RFP Clarification (Coconino) JUN242020.pdf

Coconino County Health & Human Services 1 Solicitation BPM002372 – Clarification Request

Health Start Program Solicitation BPM002372 – Clarification Request

Coconino County

Method of Approach

6.2.1.2.2.

Health Start services in Coconino County would provide a service that would help to improve the health outcomes of at-risk pregnant women and mothers whom struggle with social, health, educational, environmental, and, economic issues that are common throughout northern Arizona.

Coconino County Health & Human Services (CCHHS) northern region office is located in Page, Arizona. The northern region includes the communities of Page, LeChee, Kaibeto, Coppermine, Gap-

Bodaway, Tuba City, Tonalea, Cameron, Bittersprings, and, Cedar Ridge. Nine (9) of these communities are within the boundaries of the Navajo Indian reservation. 39.1% of Coconino County is composed of tribal lands. The county is home to the Navajo, Hopi, Hualapai, Havasupai, San Juan

Southern Paiute, and Kaibab Band of Paiute Indians. In 2017, American Indians make up for almost a third of the total Coconino County population of 138,639. (CHA, 2019). American Indian

Image 1: Service Area Map

Zip Codes City

1 86040 Page

2 86045 Tuba City*

3 86053 Kaibeto*

4 86044 Tonalea*

5 86002 Cameron*

6 None LeChee*

7 None Bittersprings*

8 None Cedar Ridge*

9 None Coppermine*

10 None Gap-Bodaway*

Gap

Kaibeto

Coconino County Health & Human Services 2 Solicitation BPM002372 – Clarification Request populations suffer from high mortality rates, poverty, low educational attainment, unemployment, and other social issues that impact their health from infancy into adulthood. In addition, many families lack the nutrition to maintain their health due to the limited number of grocery stores, lack of fresh fruit & vegetable options, and limited healthy food options at the local gas stations. Many of the local

American Indian communities also suffer from chronic lifestyle diseases such as heart disease, obesity, and diabetes.

American Indians of Arizona have a higher mortality rate from “alcohol-induced causes, chronic liver disease and cirrhosis, motor vehicle accidents, diabetes, septicemia, nephritis, assault, unintentional injuries, influenza and pneumonia, post-neonatal mortality, drowning, and sudden infant death syndrome: all contributing to the premature death rate of 78.8 percent” according to the Health

Status Profile of American Indians in Arizona - 2018 Data Book. The median age of death of American

Indians is 60 compared to all Arizonans at 76 (ADHS, 2018). In 2019, Coconino County Community

Health Assessment (CHA) reported in 2017 that 30% of the Coconino County American Indian population suffered from poverty and Coconino County ranked 6th in Arizona for the population living below the federal poverty line. 23.2% of Coconino County children under the age of 18 live in poverty in 2017. 38.4% of children live in single parent household, which is higher than the state of Arizona at 35.4%. Housing in Coconino County is a challenge for low income families with the increase in home values of 34.6% from 2013 to 2017. In 2017, the median rent and mortgage is higher in

Coconino County than Arizona at $1,079 and $1,490, respectively (CHA, 2019). Low income housing is available but limited. According to the census data estimates from 2014-2018, 89.6% of the persons age 25 years and older graduated high school in Coconino County and only 35.6% graduated with a bachelor’s degree or higher.

Coconino County Health disparities in northern region are also attributed to the unemployment rate of 5.8% (AZeconomy, 2010) and poverty rate of 15.9% (Census, 2010). With the recent closures of the Page Power Plant and Kayenta Mine, and the February 2020 onset of Covid-19, the unemployment rates in the northern region exceed 50% in some communities. With only three (3) health facilities with prenatal care in the northern region, care is limited to those that live in either

Page or Tuba City. Primary care facilities include Page Banner Clinic, Canyonlands Healthcare –

Lake Powell Medical Center, Encompass Health Care, Tuba City Regional Health Care Corporation, LeChee Health Center, and Inscription House Health Center. Of those facilities only three (3): Page

Banner Clinic, Canyonlands Healthcare – Lake Powell Medical Center, and, Tuba City Regional

Health Care Corporation provide prenatal care. Pregnant women, mothers, and their children travel

30 to 70 miles to receive health care services. In 2016, 67.7% of Coconino County mothers initiated prenatal care in the first trimester and has since decrease to 65.4% in 2018, a 2.3% decrease. Well below the national percentage of 75.5% (CHA, 2019). 13.1% of the population is also without health

Coconino County Health & Human Services 3 Solicitation BPM002372 – Clarification Request insurance creating another barrier for mothers and pregnant women to obtain the health care services they need to have a healthy baby or give birth to a healthy baby (Census, 2010). The births among

American Indians increased from 38.8% to 43.4% from 2017 to 2018. Showing a greater need for maternal child health programs and services for Coconino County.

Coconino County’s American Indian neonatal mortality rate is worse than the average Arizona rate by 35.9%. American Indian low birth weight percentage of 7.9 and lack of early prenatal care for mothers could be factors in the high mortality rates. In addition, preterm birth rates, births to teen mothers, and other factors may contribute to the mortality rates, as well. Preterm births for Coconino

County in 2018 was at 8.2%, just below the Healthy People 2020 goal of 9.4%, but peaked in 2017 at 11.0% (CHA, 2019). In 2018, 9.8% of birth to teenage mothers were of American Indian ethnicity was higher than other births of Arizonan teenage mothers at 5.8%. (ADHS, 2020). The Community

Health Assessment completed by Coconino County Health & Human Services (CCHHS) reported a declining rate of births for the county at 10.5 per 1,000 population, which is lower than the state rate of 11.7 per 1,000 population.

American Indians in Arizona are 87.2% worse than the average Arizonan for intentional self-harm (suicide) (ADHS, 2020) and residents of Coconino County reported 4.5 mentally unhealthy days in a month (CHA, 2019). The county ranks 4th in the state for adults that reported 14 or more days of poor mental health in a month at 14% (CHA, 2019). Mental health is an issue for the Coconino County, and it is not well address due to the limited mental health resources and support in the area.

Encompass Behavioral Health, Canyonlands Healthcare – Lake Powell Medical Center Behavioral

Health & Counseling, Navajo Nation Department of Behavioral Health, and Tuba City Regional Health

Care Corporation Mental Health department are the only behavioral health facilities in region. Like the health care facilities, mental health care services are few and many must travel to over hour to receive care.

Pregnant women, mothers, and their children have little to no resources for maternal child health or support. Besides the education and screenings completed at local health facilities, many women do not have education on infant growth and development, changes a pregnant women experiences, health screenings for mom and baby, growth and development education, healthy relationships, and, other maternal child health topics. Coconino County partners with the Health

Families Program but only one (1) case worker covers the community of Page and small radius around Page. Other maternal child health programs and services are out of reach in Window Rock on the Navajo Reservation like First Things First, and other programs in Flagstaff. With the limited options for pregnant women and mothers, many do not receive the preventative education needed to have healthy births. The need for a Health Start Program would add an additional care worker to the

Page CCHHS team and expand the services to at-risk pregnant women and mothers.

Coconino County Health & Human Services 4 Solicitation BPM002372 – Clarification Request

References:

1. Arizona Department of Health Service, March 2020. Health Status Profile of American

Indians in Arizona - 2018 Data Book. Website: https://pub.azdhs.gov/health-stats/report/hspam/2018/indian2018.pdf

2. AZeconomy, 2010. Website: https://www.azeconomy.org/data/coconino-county/

3. Census,2010. Website:

https://www.census.gov/quickfacts/fact/dashboard/coconinocountyarizona/POP010210#PO

P010210

4. Commission on Social Determinants of Health (CSDH), 2008. Closing the gap in a generation: health equity through action on the social determinants of health. Final Report of the Commission on Social Determinants of Health. Geneva, World Health Organization.

5. Coconino County Health & Human Services, 2019. Community Health Assessment, October 2019.

https://pub.azdhs.gov/health-stats/report/hspam/2018/indian2018.pdf https://pub.azdhs.gov/health-stats/report/hspam/2018/indian2018.pdf https://www.azeconomy.org/data/coconino-county/ https://www.census.gov/quickfacts/fact/dashboard/coconinocountyarizona/POP010210#POP010210 https://www.census.gov/quickfacts/fact/dashboard/coconinocountyarizona/POP010210#POP010210