A Community Health needs assessment conducted by Williamson County’s Health Department in conjunction with Vanderbiit University Medical Center and Ascension St. Thomas Hospital identified four top health priorities to focus on between 2023 and 2025. (Source: Williamson County Community Health Needs Assessment/Community Impact Newspaper)
While data shows in some ways Williamson County is one of the healthier areas in the state, health care officials and others said the region faces an important need for dialogue in the areas of mental health awareness, expanding affordable housing and access to medical care, based on results of the Community Health Needs Assessment released this spring.
The assessment, or CHNA, which began in May 2021, is being conducted jointly by Vanderbilt University Medical Center, Ascension St. Thomas Hospital and the county’s health department for the third time.
“While we might be a healthy place, we’re not immune to the issues being faced around the state, around the country and around the world,” said Mindy Tate, CEO of Franklin Tomorrow, a local nonprofit that has been involved with helping guide the effort.
Assessing health data
Since 2013, nonprofit hospitals have been required by the Affordable Care Act to conduct a CHNA every three years to preserve their tax-exempt status. The study gathers input from residents, local health departments and other agencies to develop initiatives to improve health.
In February, a committee reviewing the data on the region’s health voted to designate Williamson County’s four broad areas—mental health; affordable housing; healthy living and prevention; and substance misuse—as those most in need of community attention.
“We provide some funds for organizations that work on the issues, but the biggest thing is just sitting at the table working collaboratively with everyone,” said Elisa Friedman, associateice president of Vanderbilt University Medical Center’s Center for Medical Equity, which is spearheading Vanderbilt’s involvement in t•he process.
In coming months, the county health department, Vanderbilt and Ascension will coordinate work groups, including representatives of agencies and different demographic groups to use the information to craft the county’s health improvement plan. The county hopes to identify strategies to address the areas of concern that can take effect by early 2023, Williamson County Health Director Cathy Montgomery said.
Franklin Mayor Ken Moore said the four areas emphasized mirror those identified by a panel he convened in Franklin in 2017 that prompted a focus on suicide awareness, staying active, tobacco cessation and overall wellness efforts.
Efforts, such as the assessment, are an important way to get a handle on directing resources at chronic problems, Moore said.
“These were priorities generated by people in our community and what they see as important needs,” Moore said of the assessment. “All of them are very important for our community to grow and be healthy.”
As part of the initiative, the county and hospital interviewed public health and elected officials; chambers of commerce; and nonprofits focused on senior citizen and immigrant welfare.
The effort also drew from various county health data on issues and collected surveys from 177 area residents to identify barriers to productive change and what needs they perceived, including pollution rates, access to healthy food and housing.
“It is what our residents feel like are the real health issues in Williamson County,” Montgomery said. Mental health needs
Montgomery said residents surveyed as part of the assessment identified access to and affordability of mental health counseling as an important issue.
As of May 2022, Williamson County’s ratio of mental health counseling providers to residents is currently 490 to 1, indicating there are fewer providers than needed for the county’s 238,412 residents, Montgomery said. A better ratio would be 250 to 1, according to the assessment.
“One of the issues that fell out of our discussion around mental health in interviews was the ratio of providers for mental health versus the growing population in our community,” Montgomery said.
County residents surveyed and local police statistics also indicate that suicide is a continuing county health concern, Montgomery said.
Between 2013 and 2021 there were 224 completed suicides in Williamson County, according to the assessment, with 42%, or 94 of them, by adult men and women between the ages of 40-59. From July 1, 2017-Dec. 31, 2019, Williamson County Emergency Communications received 706 calls for service for suicide threats, according to county data.
“There is a major issue that has been identified with suicide in the county, particularly among middle-aged men,” Moore said.
In 2021, nonprofit Franklin Tomorrow spent a $7,500 grant from the Vanderbilt University Medical Center to create a program to train residents in the suicide prevention method known as QPR—or question, persuade and refer—Mindy Tate said.
Through Zoom and more recently in person, a group of trainers have given the 90-minute training to nearly 300 people on how to identify warning signs that someone may be considering taking their own life, such as talking of suicide, expressing hopelessness or giving away belongings. They plan to hold more trainings in the remainder of 2022, Tate said. “The initial trainers can now go out and train other groups,” Tate said. “It doesn’t make them a counselor, but the training does make [people] feel better equipped if they have to ask these questions of a family member, coworker or friend.”
In hopes of reducing the stigma around mental illness, in 2019, Moore and the city collaborated with Franklin Tomorrow to create the “Find Hope Franklin” initiative. The effort resulted in a website with information and links to local psychiatric and counseling services at www.findhopefranklin.com.
“What we found is there are a lot of great resources for people with a mental health, substance abuse or psychiatric disorder,” Moore said. “We’re looking to create options in our community where the people who need it are taken into a continuum of care.”
The assessment also found that 42.4% of renter-led households spend more than 30% of their household income on rent and utilities a month, a threshold that is considered a measure of housing unaffordability that undercuts living standards, according to the U.S. Department of Housing and Urban Development.
According to local demographics, households ages 15-24 and 65-plus were the hardest-hit demographic groups in Williamson County, with 66% and 67% reaching that 30% threshold, according to data from the 2019 American Community Survey.
Derwin Jackson, president and CEO of the Franklin Housing Authority, said the lack of affordable housing in Franklin and Williamson County leads to tradeoffs on other important expenses, such as food, health care and the ability to save money.
“It is not an easy thing to try and figure out,” Jackson said. “When adults struggle with the cost of housing, what you often see is the effect it has on children.”
The assessment also highlighted promoting healthier living and prevention, an area that covers a range of approaches from getting exercise to preventative care, according to the assessment’s results.
Montgomery said that while Williamson County maintains an obesity rate of 23% that is lower than the state or the nation, it is linked to many chronic conditions that are leading causes of death in the county, including cancer, heart disease a•nd diabe•tes.
The assessment also identified a concern about how to combat substance misuse among those under age 18 in Williamson County.
In the 2018-19 school year, 2,036 Williamson County eighth, 10th and 12th graders answered the TN Together Student survey that gathered data on the use of alcohol, marijuana and prescription drugs among youth.
Lynsey Wilhelm, program coordinator for the Williamson County Anti-Drug Coalition, said she regularly conducts in-school programs in Williamson County to try to deter middle and high school students from using alcohol or drugs.
Wilhelm said the pandemic delayed conducting the survey again, but that the coalition hopes to update it next school year and try to measure whether the COVID-19 pandemic worsened any of the trends.
“We really don’t know how the pandemic influenced the situation, but it is something we want to look at,” Wilhelm said.
The 2019 survey indicated 20% of the Williamson County students surveyed had used an electronic cigarette in the last month. Wilhelm said countering marketing that electronic cigarettes are not unhealthy is a challenge.
“One of the biggest challenges is communicating with younger people and speaking to them where they are,” Wilhelm said. “If you can get to them early enough, you can have more of an effect.”
Montgomery said Vanderbilt and Ascension plan on launching a website sometime in July that will include more data and conclusions about county health.
Moore said that there are difficult problems to solve in the county, but he believes the region has the resources and commitment to make progress on issues, such as affordable housing as well as improving access to mental health and primary care for all residents.
“These aren’t easy topics or problems, but I think it is great that we focus on ways to work together on important issues,” Moore said.