2015 Greater Worcester Community Health Assessment 2015 by UMass Memorial Health

Facilitating Partners Mónica Escobar Lowell, UMass Memorial Health Care, Inc. Kimberly Salmon, Fallon Health Karyn Clark, City of Worcester Division of Public Health Kimberly Reckert, UMass Memorial Medical Center Steering Committee Frances Anthes, Family Health Center of Worcester Dan Daniska, Central MA Regional Planning Commission Toni McGuire, Edward M. Kennedy Community Health Center Chris Ryan, Central MA Regional Planning Commission Linda Cavaioli, YWCA of Central MA Advisory Committee Kathy Esparza, YWCA of Central MA Alicia Cianciola, Community Harvest Project Ahn Vu Sawyer, South East Asian Coalition Dr. Alexis Travis, March of Dimes Karen Lajoie, Worcester Public Schools Dr. Deb McGovern, Worcester Public Schools Noreen Johnson-Smith, Family Health Center of Worcester Dr. Heather-Lyn Haley, UMass Medical School Dr. Suzanne Cashman, UMass Medical School Meegan Remillard, UMass Medical School James Powers, Worcester Police Department Amy Waters, Worcester Senior Center Jodi Koeman, UMass Medical School LizSheehanCastro,WorcesterFood&ActiveLivingPolicyCouncil Karin Valentine Goins, WalkBike Worcester

Casey Burns, Regional Environmental Council of Worcester Cathy O’Connor, MA Department of Public Health Shelly Yarnie, MA Department of Public Health Dr. Jan Yost, Health Foundation of Central MA Elaine Cinelli, Health Foundation of Central MA Ruth Seward, Worcester Tree Initiative Tim Garvin, United Way of Central MA John O’Brien, Clark University Mosakowski Institute for Public Enterprise Dr. Laurie Ross, Clark University Timothy McGourthy, Worcester Regional Research Bureau Carol Manning, Worcester Public Schools Jerry Powers, WalkBike Worcester Michelle Ellicks, MA Registry of Motor Vehicles Kelsa Zareski, Reliant Medical Group

Dr. Sarai Rivera, City Council District-4 Amy Borg, UMass Medical School TinaGrosowsky,CentralMATobaccoFreeCommunityPartnership Christine Frisard, UMass Medical School Dianne Bruce, Edward Street Child Services MaryBeth Burke, Worcester Regional Research Bureau Patti McKone, American Cancer Society Susan Hunt, College of the Holy Cross Waldo Zamor, UMass Medical School Dr. Janet Hale, UMass Graduate School of Nursing Thuha Le, Family Health Center of Worcester Brian Monteverd,RegionalEnvironmentalCouncilof Worcester

Dr. Stephenie Lemon, UMass Medical School Terri Russo, UMass Memorial Medical Center

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Facilitating Partners and Contracted Partners

Steering Committee

Advisory Committee

1. Community Health Status Assessment

2. Community Themes and Strengths Assessment

4. Forces of Change Assessment

Prioritization

                 

Data Source: US Census, 2010

Grafton

27.3%

Holden

26.4%

Leicester

23.2%

Millbury

22.8%

Shrewsbury

19.0% 14.2%

Worcester

26.7% 0%

19 Years or Younger

20% 20-34 Years

35-44 Years

13.4%

25.1%

12.8%

40%

16.0%

26.8%

16.3% 24.9%

13.5%

29.4%

15.1%

23.1%

14.8%

30.9%

16.6%

16.5%

10.3%

31.7%

13.8%

15.1%

19.6%

28.5%

12.9%

18.6%

28.1%

West Boylston

14.9%

23.5%

60% 45-64 years

Data Source: U.S. Census Bureau, American Community Survey, 2013

15.9% 12.1%

80%

100%

65 Years or Older

100% %Native Hawaiian and Other Pacific Islander, non-Hispanic %American Indian and Alaska Native, non-Hispanic %Other Race, non-Hispanic

90% 80% 70% 60% 50%

%Two or More Races, nonHispanic %Asian, non-Hispanic

40% 30% 20%

%Black or African American, non-Hispanic %Hispanic or Latino

10% 0%

%White, non-Hispanic

Data Source: U.S. Census Bureau, Decennial Census, 2010

Grafton Holden Leicester Millbury Shrewsbury West Boylston Worcester Massachusetts

Speak English Very Well

Speak only English

Speak Spanish

Speak other European Languages

Speak Asian Languages

Speak other Languages

97.0% 98.2% 95.2% 99.2% 89.4% 98.2% 82.5% 91.1%

84.9% 90.8% 89.2% 92.7% 75.4% 92.9% 65.2% 78.1%

2.3% 1.0% 4.7% 2.2% 2.4% 4.6% 16.8% 8.1%

7.9% 5.2% 3.3% 3.6% 11.5% 2.2% 8.6% 8.9%

4.5% 2.5% 1.8% 0.9% 8.5% 0.1% 4.9% 3.8%

0.3% 0.6% 0.9% 0.6% 2.1% 0.2% 4.5% 1.2%

% Native U.S. Citizen MASSACHUSETTS WORCESTER

% Foreign Born

% Naturalized U.S. Citizen 84.9

15.0

79.1

20.9

WEST BOYLSTON SHREWSBURY

HOLDEN GRAFTON

7.6

7.4

10.3

10.6

97.1 80.2

2.9 1.71

19.8

MILLBURY LEICESTER

% Not a U.S. Citizen

9.8

95.5

4.5

93.3 91.9 89.3

Data Source: US Census: American Community Survey (2009-2013)

10.0

6.7

2.6 1.9

5.5 1.2

8.1 3.6 4.5 10.7

5.7 5.0

700 620 600 488

506

524

537

499

FY10

FY11

FY12

FY13

FY14

500 361

400 300 200

205

177

100 0 FY06

FY07

FY08

FY09

Source: MA Office for Refugees and Immigrants (ORI)

2,000 1,517 1,500 911

1,000 500

231

121

279 241 215 55 11

15377 108

85 2

48 4

223 22

3410

28 4

Cuba

Kenya

Sierra Other Leone countries

0 Iraq

Bhutan

Burma

Somalia

Liberia DR Congo Burundi Central Uganda Vietnam African FY06-FY14 Republic

Source: MA Office for Refugees and Immigrants (ORI)

98% 96% 94% 92% 90% 88% 86% 84% 82% 80% 78%

95.1%

95.5%

94.7% 91.7% 89.6%

89.7%

89.4% 84.3%

Source: U.S. Census Bureau, American Community Survey (ACS), 2009-2013

Data Source: U.S. Census Bureau, American Community Survey (ACS), 2009-2013. Percentages with * indicate population numbers are too small to be reliable.

Massachusetts

$66,866

Worcester

$45,944

West Boylston

$82,688

Shrewsbury

$83,608

Millbury

$71,635

Leicester

$72,074

Grafton

$89,649 $0

$10,000 $20,000 $30,000 $40,000 $50,000 $60,000 $70,000 $80,000 $90,000$100,000

20.1% 20% 15% 10%

11.0% 6.3%

4.5%

2.7%

4.5%

4.2%

4.0%

Data Source: U.S. Census Bureau, American Community Survey (ACS), 2009-2013

60% 40% 20%

14% 10%

19%

42%

35%

40% 12%

20%

15%

20%

40% 17%

22% 9% 8%

30% 14%

0% CMRPHA

Worcester

Massachusetts

% White population in poverty

% White Non-Hispanic population in poverty

% Black population in poverty

% Latino population in poverty

% Asian population in poverty

% Multi-race population in poverty

Data Source: US Census American Community Survey, 2009-2013

21%

7.5%

10.0%

2.1%

3.1%

2.6%

6.0%

10.5%

4.3%

5.4%

7.9%

3.3%

1.6%

31.4%

14.7%

30% 22.7%

25% 20% 15% 10%

10.5%

8.1%

12.6% 8.2% 5.0%

3.9%

4.1%

0% Grafton

Holden

Leicester

Millbury

Shrewsbury West Boylston

Worcester

Massachusetts

10% 9% 8% 7% 6% 5% 4% 2010

2011

2012

2013

2014

Grafton

Holden

Leicester

Millbury

Shrewsbury

West Boylston

Worcester

Massachusetts

Grafton

Holden

Leicester

Millbury

Shrewsbury

Worcester

84%

West Boylston 89%

Commuters who drive alone to work Commuters who carpool to work

81%

90%

85%

84%

11%

Commuters who take public transit to work Commuters walking to work

Commuters taking other means of transportation to work Individuals who work from home

74%

60% 50% 50% 40% 26%

30% 18%

20% 10%

0% Very unhealthy

Unhealthy Somewhat healthy

Healthy

Very healthy

Age-Adjusted Rate per 100,000

900 800 700 600 500 400 300 200 100 0

Deaths All Causes

Premature Mortality ages < 75

Age-Adjusted Rate per 100,000

250 200 150 100 50 0

Cancer

Heart Disease

Stroke

9 8

Per 1,000 Births

6.42

6.87

6 5

4.29

3 2 1 0 Worcester

CMRPHA

Massachusetts

Age-Adjusted Rate per 100,000

250 178 200

182

180

150

162

191 179

132

166

150 100 50 0

Data Source: Massachusetts Department of Public Health, 2010 - 2012

500

453

450 400

Number

350

300 250 200 125

150

108

100

50 0 Lung

Colorectal

Pancreas

Breast

Age-Adjusted Rate per 100,000

100 90 80 70 60 50 40 30 20 10 0

68 60 46

38 21

19 11

Breast, Female

Colorectal

Lung

Pancreas

Data Source: Massachusetts Department of Public Health (MADPH), 2010-2012 Note: Municipalities with fewer than 10 events are not shown.

Age-Adjusted Rate per 100,000

700 600

541

526

496

548 468

437

473

500

400 300 200 100 0

700

662 612

600

541

Number

500 400 305 300 200 100 0 Lung

Breast

Prostate

Colorectal

489

Age-Adjusted Rate per 100,000 population 140

120

100

88 87 97

65 60 58 78 68

Age-Adjusted Rate per 100,000 Women Age-Adjusted Rate per 100,000 population A

300 250

165

150

180

164 135

200

149 112

150

134

100 50 0

250 200 150 100 50 0

128

176

148 102

150 91

137

141

Age-Adjusted Rate per 100,000 population

80 70

60 50 40

30 23

30 20 10 0

Smoking prevalence: Current Smoker Had a clinical breast exam, within 2 years* Had a mammogram, within 2 years* Had a pap smear, within 3 years* Had Blood Stool test, within 2 years Had Sigmoidoscopy/Colonoscopy test, within 5 years

Worcester % (CI)

Massachusetts % (CI)

23.0 (17.2 - 28.9) 75.3 (68.3 - 82.4) 80.5 (75.3 - 85.6) 76.8 (70.6 - 83.0) 13.4 (9.2 - 17.6) 41.3 (35.4 - 47.3)

16.6 (15.6 - 17.7) 82.2 (81.0 - 83.3) 84.6 (83.5 - 85.7) 77.6 (76.3 - 78.8) 13.7 (12.3 - 15.0) 53.0 (51.1 - 54.8)

     

90% 80% 70% 60% 50% 40% 30% 20% 10% 0%

77%

76%

5% Have High Blood Pressure and Take Medicine

Had a Stroke

Worcester

Had or have Angina or Coronary Heart Disease

Massachusetts

Age-Adjusted Rate per 100,000 population

1200 1000 800 600 400 200 0

Source: Massachusetts Department of Public Health (MADPH), 2010-2012

70%

60%

58%

60% 50%

40% Worcester

27% 30%

Massachusetts

24%

20% 10%

0% Obese

Overweight

   

Age-Adjusted Rate per 100,000

”12

1,600

1,388

1,400

1,110

1,200 1,000 800 600 400 200 -

837

762 539

806

780 628

920

1,800

Rate per 100,000 Visits

1,600

1,536

1,400 1,200 1,000 768

800 600 400 200 0 Worcester

Massachusetts

Percentage of Population

30% 25%

15.40%

20% 15%

11.40%

10% 5% 0% Worcester

Massachusetts

16.0%

13%

14.0%

12.0%

12%

12% 10%

10.0%

8.0%

6.0% 4.0% 2.0% 0.0%

1,295

Visits per 100,000

1400 1200

951

1000

1,171 1,006

800 600

473

401

331

400

181 148

200

0 White, NonHispanic

Black, NonHispanic CMRPHA

Hispanic

Massachusetts

Asian / Pacific Islander, NonHispanic

American Indian, Non-Hispanic

Age-Adjusted Rate per 100,000 population

3,000

2,641 2,221

2,500

2,155

2,000 1,500 1,000 500 -

1,858

1,481 1,166

1,254

1,446

1,364

18% 16% 14%

12.8% 11.0%

12% 10%

8.5%

7.2%

8% 6% 4% 2% 0% Diabetes

Pre-Diabetes Worcester

Massachusetts

Age-Adjusted Rate per 100,000 population

1,200

971

1,000 800 600 400 200 -

710 693 530

634

665

635

837 712

80% 70%

60.60% 66.50%

Percentage

60% 50%

37.40%

40%

34.80%

Worcester Massachusetts

30% 20% 10% 0% Flu Shot

Pneumonia Vaccine

Crude Rate per 100,000

700

583

600 500

400 300 200 100 -

357 248 104

128

121

126

120

Crude Rate per 100,000

90 100 80 Worcester

60 40

Massachusetts

13 20 Gonorrhea

Syphilis

Crude Rate per 100,000

600

504.86

500 400

260.79 272.82

300 200

95.76

113.12 78.64

100 0 Grafton

Millbury

Shrewsbury

West Boylston

Worcester

Massachusetts

Crude Rate per 100,000

200 180 160 140 120 100 80 60 40 20 -

159 119

54 30

Hepatitis B

Hepatitis C

Giardia Worcester

Salmonella Massachusetts

Shigella

24 9

Lyme Disease Campylobacter

Number of Falls

70 60 50 40 30 18

20 10

0-10

11-17

18-24

0 25-44

45-64

65-74

75+

Age in Years

Age Group

Hospitalizations

ED Visits

0-10

100

3,270

11-17

1,399

18-24

1,347

25-44

184

3,557

45-64

611

3,668

65-74

338

944

75+

1,370

1,754

TOTAL

2,672

15,939

60% 51%

Percentage of Total

50% 40% 30% 22%

21%

23%

20% 13% 10%

9% 4%

11-17

18-24

11%

0% 0-10

% Hospital Stays

25-44

45-64 % ED Visits

65-74

75+

n=50 2% 4% 30%

0-10 years

20%

11-17 years 18-24 years 25-44 years 45-64 years 18%

65-74 years

26%

Number of Emergency Department Visits

3,000 2,472

2,500 2,000 1,372

1,500

1,279

1,000 500

323

291 24

120

0-10

11-17

18-24

25-44

45-64

304 20

0 Occupants

Pedestrians

65+

95%

Percent

90%

90% 84%

85% 80% 75% 70% Worcester

Visits per 100,000

14000 12000

12,048 12,554 9,943 10,255

Massachusetts

11,385 9,316

10000

6,692

8000

5,782

6000

3,314 2,699

4000 2000 0 White, NonHispanic

Black, NonHispanic CMRPHA

Hispanic

Massachusetts

Asian / Pacific Islander, NonHispanic

American Indian, Non-Hispanic

        

Primary Care

Source: Worcester Division of Public Health, 2015

Service Type

Number of Patients Served

Medical

40,801

Dental

16,908

Mental Health Substance Abuse Vision

3,446 294 2,755

No Insurance

61%

No primary care provider - doctor or nurse practitioner

28%

Convenient hours

26%

Could not get appointment with primary care provider - doctor or nurse practitioner

20%

Previously seen at free clinic

13%

Did not want to go to Emergency Room

Doctor or Emergency Room too expensive

Co-pay or deductible too expensive

6% 0%

10%

Ambulatory Care Sensitive Conditions

20%

30%

40%

50%

60%

70%

Per 1,000 Medicare Enrollees

80 70

66.8

62.7

61.3

All Races

Non-Black

50 40 30 20 10

0 Black

Rate per 100,000 Hospitalizations

2,500

2,155 1,858

2,000 1,500

1,110

1,000

920

837

712

500 Asthma

Diabetes CMRPHA

Massachusetts

80% 61%

70%

Pneu/Flu

67%

Percent

60% 50%

37% 35%

40% 30%

20%

15%

13% 11%

10%

0% Asthma

Diabetes Worcester

Flu Shot Massachusetts

Pneu Vac

60 50

Wait in Days

50 40 30

45 39

34 26

33 28

10 0

Worcester County

Massachusetts

120%

100% 100%

79% 70%

80% 60% 40%

51% 40%

100%

84%

85%

75%

45% 36%

20% 0%

Worcester County

92%

Massachusetts

100% 98%

Health Insurance Coverage

Geography

% Population with Health Insurance Coverage

% Population without Health Insurance Coverage

Grafton

97.3

2.8

Holden

99.2

0.9

Leicester

97.7

2.3

Millbury

96.4

3.6

Shrewsbury

97.5

2.5

West Boylston

97.8

2.2

Worcester

95.1

4.9

Massachusetts

96.0

4.0

Adequate Prenatal Care

100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0%

88%

79%

81% 68%

72%

73% 65%

69%

79%

Dental Access

100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0%

73%

76%

Worcester

Massachusetts

           

  

Farmersâ&#x20AC;&#x2122; markets

80% 63%

62%

60% 40%

39%

37%

20% 0% Fruit RYHS Schools

Food Banks

Vegetables US

City/Town

# Food Pantries

Unique Households

Unique People

Household Visits

Total People Served (includes repeat)

Grafton

106

154

541

Holden

235

632

1,506

3,894

Leicester

215

505

1,295

2,913

Millbury

116

302

395

1,094

Shrewsbury

523

1,266

5,785

15,615

West Boylston

144

293

598

Worcester

25,546

68,606

107,764

287,580

Total

26,734

71,561

117,192

312,235

Prevalence of Obesity

CDC Diabetes Interactive Atlas. National Diabetes Surveillance System. Via the County Health Rankings. University of Wisconsin Population Health Institute. A Robert Wood Johnson Foundation program. Accessed at http://www.countyhealthrankings.org/app/massachusetts/2015/rankings/worcester/county/outcomes/ov erall/snapshot on August 5, 2015. 31

30% 25%

27% 23%

21%

25% 22%

22%

20% 15%

15% 10% 5% 0% Grafton

Holden

Leicester

Millbury

Shrewsbury West Boylston

Worcester Massachusetts

80 70

Percent

50 40 30

Worcester

25 23

Massachusetts

20 10 0

Percent

White, NonHispanic

45% 40% 35% 30% 25% 20% 15% 10% 5% 0%

Black, NonHispanic

Hispanic

40.6%

37.5%

31.2%

30.0%

26.5% 21.6% 14.0%

Grafton

Holden

Leicester

Milbury

Shrewsbury

Massachusetts Average

West Boylston

Worcester



Grafton

25%

Holden

55%

Leicester

21%

Millbury

62%

Shrewsbury

64%

West Boylston

50%

Worcester

40% 0%

10%

20%

30%

40%

50%

60%

70%



 o o o

 o

o o

 Environmental Justice Populations



100% 80% 60% 40% 20% 0%

84.6% 84.0%

20.0% 19.9%

Grafton

46.9% 45.0% 0.0% 0.0% Holden

12.5% 9.6%

10.0% 4.2%

Leicester

Millbury

% of Block Groups in EJ



Shrewsbury

36.6% 16.7%

West Boylston

% of Population in EJ Block Groups

Worcester



Per 100.000 Population

1400

1,274

1200 957

1000

846

800 600

651 464

472

545 407

447

400 200 0

Per 100,000 population

40 30 18

20 10 0 Worcester

CMRPHA

Massachusetts

Access to Mental Health Care



30%

23% 27%

25%

27%

Percent

20%

15% 15% 10%

13%

State

12% 9%

RYHS

14%

15%

5% 0% 0 days 1 day 2 days 3 days 4 days 5 days 6 days 7 days

ď&#x201A;ˇ

National

Walkability

450 389

400

Number of Pedestrians

350 300 250 200

150 100 53 50

0 Death

Walk Score

Hospitalization

ED Visits

100 90 80 70 60 50 40 30 20 10 0

54 45 30

Worcester

Shrewsbury

Millbury

West Boylston

Total Walk Score

Grafton

Holden

Leicester

Data Source: www.walkscores.com

ď&#x201A;ˇ

Have you ever felt discriminated against because of your: Income

74%

Cultural Background

26%

82%

Age

18%

73%

Gender identity

27% 88%

Sexual orientation

13%

93%

Skin color, Race, Ethnicity 0%

10%

20%

80% No (%) Yes (%) 30% 40% 50% 60%

7% 20% 70%

80%

90%

100%

 Youth and Discrimination



    



Grafton

Holden

Leicester

Millbury

Shrewsbury

West Boylston

Worcester

Have you ever witnessed violence or domestic violence incidents in your community? Percent Answering "yes"

50%

33%

55%

85%

30%

46%

61%

69%

15%

25%

15%

Have you ever been a victim of violence or domestic violence? Percent Answering "yes"

35%

18%

25%

Have you ever been forced to work against your will? Percent Answering "yes"

Have you ever been forced to sell sex to get the things you need? Percent Answering "yes"

21%

15%

23%

15%

93%

95%

85%

95%

100%

69%

98%

100%

92%

95%

100%

91%

Do you own a gun? Percent Answering "yes"

Do you feel safe in your community? Percent Answering "yes" 90% Do you feel safe at home? Percent Answering "yes"

Violence

95%

BURGLARY

2622

2535

649 963 402

149 230 98 LARCENY AND THEFT

ROBBERY

Worcester

CRIME RATE (TOTAL INCIDENTS)

PROPERTY CRIME

VIOLENT CRIME

Massachusetts

Grafton

Holden

Leicester

Shrewsbury

402

301

123 CRIME RATE (TOTAL INCIDENTS)

163

963

1489 781

770

911

1607

2535

2877

4483

CMRPHA

INCIDENTS PER 100,000 RESIDENTS

2133

3527

4483 3298 1637 2151 1480

803 1118 515

480 711 278

INCIDENTS PER 100,000 RESIDENTS

AGGRAVATED ASSAULT

VIOLENT CRIME

Millbury

West Boylston

Worcester

Massachusetts

 Youth and Violence



         

Alcohol

25%

20%

21%

19%

19% 16%

15% 10% 5% 0% Worcester Adults

MA Adults

RYHS Youth

MA Youth

U.S. Youth

Crude Rate per 100,000

800 520 419

600 500 400 300 200 100 0

Marijuana

683

700

352

299

213

216

507

12% 9.9%

9.7%

Central MA

Massachusetts

10% 8% 6% 4% 2% 0%

Central MA

Massachusetts

Other Substances

6% 5.2% 5% 4%

3.4%

2.3%

2% 1.2% 1% 0% Narcotics

Ritalin or Adderall

OxyContin or Percocet

Steroids

2000 1,703

Crude Rate per 100,000

1800 1600 1400

1,063

1200 1000 800 600 400 200 0

791

501

563

404

352 345

1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

Number of Reported Incidents

800

700

600

500

400

300

200

100



70%

Figure 1: Total Population of CMRPHA Compared to Total Population of Survey Respondents 64%

60% 46%

50% 40% 30%

23%

20% 10%

21%

13% 6%

6% 4%

4% 2%

Grafton

Holden

Leicester

3% 1%

0% Millbury

Alliance Population

Shrewsbury

West Boylston

Survey Respondent

Worcester

other

Figure 2: Where Respondents Work 70%

63.7%

60% 50% 40% 30%

25.0%

20% 6.7%

10%

1.7%

1.1%

0.8%

0.7%

0.3%

Grafton

Leicester

Holden

Millbury

West Boylston

0% Worcester

Other

Shrewsbury

Data Source: 2010 U.S. Census Bureau , 2015 Greater Worcester Community Health Assessment Public Survey

80%

Figure 3: Worcester Neighborhoods Where Respondents Live 71.1%

70% 60% 50% 40% 30% 20%

13.9% 6.7%

10%

4.2%

2.7%

Union Hill

Great Brook Valley

0% Other

Main South

Bell Hill / Belmont St.

Data Source: 2010 U.S. Census Bureau , 2015 Greater Worcester Community Health Assessment Public Survey

Figure 4: Race Distribution of CMRPHA Population Compared to Survey Respondents 100% 80%

83.0% 69.0%

60% 40% 14.0% 7.0%

20%

8.0% 5.4%

7.0% 3.3%

0.1% 1.3%

2% 3%

Native American

Other

0% White / Caucasian

Hispanic / Latino African American / Black Alliance Population

Asian / Pacific Islander

Survey Respondent

Data Source: 2010 U.S. Census Bureau , 2015 Greater Worcester Community Health Assessment Public Survey

90%

Figure 5: Gender Distribution of CMRPHA Population Compared to Survey Respondents 76.3%

80% 70% 60% 50%

51.50%

48.50%

40% 30%

23.6%

20% 10% 0% Male

Female Alliance Population

Survey Respondents

Data Source: 2010 U.S. Census Bureau , 2015 Greater Worcester Community Health Assessment Public Survey

40%

Figure 6: Age Distribution of CMRPHA Population Compared to Survey Respondents 36.1%

35% 30% 25%

26.6% 22.4%

20% 12.3%

15% 10% 5%

15.7% 13.3%

5.2%

18.4% 13.9%

7.0%7.9%

6.4% 6.1%

6.3% 1.9%

0.4%

0% Under 17 years

18-24 years

25-29 years

30-39 years

Alliance Population

40-49 years

50-64 years

65-74 years over 75 years

Survey Respondents

Data Source: 2010 U.S. Census Bureau , 2015 Greater Worcester Community Health Assessment Public Survey

80%

Figure 7: Marital Status of CMRPHA Population Compared to Survey Respondents 67.4%

70%

56.9%

60% 50%

43.1%

40%

32.6%

30% 20% 10% 0% Married

Not Married Alliance Population

Survey Respondent

Data Source: 2010 U.S. Census Bureau , 2015 Greater Worcester Community Health Assessment Public Survey

Figure 8: Household Income of CMRPHA Population Compared to Survey Respondents Over $125,000

26.30%

17.3%

$75,000 to $124,999

27.20%

21.1% 18% 17.4%

$50,000 to $74,999 11%

$30,000 to $49,999 $20,000 to $29,999

5.30%

Less than $20,000

5.50%

Donâ&#x20AC;&#x2122;t know

9.0% 18.7%

6.80%

0 0%

16.5%

10%

Survey Respondents

15%

20%

Alliance Population

Data Source: 2010 U.S. Census Bureau , 2015 Greater Worcester Community Health Assessment Public Survey

25%

30%

Figure 9: Educational Attainment of CMRPHA Population Compared to Survey Respondents 73.8%

80% 70% 60% 50% 40% 20%

17.5%

11.6%

10%

32.1%

28.9%

27.5%

30%

0.7%

6.5%

0% Less than high school graduate

High school graduate (includes equivalency) Alliance Population

Some college or associate's degree

Bachelor's degree or higher

Survey Respondents

Data Source: 2010 U.S. Census Bureau, 2015 Greater Worcester Community Health Assessment Public Survey

Figure 10: Citizenship Status of CMRPHA Population Compared to Survey Respondents 100% 90%

94.0% 82.4%

80% 70% 60% 50% 40% 30% 20% 8.4%

10%

3.1%

8.5%

3.0%

0% U.S. Citizen

Naturalized Citizen Alliance Population

Survey Respondents

Not a U.S. Citizen

Question 4: How would you rate the overall health of your community? 60% 49.9% 50% 40% 26.4%

30% 17.6%

20% 10%

3.0%

2.9%

0% Very unhealthy

Unhealthy

Somewhat healthy

2015 Greater Worcester Community Health Assessment Public Survey

Healthy

Very healthy

Is there an active sense of civic responsibility and engagement, and of civic pride in shared accomplishments?

29%

Is there economic opportunity in the community?

26%

Is this community a good place to grow old?

25%

Are there networks of support for individuals and families during times of stress need?

43%

28%

46%

26%

20%

Is the community a safe place to live?

29%

49%

30%

25%

50%

18%

57%

Are you satisfied with the health care system in the community?

21%

20%

59%

Is this community a good place to raise children?

21%

20%

59%

Are you satisfied with the quality of life in your community?

21%

19%

60%

0% Disgree

20%

Neither agree or disagree

40% Agree

60%

80%

100%

Have you ever been forced to sell sex to get the things 2% you need?

98%

Have you ever been forced to work against your will?

94%

Do you own a gun?

92%

Have you ever been a victim of violence or domestic violence?

22%

Have you ever witnessed violence or domestic violence incidents in your community?

78% 46%

Do you feel safe in your community?

54% 79%

Do you feel safe at home?

19%

92% 0%

20% Yes

40%

7% 60%

80%

100%

How easy is it to cope with day-to day challenges for you? 45% 40% 35% 30% 25% 20% 15% 10% 5% 0%

42.0% 36.9%

14.2% 1.8% Very Difficult

5.2%

Difficult

Some Challenges

Easy

Very Easy

Do you have a person that you trust to talk to about your challenges and stresses? 100%

89.4%

80% 60% 40% 10.6%

20% 0% Yes

Have you ever felt discriminated against because of your: Income

74.0%

Cultural Background

26.0%

81.9%

Age

18.1%

72.6%

gender identity

27.4% 87.5%

sexual orientation

12.5%

92.9%

Skin color, Race, Ethnicity

7.1%

80.3% 0%

20%

40% No (%)

Yes (%)

19.7% 60%

80%

100%

How often do you do the following? Wear a helmet when riding a bike

16%

10%

Wear a seatbelt when in a car

15%

Exercise 30 minutes per day

17%

Eat at least 5 servings of fruits and… Get routine eye exams

17% 78% 32%

11%

39%

11%

Get routine cancer screenings if your…

9% 9%

43% 25%

39%

41%

20% Never

40%

38%

22%

Get routine dental screenings

36%

16% 32%

41%

10%

14%

35%

15%

Get routine blood pressure screenings

Get an annual flu shot

31%

34%

Get other routine vaccinations…

52%

37%

40%

60%

80%

Once in a while

Sometimes

Regularly

100% Always

Top Indicators of a Healthy Community Low crime/safe neighborhoods

39.1%

Good jobs and healthy economy

29.6%

Good schools

28.0%

Opportunities for physical activity (youth sports, walkingâ&#x20AC;Ś

27.9%

Access to health care (e.g., family doctor)

27.2%

Access to healthy foods

23.4%

Clean environment

23.1%

Good place to raise children

22.1%

Strong family life

21.0%

Affordable housing

11.4%

Activities for youth (sports, arts, after school clubs, etc.)

11.3%

Access to mental health care

10.4%

Well-maintained parks

7.7%

Religious or spiritual values

6.4%

Community support groups

5.7%

Excellent race/ethnic relations

5.4%

Low adult death and disease rates

5.3%

Emergency preparedness

4.4%

Arts and cultural events

3.9%

Low infant deaths

3.3%

Other

2.7% 0%

10%

20%

30%

40%

Top Health Issues that Impact Overall Community Health Violence Overweight/obesity Mental health problems Low physical activity Child abuse/neglect Other (please specify) Domestic violence Cancers Aging problems (e.g. arthritis, hearing/visionâ&#x20AC;Ś Heart disease and stroke Homicide Rape/sexual assault Diabetes Infectious diseases (e.g. TB, hepatitis, etc.) Teenage pregnancy High blood pressure Suicide Motor vehicle crash injuries Sexually transmitted diseases (STDs) Natural disasters Dental problems HIV/AIDS Respiratory/lung disease Terrorist activities Infant death 0%

43.2% 40.6% 36.4% 28.5% 22.2% 17.7% 15.2% 13.0% 11.8% 9.2% 8.4% 6.1% 6.0% 5.9% 4.8% 4.4% 4.0% 3.5% 2.8% 2.7% 2.5% 2.2% 2.1% 2.0% 1.8% 10%

20%

30%

40%

50%

How Often do you do the following? Buy or sell sex

99%

Use smokeless tobacco products (dip, chew, etc.)

98%

Use prescription medications that were not prescribed to you by a doctor or nurse

96%

Use recreational drugs

92%

Smoke cigarettes/cigars or use e-cigarettes

87%

Drink to excess (more than 4 drinks in a night for women, more than 5 for men)

71% 0%

Never

Once in a while

20% Sometimes

40% Regularly

21% 60% Very Often

80%

100%

Top Issues that makes it diffilcult to get health care Long waits for appointments

32.6%

Cost of care

29.9%

Lack of evening and weekend services

29.3%

Insurance problems/lack of coverage

23.1%

Discrimination/unfriendliness of provider or office staff

9.3%

Don't know what type of services are available

7.9%

No available provider near me

7.5%

Afraid to have health check-up

6.1%

Lack of transportation

5.9%

Other (please specify)

5.3%

Having no regular source of healthcare

3.1%

Health care information is not kept confidential

2.8%

Language problems/could not communicate with providerâ&#x20AC;Ś 0%

1.1% 5%

10%

15%

20%

25%

30%

35%

128

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Areas noted as strengths by Focus Group and Stakeholder Interview participants Access to care Community resources Mental health Physical activity resources Partnerships Substance abuse Community engagement Support systems Social cohesion Food access Positive behaviors Education Community gardens Access to health supporting activities Prevention programs Treatment Built environment Data collection Youth Insurance Coverage Employee wellness Transportation Sexual health Chronic diseases Vulnerable populations Aging population Gun buyback Funding Housing

54 48 33 24 18 18 17 15 14 14 11 10 9 8 7 5 5 5 5 3 2 1 1 1 1 1 1 1 1 0

Mention count

146

Areas noted as challenges by Focus Group and Stakeholder Interview participants Positive behaviors Substance abuse Food access Mental health Education Cultural competency Economic opportunity Access to care Vulnerable populations Chronic diseases Cost Community engagement Transportation Built environment Treatment Housing Safety Youth Racism Tobacco use Physical activity resources Insurance coverage Community resources Social cohesion Media Support systems Aging population Funding Policy change Infectious disease Partnerships Lack of representation Infant mortality Distracted driving Climate Hygiene Bullying Oral health Access to health supporting activities Data collection Air quality Prevention programs Sexual health Other Motivation Stigma Water fluoridation

92 90 72 65 59 51 45 43 35 33 30 24 23 23 21 20 20 19 19 17 17 15 13 11 11 9 9 8 7 4 4 4 3 3 3 3 2 2 2 2 2 1 1 1 1 1 1 0

Mention count

147

100

What Makes it Easy to be Healthy in Your Community? Opportunities for exercise Healthy food Farmers' Markets Fresh fruits and vegetables Parks Access to physical activity resources Access to green spaces Motivation Eating right Positivity Physical activity programs Easy access to health services Access to healthy food Having healthy /Enough friends/Good people Happiness Spiritual health Similar goals/support network Lots of water Knowledge Health fairs and community events Good/Enough doctors Good health coverage Family activities or activities for kids Designated pet areas Community gardening After school programs Talking to each other Diverse communities working together Competition Clean & safe streets Active community Access to transportation

28 23 10 8 7 7 7 6 6 5 5 5 5 4 4 3 2 2 2 2 2 2 2 2 2 2 1 1 1 1 1 1 0

148

What makes it difficult to be healthy in your community? Easy Access to junk food Money issues Unhealthy food High cost of healthy food Trash/Pollution Lack of Transportation Violence/not feeling safe Lack of time/busy Lack of motivation Lack of healthy choices Bad habits Stress Time management Low number of safe parks/sidewalks Fried foods Weather/snow removal Peer pressure/temptation Lack of knowledge/skills Lack of health care No support/not working together Bad Friends/Negative perceptions of people Low number of gym places/bicycle trails Overwork Traffic No time Lack of jobs Enduring second hand smoke Drugs Disability or being in a wheel chair Lack of Exercise Other commitments Unhealthy cooking Food deserts

29 11 8 8 6 5 5 5 4 4 4 4 3 3 3 2 2 2 2 2 2 2 2 1 1 1 1 1 1 1 1 1 1 0

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Evaluation of Impact, 2013-2015 UMass Memorial Medical Center developed and approved an Implementation Strategy to address significant health needs identified in the 2013-2015 Community Health Needs Assessment (CHA). These programs support the Greater Worcester Community Health Improvement Plan (CHIP) which was developed collaboratively with the Worcester Division of Public. The Implementation Strategy closely aligns the CHIP and addresses the following health needs through a commitment of Community Benefit programs and resources:     

Domain 1: Increase Access to Health Care Domain 2: Promote Healthy Weight Domain 3: Promote Health Equity by Addressing Health Disparities (Cross cutting across all Domain Areas) Domain 4: Promote Positive Youth Development Other: Enhance the Public Health Infrastructure of the Community

To accomplish the Implementation Strategy, goals were established that indicated the expected changes in the health needs as a result of community programs and activities. Strategies to address the priority health needs/Domains were identified and impact measures tracked. The following tables outline the impact made on the selected significant health needs since the completion of the 2013-2015 CHA. UMass Memorial has a dedicated Community Benefits Department that works closely with community organizations and reports activities to the UMass Memorial Health Care Board of Trustees.

Domain 1: Increase Access to Health Care Goal Support programs and develop collaborative efforts that will improve access to care for the medically underserved/uninsured in Worcester.

Programs/Strategies to Address Health Need  Remove the stigma and barriers often associated with youth accessing mental health services.

Outcomes/Impact  



159

H.O.P.E. Coalition Peer leaders developed a Youth Mental Health Model that integrates counselors into the staff at youth organizations. Through this partnership with UMass Memorial, the Massachusetts Society for the Prevention of Cruelty to Children (MSPCC) counselors are on staff at:  The Worcester Youth Center  Boys & Girls Club  You, Inc.  Girls, Inc. (newly added in FY15)  Friendly House (newly added in FY15) Approximately 2,100 youth were served during the period by this program through one-on-one counseling, therapeutic groups and crisis intervention. A Return-On-Investment (ROI) report was completed by the Community Development Training Institute at Clark University in 2013



Reach medically-underserved populations including those who are uninsured, underinsured, or not connected to primary care medical services or dental providers.



Educate vulnerable populations on insurance enrollment and provide technical advice on issues pertaining to navigating the health care system. Provide insurance enrollment assistance and support health care reform efforts Address the high rate of tooth decay among children in the City of Worcester due to a lack of fluoridation in the city’s water supply.



Chronic Conditions



indicating for every $1 invested, $2.24 will be gained through reductions in publicly financed mental health service provision. UMass Memorial Ronald McDonald® Care Mobile program:  Served a total of 11,917 patients  Provides services at 20 schools/ 10 neighborhoods across the city of Worcester  Screenings and educational sessions held at special events and schools  Care Mobile manager co-leads the Worcester Free Clinics Coalition which is conducting an on-going survey to identify more information about the patient population utilizing these services 

In 2013 and 2014 insurance enrollment assistance was provided to a total of 21,985 people by UMass Memorial Medical Center Benefit Advisors.



Coordination of the Central Mass Oral Health Task Force which ensures the provision of preventive dental services in Worcester public and charter schools. In FY15, obtained agreement with the Worcester Public Schools (WPS) to pilot an Opt-Out option for dental screenings to be conducted for all students at the Union Hill elementary school. WPS also agreed to pilot dental X-Rays at South High School. Developed steps to promote an education campaign to reduce sugary snacks and candy intake by elementary school students. Through the collaborative, a minimum of 9,000 children received preventive dental services during the academic school year. Provided support to two community health centers in 2013 to support their oral health services. In 2013, UMass Memorial consulted with Boston Children’s Hospital to adopt an asthma home-visiting pilot project based on their successful evidence-based model. The pilot utilized specially trained Community Health Workers to conduct home visits for students of Belmont Street Community School identified by the school nurse as having high rates of absenteeism due to/related to asthma. In addition to Belmont Street Community School, program partners included: UMass Memorial Pedi-Primary Care, UMass Memorial



   

Utilizing a Community Health Worker model, reduce the high rate of absenteeism related to asthma at Belmont Street Community School focusing on the Bell Hill neighborhood and Plumley Village public housing site.

160



 

  

Reduce the high rate of pediatric asthma hospitalization and ED use in Worcester through a comprehensive, citywide approach; secure funding to expand home visiting, community/clinical linkage program.



  

161

Plumley Village Health Services, UMass Memorial Office of Community Relations and Community Legal Aid. CHWs identified and addressed home triggers, ensured families understood medications use, conducted follow-up and communicated with PCP and school staff. Pilot outcomes: program included a total of 30 families with children with high rates of absenteeism due to asthma. All participants received basic education to improve medication understanding and adherence, Asthma Action Plan review, home triggers assessment, supplies and referrals to address identified triggers and education and supplies for environmentally friendly house cleaning products to eliminate use of chemicals/cleaners that are asthma triggers. o Four homes had successful pest mitigation completed as the result of Community Health Worker (CHW) interaction and referral to the City of Worcester Public Housing. o Three homes were referred to Community Legal Aid for guidance or assistance with housing issues. o One home had a serious mold issue resolved as a result of CHW communication with the property landlord. o All participants were provided with information about the City of Worcester Wheels to Water summer swimming and recreation program. Referrals were made to CHWs to address identified home triggers and education. Several homes received successful pest mitigation as the result of CHW interaction and referral to the City of Worcester Public Housing. UMass Memorial worked closely with the Worcester Division of Public Health and other stakeholders to secure funding from the Prevention and Wellness Trust Fund (PWTF) to address a community-wide public health/chronic disease prevention initiative. Strategies of the PWTF include: addressing preventable health conditions, including Pediatric Asthma, using evidence-based and evidence-informed programs, policies and systems change. This effort was funded out of the state’s Chapter 224-Health Care Reform cost containment effort to establish linkages between community public health and clinical care. The PWTF award secured $600,000 for UMass Memorial over 2.5 years for a city-wide Pediatric Asthma community/clinical linkage. The UMass Memorial Pediatric Asthma Pilot project played a significant role in positioning the city of Worcester for the PWTF grant award. UMass Memorial Co-Chairs the PWTF Pediatric Asthma Intervention. Other Clinical partners include: Edward M. Kennedy Community Health



Reduce risk and rate of injuries among seniors due to falls resulting in increased ED usage and hospitalization.



Reduce substance abuse relapse among Latino men through case management and the delivery of wrap-around services that allow them to successfully graduate from the program and live independently. Improve access to health care services for seniors living at six Worcester Housing Authority locations and other vulnerable populations at a communitybased Latino organization.



162



Center (Co-Chair), The Family Health Center of Worcester, UMass Memorial Pedi-Primary Care, Pediatric Pulmonology, Plumley Village Health Services and the Office of Clinical Integration. Community partners include: Worcester Public Schools and Head Start Program, Worcester Community Legal Aid and the City of Worcester Division of Public Health and Healthy Homes Office. Outcomes as of September, 2015:  60 high risk Pedi-Pulmonology patients receiving meds in school during the 2013-2014 academic year had a total of 93 ER visits. In 2014-2015 ER visits for these patients decreased to 38.  Asthma Policy Task Force addresses environmental issues in schools established; Pilot launching at three public schools with high asthma rates.  In ten months, UMass Memorial sites (Pedi-Primary Care, Plumley Village Health Services, Pedi-Pulmonology and Community Relations) completed:  Home visits completed: 71 Baseline, 37 30-Day Follow Up, 7 6-Month Follow Up In 2015, secured $104,267 from the PWTF to develop a communityclinical linkage senior falls program with the UMass Memorial Trauma Clinic. Secured bi-lingual AmeriCorps member to be trained and work as CHW to conduct home visits for senior patients identified by the UMass Memorial Trauma Clinic to address risk for fall factors within the home and conduct referrals to Matter of Balance, Tai Chi classes and home remediation. Supported the Executive Medical Director position at the Hector Reyes House, a residential substance abuse treatment program for Latino men that provides intensive counseling, state-of-the-art interventions for substance abuse, access to medical care, psychiatric services, training and employment options. The program serves between 20-25 men annually.

Supports a hospital physician to provide medical services to a total of approximately 850 individuals. Total numbers served yearly decreased during the past three years due to lack of elder patient participation at the public housing sites.

Domain 2: Promote Healthy Weight Goal Reduce overweight/obesity among youth and adults and support efforts that promote Healthy Weight.

Programs/Strategies to Address Health Need  Increase knowledge of growing fresh produce and access to healthy food in food insecure areas through Community Garden efforts.

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Increase knowledge of growing fresh produce and access to healthy food in food insecure neighborhoods through Community Garden efforts.

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Promote healthy eating and nutrition education among vulnerable populations by funding and leveraging funding for Cooking Matters classes and educational grocery store tours

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The Grant Square Community Garden in Bell Hill was developed in partnership with the Regional Environmental Council (REC) with support from UMass Memorial and the City of Worcester, which provided land use at a public park for the garden. The garden includes a total of thirty raised beds maintained by youth gardeners and residents. Produce from the garden is made available to the Bell Hill neighborhood and at 15 stops in food insecure areas across the city through the REC “Veggie Mobile” mobile Farmers’ market. Three of the Veggie Mobile stops are in the Bell Hill neighborhood and average between 60-90 customers per week. Established an urban agriculture, youth leadership program for youth working at the Grant Square garden. Hospital funding supports the doubling of SNAP (food stamp) benefits at Veggie Mobile sites. Established a community garden at the Plumley Village Public Housing site. UMass Memorial supported the garden at Plumley Village beginning in 2011. The garden became self-sufficient, run by 26 participating residents, in 2013. Established a backyard gardening program in the Bell Hill neighborhood in 2013. The program had eight participants in 2013 and has increased to 25 homes in 2015. The effort provides another highly effective means of bringing fresh produce to the neighborhood, while educating individuals and families about healthy eating and how to grow their own food. The hospital funds materials for the garden beds and leverages resources for the beds which are built by the Worcester Vocational School and the Worcester Carpenters Union. Soil is provided by the City of Worcester and the hospital partners with the Regional Environmental Council to provide seedlings and conduct soil testing. Funded and leveraged funding for Cooking Matters classes to be offered at five community sites. During 2013 and 2014, a total of 816 individuals participated in healthy cooking classes, grocery store tours and one time educational sessions held at community events. Classes are currently being held in 2015 and to date, 23 people have

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Support and increase awareness of the 5-2-1-0 healthy eating campaign.

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Increase access to physical activity and recreation opportunities for inner city children and youth that incorporates a summer healthy nutrition intervention and swimming lessons for youth.

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participated in healthy cooking classes and 318 people have participated in grocery store tours. Beginning in 2014, UMass Memorial supported the Worcester Division of Public Health in a coordinated public awareness campaign to promote 5-2-1-0 Let’s Go! With messaging that recommends five or more fruits and vegetables per day, no more than two hours of recreational screen time, at least one hour of physical activity and no sugar-sweetened drinks. Multiple resources were devoted to promoting change within organizations and 5-2-1-0 messaging is featured on public buses. UMass Memorial is a member of the Worcester Food and Active Living Policy Council Steering Committee, which convenes the Community Health Improvement Plan (CHIP) Healthy Eating & Active Living Work Group and the Childhood Obesity Sub-Group targeting healthy weight and healthy eating efforts. The group focuses on policy and advocacy to promote healthy eating. Working with the Worcester Division of Public Health, supported the development of the 5-2-1-0 healthy eating public awareness campaign including bus wraps. Provided funding to the Southeast Asian Coalition (SEAC), enabling youth members to participate weekly in 54321Go! evidence-based workshops, a “MyPlate” nutrition program. An average of 20 youth participated in physical fitness activities every week. Supported the “Recreation Worcester” program - formerly Wheels to Water- that included opportunities for learning (to reduce summer learning loss), recreation, youth development, and nutrition, with students able to receive three meals a day through a partnership with Worcester Public Schools summer school. The increased breadth and depth of the program enabled WDPH to hire 77 young people as program staff. During the period, a total of 4,483 youth registered for the program. Supported physical activity and exercise through weekly afterschool and summer programs at Belmont Community and City View schools. A total of 336 children participated in summer and afterschool exercise programs funded by UMass Memorial. Funding from the hospital also supported the 5210 Let's Go! curriculum and enhanced gym and swim program at the YWCA of Central Massachusetts for 95 preschoolers and yoga for 20 of those preschoolers in 2015. An additional 60 preschoolers participated in other exercise programs funded by the hospital during the period.

Domain 4: Promote Positive Youth Development Goal Support at-risk youth programs that promote positive youth development (e.g., substance abuse, tobacco, mental health and violence prevention).

Programs/Strategies to Address Health Need  Support youth leadership development programming aimed at reducing violence, Alcohol, Tobacco and other Drug (ATOD) abuse.

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Retrieve as many firearms as possible from the community and educate gun owners on the proper storage of guns in the home as a means of reducing violence and injury.

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Healthy Options for Prevention and Education (HOPE) Coalition/ Youth Substance Abuse Prevention Task Force: HOPE is a youth-adult partnership created to reduce youth violence, substance use and promote adolescent mental health. HOPE Peer Leaders co-chair the Youth Substance Abuse Prevention Task Force along with the Worcester Division of Public Health to reduce alcohol, tobacco and other drug (ATOD) use among young people. Their work resulted in the establishment of an ordinance banning tobacco sales from all healthcare institutions including pharmacies. HOPE also organizes “Kick-Butt” campaigns and lobbying efforts to reduce tobacco use. HOPE Peer Leaders conducted a Social Norms campaign reaching 750 students at North High School to communicate accurate information about the prevalence of healthy behavior in order to reinforce healthy behaviors among youth and reduce to reduce smoking, underage drinking and prescription drug abuse. In total during the period, HOPE reached approximately 3,000 people with its “I’m About this Life” social norms campaign. HOPE Youth Art Initiative: In collaboration with the Worcester Art Museum, HOPE Coalition Peer Leaders in 2013 developed a program to enable youth to positivity express themselves through art. The artwork focused on youth substance abuse and was displayed through social media and publically at the City of Worcester’s 2013 CHIP report-out to the community at City Hall, the Massachusetts Organization for Addiction Recovery (MOAR) annual meeting attended by 200 people and the city’s Town Hall meeting on underage drinking, marijuana use, and prescription drugs. UMass Memorial Injury Prevention program holds annual Goods for Guns program to incentivize the return of guns by community members. A total of a minimum of 232 guns were retrieved during the period to date (program still to be held in 2015).

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Enhance the knowledge, skills and networks of front line youth workers by increasing their understanding of risk factors, effective planning, program development and selfevaluation.

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Provide services and support to an organization where at-risk youth can build lasting, positive change by addressing root causes of poverty. Foster self-sustainability of the organization.

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Support employment and preemployment training for youth as a means of reducing violence and breaking the poverty cycle providing exposure to workforce skills and career paths.

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HOPE Coalition Youth Worker Training Institute (YWTI): is a 15 week course offered in collaboration with Clark University and was developed based on a needs assessment conducted among youth and executive directors of youth-serving agencies. This educational opportunity empowers youth workers to be more effective in delivering services to high risk youth. HOPE now partners with Clark University to offer university credit to youth workers who take Institute courses. Through a partnership with Clark University, YWTI students are able to register for credit courses at no cost at the graduate school Community Development program. A total of 116 community youth workers completed the Youth Worker Training Institute, alongside 8 Clark students. Approximately 15 of the community youth workers enrolled in the Professional Certificate in Youth Work Practice program. UMass Memorial provided support to the Worcester Youth Center since its launch in 1994. This organization was spearheaded by UMass Memorial in 1994 due to an identified great need and became financially independent from UMass Memorial as of May, 2013. During the period, a total of approximately 2,400 youth utilized the recreational, leadership, workforce and academic programs; 230 completed work readiness, 98 received subsidized employment, 117 enrolled in GED classes, and 217 had grade level increase and 32 obtained a GED The City of Worcester Youth Opportunities Office coordinates employment and pre-employment training for youth with the Worcester Community Action Council. Working with the state-funded YouthWorks program, the office partners with nonprofit and for-profit organizations to create meaningful job placements for young people. UMass Memorial’s support of the Youth Office has helped Worcester youth job programs to collectively secure nearly $2 million in funding annually. A total of 1389 youth were placed in jobs during the period. Building Brighter Futures With Youth (BBWF): UMass Memorial provides summer employment at many medical center departments. Program serves approximately 40 students annually. Students work 24 hours per week. While most BBWF students are placed in departments across the hospital system, five youth are employed annually at Grant Square Community Garden in Bell Hill though YouthGROW, a food justice program of the Regional Environmental Council. YouthConnect, an anti-violence program involving eight agencies—The Boys & Girls Club of Worcester, Friendly House, Girls Inc., Worcester

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Other: Enhance the Public Health Infrastructure of the Community Goal

Strengthen the existing social service network in Worcester by coordinating a system of care for vulnerable transition age youth (ages 17-24) and advocating for the resources needed for primary and secondary prevention of homelessness. Enroll homeless/vulnerable young people in intensive case management throughout the year.

Programs/Strategies to Address Health Need  Develop and support strategies and systems that enhance the public health infrastructure of the Greater Worcester community.

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Establish a Center for Public Health Practice to expand the infrastructure of the Worcester Division of Public Health and

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Youth Center, Y.O.U., Inc., YMCA, YWCA and the Massachusetts Society for the Prevention of Cruelty to Children—provides recreational, educational and cultural activities to underserved middle schoolers. On average, 200-300 youth participate daily in activities during the summer. The Compass Project, a collaborative community-based initiative, focused on ending youth homelessness in Worcester, conducted an extended evaluation of Compass case management, including 55 youth active in case management for at least 1 month from January 1, 2013 through June 30, 2014 Outcome evaluation focused on 27 youth with 6-month follow-up data (changes from baseline to 6 months): 67% of youth had increased housing stability, with 38% reaching stable housing (score 4-5) at 6 months 44% had improvement in life skills 70% had improvements in family relations 44% had improvements in mental health 56% had improvements in locus of control score (thinking they can control their circumstances, vs. their circumstances being out of their control) Youth involved also reported improvements in life satisfaction, family conflict, and family cohesion.

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Supported opportunities and partnerships that aimed to improve the public health in the community through the development of the 20132015 Community Health Needs Assessment (CHA) and the Community Health Improvement Plan (CHIP) which is reviewed annually. Provided funding to support the Worcester Division of Public Health Infrastructure including the Worcester Youth Office, 5-2-1-0 Lets Go! Campaign, Recreation Worcester and other city-lead initiatives. In partnership with stakeholders, reactivated the CHNA-8 Healthy Communities Coalition as a strategy to support the 2015-2018 CHIP strategies. Center for Public Health Practice at Clark University launched in 2014: New collaboration advances work of Worcester Division of Public Health (WDPH), by informing public health practice. WDPH provides faculty and students with unique research and practicum experiences. A total of 24 students participated in the program in 2014 and 2015.

enhance public health interventions and efforts.

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The effort:  Builds capacity for the city’s public health infrastructure that brings evidence-based models  Fosters the pipeline of students and graduates for WDPH workforce  Engages students to work closely with the WDPH on public health efforts including data compilation for the 2015-2018 CHA conducting focus groups and public surveys at community events; and other projects in 2015  Hospital contribution supported the Coordinator position This program aided in enabling WDPH to be the first in the state to apply for Public Health Accreditation through the federal accreditation board.