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Our plan for making North Country lives better


At Citizen Advocates, our mission is to make lives better. We strive to fulfill our mission by providing treatment and services focused on keeping people healthy, fulfilled and independent. 

Every three years, nonprofit healthcare organizations, like ours, must complete a community health needs assessment (CHNA). The CHNA is a plan for prioritizing community mental health, special needs and substance abuse services based on state guidelines and recent health data. This summary of the report details our efforts to serve North Country communities (Franklin, Essex, St. Lawrence, and Clinton counties) through our philosophy of looking at a person’s entire health, not just their symptoms. 

Under the guidance of the New York State Prevention Agenda 2019-24, we used the following five priorities to determine our communities’ most significant health needs. 

1. Prevent chronic diseases action plan

Chronic diseases such as cancer, diabetes and heart disease are among the leading causes of death, disability and rising healthcare costs in New York State (NYS). They’re also among the most preventable. Unhealthy eating habits, lack of physical activity and tobacco use are major contributors to chronic disease.


  1. Promote tobacco-use cessation through increased counseling and/or medications among smokers enrolled in any Medicaid program.
  2. Support evidence-based care to prevent and manage chronic diseases, by decreasing the percentage of adult Medicaid members aged 18-44 with diabetes).

Why this is a priority:

  • Franklin County has a higher rate of tobacco use compared to NYS.
  • Essex County adults have a higher diabetes diagnosis rate (14.3 per 100,000) than NYS (95 per 100,000). 
  • Clinton County has the highest rate of adult obesity (36.7%) and the highest death rate from heart attacks, 51.2 per 100,000, compared to the state average of 27.5 per 100,000.
  • St. Lawrence County hospitalization rates, due to cardiovascular disease and congestive heart failure, are higher than the state average. 

2. Promote a healthy and safe environmental action plan

Five core areas affect our overall health:

  1. Water quality.
  2. The places where we live, work, learn and play.
  3. Injuries, violence and occupational health.
  4. The food and products we use and ingest.
  5. Air quality.


  1. Reduce violence by targeting prevention programs to high-risk populations through increased school-based and community programs in conflict resolution, bystander interventions and healthy relationship building.
  2. Decrease occupational injury and illness by improving workplace safety. Develop targeted occupational safety and health training programs for employers and workers in high-risk jobs.
  3. Reduce falls among vulnerable populations by promoting healthcare provider screening for fall risk among older adults and people with disabilities. Engage healthcare providers in identifying modifiable risk factors and developing fall prevention care plans. 

Why this is a priority:

  • St. Lawrence County has the highest rate of work-related injuries and hospitalizations in NYS
  • Clinton County has the highest rate of violent crimes in NYS and the highest age-adjusted rate of falls requiring hospitalization.

3. Promote healthy women, infants and children action plan

Promoting healthy development, behaviors and relationships early in the lives of women, children and their families during critical periods lay the groundwork for lifelong disease prevention. Supporting the health and wellness of women is essential to their well-being. Moreover, it requires a deep commitment to promoting health equity and eliminating disparities.


  1. Increase use of primary and preventive healthcare services among women of all ages — with a focus on women of reproductive age — by increasing the percentage of women aged 18-44 with a past year preventive medical visit.
  2. Support and enhance children and adolescents’ social-emotional development and relationships by decreasing the suicide mortality rate for youths aged 15-19. 

Why this is a priority:

  • Essex County has the highest rate in NYS of low birth weight for mothers of all ages and the highest adolescent pregnancy rate in NYS for ages 15-19.
  • St. Lawrence County has the highest infant mortality rate (aged one month to one year) per 1,000 live births (2.3%) compared to NYS (1.5%). 
  • In Franklin County the percentage of children younger than age 19 with health insurance is lower than the state average of 94.1%. For ages 12-21, the recommended number of well-child visits in government-sponsored insurance programs falls below the state average.

4. Promote well-being & prevent mental health and substance use disorders action plan

Mental, emotional and behavioral (MEB) disorders affect almost one in five young people nationally. Adverse childhood experiences and many MEB disorders, such as substance use disorder and depression, have lifelong effects on people and communities. Improvements in mental health are connected to better physical health. Our focuses are on promoting well-being and mental health and preventing substance use disorder.

Promote well-being


  1. Foster environments that promote respect and dignity for people of all ages by using personal outcome measures and satisfaction surveys to implement quality improvement initiatives.
  2. Strengthen opportunities to build well-being and resilience by reducing the age-adjusted percentage of adult New Yorkers who report frequent mental distress during the past month.
  3. Prevent and address adverse childhood experiences by increasing communities reached through building resilience, such as through programs and counseling for families, parent support services and group therapy.
  4. Reduce suicides and suicide attempts for all adolescents (grades nine to 12) by promoting connectedness, coping, problem-solving skills, social-emotional learning, peer, parenting and family relationship programs.

Why this is a priority:

  • St. Lawrence County has the highest suicide rate for teens ages 15-19 compared to the Adirondack Rural Health Network region and upstate New York.
  • Clinton County has the highest rate of adults reporting frequent mental distress over the past month (14.8 days) — the highest rate in the North Country.
  • Franklin County has the highest rate of reports of abuse and/or maltreatment among children, per 1,000, aged 0-17 (49.5), compared to NYS (17.1). The county also has the highest rate of adults reporting they have been exposed to two or more adverse childhood experiences (40.1).

Mental Health and Substance Use Disorder Prevention


  1. Prevent underage drinking and excessive alcohol consumption in adults by reducing the age-adjusted percentage of binge drinking during the past month.
  2. Reduce opioid and other substance misuse and deaths by increasing the age-adjusted rate of patients who received at least one Buprenorphine prescription for opioid use disorder. 
  3. Reduce all emergency department visits (including outpatients and admitted patients) involving any opioid overdose.

Why this is a priority:

  • Essex County has the highest rate of adults who binge drink (24.7%) compared to the Prevention Agenda Benchmark (16.4%).
  • Clinton County has the highest rate of people who reported more than 14 poor mental health days within the last month (14.8%) compared to the Prevention Agenda Benchmarks (10.7%). The county has the highest rate of admissions to OASAS-certified chemical dependency treatment programs for any opioid, ages 12 and up.
  • St. Lawrence County has the highest rate of self-admitted hospitalizations per 10,000 (5.6) compared to Upstate New York (3.5). The county has the highest rate of hospital discharges involving opioid use and the highest rate of opioid burden. It also has the highest rate of emergency room visits (outpatients) and hospital discharges involving opioid misuse, dependence, and unspecified use.
  • Franklin County has the highest rate of alcohol-related crashes and/or fatalities in the state.

5. Prevent Communicable Diseases Action Plan

A communicable disease can spread from person to person, animal to person, or animal to animal. These illnesses or infections cause sickness and death and are preventable.


  1. Reduce the number of new hepatitis C virus (HCV) cases among people who inject drugs by increasing syringe distribution, screenings and care.

Why this is a priority:

  • In 2017, most northeast counties had HCV rates above the NYS average of (73.9) per 100,000. In 2017, the highest rate was among males aged 25-29. Within Franklin County, the rate was 93.2, Clinton County, 103.6, Essex County, 97.1 and St. Lawrence County, 104.4.
  • The U.S. Surgeon General has determined that syringe service programs, when part of a prevention strategy, can play a critical role in preventing HIV among people who inject drugs. It can also ease entry into drug treatment and medical services and doesn’t increase the unsafe illegal injection of drugs. These programs have been tied to a lower risk of HCV infection.

As shown, North Country residents face distinct challenges. Through our goals to address them with a patient-centered approach, we’re dedicated to delivering quality care that makes a positive impact on all of the people we serve.

If you or someone you know has a mental health, special needs, or substance misuse issue, contact us today. Need help now? Call our 24-hour Crisis Hotline: (518) 483-3261 or (518) 891-5535.