Example 3: Needs Assessment: The Ottawa County Public Health

Department

The Ottawa County Health Department.

The Kansas Department of Health and Environment has set as one of its goals to assure access to
complete public health services to all the citizens of Kansas. Public health services are listed
below under three broad categories:
ENVIRONMENTAL AND SANITATION SERVICES

 Well water and septic system inspections

 Restaurant inspections
 Licensing of child care facilities

PREVENTIVE SERVICES

 Immunizations
 Communicable disease control
 Health screening
 Women's health services
 Women, Infants, and Children (WIC) program
 Periodic Screening, Diagnosis, and Treatment (EPSDT) programs

HEALTH PROMOTION AND EDUCATION SERVICES

 School health services

 Acquired Immune Deficiency Syndrome (AIDS) education
  Community health fairs
 Environmental health education
 Community health assessment analysis and planning for health needs.

In urban areas, these types of services have traditionally been performed by public health
departments. In smaller rural communities, services such as clinical services, health screening,
women's health, EPSDT, immunizations, and the like, are often carried out in the primary care
clinic. While the regulatory, educational, and planning components of the public health mission
are the domain of the public health department, the entire community should be a part of the
planning and decision-making process concerning these activities.
This model assumes that economies of scale are the primary variable in service delivery and does
not take into consideration factors such as geography or the ability (or necessity) to perform
traditional public health department functions through alternative mechanisms. In rural areas,
which do not have a large population base, these alternative mechanisms are often critical.
OTTAWA COUNTY SERVICES:
The Ottawa County Public Health Department provides a range of public health services. This
agency is tax supported and located in Minneapolis. The Public Health Department employed a
total of 15 people in 4.1 full time equivalent positions in 1994. In addition to the services
provided by employees, some services are offered through contract. The services which are
provided are listed in Table 21.
UTILIZATION:
Table 21 Public Health Visits by Program
Health Department Services Number of Visits Percent of Total

School Health 2,027 41.3%

Adult Health 1,715 35.0%

Early Intervention 389 7.9%

Immunization 383 7.8%

Infant & Child 233 4.7%

Maternal Health 51 1.0%

Other 48 1.0%

EPSDT 46 0.9%

High Risk Infant 6 0.1%

Family Planning 5 0.1%

Communicable Disease 3 0.1%

Total 4,906 100.0%
The department made a total of 4,906 visits in the last fiscal year. The largest program was
school health with 2,027 visits, followed by Adult Health visits at 1,715. The age break down of
those who have used public health services (excluding home health) is listed in Chart 3.
With the exception of its school health service, this department primarily serves the very young
and the elderly in the county.
The Public Health Department is primarily funded through public sources: over 50 percent of its
1994 revenue came from a single mil of county funds and over 20 percent from grants, many of
which come from state and federal programs. The sources of funds are listed in Table 22.
Table 22 1994 Ottawa County Public Health Department Revenue and Visits by Payor
Payor Source 1994 Revenue % Total Revenue Visits By Payor % of Total Visits

Medicare 0 0.0% 0 0.0%

Commercial 0 0.0% 0 0.0%

Medicaid $3,630 5.0% 86 1.8%

Self Pay/Not Insured $3,590 5.0% 2500 51.0%

Other $12,400 17.1% 2320 47.3%

Grant Funds $16,400 22.6%

Tax Revenue $36,480 50.3%

Total $72,500 100.0% 4,906 100.0%

Table 22 also shows how local tax dollars support the services of the Public Health Department.
As federal and state sources of grant funds become more difficult to obtain, this department will
depend to an even greater extent on local dollars to provide needed services.
WHAT WE LEARNED FROM THE DATA:

 Next to School Health, Adult Health visits constitute the second most frequent type of patient
care for the Ottawa County Public Health Department.
 With the exception of School Health, this agency primarily serves the very young and the elderly
in the county.
 Over 50% of the 1994 revenue for the health department came from public funds in the form of
the county mil levy.
 20% of the 1994 revenues came from grants - many of which also come from the state and federal
governments.
  The only other source of funds for this agency in 1994 was the Medicaid program and what fees
could be collected from clients who were not covered by categorical grants or the Medicaid
program.

WHAT WE LEARNED FROM COMMUNITY INTERVIEWS:

 The Ottawa County Public Health Department was commended for its services and the caring
attitude of its personnel. This was particularly evident in the communities outside Minneapolis.
 The health department was described by other providers as cooperative and in need of additional
resources.
 The Hospice program of the health department was described as an important community
resource.
 Ottawa County is under served with rural water districts, which means many of the rural residents
are on private wells.
 Some areas of the county are remote and distant from access to health services - they are only
served by the health department.
 The county has a high teenage pregnancy rate.
 Low income families that are not eligible for public funds do not access care when they should
and when they do, the care they need is more costly.
 Broaden the county-wide immunization program to more sites in smaller communities.
 Medicare certification for Hospice is very important for the community.
 More information on AIDs prevention and care including a support system for those people in the
community caring for AIDs patients is needed.
 Develop an immunization tracking system so records in various immunization sites can be
coordinated (i.e., MD Offices and the Health Department).
 Dispel the myth that the Health Department is part of SRS.
 Community education on immunizations and adequate nutrition for kids is needed.
 The pregnancy issues of unmarried or adolescent women need to be addressed.
 Unsafe water supplies and improper septic waste disposal are threats to the local system of health
care.
 Example 2: Community Concerns: Community Health Concerns Ottawa
County, KS

BACKGROUND:
Ottawa County received a grant from the Kansas Health Foundation to explore how health
services might be improved. Part of this grant is designed to encourage community-based health
promotion. The first step in this process involves identifying community health concerns. A
small group of citizens developed a survey on community health issues encountered by Ottawa
County citizens.
The survey was sent out to all households in the County (approximately 2,500). In addition, the
survey was printed on an entire page of the local newspaper (circulation approximately 1,600).
Surveys were hand-distributed to numerous sites in the County, including Senior Centers,
business clubs (such as the VFW and Lions), at the local hospital and Emergency Medical
Service site, and at a festival in Minneapolis, the county seat. The county has a population of
approximately 5,500 persons. Citizens returned 593 surveys, for a response rate of 11%.
In the survey, people were asked to rate how important each issue was, and how satisfied they
were with how the issue was being addressed in the County. An example question is included
below:
 Importance of the Satisfaction with the community's
Issue efforts

Ver
Not Not Very
y

Vaccinations are available and

0.00 1.00 2.00 3.00 4.00 0.00 1.00 2.00 3.00 4.00
affordable.

Relative Strengths:The surveys were collected, entered into a database, and analyzed to determine a)
what issues were important to citizens of the county, and b) how satisfied citizens were with how the
county deals with these important issues. There were 27 community health issues in the survey.

Items with high importance and satisfaction ratings are considered strengths -- they're important,
and the community is doing a good job in dealing with them. The issue in the above example
emerged as a relative strength in Ottawa County:
Importance of the Satisfaction with the community's
Issue efforts

Not Very Not Very

Vaccinations are available and

0.00 1.00 2.00 3.00 4.00 0.00 1.00 2.00 3.00 4.00
affordable.

84%
93%

Of people who filled out the survey, there was a 93% average rating on the importance scale (it
would be 100% if all respondents rated it very important). There was an 84% satisfaction rating
with the community's efforts on this topic. This is high compared to satisfaction ratings on other
items.
Implications. Why are citizens satisfied with aspects of the community that received high
ratings? Are these strengths at risk? Are subgroups of citizens dissatisfied with efforts in this
area? Listening sessions around the community can help answer these and other important
questions about the relative strengths in Ottawa County.

Importance of the Satisfaction with the community's

Issue efforts

Not Very Not Very

Vaccinations are available and 0.00 1.00 2.00 3.00 4.00 0.00 1.00 2.00 3.00 4.00
affordable.

40%
81%

Of people who filled out the survey, there was an 81% average rating on the importance scale.
There was a 40% satisfaction rating (If all people gave it the lowest possible score, the
satisfaction rating would be 0%). This rating of 40% is low compared to other issues on the
survey.
Implications: Why are these aspects of the community (like recycling) considered to be
problems? What might be done to work with others in the community to improve issues that are
considered problems? Listening sessions around the community can help answer these and other
important questions about the relative problems in Ottawa County.
Future Directions:
Using these data on the strengths and problems of community health issues in the County,
citizens may wish to set up committees or task forces to address one or several of the most
burning issues. Listening sessions will provide potential solutions to some of the problems. Task
forces may wish to do more systematic "strategic planning" around some issues. Community
citizens can be recruited to work on problems of most interest to them
Relative Strenghts
Average Average
Item Survey Question
Importance Satisfaction

3.00 Vaccinations are available and affordable. 93% 84%

5.00 Emergency Medical Services are available. 95% 79%

Transportation is available for people who may

18.00 need special assistance, such as older adults and 87% 80%
people with disabilities.

22.00 Hospice services are available and affordable. 89% 77%

Older adults get enough nutritious food to eat

24 through home delivered meals or are able to 87% 78%
attend group meals.

Adequate skilled health care is available for

27.00 89% 73%
older, frail adults who need it.

People have access to basic, affordable health

care services, including regular checkups, dental,
4.00 91% 65%
eye exams, glasses, mental health, and
orthodontic care as needed.
 Older adults get the help they need to stay in
21.00 87% 68%
their homes even if they have health problems.

Medical care is available and affordable for all

16.00 86% 67%
pregnant women throughout their pregnancies.

1.00 Health insurance is available. 91% 61%

Relative Problems
Average Average
Item Survey Question
Importance Satisfaction

11.0 Communities are encouraged to recycle items

81% 40%
0 that contribute to environmental pollution.

2.00 Health insurance is affordable. 82% 45%

Insurance companies offer lower rates for

9.00 82% 45%
patients who practice healthy lifestyles.

10.0 Victims of child abuse, domestic violence, and

90% 51%
0 sexual assault get the help they need.

12.0 The community's drinking water is of good

88% 50%
0 quality.

Community education programs provide

26.0
knowledge of sexually transmitted diseases and 82% 47%
0
safe sex practices.

Employers give bonuses or time off to

14.0 employees who attend classes designed to
68% 36%
0 promote exercise, stress management, and a
healthy diet.

Treatment services for drug and alcohol abuse

7.00 83% 49%
are available and affordable.

Laws against selling alcohol to minors are

8.00 89% 53%
strictly enforced.

Teens have access to pregnancy prevention

6.00 83% 52%
services and counseling.

19.0 Prescription drugs are affordable and come

88% 56%
0 with clear instructions.
 Health care providers assess and counsel
13.0
patients about their physical fitness as a normal 81% 54%
0
part of routine physical examinations.