Benton County, Oregon

Community Health Improvement Plan

Prepared by Carolyn Ahl

06/16/2021

A. Summarize Benton County’s community health issues by doing the following:

1. Describe four priority health issues in the Benton County community.
 Excessive drinking and alcohol-impaired driving deaths - Brenton County’s excessive drink
is at 21%, which is a higher rate than both the U.S. top performers of 13% and the Oregon
rate of 19% (County Health Rankings & Roadmaps, 2020). Alcohol-impaired driving deaths
at a rate of 32% are significantly higher than top U.S. performers (County Health Rankings
& Roadmaps, 2020).
The rate for sexually transmitted infections (STI) is slightly higher than the state rate and
three times higher than top U.S. performers (County Health Rankings & Roadmaps, 2020).
The percent of uninsured in Brenton County is similar to Oregon and top U.S. performers
at 7% (County Health Rankings & Roadmaps, 2020). This still means there are large
numbers of people with limited access to healthcare. Uninsured people will choose to
forgo medical care until the health concerns reach a crisis, resulting in potential
preventative emergency room visits.
15% of people in Brenton County experience food insecurity, which is higher than overall
in Oregon and top U.S. performers (County Health Rankings & Roadmaps, 2020).

2. Discuss an improvement goal (i.e., a desired health outcome) for each priority health
issue.
Excessive drinking can lead to adverse health outcomes such as alcohol poisoning,
increased blood pressure, heart attacks, STIs, fetal alcohol syndrome, and motor vehicle
crashes. As alcohol impairs one’s ability to think, reason, and muscle coordination, it
increases the likelihood that one will not be able to operate a vehicle safely. For Benton
County, we want to see a decrease in the rate of alcohol-impaired driving deaths.
STIs are preventable with some interventions outside the healthcare setting. Unsafe
sexual behaviors can lead to an STI. As well STIs can lead to other significant health
problems like infertility and cervical cancer. To achieve this, we will need to improve
access to sexual and reproductive health education and services.
The people of Benton County need assistance gaining access to medical insurance
coverage. Decreasing the number of uninsured people in Benton County and be achieved
by increasing Medicare enrollment. We will focus on promoting Medicare and Medicaid
plans available to community members and ensuring that those eligible have access to
complete the application process.
To impact those experiencing food insecurity, we will want to ensure all community
members have access to healthy and affordable food. Not having access to sufficient food
or quality food can have a significant impact on one’s health. Those who are financially
strapped often are more affordable to buy unhealthy or fast foods than healthy foods such
as fruits, vegetables, and lean meats.

3. Discuss how each priority health issue aligns with both state and national priorities,
as well as tribal priorities, if applicable.

At a national level, the Department of Health and Human Services has launched Healthy
People 2020 with a vision to attain high-quality, longer lives free of preventable disease,
disability, injury, and premature death for the people living in the U.S. [ CITATION
CDC20 \l 1033 ]. These are national health priorities that line up with many of the priority
issues for Benton County are problems that, when addressed, can help prevent other
health problems. The Oregon Health Authority (OHA) has developed Healthier Together
Oregon: 2020-2024 State Health Improvement Plan, which identifies strategies to
advance health equity for all communities [ CITATION Ore20 \l 1033 ]. The vision of the
Healthier Together Oregon (HTO) is “Oregon will be a place where health and well-being
are achieved across the lifespan for people of all races, ethnicities, disabilities, genders,
sexual orientations, socioeconomic status, nationalities, and geographic locations”
[ CITATION Ore20 \l 1033 ].
 Drinking alcohol is a part of the American lifestyle. When done in moderation, it has
minimal impact on our daily lives and communities. Yet excessive drinking can have
significant implications for one’s health as well as those of others. Nationally a leading
health indicator for Healthy People 2020 is to “reduce the portions of people engaging in
binge drinking” [ CITATION Off21 \l 1033 ]. Indian Health Services (IHS) strives to
implement alcohol and substance abuse programs for tribes at the national and state level
(n.d.a).
Decreasing STIs is supported at the national and state levels by raising awareness within
the tribal communities and supporting state programs to reduce infection rates (Indian
Health Services, n.d.b). The OHA is focused on promoting healthy families through
improved access to sexual health services [ CITATION Ore20 \l 1033 ].
Through the HTO plan, the OHA seeks to increase Medicare enrollment for older adults by
expanding the Senior Health Insurance Benefits Assistance [ CITATION Ore20 \l 1033 ]. At
a national level, the Affordable Care Act creates a competitive marketplace for small
businesses and individuals to purchase affordable coverage [ CITATION CMSnd \l 1033 ].
At the state level, the OHA wishes to address food security by increasing access to
“affordable, healthy and culturally appropriate foods for BIPOC-AI/AN and low-income
communities” [ CITATION Ore20 \l 1033 ]. Aiming to build a system that produces healthy
foods and people access healthy foods is vital to overall nutrition. Nationally a leading
health indicator for Healthy People 2020 is to “increase the contribution of total
vegetables to diets of the population aged two years and older” [ CITATION Off21 \l 1033 ].

4. Explain how you will involve stakeholders in the problem-solving process for the
outlined health issues.
Partnership with the public school system provides an opportunity for healthcare
administrators to ensure focused health education reaches the community’s youth. This
education’s primary focus should be to promote healthy behaviors to help maintain
optimum health, helping to prevent health issues from occurring. The public school system
in the county can support some of these recommendations by including education related
to STIs, obesity, drinking, and drug use as part of their health curriculum.
The state and county public health departments will help engage the community in
promoting better health outcomes. The county public health department is crucial in
keeping the community healthy through health promotion and health safety efforts like
clean drinking water and disease prevention. The public health department will have
experts that can guide our organization on health trends in the community. Experts can
provide best practice recommendations on how to respond to emerging threats. They can
also be a partner in support health-promoting activities for the community. The county
public health department can assist with educational materials for many of the
recommendations listed above. As well the public health department can help promote
awareness through their website and social media pages.
Partner with community-based health volunteer programs to promote different
recommendations. This could also look like sending volunteers to a local shelter to identify
under or uninsured individuals and setting time to help them apply for government-funded
healthcare.
To achieve some of the desired goals listed about policy change may be required. Public
officials that represent members of the community can advocate for resources and policy
changes. Both resources and policy changes can help us promote health initiatives. Public
officials can also serve as point people to convey information to community members.
Local media stations are trusted by the community and can help with communicating
public health messages. A good relationship with the local media can allow an
organization’s spokesperson to be seen and become a trusted source of information for
community members.
5. Provide a financial strategy that would support the needs of the community.
According to the National Association of Community Health Centers (NACHC), Community
Health Centers serve one in 12 people in the U.S., many of those are in special
populations (2020). For example, Community Health Center patients are
disproportionately poor, uninsured, publicly insured, members of racial and ethnic
minorities, and suffer from chronic conditions [ CITATION Nat20 \l 1033 ]. In addition,
Community Health Centers serve special populations like Veterans, the homeless, those
that speak a language other than English, agricultural works, and those in public housing [
CITATION Nat20 \l 1033 ]. All these special populations are impacts on social determinants
of health. Benton County’s population is impacted based on the stats in the table below.

Population Demographics
Location: Benton County in Oregon state
Total population: 93,053
Factor Category Distribution %
Live in poverty 16.5%
Uninsured (under 65 years) 6.3%
Language other than English 14%
Social Determinants of spoken at home
Health Veterans 5.6%
Foreign-born 9.8%
Persons with a disability (under 7.5%
65 years)
[ CITATION USC19 \l 1033 ]

NACHC demonstrates that Health Centers provide high-quality care by reducing health
disparities through services that improve patient’s access to care (2020). While this
improves the outcomes for the people of Benton County, we also need to ensure fiscal
responsibility to continue to provide services to the people of the community. While the
improved patient outcomes seen in the NACHC report are beneficial to the community, the
enabling services used to improve access are not directly reimbursed (2020). Our clinic
leadership team should consider applying for federal and state grants to help cover the
programs that help us reach our special populations. The Health Resources & Services
Administration has several grants available in open status (n.d.). Partnering with local
businesses through the Benton County Chamber of Commerce to establish fundraising
events is another opportunity to raise funds to cover these valuable services.
 Health Issue #1

B1. PRIORITY HEALTH ISSUE: Food Insecurity

B2. DESIRED HEALTH OUTCOME: Ensure access to healthy and affordable
foods for all members of the community

B3: PERFORMANCE MEASURES How will we know we are making a

difference?
Short-Term Indicators B3a. B3a.
Information Frequency
source
Increase the availability of healthy foods available to Farms and Quarterly
community members through mobile and stationary Markets
farmer’s markets.
Increase availability of school meal programs to ensure County public Quarterly
those with limited food access receive healthy meals. school
system
Long-Term Indicators B3a. B3a.
Information Frequency
source
Percentage of people experiencing food insecurity Food Yearly
environment
index
(County
Health
Rankings and
Roadmaps)
Percentage of those with limited access to healthy foods Food Yearly
environment
index
(County
Health
Rankings and
Roadmaps)

B4. SMART (SPECIFIC, MEASURABLE, Implement at least one mobile

ACHIEVABLE, REALISTIC, TIME-BOUND) farmer’s market that can reach those
OBJECTIVE #1: living in rural areas of Benton County
who are part of a food desert by April
of 2022.
Objective Type: Operational
Evidence/Data Sources: Farms and Markets
Policy Change (Y/N): No

B5. ACTION PLAN

Action Step Target Resources Lead Anticipated Progress
Date Person Product/Result Notes
Identify areas that Septem Map of Clinic Locations for Review
could benefit most ber Benton administra farmer’s market. updates to
from the mobile 2021 County tor the clinic’s
farmer’s market. food quality
desert. committee
Determin with notes
 e areas related to
where the general
people population’
are s distance
limited in from food
their sources.
access to
food.
Identify local October We will Clinic Local farmers Follow
growers 2021 need a Nutrition supply healthy updates to
connectio director foods for the the clinic’s
n to local mobile food quality
farmers in truck. committee
and near with notes
Benton related to
County. local
growers
who
currently
participate
in the
Farmer’s
Markets
and are
interested
in
expanding
to the
mobile food
truck.
Identify local October Grocery Clinic Local grocery Updates to
grocery store 2021 store Nutrition store to assist in clinic
manager director supplying healthy quality
willing to food for the committee
participat mobile food truck related to
e in the and what is not work gaps
mobile procured from in food
food truck the local growers. availability
program we have
from the
local
growers
that the
local
grocery
store would
be better
suited to
supply.
Grant funding Februar Grant Clinic Grant funding Monitor
y 2022 writer administra would signify that grant
tor the mobile applications
Funding market can be for
to finance launched for the progress.
the community. The
 project funds would allow
the purchase of a
vehicle to
transport foods
for sale to in-
need community
members, pay
staff that
supports the
mobile market,
and start funds to
purchasing food
from local
growers until the
mobile market
starts selling
produce.
Permit for food Februar Applicatio Clinic Food truck permit Review
truck y 2022 n for Nutrition updates to
permit director the clinic’s
quality
committee
on the
permit
application.
People to staff the March Nutritiona Clinic Nutritional staff Review
mobile food truck 2022 l staff Nutrition from the Nutrition updates to
from director Department of the clinic’s
Communi the clinic - quality
ty Health Identifying committee
Clinic and healthy food and the
communit options that can status of
y be transported employees
volunteer via a refrigerated and
s truck. Routinely volunteers.
work in the
mobile market
providing
education about
healthy food
choices.

B6. PLAN FOR SUSTAINING ACTION

Since many of the people we wish to reach with a mobile food market may be low-income
or live below the poverty level, we will want to ensure that the mobile market can accept
payments supported by the Supplemental Nutrition Assistance Program (SNAP) WIC
nutrition program. The mobile food truck program starts to bring in money from food sales
that can be used to supplement the grant funding to purchase food from local farmers. A
business plan will need to be in place to monitor ongoing progress of the mobile food truck
program. Like all clinic departments, a monthly budget will be generated and reviewed to
track and trend expenses and revenues to the projected budget. Quality measures related
to the program will also be developed to understand the feasibility of implementation and
the program’s long-term impact on the community. Continued connection with community
stakeholders to ensure people are engaged in the new program. Clinic leadership will be
responsible for ensuring the program is meeting critical milestones for sustainment.
 Health Issue #1 (cont.)

B4. SMART (SPECIFIC, MEASURABLE, Extend public school meal program to

ACHIEVABLE, REALISTIC, TIME-BOUND) qualifying families 12 months of the
OBJECTIVE #2: year by the end of the 2021/2022
school year.
Objective Type: Transformational
Evidence/Data Sources: Benton public schools
Policy Change (Y/N): Yes, at the school board level

B5. ACTION PLAN

Action Step Target Resources Lead Person Anticipated Progress
Date Product/Result Notes
School board October Community School board Benton County Monitor
policy change 2021 support for superintenden public schools school
to allow meal the extended t will have the board
programs 12 program policy to meeting
months of the provide school minutes
year. meals 12 to track
months of the the
year. progress
of this
initiative.
Determine January Grant writers School board State or federal Monitor
funding needs 2022 superintenden funds to school
for an t support the board
expanded financing of meeting
school meal extended meal minutes
program. programs. to track
the
progress
of this
initiative.
Identify pick February Physical Public school Local schools or Monitor
up locations 2022 location administrator community school
for summer locations for board
meal families to pick meeting
distribution up weekly minutes
meals. to track
the
progress
of this
initiative.
Coordinate April We will need Public school Volunteers to Monitor
volunteer 2022 a program administrator staff the school
program for coordinator, program during board
summer meal volunteers, the summer meeting
distribution and a months. Drivers minutes
delivery to assist with to track
option for meal delivery to the
those with rural locations. progress
limited of this
transportatio initiative.
n options.
B6. PLAN FOR SUSTAINING ACTION
We will want to review families’ eligibility to participate in the extended school meals
program, ensuring to follow Oregon’s expanded income guidelines for the National School
Lunch Program and School Breakfast Program. Making sure to meet those not just at the
federal poverty level will be essential to ensuring children receive adequate nutrition. The
Public School System will need to provide long-term funding to cover the program’s
coordinator and meals costs. This may mean looking to the community for a levy to
support the public schools. A business plan will need to be reviewed to ensure the
program sustains substantial funding to be maintained. The monthly budget will be
generated and reviewed to track and trend expenses and revenues to the projected
budget. Quality measures related to the program will also be developed to understand the
feasibility of implementation and the long-term impact on the community. Continued
connection with community stakeholders to ensure people are engaged in the new
program. The Public School Board will be responsible for ensuring the program is meeting
key milestones for sustainment.
 Health Issue #2

B1. PRIORITY HEALTH ISSUE: Sexually Transmitted Infections

B2. DESIRED HEALTH OUTCOME: Improve access to sexual and reproductive
health education and services

B3: PERFORMANCE MEASURES How will we know we are making a

difference?
Short-Term Indicators B3a. B3a.
Information Frequency
source
Schools with comprehensive sexual health education Benton Quarterly
classes available to students County Public
School
curriculum
Free condom availability Monitor Quarterly
programs
that offer free
condoms via
the County
Public Health
office
Long-Term Indicators B3a. B3a.
Information Frequency
source
Chlamydia rate for Benton County Sexually Yearly
Transmitted
Infections
(County
Health
Rankings and
Roadmaps)
Gonorrhea incidence Oregon Public Yearly
Health
Division

B4. SMART (SPECIFIC, MEASURABLE, Achieve 65% of Benton County public

ACHIEVABLE, REALISTIC, TIME-BOUND)
OBJECTIVE #1:
Objective Type:
Evidence/Data Sources:
Policy Change (Y/N):
schools with comprehensive sexual
health education classes available to
students by the 2022/2023 school
year.
Operational
Benton County Public School curriculum
No

B5. ACTION PLAN

Action Step Target Resources Lead Anticipated Progress
Date Person Product/Result Notes
Develop inclusive Septemb Human Sexual Education to Education
age-appropriate er 2021 Sexuality Health provide is key to
sexual and health Education and information about helping
education. Law for School health sex the
Oregon Health behaviors, community
 Speciali contraception use, ’s youth
[ CITATION st, and protection understan
Orend \l Oregon against STIs. We d risky
Depart would hope to see sexual
1033 ]
ment of a reduction in behaviors
Educati risky sexual that may
on behavior. lead to
unwanted
outcomes.
Integrate new Novemb School School With education Monitor
education model er 2021 principals, board potential the
into the public educators, superin outcomes, number of
school system in school tendent increased condom schools
Benton County nurses use, contraception that have
use, more teens implement
waiting to engage ed the new
in sex, reduced curriculum
teen pregnancy, and
and reduced STI barriers for
rates. those who
have not
implement
ed
education
through
the school
board.

B6. PLAN FOR SUSTAINING ACTION

As the new education program is implemented in the public schools, we will want to
monitor the percentage of students that have opted out of the curriculum. We will need to
understand the reasons why some families have chosen not to have their children
participate. This will allow the Community Health Center to dispel any myths or
misunderstandings about sexual health education.
 Health Issue #2 (cont.)

B4. SMART (SPECIFIC, MEASURABLE, Increase the number of free condom

ACHIEVABLE, REALISTIC, TIME-BOUND) programs available to community
OBJECTIVE #2: members by at least two programs by
December 2021.
Objective Type: Operational
Evidence/Data Sources: Monitor programs that offer free condoms via the County Public
Health office
Policy Change (Y/N): No

B5. ACTION PLAN

Action Step Target Resources Lead Anticipated Progress
Date Person Product/Result Notes
Partner with local Septembe Affordable High Increase condom Condom
schools to r 2021 condom school acquisition and distribution
implement a supply that principa use resulting in may
school-based the school l less risky sexual reduce
condom nurse can behavior in risky
availability have teens. sexual
program at the available behaviors
high school. for teens as in teens,
needed. and this
can be
monitored
through
the volume
of
condoms
distributed
and new
STIs for
clinic
patients.
Partner with Septembe Planned Clinic Increase condom Condom
County Public r 2021 Parenthood Social acquisition and distribution
Health to set up a – Salem Worker use resulting in may
community-based Health less risky sexual reduce
availability Center behavior in risky
program in a low- adults. sexual
income behaviors
neighborhood. in adults,
and this
can be
monitored
through
the volume
of
condoms
distributed
and new
STIs for
clinic
patients.
B6. PLAN FOR SUSTAINING ACTION
Both programs will need continued monitoring that the supply of condoms meets the
demand to prevent STIs adequately. They are partnering with Planned Parenthood in
Salem, Oregon, to identify continued supplies of condoms. Identify potential challenges in
the supply and distribution of programs. Engage community stakeholders to ensure at-risk
populations are prioritized to where the community-based free condom program is
located. It will be important for both programs that what makes groups at risk is
understood so other improvement opportunities related to sexual health education and
resources can be readily available at program locations.

References
County Health Rankings & Roadmaps. (2020). Oregan rankings, Benton. Retrieved from
https://www.countyhealthrankings.org/app/oregon/2020/rankings/benton/county/outcomes/o
verall/snapshot
Health Resources & Services Administration. (n.d.). Find Funding. Retrieved from NRSA:
https://www.hrsa.gov/grants/find-funding
National Association of Community Health Centers. (2020). Community Health Center Chartbook 2020.
Retrieved from https://www.nachc.org/wp-content/uploads/2020/01/Chartbook-2020-Final.pdf
U.S. Census Bureau. (2019, July 1). Retrieved from Quick facts Benton County Oregon:
https://www.census.gov/quickfacts/bentoncountyoregon