COMMUNITY HEALTH IMPROVEMENT PLAN - OSF HealthCare
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COMMUNITY HEALTH
IMPROVEMENT PLAN
MCLEAN COUNTY/ILLINOIS
2017 - 2019
Table of Contents
McLean County IL
Community Health Improvement Plan
2017 – 2019
I. Introduction to the McLean County Community Health Improvement Plan ...................... 3
a) Philosophy and Development of the Collaborative Approach ..................................... 3
b) Approval of the Community Health Improvement Plan ............................................... 4
II. Acknowledgements ......................................................................................................... 5
a) McLean County Community Health Council Executive Steering Committee ............... 5
b) McLean County Community Health Council Members ................................................ 7
III. Executive Summary.......................................................................................................... 9
a) Statement of Purpose ................................................................................................... 9
b) Development Process for the Community Health Improvement Plan ......................... 9
c) The Three Health Priorities for McLean County.......................................................... 12
d) Community Involvement ............................................................................................ 12
IV. Community Health Improvement Plan for Health Priority #1: Behavioral Health (Mental
Health and Substance Use)............................................................................................. 14
a) Description of the Health Priority ............................................................................... 14
b) Chart of Health Priority Risk Factors and Direct/Indirect Contributing Factors ......... 17
c) Rationale for Choice as a Health Priority .................................................................... 19
d) McLean County Community Health Improvement Plan Summary: Behavioral Health
..................................................................................................................................... 19
e) Funding for Implementing Interventions.................................................................... 20
f) Barriers to Achieving Health Improvements .............................................................. 27
g) Evaluation and Monitoring Plan ................................................................................. 28
V. Community Health Improvement Plan for Health Priority #2: Access to Appropriate
Healthcare for the Underserved and Areas of High Socioeconomic Needs ...................... 29
a) Description of the Health Priority ............................................................................... 29
b) Chart of Health Priority Risk Factors and Direct/Indirect Contributing Factors ......... 33
c) Rationale for Choice as a Health Priority .................................................................... 33
d) McLean County Community Health Improvement Plan Summary: Access ............... 33
e) Funding for Implementing Interventions.................................................................... 35
f) Barriers to Achieving Health Improvements .............................................................. 40
g) Evaluation and Monitoring Plan ................................................................................. 41
VI. Community Health Improvement Plan for Health Priority #3: Obesity ............................ 42
a) Description of the Health Priority ............................................................................... 42
b) Chart of Health Priority Risk Factors and Direct/Indirect Contributing Factors ......... 44
c) Rationale for Choice as a Health Priority .................................................................... 44
d) McLean County Community Health Improvement Plan Summary: Obesity ............. 44
e) Funding for Implementing Interventions.................................................................... 46
f) Barriers to Achieving Health Improvements .............................................................. 51
g) Evaluation and Monitoring Plan ................................................................................. 53
VII. Vehicle for Community Feedback ................................................................................... 54
VIII. Appendices .................................................................................................................... 55
1) Data Sources
I. Introduction from the McLean County
Community Health Council’s Executive Steering
Committee
a) Philosophy and Development of the Collaborative Approach
The formation of the McLean County Community Health Council in April 2015 marked an important
milestone for community health in McLean County. Prior to the development of the joint 2014-2016
Community Health Needs Assessment and 2017-2019 Community Health Improvement Plan, the two
hospitals in McLean County and the McLean County Health Department each conducted their own
needs assessment which resulted in three community health plans for McLean County. During the same
time, United Way of McLean County conducted a broad-based community needs assessment, which
included a health component. All four organizations are dedicated to improving the health of the
community and strongly believe in the philosophy of collaboration.
In 2015, collaborating together in a more effective manner was identified as the primary learning
opportunity from the previous development of the community health needs assessments and health
improvement plans. An Executive Steering Committee, consisting of at least one member from each of
the four organizations required to complete periodic needs assessments (Advocate BroMenn Medical
Center, McLean County Health Department, OSF St. Joseph Medical Center, and the United Way of
McLean County), was identified to lead a collaborative process for the 2014-2016 assessment and 2017-
2019 improvement plan period. The new McLean County Community Health Council met several times
in 2015 to oversee progress made through this collaborative effort. The goals of the collaborative are as
follows:
Establish the Executive Steering Committee and McLean County Community Health Council
(completed April 2015)
Analyze primary and secondary data collectively (completed 2015-2016)
Prioritize and select the top three health needs for McLean County (completed February 2016)
Generate one joint community health needs assessment for McLean County (completed,
approved and posted in August 2016)
Work collaboratively on a county joint community health improvement plan, addressing each of
the top three health priorities (completed, approved and posted in February 2017)
The result of the collaborative process was the production of a joint community health needs
assessment in 2016 followed by one joint community health improvement plan, instead of three, for
McLean County for 2017-2019.
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2017-2019 McLean County Community Health Improvement Planb) Approval of the Community Health Improvement Plan
BroMenn Medical Center and St. Joseph Medical Center are utilizing this joint Community Health
Improvement Plan, in conjunction with the McLean County Health Department and United Way of
McLean County, to meet their 2014-2016 Community Health Needs Assessment and 2017-2019
Community Health Improvement/Implementation Plan requirements reportable to the Internal Revenue
Service as outlined by the Patient Protection and Affordable Care Act. The McLean County Health
Department will also utilize the joint Community Health Needs Assessment and resulting community
health improvement plan to meet Illinois Project for Local Assessment of Need requirements for local
health department certification in 2017 by the Illinois Department of Public Health. United Way of
McLean County is not required to perform a community health needs assessment nor to develop an
implementation plan; however, it is collaborating with the above organizations and adopting this
collaborative approach and the resulting documents in order to better serve the health needs of McLean
County.
The McLean County Community Health Improvement Plan is a joint implementation plan developed in
partnership with representatives from over 45 community social service, healthcare and faith-based
agencies, government entities, academic facilities, and other organizations. The four entities
represented in the Executive Steering Committee (BroMenn Medical Center, the McLean County Health
Department, St. Joseph Medical Center and United Way of McLean County) are responsible for ensuring
that the plan is implemented and are all implied resources and partners for each health priority plan.
The 2017-2019 McLean County Community Health Improvement Plan was approved by the McLean
County Community Health Council on December 8, 2016; the United Way of McLean County’s Board of
Directors on January 13, 2017; the McLean County Board of Health on January 18, 2017; OSF Healthcare
System’s Board of Directors on January 23, 2017; and, Advocate BroMenn Medical Center and Eureka
Hospital’s Governing Council on January 24, 2017.
The McLean County Community Health Executive Steering Committee reserves the right to amend this
2017-2019 Community Health Improvement Plan as needed to reflect each organization’s particular role
and responsibilities in executing the Plan as well as the resources each organization is committing. In
addition, certain significant health needs may become even more significant and require amendments
to the strategies developed to address the health need. Other entities or organizations in the
community may develop programs to address the same health needs or joint programs may be adopted.
Finally, in compliance with Internal Revenue Code Section 501(r) requirements for hospitals, Advocate
BroMenn Medical Center or OSF St. Joseph Medical Center may refocus the limited resources the
organization committed to the Plan to best serve the community.
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2017-2019 McLean County Community Health Improvement PlanII. Acknowledgements
a) McLean County Community Health Council Executive Steering Committee
Representatives from the four organizations listed below comprise the McLean County Community
Health Council’s Executive Steering Committee:
Advocate BroMenn Medical Center: Sally Gambacorta, MS, MA, Community Health Manager
BroMenn Medical Center has been serving and caring for the people of Central Illinois for nearly 120
years. A 221-bed not-for-profit facility located in Bloomington-Normal, IL, BroMenn Medical Center and
its employees are part of faith-based Advocate Health Care, the largest fully integrated healthcare
delivery system in Illinois. Advocate’s mission is to serve the health needs of individuals, families and
communities through a holistic approach to healthcare that provides quality care and service, and treats
each patient with respect, integrity and dignity.
Sally Gambacorta is the Community Health Manager at Advocate BroMenn Medical Center in Normal,
Illinois. She has worked for Advocate Health Care for 22 years in Wellness and Community Health. Sally
holds a Bachelor’s of Science degree in Business Administration from Augustana College, a Master’s of
Science degree in Industrial/Organizational Science from Illinois State University and a Master’s of Arts
degree in Leisure Studies with a concentration in Corporate Fitness and Health Promotion from the
University of Iowa. Sally is the Community Health site leader for both BroMenn Medical Center as well
as Advocate Eureka Hospital in Eureka, Illinois. She is responsible for the Community Health Needs
Assessment and Community Benefits at both hospitals. She has extensive experience in collaborating
with community partners to improve the health of the community. Sally serves on the leadership
committee for the McLean County Wellness Coalition, is a member of the McLean County Mental Health
First Aid Collaborative and the Behavioral Health in Schools committee and serves on the United Way
Collective Impact Strategic Council.
McLean County Health Department: Cathy Coverston Anderson, RN, BSN, BA, SM, Assistant
Administrator and Nicole Aune, MPH, Health Promotion Manager
Since 1946, the McLean County Health Department has worked to protect the health and wellness of
McLean County residents. The department serves the largest geographic county in Illinois, with more
than 174,000 residents. Many residents may never walk through the doors of the health department,
but they will benefit in some way from the various programs and services offered. The purpose of the
McLean County Health Department is to fulfill the public interest in assuring conditions conducive to
good health and providing leadership in promoting and protecting the health of county residents.
Cathy Coverston Anderson is a registered nurse and has been the Assistant Administrator for the
McLean County Health Department since 2009. She also currently serves as a member of BroMenn
Medical Center’s and Eureka Hospital’s Governing Council. Cathy has a graduate degree in public health
from Harvard University School of Public Health and a Bachelor’s of Science degree in Nursing as well as
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2017-2019 McLean County Community Health Improvement Plana Bachelor of Arts degree from the University of Minnesota. She oversees the community health needs
assessment process, Occupational Safety and Health Administration efforts, the emergency
preparedness program, and the functions of many of the health department clinics, including dental,
sexually transmitted infections/Human Immunodeficiency Virus, tuberculosis, flu outreach, and
immunizations.
Nicole Aune was the Health Promotion Program Manager at the McLean County Health Department
until October of 2016. She received her Master’s degree in Public Health from the Colorado School of
Public Health and has a background in community needs assessments, program planning and
implementation, and development and coordination of collaborative efforts. Her responsibilities at the
health department included overseeing six grant programs, the County Government Employee Wellness
Program, and delivery of health education in McLean County. Nicole also served as the Chair of the
McLean County Wellness Coalition, a coalition of over 60 partners working together to prevent obesity
through policy, system and environmental change.
OSF St. Joseph Medical Center: Meridith Nelson, MHA, MBA, Director of Strategic Planning
OSF St. Joseph Medical Center is a 149-licensed bed, not-for-profit, acute care, and Level II Trauma
Center facility, fully accredited by the Joint Commission and designated a Magnet Hospital, most
recently in 2014. St. Joseph Medical Center is part of the OSF Healthcare System, an integrated system
serving central and northern Illinois as well as northern Michigan. In the spirit of Christ and the example
of Francis of Assisi, the mission is to serve persons with the greatest care and love in a community that
celebrates the Gift of Life. OSF HealthCare has been a participant in the Center for Medicare and
Medicaid Services’ Pioneer Accountable Care Organization demonstration project since 2012 and has
been selected as a Next Generation Affordable Care Organization.
Meridith Nelson is the Director of Strategic Planning at St. Joseph Medical Center in Bloomington,
Illinois. With nearly 20 years of experience in health care in not-for-profit, for-profit, and government
settings, she has spent the last ten years focused in health care business development, strategic
planning, and decision support in not-for-profit, faith-based health systems. She holds a Bachelor of
Science degree in Pharmacy from the University of Kansas and Master’s degree in Health Administration
and Master’s degree in Business Administration from The University of Iowa. Current areas of
responsibility and oversight for Meridith include strategic planning, program development, decision
support, community health needs assessment and planning, community benefit reporting and managed
care contracting.
United Way of McLean County: Holly Ambuehl, MSW, Vice President of Impact
United Way improves lives by mobilizing the caring power of communities around the world to advance
the common good. Founded locally in 1935, United Way of McLean County’s employer-based campaigns
raise $3.5 to $4.5 million annually. Those dollars fund local solutions in health, income stability,
education, and community strengthening that almost exclusively target low-income residents.
Holly Ambuehl serves as the Vice President of Impact for United Way of McLean County. Holly directs
the Collective Impact/Cradle-to-Career project in McLean County, Community Impact in the areas
mentioned above, policy and demographic research, community stakeholder projects, and serves on the
John M. Scott Health Commission. Holly received her Bachelor of Arts degree in Family Counseling from
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2017-2019 McLean County Community Health Improvement PlanAnderson University and a Masters in Social Work from Boston College, with a concentration in
Community Organizing, Policy, Planning, and Administration. Before United Way of McLean County,
Holly worked as a nonprofit Program Director in Romania, as a budget advocate for children’s services in
Massachusetts, as a legislative aide to former State Senator David Magnani, as Senior Budget Analyst for
the Department of Health Services under former Governor Janet Napolitano, as Director of Public Policy
for the Southwest Autism Research and Resource Center, as Director of Health Policy for the Children’s
Action Alliance, and as Senior Policy Advisor to the Minority Caucus at the Arizona House of
Representatives. Holly’s prior volunteer work includes Habitat for Humanity, Younglife, March of Dimes,
and various hospitals and food banks.
Additional Executive Steering Council Members
The 2016 Community Health Needs Assessment could not have been possible without the additional
contributions from the following individuals: Logan Frederick, Operations Improvement Leader,
BroMenn Medical Center; Dawn Irion, Strategic Reimbursement Analyst, OSF Healthcare; Melissa
Johnston-Gross, Stevenson Fellow, United Way of McLean County; Katie McHugh, Health Promotion
Specialist, McLean County Health Department. In addition to the above, Dr. Laurence G. Weinzimmer
was contracted for assistance during the community health needs assessment. Larry has a Ph.D. and is
the Caterpillar Inc. Professor of Strategic Management in the Foster College of Business at Bradley
University in Peoria, Illinois. An internationally recognized thought leader in organizational strategy and
leadership, he is a sought-after consultant to numerous Fortune 100 companies and not-for-profit
organizations. Dr. Weinzimmer has authored over 100 academic papers and four books, including two
national best sellers. His work appears in 15 languages, and he has been widely honored for his research
accomplishments by many prestigious organizations, including the Academy of Management. Dr.
Weinzimmer has served as principle investigator for numerous community assessments, including the
United Way, Economic Development Council and numerous hospitals. His approach to Community
Health Needs Assessments was identified by the Healthcare Financial Management Association (HFMA)
as a Best-in-Practice methodology.
b) 2016 McLean County Community Health Council Members
The Executive Steering Committee would like to acknowledge and thank the following individuals and
organizations that contributed their time as members of the McLean County Community Health Council
to complete the joint Community Health Needs Assessment and the Community Health Improvement
Plan for McLean County.
Name Organization Stakeholder Role
Holly Ambuehl United Way of McLean County Convener; funder; collective impact
Kim Anderson McLean County Health Department Public health; maternal & child health
Nicole Aune McLean County Health Department Public health; health education
Laura Beavers McLean County Health Department Public health; mental health
Dayna Brown McLean County Unit District No. 5 Schools; youth
Bonnie Condon Advocate Health Care Healthcare
Barb Giloth Advocate Health Care Healthcare
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2017-2019 McLean County Community Health Improvement PlanCathy Coverston Anderson McLean County Health Department Public health; communicable disease
Tom Dabareiner City of Bloomington City planning
Renee Donaldson BroMenn Medical Center Healthcare; behavioral health
Logan Frederick BroMenn Medical Center Healthcare
Sally Gambacorta BroMenn Medical Center Healthcare
Sue Grant McLean County Health Department Public health; oral health & vaccinations
Leslie Hanson Bloomington School District 87 Schools; youth
John Hesse BroMenn Medical Center Healthcare
Walt Howe McLean County Health Department Public health; systems & policy
Aimee Ingalls Economic Development Council Business; demographics
Dawn Irion OSF Healthcare System Healthcare
Michelle Carrothers OSF Healthcare System Healthcare
Paula Corrigan OSF Saint James Hospital Healthcare
Cheree Johnson BroMenn Medical Center Healthcare; faith-based community
Melissa Johnston-Gross United Way of McLean County Stevenson Fellow; research
Erin Kennedy OSF St. Joseph Medical Center Healthcare; worksite wellness
Christy Kosharek Marcfirst SPICE Developmental disabilities; early childhood
Dietra Kulicke Chestnut Health Systems Mental health; FQHC
Katie McHugh McLean County Health Department Health Promotion
Angie McLaughlin Community Health Care Clinic Underserved; uninsured
Megan Moser McLean County Center for Human Mental health
Services
Meridith Nelson OSF St. Joseph Medical Center Healthcare
Vasu Pinnamaraju McLean County Regional Planning Planning
Commission
Trina Scott Immanuel Health Center Underserved
Katie Simpson City of Bloomington City planning
Deborah Skillrud Bloomington Township; John M. Underserved
Scott Health Commission
Karen Stipp Illinois State University School of Social work & health research
Social Work
David Taylor United Way of McLean County Convener; funder; collective impact
Diane Wolf Regional Office of Education Schools; youth
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2017-2019 McLean County Community Health Improvement PlanIII. Executive Summary
McLean County Joint Community Health
Improvement Plan (2017-2019)
a) Statement of Purpose
The purpose of the McLean County Community Health Improvement Plan is to improve the health of
McLean County residents by developing and maintaining partnerships to implement Community Health
Improvement Plan interventions, encouraging health and healthcare access awareness, and promoting
healthy lifestyle choices that can improve health and reduce the risk of death and disability.
McLean County is well poised to make meaningful progress due to the innovative collaboration among
the four entities spearheading the health improvement effort: BroMenn Medical Center, the McLean
County Health Department, St. Joseph Medical Center, and the United Way of McLean County; and, the
additional strength of over 45 other entities representing key stakeholders, all of whom are eager to
continue their mission and journey in helping to improve the health and well-being of the individuals in
McLean County.
b) Development Process for the Community Health Improvement Plan
The completion and approval of the joint McLean County Community Health Needs Assessment in the
summer of 2016 included the identification of three health priorities and provided the groundwork for
the development of the McLean County Community Health Improvement Plan from September through
December of 2016. Approvals of the document were attained by the McLean County Community Health
Council on December 8, 2016, and all governing bodies by the end of January 2017.
For the development of the Community Health Needs Assessment, at least one member from each of
the four organizations spearheading the effort made up the Executive Steering Committee, which
analyzed an extensive quantity of both primary and secondary data from July 2015 to February 2016.
Due to the availability of new datasets, the steering committee was able to analyze data at a more
detailed level and identify health disparities for gender, age, race/ethnicity, and zip code for a variety of
health outcomes.
In February 2016, the Executive Steering Committee presented 13 health issues to the McLean County
Community Health Council that the data suggested were health problems. The McLean County
Community Health Council consists of 35 individuals from 14 additional organizations in McLean County
representing public entities, faith-based and private organizations, social service organizations,
healthcare facilities and city and regional planning. Although a standard prioritization methodology was
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2017-2019 McLean County Community Health Improvement Plannot utilized at this stage in the process, the following factors were taken into consideration in the
decision making process when analyzing the data:
Trending unfavorably overall
Worse than state, national, and/or Healthy People 2020 goals
Demonstrating significant local disparities
The 13 health concerns that rose to the top for McLean County are listed below in alphabetical order:
Alzheimer’s and Dementia
Birth Outcomes
Cancer
Cesarean Section
Heart Disease
Mental Health
Obesity
Oral Health
Radon
Respiratory Disease
Sexually Transmitted Diseases
Substance Abuse
Violent Crime
During the first McLean County Community Health Council meeting, robust data was presented on the
13 health issues which were then narrowed down to six health issues to be prioritized during the next
meeting. It is important to note that although it was not presented as one of the 13 health concerns,
access to appropriate healthcare continually came up as an important issue during group discussion. It
was decided upon by the group that this would be added as one of the health issues to be voted on in
addition to the 13 issues presented. Additionally, council members were informed that they could
combine any issues they felt were appropriate. For example, council members could vote for mental
health or they could combine mental health and substance abuse and vote for behavioral health.
Discussion also occurred during the meeting that diabetes, cancer and heart disease could all fall under
obesity if selected as one of the six priorities on which to vote because reducing obesity could positively
impact the incidence of each of the above diseases. After council members voted, the results of the top
six issues to be prioritized at the next meeting were as follows:
Access to Appropriate Healthcare for the Underserved and Areas of High Socioeconomic Needs
Behavioral Health (Mental Health and Substance Abuse)
Birth Outcomes
Obesity
Oral Health
Respiratory Disease
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2017-2019 McLean County Community Health Improvement PlanThe Hanlon Method was utilized during the February 25, 2016, prioritization meeting with the McLean
County Community Health Council to select the top three health priorities for McLean County from the
list of six primary health concerns identified at the February 11, 2016, meeting. For a complete
description of the Hanlon Method, please refer to pages 92 through 94 of the 2016 McLean County
Community Health Needs Assessment document found at the following link.
The following three health priorities were selected by the McLean County Community Health Council
given the data analyzed from the 2016 McLean County Community Health Needs Assessment:
Behavioral Health (including Mental Health and Substance Abuse)
o Hanlon Priority Score = 175.7
Access to Appropriate Healthcare for the Underserved and Areas of High Socioeconomic Need
o Hanlon Priority Score = 158.6
Obesity
o Hanlon Priority Score = 153.8
The three health issues that were not selected were oral health (148.4), respiratory disease (121.0), and
birth outcomes (106.9). The council acknowledged the importance of all three of these issues, but the
prioritization scores for the three selected issues were higher than those for the issues not selected.
After identification of the top three health priorities, the next step in the process included pulling key
stakeholders together to set high level goals for the health priorities. A separate meeting was held for
each health priority, during the month of April 2016, to discuss appropriate community goals for each
initiative. A total of 51 individuals participated in the goal-setting process, representing more than 45
organizations in McLean County.
The goals for each of the health priorities identified are listed below:
Access to Appropriate Healthcare Goal: By 2020, decrease barriers to utilizing primary care in 61701 in
order to reduce use of hospital emergency departments for non-emergent conditions.
Behavioral Health Goal #1: By 2020, increase coping skills to reduce deaths due to suicide and
emergency room visits due to self-inflicted injury and alcohol abuse.
Behavioral Health Goal #2: By 2020, reduce behavioral health stigma to increase earlier access to care.
Obesity Goal: By 2020, pursue policy, system and environmental changes to maintain or increase the
percentage of people living at a healthy body weight in McLean County.
The joint McLean County Community Health Improvement Plan was developed after the three
stakeholder groups from the April 2016 goal-setting sessions met in October and November of 2016 to
set specific objectives towards achieving the goals and to identify intervention strategies as well as
potential resources, additional partners, and efforts in the community. The results of these meetings
are documented in the “McLean County Community Health Improvement Plan Summary” for each of
the three health priorities.
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2017-2019 McLean County Community Health Improvement Planc) The Three Health Priorities for McLean County
For the three-year period of 2017-2019, McLean County stakeholders will be working together to
implement the McLean County Community Health Improvement Plan in order to positively impact the
three health priorities:
1) Behavioral Health (including Mental Health and Substance Abuse)
2) Access to Appropriate Healthcare for the Underserved and Areas of High Socioeconomic Needs
3) Obesity
The following pages of this document provide additional information on the McLean County Community
Health Improvement Plan by taking each of the three health priorities and providing:
Description of the Health Priority
Chart of Health Problem Risk Factors and Direct/Indirect Contributing Factors
Rationale for Choice as a Health Priority
McLean County Community Health Improvement Plan Summary: this document includes the
following components for each health priority:
Overall Goal
Outcome Objective (with baseline and State of Illinois Health Improvement Plan [SHIP]
alignment)
Impact Objectives (with baseline and Healthy People 2020 alignment)
Intervention Strategies (with emphasis on evidenced-based interventions
whenever possible)
Evaluation Plan (with process and outcome indicators)
List of Potential Resources/Partners
Funding for Implementing Interventions
Barriers to Achieving Health Improvements
Evaluation and Monitoring Plan
d) Community Involvement
The Community Health Improvement Plan could not have been achieved without first conducting a
community health needs assessment. The Community Health Needs Assessment began with the
collection of primary data through a survey of McLean County adults. The 2015 Community Health
Survey (found in Appendix 2 of the McLean County Community Health Needs Assessment found here),
conducted by a Bradley University researcher under contract with OSF Healthcare consisted of 36
demographic and health-related questions that were administered from July through September of
2015, yielding a total of 834 responses from McLean County residents. Of these, 297 of the respondents
were persons living in poverty. The survey provided valuable information about healthcare utilization
and obstacles to use, rationales for health choices, and the health behaviors of county residents.
Analysis of the survey responses, along with the assessment of the available secondary data, fueled the
12
2017-2019 McLean County Community Health Improvement Planhealth problem prioritization process as well as the identification of interventions in the McLean County
Community Health Improvement Plan.
In April 2016, 79 individuals were invited to participate in stakeholder meetings to assist with the
development of high-level goals for the Community Health Improvement Plan as well as to expand
community involvement, cultivate investment in the plan and improve the quality of it. Additional
stakeholder meetings were convened in October and November 2016 to develop objectives and identify
interventions for the plan. Fifty-one individuals representing 45 organizations, in addition to the four
Executive Steering Group agencies, accepted the invitation and had direct input into the McLean County
Community Health Needs Assessment, the Community Health Improvement Plan or both, resulting in a
strong plan with actionable interventions for McLean County. Their input is vital to the success of the
plan and their knowledge of community resources and current efforts to improve health were
invaluable. These stakeholders are positioned for collaboration and ready to move forward with
implementation in 2017 to help improve the health and well-being of McLean County residents.
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2017-2019 McLean County Community Health Improvement PlanIV. Health Priority #1: Behavioral Health
(Mental Health and Substance Abuse)
a) Description of the Health Priority
Mental illnesses are one of the leading causes of disability in the United States. In any given year,
approximately 13 million American adults have a seriously debilitating mental illness. Furthermore,
unstable mental health can lead to suicide, which accounts for the death of approximately 30,000
Americans every year (Healthy Communities Institute, 2016).
To complicate matters, people with mental health disorders are more likely than people without mental
health disorders to experience an alcohol or substance use disorder. When an individual is impacted by
both, these are referred to as co-occurring disorders, and treatment is complicated since both disorders
can have psychological, social, and biological components. The 2014 National Survey on Drug Use and
Health by the Substance Abuse and Mental Health Services Administration reports that approximately
7.9 million adults in the United States had co-occurring disorders, and individuals with these disorders
are at higher risk for other illnesses and early death, suicide, homelessness, and incarceration.
According to the 2013 Illinois Behavioral Risk Factor Surveillance System, the percentage of McLean
County adults at risk for acute/binge drinking is 26.9 percent, higher than the percentage at risk for the
state (21.8 percent). McLean County adults at risk for acute/binge drinking has increased from 19.0
percent in 2007-2009 to 26.9 percent. Men are more at risk for acute/binge drinking at 34.4 percent
compared to women at 5.1 percent.
Local hospital data received from the Healthy Communities Institute, Illinois Hospital Association
database for 2012-2014 identified some differences between those individuals accessing the emergency
room for alcohol abuse versus those hospitalized for alcohol abuse:
In McLean County, the highest emergency room rates due to alcohol abuse are seen in:
individuals aged 18-19 (96.4 emergency room visits per 10,000 population)
males (70.3 emergency room visits per 10,000 population)
Blacks or African Americans (140.2 emergency room visits per 10,000 population)
those living in Bloomington zip code 61701 (119.1 emergency room visits per 10,000 population)
In McLean County, the highest hospitalization rates due to alcohol abuse are seen in:
individuals aged 45-64 (18.1 hospitalizations per 10,000 population)
males (16.3 hospitalizations per 10,000 population)
those living in Bloomington zip code 61701 (21.5 hospitalization per 10,000 population)
The percent of motor vehicle crash deaths with alcohol involvement in McLean County is 39.3 percent.
This rate is in the worst 50th-75th percentile range compared to other counties in the United States
(County Health Rankings, 2015).
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2017-2019 McLean County Community Health Improvement PlanThe 2015 McLean County Community Health Survey asked the over 800 respondents to rate the three
most important health issues in the community out of 15 choices (Exhibit 1). The health issue that rated
highest was mental health. It was identified 60 percent of the time.
Exhibit 1: Survey Respondents’ Perception of the Most Important Health Issues
in McLean County, 2015
Source: McLean County Community Health Survey, 2015
The survey also revealed that 10 percent of respondents reported that they do not have access to
counseling services when needed. Of these, 30 percent noted that embarrassment (16 percent) and
fear (14 percent) were reasons they were not able to access counseling services. Besides emotional
barriers to care, other responses regarding barriers included those in the areas of finance or insurance
and access.
Like many illnesses, early detection and access to outpatient care as well as consistent ongoing
treatment for those with mental health and substance use disorders can improve health outcomes as
well as an individual’s quality of life. Care received in the emergency room may indicate inadequacies in
the healthcare received outside of it. In McLean County, emergency room data from the two local
hospitals provides a snapshot of the consequences of delayed access to care, inadequate care or
insufficient treatment for mental health and substance use disorders:
General:
o Psychiatric visits are in the top four reasons for visits to BroMenn Medical Center’s
emergency room for 2011-2014. From 2012-2014, they ranked second. The number of
psychiatric visits has increased 13.6 percent from 2011 (1,682 visits) to 2014 (1,911
visits).
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2017-2019 McLean County Community Health Improvement Plano Bloomington (zip code 61701) is in the worst fourth quartile range compared to other
counties in Illinois for age-adjusted emergency room visits due to pediatric mental
health, suicide and intentional self-inflicted injury, and mental health for the population
ages 18+ years.
Adolescents/Pediatrics:
o Age-adjusted emergency room visits due to adolescent suicide and intentional self-
inflicted injury and harm is in the worst fourth quartile range compared to other
counties in Illinois for both Bloomington (zip code 61701) and Normal (zip code 61761).
o The highest rates for age-adjusted emergency room visits due to adolescent suicide and
self-inflicted injury occur in individuals 15-17 years old, females and White/non-
Hispanic.
o The rate for age-adjusted emergency room visits due to pediatric mental health (aged
18 years and under) for McLean County is 61 emergency room visits per 10,000
population (Healthy Communities Institute, Illinois Hospital Association, 2012-2014).
This is in the worst 50th-75th percentile range compared to other counties in Illinois.
o The highest rates for age-adjusted emergency room visits due to pediatric mental health
occur in 12-14 and 15-17 year olds, females and Black or African Americans.
Adults:
o The highest rates for age-adjusted emergency room visits due to suicide and intentional
self-inflicted injury occur in 25-34 year olds, males and Blacks or African Americans.
o The rate for age-adjusted emergency room visits for adults due to suicide and
intentional self-inflicted injury in McLean County is 22.6 emergency room visits per
10,000 population 18 years and older (Healthy Communities Institute, Illinois Hospital
Association, 2012-2014). This is in the worst 50th-75th percentile range compared to
other counties in Illinois.
o The highest rates for age-adjusted emergency room visits due to mental health occur in
individuals 25-34 years old, females and Blacks or African Americans.
o The age-adjusted emergency room rate due to alcohol abuse is 50.7 visits per 10,000
population for McLean County. This rate is in the worst fourth quartile range when
compared to other Illinois counties and has increased 40 percent since 2009-2011.
o McLean County’s age-adjusted hospitalization rate due to alcohol abuse is 11.0 per
10,000 population, also in the worst fourth quartile range. This rate has increased 30.9
percent since 2009-2011.
The age-adjusted death rate due to suicide in McLean County is 11.7 deaths per 100,000 population
(Healthy Communities Institute, Center for Disease Control and Prevention, 2011–2013). This is higher
than the Healthy People 2020 goal to reduce the suicide rate to 10.2 deaths per 100,000 population
(Office of Disease Prevention and Health Promotion, Healthy People 2020, 2016).
There were 22 suicides in McLean County in 2015 (McLean County Coroner, 2015). As show below in
Exhibit 2, this has increased from 15 deaths due to suicide in 2007.
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2017-2019 McLean County Community Health Improvement PlanExhibit 2: McLean County Illinois Deaths Due to Suicide, 2007-2015
Source: McLean County Illinois Coroner, 2015.
Since BroMenn Medical Center has the only in-patient mental health unit in McLean County, the need to
promote and encourage early access to the available mental health and substance abuse care and
treatment services outside of the hospital is essential and would improve quality of life. Providing more
resources and evidenced-based programs to reduce behavioral health stigma and improve coping skills
may assist McLean County residents to access care and treatment earlier and decrease substance abuse,
which may reduce self-inflicted injuries as well as deaths due to suicide.
b) Chart of Health Priority Risk Factors and Direct/Indirect Contributing Factors
Both the Center for Disease Control and Prevention and the Substance Abuse and Mental Health
Services Administration acknowledge that mental health and substance use disorders can have social,
psychological and biological components. Intervention strategies could target the modifiable factors.
Refer to the chart on the following page for a list of risk factors as well as direct contributing factors and
indirect contributing factors for the development of behavioral health concerns.
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2017-2019 McLean County Community Health Improvement PlanHealth Problem _ Risk Factor Direct Contributing Factor Indirect Contributing Factor
Peer influence
Cultural norms
Familial history
and social
environment Culture accepting of alcohol
use
Stress
Lack of coping Adverse Childhood
skills Experiences
Lack of knowledge
Lack of a support system
Poor parenting practices
Relationships Abuse and neglect
Substance Community
Behavioral Abuse & violence/dysfunction
Health Mental Long wait times
Health
Lack of access to Limited insurance coverage
services or no insurance
Few providers
Stigma
Lack of using
available Financial barriers
services/resources
Cultural norms
Genetic/Hereditary
Addiction
Biological or
chemical imbalance Physical injuries
Brain trauma
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2017-2019 McLean County Community Health Improvement Planc) Rationale for Choice as a Health Priority
Behavioral health was selected as a health priority by the McLean County Community Health Council for
several reasons. Behavioral health received the highest priority score (175.7), clearly indicating the need
for further improvements in this area in McLean County. In the 2015 Community Health Survey, county
residents also indicated that mental health was an important health concern. It ranked as the number
one health issue, receiving a score of 60 percent; obesity came in a distant second place at 39 percent of
responses.
Another area of concern that assisted in bringing behavioral health issues to the forefront were the
numerous health disparities in Bloomington zip code 61701 and Normal zip code 61761 for both mental
health and substance abuse. There is also a great deal of public support and momentum behind mental
health in McLean County and has been since 2012. The county is well-situated to collaborate on mental
health and substance abuse due to the on-going efforts of numerous organizations. Mental health was
also previously selected as a key health priority by both hospitals and the health department during the
previous community health needs assessments, giving further momentum to the efforts of improving
behavioral health for county residents.
d) McLean County Community Health Improvement Plan Summary: Behavioral
Health
Behavioral Health (mental health, in particular) was identified as a priority health issue in McLean
County by the McLean County Health Department’s 2012-2017 Community Health Improvement Plan,
St. Joseph Medical Center’s 2013 Community Health Needs Assessment and BroMenn Medical Center’s
2011-2013 Community Health Needs Assessment. In addition, the McLean County Board Executive
Committee convened two workgroups in early 2014, one tasked to identify community mental health
needs and one to identify best practices. The product of these workgroups was a comprehensive Mental
Health Action Plan in 2015 for McLean County and the formation of a Behavioral Health Coordinating
Council that reports directly to the McLean County Board.
As a result of the abovementioned needs assessments and improvement plans, many task forces,
committees, programs and efforts have been underway to address the behavioral health needs in our
community since 2012. The Behavioral Health goal-setting meeting, held on April 26th, 2016, consisted
of representatives from each of the active behavioral health groups as well as schools, law enforcement,
court services and mental health service providers.
Four major themes emerged from the goal-setting discussion: 1) the need for stigma reduction 2) the
need for coordination of current efforts and funding streams 3) the need for coordination of behavioral
health services 4) the need to develop coping skills as a prevention mechanism. As the Behavioral Health
Coordinating Council will be exploring the coordination of current efforts and funding streams, and
other groups are already tackling the coordination of behavioral health services, the high-level goals
determined in April 2016, and the objectives and interventions identified in the stakeholder meeting in
October 2016, were developed around two of the themes: stigma reduction and coping skills
development, focusing on the prevention of behavioral health issues rather than the treatment of them.
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2017-2019 McLean County Community Health Improvement PlanAn overview of the goals and objectives to address Behavioral Health are listed below:
Behavioral Health Goal #1: By 2020, increase coping skills to reduce deaths due to suicide and
emergency room visits due to self-inflicted injury and alcohol abuse with a focus on low socio-
economic zip codes.
Outcome Objective #1: By 2020, reduce deaths due to suicide and emergency room visits due
to self-inflicted injury and alcohol abuse.
o Impact Objective #1: By 2020, reduce the proportion of adults at risk for acute/binge
drinking and youth using alcohol within the past year.
o Impact Objective #2: By 2020, reduce the proportion of McLean County adults reporting
8-30 days of “not good” mental health per month.
Behavioral Health Goal #2: By 2020, reduce behavioral health stigma to increase earlier access to care.
Outcome Objective #1: By 2020, increase the percentage of McLean County residents indicating
they have access to counseling services.
o Impact Objective #1: By 2020, reduce the proportion of McLean County adults who did
not access counseling services due to embarrassment or fear.
o Impact Objective #2: Greater than 90 percent of Mental Health First Aid course
participants will either agree or strongly agree that they are more confident about
recognizing and correcting misconceptions about mental health and mental illness.
The following six pages (21-26) contain the McLean County Community Health Improvement Plan
Summary for Behavioral Health.
e) Funding for Implementing Interventions
After approval of the McLean County Community Health Improvement Plan, the stakeholder group will
further address funding options and grant opportunities as they become available. The stakeholders
have worked together through the needs assessment and health plan development process, making the
community better-positioned for collaborative grant efforts. In addition, since many of the intervention
strategies for this health priority fall within the mission of some of the stakeholder agencies, letters of
support for grant proposal submissions will be encouraged.
The partners involved in the Executive Steering Committee, along with the Community Development
Division of the City of Bloomington, Illinois, recently applied for and received an Invest Health Grant
funded by the Robert Wood Johnson Foundation and the Reinvestment Fund for 50 mid-sized cities in
the United States. Through this small, 18-month planning grant, the Invest Health team has brought
together disparate sectors of the community to identify and plan for built environment changes in
Bloomington to potentially increase access to healthcare, housing and healthy foods. This grant has
widened avenues of participation and spurred the incorporation of health and healthy-lifestyles
concepts in municipal planning efforts, which may provide additional funding opportunities as well as
long-term health promotion impact.
20
2017-2019 McLean County Community Health Improvement PlanMcLean County
Community Health Improvement Plan Summary: Behavioral Health
2017-2019
HEALTH PRIORITY: BEHAVIORAL HEALTH
GOAL: By 2020, increase coping skills to reduce deaths due to suicide and emergency room (ER) visits due to self-inflicted injury and alcohol abuse with a focus on low socio-
economic zip codes.
OUTCOME OBJECTIVE: By 2020, reduce deaths due to suicide and ER visits due to self-inflicted injury and alcohol abuse.
Baseline
Deaths due to suicide: 22 deaths (McLean County Coroner, 2015)
Age-adjusted ER visits due to self-inflicted injury: adults – 22.6 visits per 10,000; adolescents – 59.2/10,000 (Healthy Communities Institute, Illinois Hospital Association, 2012-2014)
Age-adjusted ER visits due to alcohol abuse: 50.7 visits per 10,000 (Healthy Communities Institute, Illinois Hospital Association, 2012-2014)
State Health Improvement Plan (SHIP) 2021 Alignment
Reduce age-adjusted suicide rate
Reduce age-adjusted suicide rate among the veteran population
Reduce emergency department visits, hospitalizations, and incarceration due to behavioral health issues by narrowing the treatment gap and building and sustaining community-
based behavioral health treatment capacity
POTENTIAL
INTERVENTION STRATEGIES EVALUATION PLAN
RESOURCES/PARTNERS*
IMPACT OBJECTIVE #1: By Offer Too Good for Drugs, an evidence based drug and alcohol Process indicators: Project Oz
2020, reduce the proportion program with a strong coping skills component for two grade levels Conduct an inventory of evidenced-based Regional Office of
of adults at risk for in McLean County public school districts. programs aimed at reducing alcohol use in Education #17
acute/binge drinking and adults in McLean County. McLean County public
youth using alcohol within Evidence: Too Good for Drugs is a framework of social and # of public school districts in McLean school districts
the past year. emotional skills that develops goal-setting, decision-making, and County where Too Good for Drugs is Illinois State University
effective communication skills. A comprehensive body of implemented (baseline: 6 public school McLean County
Baseline: adults – 26.9% evidence demonstrates the positive effects of Too Good for Drugs districts- Project Oz, 2016). Behavioral Health in
(Behavioral Risk Factor on emotional competency skills, decision-making ability, # of students in McLean County public Schools Committee
Surveillance System [BRFSS], intentions to use illicit substances, substance use behavior, and schools participating in Too Good for Drugs Illinois State University
th
2013); 8 graders – 26% intentions to engage in aggressive behavior. Too Good for Drugs (baseline: 2472 Project Oz, 2016).
(Illinois Youth Survey [IYS], programs have demonstrated effectiveness in third party Psychological Services
th Conduct an inventory of programs with a Chestnut Health Systems
2012); 12 graders – 64% evaluations. Evaluation studies for the evidence-based program
21
2017-2019 McLean County Community Health Improvement Plan(IYS, 2012) Too Good for Drugs show the following outcomes: 1) the coping skills component offered in public
proportion of students with intentions to drink was significantly schools and community organizations in
Healthy People 2020 (HP reduced 2) the proportion of students with intentions to smoke, McLean County
2020) Alignment: use marijuana, or engage in fighting were reduced 3) scores Develop a list of programs with a coping
Reduce the proportion increased in 8 of 9 protective areas (i.e. emotional competency, skills component to distribute to or
of adolescents reporting social and peer resistance skills, goal -setting and decision- available for appropriate stakeholders (i.e.,
use of alcohol or any making, perceived harmful effects of substance use) superintendents)
illicit drugs during the http://www.toogoodprograms.org/too-good/evidence-base/ # of students in McLean County public
past 30 days. schools participating in the Illinois Youth
Reduce the proportion of Support evidence-based programs with coping skills component in Survey (baseline: 2187 students, Illinois
adults who drank McLean County. Youth Survey, 2016)
excessively in the Outcome indicators:
previous 30 days Average improvement in student pre and
post–test scores for Too Good for Drugs
(baseline: +2.11, Project Oz, 2016)
IMPACT OBJECTIVE #2: By Offer Mental Health First Aid (MHFA) to the community. MHFA Process indicators: McLean County Mental
2020, reduce the proportion courses are designed for lay people or non-mental health # of MHFA courses sponsored by Advocate Health First Aid
of McLean County adults professionals. BroMenn Medical Center (baseline: 4 Collaborative:
reporting 8-30 days of “not courses – McLean County MHFA -Advocate BroMenn
good” mental health per Evidence: Mental Health First Aid USA is an international evidence- Collaborative, 2016) Medical Center
month. based program managed, operated and disseminated by the # of MHFA courses sponsored by OSF St. -Central Illinois Area
National Council for Behavioral Health, Maryland Department of Joseph Medical Center (baseline: 3 courses Health Education Center
Baseline: 13.9% (BRFSS, Mental Health and Hygiene and the Missouri Department of Mental – McLean County MHFA Collaborative, -McLean County Center
2013) Health. Major findings of Mental Health First Aid studies found that 2016) for Human Services
participants gained: 1) better recognition of mental disorders # of McLean County community members -McLean County Health
HP 2020 Alignment: 2) better understanding of treatments 3) confidence in providing trained in MHFA per year (baseline: 421 Department
Reduce the suicide rate. help to others 4) improved mental health for themselves 5) less community members, McLean County -OSF St. Joseph Medical
Reduce suicide attempts stigmatizing attitudes and decreased social distance for people with MHFA Collaborative 2016) Center
by adolescents. mental disorders. Outcome indicators: -Chestnut Health Systems
http://www.dbsalliance.org/site/DocServer/MHFA_Evidence.pdf?doc % of MHFA course participants that “Agree” -McLean County
ID=8202 or “Strongly Agree” that they are More Emergency Medical
Services
22
2017-2019 McLean County Community Health Improvement PlanConfident About Being Aware of Their Own -Tri-County Special
Views & Feelings About Mental Health Education Association
Problems & Disorders (baseline: 98% of -Bloomington Fire
survey respondents-McLean County MHFA Department
Collaborative, 7/1/14- 6/30/16)
% of MHFA follow-up survey participants Regional Office of
that still feel prepared to assist a person Education #17
who may be dealing with a mental health McLean County schools
problem or crisis to seek professional help McLean County faith
(baseline: 81%, McLean County MHFA community
Collaborative, September 2016 )
McLean County employers
% of MHFA follow-up survey participants
Women to Women Giving
that feel prepared to ask a person whether
Circle of Illinois Prairie
s/he is considering killing her/himself
Community Foundation
(baseline: 83%, McLean County MHFA
Collaborative, September 2016) John M. Scott Health
Commission
RELATED EFFORTS
Coordinate with the McLean County Behavioral Health Coordinating Council to ensure alignment of community behavioral health efforts outlined in the 2015 Mental Health
Action Plan and in the McLean County Community Health Improvement Plan.
GOAL: By 2020, reduce behavioral health stigma to increase earlier access to care.
OUTCOME OBJECTIVE: By 2020, increase the percentage of McLean County residents indicating they have access to counseling services.
Baseline
90% (McLean County Community Health Survey, 2015)
SHIP 2021 Alignment
Evidence of new or strengthened partnerships with a wide variety of stakeholders to enhance and support the development of medical and health homes that integrate mental and
physical health and wellness across the continuum of services
Increase behavioral health literacy and conduct more Mental Health First Aid trainings to build community capacity in this area
23
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