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Community Assessment Paper (Shelburne)exemplar

notes about shelburne town for community health

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Community Health Nursing IIIA: Home Health Care (NURSE490)

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University of Massachusetts Amherst

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Running Head: COMMUNITY ASSESSMENT OF SHELBURNE 1

Community Assessment of Shelburne University of Massachusetts Amherst College of Nursing Lauren Basque, Colleen Canavan, Maura Doherty, Rachel Farley, Deanna Fleming, Kerry Liu, Philip Pham, Katelyn Sullivan

Introduction Shelburne, Massachusetts is a small town in Western Massachusetts. Located in Franklin County near Greenfield and Deerfield, the community is largely rural and boasts many natural resources and attractions. Like any small town, Shelburne does have some challenges, including infrastructure issues, a large aging population, and of course, the recent COVID-19 pandemic, which is affecting every community across the country. Shelburne’s public health initiatives, however, in collaboration with local and state efforts, are working to address these obstacles appropriately. Overall, despite its small size, Shelburne is a well-functioning community with much to offer its residents. Environment Shelburne is a small, 23 sq. mile, community in western Massachusetts surrounded by hills, the Deerfield river and Salmon falls. It is bordered by other Franklin county towns such as Buckland, Heath, Conway and Greenfield. Today, the air quality index in this area is 15. An AQI less than 50 poses little or no risk to the health of residents (Department of Environmental Protection, 2020). If this number raises above 50, it could cause respiratory concern for people sensitive to ozone or particulate pollution. This small population should try to reduce time outdoors to avoid exacerbation of any respiratory condition. According to Shelburne Fire Department, the town receives its water supply from two wells that draw from the North River aquifer in Colrain and is then stored in a tank in Shelburne. This water is not treated with chlorine and has monthly checks for bacterial levels. Since the water has an pH of 6, it has a tendency to corrode through the metal pipes it is transported in.

Public health workers may have concern for an aging population, such as those that live in Shelburne. With increasing age, comes increasing comorbidities and the need for healthcare access. While the environment in Shelburne, MA has some health implications that public health workers may closely follow and intervene, it does not deviate much from the national average and there is no outlier that poses a large health threat for this community. Transportation Shelburne is a rural community, relatively isolated from main cities and more populated areas of the state. Thus, the issue of transportation can be challenging for residents. There are a few options in the community that Shelburne locals can utilize. The Franklin Regional Transit Authority is the most prominent mode of public transportation utilized in Shelburne and surrounding areas. The bus system has 10 fixed routes throughout Franklin County. The buses do not run on nights or weekends, which is a drawback. The bus route has stops in accessible locations, including the Mohawk Trail Regional High School in Shelburne, and the Shelburne Falls Senior Center. Prices are on the lower side, with each route listed as $1 (Franklin Regional Transit Authority [FRTA], 2020). A program that increases the accessibility of transportation in the town of Shelburne is the FRTA Demand Response service. This program is “curb-to-curb” service for people 60 and older, eligible LifePath customers, nursing home residents, and eligible disabled veterans (FRTA, 2020). This program offers a more accessible alternative for transportation. Another option for residents who are looking to travel longer distances is the Amtrak train station located in Greenfield, Massachusetts, less than 30 minutes from Shelburne. While

tickets vary depending on location, Amtrak offers discounts for seniors, children, military personnel, and people with disabilities to make the cost more affordable (National Railroad Passenger Corporation, 2020). Aside from more modern modes of transportation, upon driving through the town of Shelburne, one can see that it is a walkable area. Sidewalks are utilized in most areas of the town, including busier parts like Shelburne Falls’ downtown area and around the Bridge of Flowers. Transportation, and its accessibility, can affect public health. Better access to transportation means improved access to health services, fresh foods, educational opportunities, and employment opportunities (Del Rio et al., 2017). Additionally, improved access to transportation such as walking, biking, and public transit, can help the environment by decreasing automobile usage/traffic. This can have a positive effect on air pollution, as well as the individual effects such as respiratory illnesses that are seen with those that are frequently exposed (Centers for Disease Control and Prevention [CDC], 2020). Overall, there are some concerns over the isolation of this small community and the potential implications for public health, but the town of Shelburne and its surrounding communities do provide some transportation programs that help address some of these issues. Health Services In Shelburne, a few providers and facilities provide health services to residents. The closest hospital is Baystate Franklin Medical Center, which is about 11 miles from the town. Baystate Franklin is a community hospital with 89 beds, including services such as surgery, emergency, cancer, obstetrics, mental health, amongst other specialties (Baystate Health, 2020).

need. Additionally, The Senior Center provides lunch for seniors every Tuesday and Thursday free of charge and for a reduced fee on other days. The community center coordinates potlucks and samplings of local businesses' food for town members according to their website. The Cooperative Public Health Services aids the town by providing a regional health director that frequently inspects programs, policies and businesses surrounding food in Shelburne to ensure safety in the town as well. The West County Food Pantry is a very important resource that residents have directly within the town of Shelburne. However, this resource is only open 11am-5pm on the 2nd, 3rd, and 4th Wednesday of every month. This results in limited accessibility to the pantry and free food as a result. However, the Center for Self-Reliance located in Greenfield is open every Monday, Wednesday, and Thursday (“Food Pantries”). However, this requires transportation to Greenfield. Finally, there is also a local company located in Shelburne, titled Dharma Nutrition, that teaches people about meditative nutrition, which could serve as a valuable resource to those who are able to afford it. In Franklin County, there are about 20 day care centers to provide childcare services for parents. One of these day care centers is conveniently located in Shelburne Falls, called Valley Play School. There is also a Franklin Adult Day Health Center that can provide attentive services to a more expansive range of ages. Additionally, there are two local Shelburne based child care programs run by Shelburne residents in their homes as well(“Franklin County Day Care Centers”). In assessing the use of Masshealth in the town, it was reported in December 2016 that 1,058 town members were enrolled in masshealth. In the state, there were 1,903,835 Masshealth recipients. Therefore, Shelburne comprises only .06% of Masshealth recipients. Within the

population of Shelburne, which is 1,888 people, the recipients of Masshealth comprised about 56% of the town which is a significant population(“MassHealth Data and Reports”). Shelburne is fortunate to have many non-profit organizations aimed at improving community health and wellness needs. Franklin county has provided a Community Action Family Resource Center which provides education classes and workshops for parents and children, counseling services, family events, a community closet, transportation assistance, childcare services while people are participating in groups, support regarding court, DCF, or schools, and many other supportive services. Additionally, Healthy Families is an in-home support program for pregnant or first time parents or parents with two or more children under three to provide additional education on how to manage(“Community Assessment Report and Strategic Plan”). Additionally, the Franklin Land Trust based out of Shelburne is a non-profit geared at protecting their local environment and wildlife. Finally, one of the most important non-profit organizations serving community needs is the Franklin County Hunger Task Force. Together, this force is formed by a group of local organizations that are working together to address the lack of understanding and decrease the stigma of food insecurity, provide services to create a proper safety net for those that need it, and encourage policy change to address food insecurity on behalf of their local area (“Franklin County Day Care Centers”). Housing Shelburne is a rural town and thus is estimated to have only 975 total housing units, 87% of which are occupied (United States Census Bureau, 2018). Of those that are occupied, 70% of the housing units are occupied by their owner with 29% being renter-occupied (United States Census Bureau, 2018).

Management area, High Ledges Wildlife Sanctuary and Mahican-Mohawk trail. There is no shortage of trails for hiking, biking, and getting out doors. Additionally, Bridge of Flowers and the glacial potholes in the town are desirable sight-seeing options located in the center of town. Shelburne is known for hosting the Bridge of Flowers 10k and Steve Lewis Subaru Charity 3k run/walk each summer, encouraging locals to get some exercise and enjoy the local beauty. Northfield Mountain is also in the local area and offers alternative forms of exercise such as cross country skiing, kayaking, canoeing and hiking. Finally, there is a YMCA in Greenfield that provides an option for a gym for residents. However, this as mentioned before requires transportation which may not be ideal for all residents(“Outdoor Recreation”). Franklin County and Shelburne in general is a farm friendly area which is a positive in this community assessment. There are frequent opportunities to attend the farmers Market in Shelburne on Fridays and in different surrounding towns on Wednesdays and Saturdays. Additionally, there are many CSA farms within ten miles of Shelburne. A CSA farm stands for a community supported agriculture in which community members purchase a share in the farm's crops. Each week, they receive a share of the crops so food goes straight from farmer to consumer keeping it local, direct, and more affordable. There are 9 local CSA farms in Franklin county, but Wilder Brook Farm +CSA is located directly in Shelburne. Other farms are not a shortage as well, as there are over 18 farms in the area that serve a range of fruit, veggies, meats, grains, sweeteners, pet food, and flowers. Some of the local farms include Apex Orchards, Bray farm, Davenport Maple Farm, Foxbard Farm and many more. Finally, in terms of grocery stores, there are two small general stores located in Shelburne for grocery items. However, according to prior community assessments, many residents prefer to trek to supermarkets in Greenfield for a

bigger shop. While farms and fresh sources are not at a shortage, other groceries may be more difficult for locals to obtain (“Cultivating Resilience”).

Demographic Factors In terms of the demographics of Shelburne, the median age is 52 and it is a predominantly white town (96%), followed by a small Asian population (1%) and an even smaller African American population of (1%). (Data USA, 2017). Mortality characteristics in this area are related to the chronic diseases prevalent in the town. The leading causes of death in Shelburne in 2017 were cancer, especially lung cancer, chronic lower respiratory disease (CLRD) and influenza and pneumonia. (Death Data, 2017). The chronic diseases in Shelburne and the larger Franklin County are as follows, 9% of the population has diabetes and 19% has pre-diabetes, 22% of the population is obese and an astounding 54% are oberweight, 4% of the population has cardiovascular disease and 12% of school-aged children have asthma. (Community Health Needs Assessment, 2016 ). These statistics of the chronic diseases present in Shelburne and all of Franklin County serve to explain the reasoning behind the leading causes of death in the area. Chronic diseases lead to chronic disabilities, especially for those with chronic lower respiratory diseases, like COPD or those with asthma. Also, with the higher than average median age range, chronic disabilities such as dementia become prevalent. Some behaviroal health issues in Shelburne incldue that a reported 14% of adults smoke, 22% are obese and 22% report physical inactivity. (Community Health Needs Assessment, 2016). These behavioral health actions lead to negative health implications, which will be discussed below. In terms of maternal child health, about 87% of pregnant women received adequate prenatal care, but that also leaves a little under 13% of pregnant women in the area not receiving adequate prenatal

half of the population of Franklin County is overweight and being overweight can lead to obesity. Another added factor to this overweight and obesity issue is the fact that there is a lot of reported physical inactivity in the area, which can lead to more people become overwieht and obese. An interesting finding is that Shelburne has the highest rate of stroke related hospitalizations in all of Franklin County. (Community Health Needs Assessment, 2016). Obesity can increase the risk of stroke. When an individual is obese, there is excess fatty tissue and that can become inflmed, which impedes blood flow, increasing the risk fo blockages and elading to stroke. It was also found that an estimated 24% of adults in Franklin County have hypertension and an estimated 31% have high cholesterol, both of which are risk factors for stroke. Data USA (2017).

Education In terms of education, Shelburne’s population is well-educated. 88% of the population has a high school degree or higher and 45% of the population has a bachelor’s degree or higher (United States Census Bureau, 2018). This educational status is well-reflected in their occupations with the most common employment industries being Health Care & Social Assistance, Education Services, and Manufacturing (DataUSA, 2017). In terms of access to educational resources, Shelburne has two public libraries, the Arms Library and the Shelburne Free Public Library. Given the relatively small population of the town, two public libraries is a reflection of the importance placed on education. Shelburne is served by three public regional schools: Buckland-Shelburne Elementary School located in Shelburne Falls, Mohawk Regional High School located in Buckland, and Franklin County Technical School in Turners Falls (Town of Shelburne, 2020b). Additionally, there are a lot of colleges and

universities in the area including Greenfield Community College, the Five College Consortium: UMass Amherst, Amherst College, Mount Holyoke, Hampshire College, and Smith College, as well as many other nearby colleges and universities in Massachusetts, Vermont, and New Hampshire. The diversity of type of institution and academic requirements is vast, giving a lot of opportunity for all different kinds of students. The topic of how these students transport themselves to school is more of a challenge for this town. Walking to school is not very feasible since the distance to the schools for most of the children who live in Shelburne is far too long. Additionally, the routes from Shelburne to the schools in the neighboring towns consist of many main roads without sidewalks which makes walking not a safe option. The Mohawk Trail Regional School District does have a bus system that serves each individual school and has several bus routes with many different stops along the way to transport the students (Mohawk Trail/Hawlemont Regional School Districts, 2020). However, it can be presumed that a large majority of children either get driven to school or drive themselves since 79% of the commuting population drives either alone or in a carpool to work (United States Census Bureau, 2018). Only 7% of housing units had no vehicles available to them and over half had 2 or more vehicles (United States Census Bureau, 2018). Thus, public transportation is not seen to be as big of a presence in Shelburne and most people commute to work and school by car. The health implications of the educational status of the town indicate that almost all residents will have at least some basic general health knowledge. Shelburne residents have access to elementary, secondary, vocational, and higher education opportunities and most are able to attain an education and a career that grants them health care coverage.

By providing childcare during services they are greatly increasing access for families with children. The First Congregational Church of Shelburne also has extensive community outreach including raising money for meals on wheels, providing community meals, collecting food donations, and collecting clothing donations (First Congregational Church of Shelburne, 2020). The health implications for religious organizations in Shelburne include improved resources for people with substance use disorders, increased access to food for food insecure individuals, and improved psychosocial health of individuals who may experience barriers to attending religious services such as LGBTQ community or families with children. On the other hand, individuals in the community who do not identify with these organizations may not be able to receive the benefits offered to the community. In addition, the churches are offering services virtually or via phone call while in person services are cancelled due to COVID 19 (First Congregational Church of Shelburne, 2020; St. Josephs Parish, 2020; Trinity Church, 2020) While this allows access for many, it restricts individuals who do not have the internet or a phone. Government The town of Shelburne elects their moderator, board of selectmen, board of assessors, town clerk, town collector, tree warden, and school committee (Town of Shelburne, 2020c). The town of Shelburne also has other boards and committees such as the housing authority, local cultural council, open space committee, planning board, recreation committee, sewer commissioners, technology and cable advisory committee, board of health, emergency management committee, agricultural commission, conservation committee, council on aging, finance committee, and zoning board of appeals (Town of Shelburne, 2020c). The general

strengths of the government is that their contact information, meeting times, meeting minutes, and purpose are clearly outlined on the website (Town of Shelburne, 2020c). Some of the limitations include only having annual town meetings and the Town Clerk only being available for limited hours (Town of Shelburne, 2020c). The various boards and committees provide many strengths and promote health in the community of Shelburne more specifically as well. For example, the board of health has implemented regulations on the sale of tobacco products, the use of tobacco products in public places, and facilities that sell marijuana (Town of Shelburne, 2020c). The health implications of this include decreased secondhand smoke which results in decreased rates of asthma as well as other health problems associated with smoking. In addition, the town of Shelburne’s emergency management committee and board of selectmen are actively working together to decrease the community spread of COVID19 (Town of Shelburne, 2020c). Having an emergency management committee is a huge strength in the community and is also paramount for improving the health of the community. If they did not have this committee, they would not be able to respond to community health emergencies as efficiently. Another strength of the government is the focus on environmental protection. For example, the Conservation committee protects wetlands from runoff and the agricultural commission aims to protect farmland and forests (Town of Shelburne, 2020c). The health implications of this include more local products being produced from farms as well as a healthier environment. The health implications of the town clerk is that he makes sure all community members are informed of the times of meetings as well as conducting the town census which is paramount to collect data related to public health (Town of Shelburne, 2020c). Another strength

the waterfalls in Shelburne, however, their agriculture remained their number 1 income. From 1830-1870, manufacturing became a leading producer with the establishment of the cutlery company Lamson and Goodnow. Soon after, Shelburne Falls became home to many small tool manufacturing shops and was home to two fabric mills. In addition to manufacturing, the production of butter and cheese, maple syrup, and apples for export grew residential areas along Water street(“History of Shelburne, MA”). The arrival of the Troy and Greenfield railroad in 1867, the Shelburne Falls and Colrain Railway in 1896 and introduction of hydroelectricity in 1912 contributed to the booming manufacturing businesses. Agriculture also continued to prosper during this time and Shelburne became a leading milk and cheese producer in Franklin County and started exporting products to Boston, Springfield and Northampton. Finally, in 1914, the arrival of the Mohawk Trail (route 2) brought tourism related commercial development along the highway. Since the early 20th century, a shift from manufacturing to tourist-related businesses like restaurants, bed and breakfasts, and retail stores. Shelburne Falls has since been a very artistic community, with many farms and orchards still in operation (“History of Shelburne, MA”). Safety and Protection Safety and protection is an integral component of resident safety in any community. It is important for towns to be equipped to respond to any emergency situation. The town of Shelburne has police stations, fire departments, EMS responders and programs in place to help keep its residents safe and protected.

Shelburne has two police departments to cover the town and enhance responsiveness. One is a state police department located on Mohawk trail and the other is a town police department in Shelburne Falls. This station has 1 chief officer, 1 sergeant, and 1 patrolman as well as 6 other reserve patrol officers. For emergencies, citizens are instructed to call 9-1-1 but Shelburne also has a control dispatch number for non-emergent concerns (Town of Shelburne, 2020).. Shelburne’s crime index is 49, which is far below the national average of 274. Other than burglary and theft, Shelburne rarely has any other crime reported throughout the year. There were 5 burglaries and 12 thefts recorded in 2018 (City Data, 2018). Franklin County is part of the TRIAD program. This is a crime-prevention and wellness initiative aimed at protecting the safety and welfare of senior citizens. It is staffed with nine uniformed deputies and serves 1,400 citizens, free of charge, who are 60 years of age or older and residents of Franklin County. It aims to educate, support and unite these citizens. The TRIAD program also has programs in place aimed to provide food and medical equipment loans (Town of Shelburne, 2020). Shelburne also has two fire districts, one to cover the Shelburne Falls Village area, including the water district, and the other for the remaining area. In addition to these fire departments, Shelburne EMS provides ambulances, with basic life support abilities. Luckily, the average number of fatal and other related accidents in Shelburne are far below state averages (Town of Shelburne, 2020). A possible health implication regarding Shelburne’s safety and protection could be attributed to their limited resources and response times. In any town, dispatch time always causes

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