PolicyLab

When asked recently about the most pressing unmet health needs in their community, people across southeastern Pennsylvania identified priorities including mental health, racism and discrimination in health care settings, and community violence. Grounded in quantitative and qualitative data, and for the first time including a specific “youth voice” section, the 2022 Southeastern Pennsylvania Regional Community Health Needs Assessment (rCHNA) highlights these issues and more. The onus is now on the participating health systems and other partners in this collaborative effort to respond to the identified priorities. 

Informing Data Collection for the Regional Community Health Needs Assessment 

The Affordable Care Act requires nonprofit hospitals to conduct a community health needs assessment every three years. Recognizing the overlap between the communities they serve, the rCHNA includes 10 health systems and more than 25 hospitals across Bucks, Chester, Delaware, Montgomery and Philadelphia Counties. The Health Care Improvement Foundation coordinates the collaboration, which also involves the Philadelphia Department of Public Health. The intent of the rCHNA is to bring community needs to the forefront of health system planning and, ultimately, improve health care delivery, access and health equity across the region.

We represented Children’s Hospital of Philadelphia (CHOP) on the rCHNA steering committee, and in this capacity had the opportunity to inform data collection methods and topics on which the project team would dive in deeper with community members. An effort to better understand the needs of particular populations led to discussions that included 354 youth across the five-county region and a novel section of the rCHNA devoted to the perspectives of youth. In what follows, we drill down on these data. 

Youth-identified Challenges and Solutions to Optimal Health in Our Community 

Youth identified relationships and support networks, community spaces and organizations, and shared values and positive mindset, among others, as resources and assets that make their communities healthier. When asked to comment on the biggest challenges and barriers to health in their communities, their top three concerns were violence and safety, lack of access to healthy food/food insecurity and mental health. As it relates to community violence specifically, the report says:

“A predominant concern for youth was the rampant violence in their communities. This is largely in the form of gun violence, but participants also cited instances of interpersonal violence. Youth mentioned fights in schools, police brutality, and gangs in association with violence. For youth of Asian descent, fear of anti-Asian hate crimes was significant. This threat of violence had cascading impacts on youth, both direct and indirect, resulting in not feeling safe enough to go to parks or work out outside. This fear also has a strong negative impact on mental health through experience of toxic stress.”

Aligned with these challenges, the top health needs expressed by youth centered on supporting youth’s mental health, including through reducing stigma associated with accessing mental health resources; decreasing gun violence and creating safer options for being outside and active; and improving health care access and addressing challenges with understanding/navigating confusing systems. 

Perhaps most importantly, youth contributed ideas for solutions to improve their health and that of their communities. The top points raised focused on:

• Addressing unmet social needs through actions such as improving food access, more affordable housing, making transportation options more accessible, and providing workforce development and employment opportunities 
• Improving mental health supports through greater access to mental health professionals (counselors, therapists) in community settings and schools, supporting peer advocates and teen mentors, and creating spaces for openly talking about mental health
• Improving safety, including through strategies to potentially increase safety in play areas and neighborhoods (e.g., cameras, officials and other monitoring of playgrounds), improved gun control to get guns off streets, and building capacity for healthy conflict resolution. Youth also discussed the role of police (e.g., having more officers who “look like me”) and strengthening community policing.

Many of the health needs amplified by youth in the rCHNA are not unexpected and reflect what we know about the twin crises of community violence and youth behavioral health, which were further exacerbated by the COVID-19 pandemic. Due to this, CHOP already has several important community initiatives and investments underway aligned with the needs identified. Yet there remains more work to be done, and it will be important in the years ahead to not only consider the problems that the youth raised, but also pay close attention to the potential solutions they put forward. 

How CHOP Will Respond to the Needs Expressed by Youth in Our Region 

Moving forward, we will work with CHOP researchers and experts, community youth organizations, and other stakeholders to build on our existing investments in strategies that align with youth perspectives. For example:

• In 2020, CHOP created the Center for Health Equity to better understand and more actively address disparities in children’s health care and health, while building a diverse and inclusive team that will champion these efforts. 
• Through the Healthier Together Initiative, CHOP is investing in tackling social determinants of health to improve the health of children and families. CHOP is currently increasing access to behavioral and mental health care services by opening new facilities and adding staff, while also bringing services to children in their communities through partnerships with schools and community organizations. 
• PolicyLab researchers often involve youth, families, and/or community partners in the development and execution of their research projects. The data provided in this report will serve as an excellent resource for shaping research agendas and funding proposals to meet the needs of our local youth population.
• CHOP’s Center for Violence Prevention continues to be a leader in research, policy, and intervention to reduce the exposure to and impact of violence among youth via initiatives such as gun safety education, bullying prevention programs in schools and peer-group resiliency programming.

In the coming months, CHOP will publish an implementation plan outlining the strategies we will invest in over the next three years to help address the community and youth priorities identified in the rCHNA. It is our hope that the youth perspectives collected as part of the rCHNA are only the start of an ongoing conversation with young people in and around Philadelphia about their most pressing health needs and how the health system can be a positive partner in meeting them. 

Falguni Patel, MPH, is the manager of Community Impact in the Office of Community Relations at Children’s Hospital of Philadelphia.