EXECUTIVE SUMMARY

A community health improvement plan has at its foundation the belief that communities have the wherewithal to improve the health of their own residents.  The plan is a tool to guide communities through their action steps in order to address priorities that have been defined in the community health profile through community input and review of local health data.

As a result of a community wide survey of Lincoln County residents, together with statewide and local data, the priorities of the Lincoln County Community Health Council were determined to be domestic violence/sexual assault issues, substance use and abuse, and access to care.  The plan will demonstrate uses of evidence based research and approaches and measures by which progress is assessed and implemented.  The substance abuse group has chosen to focus on prevention, with students and youth as targets for education and self esteem building.  The access to care group is in the process of conducting research, gathering data on the emerging issues within the county in preparation for community action.  The domestic violence group is currently assessing what gaps or duplication there may be within the different work groups, and providing resources, especially for victims.

The Lincoln County Community Health Council has developed this comprehensive countywide plan to promote and attempt to strengthen the health, well being, and quality of life of Lincoln County residents.   The Council will review the plan’s implementation on an annual basis for the purpose of updating the information and publishing current data.  Our mission as a Council is to assess, promote, and enhance the health and well being of county residents by creating a process that encourages broad-based community involvement.

The communities of Lincoln County boast a broad diversity in their people, as well as in the amenities they offer.  In the Ruidoso area, people can enjoy exciting horse racing, museums, the performing arts, golfing, fishing, mountain biking and hiking or relive the fascinating western history of the area.  Skiing and snowboarding are wonderful during the winter months, yet with four distinct but delightfully mild seasons, Ruidoso is a perfect choice for year-round enjoyment.

This document, the community health improvement plan, will be used in conjunction with the community health profile.  These are the product of state, local and community driven data collection and assessment of the issues of concern in this county.  Used together, the profile and plan are to clearly present a community’s health needs and issues so that they can be prioritized for action, and then to subsequently put them into action.  Community groups, grant seekers, legislators and policy makers, as well as other potential users will utilize this information.  Ultimately it will be a tool for guiding community action and for monitoring and measuring progress toward achieving common aims or goals. 

Community Health Improvement Plan

Introduction

Purpose:  The purpose of a community health improvement plan is to depict how the community works together to improve the health related issues of the county.  The plan reflects the results of a participatory planning process that includes significant involvement by key community sectors: private citizens, health care consumers, health care providers, and key elements of the public health system.  The health council is an ideal mechanism for encouraging and facilitating this collaborative process.  The goal is to develop a plan that is clear, understandable, and user-friendly, that uses evidence-based strategies, retaining a unique community “voice” that reflects an area’s shared values, traditions, and unique strengths and assets.   Overall, our purpose is to provide a plan that can be a key element in a community’s efforts to attract financial resources and to build local infrastructure to improve overall quality of life.

Community Description: With 9,000 residents, Ruidoso is the largest community in Lincoln County and serves as the regional economic hub.  Lincoln County has a land area of 4,832 square miles with an estimated population density of 3 to 7 persons per square mile.  Lincoln County has been designated as a frontier area by the U.S Census Bureau.  A frontier area is one with extremely low population density and lengthy distances or travel times to the nearest market.  Tourism and real estate are the primary economic forces and both independently and combined, they have a dynamic effect on almost every business in the region.  The county attracts older residents coming to retire in Ruidoso. As a result, the population is slightly older and more Anglo than most of New Mexico, with 17.9% of the population over 65 as compared to 11.7 % for New Mexico, and 60 % of the residents are white.  People can enjoy exciting horse racing, museums, the performing arts, golfing, fishing, mountain biking and hiking or relive the fascinating western history of the area.  Skiing and snowboarding are wonderful during the winter months, yet with four distinct but delightfully mild seasons, Ruidoso is a perfect choice for year-round enjoyment. Lincoln County’s population is seasonal, and in the summer months, the population swells by as much as 73% during the summer, when Texans (and other out-of-state folks) flock to the higher elevations of Lincoln County to escape the heat and enjoy the cool mountain air, rivers, and lakes in Lincoln County. 

Hundreds of small businesses thrive within the region, and there is a core group of major employers including the Inn of the Mountain Gods Resort and Casino and Ski Apache, the Ruidoso Downs Racetrack and Casino, Wal-Mart, Ruidoso Municipal Schools, Lincoln County Medical Center, the Village of Ruidoso, and Lincoln County.  Lakes and reservoirs: Big Flying H Lake, Cactus Flat Lake, Burro Lake, Rip Lake, Middleton Lake, Seeping Springs Lakes, Bonita Lake, Deep Lake, Shield Lake. The other major Lincoln County towns, Carrizozo, Corona, Hondo and Capitan also provide recreational areas, as well as employment and retirement options and beautiful scenery.

Description of Planning Process:  A county-wide survey was distributed in the fall/winter of 2006. Participants included residents of Ruidoso, Ruidoso Downs, Carrizozo, Capitan, Lincoln and the Hondo Valley. Results of that survey are an integral piece of the evaluation and assessment of needs and issues. A new survey will be conducted in 2009.

The data in a community health profile will lead to certain conclusions about a community’s most urgent health needs and concerns, which will then translate into priorities. The priorities for Lincoln County at this time are 1) Domestic Violence/Sexual Assault, 2) Substance Abuse and 3) Access to Care.  For each priority, there will be long and short-term aims or goals, all of which can be monitored and measured, using specific kinds of data.  For each priority, there will be specific, evidence-based strategies that will be employed—again, with verifiable and measurable outcomes.  The Executive Committee of the health council has met regularly for planning purposes, including teleconferences with the DOH contract monitor.   The health council’s membership has several who are employed by agencies that target the priorities worked on, and therefore lend much expertise and commitment to the goals.

Community Partners:  The collaborative effort of a diverse group of partners is bringing needed progress in our communities.  Some of these partners include:  The Counseling Center Prevention Program, DWI Prevention, Region IX Prevention, COPE(Center of Protective Environments), HEAL (Help End Abuse for Life),  NM Dept. of Health, Mescalero Apache Gaming Program, and Lincoln County Medical Center.  A more inclusive list is included in the section on Community Resources.

How Priorities Are Established:  The county profile is developed, identifying health deficits, assets and opportunities.  To facilitate the process of compiling a profile and formulating a plan, a full review of previous plans was completed, and subsequently incorporated into the current evaluation process.  For this process, each standing committee of the community health council was charged with examining the current health priorities, comparing new data with previously published data for the county, and making a decision as to what the priorities would be. A community health improvement plan serves as a tool for guiding community action and for monitoring and measuring progress toward achieving common aims or goals.  Plans and their accompanying community health profiles are also used in many other ways.  They serve as the basis for needs assessments by community health centers, health and social service organizations, and other public health initiatives.  They are often quoted as justification for funding requests and proposals, and they may be used to provide criteria for funding agencies for choosing proposals and projects to support. 

The data in a community health profile will lead to certain conclusions about a community’s most urgent health needs and concerns, which will then translate into priorities. The priorities for Lincoln County at this time are 1) Domestic Violence/Sexual Assault, 2) Substance Abuse and 3) Access to Care. For each priority, there will be long and short-term aims or goals, all of which can be monitored and measured, using specific kinds of data. For each priority, there will be specific strategies that will be employed—again, with verifiable and measurable outcomes. The goal is to develop a plan that is clear, understandable, user-friendly, that uses evidence-based strategies, and that retains a unique community “voice” that reflects an area’s shared values, traditions, and unique strengths and assets.  

How Community Support Was Obtained:  Subcommittees of the health council are made up of members who represent many agencies and organizations which are health-focused.  Each member brings a level of expertise and also solicits support from their area and beyond.  People are invited to be a part of all that the health council is doing.  Members also speak to civic groups and organizations which in turn bring valuable support to the table. 

Community Health Improvement Plan

Vision Statement: The Community Health Council’s vision is to improve the health status of the citizens of Lincoln County by achieving or exceeding national goals and standards in health maintenance, education, and preventive services for the citizens of Lincoln County.  This community’s health status can be defined as its ability to efficiently respond to challenges and effectively restore and sustain a "state of balance," or homeostasis.  It must be seen as a process of continuous adjustment to the changing demands of living and of the changing meaning we give to quality of life.  Maintaining that homeostasis will be part of our vision, as we work towards keeping the health and safety of our visitors balanced with that of our residents.

Community Health Assessment: The community health improvement process endeavors to improve the health and wellness of Lincoln County residents.  This process is an enormous undertaking, which utilizes the expertise and involvement of partners from many diverse entities, all working as a team focused on improving the quality of life in Lincoln County.  This team, the Lincoln County Community Health Council, is dedicated to this cause.  First, the county profile is developed, which identifies health deficits, assets and opportunities.  To facilitate the process of compiling a profile and formulating a plan, a full review of previous plans was completed, and subsequently incorporated into the current evaluation process.  For this process, each standing committee of the community health council was charged with examining the current health priorities, comparing new data with previously published data for the county, and making a decision as to what the priorities would be.  Reviews of the data revealed that since the 2004-2005 update, there were significant changes within the community.  The teen pregnancy rate had decreased significantly while the incidence of domestic violence placed Lincoln County as number one in the state of New Mexico for incidence of domestic violence.

As a result of the review process, the priorities for the health council became: 

1)     Domestic Violence/Sexual Assault,

2)     Substance Abuse, and

3)     Access to Care

Combating the problem of domestic violence has been a challenge; however, collaboration from several workgroups during the past three years has made a difference.  The diligent efforts of partners such as HEAL (Help End Abuse for Life), COPE (Center of Protective Environment), SART (Sexual Assault Response Team) and OATH (Organized Against Trafficking Humans), along with the community health council domestic violence subcommittee, has brought about a strong working collaborative that is effective. 

In terms of substance use and abuse, Lincoln County continues to work diligently to decrease the incidence of substance abuse.  The Health Council subcommittee works in committed collaboration with other groups such as preventionists from The Counseling Center, Region IX School Based Health Centers, DWI Prevention Program and local counselors.  This group has a focus on youth and prevention, leading the community in innovative programs, such as teen leadership summits, parenting education, freshmen orientation toolkits, parent-teacher appreciation and more. 

Lincoln County is faced with a lack of health care providers to match the quickly growing population.  There continues to be a significant percentage of children living in poverty, lack of affordable health care, families with food insecurity and a geographic area that makes it difficult to access care from neighboring communities.  Barriers to care include language/cultural differences, distance from healthcare facilities, number of primary care physicians by area of the county, no urgent care clinics for nights and weekends, poverty and lack of insurance. The Access to Care Committee has initiated a nurse advice line program for the county to assist those who are not insured or must travel long distances to receive care.  A new transportation system within the county which is affordable to all citizens was also initiated in January of 2009.  Recruiting for new physicians is ongoing through the hospital administration.  The Access to Care committee is collecting data to assess the most pertinent needs and begin forming strategies to address these needs.

One other issue in Lincoln County centers around the senior citizen population.  There are no assisted living or long term care facilities in Lincoln County.  The health council will be researching and collecting data to begin looking into obtaining some type of senior care options.

Utilizing these tools, the county health profile, and the community health improvement plan, the Health Council will be able to monitor and measure progress toward achieving the goals of reducing domestic violence/sexual assault, substance abuse and access to care in Lincoln County.  These tools will also assist in evaluating other needs and issues identified throughout the process.

Community Health Improvement Plan

Community-wide Goals and Objectives

PROBLEM ANALYSIS NARRATIVE

Lincoln County is located in the south-central portion of the state and bordered by the Lincoln National Forest and the Mescalero Apache Reservation.  The highest concentration of the population of Lincoln County is located in the communities of Ruidoso, Ruidoso Downs, and Alto.  Our area is considered a resort and tourist destination. This presents problems as our population is known to triple and quadruple during the tourist seasons – Christmas, spring break, and the summer months.  Part of our population is also attributed to people with summer homes in the area.  These demographics contribute to the “party mentality” of the area.  Being in a drug corridor makes access to illegal substances a problem. This attitude adds to the environmental undercurrent that affects our population, especially our youth.  The Lincoln County Community Health Council believes that by targeting the youth of the area we can make a difference by educating children and youth about the dangers of alcohol and drug use/abuse and creating a positive environment for their schools and communities.  By working collaboratively, the substance abuse subcommittee can develop a continuum which will show positive results by working with the students throughout their education. 

The primary focus of our committee is to take a proactive approach in working with the area youth. Presenting information, involvement in youth programs, and coordination of activities designed to change community norms are three avenues to address the concerns of our area. Priority areas in our County are often multigenerational concerns: substance abuse, domestic abuse, and low socioeconomic existence. Add in lack of community activities, peer pressure, social acceptability of substance abuse, and the fact that “everybody knows everybody” and many would perceive this as an uphill battle.  The committee is realistic in the realization that the risk factors, along with mental health issues, social isolation, and learned behaviors, seem insurmountable when observed consequences such as abuse, the costs of DWI and crime, teen pregnancy and STD’s continue. However, the committee is optimistic that with continued work Lincoln County can be a positive environment and produce productive citizens.

We feel that presenting evidence-based curriculum to the area youth, bringing awareness of the youth programs to the citizens of Lincoln County at governing body meetings and service clubs, using local media, and youth summits will be effective tools in promoting changes in community norms and attitudes in regard to alcohol and drugs.   These efforts play a part in strengthening protective factors and positive choices among our youth and impact alcohol-related accident statistics and underage drinking.

4.  Goals, Objectives, Community Resources, Health Status Outcomes

Health Priority One:  SUBSTANCE ABUSE

PROBLEM ANALYSIS NARRATIVE

The New Mexico Interpersonal Violence Data Central Repository 2005 Survey reported 8,037 victims of rape or attempted rape with only 1,400 (17%) incidents reported to law enforcement.

Lincoln County covers 4,832 square miles and has five small communities. The population in 2006 was 21,233: White (75.1%), African American (12.3%), Asian (3.6%), Hispanic (12.5%). Median household income is $33,886. Families living below the poverty level are 9.2%. (U.S. Census Bureau)

In 2006, Lincoln County agencies began collaborating to provide timely, compassionate, and culturally sensitive response to sexual assault victims, support victim's recovery, prevent secondary injury/illness, and increase prosecution of sex offenders.  A Lincoln County Sexual Assault Response Team was established and monthly meetings began to establish a seamless delivery of services. Agencies collaborating have included Center of Protective Environment (COPE), The Counseling Center, Sexual Assault Nurse Examiner (SANE) Program of Otero and Lincoln County, Lincoln County Medical Center (LCMC), Ruidoso Police, Lincoln County Sheriff's Office, Ruidoso Downs Police, The Nest (Women's Shelter), Ruidoso Counseling & Mediation Services, Lincoln County Health Council, Dance Gallery, and CYFD. These relationships and collaboration have served to increase capacity for identifying underserved populations and provide services.

The SANE Program reported that of the 40 exams done in 2006, eleven were from Lincoln County. Of the 50 exams done in 2007, two were from Lincoln County. Of the 58 exams done in 2008, six were from Ruidoso Police.

In terms of domestic violence, Lincoln County's first and only shelter for victims of domestic violence reports an escalating rate of service delivery from the day the shelter opened in March 2007 to present. During the first year of operation, over 200 families were served at the Nest. In 2008, 475 clients were served.

Given the nature of the economic downturn in our country, the rate of admission at the shelter has climbed dramatically over the first quarter of this year. It has not been unexpected.  Early on, strong partnerships were forged between law enforcement agencies and the Nest staff. This partnership is critical for the long-term provision of service to domestic violence victims as well as to the success of the shelter. This has led to an increased referral rate, as the police expand their understanding of services available at the shelter.

Health Priority Two:  DOMESTIC VIOLENCE/SEXUAL ASSAULT

Problem Analysis Narrative

The Lincoln County Community Health Council, through its subcommittee on Access to Care, is exploring several avenues related to gaps in service availabilities within the county.  The committee believes a priority is to gather a significant amount of data in several identified areas to assess the needs sufficiently.   The first project has been to evaluate the feasibility of sponsoring a toll free Nurse Advise Line for county residents who do not have one available in their insurance plan. It is possible that a Nurse Advice Line could alleviate routine calls to local physicians’ offices as well as decreasing the number of those who utilize the emergency room for non-emergency uses.  Since Lincoln County is a frontier, rural area, the long distance of travel for some county residents to health care facilities is a major concern.  Lincoln County has no urgent care clinics available on nights or weekends, which adds to the deficits.  In addition, with a very limited number of family practice physicians and many of those not taking new patients, county residents are left without care or the cost of travel outside the county.

The committee, upon completion of a survey, has plans that the Nurse Advice line, staffed by professional nurses with an established protocol procedure which includes options of referral to the primary care doctor within reasonable length of time (non emergency), and determination of need for emergency services, can refer people to other resources such as poison control.

Upon the request of the Lincoln County Commission, this group will begin exploring options for some type of senior care living facilities for the elderly residents of the county, beginning with a working relationship with the economic development team of the village of Ruidoso.

The Access to Care committee includes working with residents on food insecurities which are growing monthly.  We partner with the Roadrunner Food Bank mobile food pantry to feed approximately 130 families per month and school students during the summer.

Another issue which is important at this time is emergency preparedness.  The committee will be gathering and disseminating information to all county residents on emergency preparedness, whether it is related to fire, floods, natural disasters, terrorism, or any other public emergency.  This committee is newly formed and will be in the process of gathering data and making more definite determinations regarding priorities.

Health Priority Three:  ACCESS TO CARE ISSUES

COMMUNITY ACTION PLAN

A.  Council Development

B.   Community Assessment & Prioritization

C.  Community Action:  Coordination & Leadership