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HomeMy WebLinkAboutBOH agenda 012716ORANGE COUNTY BOARD OF HEALTH MEETING AGENDA DATE: January 27, 2016 TIME: 7:00 P.M. PLACE: Whitted Building, 3rd Floor Meeting Rooms 300 West Tryon Street Hillsborough, NC 27278 TIME ITEM 7:00 p.m. I. Welcome New Employees 7:00 — 7:05 II. Public Comment for Items NOT on Printed Agenda Public Comment for Items ON Printed Agenda will be handled during that agenda item (Please sign up for both on sheet near the entrance to room.) Please limit your comments to 3 minutes. 7:05 — 7:10 III. Approval of January 27, 2016 Agenda 7:10 — 7:15 IV. Actions Items (Consent) A. Minutes of November 18, 2015 7:15 — 8:25 V. Educational Sessions A. State of the Science: E- Cigarette Aerosol B. E- Cigarettes: Trends and Policy Options C. 2ND Quarter Financial Reports D. 2ND Quarter Billing Dashboard Reports 8:25 — 8:40 VI. Action Items (Non Consent) A. Safe Syringe Initiative 8:40 — 8:55 VII. Reports and Discussion with Possible Action A. Innovation Grant Update (can be moved to Feb 2016 if necessary) B. Health Director Report C. RWJF Culture of Health Nomination D. Media Items 8:55 — 9:00 VIII. Board Comments 9:00 IX. Adjournment Dr. Johnathan Thornburg, RTI Coby Austin & Alejandra Camargo Rebecca Crawford Rebecca Crawford Meredith Stewart & Robin Gasparini Meredith Stewart Colleen Bridger Colleen Bridger BOARD MEMBERS: To ensure a quorum, SEND E -MAIL to Istrange(a�orangecountync.gov advising her of your attendance at this meeting OR CALL 919 - 245 -2411. Compliance with the "Americans with Disabilities Act" and Title VI - Interpreter services and /or special sound equipment are available on request. Call the Immigrant and Refugee Health Program Manager at 919.245.2387 to request an interpreter or other accommodation. Conforme a la "Ley sobre Estadounidenses con Discapacidades" (ADA) y el Titulo VI — los servicios de interprete y/o equipo de sonido especial estan disponibles a solicitud. Llame a la Administradora del Programa de Salud para Inmigrantes y Refugiados al 919 - 245 -2387 para solicitar un interprete u otros arreglos o adaptaciones. MINUTES -Draft ORANGE COUNTY BOARD OF HEALTH November 18, 2015 ORANGE COUNTY HEALTH DEPARTMENT MISSION STATEMENT: To enhance the quality of life, promote the health, and preserve the environment for all people in the Orange County community. THE ORANGE COUNTY BOARD OF HEALTH MET ON November 18, 2015, at the Orange County Health Department, 300 West Tryon Street, Hillsborough, NC. BOARD OF HEALTH MEMBERS PRESENT: Susan Elmore, Chair; Liska Lackey, Vice Chair; Commissioner Mia Burroughs, Barbara Chavious, Dan Dewitya, Jessica Frega, Sam Lasris, Reena Mehta and Timothy Smith. BOARD OF HEALTH MEMBERS ABSENT: Paul Chelminski and Nick Galvez STAFF PRESENT: Dr. Colleen Bridger, Health Director; Christy Bridges, Physician Assistant; Alan Clapp, Environmental Health Director; Rebecca Crawford, Finance & Administrative Services Division Director; Robin Gasparini, Nursing Supervisor; Donna King, Health Promotion & Education Services Director; Pam McCall, Public Health Nursing Director; Andrea Mulholland, Family Nurse Practitioner II; Kimberlee Quatrone, Administrative Officer; Stacy Shelp, Communications Manager; Meredith Stewart, Public Health Program Manager; and La Toya Strange, Administrative Assistant II. GUESTS PRESENT: None. Welcome Liska Lackey, Vice - Chair, called the meeting to order. She mentioned that Susan Elmore, Chair, would be arriving late. II. Public Comment for Items NOT on Printed Agenda: None III. Approval of the November 18, 2015 Agenda Motion was made by Mia Burroughs to approve the agenda, seconded by Sam Lasris and carried without dissent. IV. Action Items (Consent) A. Minutes Approval of October 28, 2015 Meeting Motion to approve Consent Agenda without corrections to the October 28, 2015 minutes was made by Dan Dewitya, seconded by Jessica Frega and carried without dissent. B. 2016 Board of Health Schedule Motion to approve Consent Agenda without corrections to the October 28, 2015 minutes was made by Dan Dewitya, seconded by Jessica Frega and carried without dissent. S: \Managers Working Files \B0H \Agenda & Abstracts \2016 Agenda & Abstracts/ January Page 1 MINUTES -Draft ORANGE COUNTY BOARD OF HEALTH November 18, 2015 V. Educational Sessions A. Early Childhood Mental Health Ennis Baker, Mental Health Specialist for Orange County Head Start /Early Head Start (OCHS /EHS) and co -chair of the Early Childhood Mental Health (ECMH) Task Force, began with an introduction of herself and an overview of OCHS /EHS. She had also provided a folder full of in depth information to BOH members about OCHS /EHS, various articles on ECMH and recommendations for improving early child development. Ms. Baker stated that OCHS is available to income - eligible 3 -5 year olds living in Orange County while EHS is available to income - eligible pregnant women and children up to age 3. Ms. Baker stated that the OCHS /EHS: • only serves the Orange County school district • is serving 244 children under 5 years old including pregnant women • provides high quality child care and education, parent education, comprehensive health, mental health & developmental screening and follow up • provides in home visits and parent -child playgroups • offers a variety of services with a team of specialists that includes bilingual family specialists and home visitors, child development specialists, health /nutrition specialist, mental health specialist and mental health consultant • has a principle that states parents are a child's first and most important teacher • focuses on building the capacities of adult caregivers to provide safe, stable and nurturing relationships and environments to promote young children's mental health as the adults who care for the children also need to be mentally healthy. She continued by detailing the Orange /Chatham ECMH Task Force mission which is to support the social, emotional and mental health needs of children under 5 in Orange and Chatham Counties through advocacy, awareness, collaboration, collective action & evidence -based practice. She also highlighted some of the agencies that provide direct ECMH services to at- risk families in Orange County which included KidSCope and the OCHD. Lastly, Ms. Baker gave an overview of some of the barriers and gaps in ECMH which include: • limited services in other languages • not enough screening for trauma, toxic stress and early signs of mental health (MH) for children and MH screening of their caregivers /parents • MH services for adults are not accessed due to stigma, cost or being undocumented • limited transportation options for low- income families to access high quality preschool • no afterschool care (2p- 5:30p) available for 4 year olds in OC school district Pre -K classrooms • more calls for more attention being paid to early childhood & public health engagement around the early childhood years Meredith Stewart, Public Health Program Manager, briefly discussed guidance for next steps. Ms. Stewart recommended that the Substance Abuse and Mental Health (SAMH) subcommittee consider facilitating conversations with the Family Success Alliance (FSA) regarding wrap- around care from 2:30 -5:30 for NC Pre -K and OUTBoard /OPT and DSS regarding transportation to quality childcare. She also recommended that the SAMH review strategies to S: \Managers Working Files \BOH \Agenda & Abstracts \2016 Agenda & Abstracts/ January Page 2 MINUTES -Draft ORANGE COUNTY BOARD OF HEALTH November 18, 2015 increase screening for trauma, adverse childhood experiences and early sign of MH needs for children and parents in FSA zones and across the county. The BOH members had several questions that were addressed by Ms. Baker and Ms. Stewart. B. Strategic Plan Update Meredith Stewart, Public Health Program Manager, provided a review of the achievements and ongoing activities that resulted from the BOH 2014 -2016 strategic plan. In spring 2016, the BOH will start on the next strategic plan based off the information from the Community Health Assessment. The BOH strategic plan is an innovative, prevention focused plan, aids in establishing the BOH as a leader in NC and in laying the groundwork for the Health In All Policies project. The BOH priorities are Substance Abuse & Mental Health (SAMH), Childhood & Family Obesity Prevention, and Access to Care. Board engagement with other boards and the community as a whole was also a focus. Ms. Stewart gave an overview of the accomplishments and activities which include: • SAMH - 1St health department to dispense naloxone in NC and one of the 1St to have law enforcement equipped with naloxone (75% in Orange County). - Had 4 drug overdose reversals this past year. - New Campus and Community Director for Alcohol Initiatives position is currently in the hiring process which involves a great partnership among the UNC, the Health Department and the Town of Chapel Hill. - Hosted Raising of America this past June with over 60 people in attendance; Will continue to work with community to address the needs of early childhood and the policies needed. Safe Syringe Initiative's goal is to reduce the re -use of syringes & spread of blood -borne infectious disease by increasing access to clean syringes. The SAMH committee will bring their final recommendation to BOH for discussion in January 2016. • Childhood & Family Obesity Prevention - BOH has been looking at how child care centers can improve their nutrition. - Focused on school nutrition — new partnerships with No Kid Hungry NC (focuses on school breakfast and summer feeding programs) and UNC's Food for All (focuses on FSA zones). Access to Care - Advocating for policies to improve access to care. - Communicating about effective interventions and advocating for their funding. - Serving as catalyst /advocate for health outcomes in the FSA. - FSA's Zone Navigator Program utilizes 4 community members trained to provide support and resources to our families. - Kindergarten Readiness Program has a total of 66 families at 3 elementary school sites located within two FSA zones. Students enrolled in the kindergarten readiness programs were evaluated pre and post program utilizing the North Carolina Kindergarten Entrance Assessment and other tools to assess children in literacy, math, and social and emotional skills. S: \Managers Working Files \B0H \Agenda & Abstracts \2016 Agenda & Abstracts/ January Page 3 MINUTES -Draft ORANGE COUNTY BOARD OF HEALTH November 18, 2015 The United Way /FSA Collaborative features 9 partner organizations working towards strengthening the pipeline, sharing measurement and streamlining referrals, program and services. Fostering a culture of innovation. Innovation Grants projects from 2015 are wrapping up. There have been 24 Innovation Grant initial proposals which was an 85% increase from 2015. Twenty -one of the twenty -four proposals came from new applicants. • Engagement - Staying up to date on the actions of other County advisory boards and continuing to develop policy statements on priority health areas. The BOH members had several questions that were addressed by Ms. Stewart. C. Advisory Board Update Receiving quarterly updates on the actions of other Orange County advisory boards was one the action steps related to Engagement in the 2014 -2016 Strategic Plan. Based on availability and relevancy to the BOH Strategic Plan priorities, Meredith Stewart provided a summary of pertinent actions and information from Orange County advisory boards from June 2015 to October 2015 as they relate to the BOH Strategic Plan priorities. Some highlights include: At the August 13, 2015 meeting, the Chapel Hill /Carrboro City Schools Board of Education approved an Emergency Epinephrine Auto - Injector policy which is related to the resolution that the BOH passed in August 2014 to support an NC Board of Pharmacy rule change that would allow school personnel to receive the prescription and training from their local public health department. At the September 17, 2015 meeting, the BOCC continued a discussion on their interest in putting a bond referendum on the November 2016 ballot. The referendum is expected to include significant funds for the school systems, as well as affordable housing. Healthy Carolinians of Orange County hosted community listening sessions around the county as part of the Community Health Assessment process. Results from the community survey and from focus groups were presented and participants took part in a voting /prioritization process. HOCC will hold their annual meeting on December 11, 2015 at the Whitted Human Services Center in Hillsborough. The BOH members did not have any questions. D. 1St Quarter Financial Reports and E. 1St Quarter Billing Dashboard Reports Rebecca Crawford, Finance & Administrative Services Division Director, gave a report on the 1St quarter revenue and billing accuracy. Her report is as follows: • Total Health Department Revenue: Average YTD monthly revenue in FY16 after the 1 st Quarter is $204k /month or $593k YTD, representing 22% of our overall budgeted revenue for the year. This is a slight decrease from an average of $205k /month in FY15. Expenses were in line with revenues at 21 %. Total Billing Accuracy: Continuing with the goal of 90% billing accuracy set in FY 14 -15, the average billing accuracy rate for medical at the beginning of FY 15 -16 is 88% as S: \Managers Working Files \BOH \Agenda & Abstracts \2016 Agenda & Abstracts/ January Page 4 MINUTES -Draft ORANGE COUNTY BOARD OF HEALTH November 18, 2015 compared to 91 % in FY 14 -15 and the average rate for dental for FY 15 -16 is 95% as compared to 96% in FY 14 -15. • Dental Earned Revenue by Source: FY 15 -16 average monthly revenue ($41 k /month) is slightly below our budget projection ($46k /month) but still above our FY 14 -15 average of $35k /month. FY 15 -16 dental revenue totaled $119k at the end of the first quarter. Dental earned revenue is historically lower in the first quarter of the fiscal year than in other quarters. Medical Earned Revenue by Source: Medical earned revenue is currently below the budgeted projection for FY 15 -16. The monthly average after the first quarter ($44k /month) is lower than FY15 ($50k/y) and our budget projection ($51 k /month). This is mainly due to holding Maternal Health encounters for Global Billing (billing multiple encounters at the end of the pregnancy) and holding multiple program encounters until we come to a resolution with Medicaid of an acceptable method to bill same day appointments. We anticipate a solution by December 2015. The BOH members had questions that were addressed by Ms. Crawford and Dr. Bridger. VI. Action Items (Non- Consent) A. Fee & Eligibility Policy Ms. Crawford provided an overview of the recommended changes to the Fee and Eligibility Policy that were reviewed at the October 2015 meeting. The BOH members did not have any questions. Motion to accept the recommended changes to the Fee and Eligibility Policy without edits was made by Jessica Frega, seconded by Mia Burroughs and carried without dissent. B. Elections (Chair & Vice -Chai The Board members shall elect a Chair and Vice -Chair by majority vote each year at the last meeting of the calendar year. Motion to elect Liska Lackey to Chair for the 2016 calendar year and to elect Nick Ga /vez to Vice -Chair was made by Sam Lasris, seconded by Jessica Frega and carried without dissent. VII. Reports and Discussion with Possible Action A. Long Acting Reversible Contraceptives Report Christy Bridges, Physician Assistant, gave a presentation on increasing long acting reversible contraceptive (LARC) use in Orange County Health Department family planning patients. She began by noting that 50% of pregnancies are unplanned in the United States. She also stated that LARCs do not require the user to take some sort of action every day or before every sexual encounter. S: \Managers Working Files \BOH \Agenda & Abstracts \2016 Agenda & Abstracts/ January Page 5 MINUTES -Draft ORANGE COUNTY BOARD OF HEALTH November 18, 2015 Ms. Bridges provided information on 3 kinds of LARCs — Nexplanon subdermal implant, Mirena IUD and Paraguard IUD. Their effectiveness ranged from a maximum of 3 years up to a maximum of 10 -12 years. The associated costs (device and procedure) varied as well. In 2014 -2015, 12% of women in the OCHD Family Planning Program were using LARCS with Nexplanon having the greatest use by our clients followed by the 2 IUDs Mirena and Paraguard, respectively. In the U.S., 7.2% of women ages 15 -44 used LARCs. The Colorado Family Planning Initiative increased LARC use in Title X clinics from 4.5% in 2008 to 19.4% in 2011. The OCHD's goal is to meet and /or exceed Colorado's 19.4 %. She continued by stating that some possible barriers to LARCs were concerns regarding procedure and side effects as well as others' negative experiences. Cost was also a barrier as 59% of LARCs users were self -pay. Of that 59 %, 84% of that group actually slid to 0% having to pay nothing. Ms. Bridges also noted some of the best practices for increasing LARC use which included offering LARCs first, leading with its benefits, exploring and incorporating patient preferences and reducing barriers such as cost and the number of appointments. The recommendation to the BOH was to: Move forward with high and moderate impact, low difficulty best practices - Exam room visuals; educational pamphlets, electronic promotion /outreach - Provider tip- sharing opportunities and staff education Support initiatives for high impact, moderate -high difficulty best practices - Consider video clip use and evaluate against organizational priorities - Support work toward identification of contraceptive tool at intake The BOH members had questions that were addressed by Ms. Bridges and Dr. Bridger. B. Radon Action Month The NC Department of Health and Human Services Division of Health Service Regulation Radiation Protection Section has asked that the BOH recognize January as National Radon Month. Alan Clapp, Environmental Health Director, provided information on Radon Action Month as the OCHD is partnering with the NC Radon program to provide free short -term radon test kits in recognition of National Radon Action Month. A limited supply of 100 test kits for Orange County will be available from January 11th through January 29th. They will be distributed by Environmental Health. Motion to pass the resolution to recognize January 2016 as Radon Action Month in Orange County was made by Sam Lasris, seconded by Barbara Chavious and carried without dissent. The BOH members had questions that were addressed by Mr. Clapp. C. Media Items Media items were in the packet which focused on Orange County's events and our involvement in various efforts. VIII. Closed Session to Discuss Health Director's Annual Review S: \Managers Working Files \BOH \Agenda & Abstracts \2016 Agenda & Abstracts/ January Page 6 MINUTES -Draft ORANGE COUNTY BOARD OF HEALTH November 18, 2015 Action taken in the closed session: The Board of Health unanimously voted to evaluate Dr. Bridger's job performance as "Excellent" for this year. IX. Board Comments No additional comments given. X. Adjournment Susan Elmore, Chair, adjourned the meeting. The next Board of Health Meeting will be held January 27, 2016 at the Orange County Health Department, 300 West Tryon Street, Hillsborough, NC at 7:00 p.m. Respectfully submitted, Colleen Bridger, MPH, PhD Orange County Health Director Secretary to the Board S: \Managers Working Files \BOH \Agenda & Abstracts \2016 Agenda & Abstracts/ January Page 7 Agenda Item Number: ORANGE COUNTY BOARD OF HEALTH AGENDA ITEM SUMMARY Meeting Date: 1/27/2016 Agenda Item Subject: E- Cigarettes: Secondhand Aerosol Attachment(s): E- Cigarettes: Secondhand Aerosol (slide presentation) Staff or Board Member Reporting: Jonathan Thornburg, PhD, Director of Exposure and Aerosol Technology, RTI International Purpose: Action X Information only Information with possible action Summary Information: Dr. Thornburg will present the state -of- the - science on risks associated with the aerosol emitted from electronic cigarettes. He will describe the structure of the devices, the main components of the aerosol, and what is known about the associated health risks with an emphasis on those related to secondhand exposure. Recommended Action: Approve Approve & forward to Board of Commissioners for action Approve & forward _XAccept as information Revise & schedule for future action Other (detail): ORTI INTERNATIONAL E- Cigarettes and Vapor Products: State of the Science RTI International is a registered trademark and a trade name of Research Triangle Institute. www.rti.org HOME x� FINXNCE 'r, NEWS BY SECTOR r, R.ETAIL.LND CONSLUER Vpin g tc-ikes off pis e-cigarette sciles break through $6bn E-cigarettes are soaring in popularity and have started to steal smolung quitters away fi-om nicotine replacement products such as patches and gum 0941 0420 G 100 (D 121 02K 0 Email c�rye &legra The UK Is the world's second largest market for vaping device sales Photo: AL AMY World Health Organization [S00® WHO FRAMEWORK CONVENTION ON TOBACCO CONTROL Conference of the Parties to the WHO Framework Convention on Tobacco Control Sixth Session FCTClCOP16110 Kloscow. Russian Federationj 3 -18 October 2014 21 July 2014 Provisional agenda item 4.4.2 Electronic nicotine delivery systems Report by NN-HO INTRODUCTION 1, Tlus document was prepared in response to the request made by the Conference of the Parties (COP) at its fifth session (Seoul, Republic of Korea; 12 -17 November 2012) to the Convention Secretariat to invite WHO to exanune emerging evidence on the health impacts of electronic nicotine delivery systems (ENDS) use and to identify options for their prevention and control, for zhe New lurk T-imo Use ofE- Cigarettes Rises Sha By SABRINA TAVERN75E APRIL 16.2015 Q Email © Share y Tweet Save A More Kenny, a high school senior in Weston, likes to puff e- cigarettes during study sE with friends after school. James, a senic Fauquier County, Va., uses their outsid lunch with friends Nvho do smoke tricks sophomore from Westchester County, L while hiking with friends. E- cigarettes have arrived in the life of American teenager. Use of the devices among middle- and school students tripled from 2013 to 2 C;hc New LJork � BUSINESS DAY THE NEW SMOKE E- Cigarettes, by Other Names, Lure Young and Worry Experts HI MATT RICHTEL NIARCH 4, 2014 E- Cigarettes That Don't Look It Like a cigarette. e- cigarettes. e- haakahs and vape pent cigarette, these are unregulated by the F.D.A. They cat waffle, vanilla cupcake. and peppermint blaze BUSINESS DAY THE NEW SMOKE - 28t1COMMENT Cigarette Some E-Cigarettes Deliver a Puff of Carcinogens e- Cigarettes d ti May TrW: Elu 072 LVS oxw in 2 V Var nxt e-N rZi By MATT RICHTEL MAY 3.2014 C;hc New Rork � BUSINESS DRY THE NEW SMOKE - 28t1COMMENT E- Cigarettes, by Other Names, Lure Young and Worry Experts HI MATT RICHTEL MARCH 4. 2M4 E- Cigarettes That Don't Look It Like a cigarette. e- cigarettes. e- hookahs and vape pent cigarette, these are unregulated by the F.D.A. They cat waffle, vanilla cupcake. and peppermint blaze Cigarette tv }oy BUSINESS DAY THE NEW SMOKE Some E- Cigarettes Deliver a Puff of Carcinogens B} MATT RICHTEL NLAY 3.201=1 i The Op1111O17 Pages OP-ED CONTRIBUTORS It's Time to regulate E- Cigarettes By DAVID A. KESSLER and MATTHEW L. NTYERS APRIL 23, 2415 WREN the federal government announced last week that youth e- © Email cigarette use tripled in just one year, surpassing the use of traditional cigarettes, the reaction was appropriately string. "A wake-up call," Share said one commentator, echoing others. y► Tweet We agree. But a word that shouldn't be used to describe it is surprising. H- I , qf Disposable "Cigalikes" Tanks Available with and without nicotine Flavorings Carrier liquid is propylene glycol and /or glycerin WLfYour Trusts &esearc Von or Mouthpiece Heating element/Atomizer heats the "juice" to make vapor. Cartridge (tank) holds the liquid "juice. " Microprocessor Mary devices have a itch to a ctivate th heating element. Some devices have a light-emitting dilode On the end to simulate the to of a IDL�rning cigarette. Battery What Emissions Do E- Cigarettes Produce? • Electronic cigarettes generate a mixture of vapors and aerosols • A vapor is a gas formed by boiling or evaporating a liquid • An aerosol is a solid or liquid particle suspended in a gas, usually air • Aerosols are measured in micrometers (or microns) • A human hair is 50 to 100 micrometers (µm) thick • Note that "aerosol" and "particle" are synonyms, both terms will be used inter - changeably Composition of E- Cigarette Emissions aEthyl maltol, 2- methyl naphthalene, and 2 -tert- butyl -p- cresol present, bBHA and BHT present, cOnly in "fruit punch" flavored liquid. Chemical Class Purpose I m -j Q CM Nicotine - • - • - Glycerin and glycol _ Alkylated cyclic compoundsa • Phenolic compoundsb W High molecular weight aromatics aEthyl maltol, 2- methyl naphthalene, and 2 -tert- butyl -p- cresol present, bBHA and BHT present, cOnly in "fruit punch" flavored liquid. • Particles are small (< 1000 nm) • Size varies with the type of e- liquid used 1.0E +05 9.0E +04 8.0E +04 M E 7.0E +04 c 0 6.0E +04 L c 5.0E +04 a� o 4.0E +04 V a� .2 3.0E +04 r- M a 2.0E +04 1.0E +04 0.0E +00 --0 Fruit Punch, Humid Tobacco Pure, Humid 10 100 1000 Particle diameter (nm) Particle sizes produced by two different e- liquids • Size determines where the particles deposit in our lungs • Concentration determines how many particles deposit in our lungs • Scientific reasons for understanding size and concentration of the aerosols produced by electronic cigarettes • The chemical composition of the particles varies with size and concentration • Size and concentration determine the toxicity of the particles. • User and secondhand exposure is determined by the size, concentration, and composition of the particles Model results predicted 47% of inhaled emissions were deposited in the lung, mostly in the deep lung (RTI unpublished data) Are the potential exhaled electronic cigarette emissions a potential second -hand exposure? Respiratory Deposition of E- Cigarette Emissions Exhaled 1% 6% - - - -�. Head (nose and throat) 53% Tracheo- 40% Bronchial Region Alveolar Region (deep lung) =_ • RTI unpublished data suggests e- cigarette use within a room could cause secondhand exposures • Exhaled e- cigarette vapors from a single user were detected 6 feet away; concentrations were 25 times lower than adjacent to the user r e%r Health Implications of E- Cigarettes Emissions • Health effects and toxicity of nicotine are well known • Toxicity of some ingredients in e- cigarettes are also known • Ingredients can include known toxicants such as diacetyls (butter flavor), cinnaldehyde (cinnamon flavor), etc. • Industrial hygiene inhalation toxicology provides scientific basis • Toxicity of other ingredients are unknown • Many ingredients classified by FDA as "generally regarded as safe" for ingestion • Inhalation toxicity has not been studied • Propylene glycol, glycerin, many flavorings, and artificial colors fall into this "unknown" category • Toxicity of by- products from e- cigarette use • Improper use, user modifications, or poor quality construction can cause other toxics to be produced from the e- liquid or device • Formaldehyde: thermal decomposition of carrier liquid • Heavy metals: leaching from heating element Users • Health risks from inhalation of nicotine, certain ingredients, and some by- products of use have been established by scientific literature • Acute and chronic impacts that result from inhalation of high concentrations of many common e- liquid ingredients with unknown toxicity are unknown Secondhand exposure • Research on the potential for secondhand exposure and associated health risks has been limited Tertiary exposure • Potential exposure to nicotine or other components of e- cigarette emissions that deposit on surfaces has not been investigated • Science has not kept pace with e- cigarette development and use growth to inform policy at the national, state, county, or municipal level • Areas of most knowledge - Usage rates in adult and youth populations - Toxicity of e- cigarette emissions (generically) • Areas of least knowledge - Potential for secondary or tertiary exposure - Acute and chronic health impacts on user or others Agenda Item Number: ORANGE COUNTY BOARD OF HEALTH AGENDA ITEM SUMMARY Meeting Date: 1/27/2016 Agenda Item Subject: E- Cigarettes: Trends and Policy Options Attachment(s): E- Cigarettes: Trends and Policy Options (slide presentation) Staff or Board Member Reporting: Coby Jansen Austin (staff) and Alejandra Camargo (TRU Youth) Purpose: Action Information only _X_ Information with possible action Summary Information: Coby will provide an overview of surveillance data describing electronic cigarette use patterns among adults, including former, current, and non- smokers, as well as data on youth tobacco use. Then Carrboro High School TRU Club co- president Alejandra will share her experience and observations on use and trends from the perspective of a young person growing up in Orange County. Coby will wrap - up by providing an overview of the current regulatory landscape — at the federal, state and local level — and present potential policy options to the Board of Health. Based on the existing evidence, staff recommend that the Board of Health develop a policy to prohibit use of e- cigarettes in indoor areas of bars and restaurants. Recommended Action: Approve Approve & forward to Board of Commissioners for action _XApprove & forward to BOH Mental Health and Substance Abuse Subcommittee for further study and policy development Accept as information Revise & schedule for future action Other (detail): EmCigarettese, Trends &Policy Options Board of Health January, 27 2016 Coby Jansen Austin, MPH Alejandra Camargo, TRU Co- President, Carrboro High School LPV C M� z0 Photo Credits: CDC, ecigarette- mods.com, pinterest.com, vapes.com ORANGE COUNTY WAffIH DST Trends in Adult Use: United States • About 16% of cigarette smokers are "dual users" • 1 out of 5 people who recently quit smoking use a -cigs • Rarely used by never smokers Percentage of adults who currently use e- cigarettes, by smoking status, US, 2014 25% 20% d 15.9% 15% 10% 5% 0% Current cigarette smoker 22.0% Recent former cigarette smoker ( <1 year) 2.3% Long -term former cigarette smoker ( > =1 year) SOURCE: CDC /NCHS, National Health Interview Survey, 2014 0.4% Never smoker OR U�FY HEMIM DST Trends in Adult Use: United States Younger adults are more likely to have tried a -cigs and currently use a -rigs Percentage of adults who had never smoked cigarettes and who had ever tried an e- cigarette, by age: US, 2014 12% 10% - 9.7% 8% 6% 4% 2% 0% 18 -24 3.5% 25 -44 1.2% 45 -64 SOURCE: CDC /NCHS, National Health Interview Survey, 2014 0.2% 65 and over ORANGE COUNTY HFLXff1H DST Trends in Youth Use: North Carolina r1 .7 40 35 P 79 -31) _ 10 1ST 1� 3.. 3 3 High School Current's Smoking and Tobacco Use, 1999-2013 3 5.-B 33.7 y 2G.3 5-Making -411-Tobacci? Use 29:7 ** 1� 16.7 15,5 ► 13.5 _99' 201 2003 2005 2007 2009 2011 *Chment use is defined a_-. using on one or more of the past 30 days. "In 2011, N.C. YTS began traclaag use of emeqjng %bsc�- co products, including electronic cigar tees, clurve cif, dissoly,able, tobacco products, flavored ci49arettes, flaxrored htfle c1,g hookahs € f vuat rpi , r-011-yow-o-wa cigarettes, and sau . Data ►n timer ing tobacco prod�u.ct use prior to 2011 are not avai.labk -. TORACC€? K-EAt..ITY �1NF��T�RED Alejandra Camargo Carrboro High School Youth Perspective ORANGE UNTY HFAITIH E- cigarette use among youth is rising as e- cigarette advertising grows Dollars spent can e- cigarette advertising 10 9 a 7� C I 4 C 3 2 Cc 1 � 0 2011 2012 2013 M4 7 in 10 US middle and high school youth were exposed to e- cigarette ads in 2014 Source: National Youth Tobacco Survey, 2011 -2014; Kim et al (2014); Truth Initiative (2015), as referenced in ORANGE UftiJTY CDC Vital Signs (January 2016) - Available at: www.cdc.gov /vitaIsigns /pdf /2016- 01- vitaIsigns.pdf HPLAUM DEMRTHEM I For current smokers: For current smokers: • Promote cessation • Disease risk associated with incomplete • Reduce disease risk & cessation (dual use is common) morbidity for those who • Increased nicotine addiction (by using e -cigs quit combustible in places where normally wouldn't smoke) For youth: (appeal - flavors /marketing) • New nicotine addiction • Potential for graduation to smoking • Brain development • Future disease risks For former smokers: • Potential for relapse or return to addiction For society /non- smoker: • Secondhand aerosol exposure Adapted from Sutfin, E.L. (2014) Electronic Nicotine Delivery Systems. Breathe Easy NC Conference ' � (Presentation); CDC Grand Rounds: E- cigarettes: An Emerging Public Health Challenges. 4,4 ORANGE COUNTY 10/20/2015 (Presentation). HPLAUM DST Federal Regulations FrDAI� FDA's Current Authority: Regulate e- cigarettes as drugs or devices, but only if they are marketed for therapeutic purposes. FDA's Proposed Authority: "Deeming rule" would regulate e -cigs as tobacco products (April 2014): • No sales to minors • Free sampling prohibited • Warning label requirements • Manufacturers required to register with the FDA and seek the agency's review of new products North Carolina Laws Tobacco product ,r Childproof packaging Online purchase permitted Photo Credits: learnnc.org; www.tobaccofreekids.org; ivaporshop.com; jostarusa.com; clipartbest.com No sales to minors Excise tax References: N.C. Gen. Stat. §14 - 313(4); N.C. Gen. Stat §14- 401.18A; N.C. Gen. Stat. §14- 313(b); N.C. Gen. Stat. §105- 113.35; N.C. Gen. Stat. § 14- 313(b2) Online Purchasing Facilitates Access Teens can buy electronic cigarettes easily online — Youth buy rate of 93.7% — No attempts to verify ages at delivery — 95% of delivered orders simply left at the door Online \ purchase permitted Photo Credits: jostarusa.com References: Tob Control 2014;23:iii26 -iii30 JAMA Pediatr. 2015;169(3):e1563 E-Cigs Use Regulations Across the US Include e -cigs in smoke -free laws: 8 states 400+ counties and municipal'it'ies Mostly cover bars, restaurants, and workplaces ANRF (10/2/15). States and Municipalities with Laws Regulating E- Cigarettes. Available at: http: / /www.no- smoke.org /pdf /ecigsIaws.pdf + ORA E COUNTY N DT Local Regulations on E-Cigs Use in North Carolina No statewide policy restricting e -cig use Government Property I Other Public Places 50+ counties and municipalities in NC prohibit e -cig use in or on government property - Including Orange County Source: NC Tobacco Prevention and Control Branch • Dare County: Bars and Restaurants • Durham County: Smoke - Free Public Places Rule • Some campaigns to promote voluntary policies ORS UNTY HFAITIH DST Current Restrictions on E -Cig Use in Orange County • Tobacco -free schools • County buildings, vehicles and within 50 ft of DSS and Health Dept • Chapel Hill Public Library • UNC Athletic Facilities* • UNC Hospitals • Chapel Hill: employees cannot use in buildings and vehicles • Private businesses (as desired) O#F TOBACCO FREE S C H 0 0 L 4W7, 191 NO SMOKING NO VAPING * E -cig use also discouraged in places that are smoke -free, esp. libraries, lab buildings, residence halls and instructional facilities. Source: Daily Tarheel - http: / /www.dailytarheel.com /article/ 2014 /03 /uncs- e- cigarette- policy- to -be- determined Current Restrictions on E-Cigs Use in Orange County Photo from DSI Comedy Theatre, 2015 IF ORANGE COUNTY WALNFI DST Potential Exposure In Public Places Lessons from studies about secondhand smoke exposure: • Restaurants can be important sites of exposures to children and adults, even the principal point of exposure for children from nonsmoking homes • Servers and bartenders in places where smoking is permitted may be exposed to high levels of secondhand smoke • Among the highest concentrations of nicotine measured in public places were those found in bars and lounges References: Klepeis NE. (1999); Jarvis MJ, Foulds J, Feyerabend C. (1992); Jenkins RA, Counts RW. (1999); Maskarinec MP, et al. (2000) Photo Credit: thetimes.co.uk; laweekly.com Ilr ORANGE COUNTY NON DT Survey of Bars and Restaurants in NC 20- question survey, mailed to 663 owners /managers 20.3% response rate • Most restaurants restrict e -cig use o More than two thirds of restaurants either ban use inside (46 %) or limit use to designated areas (21 %) • Restaurants more likely than bars to restrict e -cig use inside o Bars: 10% ban use, 12% designate areas • Complaints received from customers and employees related to e -cig use indoors o 16% - from customers; 8% - from employees Staples, C.A.H. (2015). Restaurant and Bar Owners and Managers Respond to North Carolina's Smoke -free Law, Electronic Cigarette Use Inside their Businesses, and Smoke -free Outdoor Seating. Masters Thesis. Available at: http: / /thescholarship .ecu.edu /bitstream /handle /10342/4960/Staples ecu 06000 11451.pdf ?sequence =l 0 SAMPLE POLICY OPTIONS Option A: No Board of Health Rule, but encourage: • voluntary policies by employers • ordinances by municipalities &county Staff Recommendation Option B: Board of Health Rule prohibiting use in indoor areas of bars and restaurants. Option C: Board of Health Rule prohibiting use in all indoor public places. Note: Board of Health Rules apply to all jurisdictions within the county, including municipalities. REFERENCES ANRF (10/2/15). States and Municipalities with Laws Regulating E- Cigarettes. CDC Grand Rounds: E- cigarettes: An Emerging Public Health Challenges. 10/20/2015 (Presentation). CDC Vital Signs (January 2016) E- Cigarette Ads and Youth. Available at: www.cdc.gov /vitalsigns /pdf /2016 -01- vitalsigns.pdf Huang J, Kornfield R, Szczypka G, Emery SL. A cross - sectional examination of marketing of electronic cigarettes on Twitter. Tob Control. 2014;23:iii26— iii30. Jarvis MJ, Foulds J, Feyerabend C. Exposure to passive smoking among bar staff. British Journal of Addiction. 1992;87(1):111 -3. Jenkins RA, Counts RW. Personal exposure to environmental tobacco smoke: salivary cotinine, airborne nicotine, and nonsmoker misclassification. Journal of Exposure Analysis and Environmental Epidemiology. 1999;9(4):352 -63. Klepeis NE. An introduction to the indirect exposure assessment approach: modeling human exposure using microenvironmental measurements and the recent National Human Activity Pattern Survey. Environmental Health Perspectives. 1999;107(Suppl 2):365 -74. Maskarinec MP, Jenkins RA, Counts RW, Dindal AB. Determination of exposure to environmental tobacco smoke in restaurant and tavern workers in one US city. Journal of Exposure Analysis and Environmental Epidemiology. 2000;10(1):36 -49. REFERENCES (Continued) Schoenborn CA, Gindi RM. Electronic cigarette use among adults: United States, 2014. NCHS data brief, no. 217. Hyattsville, MD: National Center for Health Statistics. 2015. Staples, C.A.H. (2015). Restaurant and Bar Owners and Managers Respond to North Carolina's Smoke -free Law, Electronic Cigarette Use Inside their Businesses, and Smoke -free Outdoor Seating. Masters Thesis. Sutfin, E.L. (2014) Electronic Nicotine Delivery Systems. Breathe Easy NC Conference (Presentation) Williams RS, Derrick J, Ribisl KM. Electronic Cigarette Sales to Minors via the Internet. JAMA pediatrics. 2015; 169(3):e1563- e1563. ORANGE COUNTY HP.XffH Coby Jansen Austin,, MPH Orange County Health Department ca usti n @ ora ngecou ntync.gov 919 -245 -2424 ORANGE UNTY HFAITIH DEMRTNEW Agenda Item Number: ORANGE COUNTY BOARD OF HEALTH AGENDA ITEM SUMMARY Meeting Date: January 27, 2016 Agenda Item Subject: 2nd Quarter Financial Report FY 15 -16 Attachment(s): 2nd Quarter Financial Report 2nd Quarter Billing Dashboard Staff or Board Member Reporting: Rebecca Crawford Purpose: Action X Information only Information with possible action Summary Information: Total Health Department Revenue: Average YTD monthly revenue in FY16 after the 2nd Quarter is $236k /month or $1.49 million YTD, representing 47.7% of our overall budgeted revenue for the year. This is an increase from an average of $218k /month in FY15. Expenses were in line with revenues at 46.4 %. Total Billing Accuracy: Continuing with the goal of 90% billing accuracy set in FY 14- 15, the average billing accuracy rate for medical halfway through FY 15 -16 is 86% as compared to 92% in FY 14 -15 and the average rate for dental for FY 15 -16 is 97% as compared to 94% in FY 14 -15. Dental Earned Revenue by Source: The FY 15 -16 average monthly revenue ($39k /month) is slightly below our budget projection ($45k /month) but still above our FY 14 -15 average of $36k/month. FY 15 -16 dental revenue totaled $471 k at the end of the second quarter. Dental earned revenue will most likely continue to increase each month as our new dentist adds more clients to her schedule. Medical Earned Revenue by Source: Medical earned revenue is currently below the budgeted projection for FY 15 -16. The monthly average after the first quarter ($45k /month) is lower than FY15 ($50k /y) and our budget projection ($50k /month). This was mainly due to holding Maternal Health encounters for Global Billing (billing multiple encounters at the end of the pregnancy) and holding multiple program encounters until we come to a resolution with Medicaid of an acceptable method to bill same day appointments, which we resolved in late December. FAS anticipates the monthly average will be closer to the budget projection in subsequent quarters. Recommended Action: Approve Approve & forward to Board of Commissioners for action Approve & forward to X Accept as information Revise & schedule for future action Other (detail): TOTAL HEALTH DEPARTMENT REVENUE vs. budget projections & prior year 450 386 ` 400 s 350 H 300 250 ......................... �# ... vni zoo 1 150 100 50 •221 ................. ../........1................... J A s O N D 1 F M A M J (50) Personal Health Dental Environ Health Grants J1 State Other • Total OCHD Revenue ($1.4M YTD) -YTD Month Avg ($236k/m, - $2.8M /y) •••••• FY15 -16 Budget Projection ($260k /m, $3.1M /y) - Prior: FY14 -15 Total OCHD Revenue ($2.6M /y) Prior: FY14 -15 Revenue - Avg ($218k /m, $2.61VI/y) DENTAL EARNED REVENUE BY SOURCE vs. budget projection & prior year 60 v c 'o L F- 40 20 43 A2 Medical Billing Accuracy* vs previous year & goal 92% 90% 89% 91% 84% 58% J A s O N D 1 F M A M J M FY16 Total Accuracy (YTD avg 86%) - M FY15 Avg Accuracy (92 %) ...... Accuracy Target (90 %) Dental Billing Accuracy* vs previous year & goal 1 A s O N D 1 F M A M J D FY16 Total Accuracy (YTD avg 97%) - D FY1S Accuracy - Avg (94%) ...... Accuracy Target (90 %) MEDICAL (PH) EARNED REVENUE BY SOURCE vs. budget projection & prior year 80 -o c 0 0 60 40 20 54 0 0 J A s O N D J F M A M J 1 A s O N D J F M A M J MEDICAID INSURANCE MEDICAID INSURANCE SELF PAY • Total Earned Revenue ($235k YTD) SELF PAY • Total Earned Revenue ($271k YTD) • • • • • • Budget Projection ($45k /m, $537k /y) -YTD Month Avg ($39k /m, - $471k /y est) ...... Budget Projection ($50k /m, $600k /y) -YTD Month Avg ($45k /m, - $542k/y est) FY14 -15 D Revenue($428k /y) - FY14 -15 D Revenue - Avg ($36k /m) - FY14 -15 M Revenue($598k /y) - FY14 -15 M Revenue - Avg ($50k /m) * NOTE : FY15 -16 Billing Accuracy no longer combines dental and medical paid claims & unpaid claims. Because two different accounting systems are being used (Medical: Accrual; Dental: Cash) the two clinics are shown separately. Billing Accuracy Formulas: Medical = Paid claims /(# encounters minus no charge claims). Un- claimed appointments are no longer factored in; Dental = Paid Claims /# kept appointments. Claims can take a quarter to realize payment - billing accuracy for all months increases with time as claims are finalized and errors are reworked. Orange County Health Department Profit Loss Budget Performance 2015 -2016 TOTAL HEALTH Q2 YTD ACTUAL ANNUAL BUDGET % OF ANNUAL BUDGET Revenue Donations Finance and Admin Services 0 0 (30,000) 0.00% Health Promotion & Edu (1,000) (1,000) 0 0.00% Personal Health 0 0 (24,014) 0.00% Donations Total (1,000) (1,000) (54,014) 1.85% Internal Allocations Dental Health 0 0 (18,000) 0.00% Finance and Admin Services 0 0 (23,500) 0.00% Health Promotion & Edu 0 0 (25,000) 0.00% Internal Allocations Total 0 0 (66,500) 0.00% Service Revenue Dental Health (116,425) (235,364) (536,847) 43.84% Environmental Health (85,355) (198,820) (450,880) 44.10% Personal Health (141,278) (271,889) (606,484) 44.83% Service Revenue Total (343,058) (706,073) (1,594,211) 44.29% State Allocations Finance and Admin Services (11,814) (20,855) (42,885) 48.63% Health Promotion & Edu (8,788) (13,011) (55,832) 23.30% Environmental Health (1,076) (1,396) (34,000) 4.11% Personal Health (127,435) (247,445) (514,511) 48.09% State Allocations Total (149,113) (282,707) (647,228) 43.68% Grants Project Revenues NACCHO Grant 0 0 (6,521) 0.00% Piedmont Hlth Sry - Nutr (4,186) (7,954) (28,938) 27.49% Meaningful Use Incentive (46,062) (65,062) (40,250) 161.64% CC4C Accesscare (36,869) (74,328) (149,624) 49.68% PCM Accesscare (37,237) (73,825) (155,952) 47.34% Health Disparities 0 0 (56,916) 0.00% Medicaid Maximization 0 (287,697) (340,998) 84.37% Grants Project Revenues Total (124,354) (508,866) (779,199) 65.31% Revenue Total (617,525) (1,498,646) (3,141,152) 47.71% Orange County Health Department Profit Loss Budget Performance 2015 -2016 TOTAL HEALTH Q2 YTD ACTUAL ANNUAL BUDGET % OF ANNUAL BUDGET Expenditures Salaries 1,397,026 2,562,827 5,130,969 49.95% Benefits 460,033 867,341 1,819,498 47.67% Travel 1,808 2,488 7,495 33.19% Training 9,369 18,577 34,667 53.59% Certifications & Licensing (47) 4,336 15,756 27.52% Mileage 8,460 15,460 33,710 45.86% Telephone 8,149 22,818 75,714 30.14% Postage 2,301 5,801 15,957 36.35% Motor Pool 6,822 18,639 48,807 38.19% Equip Repairs 0 1,332 10,175 13.09% Equip Rent 246 478 1,200 0.00% Duplicating 3,114 5,062 10,865 46.59% Printing 1,104 3,711 14,156 26.22% Advertising 155 1,543 11,796 13.08% Dues 560 2,530 5,334 47.43% Subscriptions 499 499 2,827 17.66% Dept Supplies 3,352 7,932 42,661 18.59% Edu Supplies 2,120 2,923 22,430 13.03% Office Supplies 7,239 12,295 41,839 29.39% Medical Supplies 22,305 59,908 154,652 38.74% Bloodborn Path Supplies 353 (195) 9,001 -2.17% Pharmacy Supplies 59,064 99,854 221,766 45.03% Comp Supp /Software 0 574 1,576 36.43% Other Supplies 0 420 2,238 18.77% Contracted Sry 122,943 175,758 496,319 35.41% X -Ray 2,377 3,566 25,625 13.92% Lab Sry 17,752 31,154 62,502 49.84% Bonds & Insurance 0 0 10,602 0.00% Uniforms 1,243 3,877 8,199 0.00% Community Proj 2,627 5,969 83,235 7.17% Employee Wellness 0 0 1,000 0.00% Innovations Project 705 1,806 20,000 9.03% Accreditation Project 0 2,750 2,750 100.00% Wise Woman Program 0 0 0 0.00% Preparedness BT 0 0 0 0.00% Family Success Alliance 51,347 70,040 250,000 28.02% Credit Card Exp 2,687 5,120 10,000 0.00% Capital Exp Under $500 377 878 1,350 65.01% Nicotime Replacement Therapy 0 0 5,000 0.00% Grant Project Expenditures Health Disparities 25,527 47,597 56,916 83.63% Meaningful Use Incentive 13,072 25,729 40,250 63.92% Susan G. Komen Grant 1,642 1,682 0 0.00% Capital Expenditures Equipment 2,500 3,175 3,175 100.00% IT Equipment 0 4,920 9,515 51.71% Grand Total 2,238,831 4,101,173 8,821,527 46.49% Total County Revenue (Appropriation) 1,621,305 2,602,528 5,680,375 45.82% Agenda Item Number: ORANGE COUNTY BOARD OF HEALTH AGENDA ITEM SUMMARY Meeting Date: January 27, 2016 Agenda Item Subject: Safe Syringe Initiative Attachment(s): 1) Safe Syringe Initiative Presentation 2) Safe Syringe Initiative Proposal Staff or Board Member Reporting: Meredith Stewart, Program Manager & Robin Gasparini, Public Health Nursing Supervisor Purpose: X Action Information only Information with possible action Summary Information: Meredith and Robin will provide an overview of the staff and BOH Substance Abuse and Mental Health Subcommittee's recommendation to start a Safe Syringe Initiative (SSI) at the Orange County Health Department. This will include the health rationale for the program, program overview, and feedback from staff and stakeholders. Staff recommends that the Board of Health vote to approve the implementation of the Safe Syringe Initiative. Following approval, the SSI will be operational no later than April 1, 2016 to allow time for staff training and supply provision. Background: In the 2014 -2016 BOH Strategic Plan, the Substance Abuse & Mental Health subcommittee included researching methods to reduce infections passed through drug misuse and abuse as an action step. The Board received an education session on syringe exchange programs at their June 2015 meeting by Tessie Castillo of the NC Harm Reduction Coalition. Following this presentation, the Board directed staff to investigate the feasibility and design of a program to provide residents with access to safe syringes and disposal of used syringes. Staff researched best practices, communicated with law enforcement and legal stakeholders in the county, held two Substance Abuse and Mental Health subcommittee meetings, and four forums for staff comment on the topic between August 2015 and January 2016. The attached proposal is the culmination of this work. Recommended Action: X Approve _Approve & forward to Board of Commissioners for action _Approve & forward to _Accept as information _Revise & schedule for future action _Other (detail): Safe Syringe Initiative Robin Gasparini Meredith Stewart Substance Abuse & Mental Health Subcommittee Board of Health Meeting 061 )r January 27, 2016 ORANGE COUNTY WALTIH DMUMONT WHY A SSI? • A significant risk for the transmission of HCV is the sharing of syringes, with over 50% of new infections attributable to the practice (Wasley, Miller, & Finelli, 2007). • Between 2007 and 2011 in North Carolina, reported rates of acute hepatitis C (HCV) increased by 200 %. Reported rates of hepatitis A and B both decreased during the same time r)eriod, by 57% and 21% respectively. (CDC, 2013 State Health Profile) • Anecdotal evidence shows that many diabetic patients reuse syringes due to the cost and availability of syringes. ORANGE UNTY HFAITIH DEMRTHIM LOCAL SUPPORT • Law Enforcement — Local law enforcement has indicated their support for this proposal. • Criminal Justice — The District Attorney has expressed support for this proposal. (See attached e -mail) ORANGE UNTY HFAITIH DEMRTHIM PROGRAM DESIGN • The OCHD Safe Syringe Initiative (SSI) was designed using model policies, procedures, and recommended best practices from: — The Kentucky Department of Public Health — The New York State Department of Health — The Foundation for AIDS Research — North Carolina Harm Reduction Coalition ORANGE UNTY HFAITH STAFF FEEDBACK 0 0 4 sessions held to allow for questions & feedback from clinical staff — About 25 staff attended overall Overall, feedback was positive & constructive — Favored simple hand -off process without need to collect demographic data — Stressed desire to "advertise" the program with partners in Orange County (i.e. Project Connect, Freedom House, local law enforcement, etc.) — Interest in having a refresher on sharps and biohazard procedures ORANGE UNTY HFAITH OPERATING PROCEDURES: SSI KITS • Syringes, Fitpacks, &Educational Materials will be packaged in SSI kits (bags) and made available at the front desk of both clinics - Any person who asks for these materials will be given an SSI kit _ - Educational materials will include information on ~ OCHD services, mental health & substance abuse treatment, etc. - SSI kits will also be available in clinics for clinicians to provide to patients ORANGE UNTY HFAITIH DEMRTHEM OPERATING PROCEDURES: DISPOSAL • Anonymous, safe syringe disposal will be available at both sites — Containers allow for secure disposal of individual syringes as well as Fitpacks — Staff will not handle any syringes or Fitpacks themselves. Clients will be responsible for disposing of materials themselves — Emptying of containers will occur by normal clinic procedures ORANGE UNTY HFAITIH DEMRTHEM STAFF TRAINING • All Staff — Information for all staff on SS I basics at next All-Staff meeting and via e -mail • Clinic Staff — Refresher training for clinic -based staff on biohazard and sharps disposal and basics of SSA ORANGE UNTY HPAITIH DEMRTHEM OUTREACH • OCHD staff will meet with key stakeholders to 0 • 0 0 let them know about the SSI Community -based — e.g., Freedom House, NCHRC Law Enforcement o ° ° 0 Legal Leaders �L — District Attorney & Public Defender — Criminal Justice Contacts Safety Net Providers — SHAC — Piedmont Health low — UNC 44 INS! f�.ti� Freedom House Recovery Center rcardinal Inn i n TIF Al. THc CAR PROJECT CONNECT ORANGE COUNTY El Fuluro cgROl✓� 2 �N soiroaa�rr � 2: ~o '0P ORANGE UNTY BFI DEMRTF T EVALUATION • Evaluation will focus primarily on use of the SS1, as measured by: — The # of SSI kits distributed — The amount of syringes disposed at both sites — Feedback from staff on program use and improvements ORANGE UNTY HPAITIH DEMRTHEM Orange County Health Department I Safe Syringe Initiative Proposed January 2016 Background The individual and community health benefits of reducing syringe re -use and removing potentially infectious syringes from the community are clear. • A significant risk for the transmission of HCV is the sharing of syringes', with over 50% of new infections attributable to the practice (Wasley, Miller, & Finelli, 2007). • Between 2007 and 2011 in North Carolina, reported rates of acute hepatitis C (HCV) increased by 200 %. Reported rates of hepatitis A and B both decreased during the same time period, by 57% and 21% respectively. (CDC, 2013 State Health Profile) • No high - quality studies exist, however anecdotal evidence shows that many diabetic patients reuse syringes due to the cost and availability of syringes. Some research concludes that reuse of syringes leads to tissue micro trauma, increased incidence of needle breakage, and increased incidence of lipodystrophy (Look, Strauss, 1998). • A study of 851 injection drug users (IDU) in the Triangle showed that African - American IDUs were one -fifth as likely as white IDUs to report pharmacies as their primary source of syringes (Costenbader, Zule, & Coomes, 2010). • A literature review of 47 studies found that legal or health concerns are not the primary reason for pharmacists' decisions not to sell syringes to customers. The primary concern is safety, such as staff safety, theft, and improper syringe disposal. (Janulis, 2003) • OCHD has built strong relationships with a number of important community stakeholders during our county's work to increase naloxone availability. Cost Considerations The initial set -up and maintenance costs of the SSI at OCHD are expected to be minimal. The majority of the cost will be through personnel time, mainly of the Board of Health Strategic Planning Manager, clinic leadership, and select clinic personnel. Set -Up Costs • $50 — Syringes • $1,000 — Disposal materials (drop box, Fitpacks, etc.) • $250 — Printing costs of educational materials • 40 -50 hours - Staff time to design program (meetings w/ stakeholders, program design, staff training, work with media) • Board of Health member time to attend select meetings with key stakeholders Maintenance Costs per Year • $TBD — Medical waste disposal • $300 — Syringes ($0.05 /syringe, 10 syringes /person, 50 people per month, 12 months) • $250 — Printing costs of educational materials • 36 hours — Clinic staff time to educate clients and dispense syringes (4 hrs /month) • 15 hours — Staff time to monitor program and complete process /output evaluation 1 For the purposes of this summary, the term syringe includes both the syringe and needle components Operating Procedures Provision of Safe Syringe Initiative (SSI) Kits a. Any individual requesting syringes will be given a pre - packaged SSI kit that includes clean syringes, education and referral materials, and safer sex materials. b. SSI kits will be available at the front desk of each OCHD clinic and also within clinics for patients. Education attempts should be made whenever appropriate or feasible. Topics to discuss include HIV and Hepatitis A, B, C prevention, safer sex, and safer injection techniques. Participants should be encouraged to participate in individual and group delivered behavioral interventions and skills building activities. Although enrollees are offered services in addition to syringe exchange, they are under no obligation to participate in them. II. Linkage to Care a. OCHD may make provide services and referrals to outside providers according to current policies for OCHD patients. Referrals may include, but are not limited to: anonymous and confidential HIV counseling and testing services, HIV, Hepatitis A -C and general primary health care facilities, family planning, prenatal and obstetrical care, substance use treatment and related medical services, tuberculosis screening and treatment, sexually transmitted infection screening and treatment, case management and support services for HIV - infected people, and mental health services. III. Staff Training a. All staff will be trained in the basics of the SSI, including locations, procedures for a client receiving syringes, and harm reduction philosophy. b. Additionally, staff that provide syringes through the SSI will receive refresher training on the OCHD's approved policies and procedures that cover: i. Disposal of infectious waste and needle stick prevention management. ii. Procedures for making referrals, including primary care, detox and drug treatment, HIV counseling and testing, prenatal care, tuberculosis and Hepatitis A, B and C screening and treatment, screening and treatment for sexually transmitted infections, and other HIV support and social services. IV. Disposal a. Infection control training and procedures will follow follow existing policies and procedures outlines in the OCHD Infection ControlBloodborne Pathogens Program Manual. b. Individuals will be instructed to return used sharps to the Orange County Health Department. OCHD staff members should never dispose of syringes or other SSI materials for a client. Staff should instruct the client to dispose of the materials in the appropriate sharps disposal containers. c. Syringes that are returned to OCHD in glass jars or coffee cans will be accepted and carefully deposited in a sharps container by the participant. OCHD staff will educate participants on the appropriate type of plastic containers that should be used for syringe disposal. d. Personal sharps containers (Fitpacks) and FDA approved sharps containers may be discarded. e. Participants should be educated about proper disposal of syringes when they are unable to come to the OCHD. Inappropriate methods of syringe disposal such as the following should be discouraged: breaking off the tip and discarding in trash, disposal on the street or other public venues; disposal of used syringes in household garbage or residential sharps programs without containment in sealed, labeled plastic puncture resistant containers, flushing in toilets; disposal of syringes in the trash in glass jars or coffee cans. Many substance users think that syringes are discarded safely if needles are broken off and thrown in the garbage separate from the barrel of syringes. It is important to educate participants that throwing out needles in this way exposes municipal workers (sanitation) to needle stick injury. If participants are intent on discarding syringes in this manner, they should be encouraged to remove plungers from the barrel of used syringes, place needles in the barrel and replace plungers. This will reduce the risk of needle stick injury to others. V. Data Collection and Program Reporting a. Quarterly Reports i. Monthly narrative and statistical reports shall be submitted to the Nursing Services Supervisor. Quarterly reports shall be compiled by the Nursing Services Supervisor and provided the Board of Health Strategic Planning Manager. Quarterly reports shall include but not be limited to: 1. Number of enrolled participants; 2. Number of syringes collected from participants, including the average number furnished per participant per transaction; 3. Number of syringes furnished to participants, including the average number collected per participant per transaction; 4. Number and types of services directly provided or provided by referral including referrals for HIV counseling and testing; health care services (including evaluation and treatment for HIV infection, Hepatitis A -C, sexually transmitted infections, tuberculosis; family planning; obstetrical and prenatal care), supportive services; substance use treatment services; and 5. Significant problems encountered and program milestones achieved. b. Annual Report i. The Board of Health Strategic Planning Manager shall provide an annual report of activities and statistical reports to the Board of Health. VI. Complaints and Concerns a. Incidents related to the SSI from community or law enforcement shall be reported in accordance with the Orange County Health Department's Complaint Policy. The purpose of these reports is to ensure documentation of incidents in order to identify and address potential problems. b. Orange County Health Department staff will refer to Administrative Policy V.8.0 "Dealing with a Potentially Dangerous Client or Family Interactions" if any client becomes emotionally labile and angry. Evaluation Evaluation of the SSI should include both process /output measures and outcome /impact measures. Measures of the process and outputs, such as the number of syringes dispensed and number of clients dispensed to, will be relatively simple. These measures will require pharmacy tracking logs much like ones already in place for other medications and naloxone. Process indicators • Number of hours open per week for syringe provision • Number of OCHD staff assessing client need for syringes and referring to SSI • Number of OCHD staff reporting support of SSI • Number of stakeholders reporting support of SSI Output indicators • Number of participant contacts • Number of syringes distributed • Estimated number of syringes returned for disposal Applicable State and Local Rules/Regulations on Syringe Provision in NC The state of North Carolina is one of 41 states that do not require a prescription for the retail sale of syringes2. The applicable state law governing the knowing use, possession, or delivery of syringes for illegal drug use in North Carolina is the North Carolina Drug Paraphernalia Act (1981, c. 500, s. 1.) GS § 90- 113.22. § 90- 113.22. Possession of drug paraphernalia. a) It is unlawful for any person to knowingly use, or to possess with intent to use, drug paraphernalia to plant, propagate, cultivate, grow, harvest, manufacture, compound, convert, produce, process, prepare, test, analyze, package, repackage, store, contain, or conceal a controlled substance other than marijuana which it would be unlawful to possess, or to inject, ingest, inhale, or otherwise introduce into the body a controlled substance other than marijuana which it would be unlawful to possess. b) Violation of this section is a Class 1 misdemeanor. c) Prior to searching a person, a person's premises, or a person's vehicle, an officer may ask the person whether the person is in possession of a hypodermic needle or other sharp object that may cut or puncture the officer or whether such a hypodermic needle or other sharp object is on the premises or in the vehicle to be searched. If there is a hypodermic needle or other sharp object on the person, on the person's premises, or in the person's vehicle and the person alerts the officer of that fact prior to the search, the person shall not be charged with or prosecuted for possession of drug paraphernalia for the needle or z Law Atlas, accessed August 2015 sharp object. The exemption under this subsection does not apply to any other drug paraphernalia that may be present and found during the search. For purposes of this subsection, the term "officer" includes "criminal justice officers" as defined in G.S. 17C- 2(3) and a "justice officer" as defined in G.S. 17E -2(3). (1981, c. 500, s. 1; 1993, c. 539, s. 624; 1994, Ex. Sess., c. 24, s. 14(c); 2013 -147, s. 1; 2014 -119, s. 3(a).) § 90- 113.23. Manufacture or delivery of drug paraphernalia. a) It is unlawful for any person to deliver, possess with intent to deliver, or manufacture with intent to deliver, drug paraphernalia knowing that it will be used to plant, propagate, cultivate, grow, harvest, manufacture, compound, convert, produce, process, prepare, test, analyze, package, repackage, store, contain, or conceal a controlled substance which it would be unlawful to possess, or that it will be used to inject, ingest, inhale, or otherwise introduce into the body a controlled substance which it would be unlawful to possess. b) Delivery, possession with intent to deliver, or manufacture with intent to deliver, of each separate and distinct item of drug paraphernalia is a separate offense. c) Violation of this section is a Class 1 misdemeanor. However, delivery of drug paraphernalia by a person over 18 years of age to someone under 18 years of age who is at least three years younger than the defendant shall be punishable as a Class I felony. (1981, c. 500, s. l; c. 903, s. 1; 1993, c. 539, s. 625; 1994, Ex. Sess., c. 24, s. 14(c).) As of December HB 8850 the Possession of Needles /Tell Law Officer Law states that if a person alerts an officer to the fact that he /she has a hypodermic needle or other sharp object on her person, premises or vehicle prior to a search he /she cannot be charged or prosecuted with possession of drug paraphernalia for that object. The purpose of this law is to protect officers from punctures or wounds from sharp objects that could be potentially contaminated with HIV or hepatitis C and to encourage suspects to be honest with officers about paraphernalia they may have in their possession. Health Director's Report January, 2016 • 1 officially took over as the President of the Health Director's Association at the State Health Director's Conference in January. I gave a short welcome speech which I've attached to this report. • Medicaid Reform and Cost settlement have had me spending a lot of time in Raleigh. In fact, one week I went to Raleigh 4 consecutive days. We are making progress on both and I know that this time will be beneficial not just to statewide public health, but also to Orange County. • This is budget season, so we are learning about budget submission requirements under new leadership at both the state and county level. More changes locally than at the state, but we always have a strong budget, so I'm not terribly worried. • Meredith and I attended a 1.5 day training on Facilitative Leadership sponsored by Blue Cross and Blue Shield foundation. It was a good refresher for both of us as we increasingly work with our communities to address the social determinants of health. • Work is finishing up on the Community Health Assessment. This work is the foundation for our BOH strategic planning process which will start in March. I've attached a more detailed outline of what to expect to this report. • 1 started teaching this semester. The first two classes have gone well. The only concern I have is that the class is 3 hours and after class I barely have a voice left. Apparently life as a politician is not in the cards for me! My voice couldn't take it. • Meredith and I are both fielding a lot of calls about naloxone. The state wants to expand access by making some changes to how naloxone can be distributed and a few counties who are dealing with spikes in opioid - related deaths want to quickly establish programs through their Health Departments. • Speaking of naloxone, we accepted the Innovation in Government award in December for the collaborative effort to dispense naloxone through training and partnerships with law enforcement. • Speaking of innovation, we have rolled out the third round of Innovation Grants for the Health Department. This year was spectacular with the most applications from the most first time applicants. We funded a diverse set of innovative ideas include one for which I'd like us to explore patent options. • I've been doing some strategic planning work with the Family Success Alliance (I don't know what it says about a person for whom strategic planning is one of their absolute favorite things to do.), and they are doing a nice job of settling into their roles while building the plane as they learn how to fly it. I'm super impressed with all involved. • We spent some time working with the state to correct a published report on the number of syphilis cases in Orange County. They are reporting more cases than we have. We think they have figured out the problem and look forward to the next report that will reflect a slight increase, but not the 300% increase they erroneously reported. • We are working with Caitlyn and the Jail Alternatives groups to pilot a Health In All Policies process. We will keep everybody posted on our progress and I will send you the report Caitlyn is giving the BOCC. • A group of 6 people from Orange County attended a 1.5 day MCH Action Institute to learn how to work collectively to improve infant mortality rates. The irony is that the training was on Collective Impact 101 and we've already advanced to at least the 300 level. It was a required training to receive $20,000, so we went and then gave our feedback about how they could improve. Overall, however, it was not a good use of our time. • I've conducted two "Personnel trainings" over the last few weeks for supervisors, primarily focused on hiring, disciplining and terminating employees. Because we fall under the state personnel act rather than the county's personnel ordinance, we can't rely on HR to provide this training for us. • Finally, to end on a good note, at the Board meeting you'll see a video and nomination packet for Phase II of the Robert Wood Johnson Culture of Health Prize. We're super excited about this national competition and feel extremely proud of our nomination. I believe you will too. Good morning and welcome to the _ Annual State Health Director's Conference. This is my 18th time participating in this conference, and my advice for those of you for whom this is your first is this: the presenters are amazing, some of the best you'll see no matter what conferences you attend; the food is better than average (except that one year they served fish ... well, we think it was fish); but it is the company which is truly the best part of the next two days. I've been a local health director since 1997 and many of you may know that I took an 18 -month sabbatical to move to South Carolina, where I worked with a great group of folks in Greenville to start and direct a statewide non - profit called the Institute for Child Success or ICS. ICS combines research and advocacy to influence policies which support children during that most important time from birth through third grade. That experience was everything I'd hoped it would be except for one thing: I was professionally lonely. I didn't have a network of people throughout the state who faced the same challenges that I could call with questions or just to vent. You know, that person whose board member /commissioner /employee is crazier than yours. Without that I realized all I really had in Greenville was a job. What I had in North Carolina public health was a family who provided the support I needed to return to a job that is the most invigorating, frustrating, exhausting, exhilarating, amazing calling ever. So my advice to you is to spend as much time with your public health family as you can. Hang out in the hospitality suite and sit with new people at lunch and dinner. Build those relationships which ultimately will keep you going through thick and thin. Make sure you use the time we're gathered here to do so. And since I have the podium for another few minutes, I will also share a secret with you: we all feel overwhelmed, unsure and scared when faced with a new change regardless of how long we've been doing this. You know what they say ... the only person who likes change is a wet baby. I imagine we'll hear about more new changes in the next two days and for most of us we'll wonder if dealing with this change will be the straw that breaks the camel's back. Maybe, though there really isn't such a thing as a new change. Maybe it is more like when a marching band learns a new routine. Anybody here a band geek like I was in High School? In marching band, you learn 4 -5 routines each year. So the end result for the audience is a completely different set of moving pictures set to an exciting musical script ... a new routine. But for those of us in the band, however, each new routine mostly built on a skill set we already had. In my case, I played trumpet. I didn't have to learn how to play the trumpet from scratch for each new routine. I learned new music which built on my existing knowledge. I also knew that if we were marching in a square on the field for example, we did that in a very similar way to how we marched in a rectangle the last time, again building on my existing skills. Every single change we will encounter in the future will build on our experiences in the past. Are you worried about Medicaid Reform? Me too, but I also know that we've already experienced significant health system reform over the last 20 years. Think about the balanced budget act of 1997 or the terrifying switch health departments had to make to start billing using CPT codes in 1988. Think about how many health departments have electronic health records today when most didn't even have personal computers twenty years ago. I could go on and on ... but think about it. All of these big new changes have two things in common: 1) before we made it through each of them, there were some who portended the end of local health departments as a result of that particular change and 2) each change gave us a fundamental skill that made the next change easier. Think about it ... as a result of BBA we became better lobbyists to help politicians, especially at the Federal level, understand the effects of their decisions and a couple of years later most of the worst parts of BBA were repealed. We now have a paid lobbyist and work daily to develop the personal relationships we need with decision - makers to help ensure the public's health is forefront on their minds. The transition to using CPT codes made adopting ICD 10 way easier than anybody predicted. And think of all the technology skills we've learned in the last 20 years that are allowing us to embrace the use of EHRs along with apps and telehealth. So, yeah, Medicaid Reform scares me, but like Isaac Newton I know we stand on the shoulders of giants ... those in our public health family who went before us and built the platforms from which we have learned everything we need to thrive. I know that from these platforms, what we learned last year and what we'll learn here together over the next two days will prepare us to survive and even thrive in the face of any change - related challenges we face. I hope you'll enjoy this conference as much as I expect I will and I hope to see you at lunch, dinner and in the hospitality suite. 2016 -2018 Board of Health Strategic Planning Process The 2015 Community Health Assessment is complete and the resulting Community /Healthy Carolinians priorities are: 1) Mental Health /Substance Abuse, 2) Social Determinants of Health (e.g., transportation, access to care, poverty), and 3) Physical Activity /Nutrition. The report will be finalized and submitted to the state and the Board of Health in March 2016. Keeping with the precedent from previous Board of Health Strategic Plans, the Chair and Vice -Chair of the Board of Health have decided to adopt the same priorities as the Community /Healthy Carolinians priorities listed above. The Board will go through a prioritization process together to select the focus areas for each priority. Then, each subcommittee will work to select their action steps for the 2016 -2018 Board of Health Strategic Plan. The proposed timeline and process are: • March BOH meeting o Presentation of CHA report, including Community Priorities o BOH votes to accept CHA 0 5 -6 potential focus areas for each priority presented to the full board for discussion and additions, and prioritization (dot voting exercise) • Subcommittees meet once between March and May BOH meetings to develop their action steps • May BOH meeting • Subcommittees present their recommended action steps • Between May and June BOH meeting, staff compile action steps into 2016 -2018 strategic plan with timelines • June BOH meeting o Full Board vote to approve 2016 — 2018 BOH strategic plan Note: Focus Areas are broad strategies to address a health priority topic area. Examples from the 2014 -2016 strategic plan Access to Care priority are: 1) Serve as a catalyst and advocate for health outcomes in the Orange County Child Poverty Project 2) Advocate for and pursue policies /legislation to improve access to care 3) Foster a culture of innovation at the Health Department 4) Actively communicate about effective interventions and advocate for their funding Action steps are specific, time - limited activities to make progress toward the focus area in a short period of time. Examples from the 2014 -2016 strategic plan Access to Care priority, Focus Area 1 are: 1) By July 2014, the Access to Care Subcommittee will designate a Board of Health member to serve on the Orange County Child Poverty Council. 2) By October 2014, the Access to Care Subcommittee or their appointee will present the project overview to identified county stakeholders. 3) At least twice per year, the Board of Health will receive regular reports on the activities and progress of the Orange County Child Poverty Council, and provide input as appropriate. 4) By July 2016, the Access to Care Subcommittee will review the gap analysis report on programs and services to achieve a pipeline to success in Orange County from the Orange County Child Poverty Council, and provide recommendations on priority public focus areas, programs and policies. ORANGE COUNTY HEALTH DEPARTMENT INNOVATION GRANT 2015 END OF YEAR REPORT 2016 GRANT AWARDS Submitted January 15, 2016 01/15/16 2014 Innovation Grants The Innovation Grant Fund ($20,000) was established when the Board of Health passed their Innovation Resolution in August 2012. Each year, staff submit innovative proposals to provide better care, better health, and reduced healthcare costs for Orange County residents. Projects run on a calendar year cycle. This report summarizes the 2015 projects which ran from January 2015 to December 2016. The 2015 cycle funded eight (8) projects, as listed below. Innovator(s) Proposal Name Grant Amount Page Susan Clifford Video Remote Interpretation (VRI) Software and Hardware $5,000 2 Victoria Hudson Food Safety Quick Cards $1,750 3 Mike Fliss Under Desk Elliptical $650 4 Donna King Whitted Bike Share Program Pilot $3,250 5 Meredith Stewart Interactive Online Publishing: Issuu $750 6 Denise Shaver Innovation Book Club $1,650 7 Coby Austin Mobile Technologies That Work: Quitting Smart $350 8 -9 Coby Austin & Alan Clapp Healthy Homes Pilot 10 Total 2015 Grant Funds $13,400 1 Q 01/15/16 VRI: Remote Video Interpretation LESSONS LEARNED The Remote Video Interpretation project has been a challenging project and significant learning process for technology - related Innovation Grant projects. As is the case with many projects that involve new technology, many challenges that were not originally anticipated arose throughout the process. This included needing to upgrade wireless in both clinic sites to maintain video connection and a new requirement for cyber liability insurance from the county. Despite these challenges, project staff worked diligently to make this a reality. Interpretation staff piloted video interpretation and was very pleased with the technology. Additionally, the project has informed a new process for working with IT for Innovation Grants starting as staff are preparing proposals. 2 01/15/16 Food Safety Quick Cards LESSONS LEARNED This project was a relatively quick and impactful project. It took less than 5 hours of initial staff time. Cards are given during regularly scheduled inspections, and to all newly permitted food service establishments. Qualitatively, the cards have received very positive feedback from establishment owners and operators that they are doing what was expected. Operators recount that employees know how and when to report an illness of foodborne significance. The cards have also received the attention of other EH Departments in the NC. Several have asked for "permission to copy," or for contact information with the plastics company. In short, the focus of the project may have an unintended positive outcome on process improvement by effectively providing Employee Health Policy training materials. 3 01/15/16 Under Desk Elliptical LESSONS LEARNED This project followed positive experiences with the sit -stand desks and endeavored to pilot new technology for staff wellness. Following staff turnover of the project lead, this Innovation Grant was not completed and funds were diverted to the Healthy Homes Pilot. 4 01/15/16 Whitted Bike Share Program LESSONS LEARNED The Bike Share Program encountered some initial challenges in understanding program liability. As a result, the project funds were shifted to support wearable tech for OCHD staff to encourage participation in two walking challenges. OCHD now has 32 Fitbits funded by Innovation Grant funds for use by staff. Preliminary "before" surveys from wearable tech participants (N =36) show: • 77.78% Fitness Objective: positive mental health benefits of Physical Activity. • 69.4% Wearing tech because they are curious to see how active they are. • 44.44% Exercise outside of workhours, 3 -5 hours per week. • 56% Never walk during the work day. The Bike Share Program is now available at Whitted, with one bike and helmet on the third floor available for use. 5 @ 01/15/16 Interactive Online Publishing LESSONS LEARNED Materials planned to be published using Issuu were not ready to be published. The first publication will be the Family Success Alliance Gap Analysis Report in January 2016. 01/15/16 Innovation Book Club LESSONS LEARNED Following staff turnover of the project lead, this Innovation Grant was not completed and funds were diverted to the Healthy Homes Pilot. 7 01/15/16 Tobacco App Pilot LESSONS LEARNED Although all participants had smart phones, many of them had barriers to downloading an app and instead tested out a text messaging service. Some barriers to downloading apps included: • Having a Windows phone (none of our trusted app providers have created one for that platform) • Not having a credit card. To activate some app stores, even just to download free apps, users are required to enter credit card information. • Not having a data plan, which prohibited some people from using apps There were additional barriers for people who were not able to test an app, but wanted to participate in the study by testing out a text messaging service: 8 01/15/16 • Having a pay -as- you -go text messaging plan, which resulted in a cost to clients that deterred them from participating • Text messaging services require clients to receive messages from a 6 -digit phone number. These types of 6 -digit numbers can sometimes charge clients a fee so phone carriers require the user to acknowledge that they may be charged for sending /receiving messages from that number. Even though the smoking cessation text messages are all free of charge, just having to acknowledge that they might have to pay a fee was a deterring factor for some clients. This pilot has shown that it is feasible to create a list of technologies for health promotion, and some clients will take advantage of these recommendations. There remain significant logistical challenges to individuals downloading apps based on their phone or payment situation. OCHD staff are continuing to review logistical and legal solutions to increase texting and other mobile technologies for health promotion. 9 01/15/16 Healthy Homes Pilot LESSONS LEARNED The Healthy Homes pilot began work in the fall of 2015 and reached its initial number of home visits by December. Environmental Health, Health Promotion, FSA, and school system staff have been working well together to make referrals, home visits, and follow -up to families. Feedback from families and partners has been extremely positive, as evidenced by the number of referrals! With additional funds, staff expect 3 -4 referrals per month for a total of 20 visits in FY 15 -16. Staff are working hard to fit this increased demand into their schedules. 10 01/15/16 2016 Grant Awards This was an exceptional year for our Innovation Grant program. The 2016 cycle funded ten (10) projects, as listed below, from a record number of proposals (24 total). Also a record this year was the number of proposals and funded projects from applicants who had never applied and/or received a grant before. The majority of proposals not funded through the Innovation Grant this year will be funded through existing departmental budgets. 2016 Innovation Grant Funded Proposals Innovator(s) Proposal Description Grant Name Amount Victoria Food The innovation grant will be used to design 750 Hudson Establishment and to disseminate food safety information Excellence through a series of infographic stickers. The Program 4" x 4" or 6" x 6" OCHD vinyl- coated stickers in three styles will feature infographics that address gaps in English proficiency in Orange County's multicultural, food service workforce. Meredith Supporting This innovation grant will support a pilot $3,105 McMonigle & Transportation project to explore using Uber as a Allison Young Solutions for FSA transportation solution for low- income families families in Orange County. The pilot will be with families enrolled with FSA. Kathleen Mindfulness Research has shown that Mindfulness $1,500 Goodhand, Training Training and learned techniques can have a Rebecca positive effect on reducing employee work Crawford and stress and increasing morale. Excessive work Pam McCall stress and low morale can lead to employee absenteeism, turnover and poor customer service, all of which affect our clinical staff. We propose to contract with a certified Mindfulness Instructor to offer training to clinical staff for a period of 8 sessions. Melissa James Nutrition This project is an innovative way to extend $900 Services: Client the Kudos concept by developing a note card Feedback as a that Medical Nutrition Therapy (MNT) and /or Marketing Tool Diabetes Self- Management Education (DSME) clients can write a message to his/her referring medical provider explaining how he /she benefited from these Health Department services. This card will serve as a 01/15/16 cue to medical providers to remind them to continue referring and will also serve as a tool to inform medical providers of client satisfaction. Teresa Martin, Technology Funding is requested to cover the cost of $2,500 Christy Access for Patient technology dedicated to prenatal, postpartum, Bridges, Jean Education and and newborn -care patient education in McDonald Satisfaction English and Spanish. Low literacy levels identified and addressed in traditional education modalities have not reduced ED admissions of our newborns and unnecessary visits to UNCH by our MH patients. Victoria Corrective Action These infographic stickers will be affixed in $1,800 Hudson Stickers food service establishments as an education tool and a corrective action for violations of risk factors associated with hand sink usage, cross - contamination in refrigerated storage, and cooling foods. Tracey Double Handle Grant to create /modify a lifting tool for heavy 750 Langley and Lift Tool concrete lids (septic tank lids) for John Davis environmental health staff. Ana, Sallie, Prenatal Oral Create incentive program to encourage $4,200 Stephanie Health Incentive families to complete recommended initial and Program follow -up prenatal dental visits. LaTosha and Project Safe Sleep Exploring the option of safe co sleep and $650 Shelley SIDS awareness for families actively participating in home vising programs. Patients whom complete evidence based training and newborn post - partum home visit will receive safe sleep certificate and infant basket to support healthy co- sleeping. Tracey Septic Develop a Smartphone Application that $4,000 Langley and Maintenance App includes information for homeowners on basic John Davis tank maintenance, effluent filter cleaning (majority of homeowners don't even know their system has a filter), biosolids or septage removal guidance, drainfield maintenance, inspection, etc. The app would also allow the operator to set up reminders of when various maintenance items are due and connect to additional resources, how to videos, etc. Total Funded $20,155 Health Director's Report January, 2016 • 1 officially took over as the President of the Health Director's Association at the State Health Director's Conference in January. I gave a short welcome speech which I've attached to this report. • Medicaid Reform and Cost settlement have had me spending a lot of time in Raleigh. In fact, one week I went to Raleigh 4 consecutive days. We are making progress on both and I know that this time will be beneficial not just to statewide public health, but also to Orange County. • This is budget season, so we are learning about budget submission requirements under new leadership at both the state and county level. More changes locally than at the state, but we always have a strong budget, so I'm not terribly worried. • Meredith and I attended a 1.5 day training on Facilitative Leadership sponsored by Blue Cross and Blue Shield foundation. It was a good refresher for both of us as we increasingly work with our communities to address the social determinants of health. • Work is finishing up on the Community Health Assessment. This work is the foundation for our BOH strategic planning process which will start in March. I've attached a more detailed outline of what to expect to this report. • 1 started teaching this semester. The first two classes have gone well. The only concern I have is that the class is 3 hours and after class I barely have a voice left. Apparently life as a politician is not in the cards for me! My voice couldn't take it. • Meredith and I are both fielding a lot of calls about naloxone. The state wants to expand access by making some changes to how naloxone can be distributed and a few counties who are dealing with spikes in opioid - related deaths want to quickly establish programs through their Health Departments. • Speaking of naloxone, we accepted the Innovation in Government award in December for the collaborative effort to dispense naloxone through training and partnerships with law enforcement. • Speaking of innovation, we have rolled out the third round of Innovation Grants for the Health Department. This year was spectacular with the most applications from the most first time applicants. We funded a diverse set of innovative ideas include one for which I'd like us to explore patent options. • I've been doing some strategic planning work with the Family Success Alliance (I don't know what it says about a person for whom strategic planning is one of their absolute favorite things to do.), and they are doing a nice job of settling into their roles while building the plane as they learn how to fly it. I'm super impressed with all involved. • We spent some time working with the state to correct a published report on the number of syphilis cases in Orange County. They are reporting more cases than we have. We think they have figured out the problem and look forward to the next report that will reflect a slight increase, but not the 300% increase they erroneously reported. • We are working with Caitlyn and the Jail Alternatives groups to pilot a Health In All Policies process. We will keep everybody posted on our progress and I will send you the report Caitlyn is giving the BOCC. • A group of 6 people from Orange County attended a 1.5 day MCH Action Institute to learn how to work collectively to improve infant mortality rates. The irony is that the training was on Collective Impact 101 and we've already advanced to at least the 300 level. It was a required training to receive $20,000, so we went and then gave our feedback about how they could improve. Overall, however, it was not a good use of our time. • I've conducted two "Personnel trainings" over the last few weeks for supervisors, primarily focused on hiring, disciplining and terminating employees. Because we fall under the state personnel act rather than the county's personnel ordinance, we can't rely on HR to provide this training for us. • Finally, to end on a good note, at the Board meeting you'll see a video and nomination packet for Phase II of the Robert Wood Johnson Culture of Health Prize. We're super excited about this national competition and feel extremely proud of our nomination. I believe you will too. Health Department Offering Free Radon Test Kits By Chris Grunert Posted January 6, 2016 at 2:11 pm The Orange County Health Department is offering free radon testing kits to use in your home. Radon is the second leading cause of lung cancer in the United States and the number one leading cause among non - smokers. Radon is a naturally occurring gas but when high levels enter a house it can become toxic, according to the Environmental Protection Agency. It is a colorless, odorless gas that can seep through cracks in the walls. The EPA has identified more than 20,000 deaths each year from radon exposure. The best way to protect you and your family from radon is to test your home. If unsafe levels of radon are identified, there are radon reduction systems that can reduce levels in a home by up to 99 percent, according to the Orange County Health Department. Radon is present at elevated levels in about seven percent of homes in North Carolina, according to data collected by the Radiation Protection Section in the Division of Health Service Regulation. This month is National Radon Action Month, so the Health Department is offering free test kits while supplies last. The free kits are available at the Orange County Health Department's Environmental Health Office located at 131 West Margaret Lane, Suite 100 in Hillsborough. INDY�: raleigh•cary durham- chapel hill Durham County cracks down on e- cigarettes By David Hudnall Photo by TBEC Review /Courtesy of Creative Commons License Attribution 2.0 Generic Another new law for the New Year: Vapes are now the same as cigs in the eyes of Durham County law enforcement. That means no more e- cigarettes on city or county property, including parks and trails and within a 100 -foot radius of bus stops. Bars and restaurants can still decide for themselves whether they want to be vape- friendly, per state law. "We have sent out letters to local restaurants to let them know that it's within their right to restrict its use," says Durham County Public Health director Gayle Harris. Wake County has a similar county- property a -cig ban. Orange County hasn't yet added e- cigarettes to its Smoke - Free Public Places Rule, but communications manager Stacy Shelp says the county's board of health will be considering action this year. Jason Joyner, lobbyist for a klatch of brick - and -mortar shop owners, e- liquid makers and other vape- product suppliers known as the N.C. Vaping Council, says Durham County's decision was no big surprise. "Every county or municipality has the right to do it, but I did find it interesting that [Harris'] tagline on the announcement was basically, 'We know it's not as safe as clean air, so we're going to ban it in public places, "' Joyner says. "Well, if that's the precedent, then what else do we ban? Bus exhaust? What about the bull at the ballpark that blows out the huge cloud of smoke when the batter hits a home run? Is that within 50 or 100 feet of the public sidewalk ?" Moe Makki, of Cloud Vape Lounge in south Durham, says he's not too worried about the ban. "I'm more worried about the juice tax," he says. North Carolina recently became the first state in the country to pass a tax -5 cents per milliliter —on e- liquid. (That's the juice that fills up those complex - looking vaping instruments that are en vogue these days.) The law went into effect this past July. Gregory Conley of the American Vaping Association, a national advocacy group, sees a connection between the tax and the fact that North Carolina is tobacco country. "The reason that tax passed is because R.J. Reynolds supported it," Conley says. The Winston -Salem -based company has an a -cig product, VUSE, but it's what's referred to as a cigalike, which is disposable and doesn't require the purchase of e- liquid. "Tobacco companies don't want to shut down the e- cigarette product category completely, because they offer some e -cig products. But they want to erect barriers to keep new businesses from competing." Harris says the first six months of the ban are meant to be educational. "We're just trying to get the word out," she says. "We're not trying to fine anybody. You'd have to ignore several warnings to get a fine." Reach the INDY's Triangulator team at triangulator*ndyweek.com. Durham County Bans E- Cigarette Use In Public Places By Joey DeVito t "omcd Uecemher 31, 2015 at 12:23 pni Durham County has closed the loophole that allowed electronic cigarette use in public places. The ban will begin January 1, 2016. "The enforcement part will come into play in July of 2016," said health department director Gayle Harris. "We're going to spend the next six months putting the signage up, educating people and doing a better job campaigning." The ban will make it illegal to use e- cigarettes in places such as sidewalks, parks, bus stops and other public property, except where there is a permitted smoking section. "What we've seen with the introduction of electronic nicotine delivery systems has been an uptick in the use with teenagers," she said. "We certainly don't want to create an environment that sends the message that smoking is okay." Harris said non - smoking areas will be designated with the standard no smoking sign, but these areas will also include a sign that lets residents know e- cigarettes are not allowed. "There is now a universal symbol for electronic nicotine delivery systems that will also be included within a circle with a line through it," she said." In Orange County, there are a number of places, such as schools, libraries and UNC athletics facilities, which currently ban the use of e- cigarettes. However, they do not fall under the Orange County smoke free public places rule. "At this point they are not looking to extend the rule to include e- cigarettes," said Orange County Health Department public information officer Stacy Shelp. "At this point the place is to research this issue more and look at the health implications and whether or not they want to take action on it in the new year." Orange County Honored For Use Of Life Saving Drug r3;r Joey DeVito )ecember 8, 2015 at 12: 01 p? -�` N °��xone for Lary Fnlorr�mmii �' � e 'a Orange County received the Excellence in Innovation Award from the North Carolina Association of County Commissioners, on Monday night, for the Naloxone Project, which has saved the lives of four people who have overdosed on opioids. Officers across the county have started carrying naloxone kits, which help combat the effects of a heroin overdose. "With naloxone it's really neat because it builds a bridge," said Captain Chris Atack of the Carrboro Police Department. "You basically have more time to get that person to medical facilities where they can bring that person out of that danger." He said it cost his department $700 to train and supply all of their officers. During an opioid overdose, the brain tells the body to stop breathing. Sheriff Charles Blackwood said naloxone starts the breathing process again, but in a way that is safe for both officers and the person involved. "When you have someone that may come out of an opioid overdose they're violent, often times very violent, to the point you'd rather they go back to sleep" he said. "But sleep is death. This minimal dose will allow you to start breathing again, but you don't come back in a combative state." Orange County is the first health department to take advantage of the 2013 Good Samaritan /Naloxone Access legislation, allowing doctors, family and friends to administer naloxone to someone who overdoses on opioids, without being prosecuted. "Naloxone, also known as Narcan, quickly and effectively reverses overdose, if administered in time. This program places Orange County on the map, leading the way for other communities to follow this cost effective, life- saving example," said Dr. Colleen Bridger, director of the Orange County Health Department. Because of Orange County regulation, before EMS is allowed on the scene, police officers must arrive first and make sure it is safe for unarmed personnel. "It may take (EMS) a minute or two, three minutes depending on where they're staging, so if the officer can do that quick assessment, assemble the kit and administer that naloxone, you're talking minutes," Atack said. "Minutes when you're running out of oxygen, when you're brain is starving, when you may go into cardiac arrest because there's not enough oxygen, can really save a life." Kim Woodward of Orange County EMS said medical staff has been carrying naloxone for nearly 30 years and due to changes made in 2013, non - medically trained officers are now able to carry it as well. "Because the Good Samaritan Law expanded, it allowed lay -folks to give the naloxone," she said. "If lay - folks can give the naloxone, then non - medically trained folks, such as our law enforcement, could give the naloxone as well." Atack said heroin use across Orange County is on the rise due to the federal government making it harder for people to get prescription opioids. "It's a second or third chance at life for someone to get clean," he said. "I've seen neighbor's kids suffer with addiction and I can't imagine dealing with that on a daily basis so anything we can simply do to give someone a shot to get right." Officers in Chapel Hill, Carrboro and across the rest of Orange County are now trained and carrying naloxone kits. Blackwood said 97 percent of his staff has been trained. tarheel Vaccination exemptions increase risk of disease BURHAN KADIBHAI I PUBLISHED NOVEMBER 24, 2015 Vaccine - preventable diseases pose risks for possible outbreaks in schools in Orange County — and the rates reflect that risk. Of the children enrolled in all Chapel Hill - Carrboro City Schools, 15 have received medical exemptions and 127 have received religious exemptions from school- required vaccinations in the 2015 -2016 school year. BY THE NUMBERS 142 exemptions for 2015 -2016 75 exemptions in 2008 -2009 622 cases of pertussis in 2013 478 cases for under age 20 The number of religious exemptions in Chapel Hill - Carrboro City Schools has increased since the 2008 -2009 school year, when 75 students received exemptions. Jeff Nash, spokesperson for CHCCS, said some parents do not vaccinate their children due to religious reasons, which is an approved exception policy, but there are only a few of these exceptions. "The vaccination rates are high in our schools, but there is still room for improvement," Nash said. "We are continuously educating students regarding safety." The Emerson Waldorf School, an independent pre -K to 12th grade school, has a student vaccination rate of approximately 62 percent, which is the lowest rate throughout Orange County public and private schools. In 2013, 622 cases of the vaccine - preventable disease pertussis, commonly known as whooping cough, were reported in North Carolina. 478 cases of the disease were people under the age of 20. Judy Butler, the public health nursing supervisor for Orange County, said the issue of outbreak is not restricted locally, but is nationwide. "There was a measles outbreak that affected several states that resulted from someone who was unvaccinated bringing measles from abroad," Butler said. Butler said she thinks educating parents to look at the proven data about vaccinations is the key to increasing the rate of child vaccinations. "There were some studies that linked vaccinations to autism, and they have been disproved," Butler said. "They have been found to be falsified, but a lot of people listen to those studies. That's a small part of the population. The vast majority of people do believe in vaccinations." Butler said another issue is the importance of considering children with compromised immune systems, like those undergoing chemotherapy, because unvaccinated children may transfer diseases. "We need to make sure all of us who can be vaccinated are to help those children, in my opinion," Butler said. Julie Upchurch, a UNC junior said she saw both sides of the vaccination argument. "I am sure there are risks and benefits to both," Upchurch said. "From the impression I have gotten, there has been a problem with children in schools contracting diseases they had not contracted previously because other children weren't vaccinated." @burhankadibhai Read more: http://www.daiIytarheel.com/article/201 5/1 1/vaccination-exemptions-increase-risk-of- disease