Jo Daviess County Needs Assessment 2009-2014 Submitted By ...

Jo Daviess County Needs Assessment 2009-2014Submitted By Peggy Murphy, RN, BSN, MPHPublic Health Administrator1

the department has chosen to use the APEX model as a guide to conducting both phases of the IllinoisPlan for Assessment of Needs.Self Assessment of Organizational Capacity (Internal Needs Assessment)The Jo Daviess County Health Department employees 30 staff members, 20 full time employeesand 10 part time employees. The staff was provided the Part I Organizational Capacity Assessmentforms at the July 9, 2008 staff meeting and were given 3 months to complete the 63 pageassessment by ranking each indicator by perceived importance code (High, Medium, Low or NotRelevant) as well current status code (Fully met, Partially Met, Not met at all, Not relevant, or Statusunknown). The results of the Internal Needs Assessment for Jo Daviess County Health Departmentwere compiled and reviewed by the Jo Daviess County Health Department administrator and officemanager in September 2008 and a summary of the findings and recommendations were provided toJo Daviess County Board to review at the November Board of Health Meeting. The tally of the resultswas shared with the Board of Health at the October 1 st , 2008 Board of Health Meeting but the finalreport for this still needs to be developed in written format. The Board of Health reviewed andadopted the approved the internal needs assessment for the Jo Daviess County Health DepartmentDepartment during the February 4, 2009 Board of Health Meeting.See Appendix C, Internal Needs Assessment, Jo Daviess County Health Department.See Appendix D, Jo Daviess County 2010-2015 Needs AssessmentSee Appendix E, Minutes of the Jo Daviess County Board of Health, February 4, 2009.See Appendix F, Minutes of the Jo Daviess County Board, March 10, 2009Jo Daviess County Community Needs Assessment 2010-2015In June of 2008, The Public Health Administrator invited 15 community members to participateIn the 2010-2015 Community Needs Assessment process. For the Jo Daviess County HealthDepartment, this is the fourth round for implementing this process. The community partners thatparticipated included individuals from each community and representatives from Clergy, Business,4

Law enforcement, Mental health, Domestic violence, County government, Disabled, Senior citizens,Extension Services, and Consumers of health care and Human Service Providers. The committeebegan with 15 members, but due to conflicts with schedules, one committee member resigned beforebeing able to attend any of the meetings. Because many of the members worked full time, themeetings were scheduled from mid July 2008 to October 2008. The Jo Daviess Committee Assessmentcommittee met from 7:30 am to 9:30 am at the Conference Room at the Jo Daviess County HealthDepartment in Galena. The meetings were held every other week with group assignments to becompleted between meetings. Bylaws for the committee were explained and reviewed during the initialmeeting on July 24 th and future meeting dates were outlined as follows:Thursday, July 24, 2008Thursday, August 7, 2008Thursday, September 21, 2008Thursday, September 24, 2008Thursday, October 2, 2008Thursday October 16, 2008During the first meeting the committee introduced themselves and what geographic area andorganization or community group that they represented. The committee was composed of 15individuals who reside in or work in Jo Daviess. The 2010-2015 Jo Daviess County CommunityNeeds Assessment Committee included:1. Bernece Hill, Stockton, IL: County Board Member and Senior citizen2. Kevin Turner, Deputy, Elizabeth IL: Jo Daviess County Sheriffs Department, Law Enforcement3. Peg Dittmar, RN, NP, Elizabeth, IL: Midwest Medical Center Critical Access Hospital,Health Care provider4. Mark Maidek, Elizabeth, IL: University Of Illinois Extension Service, rural and farming5. Jerry Westemeier, Galena, IL: City of Galena, Chief of Police, Law Enforcement5

6. Erica Soltow, Freeport IL: Illinois Department of Human Services, Galena Office for JoDaviess County, Medicaid, All Kids, Food Stamps, Aid to Dependant Children7. Pastor Dottie Marizo, Schapville, IL: Schapville Zion Presbyterian Church, Clergy, Jo DaviessCounty Alcohol and Other Substances Coalition8. Tabetha Schemel, Dubuque, IA: RiverView Center, Sexual Assault, Domestic Violence9. Mike Bielenda, Jo Daviess County Workshop, East Dubuque IL: Developmentally Challenged orDisabled10. Jim Lander, Galena, IL: Board of Health President, Retired Medical Librarian; Health Care11. Tina Steel Leitz , Hanover, IL: Tyler Justice Center Director, Child Abuse, Domestic Violence12. Libby Miller, Galena, IL: Galena State Bank, Business Community13. Kim Shird, Galena, IL: FHN Family Counseling, Mental Health14. Matt Calvert, Galena, IL: Director of Environmental Health, Jo Daviess County Health Dept15. Tom Winter, Galena, IL: 911 Dispatch, Emergency ServicesPeggy Murphy, Public Health Administrator, attended most of the meetings but was considered an exoffio,a member of the committee but was not able to vote on the health issues identified. Her task was toprovide additional demographic and statistical data as the committee requested. Although there were 15members on the initial committee, Erica Soltow resigned from the committee when she realized that shewas not able to attend any of the meetings due to her role between two counties.In a brief synopsis, the Jo Daviess County Community Needs Assessment Committee spent timeduring the first meeting reading the by-laws, electing officers and setting the framework for reviewing theinformation provided to them in a 3 ring binder.The Committee elected officers with Jim Lander being elected President and Peggy Dittmar, VicePresident. Susan Schlegel, Jo Daviess County Health Department clerical staff member, was present ateach meeting to take the minutes. Jim Lander provided the agenda for each meeting and the by lawswere followed at each meeting. The committee used nominal consensus with their decision makingprocess and spent a great deal of time discussing many health concerns before finally voting on the6

priority health issues that were agreed upon. The PEARL Criteria was considered by the committee whendetermining the ranking for each health problem according to Propriety, Economics, Acceptability,Resources, and Legality. The committee also contemplated the Hanlon Criteria based on the size of theproblem, the seriousness of the problem, and the effectiveness of the problem. The minutes of themeetings of the Jo Daviess Community Needs Assessment committee for 2008 are included in AppendixG, Minutes of meetings.Data Reviewed for Analysis 2010-2015 Jo Daviess CountyThe Jo Daviess County Needs Assessment Committee was provided a 3 ring binder that included a varietyof health data that included State, National and County data. Every attempt was made to provide thecommittee with the most current data that was available and accessible during the time frame that theymet. Additional information was requested and provided to the committee during this process. Thefollowing is a numerical listing that contains the data that was reviewed by the committee.Each item that the committee used for their analysis of heath needs will be listed in numeric order.1. 2008 Data from the Illinois Project for Local Assessment of Needs websiteThis section includes comparisons for Jo Daviess County, the State of Illinois and the UnitedStates. Most rates are per 100,000 or as indicated.Population by age and genderDependency indicatorsRace and ethnic distributionMedian age for PopulationPopulations 25+, Non high school graduatesHigh school drop-outsPopulation in povertyPopulation receiving food stampsUnemployedRural population7

Single parent householdsPopulations enrolled in MedicaidPopulations uninsured 18yrs -64 yrsPer capita personal incomeMortality ratesLeading causes of mortalityCause specific years of potential life lostExcess non-white deathsLife expectancy at birthMedicaid enrollees to Medicaid physician vendorsAdvanced life support emergency care vehiclesPopulation residing in Primary Care HPSAPopulation with optimal fluoridated waterLive birthsInfant mortality rateLow birth weightMothers who smoke during pregnancyMothers who drink during pregnancyMothers beginning prenatal in 1 st trimesterInfants positive for cocaineLeading causes of mortality ages 1-4, ICD9WIC, low weight for heightTeen birth weightPercent birth to teensFounded child abuse/neglect rateCongenital anomaliesMedicaid deliveries8

IDPA-Eligible children receiving EPDSTKotelchuck Index of prenatal care utilizationMethod of deliveryCoronary heart disease mortality ratesCerebrovascular heart disease mortality ratesChronic Liver Disease and Cirrhosis Mortality RatesBreast Cancer (Female) Mortality RatesLung Cancer Mortality RatesColorectal Cancer Mortality RatesCervical Cancer (Female) Mortality RatesProstate Cancer (Male) Mortality RatesChildhood Cancer (Under Age 15) Mortality RatesAlcohol Dependence Syndrome Hospitalization RatesTotal Psychosis Hospitalization RatesDiabetes Hospitalization RatesOverweight, Smokers, Sedentary LifestylesBreast Cancer Age-Adjusted Incidence RateColorectal Cancer Age-Adjusted Incidence RateCervical Cancer Age-Adjusted Incidence RateLung Caner Age-Adjusted Incidence RateProstate Cancer Age-Adjusted Incidence RatePercent Diagnosed In Situ Breast Cancer (Female)Percent Diagnosed At Local Stage Colorectal CancerPercent Diagnosed At Local Stage Prostate CancerPercent Diagnosed At Late Stage Cervical CancerChildhood Cancer Age-Adjusted Incidence Rate (5yr average)Syphilis Incidence Rates9

Gonorrhea Incidence RatesChlamydia Incidence RatesAids Incidence RatesHIV Incidence RatesBasic Series ImmunizationsHaemophilis Meningitis (Ages 0-2 and 0-4)Food Pathogen Infections RatesVaccine Preventable DiseasesHepatitis B Incidence RatesTuberculosis Incidence RatesEnvironmental IndicatorsToxic Agents Released Into Air, Water, SoilMotor Vehicle Accident Mortality RatesHomicide RatesSuicide RatesNon-Fatal Head/Spinal Cord, Hip injury HospitalizationsNon -Fatal Hip Fracture Hospitalizations Rates (Ages 65 and up)Non- Fatal Head Injury Hospitalization RatesNon-Fatal Spinal Cord Injury Hospitalization RatesAlcohol-Related Motor Vehicle Mortality RatesOccupational Disease InjuryBlood Lead Levels in ChildrenAssault RatesSentinel EventsSentinel Events Cancer (5 year average)10

2. Environmental HealthJo Daviess County Septic Permits Issued 2002-2008Jo Daviess County Well Permits Issued 2002-2008Unsafe Water Well Point Map, Jo Daviess County 2007Total Wells Sampled Jo Daviess County 2007Percentage of Unsafe Well Water, Jo Daviess County 2007Composite of Well Samples Categories, 1993-2007, Jo Daviess CountyWell Water Total Samples (3,154) Jo Daviess County 1993-2007Food Establishments by Category 2007, Jo Daviess CountyPercentage of Food Establishments with Critical Violation, Jo Daviess County 2007Food Establishments by Type, Jo Daviess County 2007Restaurants by Town, Jo Daviess County 2007New Restaurants in Jo Daviess County 2007Closed Restaurants in Jo Daviess County 20073. County Risk Survey; Jo Daviess County: Behavioral Risk Factor Survey 2007This survey was competed in Jo Daviess County in 2007 and so the information from this survey wasprovided to the committee and again allowed comparisons to the other rural counties in Illinois as well asthe state as a whole. The sections were as follows:AlcoholArthritisAsthmaColorectalDiabetesDemographicsNutritionHeath StatusHIV/Aids/STD11

ImmunizationsInjury ControlOral HealthPhysical ActivityProstate ScreeningQuality of LifeTobacco UseWeight ControlWomen’s Health4. Vital Statistics Jo Daviess CountyPercent of Deaths by Disease Category, Jo Daviess County 2001 to 2005 for:Cardiovascular DiseaseCancerRespiratoryExternal CausesOther Selected CausesInfective and Parasitic DiseasePercent of Death by Cause for Jo Daviess County 2001-2005Percent of Death by Place of Residence for Jo Daviess County 2007:Births By Place of Residence For Jo Daviess County: Automated Vital Records 07-03-08Alcohol5. Communicable Disease ReportsJo Daviess County Health Department Annual Report 2006-2007Reported STDs by Provider Type, Jo Daviess County Family Planning 1-1-07 to 12-31-0712

6. Research and Program Evaluation In Illinois:Extent and Nature of Drugs and Violent Crime in Illinois Counties, Illinois Criminal JusticeInformation Authority, December 2004, 25 pages7. Featured Report:Bullying Behaviors Among Children and Adolescents, American Medical AssociationReport, August 4, 2008 (Internet) 19 pages8. Illinois Youth Survey9. Bullying Statistics:National Youth Violence Prevention Center, Internet, July 29, 2008, 3pages10. Bullying and School Safety:Journal of Pediatrics, Glew et al, January 2008, pp123-12811. Child Abuse and Neglect Statistics:July 2008, Illinois Department of Children and Family Services, July 2008, 16 pages12. Child Abuse and Neglect Statistics:October 2006, Illinois Department of Children and Family Services, 21 pages13. Domestic Violence Statistics:Choices Statistics for Jo Daviess County, July 2007 to June 2008, 1 page14. Sexual Assault Statistics for Jo Daviess County:Riverview Center, mid year 2008 1 page15. Elder Abuse Statistics for Jo Daviess County and Stephenson County:Stephenson County Senior Center, August 2008, 2 pages16. Map of Elder Abuse by County:August 2008, Internet, State of Illinois, I page17. 2008 Alzheimer’s Disease Facts and Figures:Alzheimer’s Association, 2008, 40 pages18. Prevalence of Alzheimer’s Disease State by State:2005 projections, Shere et al, Neurology, 2005, pages 5-6.13

19. Bullying Moves into Cyber Space, By Dave Ketteling, Telegraph Herald DubuqueIowa, P 1A-2AArthritisAsthmaColorectalDiabetesDemographicsNutritionHeath StatusHIV/Aids/STDImmunizationsInjury ControlOral HealthPhysical ActivityProstate ScreeningQuality of LifeTobacco UseWeight ControlWomen’s HealthOther Data Information that was requested by committeeResearch and Program Evaluation In Illinois: Extent and Nature of Drugs and Violent Crime in IllinoisCounties, Illinois Criminal Justice Information Authority, December 2004, 25 pagesFeatured Report: Bullying Behaviors Among Children and Adolescents, American Medical AssociationReport, August 4, 2008 (Internet) 19 pages14

Illinois Youth SurveyBullying Statistics, National Youth Violence Prevention Center, Internet, July 29, 2008, 3 pagesBullying and School Safety, Journal of Pediatrics, Glew et al, January 2008, pp123-128Child Abuse and Neglect Statistics, July 2008, Illinois Department of Children and Family Services, July2008, 16 pagesChild Abuse and Neglect Statistics, October 2006, Illinois Department of Children and Family Services,1 pageDomestic Violence Statistics, Choices Statistics for Jo Daviess County July 2007 to June 2008, 1 pageSexual Assault Statistics for Jo Daviess County, Riverview Center, 2008 mid year 2008, 1 pageElder Abuse Statistics for Jo Daviess County and Stephenson County, Stephenson County Senior Center,August 2008, 2 pagesMap of Elder Abuse by County, August 2008, Internet State of Illinois, I page2008 Alzheimer’s Disease Facts and Figures, Alzheimer’s Association, 2008, 40 pagesPrevalence of Alzheimer’s Disease by State, 2005 projections, Shere et al, Neurology, 2005, pp. 5-6.Bullying Moves into Cyber Space, by Dave Ketteling, Telegraph Herald, Dubuque, IA, August 3, 2008,p. 1A-2AThe Emotional Toll of Obesity, By Mary Gavin, Kids Health, June 2008, 5 pages (Internet).Overweight Problems Seen Even in Infants, in Rueters Health, August 5, 2008, 2 pagesPoor Sleep Tied to Excess Pounds in Children, August 4, 2008, Medline Plus, Archives of GeneralPsychiatry. 1 pageKids Obesity May Lead to Epidemic of Adult Diabetes, By Robert Preidt, HealthDay News,July 8, 2008, I page, (Internet)Kids Obesity May Lead to Ear Infections, Kathleen Daly, HealthDay, August 14, 2008, I page, (Internet)Child Care May Lead to unwanted Weight Gain in Infants, David Kats, HealthDay, July 7, 2008, 2 pages,(Internet)15

Rational for Priority Health Issues For Jo Daviess County 2010-2015At the conclusion of the Jo Daviess County Community Assessments meetings, the Committee votedupon and ranked 4 health issues. The Committee agreed that the entire community needs to addressthe issues over the next five years. Those issues will be discussed according to the way that they wereranked beginning with the highest priority first and then the other three issues in descending order.1. Obesity1. Obesity was discussed at great length due to all the national attention it has received during the lastfew years. Local statistics on this issue were not available, but based on the information from theBehavioral Risk Factor information of 2007, it was decided that this health concern has seriousconsequences for diabetic and cardiovascular disease diagnosis in Jo Daviess County.Cardiovascular disease is the leading cause of death for Jo Daviess County residents. Based on theCounty Frequencies for Obesity in the 2007 Behavioral Risk Factor Survey for Jo Daviess County,38.6 % were under weight/normal weight while 41.1 % were overweight and 20.3 % were obese.This compares to other rural counties in Illinois that report 36. 6% are under weight/normal weight;34.6 % are overweight and 28.8% are obese. The State of Illinois Statistics for 2007 survey shows39% are under weight/normal weight, 36.2% are overweight and 24.7% are obese. The Jo DaviessCounty results from the same survey noted that 17% were advised to loose weight, and 46% wereactively trying to loose weight while 71% were trying to maintain their weight. It appears that JoDaviess County is mirroring the Nation and the State with the health concern of obesity and theimplications that it may have for diabetes, cardiovascular disease, and other chronichealth issues. The committee had long discussions on the public health implications for obesityand although many of the references that they used were related to obesity in children, they felt thatthis health priority should be addressed in all age groups. The risk factors for obesity are found inAppendix H. The local physicians in the county have concurred that they believe that obesity is ahealth issue that needs to be addressed on a county level. As a rural county, these nine primarycare physicians have concurred that obesity is a very real concern.16

2. Intimate Contact Interpersonal ViolenceThe second priority health issue that received nominal consensus by the Jo Daviess County NeedsAssessment Committee, related to interpersonal violence that is evidenced by cases of child abuseand/or neglect, domestic violence, rape and incest, bullying and other forms of sexual intimidation.Numerous sources of data were compiled and reviewed. The members of the Jo Daviess CountyNeeds Assessment Committee also looked at local data from human service agencies that dealwith this issue. The Illinois Youth Survey, local cases of domestic violence and state statistics allvalidate that violence in rural Jo Daviess County has increased at steady rates over the lastdecade. It is difficult to determine if these figures are a reflection of better reporting requirements ordue to the increased sensitivity to law enforcement and the judicial process or a better supportservice for battered women, men and others who are victims of interpersonal violence. Althoughmuch is written about bullying in schools, this form of coercion takes place with adults as well.The statistics for Jo Daviess County for the 2007-2008 fiscal year show that the Choices Agency forDomestic Violence provided assistance to 139 individuals, provided 21 nights of shelter andresponded to 516 hot line calls. Domestic violence statistics for Jo Daviess County report that in2006 there were 163.76 cases of reported domestic violence per 100,000 people. At the sametime in fiscal year 2008, River View Center, that covers Jo Daviess County for victims of sexualassault, served 91 clients and responded to 146 non client crisis contacts. The most recent reporton reported domestic crime offenses for 2006 in Jo Daviess County was 37. A Profile of Jo DaviessCounty Criminal and Juvenile Justice Systems reports that in 2003, drug arrests for Jo DaviessCounty were 45% higher than other rural counties in Illinois for the same time frame. (1994-2003).Between 1994 and 2004 there were 3 reported cases of substance abused infants in Jo DaviessCounty. This compared to other rural counties that had an increased 23% from 83-102 of substanceexposed infants while Jo Daviess County’s increase for the same period was 43%, from 44-63.17

This is not surprising since alcohol and substance abuse has been identified consistently as a healthpriority in Jo Daviess County since 1992. The Jo Daviess Community Needs AssessmentCommittee decided to list interpersonal violence as an issue, knowing that alcohol and substanceabuse is probably a related risk factor or contributing factor to this issue. The Risk Factors forInterpersonal Violence are found in Appendix I.3. Breast CancerThe committee looked cancer as one of the leading causes of premature death in Jo DaviessCounty. Although it is not the leading mortality in Jo Daviess County, the cancer diagnosis hastouched the lives of people in every community and breast cancer is a prevalent concern. Thebehavioral risk factor survey for 2007 noted that very few women have taken advantage ofmammography that is readily available through a grant funding for Well Woman of NorthwestIllinois. In the survey, 32% of the women reported that they had never had a mammogram and at thesame time 10% reported never having a breast exam while 14% had not had a breast exam in thelast year. This compares to the results of the state data from the same survey that report 34% of thewomen who responded to the survey reported never had a mammogram while 11% have never hada breast exam. The risk factors for breast cancer are found in Appendix J.4. Prostate CancerAccording to the 2007 Behavioral Risk Factor Survey for Jo Daviess County, 40% of the maleswho responded to the survey have never had a PSA test to evaluate their risk for prostate cancer.Of those who did have a PSA test, 75 % had one within the last year. 5% reported that they weretold that they had prostate cancer. The State of Illinois comparison for the same survey notesthat of the men who responded, 45% had never had a PSA test. Of those who did have the test,72% had it within the last year and 4% were informed that they had prostate cancer. Access tocare may play a factor in seeking health care for both prostate and breast cancer in a rural area.The risk factors for prostate cancer are found in Appendix K.18

Plan to Address Four Jo Daviess County Health Priorities 2010-2015Jo Daviess County Health Department appreciates time and effort that the Jo Daviess County NeedsAssessment Committee has spent a lot of time to review a vast amount of data and informationbefore deliberating and identifying these four health issues. The Health Department has beenparticipating in the community needs assessment process since 1992. It repeats this comprehensiveplan every five years and this is the fourth round for Jo Daviess County Health Department. Thedepartment is pleased to recognize how the community is willing to partner and implement the or addressthe health needs identified in this process over the next five years.Purpose of Jo Daviess County Community Needs Assessment Plan for 2010-2015The following plan is to identify interventions to address the four priority heath needs in Jo DaviessCounty so that the objectives for each issue serve as a guideline to direct and focus a community wideeffort to affect these health concerns of 1. Obesity2. Intimate Partner Personal Violence.3. Breast Cancer4. Prostate CancerThe hope is that best practices and research based interventions will be used when ever possible forthese health issues. This effort will involve many community partners including health and human serviceagencies, the medical community, law enforcement and government agencies.1. ObesityThe premature death related to obesity is a challenging health issue and is very complex in that it willneed to involve a community wide effort to even research the scientific interventions that can truly impactthis topic. The medical community, the local hospital, mental health agencies, schools, and the humanservice agencies need to collaboratively establish a plan to address obesity and to develop measurableobjectives to impact this problem over the life span.Impact Objective for Obesity: By November 30 th . 2015 Jo Daviess County will establish aJo Daviess County Obesity Coalition to explore research based interventions for obesity with afocus on prevention. This coalition will establish its purpose and by laws in writing and meet on19

a consistent basis as validated by meeting minutes.Impact Objective for Obesity: The Jo Daviess County Board of Health will be updatedon an annual basis, at one of the six boards of health meetings, on the progress and activities ofthe Jo Daviess County Obesity Coalition, as verified by Jo Daviess County Board of Health meetingminutes 2010 to 2015.Outcome Objective For Obesity: Potential measurements to verify a 5%reduction for obesity in Jo Daviess County may be found in information in the Jo Daviess CountyBehavioral Risk Factor Survey that is done on a regular 3 year cycle with comparisons for JoDaviess County, other rural counties in Illinois and the State of Illinois. Other local data forobesity could be derived from infants and children served by the WIC Program in Jo DaviessCounty via the Cornerstone Computer System. That would be one way to determine anydecrease in obesity over a five year period.Obesity and Health People 2010: According to Health People 2010 there are severalgoals for obesity and the ones that may apply to Jo Daviess County.19.2 Reduce the proportion of people who are obese.Measurement: Percent age adjustedBaseline: 23% (1988-1994)19.3 Reduce the proportion of children and adolescents who are overweight or obeseMeasurement: Percent (using BMI)Baseline; 11% (1988-1994)19.3a Children ages 6 -11 yearsNumber of children in this age rage at or above 95 th percentile with CDC growth chartMeasurement: PercentageBaseline: 11% (1988-1994)Resources for obesity: Jo Daviess County has a variety of Medical and human resource agenciesthat will be invited to participate in the Jo Daviess County Obesity Committee including MidwestMedical Center (the county local Critical access hospital) 9 county physicians, 4 dentists, and 6School districts, 3 private or parochial schools and the Jo Daviess County Extension office andseveral fitness offices or programs and numerous civic groups.Barriers for obesity. Jo Daviess County is rural in nature so lack of public transportation and lack20

qualified nutritionists would be a concern. The schools all have tight budgets and school lunchprograms are minimal. Many families do not have health insurance and if they do dietary counselingand fitness are not always covered. There is no grant funding available to address obesity at thistime.2. Intimate Partner Interpersonal ViolenceInterpersonal violence can take on many forms. Jo Daviess County is fortunate to have threeSeparate agencies who provide services for domestic violence (Choices), sexual violence(Riverview Center) and physical neglect and childhood endangerment (Tyler’s Justice Center).Interpersonal violence will be addressed through a joint effort of these agencies, in cooperationwith Freeport Health Network Family Counseling that has an office in Jo Daviess County.The Jo Daviess County Board of Health will request that these agencies take the lead roleon the health priority of Interpersonal Violence. The Jo Daviess County Health Department willmonitor the progress toward a community level approach to decreasingthe cases of interpersonal violence in Jo Daviess County.Impact Objective for Intimate Partner Interpersonal Violence: By November 30, 2015 JoDaviess County will establish a mechanism to identify cases of interpersonal violence through aconsistent computerized soft- ware system that would tract cases that would be used by allauthorized reporting agencies in Jo Daviess County. This data would be provided to the JoDaviess County 708 Board.Impact Objective for Interpersonal Violence: The mental health agencies in Jo Daviess Countywill make a united effort to educate the 708 board on the identification of Interpersonal Violence asa priority health issue for the 2010-2015 Jo Daviess County Needs Assessment so that the Boardunderstands the need for staff and resources to address this issue on a county wide level.Outcome Objective for Interpersonal Violence: By November 30 th , 2015,21

Jo Daviess County will show a decrease in cases of interpersonal violence by 5% based on dataIn the most current Illinois Youth Survey as well as in data form the Illinois Behavioral Risk FactorSurvey, as well as local data from individual agency reports. This would be based on a five yearaverage.Healthy People 2010 goals for intimate partner personal violence15-34 Reduce the rate of physical assault by current or former intimate partners.Measurement: Per 1,000 populationBaseline: 4.4 (1998)Resources for intimate partner interpersonal violenceJo Daviess County has a separate levy for mental health and that board oversees all theMental health agencies that service Jo Daviess County. (The 708 Board) Many of those agenciesWork collaboratively with the health department, schools, medical providers on issues like violenceand alcohol and substance abuse. Community groups also participate in the Juvenile JusticeCommittee and Alcohol and other Substances Coalitions that are very active in the county.There is a lot of collaboration with all the agencies that have previously been mentioned.Barriers for intimate partner interpersonal violenceThere have been large fiscal limitations in Illinois due to the state budget cuts for the currentfiscal year of 2008-2009. The cuts with mental health agencies has limited their hours and staffcuts have been made. Funding for mental health has always been a lacking nation wide. Thefunding is more for treatment than prevention. There still remains a stigma for people in ruralareas where lack of access to qualified mental health specialist is very limited and also costly.Many of these services are located outside the county.22

Breast Cancer and Prostate CancerBoth breast cancer and prostate cancer were identified as health priorities in Jo Daviess County. Localdata for these are not easy to identify from morbidity statistics but some attempt must educate the publicon early diagnostic screening tests for both these diseases. It is obvious that despite the fact that thesetests are available locally, various barriers to care prevent the public from seeking this service.3. Breast CancerJo Daviess County Health Department has access to the Northwest Illinois Well Woman Program,which would allow income eligible women in Jo Daviess County to receive an annual mammogramat no charge. Although this is promoted in the local weekly papers, few women avail themselvesof this service. Perhaps more one on one education needs to be done to promote early detectionof breast cancer. Midwest Medical Center, in Galena, provides the mammograms for women whomeet the income guidelines. The grant provides that 95 women in the county can receive thisservice and yet only 22 clients have used the service.Objective for Breast Cancer: The Daviess County Health Department will continue toparticipate in the regional cervical and breast cancer grant awarded to Jo Daviess County.The health department will continue to send a representative to the quarterly meetings thatare held at the Stephenson County Health Department in Freeport, Illinois. This will beverified through the written attendance in the meeting minutes of the Wise Woman Programat Stephenson County Health Department.Measurable or Outcome Objective for Breast Cancer: Jo Daviess County HealthDepartment will continue to work with the Stephenson Health Department Well WomanProgram to promote mammography screening to at least 90 women a year, based on incomeGuidelines. This program will be promoted though all the public health nursing programs23

at the health department. The intent would be to increase the number of women served by10 % a year, (10% in 2010, 20% in 2011, 30% in 2012, 40% in 2013, 50% in 2014, and56% in 2015). This percentage is based on the 2010 grant allocation for Jo Daviess Countywhich is 95 women and may be modified if the allocation changes each grant year).Healthy People 2010 goals for reducing breast cancer death rateMeasurement: Rate per 100,000 womenBaseline: 27.9 (1998)Numerator: Number of female deaths due to breast cancerDenominator: Number of females in the population4. Prostate CancerIn addition to breast cancer, prostate cancer was identified as a priority health need by the committee.Early detection of this type of cancer is advised, yet males are reluctant to seek primary prevention forprostate cancer. Lab work for prostate specific antigens (PSA’s), are presently offered at by the JoDaviess County Health Department through monthly scheduled clinics that provide lab work forhypertension and cholesterol screening. The intent of those screenings is to identify elevatedhypertension and cholesterol levels in order to reduce premature death related to cardiovascular diseases.(Please refer to Appendix L) The screenings do include lab work for a variety of other chronic diseasesbut its original intent was not to screen for prostate cancer. This screening was added at the request of thepublic. With that in mind, it is very feasible to collaborate with the local hospital that provides this labscreening to develop a collaborative approach to provide this screening specifically for Jo Daviess Countymen who meet the risk factors for prostate cancer.Impact Objective for Prostate Cancer: Between December 1, 2010 and November 30, 2015, thepublic in Jo Daviess County will be educated about the risk factors of prostate cancer through theuse of the media, local newspapers, American Cancer Society brochures, and other methods inorder to promote prostate cancer screening.24

Impact Objective for Prostate Cancer: Develop a collaborative relationship with MidwestMedical Center to explore the feasibility of establishing a county-wide screening to provide labWork (PSA’s) for men who are asymptomatic and are in the high risk category for prostatecancer. Potentially, these screenings provided by the Jo Daviess County Health Departmentand Midwest Medical Center could be offered semi annually at various sites within the countyfor a reasonable fee and be offered county wideMeasurable Outcome Objective: By November 30, 2015, the number of men who seekearly detection for prostate cancer will increase by 7%, based on the most current Jo DaviessCounty Behavioral Risk Factor survey questions. “Have you had a PSA Test? “and “Have youhad a digital rectal exam”. Hopefully, 67% of those responding will have had a PSA in the lastyear by 2015 and 87% over the age of 40 will have had a rectal exam.Health People 2010: Goal reducing deaths due to prostate cancerMeasurement: Rate per 100,000 male population (age adjusted)Baseline: 32 (1998)Numerator: number of male deaths due to prostate cancerDenominator: Number of males in population to be studiedResources: Jo Daviess County Physicians work collaboratively with the JoDaviess County Health Department as does the American cancer society.Local media is willing to print schedules for screening clinics in the weekly local papers.The Local Hospital Midwest Medical Center is very willing to partner with the health departmentand the American Cancer Society to provide screening clinics for lab work for PSA testing.Barriers: Men do not take advantage of health screenings and will need to be promptedFor cancer prevention. Cost for screenings may be a barrier for the uninsured or thosewho have no insurance. Cancer has a fear factor associated with in. Access to care and lackof public transportation may be another impede seeking this type of service despite theeducation.25

BibliographyResources used for the Jo Daviess County Needs Assessment for 2010 to 2015.1. Jo Daviess County Reference and Year Book 2007-2008,compiled by Jean Dimke, County Clerk and Recorder, Galena, Illinois2. Map of Jo Daviess County courtesy of Joe Kratcha, Jo Daviess County GIS3. Jo Daviess County Level of Unemployment map, 2008, State of Illinois Website, Illinois facts4. Assessment Protocol for Excellence Workbook, National Association of City andCounty Officials, 1998.5. Jo Daviess County Internal Needs Assessment written Summary, 2008,Peg Murphy6. Jo Daviess County Health Department Board of Health Minutes, February 4, 20097. Jo Daviess County Board of Health Minutes, March 10, 20098. Jo Daviess County Community Assessment Committee meeting minutes, 19989. Jo Daviess County, Illinois Behavioral Risk Factors Survey, Fourth Round,Illinois Department of Public Health, 200710. Illinois Youth Survey 2008, The Chestnut Health Systems11. Jo Daviess County Environmental Health Program statistics for food,water, septic systems, non community water, vector control, and tobaccoprograms. Jo Daviess County Health Department.12. Jo Daviess County Births and Jo Daviess County Deaths for 2007, Jo DaviessCounty Health Department26