Population

Reynolds County Health Center serves 6,275 residents in 811 square miles. Within these square miles there are over 51,000 acres of land belonging to the Mark Twain National Forest and Missouri Conservation Department. 452 Reynolds County residents live in Bunker, 210 in Centerville, 1000 in Ellington, 787 in Lesterville and 3,826 on small farms and acreages throughout the county. As of March 2016, Southeast Hospital of Reynolds County, affiliated with SE Hospital in Cape Girardeau, closed our only critical care access hospital in the county. They also owned the Rural Health Clinic, in Ellington, which was also closed leaving Reynolds County with only one medical provider which is a FQHC.

Unemployment

In August of 2019, the United States unemployment rate was 3.5% and the Missouri state rate was 3.2% compared to Reynolds County with a rate of 4.0%, with the surrounding counties of Carter at 4.6%, Iron at 4.9%, Wayne at 4.7% & Shannon at 5.1%.

Poverty

According to the 2017 US Census Bureau, the median family income in Reynolds County was $40,265 compared to $51,542 for Missouri and all persons living below poverty 17.3 % compared to state rate of 14.6%. 2017 Kids Count show the county children living below poverty is 33.4% compared to state rate of 18.5%. The 2016 Missouri Hunger Atlas shows children in families receiving SNAP at 18.2% compared to Missouri at 14.3%. It also states that 70.2% of children in Reynolds County were enrolled in the free and reduced lunch program, compared to 50.3% statewide. 53.5% of children under 5 yrs. old are on WIC. Kids Count Data shows that Reynolds County infants born with low birth weight rate at 8.4% and Missouri at the same rate of 8.4% & births to teenage mothers (Rate per 1,000 females ages 15-17) at 25.5 & Missouri at 22.5. This same profile for our county shows child abuse and neglect (Rate per 1,000 children) at 9.5 compared to state at 3.3.

Priority Health Issue and Supporting Data

Following the Community Health Assessment conducted in December 2013, by Southeast Health Hospital of Reynolds County, it was determined that our county’s priority health issue is Mental Health/Substance Abuse (Drug & Alcohol).

The 2017 Status Report on Missouri’s Substance Abuse and Mental Health Problems show that the primary drug problems are Alcohol, Marijuana, & Prescription Misuse. According to the June 2019 Behavioral Health Profile for Reynolds County, created by the Missouri Department of Mental Health, in 2017, Reynolds County had 4 alcohol-related traffic crashes. This number was lower than 2016, which was at 16. One of those 4 traffic crashes resulted in 1 drug fatality, 1 drug injury & 3 with property damage. Also in 2017, Reynolds County had 25 DWI arrests, 6 liquor law violations, & 48 drug arrests. In 2074, Reynolds County residents had a total of 14 alcohol-related and 15 drug-related hospitalizations. 2018, shows 25 in drug court compared to 24 in 2016. In 2017, 51 received treatment for seriously mental illnesses & in 2018, 4 died of suicide.

When mental illness data is researched, the 2017 Mental Health Psychiatric Services Report shows there were 35 Mood Disorders, 9 Psychotic, 16 Anxiety Disorders were treated. 50 cases were voluntary commitments. The 2016 Missouri Student Survey for Reynolds County shows the average age of students’ first use of Marijuana went from 14 to 13 years old. 5.6% use OTC (Over the Counter) medications to get high, 12% use prescriptions that are not theirs, & 24.5% use alcohol. 18.2% use e-cigarettes (Vaping). 20% stated they have ridden with someone who drank alcohol. The percent whose parents would disapprove if they used Marijuana went from 94.5% in 2010 to 88.3% in 2018. In the percent of students who, in the past 12 months, made plans about how they would attempt suicide went from 7.7% to 11.3%. The percent of students who, in the past three months, were victims of an embarrassing or hurtful text message or something posted on the internet jumped from 13.2% in 2016 to 22.2% in 2018.

Missouri Department of Health & Senior Services MICA Date Program shows that from 2007-2017 there were 4 infant deaths (6.1%) compared to the state rate of 6.67%. An unintentional injury is one that is not inflicted by deliberate means. This category includes those injuries and poisonings described as accidental, regardless of whether the injury was inflicted by oneself or by another person. MICA shows the 2016 Death Rate at 875.93 with Missouri at 815.85, ER Visits Rate at 446.19 with Missouri at 391.02, and unintentional injury at 103.35 with Missouri at 49.98.

In the 2017, Reynolds County Health Questionnaire completed by citizens, the data received is as follows – 34.8% felt their health status was fair to poor while the state rate was 20.1%, 28.5% have no health insurance, 32.7% are physically inactive, 43.4% use some form of tobacco products, 37.2% are overweight (BMI 25-29.9), 36.1% are obese (BMI >30), 47% reported High Blood Pressure, 55.9% high cholesterol (35 years or older), & 17.11% have diabetes. These health indicators are tied to lifestyle choices & continued family traditions of eating.

This is supported by data from:

  • Missouri Hunger Atlas 2016
  • MO Kids Count 2017
  • MO Division of Behavioral Health – Substance Abuse
  • MO Department Health and Senior Services
  • Missouri Information for Community Assessment
  • U.S. Census Bureau
  • Missouri Mental Health Psychiatric Services Report 2017
  • Missouri Student Survey 2019
  • Reynolds County Health Questionnaire

Best practices, evidence-based strategies that are recommended to improve the health issues:

The Guide to Community Preventive Services recommends:

Informational approaches to nutrition, increased physical activity, and Drug/Alcohol Usage

  • Community wide education
  • Individual Education
  • Organizational Awareness
  • System Assessment

Behavioral and social approaches to increase physical activity & decrease alcohol/drug issues

  • School-based drug/alcohol education & activities
  • Social support interventions in community
  • Support Individually- adapted health behavior change programs

Environmental and policy approaches to increased decreased Alcohol/Drug Issues

  • Community Policy Changes
  • Coalition Gap Analysis of Needs

Inventory of public policy, population based strategies, and community physical environment that already exists to support improvement in the priority issue:

  • After working the past 5 years in county schools, a School Health Index Self-Assessment & Planning Guide for Elementary/Middle/High Schools has been completed. Individual school health committees have been formed & they have developed their Wellness Policy Plans.
  • RCHC will promote Patients with Arthritis Can Exercise (PACE) classes offered by Whole Health Outreach (WHO).
  • RCHC will provide through the WIC program with breastfeeding information, supplies & Breast Feeding Peer Counselor supported by the Regional WIC Grant.
  • RCHC will provide B/P, BS, and Education to the public via Food Pantry Days
  • RCHC shall have a bulletin board in the health center with Health Education that will focus on the monthly topics identified by the Missouri Hospital Association
  • MHHC offers health screenings and medication assistance at reduced cost and sliding fee scale to those patients who qualify.
  • Whole Kids Outreach (WKO) offers summer camp and after school programs to school age children for improved nutrition and increased physical activity. They also are participating in the “Healthy Families of America” Program.
  • RCHC will offer age appropriate car seats to Reynolds County residents who qualify financially, as funding allows.
  • RCHC MCH grant staff has formed a Maternal Child and Family Health Coalition to gather community members together to work collectively towards identifying and solving health issues. There will be a Strategic Plan developed with focus areas to address as Substance Abuse and County Resources.
  • Three local schools has added Cross Country to intramural sports and two schools has added track.
  • RCHC will continue their Facebook Page for the community to promote Health Topics and activities being held.
  • RC Sheriff’s Department is participating in the “Take Back” Drop Box programs throughout the year to assist citizens to properly dispose of their prescription medications no longer in use or expired.
  • RCHC will promote use of the county walking trails on their website to increase physical activity as well as a page for tips on seasonal activities to remain active.
  • Radar Speed Signs are placed in Centerville & Lesterville School areas to slow traffic down to help promote walking and prevent accidents.
  • RCHC CCHC Program will work with Preschools & Headstart to educate children on Health Promotion topics.
  • RCHC will work with the Drug Court Program to screen participants for B/P, B/S, Lipid Profiles, Medical History, Imm., BMI, etc. & Education on keeping healthy
  • RCHC is become more Health Literate Aware by revising forms and Health Center for places to become more Health Literate for clients.
  • Language Link has been contracted for translation services.
  • Implementation of a PDMP program (Prescription Drug Monitoring Program) to aid pharmacies & doctors to actively look at patients’ prescription histories before writing scripts for pain medication.
  • RCHC continues to participate in the WIC Regional Contract with Region G Collaborative to decrease costs.
  • RCHC offers a Breastfeeding peer Counselor to assist Prenatals in education and support for breastfeeding is known to decrease obesity.
  • RCHC has redeveloped and updated the website to accommodate all technologic devices.
  • a “Maternal Substance Abuse Screening” form has been introduced to screening packets when doing a Pregnancy Test.
  • Pre-conception education has been developed on all negative testing & for postpartum case management clients.
  • Narcan is being housed and distributed to Emergency Personnel for use to combat Opioid overdoses.
  • Narcan is being distributed to community residents for use to combat family members who may be using opioids. They will be trained on how to administer.
  • We are participating with Butler County Health Department in the Opioid Quality Improvement Program.
  • RCHC participates in the HRSA Opioid Grant with Missouri Highlands.
  • RCHC is referring substance abuse clients seeking help to SEMO Behavioral Health & FCC Behavioral Health.
  • FCC Behavioral Health is offering counseling services in Ellington.
  • Continue Hepatitis C testing in collaboration with the Hepatitis C Alliance.
  • Continue with assistance with Medicaid for Pregnant Women under the Missouri Show Me Healthy Babies Program.
  • Continue participating in the Southwest Healthcare Coalition group.

Intervention that is planned for implementation:

  • RCHC will continue to promote the Reynolds County Food Pantries located in Ellington (SEMO Food Bank), Lesterville, and Black (USDA).
  • RCHC will remain active in Missouri Council for Nutrition and Physical Activity (MOCAN) coalition and keep aware of their progress in policy change for better nutrition and increase physical activity.
  • RCHC will continue to offer to loan to local schools education materials dealing with alcohol and substance abuse and driving while under influence of alcohol.
  • RCHC will continue to partner with agencies, medical schools, and local schools to offer shadowing opportunities to facilitate students considering health and medical careers.
  • RCHC will continue promotion of the Alcoholic Anonymous meetings in Reynolds County every Tuesday evening at 6:00 PM at the Reynolds County Courthouse in Centerville & “Celebrate Recovery” at the Black River Baptist church.
  • RCHC will maintain marketing strategy of using Facebook to followers to announce educational information and awareness campaigns as well as Instagram.
  • RCHC will continue to refer clients who need assistance with prescription costs to Missouri Highlands to meet their healthcare needs.
  • Drug Take Back Box will remain in place at RC Sheriff’s Office to assist the community to have a safe place to dispose of unused and outdated prescriptions to decrease access to drug abusers.
  • RCHC will continue to refer infants in need of Safe Sleep Cribs to programs available.
  • RCHC will continue the Prenatal High Risk Case Management to all women who meet criteria and choose to participate to be educated on healthy pregnancy and birth outcomes.
  • A 2020 Health Fair will be held by RC MCFH Coalition.

Target Group/geographic area:

Our target population is the 6,275 residents that live in the 811 square miles of Reynolds County.

Outcome the plan is intended to achieve:

Reynolds County residents will have an increased Drug/Alcohol awareness and prevention programs. Reynolds County residents will have increased knowledge of how lifestyle choices directly affect their health and the incidence of chronic disease and in many cases their longevity.

Identified Barriers:

Severe lack of funding in a community resistant to change

RCHC small staff

Maintaining commitment and interest levels of community members is difficult.

Reaching county residents with education materials who do not have access to radio, newspaper, and internet is an ongoing challenge.

Public schools are reducing the amount of time available for health education interventions in the classrooms, due to curriculum changes, state requirements and levels of achievements.

Finding individuals to fill jo openings that meet educational requirements.