Joint Coalition on Health of North Central Massachusetts

1. Joint Coalition on Health of North Central Massachusetts Community Health Assessment 2003 Funding provided by: Health Foundation of Central MA HealthAlliance Heywood Hospital Montachusett Opportunity Council CHNA #9

2. Joint Coalition on Health of North Central Massachusetts Co-Chairs • Lorie Martiska (Heywood Hospital) • Kathleen McDermott (Montachusett Opportunity Council) Steering Committee Members • Janice LeClair (Mount Wachusett Community College) • Mary Lourdes Burke (HealthAlliance) • Bill O’Connell (Massachusetts Department of Public Health)

3. Joint Coalition on Health of North Central Massachusetts Consultants Initial Project Design and Data • Roger Fitch Qualitative Measures, Additional Data Gathering, Analysis, Assessment Compilation, and Editing • Joanne Calista, LICSW (Central MA Area Health Education Center) • Lori Miller, LSW (Central MA Area Health Education Center)

4. Joint Coalition on Health of North Central Massachusetts The Joint Coalition on Health is a group of committed individuals and organizations working collaboratively as catalysts for change and advocates for the underserved to improve the health and well-being of everyone in North Central Massachusetts. Mission Statement

5. Accomplishments of the Coalition • Health Education Resource Guide • Informational kiosk at Searstown Mall • Spin-off Projects: • Dual Diagnosis • Domestic Violence • GHAP for the uninsured • CHC Family Health Center • CHC Dental Service • SBHC at Murdock Middle/High School • Oral Health Initiative

7. Methodology Sources of input included: • Community Leader Interviews • Community Leader Mail Survey • Community-wide Telephone Survey • Eleven Three-Tiered Discussion Groups • Tier I: Broad Scope • Tier II: Specific Needs and Identified Health Concerns • Tier III: Specific Populations and Health Concerns • Health Status Indicators • Three Year Averages and Trend Data

8. US Census 2000 Data *Towns of Ashby, Lunenburg, and Townsend **Towns of Ashburnham, Hubbardston, Templeton, Westminster, and Winchendon ***Towns of Fitchburg, Fitchburg Area, Gardner, Gardner Area, and Leominster

9. Distribution by Race/Ethnicity • Overall, the Study Area’s racial/ethnic composition reflects that of Massachusetts as a whole. • In Massachusetts, 84.5% of the population describes themselves as White, 5.4% as Black/African American, 6.8% as Hispanic, and 3.3% as Other Racial/Ethnic Groups. • Within the Study Area cities, the racial/ethnic composition differs significantly. Eleven percent of Leominster’s and 15% of Fitchburg’s populations are Latino, while other segments of the Study Area show 4% or less. • Throughout the Study Area, the Latino population has grown at an average rate of +30% over a ten year period. In Gardner Area communities, the growth rate is +53%. • With a growth rate over a ten year period of 17% in Fitchburg Area towns to 68% in Leominster, Asians are the fastest growing population within the Study Area.

10. Mortality Findings MDPH Data (Average 1999-2001) *Towns of Ashby, Lunenburg, and Townsend **Towns of Ashburnham, Hubbardston, Templeton, Westminster, and Winchendon ***Towns of Fitchburg, Fitchburg Area, Gardner, Gardner Area, and Leominster

11. Mortality Findings • The cancer death rate per 100,000 is higher in the Fitchburg Area, Gardner, and the city of Fitchburg than the Massachusetts’ rate. • Although lung cancer in Fitchburg almost doubled between 1994 and 1998 after experiencing a decline in the prior five years, the rate decreased between 1999 and 2001. This has brought the rate much closer to that of the state. • The rate of breast cancer deaths in Gardner is higher than the state’s rate. • In profiling the Study Area and particularly the Fitchburg Area, motor vehicle deaths are higher as compared to the state’s rate.

12. Mortality Findings MDPH Data *Towns of Ashby, Lunenburg, and Townsend **Towns of Ashburnham, Hubbardston, Templeton, Westminster, and Winchendon

13. Mortality Findings MDPH Data (Average 1999-2001) *Towns of Ashby, Lunenburg, and Townsend

14. Mortality Findings • Compared to the Massachusetts’ rate of cardiovascular disease deaths, all of the Study Area’s groupings other than the Fitchburg Area’s rates are somewhat higher. • Cerebral vascular disease death rates have historically been, and continue to be, high in Leominster. The cerebral vascular disease death rate for the rest of the Study Area is approximately the same as Massachusetts’ rate.

15. Peri-Natal Indicator Findings MDPH Data (Average 1998-2000) *Towns of Ashby, Lunenburg, and Townsend **Towns of Ashburnham, Hubbardston, Templeton, Westminster, and Winchendon ***Towns of Fitchburg, Fitchburg Area, Gardner, Gardner Area, and Leominster Healthy People 2010 Target 90%

16. Teen and Adolescent Health Findings MDPH Data

17. Teen and Adolescent Health Findings • The 2002 rate of admissions into substance abuse treatment programs for those under the age of 21 in Gardner (284 per 100,000) was nearly double the rate for the same age group in Massachusetts (157 per 100,000). “Drugs are a big problem… You can get just about anything you want… The big things are alcohol, weed, heroin, cocaine, mushrooms, acid, and ecstasy.”

18. Teen and Adolescent Health Findings • In 2002, teens accounted for 40% of all reported chlamydia cases in the Study Area. “We have sex ed now in school, but it’s all lumped in with ‘health’ so we really don’t get much information. It would help to really get into it, like on TV I saw this live birth, that’s enough to scare kids away from getting pregnant…also to see what the STDs look like and feel like… We need to know this stuff…more visual, more info.”

19. Sexually Transmitted Infection and Infectious Disease Findings • Fitchburg’s average rate of chlamydia incidence is 50% higher than the state’s average. • The HIV prevalence rate per 100,000 in Fitchburg is close to that of the state, while the rest of the Study Area’s rates are well below Massachusetts’ rate. • Hepatitis C was a concern raised in the substance abuse focus group.

20. Sexually Transmitted Infection and Infectious Disease Findings Although the identified focus for one of the Discussion Groups was substance abuse, the participants focused heavily on their concerns regarding Hepatitis C. Fourteen of the eighteen participants in the group indicated that they had tested positive for the Hepatitis C virus. “Making a decision about Interferon for my Hep C is a scary thing. The Interferon brings on a bad depression, and you have to use a needle to take the Interferon… Both the depression and the needle could trigger another relapse… Another relapse could kill me.”

21. Behavioral Health Findings MDPH BSAS Data, 2003; US Census Data, 2000 *Towns of Ashby, Lunenburg, and Townsend **Towns of Ashburnham, Hubbardston, Templeton, Westminster, and Winchendon ***Towns of Fitchburg, Fitchburg Area, Gardner, Gardner Area, and Leominster

22. Behavioral Health Findings Substance Abuse With the exception of the Gardner Area towns, the percentages of heroin use within the Study Area are higher than the state’s percentage. “When I started to use, it was beer, then pot, then after years of that, heroin… These kids are going straight into the heroin…and at younger ages… My 19 year old has been ‘clean’ for 3 years, but my 17 year old is still using.”

23. Behavioral Health Findings Mental Health MDPH Data (Average 1999-2001) *Towns of Ashby, Lunenburg, and Townsend **Towns of Ashburnham, Hubbardston, Templeton, Westminster, and Winchendon ***Towns of Fitchburg, Fitchburg Area, Gardner, Gardner Area, and Leominster

24. Behavioral Health FindingsMental Health • From 1999 to 2001, the suicide rates in the city of Gardner and the Fitchburg Area towns were 2.5 times that of the state’s. • In Discussion Groups, interviews, and surveys, access to mental health services (particularly for children) was cited as a major concern.

25. Behavioral Health FindingsMental Health One Discussion Group participant, whose three year old child was banging his head against the table during the group, stated, “I have been trying to get my son mental health treatment. I can tell he needs it, and they told me I need to wait 8 months to have him seen!”

26. Injury and Violence Findings Violence-Related Injuries MDPH Injury Surveillance Data (Average 1999-2001) *Towns of Ashby, Lunenburg, and Townsend **Towns of Ashburnham, Hubbardston, Templeton, Westminster, and Winchendon ***Towns of Fitchburg, Fitchburg Area, Gardner, Gardner Area, and Leominster

27. Injury and Violence Findings Violent Crime Bureau of Justice Statistics Data

28. Injury and Violence Findings Child Abuse and Domestic Violence • From 1995 to 1999, the rate of reported child abuse/neglect cases in both Fitchburg and Gardner were considerably higher than the state’s average. • Results of a community telephone survey respectively ranked child abuse/neglect and domestic abuse and violence as the 3rd and 4th most important health issues for the region. “Domestic violence is so shameful. I thought there was something wrong with me. It didn’t occur to me to challenge what I was told.”

29. Oral Health Issues • Planning grant in 2001 • No dentists accepted MassHealth at the time. • There was no coverage for adult MassHealth patients. • 42,000 people were in need of dental services; 22,000 of these people were covered by MassHealth while 20,000 were low income with no insurance. • Consumers were traveling out of the area for services. There were long waiting lists. People began showing up in the ER with dental emergencies. • The Wachusett District Dental Society wanted to help.

30. Oral Health InitiativeFunded by HFCM • Implemented a five-chair dental service • Implemented dental sealant program • Began GHAP Dental Program • Provided oral health education • Began hygienist training program (MWCC) • Explored dental residency program • Provided regional & statewide advocacy regarding oral health issues

31. Access Issues • Dental services • Cost of prescription drugs • Outpatient mental health and child psychiatry services • Services for school-age populations • Cultural and linguistic barriers

32. Access Issues In an adolescent specific Discussion Group, 85% of the participants reported that they had missed school on more than one occasion to interpret for family members. “I interpret for my Mom when she goes to the doctor, but I’m not trained in medical things. I’m so uncomfortable doing this… What if I say the wrong information?”

33. Where Consumers Seek Health Care Joint Coalition on Health Phone Survey Data, 2002

34. Health Care System Satisfaction • Most contacts with the system are in the doctor’s office where there is a high level of satisfaction (97%). • Most contacts with hospitals are via the ER or outpatient diagnostic services. There are 83-87% satisfaction levels for these services. • The highest failed expectation rate occurs in ER (15%) and mental health services (17%). • The highest overall satisfaction level (97%) occurs in home care services.

35. Resource Availability • North Central Massachusetts has been identified as a high risk area with low resources. • New resources have been added into the community through the works of dedicated individuals and groups such as: • Congressman John W. Olver • Health Foundation of Central Massachusetts • Other funders • Currently, both state and federal budgets are a disaster. • There is a need to collaborate and seek alternative sources for the area such as: • Grants, private donations, federal funds, etc.

36. Concerns: Poverty Mortality rates Teen pregnancy Adequacy of pre-natal care Substance abuse Mental health Child abuse/neglect Domestic violence Cultural and linguistic barriers Resource reduction Summary

37. Summary • Assets: • Improved oral health access • Consumer satisfaction • Very satisfied with doctors and home care • Somewhat satisfied with other aspects of the healthcare system • Strong collaboration within the region • Added resources to address some issues • Improved infrastructure for attracting grant funding • Strong interest among city governments and legislators to improve the quality of life

38. MDPH Data (Average 1999-2001 unless otherwise indicated); Healthy People 2010 Data *Study Area: Towns of Ashburnham, Ashby, Fitchburg, Gardner, Hubbardston, Leominster, Lunenburg, Templeton, Townsend, Westminster, and Winchendon All rates are per 100,000 population unless otherwise indicated.