Tazewell County Implementation Strategy FY 2025-2027

Tazewell County Community Health Assessment HEALTH IMPROVEMENT IMPLEMENTATION STRATEGY FY 2025-2027 NOVEMBER 30, 2024

Carilion Tazewell Community Hospital CarilionClinic.org/community-health-assessments

Contents

Carilion Tazewell Community Hospital Health Improvement Implementation Strategy ............... 3 Overview ................................................................................................................................ 3 Community Served ................................................................................................................. 3 Target Population ................................................................................................................... 4 Priority Health Needs.............................................................................................................. 4 Drivers of Priority Health Needs.............................................................................................. 4 Board Adoption....................................................................................................................... 4 Disclaimer .............................................................................................................................. 5 CTCH Action Plan ...................................................................................................................... 6 Access to Care ....................................................................................................................... 6 Community Partnerships ........................................................................................................ 6 Community Grants.................................................................................................................. 6 Carilion’s Mission and Health Equity ....................................................................................... 6 Priority Areas to Be Addressed .................................................................................................. 8 Chronic Disease ..................................................................................................................... 8 Mental Health/Substance Use ................................................................................................ 9 Injury/Violence .......................................................................................................................10 Strategies Impacting Multiple Priority Areas ..........................................................................11 About Us ...................................................................................................................................12 Appendices ...............................................................................................................................13 Appendix 1: Community Health Assessment Team............................................................13 Appendix 2: Community Health Need Prioritization Activity Table ......................................14

2

Carilion Tazewell 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 Tazewell County 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 Tazewell County Community Health Assessment (TCCHA) 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 and the Cumberland Plateau Health District (CPHD) partnered to conduct the 2024 TCCHA alongside additional community partners, the Community Health Assessment Team (CHAT). After review and discussion of the data collected, the 2024 TCCHA 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 Medical Center’s (CMC) 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 CMC Board of Directors twice yearly.

Please visit https://carilionclinic.org/community-health-assessments to review the full 2024 TCCHA.

Community Served

In fiscal year 2023, CTCH served 7,351 unique patients. Patient origin data revealed that during this year, 94% of those patients lived in Tazewell County. Therefore, the 2024 TCCHA focused on the Tazewell County community.

3

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 TCCHA resulted in the following health priorities:

Chronic Disease

Overweight/Obesity Diabetes Hypertension

Mental Health and Substance Use

Poor Mental Health Substance Use Depression

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 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 CTCH Board of Directors on November 20, 2024, and formally adopted as the 2024 Tazewell County Community Health Assessment Health Improvement Implementation Strategy.

4

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.

5

CTCH 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, such as establishing the Family and Community Medicine practice in Bluefield. Not only does this facility provided primary care for the community, but also functions as a telehealth hub for specialty care including General Surgery, Orthopaedics, Urology and Pulmonology. 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 work to improve health. In Tazewell, we will continue to support community-focused organizations on initiatives to improve health, wellness and address SDOH, while also facilitating the creation of a sustaining health-focused collaborative to directly address community-identified health needs in fiscal years 2025-2027.

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.

6

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.

7

Priority Areas to Be Addressed Chronic Disease

Overweight/obesity, diabetes and hypertension Goal: Improve health behaviors and outcomes for individuals with overweight/obesity, diabetes and hypertension who are also experiencing health-related social needs Strategy

Metrics

Resources

Collaborators

Timeline

Explore implementation of a fruit and vegetable prescription program

• Number of participants • Value of prescriptions redeemed • Participant food insecurity, body weight and blood pressure

• Designated staff and department support

Carilion Community Health and Outreach, Carilion Family and Community Medicine, Appalachian Sustainable Development, Four Seasons YMCA

FY25 – FY27

Implement Healthy Heart Ambassadors program

• Number of participants • Participant blood pressure

• Designated staff and department support • CDC grant via VHHA Foundation

Carilion Community Health and Outreach, Carilion Family and Community Medicine, VDH, VHHA Foundation

FY25 – FY27

Implement evidence-based health and nutrition education programs

• Number of participants • Participant dietary behaviors and physical activity frequency

• Designated staff and department support

Carilion Community Health and Outreach, Carilion Family and Community Medicine, Carilion Wellness

FY25 – FY27

8

Mental Health/Substance Use

Poor mental health, substance use and depression Goal: Increase access to and capacity of mental health and substance use services for lowincome individuals Strategy

Metrics

Resources

Collaborators

Timeline

Expand Carilion’s peer support specialist workforce

• Number of staff across service area • Number of referrals and consults

• Staff and department leadership

Carilion Community Health and Outreach, Carilion Mental Health, Carilion Women’s, other internal departments as applicable

FY25 – FY27

Implement evidence-based mental health education and wellbeing programs

• Number of participants • Participant stress management skills, anxiety and depression symptom frequency and resilience indicators

• Designated staff and department support

Carilion Community Health and Outreach, Carilion Mental Health, Carilion Women’s, Carilion Wellness, Tazewell Community Health Center

FY25 – FY27

9

Injury/Violence

Interpersonal violence Goal: Decrease the prevalence of interpersonal violence across the service area Strategy

Metrics

Resources

Collaborators

Timeline

Work with forensic nursing program to identify opportunities and fill gaps in transitioning patients from acute care to the community

• 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

Clinch Valley Community Action

FY25 – FY27

10

Strategies Impacting Multiple Priority Areas Goal: Create a system of care that addresses health-related social needs within the community and clinical services Strategy

Metrics

Resources

Collaborators

Timeline

Facilitate the development of a sustaining collaborative focused on improving health and well-being in Tazewell County

• Milestones: o Inaugural meeting o Standard meeting schedule set o Meeting logistics covered by another entity o End of facilitation support • Number and types of organizations at meetings

• Department leadership • Staff support

Cumberland Plateau Health District, Tactical Retreat Unplugged

FY25-27

Expand Carilion’s community health worker workforce

• Number of staff across service area • Number of referrals and consults

• Staff and department leadership

Carilion Community Health and Outreach, other internal departments as applicable

FY25 – FY27

Implement pop-up clinic model for safety net partnerships

• Number of clinics held • Number of patients seen and types of services received

• Department leadership • Staff support • Clinical supplies

Carilion Family and FY25Community FY27 Medicine

Develop employee volunteer program to support the capacity of local organizations working to address CHAidentified 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

Internal collaboration

FY25

11

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 Tazewell Community Hospital (CTCH) is located in Southwest Virginia in Tazewell County. CTCH is a not-for-profit, 56-bed hospital dedicated to quality care and patient comfort.

We support an extended care recovery program (Swing Bed) that gives eligible patients an opportunity to grow stronger before going home. CTCH hosts diagnostic services such as advanced imaging, including screening mammography, and therapy services, including physical therapy and respiratory therapy. CTCH offers 24/7 emergency services and can arrange access to higher levels of care if needed. Medicated Assisted Therapy (MAT) services are available on our campus through the local Federal Qualified Health Center’s (FQHC) New Day Recovery Program. Primary care is available through Carilion Clinic Family and Community Medicine and the Tazewell Veteran’s Outpatient Clinic.1

1 https://www.carilionclinic.org/locations/carilion-tazewell-community-hospital

12

Appendices Appendix 1: Community Health Assessment Team Name

Organization Type

Brian Beck

Transportation/Older Adults

Holly Otsby Nick Bilbro Ashley Hash Molly Roberts

Community Health Improvement Community Data Analysis Community Health Improvement Community Benefit Peer Support Specialist/Community Health Worker

Penny Shelton Karen Mulkey

Health Education

Alicia Bales Kim Brown Jennifer Bourne Jordan Dillon Anne Coates Curtis Breeding Ema Johnson

Healthcare Emergency Medicine Safety-Net Services Planning/Development Safety-Net Services Transportation/Economic Development Recidivism Reduction Alternative Care - Mental/Behavioral Health Local Business Representative Community Spaces Community Spaces Public School K-12 Public Safety Public Safety Child Development - 4H Family Consumer Science Child Development - 4H Public Health Public Health (Data) Public Health (Maternal and Child Health) Public Health (Pop Health Coordinator) Public Health Private Health Coaching Service

Matthew Brandt Keisha Cole Erica Galloway James C. Wilkes Chris Stacy Teresa Stiltner Randy Ann Davis Kathy Dalton Kristen Gibson Tammy Sparks Cecil Peck Paige Lucas Victoria Bartfai Daniel Hunsucker Reisa L. Sloce Susan Jewell

Organization Name Appalachian Agency for Senior Citizens/Four County Transit Carilion Community Benefit Carilion Community Benefit Carilion Community Benefit Carilion Community Benefit Carilion Community Health and Outreach Carilion Community Health and Outreach Carilion Tazewell Community Hospital Carilion Tazewell Community Hospital Clinch Valley Community Action Cumberland Plateau Planning District Department of Social Services Industrial Development Authority (IDA) Project13Three Tactical Retreat Unplugged Tazewell Chamber of Commerce Tazewell County Public Library Tazewell County Public Library Tazewell County Public Schools Tazewell County Sheriff's Office Town of Tazewell Sheriff's Office- E911 VA Cooperative Extension VA Cooperative Extension VA Cooperative Extension Cumberland Plateau Health District Cumberland Plateau Health District Cumberland Plateau Health District Cumberland Plateau Health District Cumberland Plateau Health District Vibrant H&W Coaching

13

Results*

Method

Appendix 2: Community Health Need Prioritization Activity Table Prioritization Survey

Dot Voting Activity

Group Discussion

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

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 6 (ties present): • Substance use • Mental health • Depression • Overweight/obesity • Diabetes • Domestic violence/Intimate partner violence

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 Yes, mental health, substance use, and overdose are all intertwined, but so are many of the other identified areas (for example, STIs & Hep C w/Sub use) • Violence in more general, not just domestic violence/Intimate partner violence • Consider how certain communities/groups are impacted more than others: o Food insecure o Unstably housed

Mental Health/Substance Use • Substance use • Poor mental health • Depression Chronic Disease • Overweight/obesity • Diabetes • High blood pressure Maternal/Child Health • Teen pregnancy • Infant mortality • Low birthweight Injury/Violence & Infectious/Communicable Disease • Domestic violence/Intimate partner violence • Firearm injuries/deaths • Motor vehicle crashes • STIs • Hepatitis C

Top 5: • Substance use • Mental health (including depression) • Overweight/obesity • Diabetes • Violence

*Results are not presented in any ranked order.

14