Human Services
From Sustaining Jackson Hole Wiki
I. Overview
Sustaining Jackson Hole 2004 had separate working groups for Health and Social Services. At about the time Sustaining Jackson Hole 2004 was starting, however, organizations in both groups were creating a “Systems of Care” group to try to address issues of common concern, including many of the topics of interest to Sustaining Jackson Hole.
During their 2004 meetings, the Systems of Care group adopted or adapted many Sustaining Jackson Hole concepts (e.g. developing consistent measurement techniques across organizations, creating a Statement of Ideal, etc.). Wishing to honor this work, Sustaining Jackson Hole 2005 merged its Health and Social Services groups into one Human Services group, using the preferred term of the Systems of Care group itself.
As a phrase, “Human Services” recognizes the inter-connectedness of health and social issues. For example, physical afflictions such as asthma can be made worse or even induced by factors as varied as stress at home or poor air quality; social problems such as domestic violence can be influenced or caused by factors ranging from alcoholism to work or home environment. Recognizing this reality, the Systems of Care group tries to integrate Jackson Hole’s many social service and health organizations, with a goal of most efficiently using resources and, ultimately, more effectively addressing multi-factorial problems.
Whether focused on health or social services issues, all of these agencies derive their funding from a variety of sources, among them private donors (including Old Bill’s Fun Run), churches, grants, and state and federal programs. As local organizations, these agencies were founded to address specific identified needs in the community. The strength of this approach is that these organizations are especially aware of local needs; the downside is that there are sometimes gaps in services that keep residents in need from enjoying a human services “continuum of care.”
To address this need, a number of local service providers recently created the Community Resource Center, a service clearinghouse for potential clients. In its brief existence, the center has proved to be an effective tool in referrals and resource sharing among Teton County social services organizations.
II. Participants
• Deidre Ashley, Community Entry Services
• Stacey Caesar, Planned Parenthood
• Colleen Cherette, Our Families, Our Future
• Jean Coldsmith, Teton County School District
• Karen Connelly, St. Johns Medical Center
• Katharine Conover, Community Safety Network
• Vida Day, El Puente
• Terri Gregory, Teton County Public Health
• Carl Mason, The Refuge
• Sarah Mitchell, Teton County Grantwriter
• Carmina Oaks, Latino Resource Center
• Jill Oja-Johnson, Teen Center of Jackson
• Smokey Rhea, Community Resource Center
• Jen Simon, Teton Literacy
• Peggy-Marie Smith, Community Childrens Project
• Deb Sprague, Jackson Hole Community Counseling Center
• Pier Trudelle, Teton County School District
• Ed Wigg, Curran-Seeley
III. Indicators
A. Health-oriented organizations in Teton County
A1. Financial health of St. John’s Medical Center
Rationale: The financial health of St. John’s indicates the extent to which the community can financially rely on the services and level of care being delivered by the hospital. St. John’s is the primary asset of the Teton County Hospital District, a public body with the authority to levy property taxes. Traditionally, the hospital district chooses to levy 3 mills. Included here are the primary measures of St. John's finances; additional information is including in the appendix.
Comment: In recent years, St. John's has attempted to generate an annual operating profit. When successful, this strategy allows the medical center to use its non-operating revenues (e.g. property taxes) to strengthen its balance sheet.
A2. Number of doctors and allied professionals with privileges at St. John’s Medical Center
Rationale: St. John’s is the major provider of health care services for the region, a “catchment area” that includes eight counties in Wyoming, Idaho, and Montana. The number of medical staff associated with St. John’s reflects the range of services available to the community and, to a lesser extent, the accessibility to health care providers in Jackson Hole.
Comment: The current list of physicians at St. John’s can be found on the hospital’s website. Specialists include anesthesiology/pain medicine, cardiology, child and adolescent psychiatry, dentistry, dermatology, emergency medicine, ear, nose, and throat, general surgery, neurology, obstetrics and gynecology, oncology and hematology, ophthalmology, oral and maxillofacial surgery, orthopaedics, pathology, pediatric cardiology, perinatology, physical medicine and rehabilitation, plastic and reconstructive surgery, psychiatry, psychology, pulmonology, radiology, telemedicine, urology, and vascular surgery, bariatric surgery, acupuncture, genetic counseling, hand therapists, massage therapists, critical care specialists, spine surgery, professional counseling, sleep medicine, lactation consultant, midwives, advanced nurse practitioners, physician assistants, and surgical assistants.
Specialties represented by visiting, seasonal, or part-time physicians include: child and adolescent psychology, cardiology, neurology, oncology and hemotology, pediatric cardiology, perinatology, podiatry, and pulmonology. Everyone on the SJMC medical staff is board certified in their field, including allied health professionals.
A3. Number of practitioners working in alternative and integrative specialties
Rationale: Alternative medicine is playing a larger role in health care and wellness. The more options offered in the community, the better the chances of individuals receiving their preferred treatments.
Comment: This list double-counts practitioners who practice more than one specialty. The Integrative Healthcare Foundation provides a continually-updated directory of alternative health care providers in Teton County at www.tetonwellness.org.
A4. Clients seeking mental health services from the Community Counseling Center Rationale: The number of clients seeking mental health services indicates the need for these types of services. A growing or declining client base may also reflect the degree of stigma associated with seeking assistance for mental health issues.
Comment: The Community Counseling Center is the only public provider of mental health services in Teton County. We were unable to gather data from private practitioners, 15 of whom are listed in the 2005-2006 Jackson Hole Phone Directory.
B. Public Health
The Teton County Public Health office is a service run by Teton County, under a mandate by the state. Its mission is to promote, provide for & protect the health & well being of the community and environment. Services offered include immunizations, disease testing, water testing, restaurant inspections, and other public health-oriented items.
B1. Immunization Rates
Rationale: Immunizations help protect individuals from communicable disease outbreaks. The state and national goals are to have 90 % of the population inoculated, which is considered the “herd immunity” level (i.e. where population immunity is reached). Perhaps for reasons of personal beliefs, there is a segment of Teton Count’s population who choose not to be immunized. When pockets of populations fall below a 90% immunization rate, the potential for disease outbreak sharply increases.
Source: Terri Gregory, Teton County Public Health Department
B2. Communicable disease rates
Rationale: Communicable and infectious disease rates indicate what health threats may be imminent in the community. E.coli and salmonella are included here because they are indicators of food and water safety. Chlamydia is included as an indicator of sexual health of Teton County residents.
Comment: The Public Health Nurse receives a report daily from the state Department of Health indicating new disease cases. Other infectious and communicable disease cases are listed in the appendix.
Source: Terri Gregory, Teton County Public Health Department
B3. Food safety
Rationale: The safety of food prepared in public settings is fundamental in preventing the spread of food-borne or food-related illnesses.
Source: Julie Hayward, Environmental Health, Teton County Public Health
Comment: The Teton County Public Health Department performs routine restaurant inspections, as well as inspections of temporary food vendors at local events. Critical violations are defined as imminent health hazards or likely to lead to imminent health hazards.
The State of Wyoming also performs inspections in Teton County at 12 non-restaurant food service providers (i.e. grocery stores and mini-marts). There are approximately 50 unlicensed food vendors in Teton County that are not inspected.
C. Environmental quality measures
C1. Water Quality
Rationale: Jackson Hole has long been considered to have a healthy natural environment. Air and water quality are fundamentally linked to public health. Air quality should meet or exceed EPA standards; water quality should meet or exceed DEQ standards. Comment: These samples came from both public and private water systems. Those that did not meet DEQ standards tested positive for e.coli or coliform. The Environment chapter of this report (Chapter 10) has a detailed discussion of broader air and water quality issues in Teton County.
D. Social services in Teton County
D1. List of Teton County’s social services organizations
Rationale: The number and range of social services organizations in Teton County reflects the community’s needs, the extent of services available to the community, and accessibility to local providers. An updated list can be found in the Community Foundation of Jackson Hole’s non-profit directory, found online at www.cfjacksonhole.org.
Teton County’s social services organizations:
• Adoption in the Tetons: adoption information and services to those seeking to adopt, counseling services for pregnant women and adopting families, and infertility support groups
• City Kids Wilderness Project: experiences that inspire disadvantaged young people from Washington, D.C.
• Community Children’s Project: early childhood education and surround care for children 6 weeks to 8 years of age; referral services; scholarships; parenting classes; leadership training; early childhood education classes for childcare providers in Teton and Lincoln Counties
• Community Counseling Center: individual, group, and family counseling, in-clinic or in
the community (home or school) for children and adults; case management; job coaching; medication management; psychological evaluations; mental health assessments; prevention and community education services; consultation; outreach; round-the-clock emergency services
• Community Entry Services: services that empower people with disabilities to maximize their independence and lead productive lives in the community
• Community Resource Center: clearinghouse of information to the social services in Teton County, referring individuals to appropriate service providers and facilitating the cooperation of various service organizations
• Community Safety Network: 24 hour crisis line, legal advocacy, case management, referral, counseling, and safe house services and transitional housing, to those affected by family violence or sexual assault
• Crisis Pregnancy Center of Jackson Hole: free, confidential pregnancy and HIV tests, clothing, furnishings, and referrals as well as abstinence, STD, and pregnancy education to women, men, and families with stressful pregnancies
• Curran-Seeley Foundation: detailed testing, evaluation, counseling, treatment, after care support, and DWUI classes to those who have addiction problems
• El Puente: improve the functionality of the health care system among limited-English speakers by providing medical interpretation in every health care setting and by assisting limited-English speakers and their providers at every other point of access in the system , i.e: billing, appointments, relay of medical information via phone, applying for financial assistance and Medicaid
• Family Safety Network: domestic violence protection, prevention, and education for the community in order to promote healthy families in Teton County, Idaho
• Horse Warriors: horseback riding, art, creative writing, community service, peer mentoring, parenting classes, in-school tutoring, demonstrations, resource awareness, cooking/life skills for those with physical, mental, and emotional disabilities; broken families; substance abuse; low self-esteem; academic failure; failure to thrive; histories of abuse, irresponsibility, and fear
• Jackson Cupboard: short-term food shortage relief
• Latino Resource Center: legal, referral, advocacy, mediation, and educational services offered to Latinos in the greater Jackson Hole area
• Senior Center of Jackson Hole: congregate meals, home-delivered meals, transportation, home health, and a wide range of health and recreational activities
• Teton County Victim/Witness: crisis intervention and follow-up; emergency assistance; security repairs; criminal justice system information and support; impact statements; restitution; referral counseling; victim advocacy; compensation; DUI Victim Impact panels; restorative group conferences; and youth impact panels
• Teton Youth and Family Services: a continuum of services ranging from prevention to residential treatment that addresses behavioral, emotional, and/or mental health issues; entities include the Van Vleck House, Hirschfield Center, and Red Top Meadows
• Western Wyoming Family Planning: access to comprehensive, high quality, voluntary family planning and other reproductive health care services to residents of Wyoming
Comment: More extensive descriptions of the services offered by some of these organizations can be found in the Social Services section of this report’s Appendix.
D2. Aggregate expenditures by human services organizations in Teton County
Rationale: Human services organizations in Teton County spent over $60 million in 2004 in pursuit of their respective missions. St. John’s Medical Center accounted for $44 million of this, or nearly 80 percent of the total. Looking at total, mean, and median expenditures provides a sense of the relative size of human services organizations, and whether they are growing. Although each organization provides budget information, there is currently no “apples to apples” way to compare different organizations’ per-client cost of service.
Comment: St. John’s Medical Center’s revenues are growing much more rapidly than those of the human services community as a whole.
Expenditures by social services are taken from the annual non-profit directories published by the Community Foundation of Jackson Hole. Organizations included are: Big Buddy Mentoring Program, City Kids Wilderness Project, Community Safety Network, Community Children’s Project, Community Entry Services, Crisis Pregnancy Center of Jackson Hole, Curran-Seeley Foundation, C-V Ranch, Family Safety Network, Horse Warriors, Jackson Hole Therapeutic Riding Association, Moose Day Care, Red Top Meadows, Senior Center of Jackson Hole, Teton County Pal, Teton County Youth Project, Teton County Youth and Family Services, Van Vleck House, and Western Wyoming Family Planning.
D3. Dollars spent on human services by local government
Rationale: Local government provides critical financial support to local human services organizations. The amount of money provided reflects the priority town and county government place on these services. Source: Town of Jackson, Teton County
Comment: Teton County is mandated by the state to support a broader variety of human services organizations and services than is the Town of Jackson.
E. Clients using social services
E1. Number of people served annually by social services organizations in Teton County
Rationale: The number of people served annually reflects the need for and accessibility of social services in Teton County.
1 The Latino Resource Center receives roughly 600 inquiries a month; these could be the same individuals inquiring multiple times.
2 Van Vleck & other programs: 454; Hirschfield Center: 98; Red Top Meadows: 34
3 El Puente does not count clients; however they provide medical interpretation for about 110 appointments/ week. They also attend to 40-50 phone calls/ day dealing with scheduling, billing, and medical problems.
Comment: All data are the most current available. Blank entries in the table indicate those groups from which we were unable to obtain data.
V1. Human Services Wish List
• Indoor air quality
• Information on access to care, especially for under-represented groups such as
the elderly and the Latino population
• Percentage of residents with/without health insurance
• Number of residents who utilize alternative health options
• Number of people receiving mental health care from private professionals
• Clients served by independent social services providers
• Amount of unlicensed childcare occurring in Teton County
• Staff turnover and average length of employment in the social services sector
• Overlap in multiple services/capacities provided to Teton County residents
• Gaps in the extent of services offered in the community
V. Statement of Ideal:
Every Teton County resident, every time, will receive:
• Exactly the right care and/or education needed;
• At exactly the right time;
• With no waste;
• In an atmosphere of absolute safety (mental, physical, spiritual, and
professional) for all parties concerned (patients/clients, families, care
givers, and all other employees)
Comment: The Human Services Statement of Ideal takes into account the facts that there are broad differences in individuals’ views of “acceptable” and “appropriate” health care levels and modalities, and in the community’s views of “acceptable” and “appropriate” levels of social services. To this end, the Statement of Ideal focuses on the quality of the services provided, regardless of what those services are.
Once those services are defined (whether by the individual or community), the Statement of Ideal stresses that resulting products and services need to be delivered without wasting resources, whether physical or temporal. They also need to be delivered in a fashion which ensures safety, if for no other reason than to pre-empt additional health-related problems.
Ideal Indicators/Additional Steps Needed:
While there are a number of human service indicators available, few of them are useful for gauging progress towards Ideal.
One type of data needed are those which would accurately indicate Teton County residents’ health and human service status, knowledge, and access to the modalities of their choice. Another type of measurement is the efficiency and effectiveness of each human service organization in delivering its goods and services. A third general category would join the first two, by measuring the satisfaction and safety levels experienced by clients/patients, providers, and all other involved parties.
The particulars related to each components of the Statement of Ideal are:
• Exactly the right care and/or education needed
As with many other Areas of Interest, for Jackson Hole to meet its Human Services Ideal, there is a need for a central repository of information about different modalities and interests. Such a clearing house of information would allow the Human Services community to gauge where Jackson Hole is falling short in needed services and information.
• At exactly the right time
Measurements are needed of access issues, in particular whether Jackson Hole residents are getting the services or information they need at the time they need it.
• With no waste
Each individual and organization involved in Human Services needs to establish measurements for:
• unambiguously defining and measuring performance, and
• unambiguously defining and eliminating waste.
• In an atmosphere of absolute safety (mental, physical, spiritual, and
professional) for all parties concerned (patients/clients, families, care givers,
and all other employees)
An understanding needs to be developed of the different safety concerns affecting each party involved in the delivery or consumption of Human Services information and services. Based on this, a system needs to be developed for clearly measuring how well those safety definitions are met and, if they are not, why not.
VI. Action Component
The Systems of Care group will continue to try to establish standard ways of measuring costs and services across organizations, as well as identifying where services in the community are either missing or overlapping.
