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					COMMUNITY HEALTH PLANNING:
A Guidebook for Rural Oklahoma Communities




          Oklahoma Cooperative Extension Service
                Oklahoma State University

             Oklahoma Office of Rural Health
           Oklahoma State Department of Health

                      February 2001
  COMMUNITY HEALTH PLANNING:
A Guidebook for Rural Oklahoma Communities



          Oklahoma Cooperative Extension Service
                Oklahoma State University
                     405-744-6081

                    Gerald A. Doeksen
                     Cheryl St. Clair
                     Mary K. Lawler
                     R. David Shelton
                       Stan Ralstin
                        Jack Frye


             Oklahoma Office of Rural Health
           Oklahoma State Department of Health
                     405-271-8750

                       Val Schott
                      Rod Hargrave




                      February 2001
                COMMUNITY HEALTH PLANNING:
             A Guidebook for Rural Oklahoma Communities

                            TABLE OF CONTENTS


Chapter 1      An Overview of the Community Health
                Planning Process ...............................................................1

Chapter 2      Community Health Steering Committee ..............................9

Chapter 3      Publicity Task Force ..........................................................15

Chapter 4      Health Services Directory Task Force ...............................16

Chapter 5      Community Survey Task Force .........................................17

Chapter 6      Data and Information Task Force ......................................19

Chapter 7      Community Health Plan .....................................................20


Appendix A Health Planning Introductory Tools

Appendix B Economic Impact of the Health Sector

Appendix C Publicity

Appendix D Health Services Directory

Appendix E Community Survey

Appendix F Data and Information

Appendix G Plan of Action


References




                                             i
                                        CHAPTER 1

                  An Overview of the Community Health Planning Process


       The community health planning process is a strategic planning process and assists

local communities:

         To identify their health care needs

         To examine the social, economic, and political realities affecting the local
           delivery of health care

         To determine what they want and realistically can achieve in a health care system
           to meet their needs

         To develop and mobilize an action plan based on their analysis and planning
The community health planning process involves cooperation among people, organizations,

and institutions to pursue common goals. The process is designed to answer three questions:

        Where is the community now?

        Where does the community want to be?

        How will the community get there?
The process should be started when community citizens have a shared need or vision for

health care, when community leaders can be mobilized to take action, when a local citizen is

willing to become the community facilitator, and when a Resource Team or facilitating group

can be identified to assist the community through the process.

       The community health planning process must be "community-driven." The

community, as represented by the community leaders, must "own" or "drive" the process; it

should be community-based, not hospital-based or health care provider-based. Local

community residents and the community leaders must come forth. A current knowledge of

                                                1
the health care industry is not necessary. This process is about local people solving local

problems. The local community hospital and community health care providers should be

involved, have input into the process, and support and "trust" the process. But ultimately, the

community must provide the energy and commitment.

       The definition of community is important to this process. A community is a place

where individual citizens' basic health needs are met. In this respect, a person may live in

one place, but link with another place to meet health care needs. This linkage makes up the

greater community. The Community Health Steering Committee will have to define their

health care "community." A community could be a single town and its surrounding

agricultural area, or it may be a cluster of towns that collaborate to solve their health

problems and needs. In other cases the health community may be the entire county area.

When defining a health care "community," the community leaders should consider the

following:

        Do the leaders have a shared vision and/or need?

        Are there current health linkages that can be strengthened, such as hospitals that
             share common administration or service delivery?

        Is there evidence of past cooperation among towns?

        Is there a shared problem or common set of needs now or anticipated in the next
             few years?

        Will the process increase the capacity of the citizens to meet or provide health
             care needs?

             (Community capacity could be increased through an enlarged
             population, economic, or power base that generates more revenue or
             political clout or through an enlarged medical market area for a
             particular service; collaboration could achieve a critical mass that
             could enable the garnering of more resources, grants, etc.)


                                                  2
          Can a collaborative process be sustained?

          Will the benefits of shared planning be greater than the risks?

The defined "community" is determined by current and anticipated health care linkages and the

citizens' willingness to implement a health care plan.

       The community leaders must be willing to assess the citizens' perceptions of available

health care services and, when appropriate, those health care services and needs that are not

currently being met. Community leaders must analyze and identify key issues facing the

community and realistically evaluate what is feasible. The Resource Team can provide

technical assistance in the identification and evaluation of the key issues.

       A local Community Facilitator is necessary to provide an interface between the

Resource Team and the local Community Health Steering Committee. This connection is

vital for arranging meetings, mailing notices, contacting people, writing and distributing

publicity, providing continuity, and nurturing local leadership and participation.

       The use of this guidebook as a model of the community health planning process can

help to facilitate and guide a community through the planning process. The guidebook

describes a set of activities that involves the community and the Resource Team. The

Resource Team consists of representatives from the Office of Rural Health, Oklahoma State

Department of Health and the Oklahoma Cooperative Extension Service of Oklahoma State

University. The goal of the Resource Team is to create an interagency Resource Team

available to assist rural communities with community health planning and to create a process

for rural communities to use to enhance local health care systems. The Resource Team offers

technical assistance to the local community with the development, presentation, and analysis




                                                  3
of data and information, surveys, and health services. and facilities; as well as with

analytical, facilitation, and strategic planning skills.

        The community health planning process is outlined in Figure 1 and begins with a

group of citizens of a community becoming interested in reviewing and analyzing the health

care system of the community. This group of citizens is the Initiating Group (Figure 1).

Often this may result from a change in the current health care delivery system such as the

loss of a physician or a hospital or a change in the type of services or facilities offered. A

community that is not currently experiencing changes or problems in their health care system

can also benefit from community health planning by enhancing or improving the current

system or by being prepared for future changes and developments in health care. The

Initiating Group of citizens will form a Community Health Steering Committee to work

through the process of community health planning to develop a health plan, implement the

plan, and continue the process annually.

        An individual or an organization will need to take the lead role and become the

Community Facilitator to maintain communications. The Community Health Steering

Committee through the community facilitator will work closely with an outside Resource

Team. The utilization of an outside Resource Team is necessary as the Resource Team is

trained in the community health planning process and has health sector expertise. The

Resource Team also has contact with other agencies that may be able to provide special

technical assistance and other resources.

        Communities must fully understand their health care needs as well as other factors

that influence how health care services are provided in order to make wise decisions in the

planning process. To develop a Community Health Plan, the Community Health Steering


                                                    4
                      Initiating
Figure 1.              Group

Strategic
                     Community                Resource
 Health              Facilitator               Team
Planning
                      Steering
                     Committee


  Publicity    Directory          Survey      Data & Info
 Task Force   Task Force         Task Force   Task Force


                       Develop
                        Plan


                    Community
                    Reviews Plan


                       Revise
                        Plan


                     Implement
                     Action Plan


                    Follow-Up &
                    Continuation
                             5
Committee will need information and data about the community and will need to

communicate with the community. As specified in Figure 1, the Community Health

Steering Committee will divide into four task forces, which include:

       1. Publicity Task Force

       2. Health Services Directory Task Force

       3. Community Survey Task Force

       4. Data and Information Task Force

       The Publicity Task Force will provide news articles, radio announcements, and other

public notices, including meeting notices for the Community Health Steering Committee.

       The Health Services Directory Task Force will gather detailed information on all

health services and facilities provided within the community. A result of this task force

could be a directory of health services and facilities in the community. The Resource Team

can be helpful in gathering the basic health services and facilities' data. However, the task

force members will know the local services and facilities firsthand and will be critical in

determining the accuracy and completeness of the directory.

       The Community Survey Task Force will design a community health survey, have the

survey conducted and analyzed, and will review the results of the survey analysis. This task

force will determine the local community's opinions and needs related to the health care

system by obtaining input and feedback from the community. The Community Survey Task

Force will review the community survey results to determine the need for further community

analysis of specific needs. The Resource Team can assist with conducting and analyzing a

survey and can assist with the determination of the need for further community analysis.




                                                 6
       The Data and Information Task Force will gather and analyze current sources of data

and information about the community and the community's health care system.

Demographic, economic, and health/medical data and information are available from

different secondary sources. The Resource Team can be helpful in gathering, presenting, and

analyzing this data and information.

       After the task forces (except for the Publicity Task Force) have completed their

research and analyses, final reports, including each task force’s listing of health problems,

needs, or concerns, will be presented to the complete Community Health Steering

Committee. The information from these three task forces will be reviewed and integrated

with duplications eliminated. The Steering Committee will then determine the final points of

emphasis to build a plan of action, the Community Health Plan.

       Research may be needed on some of the points of emphasis to determine what

course(s) of action are feasible. The Resource Team can assist with developing further

information related to specific points of emphasis. After all items have been thoroughly

researched, the Community Health Steering Committee will review the final information. A

proposed plan of action will be completed with a timetable and specific steps for

implementation.

       The proposed Community Health Plan will be shared with the community through the

news media. This allows the members of the community the opportunity to provide input

and discussion of the plan. Every community member is invited at any time to participate in

the community health planning process and the implementation of the plan. After

publicizing the proposed Community Health Plan to the community and reviewing the input

from the community members, the Community Health Steering Committee will then modify


                                                 7
and revise the plan as appropriate. The final Community Health Plan will include specific

community assignments and timelines. A system for reviewing the results of the Community

Health Plan must be determined and follow-up assignments and meetings are crucial for

accomplishment of the plan.

       The Community Health Steering Committee will start the entire community health

planning process again at the end of the first year. The process is designed to be ongoing

annually. The first year's Community Health Plan will be in the implementation stage while

the second year’s Community Health Plan is being initiated and the entire process begins

anew. The second year will be less intense as the process will build on the first year's plan

and much of the data will only have to be updated. The community involvement in the

community health planning process is key to continuing the process on an annual basis.

       Each step of the community health planning process is described in the following

chapters. Further detailed templates and documents are provided in the attached

Appendices.




                                                 8
                                        CHAPTER 2

                           Community Health Steering Committee


       The Community Health Steering Committee is key to the success of the community

health planning process. The local community must realize the need for the community

health planning process and make a commitment to the process. The Initiating Group starts

with a small core of a few individuals (Figure 1). This Initiating Group must be thoroughly

committed in order to "mobilize" the remainder of the community. The Initiating Group will

introduce the community health planning process to key community leaders and organize the

Community Health Steering Committee. A meeting of the Resource Team and the Initiating

Group is held to provide the group with information on the planning process as well as

information and tools for help in approaching other citizens and community leaders to

participate in the process. A proposed agenda for this first meeting with the Initiating Group

is presented in Appendix A (p. A1) along with a suggested timetable (Appendix A, p. A2).

A brief overview of the community health planning process is also included in Appendix A

(pp. A3-A4).

       The Community Health Steering Committee will need to represent a cross-section of

the community, including but not limited to health care providers, health care consumers,

city, county, and state government, Chamber of Commerce, local businesses, education, civic

organizations, churches, agriculture, banking, economic development, retail, social

organizations, etc. It is important to have a variety of people on the Community Health

Steering Committee to assist with the development of a Community Health Plan as well as to

assist with outreach to obtain communication and acceptance of the Community Health Plan



                                                9
in the community. The committee members will represent not only the medical sector but

the entire social and economic structure of the community as well.

       The Initiating Group works with the Resource Team in the selection of their

Community Health Steering Committee. The Initiating Group can send a letter to potential

members; a copy of a draft letter is attached in Appendix A (pp. A5-A6). This letter should

be modified to fit the community situation and the Initiating Group's ideas. A copy of a

brochure developed by the Resource Team to assist the Initiating Group in soliciting

community support and organizing the Community Health Steering Committee is also

presented in Appendix A (pp. A7-A8). This brochure should be personalized and utilized by

the group as appropriate. The Initiating Group can share this brochure with community

members at civic, social, and church group meetings, at the coffee shops and restaurants, in

company and organization break rooms, and any other appropriate communication avenue.

        The Initiating Group should stress the benefits of community health planning by

emphasizing:

            Better use of scarce resources
            Access to more services locally
            Improved coordination of health care services
            Increased cooperation between and among health care providers
            Increased public awareness of health care services
            Strengthened position of the community
            Encouragement of forward-thinking
       A news release about the community health planning process and the first meeting of

the Initiating Group and the Resource Team would also be useful in obtaining public

awareness of the process and the need for community participation. When the Initiating

                                               10
Group is able to obtain a commitment from approximately 25-40 community leaders to serve

on the Community Health Steering Committee, the Resource Team will hold the first steering

committee meeting. The Resource Team will present the process of community health

planning and the economic impact of the health sector on the community and will obtain a

commitment to the community health planning process from the Community Health Steering

Committee members. A proposed agenda for this meeting is included in Appendix A (p.

A9). The objective of this meeting is to obtain the commitment and support of a

representative cross-section of local community members to participate in the community

health planning process.

       The specific assignments of each task force will be discussed in the first Steering

Committee meeting; the handouts on the objectives of the Steering Committee and the task

forces are included in Appendix A (pp. A10-A14). The attendance sheets used for the

Steering Committee meetings and the sign-up sheets for the task force assignments are also

included in Appendix A (pp. A15-A19). An Economic Impact Study of the community's

health sector is prepared by the Resource Team and presented at this first Community Health

Steering Committee meeting. The Economic Impact can only be accomplished with the help

of local community members providing information pertaining to their local health sector.

An Economic Impact worksheet like the one in Appendix A (p. A20) should be filled out by

the local community facilitator and returned to the Resource Team. An example of a

completed Economic Impact worksheet is provided in Appendix A (p. A21). The Impact

Study demonstrates to the Steering Committee members the economic importance of the

health sector to their community. A copy of the Economic Impact Study for Atoka,

Oklahoma, is presented as an example in Appendix B (pp. B1-B16).


                                                11
       The community needs to be prepared to provide data gathering assistance and review

the analysis of the data. The community will be involved in decision making, input,

evaluation, and acceptance of the Community Health Plan; participation in implementation of

the plan; and the continuation of the community health planning process annually. One

important role of the Community Health Steering Committee is to determine the health care

needs of their local community and to review the data and information presented by the

Resource Team to confirm its accuracy and completeness.

       The objective of the Community Health Steering Committee is to provide leadership

and direction of the community health planning process. One of the major tasks of the

Steering Committee is to assist with data gathering and data analysis through four task

forces, which are:

       1.      Publicity

       2.      Directory Task Force

       2.      Survey Task Force

       3.      Data and Information Task Force

       The Steering Committee will divide into these four task forces (Figure 1). A series

of 2-3 meetings will be held with each task force meeting in separate groups to complete

their particular objectives. Each task force's specific objectives are covered in the next four

chapters.

       After the four task forces have completed their research and analyses, a final report

with main points of emphasis from each task force will be presented to the Community

Health Steering Committee. The Steering Committee, as a group, will evaluate the results of

each of these four task forces with the information being reviewed, integrated, and


                                                 12
duplications eliminated. The Steering Committee will then determine the main points of

emphasis on which to build a plan of action.

       Research may be needed on some of the points of emphasis to determine what

course(s) of action are feasible. The Resource Team may be able to assist with developing

further information to address a specific solution to a problem. At times it may be necessary

to seek additional revenue sources to support these research efforts. After all items have been

thoroughly researched, the Community Health Steering Committee will review the final

information. A proposed Community Health Plan will then be completed, including a

timetable and specific steps of action for implementation.

       The proposed Community Health Plan will be shared with the community through the

news media. This allows the members of the community the opportunity to provide input

and discussion about the plan. Any community member is invited to participate in the

community health planning process and in the implementation of the plan at any time if they

so desire. After publicizing the proposed Community Health Plan to the community and

reviewing the input from the community members, the Community Health Steering

Committee will then modify and revise the plan as appropriate. The final plan will include

specific community assignments and deadlines. A performance evaluation system for

reviewing the results of the plan of action must be determined and follow-up assignments and

meetings are crucial for accomplishment of the plan.

       The Community Health Steering Committee will start the entire community health

planning process again at the end of the first year. The membership of the Community

Health Steering Committee may be altered at any time. The process is designed to be

ongoing annually. The first year's Community Health Plan will be in the implementation


                                                13
stage while the second year's plan is being initiated and the entire process begins anew. The

second year will be less intense as the process will build on the first year's plan and much of

the data will only have to be updated. The community's involvement in the community

health planning process is key to continuing the process on an annual basis.




                                                 14
                                         CHAPTER 3

                                     Publicity Task Force


         The Publicity Task Force will work with the Community Health Steering Committee

and the local news media to publicize the meetings and activities of the Community Health

Steering Committee. This task force will also keep the community informed of the progress

and results of the community health planning process. The activities of this task force are

crucial as the community residents need to be fully informed of all health planning activities.

It is very helpful to have members of the community’s print, television, and/or radio media

on this task force. The Steering Committee members and the community at large will

respond more positively to local correspondence and publicity rather than to correspondence

and publicity from Resource Team members. The Resource Team should work through the

local Publicity Task Force on all publicity items, meeting notices, or other communication

items.

         The Publicity Task Force will need to coordinate with the Community Survey Task

Force to gain the participation and support of the community when the survey is being

conducted. Examples of meeting notices, press releases, and news articles are included in

Appendix C (pp. C1-C8). These examples may also be edited and used to meet the local

community’s specific needs.




                                                15
                                          CHAPTER 4

                             Health Services Directory Task Force


       The Health Services Directory Task Force has the objective of reviewing and listing

all current health resources, services, and facilities. The Resource Team can be of assistance

to this task force by obtaining the basic information from the yellow pages of the local

telephone book(s). However, the task force members will need to "fill in the blanks" for

those health care services that are not listed in the yellow pages. The Atoka Health Services

Directory is included as an example for illustration purposes only (Appendix D pp. D1-

D32). The purpose of the Health Services Directory Task Force is to list every health care

service and facility within the local health service area. It provides a current picture of the

present health care delivery system. It is necessary to know exactly what a community

currently has available in their health care system before planning for the future. This will

assist in determining any duplication of services or any lack of particular services. The

information can be organized in the form of a directory that could be printed and distributed

in the community.

       The Health Services Directory Task Force will work closely with the Publicity Task

Force to seek a local sponsor to publish the community health directory. Also, a method for

distribution of the directory will need to be determined. A local contact person would be

helpful to provide a contact point for future updates and revisions of the directory.

       Upon completion of the listing of health services, resources, and facilities, the task

force will present this listing, with their analysis of health care needs and concerns, to the

entire Community Health Steering Committee.



                                                  16
                                         CHAPTER 5

                               Community Survey Task Force


       The objective of the Community Survey Task Force is to gain local input from the

community as to their wants and needs from the health care system. A basic technique for

accomplishing this is through a Community Health Survey. The Resource Team assists the

Community Survey Task Force in designing a survey instrument. The instrument is designed

to obtain "first-hand" information and can be tailored to the community's specific needs. The

Resource Team may assist with conducting and analyzing the Survey. This step can be

costly in the community health planning process and may require financial resources to

accomplish. If finances are not available, a less costly approach such as a mailed survey or

focus groups may be necessary.

       The Survey encourages the local community to express their concerns or their praises

with the health care delivery system. It can provide insight into the perceptions,

expectations, preferences, or perceived barriers about a particular issue. The Survey can be

useful in defining health care needs and can be used to assess a community's receptivity to

alternative plans of action. It is a way to get detailed information on unique problems or

populations from the individuals, groups, and organizations that have a vested interest in a

particular issue. The Survey provides a "snapshot" of current local conditions and citizens'

subjective perceptions of an issue. The Survey does not provide a look at trends over time.

A copy of a sample Survey for Atoka County is included in Appendix E (pp. E1-E6).

       The Publicity Task Force is critical to obtaining the community support necessary for

individuals to take the time to answer the Survey accurately and completely. The Survey

methodology for the Oklahoma model is a telephone Survey. The success of the Survey

                                                17
depends upon randomly selecting your survey population. It is necessary to obtain

representation from a cross-section of all citizens.

       Upon completion of the Survey, no individual Survey answers are disclosed. The

aggregate totals of the entire Survey are analyzed and presented. A sample of aggregate

Survey results with illustrations of the Survey analysis is included in Appendix E (pp. E7-

E15). The Resource Team may conduct the analysis and present the results to the Survey

Task Force. The task force reviews the data and selects the points of emphasis.

       At this point, the task forces and Resource Team will need to determine if any

additional community needs should be assessed. If the survey provides accurate insight into

the community's health care system needs, no further needs assessments will be necessary.

However, if the community survey does not produce viable results, it could be determined

that an instrument for additional community needs assessment should be prepared. If it is

determined that an additional needs assessment should be conducted, the Resource Team can

assist the task force in determining the methodology, which could include organizing and

conducting focus group meetings. The results of these group meetings would then be

organized and presented to the task force. The task force, upon review and summary, will

present their results to the entire Community Health Steering Committee.




                                                 18
                                        CHAPTER 6

                              Data and Information Task Force


        The Data and Information Task Force has the task of gathering and analyzing any and

all current relevant sources of data and information about the local community's health care

system. This information includes economic, health/behavioral, education, traffic, and crime

data.

        Specifically, the Resource Team accumulates relevant secondary data and prepares

the data for presentation to the Data and Information Task Force. Sources of data include the

U.S. Census of Population and Housing, Regional Economic Information Service Bureau of

Economic Analysis, Woods and Poole Economics, Inc., County Business Patterns, the State

Health Department Hospital Utilization (HUPS) data and the Regional Perinatal Health data.

The data and information for Atoka is presented as an example in Appendix F (pp. F1-

F48). The Data and Information Task Force reviews the data to be sure it is accurate and that

all relevant data are included. From the information and data presented, the task force

determines the points of emphasis, summarizes their results, and determines recommended

courses of action. The Data and Information Task Force prepares a final report to present to

the entire Community Health Steering Committee.




                                               19
                                          CHAPTER 7

                                    Community Health Plan


       After each of the four data task forces has completed the research and data analysis, a

final report with main points of emphasis from each task force will be presented to the

complete Community Health Steering Committee. The information from the four task forces

will be reviewed, integrated, and duplications eliminated. The Steering Committee will then

determine the main issues to build a plan of action. It is recommended by the Resource

Team that only one to three health issues should be identified for action in the first year.

Other items may and should be addressed in subsequent years. The Community Health

Steering Committee may want to use some type of point system to rank the issues and

determine the top issues. An example of this process is included in Appendix G (pp. G1-

G2).

       In analyzing and prioritizing the issues, certain questions should be considered:

        What do the different sets of data suggest about health care services in the
           area? Is there agreement or apparent contradiction?

        What does the community WANT?

        Is there a difference between wants and needs?

        What prioritized health services are needed?
       After all issues have been thoroughly analyzed, prioritized, and researched, the

Community Health Steering Committee will review the final information. The Plan should

cover the following areas:




                                                 20
         What does the community have to do to MAINTAIN existing services that are
            already meeting needs?

         What does the community have to do to DEVELOP needed services?
A proposed Plan of action will need to be completed for each issue, with a timetable and

specific steps of action for implementation for each issue.

        The proposed Plan of action will be shared with the community through the news

media. This allows the members of the community the opportunity to provide input and

discussion about the plan. Every community member is invited to participate in the

community health planning process and in the implementation of the Plan at any time. After

publicizing the proposed Plan to the community and reviewing the input from the community

members, the Community Health Steering Committee will then modify and revise the Plan,

as appropriate. The final Plan will include specific community assignments and deadlines

(Appendix G, pp. G3-G4). A system for reviewing the results of the Plan of action must be

determined and follow-up assignments and meetings are crucial for accomplishment of the

plan.

        Research may be needed on the issues to determine what course(s) of action are

feasible. The Resource Team can assist in developing further information related to specific

issues. The Resource Team in Oklahoma has done studies of the demand for primary care

physicians and cost to establish a practice, emergency medical services in a community,

feasibility of an outpatient rehabilitation facility, and feasibility of an adult day care center.

Copies of these feasibility studies are available upon request from Oklahoma Cooperative

Extension Service.




                                                   21
       The Community Health Steering Committee will start the entire community health

planning process again at the end of the first year. The process is designed to be ongoing

annually. The first year's Plan of action will be in the implementation stage while the second

year's plan is being initiated and the entire process begins anew. The second year will be less

intense as the process will build on the first year's Plan and much of the data will only have to be

updated. The community involvement in the community health planning process is key to

continuing the process on an annual basis.




                                                  22
APPENDIX A
INITIATING GROUP MEETING
            (Day of the Week), (Date)

                   AGENDA
    Introductions and Welcomes

    Critical Access Hospital

    Overview of the Community Health Planning Process

    Community Health Steering Committee

    Task Forces

        Publicity Task Force
        Health Services Directory Task Force
        Community Survey Task Force
        Data and Information Task Force

    Time Frame – Meeting Dates

    Economic Impact of the Health Sector

    Next Meeting Date




                       A1
                                   SUGGESTED TIME TABLE
                                                                  Months
Action                                              1    2   3         4        5     6

Initiating Group Meeting to Explain
    CHP Process                          ▄▄

Create Community Steering Committee           ▄▄

1st Steering Committee Meeting                     ▄▄
     Explain CHP Process
     Present Economic Impact
     Sign Up for Task Forces

2nd Steering Committee Meeting                          ▄▄
  Break-Out Task Force Groups
    Draft Directory
    Review D & I
    Edit Survey Instrument
    Develop Publicity

3rd Steering Committee Meeting                               ▄▄
  Break-Out Task Force Groups
    Finalize Directory
    Summarize D & I
    Finalize Survey Instrument & Dates
    Finalize Publicity for Survey

Conduct Survey & Prepare Results                                    ▄▄

4th Steering Committee Meeting                                             ▄▄
    Present Survey Results

5th Steering Committee Meeting                                                  ▄▄
    Develop Action Plan Based on Task Force Results

COMMUNITY MEETING – Present Proposed Plan (Optional)                                 ▄▄

6th Steering Committee Meeting
    Revise and/or Implement Action Plan                                                   ▄▄




                                               A2
             THE OKLAHOMA COMMUNITY HEALTH PLANNING PROCESS
                             A Brief Overview

        The community health planning process is being offered to each community eligible for
the Critical Access Hospital designation. The process consists of a series of 5-7 meetings over a
3-4 month period. A flow chart is inserted below to illustrate the components of the process.
                                                 Initiating
                                                  Group

                                             Community                     Resource
                                             Facilitator                    Team

                                              Steering
                                             Committee

                    Publicity       Directory                   Survey      Data & Info
                   Task Force       Task Force                Task Force    Task Force

                                                 Develop
                                                  Plan
                                            Community
                                            Reviews Plan
                                                  Revise
                                                   Plan
                                             Implement
                                             Action Plan
                                            Follow-Up &
                                            Continuation

        First, a small Initiating Group of individuals from the community meets to review the
health planning process, discuss the membership of the Steering Committee, gather the primary
data for the economic impact study, and set the date for the first health planning meeting. A
broad-based community Steering Committee is organized and the first meeting is held to present
the economic impact of the health sector on the community. The Steering Committee is then
divided into four task forces: 1) Publicity, 2) Health Services Directory, 3) Community Survey,
and 4) Data and Information.

        The next two to three health planning meetings involve the Steering Committee breaking
out into these task forces. The Publicity Task Force publicizes the process as well as provides a
publicity ―blitz‖ the week or two before the community survey is taken. The Inventory Task
Force organizes and finalizes a community health services directory. The Survey Task Force
develops a survey instrument that will deal with access to health care and health care utilization
patterns. The Data and Information Task Force is presented with secondary data in the areas of
demographic and economic, health and behavioral, traffic accident, education, and crime. This
task force reviews the information and looks for strengths and/or weaknesses in the community
data. The process results in four products: 1) Economic Impact of the Health Sector, 2) Health
Resources Directory, 3) Survey Results, and 4) Data and Information. Copies of these four
products are available upon request.




                                                    A3
       After the task forces complete their meetings, the next health planning meeting will be to
summarize the information received from the task forces; the Health Services Directory Task
Force will look for duplication of services, possible integration of services, or for services
lacking in the community. The Community Survey Task Force reviews and summarizes the
survey results, looking for any areas of need in the community. The Data and Information Task
Force summarizes the needs as indicated from the data review.

        The results of the task forces are reviewed by the entire Steering Committee and then
prioritized by the group to determine the top 3-5 issues within the community. From these top
issues, the group develops an action plan to deal with an issue or with several issues. The
Steering Committee then shares their proposed action plan with the community at large for their
review and input.

         The community Resource Team, consisting of representatives from the Oklahoma
Cooperative Extension Service and the Oklahoma Office of Rural Health, provide facilitation of
these 5-7 meetings and provide staff to the process. The community process ends with the
development of the action plan and the community implements the plan. The Resource Team is
still available for feasibility studies and follow-up to the process.




                               For additional information, contact:


               Stan Ralstin, Rural Development Specialist for Western Oklahoma
                           Oklahoma Cooperative Extension Service
                                        (580) 233-5295

                 Jack Frye, Rural Development Specialist for Eastern Oklahoma
                            Oklahoma Cooperative Extension Service
                                        (580) 332-4100

                           Mary K. Lawler, State Extension Specialist
                           Oklahoma Cooperative Extension Service
                                       (405) 744-6081

                          R. David Shelton, State Extension Specialist
                           Oklahoma Cooperative Extension Service
                                        (405) 744-6081

                          Cheryl F. St. Clair, State Extension Specialist
                           Oklahoma Cooperative Extension Service
                                         (405) 744-6081




                                               A4
DRAFT STEERING COMMITTEE LETTER (to be sent from the Initiating Group)

       A small group of us have been talking and have become increasingly concerned about

what is happening nationally and what might be "coming down the pike" to our local health care

system. We have decided that the time is right for our community to take action. The

importance of our medical community is so vital to the economy and well being of (community)

that we cannot afford to take the chance of losing these vital services or of losing control of these

vital services. In order to continue to provide "local" access to quality health care services and to

maintain "local" control of our health care services, we must become involved NOW.

       The entire system for providing health care in our country is in transition and appears to

be in distress. There are so many changes happening with the new managed care, changes in

payment of Medicare and Medicaid, and the formulation of health care networks, such as PPO's,

HMO's, etc. These changes have already starting affecting us: Medicare payment changes are

already effecting our elderly population and the Medicaid system in Oklahoma is proceeding

with a managed care system. These changes will eventually impact our own health care services

right here in (community).

       As a (concerned leader in our community, a concerned health care provider in our

community, a concerned local government official in our community, a concerned educator, a

concerned retiree, etc.), we are asking for your assistance. We need your involvement in

developing a community health plan for (community). The community health planning process

will be facilitated by a team from the Oklahoma Office of Rural Health and the OSU

Cooperative Extension Service.

       We are asking you to join us for an initial meeting with the team listed above. The

purpose of the meeting is: 1) to explain the process of community health planning; and 2) to


                                                 A5
determine if we, as a community, would like to participate in the process to develop a

community health plan. If the decision is positive, we will also need to determine who should be

on a Steering Committee.

       The meeting will be held on (date) at (time) in the (room) in the (organization) at

(address). One of us will be calling you to discuss this meeting prior to the date. We need your

ideas and thoughts about health care. If unable to attend, you could send a representative on

your behalf. If you know of others who might be willing to assist, please share this information

when you are called. We hope you will be able to take the time to assist in shaping our

(community)'s future in health care.

Sincerely,



(Initiating Group Names, Organizations, and Phone Numbers)




                                               A6
Community residents are being asked to work with the                 COMMUNITY HEALTH PLANNING FOR
                                                                           (COMMUNITY XYZ)
resource team:

           To assist with gathering and reviewing health
            services information,

           To review data and information concerning the
            community and/or the county,

           To revise a phone survey instrument to
            determine the needs of the community,

           To write the a health care plan, and

           To implement the plan.

     Community residents will also be asked:
                                                                  (Community) is considering becoming involved in a
           To consider continuing the community health
                                                                     community health planning process to develop a
            planning process on a yearly basis.
                                                                 strategic health plan. Residents in the community will
                                                                             work with a resource team from:
VOLUNTEERS ARE NEEDED TO JOIN THE
(COMMUNITY XYZ) COMMUNITY HEALTH                                       Oklahoma Cooperative Extension Service
STEERING COMMITTEE!                                                          Oklahoma State University

FOR MORE INFORMATION, CONTACT                                             Oklahoma Office of Rural Health
_(NAME)_OR (NAME) AT _(PLACE) AT (PHONE)_                               Oklahoma State Department of Health


                                                            A7
WHAT IS COMMUNITY HEALTH PLANNING?

An ongoing planning process that:

             Gathers and reviews health/behavioral, economic,
              education, crime, and traffic accident data &
              information,

              Assesses the community’s health care needs,

              Writes a health care action plan,

              Implements the health care plan,
                                                                      BENEFITS OF COMMUNITY HEALTH PLANNING:
              Reviews the outcome of the plan, and
                                                                               Appropriate use of scarce resources,
              Continues the health planning process yearly.
                                                                               Improves coordination of health care services,

                                                                               Builds cooperation between health care providers,

                                                                               Increases public awareness of health care services,

                                                                               Strengthens the position of the community, and

                                                                               Encourages forward-thinking.


                                                                      The resource team will work with the community by providing an
                                                                      economic impact of the health sector, drafting and revising a
                                                                      health services directory, assisting with phone survey, preparing
                                                                      data and information, and overseeing the community health
                                                                      planning process.

                                                                 A8
     (COMMUNITY) MEETING
COMMUNITY HEALTH STEERING
       COMMITTEE
            (Day of the Week), (Date)

                 AGENDA
     Introductions and Welcomes

     Overview of the Community Health Planning Process

        Community Health Steering Committee

        Task Forces
          Publicity Task Force
          Health Services Directory Task Force
          Community Survey Task Force
          Data and Information Task Force

     Economic Impact of the Health Sector

     Task Force Assignments and Sign-Ups

     Next Meeting Date




                       A9
Community Health Steering Committee
          Objectives

    Provide leadership and direction of the strategic health

     planning process.

    Actively participate on a task force.

        o Publicity Task Force

        o Health Services Directory Task Force

        o Community Survey Task Force

        o Data and Information Task Force

    Decision-making, input, evaluation, and

     implementation of community health plan.

    Continuation of the strategic health planning process.




                         A10
Publicity Task Force Objectives

 Work with local media to run news articles on the

  strategic health planning process.

 Prepare notices of meetings for publication.

 Look for other ways of publicizing the strategic health

  planning process.

 Coordinate with the Community Survey Task Force.




                      A11
Health Services Directory Task Force
             Objectives

  Identify health services and facilities.

      o Review information in the draft health services

         directory.

  Gather missing information on health services and

   facilities in the community.

  Seek a sponsor to fund the health directory.

  Publish and distribute directories.

  Provide mechanism for a contact person to update and

   distribute directories in future.




                         A12
     Community Survey Task Force
          Objectives
 Review and revise proposed survey instrument.

 Assist with identifying survey sample.

 Review survey results.

 Identify high priority actions from survey.

 Share survey results with community.




                           A13
   Data and Information Task Force
              Objectives
 Review information and data compiled by the resource team

  members.

     o Demographic information

     o Health/Behavioral data

     o Economic data

     o Education

     o Traffic

     o Crime

 Identify high priority actions from the data.

 Share data and information with community.




                          A14
       COMMUNITY HEALTH STEERING COMMITTEE MEETING
                      SIGN UP SHEET
                       (Date of Meeting)

Name                Address            Phone/Email




                              A15
       PUBLICITY TASK FORCE
          SIGN UP SHEET


Name    Address               Phone/Email




                  A16
       HEALTH SERVICES DIRECTORY TASK FORCE
                   SIGN UP SHEET


Name            Address             Phone/Email




                          A17
       SURVEY TASK FORCE
         SIGN UP SHEET

Name   Address             Phone/Email




                 A18
       DATA AND INFORMATION TASK FORCE
                 SIGN UP SHEET

Name          Address            Phone/Email




                        A19
                           Direct Economic Activities
                                of Health Sector
                           in __________ Community


      Component                     Estimated Employees* Estimated Payroll

      Hospital (#)                              _____          _____

     Doctors and Dentists
       Physicians (#)              _____                      _____
       Dentists (#)                _____                      _____
  Other                       _____                      _____
     Nursing & Protective Care (#) _____                      _____

      Other Medical & Health Services
       Home Health Care (#)        _____                       _____
       County Health Department _____                          _____

      Pharmacies (#)                            _____          _____

      TOTALS                                    _____          _____

SOURCE: Local survey and estimated from research

* Full-Time equivalent employment




                                          A20
                                    EXAMPLE TABLE
                        Direct Economic Activities of Health Sector
                                in ___________, Oklahoma

                                                         Estimated     Estimated
Component                                               Employees        Payroll

Hospital (1)                                                   119    $2,656,800



Doctors and Dentists (18)                                       67    $2,896,800
 Includes 7 physicians, one physician assistant,
  one optometrist, 2 chiropractors, 3 dentists,
  & four full-time equivalent emergency
  room physicians

Nursing and Protective Care (2)                                 95    $1,100,000
 Includes two nursing homes



Other Medical and Health Services                               43     $935,000
 Includes one home health agency and
 the county health department




Pharmacy - 4 pharmacies & 6 pharmacists                         21     $690,000



TOTAL                                                          345    $8,278,600



SOURCE: Local survey and estimated from research




                                               A21
APPENDIX B
          Atoka County -
Economic Impact of the Health Sector
              o tl
               s s
               p
              Hia




                                     u gm
                                      r H
                                      si
                                     Nn oe




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                   omy
                   Cmi
                     n
                     ut
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   r eo s
  O P sn




                                        h a
                                         a c
                                         r i
                                        Pmse


      te e l r e
      h d Si s
       r  i
          c
      O Maec v




      Oklahoma State Department of Health,
              Office of Rural Health
     Oklahoma Cooperative Extension Service,
            Oklahoma State University

                 March 2000

                       B1
                                                                        AE-0025




              The Economic Impact of the Health Sector
             on the Economy of Atoka County, Oklahoma




      Cheryl F. St. Clair - Extension Associate, OSU, Stillwater
                            (405) 744-6081

      Gerald A. Doeksen - Extension Economist, OSU, Stillwater
                           (405) 744-6081

    Jack Frye - Area Extension Rural Development Specialist, Ada
                           (580) 332-4100

Val Schott - Director, Oklahoma Office of Rural Health, Oklahoma City
                            (405) 271-8750

Jody R. House - Atoka/Coal Counties - Unit Extension Director, Atoka
                         (580) 889-7337




               RURAL DEVELOPMENT
      OKLAHOMA COOPERATIVE EXTENSION SERVICE
            OKLAHOMA STATE UNIVERSITY




                                 B2
                                         March 2000
                            The Economic Impact of the Health Sector
                           on the Economy of Atoka County, Oklahoma


       Medical facilities have a tremendous medical and economic impact on the community in

which they are located. This is especially true with health care facilities, such as hospitals and

nursing homes. These facilities not only employ a number of people and have a large payroll,

but they also draw into the community a large number of people from rural areas that need

medical services. The overall objective of this study is to measure the economic impact of the

health sector on the economy of Atoka County. The specific objectives of this report are to:

       1.      summarize the direct economic activities of the health sector;

       2.      review concepts of community economics and multipliers; and

       3.      estimate the secondary impacts of the health sector on Atoka County’s economy.

No recommendations will be made in this report.



                           County Demographic and Economic Data

       The population and employment for Atoka County will be illustrated in this section. The

populations for Atoka County are presented in Table 1. The population of Atoka County was

12,778 in 1990 according to the U.S. Census Bureau and is estimated to be 13,200 in 1998

according to the U. S. Census Bureau, Population Estimates Branch. The population of the City

of Atoka was 3,298 in 1990 and is estimated to have decreased to 3,270, according to the Census

Estimates for 1998. The communities of Caney, Stringtown, and Tushka have all increased

slightly from 1990 to 1998. The community of Wardville’s population has remained basically

the same. The rural areas of Atoka County have increased considerably from 8,622 in




                                                 B3
                                                         Table 1

                                Population of Atoka County, Oklahoma



                                                          1990                                                1998 Estimated
                                                                   1                                                       2
                                                        Population                                              Population

Atoka County .......................................... 12,778 ..................................................... 13,200
 Atoka ....................................................... 3,298 ....................................................... 3,270
 Caney ......................................................... 184 .......................................................... 190
 Springtown ................................................. 366 .......................................................... 370
 Tushka ........................................................ 256 .......................................................... 270
 Wardville...................................................... 52 ............................................................ 50
 Balance of Atoka County ........................ 8,622 ....................................................... 9,080

  1
      SOURCE: Population data from the U. S. Bureau of the Census, 1990.
  2
      SOURCE: Population data from the U. S. Bureau of the Census, Population Estimates
      Branch, 1998.




                                                             B4
1990 to 9,080, according to the 1998 Estimates. In summary, the population of Atoka County

has increased, predominantly in the smaller communities and in the unincorporated rural areas.

Employment data for Atoka County are presented in Table 2; data is for 1997 from the Bureau

of Economic Analysis, Regional Economic Information System. The industry sectors with the

largest employment are farms (1,165), retail trade (942), services (919), and state and local

government (1,124). Atoka County has a farm, government, retail trade, and services economic

base.



                                The Direct Economic Activities

        Employment and payroll are the important direct economic activities created in Atoka

County from the health sector. The health sector is divided into the following five components:

               Hospitals
               Doctors and Dentists (includes other medical professionals)
               Nursing and Protective Care
               Other Medical and Health Services (includes home health care and county health
                departments)
               Pharmacies

        The total health sector in Atoka County employs 303 full-time equivalent employees and

has an estimated payroll of $6,755,067 (Table 3). The health sector in Atoka County is typical

of many rural areas, with one hospital, two physician offices, two dental offices, two nursing

homes, and three pharmacies. The Hospital component employs 97 people with an annual

payroll of $2,400,000. The Doctors and Dentists (& Other Medical Professionals) component

employs 36.5 full-time equivalent employees, with an annual payroll of $1,302,114. The

Nursing and Protective Care Component employs 92 people with an annual payroll of




                                                B5
                                                          Table 2

                               Employment in Atoka County, Oklahoma


                                                  EMPLOYMENT


                                                                                    1997                                        1999

TOTAL EMPLOYMENT ..................................................5,624.......................................5,730

By Type:

   Wage and Salary ............................................................3,311........................................n/a
   Proprietors .....................................................................2,313........................................n/a
     Farm ..........................................................................1,065........................................n/a
     Nonfarm ....................................................................1,248........................................n/a

By Industry:

   Farm ...............................................................................1,165....................................1,140
   Nonfarm .........................................................................4,459....................................4,590
     Private .......................................................................3,198....................................3,310
         Ag. serv., for., fish., and other ...................................98.......................................100
         Mining .......................................................................50.........................................50
         Construction ............................................................201.......................................230
         Manufacturing .........................................................411.......................................420
         Transportation and public utilities...........................290.......................................290
         Wholesale trade ......................................................167.......................................180
         Retail trade ..............................................................942.......................................940
         Finance, insurance, and real estate ..........................120.......................................120
         Services ...................................................................919.......................................980
     Government and government enterprises..................1,261....................................1,280
         Federal, civilian .........................................................70.........................................70
         Military ......................................................................67.........................................70
     State and local ...........................................................1,124....................................1,140


       SOURCE: 1997 data is from the Bureau of Economic Analysis, Regional Economic
       Information System; 1999 data is from Woods & Poole Economics Year 2000.




                                                              B6
                                         Table 3
                      Direct Economic Activities of the Health Sector
                               in Atoka County, Oklahoma


                                                      Estimated          Estimated
    Component                                        Employees             Payroll


    Hospital (1)                                           97.0         $2,400,000
     (Includes the Hospital Home Health
     and the Atoka County EMS)

    Doctors and Dentists                                   36.5         $1,302,114
     (Includes 2 physicians, 2 optometrists,
     2 dentists, and 1 chiropractor)

    Nursing & Protective Care (2)                          92.0         $1,272,000

    Other Medical & Health Services                        58.5         $1,083,453
     (Includes 4 home health agencies,
     county health dept., and 2 DME
     suppliers)

    Pharmacies (3)                                         19.0          $697,500

    TOTALS                                                303.0         $6,755,067


SOURCE: Local survey and estimated from research




                                               B7
$1,272,000. The Other Medical and Health Services component employs 58.5 employees, with

an annual payroll cost of $1,083,453. The Pharmacies component has a total of 19.0 employees

totaling a payroll of $697,500. It should be noted that many rural communities have a large

number of elderly, and the ranchers and farmers often retire in the towns. Thus, Nursing and

Protective Care facilities are an important component of the health sector.

       In summary, the health sector is vitally important as a community employer and

important to the community's economy. The health sector definitely employs a large number of

residents. The health sector and the employees in the health sector purchase a large amount of

goods and services from businesses in Atoka County. These impacts are referred to as secondary

impacts or benefits to the economy. Before the secondary impacts of the health sector are

discussed, basic concepts of community economics will be discussed.



                     Some Basic Concepts of Community Economics and
                           Income and Employment Multipliers

       Figure 1 illustrates the major flows of goods, services, and dollars of any economy. The

foundation of a community's economy is those businesses that sell some or all of their goods and

services to buyers outside of the community. Such a business is a basic industry. The flow of

products out of, and dollars into, a community are represented by the two arrows in the upper

right portion of Figure 1. To produce these goods and services for "export" outside the

community, the basic industry purchases inputs from outside of the community (upper left

portion of Figure 1), labor from the residents or "households" of the community (left side of

Figure 1), and inputs from service industries located within the community (right side of Figure

1). The flow of labor, goods, and services in the community is completed by households using




                                                B8
Inputs                               $

               Basic
    $         Industry               Products



    Labor       $        $   Inputs

              Goods &
              Services

Households                   Services
                    $


$                                         $



                 Figure 1.
         Community Economic System



                    B9
their earnings to purchase goods and services from the community's service industries (bottom of

Figure 1). It is evident from the interrelationships illustrated in Figure 1 that a change in any

one segment of a community's economy will have reverberations throughout the entire economic

system of the community.

        Consider, for instance, the closing of a hospital. The services section will no longer pay

employees and dollars going to households will stop. Likewise, the hospital will not purchase

goods from other businesses and dollar flow to other businesses will stop. This decreases

income in the "households" segment of the economy. Since earnings would decrease,

households decrease their purchases of goods and services from businesses within the "services"

segment of the economy. This, in turn, decreases these businesses' purchases of labor and inputs.

Thus, the change in the economic base works its way throughout the entire local economy.

        The total impact of a change in the economy consists of direct, indirect, and induced

impacts. Direct impacts are the changes in the activities of the impacting industry, such as the

closing of a hospital. The impacting business, such as the hospital, changes its purchases of

inputs as a result of the direct impact. This produces an indirect impact in the business sectors.

Both the direct and indirect impacts change the flow of dollars to the community's households.

The households alter their consumption accordingly. The effect of this change in household

consumption upon businesses in a community is referred to as an induced impact.

        A measure is needed that yields the effects created by an increase or decrease in

economic activity. In economics, this measure is called the multiplier effect. A Type III

multiplier is used in this report. It is defined as:




                                                  B10
         Type III 1 - is the ratio between direct employment, or that employment used by the
         industry initially experiencing a change in final demand and the direct, indirect, and
         induced employment.

         A Type III employment multiplier of 3.0 indicates that if one job is created by a new

industry, 2.0 jobs are created in other sectors due to business (indirect) and household (induced)

spending.



                      Secondary Impacts of Health Sector on the Economy
                                 of Atoka County, Oklahoma

         Employment and income multipliers for the area have been calculated by use of the

IMPLAN model. It was developed by the U.S. Forest Service2 and is a model that allows for

development of county multipliers. The Type III employment multipliers for the five

components of the health sector are shown in Table 4, column 3. The Type III employment

multiplier for the hospital component is 1.70. This indicates that for each job created in that

sector, 0.70 jobs are created throughout the area due to business (indirect) and household

(induced) spending. The Type III employment multipliers for the other health sector components

are also shown in Table 4, column 3. The Type III income multiplier for the hospital sector is

1.47 (Table 4, column 6). This indicates that for each dollar created in that sector, 0.47 dollars




1
  The Type III multiplier is a modified Type II multiplier and is calculated slightly differently
than normal type II methodology. Researchers feel it is more accurate. For specific reasons and
how to calculate see [1].
2
    For complete details of model, see [1] and [2].


                                                B11
                                                          Table 4
                                            Economic Impact of the Health Sector
                                    on Employment and Income in Atoka County, Oklahoma


         (1)             (2)       (3)       (4)                   (5)          (6)             (7)              (8)           (9)
    Health Sector               Type III Employment                           Type III        Income            Retail      One Cent
     Component       Employment Multiplier Impact                Income       Multiplier      Impact            Sales       Sales Tax


Hospitals                 97.0         1.70         165        $2,400,000         1.47       $3,528,000        $1,179,040    $11,790

Doctors & Dentists        36.5         1.79          65        $1,302,114         1.34       $1,744,833         $583,114      $5,831

Nursing &
 Protective Care          92.0         1.54         142        $1,272,000         1.66       $2,111,520         $705,659      $7,057

Other Medical &
 Health Services          58.5         1.62          95        $1,083,453         1.62       $1,755,194         $586,577      $5,866

Pharmacies                19.0         1.49          28          $697,500         1.61       $1,122,975         $375,293      $3,753

TOTALS                  303.0                       495        $6,755,067                   $10,262,522        $3,429,683    $34,297
SOURCE: 1996 IMPLAN Data Base

SOURCE: 1996 IMPLAN Data Base
*
Since the communities in the county have different sales tax rates, the amount of collections generated by a
one cent sales tax is presented.



                                                                 B12
are created throughout the area due to business (indirect) and household (induced) spending.

The Type III income multipliers for the other four health sector components are also given in

Table 4, column 6.

       Applying the employment multipliers to the employment for each of the five health

sector components yields an estimate of each component’s employment impact on Atoka County

(Table 4, columns 2, 3, and 4). For example, the hospital has employment of 97 employees;

applying the Type III employment multiplier of 1.70 to the employment number of 97 brings the

total employment impact of the hospitals to 165 employees (97 x 1.70 = 165). The Doctors and

Dentists component has a direct impact of 36.5 employees and with the application of the Type

III multiplier of 1.79; the total impact comes to 65 employees (36.5 x 1.79 = 65). The Nursing

and Protective Care component has a direct effect of 92 employees and an employment

multiplier of 1.54, to bring the total impact to 142 employees (92 x 1.54 = 142). The Other

Medical & Health Services component has a direct effect of 58.5 employees, an employment

multiplier of 1.62, and a total employment impact of 95 employees (58.5 x 1.62 = 95). The

Pharmacies component has 19 employees and a total impact of 28 employees, applying the

employment multiplier of 1.49 (19 x 1.49 = 28). The total employment impact of the health

sector in Atoka County is estimated at 495 employees (Table 4, total of column 4).

       Applying the income multipliers to the income (payroll) for each of the five health sector

components yields an estimate of each component’s income impact on Atoka County (Table 4,

columns 5, 6, and 7). The Hospital component has a total payroll of $2,400,000; applying the

Type III income multiplier of 1.47 brings the total Hospital income impact to $3,528,000

($2,400,000 x 1.47 = $3,528,000). The Doctors and Dentists have a total income impact of




                                              B13
$1,744,833 ($1,302,114 x 1.34 = $1,744,833), based on the application of the income multiplier

of 1.34 to the payroll of the Doctors and Dentists component of $1,302,114. The Nursing &

Protective Care component has a payroll of $1,272,000, a multiplier of 1.66, resulting in an

income impact of $2,111,520 ($1,272,000 x 1.66 = $2,111,520). The Other Medical & Health

Services has an income impact of $1,755,194, based on the direct payroll of $1,083,453 and the

income multiplier of 1.62. The Pharmacies has an income impact of $1,122,975, based on the

direct payroll of $697,500 and the income multiplier of 1.61. The total income impact of the

health sector in Atoka County is projected to be $10,262,522 (Table 4, total of column 7).

       Income also has an impact on retail sales. If the county ratio between retail sales and

income continues as in the past several years, then direct and secondary retail sales generated by

the health sector and its employees equals $3,429,683 (Table 4, total of column 8). Each of the

five health sector components’ income impacts is utilized to determine the retail sales and a 1-

cent sales tax collection for each component. Then the five components are totaled to determine

the direct and secondary retail sales generated by the health sector. A 1-cent sales tax collection

is estimated to generate $34,297 in Atoka County as a result of the total health sector impact

(Table 4, total of column 9). This estimate is probably low, as many health care employees will

spend a larger proportion of their income in local establishments that collect sales tax. The

bottom line is that the health sector not only contributes greatly to the medical health of the

community, but also to the economic health of the community.



                                             Summary

       The economic impact of the health sector upon the economy of Atoka County is

tremendous. The health sector employs a large number of residents, similar to a large industrial



                                                B14
firm. The secondary impact occurring in the community is extremely large and measures the

total impact of the health sector. If the health sector increases or decreases in size, the medical

health of the community as well as the economic health of the community is greatly affected.

For the attraction of industrial firms, businesses, and retirees, it is crucial that the area have a

quality health sector. Often overlooked is the fact that a prosperous health sector also contributes

to the economic health of the community.




                                                  B15
                                       References


[1]   Palmer, Charles and Eric Siverts, IMPLAN ANALYSIS GUIDE. U.S. Department of
      Agriculture, Forest Service Land Management Planning Systems Section, Rocky Mountain
      Forest and Range Experiment Station, Fort Collins, Colorado, 1985.

[2]   Siverts, Eric, Charles Palmer, Ken Walters, and Greg Alward, IMPLAN USER'S
      GUIDE, U.S. Department of Agriculture, Forest Service, Systems Application Unit, Land
      Management Planning, Fort Collins, Colorado, 1983.




                                           B16
APPENDIX C
 PROPOSED PRESS RELEASE – PRIOR
  TO FIRST STEERING COMMITTEE
             MEETING
                    (Community) Health Services Concern of Local Citizens

        Maintaining health services in our community is of utmost concern to all of us. The
(Community Hospital Name) is asking for community involvement and support in a community
health planning process. The Oklahoma State Department of Health and the Oklahoma
Cooperative Extension Service from Oklahoma State University will be facilitating our
community through the process.

        All community members are encouraged to become involved in the community health
planning process! As a Steering Committee member, you will need to attend about 6-7 meetings
over a period of 4-6 months.

        The process involves a look at the new critical access hospital designation. A video will
be shown to explain what this new designation means for a community hospital. The economic
impact of the health sector on (Community) will be illustrated. The process will assess health
care needs through the development of a health services directory and through the review of data
and information. A phone survey is planned that will ask area residents questions on what
health services they are utilizing and what health services they feel are needed in the local area.

      The first meeting is planned for (Date & Time) at the (location & address of meeting). If
you would like to become a part of the community health planning process and join the Steering
Committee, please contact (Name and phone number) or (Name and phone number).




                                                C1
          Samples of stuffers for mailers, utility bills, church bulletins, paychecks


                  TAKE TIME TO BE HEARD—YOUR OPINION COUNTS

The ________ Health Care Steering Committee has joined together to study the health care
needs of the ________ area. We need your help! Input is needed from people in all parts of our
area and all walks of life. A good response is vital in identifying and solving health concerns in
our community and surrounding areas.

A professional out-of-town polling group will be conducting a phone survey on ________. We
urge you to take a few minutes to answer their questions. All answers are strictly confidential;
there is no way to associate a name with survey responses. If you have caller ID, the call will be
identified as ―Out of Area‖ or ―Unknown‖. The results of this survey will be used to better our
community.


                  TAKE TIME TO BE HEARD—YOUR OPINION COUNTS

The ________ Health Care Steering Committee has joined together to study the health care
needs of the ________ area. We need your help! Input is needed from people in all parts of our
area and all walks of life. A good response is vital in identifying and solving health concerns in
our community and surrounding areas.

A professional out-of-town polling group will be conducting a phone survey on ________. We
urge you to take a few minutes to answer their questions. All answers are strictly confidential;
there is no way to associate a name with survey responses. If you have caller ID, the call will be
identified as ―Out of Area‖ or ―Unknown‖. The results of this survey will be used to better our
community.


                  TAKE TIME TO BE HEARD—YOUR OPINION COUNTS

The ________ Health Care Steering Committee has joined together to study the health care
needs of the ________ area. We need your help! Input is needed from people in all parts of our
area and all walks of life. A good response is vital in identifying and solving health concerns in
our community and surrounding areas.

A professional out-of-town polling group will be conducting a phone survey on ________. We
urge you to take a few minutes to answer their questions. All answers are strictly confidential;
there is no way to associate a name with survey responses. If you have caller ID, the call will be
identified as ―Out of Area‖ or ―Unknown‖. The results of this survey will be used to better our
community.




                                                C2
     DON’T MISS THE CHANCE TO ―PUT IN YOUR TWO CENTS WORTH‖ ABOUT
                             HEALTH CARE

The Oklahoma State Department of Health and the OSU Extension Service have joined with the
________ Health Care Steering Committee to study the impact of health care services provided
in our community and surrounding area. WE NEEDYOUR HELP!

A health care survey will be conducted by telephone during the week of ________. Please take a
few moments and participate and ―Tell it like it is‖. All questions are completely confidential.
Your caller ID will show ―Out of Area‖ or ―Unknown‖.

The overall goal of the survey is to obtain input from the residents of ________ as to the health
care needs now and in the future.


          DON’T MISS THE CHANCE TO ―PUT IN YOUR TWO CENTS WORTH‖
                            ABOUT HEALTH CARE

The Oklahoma State Department of Health and the OSU Extension Service have joined with the
________ Health Care Steering Committee to study the impact of health care services provided
in our community and surrounding area. WE NEEDYOUR HELP!

A health care survey will be conducted by telephone during the week of ________. Please take a
few moments and participate and ―Tell it like it is‖. All questions are completely confidential.
Your caller ID will show ―Out of Area‖ or ―Unknown‖.

The overall goal of the survey is to obtain input from the residents of ________ as to the health
care needs now and in the future.


          DON’T MISS THE CHANCE TO ―PUT IN YOUR TWO CENTS WORTH‖
                            ABOUT HEALTH CARE

The Oklahoma State Department of Health and the OSU Extension Service have joined with the
________ Health Care Steering Committee to study the impact of health care services provided
in our community and surrounding area. WE NEEDYOUR HELP!

A health care survey will be conducted by telephone during the week of ________. Please take a
few moments and participate and ―Tell it like it is‖. All questions are completely confidential.
Your caller ID will show ―Out of Area‖ or ―Unknown‖.

The overall goal of the survey is to obtain input from the residents of ________ as to the health
care needs now and in the future.




                                                C3
Samples of short messages suitable for bank and store marquees, runners in
newspaper, runners on local television stations.


DON’T FORGET THE HEALTH CARE TELEPHONE SURVEY ON (INSERT DATE).
YOUR OPINION COUNTS!



HEALTH CARE TELEPHONE SURVEY ON (INSERT DATE). GIVE YOUR TWO CENTS
WORTH!




YOUR OPINION COUNTS! HEALTH CARE TELEPHONE SURVEY ON (INSERT DATE).



DON’T HANG UP! YOUR OPINION COUNTS! HEALTH CARE PHONE SURVEY
(INSERT DATE).




HEALTH CARE TELEPHONE SURVEY (INSERT DATES) FROM 5PM TO 8PM. BE
READY TO GIVE YOUR OPINION!




(INSERT NAME OF COMMUNITY) NEEDS YOUR HELP! ANSWER THE PHONE AND
GIVE YOUR OPINION! HEALTH CARE TELEPHONE SURVEY (INSERT DATES AND
TIMES).




                                           C4
Sample of news release to use prior to telephone survey.



       NEWS RELEASE


       Notice for survey to be taken, _____________.

       YOUR OPINION COUNTS!!! A local health care survey will be conducted by
       telephone during the week of ____________. If you should be called, take a few
       moments and participate. Answer the questions and ―Tell it like it is!‖ Only a few
       people will be called, so it is even more important for those of you who are called to
       respond to the survey. All answers are completely confidential; only the overall total
       responses will be shared. The results of the health care survey will be released publicly
       upon completion.

       Be prepared to share you opinions about health care and to share your experiences with
       the health care system in ______ County. A group of concerned organizations and
       citizens in _____ County are looking forward to hearing your opinions and concerns with
       health care in _____ County. The group wants to know your attitudes about health care
       and your use of the health care services in _____ County.

       The results will assist the group with a long-term plan for health care in _____ County.
       The overall goal of the survey is to obtain input from the residents of _____ County as to
       the needs in health care now and for the future. Concern is not only with maintaining the
       current level of health care services, but with providing high-quality, necessary health
       care services and with recruiting and retaining appropriate physicians and health care
       professionals for the future. WE NEED YOUR HELP!!! Be sure to take a few minutes
       and answer that survey call.



       NOTE: Names of key Steering Committee members can be added to this news release.




                                               C5
Press release explaining economic impact of health sector on the community—suitable for
use in explaining the Community Health Planning Process in community and statewide
media.

                       For Immediate Release
March 1, 1999
                         Local Health Care Vital to Rural Economic Strength
                                       By Donald Stotts

        STILLWATER – Health care can do more than save a life, it also can help save
Oklahoma communities and counties, according to recent research conducted by Oklahoma State
University and the State Office of Rural Health, in cooperation with Operation Rural Health
Works.
        ―Many rural residents don’t realize the importance of the health sector, both directly to
the local economy and as an impetus to spur economic growth overall,‖ said Gerald Doeksen,
OSU Cooperative Extension rural development specialist.
        Operation Rural Health Works research indicates from 10 percent to 15 percent of the
jobs in many rural counties are in the health sector. In addition the health care sector accounts
for 15 percent to 20 percent of all jobs if secondary benefits are included. Hospitals often are the
second largest employer in many rural counties, trailing only local school systems.
        ―Studies on industrial and business location conclude that schools and health services are
the most important quality of life variables in decisions by businesses to come to or stay in a
certain area,‖ Doeksen said. ―For retirees, research concludes that the most important variables
are safety and health services.‖
        Unfortunately, many rural hospitals are in financial trouble.
        ―Research shows roughly 48 percent of rural residents believe urban health services to be
superior to rural services,‖ said Val Schott, Director, State Office of Rural Health.‖ Financial
distress of local hospitals results when too many residents feel compelled to go outside their area
for primary health care services.‖
        Further complicating the issue are business, legislative and technological changes that are
occurring in the delivery of health services, changes that could greatly affect the availability of
future health services to rural areas. The changes include:
     A society-wide movement to managed care that may cause patients to by-pass local
        health care providers;
     Reduction in Medicare and Medicaid payments that may force a decrease in types of
        health care services provided locally;
     Creation of provider networks that may establish care patterns that could eliminate local
        providers treating local patients;
     New opportunities in telemedicine; and
     Opportunities for local hospitals to become critical access facilities, which could help
        maintain health care services in rural areas.




                                                C6
Page 2 of press release explaining economic impact of health care sector on the community
suitable for use in explaining the Community Health Planning Process.

    ―It’s imperative for local decision-makers to become proactive and revitalize local health
care because of these changes,‖ Schott said. ―Rural residents are more likely to lack health
insurance as compared to urban counterparts, and more than 80 percent of rural health revenue
often is generated by Medicare and Medicaid.‖
    Schott and Doeksen said they both welcome the opportunity to work with community leaders
to address local health care concerns as they relate to economic development.
    ―Call us,‖ Doeksen said. ―We’ll set up a time and go through the various options and
opportunities available, covering everything from new advances in telemedicine to what it takes
to become a critical access hospital. We have health care research data for every Oklahoma
County to assist in those decisions.‖ Doeksen can be contacted by telephone at 405-744-6081.
Schott can be contacted at 405-271-8750.
    The willingness to pitch in and do what is necessary has been a hallmark of Operation Rural
Health Works from its inception.
    ―It was a case of specialists in five states – Oklahoma, Kentucky, Missouri, Nevada, and
Pennsylvania – getting together and agreeing this was a vital need; funding was secondary, we
gave our time and expertise willingly,‖ Doeksen said.
    Operation Rural Health Works is a partnership of the Rural Policy Research Institute, Federal
Office of Rural Health Policy and USDA Cooperative Extension Research, Education and
Extension Service.
    ―It’s time for community and county leaders to take hold of the situation now,‖ Schott said.
―Operation Rural Health Works has the research data. We have the expertise and the
willingness. Local leaders need only to contact us.‖




                                               C7
Sample of flyer advertising telephone survey—can be poster, handout, flyer for school
children to take home, etc.


     PLEASE TAKE HOME TO YOUR
             PARENTS!

         YOUR OPINION COUNTS
           for _________________
    Important Health Survey To Be Conducted
           The Week of _________, ____



A Health care survey will be conducted by
telephone during the week of        _________, by a
professional polling group. If you should be
called, please take a few minutes to participate.
As you answer, “Tell it like it is”. All answers are
completely confidential.

The goal of the survey is to obtain input from the
residents of _________, as to the health care
needs now and for the future. The results will be
used to assess current strengths and weaknesses
and give our community a direction for future
health care planning.

                     Take time to be heard!!
                     Your Opinion Counts!!!


                                           C8
APPENDIX D
D1
                                                           AE-9968




            Atoka County
       Health Services Directory




         Cheryl F. St. Clair, Extension Associate
               Stillwater (405) 744-6081


        Gerald A. Doeksen, Extension Economist
               Stillwater (405) 744-6081


Jack Frye, Eastern Oklahoma Rural Development Specialist
                   Ada (580) 332-4100


   Harold Stephens, Atoka County Extension Director
                Atoka (580) 889-7337




         RURAL DEVELOPMENT
OKLAHOMA COOPERATIVE EXTENSION SERVICE
      OKLAHOMA STATE UNIVERSITY




                    November 2000



                           D2
                                        Atoka County
                                   Health Services Directory

                                          EMERGENCY NUMBERS

                                           Police                           Fire                             Ambulance

ATOKA COUNTY                                911                             911                                   911

Wardville Ambulance (Call Coalgate).....................................................................580-927-2339

Wardville Fire Department ...........................................................Call Coalgate at 580-927-3911

Sheriff - Atoka County (Atoka) ...................................................................................... 889-2221

Highway Patrol – Durant ................................................................................................ 924-2601

Oklahoma Poison Control ............................................................... 1-800-764-7661 (POISON 1)



                                   OTHER EMERGENCY NUMBERS

Environmental Spills and Complaints
   (OK Dept. of Environmental Quality) ...................................................... 1-800-522-0206
FBI (OKC) ...................................................................................................... 1-405-842-7471
Federal Bureau of Alcohol Tobacco, and Firearms (Oklahoma City) ............ 1-405-231-4141
   Tulsa........................................................................................................... 1-918-581-7731
Oklahoma Bureau of Narcotics & Dangerous Drugs Control ........................ 1-800-522-8031
Oklahoma State Bureau of Investigation (OKC) ............................................ 1-800-522-8017
Poison Control Center ..................................................................................... 1-800-522-4611
Rape Crisis Hotline (Ardmore) .................................................................................. 226-6424
Toxic Chemical & Oil Spills........................................................................... 1-800-424-8802
U.S. Drug Enforcement Administration (Tulsa) ............................................. 1-918-581-6391
U.S. Marshall Service (Tulsa) ......................................................................... 1-918-581-7738
U.S. Secret Service (Tulsa) ............................................................................. 1-918-581-7272




                                                             D3
                                          Atoka County
                                     Health Services Directory

                 LOCAL NON-EMERGENCY NUMBERS
                                      for Police, Fire, and Ambulance
Atoka Fire ........................................................................................................................ 889-2121
Atoka Police .................................................................................................................... 889-3250
Bentley Fire ............................................................................................. Call Sheriff at 889-2221
Caney Fire ............................................................................................... Call Sheriff at 889-2221
Crystal Fire ............................................................................................. Call Sheriff at 889-2221
Daisy Fire ............................................................................................... Call Sheriff at 889-2221
Farris Fire ............................................................................................... Call Sheriff at 889-2221
Harmony Fire ......................................................................................... Call Sheriff at 889-2221
Hopewell Fire ......................................................................................... Call Sheriff at 889-2221
Lane Fire.......................................................................................................................... 889-2116
Stringtown Ambulance.................................................................................................... 889-5228
Stringtown Fire ................................................................................................................ 346-7035
Stringtown Police ....................................................................................... 346-7200 or 845-2412
Tushka Fire ............................................................................................. Call Sheriff at 889-2221
Ward’s Chapel ........................................................................................ Call Sheriff at 889-2221
Wardville Fire................................................................................Call Coalgate at 580-927-3911




                                                                 D4
                                            Atoka County
                                       Health Services Directory

                                LOCAL HEALTH SERVICES

Hospital

   Atoka Memorial Hospital................................................................................................ 889-3333
   1501 S. Virginia (Atoka)

        Inpatient Services include:
            Inpatient Acute Care
            Skilled Nursing Program
            Intensive Care Unit

        Outpatient Services include:
            Emergency Room
            Medical Laboratory
            Medical Imaging
            Home Health Care
            Respiratory Therapy
            Physical Therapy
            Cardiac Rehabilitation
            Ophthalmology Clinic
            Urology Clinic


Ambulance/Emergency Medical Services

   Atoka County Ambulance Service.................................................................................. 889-5228
   1501 S. Virginia (Atoka)

   Stringtown Ambulance.................................................................................................... 889-5228

   Wardville Ambulance (Call Coalgate).....................................................................580-927-2339


Medical Professionals

Primary Care Physicians and Clinics (includes M.D.'s & D.O.'s)

   Helton, R. J., DO
   Corley, Theresa, PA
   Mutch, Charles, PA
   ABC Clinic Inc. ............................................................................................................... 889-3355
   1508 S. Virginia St. (Atoka)
                                                                 D5
                                            Atoka County
                                       Health Services Directory

                                LOCAL HEALTH SERVICES

Primary Care Physicians and Clinics (Continued

   Rippee, Don L., DO
   Emerson, Noel, DO
   Family Practice Clinic of Atoka Inc. .............................................................................. 889-6621
   1502 S. Virginia St. (Atoka)


Physician Assistants

   Corley, Theresa, PA
   Mutch, Charles, PA
   ABC Clinic Inc. ............................................................................................................... 889-3355
   1508 S. Virginia St. (Atoka)


Chiropractors

   Dingle, Dr. Donald L. .................................................................................................... 889-3338
   621 W. 13th (Atoka)


Dentists

   Briggs, Dr. James A....................................................................................................... 889-6637
   603 W. 13th (Atoka)

   Dial, Michael L., DDS ................................................................................................... 889-2505
   104 Ruth Ave. (Atoka)


Optometrists

   Evans, W. L.
   Evans, Bill
   100 E. 2nd (Atoka) ........................................................................................................... 889-3492

   Hardin, Michelle
   902 W. 13th (Atoka)........................................................................................................ 889-9500



                                                                   D6
                                             Atoka County
                                        Health Services Directory

                                 LOCAL HEALTH SERVICES

Pharmacies

   RX Shoppe ...................................................................................................................... 889-3331
   1002 W. 13th (Atoka)

   Sonny’s Discount Pharmacy ............................................................................ 889-MEDS (6337)
   500 S. Mississippi (Atoka)

   Wal-Mart Pharmacy ........................................................................................................ 889-3000
   1901 S. Mississippi (Atoka)


Veterinarians


   Harvey, Dana J., DVM
   All Animal Veterinary Hospital ...................................................................................... 889-6183
   Or Call ........................................................................................... 1-800-888-0887 (pager 7759)
   620 E. Court (Atoka)

   Arnold, Harvey, DVM
   Arnold’s Veterinary Clinic .............................................................................................. 889-7990
   ½ mi. E on Hwy 3 & 7 (Atoka)

   Martin, Shannon A., DVM
   Atoka Veterinary Clinic .................................................................................................. 889-2125
   1710 Haskell St. (Atoka)

   Kaaz, James, DVM
   Southeastern Veterinary Services .............................................................................. 889-5511
   Hwy 3 & 7 E of Atoka (Atoka)




                                                                   D7
                                               Atoka County
                                          Health Services Directory
                     Government - Community - Social Services

Alcohol and Drug Treatment Programs

     Oaks Behavioral Center .................................................................................................. 889-2260
     119 N. Ohio (Atoka)

     Personal Care Support Group.......................................................................................... 889-3670
     204 N. Ohio (Atoka)


Animal Control

     City of Atoka Animal Control (Atoka) ........................................................................... 889-3341


Better Business Bureau (Information) .........................................................................405-239-6081


Birth Certificates ..........................................................................................................405-271-4040


Chamber

     Atoka Chamber of Commerce ................................................................................... 889-2410


Child Abuse and Neglect Services

     Child & Youth Services .................................................................................................. 889-3182
     Atoka County Department of Human Services


City Offices Information

     City of Atoka ................................................................................................................... 889-3341
     City of Caney................................................................................................................... 889-8842
     City of Stringtown ........................................................................................................... 346-7789
     City of Tushka ................................................................................................................. 889-3046


Civil Rights

     U.S. Health & Human Services Dept.
        Office of Civil Rights................................................................................ 1-800-368-1019
                                                                     D8
                                              Atoka County
                                         Health Services Directory

                     Government - Community - Social Services

Community Action Programs/Head Start Programs

     Choctaw Headstart .......................................................................................................... 889-7054
     711 Greathouse Dr. (Atoka)

     INCA Community Services ............................................................................................ 889-5193
        Atoka Headstart (Atoka) ........................................................................................... 889-3239
        Caney Headstart School (Caney) .............................................................................. 889-6758
        Farris Headstart ......................................................................................................... 889-6073
        Stringtown Headstart (Stringtown) ........................................................................... 346-7414
        Tushka Headstart (Tushka) ....................................................................................... 889-3071


Counseling

     Atoka Family Center .................................................................................................... 889-555
     Two locations: 618 W. 13th and 107 N. Penn (Atoka)

     Counseling Inc. (Child & Adolescent Guidance Counselors) ................................... 889-3247
     201 E. Court (Atoka)

     F-OKLA Psychological Services ............................................................................... 889-3799
     200 S. Mississippi (Atoka)

     J.C. Mental Health ..................................................................................................... 889-6889
     303 E. Court (Atoka)

     Personal Care Mental Health ..................................................................................... 889-3670
     202 N. Ohio (Atoka)


Crime Prevention

     WeTip ................................................................................................................... 1-800-782-7463


Death Certificates .........................................................................................................405-271-4040




                                                                     D9
                                             Atoka County
                                        Health Services Directory

                   Government - Community - Social Services

Department of Human Services

   Atoka County Department of Human Services
   401 Greathouse Dr. (Atoka)
      Adult Protective Services ..................................................................................... 889-3395
      Children & Youth Services .................................................................................. 889-3182
      Information .......................................................................................................... 889-3394
      Payment-Services Unit......................................................................................... 889-3395


Disability

   Social Security Administration ............................................................................ 1-800-772-1213
   Or Call TDD ......................................................................................................... 1-800-325-0778


Environmental Agencies

   Dept. of Environmental Quality
      Customer Service ...............................................................................................405-702-6100
      Complaints ..................................................................................................... 1-800-522-0206
      General Information ....................................................................................... 1-800-869-1400


Family Services

   Atoka Ministerial Alliance .............................................................................................. 889-5186
   322 E. Court

   INCA Community Services ............................................................................................ 889-5193
   (Includes meals, food bank, clothing bank, seasonal produce, weatherization,
   medications assistance, etc.)


Fire Departments

   Atoka Fire ........................................................................................................................ 889-2121
   Bentley Fire ............................................................................................. Call Sheriff at 889-2221
   Caney Fire ............................................................................................... Call Sheriff at 889-2221
   Crystal Fire ............................................................................................. Call Sheriff at 889-2221
   Daisy Fire ............................................................................................... Call Sheriff at 889-2221
   Farris Fire ............................................................................................... Call Sheriff at 889-2221
                                                                   D10
                                              Atoka County
                                         Health Services Directory

                    Government - Community - Social Services

Fire Departments (Continued)

    Harmony Fire ......................................................................................... Call Sheriff at 889-2221
    Hopewell Fire ......................................................................................... Call Sheriff at 889-2221
    Lane Fire.......................................................................................................................... 889-2116
    Stringtown Fire ................................................................................................................ 346-7035
    Tushka Fire ............................................................................................. Call Sheriff at 889-2221
    Ward’s Chapel ........................................................................................ Call Sheriff at 889-2221
    Wardville Fire................................................................................Call Coalgate at 580-927-3911


Food and Drug Complaints (Oklahoma City) ............................................................405-231-4544

    Atoka County Health Department ............................................................................. 889-2116
    1006 W. 13th (Atoka)


Funeral Homes

    Atoka Funeral Home .................................................................................................. 889-3322
    1000 Liberty Rd. (Atoka)

    Brown’s Funeral Service............................................................................................ 889-9339
    800 W. 13th (Atoka)


Health Department

    Atoka County Health Department .................................................................................. 889-2116
    1006 W. 13 (Atoka)

    Department of Health, State of Oklahoma...............................................................405-271-4200
    1000 N.E. 10th St., Oklahoma City, OK 73117-1299


Health Education/Schools/Colleges/Universities

    Kiamichi Technology Center ......................................................................................... 889-7321
       Childcare Center........................................................................................................ 889-7080



                                                                    D11
                                           Atoka County
                                      Health Services Directory

                  Government - Community - Social Services

Home Health Care Programs

   Atoka Memorial Hospital Home Health Agency ........................................................... 889-9569
   1501 S. Virginia (Atoka)

   CHC Med-Corp Plus (Personal Care/Advantage) .......................................................... 889-1992
   211 E. Court (Atoka)

   Healthback’s Medcare Home Health ..................................................889-3996 or 888-552-2009
   303 S. Mississippi (Atoka)

   Heartland Health Care ..................................................................................................... 889-7901
   1502 ½ S. Virginia Ave. (Atoka)

   Mays Housecall Home Health ........................................................................................ 889-5563
   203 E. Court (Atoka)

   Mays Plus, LLC (Antlers) ........................................................................................580-298-6917

   Olsten Health Services (Tishomingo) .................................................................. 1-800-568-6469

   Red River Health Care Systems (Durant) ................................................................580-920-2088

   Tendercare Home Health Agency (Coalgate)..........................................................580-927-2327

   Victory Home Health & Hospice.................................................................................... 889-8905
   301 E. Court (Atoka)


Hospices

   Home Town Hospice....................................................................................................... 889-4801
   1103 W. 13th (Atoka)

   Victory Home Health & Hospice.................................................................................... 889-8905
   301 E. Court (Atoka)




                                                                D12
                                             Atoka County
                                        Health Services Directory

                   Government - Community - Social Services

Housing - Elderly

   Atoka Housing Authority ................................................................................................ 889-7311
   Cedar Circle (Atoka)

   Colonial Village Senior Living ....................................................................................... 889-6009
   701 W. Cedar (Atoka)


Housing - General

   Farmers Home Administration County Office ............................................................... 889-2554
   2341 S. Mississippi (Atoka)

   Farmers Home Administration District Office ............................................................... 889-6668
   104 Ruth (Atoka)

   Housing Urban Development (HUD) - State Office (OKC) ...................................405-553-7401
   Or ........................................................................................................ 1-800-256-1489 (Dial #1)

   Oklahoma Housing Finance Authority (OKC) ........................ 405-848-1144 or 1-800-256-1489

   USDA Rural Development ............................................................................................. 889-6668
   102 W. Ruth Ave. (Atoka)


In-Home Services

   Area Agency on Aging (Area No. 4) .......................................................................580-920-1388
   Or Call the Toll-Free Senior Info Line ................................................................ 1-800-211-2116


Juvenile Correctional Services

   Juvenile Affairs ............................................................................................................... 889-2255




                                                                  D13
                                             Atoka County
                                        Health Services Directory

                   Government - Community - Social Services

Law Enforcement Services - Crime Prevention Services

   Adult Probation & Parole ................................................................................................ 889-3561
   Court House (Atoka)

   Department of Corrections (Atoka) ................................................................................ 889-2991

   Juvenile Affairs ............................................................................................................... 889-2255


Maternal Health Services

   WIC Program

        Atoka County Health Department ............................................................................ 889-2116
        1006 W. 13 (Atoka)

        Choctaw Nation WIC (Atoka) ............................................................................. 889-5825


Medicaid/Medicare

   Atoka County Department of Human Services - Information........................................ 889-3394
   Payment-Services Unit .................................................................................................... 889-3395
   401 Greathouse Dr. (Atoka)

   Medicare Hotline .................................................................................................. 1-800-638-6833

   Social Security...................................................................................................... 1-800-772-1213


Medical Equipment

   Home Medical Services Inc. ........................................................................................... 889-5557
   Or ........................................................................................................................ 1-800-729-9497
   1615 S. Virginia (Atoka)

   Lake Country Medical Services ...................................................................................... 889-7878
   803 S. Mississippi (Atoka)



                                                                   D14
                                           Atoka County
                                      Health Services Directory

                  Government - Community - Social Services

Mental Health

   Carl Albert Mental Health Center ................................................................................... 889-6459
   1002 W. Liberty (Atoka)


Ministerial Alliance

   Atoka Ministerial Alliance .............................................................................................. 889-5186
   322 E. Court (Atoka)


Newspapers

   Atoka County Times ....................................................................................................... 889-3319
   1004 W 13th (Atoka)


Nursing Homes

   Atoka Colonial Manor Nursing Home............................................................................ 889-7341
   1500 Virginia St. (Atoka)

   Colonial Living Center .................................................................................................... 889-3373
   323 W. 6th (Atoka)


Nutritional Services

   Lane Senior Citizens Center............................................................................................ 889-3678

   Southern Oklahoma Nutrition Program .......................................................................... 889-3080
   80 Cedar Circle (Atoka)

   Southern Oklahoma Nutrition Program (Caney) ............................................................ 889-6738

   Southern Oklahoma Nutrition Program (Stringtown) .................................................... 346-7822




                                                                D15
                                            Atoka County
                                       Health Services Directory

                   Government - Community - Social Services

Pregnancy Crisis Services

    Women’s Center (CPS)................................................................................................... 889-7566
    111 E. A St. (Atoka)


Prenatal Health Services

    WIC Program

    Atoka County Health Department .................................................................................. 889-2116
    1006 W. 13 (Atoka)

    Choctaw Nation WIC (Atoka) ........................................................................................ 889-5825


Pollution Control

    Dept. of Environmental Quality
       Customer Service ...............................................................................................405-702-6100
       Complaints ..................................................................................................... 1-800-522-0206
       General Information ....................................................................................... 1-800-869-1400


Preventive Health/Health Education/Wellness Programs

    OSU Cooperative Extension Center ............................................................................... 889-7337
    200 E. Court, Suite 205W (Atoka)
Red Cross
    Contact Paulette Hargis at Department of Human Services ......................................... 889-3394


Road and Weather Conditions....................................................................................405-425-2385


Salvation Army

    Contact INCA Community Services (Atoka) ................................................................. 889-5193



                                                                D16
                                               Atoka County
                                          Health Services Directory

                     Government - Community - Social Services

Senior Citizens Community Centers

     Atoka Community Center (Southern Oklahoma Nutrition Program) ............................ 889-7311
     Cedar Circle (Atoka)

     Lane Senior Citizens Center............................................................................................ 889-3678

     Southern Oklahoma Nutrition Program (Caney) ............................................................ 889-6738

     Southern Oklahoma Nutrition Program (Stringtown) .................................................... 346-7822


Senior Services

     AARP State Information Center ..............................................................................405-632-1945
     Crossroads Mall, Upper Level (Adjacent to Foley's), at I-240 & I-35
     7000 Crossroads Blvd., Oklahoma City, OK 73149

     Elder Care ........................................................................................................................ 889-7447
     1006 W. 13th (Atoka) (Located in the Health Dept.)

     Eldercare Locator ................................................................................................. 1-800-677-1116

     Area Agency on Aging - SODA .................................. Senior Information Line 1-800-211-2116

     Social Security Administration ............................................................................ 1-800-772-1213


Social Security

     Social Security Administration ............................................................................ 1-800-772-1213


State Offices Information ............................................................................................405-521-2011


Suicide Prevention

     Crisis Intervention Service (24-hour) Suicide & Crisis Helpline ............................405-848-2273




                                                                     D17
                                          Atoka County
                                     Health Services Directory

                 Government - Community - Social Services

Transportation

    Atoka Cab Company ................................................................................................ 889-1950

    INCA – JAMM (Public Transit) .............................................................................. 889-5193

    INCA – Senior Citizens Transportation Program .................................................... 889-5193

    Sooner Ride ................................................................................................... 1-877-404-4500
    (Non-emergency rides for Medicaid patients for non-emergency medical
     appointments)

Tribal Government
   Choctaw National Tribal Field Office ............................................................................ 889-6147
   211 E. Court (Atoka)


Veterans Services

   Veterans’ Administration ..................................................................................... 1-800-827-1000

   Veterans of Foreign Wars, Contact Glenn Norton ........................................................ 889-6010

   Disabled American Veterans .......................................................................................... 889-6104
   203 E. 1st (Atoka)

   Oklahoma Department of Veterans Affairs (OKC) .................................................405-521-3684
   Website: http//www.odva.state.ok.us

   Oklahoma City Medical Center (OKC) ................................... 1-800-694-8387 or 405-270-0501

   Mid-America Paralyzed Veterans (OKC)................................................................405-721-7168
   Website: www.mapv.org




                                                             D18
                                             Atoka County
                                        Health Services Directory

                    Government - Community - Social Services

Welfare Information

    Atoka County Department of Human Services
    401 Greathouse Dr. (Atoka)
       Adult Protective Services .......................................................................................... 889-3395
       Children & Youth Services ....................................................................................... 889-3182
       Information................................................................................................................ 889-3394
       Payment-Services Unit.............................................................................................. 889-3395


Workers’ Compensation (Oklahoma City) .................................................................405-522-8600




                                                                  D19
                                             Atoka County
                                        Health Services Directory
          Information Services - Support Groups - Help Lines

Advocacy for Long Term Care Patients

   Ombudsman (Advocate for Long Term Care) .................................................... 1-800-482-4594
   Or ........................................................................................................................ 1-800-211-2116

AIDS
   AIDS Hotline (24 hours a day, 7 days per week) ................................................ 1-800-342-2437

   Spanish (Es Spanol) 8:00 am to 2:00 am, 7 days per week ................................. 1-800-344-7432

   TTY for Deaf 10:00 am - 10:00 pm Monday through Friday ............................. 1-800-243-7889

   National AIDS Hot Line ................................................................................. 1-800-342-2437

   National AIDS Hot Line (TDD) ..................................................................... 1-800-243-7889

   National AIDS Information Clearinghouse .................................................... 1-800-458-5231

   National Native American AIDS Prevention Center ...................................... 1-800-283-2437

   Safe Choice HIV Prevention & Technical Assistance Hot Line .................... 1-800-878-2437


Allergy Information
   Allergy Information Center .................................................................................. 1-800-727-5400


Alzheimer's

   Alzheimer's Disease Education & Referral Center.............................................. 1-800-438-4380

   Alzheimer's Disease Foundation, Bartlesville Branch.............................................918-337-1473
   National Alzheimer's Association
   410 Frank Phillips Blvd., Bartlesville, OK 74003




                                                                   D20
                                          Atoka County
                                     Health Services Directory
      Information Services - Support Groups - Help Lines

Alzheimer's (Continued)

   Alzheimer's Disease Foundation, Tulsa Green Country Chapter ........................ 1-800-493-1411
   Oklahoma Chapter....................................................................................................918-481-7741
   6465 S. Yale, Suite 206, Tulsa, OK 74136

   Alzheimer's Information Line (Nationwide)........................................................ 1-800-272-3900


Cancer

   Cancer Information .............................................................................................. 1-800-422-6237


Cystic Fibrosis

   Cystic Fibrosis Foundation .................................................................................. 1-800-344-4823


Dental Services

   D-Dent (Oklahoma Dental Association) (Tulsa) ..................... 918-610-0855 or 1-800-722-9510

   Senior Dent Program (Oklahoma Dental Association)
      (Oklahoma City) ................................................................ 405-848-8873 or 1-800-876-8890


Diabetes

   American Diabetes Association (Administration) ............................................... 1-800-259-6552
   (Patient Information) ............................................................................................ 1-800-259-6552
   6600 S. Yale Ave., Suite #1310, Tulsa, OK 74136


Disability Services

   Ability Resources ..................................................................... 918-592-1235 or 1-800-722-0886

   ABLE Tech INFO-Line (Voice/TDD)................................................................. 1-888-885-5588
   (Assisting Brighter Living with Enabling Technology)

   American Paralysis Association........................................................................... 1-800-225-0292

                                                              D21
                                           Atoka County
                                      Health Services Directory
      Information Services - Support Groups - Help Lines

Disability Services (Continued)

   AT&T Special Needs Center ............................................................................... 1-800-233-1222

   Department of Rehabilitation and Visual Services .................. 405-951-3400 or 1-800-845-8476
   Website: www./net~dvspi.owm

   Mid-America Chapter Paralyzed Veterans of America ........... 405-721-7168 or 1-800-321-5041

   Office of Handicapped Concerns (Voice/TDD) ...................... 405-521-3756 or 1-800-522-8224

   Oklahoma Areawide Services Information System (OASIS) ............................. 1-800-426-2747
   Website: www.okstate.edu/wellness/at-home.htm or www.oasis.ushsc.edu

   Oklahoma Equipment Connection Assistive Technology Resale
      & Recycle ....................................................................................................... 1-888-885-5588

   Oklahoma Library for the Blind and Physically
      Handicapped....................................................................... 405-521-3514 or 1-800-523-0288
   Website: www.oklaosf.stateok.us.-LIB

   TSHA, Inc. ............................................................................... 1-888-311-3523 or 918-832-8742
   Website: Disability network.org


Domestic Violence/Family Violence

   Child or Adult Abuse Hot Line ....................................................................... 1-800-522-3511

   Child Help USA (Child Abuse Hot Line) ....................................................... 1-800-422-4453

   National Council on Child Abuse & Family Violence ................................... 1-800-222-2000

   National Domestic Violence Hotline .............................................................. 1-800-799-7233

   National Resource Center for Child Abuse & Neglect ................................... 1-800-227-5242

   Parents Anonymous (Abusive parents/guardians) .......................................... 1-800-421-0353

   REACH-OUT (Mental Health, Substance Abuse,
     Domestic/Sexual Violence) ...................................................................... 1-800-522-9054


                                                               D22
                                           Atoka County
                                      Health Services Directory
      Information Services - Support Groups - Help Lines

Domestic Violence/Family Violence (Continued)

   SAFELINE (Domestic Violence)(Voice/TDD) .............................................. 1-800-522-7233


Down's Syndrome

   National Down's Syndrome Society .................................................................... 1-800-221-4602


Drugs/Narcotics Abuse and Prevention

   Narcotics and Dangerous Drugs - State Bureau .................................................. 1-800-522-8134

   Data Center & Clearinghouse for Drugs & Crime.......................................... 1-800-666-3332

   Department of Rehabilitation Services ........................................................... 1-800-833-8973

   Drug Information & Treatment ....................................................................... 1-800-788-2800

   National Council on Alcoholism & Drug Dependence Hot Line ................... 1-800-622-2255

   National Alcohol/Drug Abuse Hotline ........................................................... 1-800-662-4357

   Partnership for a Drug-Free America ............................................................. 1-800-624-0100

   REACH-OUT (Mental Health, Substance Abuse,
     Domestic/Sexual Violence) ...................................................................... 1-800-522-9054


Eldercare

   Eldercare Locator ................................................................................................. 1-800-677-1116


Eye Services

   American Council of the Blind ............................................................................ 1-800-424-8666

   National Eye Care Project Hot Line .................................................................... 1-800-222-3937



                                                               D23
                                             Atoka County
                                        Health Services Directory
       Information Services - Support Groups - Help Lines

Advocacy for Long Term Care Patients

   Ombudsman (Advocate for Long Term Care) .................................................... 1-800-482-4594
   Or ........................................................................................................................ 1-800-211-2116


AIDS

   AIDS Hotline (24 hours a day, 7 days per week) ................................................ 1-800-342-2437

   Spanish (Es Spanol) 8:00 am to 2:00 am, 7 days per week ................................. 1-800-344-7432

   TTY for Deaf 10:00 am - 10:00 pm Monday through Friday ............................. 1-800-243-7889

   National AIDS Hot Line ................................................................................. 1-800-342-2437

   National AIDS Hot Line (TDD) ..................................................................... 1-800-243-7889

   National AIDS Information Clearinghouse .................................................... 1-800-458-5231

   National Native American AIDS Prevention Center ...................................... 1-800-283-2437

   Safe Choice HIV Prevention & Technical Assistance Hot Line .................... 1-800-878-2437


Allergy Information

   Allergy Information Center .................................................................................. 1-800-727-5400


Alzheimer's

   Alzheimer's Disease Education & Referral Center.............................................. 1-800-438-4380

   Alzheimer's Disease Foundation, Bartlesville Branch.............................................918-337-1473
   National Alzheimer's Association
   410 Frank Phillips Blvd., Bartlesville, OK 74003




                                                                   D24
                                          Atoka County
                                     Health Services Directory
      Information Services - Support Groups - Help Lines

Alzheimer's (Continued)

   Alzheimer's Disease Foundation, Tulsa Green Country Chapter ........................ 1-800-493-1411
   Oklahoma Chapter....................................................................................................918-481-7741
   6465 S. Yale, Suite 206, Tulsa, OK 74136

   Alzheimer's Information Line (Nationwide)........................................................ 1-800-272-3900


Cancer

   Cancer Information .............................................................................................. 1-800-422-6237


Cystic Fibrosis

   Cystic Fibrosis Foundation .................................................................................. 1-800-344-4823


Dental Services

   D-Dent (Oklahoma Dental Association) (Tulsa) ..................... 918-610-0855 or 1-800-722-9510

   Senior Dent Program (Oklahoma Dental Association)
      (Oklahoma City) ................................................................ 405-848-8873 or 1-800-876-8890


Diabetes

   American Diabetes Association (Administration) ............................................... 1-800-259-6552
   (Patient Information) ............................................................................................ 1-800-259-6552
   6600 S. Yale Ave., Suite #1310, Tulsa, OK 74136


Disability Services

   Ability Resources ..................................................................... 918-592-1235 or 1-800-722-0886

   ABLE Tech INFO-Line (Voice/TDD)................................................................. 1-888-885-5588
   (Assisting Brighter Living with Enabling Technology)

   American Paralysis Association ..................................................................... 1-800-225-0292

                                                              D25
                                           Atoka County
                                      Health Services Directory
      Information Services - Support Groups - Help Lines

Disability Services (Continued)

   AT&T Special Needs Center ............................................................................... 1-800-233-1222

   Department of Rehabilitation and Visual Services .................. 405-951-3400 or 1-800-845-8476
   Website: www./net~dvspi.owm

   Mid-America Chapter Paralyzed Veterans of America ........... 405-721-7168 or 1-800-321-5041

   Office of Handicapped Concerns (Voice/TDD) ...................... 405-521-3756 or 1-800-522-8224

   Oklahoma Areawide Services Information System (OASIS) ............................. 1-800-426-2747
   Website: www.okstate.edu/wellness/at-home.htm or www.oasis.ushsc.edu

   Oklahoma Equipment Connection Assistive Technology Resale
      & Recycle ....................................................................................................... 1-888-885-5588

   Oklahoma Library for the Blind and Physically
      Handicapped....................................................................... 405-521-3514 or 1-800-523-0288
   Website: www.oklaosf.stateok.us.-LIB

   TSHA, Inc. ............................................................................... 1-888-311-3523 or 918-832-8742
   Website: Disability network.org


Domestic Violence/Family Violence

   Child or Adult Abuse Hot Line ....................................................................... 1-800-522-3511

   Child Help USA (Child Abuse Hot Line) ....................................................... 1-800-422-4453

   National Council on Child Abuse & Family Violence ................................... 1-800-222-2000

   National Domestic Violence Hotline .............................................................. 1-800-799-7233

   National Resource Center for Child Abuse & Neglect ................................... 1-800-227-5242

   Parents Anonymous (Abusive parents/guardians) .......................................... 1-800-421-0353

   REACH-OUT (Mental Health, Substance Abuse,
     Domestic/Sexual Violence) ...................................................................... 1-800-522-9054


                                                               D26
                                           Atoka County
                                      Health Services Directory
      Information Services - Support Groups - Help Lines

Domestic Violence/Family Violence (Continued)

   SAFELINE (Domestic Violence)(Voice/TDD) .............................................. 1-800-522-7233


Down's Syndrome

   National Down's Syndrome Society .................................................................... 1-800-221-4602


Drugs/Narcotics Abuse and Prevention

   Narcotics and Dangerous Drugs - State Bureau .................................................. 1-800-522-8134

   Data Center & Clearinghouse for Drugs & Crime.......................................... 1-800-666-3332

   Department of Rehabilitation Services ........................................................... 1-800-833-8973

   Drug Information & Treatment ....................................................................... 1-800-788-2800

   National Council on Alcoholism & Drug Dependence Hot Line ................... 1-800-622-2255

   National Alcohol/Drug Abuse Hotline ........................................................... 1-800-662-4357

   Partnership for a Drug-Free America ............................................................. 1-800-624-0100

   REACH-OUT (Mental Health, Substance Abuse,
     Domestic/Sexual Violence) ...................................................................... 1-800-522-9054


Eldercare

   Eldercare Locator ................................................................................................. 1-800-677-1116


Eye Services

   American Council of the Blind ............................................................................ 1-800-424-8666

   National Eye Care Project Hot Line ..................................................................... 1-800-222-3937



                                                               D27
                                            Atoka County
                                       Health Services Directory
      Information Services - Support Groups - Help Lines

Eye Services (Continued)

   Optometry Board .................................................................................................. 1-800-725-6723

   Visual Services Information Line for 55 years and over and legally blind ......... 1-800-829-3255


Headache

   National Headache Foundation ............................................................................ 1-800-843-2256


Health Information

  National Health Information Center ...................................................................... 1-800-336-4797

   Immunization Hot Line ................................................................................... 1-800-522-0203

   National Sexually Transmitted Diseases Hot Line ......................................... 1-800-227-8922

   Poison Control ................................................................................................ 1-800-522-4611

   WIC Hotline .................................................................................................... 1-800-522-0203

   OASIS Information/Referral Service (Voice/TDD) ....................................... 1-800-426-2747

   Al-Anon Family Group Information ............................................................... 1-800-356-9996

   SIDS ................................................................................................................ 1-800-235-7437

   Social Security Administration ....................................................................... 1-800-772-1213


Hearing and Speech

   Hearing Aid Assistance Program (Oklahoma State Dept. of Rehabilitation
   Services for the Deaf (OKC) .................................................................... (V/TTY) 405-634-9937
   or TDD .....................................................................................................................405-424-2794
   or V/TTY ....................................................................................................... 1-800-833-8973




                                                                  D28
                                          Atoka County
                                     Health Services Directory
        Information Services - Support Groups - Help Lines

Hearing and Speech (Continued)

   Hearing Aid Help Line ......................................................................................... 1-800-521-5247

   National Association for Hearing and Speech Action Line................................. 1-800-638-8255
   Tele Relay for the Deaf ........................................................................................ 1-800-772-0353

   Newborn Hearing Screening Program ............................................................ 1-800-766-2223


Heart

   American Heart Association ................................................................................ 1-888-242-0208

   American Heart Association ....................................................................................918-747-8254
   2865 E. Skelly Drive, Tulsa, OK 74105-6200


Kidney

   American Kidney Fund (Monday through Friday, 8:00 am - 5:00 pm).............. 1-800-638-8299


Liver

   American Liver Foundation (Hepatitis/Liver Disease Hotline) .......................... 1-800-223-0179


Lung

   American Lung Association.....................................................................................405-524-8471
   201 NE 50th St., P.O. Box 18878, Oklahoma City, OK 73154

   Lung Line Information Service ............................................................................ 1-800-222-5864


Mental Health

   Oklahoma Alliance for the Mentally Ill ............................................................... 1-800-583-1264

   Reach-Out State Department of Mental Health & Substance Abuse .................. 1-800-522-9054
   (Drug and Alcohol Information Assistance Service)

                                                             D29
                                           Atoka County
                                      Health Services Directory
       Information Services - Support Groups - Help Lines

Mental Health (Continued)

    Mental Health Crisis ....................................................................................... 1-800-722-3611

    REACH-OUT (Mental Health, Substance Abuse,
      Domestic/Sexual Violence) ...................................................................... 1-800-522-9054


Parkinson's Disease

    National Parkinson's Disease ............................................................................... 1-800-223-2732

    Parkinson's Disease Information, Hillcrest ..............................................................918-747-3747
    3220 S. Peoria, Tulsa, OK 74105-2099

    Parkinson's Disease Oklahoma Support Group Information ............................... 1-800-364-4450


Protective Services

    Adult Protective Services -DHS .......................................................................... 1-800-522-3511

    National Runaway Switchboard ..................................................................... 1-800-621-4000


Senior Information

    Senior Information Line ....................................................................................... 1-800-211-2116


Spanish Speaking Helpline

Helpline (Linea de Ayuda: Se Habla Espanol) ..................................................... 1-405-271-4725


Transport Services for Patients

    National Patient Air Transport Help Line ............................................................ 1-800-296-1217
    Website: www.America.com/-jpringle/acahome.html




                                                              D30
                                           Atoka County
                                      Health Services Directory
      Information Services - Support Groups - Help Lines

Veterans' Services

   Department of Veterans Affairs Toll Free Hot Line............................................ 1-800-827-1000


Youth Services

   Boys’ Town National Hot Line....................................................................... 1-800-448-3000

   Child Find ....................................................................................................... 1-800-431-5005

   Juvenile Justice Clearinghouse ....................................................................... 1-800-638-8736

   Missing & Exploited Children National Hot Line .......................................... 1-800-843-5678

   National Youth Crisis Hot Line ...................................................................... 1-800-448-4663

   Oklahoma Crisis Teen Line ............................................................................ 1-800-522-8336

   Teen Hotline.................................................................................................... 1-800-522-8336

   Youth Crisis & Runaway Hot Line ................................................................. 1-800-448-4663




                                                              D31
    DIRECTORY UPDATES AND CHANGES




 To provide updated information for this directory or

to add new health and medical services to the directory,

                PLEASE CONTACT:

               Atoka County Hospital

          Hospital Administrator’s Office

                    (580) 889-3333




                          D32
APPENDIX E
        Atoka County
Phone Survey Form and Results

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       Oklahoma State Department of Health,
               Office of Rural Health

       Oklahoma Cooperative Extension Service,
              Oklahoma State University

                                                                   June 2000


                                                                                            E1
                                                                    AE-0053

              Atoka County Phone Survey Form and Results


                Sarah Trzebiatowski & Turia Sporleder
                    Student Extension Associates
                      Stillwater (405) 744-6083


        Cheryl F. St. Clair, Assistant State Extension Specialist
                       Stillwater (405) 744-6081


              Gerald A. Doeksen, Extension Economist
                     Stillwater (405) 744-6081


           Jack Frye, Eastern Rural Development Specialist
                         Ada (580) 332-4100


Val Schott - Director, Oklahoma Office of Rural Health, Oklahoma City
                            (405) 271-8750

Rod Hargrave – Coordinator, Oklahoma Flex Program, Oklahoma City
                         (405) 271-8750


         Jody House, Atoka/Coal County Extension Director
          Brenda Voice, Atoka County Extension Educator
                      Atoka (580) 889-7337


               RURAL DEVELOPMENT
      OKLAHOMA COOPERATIVE EXTENSION SERVICE
            OKLAHOMA STATE UNIVERSITY
                    June 2000




                                   E2
 Atoka County Telephone Survey                                                                Page 1 of 4

1.    Do you use a family doctor for most of your routine health care?
        Yes        No

2.    If no, whom do you go to for routine care? ________________________________________________

3.    About how long has it been since your last routine check-up?
        Within 12 months
        More than 1 year, Less than 2 years
        More than 2 years, Less than 5 years
        More than 5 years
        Never

4.    Where do you go the most for your family’s primary health care needs?
            Atoka                   Ada                         Antlers
            Durant                  Coalgate                    McAlester
            Denison, TX             Sherman, TX                 Oklahoma City
            Tulsa                  ___________________

5.    If you use a family doctor outside of Atoka County, why? ____________________________________
       _____________________________________________________________________________________

6.    Are you able to get an appointment with your family doctor when you need one?
        Yes        No

7.    How long do you normally wait in the waiting room to see your family doctor?
       No wait                    31 minutes – 1 hour
       Less than 15 minutes       1 – 2 hours
       16-30 minutes              2+ hours

8.    Does your family doctor give you enough time in his/her office to discuss your health
      needs?
       Yes        No

9.    How would you describe the quality of care provided by your family doctor?
       Satisfied           Dissatisfied
      Why? _______________________________________________________________________________

10.   Do you think there are enough family doctors in Atoka County?
       Yes       No         Don’t Know

11.   Do you think that additional specialty physicians are needed in Atoka County?
       Yes       No         Don’t Know

12.   If yes, which specialties are needed? _____________________________________________________
      ____________________________________________________________________________________




                                                     E3
Atoka County Telephone Survey                                                            Page 2 of 4

13. What health insurance covers you and your family?
                                              You Family
     Insurance through Employer/
       Previous Employer                            
     Medicare                                       
     Medicaid or Sooner Care                        
     Champus                                        
     Self-Paid Plan                                 
     Native American Benefits                       
     Do Not Have Health Insurance                   
     ___________________                            

14.   If you do not have health insurance coverage, which best describes why?
         Cannot afford coverage
         Medical problems
         Denied coverage
         __________________________________________

15.   How many miles do you travel one way for the following medical services?

                                   0-10    11-20        21-50     51-100         101+   Don’t Use
      Doctor                                                                          
      Hospital                                                                        
      Dentist                                                                         
      Pharmacy                                                                        
      Durable Medical Equipment                                                       
      Other ___________________                                                       

16. Has any member of your household used the services of a hospital in the past 12 months?
      Yes       No

17. If Yes, at which hospital were services received?
        Atoka Memorial Hospital                       Carl Albert Indian Hospital (Ada)
        Mary Hurley Hospital (Coalgate)               Valley View Regional Hospital (Ada)
        Pushmataha County Hospital (Antlers)          Medical Center of S.E. Okla. (Durant)
        Texoma Medical Center (Denison, TX)           Pushmataha County Hospital (Antlers)
        Wilson N. Jones Hospital (Sherman, TX)  McAlester Regional Hospital (McAlester)
        ______________

18. Why did you choose this hospital?
      Insurance Coverage                  Personal Preference
      Doctor Referral                     Distance from Home
      Specialty Services                  ________________
      Recommended by Friend




                                                   E4
Atoka County Telephone Survey                                                           Page 3 of 4

19. What hospital services did you use?
       Specialty Doctor                            Emergency Room
       Outpatient Surgery                          Inpatient Surgery
       Laboratory (blood) Tests                    Inpatient Stay
       Radiology (x-ray, CT, mammogram)            Birthing Services
       Physical Therapy                            _______________

20. How would you describe your last hospital experience?
       Satisfied          Dissatisfied
    Why? ______________________________________________________________________________

21. Do you think Atoka Memorial Hospital is meeting the health needs of Atoka County residents?
     Yes        No      Don’t Know

22. How could Atoka Memorial Hospital improve? __________________________________________
    _________________________________________________________________________________

23. Has any member of your household used the services of the Atoka County Health Department in the
    past 12 months?
     Yes       No

24. If Yes, were you:
      Satisfied          Dissatisfied
     Why? _____________________________________________________________________________

25. Would you recommend a nursing home in Atoka to someone in need of long term care?
     Yes       No      Don’t Know

26. Do you think your community has adequate home health care services?
     Yes        No       Don’t Know

27. Is the EMS service (ambulance) in your area adequate?
      Yes       No        Don’t Know

28. Do you feel that Atoka County provides adequate services for the following:

                                             Yes           No       Don’t Know
                Adult Day Care                                        
                Physical Fitness                                      
       Pharmacy                                                       
       Dental Services                                                
       Residential Care                                               
       Assisted Living Facilities                                     
       Speech Therapy                                                 
       Physical Therapy                                               
       Occupational Therapy                                           
       Other:____________________                                     


                                                     E5
Atoka County Telephone Survey                                                       Page 4 of 4

29. Do you feel your community needs additional resources and/or education about:

                                         Yes          No        Don’t Know
              Teenage Pregnancy                                   
         Mental Health                                            
         Substance Abuse                                          
         Child Abuse                                              
         Spouse Abuse                                             
         Elderly Abuse                                            
         Other ________________                                   

30. What are the three most important health concerns in your community?

     1. ___________________________________________________________________________________
     2. ___________________________________________________________________________________
     3. ___________________________________________________________________________________

31. What is your age?
     1-20      21-30         31-40        41-50
     51-60     61-70         71-80        81+

32. What is your race? (Optional)
     White          Asian                  Hispanic
     Black          Native American

33. What is your zip code?
     74525  74533         74540           74542
     74555  74569         74573           74576

34. What is your yearly household income?

    ______Less than $10,000
    ______$10,000 to less than $15,000
    ______$15,000 to less than $20,000
    ______$20,000 to less than $25,000
    ______$25,000 to less than $35,000
    ______$35,000 to $50,000
    ______Over $50,000
       [Do not read       ______Don't know/Not sure
        these responses.] ______Refused

35. DO NOT ASK THIS QUESTION!!!!
    Interviewer will decide on the answer to this question!!!
     Male      Female        Unknown (Can’t Tell)




                                                      E6
                         Screener
                   What is your zip code?

                                            Frequency   Percent
74525 Atoka                                       140      70%
74533 Caney                                        12       7%
74540 Daisy                                         4       2%
74542 Atoka                                         4       2%
74555 Lane                                         23      11%
74569 Stringtown                                   11       5%
74576 Wardville                                     7       3%
Total                                             201    100%




                                  E7
                                Table 1
    Do you use a family doctor for most of your routine health care?

                          Frequency                         Percent
Yes                             182                            91%
No                               19                             9%
Total                           201                          100%




                                  E8
                                       Table 1A
                    If no, who do you go to for routine health care?

Response                                             Frequency
does not use health care/doesn't go to anyone                           5
veteran's hospital                                                      2
anyone they can get hold of                                             1
don't like them                                                         1
he retired                                                              1
heart doctor                                                            1
gynecologist                                                            1
hospital                                                                1
can't find family doctor to go to                                       1
don't go unless I'm sick                                                1
haven't had to go to anyone                                             1
depends on who's available                                              1
health department                                                       1
Indian clinic                                                           1
don't unless it's an emergency                                          1

Total Responses                                                        20




                                                E9
                              Table 2
      How long has it been since your last routine check-up?

                                                  Frequency    Percent
Within the past 12 months                               140       71%
More than 1 year but less than 2 years                   23       11%
More than 2 years but less than 5 years                  15        7%
More than 5 years                                        20       10%
Never                                                     3        1%
Total                                                   201     100%




                                E10
                               Table 3
Where do you go the most for your family's primary health care needs?

                                   Frequency               Percent
         Atoka                            77                  39%
         Ada                              10                   5%
         Antlers                          10                   5%
         Coalgate                         14                   7%
         Denison, TX                       9                   4%
         Durant                           44                  22%
         McAlester                        16                   8%
         Oklahoma City                     2                   1%
         Sherman, TX                       7                   3%
         Tulsa                             3                   2%
         Other                             9                   4%
         Total                           201                100%




                                E11
           Table 3A - "Other" where do you go for primary health care needs?

"Other" Response                                                               Frequency
Talihina, OK                                                                           2
Stroud, OK                                                                             1
Stigler, OK                                                                            1
Paris, TX                                                                              1
Hugo, OK                                                                               1
Houston, TX                                                                            1
Bonham, TX                                                                             1
Arlington, TX                                                                          1

Total Responses                                                                       9




                                         E12
                                               Table 4
                    If you use a family doctor outside of Atoka County, why?
Response                                                                        Frequency Percent
Confidence/Quality of Care                                                             53 38%
specialists: pediatrics, oncologists, gynecologists, cardiologists, obstetrics,
    diabetic services, mammogram, and surgeons                                         22 16%
Closer to Home/Convenience                                                             11     8%
Recommendations/referrals                                                              11     8%
Availability                                                                            5     4%
Indian services                                                                         5     4%
no choice                                                                               5     4%
better facilities/hospitals                                                             4     3%
Insurance Reasons/Cost/Affordability                                                    3     2%
don't know                                                                              2     1%
family uses doctor                                                                      2     1%
VA Services                                                                             2     1%
Atoka cannot provide me with the services I need                                        1     1%
Atoka only has a doctor for minor things and he's very good                             1     1%
availability to run tests, one stop assistance                                          1     1%
better equipment                                                                        1     1%
doctor retired, so I switched to this one                                               1     1%
Established Patient/Former Resident                                                     1     1%
female gender physician                                                                 1     1%
haven't been in Atoka long                                                              1     1%
no reason                                                                               1     1%
other                                                                                   1     1%

Total Responses                                                                      135 100%




                                              E13
                                  Table 6
How long do you normally wait in the waiting room to see your family doctor?

                                      Frequency               Percent
    No Wait                                   6                   3%
    15 Minutes or Less                       48                  24%
    16-30 Minutes                            92                  47%
    31 Minutes to 1 Hour                     35                  17%
    1-2 Hours                                11                   5%
    Over 2 Hours                              1                   0%
    No Response                               8                   4%
    Total                                   201                100%




                                    E14
                                         Table 7
Does your family doctor give you enough time in his/her office to discuss your health needs?

                                                      Frequency            Percent
        Yes                                                 163               81%
        No                                                   30               15%
        No Response                                           8                4%
        Total                                               201             100%




                                             E15
APPENDIX F
      Atoka County
    Data & Information


               c i
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               C

 Oklahoma State Department of Health,
          Office of Rural Health

Oklahoma Cooperative Extension Service,
        Oklahoma State University

             March 2000


                  F1
                       AE-0024


         Economic Data, Health/Behavioral Data,
  Education Data, Traffic Accident Data, and Crime Data
      for Atoka County and the State of Oklahoma




Sarah Trzebiatowski, Sara ―Renee‖ Thorsell, Turia Sporleder
               Student Extension Associates
                 Stillwater (405) 744-6083


  Cheryl F. St. Clair, Assistant State Extension Specialist
                 Stillwater (405) 744-6081


         Gerald A. Doeksen, Extension Economist
                Stillwater (405) 744-6081


     Jack Frye, Eastern Rural Development Specialist
                   Ada (580) 332-4100


    Jody House, Atoka/Coal County Extension Director
                 Atoka (580) 889-7337




          RURAL DEVELOPMENT
 OKLAHOMA COOPERATIVE EXTENSION SERVICE
       OKLAHOMA STATE UNIVERSITY




                        March 2000




                             F2
A. ECONOMIC DATA




       F3
                                                     Section A, Table 1
                           Population - Population Estimates and Projections and Percent Changes
                                      for Atoka County and for the State of Oklahoma
                                           Atoka City of Town of    Town of Town of Town of Remainder    State of
                                          County Atoka     Caney Stringtown Tushka Wardville of County Oklahoma
1970 Population (Census)                  10,972 3,346       200         397   230      n/a      6,799 2,559,463
1980 Population (Census)                  12,748 3,409       147       1,047   358       61      7,726 3,025,290
1990 Population (Census)                  12,778 3,298       184         366   256       52      8,622 3,145,576

1998 Population                           13,200    3,270        190        370       270            50    9,050 3,346,713
  (Census Estimate)

Projected 2005 Population (ODOC)          14,115    3,565        190          0       215            50   10,095 3,532,180
Projected 2010 Population (ODOC)          14,390    3,625        190          0       210            50   10,315 3,619,850
Projected 2020 Population (ODOC)          14,750    3,685        190          0       190            50   10,635 3,717,500

Historical
 1970-1990 % Change                       16.5%       n/a    -8.0%        -7.8%     11.3%         n/a     26.8%     22.9%
 1980-1990 % Change                        0.2%    -3.3%     25.2%       -65.0%    -28.5%     -14.8%      11.6%      4.0%
 1990-1998 % Change                        3.3%    -0.8%      3.3%         1.1%      5.5%      -3.8%       5.0%      6.4%

Projected
  1998-2005 % Projected Change             6.9% 9.0%          0.0%     -100.0%     -20.4%          0.0%   11.5%      5.5%
  1998-2010 % Projected Change             9.0% 10.9%         0.0%     -100.0%     -22.2%          0.0%   14.0%      8.2%
  1998-2020 % Projected Change            11.7% 12.7%         0.0%     -100.0%     -29.6%          0.0%   17.5%     11.1%

SOURCE: U. S. Census Bureau, 1970, 1980, 1990, and 1998 Estimates
SOURCE: Oklahoma Department of Commerce, "County and MSA Population Projections: 1990-2020,"
    and "Population Projections of Cities and Towns in Oklahoma: 1990-2020."
                                                             A-1

                                                            F4
                                Section A, Table 2
                 1998 Estimated Population by Age Groups and Sex
                                 for Atoka County
          Age                          Male             Female            Total

          0-4                           407                376              783
          5-9                           461                393              854
         10-14                          540                488            1,028

         15-19                          603                501            1,104
         20-24                          426                319              745
         25-29                          509                343              852

         30-34                          497                318              815
         35-39                          532                419              951
         40-44                          533                473            1,006

         45-49                          454                424              878
         50-54                          433                404              837
         55-59                          401                379              780

         60-64                          319                299              618
         65-69                          246                303              549
         70-74                          219                276              495

         75-79                          210                213              423
         80-84                          101                180              281
          85+                            68                170              238

                                      6,959              6,278           13,237




SOURCE: U. S. Bureau of the Census, Estimates, 1998; Oklahoma Department of Commerce,
State Data Center.




                                      A-2

                                       F5
                                   Section A, Table 3
                                Persons <19 Years of Age
                    Population Numbers and Percent of Total Population
                       for Atoka County and the State of Oklahoma

                                                            Atoka              State of
                                                           County            Oklahoma

1970
  Population <19 Years                                       3,944             943,880
  Percent of Total Population                               35.8%               36.7%

1980
  Population <19 Years                                       3,859             973,480
  Percent of Total Population                               30.3%               32.0%

1990
  Population <19 Years                                       3,692             939,859
  Percent of Total Population                               28.9%               29.9%

1999
  Population <19 Years                                       3,779             987,592
  Percent of Total Population                               28.5%               29.3%


SOURCE: Woods & Poole Economics, Inc., "County & State Projections to 2025," 2000.




                                           A-3

                                           F6
                                    Section A, Table 4
                                 Persons >65 Years of Age
                     Population Numbers and Percent of Total Population
                        for Atoka County and the State of Oklahoma

                                                               Atoka            State of
                                                              County          Oklahoma

1970
  Population >65 Years                                          1,564           299,744
  Percent of Total Population                                  14.2%             11.7%

1980
  Population >65 Years                                          1,944           379,440
  Percent of Total Population                                  15.3%             12.5%

1990
  Population >65 Years                                          1,960           424,387
  Percent of Total Population                                  15.4%             13.5%

1999
  Population >65 Years                                          2,010           452,556
  Percent of Total Population                                  15.2%             13.4%


SOURCE: Woods & Poole Economics, Inc., "County & State Projections to 2025," 2000.




                                            A-4

                                            F7
                                    Section A, Table 5
          Race - 1990 and 1998 Population Numbers and Percent of Total Population
                        for Atoka County and the State of Oklahoma
                                                                   Atoka          State of
                                                                  County        Oklahoma
1990 Census

  White - Population Numbers                                      10,365            2,583,512
  White - % of Total Population                                   81.1%                82.1%

  Black - Population Numbers                                        760              233,801
  Black - % of Total Population                                    5.9%                7.4%

  American Indian - Population Numbers                             1,587             252,420
  American Indian - % of Total Pop.                               12.4%                8.0%

  Other - Population Numbers                                          66              75,852
  Other - % of Total Population                                    0.5%                2.4%

  Hispanic Origin (of any race) – Population Numbers                118               86,160
  Hispanic Origin (of any race) - % of Total Population            0.9%                2.7%

1998 Census Estimates

  White - Population Numbers                                      10,686            2,667,778
  White - % of Total Population                                   80.7%                79.7%

  Black - Population Numbers                                        821              261,945
  Black - % of Total Population                                    6.2%                7.8%

  American Indian - Population Numbers                             1,592             263,360
  American Indian - % of Total Pop.                               12.0%                7.9%

  Other - Population Numbers                                          26              44,579
  Other - % of Total Population                                    0.2%                1.3%

  Hispanic Origin (of any race) – Population Numbers                164              130,168
  Hispanic Origin (of any race) - % of Total Population            1.2%                3.9%

SOURCE: U.S. Census of Population, 1990; 1998 Census Estimates.
                                          A-5



                                              F8
                                      Section A, Table 6
                          Per Capita Income and Transfer Payments
                         for Atoka County and the State of Oklahoma
                                                          Atoka                   State of
                                                         County                 Oklahoma

Per Capita Personal Income

                  1990                                    $9,069                     $15,633
                  1991                                   $9,461                      $16,137
                  1992                                   $9,928                      $16,832
                  1993                                  $10,665                      $17,419
                  1994                                  $11,220                      $17,984
                  1995                                  $11,655                      $18,544
                  1996                                  $12,084                      $19,342
                  1997                                  $12,776                      $20,305
                  1998                                  $13,352                      $21,304
                  1999                                  $13,827                      $22,034
                  2000                                  $14,325                      $22,810

Transfer Payments as a
 Percent of Personal Income

                  1990                                    29.0%                       17.3%
                  1991                                    29.2%                       18.1%
                  1992                                    30.2%                       19.0%
                  1993                                    30.0%                       19.3%
                  1994                                    30.6%                       19.5%
                  1995                                    31.7%                       20.4%
                  1996                                    31.8%                       20.3%
                  1997                                    31.3%                       20.0%
                  1998                                    31.0%                       20.0%
                  1999                                    31.1%                       20.0%
                  2000                                    31.2%                       20.1%


SOURCE: Woods & Poole Economics, Inc., "County & State Projections to 2025," 2000.




                                            A-6


                                            F9
                                           Section A, Table 7
                               FULL-TIME AND PART-TIME EMPLOYMENT
                                        BY MAJOR INDUSTRY
                                         (NUMBER OF JOBS)

    Atoka County Oklahoma                        1994a     1995a      1996a     1997a     1998b      1999b

              Total full- and part-time          5,274      5,432     5,536     5,624     5,676      5,730
                employment
      Wage and salary employment                 3,132      3,233     3,281     3,311        NA       NA
      Proprietors' employment                    2,142      2,199     2,255     2,313        NA       NA
         Farm proprietors' employment            1,033      1,046     1,047     1,065        NA       NA
         Nonfarm proprietors' employment1        1,109      1,153     1,208     1,248        NA       NA
    By Industry:
      Farm employment                            1,130      1,142     1,149     1,165     1,151      1,139
      Nonfarm employment                         4,144      4,290     4,387     4,459     4,525      4,591
         Private employment                      2,915      3,039     3,150     3,198     3,256      3,312
          Ag. serv., for., fishing, and other2     (D)                   91        98        99        100
          Mining                                   (D)         59        52        50        49         49
          Construction                             199        188       193       201       215        226
         Manufacturing                             347        356       374       411       416        421
         Transportation and public utils           247        247       275       290       290        290
         Wholesale trade                           180        152       149       167       174        179
         Retail trade                              843        923       928       942       939        943
         Finance, ins., and real estate            113        115       117       120       122        124
         Services                                  839        913       971       919       952        980
      Government and govt enterprises            1,229      1,251     1,237     1,261     1,269      1,279
         Federal, civilian                          71         68        71        70        71         71
         Military                                   68         69        67        67        65         65
         State and local                         1,090      1,114     1,099     1,124     1,133      1,143
1
  Excludes limited partners.
2
  "Other" consists of the number of jobs held by U.S. residents employed by international
   organizations and foreign embassies and consulates in the U.S.
(D) Not shown to avoid disclosure of confidential information, but the estimates for this item are
    included in the totals.
a
 SOURCE: 1994-1997 Regional Economic Information System .
b
  SOURCE:1998-1999, Woods & Poole Economics, Inc., "County & State Projections to 2025,"
  2000.




                                                   A-7


                                                   F10
                                         Section A, Table 8
                                         Labor Force Data
     Year                  Labor Force        Employment      Unemployment    Unemployment Rate
Atoka County1
         1990                    4,790                4,390            400                      8.3
         1991                    4,800                4,380            420                      8.7
         1992                    4,750                4,440            310                      6.6
         1993                    4,870                4,540            330                      6.7
         1994                    4,830                4,550            280                      5.7
         1995                    4,920                4,660            260                      5.3
         1996                    4,870                4,660            210                      4.3
         1997                    4,760                4,570            190                      4.1
         1998                    4,860                4,640            220                      4.4
         1999                    4,900                4,710            190                      3.9
    2000 Preliminary

State of Oklahoma1
         1990                1,513,840           1,427,890           85,950                     5.7
         1991                1,499,930           1,399,170          100,760                     6.7
         1992                1,520,850           1,433,460           87,390                     5.7
         1993                1,529,470           1,435,800           93,670                     6.1
         1994                1,544,260           1,454,360           89,900                     5.8
         1995                1,546,270           1,473,610           72,660                     4.7
         1996                1,576,010           1,512,000           64,010                     4.1
         1997                1,601,150           1,535,130           66,020                     4.1
         1998                1,627,280           1,553,660           73,620                     4.5
         1999                1,657,100           1,597,625           59,485                     3.6
    2000 Preliminary

National2
      1990                 125,820,917         118,761,417        7,059,500                     5.6
      1991                 126,346,308         117,718,308        8,628,154                     6.8
      1992                 128,105,077         118,492,000        9,612,846                     7.5
      1993                 129,199,769         120,259,231        8,940,308                     6.9
      1994                 131,061,154         123,064,769        7,996,538                     6.1
      1995                 132,304,077         124,899,692        7,404,308                     5.6
      1996                 133,943,385         126,707,538        7,235,769                     5.4
      1997                 136,296,846         129,557,923        6,738,846                     4.9
      1998                 137,673,231         131,463,462        6,209,692                     4.5
      1999                 139,367,615         133,487,923        5,879,615                     4.2
2000 Preliminary           139,621,000         133,357,000        6,264,000                     4.5

1
    SOURCE: Oklahoma Labor Force Reports, 1990-1999, Oklahoma Employment Security Commission.
2
    SOURCE: Bureau of Labor Statistics Data

                                                A-8

                                                F11
                                         Section A, Table 9
                       PERSONAL INCOME BY MAJOR SOURCE AND EARNINGS BY
                                    (THOUSANDS OF DOLLARS)
    Atoka County Oklahoma                                  1994a      1995a       1996a       1997a       1998b       1999b
    Income by Place of Residence
     Total Personal income (thousands of dollars)         146,911    154,412     159,695     170,581     176,160     183,180
          Nonfarm personal income                         143,895    155,424     161,361     169,444         NA          NA
          Farm income 1                                     3,016     -1,012      -1,666       1,137         NA          NA
       Population (number of persons) 2                    13,094     13,249      13,215      13,352
       Per capita personal income (dollars)                11,220     11,655      12,084      12,776       14,999     15,871
       Transfer payments                                   45,017     48,988      50,794      53,356       53,540     55,610
    Earnings by Place of Work
        Wage and salary disbursements                      52,017     55,171      57,363      59,254       62,850     65,580
        Other labor income                                  6,589      6,642       6,699       6,666        6,620      6,890
       Proprietors' income 3                               22,816     20,891      20,247      24,942       25,920     26,880
           Farm proprietors' income                         2,472     -1,655      -2,310         501          NA         NA
           Nonfarm proprietors' income                     20,344     22,546      22,557      24,441          NA         NA
    Earnings by Industry
    Total Earnings                                         81,422     82,704      84,309      90,862       95,380     99,350
        Farm earnings                                       3,016     -1,012      -1,666       1,137        3,680      3,760
        Nonfarm earnings                                   78,406     83,716      85,975      89,725       91,700     95,590
           Private earnings                                49,824     53,933      55,527      57,979       58,880     61,560
            Ag. serv., for., fishing, and other 4             (D)        508         486         550          500        520
          Mining                                              (D)      3,301       3,712       4,006        2,150      2,230
          Construction                                      2,731      3,046       2,929       3,259        3,540      3,830
          Manufacturing                                     9,618      9,988       9,714      11,133       11,560     12,090
            Durable goods                                   9,303      9,637       9,375      10,785          NA         NA
            Nondurable goods                                  315        351         339         348          NA         NA
          Transportation and public utilities               7,242      7,877       7,808       8,195        8,400      8,630
          Wholesale trade                                   2,985      2,823       2,726       3,380        3,630      3,830
          Retail trade                                     12,090     13,202      13,777      14,251       14,550     14,980
          Finance, insurance, and real estate               2,037      2,249       2,292       2,323        2,780      2,930
          Services                                         10,006     10,939      12,083      10,882       11,770     12,520
       Government and government enterprises               28,582     29,783      30,448      31,746       32,800     34,030
         Federal, civilian                                  2,531      2,477       2,665       2,796        2,930      3,050
         Military                                             534        541         539         553          550        570
         State and local                                   25,517     26,765      27,244      28,397       29,320     30,410

1
   Farm Income consists of proprietors' income; the cash wages, pay-in-kind, and other labor income of hired farm workers;
    and the salaries of officers of corporate farms.
2
   Census Bureau midyear population estimates. Estimates for 1992-1997 reflect State and county population estimates
    available as of March 1999.
3
   Proprietors income includes the inventory valuation adjustment and capital consumption adjustment.
4
   "Other" consists of wage and salary disbursements to U.S. residents employed by international organizations and foreign
embassies and consulates in the U.S.
(D) Not shown to avoid disclosure of confidential information.
(L) Less than $50,000, but the estimates for this item are included in the totals.
a
  SOURCE: 1994-1997 Regional Economic Information System .
b
  SOURCE:1998-1999, Woods & Poole Economics, Inc., "County & State Projections to 2025," 2000.

                                                            A-9

                                                             F12
                                                Section A, Table 10
                                   TRANSFER PAYMENTS (THOUSANDS OF DOLLARS)
Atoka County Oklahoma                                          1994a   1995a  1996a                                                             1997a           1998b 1999b
Total transfer payments (thousands of dollars)                45,017  48,988 50,794                                                            53,356          53,840 55,610
Government payments to individuals                            43,057  46,849 48,697                                                            51,235             NA     NA
 Ret. & disab. insurance benefit payments                     19,151  20,490 20,358                                                            21,348             NA     NA
  Old-age, surv. & disability insur. payments                 12,743  13,406 13,692                                                            14,326             NA     NA
  Railroad retirement & disability payments                       108     97    103                                                               107             NA     NA
  Federal civil. employee retirement payments                   2,423  2,581  2,449                                                             2,538             NA     NA
  Military retirement payments                                  1,193  1,211  1,210                                                             1,333             NA     NA
  State & local govt. employee ret. payments                    1,167  1,389  1,416                                                             1,546             NA     NA
  Workers' comp. payments (federal & state)                     1,501  1,788  1,468                                                             1,483             NA     NA
Other govt. disability insur. & ret. pay. 1                       (L)    (L)    (L)                                                               (L)             NA     NA
 Medical payments                                             14,657  16,532 18,108                                                            19,460             NA     NA
  Medicare                                                      9,085 10,922 12,237                                                            12,992             NA     NA
  Public assistance medical care 2                              5,452  5,501  5,764                                                             6,354             NA     NA
  CHAMPUS                                                         120    109    107                                                               114             NA     NA
 Income maintenance benefit payments                            6,132  6,714  7,096                                                             7,266             NA     NA
  Suppl. security income (SSI) payments                         2,363  2,436  2,563                                                             2,594             NA     NA
  Family assistance 3                                             827    825    558                                                               454             NA     NA
  Food stamps                                                   1,398  1,432  1,439                                                             1,298             NA     NA
  Other income maintenance 4                                    1,544  2,021  2,536                                                             2,920             NA     NA
 Unemployment insurance benefit payments                          378    397    359                                                               279             NA     NA
  State unemployment insurance compensation                       362    382    347                                                               269             NA     NA
  Unemp. comp. for fed. civilian empl.(UCFE)                      (L)    (L)    (L)                                                               (L)             NA     NA
  Unemp. compensation for railroad employees                      (L)    (L)    (L)                                                               (L)             NA     NA
  Unemp. compensation for veterans (UCX)                          (L)    (L)    (L)                                                               (L)             NA     NA
  Other unemployment compensation 5                                 0      0      0                                                                 0             NA     NA
 Veterans benefit payments                                      2,562  2,430  2,477                                                             2,553             NA     NA
  Veterans pensions & compensation payments                     2,396  2,266  2,302                                                             2,334             NA     NA
  Educ. asst. to vets, depend., & surviv. 6                        77     76     79                                                               128             NA     NA
  Veterans life insurance benefit payments                         86     85     91                                                                88             NA     NA
  Other assistance to veterans 7                                  (L)    (L)    (L)                                                               (L)             NA     NA
 Fed educ. & trng. asst. pay. (excl. vets) 8                       89    185    154                                                               233             NA     NA
 Other payments to individuals 9                                   88    101    145                                                                96             NA     NA
Payments to nonprofit institutions                              1,125  1,206  1,167                                                             1,185             NA     NA
 Federal government payments                                      300    310    310                                                               311             NA     NA
 State and local government payments 10                           465    519    463                                                               450             NA     NA
 Business payments                                                360    377    394                                                               424             NA     NA
Business payments to individuals 11                               835    933    930                                                               936             NA     NA
1
   Consists largely of temporary disability payments and black lung payments.
2
  Consists of Medicaid and other medical vendor payments.
3
  Consists of aid to families with dependent children and, beginning with 1996, assistance programs operating under the Personal Responsibility and Work Opportunity
Reconciliation Act of 1996.
4
  Consists largely of general assistance, emergency assistance, refugee assistance, foster home care payments, earned income tax credits, and energy assistance.
5
  Consists of trade readjustment allowance payments, Redwood Park benefit payments, public service employment benefits payments, and transitional benefit payments.
6
  Consists largely of veterans' readjustment benefit payments and educational assistance to spouses and children of disabled or deceased veterans.
7
  Consists largely of payments to paraplegics, payments for autos and conveyances for disabled veterans, veterans' aid and veterans' bonuses.
8
  Consists largely of federal fellowship payments (National Science Foundation fellowships and traineeships, subsistence payments to State maritime academy cadets, and other
federal fellowships), interest subsidy on higher education loans, basic educational opportunity grants, and Job Corps payments.
9
  Consists largely of Bureau of Indian Affairs payments, education exchange payments, Alaska Permanent Fund dividend payments, compensation of survivors of public safety
officers, compensation of victims of crime, disaster relief payments compensation for Japanese internment, and other special payments to individuals.
10
   Consists of State and local government payments for foster home care supervised by private agencies, State and local government educational assistance payments to nonprofit
institutions, and other State and local government payments to nonprofit institutions.
11
   Consists largely of personal injury payments to individuals other than employees and other business transfer payments.
(L) Less than $50,000, but the estimates for this item are included in the totals.
(N) Data not available for this year.
a
  SOURCE: 1994-1997 Regional Economic Information System.
b
  SOURCE: 1998-1999, Woods & Poole Economics, Inc., "County & State Projections to 2025," 2000
                                                                                      A-10

                                                                                      F13
                                                        Section A, Table 11
                                               Sales Tax Collections by City and by County
                                                      for Atoka County, 1990-1999

                         FY 1991    FY 1992     FY 1993    FY 1994     FY 1995    FY 1996    FY 1997    FY 1998      FY 1999


Atoka1                   $759,354   $795,135    $786,592 $810,091      $931,760 $1,099,576 $1,136,793 $1,160,090   $1,213,546


Caney (2%)                $11,344    $13,676     $13,360   $12,840      $13,345    $14,588    $15,420    $17,262     $16,394


Stringtown (3%)           $75,835    $70,903     $66,494   $78,231      $87,950    $83,389    $96,033    $86,702    $109,846


Tushka (2%)               $22,032    $23,322     $23,875   $28,105      $27,834    $28,130    $26,220    $31,162     $35,785


Atoka County (1%)        $521,352   $528,823    $517,593 $532,162      $564,920   $585,360   $608,116   $618,816    $628,878



SOURCE: Annual Reports, Oklahoma State and Municipal Sales and Use Taxes, Fiscal Year Ended June 30, 1991-1999.
        Oklahoma Tax Commission, Sales and Use Tax Division, Prepared by The Office of Economic Research.
1
    Atoka Sales Tax increased from 2% to 2.5% during FY 1995.




                                                                A-11

                                                                F14
B. HEALTH/BEHAVIORAL DATA




           F15
                                         Section B, Table 1
                                    Economic Distress Indicators
                             for Atoka County and the State of Oklahoma


                                                                     Atoka            State of
                                                                    County          Oklahoma

Persons in Poverty (1995)1
  Number                                                              3,725             594,263
  Percent of Total Population                                          30.1                18.2
  County Ranking (1 = most favorable)                                    73                  ---

TANF (FY 1999 Monthly Averages)2
Total Cases                                                            114               20,075
Total Persons Receiving TANF                                           298               53,127
Total Persons as % of Population                                      2.2%                1.6%

Food Stamps (FY 1999 Monthly Averages)2
Total Unduplicated Cases                                              1,273             213,381
 No. of Persons (Monthly Average)                                     1,632             276,347
 Percent of Total Population                                         12.3%                8.2%

WIC (FY 1999 Monthly Averages)2
Total WIC Participant                                                  404               90,609
  Percent of Population Receiving WIC                                 3.0%                2.6%
Women                                                                    93              22,621
Infants                                                                  92              24,628
Children                                                               219               43,360

Medicaid (FY 1999 Monthly Averages)2
Total Medicaid Cases                                                  1,588             220,265
Total Persons Receiving Medicaid                                      2,300             333,207
 Percent of Population Receiving Medicaid                            17.3%                9.9%


SOURCE1: State of the State's Health, 2000
SOURCE2: Oklahoma Department of Human Services Facts and Figures. FY 99 Annual Report


                                                B-1


                                                F16
                                           Section B, Table 2
           Elderly Medicaid1, Support Services1, Geriatric Day Care1, and Nursing Home Beds2
                                 For Atoka and the State of Oklahoma

                                                                      Atoka County                   Oklahoma
1999 Monthly Averages

Total Persons Receiving Medicaid > 651                                           529                    50,189
  Percent of population age > 65                                               26.3%                    11.1%
Total Persons Receiving Medicare1                                               2,153                  500,600
  Percent of total population                                                  16.2%                     14.8%

Elderly Support Services1
  Congregate Meals                                                             2,081                   220,129
  Meals Served at Home                                                         1,210                   143,234
  Total Meals Served                                                           3,291                   363,363
    County Ranking (1 = most favorable)                                           59                        ---

Geriatric Day Care Recipients1
  Total Served                                                                      0                       681
  New Referrals                                                                     0                       356
  Number Licensed                                                                   0                       709
   Occupancy Rate                                                                   0                      0.96

Long Term Care Facilities (1998)2
  Nursing Home Facilities                                                           2                      390
  Nursing Home Beds                                                               192                   34,969
   Rate per 1,000 > 75                                                           14.4                    167.5
  Assisted Living Facilities                                                        0                        77
  Assisted Living Beds                                                              0                    4,379
   Rate per 1,000 > 65                                                              0                       9.8

SOURCE1: Oklahoma Department of Human Services Facts and Figures; FY99 Annual Report
SOURCE2: Oklahoma State Department of Health Dir. Of Oklahoma Licensed Long Term Care Facilities, 1998
Population estimates came from Woods & Poole Economics, Inc.,‖County and State Projections to 2025,‖2000.

FOOTNOTE: Nursing home facilities do not include specialized facilities for the Mentally Retarded, Alzheimer’s
and Dementia Residents, nor Veterans nursing facilities, but do include Continuum Care Centers.




                                                      B-2
                                                      F17
                                          Section B, Table 3
          Children in Poverty and Children Receiving Assistance from Medicare and/or TANF
                              in Atoka County and the State of Oklahoma


                                                                Atoka County          State of Oklahoma

Children <18 in Poverty (1995)1
 Number                                                                    1,327                 233,814
 Percent of Total Children                                                37.9%                   26.0%
 County Ranking (1 = most favorable)                                          67                      ---

Children Receiving TANF (1999 Monthly Average)2
  Total Number < 18                                                          224                  39,487
  Rate per 1,000 Children                                                   67.6                    47.2

Children Receiving Medicaid (1999 Monthly Average)2
 Total Number                                                              1,060                 178,127
  Rate per 1,000 Children                                                  280.5                   180.4

  Age under 5                                                                450                  80,504
  Rate per 1,000 Children                                                  467.4                   288.8

  Age 6-12                                                                   415                  66,085
   Rate per 1,000 Children                                                 321.0                   194.5

  Age 13-17                                                                  195                  31,538
   Rate per 1,000 Children                                                 181.0                   120.7

SOURCE1: U.S. Bureau of the Census
SOURCE2: Oklahoma Department of Human Services Facts and Figures
Footnote: Populations estimates for rate calculators:Woods & Poole Economics, Inc.,
          "County and State Projections to 2025,"2000.




                                                 B-3

                                                 F18
                                        Section B, Table 4
                 Child Abuse, Domestic Violence, and Juvenile Violent Crime Arrests
                              Atoka County and the State of Oklahoma


                                                     Atoka County             State of Oklahoma
                                                  1997   1998 1999          1997 1998        1999

Child Abuse and Neglect1
  Number of Confirmed Cases                           NA       48      69     NA 16,710         16,217
  Rate per 1,000 Children                             NA     14.5    20.8     NA   20.0           19.4
  County Ranking                                      NA      NA       45      ---   ---            ---

Domestic Violence
 Number                                               NA        9     NA      NA 21,435            NA
 Rate per 1,000 Population                            NA      0.7     NA      NA     6.4           NA
 County Ranking                                       NA      NA      NA       ---    ---           ---

Juvenile Violent Crime Arrests (1997)
  Number                                                0       0     NA    1,171     1,145        NA
  Rate per 1,000 Population                             0       0     NA       2.8       1.2       NA
  County Ranking (tie)                                  1             NA        ---       ---       ---


SOURCE1: Oklahoma Department of Human Services Facts and Figures, FY99 Annual Report




                                                B-4



                                                F19
                                            Section B, Table 5
             Low Birthweight, Infant Mortality, Child Deaths, Births to Teens, and Fertility Rate
                               for Atoka County and the State of Oklahoma
                                                                     Atoka County                         State of Oklahoma
                                                          1992-96        1993-97 1994-98             1992-96     1993-97 1994-98
Low Birthweight
 Total Number for 5 years                                           60         52            59        15,953      16,249      16,708
  Average Annual Percent                                        8.1%         7.0%            7.8        7.0%        7.1%        7.2%
 County Ranking (1=most favorable)                                 72           52            64           ---         ---         ---


Infant Mortality1,2
  Total Number of Infants                                          8            8              8        1965         1913       1,930
   Rate per 1,000 Live Births                                   10.9         10.7           10.5          8.5         8.3          8.2
 County Ranking (1= most favorable)                               69            67            66          ---          ---          ---
 Total Number of Neonatal                                        NA             ---            4         NA            ---      1,171
  Rate of Neonatal per 1,000 Live Births                         NA            6.7           5.2         NA           4.8          5.0
 Total Number of Post-neonatal                                   NA             ---            4         NA            ---        753
  Rate of Post-Neonatal per 1,000 Live Births                    NA              4           5.2         NA           3.5          3.2

                                                          1994-96        1995-97       1996-98       1994-96     1995-97     1996-98
             3
Child Deaths
 Total Number for 3 years                                        NA                8             7       NA           675         633
 Avg. Rate per 1,000 Births                                      NA            4.2           2.0         NA           4.8           4.4
 County Ranking (1= most favorable)                              NA            30            15            ---         ---          ---

Births to Teens Age 15-17
 Total Number for 3 years                                        NA            36             37        8,323       8,340       8,281
 Avg. Rate per 1,000 Births                                      NA          76.1           75.7          NA         59.7        57.6
 County Ranking (1= most favorable)                              NA            48            46            ---         ---          ---

Fertility Rate4
 Women Age 15-17                                                39.8         41.6           37.1         41.0        37.8        35.9
 Women Age 15-44                                                60.3         66.4           68.2         62.0        65.5        67.0
 County Ranking (1= most favorable)                                 45         36            33            ---         ---          ---

SOURCE: MCH planning and Evaluation, Maternal & Child Health Services, Oklahoma State Department of Health:
Oklahoma City, Oklahoma
1
  Infant mortality is defined as death occurring to an infant less than one year of age and child deaths include children ages 1-
14.
2
  Births and infant mortality data is reported according to mother's residence.
3
  Child death data is reported according to child's residence.
4
  Fertility Rate is defined as births per 1000 women in a given age range.



                                                               B-5

                                                               F20
                                Section B, Table 6
                            Teen Births and Total Births
                    for Atoka County and the State of Oklahoma

               Births by                                Atoka         State of
              Age Groups                               County       Oklahoma

1998 Data

Under 15 Years of Age                                           3         126
15-17 Years of Age                                             13       2,704
18-19 Years of Age                                             15       5,174

Total Births to Under Age 20                                   31       8,004

% of Births to Under Age 20                             20.3%          16.2%

20-24 Years of Age                                             57      15,771
25-29 Years of Age                                             37      13,566
30-34 Years of Age                                             18       7,816
35 Years and Older                                             10       4,064
Unknown                                                         0         135

Total Births                                              153          49,356

    Low Birthweight                                         10          3,926
    % Low Birthweight                                    5.8%           7.3%
    Very Low Birthweight                                     3            646
    %Very Low Birthweight                                1.8%           1.2%

Birth Rate1                                               11.6           14.7

% of Births to Single Mothers                           38.9%          33.5%
% of Births to Single Teen                              82.1%          70.4%
Mothers


SOURCE: MCH planning and Evaluation, Maternal & Child Health Services,
        Oklahoma State Department of Health: Oklahoma City, Oklahoma.
1
 Birth Rate is total live births per 1,000 total population.



                                          B-6



                                          F21
                               Section B, Table 7
                     Resident Live Births by Mother's Race
   and Maternal Education Level for Atoka County and for the State of Oklahoma


                              Atoka County                State of Oklahoma
                            Number    % of Total         Number        % of Total

1998 - Mother's Race

White                          110        73.3%           38,464           77.9%
Black                            8         5.3%            4,788             9.7%
American Indian                 32        21.3%            4,846             9.8%
Other                            0         0.0%              886             1.8%
Unknown                          0         0.0%              370             0.7%
 Total Births                  150       100.0%           49,354            100%

1998 - Maternal Education

< 12 Grades                     46        30.7%           11,128           23.0%
> 12 Grades                    104        69.3%           38,226           77.0%
  Total Births                 150       100.0%           49,354          100.0%


SOURCE: MCH planning and Evaluation, Maternal & Child Health Services,
        Oklahoma State Department of Health: Oklahoma City, Oklahoma.




                                       B-7



                                       F22
                                      Section B, Table 8
                     High Parity, Short Interval Births, and Entry into Care
                         for Atoka County and the State of Oklahoma

                                                              Atoka              State of
                                                             County            Oklahoma

1998 Data
 High Parity Births1

    Age < 20 with 2+ deliveries                                    0                 204
     Percent                                                    0.0%              17.8%
    Age > 20 with 4+ deliveries                                    2               1,240
     Percent                                                    2.8%               6.9%

Short Birth Interval2

    < 18 months                                                   20               4,893
      Percent                                                 23.0%               18.0%
    < 24 months                                                   26               8,502
      Percent                                                 29.9%               31.3%

Entry into Care

    No Care                                                       2                  394
    Percent No Care                                            1.4%                0.9%
    First Trimester Care                                        104               32,654
    Percent First Trimester Care                              73.2%               78.6%


SOURCE: MCH planning and Evaluation, Maternal & Child Health Services,
        Oklahoma State Department of Health: Oklahoma City, Oklahoma.
1
  High Parity -Teens, under age 20, with 2 or more previous births.
               -Adults, age 20 and over, with 4 or more previous births.
2
  Short Birth Interval - Less that 24 months since last delivery.
                      - Less than 18 months since last delivery.



                                              B-8


                                              F23
                                 Section B, Table 9
           Injury Incidence for Brain, Spinal Cord, Motor Vehicle, Burn, Submersion,
      Firearm, Homicide and Suicide for Atoka County and for the State of Oklahoma


                                               Atoka          State of       United
1998 Data                                     County        Oklahoma         States

Brain Injuries                                     9
 Average Rate per 1,000                         0.68              0.89          NA

Spinal Cord Injuries                               0
 Average Rate per 1,000                         0.00              0.04          NA

Motor Vehicle Deaths                               7
 Average Rate per 1,000                         0.52              0.22         0.15

Burn                                               1
 Average Rate per 1,000                         0.08              0.11          NA

Submersion                                         1
 Average Rate per 1,000                         0.08              0.04          NA

Homicide                                           0
 Average Rate per 1,000                         0.00              0.07         0.07

Suicide                                            2
 Average Rate per 1,000                         0.16              0.13         0.10


SOURCE: State of the State's Health, 2000.




                                        B-9


                                        F24
                                  Section B, Table 10
                     Leading Causes of Death by County of Residence
                  for Atoka County, the State of Oklahoma, and the U.S.


1998 Data                                              Atoka        State of      United
Age Adjusted Death Rateb                              County      Oklahoma        States
Ten Leading Causes of Death                             Ratea             Ratea    Ratea

Heart Disease                                             1.4               1.5      1.3

Cancer                                                   1.25             1.26      1.23

All Injuries                                             0.78             0.61      0.47

Stroke                                                   0.34             0.28      0.25

Chronic Obstructive Pulmonary Diseases                   0.06             0.26      0.22


SOURCE: State of the State's Health, 2000.
a
Rates Calculated per 1,000 Population.
b
Adjusting death rates for age provides a common base for county comparisons.




                                             B-10



                                             F25
                                 Section B, Table 11
                              Hospital Incidence Data for
                                    Atoka County


                                                                  Atoka Memorial
Category                                                                 Hospital

1998 Data

Licensed Beds                                                                  37
Staffed Beds                                                                   25

Admissions                                                                    559
Discharges                                                                    555
Inpatient Days                                                              2,937

Emergency Room Visits                                                       3,723
Outpatient Visits                                                           6,508
Inpatient Surgeries                                                             0
Outpatient Surgeries                                                          102

Medicare Discharges                                                           337
  % of Total Discharges                                                    60.7%
Medicare Inpatient Days                                                     1,814
  % of Total Inpatient Days                                                61.8%

Medicaid Discharges                                                            37
  % of Total Discharges                                                     6.7%
Medicaid Inpatient Days                                                      157
  % of Total Inpatient Days                                                 5.3%

Total Personnel (FTE)                                                          79
Part-Time Personnel                                                            43

Occupancy Rate
Atoka Memorial Hospital                                                    21.7%


SOURCE: Hospital Utilization and Plan Survey, Oklahoma State Dept. of Health, 1998.

                                        B-11

                                         F26
                                       Section B, Table 12
                Hospital Visits based on Patient Origins and Patient Destinations
                                        for Atoka County
                                                                      Hospital Visits
             County of Hospital Reporting*                 Patient Origina   Patient Destinationb
                                                                Atoka Memorial Hospital
Atoka County                                                         519                     519
Bryan                                                                    9                   504
Carter                                                                   0                     4
Choctaw                                                                  0                     0
Cleveland                                                                0                    42
Coal                                                                    22                     0
Craig                                                                    0                     1
Garfield                                                                 0                     2
Hughes                                                                   0                     0
Johnston                                                                 4                     1
Latimer                                                                  0                     0
Le Flore                                                                 0                    21
Love                                                                     0                     0
Marshall                                                                 0                     1
Muskogee                                                                 0                    19
Oklahoma                                                                 0                   104
Okmulgee                                                                 0                    12
Pittsburg                                                                0                   129
Pontotoc                                                                 0                   134
Pushmataha                                                               1                    53
Tulsa                                                                    0                    51

All Others                                                            NA                    N/A

Total Hospital Visits                                                 555                  1,597

Percent - Within Atoka County                                       93.5%                 32.5%

SOURCE: OSDH, Hospital Utilization and Plan Survey, 1998 updated data (Feb. 2000).
            Based on hospitals reporting either admission/discharge data; 86% of OK hospitals
            reported to HUPS in 1998.
a
  Atoka Memorial Hospital visits are based on admissions.
b
  Includes all types of hospitals; i.e. VA, mental Health, Indian service, and Rehabilitation.

                                              B-12


                                              F27
C. EDUCATION DATA




       F28
                                                    Section C, Table 1
                                Education Statistics for School Districts in Atoka County

                       Iowa Test of Basic Skills (ITBS) - Test Scores for State of Oklahoma
                                                            School Districts in Atoka County
96-97
SCHOOL YEAR             State       Atoka       Caney        Farris        Harmony     Lane    Stringtown   Tushka

  3rd GRADE
    Reading              58          57           56            38           42         47        55         52
    Language             68          70           67            39           52         60        82         68
    Social Studies       61          63           61            42           46         46        66         48
    Sources of Info.     64          62           53            61           45         54        66         57
    Math                 66          62           65            46           46         59        64         65
    Science              65          60           68            60           56         52        69         61
    Composite            64          62           62            46           47         51        68         58


  7th GRADE
    Reading              57          48           56            59           58         55        54         68
    Language             59          54           44            61           58         61        47         71
    Social Studies       56          47           50            59           63         52        47         68
    Sources of Info.     57          50           50            42           61         56        46         67
    Math                 58          54           57            55           64         60        36         66
    Science              56          49           48            58           58         55        42         67
    Composite            57          49           50            55           60         57        44         68


SOURCE: OK Office of Accountability, "Profiles 1997 -- District Report."


                                                          C-1

                                                          F29
                                                    Section C, Table 2
                                Education Statistics for School Districts in Atoka County

                       Iowa Test of Basic Skills (ITBS) - Test Scores for State of Oklahoma
                                                            School Districts in Atoka County
97-98
SCHOOL YEAR             State       Atoka       Caney        Farris        Harmony     Lane    Stringtown   Tushka

  3rd GRADE
    Reading              58          52           51            67           50         56        51         51
    Language             68          67           57            77           53         62        64         58
    Social Studies       61          56           47            68           59         57        54         46
    Sources of Info.     63          54           59            70           49         53        54         50
    Math                 66          50           55            78           51         60        77         46
    Science              65          52           64            84           64         43        52         59
    Composite            64          55           55            76           54         54        60         50


  7th GRADE
    Reading              57          40           45            71           61         78        45         70
    Language             59          37           49            76           63         69        57         81
    Social Studies       57          45           44            66           74         77        48         73
    Sources of Info.     57          43           50            66           58         71        50         73
    Math                 58          44           58            72           69         61        46         76
    Science              56          43           40            70           53         79        48         75
    Composite            57          40           47            71           63         74        48         76


SOURCE: OK Office of Accountability, "Profiles 1998 -- District Report."

                                                          C-2


                                                          F30
                                               Section C, Table 3
                           Education Statistics for School Districts in Atoka County

Oklahoma Core Curriculum Tests (OCCT)
                                                     School Districts in Atoka County
96-97
SCHOOL YEAR        State     Atoka        Caney        Farris     Harmony       Lane    Stringtown   Tushka

 5th GRADE
   Math             80         84          100           86           65          73       72          52
   Science          81         84           76           86           40         100       67          74
   Reading          77         89           76           86           60         100       61          70
   Writing          95         97           95           86           90          93       94         100
   History          71         74           29           57           50          80       33          52

 8th GRADE
   Math             72         54           72           89           71         100       33         73
   Science          77         76           83          100           88         100       58         85
   Reading          72         71           59           89           76          92       58         69
   Writing          89         82           93          100           88          92       77         96
   History          58         52           55           67           29          77       17         58

 11th GRADE
   Math             58         58           38          NA           NA          NA        26         78
   Science          72         66           52          NA           NA          NA        37         83
   Reading          75         81           55          NA           NA          NA        68         83
   Writing          94        100           87          NA           NA          NA        90         95
   History          74         86           28          NA           NA          NA        53         78


                SOURCE: OK Office of Accountability, ―Profiles 1997 – District Reports‖

                                                     C-3

                                                     F31
                                                         Section C, Table 4
                                     Education Statistics for School Districts in Atoka County

        Oklahoma Core Curriculum Tests (OCCT)
                                                               School Districts in Atoka County
        97-98
        SCHOOL YEAR          State     Atoka        Caney        Farris     Harmony       Lane    Stringtown   Tushka

         5th GRADE
           Math               82         76           74          100           89         100       87         100
           Science            85         82           74           77           78         100       80          92
           Reading            76         67           65           77           89         100       73          75
           Writing            91         94           79           92          100         100       87          92
           History            73         65           48           85           56          89       53          83
          Geography           57         49           30           54           33          89       40          83
         8th GRADE
           Math               71         52           92           86           80          60       67          84
           Science            78         70           88          100           80          93       87          89
           Reading            75         65           88           86           80          67       93          89
           Writing            91         90          100          100           86         100       93         100
           History            59         42           83           57           85          80       80          53
          Geography           46         42           67           29           70          20       60          74
         11th GRADE
           Math               61         49           31          NA           NA          NA        43         65
           Science            75         69           50          NA           NA          NA        43         76
           Reading            72         72           31          NA           NA          NA        48         71
           Writing            94         97           75          NA           NA          NA        85         94
           History            73         69           44          NA           NA          NA        48         88
          Geography           43         32           13          NA           NA          NA        33         41
          Okla. History       49         47           19          NA           NA          NA        33         47
SOURCE: OK Office of Accountability, "Profiles 1998 - District Reports"
                                                              C-4
                                                               F32
                                                      Section C, Table 5
                                  Education Statistics for School Districts in Atoka County

American College Test Assessment (ACT)
  School
   Year      National    State     Atoka             Caney         Farris     Harmony         Lane   Stringtown   Tushka

   90-91        20.6       20.1
   91-92        20.6       20.0
   92-93        20.7       20.2

   93-94        20.8       20.3
   94-95        20.8       20.3

   95-96        20.9       20.5
   96-97        21.0       20.8         20.9          NA            NA           NA           NA        17.8       19.8
   97-98        21.0       20.5         20.4          17.6          NA           NA           NA        17.1       19.6


SOURCE: OK Office of Accountability, "Profiles 1997, District Reports," "Profiles 1998, District Reports," and OK Dept. of
        Education, Student Assessment, Research, and Planning, April 1997.




                                                             C-5


                                                             F33
                                                      Section C, Table 6
                                            Education Statistics for School Districts
                                                       in Atoka County


               Dropout
              Rates
                   Old          New                                 Atoka County School Districts
      School      (<18)        (<19)
       Year     State Rate   State Rate    Atoka        Caney        Farris      Harmony     Lane   Stringtown   Tushka

      93-94        3.6

      94-95        4.1          5.5

      95-96        4.0          5.4

      96-97        NA           5.6          2.7          0           NA            NA        NA        4.4        1.8

      97-98                     5.5          6.2          0           NA            NA        NA        6.7        5.2


SOURCE: OK Office of Accountability, Dropout Rate Reports for School Years 93-94, 94-95, 95-96, and 94-95, 95-96, 96-96, and
        97-98, and "Profiles 1997 - District Reports" and "Profiles 1998 - District Reports."




                                                              C-6

                                                              F34
                                                 Section C, Table 7
                                       Education Statistics for School Districts
                                                  in Atoka County


                                           High School Graduation Rates
                                                               Atoka County School Districts
School    National       State
 Year      Rate          Rate         Atoka        Caney        Farris      Harmony     Lane    Stringtown    Tushka

90-91                   78.5%
91-92                   79.4%
92-93                   77.1%
93-94                   77.1%
94-95      68.8%        75.0%
95-96                   74.0%
96-97      67.6%        72.9%        78.9%         89.0%         NA            NA        NA       124.4%      103.1%
97-98       NA          73.4%        66.7%        101.8%         NA            NA        NA       114.1%      103.7%


   SOURCE: OK Office of Accountability, "Profiles 1997 - District Reports" and "Profiles 1998 - District Reports,"
         and Okla. State Dept. of Education Graduation Rates, 1991-1998.




                                                         C-7


                                                         F35
                                                   Section C, Table 8
                                                   Education Statistics


           School Enrollment (Average Daily Membership and Number of Schools in Atoka County
                                          School Districts
                                                             School Districts in Atoka County

                         State       Atoka       Caney           Farris   Harmony       Lane      Stringtown      Tushka
      SCHOOL
   ENROLLMENT
     Year 94-95         599,455
     Year 95-96         604,723
     Year 96-97         615,607       954          305            90        202          190         246           347
     Year 97-98         618,240       898          291            92        204          215         237           345
    % Change from
    96-97 to 97-98       0.4%        -5.8%        -4.6%          3.1%       1.0%       12.8%        -3.8%         -0.7%

    NUMBER OF
     SCHOOLS

      Elementary                       2            1              1          1           1           1             1

    Middle/Jr. High                    1            0              0          0           0           0             0

     High School                       1            1              0          0           0           1             1


SOURCE: OK Office of Accountability, "Profiles 1997 - District Reports" and "Profiles 1998 - District Reports."


                                                           C-8

                                                           F36
                                                     Section C, Table 9
                                            Education Statistics for Atoka County

Juvenile Offenders, Average Number of Offenses per Offender, and Gang Activity
                                                          School Districts in Atoka County

                        State       Atoka         Caney           Farris    Harmony      Lane     Stringtown      Tushka
For 96-97
School Year

Offenders/School
 Enrollment             49.5        43.0           44.0            0.0         0.0       85.0         49.4         38.7
Average No.
 of Offenses             2.0         1.3            1.4            0.0         0.0        1.0         1.4          1.1
% Involved -
 Gang Activity          4.0%        0.0%           0.0%           0.0%        0.0%       0.0%        0.0%         0.0%

For 97-98
School Year

Offenders/School
 Enrollment             47.5        32.4           292.0           0.0         0.0       32.8         48.4        167.5
Average No.
 of Offenses             2.0         1.8            2.0            0.0         0.0        1.2         1.0          1.0
% Involved -
 Gang Activity          4.0%        4.0%           0.0%           0.0%        0.0%       0.0%        0.0%         0.0%


SOURCE: OK Office of Accountability, "Profiles 1997 - District Reports" and "Profiles 1998 - District Reports."

                                                            C-9

                                                            F37
                                                 Section C, Table 10
                                         Education Statistics for Atoka County

Average Salaries of Teachers for State of Oklahoma and Atoka County School Districts
                                                        School Districts in Atoka County
  School
    Year         State        Atoka         Caney       Farris       Harmony        Lane       Stringtown     Tushka

    94-95      $30,269

    95-96      $30,814

    96-97      $30,221      $28,729       $28,741       $28,845       $29,045      $29,156      $28,908      $29,754

    97-98      $30,529      $29,421       $29,230       $29,671       $30,678      $31,333      $29,176      $31,587


SOURCE: OK State Office of Accountability, "Profiles 1997 - District Reports" and "Profiles 1998 - District Reports."




                                                         C-10


                                                          F38
D. TRAFFIC ACCIDENT DATA




           F39
                               Section D, Table 1
                              Traffic Accident Facts
                   for Atoka County and the State of Oklahoma


Traffic Fatalities (Deaths)
             Year                    Atoka County               State of Oklahoma

            1988                                 4                           643
            1989                                 6                           656
            1990                                 3                           649
            1991                                 5                           649
            1992                                 6                           619
            1993                                 8                           672
            1994                                 2                           695
            1995                                 8                           674
            1996                                10                           775
            1997                                 6                           846
            1998                                 7                           769


SOURCE: OK Dept. of Public Safety, " OK Traffic Accident Facts," 1993 & 1994;
        "OK Traffic Crash Facts," 1995-1996; "OK Crash Facts," 1997 & 1998.




                                      D-1



                                      F40
                                    Section D, Table 2
           Traffic Accident Facts for Atoka County and the State of Oklahoma

Number of Persons Injured by Highway Class
Atoka COUNTY                      1993     1994        1995     1996     1997        1998

US Highways                          74          40      85       89           40      47
Interstate Highways                   0           0       0        0            0       0
Turnpikes                             1           0       5        2            0       2
State Highways                       60          50      45       65           35      67
County Roads                         71          51      52       45           40      44
City Streets                         22          11      15       10            5      43
U. S. Hwy. & City St.                                                          16     116
State Hwy. & City St.                                                           1      19

TOTALS                             228          152     202      211       137        338

STATE OF OKLAHOMA                 1993      1994       1995     1996     1997        1998

US Highways                      4,858      5,034      5,524    5,787    3,497       4,232
Interstate Highways              3,766      3,667      4,034    4,473    3,933       6,376
Turnpikes                          411        477        484      717      670       1,240
State Highways                   4,492      4,757      4,926    5,395    3,785       4,460
County Roads                     4,869      5,033      5,475    5,554    5,496       6,462
City Streets                    28,147     29,130     31,018   31,338   30,342      50,636
U. S. Hwy. & City St.                                                    2,672       4,504
State Hwy. & City St.                                                    1,685       2,466

TOTALS                          47,147     48,098     51,461   53,264   52,080      80,376


SOURCE: OK Dept. of Public Safety, "OK Traffic Accident Facts," 1993 & 1994; "OK
        Traffic Crash Facts," 1995 & 1996; "OK Trash Facts," 1997 & 1998.




                                          D-2



                                          F41
                                                     Section D, Table 3
                            Traffic Accident Facts for Atoka County and the State of Oklahoma
Collisions (Crashes) by Injury Severity
Atoka COUNTY                         1994     1995      1996              1997                        1998
                                                                  OHP Non-OHP         Total      OHP Non-OHP          Total
Killed
  OHP                                    2        6         6        5                               5
  Mun                                    0        1         3                    0                               2
  Subtotal Killed                        2        7         9                             5                                  7
Injured
  OHP                                  78       78         98
  Mun                                  18       33         26
    Incapacitating Crashes                                          16           3       19        17           4           21
            NonIncapacitating Crashes                               41           3       44        39          12           51
    Possible Injury Crashes                                         16           5       21        20          31           51
    Non-Injury Crashes                                              83         12        95        80         127          207
    Unknown Injury Crashes                                           0           0        0         0           1            1
  Subtotal Injured                     96      111        124      156         23      179        156         175          331
Property Damage
  OHP                                  60       64         66
  Mun                                  29       61         31
  Subtotal Property Damage             89      125         97
TOTAL (All Three)                     187      243        230      161         23      184        161     177              338
STATE OF OKLAHOMA                    1994     1995      1996              1997                        1998
                                                                  OHP Non-OHP         Total      OHP Non-OHP          Total
Killed
  OHP                                 440      445        489      538                            475
  Mun                                 172      156        187                 191                             182
  Subtotal Killed                     612      601        676                          729                                 657
Injured
  OHP                           9,043        9,596    10,506
  Mun                          20,883       22,220    22,320
   Incapacitating Crashes                                         1,784      1,900     3,684     1,624      1,740     3,364
            NonIncapacitating Crashes                             4,224      7,316    11,540     4,327      7,002    11,329
   Possible Injury Crashes                                        4,392     12,604    16,996     4,242     12,693    16,935
   Non-Injury Crashes                                            10,961     33,606    44,567    11,470     34,335    45,805
   Unknown Injury Crashes                                           329      1,910     2,239       352      1,934     2,286
  Subtotal Injured             29,926       31,816    32,826     21,690     57,336    79,026    22,015     57,704    79,719
Property Damage
  OHP                           9,623       10,088    11,219
  Mun                          34,170       35,207    35,671
  Subtotal Property Damage     43,793       45,295    46,890         n/a        n/a       n/a
TOTAL (All Three)              74,331       77,712    80,392     22,228     57,527    79,755    22,490     57,886    80,376
 SOURCE: OK Dept. of Public Safety, "OK Traffic Accident Facts," 1993 & 1994; "OK Traffic Crash Facts," 1995 & 1996; "OK
         Crash Facts," 1997 & 1998.
                                                           D-3
                                                           F42
                                                Section D, Table 4
                       Traffic Accident Facts for Atoka County and the State of Oklahoma

Injuries by Severity
Atoka CO.                1993     1994    1995     1996            1997                   1998
                                                                    Non-                   Non-
                                                            OHP     OHP      Total    OHP  OHP      Total
Killed
 OHP                                 2        7        7       6
 Mun                                 0        1        3                0
 Total Killed                8       2        8       10                         6                     7

Injured
  OHP                              121      135     168
  Mun                               31       67      43
  Incapacitating                                              19        3      22       21      6     27
          Non-Incapacitating                                  73       10      83       63     13     76
  Possible Injuries                                           25        7      32       43     48     91
  Total Injured         228        152      202     211      117       20     137      127     67    194

Total                     236      154      210     221      123       20     143      127     67    201

OKLAHOMA                 1993     1994    1995     1996 1997                         1998
                                                                    Non-                     Non-
                                                            OHP     OHP      Total    OHP    OHP    Total
Killed
  OHP                   N/A    509    502    571    636
  Mun                   N/A    186    172    204           210
  Total Killed          672    695    674    775                  846                  769
Injured
  OHP                   N/A 14,966 16,062 17,435
  Mun                   N/A 33,132 35,399 35,829
  Incapacitating                                  2,524 2,394 4,918 2,268 2,197 4,465
          Non-Incapacitating                      6,802 10,800 17,602 6,871 10,036 16,907
  Possible Injuries                               8,035 21,528 29,563 7,635 21,242 28,877
  Total Injured      47,147 48,098 51,461 53,264 17,361 34,722 52,083 16,774 33,475 50,249

Total                  47,819 48,793 52,135 54,039 17,997 34,932 52,929 16,774 33,475 51,018

 SOURCE: OK Dept. of Public Safety, "OK Traffic Accident Facts," 1993 &1994;
        "OK Traffic Crash Facts," 1995 & 1996; "OK Crash Facts," 1997 & 1998.
                                               D-4


                                                     F43
                                          Section D, Table 5
                 Traffic Accident Facts for Atoka County and the State of Oklahoma
Alcohol-Related and NonAlcohol-Related Fatalities and Injuries*
Atoka COUNTY                                1993      1994      1995       1996    1997            1998
Alcohol-Related
 Fatalities                                     3         0         2          1      3               1
 Injuries                                      32        20        23         24
   Incapacitating Injury                                                              2               0
   Non-Incapacitating Injury                                                          4               7
   Possible Injury                                                                    3               1
   No Injury                                                                         17              15
   Unknown                                                                            1               0
Total Alcohol-Related                          35        20        25         25     30              24
NonAlcohol-Related
 Fatalities                                   n/a         2         6          9      3               6
 Injuries                                     n/a      132       179        187
   Incapacitating Injury                                                             20              27
   Non-Incapacitating Injury                                                         79              69
   Possible Injury                                                                   29              89
   No Injury                                                                        165             423
   Unknown                                                                           19               7
Total NonAlcohol-Related                               134       185        196     315             621
STATE OF OKLAHOMA                            1993       1994      1995         1996      1997      1998
Alcohol-Related
 Fatalities                                   199         204       165          162      200       172
 Injuries                                   4,382       4,282     4,246        4,447
   Incapacitating Injury                                                                   846       848
   Non-Incapacitating Injury                                                             2,002     2,068
   Possible Injury                                                                       1,806     1,856
   No Injury                                                                             4,015     4,027
   Unknown                                                                                 575       104
Total Alcohol-Related                       4,581       4,486     4,411        4,609     9,444     9,075
NonAlcohol-Related
 Fatalities                                    n/a       491        509       613         646       597
 Injuries                                      n/a    43,816     47,215    48,817
   Incapacitating Injury                                                                 4,072     3,610
   Non-Incapacitating Injury                                                            15,600    14,712
   Possible Injury                                                                      27,757    26,857
   No Injury                                                                           100,801   100,243
   Unknown                                                                              13,320     3,075
Total NonAlcohol-Related                              44,307     47,724    49,430      162,196   149,094
SOURCE: OK Dept. of Public Safety, "OK Traffic Accident Facts," 1993 & 1994;
       "OK Traffic Crash Facts," 1995 & 1996; "Ok Crash Facts," 1997 & 1998.
                                                  D-5

                                                  F44
                                                  Section D, Table 6
                         Traffic Accident Facts for Atoka County and the State of Oklahoma
Unsafe Speed and Alcohol-Related Accidents (Primary Drivers Only)
ATOKA COUNTY                                    1993          1994         1995         1996               1997    1998
Unsafe Speed
 Drivers Involved                                  46           40            36          37                 53      45
 Total Injured                                     53           34            43          33                 53      40
   Incapacitating Injury                                                                                      2       6
   Non-Incapacitating Injury                                                                                 13       9
   Possible Injury                                                                                            7      10
   No Injury                                                                                                 31      15
   Unknown                                                                                                    0       0
 Total Killed                                       4            0             1           1                  0       5
Alcohol-Related
 Drivers Involved                                  19           15            12          21                 17      18
 Total Injured                                     23           10            11          22                 15      17
   Incapacitating Injury                                                                                      3       0
   Non-Incapacitating Injury                                                                                  3       6
   Possible Injury                                                                                            1       1
   No Injury                                                                                                  8      10
   Unknown                                                                                                    0       0
 Total Killed                                       2            0             0           1                  2       1
STATE OF OKLAHOMA                               1993            1994         1995           1996           1997    1998
Unsafe Speed
 Drivers Involved                               8,534           8,110        9,688        10,214          14,361   9,996
 Total Injured                                  6,718           6,579        7,939         8,043          14,201   9,811
   Incapacitating Injury                                                                                     592     632
   Non-Incapacitating Injury                                                                               1,863   2,026
   Possible Injury                                                                                         2,396   2,161
   No Injury                                                                                               9,068   4,639
   Unknown                                                                                                   282     353
 Total Killed                                     159            150          168            238             160     185
Alcohol-Related
 Drivers Involved                               3,068           3,050        3,350         3,627           4,655   4,546
 Total Injured                                  2,743           2,624        3,062         3,192           4,553   4,399
   Incapacitating Injury                                                                                     457     549
   Non-Incapacitating Injury                                                                                 998   1,201
   Possible Injury                                                                                           644     860
   No Injury                                                                                               2,415   1,766
   Unknown                                                                                                    39      23
 Total Killed                                     104            106          114            130             102     147
 SOURCE: OK Dept. of Public Safety, "OK Traffic Accident Facts," 1993 & 1994; "OK Traffic Crash Facts,"
       1995 & 1996; "OK Crash Facts," 1997 & 1998.
                                                          D-6


                                                          F45
                                    Section D, Table 7
           Traffic Accident Facts for Atoka County and the State of Oklahoma

Persons Injured in Crashes Involving a School Bus
Atoka COUNTY                            1994      1995       1996      1997    1998

Unknown Injury                            0          0           0         0     0
No Injury                                 0          2           0         0     0
Possible Injury                           0          0           0         0     0
Non-Incapacitating Injury                 0          1           0         0     0
Incapacitating Injury                     0          0           0         0     0
Fatal Injury                              0          0           0         0     0

Total Injuries                            0          3           0         0     0

STATE OF OKLAHOMA                     1994       1995        1996      1997    1998

Unknown Injury                           61         53         58        50       1
No Injury                               517        545        566       503      10
Possible Injury                         118        253        214       174      95
Non-Incapacitating Injury                50         75        121       105     180
Incapacitating Injury                    16         10          8         9     558
Fatal Injury                              1          2          2         3      59

Total Injuries                          763        938        969       844     903


SOURCE: OK Dept. of Public Safety, "OK Traffic Accident Facts," 1993 & 1994;
       "OK Traffic Crash Facts," 1995 & 1996; "OK Crash Facts," 1997 & 1998.




                                         D-7



                                         F46
E. CRIME DATA




     F47
                                                     Section E, Table 1
                                              Crime Incidence for Atoka County

Oklahoma Crime Index Offenses for Atoka County Law Enforcement Agencies
                                   Total                                                                         Motor
                                  Crime        Crime                          Felonious Breaking &              Vehicle
  Agency     Year Population Index Rate/1,000 Murder             Rape Robbery   Assault    Entering   Larceny    Theft

TOTALS
Atoka        1996        13,305     269        20.22       1         0        0             22   66      156        24
 County      1997        13,368     261        19.52       0         0        2              8   86      144        21
             1998        13,456     256        19.02       0         0        1              6   92      142        15
Sheriff’s    1996         9,295     149        16.03       1         0        0             16   48       64        20
 Office      1997         8,966     117        13.05       0         0        2              6   61       39         9
             1998         9,405      75         7.97       0         0        0              2   33       34         6
Atoka        1996         4,010     120        29.93       0         0        0              6   18       92         4
  Police     1997         4,029     137        34.00       0         0        0              2   23      101        11
  Dept.      1998         3,392     153        45.11       0         0        1              1   51       93         7
Stringtown   1996                                         Reported through County SO.
  Police     1997          373        7        18.77       0         0        0              0    2        4         1
  Dept.      1998          383       11        28.72       0         0        0              1    6        3         1
Tushka       1996                                         Reported through County SO.
  Police     1997                                         Reported through County SO.
  Dept.      1998          276       17        61.59       0         0        0              2    2       12         1


SOURCE: Oklahoma State Bureau of Investigation, Oklahoma Crime Index Offenses, 1996-1998.




                                                                 E-1


                                                                 F48
APPENDIX G
        Minutes of Strategic Health Planning Steering Committee for
                  _______________ medical community
                                   May 4, 19956, 7 pm, City Hall


1.   Attendance:




     Resource Team Attendance:
           Richard Perry, Rural Health Projects, Inc., Enid
           Cheryl St. Clair, Okla. Cooperative Ext. Service, Stillwater
           Stan Ralstin, Okla. Cooperative Ext. Service, Enid
           Gerald A. Doeksen, Okla. Cooperative Ext. Service, Stillwater
           Mary Jac Rauh, Rural Health Projects, Inc., Enid

3.   Notebooks containing reports from the three committees and the economic impact of the health service
     sector on the economy of _______________ and surrounding medical service were handed to each
     member of the Steering Committee. The importance of the health sector to the economy of the medical
     service area was presented by Gerald Doeksen.

4.   The Data and Information Committee identified the following list:
            High Rate of Motor Vehicle Accidents
            High Rate of Cancer
            High Rate of Diabetes
            High Rate of Teen Births
            High Rate of Child Abuse
            High Rate of Infant Mortality
            High Incidence of Heart Cases

5.   The health Survey Committee identified the following list:
             Low Utilization of Preventive Services
             Distance to Services
             Exercise (Positive point that No. that exercise is so high)
             Promotion of Health Education
             Tobacco Use
             Public Relations of ___________ Hospital Services
             No. Responding to ―All Services Available‖ at _________ Hospital seemed unrealistic to the
                members

6.   The Inventory Committee identified the following list:
             Age Increasing-Nursing Homes
             Nutrition Education-Diabetes, especially Indian population
             Education/Prevention – Alcohol – Speed - Car Wrecks - Teens: Consider Alternative
               Activities for Teens
                                                   G1
                  Community Quality of Life – Recruitment, Professional, Support
                  Prenatal Care – Adequate?? In ________ County (Entry)
                  Cervical Cancer – Screening – Health Dept. Mobile – Health Board on Nutrition and
                   Prevention

7. The three lists were consolidated into one master list, eliminating any duplications and overlaps, as follows:
                Motor Vehicle Accidents
                Cancer
                Diabetes
                Heart/Circulatory
                Prenatal Care/ Infant Mortality
                Teen Births
                Child Abuse
                Excellent Quality of Care in ________ Hospital
                Health Education/Nutrition/Wellness/Prevention/Healthy Lifestyle
                Quality Nursing Home Care/Retirement Facilities
                Public Relations of ________ Hospital
                Distance to Service
                Professional/Business Recruitment
                Non-Insured/Under-Insured

8.     Each member of the group was allowed three votes to identify their priorities, resulting in the following
       list:
                                                             Votes
             Health Education                                    8
             Nursing Home/Retirement Facility                    8
             Motor Vehicle Accidents                             3
             Public Relations - ________ Hospital                3
             Professional/Business Recruitment                   3
             Child Abuse                                         1
             Non-Insured                                         1
             Cancer                                              1
             Heart                                               1
             Teen Births                                         1

9.     Due to the late hour, if was decided that another meeting would be scheduled to discuss what can be
       done for a few of the top issues (possibly only 3 issues). The Resource Team will bring to this meeting
       suggestions/proposed solutions for each issue in the final list. Each Steering Committee Member is
       encouraged to bring his/her own suggestions/proposed solutions.

10.    Next meeting is Tuesday, June 6, 1995, at 7 pm. Each Steering Committee Member is
       encouraged to invite the participation of other members of the community at the next meeting. The
       meeting is open to anyone within the defined medical service area, whether they are a provider of
       medical services or a user of medical services.




                                                       G2
   Minutes of Strategic Health Planning Steering Committee for
             _______________ medical community
                                          June 7, 1995

23 community residents attended including __________ who will be moving to __________
soon if all the paper work can be completed.

Resource team: Mike Brown (OSDH), Mary Jac Rauh and Richard Perry.

The health planning process to date was reviewed and manuals with corrected Inventory section
were handed out to new taskforce attendees.

A short film on rural health issues was shown and the solutions (EACH/RPCH and Community
Health Organizations) were discussed with the group.

The priorities set by the group at the last meeting were reviewed and discussed. Issues not put
on the priority list last time but added during this meeting included:
         No health department
         Little Native American participation

1. Regarding the priority item, ―Nursing Homes‖, there was a great deal of discussion:
        Part of the roof at the ___________ nursing home has fallen in. The group was very
concerned about the quality of care being provided. They inquired as to the process of getting a
state health department inspection of the nursing home and whether a petition would help in
getting an inspection done.
        Mike Brown explained the inspection process and offered to organize a meeting with the
inspector and get a copy of the NH facility/care standards for the group. Such a meeting was
requested along with some discussion of the Certificate of Need process and the financial
feasibility of building a new facility.
        The different levels of long term care were discussed: home health care, day care,
assisted living (none requiring a Certificate of Need), and the three levels of nursing home care –
intermediate (traditional), skilled and sub-acute (all requiring a CON from the state health
department).
        Long term care alternatives all have their own staffing requirements, thus requiring that a
community also be able to attract younger people to work in the facility. A range of long-term
care options would also create a demand for additional hospital services.
        __________ discussed the concept of ―swing beds‖, using hospital beds for short-term
nursing home care. The hospital is looking at this option now.
        Eldercare services were also discussed – assessment and case management rather than
direct services.
        The group wants to focus on nursing home and retirement options for now. There was
some discussion that there was enough money in the community to build a good nursing
home/retirement center if the idea was sound and well presented.


                                                G3
2. Health Department – Mike Brown shared some ―thoughts‖ on the development of health
department services in _ County.
         He stressed that the local health department is a County health department with a board
made up of county commissioners, health providers, and other community members. They must
assume a large responsibility for designing local services.
         Usually health departments are partially supported by property taxes, but now counties
can pass a sales tax to support services. This is probably the best way as it spreads the tax
burden out on everyone.
         One idea might be to develop a ―mini‖ health department with fewer services and shared
staff, even shared space, with the hospital. WC is now contracted through the hospital.
         To pass a tax there needs to be a grass roots committee pushing the idea and lots of public
relations to explain the need.
         Mike Brown is available to the group to keep the discussion alive if more health
department services are wanted.

3. Health Education – Mary Jac Rauh presented the PATCH/AmeriCorps program as a possible
way to get a full time person assigned to the community to assist in community health education.
 She handed out applications and encouraged people to consider being an AmeriCorps member.

No definite date was set for the next meeting. A committee was formed to work with Mike
Brown to set and plan a meeting to discuss nursing homes. Will work around harvest.

                                                                                    R***** P****




                                                G4
REFERENCES
             COMMUNITY HEALTH PLANNING REFERENCES


Alabama County Health Councils Handbook, Handbook Development Team: E. G. Hooten, S.
      R. Raftery, and W. McCord of Alabama Cooperative Extension Service, and V. Stalker of
      the University of Alabama at Birmingham, Spring 1992.

The Community Benefit Network Ivinson Memorial Hospital, 255 No. 30th St., Laramie, WY.

Community...planting the seeds for good health, A Guide for Development, Assessing and
    Improving Health Status, The Hospital Association of Pennsylvania.

Coordinator's Guide, A Guide for the PATCH Local Coordinator, The Planned Approach to
      Community Health, U. S. Department of Health and Human Services, Public Health
      Service, Centers for Disease Control, National Center for Chronic Disease Prevention and
      Health Promotion, Division of Chronic Disease Control and Community Intervention,
      Atlanta, GA 30333, Draft, July 1992.

The Entrepreneurial Community: A Strategic Leadership Approach to Community Survival,
      Heartland Center for Leadership Development.

Healthy Futures - A Development Kit for Rural Hospitals, written by Paul B. McGinnis,
      Mountain States Health Corporation.

Hometown Health -- Community-Based Health Care Planning, A Facilitator's Guide
     developed cooperatively by Center for Rural Health and Primary Care, Iowa Department of
     Public Health, Iowa State University Extension to Communities, and Iowa State University
     Social and Behavioral Research Center for Rural Health, EDC-8/September 1994.

Implementing a Community-Based Approach to Strengthening Rural Health Services: The
      Community Health Services Development Model, written by Bruce A. Amundson, Amy
      Hagopian, Deborah G. Robertson, WAMI Rural Health Research Center, Department of
      Family Medicine, Research Section, University of Washington HQ-30, Seattle, WA 98195,
      Rural Health Working Paper Services, Working Paper #1, February 1991.

Measuring the Economic Importance of the Health Sector on a Local Economy: A Brief
     Literature Review and Procedures to Measure Local Impacts by Gerald A. Doeksen,
     Tom Johnson, and Chuck Willoughby, funded by Southern Rural Development Center,
     1997.

Organizing Communities for Change: A Guide for Action by Center for Rural Health,
      University of North Dakota School of Medicine.

Plugging the Leaks in Health Care: Harnessing Economic Opportunity in Rural America, A
       Project of the Center for the New West, Denver Center, 600 World Trade Center, 1625
       Broadway, Denver, CO 80202, Funded by The Colorado Trust, December 1992.
Rural Health Challenges in the 1990's, Strategies from the Hospital-Based Rural Health Care
      Program, Robert Wood Johnson Foundation.

				
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