Community Health Needs Assessment 2019

COMMUNITY HEALTH NEEDS ASSESSMENT
2019

Table of Contents
Letter from the CEO.............................................................3
2019 Executive Summary.....................................................5
Demographic Data...............................................................6
Review of 2016 Implementation Strategy, Outcomes........11
Methodology and Process for 2019 CHNA.........................22
Findings..............................................................................24
Implementation Strategy 2019..........................................34
Appendices........................................................................43
Community Health Needs Assessment is produced by
the Marketing and Community Benefit Departments
at East Tennessee Children's Hospital.
Editor: Leandra Wilkins
Content Coordinator: Linda Cox-Collier
Photography: Neil Crosby & Michael Dayah

Onanygivenday atChildren’s
Hospital,youcanseeanewborndeterminedtotakeeach
breath,acancerpatientdeterminedtomakeitthrough
anotherchemotreatment,orateenagerdeterminedtowalk
againafteraninjury.It’showyoudescribetheirmedicalteams
astheyfightalongsidetheirpatientstoprovidethebestcarefor
them. DeterminedisalsoawordIusetodescribetheirparents
astheywilldoanythingtomaketheirchildwell.
Children’sHospitalisdeterminedtopreventillnessandinjury.
Wearedeterminedtoaddressthehealthneedsofour
community.Theabilitytohealandmakehealthydoesn’t
comejustfromourhospital.Webelieveourcarefarexceeds
ourhospitalandourfacilities. Wetakehealthcareintothe
communitiesweserve,wemeetfamilieswheretheywantto
receiveinformation,weteachchildreninschoolsandweare
closetotheirhomes.
Itisaboutmakingsurethenextgenerationofcommunity’s
childrenisashealthyastheycanbe.Theprocessofconducting
our 2019 Community Health Needs Assessment has helped
us to refine our understanding of the population we serve.
It also allows us to deepen partnerships that allow us to
maximize our ability to align resources in a way that helps
foster healthier environments for our children to grow in.
The 2019 Community Health Needs
Assessment is a compilation of months of
research including key informant interviews,
focus groups, surveys and qualitative data.
Weusethisinformation to identify the most
important health concerns of those we serve
and to develop a strategy to continue to
make a productive impact.
Every action adds up. We look forward to our
next steps in our strategic plan, in partnership
with others, and we are confident that this
collaboration will help keep our priorities
where they are most effective.
letter from the CEO
Thankyoutoourcommunity partners,
hospital administration, board members,
staff and physicians for their continued
input and support so important to our
mission.
Sincerely,
Keith D. Goodwin
President & CEO
3

2019 executive summary
At East Tennessee Children’s Hospital, children are
our only concern. We are dedicated to improving
the health of children through exceptional and
comprehensive family-centered care, promotion
of wellness, and education. That mission extends
beyond our campus, and into the community we
serve.
Community assessment is the foundation for
improving and promoting the health of community
members. This Community Health Needs Assessment,
in compliance with the 2010 Patient Protection
and Affordable Care Act, provides our organization
with the information we need to guide the strategic
decision-making. The data collected in this report
allows East Tennessee Children’s Hospital to help
shape the health and well-being of our community.
Beginning in early 2018 through spring 2019,
key stakeholders at Children’s Hospital began
conducting interviews, distributing surveys, and
collecting data from state and county-specific
organizations. After careful evaluation of all primary
and secondary data, three health priorities were
identified as being a top concern for our area:
• childhood obesity
• mental and emotional health
• substance abuse
The remainder of this assessment is dedicated to
reviewing the outcomes of the 2016 implementation
strategy, identifying our service area, reviewing
demographic data through primary and secondary
resources, explaining our process and methods
for the assessment, identifying the health needs
selected as priorities, evaluating current resources,
identifying our implementation strategy and reporting
on community needs not addressed and why.
5

East Tennessee Children’s Hospital is certified by the State of Tennessee
as a Comprehensive Regional Pediatric Center (CRPC). As the only free
standing pediatric hospital in Tennessee, we provide comprehensive
specialized pediatric medical and surgical care to all acutely ill and
injured children across 16 counties and three states.
Our continued dedication to patient safety extends beyond excellent
family-centered care. East Tennessee Children’s Hospital also serves
as an educator and center of innovation for pediatric care in Tennessee.
As a CRPC, we meet state guidelines for the highest level of pediatric
care. We share this knowledge and expertise with hospitals and
emergency agencies in our service area. Our CRPC outreach coordinator
and injury prevention specialists provide on-site education in areas such
as pediatric advance life support (PALS) techniques, line insertion,
trauma care, injury prevention and more.
Not only do we serve the health care needs of children and families,
we also advocate for health care improvement on their behalf.
who we are
6

Scott
1,883
Campbell
3,920
Claiborne
2,085
Union
2,291
Grainger
2,025
Jefferson
4,347Knox
62,268
Anderson
7,151
Morgan
1,933
Roane
3,213
Loudon
4,311
Monroe
3,003
Blount
12,345
Sevier
10,318
Cocke
1,777
Hamblen
3,601
Other – 1,142
Tennessee
134,950
Kentucky
597
Virginia
503
Outpatient Visits
Patient Visits by County
Children’s Hospital and its services reach families throughout the southeast region,
including Southeast Kentucky, Southwest Virginia, and 16 Tennessee counties.
Number of primary
care offices who refer
to Children’s Hospital:
more than 70
East Tennessee Children’s Hospital serves
patients across three states and 16 counties.
Nearly 49% of patient visits came from
Knox County, but for this community
health needs assessment, we will also
include the following counties: Knox,
Blount, Sevier, Jefferson, Anderson,
Scott, Campbell, Claiborne, Morgan,
Union, Grainger, Hamblen, Cocke,
Monroe, Roane, and Loudon.
7

FINANCIALS
Gross revenue for 2017-2018 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $461,973,140
Cost to operate Children’s Hospital
• Per day . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $460,481
• Per year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $168,075,564
Payer Mix
Donors
• Number of donors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5,562
• Total given (including capital campaign) . . . . . . . . . . . . . . . . . . . . . . . . . . $7,240,555
• Capital campaign . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $1,625,304
• Other annual gifts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $5,615,250
TennCare/
Medicaid:
65.63%
PPO/HMO
Commercial
31.96%
Other
2.42%
financials
8

patient demographic data
East Tennessee Children’s Hospital serves children and young adults,
newborn to age 21. During fiscal year 2018, East Tennessee Children’s
Hospital served 82,437 children and young adults. The age group
most frequently served was newborn to 3 years old (44.8%).
The large majority of children served by East Tennessee Children’s
Hospital during the 2018 fiscal year identified as “white” (73.8%).
When compared to the greater service area population, Children’s
Hospital’s non-white patients were overrepresented.
See Appendix F for more stats.
9

The percentage of children living
in poverty in Knox County and
surrounding counties is similar or
lower than Tennessee. However,
the rate of childhood poverty for
9 of the remaining 11 counties
in the service area exceeds the
rate in Tennessee.
See Appendix F for more
patient demographic stats.
10

The 2016 CHNA conducted by East Tennessee Children’s
Hospital revealed the following health priorities:
• neonatal abstinence syndrome (NAS)
• project ADAM Tennessee
• injury prevention
• childhood obesity
• allergies and asthma
From 2016 to 2019, Children’s Hospital made these
items its key focus and implemented a strategy
to address and improve them.
2016 implementation
strategy review
11

cess to
each
pe their
ed in the
the time
d the
havioral
ort
unity
lop best
eded
al health,
and/or
ology,
ogy).
h
igate
eeds.
and that information will be shared with the care
coordinator.
months of age. The clinic will be held at Chi
Hospital’s main campus, South Tower, secon
Grow With Me
Clinic Stats
2017 - present
237 Unique patients
644 patient visits
What’s next?
In May of 2019, the
program will incorporate
a screener for ACEs
(Adverse Childhood Experiences).
12

Since 2011, East Tennessee Children’s Hospital
has continued to see a dramatic increase in the
number of newborns with Neonatal Abstinence
Syndrome (NAS). To better understand this
phenomona, our team of experts agreed that
we needed a better method for tracking trends
and collecting data.
As a result, the hospital has spent three years
researching and developing a formal NAS care
coordination service to address the gap in
tracking, support and follow-up for a significant
number of infants and their caregivers after
discharge.
PHASE I
The goals for the first phase of the program
included:
• Conduct site visits to otherNASprograms
to evaluate best follow-up practices
• Develop collaborative partnerships
with other programs working with NAS
patient families
• Research former patients with a history
of NAS to identify services being used
after discharge
• Develop a business plan for creating a
NAS care coordination service
PHASE II
Children’s Hospital launched Grow with
Me, a program that preemptively
addresses the medical, developmental
and emotional needs of children born
with NAS.
Under the guidance of East Tennessee
Children’s Hospital, the Grow With Me
coordinator ensures every patient has
an appropriate primary care physician,
connects parents with behavioral health
care providers, primary care providers,
addiction services and other resources
that will help build a healthy home
environment for the child.
Today, Grow With Me has 250
patients and an average 68 percent
participation rate.
neonatal abstinence syndrome (NAS)
13

Project ADAM Tennessee was launched by Children’s Hospital in 2011 with the
mission of placing Automated External Defibrillators (AEDs) in elementary and
middle schools and instructing school personnel in the proper use of CPR and
AEDs in Knox County.
The goal was to make AEDs available to all area schools and work toward
eliminating sudden cardiac death in children and community members
through education and prevention.
Since starting the program, the focus has expanded beyond Knox County and now
includes support to schools and programs throughout the state. We now have a
Project ADAM Tennessee training site, which has certified school nurses in seven
different counties as HeartSaver Instructors. In turn, these school nurses are
certified to train their school staff in CPR and AED use.
Partnerships with Knox County Schools and Coordinated School Health have
helped Project ADAM Tennessee continue to make a difference. Opportunities
continue to promote the program’s expansion. As of July 1st, 2018, a new
Tennessee law requires all public high schools to carry and clearly display AED
devices. It is also strongly encouraged for public middle and elementary schools
and private schools to place AED devices.
Since the passing of this law -- and the “Sudden Cardiac Arrest Prevention
Act” -- interest in Project ADAM will only continue to grow in years to
come.
Project ADAM Tennessee
14

Over the past three years, the injury prevention
program at East Tennessee Children’s Hospital
has grown from 29 community partners to over
70 partnering agencies. These additional
partnerships have lead to a substantial
increase in the number of families that are
served through various injury prevention
programs.
The overall design of the partnerships has
evolved to allow partners to host events and
provide community education customized to the
needs in their own communities. Flexibility in
programming has also increased the number of
partnering smaller agencies who now have an
opportunity to participate in injury prevention
programs such as child passenger safety and bike
safety.
These partnerships have also allowed us
to reduce the cost of car seats by 40% in
three years -- even in the face of increased
demand. With this cost savings, we are able
to reach more families and communities,
including hosting walk-in appointments for
child passenger, bike, water and sleep
safety. We were able to increase thenumber
of child passenger safety technicians we
can certify by 38%.
Our network of safety experts continues
to grow and to provide the most current
and life saving information possible to
keep our children safe.
injury prevention
17

CHILDHOOD OBESITY COALITION
In Spring 2018, the University of
Tennessee’s Department of Nutrition,
under leadership from the Maternal
and Child Health (MCH) Nutrition
Leadership and Education Program
faculty, Drs. Marsha Spence and
Betsy Anderson Steeves, and funded
trainees in the program, took over
facilitation of the coalition; and it
was renamed the East Tennessee
Childhood Obesity Coalition (ETCOC).
East Tennessee Children’s Hospital
remains as a partner to support
ETCOC and continues to advocate
for obesity prevention policies.
childhood obesity
HEALTHY KIDS CLUB (HKC)
This 12-week nutrition and physical
activity program is implemented after
school to elementary students. Each
week participants receive 30 minutes
of nutrition education which includes
a taste test and 30 minutes of
structured physical activity. A pre-
and post-assessment are used to
evaluate the program.
Ronald McDonald House and the
Siddiqui Foundation provided funding
to administer the program to 31
schools during the 2016-2017 school
year. A total of 12,622 children
participated. Participating schools
increased their average number of
pacer laps by 4.44 laps and their
nutrition knowledge showed a
22.7% increase.
18
Continued on page 19

For the 2017-18 school year, nine
schools participated in HKC, with a total
of 4,154 participants. Improvement was
shown in the average number of laps
completed during the pacer assess-
ments and in their nutrition knowledge.
Currently, the HKC program is
conducted in five schools with a
weekly average of 270 participants.
Seven additional programs will be
implemented in the spring of 2019.
Other programs East Tennessee Children’s Hospital has
coordinated to reduce childhood obesity over the last 3
years include:
• Health Happens (HH), a 12-week nutrition and physical
activity program that is provided to pre-schools
• Grub Club (GC), a gardening program
• Kids Can Bike (KCB), a weekly bike program held at Safety
City for four weeks
• In 2018 the KCB program transitioned to the City of
Knoxville Parks and Recreation Department
• Knox Rocks (KR), a 12-week intramural sports program
funded by the United Way
19

Children with asthma have always struggled with seasonal allergies in our area. Knoxville has been ranked as one of the
most difficult cities in the state to live with asthma.
East Tennessee Children’s Hospital is committed to leading the way in excellent pediatric asthma care, and in 2015 we
convened a group of key stakeholders to determine an action plan for asthma excellence.
Over the past three years, East Tennessee Children’s Hospital has launched two innovative programs to help this patient
population.
ASTHMA COLLABORATIVE
By teaming up with state and local partners, East Tennessee
Children’s Hospital has seen:
• Decreased readmissions
statewide, in collaboration with other children’s
hospitals
• Improved follow-up care
two specially-certified staff members assigned to
identify gaps in knowledge, concerns, and ease-of-
access
• Innovative technology
partnered with University of Tennessee to trial an app
which improves self-
management of asthma
• Improved environmental concerns
by offering free legal aid to all patients and families,
we can ensure that patients are awarded safe, equal
housing
BREATHE EASY ASTHMA SCREENINGS
Over the past five years, the Breathe Easy Program has
provided free asthma screenings, assessments, and
asthma education to low socioeconomic, high-risk areas
in our service area.
Screenings are provided for children 5 years and older.
We have seen improved success by partnering with local
school districts and community organizations to conduct
screenings during school hours.
In 2018, East Tennessee Children’s Hospital
Breathe Easy Program successfully completed
nine independent events, reaching a total of
536 children and adults.
allergies & asthma
21

PLANNING
The planning processfortheEastTennessee
Children’s Hospital 2019 Ccommunity
Health Needs Assessment began in
January of 2018.
An internal team was formed to identify
and approve resources and timelines
for conducting the necessary steps for
completion. The committee included the
members of the administrative and
community benefits teams.
2019 methodology & process
This group built a time line for collecting
resourcesandconductingcommunityinterviews
and surveys. The internal team used a modified
version of the MAPP (Mobilizing for Action
through Planning and Partnerships) process.
This process is commonly used to assist
community health organizations during the
needs assessment process. The MAPP
process provided the framework for Children’s
Hospital to organize, visualize, assess,
strategize, formulate goals and to take action.
22

GATHERING & ANALYZING INFORMATION
Key Informant Interviews
Interviews were conducted by members of East Tennessee Children’s Hospital’s administrative team, which included two
physician leaders. Each interview was conducted using a uniform script (see Appendix B). Summary findings of the Key
Informant Interviews can be found in Appendix C.
Similar to previous assessments, key informants were identified (see Appendix A) using the following criteria:
• Those with special knowledge of or expertise in public health
• At least one state, local, tribal, or regional government public health department (or equivalent department or agency) or
State Office of Rural Health with knowledge, information, or expertise relevant to the health needs of that community
• Members of medically underserved, low-income, and minority populations in the community served by the hospital facility,
or individual or organizations serving or representing the interest of such populations
• Members of medically underserved populations include populations experiencing health disparities or at risk of not
receiving adequate medical care as a result of being uninsured or underinsured or due to geographic, language, financial
or other barriers
Focus Groups
Six focus groups were conducted by evaluators from the College of Social Work Office of Research and Public Service
(SWORPS) at the University of Tennessee. The demographics and findings of this process are included in Appendix D.
The focus groups were conducted with:
1. East Tennessee Children’s Hospital Family Advisory Council
2. Regional coordinated school directors
3. Regional Health Department directors
4. Primary care physicians
5. East Tennessee Children’s Hospital Board of Directors
6. East Tennessee Children’s Hospital management team
Community Survey
A survey for the general population was created to gain input from community residents and key stakeholders about the top
health needs and priorities of children in our community. A survey was promoted by providing a survey link on the hospital’s
website and social media outlets to encourage people to take a few minutes to complete an online, confidential survey.
A complete reporting of the survey results can be found in Appendix E. 23

Data from the key informant interviews, focus groups, and community survey were analyzed to triangulate findings and
identify common themes. Three primary health issues of concern emerged: mental and behavioral health, obesity,
and substance abuse-related issues -- including, but not limited to: neonatal abstinence syndrome (NAS), addiction
and incarceration of parents, and drug experimentation by children.
findings
24

mental & behavioral healthConcern about the emotional and behavioral well-being of children and youth was a prevalent topic of discussion.
These discussions focused largely on the perceived increase in stress and resulting anxiety children experience. While
the source of stress may vary across demographic groups, every group shares in the anxiety and depression imposed by
those stressors.
Discussions further centered on the lack of behavioral and mental health services and providers in the region. Many
interviewees expressed that current mental and behavioral services are designed for adults and are therefore not
accommodating to the unique mental and behavioral needs of children and youth.
“[Children in different socioeconomic groups face]
different stressors, but the same anxiety.”
“What’s going to happen to these kids in 10, 15, 20
years? When you see random shootings [involving]
children across the country, [the shooters] have had
some mental health issues for years, and they were
slowly progressing, but they didn’t get addressed
because parents were [ignoring them].”
“The [behavioral and mental health] services that
are available aren’t geared towards kids, they’re
geared towards adults.”
“Still a lot of [attention deficit hyperactivity
disorder], anxiety, and depression, I would say, are
our most common diagnoses that we see…
Psychosis has obviously been a lot more
predominant as we’ve really taken our first episode
psychosis program and served the young adult
population.”
“There’s some mental health banging around out
there that we’ve become suddenly very conscious
of, [including] suicides, but I can’t help but wonder
if the medical community shouldn’t be in a better
position to try to ferret that out.”
survey feedback
25

obesityChildhood obesity was a shared concern among community members and professionals. Much concern was expressed
about the link between obesity and other health issues such as diabetes and high blood pressure. During one focus
group, school health administrators discussed the rise in Type II Diabetes and the stress school faced in monitoring
sugar levels and administering insulin.
The sources for this increase in childhood obesity were identified as fast food consumption, lack of nutritional
knowledge, and lack of awareness among children and their parents.
“Obesity is the equal-opportunity destroyer.”
“A lot of patients I see live in poverty, so
trying to obtain fresh fruits and vegetables
as opposed to fast food or things that come
in a box [is difficult].”
“Processed foods are cheaper, but they’re
not good for you…it comes down to
access to money.”
“You’re going to have high blood pressure, you’re
going to have diabetes, you’re going to have
obesity, because you don’t even have access
[to healthy food]… [A lot of parents] don’t even
know how to cook. So, how do I fix a nutritious
meal, when I can go to McDonald’s and get a
drive-thru bag of fries and hamburger and soda
and the kid will be happy and I can go on about
my business, instead of me sitting at home for
three hours?”
survey feedback
26

substance abuseThe discussions about substance abuse were multi-faceted, and included concerns about the impact of parental
substance abuse and drug use among young people. Another area of concern was the documented increase in
babies who are exposed to drugs during pregnancy or who are born drug-dependant.
Additionally, several focus groups observed that the problems of mental and behavior health, obesity, and substance
abuse are intertwined and should be treated by addressing the root causes.
“Opioids are an issue here… We have issues
[with parents not] being able to pass the drug
test to work, even in our police force. We have
issues with our workforce in general being able
to pass a drug test. I know there are some
independent businesses who don’t give drug
tests for that reason. That’s just a fact.”
“We have a lot of children being raised by
grandparents or in and out of DCS custody due
to opioid and drug use. We have quite a few
students who have parents who are incarcerated
or deceased due to drug use. It is absolutely on
the rise.”
“So many of our children are locked in the
addiction crisis—grandparents have custody,
parents living with addiction, so children are
neglected, or simply in the foster system. How
could we partner to help break this cycle of
addiction?”
“They’re all connected. I think the substance
abuse disorders and their collective impact on all
of us is something that we all need to focus on,
but then the root cause of that...That’s how the
community is going to solve these problems, is
to address those root causes… but I think mental
health and substance abuse disorders are really
connected to obesity, they’re connected to each
other and all of those other things.”
survey feedback
27

healthcare accessHaving identified the most pressing health issues facing children in the community, the group discussion participants
engaged in a brainstorming exercise to explore how East Tennessee Children’s Hospital can enhance its efficacy to
influence positive change for these issues.
The primary strategy that arose from this exercise was to improve healthcare access.
“Every year we graduate from medical school more kids than there
are residencies available, and that’s in every specialty, including
pediatrics… there’s not enough [specialists] to maintain [and] treat
America’s population. That’s going to make it hard for any medical
provider [like] Children’s Hospital to recruit and retain all of these
sub-specialties that you’re going to need.”
“[Lack of access to mental health resources, lack of transportation, lack
of insurance]—it’s a melting pot of issues that make our kids sick.”
“In my clinic, the large majority are TennCare patients. We have a lot of
poverty where I work, and that is the overriding issue related to every
health condition that happens to our patient population. It’s not that
they don’t want to follow through on things, it’s just for a variety of
different [reasons]—resources, transportation, whatever it may be—
they just can’t [access mental health services].”
survey feedback
28

While mental and behavioral health, obesity, and substance abuse-related issues have been the
most universally identified thus far, many other important health issues and social determinants
have been discussed in the course of the CHNA process and are worthy of consideration in the later
strategic planning phase. These issues include but are not limited to:
• Access to transportation
• Adversechildhoodexperiences
(ACESs)
• Asthma and allergies
• Attention deficit and hyper-
activity
• Autism and sensory processing
disorders
• Dental care access
• Domestic violence
• Durable medical equipment
for children with special
needs
• Economic underdevelopment
• Food insecurity
• Low-quality housing
• Multi-generational poverty
• Parenting education
• Sex education
• Smoking and nicotine vaping
• Social media and cyberbullying
• Suicide prevention
• Unemployment
additional concerns
29

A number of specific suggestions have been offered for fostering relationships with existing
community partners to help address the health issues identified so far.
suggestions
“The emerging issues are exceeding
traditional health issues which ties
to the ‘comprehensive’ aspect of our
mission—beyond simple health and
wellness—to treat the child, we treat
the family, in their environment, in their
location.”
“Explore opportunities in legislature to
sway better reimbursement. Explore
new partnerships with THA, CHAT, UT
School of Psychology, [and] Covenant.”
“Healthcare access in schools—improve
our presence—have staff assigned to
schools to support health care
initiatives.”
“Partner/collaborate with behavioral
health organizations/agencies.”
“NAS—train educators on how to deal/
approach kids”
“I’m not sure [East Tennessee Children’s
Hospital’s social workers] fully
understand all the programs at the
health department. We can educate,
but people forget and jobs change. I
think when they have a specific need,
they call us, but I don’t think they
recognize the huge amount of services
we can offer families.”
survey feedback
30

In addition to engaging community members and
soliciting input from community stakeholders,
East Tennessee Children’s Hospital also compiled
internal administrative data and key health
indicators to further explore the current needs of
our community.
Internal administrative data was collected from
admission records, diagnoses, and screenings
implemented in physicians’ offices. External data
was collected from the Knox County Health
Department Community Health Needs Assessment
which can be found at http://www.knoxcounty.
org/health/pdfs/CHA; County Health Rankings
2018, Tennessee; Robert Wood Johnson Foundation;
2018 State and County QuickFacts, and U.S. Cen-
sus Bureau).
There are significant disparities in
socioeconomic conditions between the 16
counties served by East Tennessee Children’s
Hospital. The rate of children living in
poverty is equivalent or exceeds 25% of
the childhood population in 10 of the 16
counties. The percentage of children who
are participating in free or reduced lunch
programs at school approaches 50% for all
counties and exceeds 70% in four counties.
Poverty and food insecurity is a growing
concern because of the linkages between
these social determinants and poor health
outcomes.
In December 2017, physicians offices began
screenings for food insecurity. Initial findings
showed that 12% of parents reported their
families struggled to put food on the table.
Research has found a correlation between
food insecurity, fast food consumption,
childhood obesity, and childhood
diabetes. According to school health
officials, thenumberofinsulindependent
children in the schools is on the rise.
This places increased stress on school
personnel who now be responsible for
monitoring students’ sugar levels and
insulin administration. According to
statistics provided by patient records,
the average age of patients when first
diagnosed with Type 2 Diabetes is
declining (see figure below).
secondary data summary
31

IDENTIFYING HEALTH NEEDS
analyzed all of the quantitative and
qualitative data described in this CHNA
and in the appendices hereafter.
While there were slight variations in the
prioritization of community needs, the
identification of these needs was quite
consistent among community members
and those whose primary role is to deliver
health care services.
The health needs identified through the
information gathering process include:
childhood obesity, mental and behavioral
health, and NAS.
SELECTING PRIORITIES FOR
GUIDANCE WITH THE
IMPLEMENTATION STRATEGY
The purpose of an implementation plan
is to identify the scope of activities and
resources required to enact quantifiable
improvement in these trouble areas.
Ultimately, such plans allow for proper
allocation of staff and financial resources.
developed this implementation
strategy based on the findings of the
current assessment, which included
rankings of health needs from primary
and secondary data. These collaborative
efforts help key partners stay focused on
critical issues working towards healthy
futures for our children.
GATHERING, TRACKING AND
REPORTING COMMUNITY BENEFIT
EFFORTS
Community Benefits department provides
oversight for more than 30 reporters who
gather, track and record occurrences.
These specialists utilize the tracking and
reporting software program called CBISA
from Lyon Software.
See Appendix G for current resources.
findings & conclusions
32

2019 implementation strategy
Based on the findings and conclusions presented in this
assessment, East Tennessee Children’s Hospital has begun
strategizing ways to address these community concerns.
What follows are specific ways this organization is approaching
those needs.
34

mental & behavioral healthIMPLEMENTATION GOAL: To address the gaps and shortages in the management and care of pediatric mental and
behavioral health patients.
IMPLEMENTATION OBJECTIVE: Remain responsive to the health needs of our community.
Improve the ability to direct children with psychiatric
issues to appropriate services.
WHO IT HELPS: Children and adolescents entering the Emergency
Department while experiencing a behavioral health crisis
DEPARTMENTS RESPONSIBLE: Emerencgy Services, Social Work
COMMUNITY PARTNERS: Helen Ross McNabb Center and Trinity
Health Foundation
ACTIONS: The hospital has partnered with the Helen Ross McNabb
Center (HRMC), which received funding through the Trinity Health
Foundation and the Helen Ross McNabb Foundation, to pilot a
program to provide consultation psychiatric services within the
emergency department. By partnering with HRMC, and having a
child psychiatrist in the emergency department, hospital physicians
will be able to access medication consultations from experts in
psychiatry. Through the program, emergency room physicians will
receive consultation services on behavioral health cases, enabling
them to continue providing high quality medical treatment to all.
Provide pediatricians with additional resources
to help evaluate and manage the care of their
pediatric patients.
WHO IT HELPS: Pediatricians
DEPARTMENTS RESPONSIBLE: Care Coordination
COMMUNITY PARTNERS: Helen Ross McNabb Center, Trinity
Health Foundation, 3rd
party insurance payers, physicianchampions
ACTIONS: The hospital will design and prepare for implementation
of behavioral health screenings, medication management and
behavioral health care in pediatric practices through a 2-3 hour
training session. In addition, psychiatry consultation will be
available via phone or email for subsequent assistance.
Initiative 1 Initiative 2
36

neonatal abstinence syndrome (NAS)IMPLEMENTATION GOAL: Collaborate with caregivers to help children achieve the best possible outcome while also
impacting the caregiver in a positive manner to support recovery and resistance to future substance abuse.
Enhance the Grow with me Clinic to include an ability to further improve outcomes by addressing
Adverse Childhood Experiences (ACEs).
WHO IT HELPS: Children born with neonatal abstinence syndrome, and who are treated from newborn to age 5
DEPARTMENTS RESPONSIBLE: Grow With Me Clinic (including program coordinator, nurse practitioner, clinic nurse,
speech therapist, occupational therapist, dietician, psychologist, patient navigator, and volunteer cuddlers)
COMMUNITY PARTNERS: Department of Childre Services, area court systems, community services, primary care physi-
cians, and more
ACTIONS: In May of 2019, the program will incorporate an ACES (Adverse Childhood Experiences) screener.
The program will now accept referrals from the University of Tennessee Medical Center program, pediatricians, Department
of Child Services, Tennessee Early Intervention System and self referrals from word-of-mouth.
Initiative
37

community outreach, health, wellness and injury preventionIMPLEMENTATION GOAL: Continue our commitment to provide community benefit activities designed to promote
health, wellness and injury prevention for children.
Allergies and asthma
WHO IT HELPS: General pediatric public
DEPARTMENTS RESPONSIBLE: Community Benefit, Pulmonology
and Respiratory Care, Legal Services
COMMUNITY PARTNERS: University of Tennessee College of
Nursing, pediatricians and nurse practitioners, nurses, nursing
students, emergency physicians, schools, granting organizations
ACTIONS: The Breathe Easy Program at East Tennessee Children’s
Hospital targets low-socioeconomic, high-risk areas to improve
access to health care and descrease asthma disparities. The
program provides free asthma screenings and assessments,
education, and follow-up phone calls for families with children
age 5 and older. The Asthma Collaborative and Call Back Program
will continue to: identify education gaps regarding medications
and the ability to obtain and fill prescriptions; address environmental
concerns.
Injury prevention
WHO IT HELPS: Children, age newborn to 15 years
DEPARTMENTS RESPONSIBLE: Children’s Hospital Injury Prevention
Program, SafeKids of Greater Knoxville
COMMUNITY PARTNERS: Knoxvillepolice,fire,EMSandcommunity
childservices,SafeKids,worldwidegrantingorganizations
ACTIONS: East Tennessee has seen an increase in drowning
events recently. The state is also currently ranked 8th
in the
country for heat-related fatalities. With this in mind, our
organization will continue to partner with appropriate agencies
to increase media outreach and community event opportunities,
in order to expand our education and outreach programs.
38

Safe Sitter classes
WHO IT HELPS: Children, age 11 - 14
DEPARTMENTS RESPONSIBLE: Community
Benefit
COMMUNITY PARTNERS: SafeSitterProgram
ACTIONS: East Tennessee Children’s Hospital
provides education on correct babysitting
techniques & emergency responses.
Healthy Kids Club
WHO IT HELPS: Elementary school-aged
children
Benefit
COMMUNITY PARTNERS: Areaschools,Ronald
McDonaldHouseCharities,SiddiquiFoundation,
EastTennesseeChildhoodObesityCoalition
coordinates programs which prevent and
reduce childhood obesity by promoting
healthy, active lifestyles through family,
community and inter-professional
collaborations.
Initiative 3
Project ADAM school outreach
WHO IT HELPS: Children in grades 1st
through
12th
in East Tennessee
Benefit
COMMUNITY PARTNERS: ProjectADAM,area
schoolsystems,grantingorganizations
provides life-saving equipment and training
in CPR to Tennessee schools and other public
areas where children are present. We also
partner with schools to provide useful
information regarding health and wellness.
Initiative 5Initiative 4
39

Pediatric resource directory
WHO IT HELPS: Families of children age newborn to 21 years,
pediatricians, schools and other agencies
DEPARTMENTS RESPONSIBLE: Community Benefit
COMMUNITY PARTNERS: Multiple
ACTIONS: East Tennessee Children’s Hospital will research
and design an online resource directory to help families,
pediatricians, school personnel and others in the community
find education, information and services. The directory will
be a valuable tool to allow access to important information,
services and programs that will benefit children and families
throughout the community.
CPR classes
WHO IT HELPS: General public, ages 14 years and up
DEPARTMENTS RESPONSIBLE: Community Benefit
COMMUNITY PARTNERS: AmericanHeartAssociation
ACTIONS: East Tennessee Children’s Hospital offers CPR
classes to families, in order to provide them with the education
they need to respond to emergencies in the home.
40

REQUEST FOR MORE INFORMATION, WRITTEN COMMENTS SOLICITED
In addition to this CHNA being publicly available on our website, other reports relevant to this process can be
made available by request to:
Community Benefits Department
2018 Clinch Avenue
Knoxville, TN 37916
Phone: 865-541-8532
Email: lcoxcollier@etch.com
East Tennessee Children’s Hospital solicits written comments on each Community Health Needs Assessment.
This is indicated on the East Tennessee Children’s Hospital website at https://www.etch.com/community/chna/.
As of March 4, 2019 there have been no written comments regarding the 2016 Community Health Needs
Assessments.
41

In order to capture all of the information we talk about, I’d like to record/take notes about our
conversation. I will not record your name in the interview and I will only start the recording with the
beginning of the questions.
After the interview is completed, we will transcribe and code the interviews so that we can see if any
themes arise across the multiple interviews conducted. Your answers will be used to compile input,
however your responses will not be tied back to you in any way; the results of the interviews will only
be reported in aggregate.
Now, let’s get started.
1.) Tell me about yourself and your organization. (Mission? How long in position? Service area?)
---------------------------------------------------------------------------------------------------------------------------------------------
---------------------------------------------------------------------------------------------------------------------------------------------
---------------------------------------------------------------------------------------------------------------------------------------------
---------------------------------------------------------
2.) Tell me about the children with whom you work. (Ages, ethnicity, socioeconomic status)
---------------------------------------------------------------------------------------------------------------------------------------------
---------------------------------------------------------------------------------------------------------------------------------------------
---------------------------------------------------------------------------------------------------------------------------------------------
---------------------------------------------------------
3.) What are major health issues you see in your community:
a. Children from birth to 14 years (prompt: children from 14-21 years)
--------------------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------------------
appendix b: key informant interview guide
44

----------------------------------------
b. Children among low income/underserved families
-------------------------------------------------------------------------------------------------------------------------------------------------------------
-------------------------------------------------------------------------------------------------------------------------------------------------------------
------
4.) What are some of the most critical medical/health and non-medical health needs of children in your communi-
ty? (Cover at least one, no more than 3).
-------------------------------------------------------------------------------------------------------------------------------------------------------------
-------------------------------------------------------------------------------------------------------------------------------------------------------------
-------------------------------------------------------------------------------------------------------------------------------------------------------------
---------
5.) Do you have any suggestions on how these needs can be met?
-------------------------------------------------------------------------------------------------------------------------------------------------------------
-------------------------------------------------------------------------------------------------------------------------------------------------------------
------
6.) What are community advocacy groups (or resources) in the area like?
-------------------------------------------------------------------------------------------------------------------------------------------------------------
-------------------------------------------------------------------------------------------------------------------------------------------------------------
------
7.) Is there anything else that you want to add or do you think we need to know or is important?
-------------------------------------------------------------------------------------------------------------------------------------------------------------
-------------------------------------------------------------------------------------------------------------------------------------------------------------
-------------------------------------------------------------------------------------------------------------------------------------------------------------
---------
8.) Are there other people you think we should talk to? Have we covered everything you think is important?
-------------------------------------------------------------------------------------------------------------------------------------------------------------
-------------------------------------------------------------------------------------------------------------------------------------------------------------
-------------------------------------------------------------------------------------------------------------------------------------------------------------
---------
45

Key informants were asked to identify health issues that are being faced by children and young adults in
their communities. A summary of the issues discussed and the number of key informants who discussed
the issue is found in the table below.
Poor nutrition, lack of exercise, and the resulting obesity and diabetes were the most frequently issues
cited. Economic and food insecurity were frequently linked with these issues.
“This county does not have the resources of the larger counties to feed these kids when school is
out or at night and on weekends. Fresh food we all know is more expensive than the dollar menu
at McDonalds. With very limited money they are going to choose the cheaper every time.”
“….. we have 64% of the kids that are on free or reduced meal programs. So, there’s economic
challenges where there is an issue with kids getting enough to eat.”
Access to health providers was the second most frequently mentioned issue. Lack of providers in more
rural areas was cited as a contributing factor while the high cost of for those with insurance and providers
not being available outside of parents’ work schedules were common themes regardless of location.
“Patients either do not have a pediatrician in their community, their pediatrician is not open when
they are off from work or school, or the wait to be seen is too long…. The rural areas also do not
have access to after hours pediatric care.”
“Patients with a high deductible insurance essentially do not have access to health care. TennCare
patients actually have better access to care than these patients. The families do not seek treatment
because they cannot afford the deductible.”
appendix c: key informant interview summary
46

The East Tennessee region is being heavily impacted by the opioid epidemic and drug abuse and addiction. Drug use and abuse has
resulted in unstable homes, poor mental and behavioral health among children and young adults, and an increase in babies born
with NAS. This societal problem is leading to an increased need for mental health providers specifically for young children.
“As the NAS babies reach school age-they are seeing a lot of school behavior problems and little treatment options.”
“There needs to be more pediatric providers for children that deal with mental health….”
“We have an abnormal percentage of special needs kids in our county and more have mental needs that lead to behavioral
needs. It seems as though there is not a system in place to help with mental health or at least not an effective one.”
47

Six focus groups were conducted for ETCH by evaluators from the College of Social Work Office of Research
and Public Service (SWORPS) from the University of Tennessee. A focus group was conducted with the
following groups:
1. East Tennessee Children’s Hospital Family Advisory Council
2. Regional coordinated school directors
3. Regional health department directors
4. East Tennessee Children’s Hospital Board of Directors
5. Primary care physicians
6. East Tennessee Children’s Hospital management team
While each group offered a unique perspective on the issues facing the communities served by East
Tennessee Children’s Hospital that was influenced by their roles and professions, there was tremendous
overlap between groups. From these groups, a number of common themes regarding issues that need to
be addressed emerged: childhood obesity, mental and behavioral health, parental substance abuse, and
neonatal abstinence syndrome. Full reports from each focus group are available upon request by utilizing
the contact information available on page 35.
appendix d: focus group summary listing & findings
48

A survey link was provided on East Tennessee Children’s Hospital’s website and social media outlets to
encourage community members to provide input. The link was available from September 1, 2018 through
December 1, 2018. Sixty-nine (69) people completed the survey.
Community Needs Assessment Survey
East Tennessee Children’s Hospital wants to be sure that we are meeting the healthcare needs of all
children in our community. Please fill out this short survey to help us identify areas in which we can
better serve you.
What are the ages of the children in your home? *
Does your child have a primary care doctor? *
How would you rate your child’s Health? *
Does your child have a chronic health care condition? *
If yes, what is the diagnosis?
Do you have difficulty finding healthcare for your child? *
How often does your child go to a hospital emergency room? *
Does your child’s school nurse help meet the healthcare needs of your child? *
Which health care issue (s) listed below do you feel are the largest problems in our area (check
all that apply)? *
What is your ethnicity? *
What is your ZIP code? *
What kind of insurance do you have for your child? *
Please let us know any additional thoughts, ideas or concerns you may have about healthcare
needs and issues in our community.
appendix e: community survey & summary of key findings
49

summary of results survey
Does your child have a primary care doctor? How often does your child see this doctor?
50

How would you rate your child’s health?
Issue Number of Responses
Behavioral Health 37
Illegal Drug Use, Parental 34
Obesity 33
Allergies and Asthma 26
Parenting/Parent Education 22
Illegal Drug Use, Child 18
Dental Care 18
Smoking 15
Health Education in Schools 15
Immunizations 14
Handicapped Access 12
Access to Primary Care 11
Diabetes 8
Diversity 8
Teen Pregnancy 6
Injury Prevention 4
Which health care issue (s) listed below
do you feel are the largest problems in our area?
51

* = new language from County Health
Rankings is “Children Eligible for Free
or Reduced Price Lunch”
** = variable found under “Physical
Environment” category from County
Health Rankings but not listed in 2014
chart
*** = July 1, 2018 according to
https://www.census.gov/quickfacts/
fact/table/US/PST045218#PST045218
SOURCES:
www.countyhealthrankings.org/app/
tennessee/2018/rankings/knox/coun-
ty/factors/overall/snapshot
53

appendix g: current community resources
• Allies for Substance Abuse Prevention (ASAP)
• Anderson County Coalition
• Big Brothers/Big Sisters
• Blount County Chamber
• Blount County Community Health Initiative
• Blount Benefits
• Food Allergy Action Team (FACET)
• Mental Health Awareness and Suicide
Prevention Alliance (MHASPA)
• Safe Blount County
• Substance Abuse Prevention Group
• Teen Pregnancy Prevention
• Blount County School System
• Boys and Girls Club
• Catholic Charities
• Change Center
• Cherokee Health Systems
• City of Knoxville Parks and Recreation
• Civitan Club
• Clinton Drug Store
• Clinton Fire Departments
• Clinton Lions Club
• Columbus Home
• Community Action Committee (CAC)
• Community Groups
• Compassion Coalition
• Coordinated School Health
• County Health Departments
• Department of Children’s Services
• East Tennessee Children’s Hospital
• Project Adam
• Safe Kid’s
• Obesity Coalition
• Emerald Youth Foundation
• Emergency Shelters
• ETSU 3rd Year Medical Students
• Fellowship of Christian Athletes
• Harmony Center
• HEAL & MOMS
• Health Advisory Council
• Helen Ross McNabb
• Jefferson County Health Council
54

• Knox Area Rescue Ministries (KARM)
• Knox County Schools
• LaFollette Medical Center
• Leadership Knoxville
• Local Churches
• Local Donors
• Mobile Crisis Unit
• New Hope Advocacy Center
• Peninsula
• Police Departments
• Public Health
• Omni Vision
• Optimus Club
• Rotary Club
• Salvation Army
• Second Harvest Food Bank
• Sevier County Health Improvement Council
• Sevier County Promise
• Sevier County School Nurses
• Smoky Mountain Children’s Home
• State Department of Health
• United Way
• UT Extension Program
• UT Nursing Program
• Vine Health Center
• YWCA
• YMCA
• Youth Villages
55

Community Health Needs Assessment 2019

Community Health Needs Assessment 2019

Recomendados

Recomendados

Mais conteúdo relacionado

Mais procurados

Mais procurados (20)

Semelhante a Community Health Needs Assessment 2019

Semelhante a Community Health Needs Assessment 2019 (20)

Mais de East Tennessee Children's Hospital

Mais de East Tennessee Children's Hospital (20)

Último

Último (20)

Community Health Needs Assessment 2019