Carilion Giles Community Hospital
CarilionClinic.org/community-health-assessments
Carilion Giles Community Hospital Health Improvement Implementation Strategy
Overview
Carilion Clinic is committed to joining with our partners to pursue the essential work of improving and maintaining the health of the Giles 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 Giles County Area Community Health Assessment (GCACHA) 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, Giles County FOCUS (Focus on Communities Utilizing Services) and the New River Health District collaborated to conduct the 2024 GCACHA alongside additional community partners, the Community Health Assessment Team (CHAT). After review and discussion of the data collected, the 2024 GACHA led the CHAT to identify seven priority health issues in the community.
As a component of our systemwide Community Health and Equity Improvement and Investment Plan, this Implementation Strategy (IS) gives an overview of key components of the localized response to community needs within Carilion Giles Community Hospital (CGCH) service area. This plan applies to fiscal years 2025-2027 and will be updated as appropriate with the identification of new programs and strategy updates. Progress on initiatives described in this document will be reported to the CGCH Board of Directors twice yearly.
Please visit https://carilionclinic.org/community-health-assessments to review the full 2024 GCACHA.
Community Served
Based on patient origin data, the service area for the 2024 CGCH included Giles County, Virginia, and Monroe County, West Virginia. It is important to note that Giles County is considered part of a regional area called the New River Valley (NRV) and is partly served by Carilion New River Valley Medical Center (CNRV) located in Christiansburg, Virginia. Giles is located at the northern edge of the NRV region, sitting along the West Virginia state border. A mountain ridge runs along the border, somewhat dividing Giles County from the rest of the NRV home to universities, shopping and business centers.
Target Population
The target population for Carilion’s CHA projects consists of underserved/vulnerable populations disproportionately impacted by the social determinants of health (SDOH), including poverty, race/ethnicity, age, education, access and/or lack of insurance. Strategies are implemented to impact specific populations and life-stages, including parents of young children and adolescents, women of child-bearing age, adults and the elderly. Other considerations include race, ethnicity and income levels. Distinct efforts were taken to ensure the CHA reflects those residing in Medically Underserved Areas and Health Professional Shortage Areas, and all patients were considered in the assessment regardless of insurance status or financial assistance eligibility
Priority Health Needs
In collaboration with the CHAT, we identified key health needs to align resources and other efforts for the following three years. The CHAT reviewed extensive data, asked questions and participated in a consensus-building prioritization process. The 2024 GCACHA resulted in the following health priorities:
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 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. Some strategies included in this plan are intended to impact the root causes of health.
Board Adoption
This document was approved by the CGCH Board of Directors on November 20, 2024, and formally adopted as the 2024 Giles County Area Community Health Assessment Health Improvement Implementation Strategy
Disclaimer
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.
CGCH Action Plan
While the focus of this plan is on new and innovative programs and initiatives, we will continue to respond to community health needs through ongoing efforts, including:
• Ensuring access to state-of-the-art healthcare close to home,
• Working with other organizations on community-wide strategies to reduce barriers, coordinate resources and enhance community strengths,
• Providing community-based health and wellness programming, and
• Providing targeted grants for community health improvement.
Access to Care
We address access to care in numerous ways to ensure our patients can access the type of care they need, when and how they need it. We do this by expanding our services and updating our facilities, including a regular rotation of specialty service providers at the Giles Medical Office Building We focus on giving patients more choices about how they receive care and communicate with their providers by utilizing digital health initiatives and other advancements Through projects that look at internal efficiencies, we are making it easier for patients to get appointments and be proactive about their health.
Community Partnerships
Carilion believes in the power of collaboration and understands that area health issues must be addressed together, with the community. To ensure lasting impact from the health assessment and community health improvement process, Carilion provides support to coalitions that address area needs, such as Giles County FOCUS FOCUS is an initiative that works to identify under-resourced neighborhoods and increase access to preventative and supportive services In addition, Carilion partners with multiple organizations and coalitions on initiatives to improve health, wellness and address SDOH
Community Grants
Carilion’s community grants help build and sustain community health improvement programs through partner organizations Each year, Carilion provides grants and community health sponsorships to help local charitable organizations fulfill their missions as they relate to the health and well-being of our communities. Community grant dollars are allocated across Carilion’s entire service area based on requests that align with CHA priorities, with particular focus on helping members of underserved communities with little access to services.
Carilion’s Mission and Health Equity
Our mission improving the health of the communities we serve 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. Community heath improvement strategies are focused on identifying and serving those who need it most, seeking to broaden the potential for everyone across our communities to thrive.
The Vital Conditions for Health and Well-Being is a widely adopted framework that asserts that there are two ways to safeguard the health and well-being of a community:
Image source: https://rippel.org/vital-conditions/
This framework provides an important lens for assessing opportunities to respond to health inequities Its balanced approach helps people facing adversity today (urgent services) while also addressing conditions that reduce the number of people who need crisis services (vital conditions). As we seek to improve the health of the community, we are mindful of this balance to encourage thriving communities
In addition to focusing on the community at-large, we also consider how we can support health equity for our employees. One mechanism by which we support our employees is through our employee benefits program with tiered premiums corresponding to employee salary ranges Other examples include financial support for dependent care and a robust employee wellness program which provides regular programming to improve both physical and mental health and well-being. Additionally, employees can participate in programs such as evidence-based health education and work with community health workers to navigate SDOH needs. We also have an employee emergency fund to help fill gaps in times of need. Through other programs such as YES and Grow Our Own, we provide opportunities for entry-level employees to gain skills and education leading to higher pay careers at little-to-no-cost to the employee. We continue to seek innovative ways to support employee health, well-being and ability to thrive.
Priority Areas to Be Addressed
Chronic Disease
Overweight/obesity, hypertension and heart disease
Goal: Improve health behaviors and outcomes for individuals with overweight/obesity, hypertension and heart disease who are also experiencing health-related social needs
Strategy Metrics
Explore implementation of a fruit and vegetable prescription program
Implement Healthy Heart Ambassadors program
• Number and type of partners engaged in planning
• Additional metrics will be added following implementation
Resources Collaborators Timeline
• Designated staff and department support
Carilion Community Health and Outreach, Carilion Family and Community Medicine, Thrive NRV, Giles Christian Service Mission, Giles Community Garden
FY25 –FY27
Implement evidence-based health and nutrition education programs
• Number of participants
• Participant blood pressure
• Number of participants
• Participant dietary behaviors and physical activity frequency
• Designated staff and department support
• CDC grant via VHHA Foundation Carilion Community Health and Outreach, Carilion Family and Community Medicine, VDH, VHHA Foundation, Giles County FOCUS
• Designated staff and department support Carilion Community Health and Outreach, Carilion Family and Community Medicine, Carilion Wellness, Giles County FOCUS
FY25 –FY27
FY25 –FY27
Mental Health/Substance Use
Mental health challenges and substance use
Goal: Increase access to and capacity of mental health and substance use services for lowincome individuals
Strategy Metrics
Expand Carilion’s peer support specialist workforce
• Number of staff across service area
• Number of referrals and consults
Implement evidence-based mental health education and well-being programs
• Number of participants
• Participant stress management skills, anxiety and depression symptom frequency and resilience indicators
• Staff and department leadership
• Designated staff and department support
Carilion Community Health and Outreach, Carilion Mental Health, other internal departments as applicable
Carilion Community Health and Outreach, Carilion Mental Health, Carilion Women’s, Carilion Wellness, Giles County FOCUS
FY25 –FY27
FY25 –FY27
Injury/Violence
Interpersonal violence
Goal: Decrease the prevalence of interpersonal violence across the service area
Strategy Metrics
Work with forensic nursing program to identify opportunities and fill gaps in transitioning patients from acute care to the community
Convene local and external partners to explore collaborative initiatives to reduce interpersonal violence in Giles County
• Number of patients seen
• Number of patients referred to community organizations
• Number and types of resources provided
• Department support
• Financial support to address SDOH needs
• Number and type of partners convened
• Designated staff and leadership support
Women’s Resource Center of the NRV, New River Valley Community Services, New River Valley Community Action
Carilion Forensic Nursing, Virginia Commonwealth Attorney’s Office, local law enforcement
FY25 –FY27
FY25
Dental Health
Goal: Increase access to and capacity of affordable dental health care across the service area
Strategy Metrics Resources Collaborators Timeline
Support collaborative, communityidentified efforts to increase access to dental care.
• Number and types of organizations engaged during strategy development conversations
• Designated staff and leadership support
PATH NRV; Community Health Center of the New River Valley; Giles County FOCUS
FY25 –FY27
Strategies Impacting Multiple Priority Areas
Goal: Create a system of care that addresses health-related social needs within the community and clinical services
Strategy
Support the creation of a community wellness center and resource hub
Expand adolescent health and other wraparound services
Explore pop-up clinic model for safety net partnerships
Expand Carilion’s community health worker workforce
• Milestones:
o Center opening
o Carilion services started
• Number and types of services provided by Carilion
• Milestones:
o Business case approval
o Complete Epic build
• Number of clinics held
• Number of patients seen and types of services received
• Number of staff across service area
• Number of referrals and consults
• Staff support
• Financial support
Giles County Administration
Develop employee volunteer program to support the capacity of local organizations working to address CHA-identified needs
• Development of employee volunteer program
• Number of employees engaged in volunteerism
• Financial value of employee time supporting organizations addressing community health needs
• Department leadership
• Staff support
• Clinical supplies
• Department leadership
• Staff support
• Clinical supplies
Giles County Public Schools, Carilion Children’s
New River Health District FY26 –FY27
• Staff and department leadership Carilion Community Health and Outreach, other internal departments as applicable
• Department leadership
• Staff support
FY25 –FY27
Internal collaboration FY25
About Us
Carilion Clinic is a not-for-profit, integrated healthcare system located among the Blue Ridge Mountains. Carilion provides quality care for nearly one million individuals through a comprehensive network of hospitals, primary and specialty physician practices, wellness centers and other complementary services. Our roots go back more than a century when a group of dedicated citizens came together and built a hospital to meet the community’s healthcare needs. Today, Carilion is a vital anchor institution focused on healthcare and dedicated to our mission of improving the health of the communities we serve.
With an enduring commitment to our region’s health, we advance through clinical services, medical education, research and community health investments. Carilion believes in service, collaboration and caring for all. We invest in discovering and responding to local and regional health needs, understanding that we must involve additional stakeholders to address community health issues and create change effectively.
Carilion recognizes the impact the environment has on the health of our communities. Efforts continue to make our hospitals and other facilities more energy-efficient, increase recycling and use of recyclable or bio-degradable materials, reduce waste materials and serve local, sustainable foods to patients and in our cafeterias. Carilion has an office of sustainability which leads these efforts and empowers employees to be involved in environmental health related projects.
Carilion Giles Community Hospital (CGCH) is a modern, 25-bed Critical Access hospital, offering emergency services recognized nationally for quality and patient satisfaction in addition to high-quality inpatient care and an extended care recovery program (Swing Bed) that gives eligible patients an opportunity to grow stronger before going home. The main entrance serves as the access point for all walk-in patients needing emergency care, diagnostics, rehabilitation and other outpatient services. CGCH works to bring new services to the community as the need is identified. 1
1 https://www.carilionclinic.org/locations/carilion-giles-community-hospital
Appendices
Appendix 1: Community Health Assessment Team
Participant Organization Type Organization Name
Allison Patrick Veteran's Services
Andi Golusky Children's Violence Prevention Resources
Andy Wilburn Transportation
Ann Goette Children's Education/Reading Access
Anne Spangler Agency on Aging
Ashley Hash Community Health Improvement
Beverly Hill
Public Health - Local Health District
Bobby Lilly Commonwealth's Attorney
Brittany Long Agency on Aging
Caroline Jones Public Health (Student)
Caryl Allen County Administration
Cayla Trueheart Public Health - Local Health District
Charlie Herbert Food Access
Chris McClarney County Administration
Christien Poe
Public Health - Local Health District
Dana Carhart Public Health (Student)
Deanna Williams
Emil Morris
Domestic Violence Resources
Emily Moye Cooperative Extension (FNP)
Erica Short Public Health - Local Health District
Helen Wallace Adult & Child Day Care/Transportation
Holly Lesko Economic Development
Holly Otsby Community Health Improvement
Jeff Dinger County Administration
Jennifer Darnell Public Health - Local Health District
Jesse Glover Public School - K-12
Jessica Wirgau Philanthropy/Community Development
Jim Nelson Healthcare
John Hale County Administration
Jon Butler County Administration
Joshua McDonald Veteran's Services
Katie Stinnett Public Health - Local Health District
Kim Snider Agency on Aging
Kinsey Weaver Economic Development
Kristie Williams Healthcare
Lesia Palmer Food Access
Margaret Hurst Early Childhood Network Development
Mike Evans County Administration
Virginia Department of Veterans Services
NRV Cares
Giles Health and Family
Giles Early Education Project
NRV Agency on Aging
Carilion Community Benefit
New River Health District (NRHD)
Commonwealth's Attorney Office
NRV Agency on Aging
Virginia Tech
Giles County Administration
New River Health District (NRHD)
Giles Community Garden
Giles County Administration
New River Health District (NRHD)
Virginia Tech
Women's Resource Center of the NRV
VA Cooperative Extension
New River Health District (NRHD)
Giles Health and Family
NRV Regional Commission
Carilion Community Benefit
Giles County Administration
New River Health District (NRHD)
Giles County Public Schools
The Community Foundation of the NRV
Monroe Health Center
Giles County Administration
Giles County Administration
Virginia Department of Veterans Services
New River Health District (NRHD)
NRV Agency on Aging
NRV Regional Commission
Carilion Giles Community Hospital
Giles County Christian Service Mission
First Steps NRV/CFNRV
Giles County Administration
Participant Organization Type
Molly Buckwalter-Fairfield Low-Income Community Resources
Molly Roberts Community Health Improvement
Morris Fleischer Faith Community
Nick Bilbro Community Health Improvement
Noelle Bissell Public Health - Local Health District
Pam Ray Public Health - Local Health District
Patty Hall Domestic Violence Resources
Samuel "Lakin" Barnes Health Education
Sheri Nipper-Williams Department of Social Services
Stephanie Spencer Health Education
Susan Dalrymple Cooperative Extension (FNP)
Suzanne Woodward Public School - K-12
Tamy Mann Victim Advocacy Resources
Tanya Patteson Public School - K-12
Walter Midkiff Economic Development
Zaria Solk Public Health - Local Health District
Organization Name
New River Community Action
Carilion Community Benefit
Giles Ministerial Association
Carilion Community Benefit
New River Health District (NRHD)
New River Health District (NRHD)
Women's Resource Center NRV
Carilion Community Health and Outreach
Giles County DSS
Carilion Community Health and Outreach
VA Cooperative Extension
Narrows High School
Giles Victim Witness
Narrows High School
NRV Regional Commission
New River Health District (NRHD)
Method
Appendix 2: Community Health Need Prioritization Activity Table
Prioritization Survey Dot Voting Activity
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 5 topics of the remaining categories
Mental Health/Substance Use
• Substance use
• Poor mental health
• Overdoses Chronic Disease
• Overweight/obesity
• Heart disease
• Poor dental health Injury/Violence
• Firearm injuries/deaths
• Domestic violence/intimate partner violence
• Motor vehicle crashes
• Childhood injury
Maternal/Child Health & Infectious/Communicable Disease
• Teen pregnancy
• Infant mortality
• STIs
• Hepatitis C
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 5), CHAT facilitators noted this to the group and separated them visually on the screen.
Top 5:
• Substance use
• Mental health
• Overweight/obesity
• Heart disease
• Domestic violence/intimate partner violence
Additional:
• Overdoses
• Poor dental health
Group Discussion
The group was asked to reflect on the results of the dot voting exercise. The following points were made during that discussion:
• “Mental health” vs. “Substance use” vs. “Overdose”
o Substance misuse often cooccurs with undiagnosed mental health disorder(s)
o Victims of violence often use/misuse substances to cope.
o Importance of addressing stigma
• Important to include “intimate partner violence” not just “domestic violence”.
• “Overweight/obesity” & “Heart disease” vs. “Chronic disease”
o Drill down to what is actionable?
o How far do we want to go as a community?
• Many of these are interrelated and closely connected to social determinants of health transportation was discussed specifically.
Top 5:
• Mental health
• Substance use
• Chronic Disease (Overweight/obesity & Heart disease)
• Domestic violence/intimate partner violence
• Dental health
*Results are not presented in any ranked order.