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HomeMy WebLinkAboutMinutes 04-14-2015 - BOH - Early APPROVED 6/2/2015 MINUTES ORANGE COUNTY BOARD OF COMMISSIONERS JOINT MEETING WITH BOARD OF HEALTH April 14, 2015 5:30 p.m. The Orange County Board of Commissioners met for a joint meeting with the Board of Health on Tuesday, April 14, 2015 at 5:30 p.m. at the Southern Human Services Center in Chapel Hill, N.C. COUNTY COMMISSIONERS PRESENT: Chair McKee and Commissioners Mia Burroughs, Barry Jacobs, Bernadette Pelissier, Renee Price and Penny Rich COUNTY COMMISSIONERS ABSENT: Mark Dorosin COUNTY ATTORNEYS PRESENT: COUNTY STAFF PRESENT: County Manager Bonnie Hammersley, Assistant County Manager Cheryl Young and Clerk to the Board Donna Baker (All other staff members will be identified appropriately below) BOARD OF HEALTH MEMBERS PRESENT: Chair Susan Elmore, Dan Dewitya, Tony Whitaker, Liska Lackey, and Nick Galvez BOARD OF HEALTH MEMBERS ABSENT: Paul Cheminski, Sam Lasris, Corey Davis, Michael Carstans BOARD OF HEALTH STAFF PRESENT: Health Director Colleen Bridger Chair McKee called the meeting to order at 5:32 p.m. He said that Commissioner Price may be late and Commissioner Dorosin would be unable to attend tonight. Welcome from the Chairs Susan Elmore thanked the Board of County Commissioners (BOCC) for meeting with the Board of Health (BOH) tonight. She said the BOH will be presenting their strategic plan with 4 focus areas: 1.) Substance Abuse and Mental Health 2.) Child and Family Obesity 3.) Access to Care 4.) Engagement She said Health in All Policies will also be discussed. She said there will be a Family Success Alliance update as well as a Dental Clinic update. 1. Update on Board of Health Strategic Plan Dr. Colleen Bridger said there is a lot of information being presented this evening. She said the PowerPoint presentation would be presented along with the opportunity for questions at any time. Liska Lackey presented the following PowerPoint slides: Orange County Board of Health Strategic Plan Update Highlights Innovative, Prevention Focused Plan 2014-2016 Strategic Plan Started Summer 2014 Evidence-Based Interventions Substance Abuse/Mental Health • Advocate for improved substance abuse and mental health services • Advocate for the importance of early childhood and mental health • Explore connection between health and the criminal justice system • Continue to support partners in Smoke Free Public Places (SFPP) policy implementation and evaluation Communication Efforts • OC — Proud to be Smoke Free • Buzz Rides • prominent advertising and surveying with UNC Student transport business Compliance • Employee and resident videos on approaching others about smoking in public places • Addressing Underage and Binge Drinking • Health Department involvement in Town and Gown Task Force to address underage drinking, and binge drinking • New collaborative position to implement action steps in plan • Liska Lackey said research and experience show a healthy childhood is the foundation for future success. She said the Health Department is developing a campaign focused on the importance of early childhood. She said this message will appear in written articles, print advertising, and social media, culminating with a community screening of the documentary Raising of America. She said a survey shows the community is gaining greater awareness of the SFPP. She added that new university students entering the area each year requires a greater push for education about the policy. She said this public education is taking place in various ways. She said the Health Department has conducted fourteen Fresh Start classes; six hundred and fifty boxes of nicotine replacement therapy have been distributed; the staff has successfully advocated for the reimbursement of smoking cessation counseling and has also secured these services for clients at Orange County Mental Health. She said all staff members at the Inter-Faith Council shelter have been trained on tobacco cessation and piloting a cessation program with Freedom House. Liska Lackey said in the past year, the BOH has advocated for changes in the State of North Carolina Pharmacy Regulations and lead the way in making "naloxone"( more accessible to the community in fall 2013. She said Orange County passed the first standing order for dispensing at a health Department. She added because of these efforts, every health department in North Carolina can now do the same. She said these efforts have expanded to allow first responders to carry naloxone locally as well, with Carrboro already trained, Chapel Hill going live shortly, and the Sheriff's Department in the midst of training now. She said these changes are a tremendous example of interdepartmental collaboration. Liska Lackey said the Health Department has been working with Healthy Carolinians regarding the safe disposal of unused prescriptions drugs. She said all law enforcement agencies now have at least one box for such disposal. She said Healthy Carolinians has been leading the conversation about prescription drug misuse, abuse and overdose. Nick Galvez presented the following slides: Childhood & Family Obesity • Catalyze and facilitate obesity prevention partnerships • Identify evidence-based interventions to implement county-wide • Advocate for policies to reduce obesity through environmental and regulatory changes • Making Orange County Breastfeeding Friendly Health Considerations in Transit • Continued to invite local and state transportation stakeholders to educate the Board • Lauren Blackburn, NCDOT, Director of Bicycle and Pedestrian Division • Bret Martin, Orange County Planning Department • Sought seat on Orange Unified Transportation Board to increase the formal input of health in transportation planning Ongoing Projects Nick Galvez said that the Health Department has created a dedicated breastfeeding room in Whitted Clinic. He said current human resource policies regarding breastfeeding are being reviewed. He said steps are being recommended for improvement on best practice, including the need for formal policy language for staff about breastfeeding support and education from the insurance company, availability of private space for breastfeeding, and the availability of flexible scheduling to accommodate breastfeeding mothers. He said the BOH passed a breastfeeding resolution outlining the health and economic benefits of breastfeeding in June 2014. Nick Galvez said an ongoing project is the Childcare Recognition Program. He said a survey of childcare centers was conducted regarding their willingness to participate in a childcare recognition program involving the implementation of the Nutritional and Physical Self Assessment for Childcare (NAPSAC) and the Let's Move Improvement Program. He said staff is currently working to implement the survey and will present findings to the BOH. Nick Galvez said the BOH is looking at school nutrition. He said the BOH has outlined a number of action steps related to providing technical assistance to schools to improve nutrition policies and offerings. He said the BOH is also seeking to participate in the local Food Policy Council. He said the BOH plans to request policy recommendations from this Council in the future. Commissioner Rich asked about local childhood obesity rates. Nick Galvez said this is tracked at the high school level but not at younger ages. Commissioner Rich said she would like to see childhood obesity taken seriously and understands it is a larger issue than the BOH can handle alone. Commissioner Pelissier asked if the food in schools will become healthier. Colleen Bridger said there have been some discussions with the school nutritionists. She added it is a challenge because it costs less money to provide less healthy foods. She said a middle ground needs to be found. She said a new superintendent has been appointed in Orange County Schools (OCS), and she is hopeful this will provide some continuity that has been missing due to staff turnover. Commissioner Jacobs said he has a proposal to make it easier for the schools to buy local food. He said this proposal will be discussed in the work session following this meeting. He said progress can be made in small steps. He mentioned Child Care Services, which prepares many meals each year. He said working with them may be a way to have a smaller scale starting point for change instead of tackling an entire school system. Colleen Bridger said she and Commissioner Pelissier visited Headstart in several OCS elementary schools. She said the food in these programs was healthier than the elementary school student food, and perhaps lessons could be learned from Headstart. Dan Dewitya presented the following slides: Access to Care • Serve as catalyst/advocate for health outcomes in the Family Success Alliance • Advocate for policies to improve access to care • Foster a culture of innovation • Communicate about effective interventions and advocate for their funding Family Success Alliance • Growing # and % of children living in poverty in Orange County • Early childhood has a large impact for entire lifespan — academics, health, job, community Innovation Grants Engagement • Stay up-to-date on conversations and actions from other county advisory boards • Develop policy statements on priority health areas Dan Dewitya said 2014 Innovation Grants included: • A speaker series with topics such as Mobile Health Technologies and Anna the Avitar, a virtual reality character for WIC participants • Home visiting tablets were used to aid in processing times • A wearable personal health technology rental system was started as well as sit/stand work stations. He said in 2015 projects include • Video remote interpretation software service • The Whitted Bike Share Program pilot • Improving mobile technology apps for health improvement Commissioner Rich asked about the Whitted Bike Share Program. Donna King said they are replicating a bike program, similar to one at UNC, for staff housed at the Whitted Building to take out a loaner bike when needing to take small trips around Hillsborough. She said they are still researching details before starting the program. Commissioner Rich asked if this program is an effort to promote bicycle use over automobile use for short trips. Donna King said yes. Commissioner Burroughs asked for more information about sit-stand stations. Colleen Bridger explained that there is a platform for the computer keyboard and a holder for the screen. She said you move these items up when you want to stand and down when you want to sit. She said the pilot run of these stations showed that participants spent about fifty percent of their day sitting and fifty percent standing, which is optimal. She said twenty percent of staff has elected to use the sit stand desk. Commissioner Pelissier said she would like the Commissioners to have such work stations. 2. Health in All Policies Tony Whitaker said this is an idea that is cross departmental and a collaborative approach that attempts to include health considerations in all policy decisions. He presented the following PowerPoint slides: How can decisions impact our health? Tony Whitaker shared a graphic showing how many different areas play into public policy. He said the graphic shows that seventy percent of the factors that influence health are related to behaviors and environment. He added environment includes social environment, economic climate, educational environment as well as our physical environment. He said this is not a novel concept yet it is also not widespread. Examples • Health Impact Assessment (HIA) Tool • California's Health in All Policies Task Force • Staffing to increase HIAP • Require it! The How-To to HIAP Tony Whitaker asked what Health in All Policies could look like in Orange County. He said it would be a systematic way, as policies are developed, for health based considerations to be made before policies are enacted. He added the BOCC is already good at doing this in an informal way. He said he wanted to present Health in All Policies as a bona fide concept that has precedent. He said the BOH would like to partner with the BOCC to implement it in a tangible way that would better the health of Orange County residents. Commissioner Rich said she liked the idea and how can they incorporate it into the County Manager's budget recommendations. Commissioner Pelissier said as a Board they should adopt a resolution committing to Health in All Policies and ask the Board of Health for help in implementation. She said the Southern Human Services Center is already geared towards healthy living, and this concept could be furthered as services are expanded on the campus. Bonnie Hammersley said she has some experience with Health in All Policies from previous work in another county. She said it is an interesting approach that considers the big picture of how people are impacted by decisions made by County Government, which she thinks is a good idea. Commissioner Rich suggested making Health in All Policies part of the BOCC annual retreat's goals. Commissioner Jacobs said Health in All Policies could be wedded to social justice, and he would rather see social justice as the larger heading and make Health in All Policies a smaller heading. 3. Family Success Alliance Update Meredith Stewart said one of the catalysts for the initiative was seeing that the number of children living in poverty was increasing in Orange County. She said this also reflected statewide trends. She reiterated the importance of early childhood to future success in all areas of life. She said brain formation during early years has implications for years to come. She said a particular area of influence are Adverse Childhood Experiences (ACEs)that can change the way the brain is built in early childhood. She said those facts combined to create a desire to mitigate the effects of poverty on children and families in Orange County. She said the Harlem Children's Zone, which presents the idea of a pipeline from cradle to college/career, was considered as a potential model to adapt to Orange County. She said the pipeline idea presents a seamless set of services, programs and policies that provide for the success of children and families. She said a slightly modified version of the pipeline idea is being created in Orange County. She said it has four large goals: 1.) Children are healthy and prepared for school 2.) Children and Youth are healthy and succeed in school 3.) Youth graduate from High School and go on to college or a career 4.) Families and neighborhoods are supporting the healthy development of children She said in the Fall of 2014, an initial six zones, where the largest number of children and families were struggling to make ends meet, were narrowed down to two. She said the process included community input in writing and in-person presentations by each zone. She said zone four and zone six are the final two zones and will ultimately receive a different name. She said zone four is in the northern part of the County near New Hope Elementary and A.L. Stanback Middle School. She said zone six is in western Chapel Hill/Carrboro area. She commented that the two zones are extremely different in many ways. She said a gap analysis was started to see where the gaps in the pipeline were in the two zones. She said the analysis was completed via door to door interviews with community members, one on one interviews with service providers and organizations, focus groups, and an online survey. She said the information gathered through this process was just presented to the two zones last week. She said there was a great response and feedback from both communities. She said the information presented to the two zones were both qualitative and quantitative. She said the community feedback will be presented to the Family Success Alliance Advisory Council on Monday, April 20tH Meredith Stewart said the next part of the process is to identify short term and long term ambitious ideas that can fill the gaps in the pipeline. She said additional goals are to create a robust evaluation plan, increasing data available to do the evaluation, and continuing with strong community engagement. She said a group will be traveling to the Harlem Children's Zone to visit the practitioners institute and see how the pipeline works in person versus theory. Chair McKee expressed thanks for the efforts of all working on this project and agreed with the crucial timing of working with children in need as early as possible in order to secure future success. 4. Dental Clinic Update Colleen Bridger distributed and reviewed a hand out. She said the first graph shows that before closing the Southern Human Services Center clinic the average annual revenues were $300,000. She said after closing the dental clinic these numbers dropped off and have taken a couple of years to return to baseline. She said the projections for this year's revenues are $425,000 to $450,000 with just one clinic in Hillsborough. Colleen Bridger said the other key point is the number of patients they serve. She said this number has increased by 912 patients from Fiscal Year 2009-2010 to Fiscal Year 2013-2014. She said this is a sixty one percent increase. She said this is a real testament to the Dental Clinic staff. Colleen Bridger said the amount of money received per patient is down, which means fewer patients have insurance and are paying on a sliding scale. Colleen Bridger said the question she gets a lot is what happened to those patients in the southern portion of the County. She said more patients from the southern portion of the County are being seen now than when there were two clinics. She added when the percentage of patients is considered, the percentage of patients from the southern portion of the County is lower than it was when there was a clinic there. Colleen Bridger said the bottom line is that the consolidation was good for their Dental Clinic and for determining how to deliver dental services efficiently and effectively. She said when the Southern Human Services Center is expanded in the near future; she would like to see another dental clinic in the facility. She said part of the consolidation involved going from a four operatory clinic in Chapel Hill to an eight operatory clinic in Hillsborough. She said they are ready to expand the number of staff in Hillsborough. She said there is a fairly long waiting list for non-emergency adult patients. She said the Health Department's Budget request includes an additional Dental Team. She said a good amount of the cost of the request is offset by additional revenues from billing for those services. She said dental services in Hillsborough should be expanded this year and there should be a plan for expansion in the next few years in the southern half of the County. Commissioner Rich asked if more people are visiting the Clinic because they cannot afford care elsewhere. Colleen Bridger said there are two types of other dental facilities: private providers and Piedmont Health Services. She said that the private dental offices are absolutely out of financial reach for the patients of the Dental Clinic. She said that Piedmont Health Services are more expensive than Orange County, but she does not think that this is part of the motivation but rather that they have limited operatory clinics and thus very long wait lists. Commissioner Burroughs asked if Piedmont is limited by space. Colleen Bridger said yes. She added if a clinic is built by the County at the Southern Human Services Center, perhaps Piedmont could staff and operate it. She said this idea would solve Piedmont's space issues and the community's access issues. Commissioner Jacobs asked if the Dental Clinic at the University of North Carolina (UNC) continues to exist. Colleen Bridger said yes, but the community is triaging patients that cannot be seen at the County Dental Clinic to be seen by the UNC Dental Clinic. She said the UNC clinic is not seen as a safety net dental provider but rather a safety net dental specialist. She said complicated cases are referred to the UNC Dental Clinic. Commissioner Jacobs recalled an award had been given and that congratulations were in order for Dr. Bridger and Stacy Shelp for publicizing some aspect of public health. Colleen Bridger said that Ms. Shelp created the wonderful annual report for the Health Department. She said the report was submitted to the North Carolina City and County Communicators (NC3C), and it was awarded first place. Commissioner Price arrived at 6:27 p.m. Commissioner Jacobs said the information about the Dental Clinic would be perfect for a press release. He said the data presented this evening show that good services are being provided and that demand is high. He said as the potential of a second clinic is a contested topic, it would be nice for the community to be up to date. Colleen Bridger said this could be done. Chair McKee said he thought that Piedmont had taken on some of the southern residents. Colleen Bridger said there was an arrangement that Piedmont would see former Health Department patients at Health Department rates, but this has not actualized due to Piedmont having long wait times. Chair McKee agreed that collaboration between Piedmont Health Services and the Health Department at a future dental clinic at Southern Human Services Center would be a good idea. He asked if Piedmont Health Services has been approached about this possibility. Colleen Bridger said yes, there have been multiple conversations, and Piedmont Health Services is very interested in this potential partnership. 5. Questions and Answers Commissioner Rich said on page twenty-one of the BOH Strategic Plan the leading causes of death in Orange County are listed. She said that in regard to deaths caused by cancer, the report states the three top cancers are all related to lung cancers. She asked if this is atypical. Colleen Bridger said the only cancer rate where Orange County is higher than the State rate is breast cancer. Chair McKee thanked the BOH for their time this evening and for their efforts on behalf of the health of Orange County. The meeting adjourned at 6:35 p.m. Earl McKee, Chair Donna Baker, Clerk to the Board