have You Had a Sunburn Within the Past 12 Months
                         Yes                                          33.0%

                         No                                           66.0%

                       Not Sure                                       0.9%

                                             Table 3.16:

                                  When Was the Last Time You:

                                  (Preventative Health Behaviors)
                         Never       Past Year    1-2 Yrs   3-5 Yrs    Over 5   Don’t Know

Visited a Dentist or     1.3&        65.9%        15.9%      7.5%       5.6%     3.8%
Dental Clinic            (4)         (211)        (51)       (24)       (18)     (12)

Had Your Teeth           5.2%        58.4%        16.1%      8.4%       7.7%     4.2%
Cleaned                  (16)        (181)        (50)       (26)       (24)     (13)

Had a Flu Shot           26.2%       52.1%        10.4%      4.1%       6.3%     0.9%
                         (83)        (165)        (33)       (13)       (20)     (3)

Had a Colorectal         54.7%       23.1%        8.2%       9.5%       2.8%     1.6%
Cancer Screening         (173)       (73)         (26)       (30)       (9)      (5)

Had Your Blood           3.1%        91.3%        3.4%       1.6%       0.3%     0.3%
Pressure Checked         (10)        (293)        (11)       (5)        (1)      (1)

Had Your Cholesterol 14.0%           76.0%        6.5%       2.5%       0.6%     0.3%
Checked              (40)            (244)        (21)       (8)        (8)      (1)

Had a Skin Cancer        53.5%       29.9%        6.1%       3.8%       3.2%     3.5%
Checked                  (168)       (94)         (19)       (12)       (10)     (11)

Had Blood Sugar          16.7%       69.7%        9.3%       1.9%       1.2%     1.2%
Checked                  (54)        (225)        (30)       (6)        (4)      (4)

Had a Routine Check      3.4%        79.4%        10.3%      2.5%       2.8%     1.6%
Up                       (11)        (255)        (33)       (8)        (9)      (5)


                                                                                        31
                                             Table 3.17:

                                  When Was the Last Time You:

                         (Preventative Health Behaviors—Women Only)
                 Never           Past Year    1-2 Yrs       3-5 Yrs    Over 5 Yrs   Don’t Know

   Had a               31.5%        44.4%         10.2%         6.9%       5.6%         1.4%
 Mammogram              (68)         (96)          (22)         (15)       (12)          (3)

Had a Clinical         5.9%         68.2%         12.7%         5.0%       5.0%         3.2%
Breast Exam            (13)          (150)         (28)         (11)       (11)          (7)

Had a PAP Test         5.5%         64.1%         13.2%         6.4%       9.1%         1.8%
                       (12)          (141)         (29)         (14)       (20)          (4)

   Had a           68.4%             5.1%         0.5%          2.8%       22.8%        0.5%
Hysterectomy        (147)            (11)          (1)           (6)        (49)         (1)



                                             Table 3.18:

                                  When Was the Last Time You:

                          (Preventative Health Behaviors—Men Only)
               Never           Past Year     1-2 Yrs       3-5 Yrs     Over 5 Yrs   Don’t Know

Had a PSA        39.6%            42.7%          8.3%          3.1%        5.2%         1.0%
  Test            (38)             (41)           (8)           (3)         (5)          (1)

   Had a         41.0%            31.0%         14.0%          10.0%       4.0%          0
  Digital         (40)             (31)          (14)           (10)        (4)          0
Rectal Exam




                                                                                               32
                                           Table 3.19:

    During the Summer of 2009, Did You Take Any of the Following Precautions in
                            Preventing Mosquito Bites

                            Yes                   No                     No Need
Replace or Repair Window          10.1%                   35.1%               54.9%
         Screen                    (31)                   (108)                (169)

 Remove Standing Water            37.5%           25.6%           (80)        36.9%
                                   (117)                                      (115)



                                           Table 3.20:

  During the Summer of 2009, Did You Wear Long Sleeved Shirts or Other Protective
                                Clothing Outdoors
                   Never                                           39.7%

                   Rarely                                          38.8%

              50% of the Time                                      14.1%

                 Most Days                                         4.8%

                  Always                                           2.6%




                                                                                       33
                                           Figure 3.7:

    Are You Covered by Health Insurance or Some Other Kind of Health Care Plan?




*Yes = 89.8%, No = 9.6%, Not Sure = 0.6%

                                           Figure 3.8:

    Do You Have One Person You Think of As Your Personal Doctor or Health Care
                                   Provider




*Yes = 83.4%, No = 15.0%, Not Sure = 1.6%
                                                                                  34
                                            Table 3.21:
  On a Scale of 1-10, Indicate the Amount of Attention Each of the Following Topics Should Receive

                    Much Less   Somewhat Less   Some       Some More     Much More     Don’t Know

Clean Outdoor Air       5.3%         7.9%         43.4%        17.4%         15.8%          10.2%

Clean Indoor Air        8.3%        10.2%         38.0%        17.8%         15.5%          10.2%

  Exposure to           8.6%         9.5%          21.7%       19.4%         34.9%          5.9%
  Secondhand
    Smoke

Clean Water from        2.6%         5.0%          29.8%       23.2%         32.1%          7.3%
    Drinking

 Clean Water for        3.3%         3.3%          31.5%       20.9%         34.1%          7.0%
   Recreation

  Recyclable            2.7%         6.0%          27.0%       18.0%         38.7%          7.7%
Materials in Land

Chemical Storage        3.3.%        3.7%          22.6%       22.3%         41.2%          7.0%
 and Disposal of
Chemical Waste

 Illegal Dumping        2.9%         3.6%          20.1%       20.8%         44.8%          7.8%
   of Hazardous
      Waste

  Safe Food at          3.0%         3.3%          23.0%       24.0%         40.8%          5.9%
  Restaurants

  Safe Food at          3.0%         3.7%          24.9%       21.9%         39.9%          6.6%
 Grocery Stores

 Clean Childcare        3.0%         2.0%          22.0%       22.7%         37.5%          12.8%
    Facilities

    Diseases            2.3%         4.6%          26.8%       23.9%         31.4%          11.1%
  Transmittable
      From
 Animals/Insects


                                                                                                     35
                                         Figure 3.9:

During the Past Twelve Months, Was There Anytime You Needed Prescription Medicine
                 But Did Not Get It Because You Couldn’t Afford It?




*Yes = 23.0%, No = 74.1.0%, Not Sure = 0.3%, N/A = 2.6%




                                                                               36
                                   Table 3.22:

  If You Have Health Care Coverage, Does it Cover At Least Part Of The Cost For:
                         Yes               No                   Not Sure

    Dental Service             64.0%               34.6%                   1.4%

    Vision Services            65.3%               32.3%                   2.4%

Mental Health Services         62.6%               13.8%                   23.5%

Drug and Alcohol Detox         40.4%               14.4%                   45.3%

  Prescription Drugs           88.9%               9.4%                    1.7%

  Chiropractic Drugs           65.0%               14.3%                   20.6%

   Family Planning             43.5%               19.6%                   36.8

    Immunizations              65.2%               15.0%                   19.9%

  Smoking Cessation            31.6%               20.9%                   47.5%

  Walking Assistants           46.1%               11.8%                   42.1%

       Glasses                 50.4%               40.8%                   8.8%

     Hearing Aids              27.0%               29.2%                   43.8%




                                                                                   37
                                           Table 3.23:

              If You Do Not Have Health Insurance, What Are The Reasons
       Cannot Afford to Pay the Premium                      (27)

         Lost Job or Changed Employer                        (14)

         Became Divorced or Separated                         (2)

             Spouse or Parent Died                            (0)

Became Ineligible Because of Age or Left School               (4)

  Employer Doesn’t Offer or Stopped Offering                 (12)
                 Coverage

 Cut Back to Part-Time or Became a Temporary                  (3)
                   Employee

Benefits From Employer or Former Employer Ran                 (1)
                     Out

     Insurance Company Refused Coverage                       (2)

 Lost Medicaid or Medical Assistance Eligibility              (9)

     Choose Not To/Do Not Want to Work                        (2)

           Don’t Know How to Get it                           (6)




                                                                          38
                                       Table 3.24:

 In the Past 12 Months, Have You Had to do Any of the Following Because it Was Too
                                    Expensive
                       Never           Rarely          Often           N/A

  Put off Going to             60.9%        15.1%              17.7%         6.4%
Health Care Provider

Skipped Medication             64.4%        16.9%              10.5%         8.1%
   or Treatment

Put Off Going to the           54.1%        14.5%              25.3%         6.1%
      Dentist

  Put Off Going to             50.7%            2.8%           9.0%          37.6%
   Mental Health
      Provider

  Put Off Buying               54.1%            3.1%           2.1%          40.8%
 Assistive Devices
(Crutches, Walkers,
 Wheelchairs, etc.)

  Put Off Buying               52.0%        14.6%              18.4%         15.0%
  Glasses, Hearing
     Aids, etc.




                                                                                     39
                                        Figure 3.10:

During the Past Twelve Months, Was There Anytime You Needed Prescription Medicine
                 But Did Not Get It Because You Couldn’t Afford It?




*Yes = 35.9%, No = 64.1%

                                        Figure 3.11:

  Are Any of Your Children Age 4 or Younger Limited in the Kind or Amount of Play
     Activities They Can Do Because of a Physical, Mental or Emotional Problem




*Yes = 2.1%, No = 41.1%, Not Sure = 0.4%, N/A = 56.4%
                                                                                    40
                                       Table 3.25:

                  Please Indicate How Often You Do the Following Things
                Never      Rarely      Sometimes     Almost Always Always    N/A

Buckle Your        2.3%        0.0%        0.5%          1.4%        37.1%         58.8%
  Child or
Children into
a Car Safety
  Seat (<3)

Place a Child      2.3%        0.5%        1.8%          2.3%        36.7%         56.6%
in a Booster
    Seat

Place a Child      3.6%        2.2%        4.0%          4.0%        36.8%         49.3%
Buckled Only
    in the
Backseat (age
     12)

Require Your       8.9%        6.3%        7.6%          7.1%        20.5%         49.6%
 Children to
  Wear a
  Bicycle
  Helmet




                                                                                           41
                                           Table 3.26:

How Many Children Age 18 and Younger in Your Household Have the Following Types
                                 of Insurance
               None           One          Two           Three      Four          Five +

 Medicaid        80.3%          11.8%         3.1%           3.1%          0.8%       0.8%

  CHIP           94.7%              1.8%      2.7%           0.9%          0.0%       0.0%

  Private        40.6%          25.8%         26.6%          4.7%          2.3%       0.0%
 Insurance

  Other          96.6%              2.3%      1.1%           0.0%          0.0%       0.0%

  None           95.4%              1.1%      2.3%           1.1%          0.0%       0.0%

   N/A           97.3%              0.9%      0.0%           0.0%          0.0%       1.8%




                                           Table 3.27:

          Are the Children in Your Home Up to Date on Their Immunization Shots
                      Yes                                           45.5%

                      No                                            0.9%

                      Some                                          0.0%

                   Not Sure                                         0.9%

                      N/A                                           52.7%




                                                                                             42
                                           Table 3.28:

                  In Reference to the Above Question, If Not, Then Why
                Too Expensive                                   (0)

             No Health Insurance                                (2)

                  No Provider                                   (0)

           Can’t Get Time Off Work                              (0)

    Didn’t Know They Had to Be Immunized                        (1)

 Didn’t Know When They Had to Be Immunized                      (0)

   Don’t Believe the Child(ren) Will Get Sick                   (0)

         Against My Religious Beliefs                           (0)

          Don’t Think It’s Important                            (0)

                     N/A                                        (84)



      4. Community Health Assessment Demographic Questions:

                                                Figure 4.1:

                                        What is Your Gender




*Male = 31.2%, Female = 68.8%
                                                                         43
                                       Table 4.1:

                                    What is Your Age
18-24                                       4.6%

25-34                                       15.5%

35-44                                       17.5%

45-54                                       20.1%

55-64                                       21.5%

65-74                                       13.2%

75+                                         7.6%



                                       Table 4.2:

                 What Racial or Ethnic Group Do You Identify With
                 White                                      (296)

        Black or African American                            (0)

             Hispanic/Latino                                 (1)

          Asian/Pacific Islander                             (0)

        American Indian or Eskimo                            (1)

               Mixed Race                                    (4)




                                                                    44
                                            Table 4.3:

                                             Zip Code
                     42025                                                194

                     42029                                                36

                     42066                                                 2

                     42048                                                18

                     42044                                                30

                     42071                                                 2

                     42082                                                 2

                     42001                                                 1

                     75605                                                 1

                     35976                                                 1



                                             Figure 4.2:

                                    What is Your Marital Status




*Married = (213), Seperated = (8), Divorced = (35), Widowed = (29), Single/Never Married = (17)
                                                                                                  45
                                     Table 4.4:

                       How Many People Live in Your Household

                             Average of 2 per household




                                    Figure 4.3:

               Do Any People Aged 65 and Older Live In Your Household




*Yes = 22.3%, No = 77.7%




                                                                        46
                                     Table 4.5:

                      What Type of Housing Unit Do You Live in
             Single Family Home                               77.3%

            Condo or Townhouse                                0.7%

              Apartment/Duplex                                8.9%

                Mobile Home                                   13.2%



                                     Figure 4.4:

                          Is Your Residence Owned or Rented




*Owned = 83.9%, Rented = 16.1%




                                                                      47
                                     Table 4.6:

                  What Was Your Household’s Total Income Last Year
              Less Than $25,000                             (64)

               $25,000-$34,999                              (43)

               $35,000-$49,999                              (46)

               $50,000-$74,999                              (44)

               $75,000-$99,999                              (37)

             $100,000-$124,999                              (19)

                 $125,000+                                  (12)

                 Don’t Know                                 (25)




                                    Figure 4.5:

  Do You or Anyone in Your Household Prefer to Use a Language Other Than English




*Yes = 1.6%, No = 98.4%
                                                                                   48
                                        Table 4.7:

                       Do You Receive Any of the Following
            Food Stamps                                      (30)

          Public Assistance                                   (8)

Temporary Assistance for Family Needs                         (2)

                WIC                                          (12)

           Social Security                                   (69)

          Railroad Income                                     (5)

           Private Pension                                   (28)

                 SSI                                         (10)

              Disability                                     (15)

      Other Retirement Income                                (25)

         None of the Above                                   (109)




                                                                     49
           Table 4.8:

How Much Do You Weigh
             185 (5)
  93 (1)
             190 (1)
  104 (1)
             195 (1)
  120 (1)
             198 (1)
  122 (1)
             199 (1)
  125 (1)
             200 (3)
  127 (1)
             202 (2)
  128 (1)
             205 (2)
  129 (2)
             206 (2)
  130 (3)
             209 (1)
  134 (1)
             210 (5)
  135 (3)
             214 (1)
  137 (1)
             215 (1)
  138 (3)
             217 (1)
  139 (1)
             218 (1)
  140 (11)
             219 (1)
  143 (1)
             220 (4)
  144 (1)
             225 (1)
  145 (1)
             230 (2)
  146 (2)
             233 (1)
  149 (1)
             240 (3)
  150 (6)
             250 (4)
  152 (1)
             260 (1)
  154 (2)
                        50
                                           264 (1)
                                 155 (3)
                                           265 (1)
                                 158 (1)
                                           268 (1)
                                 159 (1)
                                           270 (1)
                                 160 (1)
                                           275 (2)
                                 161 (1)
                                           280 (2)
                                 162 (3)
                                           290 (2)
                                 164 (1)
                                           299 (1)
                                 165 (5)
                                           300 (3)
                                 168 (3)
                                           310 (1)
                                 169 (1)
                                           320 (1)
                                 170 (2)
                                           324 (1)
                                 173 (1)
                                           340 (1)
                                 175 (2)
                                           367 (1)
                                 179 (1)
                                           380 (1)
                                 180 (5)



                                       Table 4.9:

Which of the Following Describes Your Main Activity During the Last Three Months
      Working at a Job or Business                         (197)

           Looking for Work                                (20)

            Going to School                                (18)

                Retired                                    (68)

            Keeping House                                  (47)




                                                                                   51
                                    Figure 4.6:

                  Does Your Home Receive Water From a Private Well




*Yes = 15.7%, No = 84.3%




                                                                     52
              5. Public Health System Assessment:


Local Public Health System Performance Assessment - Report of Results
Marshall County Health Department
3/25/2010


I. How well did the system perform the ten Essential Public Health Services (EPHS)?
Table 1: Summary of performance scores by Essential Public Health Service (EPHS)

  EPHS                                                                                                Score
  1      Monitor Health Status To Identify Community Health Problems                                   66
  2      Diagnose And Investigate Health Problems and Health Hazards                                   92
  3      Inform, Educate, And Empower People about Health Issues                                       67
  4      Mobilize Community Partnerships to Identify and Solve Health Problems                         68
  5      Develop Policies and Plans that Support Individual and Community Health Efforts               79
  6      Enforce Laws and Regulations that Protect Health and Ensure Safety                            96
         Link People to Needed Personal Health Services and Assure the Provision of Health Care
  7                                                                                                    65
         when Otherwise Unavailable
  8      Assure a Competent Public and Personal Health Care Workforce                                  66
         Evaluate Effectiveness, Accessibility, and Quality of Personal and Population-Based Health
  9                                                                                                    62
         Services
  10     Research for New Insights and Innovative Solutions to Health Problems                         74
  Overall Performance Score                                                                            74


Figure 1: Summary of EPHS performance scores and overall score (with range)




                                                                                                              53
Local Public Health System Performance Assessment - Report of Results
Marshall County Health Department
3/25/2010




Table 1 (above) provides a quick overview of the system's performance in each of the 10 Essential Public Health
Services (EPHS). Each EPHS score is a composite value determined by the scores given to those activities that
contribute to each Essential Service. These scores range from a minimum value of 0% (no activity is performed pursuant
to the standards) to a maximum of 100% (all activities associated with the standards are performed at optimal levels).

Figure 1 (above) displays performance scores for each Essential Service along with an overall score that indicates the
average performance level across all 10 Essential Services. The range bars show the minimum and maximum values of
responses within the Essential Service and an overall score. Areas of wide range may warrant a closer look in Figure 4 or
the raw data.




                                                                                                                      54
Local Public Health System Performance Assessment - Report of Results
Marshall County Health Department
3/25/2010


Figure 2: Rank ordered performance scores for each Essential Service




Figure 3: Rank ordered performance scores for each Essential Service, by level of activity

                         No Activity    Minimal      Moderate      Significant    Optimal




Figure 2 (above) displays each composite score from low to high, allowing easy identification of service domains where
                                                                                                                     55
Local Public Health System Performance Assessment - Report of Results
Marshall County Health Department
3/25/2010


performance is relatively strong or weak.

Figure 3 (above) provides a composite picture of the previous two graphs. The range lines show the range of responses
within an Essential Service. The color coded bars make it easier to identify which of the Essential Services fall in the five
categories of performance activity.
Figure 4 (next page) shows scores for each model standard. Sites can use these graphs to pinpoint specific activities
within the Essential Service that may need a closer look. Note these scores also have range bars, showing sub-areas that
comprise the model standard.


Local Public Health System Performance Assessment - Report of Results
Marshall County Health Department
3/25/2010


II. How well did the system perform on specific model standards?
Figure 4: Performance scores for each model standard, by Essential Service




                                                                                                                          56
Local Public Health System Performance Assessment - Report of Results
Marshall County Health Department
3/25/2010




                                                                        57
Local Public Health System Performance Assessment - Report of Results
Marshall County Health Department
3/25/2010


Table 2: Summary of performance scores by Essential Public Health Service (EPHS) and model standard

Essential Public Health Service                                                                        Score
EPHS 1. Monitor Health Status To Identify Community Health Problems                                      66
 1.1 Population-Based Community Health Profile (CHP)                                                     69
   1.1.1 Community health assessment                                                                    100
   1.1.2 Community health profile (CHP)                                                                  89
   1.1.3 Community-wide use of community health assessment or CHP data                                   17
 1.2 Access to and Utilization of Current Technology to Manage, Display, Analyze and Communicate
                                                                                                        29
 Population Health Data
   1.2.1 State-of-the-art technology to support health profile databases                                 25
   1.2.2 Access to geocoded health data                                                                  13
   1.2.3 Use of computer-generated graphics                                                              50
 1.3 Maintenance of Population Health Registries                                                        100
   1.3.1 Maintenance of and/or contribution to population health registries                             100
   1.3.2 Use of information from population health registries                                           100
EPHS 2. Diagnose And Investigate Health Problems and Health Hazards                                      92
 2.1 Identification and Surveillance of Health Threats                                                   81
   2.1.1 Surveillance system(s) to monitor health problems and identify health threats                  100
   2.1.2 Submission of reportable disease information in a timely manner                                100
   2.1.3 Resources to support surveillance and investigation activities                                  44
 2.2 Investigation and Response to Public Health Threats and Emergencies                                100
   2.2.1 Written protocols for case finding, contact tracing, source identification, and containment     98
   2.2.2 Current epidemiological case investigation protocols                                           100
   2.2.3 Designated Emergency Response Coordinator                                                      100
   2.2.4 Rapid response of personnel in emergency / disasters                                           100
   2.2.5 Evaluation of public health emergency response                                                 100
 2.3 Laboratory Support for Investigation of Health Threats                                              95
   2.3.1 Ready access to laboratories for routine diagnostic and surveillance needs                     100
   2.3.2 Ready access to laboratories for public health threats, hazards, and emergencies                81
   2.3.3 Licenses and/or credentialed laboratories                                                      100
   2.3.4 Maintenance of guidelines or protocols for handling laboratory samples                         100
EPHS 3. Inform, Educate, And Empower People about Health Issues                                          67
 3.1 Health Education and Promotion                                                                     100
   3.1.1 Provision of community health information                                                      100
   3.1.2 Health education and/or health promotion campaigns                                             100
   3.1.3 Collaboration on health communication plans                                                    100
 3.2 Health Communication                                                                                54
   3.2.1 Development of health communication plans                                                       52
   3.2.2 Relationships with media                                                                        79
                                                                                                               58
Local Public Health System Performance Assessment - Report of Results
Marshall County Health Department
3/25/2010


    3.2.3 Designation of public information officers                                        31
  3.3 Risk Communication                                                                    46
    3.3.1 Emergency communications plan(s)                                                  59
    3.3.2 Resources for rapid communications response                                       75
    3.3.3 Crisis and emergency communications training                                      25
    3.3.4 Policies and procedures for public information officer response                   25

Local Public Health System Performance Assessment - Report of Results
Marshall County Health Department
3/25/2010

Essential Public Health Service                                                            Score
EPHS 4. Mobilize Community Partnerships to Identify and Solve Health Problems                68
 4.1 Constituency Development                                                                89
   4.1.1 Identification of key constituents or stakeholders                                  94
   4.1.2 Participation of constituents in improving community health                         75
   4.1.3 Directory of organizations that comprise the LPHS                                  100
   4.1.4 Communications strategies to build awareness of public health                       88
 4.2 Community Partnerships                                                                  47
   4.2.1 Partnerships for public health improvement activities                               92
   4.2.2 Community health improvement committee                                               0
   4.2.3 Review of community partnerships and strategic alliances                            50
EPHS 5. Develop Policies and Plans that Support Individual and Community Health Efforts      79
 5.1 Government Presence at the Local Level                                                  80
   5.1.1 Governmental local public health presence                                          100
   5.1.2 Resources for the local health department                                           90
   5.1.3 Local board of health or other governing entity (not scored)                         0
   5.1.4 LHD work with the state public health agency and other state partners               50
 5.2 Public Health Policy Development                                                        81
   5.2.1 Contribution to development of public health policies                               92
   5.2.2 Alert policymakers/public of public health impacts from policies                    75
   5.2.3 Review of public health policies                                                    75
 5.3 Community Health Improvement Process                                                    56
   5.3.1 Community health improvement process                                                93
   5.3.2 Strategies to address community health objectives                                    0
   5.3.3 Local health department (LHD) strategic planning process                            75
 5.4 Plan for Public Health Emergencies                                                     100
   5.4.1 Community task force or coalition for emergency preparedness and response plans    100
   5.4.2 All-hazards emergency preparedness and response plan                               100
   5.4.3 Review and revision of the all-hazards plan                                        100

                                                                                                   59
Local Public Health System Performance Assessment - Report of Results
Marshall County Health Department
3/25/2010


EPHS 6. Enforce Laws and Regulations that Protect Health and Ensure Safety                                   96
 6.1 Review and Evaluate Laws, Regulations, and Ordinances                                                   97
   6.1.1 Identification of public health issues to be addressed through laws, regulations, and ordinances   100
   6.1.2 Knowledge of laws, regulations, and ordinances                                                     100
   6.1.3 Review of laws, regulations, and ordinances                                                         88
   6.1.4 Access to legal counsel                                                                            100
 6.2 Involvement in the Improvement of Laws, Regulations, and Ordinances                                     92
   6.2.1 Identification of public health issues not addressed through existing laws                          75
   6.2.2 Development or modification of laws for public health issues                                       100
   6.2.3 Technical assistance for drafting proposed legislation, regulations, or ordinances                 100
 6.3 Enforce Laws, Regulations and Ordinances                                                                98
   6.3.1 Authority to enforce laws, regulation, ordinances                                                  100
   6.3.2 Public health emergency powers                                                                     100
   6.3.3 Enforcement in accordance with applicable laws, regulations, and ordinances                        100
   6.3.4 Provision of information about compliance                                                          100
   6.3.5 Assessment of compliance                                                                            92


Local Public Health System Performance Assessment - Report of Results
Marshall County Health Department
3/25/2010


Essential Public Health Service                                                                             Score
EPHS 7. Link People to Needed Personal Health Services and Assure the Provision of Health Care when
                                                                                                             65
Otherwise Unavailable
 7.1 Identification of Populations with Barriers to Personal Health Services                                 67
   7.1.1 Identification of populations who experience barriers to care                                       75
   7.1.2 Identification of personal health service needs of populations                                      63
   7.1.3 Assessment of personal health services available to populations who experience barriers to care     63
 7.2 Assuring the Linkage of People to Personal Health Services                                              63
   7.2.1 Link populations to needed personal health services                                                 75
   7.2.2 Assistance to vulnerable populations in accessing needed health services                            63
   7.2.3 Initiatives for enrolling eligible individuals in public benefit programs                           75
   7.2.4 Coordination of personal health and social services                                                 38
EPHS 8. Assure a Competent Public and Personal Health Care Workforce                                         66
 8.1 Workforce Assessment Planning, and Development                                                          46
   8.1.1 Assessment of the LPHS workforce                                                                   100
   8.1.2 Identification of shortfalls and/or gaps within the LPHS workforce                                  38
   8.1.3 Dissemination of results of the workforce assessment / gap analysis                                  0
 8.2 Public Health Workforce Standards                                                                      100
   8.2.1 Awareness of guidelines and/or licensure/certification requirements                                100
                                                                                                                    60
Local Public Health System Performance Assessment - Report of Results
Marshall County Health Department
3/25/2010


   8.2.2 Written job standards and/or position descriptions                                          100
   8.2.3 Annual performance evaluations                                                              100
   8.2.4 LHD written job standards and/or position descriptions                                      100
   8.2.5 LHD performance evaluations                                                                 100
 8.3 Life-Long Learning Through Continuing Education, Training, and Mentoring                         66
   8.3.1 Identification of education and training needs for workforce development                    100
   8.3.2 Opportunities for developing core public health competencies                                 50
   8.3.3 Educational and training incentives                                                          63
   8.3.4 Interaction between personnel from LPHS and academic organizations                           50
 8.4 Public Health Leadership Development                                                             53
   8.4.1 Development of leadership skills                                                             63
   8.4.2 Collaborative leadership                                                                     38
   8.4.3 Leadership opportunities for individuals and/or organizations                                75
   8.4.4 Recruitment and retention of new and diverse leaders                                         38


Local Public Health System Performance Assessment - Report of Results
Marshall County Health Department
3/25/2010


Essential Public Health Service                                                                      Score
EPHS 9. Evaluate Effectiveness, Accessibility, and Quality of Personal and Population-Based Health
                                                                                                      62
Services
 9.1 Evaluation of Population-based Health Services                                                   84
   9.1.1 Evaluation of population-based health services                                               88
   9.1.2 Assessment of community satisfaction with population-based health services                   75
   9.1.3 Identification of gaps in the provision of population-based health services                  75
   9.1.4 Use of population-based health services evaluation                                          100
 9.2 Evaluation of Personal Health Care Services                                                      72
   9.2.1.In Personal health services evaluation                                                       71
   9.2.2 Evaluation of personal health services against established standards                         75
   9.2.3 Assessment of client satisfaction with personal health services                              63
   9.2.4 Information technology to assure quality of personal health services                         50
   9.2.5 Use of personal health services evaluation                                                  100
 9.3 Evaluation of the Local Public Health System                                                     31
   9.3.1 Identification of community organizations or entities that contribute to the EPHS           100
   9.3.2 Periodic evaluation of LPHS                                                                  25
   9.3.3 Evaluation of partnership within the LPHS                                                     0
   9.3.4 Use of LPHS evaluation to guide community health improvements                                 0
EPHS 10. Research for New Insights and Innovative Solutions to Health Problems                        74
 10.1 Fostering Innovation                                                                            63
                                                                                                             61
Local Public Health System Performance Assessment - Report of Results
Marshall County Health Department
3/25/2010


  10.1.1 Encouragement of new solutions to health problems                                                           50
  10.1.2 Proposal of public health issues for inclusion in research agenda                                            0
  10.1.3 Identification and monitoring of best practices                                                            100
  10.1.4 Encouragement of community participation in research                                                       100
 10.2 Linkage with Institutions of Higher Learning and/or Research                                                   92
  10.2.1 Relationships with institutions of higher learning and/or research organizations                           100
  10.2.2 Partnerships to conduct research                                                                           100
  10.2.3 Collaboration between the academic and practice communities                                                 75
 10.3 Capacity to Initiate or Participate in Research                                                                69
  10.3.1 Access to researchers                                                                                      100
  10.3.2 Access to resources to facilitate research                                                                 100
  10.3.3 Dissemination of research findings                                                                          50
  10.3.4 Evaluation of research activities                                                                           25


Local Public Health System Performance Assessment - Report of Results
Marshall County Health Department
3/25/2010


III. Overall, how well is the system achieving optimal activity levels?
Figure 5: Percentage of Essential Services scored in each level of activity
                                                                           Figure 5 displays the percentage of the
                                                                           system's Essential Services scores that fall
                                                                           within the five activity categories. This chart
                                                                           provides the site with a high level snapshot
                                                                           of the information found in Figure 3.




Figure 6: Percentage of model standards scored in each level of activity
                                                                           Figure 6 displays the percentage of the
                                                                           system's model standard scores that fall
                                                                           within the five activity categories.



                                                                                                                             62
Local Public Health System Performance Assessment - Report of Results
Marshall County Health Department
3/25/2010




Figure 7: Percentage of all questions scored in each level of activity
                                                                         Figure 7 displays the percentage of all
                                                                         scored questions that fall within the five
                                                                         activity categories. This breakdown provides
                                                                         a closer snapshot of the system's
                                                                         performance, showing variation that may be
                                                                         masked by the scores in Figures 5 and 6.




                                                                                                                        63
IV. Forces of Change Assessment
    The MAPP/CHAT sub-committee conducted a Forces of Change assessment in Summer 2010. Ten
    members attended the meeting and took part in the assessment. At this assessment, participants
    engaged in brainstorming sessions aimed at identifying forces. Forces are broad and all-
    encompassing, and include trends, events, and factors. Trends are patterns over time, such as
    migration in and out of a community or a growing disillusionment with government. Factors are
    discrete elements, such as a community's large ethnic population, a rural setting, or the jurisdiction's
    proximity to a major waterway. Events are one-time occurrences, such as a hospital closure, a
    natural disaster, or the passage of new legislation.

    The following are the items identified from the Forces of Change brainstorming session:

    Political
    Changes in government due to elections
    Healthcare reform
    Commonwealth of Kentucky Budget
    Demographic shifts
    Changes in regulation and laws

    Economic
    Commonwealth of Kentucky budget / decreased state spending
    Lack of jobs / job loss
    Increased taxes

    Social
    Demographic changes in County
    Alcohol and Drugs
    Social interaction
    Changing family structures

    Technology
    Issues related to electronic medical records
    Self-diagnosis
    Haves and have-nots
    Cost of keeping up with technology
    Medicaid issues

    Environment
    Regulation
    Transportation / walkability
    Pollution /chemicals
    Water pollution

    Scientific
    Vaccines / Trust in vaccines
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University research
New diseases / outbreaks
Epidemiological Response

Legal / Ethical
Regulatory changes
Lack of Public Trust in institutions –political, agency, government, private
Sentencing changes –more or fewer incarcerations
Mental Health treatment availability concerns




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V.   Community Strategic Plan
     1. Goal: Update existing comprehensive directory of what specific services county/community
        agencies provide to the public by October 2012.

               Objective: Contact agencies/organizations to update information regarding services
               available to the public utilizing the Marshall County Resource Guide, ridepart.com and
               Marshall County Directory of Community Services.

               Objective: Create a usable format for a central agency directory.

               Objective: Place updated directory on a central website and link to other community
               website (school, churches, media site, etc.).

               Objective: Market the updated directory to organizations/agencies throughout the county
               for use.

               Objective: Develop a system to maintain current information within the central directory.

     2. Goal: Update the Marshall County.gov website so that citizens may link to public service
        agencies by February 2013.

               Objective: Research existing websites for public agencies that would like to be linked to
               central site. (Linked sites to be maintained by originating agency)

               Objective: County website administrator work to design new central
               MarshallCounty.gov site with public resource directory and links.

               Objective: Assign one person to insure linked sites are updated on a bi-annual basis.



     3. Goal: Re-form avenue of communications for local agencies/organizations to update each other
        on activities, services, etc. by October 2011.

               Objective: Update CUBS list and set date for community agency meeting.

               Objective: Agree upon recurring meeting date/frequency.

               Objective: Set up social media avenue of communications among agencies (facebook,
               twitter, listserve, password protected website).

               Objective: Revive ―Leadership Marshall County Program‖ to serve and educate
               agencies/organizations, and to build a team mentality between agencies.


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4. Goal: As a Community Group, look at identified gaps found in MAPP assessment and write
   long term strategic plan to identify solutions to issues (may continue into next MAPP assessment
   cycle.) Include issues identified in previous brainstorming sessions including obesity, dentistry,
   skin cancer and mental health.

           Objective: Work together during community meeting to write long-term strategic plan
           for Marshall County.

           Objective: Work together to solicit grants to assist in filling gaps/issues identified in
           assessments/long-term plan.

           Objective: Gather data/evaluate programs to measure effectiveness of planning long-
           term.

           Objective: Update plan as needed and continue throughout MAPP cycle (conducted
           every 3 years.)




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