DeWitt Piatt CommunityJanuary 21, 2019
DeWitt/Piatt Community Health Partnership
•I. Description of Organization
The DeWitt/Piatt Community Health Partnership (DPCHP) is organized as a IRS designation 509(a)(3) Supporting Organization, a type of not-for-profit (501(c)(3)) organization designed specifically to support one or more other tax exempt organizations operating within DeWitt and Piatt Counties focused on community health/safety. The organization was formed to provide a level of fiscal support for the DeWitt/Piatt Bi-County Health Department, but may also provide additional support to other community-based organizations throughout the area, assisting them with raising funds to serve the mission of improving the community health and/or public safety of residents of DeWitt and Piatt County.
As the overall trend toward smaller government has reached local levels, the ability of local health departments to sustain themselves has become a growing concern. Local health departments, by state statute, operate primarily through funding received via property tax levies at the county level. For many, especially farm communities, property tax levies seem unfair, because the land owner is taxed on the land even though it may not have produced any income for the land owner. As such, county boards of government are becoming increasingly reticent to approve tax rates which appropriate any additional revenue to local units of government. In fact, in some cases, county boards in Illinois have adopted PTEL (Property Tax Extension Limitation) ordinances that establish tax caps to limit such expansion. (See http://www.ila.org/advocacy/taxcap.htm).
In this environment, local health departments must seek out alternative sources of revenue to ensure the continued delivery of services to communities in need. Unfortunately, as a unit of government, local health departments are limited to submitting applications for select sources of grant monies that are restricted to governmental units. In developing a not-for-profit arm of the health department, broader access to other sources of grant funds beyond those only open to units of government is ensured.
This mission of the DeWitt/Piatt Bi-County Health Department is to promote and protect the health of the residents of DeWitt and Piatt Counties. In general terms, our agency operates numerous services based around concepts of primary and secondary prevention described below:
What Public Health Does (The Purpose of Public Health):
The fundamental obligation of agencies responsible for population-based health is to:
- Prevent epidemics and the spread of disease
- Protect against environmental hazards
- Prevent injuries
- Promote and encourage healthy behaviors and mental health
- Respond to disasters and assist communities in recovery
- Assure the quality and accessibility of health services
These responsibilities describe and define the function of public health in assuring the availability of quality health services. Both distinct from and encompassing clinical services, public health's role is to assure the conditions necessary for people to live healthy lives, through community-wide prevention and protection programs.
How Public Health Serves (The Practice of Public Health):
Public health serves communities and individuals within them by providing an array of essential services. Many of these services are invisible to the public. Typically, the public only becomes aware of the need for public health services when a problem develops (e.g., an epidemic occurs). The practice of public health becomes the list of "essential services."
Monitor health status to identify and solve community health problems: This service includes accurate diagnosis of the community's health status; identification of threats to health and assessment of health service needs; timely collection, analysis, and publication of information on access, utilization, costs, and outcomes of personal health services; attention to the vital statistics and health status of specific-groups that are at higher risk than the total population; and collaboration to manage integrated information systems with private providers and health benefit plans.
Diagnose health problems and health hazards in the community: This service includes epidemiologic identification of emerging health threats; public health laboratory capability using modern technology to conduct rapid screening and high volume testing; active infectious disease epidemiology programs; and technical capacity for epidemiologic investigation of disease
outbreaks and patterns of chronic disease and injury.
Inform educate, and empower people about health issues: This service involves social marketing and targeted media public communication; providing accessible health information resources at community levels; active collaboration with personal health care providers to reinforce health promotion messages and programs; and joint health education programs with schools, churches, and worksites.
Mobilize community partnerships and action to identify and solve health problems: This service involves convening and facilitating community groups and associations, including those not typically considered to be health-related, in undertaking defined preventive, screening, rehabilitation, and support programs; and skilled coalition-building ability in order to draw upon the full range of potential human and material resources in the cause of community health.
Develop policies and plans that support individual and community health efforts: This service requires leadership development at all levels of public health; systematic community-level and state-level planning for health improvement in all jurisdictions; development and tracking of measurable health objectives as a part of continuous quality improvement strategies; joint evaluation with the medical health care system to define consistent policy regarding prevention and treatment services; and development of codes, regulations and legislation to guide the practice of public health.
Enforce laws and regulations that protect health and ensure safety: This service involves full enforcement of sanitary codes, especially in the food industry; full protection of drinking water supplies; enforcement of clean air standards; timely follow-up of hazards, preventable injuries, and exposure-related diseases identified in occupational and community settings; monitoring quality of medical services (e.g. laboratory, nursing homes, and home health care); and timely review of new drug, biologic, and medical device applications.
Link people to needed personal health services and assure the provision of health care when otherwise unavailable: This service (often referred to as "outreach" or "enabling" services) includes assuring effective entry for socially disadvantaged people into a coordinated system of clinical care; culturally and linguistically appropriate materials and staff to assure linkage to services for special population groups; ongoing "care management"; transportation services; targeted health information to high risk population groups; and technical assistance for effective worksite health promotion/disease prevention programs.
Assure a competent public and personal health care workforce: This service includes education and training for personnel to meet the needs for public and personal health service; efficient processes for licensure of professionals and certification of facilities with regular verification and inspection follow-up; adoption of continuous quality improvement and life-long learning within all licensure and certification programs; active partnerships with professional training programs to assure community-relevant learning experiences for all students; and continuing education in management and leadership development programs for those charged with administrative/executive roles.
Evaluate effectiveness, accessibility, and quality of personal and population-based health services: This service calls for ongoing evaluation of health programs, based on analysis of health status and service utilization data, to assess program effectiveness and to provide information necessary for allocating resources and reshaping programs.
Research for new insights and innovative solutions to health problems: This service includes continuous linkage with appropriate institutions of higher learning and research and an internal capacity to mount timely epidemiologic and economic analyses and conduct needed health services research.
Understanding the relationship between mental health and oral health problems to overall health, we are in a position to advocate on behalf of other health concerns although we may not provide community leadership in addressing those concerns. In this respect, the mission of the DPCHP would extend beyond the Health Department as the only supported organization, but will also include other community partners focused on improving the overall health of the community. Grants received for other health concerns where the Health Department may not be in the best position to fulfill the obligations of the grant will be shared in whole or in part with these other community partners.
•II. Market Analysis
Many of the issues that our area struggles with from a health/safety perspective mirror those experiences found in other rural areas. These experiences often relate to economic conditions, access, and poorer health outcomes in rural communities nationwide. According to a report from the DHHS Rural Health Task Force (July, 2002), "rural communities experience challenges in remaining economically competitive. These challenges include the inability to attract new investments, significant numbers of working poor and difficulty in achieving economies of scale in delivering health care, social services, education and training. Rural workers are nearly twice as likely as urban and suburban workers to earn the minimum wage. Rural workers also remain more likely to be under-employed and are less likely to improve their employment circumstances over time. Rural poor families are more likely to be employed and still poor."
With regard to access, this report indicates that:
Two central issues predominate when considering health and social services in rural communities: lack of access and, related to this lack of access, poorer health and greater poverty. A number of factors inherent to rural areas affect rural residents' access to health care and social services. Geography plays an important role in limiting rural residents' access because they often must travel longer distances to see health care and social services providers. Complicating the longer travel distances is the scarcity of public transportation in rural areas. With limited public transportation, rural residents without reliable private transportation have fewer options for accessing these services... An inability to pay for health care also compromises access to these services. Rural residents are less likely to have health insurance, a significant factor in their ability to access health services. In 1997, between 18 and 20 percent of central metropolitan and non-metropolitan county residents lacked health insurance, compared to 12 percent of suburban residents. One cause of lower rates of insurance in rural areas is the prevalence of industries less likely to insure. One factor in this disparity is the prevalence of small businesses in rural areas. Many small businesses do not have the resources to provide health insurance.
Rural residents also experience relatively poorer health and social welfare outcomes. The most dramatic health-related disparities between rural and urban residents are in the areas of mental health, substance abuse, pubic health outcomes and oral health. The communities of DeWitt and Piatt County suffer in similar ways to those situations that many rural communities experience nationwide, yet many of these situations are exacerbated by locally relevant factors that play a role in access to care as highlighted by the data below from the IPLAN and Behavioral Risk Factor Surveillance Systems (see www.idph.state.il.us view "health statistics")
- A higher percentage of DeWitt County residents cited the number of days physical health as not good between 8 - 30 days. This rate is 20% higher than state averages.
- In 2005, residents cited the number of days mental health as not good between 8 - 30 days at a rate 20% higher than state averages.
- 14.1% of residents have no health plan; 14.5% don't have a usual person as the provider of care.
- In 2001, residents cited that they avoided a doctor because of cost at rates more than twice that of state averages.
- In 1998, residents indicated that they had no health coverage for at least one year at a rate 20% higher than state averages.
- In 2001 and again in 2005, residents who indicated that their last dental visit was 2 or more years ago/never was 30% higher than state averages.
- 48.8 percent of residents have no dental insurance, roughly 10% higher than state averages.
- 25.4% of the population aged 25 and older are non-high school graduates, compared to just 23.9% of the population in Illinois.
- 29.0% of the population is below 200% of the federal poverty level as compared to 27.1% in the state of Illinois.
- A higher percentage of residents are unemployed than for the state of Illinois as a whole.
- A higher percentage of residents are enrolled in Medicaid than for the state of Illinois as a whole.
- Per capita personal income is $6577 less than state averages.
- Access to dental care was cited as a leading health priority in the 2007 local IPLAN for DeWitt and Piatt Counties.
- The ratio of Medicaid enrollees to Medicaid Physicians is 206.9 to 1, as compared to 82.3 to 1 in the State of Illinois.
- Residents are typically non-compliant with routine secondary screening procedure recommendations as noted by higher than state average rates for last cholesterol check longer than one year ago (70% higher than state averages), last clinical breast exam greater than one year ago (20 % higher than state averages), last mammogram greater than one year ago (40% higher than state averages), last PAP test greater than one year ago (60% higher than state averages), last digital rectal exam greater than two years ago (70% higher than state averages), those never having had a PSA test (40% higher than state averages).
In addition, a number of events over the last few years have exacerbated the socioeconomic conditions of this population since the last census, 1) the nuclear power plant was depreciated, subsequently affecting the amount of funds coming into county supported organizations such as the DeWitt/Piatt Bi-County Health Department (DPBHD) through local property tax levies, 2) approximately 5 years ago, a major employer in our community, Revere, closed local operations. This plant closure resulted in additional loss of tax revenue, as well as higher unemployment rates, 3) Thrall, Inc. a major manufacturer of railroad cars, also closed, resulting in even more loss of tax revenue and higher unemployment rates, and 4) another major employer, The Pottery, also ceased operations. This organization employed a number of individuals from lower socioeconomic status including many individuals representing minority populations in our community. Combined, these factors represent a significant impact and have exacerbated an already challenging local environment with regard to access to care.
- A higher percentage of Piatt County residents cited the number of days mental health not good was between 8 - 30 days. This rate is 20% higher than state averages.
- In 2001, rates of residents who cited that they avoided a doctor because of cost were 70% higher than state averages.
- In 1998, rates of residents who cited that their last routine checkup was more than one year ago was 10% higher than state averages.
- 41.3% of residents indicated that they had no dental insurance.
- More residents indicated that they had no health plan in comparison to state averages.
- 10.2% of residents indicated that they don't have a usual person as a health care provider.
- 22.0% of residents are below 200% of the federal poverty rate.
- Slightly more Piatt Co. residents are unemployed when compared to state averages.
- Per capita personal income is $5172 less than state averages.
- The ratio of Medicaid enrollees to Medicaid Physicians is 318.2 to 1, as compared to 82.3 to 1 in the State of Illinois.
- Access to dental care was cited as a leading health priority in the local IPLAN for DeWitt and Piatt Counties.
- Residents are typically non-compliant with routine secondary screening procedure recommendations as noted by higher than state average rates for last blood pressure taken longer than one year ago (10% higher than state averages), last cholesterol check longer than one year ago (60% higher than state averages), last clinical breast exam greater than one year ago (20 % higher than state averages), last PAP test greater than one year ago (30% higher than state averages), last digital rectal exam greater than two years ago (20% higher than state averages).
This information is provided as examples of the significant needs present in our two county area, which compounds the issue of access to care, both in terms of socioeconomic indicators and poorer health outcomes.
Special Health Needs
Four major need areas have been widely cited by local partners and deserve special acknowledgement throughout this market analysis. These areas include mental health services, dental services, primary care services, and coordination of care. It is estimated that the DeWitt/Piatt Community Health Partnership will focus most effort on addressing this concerns.
Mental Health Services
In 2005, an assessment process was undertaken to determine the resources and needs for mental health services in DeWitt County. This assessment project, detailed in the report entitled Recognizing Mental Health: DeWitt County Resources and Needs to Address Mental Illness, Substance Abuse, and Developmental Disabilities, combined quantitative and qualitative approaches to best inform the DeWitt County Community Mental Health Board about needs and organizations' services and programs in the County. Significant portions of the final report have been used in this section of this grant application. The Applied Social Research Unit of Illinois State University (ASRU), the organization contracted to provide administrative services to the DeWitt County Community Mental Health Board, collected public data, convened a public meeting, and surveyed health and human service organizations providing services in DeWitt County. In all, more than 60 individuals and 42 organizations directly participated in this research.
Results of this community assessment process indicated that despite the organizations and services available, DeWitt County providers and residents need particular services that aren't available close to home or at times and in ways they can access services. Survey and public forum participants rated how problematic they think particular issues and availability of services are in DeWitt County. Then, they indicated their top five issues and/or services calling for increased attention by providers. A majority of survey respondents consider alcohol and drug abuse issues, employment for people with mental illness or developmental disabilities, and ability to meet basic needs as serious or very serious problems in the County. Public transportation, residential services, child care, and dental care were among the service needs identified as serious or very serious problems by the largest percentages of respondents.
The U.S. Department of Health and Human Services, Health Resources and Services Administration (HRSA), has designated DeWitt County as a Health Professional Shortage Area (HPSA) for mental health. To be designated as such, the County has to meet the following criteria: be considered "a rational area for the delivery of mental health services"; exceed certain population-to-core-mental health professional ratios; have "unusually high needs for mental health services"; and have "mental health professionals in contiguous areas [that] are over utilized, excessively distant or inaccessible to residents" of the County. Core mental health professionals include psychiatrists, clinical psychologists, clinical social workers, psychiatric nurse specialists, and marriage and family therapists. HRSA defines the criteria and requirements for core professionals further at its Website.  There is a significant difference in the availability of psychiatrists, clinical psychologists, clinical professional counselors, and clinical social workers (per 100,000 people) between rural and urban counties within the Illinois Department of Human Services east central region. That is, DeWitt County, and other rural counties in this region, are underserved by mental health professionals as compared to McLean, Champaign, and Macon Counties. Also, DeWitt County is one of 59 rural counties in Illinois without a practicing psychiatrist. 
Psychiatric care and medications
Availability of psychiatric care is not a new issue for DeWitt County. During visits with business leaders by the Dr. John Warner Hospital CEO in 1999, 11 of 40 leaders-the largest number of leaders indicating any service-identified psychiatric services as needing to be added in the community.  One table at the August 2005 public forum discussed the unavailability of psychiatric care in DeWitt County. A Dr. John Warner Hospital employee commented on the amount of crisis intervention occurring in the emergency room and the need for provision of psychotropic medications. Although primary care MD's prescribe medications for mental conditions, they often are uncomfortable doing so according to this participant. An Human Resource Center (HRC) staff member commented that HRC is limited to providing psychiatric services twice per month.
The second largest percentage of survey and public forum respondents (80%) identified prescription drug affordability as a serious or very serious problem in DeWitt County. Several respondents also listed this issue as a top priority issue. A parent commented on the financial burden of purchasing $800 worth of medications per month to treat a child's mental illness. Although St. John's Catholic Church provides some assistance for paying for medications through its Outreach Program, one provider identified support for medications as a gap in services.
Issues with provision of mental health services and medications are not limited to DeWitt County's hospital or mental health facility. Assessment participants named the school and criminal justice systems as key players in mental health.
Counseling services, case management, and intervention
One-third of survey and forum respondents rated availability of counseling services as a serious or very serious problem in DeWitt County with six people rating increased provision of services a priority. Several survey respondents and public forum participants indicated gaps in counseling services through HRC, DOVE, and the public school system. The Clinton Community Unit School District 15 eliminated a counseling position last year due to funding cuts but is reinstating the position this school year. Participants also suggested increasing opportunities for school-based mental health and early intervention services for infants and young children. Both survey and forum participants called for local schools and the mental health system to work together more closely.
Other participants shared perceptions about and/or suggestions for improvements to both the Clinton school district and local juvenile justice system regarding response to mental health issues. One school representative commented, ". . . students on probation who do not come to school face no repercussions. [There is] no ‘re-entry' program or communication when a student re-enters school from St. Mary's or after a mental illness." A parent suggested greater recognition and understanding of mental illness, substance abuse issues, and co-occurring disorders by local schools, courts, and probation.
Public forum participants discussed the importance of case management and/or a need for increasing case managers through local organizations. One participant commented, "Counseling may have been great but emphasis on helping find resources or services such as daycare, transportation, and housing is important." One person providing input outside of the forum commented that information about and help for finding resources also could be provided more readily by local schools and probation.
Substance abuse issues and services
A majority of Health and Human Service Providers' Survey and public forum respondents rated alcohol use, drug abuse, and tobacco use as problems or very serious problems in DeWitt County These issues were also among their top priorities requiring further attention. Over one-third of respondents (36% of both community and parent respondents) to a spring 2005 underage drinking assessment conducted by HRC staff indicated that they believe prevention of underage drinking should be a top concern of the community.  Although the committee working with the DeWitt Piatt Bi-County Health Department 1999-2004 Community Health Plan did not choose substance abuse as a top priority in 1999, it did identify "substance abuse (alcohol, illegal, and over the counter)" as 1 of 12 problems identified through brainstorming.  The 2005 Illinois Behavioral Risk Factor Survey results indicate that 24.2 percent of DeWitt County adults were at risk for acute or binge drinking. 
The DeWitt County Human Resource Center provides substance use education for several groups: for young people, primarily through the schools, aimed at preventing alcohol, tobacco, and other drug use; for alcohol vendors; and for DUI offenders, a state curriculum on the impact of alcohol use. HRC's Addiction Recovery Program provides outpatient substance abuse assessment, counseling, and individual and group therapy.
One organizational representative said, "Substance abuse services are lacking or else we are not aware of services available." In addition to participants making comments indicating a general lack of substance abuse-related services, at least one participant commented on needs for detoxification services, intensive or extended outpatient rehabilitation, and extended in-patient substance abuse treatment.
In addition to alcohol, methamphetamine use has been of particular concern in rural areas in the State. In 2005, the State of Illinois has pledged $80,132 to the Zone 6 Task Force serving DeWitt, McLean, and Livingston Counties to help fight manufacture and use of the drug. 
A few participants commented that more could be done locally to address co-occurring mental illness and substance abuse issues. One table at the public forum perceived substance abuse to be a major problem in DeWitt County and discussed a relationship between mental illness and substance abuse.
Overall, the proportion of persons who experienced a dental visit in the past year has remained constant over recent years, and the same is true for most subgroups. But, disparities among subgroups in the population are observable across urban/rural areas, race, ethnic group, age, and income level. The causes of the oral health disparity between urban and rural areas can be traced to several factors that can be categorized as access to care and utilization, economic, and dental resources.
Challenges to access to care include lack of dentists, inadequate supply of dentists who accept Medicaid or other discounted fee schedules, reluctance by dentists to participate in managed care programs, socioeconomic nature of rural populations (poverty, low educational attainment, cultural differences, lack of transportation), and absence of a coordinated screening and referral network.
Ability-to-pay, including access to health and dental insurance, is an important determinant of receiving adequate and necessary dental care. According to the Surgeon General's report, children with dental insurance are 2.5 times more likely to receive dental care than children without dental insurance. However, less than 20 percent of children with Medicaid insurance coverage receive one dental visit each year.
Income level is a major factor contributing to utilization of access to care. Adults living in poverty (income at 200 percent of the federal poverty level or below) are less likely to receive dental care than wealthier adults. Among people who are considered non-poor (incomes 200 percent or greater than the Bureau of the Census poverty threshold), 72 percent had a dental visit the past year. Among the near poor (incomes of 100 percent to less than 200 percent of the poverty threshold), the percentage dropped to 48.5 percent in 1999. Among the poor (incomes below the poverty threshold), the percentage is even lower at 46.2 percent having a dental visit the past year.
A significant barrier to oral health care in rural areas is the lack of an adequate dental workforce. The distribution of dentists in large metropolitan areas is over 60 per 100,000. In DeWitt and Piatt Counties, the ratio is 32.25 dentists per 100,000. This disparity may become more serious as the supply of dentists decreases due to declining numbers of dental students and an increase in the number of retiring dentists.
As part of our ongoing assessment responsibilities, the DeWitt/Piatt Bi-County Health Department has engaged, over the past year, in an assessment process entitled MAPP: Mobilizing for Action through Planning and Partnership. This assessment model is a community-wide strategic planning tool for improving community health. Facilitated by public health leadership, this tool helps communities prioritize public health issues and identify resources for addressing them. Fundamental to MAPP is the recognition that no single organization, including a governmental public health agency, can by itself achieve the outcomes needed to improve community health. The MAPP process involves four separate assessments: A community themes and strengths assessment, a local public health system assessment, a community health status assessment, and a forces of change assessment. The results of these assessments have identified a list of priority themes common in multiple focus group sessions in both counties. These focus groups involved a broad cross section of individuals representing a variety of different social service organizations operating within the two counties. Dental care for low income and Medicaid recipients (children and adults) was one of the leading health priorities for our jurisdiction cited in these focus group meetings.
Behavioral Risk Factor Surveillance System data indicated that in 2005, those residents indicating that their last dental visit was greater than 2 years ago or never was 30% higher than similar state of Illinois rates. This totals 24.7% of the population as a whole. In Piatt County, these numbers are equal to state averages, with approximately 18% of the population indicating same. Approximately 48.8% of DeWitt County residents have no dental insurance along with 41.3% of Piatt County residents, further exacerbating the access to care issue surrounding dental concerns in rural communities.
In 2000, twenty persons formed an advisory committee to conduct an Oral Health Needs Assessment focusing on DeWitt and Piatt Counties. The committee members consisted of 5 health department staff, 2 school nurses, 5 local dentists, 1 county board member, and 6 representatives from community service organizations. In addition, our regional dental representative from IDPH was invited to participate. At the initial meeting the IPLAN data, a survey of dental practices, and a survey given to health department WIC clients to determine infant feeding practices were analyzed. It was determined that only one dentist in the bi-county area accepts Medicaid clients. No one accepts medically indigent clients. It was immediately determined that we have an "access to care" problem. The dentists discussed the main reasons for not accepting Medicaid clients. They are as follows:
- Inadequate reimbursement rates.
- Clients are "no shows" when given an appointment.
- The client comes with numerous family members and they are difficult to control.
- Dentists rarely have open appointment times to add these clients.
Only 50% of the dental practices surveys were returned. In this survey, a question was asked of all dentists, "for those children who have difficulty obtaining the dental care they need, please rank what you think are the three most important barriers". The dentists responding to the survey indicated 1) few dentists in the area accept public aid, 2) lack of money/adequate insurance benefits to pay for dental care, and 3) dental care is seen as a low priority, as the three most important barriers.
These data confirm the presence of an ongoing and growing concern regarding dental care in our two county area.
Primary Medical Services
Rural areas are especially vulnerable to issues pertaining to access to care. These issues are reflected in much of the literature which characterizes health care in rural settings nationwide. Rural health care facilities are facing increased challenges to remain viable and at the same time continue to deliver high quality care to their communities. Pressures to contain rising costs have created many challenges for healthcare providers, rural and non-rural alike. How providers respond to these cost pressures truly impacts our local communities, especially if that response involves reducing access to services by the most vulnerable in the population, as we see occurring in DeWitt and Piatt Counties.
Rural providers are increasingly faced with their own set of unique challenges including service area size, physical barriers, and travel patterns which make it more difficult for rural providers to develop services, markets and businesses. This issue, coupled with low population density, and the inability to attract and retain medical personnel, makes it difficult to develop and support new programs. According to the Institute of Medicine Report, Quality Through Collaboration: The Future of Rural Health Care published in 2004, some of the quality shortcomings in rural areas stem from the lack of access to "core health care services, defined for purposes of this report as primary care in the community, emergency medical services, hospital care, long-term care, mental health and substance abuse services, oral health care, and public health services. For some core health care services, most notably emergency medical services, mental health and substance abuse services, and oral health care, access is severely constrained in many if not most rural communities by long-standing shortages of qualified health professionals. Rural communities also confront a different mix of health and health care needs than do urban areas. Rural populations tend to be older than urban populations and to experience higher rates of limitations in daily activities as a result of chronic conditions. Rural populations exhibit poorer health behaviors (i.e., higher rates of smoking and obesity and lower rates of exercise) relative to most urban populations, although there is variability in health behaviors among rural communities. Unless action is taken now, the future burden of chronic disease in many rural communities will be enormous".
Perhaps unique to the perspective of rural health, both DeWitt and Piatt County have a hospital operating in each county, with Kirby Hospital operating in Monticello, the county seat of Piatt County, and John Warner Hospital operating in Clinton, the county seat of DeWitt County. Despite the existence of these hospitals however, access to care is not ensured for all residents. This fact is most notably underscored in local statistics from the behavioral risk factor surveillance system cited earlier in this section, especially statistics that reflect health status and health care utilization indicators, and compliance with screening recommendations:
- More individuals in our communities have indicated above state average statistics for days physical health is not good.
- Above average statistics for avoiding a MD because of cost.
- Last routine checkup > 1 year ago.
- Last blood pressure taken > 1 year ago.
- Last cholesterol check > 1 year ago.
- Last mammogram >1 year ago.
- Last clinical breast exam > 1 year ago.
- Last PAP test > 1year ago.
- Last digital rectal exam > 2 years ago.
- Never had a PSA test.
Despite the existence of medical personnel within both counties, we continue to see problems related to access to care, including compliance with screening recommendations. It is also notable that these below state average statistics are consistent regardless of the type of screening.
Coordination of Care
According to the report, One Department Serving Rural America: HHS Rural Task Force Report to the Secretary from July 2002, coordination of services is especially salient in rural communities. "The strong relationship between adequate income, sufficient food, strong social networks and good health necessitates coordination among various health care and social service agencies. This coordination is especially important in rural communities, where services and providers are limited in numbers. In many rural communities, service providers often make alliances with one another and exhibit extraordinary resourcefulness and resilience. In some cases, rural providers facilitate a better response to people in need than urban providers because of smaller office size and more familiarity with clients. When given the opportunity, local administrators are often energized by the increased responsibility to attempt innovations in social service provision. However, coordination in rural communities is difficult for a number of reasons. Some services are becoming more fragmented as rural service providers specialize in an attempt to simplify administrative responsibilities and to meet federal grant requirements. Possibly the most important factor in fragmentation and lack of coordination in rural areas is the continuing conceptual and practical separation among primary health care, behavioral health care and social services. Although health and social welfare are strongly association with one another, in many cases federal, State and local planning efforts continue to address them separately".
Coordination of services is an issue that has been routinely cited as a concern of local providers. As noted in the aforementioned report, there is a fragmentation of services across the health spectrum, which presents challenges in attempts to coordinate services for the underserved, especially in rural areas.
•III. Organization and Management
The DPCHP operates as a Supporting Organization as designated in Section 509(a)(3) of the IRS Code.
A Supporting Organization is a public charity that carries out its exempt purposes by supporting one or more other exempt organizations. The key feature of a supporting organization is a strong relationship with an organization it supports, in this case, the DeWitt/Piatt Bi-County Health Department. The strong relationship enables the supported organization to oversee the operations of the supporting organization. In fact, Type I supporting organizations are "operated, supervised, or controlled by" the supported organization, as is the case with the DeWitt/Piatt Bi-County Health Department. An organizational chart describing this relationship is seen below.
In fulfilling obligations of any grant agreements extended to the DPCHP, the organization has at its disposal all of the staff of the DeWitt/Piatt Bi-County Health Department, and if necessary will hire additional staff, provided that funding is available.
The DeWitt/Piatt Bi-County Health Department receives its authority to operate through the Illinois State Statutes (55 ILCS 5/5-25000). The DeWitt/Piatt Bi-County Health Department is governed by a Board of Health made up of officials appointed by the county boards of each jurisdiction. There are eight board members, and as determined by statute, at least one of these eight officials must be a physician licensed to practice medicine in the state of Illinois, and at least one must be a dentist, licensed to practice dentistry in the state of Illinois. The statutes also define that the board members are equally split by county of residence, meaning that four of the board members must reside in DeWitt County and four in Piatt County. In addition, a representative from each respective county board must sit on the Board of Health.
The DeWitt/Piatt Bi-County Health Department operates through four primary divisions: a Division of Nursing for Piatt County, a Division of Nursing for DeWitt County, a Division of Environmental Health, and a Division of Administrative Services.
IV. Strategic Orientation
The development of the DeWitt/Piatt Community Health Partnership has been primarily oriented around the issue of funding. As such, it is the intent of this body to routinely seek out and apply for funding specific to 501(c)(3) organizations, i.e., the United Way. A subset of the DeWitt/Piatt County Board of Health will oversee the operations of this organization, and the organization will be coordinated through the efforts of the executive director of the DeWitt/Piatt Bi-County Health Department. The deliverables and work responsibilities of any grant funds that might be secured will be implemented through existing DeWitt/Piatt Bi-County Health Department staff, or through additional staff that would be hired for those specific purposes. Other organizations may be supported by this body provided that they are similarly oriented in their mission.
 Health Resources and Services Administration, Health Professional Shortage Areas Mental Health Designation Criteria, [Internet], http://hhpr.hrsa.gov/shortage/hpsacritmental.htm, (accessed October 2005).
 Kyle, M., C. Dankwa, and M. MacDowell, Assessment of Mental Health Services in Rural Illinois, "Appendix A: Maps of Illinois" and "Appendix B: Density of Mental Health Professionals," (September 2005), (research supported in part through Project EXPORT Center for Excellence in Rural Health of the National Center for Rural Health Professions, University of Illinois at Rockford).
 DeWitt-Piatt Bi-County Health Department, Community Needs Assessment and Community Health Plan, 1999-2004, p. 10, and "Community Health Plan, Appendices H and I," pgs. 28 and 30, (July 1999).
 The DeWitt County Human Resource Center, Summary Data for Spring 2005 Underage Drinking Assessment, (September 2005).
 DeWitt-Piatt Bi-County Health Department, Community Needs Assessment and Community Health Plan, 1999-2004, "Community Health Plan, Appendix E," p. 25, (July 1999).
 Illinois Department of Public Health, Illinois Behavioral Risk Factor Survey Results, (2005). The 2005 Illinois Behavioral Risk Factor Survey results for DeWitt County should be available later this year at the Illinois Behavioral Risk Factor Surveillance System Website at http://app.idph.state.il.us/brfss.
 The DeWitt County Constitution, "Task force receives $80,132 to fight meth," (August 25, 2005).