2013-2017 COMMUNITY HEALTH ASSESSMENT November 2013 SULLIVAN COUNTY PUBLIC HEALTH SERVICES 50 Community Lane, Liberty, NY 12754 (845) 292-5910 Sullivan County Public Health Services Community Health Assessment Page 1 November 2013 Sullivan County Public Health Services Community Health Assessment November 2013 TABLE OF CONTENTS Executive Summary 3 Community Health Needs Assessment Overview 4 Secondary Data Profile 7 Community Survey 24 A. Focus Groups Overview 39 B. Minority Health Profile 43 Identification of Community Health Needs & Planning 70 Compendium of Health Resources 73 Appendix A: Secondary Data Profile References 105 Appendix B: Community Survey Statistical Considerations 107 Appendix C: Community Survey Participant Demographics 108 Appendix D: Prioritization Session Participants 109 Appendix E: Additional Community Resources for Youth and Families 110 Page 2 Sullivan County Public Health Services Community Health Assessment November 2013 EXECUTIVE SUMMARY Sullivan County Public Health Services led a comprehensive Community Health Assessment (CHA) to evaluate the health needs of individuals living in Sullivan County beginning in 2013. The aim of the assessment is to reinforce Sullivan County Public Health Services’ commitment to the health of Sullivan County residents and to align its health prevention efforts with the community’s greatest needs. The assessment examined a variety of indicators including risky health behaviors (alcohol use, tobacco use) and chronic health conditions (diabetes, heart disease). The completion of the CHA enabled Sullivan County Public Health Services to take an in-depth look at its greater community. The findings from the assessment were utilized to prioritize public health issues and develop a community health improvement plan focused on meeting community needs. Sullivan County Public Health Services is committed to the people it serves and the communities where they reside. Healthy communities lead to lower health care costs, robust community partnerships, and an overall enhanced quality of life. This CHA Final Summary Report serves as a compilation of the overall findings of each research component. CHA Components Secondary Statistical Data Profile of Sullivan County, New York Community Survey with 752 residents Focus Group Discussions with 14 Rural Health Network representatives and 5 young adult community members Compendium of Health Resources Minority Health Profile of Sullivan County, New York Prioritization Session Community Health Improvement Plan (CHIP) Prioritized Health Issues Based on the feedback from community partners including health care providers, public health experts, health and human service agencies, and other community representatives, Sullivan County Public Health Services plans to focus community health improvement efforts on the following health priorities over the next five-year cycle: Prevent chronic disease Promote healthy women, infants, and children Promote mental health and prevent substance abuse Documentation A final report of the CHA was made public in November 2013. The Community Health Improvement Plan was also developed and adopted by each appropriate authority in November 2013. Both documents can be found at http://co.sullivan.ny.us/. Page 3 Sullivan County Public Health Services Community Health Assessment November 2013 COMMUNITY HEALTH ASSESSMENT OVERVIEW Background Sullivan County Public Health Services is committed to serving the residents of Sullivan County, New York. They currently offer a wide-range of programs and services designed to improve the overall health status of the community and enhance resident’s access to care. The programs and services that are offered by Sullivan County Public Health Services include: Core Public Health Services o Childhood Lead Poisoning and Prevention Program o Epidemiology Program o HIV Counseling and Testing Program o Immunization Program o Sexually Transmitted Infection Program o Tuberculosis Control Program Certified Home Health Agency o Offer the sole Certified Home Health Agency in the county for individuals recovering from an illness or injury, or individuals who are disabled and/or chronically ill Long Term Home Health Care o Provides home-based services to individuals who would otherwise be placed in a skilled or residential health care facility for an extended period of time Women, Infants & Children (WIC) Program o Provides nutritional assessment, education, and food vouchers to eligible women and infants and children under the age of five Early Care Program o Identifies and provides services to children experiencing developmental delays, and connects parents of children with special health care needs to support services and educational opportunities Healthy Families of Sullivan Program o A family support home visiting program that encourages strong parent-child interaction and development Community Health Worker Program o Assists in connecting pregnant women to the services they need Car Seat Program o Provides free car seats to eligible residents and free checks for proper fitting of care seats Health Education o Provides services and programs designed to ensure the well-being of residents Page 4 Sullivan County Public Health Services Community Health Assessment November 2013 CHA Partners Sullivan County Public Health Services is an active partner of the Sullivan County Rural Health Network. The Rural Health Network is dedicated to improving the health status of Sullivan County residents by increasing access to coordinated, cost effective health care services. The Network, which is comprised of representatives from the community organizations listed below, was engaged in the CHA process through the development and distribution of the resident survey, focus group discussions, the prioritization of key community issues, and the development of the CHIP framework. Community organizations are presented in alphabetical order. CACHE Catskill Regional Medical Center Family Empowerment Council, Inc. Hospice of Orange & Sullivan Counties, Inc. Hudson River HealthCare, Inc. Hudson Valley Community Services Maternal Infant Services Network PRASAD Children’s Dental Health Program Sullivan County BOCES Sullivan County Center for Workforce Development Sullivan County Child Care Council Sullivan County Community College Sullivan County Department of Community Services Sullivan County Office for the Aging Sullivan County Youth Bureau The Recovery Center United Way of Sullivan County In addition, Sullivan County Public Health Services collaborated with Greater Hudson Valley Health System (which includes Catskill Regional Medical Center) in conducting the CHA. The two partners shared resources and the results of their individual and joint research efforts so as to avoid duplicating efforts and to work in a more effective manner. The partners will continue their collaborative efforts through the strategies presented in the CHIP. Methodology The CHA was comprised of both quantitative and qualitative research components. A brief synopsis of the research components is included below with further details provided throughout the document. Quantitative Data: A Statistical Secondary Data Profile depicting population and household statistics, education and economic measures, morbidity and mortality rates, incidence rates and other health statistics for Sullivan County, New York was compiled. A Community Survey was conducted with 752 community residents. The survey was modeled after the Health Care Efficiency and Affordability Law for New Yorkers (HEAL NY) project and custom questions developed by Sullivan County Public Health Services. A Compendium of Health Resources was developed to document the assets in Sullivan County that can be employed to address the identified health issues. Page 5 Sullivan County Public Health Services Community Health Assessment November 2013 A Minority Health Profile depicting health needs, outcomes, and risky health behaviors among minority population, and disparities that may exist. Qualitative Data: Two Focus Groups were held with 14 Rural Health Network representatives and 5 young adult community residents in September 2013. Research Partner Sullivan County Public Health Services contracted with Holleran, an independent research and consulting firm located in Lancaster, Pennsylvania, to conduct research in support of the CHA. Holleran has 21 years of experience in conducting public health research and community health assessments. The firm provided the following assistance: Collected and interpreted secondary data Conducted, analyzed, and interpreted data from the community survey Assisted in the update of a community compendium of health resources Conducted focus groups with community members Facilitated a prioritization session Prepared all reports Community Representation Community engagement and feedback were an integral part of the CHA process. Sullivan County Public Health Services sought community input through a community health survey, focus groups with community representatives, and inclusion of community leaders in the prioritization and improvement planning process. Public health and health care professionals shared knowledge and expertise about health issues, and leaders and representatives of nonprofit and community-based organizations provided insight on the community, including the medically underserved, low income, and minority populations. Research Limitations It should be noted that the availability and time lag of secondary data may present some research limitations. Additionally, language barriers, timeline, and other restrictions may have impacted the ability to survey all community stakeholders. Sullivan County Public Health Services sought to mitigate limitations by including representatives of diverse and underserved populations throughout the research components. Prioritization of Needs Following the completion of the CHA research, Sullivan County Public Health Services prioritized community health issues and developed a community health improvement plan to address prioritized community needs. Page 6 Sullivan County Public Health Services Community Health Assessment November 2013 SECONDARY DATA PROFILE OVERVIEW Background One of the initial undertakings of the CHA was to create a secondary data profile. Secondary data is comprised of data obtained from existing resources and includes demographic and household statistics, education and income measures, morbidity and mortality rates, and health indicators, among other data points. The data was gathered and integrated into a graphical report to portray the current health and socio-economic status of residents in Sullivan County, New York. Secondary data was collected from reputable sources including the U.S. Census Bureau, Centers for Disease Control and Prevention (CDC), New York State Department of Health, and the Robert Wood Johnson Foundation. Data sources are listed throughout the report and a full reference list is included in Appendix A. The data represents a point in time study using the most recent data possible. When available, trending data and state and national comparisons are provided as benchmarks. The profile details data covering the following areas: Demographic/Socioeconomic Statistics Mortality Statistics Maternal & Child Health Statistics Sexually Transmitted Illness & Communicable Disease Statistics Mental Health Statistics Cancer Statistics Environmental Health Statistics Health Care Access Statistics Crime Statistics Secondary Data Profile Key Findings This section serves as a summary of the key takeaways from the secondary data profile. A full report of the findings is available in a separate document. Sociodemographic Statistics Demographics According to the U.S. Census Bureau, the total population in Sullivan County is 76,793, a slight increase of 3.8% since 2000. The majority of residents identify as White (80.4%), indicating a less racially diverse population when compared to all of New York and the nation. Approximately 8% of residents identify as Black/African American and 14% identify as Hispanic or Latino. The primary spoken language is English, but 15% of residents speak another language. The median age in Sullivan County is 41.8, which denotes an older population when compared to New York (median age of 38) and the nation (median age of 37.2) (U.S. Census Bureau, 2012). Page 7 Sullivan County Public Health Services Community Health Assessment November 2013 Table 1. Racial Breakdown of Overall Population (2009-2012)a U.S. New York Sullivan County White 74.2% Black/African American 12.6% 4.8% 4.8% 16.4% 65.9% 15.6% 80.4% 8.3% 7.4% 8.2% 17.7% 1.6% 5.6% 13.6% Asian Other Race Hispanic or Latino (of any race)b Source: U.S. Census Bureau, 2012 a b Percentages may equal more than 100% as individuals may report more than one race Hispanic/Latino residents can be of any race, for example, White Hispanic Figure 1. Percentage of population speaking a language other than English, 2009-2011 Source: U.S. Census Bureau, 2012 Household Statistics Sullivan County is comprised primarily of family households (64.5%), which are defined as more than one person living together, either as relations or as a married couple. Family and nonfamily households occupy approximately 61% of the available housing units in the county. As a result, 38.8% of the housing units in Sullivan County are vacant, which compares to 11% across all of New York and 12.8% across the nation. The median value for owner-occupied units is $179,000, which is lower than the median value across the state ($294,400), but similar to that of the nation ($179,500) (U.S. Census Bureau, 2012). Page 8 Sullivan County Public Health Services Community Health Assessment Figure 2. Percentage of vacant housing units, 2009-2011 Source: U.S. Census Bureau, 2012 Figure 3. Median value for owner-occupied unit, 2009-2011 Source: U.S. Census Bureau, 2012 Page 9 November 2013 Sullivan County Public Health Services Community Health Assessment November 2013 Approximately 47% of Sullivan County residents ages 15 years and over are currently married, which is comparable to New York (45%) and the nation (49%). However, among residents who have been married, a slightly higher percentage are divorced (11.0%) when compared to New York (8.5%) (U.S. Census Bureau, 2012). Figure 4. Divorce Rate, 2009-2011 Source: U.S. Census Bureau, 2012 Income and Poverty Statistics The median income for households and families across Sullivan County ($46,287 and $58,436 respectively) is lower than across all of New York ($55,972; $68,161) and the nation ($51,484; $62,735). The same trend is true of the median income for individual workers. The percentage of families and individuals living in poverty in the past 12 months is also higher in Sullivan County than in all of New York and the nation for the following categories: All Families Married Couple Families Families Headed by a Female, No Husband Present All People People Under 18 Years People 18 Years and Over Unrelated Individuals 15 Years and Over Households headed by a female, with children under 18 years, are particularly prone to poverty in Sullivan County. Nearly half (48.4%) of these households live in poverty compared to 37.6% across New York and 39.5% across the nation (U.S. Census Bureau, 2012). Page 10 Sullivan County Public Health Services Community Health Assessment Figure 5. Median household income, 2009-2011 Source: U.S. Census Bureau, 2012 Figure 6. Median family income, 2009-2011 Source: U.S. Census Bureau, 2012 Page 11 November 2013 Sullivan County Public Health Services Community Health Assessment November 2013 Table 2. Poverty Status of Families and People in the Past 12 Months (2009 - 2011) Sullivan U.S. New York County 11.5% 12.8% All families 11.1% Married couple families Families with female householder, no husband present With related children under 18 years 5.5% 5.7% 6.2% 30.3% 27.8% 34.6% 39.5% 37.6% 48.4% All people 15.2% 15.1% 18.5% Under 18 years 21.4% 21.2% 27.9% 18 years and over 13.2% 13.3% 15.8% Unrelated individuals 15 years and over Source: U.S. Census Bureau, 2012 26.2% 24.8% 31.1% The percentage of Sullivan County residents who are enrolled in benefits programs like supplemental security income, cash public assistance, and SNAP is lower than the percentage across New York, and comparable to the nation. However, the mean income that Sullivan County residents receive from these benefits is higher than both New York and the nation. For example, the mean supplemental security income received by Sullivan County residents is $9,061. The mean supplemental security income across all of New York and the nation is $8,917 and $8,811 respectively (U.S. Census Bureau, 2012). Table 3. Households with Supplemental Benefits in the Past 12 Months (2009 - 2011) Sullivan U.S. New York County Households with supplemental security income 4.7% 5.6% 4.8% Mean supplemental security income Households with cash public assistance income Mean cash public assistance income Households with food stamp/ SNAP benefits in the past 12 months Source: U.S. Census Bureau, 2012 Page 12 $8,811 2.8% $3,860 $8,917 3.3% $4,039 $9,061 2.9% $4,116 11.7% 13.8% 12.7% Sullivan County Public Health Services Community Health Assessment November 2013 Employment Statistics According to the Bureau of Labor Statistics (2013), 10.9% of the civilian labor force in Sullivan County is unemployed, which is a higher than the percentage that is unemployed across New York (8.8%) and the nation (8.1%). Of the residents who are employed, the majority work in management, business, science, and arts and are private wage and salary workers. A notable percentage of residents are also employed in natural resources, construction, and maintenance (U.S. Census Bureau, 2012). Figure 7. Unemployment rate for civilian labor force, 2013 Source: Bureau of Labor Statistics, 2013 Educational Attainment Education is an important social determinant of health. Studies have shown that individuals who are less educated tend to have poorer health outcomes. Fewer residents in Sullivan County have graduated from high school and a higher education institute when compared to all of New York and the nation. In particular, 20.4% in Sullivan County residents have graduated from a higher education institute compared to 32.6% in New York and 28.2% in the nation (U.S. Census Bureau, 2012). Health Insurance Coverage Health insurance coverage is an important indicator of access to health care and overall health status. In Sullivan County, 85.8% of the civilian, non-institutionalized population is insured, which compares to 88.4% across New York and 84.8% across the nation. Of the population that is insured, the majority (59.9%) are covered by private health insurance. However, a higher percent is covered by public insurance (37.6%) when compared to New York (32.9%) and the nation (29.5%) (U.S. Census Bureau, 2012). Page 13 Sullivan County Public Health Services Community Health Assessment November 2013 Health Status Indicators Mortality Rates The overall age-adjusted mortality rate per 1,000 for Sullivan County is 7.7, which is higher than the mortality rate for New York (6.7) and the nation (7.4). In addition, Sullivan County has a higher percentage of premature deaths (death before age 65) when compared to New York. As depicted in the graph below, premature deaths were declining steadily in Sullivan County from 2007 to 2010, but there was a sharp increase from 27.9% in 2010 to 33.0% in 2011. (New York State Department of Health, 2011; 2012 & Centers for Disease Control and Prevention, 2012). Figure 8. Percentage of premature deaths, 2007 - 2011 Source: New York State Department of Health, 2008 - 2012 The graphs below detail the age-adjusted death rates per 100,000 for the three leading causes of death in Sullivan County: heart disease, cancer, and accidents. For all of these causes, Sullivan County has a higher death rate than New York and the nation. The death rate due to accidents is particularly high (62.2) when compared to New York (29.6) and the nation (38.0). (New York State Department of Health, 2012 & Centers for Disease Control and Prevention, 2012). Page 14 Sullivan County Public Health Services Community Health Assessment November 2013 Figure 9. Deaths due to diseases of the heart per age-adjusted 100,000, 2011 Sources: Center for Disease Control and Prevention, 2012; New York State Department of Health, 2012 Figure 10. Deaths due to malignant neoplasms (cancer) per age-adjusted 100,000, 2011 Sources: Center for Disease Control and Prevention, 2012; Healthy People 2020, 2012; New York State Department of Health, 2012 Page 15 Sullivan County Public Health Services Community Health Assessment November 2013 Figure 11. Deaths due to accidents per age-adjusted 100,000, 2011 Sources: Center for Disease Control and Prevention, 2012; New York State Department of Health, 2012 Maternal & Infant Health The birth rate per 1,000 in Sullivan County is 10.5, which is comparable to New York (10.8), but lower than the nation (12.7). Hispanic mothers have the highest birth rate in Sullivan County (16.5), while White mothers have the lowest (9.3) birth rate. The teenage pregnancy rate in Sullivan County is 42.3,compared to 30.8 across New York. Approximately 60% of teen pregnancies result in live births, while 40% result in abortions. The percentage of preterm births is also higher in Sullivan County (12.0%) than in New York (10.4%). Sullivan County saw a sharp decline in preterm births from 14.6% in 2007 to 10.5% in 2009; however, the percentage has steadily rose since then (New York State Department of Health, 2009, 2011, 2013 & Centers for Disease Control and Prevention, 2012). Table 4. Teenage (15 – 19 Years) Pregnancies (2011) New York Total teenage pregnancies Teenage pregnancy rate per 1,000 Result of Pregnancy Live births Induced abortions Sullivan County 12,239 30.8 n 7,333 4,645 261 Spontaneous fetal deaths Source: New York State Department of Health, 2013 105 42.3 % 59.9 38.0 n 62 42 % 59.0 40.0 2.1 1 1.0 Five infant deaths occurred in Sullivan County in 2011 for a rate of 6.2 per 1,000 live births. The rate is higher when compared to New York (5.6), but comparable to the nation (6.1) and the Page 16 Sullivan County Public Health Services Community Health Assessment November 2013 Healthy People 2020 goal (6.0). The current infant mortality rate represents a notable decline from 2009 when it was 10.5. However, perinatal deaths are still a concern in Sullivan County. The perinatal death rate is 12.3 compared to 8.7 across New York (New York State Department of Health, 2011, 2013; Centers for Disease Control and Prevention, 2012; & Healthy People 2020, 2012). Figure 12. Infant mortality per 1,000 births, 2007 - 2011 Source: New York State Department of Health, 2009 - 2013 Despite a declining infant mortality rate, the percentage of low birth weight infants in Sullivan County is higher and has been on the rise. Approximately 10% of infants are born with low birth weight compared to approximately 8% across New York and the nation. In particular, the percentage of infants born with low birth weight is higher among mothers ages 30 or older (10.8%) when compared to New York (8.0%). The low birth weight percentage has varied in Sullivan County from year to year, but overall, has been on the rise since 2007 (New York State Department of Health, 2013; & Centers for Disease Control and Prevention, 2012). Breast feeding and prenatal care are also areas of opportunity for Sullivan County. The rate per 1,000 live births for infants who are exclusively breast fed in the hospital is 432.0. The rate represents an increase from 409.8 in 2008, but still falls short of the current rate for all of New York, 473.9. In addition, only 67% of mothers in Sullivan County receive prenatal care in the first trimester compared to 70.1% across New York and the Healthy People 2020 goal of 77.9%. Mothers ages 15 to 17 years are the most likely to receive late or no prenatal care. However, as the graph below depicts, first trimester prenatal care has been on the rise in Sullivan County since 2008 (New York State Department of Health, 2012, 2013; & Healthy People 2020, 2012) Page 17 Sullivan County Public Health Services Community Health Assessment November 2013 Figure 13. Percentage of infants born with low birth weight, 2007 - 2011 Source: New York State Department of Health, 2009 - 2013 Figure 14. Mothers who receive prenatal care in the first trimester, 2007 - 2011 Source: New York State Department of Health, 2009 - 2013 Additional indicators of child health include obesity, tooth decay, and well-child visits. In Sullivan County, 22.2% of children and adolescents are obese, which is higher than all of New York and represents an increase from 19.4% in 2008. In addition, 52.8% of Sullivan County third-graders have evidence of untreated tooth decay compared to 24% across New York. Lastly, 65.1% of Sullivan County children who are in government sponsored insurance program have had the recommended number of well-child visits compared to 69.9% across New York (New York State Department of Health, 2013). Page 18 Sullivan County Public Health Services Community Health Assessment November 2013 Sexually Transmitted Illnesses The following table depicts the sexually transmitted illness rates per 100,000 in Sullivan County. Overall, rates are lower for HIV/AIDS and gonorrhea and higher for chlamydia and syphilis. In particular, the gonorrhea rate in Sullivan County (37.4) is a strength when compared to New York (55.7) and the nation (104.2). In contrast, the chlamydia rate in Sullivan County (404.9) is an area of opportunity when compared to New York (334.7) and annual trends. The chlamydia rate has rapidly increased from 269.3 in 2007 to its current rate of 404.9 (New York State Department of Health, 2012 & Centers for Disease Control and Prevention, 2012, 2013). Table 5. Sexually Transmitted Illness Cases per 100,000 (2011) U.S. New York n Rate n Rate 32,052 10.3 736 6.6 AIDS b 42,181 15.8 1,043 9.3 HIV 321,849 104.2 6,240 55.7 Gonorrhea 1,412,791 457.6 37,494 334.7 Chlamydia Syphilis (Early) 13,136 4.3 351 3.1 Syphilis (Late) 18,576 6.0 517 4.6 Sources: New York State Department of Health, 2012 Centers for Disease Control and Prevention, 2012; 2013 a Sullivan County n 5 6 29 314 5 6 a Rate 6.4 7.7 37.4 404.9 6.4 7.7 Includes all newly reported cases, excluding inmates Includes all newly reported cases, regardless of concurrent or subsequent AIDS diagnosis and excluding inmates b Figure 15. Chlamydia rate per 100,000, 2007 - 2011 Source: New York State Department of Health, 2008 - 2012 Page 19 Sullivan County Public Health Services Community Health Assessment November 2013 Communicable Disease Statistics Sullivan County has favorable rates for most communicable diseases. During the most recent reporting year, the county did not experience any cases of acute hepatitis. In addition, the county only experienced one case of tuberculosis and the rate per 100,000 for influenza (51.6) was notably lower than the rate for New York (115.3). The exception to the overall favorable findings is the rate of Lyme’s disease. Sullivan County experienced 121 cases of Lyme’s disease for a rate of 156.0 per 100,000. This rate compares to a rate of 64.9 across New York and a rate of 7.8 across the nation (New York State Department of Health, 2012 & Centers for Disease Control and Prevention, 2012). Mental Health Statistics The suicide rate is considered to be an indicator of the mental health status of an area. The suicide rate per 100,000 in Sullivan County is 12.6, which exceeds that of New York (9.7), the nation (12.0), and the Healthy People 2020 goal of 10.2. The suicide rate has fluctuated in Sullivan County, but it has historically been higher than that of New York. The rate peaked in 2007 at 16.1. In addition to having a higher suicide rate, Sullivan County residents have more poor mental health days. Approximately 14% of residents reported 14 or more days of poor mental health in the past month, which compares to 11% across New York and the Prevention Agenda 2013 objective of 7.8% (New York State Department of Health, 2010, 2012; Centers for Disease Control and Prevention, 2012; & Healthy People 2020, 2012). Figure 16. Age-adjusted suicide rate per 100,000, 2007 – 2011 Source: New York State Department of Health, 2008 - 2012 Page 20 Sullivan County Public Health Services Community Health Assessment November 2013 Adult Health Statistics Sullivan County adults are more prone to health-risk behaviors like excessive alcohol consumption, smoking, and obesity. In the most recent Behavioral Risk Factor Surveillance System study, 18.6% of Sullivan County adults participated in binge drinking in the past month. The percentage compares to 19.8% across New York, 15.8% across the nation, and the Prevention Agenda 2013 Objective of 13.4%. Approximately 30% of Sullivan County adults are also current smokers, compared to 19% across New York, 18% across the nation, and the Prevention Agenda 2013 Objective of 12%. Lastly, 29.5% of Sullivan County adults are obese, compared to 24.3% across New York, 26.9% across the nation, and the Prevention Agenda 2013 Objective of 15% (New York State Department of Health, 2010). Cancer Statistics Cancer is the second leading cause of death in Sullivan County and disproportionately affects both males and females when compared to New York and the nation. The age-adjusted cancer mortality rate per 100,000 in Sullivan County for males and females is 223.8 and 169.8 respectively, which is higher when compared to New York (211.6 and 154.2 respectively) and the nation (219.4 and 151.1 respectively). The following graph illustrates the overall disparity in Sullivan County. In particular, males in the county are more likely to die of prostate cancer and females in the county are more likely to die of colorectal and lung and bronchus cancer (New York State Department of Health, 2011 & Centers for Disease Control and Prevention, 2013). Figure 17. Average annual cancer mortality per age-adjusted 100,000, 2005-2009 Source: New York State Department of Health, 2011 Males and females in Sullivan County are more likely to die of cancer, but only females are more prone to developing cancer. The cancer incidence rate per age-adjusted 100,000 for females is 494.3. The county rate compares to a rate of 473.4 across New York and a rate of 417.7 across the nation. Sullivan County females are particularly prone to lung and bronchus cancer. The Page 21 Sullivan County Public Health Services Community Health Assessment November 2013 incidence rate for female lung and bronchus cancer is 78.9 in Sullivan County, compared to 64.5 in New York and 55.7 in the nation (New York State Department of Health, 2011 & Centers for Disease Control and Prevention, 2013). The following chart depicts incidence rates for all reported cancer types by gender. Table 6. Average Annual Cancer Mortality, per Age-Adjusted 100,000 (2005 - 2009) HP 2020 U.S. New York Sullivan County Rate Rate n Rate n Rate Female breast Colorectal Male Female Lung & bronchus Male 20.6 23.0 1,625.6 22.4 9.4 20.2 N/A N/A 20.2 14.1 1,019 1,067.4 19.2 13.8 7.8 7.4 19.9 15.0 N/A N/A 65.7 3,336.2 61.0 26.4 64.2 39.6 3,048.6 42.2 25.4 54.4 N/A 4.1 222 4.0 0.8 2.0 N/A 21.2 1.7 23.6 121.4 1,056 1.7 21.3 0.6 10.0 1.3 28.2 N/A 219.4 11,400.4 211.6 90.4 223.8 N/A Female 151.1 11,338.8 Sources: New York State Department of Health, 2011 Centers for Disease Control and Prevention, 2013 154.2 79.8 169.8 Female Melanoma of the skin Male Female Prostate All sites Male Environmental Health Statistics The environment that residents live, work, and play in can have a profound impact on their health. An indicator of the environmental health of an area is the prevalence of asthma. In Sullivan County, the rate per 100,000 for emergency department visits due to asthma is 52.3. The rate is slightly higher than the New York rate of 49.4. Populations that are more prone to emergency department visits due to asthma in Sullivan County are children ages five to 14 years, teens to young adults ages 15 to 25 years, and adults ages 25 to 44 years. A positive finding is that Sullivan County did not experience any deaths due to asthma during the most recent reporting year (New York State Department of Health, 2012). Table 7. Asthma Emergency Department Visits, per 10,000 (2010) New York Sullivan County Total emergency department visits 55,146 400 49.4 52.3 Crude rate Source: New York State Department of Health, 2012 Page 22 Sullivan County Public Health Services Community Health Assessment November 2013 County Health Rankings The County Health Rankings were developed as a collaboration between the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute. They were developed to illustrate the indicators that impact health, including health behaviors, clinical care, social and economic indicators, and physical environment. These indicators are then used to assign an overall rank for each county. New York has 62 counties, resulting in a possible ranking of one to 62. In general, Sullivan County ranks worse compared to other counties in the state. In particular, it has the worst ranking for mortality and the second to worst ranking for health outcomes. The highest ranking that Sullivan County received (rank of 40) is for physical environment (County Health Rankings, 2013). Table 8. Health Outcome and Factor Rankings (2013) Sullivan County Rank Out of 62 Health Outcomes Rank Mortality Rank Morbidity Rank Health Factors Rank Health Behaviors Rank Clinical Care Rank Social & Economic Factors Rank Physical Environment Rank Source: County Health Rankings, 2013 61 62 55 55 54 52 57 40 Secondary Data Profile Summary of Findings The secondary data profile provided valuable context regarding how socioeconomic factors like income, education levels, and housing may influence local health outcomes. In Sullivan County, the median income for households and families is lower and more residents live in poverty when compared to New York and the Nation. Residents are also less likely to have attained higher education, more likely to be unemployed, and less likely to have health insurance coverage. In terms of health outcomes, Sullivan County is ranked as the second to worse county in New York. It has a higher overall mortality rate and a higher percentage of premature deaths. In 2011, 33% of all deaths were premature. Sullivan County also has worse maternal and child health outcomes for teen pregnancy, low birth weight, breast feeding, prenatal care, preterm births, child obesity, child tooth decay, and well-child visits. In particular, the teenage pregnancy rate per 1,000 females is 42.3, 9.5% of infants are born with low birth weight, and only 67% of mothers start prenatal care in the first trimester. Additional areas of concern in the county are chronic disease, health behaviors, and mental health. Sullivan County residents are more likely to die from chronic conditions like heart disease and cancer. Contributing factors may be the increased percentage of residents who smoke and/or are obese and the increased incidence of Lyme’s disease. Sullivan County residents are also more likely to have poor mental health. Approximately 14% reported 14 or more days of Page 23 Sullivan County Public Health Services Community Health Assessment November 2013 poor mental health in the past month and the suicide rate for the county (12.6 per 100,000) exceeds that of New York (9.7) and the nation (12.0). Sullivan County has a number of strengths and assets to build upon, despite having primarily negative socioeconomic factors and health outcomes. One area of strength is maternal and child health. The county continues to struggle in this area, but it has seen improvement in recent years. The infant mortality rate per 1,000 live births decreased from 10.5 in 2009 to 6.2 in 2011. In addition, the rate of infants who are exclusively breastfed in the hospital increased from 409.8 in 2008 to 432.0 in 2010, the percentage of mothers who receive prenatal care in the first trimester increased from 61.1% in 2007 to 67.0% in 2011, and the percentage of preterm births decreased from 14.6% in 2007 to 12.0% in 2011. Additional areas of strength in Sullivan County are lower death rates due to diabetes and stroke and lower rates for all reported communicable diseases except Lyme’s disease. COMMUNITY SURVEY OVERVIEW Background A community survey was conducted among Sullivan County residents between the dates of August 14, 2013 and September 16, 2013. The survey was based on the Health Care Efficiency and Affordability Law for New Yorkers (HEAL NY) project. The HEAL NY project was launched by the state of New York in 2005 to provide funding and technical support to community-based alliances for implementation of electronic health records and health information exchange. In addition, the survey included a number of customized questions that were added to gather information about health risk behaviors and community perceptions. The community survey was made available both online and in paper format through various locations throughout Sullivan County. Surveys were also made available in both English and Spanish. All surveys were returned to Holleran for analysis. A total of 752 individuals who reside within Sullivan County were surveyed, 374 through an online survey link and 378 through paper surveys that were distributed. Only respondents who were at least 18 years of age were included in the study. Select participant demographics are included in Appendix C. The customized survey tool consisted of approximately 37 factors. Depending upon individuals’ responses, survey length ranged from 10 to 15 minutes. Overall, the survey assessed dietary behaviors and weight management, healthcare practices and resources, alcohol and tobacco use, mental health, disease prevalence, and community resources, strengths, and opportunities. Statistical considerations for the study can be found in Appendix B. Community Survey Key Findings This section provides a summary of the Resident Survey results. A full report of the community survey results is available in a separate document. Page 24 Sullivan County Public Health Services Community Health Assessment November 2013 Dietary Behaviors and Weight Management Fruit and Vegetable Consumption Among survey respondents, 46.4% ate fruits and/or vegetables daily. Only 26 respondents or 3.5% of the total sample, never ate fruits and/or vegetables. The most cited reason for not eating fruits and/or vegetables was that respondents do not like them. Other reasons included the expense of fresh fruits and vegetables, their availability, their quality, and the time it takes to prepare them. Table 1. Fresh fruit and vegetable consumption Response Options How often do you eat fresh fruits and/or vegetables? Count Percentage Daily 344 46.4% 3 - 6 days/week 187 25.2% Less than 3 days/week 184 24.8% Never 26 3.5% Response Options I do not like fresh fruits and/or vegetables Too expensive Not available where I shop or in my community Other Reason(s) for never eating fresh fruits and/or vegetables Count Percentage 13 52.0% 9 36.0% 3 12.0% 3 12.0% Females were significantly more likely than males to eat fruits and/or vegetables daily. Conversely, males were significantly more likely than females to never eat them. Caucasian respondents were also more likely to eat fruits and/or vegetables daily when compared to African American and other race respondents. Only 17.8% of Hispanic respondents eat fruits and/or vegetables daily, which is significantly different than the percentage of Non-Hispanic respondents (53.6%). Table 2. Fresh fruit and/or vegetable consumption among demographic subgroups Frequency of fresh fruit and/or vegetable consumption Daily A. Female Less than 3 days/week Never 50.7% (B) 22.2% 24.8% 2.3% B. Male 33.5% 32.0% (A) 27.0% 7.5% (A) A. 18 - 24 31.4% 27.5% 31.4% 9.8% B. 25 - 34 36.9% 32.1% 28.6% 2.4% C. 35 - 44 34.3% 27.5% 34.3% 3.9% D. 45 - 64 49.8% 23.2% 24.0% 3.0% E. 65 - 80 51.3% 25.2% 20.0% 3.5% F. 81+ 54.5% 20.5% 20.5% 4.5% A. African American 26.2% 40.5% 26.2% 7.1% B. Asian/Pacific Islander 50.0% 12.5% 25.0% 12.5% 1.9% C. Caucasian 54.6% (A E) 26.4% 17.1% D. Native American/Alaska Native 50.0% 30.0% 20.0% 0.0% E. Other 22.0% 34.1% 31.7% 12.2% 17.8% 21.8% 48.9% (B) 11.5% 53.6% (A) 27.1% 18.0% 1.2% A. Hispanic B. Non-Hispanic Page 25 3-6 days/week Sullivan County Public Health Services Community Health Assessment November 2013 Farmer’s Markets The availability of farmer’s markets can impact fruit and vegetable consumption. Among survey respondents, a majority (61.7%) reported that they visited a local farmer’s market in the past year. The towns that respondents visited the most for farmer’s markets were Monticello, Liberty, and Callicoon. Among the 38.3% respondents who did not visit a farmer’s market, the most cited reason was that they are too expensive. The second most cited reason was that respondents did not have transportation. The third most cited reason was that the hours or days that the markets are held are not convenient. In addition, many respondents stated that it is more convenient to buy fruits and vegetables at the supermarket or that they grow their own in a home garden. Table 3. Farmer’s market visits Have you visited any local farmer's markets in the past year? Response Options Count Percentage Yes 455 61.7% No 283 38.3% Response Options Too expensive Did not have transportation The hours or days the markets are held are not convenient for me I don't know where to find them Other Reason(s) for not visiting a local farmer's market in the past year Count Percentage 102 40.3% 77 30.4% 72 28.5% 63 45 24.9% 17.8% Female were almost twice as likely as males to visit a farmer’s market. Of the females who did not visit a farmer’s market, a significantly higher proportion said it was because they are too expensive. In contrast, males were significantly more likely to state that the reason they did not visit a farmer’s market was that they did not know where to find them. Among the defined age groups, respondents ages 45 and up were more likely to visit farmer’s markets when compared to younger groups. Among racial group, 73% of Caucasian respondents visited a farmer’s market in the past year compared to 51.2% of African American respondents and 42.9% of other race respondents. Hispanic respondents were more than two and a half times less likely to visit a farmer’s market; only 28.6% visited one in the past year. A significantly higher proportion of Hispanic respondents said that the reasons they do not visit farmer’s markets are because they are too expense, they do not have transportation, and they do not know where to find them. Page 26 Sullivan County Public Health Services Community Health Assessment November 2013 Table 4. Reason(s) for not visiting a farmer’s market among demographic subgroups Reason(s) for not visiting a local farmer's market in the past year Too expensive A. Female I don't know The hours or days the Did not have where to find markets are held are transportation them not convenient for me Other 44.7% (B) 32.2% 18.4% 30.3% 17.1% B. Male 25.9% 32.9% 36.5% (A) 24.7% 21.2% A. 18 - 24 21.9% 37.5% 37.5% 21.9% 18.8% B. 25 - 34 32.4% 29.7% 35.1% 32.4% 16.2% C. 35 - 44 47.7% 38.6% 20.5% 27.3% 15.9% D. 45 - 64 45.0% 30.0% 21.2% 28.7% 18.8% E. 65 - 80 39.4% 18.2% 21.2% 30.3% 27.3% F. 81+ 12.5% 50.0% 25.0% 25.0% 12.5% A. African American 22.2% 22.2% 33.3% 11.1% 22.2% B. Caucasian 23.7% 12.3% 14.9% 38.6% 28.9% C. Other 18.2% 31.8% 22.7% 59.1% 13.6% 55.4% (B) 54.5% (B) 34.8% (B) 18.8% 4.5% 23.9% 12.8% 17.1% 35.0% (A) 30.8% (A) A. Hispanic B. Non-Hispanic Body Mass Index Obesity and its connection to serious medical conditions has become a national concern. The body mass index (BMI) of respondents was calculated based on their self-reported height and weight. Based on this calculation, 61.5% of 2013 survey respondents were overweight or obese (BMI of 25 or higher). Thirty-six percent of respondents were considered to have a normal weight or a calculated BMI of 18.5 to 24.9. These results are favorable when compared to the results of the 2009 resident survey. In 2009, 73.2% of respondents were overweight or obese and only 24.4% had a normal weight. Table 5a. Calculated BMI (2013 Survey) BMI Response Options Count Percentage Underweight 16 2.5% Normal Weight 228 36.0% Overweight 196 31.0% Obese 193 30.5% Table 5b. Calculated BMI (2009 Survey) Response Options Underweight Normal Weight Overweight Obese BMI Count Percentage 6 2.4% 61 24.4% 91 36.4% 92 36.8% Respondents ages 18 to 24 and 81 and up were more likely to have a normal BMI, particularly when compared to respondents 45 to 80 years of age. Respondents ages 45 to 64 were the most likely to be obese. Approximately 69% of respondents ages 45 to 64 and 67% of respondents ages 65 to 80 were overweight or obese. Page 27 Sullivan County Public Health Services Community Health Assessment November 2013 Table 6. Calculated BMI among demographic subgroups BMI A. Female 3.0% Normal weight 36.9% 28.5% 31.5% B. Male 0.6% 34.8% 34.8% 29.8% A. 18 - 24 2.4% 52.4% (D E) 23.8% 21.4% B. 25 - 34 2.7% 40.0% 29.3% 28.0% C. 35 - 44 3.2% 36.2% 31.9% 28.7% D. 45 - 64 0.8% 30.7% 31.5% 37.1% (F) E. 65 - 80 4.0% 29.0% 37.0% 30.0% F. 81+ 5.6% 61.1% (D E) 22.2% 11.1% A. African American 0.0% 48.4% 22.6% 29.0% B. Asian/Pacific Islander 20.0% 40.0% 20.0% 20.0% C. Caucasian 2.5% 34.1% 31.4% 32.1% D. Native American/Alaska Native 0.0% 40.0% 0.0% 60.0% E. Other 2.8% 38.9% 22.2% 36.1% A. Hispanic 1.4% 45.7% 27.9% 25.0% B. Non-Hispanic 2.5% 32.9% 31.1% 33.6% Underweight Overweight Obese Healthcare Practices and Resources Preventative Care Approximately 90% of 2013 survey respondents visited a doctor for a routine physical exam or check-up within the past two years; 80% visited a doctor within the past year. Respondents who did not visit a doctor for a routine physical exam or check-up within the past two years cited their inability to afford the visit as the primary reason. Additional reasons of note were that respondents do not like to go or are afraid to go, lack health insurance, consider the cost of the co-pay or deductible to be too high, and/or lack the necessary time. The 2013 survey results are similar to the 2009 survey results. In 2009, 92.6% of respondents visited a doctor for a routine physical exam or check-up within the past two years. The likelihood of respondents to visit a doctor for a routine physical exam or check-up varied significantly by their age, race, and ethnicity. Respondents ages 45 and older were more likely to have visited a doctor within the past year. In particular, 90.4% of respondents ages 65 to 80 and 97.5% of respondents ages 81 and older visited a doctor within the past year. In contrast, younger respondents (ages 18 to 44) were more likely to have visited a doctor within the past two years. Among racial groups, Caucasians and Native Americans/Alaska Natives were the most likely to visit a doctor within the past year. However, the percentage for Native Americans/ Alaska Natives is based on a low respondent count and therefore cannot be verified as statistically significant from other racial groups. Racial groups that were the most likely to have visited a doctor five or more years ago or never were African Americans and respondents of Page 28 Sullivan County Public Health Services Community Health Assessment November 2013 another race. Among ethnic groups, Non-Hispanic respondents were significantly more likely than Hispanics to have visited a doctor within the past year. In contrast, Hispanics were significantly more likely than Non-Hispanics to have visited a doctor within the past two years. Table 7. Routine physical exam or check-up among demographic subgroups Last doctor visit for a routine physical exam or check-up A. Female In the past year 81.1% In the past 2 In the past 5 years years 10.1% 3.3% 5 or more years ago 2.9% Don't know Never 2.1% 0.6% B. Male 74.9% 12.6% 7.0% 3.0% 1.0% 1.5% A. 18 - 24 56.9% 17.6% (E) 13.7% (D E) 5.9% 3.9% 2.0% B. 25 - 34 72.9% 14.1% (E) 7.1% 1.2% 1.2% 3.5% C. 35 - 44 72.5% 15.7% (E) 4.9% 3.9% 2.0% 1.0% D. 45 - 64 80.9% (A) 10.3% 3.3% 3.3% 1.8% 0.4% E. 65 - 80 90.4% (A B C) 3.5% 1.8% 2.6% 1.8% 0.0% 97.5% (A B C D) 2.5% 0.0% 0.0% 0.0% 0.0% F. 81+ A. African American 71.4% 7.1% 2.4% 7.1% 11.9% 0.0% B. Asian/Pacific Islander 71.4% 28.6% 0.0% 0.0% 0.0% 0.0% 81.8% (E) 9.9% 3.7% 2.9% 1.0% 0.6% D. Native American/Alaska Native 90.0% 0.0% 10.0% 0.0% 0.0% 0.0% E. Other 64.3% 14.3% 7.1% 7.1% 4.8% 2.4% 68.4% 16.4% (B) 6.8% 2.8% 4.0% 1.7% 82.9% (A) 9.2% 3.3% 3.1% 0.8% 0.6% C. Caucasian A. Hispanic B. Non-Hispanic Dental Care Approximately 58% of 2013 survey respondents had a routine dental check-up in the past 12 months. Among the 42% of respondents who did not have a routine dental check-up, a number of reasons were cited. The primary reason, cited by more than 50% of respondents, was that they could not afford it. Other reasons included lack of time, lack of transportation, and that respondents do not like to go or are afraid to go. Many respondents also stated that there is not a need for them to get a dental check-up because they either have dentures or do not have a dental problem. Since 2009, the percentage of respondents who received a routine dental check-up in the past 12 months dropped by about nine percentage points. Approximately 67% of 2009 respondents received a routine dental check-up compared to 58% in 2013. The likelihood of respondents to receive a routine dental check-up in the past 12 months varied based on their age, race, and ethnicity. Older respondents ages 45 and older were more likely to receive a routine dental check-up when compared to younger populations. In particular, respondents ages 45 to 80 were significantly more likely than respondents ages 25 to 34 to receive a routine dental check-up. Approximately 70% of Caucasians received a routine dental check-up, which is significantly higher than the percentage of African Americans (44%) and other race respondents (34%). Non-Hispanic respondents were also significantly more likely than Hispanic respondents to receive a routine dental check-up (66.5% compared to 29.7%). Page 29 Sullivan County Public Health Services Community Health Assessment November 2013 Table 8. Routine dental check-up among demographic subgroups Routine dental check-up in the past 12 months Yes No A. Female 59.7% 40.3% B. Male 52.7% 47.3% A. 18 - 24 45.8% 54.2% B. 25 - 34 41.5% 58.5% (D E) C. 35 - 44 56.6% 43.4% D. 45 - 64 62.2% (B) 37.8% E. 65 - 80 62.5% (B) 37.5% F. 81+ 60.0% 40.0% A. African American 44.4% 55.6% (C) 57.1% 42.9% 70.1% (A E) 29.9% B. Asian/Pacific Islander C. Caucasian D. Native American/Alaska Native 44.4% 55.6% E. Other 34.1% 65.9% (C) 29.7% 70.3% (B) 66.5% (A) 33.5% A. Hispanic B. Non-Hispanic Overall, the reasons that respondents did not receive a routine dental check-up in the past 12 months were consistent among demographic groups. Respondents ages 35 to 44 and/or of Hispanic origin presented the only exceptions. Both demographic groups were significantly more likely to report cost as a barrier to receiving routine dental check-ups. Hispanic respondents were also significantly more likely to report lack of transportation as a barrier. The primary source of dental care for respondents and their children was private dental offices. Fewer than 12% sought dental care through another source and approximately 20% did not see a dentist at all. Among demographic groups, females, Caucasians, and Non-Hispanics were the most likely to receive dental care in a private dental office. African American and Hispanic respondents were the most likely to have not seen a dentist at all. Healthcare Access and Information The majority of respondents (56.1%) received their healthcare from a private doctor’s office. However, respondent’s usual source of care varied by their demographic profile. Younger respondents ages 18 to 44 were more likely than older respondents to receive care from the hospital/emergency room. Respondents ages 25 to 34 were also more likely to receive care from a free or reduced fee clinic. African Americans and other race respondents were more likely to receive care from the hospital/emergency room when compared to Caucasians. In addition, other race respondents were more likely to receive care from a free or reduced fee clinic when compared to Caucasians. Hispanic respondents were more likely to receive care from the hospital/emergency room and free or reduced fee clinics. In contrast, Non-Hispanic respondents were more likely to receive care from private doctor’s offices and large multi-specialty groups. Page 30 Sullivan County Public Health Services Community Health Assessment November 2013 Males and females did not differ notably in where they received care, but males were more likely to report that they do not receive care in general. Table 9. Healthcare access Response Options Private doctor's office Large multi-specialty group The hospital/emergency room Free or reduced fee clinic I don't get healthcare Other Where do you usually go for healthcare? Count Percentage 382 56.1% 108 15.9% 73 10.7% 68 10.0% 30 4.4% 20 2.9% Respondents received most of their information about healthcare locations and events through the newspaper (47.7%) and referrals from friends or doctors (45.5%). Other popular sources for healthcare information included flyers on bulletin boards or in offices and the radio. The most unused information resource among respondents was health-related or government websites. Table 10. Healthcare information resources Response Options Newspaper Referrals from friends or doctors Flyers on bulletin board or in offices Radio Online social media (Facebook, Google) Health related or government websites Other To learn about healthcare locations or events in the area, what resources are you most likely to use? Count Percentage 299 47.7% 285 45.5% 209 33.3% 186 29.7% 149 23.8% 89 14.2% 27 4.3% Prescription Drug Storage The majority of respondents (75%) stored their prescriptions drugs either in the kitchen or in the bathroom. Twenty-five percent of respondents stored their prescription drugs next to their bed/nightstand or in another location. Among the respondents who stored their prescriptions in another location, there was great variability. Some of the storage locations that respondents listed included a bedroom drawer/dresser, living room, and lock armor. Alcohol and Tobacco Use Smoking Habits and Cessation Fifteen percent of survey respondents reported that they currently smoke cigarettes. This percentage did not differ significantly among demographic groups, with the exception of African Americans versus Caucasians. Approximately 29% of African Americans reported that they currently smoke cigarettes compared to 14% of Caucasians. A higher proportion of Page 31 Sullivan County Public Health Services Community Health Assessment November 2013 Asians/Pacific Islanders also reported currently smoking, but the proportion is based on a small respondent count and cannot be verified as statistically significant. Table 11. Current smoking status Do you smoke? Response Options Count Percentage Yes 107 15.0% No 607 85.0% Among the respondents who currently smoke, the majority (61%) initiated smoking more than 10 years ago. Less than 6% initiated smoking in the past six months and approximately 32% initiated smoking two to 10 years ago. The only significant difference that exists among demographic groups is for Hispanics versus Non-Hispanics. Approximately 77% of Non-Hispanic smokers have smoked for more than 10 years compared to 23% of Hispanic smokers. The survey also assessed the smoking habits of individuals living in the survey respondent’s household. According to Table 12, 84% of respondents who do not smoke live in a household in which no one else smokes. In contrast, only 47% of respondents who smoke live in a household in which no one else smokes. In general, approximately 22% of respondents live in a household in which someone other than them smokes. Younger adults ages 18 to 24 were the most likely to live in a household in which at least one other member smokes. Table 12. Smoking habits of respondent crossed with total household smokers Do you smoke? Yes How many people in your household, other than you, smoke? None 1 person 2 - 3 people More than 3 people Count 48 37 11 6 Percentage 47.1% 36.3% 10.8% 5.9% No Count 467 74 10 4 Percentage 84.1% 13.3% 1.8% 0.7% Alcohol Consumption Approximately 40% of respondents stated that they drink alcohol. The populations that were most likely to consume alcohol were ages 18 to 64 and Non-Hispanic. The majority of respondents (41.1%) drank alcohol less than once per week; only 15% of respondents drank alcohol daily. Respondents ages 65 to 80 were the most likely to drink alcohol daily. Table 13. Alcohol consumption Do you drink alcohol? Response Options Count Percentage Yes 284 39.8% No 429 60.2% Page 32 Sullivan County Public Health Services Community Health Assessment November 2013 Table 14. Alcohol consumption among demographic subgroups Alcohol consumption Yes No A. Female 39.0% 61.0% B. Male 41.3% 58.7% A. 18 - 24 43.1% (F) 56.9% B. 25 - 34 43% (F) 57.0% C. 35 - 44 50% (E F) 50.0% D. 45 - 64 44.8% (E F) 55.2% E. 65 - 80 27.6% 72.4% (C D) F. 81+ 16.3% 83.7% (A B C D) A. African American 45.2% 54.8% B. Asian/Pacific Islander 50.0% 50.0% C. Caucasian 45.6% 54.4% D. American Native/Alaska Native 36.4% 63.6% E. Other 35.7% 64.3% 25.7% 74.3% (B) 44.6% (A) 55.4% A. Hispanic B. Non-Hispanic Only 40% of respondents reported that they consume alcohol; however, of those respondents, approximately 50% binge drank at least once during the past 30 days. Approximately 19% binge drank three or more times during the past 30 days. There were no significant differences in the proportion of respondents who binge drank based on demographic characteristics. However, Table 15 illustrates the frequency of binge drinking among respondents based on their knowledge of where to find help for an alcohol or substance abuse problem. Among respondents who binge drank at least once in the past 30 days, the majority knew where to find help for an alcohol or substance abuse problem. However, respondents who binge drank five or more times in the past 30 days were the least likely to know where to find help. Table 15. Knowledge of alcohol or substance abuse resources crossed with frequency of binge drinking Do you know where to find help if you or someone you know has an alchol or substance abuse problem? Yes No Considering all types of alcoholic beverages, how many times during the past 30 days did you have four (Women) / five (Men) or more drinks on one occasion? 5 or more times 3 - 4 times Twice Once Never Page 33 Count 16 19 24 42 109 Percentage 66.7% 76.0% 75.0% 82.4% 82.0% Count 8 6 8 9 24 Percentage 33.3% 24.0% 25.0% 17.6% 18.0% Sullivan County Public Health Services Community Health Assessment November 2013 Mental Health Anxiety and Depression Slightly more than half of respondents did not feel anxious or depressed during the past week; however, a notable percentage (45.4%) did feel anxious or depressed on at least one day. Of the 318 respondents who felt anxious or depressed, the majority (63.2%) only felt this way on one or two days. There was no notable difference in the frequency of anxiety or depression among demographic groups. Table 16. Days of feeling of anxious or depressed Response Options No days 1 - 2 days 3 - 6 days Every day How many days in the past week did you feel anxious or depressed? Count Percentage 382 54.6% 201 28.7% 65 9.3% 52 7.4% The majority of respondents (75.7%) knew where to seek help to prevent a suicide and the prevalence of this knowledge did not differ significantly among demographic groups. However, individuals who may be more prone to suicide (felt anxious or depressed every day of the past week) were the least likely to know where to seek suicide help. Only 62% of respondents who felt anxious or depressed every day knew where to seek suicide help compared to 79% of individuals who never felt anxious or depressed. Table 17. Knowledge of suicide resources crossed with the number of days that respondents felt anxious or depressed Do you know where to seek help if you or someone you know is thinking about suicide? Yes No How many days in the past week did you feel anxious or depressed? No days 1 - 2 days 3 - 6 days Every day Count 275 138 43 31 Percentage 79.0% 76.7% 67.2% 62.0% Count 73 42 21 19 Percentage 21.0% 23.3% 32.8% 38.0% Disease Prevalence Chronic Conditions The most commonly diagnosed chronic condition among respondents was high blood pressure; 55.8% of respondents stated that they have this condition. The second most commonly diagnosed condition, high cholesterol, was reported by 44.9% of respondents. Cancer was only reported by 10.4% of respondents and was the least commonly diagnosed condition. Many respondents also reported other conditions that they have been diagnosed with by a doctor. The most commonly reported “other” conditions were arthritis, thyroid disease, and Hepatitis C. Page 34 Sullivan County Public Health Services Community Health Assessment November 2013 Table 18. Prevalence of chronic health conditions Please check any chronic health condition(s) that you have been diagnosed with. Response Options High blood pressure High cholesterol Other Diabetes Heart disease Cancer Count 231 186 102 95 54 43 Percentage 55.8% 44.9% 24.6% 22.9% 13.0% 10.4% The prevalence of chronic health conditions did not differ notably among demographic groups and many of the differences that did occur were expected. For example, older adults were more prone to every chronic condition and in some cases, significantly more prone. A difference that may or may not have been expected was that Non-Hispanic respondents reported more cases of high blood pressure and “other” conditions. Key Health Issues Respondents were asked to identify the most important health issue(s) that Sullivan County should focus on. According to 54.8% of respondents, drug abuse (prescription and illegal) is the key health issue in the area. It is followed closely by mental health (depression, anxiety, stress, etc.) and chronic disease (diabetes, heart disease, cancer, etc.). Infectious disease is considered to be the least important health issue in Sullivan County and was only selected by 22.1% of respondents. Overall, many respondents felt that there was not just one issue burdening the county. This sentiment is evidenced by the number of selections that each health issue received. Table 19. Key health issues in Sullivan County Response Options Drug abuse (prescription and illegal) Mental health (depression, anxiety, stress, etc.) Chronic disease (diabetes, heart disease, cancer, etc.) Nutrition (healthy eating habits, food allergies, etc.) Key health issues in Sullivan County Count Percentage Response Options Tobacco use (cigarettes, snuff, 352 54.8% etc.) Count Percentage 218 34.0% 314 48.9% Sexually transmitted diseases 193 30.1% 300 46.7% Diseases from ticks and mosquitoes 188 29.3% 284 44.2% Clean air and water 187 29.1% Aging related issues 276 43.0% 184 28.7% Physical inactivity 269 41.9% 161 25.1% Alcohol abuse 255 39.7% 158 24.6% Dental health (healthy teeth) 238 37.1% 142 22.1% Healthy babies and mothers 237 36.9% 41 6.4% Page 35 Disabilities (physical, intellectual, developmental) Immunizations (getting a shot to prevent a disease) Accidental injuries (falls, drowning, car crashes, etc.) Infectious disease (Ex: Flu or tuberculosis) Other Sullivan County Public Health Services Community Health Assessment November 2013 Community Strengths and Opportunities Community Strengths Respondents were asked to identify the greatest strength(s) in Sullivan County. The number one strength, identified by 50.7% of respondents, was the local 24-hour police, fire, and rescue services. The second and third greatest strengths in the community focused on the physical environment of Sullivan County. The second greatest strength, identified by 43.2% of respondents, was access to parks and recreation (bike trail, playground) and the third greatest strength, identified by 37.5% of respondents, was a clean and healthy environment. The strengths that were ranked last by respondents were a bike-able, walk-able community (limited need for a car) and access to public transportation. Table 20. Greatest strengths in Sullivan County What are the greatest strengths in our community (Sullivan County)? (check all that apply) Response Options Count Percentage Response Options Count Percentage Local 24-hour police, fire and rescue services 311 50.7% Access to medical screenings 103 16.8% Access to parks and recreation (bike trail, playground) 265 43.2% Services and support for individuals needing help during times of stress and crisis 94 15.3% Clean and healthy environment 230 37.5% Emergency preparedness 83 13.5% Access to arts and cultural events 210 34.3% Access to affordable housing 81 13.2% Access to basic health care 178 29.0% Low violence/abuse (domestic, elder, child) 74 12.1% Safe neighborhoods 151 24.6% Programs, activities, and support for youth and teens during non-school hours 68 11.1% Programs, activities, and support for the senior community 139 22.7% Bike-able, walk-able community (limited need for car) 55 9.0% Low crime (theft, homicide, etc.) 130 21.2% Access to public transportation 51 8.3% Access to affordable, healthy food 116 18.9% Other 37 6.0% Tolerance for diversity (race, gender, religion, etc.) 107 17.5% Opportunities for Improvement Respondents were asked to identify the areas that they felt the community should focus its resources and attention on to improve the quality of life in Sullivan County. Access to affordable housing was considered to be the area most in need of resources and attention and was identified by almost 60% of respondents. The second focus area was identified as programs, activities, and support for youth and teens during non-school hours. The third focus area was identified as access to public transportation. Page 36 Sullivan County Public Health Services Community Health Assessment November 2013 Table 21. Areas to focus on to improve the quality of life in Sullivan County Where should the community focus its resources and attention to improve the quality of life in Sullivan County? (check all that apply) Response Options Count Percentage Response Options Count Percentage Access to affordable housing 386 59.8% Services and support for individuals needing help during times of stress and crisis 205 31.7% Programs, activities, and support for youth and teens during non-school hours 364 56.3% Access to medical screenings 198 30.7% Access to public transportation 337 52.2% Clean and healthy environment 195 30.2% 186 28.8% 186 28.8% 162 25.1% 148 22.9% 131 20.3% 67 10.4% Access to affordable, healthy food 315 48.8% Bike-able, walk-able community (limited need for car) Access to basic health care 276 42.7% Emergency preparedness Safe neighborhoods 267 41.3% Low crime (theft, homicide, etc.) 254 39.3% Access to parks and recreation (bike trail, playground) Access to arts and cultural events Programs, activities, and support for the senior community 241 37.3% Local 24-hour police, fire and rescue services Low violence/abuse (domestic, elder, child) 215 33.3% Other Tolerance for diversity (race, gender, religion, etc.) 208 32.2% Household Telephone Survey Summary of Findings The resident survey provided important information about the current health behaviors and health perceptions of individuals living in Sullivan County. A review of the results yields several areas of strength and opportunity for the community. Overall, the majority of respondents practiced positive health behaviors like fruit and vegetable consumption and primary care visits. In addition, few respondents were current smokers and less than half consumed alcohol. However, disparities existed within different demographic populations in the community and many residents demonstrated risky health behaviors like being overweight or obese. Fruits and/or vegetables were consumed on at least a weekly basis by all but 3.5% of respondents. More than 46% of respondents reported eating fruits and/or vegetables daily. Respondents who were the most likely to eat fruits and/or vegetables on a daily basis were female, Caucasian, and Non-Hispanic. The availability of farmer’s markets can impact fruit and vegetable consumption. Many respondents (61.7%) visited a farmer’s market within the past year. Respondents who were the most likely to visit farmer’s markets were female, Caucasian, 45 years of age or older, and Non-Hispanic. The majority of respondents who did not visit a farmer’s market cited that they are too expensive and that they do not have transportation to the markets. Healthy eating habits like fruit and vegetable consumption can also influence BMI. Among survey respondents, 61.5% had a calculated BMI that is considered overweight or obese. This percentage is down from 73.2% in 2009, but still constitutes a significant portion of the community. Respondents who were the most likely to be overweight or obese were ages 45 to 64. Page 37 Sullivan County Public Health Services Community Health Assessment November 2013 Almost all of the respondents (90.2%) visited a doctor for a routine check-up in the past two years and 80% visited a doctor for a routine check-up within the past year. This statistic is comparable to the results of the 2009 resident study. Respondents who were the most likely to visit a doctor within the past year were Caucasian and 45 years of age or older. Respondents who were the least likely to visit a doctor within the past year were African American, Asian/Pacific Islander, and of another race. The primary reason for not visiting a doctor among all respondents was that they could not afford it. The main source of healthcare and healthcare information varied among respondents. The majority of respondents received their care at a private doctor’s office. However, young adults, African Americans, and Hispanics were more likely to utilize the hospital or emergency room for healthcare. The primary source of healthcare information for respondents was the newspaper and referrals from friends and doctors. Many respondents visited a dentist for a routine check-up in the past year. However, the overall percentage of respondents who received a routine dental check-up (58%) was much lower than the percentage who received a routine physical check-up (80%). The current percentage is also down from 66.9% in 2009. Respondents who were the most likely to receive a routine dental check-up within the past year were Caucasian and 45 years of age or older. Respondents who were the least likely to receive a routine dental check-up within the past year were African American and of another race. The main source of dental care for all respondents was private dentist’s offices. Fifteen percent of respondents reported that they currently smoke. Among these respondents, 61% have smoked for more than 10 years and 52.9% live in a household in which at least one other person smokes. A positive finding from the survey was that 65.1% of respondents who smoke were willing to try and quit smoking if free resources were provided to them. Approximately 40% of respondents reported that they drink alcohol. Among these respondents, 41.1% drank less than once per week. In general, fewer respondents reported drinking any alcohol, but a concern is that of these respondents, more than half reported that they binge drank in the past 30 days. In addition, respondents who binge drank five or more times during the past 30 days were the least likely to know where to find help for an alcohol or substance abuse problem. Approximately 45% of respondents reported feeling anxious or depressed on at least one of the past seven days. The majority of these respondents only felt this way on one or two days, but 36.8% felt this way on three or more days. In addition, only 62% of respondents who felt anxious or depressed every day of the last week knew where to seek help if they were thinking about Page 38 Sullivan County Public Health Services Community Health Assessment November 2013 suicide. This statistic compares to 79% of respondents who did not feel anxious or depressed on any of the past seven days and knew where to seek help. Respondents were asked to report chronic conditions that they have been diagnosed with by a health care provider. Approximately 56% of respondents reported that they have high blood pressure and 45% reported that they have high cholesterol. A number of other conditions were identified by respondents, the most common of which were arthritis, thyroid disease, and Hepatitis C. In addition to reporting the conditions that they have been diagnosed with, respondents were asked to identify the key health issues in the community. Drug abuse was identified by the most respondents as the key health issue in the community. The second key health issue identified by respondents was mental health and the third key health issue identified by respondents was chronic disease. Respondents were also asked to identify the greatest strengths in the community and the areas in which the community needs to focus its resources and attention to improve the quality of life in Sullivan County. The greatest strengths were identified as the local 24-hour police, fire, and rescue services, access to parks and recreation, and a clean and healthy environment. The areas that require more resources and attention were identified as access to affordable housing, programs, activities, and support for youth during non-school hours, and access to public transportation. FOCUS GROUPS OVERVIEW Background Two focus groups were held at the Sullivan County Public Health Services facility in September 2013. One of the groups was conducted with Rural Health Network representatives; the other was conducted with young adult community members (ages 18 to 26). Focus group topics addressed access to care, key health issues and challenges, and community aspirations and capacity. Each session lasted approximately 90 minutes and was facilitated by trained staff from Holleran. Participants were recruited through the CHA partners. In exchange for their participation, young adult community members received $50 cash. Rural Health Network members were not provided an incentive for their participation. Two discussion guides developed in consultation with Sullivan County Public Health Services, were used to prompt discussion and guide the facilitation. Page 39 Sullivan County Public Health Services Community Health Assessment November 2013 In total, 19 people participated in the focus groups. It is important to note that the results reflect the perceptions of a limited number of providers and community members and may not necessarily represent all providers and residents of Sullivan County. Focus Groups Key Findings The following section provides a summary of the focus group discussions including key themes and select comments. A full report of the focus group results is available in a separate document. Access to Care A number of issues were identified by community residents as barring people from accessing health care. Many issues were centered on the cost of care and transportation. Participants identified lack of health insurance, the cost of copayments and medications, lack of sick days, and increasing premiums and deductibles, specifically. They also expressed concern that Medicaid is often not accepted by providers. Transportation is an issue in Sullivan County because of its rural nature and size. Residents are reliant upon their ability to afford a car that they can drive themselves or having a reliable friend/family member to drive them. Other issues included a lack of awarenss of what constitutes wellness, clinic hours of operation, a lack of providers, and the transient lifestyle maintained by young adults. One participant stated, “The general public doesn’t really understand the concept of wellness. Considering the amount of poverty and the educational level of most of our communities, [wellness activities] are not things that people are all that familiar with in general and it is just now that we are starting to see a little bit of that impact in our communities.” Participants felt that the elderly and immigrant populations were not being adequately served by local health services. The elderly struggle with issues related to lack of transportation, fixed incomes, and pride in asking for assistance. In reference to fixed incomes, one participant stated that, “They have a totally different way of looking at money. It’s so fixed and it’s almost all allocated so if something comes up like a medical issue, there’s a decision that has to be made.” That decision may include not obtaining medical appointments or medications or not buying food. Participants recommended a structured volunteer system to expand the services available to seniors. The immigrant population was viewed as underserved due to lack of trust and language barriers. One participant shared, “The immigrants don’t trust. They’re very fearful of coming into any organized agency.” In addition to identifying specific populations that are underserved by local health services, participants stated that residents of the entire community tend to go outside of Sullivan County for health services because of the perception that they receive better care. One participant shared that on the last community survey, 30% of residents said that they traveled outside of the county for healthcare. Residents believe that there are better providers available to them when they travel outside of the county and that their experience in the healthcare system is better. Page 40 Sullivan County Public Health Services Community Health Assessment November 2013 Healthcare services were deemed to be missing in Sullivan County across the age spectrum and across primary and specialty care. Participants felt that there are insufficient private pediatric providers, dental providers (specifically for seniors relying on Medicare), overweight/obesity programs, geriatric assessment programs, Lyme’s disease providers and education programs, eye care providers, and substance abuse services. Related to substance abuse services, one participant shared that outpatient services are available for adults, but these patients are in such “bad shape” that it is difficult to treat them in this setting. He stated, “These are addicts like we’ve never had to deal with before. Even cocaine was easier to deal with than what we’re currently seeing.” Key Health Issues and Challenges Nine health issues were identified as major concerns in the community. Among the issues, overweight/obesity, maternal health, and mental health and substance abuse were considered the most pressing. Overweight and obesity rates were seen as high, especially among children. One participant shared that 16% of WIC children (ages 2 to 4) are overweight and that recent tracking efforts showed that overweight/obesity rates are highest among schools with higher poverty rates. Participants also shared that many mothers in Sullivan County receive late or no prenatal care. Lack of prenatal care was viewed as not only impacting health indicators like infant mortality and birth weight, but also the ability to diagnose and treat mothers for existing chronic conditions. Participants identified mental health and substance abuse as a key health issue. Young adult participants stated that alcoholism and addiction to painkillers and prescription drugs are the biggest issues. They felt that a contributing factor to painkiller addiction was that individuals are being prescribed too many and their prescriptions are being refilled too often. Rural Health Network participants echoed alcoholism as an issue and added that there is also a high incidence of untreated depression and suicide. Participants noted a number of challenges for people in the community trying to stay physically fit and eat healthier. There was broad agreement that Sullivan County does not offer adequate opportunity for physical activity and access to healthy foods. Participants shared that there are no affordable gyms in the area, and access to parks and playgrounds is limited. Participants also shared that there is easy access to fast food, but “You can drive 10, 20, 50 miles without seeing a grocery store.” As a result, many residents buy items with longer shelf lives versus fresh foods. Participants offered a number of solutions for increasing access to physical fitness areas including: Providing a bus that transports school-aged kids to parks Offering more programs for older students, not just younger students Creating a walking trail in Liberty similar to the one in Kingston that is about two miles long and allows biking, rollerblading, etc. Page 41 Sullivan County Public Health Services Community Health Assessment November 2013 Developing more hiking trails Encouraging employers to allow employees the use of gym equipment at any time Promoting a closer relationship between the health department and the planning department to create walkable communities and incorporate health-related issues in planning and grant funding. One participant stated that, “The last 2020 plan I looked at had not one word about health.” Capitalizing on the opportunities for kids to exercise using technology – Wii Fit, etc. A number of weaknesses related to lack of resources and a disconnect between residents and available community assets were identified within the community. Participants stated that there is a lack of available summer activities for children, a lack of gyms and medical offices offering evening hours, and a lack of monetary resources through foudations and grant funds. They also noted a lack of connection between free health-promoting activities in the community and residents. For example, one participant shared that Robert Wood Johnson Foundation data showed that Sullivan County has terrible health statistics in general, but good access to the outdoors and recreation. Another participant shared that the county spends a lot of time promoting available outdoor recreation options to outside tourists, but not to residents within the community. Participants cited a need for stronger collaboration among small, non-profit organizations to address these weaknesses. Community Aspirations & Capacity Participants offered a number of suggestions for improving the health of the community. Specific examples included forming initiatives to identify action steps, building community gardens, creating a website that lists all of the resources available in the community, and hosting community-wide competitions like Biggest Loser. Young adults participants also felt that incentives were the key to engaging community members in improving their health and the well-being of Sullivan County. Young adult participants urged community organizations to concentrate on providing more resources for physical activity and community supported agriculture options, and relocating farmer’s markets to convenient locations. Rural Health Network members urged local hospitals and public health to create more health education opportunities and health information materials. They stated that health education needs to be more integrated into schools and social media, and that there needs to be more health fairs that offer free testing and literature. They also stated that they need more health information materials that are at appropriate reading levels, bilingual, and culturally sensitive. Focus Group Summary of Findings The two focus groups were engaging and not shy in sharing their opinions. They offered different perspectives of the community related to access to care, key health issues and challenges, and community aspirations and capacity. Sullivan County is an area of great need as a result of its rural nature and poor socioeconomic status. The county struggles to recruit and retain necessary Page 42 Sullivan County Public Health Services Community Health Assessment November 2013 medical professionals and provide easy access to medical services. Medical services that were deemed missing or limited in the community spanned both primary and specialty care. Many residents have to travel outside of the county for these services or go without them as transportation is a huge barrier to accessing care. In addition to the barriers that are caused by the rural nature and poor socioeconomic status of Sullivan County, a general lack of understanding of what wellness means and why it is important contributes to poor access to care among residents. The populations that were deemed to have the most underserved were seniors and immigrants. A number of major health issues were identified within the community; however, the most pressing were overweight/obesity, maternal health, and mental health and substance abuse. Factors that contribute to overweight/obesity are lack of access to healthy foods and safe areas for physical activity. Participants offered several recommendations to increase access to healthy foods and areas for physical activity. An example was the suggestion to create a partnership between the public health department and the community planning department to incorporate health-related issues into planning and grant funding activities. Factors that contribute to poor maternal health and mental health and substance abuse are lack of access to medical providers and socioeconomic indicators like poverty and education. Participants made a number of suggestions to improve the overall health of the community. Young adult participants recommended that a website of all available resources within the county be made available and that competitions and incentives be used to encourage community health and involvement. Rural Health Network participants made recommendations for resources that would help them better serve the residents of Sullivan County. Many of these resources involved health education and health materials that could be distributed within the community. MINORITY HEALTH PROFILE Background In 2012, Sullivan County Public Health Services, in partnership with other area agencies and providers, conducted a minority health profile. The intent of the profile was to fully understand the health status and outcomes of minority populations within the county, and disparities that may exist. Specifically, the study assessed the health needs, outcomes, and risky health behaviors within these populations. The data is intended to lend perspective to potential interventions and advancements for health equity for all of those who live in Sullivan County. The report is a compilation of existing health data for the county, also known as secondary data. Data was gathered by a Master of Public Health (MPH) student, recruited by the New York State Department of Health and Sullivan County Public Health Services, and was integrated into a report prepared by Holleran. The specific data sources are listed throughout the report. It should be noted that in some cases, local-level data may be limited or dated. This is an inherent limitation with secondary data. The most recent data is used wherever possible. Additionally, Page 43 Sullivan County Public Health Services Community Health Assessment November 2013 when available, state and/or regional comparisons were also provided as benchmarks for the Sullivan County statistics. Minority Health Profile Key Findings The following section provides a summary of the focus group discussions including key themes and select comments. A full report of the focus group results is available in a separate document. Access to Care Sullivan County includes six federally designated Medically Underserved Areas/Populations due to low income. According to HRSA (Health Resources and Services Administration), “Medically Underserved Populations” may include groups of persons who face economic, cultural or linguistic barriers to health care.” In addition, Sullivan County currently has five HRSA designated Health Professional Shortage Areas. New York State has a health insurance plan for children, called Child Health Plus (CHIP). Both Children's Medicaid and Child Health Plus are available through various providers throughout the state. As of June 2012, more than 2,100 children in Sullivan County were enrolled in CHIP. Based on current population estimates of the number of children under 18 living in Sullivan County (17,150< that translates into approximately 12.6% of the county’s children enrolled in CHIP. This is above the percentage throughout the state of New York (approximately 8.6% of children enrolled in CHIP).The table below details the specific total of enrollees by insurance provider. CHIP Enrollees Provider Type June 2012 TOTAL CHILDREN ENROLLED Sullivan County New York State 2,165 366,917 EBCBS 225 56,890 FIDELIS 247 67,661 1,693 19,113 HUDSON Sources: http://www.health.ny.gov/health_care/managed_care/medicaid/2005/enrollment_report_0405.htm http://www.health.ny.gov/statistics/child_health_plus/enrollment/ EBCBS: Empire Healthchoice; FIDELIS: New York State Catholic Health Plan, Inc; HUDSON: Hudson Health Plan Family Health Plus is a public health insurance program for adults who are aged 19 to 64 who have income too high to qualify for Medicaid. Family Health Plus is available to single adults, couples without children, and parents who are residents of New York State and are United Page 44 Sullivan County Public Health Services Community Health Assessment November 2013 States citizens or fall under one of many immigration categories. The statistics below show that as of April 2012, 1,374 individuals between the ages of 19 and 64 in Sullivan County were enrolled in Family Health Plus. This translates into 2.9% of the 19-64 year olds, compared to 3.9% for New York state overall. Family Health Plus Enrollees Sullivan County Upstate New York New York Overall TOTAL ENROLLEES 1,374 138,662 493,341 ADULTS WITH CHILDREN 1,115 106,411 304,804 1,086 N/A N/A 29 N/A N/A 259 32,251 188,537 256 N/A N/A 3 N/A N/A April 2012 HUDSON GHI HMO Select ADULTS WITHOUT CHILDREN HUDSON GHI HMO Select Source: http://www.health.ny.gov/health_care/managed_care/medicaid/2005/enrollment_report_0405.htm N/A = Data not available Medicaid eligibility, beneficiary, and expenditure statistics are detailed in the following tables. These figures are for all Sullivan County residents in aggregate, not segmented by race or ethnicity. As of April 2012, it was estimated 16,734 residents of Sullivan County were eligible for Medicaid. Of those eligible, on average, 13,530 were enrolled. This translates into 80.8% of those eligible who are also enrolled. This is slightly below the statewide percentage of eligibles-toenrollees, which is 84.1%. Page 45 Sullivan County Public Health Services Community Health Assessment November 2013 Average Yearly Medicaid Eligibles Category of Eligibility Jan. ’11-Dec. ‘11 Total Medicaid Eligibles Sullivan County New York State (excluding NYC) New York Overall 16,734 1,823,974 4,898,205 MEDICAID & SUBSISTENCE Medicaid avg. monthly eligibles 16,734 1,823,974 4,898,205 TANF children 982 93,932 260,355 TANF adults 470 40,479 93,243 Safety net children 217 29,870 111,873 Safety net adults 407 46,102 152,315 SSI aged 208 29,447 152,235 2,487 241,592 561,270 SSI blind & disabled MEDICAID ONLY TANF children 5,102 531,366 1,294,887 TANF adults 1,924 238,158 498,099 32 11,983 130,227 Safety net adults 1,164 154,514 697,350 SSI aged 1,164 125,273 285,879 SSI blind & disabled 1,150 119,224 190,581 Family Health Plus 1,408 19 19 155,233 431,126 6,803 38,767 Safety net children Other Source: http://www.health.ny.gov/statistics/health_care/medicaid/quarterly/aid/ Page 46 Sullivan County Public Health Services Community Health Assessment November 2013 Average Monthly Medicaid Beneficiaries Category of Eligibility Jan. ’11-Dec. ‘11 Sullivan County New York State (excluding NYC) New York Overall 13,530 1,423,997 4,119,436 13,530 1,423,997 4,119,436 TANF children 814 79,217 229,887 TANF adults 297 26,908 73,179 Safety net children 200 27,072 101,358 Safety net adults 393 43,632 136,978 SSI aged 142 19,951 115,751 2,152 205,798 487,759 Average Monthly Beneficiaries MEDICAID & SUBSISTENCE Medicaid avg. monthly beneficiaries SSI blind & disabled MEDICAID ONLY TANF children 4,344 420,040 1,071,121 TANF adults 1,643 178,752 386,882 Safety net children 30 11,125 114,695 Safety net adults 979 125,530 518,903 SSI aged 513 61,576 159,124 SSI blind & disabled 756 76,761 128,175 1,381 143,533 403,402 154 35,510 256,601 Family Health Plus Other Source: http://www.health.ny.gov/statistics/health_care/medicaid/quarterly/aid/ Page 47 Sullivan County Public Health Services Community Health Assessment November 2013 Yearly Medicaid Expenditures Category of Eligibility Jan. ’11-Dec. ‘11 Sullivan County New York State (excluding NYC) New York Overall 184,677,573 16,458,412,546 44,512,697,166 184,677,573 3,077,574 16,458,412,546 267,839,842 44,512,697,166 759,501,678 2,535,420 190,472,479 542,921,059 761,461 84,614,428 317,717,762 Safety net adults 4,897,211 421,031,265 1,669,057,198 SSI aged 1,895,505 327,038,833 3,039,449,430 SSI blind & disabled 72,029,573 5,206,588,538 12,684,096,670 Total Medicaid expenditures beneficiaries MEDICAID & SUBSISTENCE Medicaid avg. monthly beneficiaries TANF children TANF adults Safety net children MEDICAID ONLY TANF children 14,959,682 1,522,675,191 4,059,705,297 TANF adults 12,643,363 1,186,162,141 2,704,233,081 98,124 46,307,894 380,824,004 Safety net adults 10,299,520 1,048,302,007 3,827,248,665 SSI aged 21,557,664 2,806,395,330 6,639,993,452 SSI blind & disabled 32,086,814 2,413,187,118 4,338,450,154 Family Health Plus 6,622,458 625,004,764 1,646,899,515 Other 1,213,204 312,792,716 1,902,599,201 Safety net children A survey was conducted among Sullivan County residents to better understand health insurance coverage and potential access to care issues. When asked if there was a period of time when they could not get needed health care, roughly 11% of county residents responded, “yes.” This increases to 33.6% when looking at just the uninsured residents in the county. The most common reason for not being able to obtain the care was a lack of insurance coverage, followed by the health insurance not covering the needed service and being denied for the treatment or claim. The figures below detail these survey responses. Length of Time Uninsured Sullivan Co. residents without health insurance Page 48 Less than 1 year 19.7% 1 year to < 2 years 2 years to < 5 years 5 years to < 10 years 11.5% 26.9% 14.5% 10 years or more 27.4% Sullivan County Public Health Services Community Health Assessment November 2013 Was there a time when you couldn't obtain needed health care? 66.4% No 89.1% 33.6% Yes 10.9% 0% 20% 40% 60% Uninsured respondents 80% 100% All respondents Primary reasons for not obtaining needed health care No health insurance 64.8% 1.3% 11.7% 3.9% 6.2% 1.3% 5.6% 0.0% 1.2% Health insurance didn't cover Health insurance denied tx/claim No available provider Lack of transportation 0% 20% Uninsured respondents Page 49 92.1% 40% 60% All respondents 80% 100% Sullivan County Public Health Services Community Health Assessment November 2013 Coverage for Individuals with Insurance Does your insurance cover the following...? Hospital care 99% Doctor's visits 98% 87% Prescription drugs 84% Mental health tx 81% Substance abuse 62% Eyeglasses 56% Dental care 0% 20% 40% 60% 80% 100% As seen in the bar graphs above, a number of those with health insurance reported being unable to access needed care. While the majority of those with some form of health insurance report coverage for hospital care and doctor’s visits, fewer report full prescription drug coverage, mental health treatment, and substance abuse treatment. Vision and dental care is only included for slightly above half of those in Sullivan County with some form of health insurance coverage. Cost Prevented Seeing a Doctor BY Gender Sullivan 2008-2009 BRFSS County Males 13.5% Females 21.3% New York State 12.7% 14.6% Females living in Sullivan County are more likely than their male counterparts to report cost as a barrier to seeing a doctor (21.3% versus 13.5%). While the proportion of males with financial barriers is equitable to males statewide, the proportion of women reporting these cost barriers is higher than what is generally seen throughout New York. The uninsured survey respondents were compared against their demographics to better understand the characteristics of those without health insurance in Sullivan County. The table below details that many of the uninsured (62%) are employed, 70% of them with full-time positions. The largest proportion (41%) has a high school diploma or GED (General Education Diploma) and 28% report having some college education. Not surprisingly, there is a clear trend in insurance coverage when compared against household income levels. Page 50 Sullivan County Public Health Services Community Health Assessment November 2013 Demographics of Uninsured Survey Respondents Sullivan County Uninsured respondents Employed Yes 62% No 38% Part-time 70% Full-time 30% Education Less than high school 17% High school diploma/GED 41% Some college 28% Associates degree 7% Bachelors degree 7% Post-graduate degree 1% Household income Less than $15,000 30% $15,000 - $24,999 30% $25,000 - $44,999 25% $45,000 - $74,999 12% $75,000 or higher 3% The table below shows that roughly 13% of White residents and 13% of Black residents within Sullivan County are without some form of health insurance. Other sources, such as the 20082009 Behavioral Risk Factor Surveillance Survey (BRFSS), show the figures to be even higher, at 16.7% of White residents. Within these two racial groups, the 18-24 year-old population is the most likely to be without health insurance. Roughly 38% of White young adults and 32% of Black young adults in this age group are uninsured. The “other” racial group is likely comprised of those individuals of Hispanic/Latino origins. The percentages of uninsured residents within this group is pronounced (42.5% overall). As detailed in the table, there is a dramatic jump within this group once the individual turns 18 years old, with 9.1% uninsured between the ages of 6-17 and a dramatic 87.3% within the 18-24 year age group. The 2008-2009 BRFSS also notes minimal differences between males and females in the proportion who are insured. Page 51 Sullivan County Public Health Services Community Health Assessment November 2013 Uninsured by Age and Race Sullivan County White Black Other race Under age 6 9.5% 7.5% 0.0% 6-17 years 7.6% 5.0% 9.1% 18-24 years 38.3% 32.2% 87.3% 25-34 years 14.6% 10.7% 51.5% 35-44 years 20.4% 17.2% 48.9% 45-54 years 19.5% 16.5% 37.4% 55-64 years 14.7% 14.6% 0.0% 65-74 years 0.9% 4.5% 40.7% 75 years and over 0.0% 0.0% 0.0% 13.4% 13.3% 42.5% TOTAL Note: The percentages represent the proportion of residents within that demographic group who are estimated to be uninsured. “Other” race is likely comprised of a significant number of Hispanic/Latino residents. Individual Hispanic/Latino statistics were not readily available. Healthy People 2010 aims to improve access to quality healthcare, including ensuring that people have a usual and ongoing source of care. The “2009 Heal 9 Consumer Health Survey,” surveyed Sullivan County residents on a variety of primary care and access to care topics. Approximately 86% of those surveyed reported having a regular place for medical care. This figure decreases to 60.7% among the uninsured. The 2008-2009 BRFSS survey further details that females in Sullivan County are more likely to have a regular source of medical care compared to their male counterparts (85.5% versus 76.6%). When asked to specify where the regular source of care is received, 81.5% of the survey respondents reported that the care is in a doctor’s office. This number drops to 60.6% for the uninsured. Roughly one-quarter of the uninsured respondents reported that a clinic is their usual source of care and another 14% stated that a hospital emergency room serves as their primary place for medical care. Page 52 Sullivan County Public Health Services Community Health Assessment November 2013 Regular Place For Medical Care Heal 9 Consumer Survey 60.6% Doctor's Office 81.5% 25.4% 14.3% Clinic 14.1% 4.2% Emergency Room 0% 20% 40% Uninsured respondents 60% 80% 100% All respondents The “Heal 9” survey also identified that among Sullivan County residents, 22% seek regular care in a county outside of Sullivan County, but remain in New York State. Roughly 13% seek care in New York City and 10% report receiving care in Pennsylvania. They are most likely to receive care outside of the county for dental care and obstetric/gynecological services. The two primary reasons for doing so was to “seek better care” and because the resident could not find a provider within the county to provide the needed service. Key Access to Care Takeaways: Approximately 8 out of 10 individuals in Sullivan County who are eligible for Medicaid and Subsistence programs receive benefits. Sullivan County has proportionally more children enrolled in CHIP than throughout New York state. Roughly 11% of Sullivan County residents report needing to seek medical care at some point, but not being able to. This number increases to approximately 34% among the uninsured. Lack of insurance coverage, limited insurance coverage, and cost were the most common barriers. Females in Sullivan County are more likely than the males in the county to identify cost as a barrier to healthcare. The Hispanic/Latino residents within the county are associated with the highest rates of being uninsured, especially the 18-24 year-old age group. The uninsured are more likely to report the hospital emergency room as their source of regular health care than those with some form of insurance. Page 53 Sullivan County Public Health Services Community Health Assessment November 2013 Many county residents seek healthcare services outside of the county due to either a perception of better quality of care outside of Sullivan County and/or limited availability of certain health care services within the county. Health Status The average life expectancy of a resident of Sullivan County is 75.4 years. This is equivalent to peer counties and the United States overall. Approximately 17.4% of county adults report “fair” or “poor” health and average 6.5 unhealthy days in the past month. According to the 2008-2009 BRFSS, Sullivan County residents had the highest proportion of adults reporting “fair” or “poor” health in the entire region, also above New York as a whole (New York = 14%). Health Status Average life expectancy 75.4 Peer County Ranges 74.5-77.1 Average number of unhealthy days in the past month 6.5 5.7-8.2 Sullivan County Sullivan County All counties U.S. Median 76.5 6 Source: http://www.communityhealth.hhs.gov/SummaryMeasuresOfHealth Fair or Poor Health Sullivan County Percent of adults who report “fair” or “poor” health Sullivan County 17.4% New York 14% Source: 2008-2009 BRFSS Key Health Status Takeaways: The average life expectancy for Sullivan County residents is 75.4 years. On average, Sullivan County adults report 6.5 unhealthy days in a typical month. Roughly 17% of Sullivan County adults state that they are in “fair” or “poor” health, above the percentage statewide (14%). Mortality Rates The age-adjusted mortality rate for Sullivan County is 828.9 per 100,000. As detailed in the graph below, the mortality rate is highest for Black residents of Sullivan County, with an ageadjusted rate of 924.4. Additionally, Black residents within the county have the largest number of years of potential life lost. The Hispanic and Black residents in the county have the highest Page 54 Sullivan County Public Health Services Community Health Assessment November 2013 percentage of premature deaths. Only 72% of Hispanic residents of Sullivan County live to reach 75 years of age. The Asian residents in the county have the lowest mortality rates. Age-Adjusted Mortality Rates 828.9 Sullivan Co. 500.2 Asian 838.6 White 610.4 Hispanic 924.4 Black 0 200 400 600 800 1,000 Source: Minority Health Surveillance Report, County Edition, 2010 Percent Premature Deaths (<75) 49.1% Sullivan Co. 53.3% Asian 46.1% White 72.3% Hispanic 75.0% Black 0% 10% 20% 30% 40% 50% 60% 70% 80% Source: Minority Health Surveillance Report, County Edition, 2010 Premature deaths: Defined as the percentage of deaths under age 75 that are considered to be preventable. The top four leading causes of death in Sullivan County are heart disease, cancer, chronic lower respiratory disease, and unintentional injury. Males in Sullivan County show higher mortality Page 55 Sullivan County Public Health Services Community Health Assessment November 2013 rates due to heart disease, cancer, and unintentional injury compared to Sullivan County females. Females outpace males in mortality due to chronic lower respiratory disease. Leading Causes of Death BY Gender Per 100,000 Age adjusted Sullivan County Males Females Heart Disease 235 263 206 Cancer 179 193 172 Chronic Lower Respiratory Disease 48 40 54 Unintentional Injury 40 50 29 The following table outlines leading causes of death by race and ethnicity. Note that Black residents in Sullivan County outpace other demographic groups in the majority of the categories with the exception of congestive heart failure and unintentional injury. The Hispanic residents have the highest mortality rates for stroke. Leading Causes of Death BY Race Per 100,000 Age adjusted Sullivan County White Black Asian Hispanic Diseases of the heart 207.8 210.2 232.8 N/A 140.2 Coronary heart disease 152.3 154.4 174.5 N/A 101.6 Congestive heart failure 22.6 25.8 19.5 0 N/A Stroke 27.9 27.3 N/A N/A 53.6 53 57 41.6 0 37.6 Diabetes 33.6 31.1 61 N/A 41.6 COPD/CLRD (18+ yrs.) 80.9 95.9 38.9 0 16.5 White Black Asian Hispanic 19.3 N/A N/A N/A Unintentional Injury Source: Minority Health Surveillance Report, County Edition, 2010 N/A = Too few data to report Cancer Deaths BY Race Per 100,000 Age adjusted Colorectal cancer Sullivan County 17.9 Female breast cancer 18.2 18.1 N/A N/A N/A Cervix uteri cancer 3.1 3.6 N/A N/A N/A Source: Minority Health Surveillance Report, County Edition, 2010 N/A = Too few data to report Data on the leading causes of death by race within various age groups is limited. Of the data that is available, the following are notable trends for Sullivan County: Page 56 Sullivan County Public Health Services Community Health Assessment November 2013 Ages 25-44 o Blacks outpace Whites in heart disease and HIV/AIDS deaths. Roughly four out of ten (39.1%) of AIDS diagnoses are among the Black population in the Mid-Hudson region of New York state (Dutchess, Orange, Sullivan, and Ulster). Ages 45-64 o Whites outpace Blacks and Hispanics in deaths due to cancer o Blacks have higher percentages of deaths due to heart disease compared to Whites and Hispanics Ages 65+ o Whites and Hispanics share similar percentages of deaths due to heart disease, above the percentage for Blacks. o Similar percentages are seen for cancer deaths. As stated above, Blacks in Sullivan County are more likely than Whites to die of HIV/AIDS. Additionally, when looking at the Mid-Hudson region, 59.4% of the cases are Male. This suggests that Black Males are likely the most at risk for HIV/AIDS. Source: http://www.communityhealth.hhs.gov/NationalLeadingCausesofDeath Key Mortality Rate Takeaways: The highest overall mortality rate in Sullivan County is among Black residents, followed by White residents. Asian residents have the lowest overall mortality rate. When looking at potential years of life lost, the Hispanic and Black residents record the largest number of years lost. The infant mortality rate in Sullivan County is above the rate statewide and nationally. Health Behaviors The graph below details the percent of adults who have visited a dentist in the past year in Sullivan County. Overall, 64% of adults visited a dentist, which is below New York as a whole. Females are more likely to have gone to a dentist than males. Additionally, the White, NonHispanic residents are above the countywide average. This suggests that some or all other racial groups are less likely to have visited a dentist in the previous year. Recall in the “Access to Care” section of the report, individuals from Sullivan County reported having to go outside of the county for some of their oral health needs. Page 57 Sullivan County Public Health Services Community Health Assessment November 2013 Percentage of Adults Who Reported Visiting a Dentist in the Previous Year 2008-2009 BRFSS White (Non-Hispanic) 66.1% 74.7% Females 68.0% 73.5% 60.1% 68.4% Males 64.0% 71.1% Overall -10% 10% 30% Sullivan Co 50% 70% 90% New York The two following graphs detail the percentage of adults in the county who have had a flu shot or nasal flu vaccine in the past year. Similar to the dental care graph, figures are reported separately for certain demographic groups. Percentage of Adults Who Received Flu Shot or Vaccine in Past year 2008-2009 BRFSS 39.8% 43.6% White (Non-Hispanic) 37.9% 45.1% Females 35.9% 40.0% Males 36.9% 42.7% Overall 0% 10% 20% Sullivan Co Page 58 30% 40% New York 50% 60% 70% Sullivan County Public Health Services Community Health Assessment November 2013 Percentage of Adults Who Received a Pneumonia Shot or Vaccine in Past year 2008-2009 BRFSS 28.9% 28.7% White (Non-Hispanic) 25.4% 26.9% Females 28.8% 25.2% Males 27.0% 26.1% Overall 0% 10% 20% Sullivan Co 30% 40% 50% New York Percentage of Adults Who Had a Routine Checkup in Past year 2008-2009 BRFSS 66.3% 72.4% White (Non-Hispanic) Females 66.2% Males 61.3% 66.9% 63.7% 72.9% Overall -10% 78.5% 10% 30% Sullivan Co 50% 70% 90% New York In general, Sullivan County residents are less likely to have visited a doctor or other healthcare provider in the previous year for a routine checkup compared to statewide averages. Females are more likely than males and White residents show a higher percentage than countywide, suggesting lower proportions of minorities who are having a routine checkup annually. Risky behaviors, such as tobacco use and excessive alcohol use also contribute to poorer health outcomes. Roughly 28% of Sullivan County adults are regular smokers, which compares to 16.8% throughout New York overall. This percentage is among the highest in the state and Page 59 Sullivan County Public Health Services Community Health Assessment November 2013 region. Additionally, Sullivan County reports fewer individuals living in non-smoking households (74.1%) compared to statewide (79.1%). Key Health Behaviors Takeaways: Sullivan County residents are less likely than residents living throughout the state of New York to have visited a dentist in the past year. The White residents in the county compare above the county average, suggesting lower rates among the minority groups in the county. Sullivan County residents are less likely than residents living throughout the state of New York to have visited a doctor or other healthcare provider in the past year for a routine checkup. The White residents in the county compare above the county average, suggesting lower rates among the minority groups in the county. Sullivan County is equitable, or above, the statewide average for the percentage of individuals who received a pneumonia vaccine or shot in the past year. Sullivan County is below the statewide average for the percentage of individuals who received a flu shot or flu spray in the nose in the past year. Sullivan County has a higher percentage of smokers compared to statewide averages as well as fewer non-smoking households compared to throughout New York. Chronic Disease According to the Centers for Disease Control and Prevention, chronic diseases are the leading causes of death and disability in the United States. Chronic diseases include diabetes, heart disease, cancer, and obesity among others. The table below displays rates and percentages for various cancer indicators. Where available, the figures are reported by race and ethnicity. The age-adjusted incidence rate for lung care throughout the United States is 79.5, which is relatively equivalent to the Sullivan County rate. Sullivan County, however, rates above the state rate of 75.1. When looking at the incidence rates by race and ethnicity, however, there are some variations. For New York state as a whole, the incidence rate for Black residents is 69.7 and increases to 77.2 for Whites. (Centers for Disease Control and Prevention, National Program of Cancer Registries). Page 60 Sullivan County Public Health Services Community Health Assessment November 2013 Cancer Indicators 2003-2007 Lung cancer incidence (per 100,000 age adjusted) Sullivan County 80.1 White Black Asian Hispanic 84.3 77.2 N/A N/A Percent early stage colorectal cancer 45.1% 46.7% N/A N/A N/A Percent early stage female breast cancer 59.9% 60.3% 62.5% N/A N/A Percent early stage cervical cancer 41.2% N/A N/A N/A N/A Source: Minority Health Surveillance Report, County Edition, 2010 N/A = Too few data to report Significant differences are noted across racial groups with regard to asthma hospitalization rates. This is true for both adults and children. There is a pronounced difference in hospitalizations among children in Sullivan County. In all, 19.6 children per 100,000 are hospitalized for asthma. The number is highest among Black children, with a rate slightly above 30. Asthma hospitalizations are lowest among White children. For adults, however, White residents in Sullivan County are highest among the racial groups for hospitalizations due to COPD or CLRD. Asthma Per 100,000 Asthma hospitalizations (age adjusted) Sullivan County 14.8 White Black Asian Hispanic 12.5 24.8 6.9 21.5 Asthma hospitalizations (0-17) 19.6 17.7 30.3 0 19.3 COPD/CLRD hospitalizations (18+ years) 44.7 44.7 36.3 13.2 26.9 Source: Minority Health Surveillance Report, County Edition, 2010 Page 61 Sullivan County Public Health Services Community Health Assessment November 2013 Prevention Quality Indicators Hospital Admission Data: Respiratory Sullivan County COPD Asthma Admissions 155 70 Rate 247 111 128% 64% 232 113 % As Expected, White 132% 47% % As Expected, Hispanic 123% 147% % As Expected, Black 77% 166% % As Expected, Asian N/A N/A % As Expected, Other N/A N/A % As Expected Age/Sex Adjusted Rate Source: https://apps.nyhealth.gov/statistics/prevention/quality_indicators/ N/A = Too few data to report Note: The ratio of the observed number of admissions to the number of "expected" admissions. The number of "expected" admissions is the number of admissions that would be observed if the rate for each age-sex group in the area were the same as it is for the state as a whole. Diabetes statistics show similar health inequities to some of the previous tables. Black adults in Sullivan County are more than twice as likely to be hospitalized for diabetes as are White adults, with a hospitalization rate of 36.9 per 10,000 (compared to 13.0 per 10,000 for Whites). Diabetes Per 10,000 Diabetes hospitalizations (age adjusted-primary diagnosis) Diabetes short-term complications from hospitalizations (6-18 yrs.) Diabetes short-term complications from hospitalizations (18+ yrs.) Sullivan County 15.4 White Black Asian Hispanic 13.0 36.9 0 16.5 3.0 2.7 8.0 0 0 6.3 5.2 13.6 0 6.3 Source: Minority Health Surveillance Report, County Edition, 2010 Page 62 Sullivan County Public Health Services Community Health Assessment November 2013 Prevention Quality Indicators Hospital Admission Data: Diabetes Uncontrolled Diabetes Lower Extremity Amputation Short-Term Complications Long-Term Complications Admissions 10 6 29 44 Rate 17 10 46 70 45% 38% 88% 53% 16 9 47 65 % As Expected, White 52% 38% 75% 48% % As Expected, Hispanic 27% 0% 40% 41% % As Expected, Black 32% 97% 259% 124% % As Expected, Asian N/A N/A N/A N/A % As Expected, Other N/A N/A N/A N/A Sullivan County % As Expected Age/Sex Adjusted Rate Source: https://apps.nyhealth.gov/statistics/prevention/quality_indicators/ N/A = Too few data to report Note: The ratio of the observed number of admissions to the number of "expected" admissions. The number of "expected" admissions is the number of admissions that would be observed if the rate for each age-sex group in the area were the same as it is for the state as a whole. Statistics for diseases of the heart also point to elevated levels among the Black residents of Sullivan County with hospitalization rates at nearly 162 for Blacks versus 122 for Whites. The pattern is similar for stroke hospitalizations, although the gap is not as pronounced. Diseases of the Heart Age adjusted Per 10,000 Diseases of the heart hospitalizations Sullivan County 131.5 White Black Asian Hispanic 121.5 161.8 18 95.8 Stroke hospitalizations 23.7 22.4 34.9 9.1 19 Coronary heart disease hospitalizations 65.3 58.4 57.2 12.5 58.5 Congestive heart failure hospitalizations 44 45.5 62.3 N/A 15.4 Source: Minority Health Surveillance Report, County Edition, 2010 N/A = Too few data to report Page 63 Sullivan County Public Health Services Community Health Assessment November 2013 Prevention Quality Indicators Hospital Admission Data: Circulatory Hypertension Congestive Heart Failure Angina Admissions 20 186 39 Rate 33 295 63 44% 81% 188% 31 284 60 % As Expected, White 30% 77% 175% % As Expected, Hispanic 45% 25% 315% % As Expected, Black 189% 166% 263% % As Expected, Asian N/A N/A N/A % As Expected, Other N/A N/A N/A Sullivan County % As Expected Age/Sex Adjusted Rate Source: https://apps.nyhealth.gov/statistics/prevention/quality_indicators/ N/A = Too few data to report Note: The ratio of the observed number of admissions to the number of "expected" admissions. The number of "expected" admissions is the number of admissions that would be observed if the rate for each age-sex group in the area were the same as it is for the state as a whole. Prevention Quality Indicators Hospital Admission Data: Acute Sullivan County UTI Dehydration Bacterial Pneumonia Admissions 62 38 168 Rate 98 62 267 % As Expected 60% 71% 95% Age/Sex Adjusted Rate 100 61 259 % As Expected, White 54% 70% 91% % As Expected, Hispanic 51% 33% 74% % As Expected, Black 86% 82% 117% % As Expected, Asian N/A N/A N/A % As Expected, Other N/A N/A N/A Source: https://apps.nyhealth.gov/statistics/prevention/quality_indicators N/A = Too few data to report Page 64 Sullivan County Public Health Services Community Health Assessment November 2013 Note: The ratio of the observed number of admissions to the number of "expected" admissions. The number of "expected" admissions is the number of admissions that would be observed if the rate for each age-sex group in the area were the same as it is for the state as a whole. Key Chronic Disease Takeaways: Chronic disease statistics for Sullivan County do not suggest a favorable trend among Black residents. With the exception of some cancers, Black residents in the county are more likely to have diabetes, asthma, and diseases of the heart. Incidence rates of lung cancer, while equitable to national figures, are above the New York statistic. This trend holds true for residents overall as well as across racial groups. The obesity rates for Sullivan County are unfavorable compared to New York state as a whole, while the percentages of adults who are overweight are fairly similar to the state averages. Maternal Health Indicators The percentage of low-birth weight babies is roughly around 9%, which is above the statewide and national percentages, which average around 8% of births. White infants are the least likely to be of low birth weight, while Black, Asian, and Hispanic babies are more likely to be of low birth weight, with percentages in the double digits. The proportion of teen pregnancies in Sullivan County is also quite pronounced. All racial and ethnic groups appear to be above national levels for teen pregnancies, but the figure is highest among Hispanic/Latino teens. Birth-Related Indicators Age adjusted Per 10,000 Sullivan County White Black Asian Hispanic 959 646 83 12 177 Percent births with early (1st trimester) prenatal care 61.5% 64.3% 57.5% 52.9% 56.0% Percent adequate prenatal care (Kotelchuk Index) 55.4% 59.1% 50.9% 47.1% 48.6% Percent premature birth (<37 weeks) 13.6% 13.5% 17.9% 8.6% 12.6% Percent low birthweight births (< 2.5kg) 9.1% 8.0% 14.1% 13.9% 10.0% Teen (age 15-17) pregnancy rate per 1,000 23.9 19.1 27.5 0 49 Total pregnancy rate per 1,000 age 15-44 females 85.5 75.3 95.9 19.3 118.1 Fertility rate per 1,000 (all births/female population 15-44) 64.2 57.3 60.2 36.6 92.2 Infant mortality per 1,000 live births 5.6 3.1 12.1 0 11.3 Number of births per year (three year average) Source: Minority Health Surveillance Report, County Edition, 2010 Page 65 Sullivan County Public Health Services Community Health Assessment November 2013 Note: The Kotelchuck Index, also called the Adequacy of Prenatal Care Utilization (APNCU) Index, uses two crucial elements obtained from birth certificate data-when prenatal care began (initiation) and the number of prenatal visits from when prenatal care began until delivery (received services). A ratio of observed to expected visits is calculated and grouped into four categories: 1. 2. 3. 4. Inadequate (received less than 50% of expected visits), Intermediate (50%-79%), Adequate (80%-109%), Adequate Plus (110% or more). Key Maternal Health Takeaways: Significant racial and ethnic disparities exist in Sullivan County with regard to maternal and child health indicators. Sullivan County compares unfavorably to the state and nation across most indicators, including low birth weight babies and teen pregnancy. The Hispanic/Latino mothers are among the least likely to have early prenatal care, along with Asian mothers. The teen pregnancy rates are also more than 32.5 points above the countywide rate. African American mothers are also showing unfavorable maternal health indicators compared to the White mothers in Sullivan County. Specifically, higher rates of premature births, low birth weight babies, teen pregnancy rates, and infant mortality rates. Mental Health As depicted in the graph below, drug-related hospitalizations for substance abuse and mentalhealth related disorders are highest among the White residents of the county. The Asian statistics were too small to report. It is important to note that these figures reflect hospitalizations only. It can therefore be concluded that many more individuals in the county struggle with mental health issues that do not necessarily require a hospitalization. Page 66 Sullivan County Public Health Services Community Health Assessment November 2013 Drug-Related Hospitalizations per 10,000 48.6 Sullivan Co. 0.0 Asian 51.0 White 43.2 Hispanic 48.3 Black 0 10 20 30 40 50 60 70 Suicide statistics can be influenced by small numbers and should be interpreted with caution. As evidenced by the following graph, the Asian and Hispanic residents in the county either had no suicides for this time period or the counts are too small to consider reliable. Overall, the countywide suicide mortality rate is 14.6 per 100,000 residents. The rates are highest among Black residents of the county compared to the White residents. According to the Centers for Disease Control and Prevention, in 2010, suicide was the tenth leading cause of death for persons 10 and older, with an age-adjusted rate of 11.2 per 100,000. This suggests an elevated suicide mortality rate in Sullivan County compared to nationally. Suicide Mortality per 100,000 11.2 United States 14.6 Sullivan Co. 0.0 Asian 15.2 White 0.0 Hispanic 17.4 Black 0 5 10 15 Source: Minority Health Surveillance Report, County Edition, 2010 National Vital Statistics Report, January 2012 Page 67 20 Sullivan County Public Health Services Community Health Assessment November 2013 The table below provides a variety of statistics on adults and children who have been diagnosed with a mental illness. The number of Sullivan County adults with a serious mental illness (SMI) is roughly 581. The racial and ethnic statistics show that a diagnosis of a mental illness is greater among the White population in the county compared to the Black and Hispanic/Latino residents. These statistics only reflect Sullivan County residents who have sought treatment. Mental Health Consumers Sullivan County (count) 581 Sullivan County (%) New York (count) New York (%) --- 120,483 --- 113 --- 29,287 --- Youth, 0-17 130 15.8% 36,739 20.6% Adults, 18-64 634 77.1% 129,052 72.4% Adults, 65+ 58 7.1% 12,413 7.0% White 467 56.8% 81,366 45.6% Black 190 23.1% 42,553 23.9% Hispanic/Latino 127 15.5% 41,472 23.3% Adults with Serious Mental Illness (SMI) Children with SED (Severe Emotional Disturbance) AGE RACE Source: http://bi.omh.ny.gov/cmhp Key Mental Health Takeaways: Per self-report measures of mental well-being, Sullivan County adults report poorer mental health than statewide comparisons. Statistics are limited for the Asian and Hispanic/Latino population for Sullivan County, but data suggests that the majority of mental health concerns are among the White and Black residents in the county. Black residents of Sullivan County demonstrate the highest suicide mortality rates in the county. County suicide rates are above the national rates. Page 68 Sullivan County Public Health Services Community Health Assessment November 2013 Hasidic Jewish Population During the summer months, the Hasidic Jewish population increases dramatically in Sullivan County. The Hasidic population comes primarily from the New York City area of the state. While data is scare for this population within Sullivan County, a number of statistics are available for the Hasidic population in the New York City area. The following statistics come from the Jewish Community Study of New York in 2011, published by the UJA Federation of New York as well as an article published in June of 2012 by the Jewish Daily Forward entitled, “Time to Rethink the New York Jew.” The birthrate among Hasidic Jews is three times that of non-orthodox Jews. 1 in 5 (19%) of Jewish households are under 150% of federal poverty levels (FPL). 1 in 10 Jewish households are between 150% and 250% of federal poverty levels. Forty-three percent (43%) of Hasidic Jewish households are poor (under 150% of FPL). Fifteen percent (15%) of Jewish households get at least one form of public assistance. The top services sought by Jewish families are: chronic disease management (16%), disability services (15%), and job search services (14%). Hasidic Jewish women have an average of 5.8 children. Hasidic children make up 62% of orthodox Jewish children. The above statistics are shared as these social determinants and birth rates impact the local public health and healthcare systems in Sullivan County, especially during the summer months. Minority Health Profile Summary of Findings While Sullivan County, New York, is not alone in the existence of health inequities and disparities across different racial, ethnic, and demographic groups, the gaps seem more pronounced than in many areas throughout New York. The growing number of Hispanic/Latino residents, particularly the undocumented, is leading to a higher proportion of uninsured, individuals with chronic disease, and poor perinatal indicators. The Black residents in the county also demonstrate poorer health outcomes with higher mortality rates and chronic disease rates than White residents throughout the county. While the White residents within the county often compare favorably to other racial groups, when compared to statewide averages, the White residents often fall below these New York figures. While interventions are possible around access to care issues, reducing barriers, educating residents about preventive screenings, and healthy lifestyle behaviors, many of the unfavorable health outcomes that are detailed in this report are synonymous with poverty, unemployment, and low education levels. It is suggested that providers, elected officials, and other concerned organizations and agencies take a holistic approach to the definition of wellness and pay particular attention to these socio-economic influencers. Page 69 Sullivan County Public Health Services Community Health Assessment November 2013 IDENTIFICATION OF COMMUNITY HEALTH NEEDS & PLANNING Prioritization Session On October 21, 2013, approximately 20 individuals representing Sullivan County gathered to review the results of the 2013 Community Health Assessment (CHA). Among the attendees were representatives from local health and human service agencies, area non-profit organizations, health providers, and public health representatives. The goal of the meeting was to discuss and prioritize key findings from the CHA and to set the stage for the development of the Community Health Improvement Plan. A list of attendees can be found in Appendix D. Process The prioritization meeting was facilitated by Holleran Consulting. The meeting began with an abbreviated research overview, which presented the results of the primary and secondary research and key findings of the CHA. Following the research overview, participants were provided with information regarding the prioritization process, criteria to consider when evaluating key areas of focus, and other aspects of health improvement planning, such as goal setting and developing strategies and measures. The criteria that participants were asked to consider in evaluating areas of focus included: Size Seriousness Trends Equity Intervention Impact Values Resources Others How many people are affected by the issue? What will happen if the issue is not addressed (deaths, disability, etc.)? Is the issue getting worse or better? Are some groups more affected by the issue? Is there a proven strategy to addressing the issue? Can we make a difference? Does our community care about it? Do we have the appropriate framework, expertise, funds, etc. to address the issue? Social determinants, root causes, etc. In a large-group format, attendees were then asked to share openly what they perceived to be the needs and areas of opportunity in the county. During this discussion, attendees were asked to consider five priority areas for community health improvement activities. The priority areas are part of the Prevention Agenda Objectives that are set by the state of New York as the blueprint for state and local action to improve the health of New Yorkers. Local health departments and hospitals in New York are required to select at least two of these priority areas and develop a community plan that addresses them and improves community health outcomes. The priority areas are presented below in alphabetical order: Prevent chronic disease Prevent HIV, STDs, vaccine preventable diseases and healthcare associated infections Promote a healthy and safe environment Page 70 Sullivan County Public Health Services Community Health Assessment November 2013 Promote health women, infants and children Promote mental health and prevent substance abuse To aid the discussion around priority areas, a list of the needs that were identified through the CHA research components was created and then each need was grouped according to the priority area it aligned with. The following chart depicts the five priority areas and the needs that correspond to them. Identified Health Priorities Attendees reviewed the findings from the CHA and discussed cross-cutting approaches to further hone the priority areas. Ultimately, the following three priority areas for Sullivan County were adopted: Prevent Chronic Disease Promote Healthy Women, Infants, and Children Promote Mental Health and Prevent Substance Abuse Goal Setting Following the prioritization session, Sullivan County Public Health Services reviewed the identified priorities and develop goal statements to guide community-wide health improvement efforts. The following goals were adopted for each priority area: Prevent Chronic Disease Goal 1: Create community environments that promote and support healthy food and beverage choices and physical activity. Page 71 Sullivan County Public Health Services Community Health Assessment November 2013 Goal 2: Increase screening rates for cardiovascular disease, diabetes and breast, cervical and colorectal cancers Promote Health Women, Infants, and Children Goal 1: Reduce premature births. Goal 2: Increase the rate of Sullivan County babies who are breastfed. Goal 3: Prevent unintended and adolescent pregnancy. Promote Mental Health and Prevent Substance Abuse Goal 1: Promote mental, emotional, and behavioral well-being in communities. Goal 2: Prevent underage drinking, non-medical use of prescription pain reliever drugs by young, and excessive alcohol consumption by adults. Goal 3: Prevent suicides among youth and adults. Goal 4: Promote tobacco use cessation among adult smokers. Action Planning To set a course for ongoing community health improvement activities and evaluation, a Community Health Improvement Plan (CHIP) was developed by Sullivan County Public Health Services. The CHIP was adopted in November 2013 and is available for review at http://co.sullivan.ny.us/. Page 72 Sullivan County Public Health Services Community Health Assessment November 2013 COMPENDIUM OF HEALTH RESOURCES The following is a comprehensive list of organizations involved in the community health improvement process, both individually and in conjunction with the health department. The services that the organizations provide are included. The list The listis not meant to be exhaustive, and undoubtedly some resources may have inadvertently been left out. However, we have tried to include as many community resources as possible to reflect the overall availability of services throughout the county for individuals and families. PARENTING EDUCATION/SUPPORT/CHILD CARE Sullivan County Child Care Council, Inc. Liberty, NY Service Description: Referral service for children, parents, and child care providers that provides research-based information, educational opportunities and training to child care providers, parents and community. Promotes quality, safe, secure, and affordable child care, and acts as a link between community agencies, childcare providers and parents. Sullivan County Community College Child Development Center Loch Sheldrake, NY Service Description: Licensed day care and support services for students attending classes. Sullivan County BOCES Service Description: GED programs and parenting groups provided for families having difficulties dealing with the parenting concept or children with special needs. ASK (Academic Support for Kids) - Education of homeless children and youth; case management for homeless youth to ensure equal educational access; coordination with local district homeless liaisons on issues of enrollment, transportation and documentation. Early Intervention Program Liberty, NY Service Description: The Early Intervention Program provides services to developmentally delayed or disabled children between birth and three years of age. Head Start of Sullivan County WoodBourne NY & Monticello NY Service Description: Program is designed to provide a warm, supportive learning environment where children can develop individually by learning through play and educational models; a full and part time day program for pre-school age children. Page 73 Sullivan County Public Health Services Community Health Assessment November 2013 Youth Educational School Services (YESS)/ Family Empowerment Council Inc. Middletown, NY Service Description: Provides advocacy, training and/or mentoring in Sullivan County. Advocates work to protect the educational rights of students from pre-school through high school. Funding is received through OMRDD Hudson Valley DDSO, Family Support Services. Boys & Girls Club of Sullivan County Monticello NY Service Description: Community oriented activities to encourage positive interactions between peers and the community; development of positive self esteem and personal growth in youth; after-school activities and weekend opportunities for youth. Monticello Housing Authority Monticello NY Service Description: Provides 80-plus low income units public housing at Evergreen Housing Project with an after school recreation program for the residents; provides oversight for 80-plus units at the Senior Citizen housing facility at Liberty Street in Monticello; provides Section Eight housing for Sullivan County residents who apply and qualify. Maternal-Infant Services Network Central Valley, NY Service Description: Provides family and community health and wellness services to pregnant women and women of childbearing age; parents of infants and young children; schools concerned with pregnant and parenting teens; and health and human service providers. Parent and caregiver workshops include: How to Talk to Your Teen About Anything - This workshop discusses the ways that parents and caregivers can engage their children in discussions that range from everyday challenges to those involving sexuality. We provide a basic overview of youth developmental stages, offer tips on how to keep the lines of communication open with your child, tools to help you answer those tough questions, and strategies to help you can make conversations more comfortable for you and your child. Healthcare and Health Insurance for Your Teen - Access to regular health care services helps support healthy development in adolescence, but many barriers, such as lack of insurance, can make it difficult to access care. This workshop will give you information about for state funded health insurance programs, as well as other low or no cost services and benefits that can help your family members access medical, dental, and vision care. Keeping your Teen Safe in a Technological World - Youth are growing up in a world that requires them to spend a lot of time on-line for many reasons – education, Page 74 Sullivan County Public Health Services Community Health Assessment November 2013 socialization and entertainment. While there are many benefits that come from access to technology, there are also some potentially serious risks. In this workshop, we’ll explain how teens use the web, the dangers that they could be exposed to, and what you can do as a parent or caregiver to protect you teen. Youth Development and You - This workshop explains the ways which educators and youth program staff make a difference in the lives of children. In addition to providing a general overview of adolescent development, we describe how to really listen to what teens are saying, keep the lines of communication open, and answer the questions that adolescents may come to you with. Participants will also be provided with local resources to share with youth that might need some additional support. Teen pregnancy prevention services include: Project AIM – A 13-session program for middle school age youth. Program participants will develop a picture of themselves as successful adults, set goals and identify barriers to achievement and learn how to protect their future by reducing risky behavior now with the intent to reduce teen pregnancy and STI risks. Making Proud Choices – An eight-hour series that aims to increase knowledge and support positive decision making in Middle School age youth with the goal of reducing pregnancy, HIV and STI’s. APPROVED PRE-SCHOOL PROGRAM/ EVALUATION SITES Best Friends Services, Inc. Service Description: This day care program for preschool and school-age children provides early intervention, special education and regular day care services. Ellenville Children’s Annex Ellenville, NY Service Description: This center-based program is a school for preschool and school-age children who are 3 through 8 eight years old, have the educational classification of preschooler and a disability, autism, emotional disability or multiple disabilities. Inspire Kids/CP Center Goshen NY Service Description: Early Intervention services: Inspire provides evaluation, therapy, and service coordination through the New York State Early Intervention Services Program. This program supports the development of children with special needs from birth through age 2-and-a-half years. Evaluations are provided in the home and Inspire can be selected as a provider. Page 75 Sullivan County Public Health Services Community Health Assessment November 2013 Preschool services: Inspire Kids is dedicated to developing in each child a positive selfimage and a true love of learning. The staff endeavors to achieve this goal in a multi-age classroom setting, in which basic skills are taught within an individualized program augmented by age-appropriate enrichment. Inspire Kids Preschool: Inspire Kids is a special education preschool and an evaluation site approved by the New York State Department of Education. The preschool is located at Inspire’s 2 Fletcher Street headquarters in Goshen. Children who have been approved through their local school district’s Committee on Preschool Special Education are eligible for services at Inspire Kids. Therapy services are available on an individual basis according to a child’s Individualized Education Program (IEP). Some classes offer an integrated setting where children with special needs and typically developing children learn together. Programs for both the school year and a six-week summer session are available. Golden Apple Preschool: The Golden Apple Preschool, located within Inspire Kids, is open to the general public and offers half-day inclusionary preschool classes for typically developing children between the ages of 2 ½ and 5 years. The children learn within integrated classroom settings in which children with typical and special needs together benefit from an early education curriculum of learning, play and social skills. Audiology: Inpire’s Audiology Department is staffed by New York State licensed and American Speech-Language and Hearing Association certified audiologists. The department is dedicated to the early identification and treatment of hearing disorders in infants, children, and adults. A broad range of diagnostic and support services are provided, including comprehensive hearing evaluations, newborn hearing screenings including Otoacoustic Emissions testing (OAE), testing for auditory processing difficulties, hearing aid consultation and testing, and auditory training for hearing loss and cochlear implants. Dentistry: Inspire’s state-of-the-art Dental Department provides preventive and diagnostic treatment for all patients, and specializes in general dentistry for people with special needs. Occupational Therapy: Inspire’s Occupational Therapy Department offers evaluations and treatment programs in their Diagnostic and Treatment Center and in some public schools for individuals of all ages but specializing in the pediatric population. Skilled therapists perform evaluations to assess the areas of fine motor performance, visual motor and visual perceptual skills, self-management, and sensory motor integration. Intervention occurs through one-on-one treatment sessions, consultations with parents and teachers, and/or the provision of home programs. Page 76 Sullivan County Public Health Services Community Health Assessment November 2013 Physical Therapy: Inspire’s Physical Therapy Department provides evaluations and therapy services for individuals of all ages. The Physical Therapy Department is staffed by experienced physical therapists and physical therapist assistants trained in the treatment of various diagnoses of orthopedic and neurological origin. Preschool Special Education Program Liberty, NY Service Description: The Preschool Special Education Program provides services to developmentally delayed or disabled children between three and five years of age. Preschool learning experience (George Robinson Center) Middletown, NY Service Description: The Preschool Learning Experience (PLE) program is located in Middletown, New York, at the George Robinson Center for Child Development and in New Windsor, New York, on the grounds of the Mt. St. Joseph campus. This program is available to all children between the ages of 2½ and 4 years. The PLE program is an integrated preschool program for both typically developing as well as developmentally delayed children. The preschool program offers full-day and half-day sessions depending on the needs of the child. The integrated nursery school component offers only half-day sessions. The New Windsor center offers 10 self-contained special education classrooms and two integrated classrooms. The Middletown center offers nine full-day and two half-day selfcontained special education classrooms and one integrated classroom. Classroom sizes are limited to between 9 and 12 children. Each class has 1 teacher and up to 4 teachers' aides. If required by the child's Individual Education Plan (IEP), a oneon-one aide is provided as well. Dually licensed teachers in both early childhood education and special education teach all integrated classrooms. The children who are enrolled in the preschool program as preschoolers with a disability receive any or all of the following services: each child referred by his/her school district of origin comes to the preschool program with an Individualized Education Plan (IEP). This plan states what goals and objectives the classroom and related service staff must address throughout the school year. As the child progresses throughout the year, progress is noted and the IEP may be updated as necessary. Any child between the ages of 2 ½ and 4 years who has had a formal evaluation and had a program recommended through his/her home school district may attend an integrated or non-integrated preschool class. Project Excel (Easter Seals) Monticello NY Service Description: Modeled after Project Discovery, the first integrated preschool program in New York State, Project Excel provides educational services for the Universal Pre-kindergarten Page 77 Sullivan County Public Health Services Community Health Assessment November 2013 students of Monticello and classified pre-school children in the area. In partnership with the Monticello School District, the program offers integrated preschool classes with “push-in services” for children ages 3.5 to 4.9 years of age. Easter Seals also offers an evaluation team for children referred by the districts, 80 Universal Pre-kindergarten slots, Early Intervention services, related services at local programs, and a focus on family participation in the treatment and education of children. DRUG AND ALCOHOL Daytop Village, Inc. – Substance Abuse Treatment Parksville, NY Service Description: Two treatment centers for substance abusers offer services comprised of treatment, ancillary services, and in-house support services. Catskill Regional Medical Center – Bio-Chemical Dependency Unit Harris, NY Service Description: Offers 10-to-15-day stays, drug-free medical detoxification, methadone-free detoxification from heroin and methadone, alcohol and cocaine detoxification and aftercare referrals. Eligibility: Current drug use; medical insurance Council on Alcoholism and Drug Abuse of Sullivan County, Inc. (Recovery Center) Monticello, NY Service Description: Not-for-profit community agency providing information, education, consultation, and treatment to those whose lives have been affected by the disease of alcoholism and other drug addictions; promotes public awareness and interest in the prevention and treatment of addictions; provides non-medical detoxification, halfway house (residential), HIV/AIDS services, KIDS Klub, CARE CORPS and Safe Summer Camp to recovering addicts. Outpatient clinic is located at 196 Broadway, Monticello, NY. Community Residence/Halfway House: Community Residence is a residential Halfway House to assist individuals to maintain abstinence and continued recovery in a safe, semi-independent living situation while attending outpatient services. Separate units for men and women. Day Rehabilitation: Intensive rehabilitation services up to five days a week, individual and group counseling, didactic/interactive sessions, and health services, recreation and art therapy, Life Skills, GED prep., vocational compound, discreet women’s program. HIV/AIDS Outreach and Support Services: HIV/AIDS support groups (men’s, women’s, mixed), 1-1 counseling, family counseling, counseling for significant others, on-site testing, pre- and post-test counseling, referral and resources information, stress Page 78 Sullivan County Public Health Services Community Health Assessment November 2013 management services, CERTA Program for children, Congregate Meal Program, confidentiality trainings, lectures. KIDS Klub: A prevention program for children ages 7-12 affected by alcoholism and other drug abuse. Based on the program “Children are People”, the children are taught the following about alcoholism and other drug abuse: THEY DID NOT CAUSE IT, THEY CANNOT CURE IT, THEY CAN COPE WITH IT. Outpatient Clinic: Evaluations, individual and group therapy, Sober Teens Outpatient Services (STOPS), Teen COA group, Family Program, Family Intensive, High Intensive Program (HIP), Healthy Alternatives (HALT) for batterers, relapse prevention, Parent-Child Program, Spanish-speaking group, DWI services, Gay/Lesbian group, women’s group. Prevention-Intervention-Education Services: Prevention, intervention, and education training for community organizations and human service agencies; professional training and impactor training; annual alcohol and drug abuse poster contest; professional presentations at community organizations/fairs and schools (elementary, middle and high school levels). Primary Care Unit: Provides 24-hour care and services with medical support for intoxicated persons and persons in need of withdrawal services. Services provided in a safe, structured setting with linkages to ongoing treatment and rehabilitation services. Respite care for those in danger of relapse. Public Information and Education: Professional trainings for alcohol/drug and other human service professionals. Impactor trainings for community organizations and businesses, faith communities, parents, teachers, neighborhood groups on preventing, intervening, and treatment alcohol and drug problems. Particular emphasis on effective prevention programs and activities which assist young people to develop “protective factors” that help them avoid high risk behaviors and problems with alcohol and other drugs. Participation in health fairs and community events. Public awareness through media activities and public service announcements. Participation in awareness campaigns, including annual Poster Contest. Resource library available. Publication and distribution of quarterly newsletter. Safe Summer Camp: A one-week sleepover camp for 30 at-risk children. Competency building, educational and recreational activities, prevention, education, self-esteem building. Camp is located at Frost Valley YMCA. Page 79 Sullivan County Public Health Services Community Health Assessment November 2013 Dynamite Youth Community, Inc. – Drug Free Therapeutic Community Fallsburg, NY Service Description: Dynamite Youth Community, Inc. is a New York State licensed and funded drug rehabilitation program for adolescents and young adults. Two facilities: a day service and outpatient unit located in Brooklyn and a residential component located in Fallsburg, NY. Services provided: group, individual and family counseling, and a comprehensive educational and vocational program. New Hope Manor – Residential Substance Abuse Treatment Center for Women Barryville, NY Service Description: Residential substance abuse treatment for women 13 years of age and up. Pregnant women and their infants are accepted. Assessments, referrals, speakers provided. Weekly seminars open to the public. Sullivan County Cares Coalition, Inc. Monticello, NY Service Description: Provide youth with alternatives to substance abuse by providing a variety of programs (i.e., theater workshops, dance, prevention groups, positive alternatives for youth) sponsored/co-sponsored recognition. Sullivan County Division of Health & Family Services - Sullivan County Alcohol & Drug Abuse Services (SCADAS) Liberty, NY Service Description: SCADAS is an outpatient drug and alcohol clinic. Services provided: evaluations; individual, family and group counseling for substance abusers and those family members affected by drug and alcohol abuse. Veritas Therapeutic Community, Inc. – Residential Drug and Alcohol Treatment Barryville, NY Service Description: Group, individual, vocational counseling, HSE program, family therapy, structured environment, NA and AA seminars and meetings, HIV+ and STD counseling. Village of Liberty Police Department – Liberty D.A.R.E. (Drug Abuse Resistance Education program) Liberty, NY Service Description: To educate and counsel 5th grade students within the Liberty school district of drug abuse and violence resistance techniques through the presentation of a 17-week curriculum. Page 80 Sullivan County Public Health Services Community Health Assessment November 2013 EMERGENCY SERVICES Mobil Medic Hurleyville, NY Service Description: 24 hour emergency EMT ambulance services to local hospital emergency room. American Red Cross – Sullivan County Chapter - Disaster Services Monticello, NY Service Description: The Chapter aids victims of disaster, providing food, clothing, and emergency shelter. Trained volunteers and staff can open a reception center or shelter on short notice. Catskill Emergency Service – Catskill Emergency Service Sullivan County Monticello, NY Service Description: Psychiatric emergency service operating when the mental health clinics (Community Services) are closed. RISE (Rape Intervention Services and Education) – Rape/Sexual Assault Monticello, NY Service Description: 24-hour hotline, limited case management, survivor of sexual assault support group, short term counseling, court, police and emergency room advocacy, sexual assault prevention education. Community Action Commission to Help the Economy, Inc. (CACHE) Liberty, NY Service Description: An anti-poverty agency which serves the poor through multi-services. These include: housing assistance program, weatherization, food and other program assistance. Community Residence/Halfway House: Community Residence is a residential Halfway House to assist individuals to maintain abstinence and continued recovery in a safe, semi-independent living situation while attending outpatient services. Separate units for men and women. CACHE – Safe Passage: For victims of domestic violence only, 24-hour hotline. Safe Passage provides advocacy to courts, police departments, Department of Social Services, hospitals; provides short-term counseling to victims of domestic violence; provides safe dwelling, support groups and education; provides information about other services in the community; makes referrals to other programs. Bilingual services are also provided. CACHE – Hunger Prevention and Nutrition Assistance (HPNAP): Provides low income or homeless individuals and families with food to supplement their nutritional needs. Up to nine meals per month per household member may be provided. The agency also distributes surplus commodity food approximately four times per year. Page 81 Sullivan County Public Health Services Community Health Assessment November 2013 CACHE – Share Program: For 2 hour’s community service and $15.00 per unit, county residents can receive up to $30.00 worth of food. Payment can be cash or food stamps. This can be done on a monthly basis. CACHE – Weatherization Program/Local Initiative Program: Local Initiative Program provides but is not limited to outreach, information, referral, and advocacy to those at or below the poverty level requiring help to access public assistance, legal services, public health services, emergency help, employment counseling, and consumer education. Weatherization Program provides replacement windows, doors, insulation, and other energy conservation improvements for the economically disadvantaged. CACHE - Youth and Family Services: A team of professionals and paraprofessionals who educate, role model, and advocate for families referred through a contract with the Department of Family Services. The goal of the program is to prevent out of home placement. Sullivan County Federation for the Homeless, Inc. Monticello, NY Homeless Prevention Program/Tom’s Kitchen: The Homeless Prevention Program works to prevent evictions, maintain a landlord and apartment list, refer to other agencies. Tom’s Kitchen works to prevent hunger, serves hot noon-time meals, food pantry bags one day a week, referrals to other agencies. Together for Meals (Tom’s Kitchen) program: Provides food pantry services and hot lunches. Clothing rack with donated clothing on site. Referrals to other agencies. The Salvation Army Monticello, NY Service Description: Emergency Services: To provide emergency food for a natural or manmade disaster. Energy: Pay for home heating fuel, propane and electric bill. Medications: Pay for medications under emergency basis. Pantry: Distribution of Food bags, holiday dinners, and Thanksgiving baskets. Rent: Help pay for rent when funds are available. Transportation: Transportation under emergency needs only. Page 82 Sullivan County Public Health Services Community Health Assessment November 2013 United Way of Sullivan County Monticello, NY Service Description: The United Way of Sullivan County is a local community-based organization designed to offer assistance to the residents of the County. Assistance is provided in many different ways, including planning, allocations, communications, cooperative services, a Dress to Work Program, and fundraising for area non-profits. The United Way works in close partnership with schools, government, private business, and agencies to pinpoint and address critical community issues. The United Way mobilizes community volunteers to help people in need and offers information and referral. The United Way uses contributions to fund a wide variety of programs and services. FAMILY PRESERVATION AND SUPPORT Community Action Commission to Help the Economy, Inc. (CACHE) – Safe Passage – Domestic Violence Program Liberty, NY Service Description: For victims of domestic violence only, 24 hour hotline. Safe Passage provides advocacy to courts, police departments, Department of Family Services, hospitals; provides short-term counseling to victims of domestic violence; provides safe dwelling, support groups and education; provides information about other services in the community; makes referrals to other programs. Bilingual services are also provided. Center for Workforce Development (Center for Career Development) Monticello, NY Service Description: Assistance in preparing for job searches, composing a resume and acquisition of job skills. Free GED/ESL classes. ARC– HCBS (Home & Community Based Services) Waiver Monticello, NY Service Description: Under the “Waiver”, service coordination, residential habilitation, environmental modifications, and adaptive technologies may be accessed. DRC (Dispute Resolution Services) Monticello, NY Service Description: The DRC is a private, not-for-profit organization dedicated to helping people resolve conflicts through its many programs. At the heart of this effort is Alternative Dispute Resolution. Dealing with: (Landlord/Tenant, Neighbor/Neighbor Boyfriend/Girlfriend, Employee/Employer, Credit Card Disputes, Consumer Merchant Issues Crisis Intervention Hotline, Elder mediation, Divorce mediation, Parent Access (Custody/Visitation), Parent Child mediation, Peer mediation and Special Education mediation. Page 83 Sullivan County Public Health Services Community Health Assessment November 2013 Cornell Cooperative Extension Financial Education Liberty, NY Service Description: Offers financial education materials and information regarding family budgets, credit management and debt repayment planning. One-on-one budgeting – A financial educator works with clients to help them construct a family spending plan. AARP Volunteer Income Tax Program (VITA) - Trained community volunteers prepare taxes for people over 60 as well as individuals with low-to-moderate incomes. First Time Home Buyers Class – Educator-organized class focusing on the process of buying a home. EmPower NY- Classes are offered year-round at locations around the county that teach consumer strategies for managing energy costs. Cornell Cooperative Extension Consumer Education Liberty, NY Service Description: The Consumer Education program offers educational materials and workshops to help consumers avoid financial hardship caused by fraud. The Consumer Education program partners with the Caregiver Resource Center on the Long Term Care Insurance Education and Outreach Program, offering classes and lunches to community members and groups. Family Empowerment Council INC. Middletown, NY Service Description: Provides funding and assistance to individuals with developmental disabilities living at home with their families, A FEP panel reviews requests for funding and provides information for referrals for community resources. Interfaith Outreach United, Inc. – I.O.U. Emergency Assistance/Thrift Shop Callicoon, NY Service Description: I.O.U. is a community and church-based organization serving an area of about 12 miles radius from the hamlet of Callicoon in the Town of Delaware (including the towns of Cochecton, Fremont, and the Pennsylvania town of Damascus). The I.O.U. operates Thrift Shop at 107 Main Street in Callicoon and provides emergency assistance to persons and families in need. The Thrift Shop has a large Food Pantry which provides food assistance for those in need, as well as a limited amount of furniture. Several area churches provide their local outreach through the I.O.U. Page 84 Sullivan County Public Health Services Community Health Assessment November 2013 People for People Fund Middletown, NY Service Description: The People for People Fund assists people in obtaining a fresh start; offers aid to those who have exhausted all other avenues of financial relief. Will serve Sullivan County. Self-sufficiency is an objective. Sullivan County Advocate Program Liberty, NY Family Preservation & Support: Intense advocate services for children and families at serious risk of out-of-home placement owing to PINS and JD behavior. Wrap-Around Programs and Families Count: Short term crisis intervention services and intense advocate and case management services for youth and their families at serious and imminent risk of out-of-home placement. Sullivan County Department of Community Services – Sullivan Family Support – Parents for Parents Liberty, NY Service Description: Family Support Group and services to families with a child/youth with emotional or behavioral difficulties. Group meets in Liberty and Monticello three times/month. Sullivan County Department of Family Services Adult Services Unit: Adult protection, health-related, housekeeper/chore, homemaker, personal care aide, home management, housing improvement, residential placement. Child Protective Services: Child Protective services (abuse & neglect) investigation. Children’s Services Unit: Foster care, child preventive, adoption. Home Energy Assistance Program (HEAP): Income-based program during an emergency to assist in paying fuel and/or utility bills during heating season. Human Services Intervention and Outreach: Review and investigate citizen or agency concerns and inquiries relating to the delivery of human services. Assistance in resolving issues and/or makes referrals to appropriate services. Available to answer questions and provide information regarding services in Sullivan County. *If not available at time of call, please leave message. All calls returned promptly. Medical Assistance: Medical for most medical needs including long term care. Page 85 Sullivan County Public Health Services Community Health Assessment November 2013 Temporary Assistance/Food Stamps: Public assistance for monthly income. Food stamps as supplementation of food needs. Sullivan County Youth Bureau Monticello, NY Service Description: Lead county department in planning services for Sullivan County youth and families. Outreach, coordination, needs assessment, linkages, and advocacy in addressing youth needs. Assists in development of programs and services to Sullivan County youth. Provides funding for programs serving youth in Sullivan County (e.g., special delinquency prevention programs, Boys & Girls Club, Cares Coalition, youth service and recreation programs; including municipal recreation programs). Monitors funded programs serving youth to assure high-quality delivery of services. HEALTH AND SAFETY SERVICES Hudson Valley Community Services Monticello, NY Service Description: HIV testing, case management; individual and group counseling; support services; education presentations; health home care management for people with active Medicaid who have one serious mental illness, or two chronic health conditions, or one chronic health condition and the risk of developing another. Pathstones (formerly; Sullivan County Rural Opportunities INC.) Monticello, NY Service Description: Case management; individual and group counseling; support services; education presentations, assistance with financial, medical and housing for people living with HIV. Health Information Library at Catskill Regional Medical Center Harris, NY Service Description: The CRMC Library offers FREE consumer friendly health information services to all Sullivan County Residents. Offering library facilities; computer access up-to-date reliable health information for all ages. A trained Medical librarian to assist you. Catskill Regional Medical Center Harris, NY Service Description: The Sole hospital provider in Sullivan County 164 bed facility, CRMC provides services at its Harris campus and Callicoon as well as its family health centers in Bethel, Monticello and Wurtsboro. Providing the highest quality care. CRMC recently added a new MRI, a response helicopter and new Birthing center: Offering expectant family child birth classes (call for more information and availability). Page 86 Sullivan County Public Health Services Community Health Assessment November 2013 Case Management Department located at Catskill Regional Medical Center Harris, NY Service Description: This department provides discharge planning for hospitalized patients both in the Harris and Callicoon divisions; and for patients in the Harris Family Health Clinic and Emergency Department. Case Managers assess the patient's level of capacity for self care and the formal supports necessary to facilitate an appropriate discharge plan. The Case Manager initiates referrals to agencies, nursing homes or adult homes as appropriate American Cancer Society Kingston, NY (serves Sullivan County) Service Description: Information and referrals; educational programs; patient services; Look Good…Feel Better; limited financial services. Hudson River HealthCare Inc. Monticello, NY Service Description: Comprehensive quality health care center providing healthcare for all ages. Same day appointments, offering adult well and sick care, child well and sick care, family planning, health education, health screenings, HIV testing and counseling, immunizations, internal medicine, pediatrics. Offering special programs: cancer risk assessments, child health plus, colorectal screening, family health plus, diabetes control program, healthy women’s partnership, nutrition counseling. Fidelis Care Health Plan/W.P.H.S.P. – Child/Family Health Plus Liberty, NY Service Description: State subsidized insurance program/plan for uninsured children 18 years and under, living in Sullivan County at low cost or no cost. Hudson Health Plan/W.P.H.S.P. – Child/Family Health Plus Monticello, NY Service Description: State subsidized insurance program/plan for uninsured children 18 years and under, living in Sullivan County at low cost or no cost. Maternal Infant Services Network (covers 4 county area including Sullivan) Central Valley, NY 10917 (845) 928-7448 Provision of referrals to prenatal care. NYS Health Department/Monticello Regional office – Environmental Health Monticello, NY Service Description: Inspect and regulate children’s camps, food services, temporary residences, swimming pools, bathing beaches, public water supplies, mobile home parks, sale of tobacco, childhood lead poisoning home investigations. Page 87 Sullivan County Public Health Services Community Health Assessment November 2013 Planned Parenthood Mid-Hudson Valley, Inc. – Planned Parenthood Monticello, NY Service Description: Pregnancy testing, GYN exams, birth control methods, HIV antibody testing, Morning After pill, Pap smear, STD testing, referrals for colonoscopy/mammograms, HRT. Sullivan County Women’s Health Partnership (NYSDOH grant) C/o Catskill Regional Medical Center Harris, NY Service Description: Sullivan County Breast Health Partnership offers free mammograms, clinical breast exams, breast self-exam education, and pap smears to women 40 and older who meet program guidelines. Eat Smart New York (Cornell Cooperative Extension) Liberty, NY Service Description: Health and Nutrition program nutrition education for limited income families, youth and senior citizens. Food Safety Improving Dietary Quality Resource Management and Budgeting Hunger and Food Insecurity Issues Crystal Run Health Care Rock Hill, NY Service Description: Crystal Run Healthcare employs 140 physicians in ten locations throughout the Mid-Hudson Valley and lower Catskill regions. You can have most of your health care needs met in one place. You can see your primary physician, have lab work and tests done, and make an appointment with a specialist...all in one day, without leaving the building. Also on-sight URGENT Care facility. Sullivan County Public Health Services Liberty, NY Service Description: Sullivan County Public Health Services commits to achieving this mission through the ten essential public health services: Page 88 Bilingual Outreach: The bilingual outreach program works to reach underserved Latino populations and emphasize the importance of learning the principles of becoming self-sufficient in promoting health for themselves and their families. They are given the skills to overcome cultural and linguistic barriers to accessing medical appointments and prenatal care, for example, by getting connected with resources Sullivan County Public Health Services Community Health Assessment November 2013 for learning English as a second language. Translation and interpretation is available for PHS clinic appointments and maternal child health programs and visits. Page 89 Child Passenger Safety Seat Program: The Sullivan County Child Passenger Safety Seat Program is a program which provides car seats to families (with children newborn to 8 years old) who reside in Sullivan County and are low income and need of a car seat; receive education regarding safety awareness; and can show proof of full time residency. Disease Prevention and Control: Sometimes known as the epidemiology program, this office tracks chronic and communicable disease trends in Sullivan County, investigates and responds to outbreaks, implements health education programs in regard to many of the more outstanding health risks in the county, and provides preventive treatment for many of the more dangerous contagious illnesses such as rabies, tuberculosis, and meningitis. The office also provides immunization clinics, HIV counseling and testing, sexually transmitted infection diagnosis and treatment, lead poisoning prevention and case management, tuberculosis control, rabies and flu clinics, and much more. Early Care: Early Care continues its mission to identify and evaluate, as early as possible, those infants, toddlers and preschoolers whose healthy development is compromised, and provide for appropriate intervention to improve child and family development. Health Education: PHS continues to deliver public health education through public speaking, convening and facilitation of groups, production of teaching materials, dissemination of public service announcements, and grant paid public awareness campaigns. Health Emergency Planning: The health emergency planning program in the county prepares for and maintains readiness for emergencies, man-made or natural. Healthy Families of Sullivan: The mission of the Healthy Families of Sullivan program is to support and serve pregnant and parenting families in Sullivan County through activities and education that promote positive parent-child bonding and relationships, promote optimal child health, development, and safety, enhances parental self-sufficiency, and prevents child abuse and neglect. Certified Home Health Agency (CHHA): The certified home health agency is the sole provider of intermittent home care in Sullivan County permitted by the Federal and State government to care for Medicare and Medicaid recipients. Care is provided to residents of Sullivan County from birth to death. Sullivan County Public Health Services Community Health Assessment November 2013 Long Term Home Healthcare Program (LTHHCP): The Long Term Home Health Care Program (LTHHCP) continued to maintain and establish solid nurturing relationships with patients who qualify for nursing home level of care, but who can be kept at home at a fraction of the cost, in a more comfortable environment. Maternal-Child Health Nursing: Maternal Child Health (MCH) Nurses perform skilled nursing visits to antepartal, postpartal and pediatric patients throughout Sullivan County. Nurses collaborate with other agencies and programs to manage cases and optimize outcomes. In 2008, the MCH Coordinating Council was developed to improve communication and collaboration and develop cost-savings measures between the various programs at Public Health serving the childbearing population. Physically Handicapped Children’s Program (PHCP): All income-eligible children under 21 years of age with a qualifying physically handicapped condition are identified through referrals and self-referral for evaluation. Children not eligible for either are assisted through this program. The PHCP pays for specific medical care without causing undue financial hardship on the family. PHCP assists many families to access Child Health Plus or Medicaid. Rural Health Network: The Rural Health Network (RHN) is a collaboration of multiple agencies concerned about health in the County. The Rural Health Network receives funding from the New York State Department of Health, which offsets salaries as well as funds activities and subcontracts to improve the overall health of county residents. The NYSDOH Office of Rural Health monitors the contract deliverables and expenditures of the grant. Women, Infants and Children (WIC): The goal of this program is to prevent low birth weight deliveries and keep babies and children healthy. The program provides nutrition education and food vouchers for healthy foods for pregnant and breastfeeding women, infants and children each month. These vouchers are spent in county stores and keep dollars within the County. PHS operates the only WIC Program in NYS that does presumptive Medicaid Eligibility applications for the purpose of getting pregnant women into early prenatal care. The PRASAD Project – PRASAD Children’s Dental Health Program Hurleyville, NY Service Description: Comprehensive dental health program in Sullivan County schools; fluoride programs, education programs, dental screenings and treatment on mobile dental van. For Children 6 months and older and pregnant women currently enrolled in WIC. Page 90 Sullivan County Public Health Services Community Health Assessment November 2013 Maternal-Infant Services Network Central Valley, NY Service Description: Provides health insurance enrollment and in person navigator assistance for New York State of Health Marketplace for individuals ages 0 to 64 and small businesses. Health insurance enrollment includes commercial insurance and Medicaid/Child Health Plus. Women’s Health Center at Hudson River Healthcare Monticello, NY Service Description: Provides women’s health care services: mammograms, clinical breast exams, breast self-exam education, and pap smears and all phases’ ob-obstetrics and mid-wife care. Neighboring Hospitals Ellenville Community Hospital (Ellenville), in neighboring Ulster County, isutilized by some residents of the Grahamsville, Neversink, and Woodbourne areas. Wayne Memorial Hospital, in Wayne County, Pennsylvania, is used by some residents in Narrowsburg, Jeffersonville, Callicoon and residents who live along Route 97 on the western end of the county which borders Pennsylvania. Bon Secours Community Hospital in Port Jervis is utilized by some residents of the Glen Spey and Forestburgh areas. Orange Regional Medical Center in neighboring Middletown is used by some residents in Mamakating. Refuah New Square, NY Service Description: The Refuah Health Center exists to provide high-quality medical, dental and supportive services to all who wish to avail themselves of the Center, regardless of economic status. Based out of Rockland County, Refuah provides services in the following disciplines: Page 91 Allergy Behavioral Health Bone Densitometry Case Management Dermatology Pediatric/Adult Dentistry Digital Mammography Family Practice Gastroenterology Geriatrics Obstetrics Otolaryngology Ophthalmology and Optical Services Pain Management Pediatrics Podiatry Physical Therapy Pulmonolgy Urology Sullivan County Public Health Services Community Health Assessment November 2013 A & T Healthcare, LLC Newburgh, NY Service Description: A & T Healthcare is a licensed home care agency owned and operated by Registered Nurses. The agency provides the following services: Skilled nursing Home Health Aides Live-in Home Health Aides Personal Care Aides Companions and hospital sitting Private duty nursing Physical, occupational, and speech therapy Social work Hospice of Orange & Sullivan Counties, Inc. Newburgh, NY Service Description: Hospice care is a specialized form of treatment and service for a patient with an advanced end stage illness having a life expectancy of less than six months. Hospice enables patients to live every day of life to the fullest, focusing on comfort and the enhancement of the individual's quality of life. Sullivan County Veterans Service Agency Monticello, NY Service Description: Benefits and services available to veterans who have received an honorable discharge include: medical care advocacy, disability compensation claims, disability pension claims, insurance, death pension benefits, dependency and indemnity compensation, burial in a veteran's cemetery (either Sullivan County or national) with headstone or grave marker and burial flag. SPECIAL CARE NEEDS Sullivan ARC Service Description: A. Clinical Services provides services to individuals with developmental disabilities and mental retardation. The staff provides professional, high quality services aimed at assisting individuals with functional and/or adaptive behavioral skill limitations achieve higher levels of independence. Areas addressed include: Mobility, activities of daily living, socialization, functional communication, self-esteem, assertiveness, problem solving, frustration tolerance, vocational enhancement, hearing-aid training, mental health, dental, foot care, nutrition and nursing services. Services offered are: Page 92 Audiology Psychology Psychiatry Nursing Social Work Dentistry Podiatry Speech Therapy Occupational and Physical Therapy Nutrition / Dietary Services Rehabilitation Counseling Sullivan County Public Health Services Community Health Assessment November 2013 B. Day Program Pre-Vocational: Provides opportunities for consumers of all types of developmental disabilities to learn how to function in a work atmosphere. Training focuses on developing the basic work skills/ethics and social appropriateness for the world of work. Pre-Academic/Environmental Awareness: Skills for daily living. Senior Center: Social, recreational and learning opportunities for persons 50 and older. Sensory Stimulation: Helps to develop physical, mental and emotional well being through sensory responses, in areas such as balance, strength, coordination and selfawareness. Day Habilitation: Provides opportunities for consumers with all types of developmental disabilities to learn how to access their community. The program addresses issues that prevent consumers from accessing their community such as social skills, hygiene and behavioral skills. The program also has a general health and wellness component that addresses weight control, dietary needs, and stress reduction techniques. C. Vocational Services SullivanArc’s Vocational Services has a double identity – working with individuals to strengthen their job and social skill, and providing real work opportunities in a range of appropriate, manageable settings, developing their work skills. It is a safe and supported learning environment where individuals can grow and mature to reach their greatest potential in the workplace. Employment services, affords individuals one-on-one job support and training in community job placements. Often called “Supported Employment,” this model utilizes an employment developer and a job coach, and job support. D. Residential Services Page 93 SullivanArc’s Residential Program provides family style housing in 27 neighborhoods throughout Sullivan County. Options include supportive apartments, supervised apartments and family-style households (individualized residential alternatives, or I.R.A’s) for 3-10 persons, each designed to offer support and independence, personal privacy and access to the community. Sullivan County Public Health Services Community Health Assessment November 2013 New Hope Community Loch Sheldrake, NY Service Description: This is a residential setting for individuals with developmental and other disabilities and in the community. New Hope is dedicated to providing viable options for individuals to live, experience and explore their greatest level of independence. New Hope Community offers an array of living options that are individually suited for each person. They provide supports to over 200 people currently living in their community and provide a variety of living options ranging from apartments, small homes, to a campus based setting. They offer specialized homes and options for people with intellectual and other developmental disabilities who are aging and may also be experiencing Alzheimer’s and dementia. They also provide specialized homes that support adults with autism as well as home environments and day activities for adults with challenging behaviors. Crystal Run Village Inc. Monticello NY Service Description: Group and Independent Residential Opportunities, Supported Employment/Job Placement, Service Coordination, Educational and vocational Services, Respite House and In-home Respite, Village Care, Mobile Work Crew, Mental Health Services, The Invisible Children’s Program, Residential Services for the Dually Diagnosed, Day Habilitation & Residential Habilitation, HUD Supportive Housing for Families, Shelter Care Plus, Single Point of Entry for Mental Health Services, Recreation, and Community Development for People with Disabilities who are Homeless. Crystal Run Village, Inc. serves individuals with developmental disabilities attributable to mental retardation, autism and spectrum disorders, downs syndrome, epilepsy, neurological impairment, cerebral palsy and/or mental illness. Sullivan Diagnostic Treatment Center (Center for Discovery) Harris, NY Service Description: Educational Services: Social Interaction Total Communication Environmental Interaction Integrated Services Nutritional and Health Vigorous Exercise and Physical Structured Approach to Teaching Well-being Independence in Interactions Evidence based outcomes Residential Services Program: Page 94 Pediatric residences: are home to children from the age of 5 to 21. The program and the environments themselves are informed by the belief that all children can be motivated, challenged and developed as complete individuals. The Adult residences: at offers residential-living options to individuals over 21. In support of its mission to help everyone reach their full potential each home is Sullivan County Public Health Services Community Health Assessment November 2013 designed to accommodate different levels of independence and to give individuals the opportunity to develop as part of a community. Clinical Services: The Health Center houses an Article 28 Clinic which provides on-site primary medical, dental, neurology, orthopedic, audiology, psychiatry, podiatry and other specialty clinics. Lighthouse International -- Mid Hudson Valley New York, NY Service Description: Lighthouse International offers vision rehabilitation services to equip people with vision impairment -- from partial sight to blindness -- with the skills and strategies they need to remain safe, independent, and active at any stage of life. Arcadia Residence Liberty, NY Service Description: Provides adult home care and health services to any individual age 18 and over and in need of assistance with personal care, assistance with taking medications, or meals. Narrowsburg Home for Adults Narrowsburg, NY Service Description: Provides services to adults ages 21 and over with the ability to care for own personal needs with minimal assistance. Personal services include assistance with bathing and grooming, beautician and barber, medication management, 24-hour a day supervision, daily activity events, case management, weekly on-site psychologist. A Certified Home Health Agency provides nurses and home health aides. Residential services include private and semi-private air conditioned rooms, personal laundry service, housekeeping, three nutritious meals daily, special diets, healthy snacks, call bell system, courtesy phone, and a business office. Additional services include cable TV in the room and medical transportation. The New Swan Lake Adult Home Swan Lake, NY Service Description: Provides adult home services including: Private and semi-private rooms On-site physician follow-up and doctors on call 24 hours a day Individual personal care 24 hours a day including supervision and assistance with medications, personal hygiene and ambulation Every day three nutritionally balanced meals and evening snack supervised by licensed nutritionist, with special attention given to prescribed diet Planned social and cultural activities Religious services Comfortable home atmosphere On-site beauty salon Opportunities to develop new friendships and to socialize with peers Page 95 Sullivan County Public Health Services Community Health Assessment November 2013 Jeffersonville Senior Living Jeffersonville, NY Service Description: Provides adult home services including long-term residential care, room, board, housekeeping, personal care, and supervision. Early Childhood Direction Center Located at Independent Living, Inc. Newburgh, NY Service Description: The Early Childhood Direction Center (ECDC) provides information and assistance related to programs and services for children, under age 5, who have special needs, diagnosed conditions, or suspected delays in development. Delays may include difficulty: talking, moving around, thinking, learning,or behaving. Special needs may be related to chronic medical conditions. Traumatic Brain Injury (TBI) Service Coordination located at Independent Living, Inc. Newburgh, NY Service Description: The program assists persons with Traumatic Brain Injury (TBI) in developing and maintaining a service plan that will allow them to access and secure necessary services and supports so that they may live as independently as possible in the community. Persuad Family Homes Jeffersonville, NY Service Description: Family-type homes that provide an atmosphere of family living for adults who are unable to live on their own. Family-Type Homes for Adults are provided by people who have a desire to help others and have extra room in their homes. WILLCARE Monticello, NY Service Description: WillCare, a family owned agency, provides the following programs: Co-Pilot: In cooperation with Sullivan County Department of Family Services, is designed for self-directing individuals – who require or receive personal care and housekeeping assistance under Medicaid – to manage their own home care services. Lend-A-Friend: Lend-A-Friend is a private homemaker and companion program that provides at-home assistive services for daily living. This program is designed for those able to manage their personal care but who need assistance with tasks and activities, or a personal companion. Aide Services: Provides services including: Home health aides; personal care aides; environmental aides; homemakers; companions; and sitters and escort aides that provide assistance ranging from personal care, light housekeeping, meal preparation and shopping to routine maintenance exercises, medication compliance and monitoring vital signs. Page 96 Sullivan County Public Health Services Community Health Assessment November 2013 Skilled Nursing Services: Our registered and licensed nurses are available 24 hours a day, everyday, to provide a variety of in-home or in-facility skilled nursing services. Direction at Family Empowerment Council, Inc. Middletown, NY Service Description: "Direction" is a Consumer Directed Personal Assistant program. Individuals with disabilities receive assistance in their homes with activities of daily living. The individual hires a personal assistant of his/her own choosing to assist with personal hygiene, environmental care, and errands. Any-Time Home Care, Inc. Middletown, NY Service Description: Any-Time Home Care provides home care services that encourage personal growth and a return to a healthy and independent lifestyle. Options/CDPAS located at Independent Living, Inc. Newburgh, NY Service Description: As an Independent Living Center, we offer core services to persons with disabilities that are critically important to fostering motivation, independence, self-direction, employment, social integration, community participation and the elimination of attitudinal, physical, and systemic barriers. Independent Living Inc. is run by people with disabilities for people with disabilities. Core programs include information and referral services, peer counseling, individual and systems advocacy, and independent living skills training. Other services vary from center to center but generally include: assistance with housing, education, employment, medical needs and personal attendant services. Personal Care Services Liberty, NY Service Description: An aide assists disabled or elderly Medicaid recipients in the activities of daily living. Sherry Kay Home Health Care, Inc. Port Jervis, NY Service Description: Provides assistance with household tasks such as laundry, shopping, or meal preparation, assistance with the physician's plan of treatment such as wound care, medication administration, assistance with daily activities such as bathing, dressing, or eating, respite from care of a child, spouse, parent, or other loved one, and warm and caring companionship. Unlimited Care, Inc. Middletown, NY Service Description: Unlimited Care is a licensed provider of home care services, including:Health care services, convalescent care, respite care, pediatric care specialties, private duty, insurance visits, and hi-tech infusions services. Page 97 Sullivan County Public Health Services Community Health Assessment November 2013 Wellness Home Care, Ltd. Goshen, NY Service Description: Wellness Home Care, Ltd. provides skilled nursing and personal services including Registered Nurses (RNs), Licensed Practical Nurses (LPNs), Personal Care Aides (PCAs), Home Health Aides, companions, rehabilitation therapists, and home care management. Medicaid Department at Sullivan County Department of Family Services Liberty, NY Service Description: Determines Medicaid eligibility for nursing home care based on resources and income. Community Home Health Care Spring Valley, NY Service Description: Licensed provider of home care that provides aide, nursing, and therapy services to clients. Respite Care: Help for the Caregiver Cornwall, NY Service Description: Licensed provider of home care that provides medical care and/or assistance with daily tasks to enable elderly adults to stay in their home. Call Care Management Warwick, NY Service Description: A geriatric care management agency that helps families determine what kind of health and social care their aging or diabled loved-one needs, and the community and entitlement resources available to them. The agency then assists in planning and coordinating that care on an ongoing basis. LEGAL SERVICES Sullivan Legal Aid Panel INC Monticello, NY Service Description: Providing free or Low cost legal services to individuals in need. Sullivan County Bar Association Lawyer Referral Service Liberty, NY Service Description: This is a 24-hour answering service. When a person calls, he/she will be given one referral -- the name, address, and telephone number of an attorney. A person may call multiple times, but will only receive one referral in a twenty-four hour period, thus allowing time for the attorney to respond. Page 98 Sullivan County Public Health Services Community Health Assessment November 2013 Legal Assistance for Seniors (Office for the Aging) Monticello, NY Service Description: Legal assistance is available to assist seniors with problems involving Social Security, Medicare, and other benefit programs; landlord/tenant disputes; problems relating to the ownership of property; and problems which are not of a fee-generating nature. Legal Services of the Hudson Valley Newburgh, NY Service Description: Provides free, high quality counsel in civil matters for poor and low-income individuals and families who cannot afford to pay an attorney, where basic human needs are at stake. Dispute Resolution Center Monticello, NY Service Description: The Dispute Resolution Center uses a panel of trained volunteer mediators to assist people in resolving conflicts related to elder mediation, landlord/tenant, husband/wife, neighbor/neighbor, small claims issues, parent/child, Lemon Law arbitration, manufactured home mediation, agricultural mediation, custody/visitation, divorce mediation, special education mediation, and parent education. MENTAL HEALTH Catskill Regional Medical Center – Mental Health Unit Harris, NY Service Description: Inpatient psychiatric treatment for adolescents and adults. Friends & Advocates for Mental Health Monticello, NY Service Description: Family support and advocacy for people recovering from mental illness. They promote education and public awareness of mental illness as well as advocate for continually improved programs for people living with mental illness. Sponsor social programs. NYS Office of Mental Health – Rockland Children’s Psychiatric Center Liberty, NY Service Description: Intensive Day Treatment: Clinic and crisis intervention services to prevent placement and/or to transition children returning from hospitals. Sullivan Intensive Day Treatment: Crisis program providing equal mix of academics and therapeutic interventions for students in Sullivan County schools, daily group therapy, and individual sessions as needed. Transitioning services to home schools. Page 99 Sullivan County Public Health Services Community Health Assessment November 2013 Stepping Stones – Psychosocial Club Monticello, NY Service Description: Club for adults who are mentally challenged offering vocational, socialization, rehabilitation, education, and recreation. Aim is to reintegrate people with mental disabilities into the community to provide a social support network. Sullivan County Department of Community Services Liberty, NY Service Description: Case Management Unit: Psychiatric case management (advocacy, linkage, coordination, monitoring of clients through outreach services and home visits); services provided to chronic mentally ill population of Sullivan County. Continuing Day Treatment Program: Continuing treatment (all day) program for the seriously and persistently mentally ill, therapeutic activities, individual and group therapy, case management, activities of daily living training, and medication management. Mental Health Clinic: Full range of mental health services for adults and children including social work, psychological and psychiatric treatment. Treatment modalities include individual, group, family and medication evaluation. Treatment Reaching Youth (TRY) Program: The TRY Program provides the full range of mental health treatment services onsite in all Sullivan County school districts except for BOCES and Roscoe. “Turning Points” Intensive Psychiatric Rehabilitation Program: “Turning Points” is a program for the chronically mentally ill client who has the ability and desire to establish and begin working in a rehabilitation goal in one of the areas of working; living space; learning and/or socializing in a time limited milieu. The Council on Alcoholism & Drug Abuse of Sullivan County, Inc. – Recovery Center Monticello, NY Service Description: An innovative 16-week cycle program for children at risk of being orphaned as a result of AIDS. Program uses art, play and education to help children talk about their feelings, help families to communicate, and to assure permanency planning. Page 100 Sullivan County Public Health Services Community Health Assessment November 2013 SENIOR SERVICES Sullivan County Office for the Aging Monticello, NY Aging Services: To provide opportunities for the older population to secure and maintain its independence and dignity, to improve the quality of life for all persons 60 years of age and older. Caregivers: The OFA provides training and support of family members, friends and neighbors who care for the elderly. Caregiver manuals, pamphlets, and video tapes are available. Expanded In-Home Services for the Elderly Program: Non-medical in-home support services to eligible individuals. Targeted to assist individuals who are not eligible to receive in-home services through Medicaid. It is a cost sharing program determined by a sliding scale and the amount of household income. EISEP provides case management, assistance with dressing, bathing, cooking and cleaning. HEAP/Weatherization: HEAP (Home Energy Assistance Program) is a federally funded program designed to assist senior and low-income people meet their energy costs. In conjunction with HEAP, there are various programs to help with weatherization. These programs include insulation, weather-stripping, storm windows, furnaces, and other forms of energy-saving measures. Information and Referral & Case Management Services o The OFA’s Information and Referral Office answers questions, solves problems, and makes arrangements for the senior to receive various types of services (EPIC, Adult Protective, Housing-Income, Legal Services, Social Security, etc...). o `Case Management is one of the basic services provided by the OFA. The caseworkers offer individualized information to clients on a one-to-one basis in their own homes. The home visits are for persons who are homebound, frail and/or isolated. Nutrition Program: Provides a hot, nutritious meal to the elderly of Sullivan County, both in the congregate and homebound setting, to offer nutrition education to those who need it, and help maintain the independency of all elderly. Senior Transportation Services: Shopping bus from home to Liberty or Monticello. Available every weekday in different areas of the county. Bus picks up passengers at their homes. We provide medical transportation for the wheelchair bound and those with ambulatory problems. Suggested donation: Page 101 Sullivan County Public Health Services Community Health Assessment November 2013 Health Insurance Information Counseling & Assistance Program: Provides information to seniors who are having problems with their insurance. Volunteers assist in dealing with issues. Equipment Loan Closet: Provides medical equipment that seniors may borrow for their personal use. Durable medical equipment is available which allows seniors to get the equipment they need without investing in something they will need only short term. RSVP Program: Retired Senior Volunteer Program RSVP members make a difference in the lives of those in need. With each new experience, volunteers meet new people and work to solve new problems, creating solutions that benefit everyone. People who participate in the Retired and Senior Volunteer Program choose among a variety of different volunteer opportunities, such as tutoring/mentoring children, helping with special events in the community, answering telephones for non-profit organizations. Sullivan NYCONNECTS: Acts as a bridge between consumers and long term care services that utilizes a single Point of Entry. A single Point of Entry makes things simpler for people who are learning about long term care services and who need to make decisions. At this single Point of Entry consumers and their caregivers will receive: Comprehensive and unbiased information and assistance regarding long term care options, screening of general social, medical and financial needs. Cornell Cooperative Extension Caregiver Resource Center Liberty, NY Service Description: Works with the Sullivan County Office for the Aging to provide services and support to families and caregivers of seniors who wish to remain within their community for as long as possible; provides information and referrals to appropriate agencies; has an extensive resource lending library to better assist the care giver and receiver; offers support groups and training programs for caregivers such as legal and estate planning issues, communication issues, stress reduction etc. Respite services are also a possibility and arrangements can be made through the Sullivan County Office of the Aging. Sullivan County Adult Care Center Liberty, NY Service Description: A full service residential 160 bed skilled nursing facility, this is a 24 hour full care nursing care facility. This facility has onsite rehabilitation, Adult day care. Achieve Rehabilitation & Nursing Facility Liberty, NY Service Description: A full service residential 140 bed skilled nursing facility, this is a 24 hour full care nursing care facility. This facility has onsite rehabilitation. Page 102 Sullivan County Public Health Services Community Health Assessment November 2013 Catskill Regional Medical Center (SNU) Harris, NY Service Description: A full service residential 64 bed skilled nursing facility, this is a 24 hour full care nursing care facility. This facility has onsite rehabilitation, Adult day health care, Clinical laboratory services, Diagnostic radiology, and PRI baseline services. Roscoe Regional Rehabilitation and Residential Health Care Facility Roscoe, NY Service Description: A full service residential 85 bed skilled nursing facility, this is a 24 hour full care nursing care facility. This facility has onsite rehabilitation, Adult day health care, short term respite care, and baseline services. Hands On! The Hudson Valley Long Term Care Ombudsman Program Poughkeepsie, NY Service Description: Program provides advocacy services for all residents of licensed long term care facilities which includes nursing homes, assisted living/adult care facilities, and family-type homes. Provides advocacy services as contained in the New York State laws, regulations, and statutes of the NYS Social Services Law, Section 487 -- Standards for Adult Homes; and in NYS Department of Health Nursing Home Standards. Managed Access/County Wide Case Management Program located at Catskill Regional Medical Center Callicoon, NY Service Description: Assists patients with no means of payment to obtain health insurance, medications, and medical services. Assists with completion of Nursing Home Medicaid applications. Assists with completion of Patient Review Instrument (PRI) for Nursing Home Placement. Assists patients with the scheduling of medical appointments. Provides patient education regarding disease process, medications, and diet. Assists in obtaining personal emergency response systems. Provides linkage to other agencies and referral services. Swing Bed Program at Catskill Regional Medical Center Callicoon, NY Service Description: Provides short term nursing care, rehabilitation, nutritional therapy, physical therapy, occupational therapy, case management, speech therapy, and respiratory therapy activities to individuals recovering from major surgery, experiencing repeated hospitalizations, recovering from a stroke, dealing with pain management, requiring wound care or amputation care, coping with congestive heart failure, resolving conditions, and/or needing enteral nutrition. Page 103 Sullivan County Public Health Services Community Health Assessment November 2013 Senior Advocacy Groups Middletown, NY; Monticello, NY; Newburgh, NY; South Fallsburg, NY Service Description: The following organizations serve and empower seniors and individuals living with disabilities to improve their quality of life: Action Toward Independence, Inc. Alzheimer’s Association Deaf and Hard of Hearing Services located at Independent Living, Inc. Independent Living, Inc. Seniors Legislative Action Committee (SLAC) of Sullivan County TRIAD Liberty, NY Service Description: TRIAD is a partnership among senior citizens, senior providers and law enforcement to assess the needs of senior citizens towards the goal of reducing elder violence, victimization and abuse. SUPPORT GROUPS: There are many support groups present through various organizations in the County, for example: Catskill Regional Medical Center, the Recovery Center, Sullivan County Community Services, BOCES, RISE, and others, run groups. Please refer to the agency which serves a specific purpose to obtain the contact information and to follow up any existing support groups that they may offer. Additional Resources: Addition resources to support healthy youth and families are provided in Appendix B. These resources are related to the following areas of need: Crisis Intervention Alcohol, Drug, Substance Abuse Social Services Economic Development Educational Support Family-Life Support Family Needs (Shelter, Food, Domestic Violence Support, Legal Assistance) Health and Medical Mental Health Mental Retardation/Developmental Disability Recreation and Youth Development Youth Employment Youth Mediation Youth Support Groups or Trainings Youth Out-of-Home Placement, Detention Page 104 Sullivan County Public Health Services Community Health Assessment November 2013 APPENDIX A: Secondary Data Profile References Bureau of Labor Statistics. (2013). Local Area Unemployment Statistics. Retrieved from http://www.bls.gov/lau/ Centers for Disease Control and Prevention. (2011). Behavioral Risk Factor Surveillance System. Retrieved from http://www.cdc.gov/brfss/index.htm Centers for Disease Control and Prevention. (2012). Births: Preliminary data for 2011. Retrieved from http://www.cdc.gov/nchs/data/nvsr/nvsr61/nvsr61_05.pdf Centers for Disease Control and Prevention. (2012). Deaths: Preliminary data for 2011. Retrieved from http://www.cdc.gov/nchs/data/nvsr/nvsr61/nvsr61_06.pdf Centers for Disease Control and Prevention. (2012).Lyme disease. Retrieved from http://www.cdc.gov/lyme/stats/index.html Centers for Disease Control and Prevention. (2012). Sexually transmitted diseases (STDs). Retrieved from http://www.cdc.gov/std/stats/default.htm Centers for Disease Control and Prevention. (2012). Tuberculosis. Retrieved from http://www.cdc.gov/tb/publications/factsheets/statistics/TBTrends.htm Centers for Disease Control and Prevention. (2012). Viral hepatitis. Retrieved from http://www.cdc.gov/hepatitis/Statistics/2010Surveillance/index.htm Centers for Disease Control and Prevention. (2013). HIV/AIDS. Retrieved from http://www.cdc.gov/hiv/statistics/index.html Centers for Disease Control and Prevention. (2013). National program of cancer registries (NPCR). Retrieved from http://apps.nccd.cdc.gov/uscs/ Federal Bureau of Investigation. (n.d.). Crime statistics. Retrieved from http://www2.fbi.gov/ucr/cius2009/index.html New York State Department of Health. (2010). New York state expanded behavioral risk factor surveillance system. Retrieved from http://www.health.ny.gov/statistics/brfss/expanded/2009/prevention_agenda/county/ New York State Department of Health. (2011). Cancer data for New York state counties. Retrieved from http://www.health.ny.gov/statistics/cancer/registry/vol1.htm Page 105 Sullivan County Public Health Services Community Health Assessment November 2013 New York State Department of Health. (2012). 2011 Communicable disease annual reports. Retrieved from http://www.health.ny.gov/statistics/diseases/communicable/2011/ New York State Department of Health. (2012). Information on asthma in New York state. Retrieved from http://www.health.ny.gov/statistics/ny_asthma/ New York State Department of Health. (2012). New York state HIV/AIDS surveillance annual report. Retrieved from http://www.health.ny.gov/diseases/aids/statistics/annual/2010/ 2010-12_annual_surveillance_report.pdf New York State Department of Health. (2012). Vital statistics of New York state. Retrieved from http://www.health.ny.gov/statistics/vital_statistics/ New York State Department of Health. (2013). Vital statistics of New York state. Retrieved from http://www.health.ny.gov/statistics/vital_statistics/ New York State Division of Criminal Justice Services. (2013). Criminal justice statistics. Retrieved from http://www.criminaljustice.ny.gov/crimnet/ojsa/stats.htm Robert Wood Johnson Foundation. (2013). County health rankings & roadmaps. Retrieved from http://www.countyhealthrankings.org U.S. Census Bureau. (2000). Census 2000 gateway. Retrieved from http://www.census.gov/main/www/cen2000.html U.S. Census Bureau. (2012). American fact finder. Retrieved from http://factfinder2.census.gov/faces/nav/jsf/pages/index.xhtml U.S. Department of Health and Human Services. (2012). Healthy People 2020. Retrieved from http://www.healthypeople.gov/2020/default.aspx U.S. Department of Health and Human Services. (2013). The 2013 HHS poverty guidelines. Retrieved from http://aspe.hhs.gov/poverty/12poverty.htm Page 106 Sullivan County Public Health Services Community Health Assessment November 2013 APPENDIX B: Community Survey Statistical Considerations The final community survey sample (752) yields an overall error rate of +/-3.6% at a 95% confidence level. This means that if one were to survey all residents in Sullivan County, the final results of that analysis would be within +/-3.6% of what is displayed in the current data set. Data collected from the 752 residents was aggregated and analyzed by Holleran using IBM SPSS Statistics. The detailed survey report includes the frequency of responses for each survey question. In addition, results from the 2009 HEAL 9 survey are included when available to indicate how the health status of Sullivan County residents has progressed over time. Frequencies and statistically significant differences between select demographic subgroups (gender, grade level, race/ethnicity) in Sullivan County are also noted. However, frequencies by demographic subgroups are omitted if the count for a subgroup is less than four, and statistically significant differences by demographic subgroups are omitted if the count for a subgroup is less than 30. For example, if less than four Black/African American participants answered a question, their responses are masked. Statistically significant differences between demographic subgroups are denoted by reference letters. If a reference letter (A, B, C, etc.) appears next to a percentage, that percentage is significantly larger than the percentage denoted by the reference letter. Table 3 provides an example of the use of reference letters. Holleran runs Z-tests and Chi Square tests in SPSS to identify statistically significant differences and uses p values <.01 as the cutoff for significance. Applied example of the use of reference letters in showing statistically significant differences A. Females Percentage of residents who visited a local farmer’s market in the past year 64.7% B B. Males 52.8% In the example, females are referenced by the letter “A” and males are referenced by the letter “B.” The reference letter, B, appears next to the percentage for females denoting that the value of 64.7% is significantly higher than that of males (52.8%). In other words, the percentage of females in Sullivan County who visited a local farmer’s market in the past year is significantly higher than the percentage of males who visited a local farmer’s market in the past year. Page 107 Sullivan County Public Health Services Community Health Assessment November 2013 APPENDIX C: Community Survey Participant Demographics Sullivan County 2013 Community Health Survey Sullivan County Population (2012 Census) 29.1% 70.9% 50.5% 49.5% 7.6% 12.9% 15.2% 40.4% 17.4% 6.5% 11.7% 15.3% 13.9% 37.8% 7.2% 1.4% 83.4% 1.9% 7.2% 13.3% 2.1% 86.0% N/A 2.9% 26.8% 73.2% 14.2% 85.8% Gender Male (n= 202) Female (n= 493) Age 18 - 24 (n= 51) 25 - 34 (n= 87) 35 - 44 (n= 102) 45 - 64 (n= 272) 65 - 80 (n= 117) 81 and Older (n= 44) 21.2% Race African American/Black (n= 42) Asian/Pacific Islander (n= 8) Caucasian/White (n= 489) Native American or Alaska Native (n= 11) Other (n= 42) Ethnicity Hispanic/Latino (n=178) Non-Hispanic/Latino (n= 486) Page 108 Sullivan County Public Health Services Community Health Assessment November 2013 APPENDIX D: Prioritization Session Participants Name Title Organization Bruce Ellsweig, MD Physician Anita Parkhurst Grant Administrator Rob Lee Administrator Greater Hudson Valley Health System Jean-Paul Vallet Director of Strategic Planning Greater Hudson Valley Health System Marcy Manheim Director of PR and Marketing Greater Hudson Valley Health System Barb Kunlik Martha Scoppa Susan Clark Laura Quigley Heide Padre Public Health Advisor Point of Entry Coordinator Sullivan County Public Health Educator Director Compliance Officer Sullivan County Office for the Aging Sullivan County Public Health Services Center for Workforce Development Refuah Health Center Caren Fairweather Executive Director Maternal-Infant Services Network Nancy McGraw Public Health Director Sullivan County Public Health Services Cecilia Escarra Administrator PRASAD Children’s Dental Health Program Kaytee J. Warren Amanda Langseder Chief Professional Officer WIC Coordinator Sonja Hedlund Independent Farming Professional United Way Sullivan County Public Health Services Apple Pond Farm & Renewable Energy Education Center Joseph Todora Director of Community Services Sullivan County Department of Community Services Joan Kern Dan Grady Director President & CEO North Branch Planning Council Hospital of Orange & Sullivan Counties, Inc. Gerard Galarneau, MD Chief Executive Officer & Chief Medical Officer Catskill Regional Medical Center Page 109 Greater Hudson Valley Health System Catskill Regional Medical Center Sullivan County Public Health Services Community Health Improvement Plan November 2013 APPENDIX E: Additional Community Resources for Youth and Families ASSESSED AREA OF NEED PROVIDER PHONE CONTACT PROGRAM SERVICES (Area Code is [845] unless otherwise noted) Crisis intervention Crisis intervention, mental health SC Community Services 292-8770 daytime only Community Services Mental Health clinic/agency Mobile Mental Health 791-7123 or toll-free (800) 710-7083; Crisis intervention 24-hour for adults (age 18 and older) Children’s Mobile Crisis Intervention 701-3777 after-hours only (5 pm–7 am) Crisis intervention for children and youth under age 18 Crisis line, after-hours, 24/7 Dispute Resolution (866) SC-YOUTH, Crisis de-escalation and emergency referrals, follow-up mediation as needed (866) 729-6884 toll-free Crisis respite services Through SC DFS 292-0100 Preventive mandated service provided by A Friend’s House (RHYA), Middletown, or by foster boarding homes Drug screening, urinalysis Probation officers 794-3000 x 3400 Random urine screening to all PINS youth when indicated and accepted by parent Drug screening, blood or urinalysis CRMC, Catskill Regional N/A medical Center, or private MD No specific private providers; refer to family practitioner or hospital; also available through intake appointments with Recovery Center or SCADAS Other evaluation or intervention Recovery Center Range of education, treatment, and support services for both teen and family; parent involvement mandated. Includes summer camp and positive quasirecreational activities for children of parents with substance-abuse problems or with HIV Alcohol, drug, substance-abuse services Page 110 794-8080 Sullivan County Public Health Services Community Health Improvement Plan ASSESSED AREA OF NEED November 2013 PROVIDER PHONE CONTACT PROGRAM SERVICES (Area Code is [845] unless otherwise noted) SCADAS, SC Alcohol/ Drug Abuse Services 292-8770 Evaluation, education, support groups, individual counseling, treatment, family Recovery Center 794-8080 DATA, day treatment program for adolescents, including education component 292-8770 Consult SC Community Services for placement options Sullivan County Intergroup Association 295-1010 For AA (Alcoholics Anonymous), NA (Narcotics Anonymous), and GA (Gamblers Anonymous), Alateen, Alanon; services include a 24-hour answering service (295-1010) for referrals to support meetings around the county Preventive, with or without family advocate SC DFS Services 292-0100 CPS or home assessment SC DFS Services 292-0100 DSS medical assistance SC DFS 292-0100 DSS public assistance SC DFS 292-0100 PathStone 343-0771 x 131 Intensive in-community treatment needed Residential treatment needed Alcohol, specifically DSS services indicated Economic development for youth, families Individual and family empowerment Page 111 Community development and human services: adult training/employment, child and family development, youth education/training, emergency/support services, housing assistance/rehabilitation, small-business entrepreneurship, community revitalization Sullivan County Public Health Services Community Health Improvement Plan ASSESSED AREA OF NEED PROVIDER PHONE CONTACT November 2013 PROGRAM SERVICES (Area code is [845] unless otherwise noted) Educational support for youth, families Special-education or other education advocacy as well as education for parents BOCES SETASC (special 292-0082 x 4040, 4042, Individual parent education and student advocacy for families with children with education technical 4046; or 295-4040, 295- special-education needs; contact family education advocate 295-4040, admin assistance service center) 4042, 295-4046 asst Faith Dymond 295-4046 ATI, Action Toward Independence 794-4228 Individual parent education and student advocacy for families with children with special-education needs; free parenting classes, autism support group, educational advocates, autism social skills for kids and teens, help with SSI/Medicaid; contact Joan Summa, Linda Simmons Independent Support Services 794-5218 Individual parent education and student advocacy for families with children with special-education needs; contact Alan Kulchinsky BOCES 292-0082 administration Range of classes and support services for children and teens with high needs and/or at special risk Project Excel (Easter Seals) 794-4020 Universal pre-K, ages 3–4. Special-needs children age 2.9 months–5 years: any CSE in county can refer child; Project Excel does all needed evaluations (psychological, speech, physical), has all therapists on site as staff or independent consultants for evaluations as well as treatment School districts N/A; individual district Suggest that parents request testing, CSE through local districts; provide referral to advocacy services such as Parents for Parents/SETASC and ATI Least restrictive environment, local School districts district N/A; individual district Larger districts have 504 classrooms, supports (e.g., Fallsburg) School districts N/A; individual district Individual districts must provide home tutoring for youth out of school (e.g., long-term suspension) and after-school learning assistance Literacy Volunteers of Sullivan County, LVSC 794-0017 Literacy-related tutoring available for older youth dropouts as well as adults; training for literacy volunteer tutors and ongoing in-services available; additional trainings through Hudson Valley / Catskill Partnership, 292-0082 x 4022 Intensive special-educational support Educational testing/evaluation, SE (special education) evaluation Tutoring Page 112 Sullivan County Public Health Services Community Health Improvement Plan November 2013 ASSESSED AREA OF NEED PROVIDER PHONE CONTACT PROGRAM SERVICES (Area code is [845] unless otherwise noted) Mentoring School districts N/A; see individual districts A number of districts have in-school mentoring programs; there is no Big Brother/Big Sister program in our area Boys & Girls Club 342-8833 After-school programs in Fallsburg, Liberty, and Monticello districts include mentoring and homework help in addition to prosocial, skill-building, preventive, and recreation activities; contact John Kane or Karen Juers Youngsville School 292-0082 BOCES For behavior problems; administered through BOCES. SE youth not eligible. Includes on-site satellite substance-abuse services through Recovery Center SC Child Care Council 292-7166 Contact Child Care Council for information, recommendations Home-schooling supports Frost Valley 985-2291 Frost Valley YMCA offers activities (mostly weekends) for home-schooling families throughout the school year; weeklong family camp end of August. Contact activities director and/or day camp director Other educational alternatives After-school alternative education programs N/A; individual district. 292-0082 BOCES After-school programs available in some districts, BOCES; in general, not an optimal educational option Other educational alternatives, continued Job Corps 887-5400 Can serve 400 youth as residents; has 50 slots for day students. Includes GED and/or college courses, vocational training, job placement and other follow-up services; an option especially for older youth at risk of dropping out, of public education due to frustration, but motivated to achieve skills for themselves SC Community College 434-5750 Older youth can test for ability to benefit, enroll in college to complete high school, receive financial aid Educational alternatives for adults: BOCES Adult Education literacy and basic education 791-4070 Literacy Zone, Community Partnership, and other programs offer adult education, including GED, vo-tech, online courses, and vocational assessment BOCES Even Start 794-4405 x 300, 310 Family literacy program offers literacy, GED, life-skills education to adults with young children. Contact Educational Support Services BOCES 292-0082 for youth 791-4040 for adults Vo-tech programs, with GED, full diploma, or IEP/local diploma Alternative schooling Child care Vocational assessment, assistance, training Page 113 Sullivan County Public Health Services Community Health Improvement Plan ASSESSED AREA OF NEED November 2013 PROVIDER PHONE CONTACT PROGRAM SERVICES (Area code is [845] unless otherwise noted) BOCES CCD, Center for Career Development 791-4070 An option for the older youth who has dropped out, particularly with assistance from VESID if applicable. Includes GED, vocational training, ESOL assistance BOCES Educational Support Services 794-4405 x 300, 310 Educational counseling, planning and advocacy, including vocational, with case management for high-risk out-of-school teens Job Corps 887-5400 Includes GED and/or college courses, vocational training, job placement and other follow-up services; an option especially for older youth at risk of dropping out, of public education due to frustration, but motivated to achieve skills for themselves VESID 794-5317 An option for older youth/dropout with special-education needs (local office located behind Dept of Labor, 50 North St, Monticello) ATI/BOCES SETASC ATI 794-4228 x 12/x16 Parenting education for special-needs (MR, DD) parents; contact ATI (Linda Simmons) or BOCES ( 295-4040) BOCES Even Start 794-4405 x 300, 310 Parenting education, including hands-on parent/child practice, for low-income families with family literacy needs. Contact Educational Support Services BOCES Teen Parenting 794-4405 x 300, 310 Parenting education for teens, in context of range of services and case management. Contact Educational Support Services CACHE Parents Anonymous 292-5821 x 629, x 633; for additional parent supports, 292-0100 Parents Anonymous, support groups for parents. Parenting education, including for parents with special needs (MR, DD, learning-disabled); no open Preventive case required for Parents Anonymous. For other parenting services, Preventive Services referral required; contact DFS Family-life support, family-life education Parenting education Page 114 DRC, Dispute Resolution 794-3377 Center In addition to family mediation and crisis intervention, DRC offers Parents Apart, education/coaching for parents involved in divorce or separation EPIC Bilingual (English/Spanish) comprehensive parenting information, education, and support in Monticello and Fallsburg. Contact Robin LaFountain in Monticello 796-3058 x 20216 Sullivan County Public Health Services Community Health Improvement Plan November 2013 ASSESSED AREA OF NEED PROVIDER PHONE CONTACT PROGRAM SERVICES (Area code is [845] unless otherwise noted) Parenting education, continued RAPP, Relatives as Parents Program 292-5250, Cornell Cooperative Extension Assists grandparents and other relatives who are primary caregivers for related children; parenting and coping skills, peer support groups, access to other services Head Start 434-4164 , 794-4622 Monthly parenting workshops for participating families include transportation and child care; parents also encouraged to take part in classroom activities to strengthen parenting skills that support children’s ability to learn SC Cares “Growing with Your Teen” 292-9100, 292-2393 Short-term (2–3-session) parent/child communication classes for the general public, in 10–15 locations throughout the county, usually at a school or church SC Parenting Network 292-5250 x 116 Outgrowth of ICP, planning and mutual-referral group; newsletter. Contact Cornell Cooperative Extension SC Public Health Healthy 292-5910, ext. 2250 Beginnings Public Health offers education and support to families expecting a child or with an infant up to 3 months of age; for families who enroll before their infant is 3 months old, services are then available until child enters Head Start or kindergarten Strengthening Families 794-8080 x 170 Multicomponent family-focused prevention programming for children ages 10– 17 years who face a variety of challenges and risks. The program is designed to help parents improve their parenting skills and reduce their children’s risk factors Parents Anonymous CACHE 292-5821 x 633 or 629 Nationally recognized support groups by parents, for parents, meeting in Liberty and Monticello. Liberty: support groups with separate group for children Friday 7–9 pm; support group for parents of teens Tuesday 7–9 pm: daytime support group Wednesday 10 am–12 noon Parent or family support groups, other Parents for Parents (BOCES SETASC) 292-0082 x 4040, 4042 or 295-4040, 295-4042 Support group for parents of children with emotional/behavioral challenges; includes educational presentations, active advocacy, provided by BOCES SETASC; contact parent educator/advocate Other SETASC support groups and services 292-0082 x 4040, 4042 or 295-4040, 295-4042 Sibling support, bereavement support, bipolar support, autism-spectrum support; advocacy; education on parenting, child development, developmental disabilities and special needs; contact parent educator/advocate Page 115 Sullivan County Public Health Services Community Health Improvement Plan ASSESSED AREA OF NEED November 2013 PROVIDER PHONE CONTACT PROGRAM SERVICES (Area code is [845] unless otherwise noted) Bipolar Support Group 566-0810 Support group for parents of children with bipolar disorder; contact Ann Bardinelli Parents’ Neighborhood Network (TLC) 791-7429, TLC Support by parents, for parents, to meet the demands of family life; information center with free materials, videos, community-resource guides to services Parental respite Through SC DFS 292-0100 Available only through DFS Preventive Services at this time Parental respite and skill building for parents with children with mental-health concerns Through Community Services 292-0100, 292-0887 While providing respite, also provides skill building to parents and child. Available only through Community Services OMH Waiver at this time Counseling, family or marital Private providers N/A See Community Services list, attached; also consult individual DFS caseworkers Sibling issues, support BOCES SETASC 292-0082 x 4040, 4042 or 295-4040, 295-4042 Sibling support group; support for siblings of special-needs children or youth. Contact parent educator/advocate Budgeting, nutrition, life skills for parents Cornell Cooperative Extension 292-5250 Workshops and individual coaching in budget management, cooking, gardening, and other skills Independent-living skills, education CACHE for youth 292-5821 x 629, x 633 Program for adolescents, teens; does not require open Preventive case Youth/family advocate: Preventive referral only CACHE Family Division 292-5821 x 629 Community action commission offers a range of parent education/support, including parenting classes and coaching for parents with special needs, and family advocates Youth/family advocate: court referral only SC CASA 794-3000 x 0672 Court-Appointed Special Advocates, accessed through Family Court only Intensive specialized family supports RSS MST, Multisystemic Therapy 794-1521; referral required, 292-0100 Multisystemic therapy; available only through DFS Preventive Services referral ICM, intensive case management 292-8770 Available through SC Mental Health; see “mental-health needs,” below Page 116 Sullivan County Public Health Services Community Health Improvement Plan November 2013 ASSESSED AREA OF NEED PROVIDER PHONE CONTACT PROGRAM SERVICES (Area code is [845] unless otherwise noted) Alternative to out-of-home placement for youth at risk: Preventive referral only Occupations, Inc 562-7244; referral required, 292-0100 Clinical casework services; available only through DFS Preventive Services referral PINS assessment and follow-up SC DFS, Department of Family Services 292-0100, Services Parents or schools thinking of filing PINS to help at-risk youth contact DFS to assess youth and family needs, resources, and available services 292-0100 DFS oversees emergency/short-term housing in local hotels for PA clients 292-0100 Spectrum of services for disaster situations; contact DFS Outreach Family needs, other intensive supports Emergency shelter or other respite SC DFS, Department of Family Services FEMA, Federal Emergency Management Federation for Homeless 794-2604 Food (includes food pantries, soup Bethel area: Faith kitchens) ministries, Presbyterian Bethel, White Lake: Shepherd’s Pantry Page 117 Spectrum of services; includes assistance with food, clothing 583-5222 Food pantry, second Thursday each month 10 am–2 pm and fourth Thursday each month 5–7 pm. Located at White Lake Reformed Presbyterian Church, Rte 17B across from Bethel Medical 583-4679 Food pantry, second Thursday 10 am–2 pm, fourth Thursday 5–7 pm, local only; at White Lake Reformed Presbyterian Church, Route 17B across from Bethel Medical Bloomingburg: Our Lady 733-1477 of Assumption Food pantry, Saturday 10 am; call for appointment by noon Wednesday; emergency only. Located on High Street Bloomingburg: To God Be the Glory 344-2676 Food pantry, Based in Middletown, stops in Bloomingburg; Monday–Friday by appointment Callicoon: Holy Cross Church 887-5450 Food pantry, anytime by appointment; located at 9719 Route 97 Callicoon: Parking lot behind the library 292-5821 x 620 CACHE HPNAP distribution, second Thursday 11:05–11:20 am; call for information or enrollment Sullivan County Public Health Services Community Health Improvement Plan ASSESSED AREA OF NEED Page 118 November 2013 PROVIDER PHONE CONTACT PROGRAM SERVICES (Area code is [845] unless otherwise noted) Callicoon: Private home 887-5515 Friday by appointment Callicoon: United Methodist Church 887-5112 Thursday 2–4 pm; walk-in with ID; located at 9290 Route 97 Callicoon Center: Park parking lot 292-5821 x 620 CACHE HPNAP distribution, usually second Thursday 10:00–10:15 am; call for information or enrollment Claryville: Claryville Reformed Church 985-2041, 985-2597 Food pantry, Tuesday and Thursday 10 am–2 pm, walk-in with no ID required, limit once per month; located on Claryville Road Eldred: Eldred Town Hall 292-5821 x 620 CACHE HPNAP distribution usually second Thursday, 12:15–12:30 pm; call for information or enrollment Grahamsville: United Methodist Church 985-2283 Food pantry, anytime by appointment; located at 356 Route 55 Hankins: Hankins Assembly of God 482-5864 Wednesday 2–4 pm, walk-in with ID; located at 14 CR 132 Hurleyville: United Methodist Church 434-6470 Thursday 6–7 pm, walk-in with no ID required; located on Main Street Jeffersonville: 292-5821 x 620 Jeffersonville Presbyterian Church CACHE HPNAP distribution usually second Thursday 10:30–10:45 am; call for information or enrollment Jeffersonville: St George’s 482-4640, call 9 am–1 RC Church pm Monday and Wednesday by appointment, local emergency only; located at 97 Schoolhouse Road Liberty: CACHE office CACHE HPNAP distribution, usually second Wednesday 9 am–1 pm; located at 63–65 Main Street 292-5821 x 620 Liberty: St Paul’s Lutheran 292-5093, 292-4626 Church Food pantry second, third and fourth Friday, 3:30–5 pm, walk-in with no ID required; located at 24 Chestnut Street Livingston Manor: Hemlock Ridge CACHE HPNAP distribution usually first Thursday 11:25–11:45 am; call for information or enrollment 292-5821 x 620 Sullivan County Public Health Services Community Health Improvement Plan ASSESSED AREA OF NEED November 2013 PROVIDER PHONE CONTACT PROGRAM SERVICES (Area code is [845] unless otherwise noted) Livingston Manor: Community Center 292-5821 x 620 CACHE HPNAP distribution usually first Thursday 11:50 am–12:15 pm; call for information or enrollment Livingston Manor: United 439-5134 Methodist Church Food pantry, 3rd Thursday 6–7 pm; call for information, limit 4 visits; located at Pearl Street and Old Route 17 Loch Sheldrake: Woodland Townhouses 292-5821 x 620 CACHE HPNAP distribution usually first Thursday 1:20–1:45 pm; call for information or enrollment Long Eddy: Long Eddy Firehouse 292-5821 x 620 CACHE HPNAP distribution usually first Thursday 10:15 –10:30 am; call for information or enrollment Monticello: Monticello Community Center 292-5821 x 620 CACHE HPNAP distribution usually first Wednesday 10 am; call for information or enrollment Monticello: Catholic Charities 791-6023 Food pantry Monday–Friday 9 am–5 pm; located at Liberty and North Streets Monticello: Federation for 791-2604 meals Soup kitchen Friday 12–1 pm; walk-in with eligibility information; no ID required the Homeless (914) 797-3490 24-hour for hot meals. Hot breakfast Monday–Friday 8:30–9:30 am; hot lunch Monday– emergencies Friday 12–1 pm; located at 9 Monticello Street Page 119 Monticello: Monticello Housing Authority 292-5821 x 620 CACHE HPNAP distribution usually first Wednesday 11:15 –11:35 am; call for information or enrollment Monticello: Salvation Army 794-2268 Monday and Friday, 1–3 pm, or anytime by appointment for emergency only; located at 2 Jones Street Monticello: St John’s Episcopal Church 794-8111 Food pantry second and fourth Tuesday 5–7 pm; call for information; located at 14 St John Street Narrowsburg: Narrowsburg Lutheran Church 292-5821 x 620 CACHE HPNAP distribution usually second Thursday 11:45–11:55 am; call for information or enrollment Neversink: Neversink Town Hall 292-5821 x 620 CACHE HPNAP distribution usually first Thursday 12:45–1 pm; call for information or enrollment Sullivan County Public Health Services Community Health Improvement Plan ASSESSED AREA OF NEED Page 120 November 2013 PROVIDER PHONE CONTACT PROGRAM SERVICES (Area code is [845] unless otherwise noted) Pond Eddy: United Methodist Church 856-1129 Food pantry, call for information; located at Church and Berme Roads Rock Hill: Church of the Nazarene 796-3729 Food pantry anytime by appointment; located at 210 Katrina Falls Road Rock Hill: United Methodist Church 794-8463 Food pantry; call for information; located at 410 Rock Hill Drive Roscoe: Roscoe Presbyterian Church (607) 498-4468, -4523 Food pantry, emergency only, anytime by appointment; located on Route 17 Roscoe: Roscoe Presbyterian Church 292-5821 x 620 CACHE HPNAP distribution usually first Thursday 10:50–11:05 am; call for information or enrollment South Fallsburg: St Andrew’s Episcopal Church 436-7539 Food pantry, second and fourth Friday 5–7 pm, walk-in with no ID required; located on Route 42 South Fallsburg: Town Hall 292-5821 x 620 CACHE HPNAP distribution usually first Friday 11:05–11:30 am; call for information or enrollment Summitville: Mamakating 647-5452 United Methodist Church Food pantry anytime by appointment, based on need only White Sulphur Springs: 292-8269 United Methodist Church Food pantry anytime by appointment, local emergency only; located at 3318 Route 52 Woodbourne: Lighthouse Assembly of God 434-5615 Food pantry fourth Saturday 9 am–12 noon, walk-in with ID, based on need and emergency only; located at 507 Hasbrouck Road Woodridge: Woodridge County Garden Apts 292-5821 x 620 CACHE HPNAP distribution usually first Friday 10:00–10:20 am; call for information or enrollment Woodridge: Town Hall 292-5821 x 620 CACHE HPNAP distribution usually first Friday 10:30–10:45 am; call for information or enrollment Sullivan County Public Health Services Community Health Improvement Plan ASSESSED AREA OF NEED Housing November 2013 PROVIDER PHONE CONTACT PROGRAM SERVICES (Area code is [845] unless otherwise noted) Wurtsboro: Wurtsboro Senior Citizen Center 292-5821 x 620 CACHE HPNAP distribution usually first Friday 11:50 am–12:05 pm; call for information or enrollment Wurtsboro: Community Church 888-5626 Pastor Robert Meyer, 134 Sullivan Street. Town of Mamakating residents only; ID required. Hudson Valley Food Bank guidelines, supplement for food for one month. In addition to canned goods, frozen food and produce. Open weekly, Wednesday 10:00 am-12 pm, Thursday 4:00-6:00 pm. Rural Opportunities, Section VIII 794-4880 Rural Op; 292-0100 DFS referral Can be expedited by referral/advocacy through Family Reunification Program CACHE weatherization 292-5821 Energy assessment and weatherization of existing homes Federation for Homeless 794-2604 Referral, advocacy; shelter SC Dept Family Services 292-0100 Assistance with temporary placement for income-eligible homeless families SC Rural Housing Corp 794-0348 Transitional living Rural Opportunities 794-4880 Domestic-violence-related supports CACHE Safe Passage 292-5821 x 618 admin; Hotline, counseling, legal education and advocacy, shelter, referrals and advocacy hotline 292-5400 for needed services, support groups Legal assistance Legal Services of the Hudson Valley/CACHE 292-5821 x 629, x 628 Assistance in areas of landlord/tenant issues, Social Services, AIDS-related services, Social Security benefit information, IEPs and other education-/school-related issues Harris Family Health Center 794-1372 Accepts Medicaid, Hudson Health Plus; for charity-care applications due to lack of insurance, call 794-3300 x 2554 Specific eligibility criteria for youth leaving foster care Health and medical concerns Medical exam Health insurance for children and teens Page 121 Hudson River Health Care 794-2010 Accepts Medicaid, Hudson Health, Child/Family Health Plus, assists with enrollment in such insurance programs; very community-oriented Family doctors See DFS provider list Refer to DFS list of providers; includes information on those accepting Medicaid Child Health Plus, Family Health Plus 292-0100; 791-7429 x 302 Applications through SC DFS; facilitated enrollment also through MISN (contact enroller Carmen Mendoza) or Hudson River Health Care Sullivan County Public Health Services Community Health Improvement Plan ASSESSED AREA OF NEED November 2013 PROVIDER PHONE CONTACT PROGRAM SERVICES (Area code is [845] unless otherwise noted) Fidelis Care 483-1292 x 25134; (800) 550-8031 Nonprofit provider of health insurance for families and individuals; also assists with facilitated enrollment Medicaid: SC DFS 292-0100; 791-7429 x 302 Applications through SC DFS; facilitated enrollment also through MISN (contact enroller Carmen Mendoza) MISN 1-800-453-8666 Health insurance enrollment (commercial and Medicaid/Child Health Plus) and inperson navigator assistance for New York State of Health Marketplace Health information Catskill Regional Medical Center, CRMC 794-3300 x 2187 CRMC’s health-information library open to the public MWF 10 am–4 pm, Tuesday noon–8 pm, Sunday 1–5 pm; will conduct online searches for you in addition to lending hard-copy books or printing out articles. Available by phone, e-mail (library@crmcny.org), or website (http://www.crmcny.org/library.html) Children's dental needs PRASAD Project 434-0376 Comprehensive dental assessment, prophylaxis, and education at no cost, through virtually all school districts; dental treatment to needy children Reproductive: ob/gyn; sex education; rape; HIV Planned Parenthood 794-3704 Exams, pregnancy and STD testing, contraception, counseling, education Rape or sex-abuse counseling Page 122 Selma Ettenberg Women’s 794-7897 Health Center Exams, mammograms, STD testing, contraception, counseling, education, referrals, prenatal care; formerly at CRMC, now located at 60 Jefferson St, Monticello Wurtsboro Women’s Health Center 888-2200 Satellite of Selma Ettenberg/CRMC; includes mammograms on site TLC/BOCES Real Deal 791-7429 TLC 794-4405 BOCES Focus on sex and relationship education, support groups, community activities for youth; outreach education to adults, parents, teachers BOCES Teen Parenting 794-4405 Sex education, counseling, relationships, responsibility; case management no longer available due to loss of funding and changes in funding streams RISE 794-3300 ext. 2442 Rape Intervention Services and Education: crisis, follow-up (both legal advocacy and counseling and referral); education, support groups, individual counseling by trained, experienced laypersons (not clinical professionals); Cindy Zingher program director Sullivan County Public Health Services Community Health Improvement Plan November 2013 ASSESSED AREA OF NEED PROVIDER PHONE CONTACT PROGRAM SERVICES (Area code is [845] unless otherwise noted) Other: nutrition, endocrine, vision, hearing Medical specialists See DFS list Please see DFS list of providers; includes information on those accepting Medicaid Neurological Center for Discovery 794-1400 Outpatient pediatric neurological evaluations; also see DFS provider list. Current information also available from Community Services (292-0887) and CACHE (2925821) SC Mental Health Clinic 292-8770 Community Services: full spectrum of mental-health services SC Mental Health TRY 292-8770 Treatment Reaching Youth, MH social workers in the schools Private providers N/A Depending on issues, certain practitioners are particularly recommended. See Community Services list of approved providers or consult Community Services School-issues-related only School-based N/A; individual district School-district social workers, guidance counselors Special support groups Hudson Valley Support Group for Families with Bipolar Children 883-9516 Local support meetings in Wurtsboro and Liberty; contact Jeanette Smith, Outreach Bipolar Support Group 566-0810 Support group for parents of children with bipolar disorder; contact Ann Bardinelli SC Mental Health Clinic 292-8770 Community Services: full spectrum of mental-health services Private N/A No specific recommendations; see Community Services list of approved providers 292-8770 Community Services includes psychiatric as well as mental-health services Catskill Regional Medical Center, CRMC 794-3300 Community hospital psychiatric services Private practitioners N/A See Community Services list of approved providers or consult Community Services. It is recommended that parents see a psychiatric professional, not a family doctor, to prescribe and monitor psychotropic medications Center for Discovery 794-1400 Outpatient pediatric neurological evaluations. Current information also available from Community Services (292-0887) and CACHE (292-5821) Mental-health needs Counseling, individual Mental-health evaluation Psychiatric; Rx eval/reevaluation SC Mental Health Clinic Neurological Page 123 Sullivan County Public Health Services Community Health Improvement Plan ASSESSED AREA OF NEED November 2013 PROVIDER PHONE CONTACT PROGRAM SERVICES (Area code is [845] unless otherwise noted) Four Winds outpatient, Fishkill 1 (800) 546-1770 Outpatient educational, psychiatric, neurological evaluations Westchester Med Center (914) 493-7000 Outpatient pediatric neurological evaluations Parental respite and skill building Through Community for parents with children with Services mental-health concerns 292-0100, 292-0887 While providing respite, also provides skill building to parents and child. Available only Community Services OMH Waiver at this time Sex-abuse treatment, sexoffender treatment SC Mental Health Clinic 292-8770 Group work available for sexual offenders and those sexually abused Private practitioners See mental-health practitioners list Certain practitioners have this as a specialization Sex-abuse counseling, advocacy RISE 794-3300 ext. 2442 Rape Intervention Services and Education: crisis, follow-up (both legal advocacy and counseling and referral); education, support groups, individual counseling by experienced laypersons (not psychiatric/clinical professionals); Cindy Zingher program director Grieving, death, and loss Children’s Grieving Center, 561-6111 Hospice of Orange A safe, neutral, and private environment for grieving children and their families. Trained volunteers and professionals lead discussions and activities designed to help in the grieving process; services are offered free of charge to the community Mental-health intensive support IDT, intensive day treatment for children IDT ICM, intensive case management SC Mental Health Clinic 794-3430, now at BOCES Intensive day treatment administered through BOCES in conjunction with RCPC, St John Street Education Rockland County Psychiatric Center, a major residential provider. Includes small, Center closely supervised class in Liberty secondary-school building, treatment, support 292-8770 x 4031 Ancillary mental-health supports RSS, Rehabilitation Support 794-1521 Services Page 124 Community Services: part of the spectrum of mental-health care Provides recreational activities for youth with mental-health diagnosis; group home, Hamptonburgh residence Sullivan County Public Health Services Community Health Improvement Plan ASSESSED AREA OF NEED November 2013 PROVIDER PHONE CONTACT PROGRAM SERVICES (Area code is [845] unless otherwise noted) Harbor House: UCMHA Info: 292-8770, SC Mental Health Clinic Therapeutic foster homes, teaching family homes. Referral through MH to main office in Kingston Catskill Regional Medical Center, CRMC 794-3300 Short-term, evaluation Four Winds 1 (800) 546-1770 Short-term and 30-day observational evaluation, treatment, placement, followup recommendations RCPC 359-7400 Evaluation, in-patient treatment Residential treatment 292-0100 Recommendations from and placement through SPOA, single point of access Hamptonburgh 794-1521, RSS Residential program for girls Assessment, residential care, therapies Center for Discovery 791-8153 Pediatric assessments available; special therapies for residential population include animal-assisted therapy (“hippotherapy”), farming and gardening Supervised community-based housing New Hope Community 434-8300 Includes community-based residences, independent-living training and housing Crystal Run Village 796-4324 Sullivan ARC 796-1350 ATI 794-4228 Crystal Run Village 796-4324 Family Empowerment 343-8100 Independent Support Services, ISS 794-5218 Contact Alan Kulchinsky New Hope Community 434-8300 Contact director of Medicaid Service Coordination Sullivan ARC 796-1350 In-patient or residential treatment programs MR/DD assessment and services Service coordination, case management Page 125 Action Towards Independence; Case management and service access for persons with disabilities; Joan Summa Sullivan County Public Health Services Community Health Improvement Plan November 2013 ASSESSED AREA OF NEED PROVIDER PHONE CONTACT PROGRAM SERVICES (Area code is [845] unless otherwise noted) Other services Early Intervention 292-5910 ext. 2718 For children ages 0–3; contact Lisa Wissman Early Childhood Directions 338-6755 (Kingston) For children ages 3–5; toll-free 1 (888) 811-3232 Hudson Valley DDSO 791-7620 Local office of state agency for MR/DD services Project Excel 794-4020 Easter Seals educational program for DD young children SC BOCES SETASC 292-0082 x 4040, 4042 or 295-4040, 295-4042 Family education support group, autism support group Recreation, school-based School districts N/A; see individual districts Many districts have after-school sports and some have other activities as well (e.g., Liberty, Monticello, Fallsburg), some Youth-Bureau funded; contact schools Recreation, other Boys & Girls Club 342-8833 After-school programs in Fallsburg, Liberty, and Monticello districts include mentoring and homework help in addition to evidence-based prosocial, skillbuilding, preventive, and recreation activities such as art, music, theater, dance; contact John Kane or Karen Juers Frost Valley YMCA 935-2291 Family and youth activities throughout the year, both free and fee-based YMCA 794-7700 x 10975 Recreational activities for adults and youth, housed at Monticello High School; fee-based. Local YMCA camp in development; contact Ross Miceli, Juliet DiPietro Bethel Woods Center for the Performing Arts 295-2446 In addition to popular adult and classical music concerts, Bethel Woods offers a series of performances for young people (contact Elaine Muscara, community outreach) and educational tours of the museum (contact museum director) Boys & Girls Club 342-8833 Art-related activities include visual arts and crafts, music, theater, and dance; contact John Kane or Karen Juers CAS, Catskill Art Society 436-4227 After-school, evening, weekend classes in a range of arts and crafts; studio tours; hosts annual spring student art show, featuring entries from all school districts Recreation and youth development Art, theater, music, performance Page 126 Sullivan County Public Health Services Community Health Improvement Plan ASSESSED AREA OF NEED PROVIDER PHONE CONTACT PROGRAM SERVICES (Area code is [845] unless otherwise noted) Cornell Cooperative Extension 292-5250 Cornell offers art workshops and annual theater activities DREAM Tank 791-5600 Development program for teens that includes personal goal setting, “a touch of class” training in social graces, and projects in art and music; contact Sonia Caycho Mullen; director Judge Josephine Finn DVAA, Delaware Valley Art Alliance 252-7576 Classes in a range of arts; financial grants to individual artists; lists of current area activities and events Footings 783-7505 After-school programs in Monticello-district elementary schools Forestburgh Playhouse 794-2005 Children’s theater includes series of performances in summer, interaction with actors The Janice Center 482-3324 Music, dance, art, theater, movement. Music Together® programs to introduce music to children 0–5; dance classes in ballet, hip-hop, jazz, tap, ballroom; art, theater, karate, Zumba. Large class programs, recitals, seminars and workshops. Contact Tanya Cohen Jillian Rahm, Bliss Art See website Range of creative arts and crafts, sculpture, collage; http://www.blissartcreative.com Liberty Free Theatre 292-3788 Free theater productions, opportunity for serious teens to learn, hands-on coaching Liberty Public Library 292-6070 Art and craft workshops, films, performers, presentations Livingston Manor Free Library 439-5440 Performers, presentations; parade, reading and music event in the local park pavilion Sunshine Hall Free Library Page 127 November 2013 Art workshops and presentations, performers Monticello Library 794-4660 Seasonal thematic film series for families and teens, with facilitated discussion NACL, North American Cultural Laboratory 557-0694 Cutting-edge theater and performance; stilt-walking, giant puppets; classes, retreats; children’s classes and family activities Sullivan County Public Health Services Community Health Improvement Plan ASSESSED AREA OF NEED PROVIDER PHONE CONTACT PROGRAM SERVICES (Area code is [845] unless otherwise noted) Radioactive Teen Theater (formerly Act Up) (570) 224-7511 Teen theater program, conducted primarily through libraries and school libraries, offers opportunity for teens to create and produce radio plays; sites include Jeff library, Honesdale, and Monticello Literacy Center; recruiting also through SW CSD (HS) school library. DVAA community artist grant funded River Springs Art Inst (Old Stone House) 434-9370 Year-round art, writing, and nature-focused activities and workshops for children, teens, and adults SC Cares Coalition 292-9100 Cares Coalition, partnering with Bethel Woods, offers teens the opportunity to design and produce performances focused on teen community issues Shakespeare in the Park 292-7690 Summer theater includes opportunities for teens; offered by director Oliver King through Liberty Parks & Recreation SC Community College College events and student activities open to other youth, families; free or group rates 434-5750 Sullivan West CSD after- 482-4610 school art 932-8560 After-school art program with professional artists and performers, offered to district children by PTSO, ranges from theater and music to ceramics and photography Western Sullivan Public Library Art and craft workshops, films, performers, presentations 482-4350, 887-4040 Youth Arts Group 518-9210 (cell) Other individual artists Cultural programs; reading/literacy SC Community College activities Page 128 November 2013 Leadership-development program, group-building techniques and professional artist mentors give youth the opportunity to explore and respond to the issues in their lives; youth discuss issues and develop projects that educate and inspire action for change. Contact Andres Chamorro Info: 794-3000 x 0396; Many other artists, illustrators, and craftspersons around the county offer classes 292-0082 x 4029 or 4027; or individual instruction, or are available for workshops; call Braman Arts, BOCES 436-4227; 252-7576 Arts in Education, Catskill Art Society, DVAA, or Youth Bureau for possibilities 434-5750 College events and student activities open to other youth, families; free or group rates Sullivan County Public Health Services Community Health Improvement Plan ASSESSED AREA OF NEED November 2013 PROVIDER PHONE CONTACT PROGRAM SERVICES (Area code is [845] unless otherwise noted) SC BOCES Arts in Education 292-0082 x 4029/x 4027 295-4029/295-4027 School-based activities with artists and published writers, including after-school workshops SC BOCES Even Start 794-4405 Family-literacy partnerships; summer camp for eligible kids up to age 8 PUBLIC LIBRARIES See below; also see Yellow Pages, “L” Liberty, Grahamsville, and Western Sullivan are most active in providing programs, but others do as well. For many, activities vary; consult individual libraries Eldred: Sunshine Hall Library 557-6258 Children’s reading activities; developing workshops for teens Fallsburg Library 436-6067 Children’s reading activities; community-oriented workshops; open-mic poetry Liberty Public Library 292-6070 In addition to reading and hands-on activities for children, sponsors other educational workshops for young adults, movies series Livingston Manor Free Library 439-5440 Children’s reading activities, summer reading program, workshops Monticello: Crawford Public Library 794-4660 In addition to reading clubs and hands-on activities for children, offers family concert and movie series Neversink/Grahamsville 985-7233 Daniel Pierce Library Children’s reading activities, plus wide range of other activities, including the “Great Pumpkin Party” fair in October Port Jervis Free Library 856-7313, 856-9154 Children’s reading activities Roscoe Free Library (607) 498-5574 Children’s reading activities Western Sullivan Public Library 482-4350 Jeffersonville, In addition to reading activities for children, sponsors other educational 887-4040 Callicoon, 252- workshops for young adults 3360 Narrowsburg Other individual writers Info: 794-3000 x 0396; Many writers around the county offer classes or individual instruction, or would 791-7429 (TLC); 292-0082 provide group workshops; call Liz Huntington at SCCC, DVAA, BOCES Arts in x 4029 or 4027 Education, or Youth Bureau for a range of resources Page 129 Sullivan County Public Health Services Community Health Improvement Plan November 2013 ASSESSED AREA OF NEED PROVIDER PHONE CONTACT PROGRAM SERVICES (Area code is [845] unless otherwise noted) Clubs, groups: Girl Scouts Girl Scouts Heart of the Hudson, Sarah Wells Council, Middletown 361-2898 Troop activities; individually designed programs for older girls; communityservice activities and skills, leadership development; summer camp, scholarships available Clubs, groups: Boy Scouts Hudson Valley Council, Boy Scouts of America 791-7239 Services include a nontraditional Cub Scout group at MHA; contact Ruth Owens is an assistant council commissioner for the Hudson Valley BSA Council, attends all SC district meetings, will liaison with individual troops and “dens” Clubs, groups: 4H, workshops, projects Cornell Cooperative Extension 292-4621, 292-6180 Group and individual activities, projects, community service, trips. Cornell also offers educational programs and presentations ranging from cooking and personal finance to environmental awareness and gardening; these are available on site at Cornell, or through arrangement at schools or other youth-group venues Recreation/group activities: youth centers Boys & Girls Club 342-8833 After-school programs in Fallsburg, Liberty, and Monticello districts include mentoring and homework help in addition to evidence-based prosocial, skillbuilding, preventive, and recreation activities such as art, music, theater, dance; contact John Kane Delaware Youth Center 887-5155 Full summer program, year-round holiday events and teen dances, skate park Monticello Housing Authority 794-6855 Child and teen activities in community-center room: computer access, preschool play area, teen community service, holiday events, trips; hosts other community services, such at TLC and parenting education YMCA 794-7700 x 10975; 344- Activities for children, teens, and adults include fitness, swimming instruction, YMCA (344-9622) yoga, specialty classes, sports Recreation/group activities: municipal Town of Bethel Page 130 794-3000 x 0396 Programs range from ice hockey through summer swim and camp or yearround field trips; most are Youth-Bureau funded; contact Youth Bureau for current list Town hall 583-4350 Summer camp (fee-based), summer swim instruction (free); year-round trips, sports Sullivan County Public Health Services Community Health Improvement Plan ASSESSED AREA OF NEED Recreation: summer camps Page 131 November 2013 PROVIDER PHONE CONTACT PROGRAM SERVICES (Area code is [845] unless otherwise noted) Town of Callicoon Town hall 482-5390 Winter basketball, grade 3–8, 482-5750; currently no summer program, preparing a site for a full-day camp program and researching other options for family recreation Town of Cochecton 252-3634, 932-8210 Year-round trips, seasonal celebrations, workshops Town of Fallsburg Parks & Rec 434-5877 Summer camp; school year swim program; year-round special events Town of Forestburgh Town hall 794-0611 Summer camp and swim (free); winter ski (fee-based) Town of Highland Town hall 557-6085 Summer camp (free) Town of Liberty Parks & Rec 292-7690 In addition to a range of free and fee-based recreational activities, offers Open Gym at the middle school in early fall; fee-based summer camp, half-day or full-day Town of Lumberland Town hall, 856-8600 Summer camp (free) Town of Mamakating Parks & Rec 888-3013, 8883049 Summer camp (fee-based); year-round trips, workshops, seasonal celebrations, including “Battle of the Bands” for teens Town of Neversink Parks & Rec 985-2262 x 312 Summer swim and swim instruction; year-round trips, workshops, seasonal events Town of Rockland Town hall 439-5450 Winter skating and Ice Carnival offered by Livingston Manor Rotary Town of Thompson Town hall 794-2500 Summer camp (fee-based) Town of Tusten Town hall 252-7146 Year-round trips, events, seasonal celebrations Village of Monticello 794-2351 Year-round sports and other activities (both free and fee-based) Delaware Youth Center 887-5155 Full summer program, including swim; mornings only Frost Valley YMCA 985-2291 Summer camps (fee-based); some “scholarships” available Boy Scouts 791-7239 Summer camps (fee-based); some “scholarships” available Girl Scouts 361-2898 Summer camps (fee-based); some “scholarships” available Town of Bethel Town hall 583-4350 Summer camp (fee-based), summer swim instruction (free), family trip and picnic Sullivan County Public Health Services Community Health Improvement Plan ASSESSED AREA OF NEED Recreation: sports groups and leagues PROVIDER PHONE CONTACT Town of Fallsburg Parks & Rec 434-5877 Summer camp; school year swim program; year round special events Town of Forestburgh Town hall 794-0611 Summer camp and swim (free) Town of Highland Town hall 557-6085 Summer camp (free) Town of Liberty Parks & Rec 292-7690 Summer camp, half-day or full-day (fee-based) Town of Lumberland Town hall, 856-8600 Town of Mamakating Parks & Rec 888-3013, Summer camp, half-day or full-day (fee-based) 888-3049 Town of Neversink Parks & Rec 985-2262 x 312 Summer swim and swim instruction School-based Individual schools Contact individual school districts Fallsburg Pop Warner Football and Cheerleading 583-6500 Full tackle football, for ages 5–15; 50–120 served yearly. Morningside Park, August 1–late November; hope to go to year-round cheerleading. Fee-based, associated with Mid-Hudson Conference Fallsburg Youth Wrestling Club 693-4307 iBAM, International Boxing Academy 468-4324 After-school and weekend boxing and fitness training; local, regional, and national competitions; life-skills and prevention training. Contact Ray Sheenan, president Liberty Bike Trail 239-2218 Bike trails and group riding events for youth, adults, and families; annual Fall Bicycling Day in October; details at website, http://www.libertybiketrail.org Liberty Little League 292-7237 Little League play on town and school fields, including Walnut Mountain field. Serves about 19 teens plus about 250 children overall; planning expansion MAFCO — Monticello 794-0487 Area Football & Cheerleading Organization Page 132 November 2013 PROGRAM SERVICES (Area code is [845] unless otherwise noted) Summer camp (free) Nonprofit serving over 100 youth annually; fee-based Sullivan County Public Health Services Community Health Improvement Plan ASSESSED AREA OF NEED PROVIDER PROGRAM SERVICES (Area code is [845] unless otherwise noted) Monticello Gymnastics 794-2835 Gymnastics, all ages, fee-based, overseen by professional gymnast/trainer Monticello Recreation Basketball, baseball leagues; some fee-based 794-2351 Rockland Football League (607) 498-5329 Football for youth in Roscoe and Livingston Manor area; fee-based SC Youth Baseball and 583-7180 Softball League League serves about 300 youth in Livingston Manor, Roscoe, Sullivan West; fee-based Other special-interest areas: WJFF public media 482-4141 Technical and creative training, youth-run radio program, field trips, hands-on coaching; hopes to develop a mobile production-studio-on-wheels to take this creative opportunity to schools and other youth group settings around the county. Participating youth are willing to do stories on youth-related events. Contact Jason Dole or Betsy Woolf River Reporter 252-7414 Publishes youth-written material periodically, and highlights youth achievements on an ongoing basis; contact youth editor Richard Ross or associate editor Mary Greene for media coverage of youth activities SC Democrat 887-5200 Excellent human-interest media coverage for youth-related events Catskill Chronicle 747-4200 Leni 985-7783 Carol Excellent human-interest media coverage for youth-related events; online zine. Contact Leni Santoro or Carol Montana 292-7680 Exhibitions and presentations of a range of animals, including comments about their relationship with human qualities and habits Other special-interest areas: Animal Alley nature, wildlife, farming, gardening, energy tech, museums Page 133 PHONE CONTACT November 2013 “Animal Encounters,” “Everything Animals” Liberty Public Library, Animal rescuers present creatures ranging from dogs, cats, rodents and hedgehogs to 292-6070 doves, tarantulas, millipedes, lizards, tortoises, snakes, frogs, toads Apple Pond Farm Education Center 482-4764 Workshops include renewable energy, Saturday “Farming with Kids” feeding animals, planting, picking, grooming horses, trimming goats. Work depends on season, age of child, and weather; children must be accompanied by an adult Ashokan Center 657-8333 Outdoor education center, nature field trip facility about 1 hour from Monticello Sullivan County Public Health Services Community Health Improvement Plan ASSESSED AREA OF NEED November 2013 PROVIDER PHONE CONTACT PROGRAM SERVICES (Area code is [845] unless otherwise noted) Butterfly Botanicals 733-7713 Butterfly farm, greenhouse; offers tours, opportunity for kids/families to learn how to "grow" butterflies for release in their yards/neighborhoods as pollinators Catskill Fly-Fishing Center and Museum 439-4810 Fishing and fly-tying exhibits, classes, and workshops on the Willowemoc Catskill Mountain Club Info:info@catskillmou ntainclub.org Web:www.catskillmou ntainclub.org CMC offers opportunities to hike, camp, fish, hunt, canoe, kayak, bike, climb, and otherwise enjoy nature and outdoors year round. Activities include group hikes, annual October “Lark in the Park” series, education, volunteer service projects. Free membership; donations encouraged. Contact Aaron Bennett, CMC coordinator; online group posts at catskillmountainclub@yahoo.com. Community Gardens: Fallsburg Bee Green Community Share in development of a community garden at Morningside Park in Hurleyville. Contact Garden, 436-4634 Kelley Gips Community Gardens: Liberty 292-9446 Community garden on Main Street; contact Jon-Jon Thomas Community Gardens: Livingston Manor 482-3857 Community garden on Pearl Street; contact Kurt Knuth Community Gardening: Livingston Manor Free Working on a program in wild plants / gardens for grades 4–8: to visit Fort Delaware, Livingston Manor Library, 439-5440 conduct plant walks, plant garden[s] Community Gardens: SCCC Page 134 434-5750 Community garden currently in development with volunteers from staff and student body; not yet open to public Delaware Valley Raptor (570) 296-6025 Center Wildlife rehabilitation for raptor birds; excellent public presentations Down on the Farm days 794-3000 x 3127 A number of area farms and horse stables sponsor “day on the farm” events; contact SC Visitors Association at the Government Center for information Eagle Institute Eagle watching, tours, volunteers welcomed to gather data; educational presentations (570) 685-5960 Sullivan County Public Health Services Community Health Improvement Plan ASSESSED AREA OF NEED Page 135 PROVIDER PHONE CONTACT November 2013 PROGRAM SERVICES (Area code is [845] unless otherwise noted) Federation of Sportsmen 439-3738 Based in Willowemoc; in addition to mentoring youth in hunting, activities include annual Fair & Youth Day Fort Delaware 252-6660; 807-0261 Fort Delaware Museum of Colonial History, 6615 SR 97, Narrowsburg, NY 12764. Open Memorial Day–Labor Day. Hands-on activities for kids. On SC website Frost Valley YMCA 985-2291 x 397 Hikes, presentations, wildlife observations, stargazing, raptor center. Some activities in collaboration with CMC, Catskill Mountain Club. Contact Natural Resources and Environmental Science coordinator Harvest Festival at Bethel 292-2448 Woods Sundays late August–early October at the original Woodstock concert site, with regional farm products and artisans, special events and music each week, children's activities, hay and corn mazes, and a scarecrow exhibit Hudson Valley Raptors Presentations of raptor birds, hawking and hunting with raptors, falconry with interspecies teamwork 853-3173 Mountaindale 434-4747 Community Development Project Community revitalization focused on youth, heritage, and environment. Activities include nature park with silent walkway; Junk Jam (1st Sunday in August): concert to promote environmental awareness: reduce, reuse, recycle; music to heal the earth; community beautification and service projects National Park Service; Upper Delaware Scenic River Presentations on a range of area resources, wildlife, cultural history; management of Delaware-area recreational facilities, safety, information, and access (570) 729-7134 (570) 729-8251 x 221 Sullivan County Public Health Services Community Health Improvement Plan ASSESSED AREA OF NEED PROVIDER PHONE CONTACT PROGRAM SERVICES (Area code is [845] unless otherwise noted) SASD, Sullivan Alliance for Sustainable Development 482-4764; 794-3000 x 0578 Information on energy sustainability, project ideas for youth: e.g., renewable energy clubs in middle schools; recycling teams in school at all grade levels around the county; renewable-energy model making and science-fair projects (e.g., build a desktop wind turbine, an electrolysis device for producing hydrogen, or even a model solar car); teams to monitor energy consumption at their school and then produce plans to downsize energy consumption — a project already under discussion at Liberty HS; work as a group on local Habitat for Humanity housing to design and install the energy-saving and energy-producing components Sullivan Renaissance 295-2440, 295-2442 Community beautification projects with extensive youth involvement; master gardener available for consultation Upper Delaware Council 252-3022 “River watch,” research, policy directions; teen volunteers welcomed Youth development: community service, leadership, skills development No systematized approach is in place for developing/finding service slots for youth Youth development, leadership, Boys & Girls Club service Community Garden [see nature activities, above] 342-8833 After-school programs in Fallsburg, Liberty, and Monticello districts include mentoring and homework help in addition to evidence-based prosocial, skill-building, preventive, and recreation activities such as art, music, theater, dance; contact John Kane 436-4634 Share in development of a community garden at Morningside Park in Hurleyville; similar activities being initiated at SCCC. Contact Kelley Gips DRC, Dispute Resolution 794-3377 Center Youth are trained as peer mediators and empowered to act as peer educators in dispute resolution, alternatives to violence; contact Kathy Kreiter DREAM Tank Anti-gang initiative for teens includes education in self-awareness, personal goals and self-presentation, and self-expression through choice of art or music media. Contact Sandra Caycho Mullen; director Judge Josephine Finn 791-5600 Hudson River Health Care 794-2010 Page 136 November 2013 Training in prevention, decision making, peer education and leadership Sullivan County Public Health Services Community Health Improvement Plan ASSESSED AREA OF NEED PROVIDER PHONE CONTACT PROGRAM SERVICES (Area code is [845] unless otherwise noted) Mountaindale 434-4747 Community Development Project Community revitalization focused on youth, heritage, and environment. Activities include nature park with silent walkway; Junk Jam (1st Sunday in August): concert to promote environmental awareness: reduce, reuse, recycle; music to heal the earth; community beautification and service projects Rockland Fire District Cadet and Junior Firefighter programs Cadets, ages 14–16; and Junior Firefighters, ages 16–18. Cadet program offers limited training toward junior firefighting and involves kids in community service fireprevention activities like cleaning chimneys, washing fire trucks, taking part in litter pluck and fundraisers; kids are required to maintain passing grades in school. In-house training; at age 16, kids can get paid training as firefighter interns. Juniors take part in Fire Prevention Week as peer educators at school 439-4423 SC Cares: “Choices,” LCA 292-9200, 292-2393 Company (“lights, Camera, Action”), and Youth Mentoring Youth groups and their adult mentors are trained in theater techniques and trustbuilding skills to defuse dispute situations, offer training to peers, and conduct public performances and presentations; individual youth placed in mentoring/job-skillsbuilding relationships with local business people as adult mentors Sullivan/Orange Chapter 294-9785 American Red Cross Skills trainings (e.g., CPR, emergency responses, fire safety) to youth and training youth to act as peer educators in these areas Sullivan Renaissance 295-2440, 295-2442 Community beautification projects with extensive youth involvement; master gardener available for consultation TLC, Teen Link to Community (MISN) 791-7429 Adolescent group projects provide a forum to develop social skills, appropriate relationships, positive socializing activities;”Hip-Hop in Me” summer performance; Wise Guys male responsibility curriculum; community projects Youth Economic Group (Rural & Migrant Ministry) 485-8627, 798-8275 Education, empowerment, and entrepreneurship opportunity for teens and young adults: a worker cooperative that serves as both a job development program and an educational vehicle. Contact Jillian Rahm Youth Empowerment 485-8627 Project (Rural & Migrant Ministry) Page 137 November 2013 Youth enabled to have greater control of their lives as they explore and internalize the concepts of self-worth, leadership, and democracy; includes Youth Arts Group, YEP summer camp and day-camp programs, leadership institutes Sullivan County Public Health Services Community Health Improvement Plan ASSESSED AREA OF NEED PHONE CONTACT PROGRAM SERVICES (Area code is [845] unless otherwise noted) Youth employment, summer Center for Workforce job Development, CWD 794-3340 Summer youth program, internships, assessments, job-seeking coaching, and resources VESID, if appropriate 794-5317 Older youth with disabilities eligible to receive training and job-placement services Youth mediation, home or school PROVIDER November 2013 DRC, Dispute Resolution 794-3377 Center Range of mediation, including parent/child mediation; crisis intervention; ; train youth as peer mediators/educators, set up school-based peer-mediation programs; contact Kathy Kreiter In-school mediation N/A; individual district Schools universally prefer to control their own mediation process; some districts are utilizing DRC training programs for student peer mediators as well. See DRC. DRC boys/girls groups 794-3377 Local police in schools N/A; individual district Monticello and Fallsburg districts in particular use police youth officers, mediators School-based N/A; individual district A number of districts have their own programs; information is not widely available; contact PINS planning group SC Mental Health 292-8770 Individual and group work for adolescent anger management; groups form based on sufficient numbers of appropriate youth MISN 1-800-453-8666 Adolescent groups impart social skills as well as sex education, appropriate relationships, and positive socializing activities for young teens Youth support groups or trainings, other Boys/girls/officers group Anger management, prosocial skills Prosocial skills, relationships Boys Council Page 138 Mediation is developing support groups, largely for at-risk youth, and exploring restorative-justice models of youth engagement in community; contact Kathy Kreiter A structured group for males between 10-18 years old that challenges myths of masculinity while providing positive opportunities to explore the natural strengths of young men. These programs are offered in conjunction with the evidence-based teen pregnancy prevention programs listed above. Groups are offered from 8-12 weeks. Sullivan County Public Health Services Community Health Improvement Plan ASSESSED AREA OF NEED PROVIDER PHONE CONTACT Girls Circles Bereavement support PROGRAM SERVICES (Area code is [845] unless otherwise noted) A structured support group for females between 10-21 years old. The groups aim to build positive relationships and develop self-esteem and self-confidence. These programs are offered in conjunction with the evidence-based teen pregnancy prevention programs listed above. Groups are offered from 8-12 weeks. Participants should be in a similar age group. Advocacy for special-needs children Advocacy for special-needs children, continued November 2013 For details, also contact SC Community Services, 292-8770 ATI 794-4228 Action Toward Independence, advocacy and services for all persons with disabilities, not limited to children/youth Independent Support Services 794-5218 Case management and service access for persons with disabilities; Alan Kulchinsky Parents for Parents (BOCES SETASC) 292-0082 x 4040, 4042 In addition to parent support and education, provides direct advocacy with CSE; or 295-4040, 295-4042 contact parent educator Other support groups (BOCES SETASC) 292-0082 x 4040, 4042 Special support groups for autism and Asperger’s syndrome, parents of bipolar or 295-4040, 295-4042 children; contact parent educator BOCES SETASC 292-0082 x 4040, 4042 Bereavement group targets children with bereavement and abandonment issues; or 295-4040, 295-4042 contact parent educator SC DFS Services 292-0100 for information Court-ordered foster care, case management, advocacy, referral to other services as needed; therapeutic foster care placement, case management, community activities, advocacy, treatment; by family court order only, through DFS care and custody. 292-0100 DFS Services, for information Transitional residential care for youth returning to community who cannot be placed with family or in family-based foster care; court-ordered Youth out-of-home placement, detention Foster care, by family court order only Group home foster care, for Abbott House youth in court-ordered placement Page 139 Sullivan County Public Health Services Community Health Improvement Plan November 2013 ASSESSED AREA OF NEED PROVIDER PHONE CONTACT PROGRAM SERVICES (Area code is [845] unless otherwise noted) Nonsecure detention (family court-mandated) Astor Homes 292-0100 DFS Services, for information Provides nonsecure beds on availability outside of Sullivan County. Must be mandated by family court; DFS provider of choice for this service Services and housing for runaway youth A Friend’s House 292-0100 DFS Services Licensed shelter and services for runaway and homeless youth; by DFS referral only information and for respite for PINS-classified youth referral Page 140