Needs Assessments & Reports

Good morning, and thank you for allowing time to share the most recent needs assessment. I also want to share this as complimentary to the report you received in March from Kathy Cahill for the county-level community health assessment. As Anna mentioned, we cover two states and multiple counties, so it’s a little different lens and different needs than were identified in the county-level assessment focused solely on Nevada County.

During the next few minutes, I’m going to highlight why we do a needs assessment, our methodology, which does differ a little bit from the county’s approach, and Nevada County uses the same approach as Placer County, so that’s their standardization there, but Tahoe Forest uses a different, more health system approach for our primary service area. I’m going to have one slide that’s really aggregating our needs, but I’m not going to drill down into data. However, I am going to show you where you can access the data yourselves and really see what stands out to you versus me taking up few pieces to share with you, and then I do want to spend some time talking about prioritization that our community members have identified thus far just in the last few months.

Community health assessments are really data-driven, systematic tools to identify what are our local needs of concern and, more importantly, make an intentional decision to put our resources and time and energy to address those needs. Collectively, there are three goals for a needs assessment. We want to improve health status, and I don’t solely mean physical health status, but mental health status, as well as your physical well-being, ultimately to elevate your overall quality of life and to elevate the overall quality of life of our residents.

Alongside with collecting data on health status and health behaviors, we collect socio-demographic information, so income and gender and age, for example, and the reason we do that is because then we can identify the subpopulations that are experiencing disparate health outcomes, and we can intentionally focus our resources on those populations that are more vulnerable or more at risk versus those who are doing really well. And at the end of the day, we want to increase accessibility to preventive services, and this helps drive the first goal in improving health status, but also it helps to identify diseases earlier and reduce treatment costs. But as a health system, Tahoe Forest does a needs assessment to really hear a community voice.

Only a fraction of a patient’s health experience is reflected in a patient chart, and more importantly, not everybody is seeking care at Tahoe Forest Health System, so we can’t rely on an electronic health record to really get a picture of our community health status. We want to have a better understanding of what is really going on in the community. What are they experiencing? What are the behaviors? What are needs we can’t identify in a chart? And we want to be responsive and responsible in allocating our means to address those needs.

As Anna mentioned, we have a large service area, and for this reason we did rely on some secondary data. That’s data we’re not collecting directly, but data at the county level or the census data, for example. However, we do want to hear from our community, and so for that reason, we included three primary data collection methodologies.

We did key informant surveys online to help with accessibility. We did a customized population-based local health survey, and we did focus groups. When I refer to secondary data, I’m referring to data collected by somebody else that’s not Tahoe Forest.
For example, Tahoe-Truckee Unified School District every two years completes the California Healthy Kids Survey, and that is directly asking youth about their health experience. So we rely on that to inform the youth element in our needs assessment. If you are to read the report, you will see mortality and vital statistics in there, and I want to be really clear that because we cover multiple states and multiple counties, we consolidated the three primary, the biggest counties that make up Tahoe Forest Health System service area and that mortality data.

So when you read this, please know it’s not solely Nevada County mortality. It’s actually all of Washoe County and all of Placer County and all of Nevada County. If you were to read the report and look at our mortality statistics, important to know that little side note.

Online key informants, we invited 130 people, and some of you are in this room, to participate in a 20-minute key informant survey. We had 61 physicians and social service leaders. Everyone from librarians to first responders were invited to participate in Nevada states, in Nevada County, and Placer County, and we asked them to respond on behalf of the populations they serve and because they really are embedded in our local community.

We did a customized local health survey that included over 100 survey items from validated questions to ask our community specific questions on health behaviors and experienced health status, etc. But more importantly, before we landed on a survey tool, we reached out to 100 community partners to get their feedback on our survey tool, and we directly incorporated that feedback into our survey. For example, I attended one subcommittee for Nevada County on the early learning and childhood to further discuss our question related to barriers and accessing health care because of child care needs.

You see that reflected in our survey questions, just our community response in the structure of the survey. And we had nearly 700 people participate on our population-based survey, which is a statistically valid number for our population. And because we use these validated questions that are from, for example, the Behavioral Risk Factor Surveillance Survey or United States Department of Agriculture or UCLA, we can follow these questions through time and we can see how we compare to Nevada states or California or the nation in terms of our health needs.

And another form of qualitative data, which the online key informant survey was as well, were focus groups. We did three targeted focus groups, each one partnering with a community organization. We partnered with Tahoe-Truckee Unified School District to use the findings from their annual youth forum in our needs assessment.

This is a every year with multiple community partners to directly hear youth voice. We partnered with the Truckee Rec Center and their Golden Hour, if you’re familiar with the Senior Golden Hour, to do a focus group at the Golden Hour. And we partnered with our wonderful community partner, Sierra Community House, to do a focus group as well in Spanish, in Kings Beach.

We also partnered with Sierra Community House to do Spanish language outreach to subpopulations we know from previous needs assessments to be under responsive. So we had community health workers equipped with tablets and they helped community members complete the survey at food distributions, at family advocacy events, etc. This whole slide is really trying to show that we really reached out to the community to try to have a comprehensive picture of our health needs in multiple states and multiple counties.
And again, I’m not going to share any data, but I’m going to show you where you can access the data. All of the community health needs assessments and community health improvement plans are on our community commitment webpage. From there, you can read the 2025 needs assessment, and I will let you know it’s around 200 pages.

But most of that are graphs that break down the health need by age, by sex, by ethnicity, by zip code in some cases. So I really do encourage you to look at the floor report, just peruse it. If that doesn’t sound appealing, you can watch a 60-minute presentation that took place a couple weeks ago that we’re calling the community forum, and we recorded this event, so you can watch it.
And finally, I’m not going to go into this dashboard, but we have tahoforest.healthforecast.net. And if you click on that, you will see the broad health categories, for example, oral health. And if you click on oral health, it’ll pull up the direct data in a graph format that, again, is breaking up by age, and in some cases, zip code, et cetera. So I really encourage you, hopefully there’s a way for any person to interact with this data in a way that works for them.

We tried to make it really accessible. Ultimately, we do this, again, to identify areas of need and areas of opportunity. And there are a few different ways that we land on these areas of opportunity.

One is with trending. So as I mentioned earlier, we’ve done a lot of these needs assessments. The first one tahoforest completed was in 2011.

And because we’re using these validated questions, we can actually trend some of our health metrics since 2011. That’s one way that we identify an area of opportunity. If the trend is worsening, it’s lending up as a need.

Another way is with overall prevalence. So if we have higher prevalence than California or Nevada State or the nation, it’s an area of opportunity. There is also statistical significance that comes into play.

So if there are changes that are statistically significant or a subpopulation that you can see as having a worse outcome in a measurable statistical manner, it’s an area of opportunity. So when we start to gravitate towards metrics that are meeting that criteria, we’re seeing access to health care, which includes access to preventative care and oral health as an area of need. Specific quantifiable metrics within access to health care include having a primary care provider, that’s PCP, or routine checkups.

In 2021, we saw a significant decline in accessing routine care. I don’t think that would surprise anybody in the room. We are continuing to see this as a need on which we should focus as a health region.

Additionally, we asked if people had ever been diagnosed with cancer and if so, what type of cancer. Skin cancer is the number one cancer site that our community has reported experiencing here. And stroke is one that came up at the county level for mortality.
And again, county is not just Nevada County. We’re looking at all of Washoe County and Placer County as well. So there’s a few specific metrics that come up under access to health care, preventive oral health, et cetera.

Mental health is another area of opportunity. And we as a region have put a lot of effort into mental health because this has been identified quantifiably as a need since that first needs assessment in 2011. However, in response to that, Tahoe Forest has built a behavioral health department and Tahoe-Truckee Unified School District has put an immense amount of resources into place-based care in the schools.

However, this continues to be a need, and I don’t want that to get lost despite the significant efforts that have gone into addressing mental health. What is coming up as a large need are all the health-related social needs. Specifically, food insecurity has increased, and not just for our community members who have an income level below the 200 percent of the federal poverty level, but in general throughout our community, we’re seeing an increase in food insecurity.

And when I say food insecurity, I’m not talking specifically about hunger. I’m talking about people are worried about being able to purchase more food or they’re running out of food before they can purchase more. There’s actually two different questions for that.
Housing, as this audience knows, continues to be a need. Transportation, health literacy is a health-related social need, and I think what might first come to mind for people is a language barrier. For example, English is a second language, and that’s not exactly what we’re talking about.

There’s also simply understanding that which your healthcare provider is saying to you in a way that’s understandable, even if you speak the same language as your healthcare provider. Caregiving is also coming up as a need in the 2025 needs assessment. And then our final big bucket is substance use.

Specific metrics are poison and drug overdose rates and youth substance use. I have the most recent California Healthy Kids Survey data. It hasn’t been widely distributed yet because it’s really new.

The good news is mental health is improving for our youth, so an area to continue to work on is substance use. So these are areas of opportunity, but I want you to have in the back of your mind, we are doing really well in so many areas. As a community, we have such lower prevalence of obesity and diabetes and high blood pressure, and we are phenomenal at getting out and participating in physical activity.

Our loneliness rates are so low. We’re well below national and state levels, but to walk away with these are really our largest needs of opportunity. And I would actually tobacco use to substance as well.

As I mentioned earlier, we’ve done some prioritization, but there’s a little bit of a story behind each of these in what this person knew going into prioritizing. Key informants are part of our needs assessment. We asked the 61 who end up participating to rank as a major problem, moderate problem, no problem at all, 16 different areas of healthcare.

And you can see they rank substance use as the leading major problem in our region, followed by social determinants. In their case, those two were grouped housing and food insecurity, mental health, et cetera. So you can see that these are people who are experts in our community and were asked to rank those not knowing any of the data yet.

At the community forum, we spent 60 minutes going over as much data as we could in detail. Afterwards, we asked those attendees to rank based on severity and scope of the healthcare issue, but also feasibility. Can we actually do something about this? And when they were asked to do that, we were asked to quantify this.

Mental health came up as the top followed by food insecurity. You can read those there. And the following day, we were at the Lions Club free health fair.

So you can see these are different populations. The community forum was open up to anybody. Anybody could come, but they were all given that 60-minute presentation.

The free health fair are people accessing free health services. They had flu shots there for free. They had oral health screenings for free. They had glasses for vision, for example. They have blood pressure and blood glucose screening. So different population.

We gave them three dots and asked them to put the dots on the area of need they think we as a community should be focusing. And for that population, housing came up as the top need followed by access to care and oral health. So out of the 16, the actual top five are really similar, even if they’re ranked a little bit differently within those top five.

Next steps. This is my last slide. We take all of this information and we start to drill down a little bit more into it and really identify our strategies to addressing these needs.

I am in the process of recruiting a community health improvement plan task force. Even tonight, I’m going to recruit someone from our patient family advisory committee. And then we’re going to start meeting in December and then meet through May to ultimately develop an action plan or strategic plan that is finalized by June 30th, 2026.

We will also be aligning with TAFOR’s strategic plan. And as a part of the Nevada County Community Health Assessment Steering Committee, as I am involved in Placer counties, we will continue to collaborate with both counties on future needs assessments and align with DHCS criteria. I’m happy to answer any questions.

I encourage you to go to the website and look at the data yourself. Great. Thank you.