Comprehensive Community Health Plan, Catron
The Health Plan provides a blueprint guide of the work that the Health council should accomplish. After developing the Profile and assessing it we are able to choose the Priorities, Strategies and Activities we will be working on this year. The Priorities were worked out by members of the council and the coordinators. The Priorities are the same as they were last year with changes only in activities. Some Planning is still a work in progress to be done by each focus group in June.
Catron County is a frontier county located in the Southwestern portion of New Mexico. The population is 3,643 individuals. The Health Council is composed of representation from areas and representing partners or agencies. The northern end of the county is experiencing most of the growth in Catron County. Many ranches are being subdivided and sold. That in itself has created problems within the county but for the Health Council, it meant that we were not reaching many of the residents of Catron County. We have hired a developer to start a satellite council in that end of the county. They will be working with us on Planning and Assessment and also doing activities in their area. It seems to be working as many of the residents there are joining the group and are interested in the needs of the county and are willing to help with the work. We will be doing some specific activities there this year.
Access and Wellness to Health and Substance Abuse continue to be our most prominent priorities. We are working on them with a few changed activities. Access and Wellness will be focused on Diabetes and Obesity along with working with the Schools and their health plan. They will also plan health fairs, and other public activities. They want to help Public Health get started up again and
Develop more sites throughout the county. They are also going to explore transportation, home health and child care to see if there is any way we can bring those needed programs to Catron County. Communications continues to be a problem. We will continue to publish the newsletter quarterly.
The SACAT (substance abuse team) continue to address our drug and alcohol problem by working with Law Enforcement. Activities include will be getting as many communities as possible on the Meth Watch and Neighborhood Watch programs. We feel that this will help deter the criminal from setting up labs or committing other crimes. The Sheriff Department is manned with a Sheriff, Under Sheriff and 4 deputies to cover almost 7000 square miles so this should offer some help to them. They are also working on presentations on meth and alcohol prevention which we will help sponsor. SACAT is also concentrating on family resiliency this year by sponsoring family activities. This came about after interviewing teenagers and asking them what would keep them from using drugs. They said doing things with their families. The council is reviving focus groups to do the work this year. Each focus group will have a timeline to work by and we will use the state outcome guides to report with.
Beginning in 2002 and continuing through April 2007, the Catron County Health Council has conducted extensive review of the health status of citizens of our county, using both primary and secondary data. The Wellness and Health Action Team has also conducted an ongoing review of the current system of health care, while the Substance Abuse Community Action Team has forged partnerships with other county agencies and services to better understand how we can change the social norms in the community. The development of the Health Profile and its ongoing updates has provided a snap shot of the current health of the county and demonstrated trends in the health of the community. Use of available data is fraught with a number of problems as well as providing valuable insights. For many health indicators, accurate data does not exist or is not reported. The small population of the county results in suppression of some data and in difficulties in examining trends. Dramatic fluctuations over time, changes in conditions and reporting practices, and varying definitions complicate interpretation of the available information. Nonetheless, analysis of the Profile and input from County residents through surveys and ongoing Community Meetings has identified a number of health and wellness priorities. A new project in the northern end of the County in starting a satellite council has made it easier to assess the needs of that area.
Making a Plan
In April 2007, the Health Council conducted its annual Strategic Planning Session and confirmed that the priorities for 2008 remain the most significant issues for the future. Each year we do this after the session and looking at the Profile to determine needs for a Plan.
The major concerns of the community are 1) coverage and access to health and 2) substance abuse.
The Catron County Health Advisory Council was initiated in 1991 by the County Manager, primarily to recruit and retain primary care providers to the area and to integrate public health and primary care services. From its inception, however, it has been active in assessment and planning for health care in the county as well as serving as an oversight committee for the Catron County Medical Center until 2002. In early 2002 the Council became a comprehensive community health council and gave up direct oversight of the clinic. The Council was endorsed in 2002 by the Catron County Commission as the Comprehensive Community Health Council for Catron County and in 2003 also became the Community Maternal and Child Health Council. Since its inception, the Council had conducted four county-wide resident surveys to determine the residents’ perspective on health care needs and gaps. Over the past 3 years, a series of
Community Meetings have been held in various small towns and subdivisions to hear residents’ concerns and explain the role of the Health Council. That along with beginning
a satellite CCHC in the northern end of Catron County is the best way .to gather primary data. Each April the Council holds a strategic planning meeting, reviewing the needs expressed and determining priorities for community action. Since the first Health Profile was completed in 2002, Data from the Health Profile has been used to help prioritize health care needs. Limitations in the available data are significant due to the small population of the County, the lack of local health and wellness services and social
services agencies, and lack of data on many health status indicators. Nonetheless, the community perspective plays a major role in determining the priorities and developing strategies to address them .The Catron County Health Council has in the past 5 years made great strides in making a healthier county. Not only do we work on our priorities of Wellness/Access and Substance Abuse but we have been instrumental in re establishing a Public health office in the County. We were able to do this with the cooperation of Public Health. The council has also obtained a grant to study and present the indigent funding program to the county. We are also working with a Cancer program, the Local Emergency Planning Council, The Wellness Coalition and Behavioral Health with JD#7. Each meeting is attended by many partners and agencies.
Residents of Catron County are generally a healthy group, in part because those with chronic health conditions and those who require specialty medical services cannot safely live here. An analysis of health status indicators reveals the following issues:
This is a County with an aging population. Although the number of residents under 20 has remained fairly stable over the past three years, the percentage between 20 and 64 has fallen from 58.4% in 2000 to 56.7% in 2002. The percent of the population ages 65 and older has risen from 18.8% in 2000 to 21.2 percent in 2002 (US Bureau of the Census, 2004). The number of births in Catron County has remained fairly stable over the last ten years at a mean of 26.2 per year. The birth rate is considerably lower than for New Mexico as a whole. Low birth weight and very low birth weight infants account for almost 10% of live born infants over the past 10 years. Teen pregnancy occurs at a rate similar to that for New Mexico and the United States as a whole. When one compares the level of prenatal care, the number of births to teenagers, and the number of low birth weight infants, there has been little improvement over the past ten years. Births to single mothers have risen.
Deaths in Catron County are similar to those in New Mexico as a whole; although the age adjusted death rates reveal a rate for males almost twice that of the state, while for females it is about one third of the state rate. Looking at the five leading causes of death, it is apparent that there are an excessive number of deaths due to diseases of the heart, malignant neoplasms, accidents and cerebrovascular disease, but this may reflect the age distribution of the population. For males Catron County had the highest death rate in the state for influenza and pneumonia and the seventh highest rate from suicide between 1998 and 2002. Females had the second highest rate of death from heart disease and the sixth highest rate for motor vehicle accidents. Deaths from suicide, drug overdoses, and prescription drug overdoses are particularly high compared with other parts of the state.
Morbidity data are suspect for Catron County, as local providers indicate that the published statistics do not reflect their experience or the number of cases that they have reported. Similarly there are no statistics for immunization rates, although data on vaccines administered has been provided to the state each year. The incidence of cancers in both males and females does not seem unusual for New Mexico. Diabetes data is an
estimate based on population demographics. Data on accidents and asthma rely on hospital discharge data, and many individuals seek emergency care outside of the state or do not go to the hospital when they are ill for a number of reasons. At Community Meetings, residents indicate that they often just “wait and hope” because of the barriers to accessing medical care.
A summary of the demographics and selected health indicators for Catron County is seen the accompanying document, “Catron County Facts at a Glance.”
Discussion of the council’s health improvement prioritization process:
The CCHC is composed of members from the various communities and from various agencies and partners 2 surveys of residents were conducted last fall. : We felt that we needed to keep the same Priorities with a few new activities.
1. Coverage and Access to Health
2. Substance Abuse.
Health improvement priority list:
Priorities identified: I. Coverage and Access to Health II. Substance Abuse
Coverage and Access to Health Indicators:
Number of hours of specialized services available in County to Catron County residents.
( Includes preventive services, medical specialty services, dental services, Public health services, Pharmacy, Home health care, immunizations, diabetes, rehabilitative services, etc.
Substance Abuse indicators:
Alcohol-related motor vehicle deaths
Increase of use of drugs in the schools
Health Improvement Priority #1—Coverage and Access to Health
Access to health and wellness care is the major problem in Catron County, encompassing all other concerns. Data clearly demonstrates the lack of availability of most services generally taken for granted in other areas of the country and state. Lack of data results in difficulty in determining how the lack of services impacts many health status indicators. When individuals do not access the health care system at all, they fail to appear in statistics. Because the population is low, national and statewide sampling methods leave our county virtually unassessed or the data is suppressed due to privacy and validity concerns. This is demonstrated by the lack of information from the BHSS, the lack of immunization statistics, etc.
a. Available data:
Catron County has a full-time physician to serve over 3,500 individuals living in an area of almost 7,000 square miles. The entire county is designated as a Health Professionals Shortage Area.
Catron County has a single source for primary care, the Catron County Medical Center, and one outreach clinic held approximately four times per month.
Catron County has no weekend or nighttime health care available.
The nearest hospitals are 80 to 100 miles from most Catron County residents. Catron County has no obstetrical care, no specialty care, no pharmacy, and minimal mental health services (approximately 32 hours per week).
Catron County has no school based health clinics.
Catron County has no paramedics. Many communities do not have enough emergency medical technicians to provide needed services.
WIC services and other services are provided in Catron County by the Public Health Office. A Public Health Office was established in 2004 after not having a presence in the County for nearly a decade. As residents are just adapting to have a PHO in the county the PHO lost its nurse manager. At this time they are advertising for a new nurse. Catron County has a low employment rate, low per capita income, and low rate of insurance coverage. See Figure 1.
Catron County has no public transportation system.
Catron County has no teen pregnancy prevention or support programs.
Health Status Indicators relevant to above:
No immunization data is available.
Levels of prenatal care:
Table 1. Adequacy of Prenatal Care Utilization, 1996-2002
Figure 2. Percent of Catron County Births with Low or No Prenatal Care,
Figure 3. Percent of Low Birthweight among Catron County Resident Live Births, 1996-200
Visits to the Catron County Medical Center for various diagnoses compared with the number of individuals in the County estimated to need care for those conditions:
Only 10 visits for “diabetes” were coded by the Catron County Medical Center in 2003 despite an estimate of 280 cases in the County.
Table 3. Leading Causes of Death in Catron County compared to New Mexico,
b. Assets in community related to priority:
Catron County has one Rural Primary Care Clinic with a single physician working 5 days per week. There is a single satellite clinic in Quemado, held an average of 4 times per month. Although there are 18 licensed nurses (RN and LPN) in county, only 3 of these are employed working in the county.
Catron County established a full time dental office in 2005. The office is equipped and staffed with a full time dentist, full time dental hygienist and a dental assistant. The dental office is open 4 days a week for a total of 40 hours a week. PMS also provide outreach and education on oral hygiene, nutrition, dangers of tobacco use, and the importance of sealants in the schools through an outreach program. A fluoride rinse pilot project was started at the Reserve Elementary School. This provides a fluoride rinse, and initial exam and a post exam free to the children (4th & 5th grades).
Other health, medical, and disability services are available but frequently require residents to leave the county. These are summarized below:
Children’s Medical Services, (Out of County in Silver City and Socorro)
Chiropractic Medicine, Glenwood & Reserve
Family Planning Services, Reserve, and (Out of County)
Catron County Dental Clinic, Reserve
Other Hospitals/Medical Centers:
Fort Bayard Medical Center, (Out of County in Silver City)
VA Outpatient Clinic, (Out of County in Silver City)
Home Health and Personal Care Services
Angelwings Home Care, Glenwood
Gila Regional Home Health Services, (Out of County in Silver City)
Heritage Home Health Care, (Out of County in Socorro)
San Vicente Home Health, (Out of County in Silver City)
Hospice, (Out of County in Silver City and Socorro)
Massage Therapy, Reserve, Glenwood
Naturopaths, Reserve, Datil
Nursing Homes, (Out of County in Silver City and Socorro)
NM Nursing Home Ombudsman, (Out of County)
Mental Health Services:
Border Area Mental Health Services, Reserve and (Out of County in Silver City) National Alliance for the Mentally Ill, (Out of County in Silver City) Socorro Mental Health Foundation, Inc., (Out of County in Socorro)
Little Colorado Behavior Health Center, (Out of County in Springerville, Az.)
There is one practicing chiropractor, 3 massage therapists and several alternative health practitioners in the county. Emergency medical services are available in several communities with a total of 42 Emergency Medical Technicians and 21 First Responders.
A number of agencies and programs contribute to the health and wellness of Catron County residents.
Border Area Mental Health Services, Inc. An in county based service organization provides several programs in Catron County, mental health counseling, family support services, and a drug abuse (especially methamphetamine) prevention program. There is a part time therapist staffed in Reserve. Problems covered include school behavior, marital problems, depression, divorce adjustment, mediation, family therapy, bereavement counseling, alcohol and drug treatment, adolescent counseling, child counseling, crisis intervention, stress management, forensic evaluations, and major mental illness. A substance abuse prevention specialist working on an inhalant and methamphetamine abuse prevention program is in Reserve fifty percent times, and a new family services coordination program has been established.
c. Needs/Gaps in community related to priority
Needs and gaps in access to health and wellness services are of two types—services that
are unavailable in Catron County, and barriers preventing residents to access those services that are available.
Unavailable services include:
1. Infrastructure to house the growing health care.
2. Adequate physician coverage.
3. Night and weekend services.
4. Prenatal care and delivery services.
6. School based health clinics.
7. Adequate mental health services.
8. Other specialty care (pediatric, ophthalmology, cardiology, oncology,
9. Home health care.
10. Physical and occupational therapy.
11. Health education programs.
12. Extended care facilities.
13. Hospice care.
14. Social service support systems (CYFD, Income Support Division, etc.)
Serious and frequently cited barriers to obtaining care: