CarilionClinic.org/community-health-assessments
Executive Summary
Carilion Clinic is committed to joining with our partners to pursue the essential work of improving and maintaining the health of the Franklin County Area in accordance with our mission Periodically assessing the health concerns of each community is a key component of addressing community needs. Every three years, the Franklin County Area Community Health Assessment (FCACHA) aims to uncover issues, indicate where improvement is needed and track and promote progress in key areas so that there is demonstrated, ongoing change. The CHA process and the public availability of its findings enable and empower our community to effectively improve and maintain health.
Carilion, Healthy Franklin County (HFC) and the West Piedmont Health District (WPHD) collaborated to conduct the 2024 FCACHA alongside additional community partners, the Community Health Assessment Team (CHAT). After review and discussion of the data collected, the 2024 FCACHA led the CHAT to identify six priority health issues in the community.
Community Health Improvement Process
Carilion believes in continuous quality improvement. The triennial CHA serves as a formal way of identifying community needs and developing plans to address them It shapes the ways we support our mission in the community and encourages collaboration and alignment with clinical teams. Not only does this process identify current needs and disparities, but also helps to ensure we are regularly evaluating and shifting to meet emerging needs
Priority Health Needs
In collaboration with the CHAT, we identify key health needs to align resources and other efforts for the following three years. The CHAT reviews extensive data, asks questions and participates in a consensus-building prioritization process. The 2024 FCACHA resulted in the following health priorities:
Injury/Violence Interpersonal Violence
Drivers of Priority Health Needs
The CHA process focused on prioritizing health conditions and outcomes, rather than a broader focus on their root causes We recognize that access to healthcare and other services and the social determinants of health (SDOH) are key facilitators of good health and well-being. As such, we focused on those and other health factors as a strategic component of action planning. The key drivers of each priority health condition, as identified by the CHAT, are discussed in the corresponding sections of this report.
Board Adoption
This document was approved by the CFMH Board of Directors on July 22, 2024 and formally adopted as the 2024 Franklin County Area Community Health Assessment.
Disclaimers
This document has been produced to benefit the community. Carilion encourages the use of this report for planning purposes and is interested in learning of its utilization. Comments and questions are welcome and can be submitted to Carilion at communityoutreach@carilionclinic.org.
Members of the leadership team reviewed all documents prior to publication. Every effort has been made to ensure the accuracy of the information presented in this report; however, accuracy cannot be guaranteed. Members of the Franklin County Area CHAT cannot accept responsibility for any consequences that result from the use of any information presented in this report.
Carilion began conducting CHAs prior to the IRS adoption of the 501(r)(3) standard which requires not-for-profit hospitals to conduct a Community Health Needs Assessment (CHNA) every three years. While meeting the CHNA requirement, Carilion maintains the longstanding formal name Community Health Assessment for our process and reports. A crosswalk of this document based on the 501(r)(3) standards can be found in Appendix A.
Our Partners
Community Health Assessment Leadership Team
The CHA Leadership Team collaborates to guide major functions of the CHA, including CHAT recruitment, data collection/analysis and shaping meeting structure. In addition to Carilion staff, membership includes leadership from the local health district and Healthy Franklin County (HFC). Carilion organizes and facilitates leadership team meetings.
• Carilion Clinic:
o Shirley Holland, VP, Community Health and Development
o Molly Roberts, Manager, Community Benefit
o Ashley Hash, Community Health Improvement Program Manager
o Holly Ostby, Community Health Improvement Program Manager
o Nicholas (Nick) Bilbro, Community Benefit Analyst
• West Piedmont Health District:
o Nancy Bell, Population Health Manager
• Healthy Franklin County:
o Leslie Clark, Director, Family Health Strategies
Community Health Assessment Team
The CHAT is a dynamic group of health and human service agency leaders, individuals/organizations serving/representing the interests of priority populations and local representatives from various community sectors. The following community partner organizations participated in the 2024 FCACHA:
Organization
Bernard Healthcare Center & Free Clinic of
Organization Type
Franklin County Free Clinic
Carilion Clinic
Disability Rights & Resource Center
Healthcare
Disability Services
Essig Center, Office on Aging Senior Services
Feeding Southwest Virginia Food Access
Franklin County Department of Public Safety Public Safety
Franklin County Habitat for Humanity Housing
Franklin County NETS Transportation
Franklin County Parks and Recreation Parks and Recreation
Franklin County Public Library System Library
Franklin County Public Safety Public Safety
Franklin County Public Schools School Representative
Piedmont Community Services Mental Health/Substance Use
Rocky Mount Police Department Public Safety
Smith Mountain Lake Good Neighbors Academic, enrichment and food programs
Southern Area Agency on Aging Senior Services
Southern VA Child Advocacy Center Child Advocacy
Tri Area Healthcare Health Center
Organization
Organization Type
United Way of Roanoke Valley United Way
Va Harm Reduction Coalition Homelessness
Virginia Harm Reduction Mental Health/Substance Use
To see a list of specific 2024 CHAT participants, please see Appendix B. Data Team
Additional data support was provided by the Virginia Department of Health Division of Population Health Data.
• Khristina Morgan, Community Health Epidemiology Regional Coordinator
• LeeAnn Gardner, Community Health Epidemiologist, Central Shenandoah Health District
• Taiwo Ilechie, Community Health Epidemiologist, Roanoke City and Alleghany Health Districts
Our Process
The first step in the ongoing community health improvement process is to conduct a CHA. Every three years, Carilion follows the formal process described below to identify community needs and develop plans to address them. The 2024 FCACHA officially began on September 26, 2023 with a data presentation and concluded with the final CHAT meeting on June 25, 2024.
STEP 1: Define Community Served
Carilion Franklin Memorial Hospital (CFMH) is a 37-bed acute care hospital located in Rocky Mount, Virginia. CFMH provides reliable, safe care close to home through both inpatient and outpatient services. Emergency services are available on site 24/7 and offers direct access to Carilion’s Level I Trauma Center in Roanoke, Virginia, if advanced care is needed. CFMH is a strong community partner and is dedicated to helping all people achieve better health and wellness.
The service areas for Carilion’s CHAs are determined by unique patient origin of the hospital in each respective market. Focus is placed on areas that are considered Medically Underserved Areas (MUAs) and Health Professional Shortage Areas (HPSAs).
In fiscal year 2023, CFMH served 24,883 unique patients. Patient origin data revealed that during this year, 92% of patients served by CFMH lived in the following localities:
• Franklin County (64%)
• Henry County (28%)
Additional Community Demographics
The Franklin County Area includes Franklin County and Henry County
In addition to Carilion, key safety net providers in the region include the Bernard Healthcare Center and Free Clinic of Franklin County, Piedmont Community Services, local offices of the Virginia Department of Health (VDH) and other service organizations. Despite these entities’ presence, many low-income, uninsured and underinsured residents do not have sufficient access to affordable healthcare services.
The localities within the service area have significant disparities in size, population and SDOH. The Weldon Cooper Center for Public Service predicts positive population change by 2040 for Franklin County, and a decrease in population for Henry County 1
1 https://www.coopercenter.org/virginia-population-projections
Table 1. Select Demographics of the FCACHA Service Area
Source: US Census Bureau, ACS, 2018-2022
Table 2. Income Data for the FCACHA Service Area
Source: US Census Bureau, ACS, 2018-2022
Specific to CFMH inpatients and outpatients in fiscal year 2023, 25 61% received Medicaid while 4.55% were self-pay, a proxy for uninsured.2
Table 3. Insurance Status of FCACHA Service Area
Source: US Census Bureau, ACS, 2018-2022
Table 4. Racial Demographics, FCACHA Service Area
Source: US Census Bureau, ACS, 2018-2022
The region is divided into urban and rural areas, which vary greatly in the economic means of the residents who live there. Both Franklin County and Henry County are designated as MUAs3 as well as a low-income HPSAs for primary care, dental health and mental health.4
Target Population
The target population for Carilion’s CHA projects consists of underserved/vulnerable populations disproportionately impacted by SDOH, including poverty, race/ethnicity, age, education, access, and/or lack of insurance. Data are reviewed where available by different life stages, including parents of children and adolescents, women of child-bearing age, adults, and the elderly. Other considerations include race, ethnicity, and income levels. All patients are included in this assessment regardless of insurance payments or financial assistance eligibility. Distinct efforts are taken to ensure the CHA reflects those residing in MUAs and HPSAs.
STEP 2: Convene Community Health Assessment Team
A 52-member CHAT participated in the assessment activities. Hearing voices from across our service area is crucial to a CHA’s success. Broad-interest community reach is a main qualification when inviting individuals to join the CHAT. In addition to Healthy Franklin County, we also invited representatives from the WPHD, local governments, the local school system, social service organizations, other community organizers and nonprofit leaders.
The CHAT met four times throughout the process, with each meeting serving a distinct purpose.
• Meeting 1: Introduction and Overview of the Process; Launch of Community Health and Well-Being Survey
• Meeting 2: Data Presentation and Data Walk
• Meeting 3: Prioritization of Needs and Discussion
• Meeting 4: Action Planning: Key Drivers and Impact/Feasibility Activity
3 https://data.hrsa.gov/tools/shortage-area/mua-find
4 https://data.hrsa.gov/tools/shortage-area/hpsa-find
Each meeting built on the one prior and fostered dialogue amongst CHAT members. Meetings were held in person with interactive opportunities to participate and engage with data and facilitated discussions with other CHAT members
The WPHD team was engaged from the beginning of the planning process (spring of 2023) throughout the assessment period and all CHAT meetings WPHD’s involvement helped shape all aspects of this assessment. The team identified community partners to serve on the CHAT, provided discussion points and suggestions on structure of CHAT meetings and offered feedback on the prioritized needs. Additionally, WPHD representatives were active on the CHAT and participated in all activities including the Stakeholder Listening Session and the prioritization activity.
In addition to WPHD, the CHAT included other individuals or organizations serving or representing the community’s medically underserved, low-income and minority populations. Examples include:
• Free clinic (Bernard Healthcare Center & Free Clinic of Franklin County)
• Federally Qualified Health Center (Tri-Area Health Center)
• Public school system (Franklin County Public Schools)
• Community-based social support organizations (Feeding Southwest Virginia)
These organizations and individuals helped gather community input by distributing the Community Health Survey. CHAT member input was solicited through the Stakeholder Survey and Listening Session. Combined, these efforts led to the identification and prioritization of community health needs.
STEP 3: Collect and Review Relevant Health Data
Various data were collected and shared regularly with the CHAT, including primary and secondary data on health outcomes, health status, socioeconomic factors and quality of life. Secondary data served as a key driver of the process, with primary data adding community context and perspectives to understand the needs of subpopulations within the community.
Community Health and Well-Being Survey
A Community Health and Well-Being Survey was conducted as part of the FCACHA This survey was used to evaluate the community’s health and identify potential geographic areas to target improvements. Input and oversight of survey development was provided by the CHAT and the CHA Leadership Team.
A 27-question survey instrument was utilized. It asked questions about access to care and other services, health status, community strengths, quality of life, subjective well-being and demographics (Appendix C: Community Health and Well-Being Survey). The survey instrument included commonly used questions and metrics from the following established community surveys:
• Cantril’s Ladder
• Community Themes and Strengths Assessments, National Association of County and City Health Officials, Mobilizing for Action through Planning and Partnerships
• Community Healthy Living Index, YMCA
• Behavioral Risk Factor Surveillance System, Centers for Disease Control and Prevention (CDC)
• National Health Interview Survey, CDC
• Youth Risk Behavior Surveillance System, CDC
• Martin County Community Health Assessment, Martin County, North Carolina
• Previous Franklin County Area Community Health Surveys
The population of interest for the survey was Franklin County Area residents 18 years of age and older. Surveys were distributed from October 2023 through December 2023. A drawing for a $50 grocery store gift card was offered as an incentive for those completing the survey.
The following subpopulations were especially targeted for sampling:
• Underserved/vulnerable populations disproportionately impacted by SDOH, including:
o Poverty
o Race/ethnicity
o Education
o Lack of insurance
A non-probability sample method was used, where respondents were not randomly selected. Although the survey was available to all residents living in the Franklin County Area, oversampling of the targeted subpopulations occurred through specific outreach efforts through community partners. Oversampling ensured that needs and assets specific to this subpopulation of interest were captured.
The survey instrument was available in both English and Spanish via the following methods:
• Qualtrics link and QR code
• Phone line (888-964-6620)
• Paper surveys (collected by volunteers and/or staff of partner agencies)
Outreach strategies for survey distribution included:
• Social media
• Flyers and posters distributed throughout the community with survey QR code, URL and phone line information
• Survey URL posted on partner agency websites
• Recruitment of participants on site at CHAT member organizations
In total, 435 surveys were collected and validated. Full survey results and validation methodology can be found in Appendix D.
All responses were entered into Qualtrics by survey respondents or, in the case of surveys completed on paper, by Carilion staff. Surveys were analyzed and reported using Qualtrics and Microsoft Excel.
Stakeholder Listening Sessions and Survey
CHAT members were invited to provide an additional perspective on the needs and barriers to health facing our community. Carilion staff from across the organization facilitated small group discussions. To quantify focus group data, CHAT members were asked to complete the Stakeholder Survey. A summary of the data can be found in appendix E.
Community stakeholders, leaders and providers were encouraged to complete the Stakeholder Survey after participating in a listening session. The online survey was shared at the CHAT meetings and via email. Surveys were analyzed and reported using Qualtrics and Microsoft Excel.
Community Listening Sessions
Community members were invited to participate in Community Listening Sessions to collect qualitative data to further understand health-related needs. A facilitated listening session was held with clients of the Franklin County Public Library System. A summary of the data can be found in Appendix E.
Secondary Data
Secondary data came from two primary sources: SparkMap and the VDH Division of Population Health Data. SparkMap is a product from the University of Missouri that quickly and accurately aggregates data across geographies for 80+ indicators from publicly available sources such as the American Community Survey, County Health Rankings and the CDC. Secondary data analysis was provided through SparkMap’s tables, maps and visual diagrams depicting indicators that are better or worse than the state average, trends over time and comparisons across different population segments such as race and life cycle.
A team of VDH epidemiology staff provided and analyzed data from specific VDH departments a critical component of the data walk. Data provided included mortality due to specific chronic diseases, incidence rates of sexually transmitted infections, sociodemographic data, cancer rates and others. VDH was also able to provide data broken down by gender and race/ethnicity for many health topics. All data shared with the CHAT for review can be found in the final section of this document, Appendix H.
Table 5. Data Sharing Summary
Community Demographic Data
Health Factors Data
Health Outcomes Data
Health & Well-Being Survey
STEP 4: Prioritize Community Health Needs
CHAT 1 Presentation
CHAT 1 Presentation
CHAT 2 Overview in Presentation
Data Packet Email prior to CHAT 3
- CHAT 1 Overview in Presentation - CHAT 2 Data Walk
Data Packet Email prior to CHAT 3
Using their community knowledge, data collectively reviewed and additional data requested and shared, CHAT members were asked to complete an electronic survey to prioritize community health needs. Prioritization topics included specific health conditions or outcomes reflecting those conditions which contribute to morbidity and mortality in the service area. The prioritization survey matched the structure utilized during the data walk at CHAT Meeting 3. This resulted in the identification of 13 community health needs.
During CHAT Meeting 3, members completed a dot voting activity to further refine the priority list. A discussion ensued to determine the final prioritized needs based on scope of issue, burden on community and feasibility to address at the community level based on CHAT member perspectives and perceptions. Appendix F summarizes the prioritization activity, including the results of each exercise component.
The 2021 FCACHA and the subsequent Implementation Strategy were posted publicly though multiple electronic channels and shared widely by community partners. An email address was provided for submission of written comments, but none were received for consideration in the identification and prioritization of health needs in the 2024 FCACHA
STEP 5: Strategic Planning to Address Priority Health Needs
The final CHAT meeting served as a springboard into both hospital and community action planning. The prioritized needs were again reviewed and a two-part activity ensued. CHAT members identified key drivers of the prioritized health outcomes/conditions using the Robert Wood Johnson County Health Rankings framework as reference. Following the identification of drivers, an impact and feasibility analysis was completed in small groups to help identify leading strategies for community change.
Our Impact: Evaluation of Actions Taken in Response to 2021 FCACHA
The prioritized needs established in the 2021 FCACHA fell into four categories: mental health, access to care, health behaviors and access to services. Key strategies included health education, grant funding to address SDOH, a community health worker intervention and support for the efforts of community partners in addressing community needs, both directly and indirectly. Below is a snapshot of outcomes from these efforts through June 30, 2024.
Our Priority: Health Equity
Carilion is part of a growing movement of health system stewards committed to unlocking our community’s potential to thrive. We, along with key partners, strive to identify and address health and socioeconomic factors that impact our communities’ health and well-being. We know that where you live is an important contributing factor of health status and outcomes. We are committed to advancing a culture of health where policies, systems, education, research and resources align for optimal health status.
Our mission calls for us to meaningfully address health inequities and disparities. Equity is a key lens for the CHA process, guiding our actions as we seek to understand community health needs. As we move forward into developing community heath improvement strategies, we will remain focused on identifying and serving those who need it most, seeking to broaden the potential for everyone across our communities to thrive.
The Area Deprivation Index (ADI), a tool developed by the University of Wisconsin-Madison, sheds light on what are considered disadvantaged areas of the community based on census block groups (neighborhoods).5 This granular data helps emphasize the importance of conditions that shape our daily lives. The image below shows the extreme variation seen across the service area in ADI scores and illustrates challenges experienced in the most rural locations. Data used in creating the index includes factors for income, education, employment and housing quality some of the key social determinant factors that influence health outcomes.
5 https://www.neighborhoodatlas.medicine.wisc.edu/
Figure 1. Area Deprivation Index Map
As we work to improve health equity across our region, our guiding principles include improving access to care and addressing SDOH This assessment focuses on those principles in the context of specific prioritized health outcomes To expect a shift in health outcomes, we must focus on improving the underlying factors that lead to them seen in the figure below in a coordinated manner. We will be addressing specific SDOH needs as aligned with the CHA focus areas.
Figure 2. Social Determinants of Health
Figure source: Institute for Clinical Systems Improvement; Going Beyond Clinical Walls: Solving complex Problems, 2014. Graphic designed by ProMedica and shared by the American Hospital Association.
Our Priority: Addressing Chronic Disease
Our prioritization process resulted in the elevation of three specific chronic diseases for focus: overweight/obesity, hypertension and diabetes The following data indicates potential areas for opportunities
Data shows need
• Residents of the service area have a higher than average occurrence of:
o Physically unhealthy days
o Obesity
o Heart disease
Why This Matters
Community indicates need
• Concern for overweight/obesity and high blood pressure was indicated through community survey
• Stress, a contributing factor of chronic disease, was also identified as a concern through the community survey
According to the Institute for Health Metrics and Evaluation (IHME), high body-mass index (BMI), high blood pressure and dietary risks are within the top 10 risks driving death and disability. In other words, these are some of the key impacts on overall health, well-being and life expectancy.6 Additionally, chronic diseases are a leading driver of health carecosts 7
Data below shows physically unhealthy days and obesity across all service area localities as reported by the CDC’s Behavioral Risk Factor Surveillance System (BRFSS). In both metrics, Henry County leads the service area as the highest
Figure 3. Physically Unhealthy Days
6 United States | Institute for Health Metrics and Evaluation (healthdata.org)
7 https://www.cdc.gov/chronic-disease/about/index.html
Heart disease and high blood pressure are also reported through BRFSS While the service area is fairly close to Virginia’s average, both localities have slightly higher rates with the highest burden in Henry County. When reviewing by census tract, key differences are apparent. The most rural, outlying areas of the county have higher rates of hypertension compared to the lessrural areas with more resources.
Figure 4. Adults With Obesity
Figure 5 High Blood Pressure
Map 1. High Blood Pressure
Source: Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System: 2021. Accessed via SparkMap.
Key Drivers
Community partners identified many key drivers of these chronic diseases, including access to healthy foods, knowledge and time to prepare healthy foods, physical activity, culture/readiness to change and the impact of stress and trauma. According to the CDC, many preventable chronic diseases are caused by the same behaviors, which include smoking, poor nutrition, lack of physical activity and excessive alcohol use. By adopting strategies to influence these behaviors, we can ultimately impact multiple diseases with coordinated strategies
Resources Available
A detailed list of community partners is available in Appendix G Key resources to address chronic diseases in the Franklin County Area include:
• Carilion health education programming
• Virginia Cooperative Extension nutrition education
• Primary care and chronic disease management through local healthcare providers
• Physical activity programs and outdoor activities
Our Priority: Addressing Mental Health and Substance Use
Our prioritization process resulted in the elevation of mental health challenges and substance use as focus areas. The following data indicates potential areas for opportunities.
Data shows need
• Compared to Virginia’s average, residents of the Franklin County Area have a higher occurrence of:
o Depressive disorder
o Cigarette smoking
• Higher occurrence of mentally unhealthy days than physically unhealthy days; mentally unhealthy days higher than Virginia average
Why This Matters
Community indicates need
• Concern for access to mental health counseling and outpatient substance use treatment was indicated through community survey
• Mental health and substance use services were indicated as a top potential quality of life improvement in the Franklin County Area
According to IHME research, drug use disorders are the number two cause of death and disability in the United States. Depressive disorders and anxiety disorders, both mental health challenges, are ranged at fifth and eighth, respectively.8 All of these health conditions have been worsening in recent years, especially in relation to the impacts of the COVID-19 pandemic.
Adults with depressive disorder, cigarette smoking and mentally unhealthy days are reported through BRFSS for the service area localities. All are higher than Virginia’s average, with Henry County experiencing highest rates for all three metrics. Despite a strong body of evidence on the negative health impacts of tobacco use, nearly 10% more adults in Henry County smoke cigarettes than Virginia’s average.
8 United States | Institute for Health Metrics and Evaluation (healthdata.org)
Figure 6. Adults With Depressive Disorder
Figure 7. Cigarette Smoking Prevalence
8. Mentally Unhealthy Days
Key Drivers
Community partners identified many key drivers of substance use, including poverty, trauma, mental health challenges, cultural acceptance and easy access to substances. Identified drivers of mental health challenges included trauma, stigma, financial circumstances and housing instability. Mental health and substance use are intertwined. Both areas can benefit from some of the same strategies, especially related to prevention. However, there are key differences in effective strategies with individuals who are actively experiencing challenges in those topic areas, which allows for all community partners to have a role in the work to address them.
Figure
Figure 9. Excessive Drinking
Resources Available
A detailed list of community partners is available in Appendix G Key resources to address mental health and substance use in the Franklin County Area include:
• Counseling, treatment and prevention services
• Harm reduction and other recovery services
• FRESH and CHILL prevention education
Our Priority: Addressing Interpersonal Violence
Our prioritization process resulted in the elevation of interpersonal violence as a focus area. The following data indicates potential areas for opportunities.
Data shows need
• Deaths from firearms are higher than average in Franklin County
• Deaths from accidents are higher than average in Franklin County and Henry County
Why This Matters
Community indicates need
• Concern about domestic violence and bullying indicated through community survey and stakeholder conversations
The American Public Health Association issued a policy brief in 2018 recommending that violence be deemed a public health crisis.9 Since that time, data shows that violence in our communities has increased. Violence as defined by the policy brief refers to “the intentional use of physical force or power, threatened or actual, against oneself, another person, or against a group or a community, which either results in or has a high likelihood of resulting in injury, death, psychological harm, maldevelopment, or deprivation ” This encompasses a wide range of challenges including child maltreatment, elder maltreatment, intimate partner violence, bullying and broader community violence.
The impact of violence is far-reaching and includes not only the directly affected individual, but also those who are exposed indirectly and the community at-large. Gun violence, for example, continues to be an issue of national concern and negatively impacts entire groups of people in addition to direct victims. Both Franklin County and Henry County see deaths from firearms at a rate higher than the Virginia average.
9 https://apha.org/policies-and-advocacy/public-health-policy-statements/policydatabase/2019/01/28/violence-is-a-public-health-issue
Key Drivers
Community partners identified many key drivers of interpersonal violence, including mental health and substance use challenges, lack of family/social support, lack of community connection, trauma, unhealthy relationships and lack of support services. Interpersonal violence can be very closely related to both SDOH and mental health and substance use challenges, further emphasizing the importance of cross-cutting strategies to address multiple health priorities.
Figure 10. Firearm Deaths
Figure 11. Deaths from Accidents
Resources Available
A detailed list of community partners is available in Appendix G Key resources to address interpersonal violence in the Franklin County Area include:
• Law enforcement
• Franklin County Family Resource Center
Next Steps
Carilion Franklin Memorial Hospital Health Improvement Strategy
Carilion will continue to work with partners and develop a Community Health Improvement Plan for the Franklin County Area, with expected completion before the end of calendar year 2024. Key focus areas will include not only the priority health outcomes, but also cross-cutting ways to address those outcomes by improving access to care and addressing SDOH.
Carilion also participates in a planning process with Healthy Franklin County, leading to the development of a community-wide strategic plan to address health needs in conjunction with hospital-specific strategics. This community-wide plan will be reviewed and updated regularly with Healthy Franklin County partners to reflect completed and ongoing initiatives and emerging needs.
Appendices
Health needs include requisites for improvement of maintenance of health status in the community at large.
Health Needs Include requisites for improvement of maintenance of health status in particular parts of the community.
Identify resources potentially available to address them. Appendix G
Solicit and take into account input from persons representing the broad interests of the community, including those with special knowledge of public health.
Include all of the following sources to Identify and prioritize significant health
501R Requirement Page
Document the CHNA in a written report that is adopted for the hospital facility by an authorized body.
Definition of community served and how this was determined. 7-9
Description of process and methods used to conduct the CHNA. 7-13
Description of how broad-interested community input was solicited and taken into account. 10-13
Description of the process and criteria used to identify needs as significant. 10-13, Appendix F
Prioritize the significant needs. Appendix F
Description of resources potentially available to address identified significant health needs. 19, 23, 26, Appendix G
Evaluation of impact of actions taken to address previous CHNA-identified significant health needs. 14
Describe the data and other information used in the assessment. 17-26, Appendix H
Describe the method of collecting and analyzing this data and information. 9-13
Identify any CHNA- related collaborative or contracted parties n/a
Describe how Carilion takes into account input received from persons representing broad interests of the community:
Describe medically underserved, low-income, or minority populations being represented by those providing input. Appendix B
Adopted by Board 3
Appendix B: CHAT List
Name Organization Type or Sector
A.W. Frith Mental Health/Substance Use
Organization Name
Piedmont Community Services
Abby White Mental Health/Substance Use Piedmont Community Services
Alex Watkins Substance Use
Virginia Harm Reduction Coalition
Alison Cronk Healthcare Carilion Clinic
Amanda Smith Healthcare Carilion Clinic
Annie Morgan Social Support
Ariel Johnson Substance Use
Bethany Philpott Health District
United Way of Roanoke Valley
Virginia Harm Reduction Coalition
West Piedmont Health DistrictIntern
Carl Cline Healthcare Carilion Franklin Memorial Hospital
Carol Tuning Disability Services Disability Rights & Resource Center
Catina Wright Substance Use
Cheryl Mosley Social Support
Christine Arena Library
Ellen Holland Free Clinic
Virginia Harm Reduction Coalition
United Way of Roanoke Valley
Franklin County Public Library
Bernard Healthcare Center / Free Clinic of Franklin Co.
Emily Waller Healthcare Carilion Family Medicine
Florence Brown Senior Services Essig Center, Office on Aging
Heidi Morris Healthcare Carilion Hospice
Holly Ostby Healthcare Carilion Clinic
Joshua Ball Public Safety
Joshua Martin Mental Health/Substance Use
Joyce Moran Child Advocacy
Kat Heredia Mental Health/Substance Use
Kim Mason Senior Services
Lashara Wade Social Support
Leslie Clark Healthy Franklin County
Lisa Lietz Academic, enrichment and food programs
Franklin County Department of Public Safety
Piedmont Community Services
Southern VA Child Advocacy Center
Piedmont Community Services
Southern Area Agency on Aging
United Way of Roanoke Valley
United Way of Roanoke Valley
SML Good Neighbors
Name Organization Type or Sector
Lucas Tuning Social Support
Lucille Bowing Community Advocate
Marcie Altice School Representative
Organization Name
United Way of Roanoke Valley
Community Member
Franklin County Public Schools
Molly Roberts Healthcare Carilion Clinic
Nancy Bell Health District
VDH- West Piedmont Health District
Nancy Oltara Tompkins Food Access Gardeners Association
Nick Bilbro Healthcare Carilion Clinic
Nicky Hale Federally Qualified Health Center Tri Area Community Health Center
Pam Chitwood Public Health
Paul Chapman Parks and Recreation
VDH-West Piedmont Health District
Franklin County Parks and Recreation
Regina Clark Mental Health/Substance Use Piedmont Community Services
Rita Pruitt Food Access
Ryan King Public Safety
Feeding SWVA
Rocky Mount Police Department
Sharon Tyree Disability Services Disability Rights & Resource Center
Sheila Overstreet Housing
Franklin County Habitat for Humanity
Shirley Holland Healthcare Carilion Clinic
Shirley Sorrentino Transportation
Stephanie Hackett Social Support
Franklin County NETS
United Way of Roanoke Valley
Sue Turner Federally Qualified Health Center Tri Area Community Health Center
Teresa Fontaine Senior Services Southern Area Agency on Aging
Tim Radford Public Safety
Tracy McCown Healthcare
Franklin County Public Safety
Carilion Franklin Memorial Hospital
Brandon Stephens Mental Health/Substance Use Piedmont Community Services
Don Mankie Food Access
Becky Ayers Public Safety
Feeding Southwest Virginia
Franklin County Public Safety
Samantha Turner Mental Health/Substance Use Piedmont Community Services
Appendix C: Community Health and Well-Being Survey
Appendix D: Survey Results and Validation Methodology
Due to the nature of the Community Health and Well-Being Survey and its public availability through online methods, data validation was necessary. To validate survey responses, data was filtered by zip codes within Carilion’s entire service area. These responses were used for further data analysis.
Appendix E: Qualitative Data Results
Appendix F: Prioritization Table
Activity Prioritization Survey Dot Voting Activity Group Discussion
Method Using their community knowledge, data collectively reviewed, and additional data shared, CHAT members were asked to complete an electronic survey to prioritize community health topics:
• The survey matched the structure utilized during the data walk at CHAT Meeting 2
• First prioritized broad categories, then specific topics within those categories
• CHAT facilitators ranked the following to develop results:
o Broad categories (resulting top 3 indicated by bold type below)
o Topics within each of the 3 top broad categories
o Remaining topics
• Results include:
o Top 3 topics of each of the top 3 broad categories
o Top 4 topics of the remaining categories
Using the results of the Prioritization Survey, the group was asked to individually choose 5 topics to prioritize:
• The CHAT facilitators hung pages around the meeting room, each with one of the topics from the Prioritization Survey results.
• Each CHAT meeting attendee was given 5 dot stickers and instructed to place one sticker on each of the 5 topics they felt were most important to address in the next three years.
• After voting was completed, the CHAT facilitators quickly tallied and ranked the results.
• The CHAT was presented with the top 5-7 topics, unranked. The number of results presented depended on any ties and how closely votes were distributed. If topics were additional (i.e. not in the true top 56), CHAT facilitators noted this to the group and separated
The group was asked to reflect on the results of the dot voting exercise. The following points were made during that discussion:
• Poor mental health vs. Substance use vs. Overdose
o Poor mental health should be considered separately from Substance use
o There were differing opinions on whether overdoses should be included with substance use. They could be combined as one category with separate goals/objectives developed during the strategic planning phase.
o Substance Use should include tobacco use, vaping and both youth and adults.
• Overweight/obesity, diabetes and high blood pressure could be combined into one category titled Metabolic Syndrome.
Activity Prioritization Survey Dot Voting Activity Group Discussion
them visually on the screen.
Results* Mental Health/Substance Use
• Substance use
• Poor mental health
• Overdoses
Chronic Disease
• Overweight/obesity
• Diabetes
• High blood pressure
Injury/Violence
• Domestic violence/intimate partner violence
• Motor vehicle crashes
• Childhood injury
Maternal/Child Health & Infectious/Communicable Disease
• Teen pregnancy
• Infant mortality
• STIs
• Hepatitis C
Top 6:
• Substance use
• Poor mental health
• Overdoses
• Overweight/obesity
• Domestic violence/intimate partner violence
• Diabetes Additional:
• High blood pressure
Top 6:
• Domestic violence/intimate partner violence
• Overweight/obesity
• Diabetes
• High blood pressure
• Substance Use (ATOD, youth and adult, overdoses)
• Poor mental health
*Results are not presented in any ranked order.
Appendix G: Resources to Address Prioritized Needs
The following organizations have been identified in the community that address the prioritized needs. Additional community resources are available, but the included list was considered representative of the primary organizations addressing each topic area at the time of this report’s publication.
Appendix H: Data Packets
The following pages include secondary data shared with the CHAT as well as chronic disease hospitalization data accessed through the Virginia Hospital and Healthcare Association (VHHA) Analytics data portal.
Key Takeaways- Secondary Data shared with the CHAT for Data Walk
Leading causes of death (2018-2021); generalized across service area
1. Diseases of the heart
2. Malignant neoplasms
3. COVID-19
4. Accidents (unintentional injuries)
5. Cerebrovascular disease
Mental Health/Substance Use
• Overdose deaths have generally been increasing across both localities, and increased steeply in Henry County between 2020 and 2021. Both localities have a rate higher than that of VA.
• Overdose hospitalizations are decreasing in Franklin County and dipped below the VA rate for 2021. Henry County is also generally decreasing, though experienced an increase from 20202021, jumping above Franklin County and VA.
• Self-reported data on adults who are current smokers indicates a higher percentage across service area than Virginia and the US by about 5%.
Maternal/Child Health
• Teen birth rates are slightly higher in both localities than VA, with the highest rate in Henry County.
• Both localities appear to be decreasing in teen pregnancy rates, though both are higher than the VA average.
• Henry County has a high rate of women smoking during pregnancy.
Injury/Violence
• Both localities have a high rate of fatal motor vehicle crashes occurring within the locality (location of the crash), at more than twice the state rate.
• A similar trend exists for alcohol-involved motor vehicle crash deaths, though the rates are fairly low (6.5 per 100,000 population across Franklin County Area).
• Unintentional injury deaths also occur at a higher rate in the service area than in VA or the US, at 75.4 deaths per 100,000 population compared to 45.3 per 100,000 population in VA.
Infectious/Communicable Disease
• Chlamydia and gonorrhea rates are lower across the service area than VA. Chlamydia diagnoses remained fairly consistent from 2017-2021 (the most recent years available), while Gonorrhea diagnoses are more variable particularly for Henry County.
• Both localities have a lower rate of newly identified Hepatitis C cases (2022) compared to the peak year of 2019. VA data for the years 2018-2020 show the service area to have higher rates of Hepatitis C than VA. Statewide data was not available as a rate for 2021 and 2022.
Chronic Disease
• Chronic disease hospitalizations are highest for hypertension and diabetes and are a little higher than the VA rates.
• Mortality due to heart disease and diabetes is higher across the service area than Virginia.
• Mortality due to COPD jumped above the VA rate in 2020 and remained higher than VA in 2021.
• Stroke mortality is less than the VA average in Franklin County while being a little higher than VA in Henry County.
