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2022Community Health NeedsAssessment

2 I Community Health Needs AssessmentTABLE OF CONTENTSINTRODUCTION.......................................................................................................................................5-7Executive Summary...............................................................................................................................................7-11Background................................................................................................................................................................11-12Graham Health System Services...............................................................................................................14-16Local Impact of COVID.......................................................................................................................................16-17ESTABLISHING THE CHNA INFRASTRUCTURE AND PARTNERSHIPS.........................19 DATA COLLECTION............................................................................................................................19-24Secondary Data.....................................................................................................................................................19-21Primary Data............................................................................................................................................................21-24DATA ANALYSIS...................................................................................................................................27-65Demographics........................................................................................................................................................27-30Social Determinants of Health....................................................................................................................31-45Health and Wellness Indicators...............................................................................................................46-63- Chronic Illness....................................................................................................................................................52-58- Substance Use...................................................................................................................................................59-61- Mental and Behavioral Health...............................................................................................................62-63Diversity and Minority Health Status............................................................................................................64Emergency Preparedness....................................................................................................................................65Copyright ©2022 by the Illinois Critical Access Network (ICAHN). All rights reserved. The contents of this publication may not be copied, reproduced, replaced, distributed, published, displayed, modied, or transferred in any form or by any means except with the prior permission of ICAHN. Copyright infringement is a violation of federal law subject to criminal and civil penalties.

Graham Health System I 3IDENTIFICATION AND PRIORITIZATION OF NEEDS.........................................................67-68Process................................................................................................................................................................................67Description of the Community Health Needs Identied...............................................................68 RESOURCES AVAILABLE TO MEET PRIORITY HEALTH NEEDS..................................71-72Hospital Resources....................................................................................................................................................71Healthcare Partners or other Resources including Telemedicine.........................................71Community Resources...........................................................................................................................................72DOCUMENTING AND COMMUNICATING RESULTS................................................................75 IMPLEMENTATION STRATEGY.....................................................................................................77-80Planning Process.........................................................................................................................................................77Implementation Strategy..............................................................................................................................78-80REFERENCES AND APPENDIX....................................................................................................83-84

Graham Health System I 5INTRODUCTIONGraham Hospital was chartered in 1905. The hospital opened in 1909, in a facility gifted by the Graham family. The rst surgery was performed in 1910 and by 1925, the hospital was looking at its rst facility expansion. A second expansion in 1959 increased the number of available beds to 135 and in 1968, the hospital was expanded to accommodate 213 beds. In 1977, a three-story expansion was built to house a new laboratory, surgery unit, and maternity suites as well as the addition of new mechanical spaces and linen quarters. In 2005, another addition was completed that now houses the Emergency Department and Administrative oces. During the 21st Century, primary and specialist access has been expanded through the opening of new clinics in Canton, Farmington, Lewistown, Elmwood, and Williamseld.In 2022, an era in which there are very few independent community hospitals remaining, Graham Health System remains an independent health system serving patients throughout central and western Illinois, with operations in three counties: Fulton, Mason, and Peoria.AdolescentsAdultsSeniorsEarly Childhood AdolescentsAdultsSeniors

6 I Community Health Needs AssessmentToday, Graham Hospital embraces the mission and values of the Graham Health System:MISSION STATEMENT To provide compassionate, quality health services, in a responsible and charitable manner, to the people and communities we serve.VALUES Innovation – By innovation, we mean we continuously improve our operations and environment by actively encouraging creative solutions.Accountability – By accountability, we mean we accept responsibility and follow through to completion.Communication – By communication, we mean we openly share information in all directions in a timely manner.Compassion – By compassion, we mean we exhibit empathy and care for others.Teamwork – By teamwork, we mean working together cohesively to achieve our common goal.

Graham Health System I 7Provisions in the Aordable Care Act (ACA) require charitable hospitals to conduct a Community Health Needs Assessment (CHNA). The CHNA is a systematic process involving the community to identify and analyze community health needs as well as community assets and resources in order to plan and act upon priority community health needs. This assessment process results in a CHNA report which assists the hospital in planning, implementing, and evaluating hospital strategies and community benet activities. This Community Health Needs Assessment was developed and conducted, in partnership with representatives from the community, by a consultant provided through the Illinois Critical Access Hospital Network (ICAHN). ICAHN is a not-for-prot 501(c)(3) corporation established in 2003 for the purposes of sharing resources, education, promoting operational eciencies, and improving healthcare services for member critical access and rural hospitals and their communities. ICAHN, with 57 member hospitals, is an independent network governed by a nine-member board of directors, with standing and project development committees facilitating the overall activities of the network. ICAHN continually strives to strengthen the capacity and viability of its members and rural health providers.This Community Health Needs Assessment will serve as a guide for planning and implementation of healthcare initiatives that will allow the hospital and its partners to best serve the emerging health needs of Canton and the surrounding area. The CHNA process was coordinated by the Executive Assistant.EXECUTIVE SUMMARY

8 I Community Health Needs AssessmentTwo focus groups met to discuss the state of overall health and wellness in the Graham Health System service area and to identify health concerns and needs in the delivery of healthcare and health services in order to improve wellness and reduce chronic illness for all residents. The focus groups included representation of healthcare providers, community leaders, community services providers, schools, a community college, faith-based organizations, local elected ocials, public health and others. Several members of these groups provide services to underserved and unserved persons as all or part of their roles. The ndings of the focus groups were presented, along with secondary data analyzed by the consultant, to a third group for identication and prioritization of the signicant health needs facing the community. The group consisted of representatives of public health, community leaders, healthcare providers, and community services providers.

Graham Health System I 9IDENTIFICATION AND PRIORITIZATION ADDRESSING THE NEED At the conclusion of their review and discussion, the identication and prioritization group advanced the following needs:1. The group rst identied and prioritized availability of mental health services, including:– Increasing access to local treatment for mental health services of alltypes for youth and adults– Improving and increasing access to long-term mental healthcareoutside the community, including care for substance use disorders– Providing community education about available local mental healthservices– Providing local access to a psychiatrist2. The group next prioritized the need to improve health education and health services in some local schools that are not currently suciently staed to fully meet these needs.3. The third prioritized need was to address homelessness.The results of the assessment process were then presented to senior sta at Graham Health System through a facilitated discussion for development of a plan to address the identied and prioritized needs.Availability of Mental Health and Substance Abuse ServicesImprove Health Education and Health Services in Local Schools Address Issues Related to Homelessness

10 I Community Health Needs AssessmentADDRESSING THE NEED CREATING THE PLANThe group addressed the needs with the following strategies:1. Availability of mental health services, including:– Increasing access to local treatment for mental health services of alltypes for youth and adults– Improving and increasing access to long-term mental healthcareoutside the community, including care for substance use disorders– Providing community education about available local mental healthservices– Providing local access to a psychiatrist• Graham Health System will add a mental health nurse practitioner to the professional sta at the clinic.• Graham Health System will collaborate with North Central Behavioral Health Systems to provide a full-time, in-house crisis worker at Graham Hospital in Canton.• Graham Health System will seek to expand contacts for out-of-the-area referrals for care for persons needing inpatient care for mental health and substance use disorders.• Graham Health System will explore telepsychiatry and tele-mental health counseling.• Graham Health System will collaborate with the Fulton County Health Department and local schools to address mental health needs for youth and community education about availability of local services for youth, adult, and family. 2. Improve health education and health services in some local schools that are not currently suciently staed to fully meet these needs.• Graham Health System will collaborate with Canton Union School District to determine needs and develop solutions based on needs of the schools.

Graham Health System I 11• Graham Health System will facilitate information-sharing opportunities for school nurses working throughout the service area.3. Address homelessness• Recognizing that this is a community-wide issue and beyond the resources and services of the hospital, Graham Health System will attempt to form and facilitate a community work-group of interested agencies, local governments, schools, businesses, and individuals to develop and implement strategies to explore the scope and address this issue.The Community Health Needs process is conducted every three years. In response to issues identied and prioritized and the implementation strategy developed to address them, Graham Health System has taken the following steps since the last CHNA. Priority #1:Due to the prevalence of obesity among youth and adults in the service area, the group identied and prioritized the need for nutrition education within the community and also, access to healthy foods.• Over the last three years, the Pritikin program continued to grow and provide nutrition education to enrolled patients.• Graham Health System hired two dietitians to support patient nutritional education needs in both the outpatient and inpatient settings.• The Wellness Coordinator is working on new strategies, post-pandemic, to expand the Community Wellness Program into new industries, including youth programs.• The Community Bike Program was successfully created with two bike locations placed strategically in Canton. Further development of the program continues as additional bike locations are added and marketing gains momentum.BACKGROUND

12 I Community Health Needs AssessmentPriority #2:The prevalence of diabetes in the service area and the need for physical health and nutrition education for youth and adults and for access to reasonably priced insulin and other diabetes medications for the underinsured and uninsured were identied and prioritized.• Over the last three years, the Pritikin program continued to grow and provide nutrition education to enrolled patients.• Graham Health System hired two dietitians to support patient nutritional education needs in both the outpatient and inpatient settings.• In 2020, Graham Medical Group opened a Diabetic Clinic to focus on the needs of its diabetic population. The clinic is currently directed by an APRN (Advanced Practice Registered Nurse) who holds a certication in diabetic education.• In 2021, Graham Health System supported the education for an RN in the Wound Clinic to complete her CDCES (Certied Diabetic Care and Education Specialist) to oer enhanced support to diabetic patients. • In 2021, Graham Health System invested in a new data management program to oer more real-time reporting for Quality measures specic to diabetic patients.Priority #3:The third prioritized need was mental health including resources to address suicide, local access to mental health providers at all levels, local mental health support services, and local access to detoxication, rehabilitation, and recovery for persons facing substance use disorders.• In 2021, the Graham Medical Group started an Integrated Behavioral Health Clinic to support the needs of its patients. The program focused on short-term, goal-based therapy.• Moving forward, Graham Health System is working to enhance the program by having a PMHNP-led (Psychiatric Mental Health Nurse Practitioner) clinic to oer more options for support and healing.• In 2022, Graham Health System partnered with North Central Behavioral Health Systems (NCBHS) to oer crisis intervention services in the Emergency Department and inpatient setting.

Graham Health System I 13Priority #4:The group next identied the need to address the number of local teen births.• Accomplishments were severely constrained by the onset of COVID-19 in March of 2020. Graham Health System reallocated the vast majority of its nancial and human resources to combat the epidemic. Graham Health System worked in concert with both the Canton Union School District and the Fulton County Health Department over an 18-20-month period on education, vaccine acquisition, adult and pediatric vaccine clinics, etc.Priority #5:The group’s nal identied need was to increase local access for dentists to serve underinsured and uninsured community members.• Accomplishments were severely constrained by the onset of COVID-19 in March of 2020. Graham Health System reallocated the vast majority of its nancial and human resources to combat the epidemic. Graham Health System worked in concert with both the Connections Clinic and the Fulton County Health Department over an 18-20-month period. Graham Health System increased its nancial support for the Connections Clinic. The clinic has an account designated specically for dental needs.

14 I Community Health Needs Assessment2022 Graham Hospital - 22 Zip CodesFebruary 09, 2022©2022 Esri Page 1 of 1CantonBushnellLewistownFairviewEllisvilleAvonBannerElmwoodAstoriaWilliamseldDunfermlineBryantTable GroveFarmingtonHavanaFor the purpose of this CHNA, Graham Health System has dened its primary service area and populations as the general population within the geographic area in and surrounding Canton, dened in detail below. The hospital’s patient population includes all who receive care without regard to insurance coverage or eligibility for assistance. Graham Health System’s area of service is comprised of around 1,175 square miles, with a population of approximately 47,242 people and a population density of 92 people per square mile. The service area consists of rural communities, including:AREA SERVED BY GRAHAM HEALTH SYSTEMCubaGlasfordNorrisMariettaSmitheldIpavaSaint DavidLondon MillsVermontLiverpool

Graham Health System I 15Graham Hospital Service Area - Key Facts22 ZIP Codes Prepared by Esri61415 (Avon) et al. Geography: ZIP Code KEY FACTS48,876Population44.0Median Age2.4AverageHousehold Size$52,165Median HouseholdIncomeEDUCATION10%No High SchoolDiploma36%High SchoolGraduate35%Some College19%Bachelor's/Grad/Prof DegreeBUSINESS1,601Total Businesses14,643Total EmployeesEMPLOYMENT59%White Collar28%Blue Collar13%Services6.7%UnemploymentRateINCOME$52,165Median HouseholdIncome$27,510Per Capita Income$152,312Median Net WorthHouseholds By IncomeThe largest group: $50,000 - $74,999 (21.9%)The smallest group: $200,000+ (3.0%)Indicator▲Value Diff<$15,000 11.4% +1.9%$15,000 - $24,999 10.2% +2.3%$25,000 - $34,999 10.4% +2.5%$35,000 - $49,999 15.2% +3.9%$50,000 - $74,999 21.9% +5.4%$75,000 - $99,999 10.8% -2.0%$100,000 - $149,999 13.0% -4.0%$150,000 - $199,999 4.2% -3.7%$200,000+ 3.0% -6.1%Bars show deviation from IllinoisThis infographic contains data provided by Esri, Esri and Data Axle. The vintage of the data is 2021, 2026. © 2022 EsriThe infographic above highlights some of the key facts of that data and provides a snapshot of the population served by Graham Health System. The data on the following pages will take a deep dive into the demographics of Graham Health System’s service area and will oer insight to both the commonality and complexity of the Graham Health System audience. The average household size in the area, at 2.4, is lower than both Illinois (3.0) and the U.S. (2.5) overall average. Median age is 44 years, which is higher than Illinois and the U.S. benchmark. The highest level of education is high school graduate, followed by some college.Graham Health System Service Area – Key Facts

16 I Community Health Needs AssessmentNote: This indicator is compared to the state average. Data Source: Johns Hopkins University. Accessed via ESRI. Additional data analysis by CARES. 2021. Source geography: CountyConrmed COVID-19 CasesLOCAL IMPACT OF COVIDCOVID-19 Conrmed Cases and MortalitiesThe COVID-19 epidemic has overshadowed many local health functions since March 2020. It has dramatically impacted overall health of the communities and the delivery of healthcare and health-related services. The broad impact has been seen throughout the communities, changing the way people work, shop, learn, and communicate. This indicator reports incidence rate of conrmed COVID-19 cases per 100,000 population. Data for this indicator are updated daily and derived from the Johns Hopkins University data feed. In the service area, there have been 9,930 total conrmed cases of COVID-19. The rate of conrmed cases is 28,498.45 per 100,000 population, which is greater than the state average of 23,879.57. The mortality rate related to COVID-19 in the service area of Graham Health System has generally exceeded the rate of the state of Illinois. Data are current as of 2/28/2022.The area’s unemployment rate of 6.7% is higher than statewide and national average. Also, as is the case in much of rural Illinois, median family household income in the service area is lower than the statewide average.Of the 38,873 population of the service area, 3,195 or 8.22% are veterans of the U.S. Army, Navy, Air Force, Marine Corps, or the Coast Guard.

Graham Health System I 17COVID-19 MortalitiesNote: This indicator is compared to the state average. Data Source: Johns Hopkins University. Accessed via ESRI. Additional data analysis by CARES. 2021. Source geography: CountyIn the service area, there have been 124 total deaths among patients with conrmed cases of the coronavirus disease COVID-19. Data are current as of 3/3/2022.COVID-19 Fully Vaccinated AdultsThis indicator reports the percent of adults fully vaccinated for COVID-19. Data is updated daily from the CDC API. Vaccine hesitancy is the percent of the population estimated to be hesitant towards receiving a COVID-19 vaccine. The Vaccine Coverage Index is a score of how challenging vaccine roll-out may be in some communities compared to others, with values ranging from 0 (least challenging) to 1 (most challenging). Data are current as of 3/3/2022.Note: This indicator is compared to the state average. Data Source: Centers for Disease Control and Prevention and the National Center for Health Statistics, CDC GRASP, 2021.

Graham Health System I 19Data Collection QuantitativeQualitativeData AnalysisESTABLISHING THE CHNA INFRASTRUCTURE AND PARTNERSHIPSData CollectionDescription of Data Sources – QuantitativeQuantitative (secondary) data is collected from many resources including, but not restricted to, the following:Source DescriptionBehavioral Risk Factor Surveillance SystemThe BRFSS is the largest, continuously conducted telephone health survey in the world. It enables the Center for Disease Control and Prevention (CDC), state health departments, and other health agencies to monitor modiable risk factors for chronic diseases and other leading causes of death.SparkMap SparkMapis an online mapping and reporting platform powered by the Center for Applied Research and Engagement Systems (CARES) at the University of Missouri. US Census National census data is collected by the US Census Bureau every 10 years.Centers for Disease ControlThrough the CDC’s National Vital Statistics System, states col-lect and disseminate vital statistics as part of the US’s oldest and most successful intergovernmental public health data sharing system.SECONDARY DATA

20 I Community Health Needs AssessmentSource DescriptionCounty Health RankingsEach year, the overall health of each county in all 50 states is assessed and ranked using the latest publicly available data through a collaboration of the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute.American Communities SurveyTheAmerican Community Survey(ACS), a product of the U.S. Census Bureau, helps local ocials, community leaders, and businesses understand the changes taking place in their communities. It is the premier source for detailed population and housing information about our nation.Illinois Department of Employment SafetyThe Illinois Department of Employment Security is the state’s employment agency. It collects and analyzes employment information.National CancerInstituteThe National Cancer Institute coordinates the National Cancer Program, which conducts and supports research, training, health information dissemination, and other programs with respect to the cause, diagnosis, prevention, and treatment of cancer, rehabilitation from cancer, and the continuing care of cancer patients, and the families of cancer patients. Illinois Department of Public HealthThe Illinois Department of Public Health is the state agencyresponsible for preventing and controlling disease and injury, regulating medical practitioners, and promoting sanitation.HRSA The Health Resources and Services Administration of the US Department of Health and Human Services develops health professional shortage criteria for the nation and uses that data to determine the location of Health Professional Shortage Areas and Medically Underserved Areas and Populations.Local IPLANS The Illinois Project for Local Assessment of Needs (IPLAN) is a communityhealth assessment and planning process that is conducted every ve years by local health jurisdictions in Illinois.ESRI ESRI (Environmental Systems Research Institute) is an international supplier ofGeographic Information System (GIS) software, web GIS and geodatabasemanagement applications. ESRI allows for specialized inquiries at the zip code, or other dened, level.Illinois State Board of EducationThe Illinois State Board of Education administers public education in the state of Illinois. Each year, it releases school “report cards” which analyze the makeup, needs, and performance of local schools.USDA USDA, among its many functions, collects and analyzes information related to nutrition and local production and food availability.

Graham Health System I 21Secondary data is initially collected through the SparkMap and/or ESRI systems and then reviewed. Questions raised by the data reported from those sources are compared with other federal, state and local data sources in order to resolve or reconcile potential issues with reported data. Two focus groups were convened at Graham Health System on January 13, 2022. The rst group included representation of healthcare providers, community leaders, community services providers, schools, faith-based organizations, local elected ocials, law enforcement, public health, and others. Several members of this group provided services to underserved and unserved persons as all or part of their roles. In response to a request to identify positive developments in health and healthcare in the service area of Graham Health System, the groups put forward the following: Focus Group One – Healthcare Providers and Community Leaders• Graham Health System has been doing a great job working with the community for COVID vaccination• Graham Health System has a new Surgery Department• Graham Health System has established a scholarship program at Spoon River College to provide for education and training for healthcare employment in order to create a local resource for healthcare professionals• Graham has expanded clinics and services to surrounding rural communities• Graham Health System has recruited young physicians and surgeons• Graham Health System invests in the community and area economic development in many ways• Graham Health System has developed in-house wellness programs and expanded access to those programs and resources to other workplaces and the community• Graham Health System has collaborated with local schools to address COVID issues impacting the schoolsPRIMARY DATA

22 I Community Health Needs Assessment• Graham Health System’s strength as a hospital provides condence to the community and serves as an economic development asset• Graham Health System has been aggressive in developing access to local specialists and specialty services through building and expanding partnerships and recruiting• Graham Health System oers a local shuttle for free access to medical appointments and services at any healthcare facility across many countiesWhen asked to identify health needs in the community and the delivery of healthcare and healthcare services, whether related to Graham Health System or not:• Explore collaborations or other approaches to provide nursing services in local schools• Explore easier access to Graham Health System from the parking lot• Address community perception that the billing process at Graham Health System leads to confusion and fear of inaccuracies• Review sta training in view of COVID, sta shortages, and new employee numbers to be sure sta is knowledgeable about the building and department locations and conscious of the need to be courteous and helpful to persons seeking help or information• Review inside signage at Graham Health System, especially directional signage• Local access to a urologist• Explore ways to improve public communication and education about COVID issues and other areas of public interest or concern about wellness and health from Graham Health System and others• Improve communication between Graham Health System and ministers on intake information about faith identication of incoming patients• Mental health – More counselors – Local services for treatment, recovery, and rehabilitation – Long-term mental health services• Improved resources for persons in need (for any reason) including food and housing

Graham Health System I 23• Access to aordable housing, residential rental properties, and building lots in Canton• Explore ways to enhance relationships between Graham Health System and senior citizens• Graham Health System needs to continue its leadership role in local economic and community development• Explore re-establishing free clinics (vein clinics) when possibleThe second group included medical professionals and partners including a pharmacist, a community wellness organization, a senior services organization, a care coordinator and others. The group reported the following recent positive developments:Focus Group Two – Medical Professionals and Partners• Graham Health System is committed to, and acting on, community outreach for healthcare and related services• There are new providers at Graham Health System including specialists, surgeons, and a family practitioner• Technology, including telehealth and teleconference• Pandemic funding has been helpful for senior service needs• CCS has been able to help seniors understand and address Medicare expenses• There is a new health-oriented restaurant in Canton• Collaboration among agencies and Graham Health System on addressing community issues and service needs is very good• The Champ program is helping to address diet issues for persons trying to return to work• Fulton County Health Department has collaborated well with schools on issues related to teen pregnancy and sexually transmitted infections• Faith-based organization, social service agencies, Fulton County Health Department, Graham Health System, and others collaborate to provide monthly community resource days

24 I Community Health Needs Assessment• Fulton County Health Department maintains an up-to-date services guide• Graham Health System, Fulton County Health Department, community agencies, and others collaborate monthly to share and update information about events, services, and resource-sharingThe group then oered the following needs:• Access to medication on evenings, nights, weekends, and holidays and for homebound persons• Services for persons recovering at home under the age of 65• Access to COVID vaccines for homebound persons• Mental health – Counselors – Access to inpatient treatment – Transportation options for inpatient treatment – Assistance for anxiety, depression, isolation for all ages but especially assistance with anxiety for youth• Local access to an endocrinologist• Local cancer care rehabilitation• Access to substance use disorder services beyond Graham Health System, especially for homeless persons and registered sex oenders• Therapy for COVID patients ready for discharge• Explore ways to provide more monoclonal antibody treatments per day• Explore ways to improve access to out-of-town ambulance transfers, urgent and non-urgent• Better access to aordable dental care• Local access to dental specialists• Access to COVID-related services for homebound persons and persons in rural areas with limited access to travel• Address an emerging resistance to health screenings• Programming and services for youth and adults facing depression

Graham Health System I 25

Graham Health System I 27Age Group EthnicityRaceDisabilityDATA ANALYSISTotal Population by Age GroupData Source: US Census Bureau, American Community Survey. 2016‐-20. Source Geography: TractDEMOGRAPHICS

28 I Community Health Needs AssessmentTotal Population by EthnicityData Source: US Census Bureau, American Community Survey. 2016-‐20. Source geography: TractTotal Population by Age Groups, Graham Health System Service Area

Graham Health System I 29Total Population by Race AloneData Source: US Census Bureau, American Community Survey. 2016‐-20. Source geography: TractTotal Population by Race Alone, Graham Health System Service Area

30 I Community Health Needs AssessmentPopulation with any DisabilityThis indicator reports the percentage of the total civilian non-institutionalized population with a disability. The report area has a total population of 46,342 for whom disability status has been determined, of which 6,541 or 22.01% have any disability. This indicator is relevant because disabled individuals comprise a vulnerable population that requires targeted services and outreach by providers.Data Source: US Census Bureau, American Community Survey. 2016-‐20. Source geography: Tract

Graham Health System I 
SOCIAL DETERMINANTS OF HEALTHThe data and discussion on the following pages will take a look into the socialdeterminants in the Graham Health System service area and will oer insight intothe complexity of circumstances that impact physical and mental wellness for theGraham Health System audience. The infographic on Page 33 provides a snapshotof the at-risk population served by Graham Health System.The CDC describes social determinants of health as conditions in the places wherepeople live, learn, work, and play that aect a wide range of health and quality oflife risks and outcomes. Healthy People 2030 uses a place-based framework thatoutlines ve key areas of SDoH:• Healthcare access and quality, including: - Access to healthcare- Access to primary care- Health insurance coverage- Health literacy• Education access and quality, including: - High school graduation- Enrollment in higher education- Educational attainment in general- Language and literacy- Early childhood education and development• Social and community context – within which people live, learn work and play, including:- Civic participation- Civic cohesiveness- Discrimination- Conditions within the workplace• Economic stability, including: - Income- Cost of living- Socioeconomic status- Poverty

32 I Community Health Needs Assessment• - Employment - Food security - Housing stability• Neighborhood and built environment, including: - Quality of housing - Access to transportation - Availability of healthy food - Air and water quality - Crime and violenceSome of the social determinant indicators reected in the data include:• 5,355 households with disability• 2,706 households below the poverty level (14%)• Median household income is $52,165, which is lower than both Illinois Economic and social insecurity often are associated with poor health. Poverty, unemployment, and lack of educational achievement aect access to care and a community’s ability to engage in healthy behaviors. Without a network of support and a safe community, families cannot thrive. Ensuring access to social and economic resources provides a foundation for a healthy community.

Graham Health System I 33AT RISK POPULATION PROFILEGeography: CountyGraham Hospital Servce Area - At Risk Population22 ZIP Codes 2 Prepared by Esri61415 (Avon) et al. Geography: ZIP Code Version 1.8© 2022 EsriSource: Esri forecasts for 2021, U.S. Census Bureau2015-2019 American Community Survey (ACS) Data,AT RISK POPULATION PROFILE22 ZIP Codes 2Geography: ZIP Code48,876Population19,621Households2.35Avg SizeHousehold44.0MedianAge$52,165MedianHousehold Income$98,669MedianHome Value67WealthIndex271HousingAffordability18DiversityIndexAT RISK POPULATION5,355Households WithDisability10,987Population 65+1,100HouseholdsWithout VehiclePOVERTY AND LANGUAGE14%Households Belowthe Poverty Level2,706Households Belowthe Poverty Level0Pop 65+ SpeakSpanish & No EnglishPOPULATION AND BUSINESSES42,784DaytimePopulation1,601TotalBusinesses14,643TotalEmployeesPOPULATION BY AGE30,00020,00010,0000Aged65+18to65Under189,15610,30429,416Language Spoken (ACS) Age 5-17 18-64 Age 65+ TotalEnglish Only 7,256 27,900 9,678 44,834Spanish 62 777 53 892Spanish & English Well 62 636 32 730Spanish & English Not Well 0 79 22 101Spanish & No English 0 61 0 61Indo-European 84 266 67 417Indo-European & English Well 84 240 67 391Indo-European & English Not Well 0 26 0 26Indo-European & No English 0 0 0 0Asian-Pacic Island 29 33 13 75Asian-Pacic Isl & English Well 29 32 13 74Asian-Pacic Isl & English Not Well 0 1 0 1Asian-Pacic Isl & No English 0 0 0 0Other Language 6 19 0 25Other Language & English Well 6 10 0 16Other Language & English Not Well 0 9 0 9Other Language & No English 0 0 0 0Graham Hospital Servce Area - At Risk Population22 ZIP Codes 2 Prepared by Esri61415 (Avon) et al. Geography: ZIP Code Version 1.8© 2022 EsriSource: Esri forecasts for 2021, U.S. Census Bureau2015-2019 American Community Survey (ACS) Data,AT RISK POPULATION PROFILE22 ZIP Codes 2Geography: ZIP Code48,876Population19,621Households2.35Avg SizeHousehold44.0MedianAge$52,165MedianHousehold Income$98,669MedianHome Value67WealthIndex271HousingAffordability18DiversityIndexAT RISK POPULATION5,355Households WithDisability10,987Population 65+1,100HouseholdsWithout VehiclePOVERTY AND LANGUAGE14%Households Belowthe Poverty Level2,706Households Belowthe Poverty Level0Pop 65+ SpeakSpanish & No EnglishPOPULATION AND BUSINESSES42,784DaytimePopulation1,601TotalBusinesses14,643TotalEmployeesPOPULATION BY AGE30,00020,00010,0000Aged65+18to65Under189,15610,30429,416Language Spoken (ACS) Age 5-17 18-64 Age 65+ TotalEnglish Only 7,256 27,900 9,678 44,834Spanish 62 777 53 892Spanish & English Well 62 636 32 730Spanish & English Not Well 0 79 22 101Spanish & No English 0 61 0 61Indo-European 84 266 67 417Indo-European & English Well 84 240 67 391Indo-European & English Not Well 0 26 0 26Indo-European & No English 0 0 0 0Asian-Pacic Island 29 33 13 75Asian-Pacic Isl & English Well 29 32 13 74Asian-Pacic Isl & English Not Well 0 1 0 1Asian-Pacic Isl & No English 0 0 0 0Other Language 6 19 0 25Other Language & English Well 6 10 0 16Other Language & English Not Well 0 9 0 9Other Language & No English 0 0 0 0Graham Hospital Servce Area - At Risk Population22 ZIP Codes 2 Prepared by Esri61415 (Avon) et al. Geography: ZIP Code Version 1.8© 2022 EsriSource: Esri forecasts for 2021, U.S. Census Bureau2015-2019 American Community Survey (ACS) Data,AT RISK POPULATION PROFILE22 ZIP Codes 2Geography: ZIP Code48,876Population19,621Households2.35Avg SizeHousehold44.0MedianAge$52,165MedianHousehold Income$98,669MedianHome Value67WealthIndex271HousingAffordability18DiversityIndexAT RISK POPULATION5,355Households WithDisability10,987Population 65+1,100HouseholdsWithout VehiclePOVERTY AND LANGUAGE14%Households Belowthe Poverty Level2,706Households Belowthe Poverty Level0Pop 65+ SpeakSpanish & No EnglishPOPULATION AND BUSINESSES42,784DaytimePopulation1,601TotalBusinesses14,643TotalEmployeesPOPULATION BY AGE30,00020,00010,0000Aged65+18to65Under189,15610,30429,416Language Spoken (ACS) Age 5-17 18-64 Age 65+ TotalEnglish Only 7,256 27,900 9,678 44,834Spanish 62 777 53 892Spanish & English Well 62 636 32 730Spanish & English Not Well 0 79 22 101Spanish & No English 0 61 0 61Indo-European 84 266 67 417Indo-European & English Well 84 240 67 391Indo-European & English Not Well 0 26 0 26Indo-European & No English 0 0 0 0Asian-Pacic Island 29 33 13 75Asian-Pacic Isl & English Well 29 32 13 74Asian-Pacic Isl & English Not Well 0 1 0 1Asian-Pacic Isl & No English 0 0 0 0Other Language 6 19 0 25Other Language & English Well 6 10 0 16Other Language & English Not Well 0 9 0 9Other Language & No English 0 0 0 0Graham Health System Service Area

34 I Community Health Needs AssessmentEconomic Stability – Income and Economics Economic and social insecurity often are associated with poor health. Poverty, unemployment, and lack of educational achievement aect access to care and a community’s ability to engage in healthy behaviors. Without a network of support and a safe community, families cannot thrive. Ensuring access to social and economic resources provides a foundation for a healthy community. Income – Median Household IncomeThis indicator reports median household income based on the latest 5-year American Community Survey estimates. This includes the income of the householder and all other individuals 15 years old and over in the household, whether they are related to the householder or not. Because many households consist of only one person, average household income is usually less than average family income.Note: This indicator is compared to the state average.Data Source: US Census Bureau, American Community Survey. 2015‐19. Source geography: Tract

Graham Health System I 35Poverty – Children Below 100% FPLIn the service area, 19.17% or 1,910 children aged 0-17 are living in households with income below the Federal Poverty Level (FPL). This indicator is relevant because poverty creates barriers to access including health services, healthy food, and other necessities that contribute to poor health status.Note: This indicator is compared to the state average.Data Source: US Census Bureau, American Community Survey. 2015‐19. Source geography: Tract

36 I Community Health Needs AssessmentPoverty – Population Below 100% FPLPoverty is considered a key driver of health status. Within the service area, 14.57% or 6,712 individuals are living in households with income below the Federal Poverty Level (FPL). This indicator is relevant because poverty creates barriers to access including health services, health food, and other necessities that contribute to poor health status.Note: This indicator is compared to the state average.Data Source: US Census Bureau, American Community Survey. 2015‐19. Source geography: Tract

Graham Health System I 37Education Attainment – Associate’s Level Degree or HigherThis category contains indicators that describe the education system and the educational outcomes of the service area populations. Education metrics can be used to describe variation in population access, prociency, and attainment throughout the education system, from access to pre-kindergarten through advanced degree attainment. These indicators are important because education is closely tied to health outcomes and economic opportunity. For the selected area, 12.4% have at least a college bachelor’s degree, while 35.7% stopped their formal education attainment after high school. This indicator is relevant because educational attainment has been linked to positive health outcomes.Note: This indicator is compared to the state average.Data Source: U.S. Census Bureau, American Community Survey, 2015-19. Source geography: County

38 I Community Health Needs AssessmentProciency – Student Math Prociency (4th Grade)Information about student performance in the 4th grade math portion of the state-specic standardized tests are displayed in the table below. Of 537 students tested, 25.4% of 4th graders performed at or above the “procient” level, and 74.4% tested below the “procient” level, according to the latest data. Students in the report area tested worse than the statewide rate of 29.8%.Note: This indicator is compared to the state average. Data Source: U.S. Department of Education, EDFacts. Additional data analysis by CARES, 2018-19. Source geography: School District

Graham Health System I 39Area Deprivation IndexThis indicator reports the average (population weighted) Area Deprivation Index (ADI) for the selected area. The Area Deprivation Index ranks neighborhoods and communities relative to all neighborhoods across the nation (National Percentile) or relative to other neighborhoods within just one state (State Percentile). The ADI is calculated based on 17 measures related to four primary domains (education, income and employment, housing, and household characteristics). The overall scores are measured on a scale of 1 to 100 where 1 indicates the lowest level of deprivation (least disadvantaged) and 100 is the highest level of deprivation (most disadvantaged).Note: This indicator is compared to the state average. Data Source: University of Wisconsin-Madison School of Medicine and Public Health, Neighborhood Atlas, 2021. Source geography: Block Group

40 I Community Health Needs AssessmentOther Social & Economic Factors – Food Insecurity RateEconomic and social insecurity often are associated with poor health. Poverty, unemployment, and a lack of educational achievement aect access to care and a community’s ability to engage in healthy behaviors. Without a network of support and a safe community, families cannot thrive. Ensuring access to social and economic resources provides a foundation for a healthy community. This indicator reports the estimated percentage of the population that experienced food insecurity at some point during the report year. Food insecurity is the household-level economic and social condition of limited or uncertain access to adequate food.Note: This indicator is compared to the state average.Data Source: Feeding America, 2017. Source geography: County

Graham Health System I 41Note: This indicator is compared to the state average. Data Source: U.S. Department of Education, EDFacts. Additional data analysis by CARES, 2019-2020. Source geography: School DistrictHomeless Children & YouthThis indicator reports the number of homeless children and youth enrolled in the public school system during the school year 2019-2020. According to the data source denitions, homelessness is dened as lacking a xed, regular, and adequate nighttime residence. Those who are homeless may be sharing the housing of other persons, living in motels, hotels, or camping grounds, in emergency transitional shelters, or may be unsheltered. Data are aggregated to the report area level based on school district summaries where three or more homeless children are counted. In the service area, of all the 6,942 students enrolled during the school year 2019-2020, there were 227 or .5% homeless students, which is lower than the statewide rate of 2.6%. Note: Data are available for 100.0% of school districts in the service area, representing 100.0% of the public school student population.

42 I Community Health Needs AssessmentTeen BirthsThis indicator reports the seven-year average number of births per 1,000 female population age 15-19. Data were from the National Center for Health Statistics - Natality Files (2013-2019) and are used for the 2021 County Health Rankings. In the service area, of the 6,686 total female population age 15-19, the teen birth rate is 30.4 per 1,000, which is greater than the state’s teen birth rate of 19.4. Note: Data are suppressed for counties with fewer than 10 teen births in the timeframe.Note: This indicator is compared to the state average. Data Source: Centers for Disease Control and Prevention, National Vital Statistics System. Accessed via County Health Rankings, 2013-2019. Source geography: County

Graham Health System I 43Young People Not in School and Not WorkingThis indicator reports the percentage of youth age 16-19 who are not currently enrolled in school and who are not employed. The service area has a total population of 2,288 between the ages specied, of which 166 are not in school and not employed.Note: This indicator is compared to the state average. Data Source: U.S. Census Bureau, American Community Survey, 2016-2020. Source geography: Tract

44 I Community Health Needs AssessmentBuilt Environment – Community Design (Park Access)This indicator reports the percentage of population living within 1/2 mile of a park. This indicator is relevant because access to outdoor recreation encourages physical activity and other healthy behaviors.Note: This indicator is compared to the state average. Data Source: Centers for Disease Control and Prevention, CDC - National Environmental Public Health Tracking Network, 2015. Source geography: Tract

Graham Health System I 45Food Environment – Grocery StoresHealthy dietary behaviors are supported by access to healthy foods, and grocery stores are a major provider of these foods. There are 10 grocery establishments in the service area, a rate of 18.40 per 100,000 population. Grocery stores are dened as supermarkets and smaller grocery stores primarily engaged in retailing a general line of food, such as canned and frozen foods; fresh fruits and vegetables; and fresh and prepared meats, sh, and poultry. Delicatessen-type establishments are also included. Convenience stores and large general merchandise stores that also retail food, such as supercenters and warehouse club stores, are excluded.Note: This indicator is compared to the state average. Data Source: U.S. Census Bureau, County Business Patterns, Additional data analysis by CARES, 2019. Source geography: County

46 I Community Health Needs AssessmentAccess to Care – Dental HealthThis indicator reports the number of dentists per 100,000 population. This indicator includes all dentists qualied as having a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), who are licensed by the state to practice dentistry and who are practicing within the scope of that license. Within the service area, there are 15 dentists. This represents 31.35 dentists per 100,000 total population.Note: This indicator is compared to the state average. Data Source: U.S. Department of Health & Human Services, Health Resources and Services Administration, HRSA - Area Health Resource File. Accessed via County Health Rankings, 2017. Source geography: CountyHEALTH AND WELLNESS INDICATORS

Graham Health System I 47Access to Care – Mental HealthThis indicator reports the number of mental health providers in the service areaas a rate per 100,000 total area population. Mental health providers includepsychiatrists, psychologists, clinical social workers, and counselors that specializein mental healthcare. Data from the 2021 Centers for Medicare and MedicaidServices (CMS) National Provider Identier (NPI) downloadable le are used inthe 2021 County Health Rankings. Within the report area, there are 19 mentalhealth providers with a CMS National Provider Identier (NPI). This represents 55.3providers per 100,000 total population. Note: Data are suppressed for counties with population greater than 1,000 and 0 mental health providers. 

48 I Community Health Needs AssessmentAccess to Care – Primary CareThis indicator reports the number of primary care physicians per 100,000 population. Doctors classied as “primary care physicians” by the AMA include: General Family Medicine MDs and Dos, General Practice MDs and DOs, General Internal Medicine MDs and General Pediatrics MDs. Physicians age 75 and over and physicians practicing subspecialties within the listed specialties are excluded. This indicator is relevant because a shortage of health professionals contributes to access and health status issues. Within the service area, there are 21 primary care physicians. This represents 43.45 providers per 100,000 total population.Note: This indicator is compared to the state average. Data Source: U.S. Department of Health & Human Services, Health Resources and Services Administration, HRSA - Area Health Resource File. Accessed via County Health Rankings, 2017. Source geography: County

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50 I Community Health Needs AssessmentPoor or Fair HealthThis indicator reports the percentage of adults age 18 and older who self-report poor or fair health (age-adjusted to the 2000 standard). Data were from the 2019 Behavioral Risk Factor Surveillance System (BRFSS) annual survey and are used for the 2021 County Health Rankings. This indicator is relevant because it is a measure of general poor health status. Within the service area, the estimated prevalence of fair or poor health among adults aged 18 years and older was 20.4%. This value is based on the crude number of adults who self-report their general health status as “fair” or “poor.”Note: This indicator is compared to the state average. Data Source: Centers for Disease Control and Prevention: Behavioral Risk Factor Surveillance System. Accessed via the 500 Cities Data Portal, 2019. Source geography: Tract

Graham Health System I 51This indicator reports estimated expenditures for cigarettes as a percentage of total household expenditures. This indicator is relevant because tobacco use is linked to leading causes of death, such as cancer and cardiovascular disease. Expenditures data are suppressed for single counties and single-geography custom areas. Rank data are not available custom report areas or multi-county areas. Note: This indicator is compared to the state average. Data Source: Nielsen, Nielsen Site Reports, 2014. Source geography: TractTobacco Expenditures

52 I Community Health Needs AssessmentHealth OutcomesMeasuring morbidity and mortality rates allows assessing linkages between social determinants of health and outcomes. By comparing, for example, the prevalence of certain chronic diseases to indicators in other categories (e.g., poor diet and exercise) with outcomes (e.g., high rates of obesity and diabetes), various causal relationships may emerge, allowing a better understanding of how certain community health needs may be addressed.Cancer Incidence – All SitesThis indicator reports the age-adjusted incidence rate (cases per 100,000 population per year) of cancer (all sites), adjusted to 2000 U.S. standard population age groups (under age 1, 1-4, 5-9, ..., 80-84, 85 and older). Within the service area, there were 338 new cases of cancer reported. This means there is a rate of 503.2 for every 100,000 total population.CHRONIC ILLNESSNote: This indicator is compared to the state average.Data Source: State Cancer Proles. 2014-18. Source geography: County

Graham Health System I 53Top Five Most Commonly Diagnosed CancersThe table below shows counts and age-adjusted incidence rates of the ve most common newly diagnosed cancers by site for the 5-year period of 2014-2018.

54 I Community Health Needs AssessmentMortality – CancerThis indicator reports the 2016-2020 ve-year average rate of death due to malignant neoplasm (cancer) per 100,000 population. Figures are reported as crude rates, and as rates age-adjusted to year 2000 standard. Rates are summarized for service areas from county level data, only where data is available. This indicator is relevant because cancer is a leading cause of death in the United States. Within the service area, there are a total of 681 deaths due to cancer. This represents an age-adjusted death rate of 189.4 per every 100,000 total population. Note: Data are suppressed for counties with fewer than 20 deaths in the timeframe.Note: This indicator is compared to the state average. Data Source: Centers for Disease Control and Prevention, National Vital Statistics System, Accessed via CDC WONDER, 2016-2020. Source geography: County

Graham Health System I 55Mortality – Coronary Heart DiseaseThis indicator reports the 2016-2020 ve-year average rate of death due to coronary heart disease (ICD10 Codes I20-I25) per 100,000 population. Figures are reported as crude rates, and as rates age-adjusted to year 2000 standard. Rates are summarized for service areas from county level data, only where data is available. This indicator is relevant because coronary heart disease is a leading cause of death in the United States. Within the report area, there are a total of 405 deaths due to coronary heart disease. This represents an age-adjusted death rate of 108.6 per every 100,000 total population. Note: Data are suppressed for counties with fewer than 20 deaths in the timeframe.Note: This indicator is compared to the state average. Data Source: Centers for Disease Control and Prevention: National Vital Statistics System. Accessed via CDC WONDER: 2016-2020. Source geography: County

56 I Community Health Needs AssessmentMortality – Heart DiseaseThis indicator reports the 2016-2020 ve-year average rate of death due to heart disease (ICD10 Codes I00-109, I11, I13, I20-151) per 100,000 population. This indicator is relevant because heart disease is a leading cause of death in the United States. Within the report area, there are a total of 717 deaths due to heart disease. This represents an age-adjusted death rate of 192.2 per every 100,000 total population. Note: Data are suppressed for counties with fewer than 20 deaths in the timeframe.Note: This indicator is compared to the state average. Data Source: Centers for Disease Control and Prevention: National Vital Statistics System. Accessed via CDC WONDER: 2016-2020. Source geography: County

Graham Health System I 57Mortality – StrokeThis indicator reports the 2016-2020 ve-year average rate of death due to cerebrovascular disease (stroke) per 100,000 population. Figures are reported as crude rates, and as rates age-adjusted to year 2000 standard. This indicator is relevant because stroke is a leading cause of death in the United States. Within the service area, there are a total of 158 deaths due to stroke. This represents an age-adjusted death rate of 41.0 per every 100,000 total population. Note: Data are suppressed for counties with fewer than 20 deaths in the timeframe.Note: This indicator is compared to the state average. Data Source: Centers for Disease Control and Prevention: National Vital Statistics System. Accessed via CDC WONDER: 2016-2020. Source geography: County

58 I Community Health Needs AssessmentMortality – Lung DiseaseThis indicator reports the 2016-2020 ve-year average rate of death due to chronic lower respiratory disease per 100,000 population. Figures are reported as crude rates, and as rates age-adjusted to year 2000 standard. Rates are summarized for service areas from county level data, only where data is available. This indicator is relevant because lung disease is a leading cause of death in the United States. Within the report area, there are a total of 221 deaths due to heart disease. This represents an age-adjusted death rate of 58.4 per every 100,000 total population. Note: Data are suppressed for counties with fewer than 20 deaths in the timeframe.Note: This indicator is compared to the state average. Data Source: Centers for Disease Control and Prevention: National Vital Statistics System. Accessed via CDC WONDER: 2016-2020. Source geography: County

Graham Health System I 59Mortality – Motor Vehicle Crash (Alcohol-Involved)Motor vehicle crash deaths are preventable and are a leading cause of death among young persons. This indicator reports the crude rate of persons killed in motor vehicle crashes involving alcohol as a rate per 100,000 population. Fatality counts are based on the location of the crash and not the decedent’s residence. Within the service area, there are a total of 43 deaths due to motor vehicle crash. This represents an age-adjusted death rate of 14.6 per every 100,000 total population. SUBSTANCE USENote: This indicator is compared to the state average. Data Source: U.S. Department of Transportation, National Highway Trac Safety Administration, Fatality Analysis Reporting System, 2015-2019. Source geography: Address

60 I Community Health Needs AssessmentChronic Conditions – AdultChronic Obstructive Pulmonary DiseaseThis indicator reports the percentage of adults age 18 and older who report ever having been told by a doctor, nurse, or other health professional that they had chronic obstructive pulmonary disease (COPD), emphysema, or chronic bronchitis. Within the service area, there were 8.9% of adults 18 and older who reported having chronic obstructive pulmonary disease of the total population.Kidney Disease (Adult)This indicator reports the number and percentage of adults age 18 and older who report ever having been told by a doctor, nurse, or other health professional that they have kidney disease.

Graham Health System I 61High Blood Pressure (Adult) This table presents the percentage of adultsever diagnosed with high blood pressure. Within the service area, there were 36.4% of adults 18 and older who reported having high blood pressure of the total population.Heart Disease (Adult)This indicator reports the percentage of adults age 18 and older who report ever having been told by a doctor, nurse, or other health professional that they had angina or coronary heart disease. In the service area, there were 7.6% of adults 18 and older who reported having coronary heart disease of the total population.

62 I Community Health Needs AssessmentMENTAL AND BEHAVIORAL HEALTH Poor or Fair Mental HealthThis indicator reports the percentage of adults age 18 and older who report 14 or more days during the past 30 days during which their mental health was not good. Data were from the 2019 Behavioral Risk Factor Surveillance System (BRFSS) annual survey. Within the report area, there were 15.4% of adults 18 and older who reported poor mental health in the past month of the total population. Note: This indicator is compared to the state average. Data Source: Centers for Disease Control and Prevention: Behavioral Risk Factor Surveillance System. Accessed via the 500 Cities Data Portal, 2019. Source geography: Tract

Graham Health System I 63Mortality – SuicideThis indicator reports the 2016-2020 ve-year average rate of death due to intentional self-harm (suicide) per 100,000 population. Figures are reported as crude rates, and as rates age-adjusted to year 2000 standard. Rates are summarized fore service areas from county level data, only where data is available. This indicator is relevant because suicide is an indicator of poor mental health. Within the service area, there are a total of 41 deaths due to suicide. This represents an age-adjusted death rate of 15.2 per every 100,000 total population. Note: Data are suppressed for counties with fewer than 20 deaths in the timeframe.Note: This indicator is compared to the state average. Data Source: Centers for Disease Control and Prevention: National Vital Statistics System. Accessed via CDC WONDER: 2016-2020. Source geography: County

64 I Community Health Needs AssessmentPopulation in Poverty Race Alone, PercentThis indicator reports the average (population weighted) Area Deprivation Index (ADI) for the selected area. The ADI ranks neighborhoods and communities relative to all neighborhoods across the nation (National Percentile) or relative to other neighborhoods within just one state (state percentile). The ADI is calculated based on 17 measures related to four primary domains (education; income and employment; housing; and household characteristics). The overall scores are measured on a scale of 1 to 100 where 1 indicates the lowest level of deprivation (least disadvantaged) and 100 is the highest level of deprivation (most disadvantaged). This indicator reports the percentage of population in poverty in the service area by race alone.DIVERSITY AND MINORITY HEALTH STATUS

Graham Health System I Graham Health System works with the US-HHS ASPR, the Illinois Department ofPublic Health, county health departments, the Illinois Emergency ManagementAgency, and other state, regional, and local partners to plan, exercise, and equipfor emergency preparedness and to ensure the ability to address a wide rangeof potential emergencies, ranging from disasters of all causes to pandemics andterrorism. Graham Health System utilizes ambulance services from the FultonCounty Emergency Medical Association and other surrounding areas.EMERGENCY PREPAREDNESS

Graham Health System I 67SECONDARY DATAThe ndings of the focus groups were presented, along with secondary data, analyzed by the consultant, to a third group for identication and prioritization of the signicant health needs facing the community. The group consisted of representatives of public health, community leaders, healthcare providers, law enforcement, faith-based organizations and community services providers. The group reviewed notes from the focus groups and summaries of data reviewed by the consultant which included SparkMaps, ESRI, Illinois Department of Public Health, CDC, USDA, Illinois Department of Labor, HRSA, County Health Rankings and Roadmaps, National Cancer Institute and other resources. PROCESSIDENTIFICATION AND PRIORITIZATION OF NEEDSAvailability of Mental Health and Substance Abuse ServicesImprove Health Education and Health Services in Local Schools Address Issues Related to Homelessness

68 I Community Health Needs AssessmentAt the conclusion of their review and discussion, the identication and prioritization group advanced the following needs as being the signicant community health needs facing the Graham Health System service area:1. The group rst identied and prioritized availability of mental health services, including:– Increasing access to local treatment for mental health services of alltypes for youth and adults– Improving and increasing access to long-term mental healthcareoutside the community, including care for substance use disorders– Providing community education about available local mental healthservices– Providing local access to a psychiatrist2. The group next prioritized the need to improve health education and health services in some local schools that are not currently suciently staed to fully meet these needs.3. The third prioritized need was to address homelessness.DESCRIPTION OF THE COMMUNITY HEALTH NEEDS IDENTIFIED

Graham Health System I 69

Graham Health System I 71Resources Services at Graham Health System•  Administration• Nursing Administration• Senior Administration• Emergency Room• Clinic• Financial support as reasonable and appropriateHOSPITAL RESOURCESAVAILABLE TO MEET PRIORITY HEALTH NEEDS• North Central Behavioral Health Systems• United Place Community Crisis Center• Fulton County Health Department•  Tele-psychiatry• Tele-mental health counselingHEALTHCARE PARTNERS OR OTHER RESOURCES, INCLUDING TELEMEDICINE

72 I Community Health Needs AssessmentCOMMUNITY RESOURCES• Schools• Canton Union Schools• Area school districts• Fulton County Sheri and other law enforcement agencies• City of Canton and other local governments• Faith-based organizations• Fulton County Housing Authority

Graham Health System I 73

Graham Health System I 75Documentation Online PresenceCommentsImplementationSECONDARY DATAThis CHNA Report will be available to the community on the hospital’s public website, www.grahamhealthsystem.org. A hard copy may be reviewed at the hospital by inquiring at the information desk at the main entrance. No written comments were received concerning the hospital facility’s most recently conducted CHNA nor on the most recently adopted Implementation Strategy. A method for retaining written public comments and responses exists,but none were received.DOCUMENTING AND COMMUNICATING RESULTS

Graham Health System I The results of the assessment process were presented to senior sta througha facilitated discussion for development of a plan to address the identied andprioritized needs on February 23, 2022.The group reviewed the needs assessment process completed to that point andconsidered the prioritized signicant needs and supporting documents. Theyrecounted some of the steps taken to address previous Community Health NeedsAssessments. They also considered internal and external resources potentiallyavailable to address the current prioritized needs.The group then considered each of the prioritized needs. For each of the threeprioritized needs, actions the hospital intends to take were identied, along withthe anticipated impact of the actions, the resources the hospital intends to committo the actions, and the external collaborators the hospital plans to cooperate withto address the need. The plan will be evaluated by periodic review of measurableoutcome indicators in conjunction with annual review and reporting.PLANNING PROCESSIMPLEMENTATION STRATEGYAvailability of MentalHealth and SubstanceAbuse ServicesImprove Health Educationand Health Services inLocal SchoolsAddress IssuesRelated toHomelessness

78 I Community Health Needs AssessmentThe group addressed the needs with the following strategies:1. Availability of mental health services, including:– Increasing access to local treatment for mental health services of alltypes for youth and adults– Improving and increasing access to long-term mental healthcareoutside the community, including care for substance use disorders– Providing community education about available local mental healthservices– Providing local access to a psychiatristActions the hospital intends to take to address the health need:• Graham Health System will add a mental health nurse practitioner to the professional sta at the clinic• Graham Health System will collaborate with North Central Behavioral Health Systems to provide a full-time, in-house crisis worker at Graham Health System• Graham Health System will seek to expand contacts for out-of-the-area referrals for care for persons needing inpatient care for mental health and substance use disorders• Graham Health System will explore hiring an outpatient Advanced Practice Provider• Graham Health System will explore tele-psychiatry and tele-mental health counseling • Graham Health System will collaborate with the Fulton County Health Department and local schools to address mental health needs for youth and community education about availability of local services for youth, adult, and familyIMPLEMENTATION STRATEGY

Graham Health System I 79Anticipated impacts of these actions:Graham Hospital anticipates that completing the anticipated hiring of specialized sta along with provider and community collaborations will address, head on, many of the prioritized needs in a relatively short time. The hospital is also optimistic that tele-services could prove to be a reasonable and eective tool to assist in addressing the needs.Programs and resources the hospital plans to commit to address health need:• Senior Administration• Emergency Room• Clinic• Financial support as reasonable and appropriatePlanned collaboration between the hospital and other facilities:• Fulton County Health Department• Schools• North Central Behavioral Health Systems• Unity Place Community Crisis Center2. Improve health education and health services in some local schools that are not currently suciently staed to fully meet these needs.Actions the hospital intends to take to address the health need:• Graham Health System will collaborate with Canton Union School District to determine needs and develop solutions based on needs of the schools• Graham Health System will facilitate information-sharing opportunities for school nurses working throughout the service areaAnticipated impacts of these actions:Graham Health System anticipates that the steps above will substantially address the needs identied by improving resources.

80 I Community Health Needs AssessmentPrograms and resources the hospital plans to commit to address health need: • Administration • Nursing administrationPlanned collaboration between the hospital and other facilities:• Canton Union Schools• Area school districts • Fulton County Health Department3. Address homelessness.Actions the hospital intends to take to address the health need: Recognizing that this is a community-wide issue and beyond the resources and services of the hospital, Graham Hospital will attempt to form and facilitate a community workgroup of interested agencies, local governments, schools, businesses, and individuals to develop and implement strategies to explore the scope and address this issue.Anticipated impacts of these actions: Graham Health System anticipates that a community workgroup will be able to fully assess and address homelessness in our communities through a collaborative eort.Programs and resources the hospital plans to commit to address health need: • Administration• Financial resources as reasonable and appropriatePlanned collaboration between the hospital and other facilities:• Fulton County Sheri and other law enforcement agencies• Fulton County Health Department• City of Canton and other local governments• Faith-based organizations• Fulton County Housing Authority

Graham Health System I 81

Graham Health System I 83Focus Groups AdministrationOrganizationsBusinessFocus Group One – Healthcare Providers and Community LeadersTrygve Meade, Attorney/Proprietor, Meade Law OceJe Standard, Fulton County SheriCarla Bobell, Executive Director, Canton Area Chamber of CommerceJed Rhoades, Real Estate & Auction ServicesKathy Lock, President, Graham Hospital Service LeagueJe Utsinger, Assistant Superintendent, Canton Union School DistrictJay Shepler, St. Mary’s Food Pantry representativeThe Rev. Kevin VanTine, Covenant Community Fellowship, CantonKent McDowell, Mayor, City of CantonDiana Pavley-Rock, Canton City ClerkFocus Group Two – Medical Professionals and PartnersLiz Utsinger, Health Professional/Health Educator, Fulton County Health DepartmentKatie Lynn, Administrator, Fulton County Health Department Missy Kolowski, Administrator, Health & Wellness Connection of Fulton CountyErin Anderson, Graham Health System Clinical Social WorkerAndy French, Senior Director, Cardiac Pulmonary Rehab & WellnessBecky Sherwood, Director, Graham School of NursingWesley Kimbrough, Supervisor, Community Care ServicesKelli Kelley, Coordinator, Community Care ServicesRachel Bundy, Pharmacist, Graham Health SystemREFERENCES AND APPENDIX

84 I Community Health Needs AssessmentIdentication and Prioritization GroupErin Anderson, Graham Health System Clinical Social WorkerJe Standard, Fulton County SheriBecky Sherwood, Director, Graham School of NursingRachel Bundy, Pharmacist, Graham Health SystemLiz Utsinger, Fulton County Health DepartmentJay Shepler, St. Mary’s Food PantryMissy Kolowski, Health & Wellness Connection of Fulton CountyImplementation Planning and Strategy Group Robert Senne, President & CEO, Graham Health System Holly Henline, VP Ancillary Services/CCO, Graham Health System Teresa McConkey, VP Nursing/CNO, Graham Health System Michelle Daly, VP Clinic Services, Graham Health System Allison Sours, VP Quality/CIO, Graham Health System Julie Reeder, VP, Finance/CFO, Graham Health System

210 W. Walnut Street, Canton, IL 61520 • (309) 647.5240 • www.grahamhealthsystem.org