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ORANGE COUNTY BOARD OF HEALTH
MEETING AGENDA
DATE: November 18, 2015
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 November 18, 2015 Agenda
7:10 – 7:15 IV. Actions Items (Consent)
A. Minutes of October 28, 2015
B. 2016 Board of Health Schedule Susan Elmore
7:15 – 8:00 V. Educational Sessions
A. Early Childhood Mental Health Ennis Baker, Early Childhood
Mental Health Task Force
B. Strategic Plan Update Meredith Stewart
C. Advisory Board Update Meredith Stewart
D. 1st Quarter Financial Reports Rebecca Crawford
E. 1st Quarter Billing Dashboard Reports Rebecca Crawford
8:00 – 8:20 VI. Action Items (Non Consent)
A. Fee & Eligibility Policy Rebecca Crawford
B. Elections (Chair & Vice-Chair) Susan Elmore
8:20 – 8:30 VII. Reports and Discussion with Possible Action
A. Long Acting Reversible Contraceptives Report Christy Bridges
B. Radon Action Month Alan Clapp
C. Media Items
8:30 – 8:55 VIII. Closed Session to Discuss Health Director’s Annual Review
Closed Session (ref. NCGS 143-318.11(a)6) to consider the qualifications, competence
performance, fitness, conditions of appointment, of an individual public officer or
employee, or prospective public officer or employee; or to hear or investigate a complaint,
charge, or grievance by or against an individual public officer or employee.
8:55 – 9:00 IX. Board Comments
9:00 X. Adjournment
BOARD MEMBERS: To ensure a quorum, SEND E-MAIL to lstrange@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 Título VI – los servicios de intérprete
y/o equipo de sonido especial están disponibles a solicitud. Llame a la Administradora del Programa de Salud para
Inmigrantes y Refugiados al 919-245-2387 para solicitar un intérprete u otros arreglos o adaptaciones.
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October 28, 2015
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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 October 28, 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, Dan Dewitya, Nick Galvez, Sam Lasris, Reena Mehta and
Timothy Smith.
BOARD OF HEALTH MEMBERS ABSENT: Paul Chelminski and Jessica Frega.
STAFF PRESENT: Dr. Colleen Bridger, Health Director; Coby Austin, Senior Public Health
Educator; Christy Bridges, Physician Assistant; Judy Butler, Community Health Services
Supervisor, Alan Clapp, Environmental Health Director; Rebecca Crawford, Finance and
Administrative Services Division Director; Regina D’Auria, Social Worker II; Dr. Michael Day,
Dentist; Ashanti Farrington, Temporary Program Assistant; Kelly Franklin, Dental Assistant;
Robin Gasparini, Nursing Supervisor; Dr. Stephanie George, Dentist; Rebekah Hermann,
Whitted Clinic Manager; Andrew (AJ) May, Public Health Nurse; Pam McCall, Public Health
Nursing Director; Jean McDonald, Family Nurse Practitioner; Dr. Julie Monaco, Physician; Stacy
Shelp, Communications Manager; Meredith Stewart, Public Health Program Manager; and La
Toya Strange, Administrative Assistant II.
GUESTS PRESENT: Sarah Boland (UNC-CH student); Tammy Grubb (Chapel Hill News)
I. Welcome
Susan Elmore, Chair, introduced new BOH member, Timothy Smith. He gave a brief
description of his background and expressed his appreciation for being appointed to serve on
the Board. Dr. Bridger introduced new staff members: Regina D’Auria, Social Worker II;
Ashanti Farrington, Temporary Program Assistant; Kelly Franklin, Dental Assistant; Robin
Gasparini, Nursing Supervisor; Dr. Stephanie George, Dentist; and Andrew (AJ) May, Public
Health Nurse.
II. Public Comment for Items NOT on Printed Agenda: None
III. Approval of the October 28, 2015 Agenda
Motion was made by Sam Lasris to approve the agenda, seconded by Dan Dewitya and
carried without dissent.
IV. Action Items (Consent)
A. Minutes Approval of September 23, 2015 Meeting
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Motion to approve Consent Agenda without corrections to the September 23, 2015
minutes was made by Dan Dewitya, seconded by Reena Mehta and carried without
dissent.
V. Educational Sessions
A. School Immunization Rates
Judy Butler, Community Health Services Supervisor, presented on the North Carolina
immunization laws regarding exemptions and the immunization rates among Orange County,
Chapel Hill-Carrboro and private schools.
• In Orange County schools, 99.2% of students are fully vaccinated.
• In Chapel Hill-Carrboro city schools, 98.7% of students are fully vaccinated.
• In private schools, 93.2% of students are fully vaccinated.
• In charter schools, 95.8% of students are fully vaccinated.
Ms. Butler defined fully vaccinated as having all immunizations against vaccine-preventable
diseases. She stated that while most parents support the immunization law, it’s still a parent’s
choice as to whether they have their child vaccinated. Ms. Butler indicated that while a parent
can request an exemption whether it is a medical or religious, they are not able to pick and
choose which vaccinations they would like for their child to receive. Once a child has received
one vaccine, they are expected to get all of them. There is one exception – the Hepatitis B
vaccine because it is a blood-based product to which Jehovah Witnesses’ have a religious
exemption. She continued by noting that a school with a rate of 99% vaccinated students may
not have to exclude the non-immunized students from school if an outbreak of an illness occurs,
whereas a school with few vaccinated students would.
The BOH members had several questions that were addressed by Judy Butler.
B. Smoke-Free Public Places Annual Report
Coby Austin, Senior Public Health Educator, began by stating that the Smoke-Free Public
Places (SFPP) Rule is one of the most comprehensive smoking bans in the nation. She stated
that the Smoking Response Teams (SRT) continue to focus on education and empowerment.
The SRTs have focused attention on reaching out to and supporting businesses in downtown
Chapel Hill which is also where the highest number of violation complaints occur. The SRTs
regularly communicate via social and traditional media as well as by reaching out to people
directly. They’ve surveyed nearly 3,000 people since 2013 including 2182 residents. So far in
2015, 56% of residents are aware of the SFPP Rule versus 46% of them being aware during the
first year of inception of the rule in 2013.
Ms. Austin also gave an update on the activities of her and her team since the last update to the
BOH in November 2014.
• They continue to promote the SFPP rule through cessation efforts. Freshstart support
classes are held at the OCHD and within the community. The OCHD now dispenses
free Nicotine Replacement Therapy (NRT) through its medical providers. Another
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cessation program, QuitlineNC, provides 8 weeks of free NRT to our clients through
OCHD providers. With the launching of the OC Partners for Tobacco Cessation, focus
has been given to the behavioral health clients in the community.
• They continue to focus on high non-compliance areas. More permanent signage has
been posted and several downtown Chapel Hill retailers have placed also placed
signage in their storefront windows.
• Enforcement through monitoring and responding to complaints is a continuous effort.
The OCHD continues to send quarterly reports to key partners on reported violations
and outreach efforts.
• They continue to promote smoke-free multi-unit housing. Technical assistance was
provided to Chapel Hill Public Housing as it considered adopting a smoke-free policy by
conducting resident surveys at all 336 units, presenting results to their leadership, and
providing Freshstart classes onsite. It is anticipated that HUD will soon require that all
public housing be smoke-free.
• Lastly, they were pleased to be featured on a panel of success stories at the NC Public
Health Association Educational Conference in September and at a statewide tobacco
policy training in August.
The BOH members had several questions that were addressed by Ms. Austin.
C. Fee & Eligibility Policy Review
Ms. Crawford began with an overview of the recommended changes to the Fee and Eligibility
Policy that occurred as a result of the Family Planning monitoring visit conducted by the NC
Division of Public Health in October. The most essential changes include:
• Purpose (Section I.E.): As recommended by the Family Planning auditors, the following
statement was added to the Purpose section to explicitly state that: There will be no
charge for Title X Services provided for individuals with income less than 100% of the
Federal Poverty Level (FPL.)
• Income Eligibility (Section III.C.): The Environmental Health section was revised to clarify
that WTMP and mobile home park fees are billed on a different schedule than other
Environmental Health fees.
• Fee Collection (Section VI.K.): As recommended by the Family Planning auditors, the
Health Department’s detailed cost analysis process for fee changes will be included in
the policy rather than merely identifying that the Health Department conducts a cost
analysis.
• Fee Collection (Section VII.E.): As recommended by the Family Planning auditors,
clients will now be given a statement at each visit showing the cost of services provided
along with any outstanding balances rather than only being informed of those items.
• Fee Collection (Section VII.G.): The client Payment Plan section was modified to clarify
that a client must make a payment in any amount in order to activate a payment plan.
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• Fee Collection (Section VII.I.2.): The Billing Cycle section for Environmental Health was
modified to include a ruling from the County Attorney that debt that becomes part of an
estate will become dissolved.
The BOH members had questions that were addressed by Ms. Crawford and Dr. Bridger.
VI. Action Items (Non-Consent)
A. Men’s Health
Rebekah Hermann, Whitted Clinic Manager, presented an assessment on men’s health needs.
This assessment was completed in response to the Board of County Commissioners request for
the OCHD to assess the healthcare needs of men in Orange County. Through information
obtained from the 2015 Community Health Assessment and with information obtained regarding
uninsured men living in Orange County, it was determined that there is a need for affordable
healthcare for men living in Northern Orange County. Currently, the OCHD only provides
primary care services to women and children enrolled in preventive health programs. There
were 3 options presented by staff as to how the need should be addressed. Those options
included 1) referring men to existing safety net providers, 2) offering primary care services to
men at OCHD clinics and 3) outsourcing to an existing primary care clinic. The pros and cons
were weighed and a recommendation was presented to the BOH members.
Motion to 1) partner with UNC Physicians Network 2) conduct a 6 month pilot program 3)
refer to Hillsborough-sited UNC clinic to serve men in Northern Orange County and 4)
cap uninsured encounters at 200 for pilot period to help control cost and analyze usage
was made by Reena Mehta, seconded by Nick Galvez and carried without dissent.
Dr. Bridger will present this recommendation to the Board of County Commissioners.
B. Board of Health Policy Revisions
Meredith Stewart, Public Health Program Manager, presented the BOH Policies and Procedures
that were reviewed at the meeting in August. Ms. Stewart briefly summarized the edits that
were previously made as a result of their review at the August meeting.
Motion to approve the Board of Health Policies and Procedures without corrections to
was made by Mia Burroughs, seconded by Sam Lasris and carried without dissent.
VII. Reports and Discussion with Possible Action
A. Elections (Chair and Vice-Chair)
Susan Elmore, Chair, stated that the positions of Chair and Vice-Chair are open. She also
prefaced that by stating that it is customary for the current Vice-Chair to occupy the Chair
position because of the experience gained as Vice-Chair. Ms. Elmore informed the BOH
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members that interested persons should send her an email within the next week. BOH
members will vote to select the Chair and Vice-Chair at the November meeting.
B. Health Director Annual Review
Susan Elmore, Chair, reviewed this year’s process for the annual review referring to the BOH
Policies and Procedures for guidance. The annual review will occur during a closed session at
the November 2015 meeting. Ms. Elmore will survey direct reports and share the results with
the Board. Dr. Bridger will prepare her WPPR and submit it to the Board.
The BOH members had several questions and comments that were addressed by Ms.
Elmore and Dr. Bridger.
C. Health Director’s Report
Dr. Bridger gave a brief update on her activities in October as well as gave highlights from Mr.
Rick Brajer’s, Secretary of the Department of Health & Human Services, visit. She also briefly
spoke on the Cost Settlement Program, the 50% cut in funds and its affect on the health
department.
The BOH members had questions and comments that were addressed by Dr. Bridger.
D. Media Items
Media items were in the packet which focused on Orange County’s events and our
involvement in various efforts.
VIII. Board Comments
Susan Elmore, Chair, mentioned that the Community Listening Sessions went well and had
great attendance. Liska Lackey, Vice-Chair, added that the Annual Healthy Carolinians meeting
will be held December 11th at 8:30am. At the meeting, they’ll be looking at the top 5 focus
topics. Ms. Lackey stated that she will forward the information to the BOH members. She also
mentioned that Ashley Mercer, Healthy Carolinians Coordinator, was very appreciative for all of
their participation in the Community Listening Sessions.
Ms. Elmore reminded all about the email she sent to them regarding the OUTBoard committee’s
solicitation for a committee member and suggested that there be representation from the BOH
on the OUTBoard committee.
VIIII. Adjournment
A motion was made by Mia Burroughs to adjourn the meeting at 8:30 p.m., was seconded
by Reena Mehta and carried without dissent.
The next Board of Health Meeting will be held November 18, 2015 at the Orange County
Health Department, 300 West Tryon Street, Hillsborough, NC at 7:00 p.m.
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Respectfully submitted,
Colleen Bridger, MPH, PhD
Orange County Health Director
Secretary to the Board
Agenda Item Number:
ORANGE COUNTY BOARD OF HEALTH
AGENDA ITEM SUMMARY
Meeting Date: November 18, 2015
Agenda Item Subject: 2016 Board of Health Schedule
Attachment(s): Proposed 2016 Board of Health Schedule
Staff or Board Member Reporting: Susan Elmore
Purpose: __X_ Action
_ __ Information only
____ Information with possible action
Summary Information:
Attached is the proposed meeting schedule for the Board of Health in 2016.
It is recommended that the Board of Health approve the schedule.
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):
2016 BOARD OF HEALTH MEETING SCHEDULE
Whitted Human Services Center
Board of Health Conference Room
Building 3rd Floor Room A 305
7:00 p.m. – 9:00 p.m.
Contact Person La Toya Strange 919-245-2411
January 27, 2016
February 24, 2016
March 23, 2016
April 27, 2016
May 25, 2016
June 22, 2016
August 24, 2016
September 28, 2016
October 26, 2016
November 30, 2016
All meetings are held on the fourth Wednesday of the meeting months and at the
Whitted Human Services Center, Hillsborough unless noted otherwise.
Agenda Item Number:
ORANGE COUNTY BOARD OF HEALTH
AGENDA ITEM SUMMARY
Meeting Date: November 18, 2015
Agenda Item Subject: Early Childhood Mental Health
Attachment(s): NCIOM "Growing Up Well" Executive Summary
Staff or Board Member Reporting: Ennis Baker, Mental Health Specialist for Orange
County Head Start/Early Head Start & Co-Chair of the Orange Early Childhood Mental
Health Taskforce
Purpose: ___ Action
_X_ Information only
___ Information with possible action
Summary Information:
The 2014-2016 Board of Health Strategic Plan includes a focus on the importance of
and need for childhood mental health services. This includes an action step for the
Board to receive and discuss priority policy recommendations from local
leaders/advisory boards in early childhood mental health (ECMH) to improve policy and
programs.
Ennis Baker, a local leader in ECMH, will present a review of the current system for
early childhood mental health in North Carolina, statewide recommendations to improve
this system, local organizations/programs working to improve ECMH in Orange County,
and identified gaps in the system for young children in our county. The statewide
recommendations are from the North Carolina Institute of Medicine's "Growing Up Well
Report". The Executive Summary is included here as information for the meeting, and
the full report is available at: http://www.nciom.org/wp-content/uploads/2012/08/Early-
Childhood.pdf
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):
Executive Summary
13Growing Up Well: Supporting Young Children’s Social-Emotional Development and Mental Health in North Carolina
The future of North Carolina’s growth and prosperity depends on our
ability to foster the health and well-being of our children. Research
shows that wise investments in children and families can lead to future
savings, better health, and increased productivity.1 Health in the earliest years—
beginning with a mother’s pre-conception health—provides the foundation
upon which future development depends. Children with good health and a
strong sense of well-being are more likely to grow into adaptable, functioning
adults equipped with the kinds of tools needed to contribute positively to their
communities.2 Young children’s social-emotional well-being, or mental health,
affects how children relate to and interact with others, how they learn, and how
well they are able to manage their emotions.3 Children need developmentally
appropriate relationships, environments, and experiences during their earliest
years to develop a foundation strong enough to support more advanced physical,
cognitive, and social-emotional skills.4,5
New scientific evidence from multiple fields, including neuroscience, biology,
genetics, and the behavioral and social sciences, confirms that developmental
and biological disruptions during the prenatal period and formative years can
impair healthy functioning, increase vulnerability to health problems later in
life, and change the actual structure of a young child’s developing brain.6,7
Significant adversity in early childhood, including trauma, abuse, living with a
parent with a substance use disorder, or being raised in persistent poverty, can
cause toxic stress which disrupts a young child’s brain circuitry and other organ
and metabolic systems.7 In the absence of protective factors such as nurturing
and responsive relationships with caregivers, these disruptions produce changes
in the body and brain that lead to lifelong impairments in both physical and
mental health. Children exposed to toxic stress have impaired functioning in the
areas of the brain that are critical for the development of linguistic, cognitive,
and social-emotional skills.8 Impoverished and adverse early experiences, in the
absence of protective factors, can lead to difficulty learning, difficulty forming
healthy relationships, and lifelong physical and mental health problems.6,7
Further, failure to address these issues at an early age can lead to inordinate
expenses to society in the areas of physical health, mental health, education,
and criminal justice system expenses.
To effectively intervene in order to prevent the short- and long-term effects
of toxic stress will require investing in substantial and sustained prevention,
promotion, and intervention services. Extensive evidence shows that effective
prevention programs, focused on children under 5 years of age, can change the
trajectory of children’s lives. Promoting positive social-emotional development
among our youngest children is far easier than trying later to solve the problems
that can result from lack of attention to mental health during formative years.1,6
A growing body of research shows that investments during early childhood
Young children’s
social-emotional
well-being, or
mental health,
affects how
children relate to
and interact with
others, how they
learn, and how
well they are able
to manage their
emotions.
Executive Summary
14 North Carolina Institute of Medicine
have the potential to generate savings and benefits to society that more than
repay their costs.1,9 Such investments include programs, policies, and services to
strengthen the relationships young children have with their caregivers, improve
the environments of young children, teach young children social and emotional
skills, ensure the workforce is adequately trained, and provide treatment for
young children and their families.
This knowledge should inform and undergird all decision-making with regard
to spending and programs intended to affect children and their families. North
Carolina has an abundance of governmental, non-governmental, non-profit,
and educational resources which address various aspects of early childhood
social-emotional development and mental health needs. This report identifies
short- and long-term strategies for addressing these problems through systemic
changes, and greater interaction and cooperation among the systems, agencies,
and individuals who interact with children who are younger than 5 years of age
and their families.
The North Carolina General Assembly (NCGA) recognized the need to examine
the social-emotional and mental health needs of North Carolina’s youngest
children. In 2010, the NCGA asked the North Carolina Institute of Medicine
(NCIOM) to convene a task force to study the adequacy of the current systems
serving the mental health, social, and emotional needs of young children and
their families.a The charge included a systematic evaluation of the needs, gaps,
strengths, and resources of the public and private systems providing prevention,
promotion, and treatment for young children’s mental health and social-
emotional well-being. Funding support for the Task Force was provided by the
North Carolina Department of Health and Human Services Division of Mental
Health, Developmental Disabilities, and Substance Abuse Services through the
North Carolina Substance Abuse Prevention and Treatment Block Grant from
the Substance Abuse and Mental Health Services Administration.
The Task Force was co-chaired by Marian Earls, MD, FAAP, Medical Director,
Guilford Child Health, Inc.; Beth Melcher, PhD, Assistant Secretary for Mental
Health, Developmental Disabilities, and Substance Abuse Services Development,
North Carolina Department of Health and Human Services; and John Thorp,
MD, Division Director and Distinguished Professor, Department of Obstetrics
and Gynecology, University of North Carolina Health Care. They were joined
by 40 other Task Force and Steering Committee members including legislators,
state and local agency representatives, service providers, and community
representatives. The Task Force met 15 times between March 2011 and June
2012. The Task Force made 12 recommendations, 3 of which were identified as
priority recommendations.
a Section 16.1of Session Law 2010-152
Wise investments
in children and
families can lead
to future savings,
better health,
and increased
productivity.
Executive Summary
15Growing Up Well: Supporting Young Children’s Social-Emotional Development and Mental Health in North Carolina
The following provides a summary of the recommendations from the Task Force
on the Mental Health, Social, and Emotional Needs of Young Children and Their
Families. The summary recommendations are numbered and correspond to the
chapter where they are discussed in more detail. Priority recommendations are
noted.
Creating a More Coordinated, Integrated System to Meet the Social-Emotional and Mental Health Needs of Young Children and Their Families
The Task Force recognized the need for a more comprehensive, coordinated,
and cohesive infrastructure and system to meet the health needs of young
children and their families. Furthermore, the Task Force recognized that we
are more likely to experience positive results if we implement evidence-based
strategies and services to positively influence young children’s social-emotional
development and meet young children’s mental health needs. Evidence-based
interventions aimed at improving the social-emotional and mental health of
young children often have a positive impact on a wide range of child outcomes.
Data is needed to measure young children’s social-emotional and mental health
needs, identify gaps in services, and monitor the effectiveness of interventions.
With better coordination and collaboration, a solid infrastructure, data, and
the strategic use of evidence-based strategies, we can meet the social-emotional
and mental health needs of young children and their families.
Recommendation 2.1: Operationalize a Comprehensive,
Coordinated System for Young Children’s Mental
Health
The North Carolina Early Childhood Advisory Council (ECAC) should
operationalize a cross-systems plan which includes all North Carolina
agencies that fund and serve the physical, social-emotional, and mental health
needs of young children and their families.
Recommendation 5.3: Coordinate Promotion,
Prevention, and Intervention Services for Young
Children with Mental Health Needs (PRIORITY
RECOMMENDATION)
The Division of Mental Health, Developmental Disabilities, and Substance
Abuse Services (DMH/DD/SAS), Division of Medical Assistance (DMA),
Division of Public Health (DPH), Community Care of North Carolina
(CCNC), Care Coordination for Children (CC4C), Children’s Developmental
Services Agencies (CDSAs), and Local Management Entities/Managed Care
Organizations (LME/MCOs) should examine the current system of care for
children ages 0-5 to ensure children at risk of or those with already identified
Executive Summary
16 North Carolina Institute of Medicine
social-emotional and mental health needs have a health home that addresses
the physical, social, emotional and mental health needs of the child. As part
of this examination, DMH/DD/SAS and partners should develop integrated
protocols outlining the criteria for determining which agency is responsible
for providing screening, assessment, care coordination, and treatment
services for young children with social-emotional and mental health needs,
the process for authorizing and paying for services, and how to strengthen
collaboration and co-management in the care of the child by providers within
the different systems.
Recommendation 2.2: Strengthen and Expand Evidence-
Based Programs
The ECAC, in collaboration with state and local agencies and North Carolina
philanthropic organizations, should strengthen and expand the availability of
evidence-based programs to improve young children’s mental health for more
families in North Carolina.
Recommendation 2.3: Develop a Data System to
Monitor and Evaluate Changes in Young Children’s
Health
The ECAC, in collaboration with the Department of Health and Human
Services (DHHS), the Division of Public Instruction (DPI), CCNC, and the
North Carolina Partnership for Children (NCPC) should ensure that data
are available and utilized for on-going assessment of the status of young
children’s health, including the social-emotional health of young children
and their families. Data should be used to identify outstanding needs and
treatment gaps, modify funding priorities to meet the largest unmet needs,
and monitor the effectiveness of interventions.
Promoting Awareness and Understanding of the Importance of Young Children’s Social-Emotional and Mental Health
Research from multiple fields confirms that all aspects of young children’s
development, including brain development, depend on the nature and
reliability of young children’s relationships with their caregivers and the quality
of their environment.8 Research has also identified many evidence-based steps
that individuals, communities, organizations, and the state can take to ensure
young children have the kinds of nurturing, supportive relationships and safe,
stable environments that promote social-emotional development. However, the
Task Force recognized that this information is not widely known or used in
practice. The Task Force feels that a broad understanding of the importance of
the early years of life as well as an understanding of effective ways to improve
young children’s well-being is needed. Without such understanding, parents,
Executive Summary
17Growing Up Well: Supporting Young Children’s Social-Emotional Development and Mental Health in North Carolina
teachers, care providers, health providers, policy makers, legislative, executive,
and judicial branches of government, and others will not pursue or employ
effective strategies to improve the social-emotional and mental health of young
children.
Recommendation 3.2: Raise Awareness of the Social-
Emotional and Mental Health Needs of Young
Children (PRIORITY RECOMMENDATION)
The ECAC, in collaboration with DHHS, should develop and implement a
communications strategy to raise awareness of the importance of young
children’s mental, social, and emotional health.
Recommendation 3.3: Educate Families, Caregivers and
Providers on Young Children’s Mental Health
DPH should continue to support the implementation of the Triple P—Positive
Parenting Program, which educates parents, caregivers, and providers on
how to promote young children’s social-emotional development, in pilot
communities.
Recommendation 4.1: Develop a Web-Based
Clearinghouse of Programs and Services for Young
Children with Mental Health Needs
North Carolina private foundations and other funding sources should
provide $125,000 to the North Carolina Infant/Young Child Mental Health
Association (NCIMHA) and other partners to develop and maintain a web-
based clearinghouse of information on programs and services available to
children and families with mental health, social, and emotional needs at
the state and county level. Information collected should include service
availability, eligibility criteria, cost, and evidence involving the effectiveness
of the programs and services.
Improving Treatment to Meet the Social-Emotional and Mental Health Needs of Young Children and Their Families
Providing effective, evidence-based interventions and treatment during the
prenatal and early childhood periods of life can significantly improve individuals’
lifelong physical and mental health.6,7,10 Given this knowledge, the Task Force
studied the current system in an attempt to identify opportunities for providing
more effective, evidence-based intervention and treatment for young children
and their parents, especially mothers. While much is being done in North
Carolina to improve care for women and young children, more could be done
Executive Summary
18 North Carolina Institute of Medicine
to meet the social-emotional and mental health needs of young children and
their families. In particular, there is a need to focus on care coordination
for women and children, treatment services for mothers with substance use
or mental health disorders which consider the needs of young children, and
evidence-based screening, triage, assessment, referral, and treatment practices
and policies.
Recommendation 3.1: Improve Care Transitions for
Women and Young Children
To enhance patient health and safety, and to ensure appropriate continuity
of care and care coordination, CCNC, the North Carolina Obstetrical
and Gynecological Society, North Carolina Academy of Family Physicians,
North Carolina Medical Society, North Carolina Pediatric Society, DMH/
DD/SAS, and other partners should identify or develop best practices to
ensure appropriate transitions of care for women and young children among
obstetrical, primary care, pediatric, and other health care providers.
Recommendation 5.1: Expand Treatment Services for
Mothers with Substance Use Disorders and Mental
Health Challenges
DMH/DD/SAS, in collaboration with DMA and DHHS housing specialists,
the Division of Social Services (DSS), and the North Carolina Housing
Finance Agency should examine ways to expand the array of treatment
options for pregnant women and mothers with substance use and mental
health disorders, including supports for women in their own home as well as
residential treatment services.
Recommendation 5.2: Establish Care and
Reimbursement Standards to Promote Women
and Children’s Mental Health (PRIORITY
RECOMMENDATION)
DMA, in collaboration with CCNC, DMH/DD/SAS, DSS, DPH, and LME/
MCOs should identify evidence-based or evidence-informed screening tools,
triage, assessment, referral protocols and clinical treatment guidelines. The
organizations should also develop a system of value-based payments for select
populations including: pregnant women using or abusing alcohol or other
harmful substances, women with mental health disorders, young children
with social-emotional and mental health needs, and women and children who
have experienced family violence.
Executive Summary
19Growing Up Well: Supporting Young Children’s Social-Emotional Development and Mental Health in North Carolina
Ensuring a Well-Prepared Workforce
Young children and their families interact with people with multiple professional
backgrounds and training. However, the Task Force recognized that two groups of
trained professionals, health care professionals and those involved in early care
and education, are uniquely involved in the social-emotional development of
young children. Individuals in these workforces come from diverse backgrounds
with varying education and training requirements. There is a need to ensure
that these professionals understand the importance of social-emotional
development and how to foster such development. In varying capacities, these
professionals must be prepared to identify and meet the social-emotional and
mental health needs of young children and their families. Much more could
be done to ensure these professionals have the understanding, knowledge, and
skills required to promote young children’s social-emotional development and
to intervene when development lags or veers off course.
Recommendation 2.4: Increase Understanding of the
Role of Social-Emotional Development Among Early
Care and Education Professionals
The ECAC should ensure that funding for early educator development
and quality improvement through the Early Learning Challenge Grant
is maintained. Additional efforts should be made to align early educator
professional development standards at the pre-service, in-service, and
continuing education levels with the Early Learning Development Standards.
Specifically, there should be an increased focus on the social-emotional
domain of development.
Recommendation 2.5: Address Clinical Workforce
Development Needs
The North Carolina Infant/Child Mental Health Association should work
with DMA, in collaboration with DMH/DD/SAS, DPH, DSS, the University
of North Carolina System, the Area Health Education Centers, and others
to identify training needs and to address barriers to developing an effective
mental health workforce which meets the clinical needs of young children
ages 0-5 and their families.
Conclusion
Young children’s social-emotional development and mental health influence
every critical developmental task of the first five years whether physical,
cognitive, linguistic, or social-emotional. Positive social-emotional development
and mental health provides the foundation for future development and
learning. Furthermore, the absence of positive social-emotional development
and mental health has been shown to have a significant negative impact on
Executive Summary
20 North Carolina Institute of Medicine
both short- and long-term cognitive development and physical and mental
health. This knowledge must inform and undergird all of North Carolina’s
investments in its citizens if the state is to grow and prosper. North Carolina
has already seen the benefits from making significant investments in the health
and well-being of young children, particularly around physical and cognitive
development. North Carolina also has a long history of supporting physical
health by providing health care coverage for low-income pregnant women and
children through the Medicaid program and cognitive development through
school readiness programs such as Smart Start, Early Head Start, Head Start,
and the NC-PreK program. The benefits of these investments would grow
further if investments in the social-emotional development and mental health
of young children were strengthened. Investments such as the ones described
in this report to support the social-emotional development and mental health
of young children and their families have the potential to prevent a wide range
of adverse outcomes as well as generate large economic returns for all of North
Carolina.
Investments
to support the
social-emotional
development and
mental health of
young children
have the potential
to prevent a wide
range of adverse
outcomes as well
as generate large
economic returns
for all of North
Carolina.
Agenda Item Number:
ORANGE COUNTY BOARD OF HEALTH
AGENDA ITEM SUMMARY
Meeting Date: November 18, 2015
Agenda Item Subject: Strategic Plan Update
Attachment(s): Strategic Plan Update Presentation (PDF)
Staff or Board Member Reporting: Meredith Stewart
Purpose: ___ Action
_X_ Information only
___ Information with possible action
Summary Information:
Meredith Stewart will provide a review of accomplishments to-date and ongoing
activities from the 2014-2016 Board of Health Strategic Plan.
As a reminder, a new Board of Health strategic planning process will take place this
spring using information and priorities gathered from the latest Community Health
Assessment.
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):
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Agenda Item Number:
ORANGE COUNTY BOARD OF HEALTH
AGENDA ITEM SUMMARY
Meeting Date: November 18, 2015
Agenda Item Subject: Orange County Advisory Board Update
Attachment(s): Quarter 4 Update Advisory Board Summary
Staff or Board Member Reporting: Meredith Stewart
Purpose: ___ Action
_X_ Information only
___ Information with possible action
Summary Information:
The Board of Health identified action steps related to engagement in the 2014-2016
Strategic Plan. One of these action steps is to receive quarterly updates on actions of
other Orange County advisory boards that relate to the BOH strategic plan priorities.
The provided summary is of pertinent actions or information from Orange County
advisory boards from June 2015 to October 2015, as available from the boards.
Meredith will highlight a number of these activities and their connection to the BOH.
Some boards being tracked do not have updates included because they do not pertain
to the BOH’s priorities or they were not available at the time of the report.
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):
0
Quarterly Report
Board of Health Engagement
BOARD BOH
BOARD
SUMMARY
Orange
County
Schools
Board of
Education
Obesity,
Access
At the July 13, 2015 meeting, Dr. Deborah
Piscatelli was elected chair of the Board.
At the August 10, 2015 meeting, Child Nutrition
Services Director Valerie Greene presented the
nutrition supplier bids for approval by the board.
By law, the bids must be done publicly and the
recommendation to the Board was to approve the
low bidders.
At the August 24, 2015 meeting, the Board
received a report on summer programs run
through Orange County Schools. This included
the FSA’s Kindergarten Readiness program at
New Hope Elementary, which received positive
teacher and parent feedback.
Also, Sherita Cobb was introduced as the new
Student Support Director. She will serve as one
of the district’s primary contacts for OCHD
programs like TRU clubs, YRBS survey
administration, and FSA.
At the September 14, 2015 meeting, the Board
received a report on the Family Success Alliance
from Meredith Stewart.
At this same meeting, the Board also received the
2014-2015 Orange County School Achievement
Report and Performance Scores.
1
Chapel
Hill/Carrboro
City Schools
Board of
Education
Access
At the August 13, 2015 meeting, the Board
approved an “Emergency Epinephrine
Auto-Injector” policy. This 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 Board
approved a new policy related to food and
nutrition - Policy 6230 “School Meal and
Competitive Food Standards.” The policy aligns
standards for food sold during the day and
outside school hours on school grounds with
federal Smart Snacks guidelines.
The Board also received their 2014 Accountability
Report.
Board of County
Commissioners
Access
At their September 10, 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.
Chapel Hill
Town
Council
Obesity,
Access
During June, the Board approved performance
agreements with human service agencies as
recommended by the Human Services Advisory
Board.
Orange
Unified
Transportatio
n Board
(OUTBoard)
Obesity,
Access
Staff from OCHD continue to attend quarterly
meetings of the Transportation Advisory Board
(TAB) when it is part of joint meetings with the
OUTBoard.
2
At their August 19, 2015 meeting, the Board
considered a list of priority transportation
projects for each MPO/RPO to make
recommendations to the BOCC to be submitted
for consideration of inclusion in the 2018-2027
State Transportation Improvement Program
(STIP).
Healthy
Carolinians
of Orange
County
All
As part of the Community Health Assessment
Process, Healthy Carolinians hosted community
listening sessions around the county. Results
from the community survey and from focus
groups were presented and participants took part
in a voting/prioritization process.
Family
Success
Alliance
Access
At their October 19, 2015 meeting the FSA
Advisory board reviewed results from the
Kindergarten Readiness Program and received
recommendations for future work. This included
supporting out-of-school time programming for
zone children (i.e. summer and after-school).
3
Agenda Item Number:
ORANGE COUNTY BOARD OF HEALTH
AGENDA ITEM SUMMARY
Meeting Date: November 18, 2015
Agenda Item Subject: 1st Quarter Financial Report FY 15-16
Attachment(s): 1st Quarter Financial Report
1st 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
1st 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
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 ($41k/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 ($51k/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.
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):
Orange County Health Department
Profit Loss Budget Performance
2015-2016
TOTAL HEALTH Q1 YTD ACTUAL ANNUAL BUDGET
% OF ANNUAL
BUDGET
Revenue
Donations
Finance and Admin Services 0 0 (30,000)0.00%
Personal Health 0 0 (17,244)0.00%
Donations Total 0 0 (47,244)0.00%
Internal Allocations
Dental Health 0 0 (18,000)0.00%
Finance and Admin Services 0 0 (23,500)0.00%
Internal Allocations Total 0 0 (41,500)0.00%
Service Revenue
Dental Health (118,939)(118,939)(536,847)22.16%
Environmental Health (113,285)(113,285)(450,880)25.13%
Personal Health (130,611)(130,611)(606,484)21.54%
Service Revenue Total (362,835)(362,835)(1,594,211)22.76%
State Allocations
Finance and Admin Services (9,040)(9,040)(42,885)21.08%
Health Promotion & Edu (4,223)(4,223)(35,832)11.79%
Environmental Health (320)(320)(34,000)0.94%
Personal Health (120,410)(120,410)(514,511)23.40%
State Allocations Total (133,993)(133,993)(627,228)21.36%
Grants Project Revenues
NACCHO Grant 0 0 (6,521)0.00%
Piedmont Hlth Srv - Nutr (3,767)(3,767)(28,938)
Meaningful Use Incentive (19,000)(19,000)(19,000)100.00%
CC4C Accesscare (37,059)(37,059)(149,624)24.77%
PCM Accesscare (36,768)(36,768)(155,952)23.58%
Health Disparities 0 0 (56,916)0.00%
Grants Project Revenues Total (96,595)(96,595)(416,951)23.17%
Total Non-County Revenue (593,423)(593,423)(2,727,134)21.76%
Orange County Health Department
Profit Loss Budget Performance
2015-2016
TOTAL HEALTH Q1 YTD ACTUAL ANNUAL BUDGET
% OF ANNUAL
BUDGET
Expenditure
Salaries 1,166,436 1,166,436 5,130,429 22.74%
Benefits 406,673 406,673 1,815,838 22.40%
Travel 680 680 7,495 9.07%
Training 9,208 9,208 34,917 26.37%
Certifications & Licensing 4,383 4,383 15,756 27.81%
Mileage 7,000 7,000 32,060 21.83%
Telephone 8,224 8,224 75,714 10.86%
Postage 3,500 3,500 15,957 21.93%
Motor Pool 11,817 11,817 48,807 24.21%
Equip Repairs 1,332 1,332 10,175 13.09%
Equip Rent 232 232 1,200 19.34%
Duplicating 1,948 1,948 10,765 18.10%
Printing 2,607 2,607 9,656 27.00%
Advertising 1,388 1,388 12,296 11.29%
Dues 1,970 1,970 5,334 36.93%
Subscriptions 0 0 1,327 0.00%
Dept Supplies 4,580 4,580 40,999 11.17%
Edu Supplies 804 804 11,701 6.87%
Office Supplies 5,056 5,056 40,839 12.38%
Medical Supplies 37,604 37,604 146,652 25.64%
Bloodborn Path Supplies (548)(548)9,001 -6.09%
Pharmacy Supplies 40,790 40,790 236,766 17.23%
Comp Supp/Software 574 574 1,576 36.43%
Other Supplies 420 420 2,238 18.77%
Contracted Srv 52,815 52,815 506,681 10.42%
X-Ray 1,189 1,189 25,625 4.64%
Lab Srv 13,402 13,402 52,502 25.53%
Bonds & Insurance 0 0 10,602 0.00%
Uniforms 2,634 2,634 8,199 32.13%
Community Proj 3,342 3,342 55,235 6.05%
Employee Wellness 0 0 1,000 0.00%
Innovations Project 1,101 1,101 20,000 5.51%
Accreditation Project 2,750 2,750 2,750 100.00%
Wise Woman Program 0 0 662 0.00%
Preparedness BT 0 0 147 0.00%
Family Success Alliance 18,587 18,587 250,000 7.43%
Credit Card Exp 2,434 2,434 10,000 24.34%
Capital Exp Under $500 500 500 1,350 37.07%
Grant Project Expenditures
Health Disparities 22,070 22,070 56,916 38.78%
Meaningful Use Incentive 12,657 12,657 19,000 66.62%
Susan G. Komen Grant 40 40 0 0.00%
Capital Expenditures
Equipment 675 675 3,175 21.26%
IT Equipment 4,920 4,920 7,165 68.67%
Expenditures Total 1,855,793 1,855,793 8,748,507 21.21%
Total County Revenue (Appropriation)1,262,369 1,262,369 6,021,373 20.96%
BOH GOVERNANCE DASHBOARD Q1 FY15-16
* NOTE :FY 15 and 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.
**FY14 Dental payments began procesing through Eaglesoft (the current system) in December. The prior months payments are not included in the data, thus producing a lower billing accuracy.
182
201 229
-
50
100
150
200
250
300
350
J A S O N D J F M A M J
Th
o
u
s
a
n
d
s
TOTAL HEALTH DEPARTMENT REVENUE
vs. budget projections & prior year
Personal Health Dental
Environ Health Grants
State Other
Total OCHD Revenue (.6M YTD)YTD Month Avg (204k/m, ~2.4M/y est)
FY16 Budget Projection (225k/m, 2.7M/y)Prior: FY15 Revenue - Avg (205k/m, ~2.5M/y)
46
36
48
-
10
20
30
40
50
60
70
80
J A S O N D J F M A M J
Th
o
u
s
a
n
d
s
MEDICAL (PH) EARNED REVENUE BY SOURCE
vs. budget projection & prior year
Self Pay Insurance
Medicaid Total PH Revenue (131k YTD)
YTD Month Avg (43.5k/m, ~522k/y est)Budget Projection (51k/m, 606k/y)
Prior: FY15 PH Revenue - Avg (50k/m, 601k/y)Prior: FY15 PH Revenue (~601k/y)
Prior: FY14 PH Revenue - Avg (44k/m, 532k/y)
36 40 43
-
20
40
60
80
J A S O N D J F M A M J
Th
o
u
s
a
n
d
s
DENTAL EARNED REVENUE BY SOURCE
vs. budget projection & prior year
Self Pay Insurance
Medicaid Total D Revenue (119k YTD)
YTD Month Avg (40k/m), ~476k/y est)Budget Projection (45k/m, 537k/y)
Prior: FY15 D Revenue - Avg (35k/m, ~423k/y)FY15 Year Dental Revenue (423k/y)
Prior: FY14 D Revenue - Avg (26k/m, 317k/y)
92%87%86%
J A S O N D J F M A M J
Medical Billing Accuracy*
vs previous year & goal
M FY16 Total Accuracy (YTD avg 88%)M FY15 Avg Accuracy (91%)Accuracy Target (90%)
103%93%90%
J A S O N D J F M A M J
Dental Billing Accuracy*
vs previous year & goal
D FY16 Total Accuracy (YTD avg 95%)D FY15 Accuracy - Avg (96%)Accuracy Target (90%)
S:\MANAGERS WORKING FILES\BOH\AGENDAS & ABSTRACTS \2015 Agenda & Abstracts\November\VI.A. BOH Abstract 11-18-15 -
Fee & Elig Policy Revisions.docx
Agenda Item Number:
ORANGE COUNTY BOARD OF HEALTH
AGENDA ITEM SUMMARY
Meeting Date: November 18, 2015
Agenda Item Subject: Fee and Eligibility Policy - Proposed Revisions
Attachment(s): Proposed edits to: I.E. Fee and Eligibility Policy
and attachments
Staff or Board Member Reporting: Rebecca Crawford
Purpose: _X__ Action
___ Information only
___ Information with possible action
Summary Information:
The NC Division of Public Health conducted a Family Planning monitoring visit in
October 2015. As a result of recommended changes to the Fee and Eligibility Policy and
our annual review of the process, we request minor revisions to the policy.
DPH and the Health Department’s Financial Review Committee (FRC) recommended
revisions are highlighted in the attached policy with tracked changes. Many edits either
removed redundancies or updated the policy to reflect current practices (e.g., minimum
fee for Nutrition Services). Substantive edits include:
- Purpose (Section I.E.): As recommended by the Family Planning auditors, the
following statement was added to the Purpose section to explicitly state that:
There will be no charge for Title X Services provided for individuals with income
less than 100% of the Federal Poverty Level (FPL.)
- Income Eligibility (Section III.C.): The Environmental Health section was
revised to clarify that WTMP and mobile home park fees are billed on a different
schedule than other Environmental Health fees.
- Fee Collection (Section VI.K.): As recommended by the Family Planning
auditors, the Health Department’s detailed cost analysis process for fee changes
will be included in the policy rather than merely identifying that the Health
Department conducts a cost analysis.
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Fee & Elig Policy Revisions.docx
- Fee Collection (Section VII.E.): As recommended by the Family Planning
auditors, clients will now be given a statement at each visit showing the cost of
services provided along with any outstanding balances rather than only being
informed of those items.
- Fee Collection (Section VII.G.): The client Payment Plan section was modified
to clarify that a client must make a payment in any amount in order to activate a
payment plan.
- Fee Collection (Section VII.I.2.): The Billing Cycle section for Environmental
Health was modified to include a ruling from the County Attorney that debt that
becomes part of an estate will become dissolved.
Recommended changes were reviewed at the October 2015 meeting, with final
approval of the revised policy to occur at this meeting.
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):
ORANGE COUNTY HEALTH DEPARTMENT
Board of Health Policy and Procedures Manual
Section I: Board Adopted Policies
Policy E: Fee and Eligibility Policy
Reviewed by: Financial Review Committee, Health Director
Approved by: Board of Health, Health Director
Page 1 of 13
Original Effective Date: January 25, 2001
Revision Dates: 6/28/01; 2/26/04; 11/16/06; 10/24/07; 3/26/09, 3/23/12, 10/15/12, 2/4/13, 8/12/13, 10/22/14, 9/22/15
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I. Purpose
A. Public health services are increasingly costly to provide. The Health Department serves
the public’s interest best by assuring that all legally required public health services are
furnished to all citizens. The department provides recommended and requested public
health services based upon the priorities established by the Board of Health.
B. Fees are a means to help provide services to the residents of Orange County. Fees help
finance and extend public health services when government funding is not sufficient to
support the full cost of providing all required and requested services.
C. Fees for Orange County Health Department services are authorized under North Carolina
G.S. 130A-39, provided that:
1. They are in accordance with a plan recommended by the Health Director and
approved by the Board of Health and the Orange County Board of Commissioners.
2. They are not otherwise prohibited by law.
3. They are deposited to the account of the local Health Department for public health
purposes in accordance with the provisions of the Local Government Budget and
Fiscal Control Act.
D. Fees for services must also be in compliance with N.C. Administrative Code, Title X
Regulations, and Women’s and Children’s Health Program Rules.
D.E. There will be no charge for Title X Services provided for individuals with income
less than 100% of the Federal Poverty Level (FPL.)
II. Policy Implementation
The implementation of this policy is delegated to appropriate financial or support staff in
each division of the health department.
III. Income Eligibility
A. Definitions
1. Definition: A family is defined as a group of individuals who are living together as
one economic unit. Individuals are considered members of a single family or
economic unit when their production of income and consumption of goods are
related. A pregnant woman is counted as a family of two in determining family size.
2. Income eligibility requirements apply to: Dental Health, Family Planning, Child
Health, Maternal Health, Adult Health, Nutrition Services and Primary Care
Services.
3. The Health Department utilizes a sliding fee scale based on Federal Poverty
Guidelines in accordance with the Fee Schedule approved annually during the
County Budget process. NC DPH updates and issues the scale yearly. Specifically,
Comment [L1]: Recommendation by Family
Planning Auditors.
ORANGE COUNTY HEALTH DEPARTMENT
Board of Health Policy and Procedures Manual
Section I: Board Adopted Policies
Policy E: Fee and Eligibility Policy
Reviewed by: Financial Review Committee, Health Director
Approved by: Board of Health, Health Director
Page 2 of 13
Original Effective Date: January 25, 2001
Revision Dates: 6/28/01; 2/26/04; 11/16/06; 10/24/07; 3/26/09, 3/23/12, 10/15/12, 2/4/13, 8/12/13, 10/22/14, 9/22/15
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the health department uses the 101% - 250% Federal Poverty Level sliding scale.
Determination of Sliding Fee percentage is based on gross income and family size.
4. Verification of income is required at time of enrollment for services, at the annual
financial interview, or if there is a change in the work status in the family unit for
clients to be eligible for the sliding fee scale.
a. An annual gross income statement is preferred for evaluation.
i. Gross income is defined as the total of all cash income before deductions for
income taxes, employee social security taxes, insurance premiums, bonds,
etc. For self-employed applicants, net income after business expenses. Gross
income does NOT include money earned by children for babysitting, lawn
mowing and other tasks.
ii. In general gross income includes: salary, wages, commissions, fees, tips,
overtime pay, unemployment compensation, public assistance money,
alimony and child support payments, Social Security benefits, VA benefits,
Supplemental Security Income (SSI) benefits, retirement & pension
payments, worker’s compensation, bonuses, prize winnings and other sources
of cash income except those specifically excluded.
B. Sources
1. Sources of income verification may include, but are not limited to:
a. Current pay stub
b. Self-employment accounting records
b.c. Letter documenting current employment and wages from employer
c.d. Recent income tax return
d.e. Unemployment or workers compensation receipt
f. Public assistance letter
e.g. Prior income verification through enrollment in other Health Department
programs
2. If an individual claims “no income” (except for minors consenting to specific
services under G.S. 90-21.5), a signed “Verification of Income and/or Residency”
form (Attachment A) indicating financial support from another party must be
submitted.
3. Failure to provide verification within 10 business days of date of service will result in
charges being assessed at 100% of sliding fee scale. The client will receive
notification of required income verification at the time the initial appointment is
made.
4. The client must read, sign and understand the “Determination of Eligibility Payment
Plan for Clinical Services” and “Statement of Financial Responsibility Payment
Plan” form (Attachment B) at their initial visit and annual financial reviews.
C. Environmental Health
Persons seeking Environmental Health services must obtain and properly complete an
application for service and pay the corresponding fee for service (all applicants pay at the
Comment [L2]: Current practice.
Comment [L3]: Recommended by Family
Planning auditors
ORANGE COUNTY HEALTH DEPARTMENT
Board of Health Policy and Procedures Manual
Section I: Board Adopted Policies
Policy E: Fee and Eligibility Policy
Reviewed by: Financial Review Committee, Health Director
Approved by: Board of Health, Health Director
Page 3 of 13
Original Effective Date: January 25, 2001
Revision Dates: 6/28/01; 2/26/04; 11/16/06; 10/24/07; 3/26/09, 3/23/12, 10/15/12, 2/4/13, 8/12/13, 10/22/14, 9/22/15
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100% pay status) before an appointment for a field visit will be scheduled. Sometimes
additional fees may be necessary if during service delivery it is determined that the
correct fees were not initially paid, or services requested are more than applied for.
Wastewater Treatment Management Program (WTMP) and Mobile Home Park fees are
the only Environmental Health services invoiced after the inspection. These inspections
are not application based but occur on a regulated, recurring schedule.
IV. Residency Requirements
A. Any individual, Orange County resident or non-resident, is eligible for services provided
by the Health Department. Exceptions include non-STD Communicable Disease cases
(Orange County residents only) and when prohibited by law or regulation.
B. Proof of Residency may be determined by using the US Postal and/or Orange County
GIS website and one of the following: Driver’s License, Government-issued
identification, Pay Stub (Within the last 30 days), Utility bill (Within the last 45 days);
Current rental or lease agreement; Personal or property tax bill; Student identification,
and Matrícula Consular (Mexican ID Card1). Clients without one of the above
identifying information sources but reportedly living within the county will be required to
produce a written statement or letter from the head of household, verifying that the
person resides in their home. Special cases will be referred to the Clinic Manager or
Supervisor. Failure to provide proof of residency may result in referral to another
resource.
C. Proof of Residency in Orange County is required for self-pay patients to be eligible for
the sliding fee scale when requesting Maternal Health, Child Health, Primary Care,
Nutrition Services, and Dental Health Services. Out-of-county residents will be assessed
at 100% of charges not covered by a third party payer source.
V. Service Limitation/Denial
A. Services will not be denied based solely on the inability to pay, with the exception of
those services that require a flat or minimum fee. Emergency dental services and urgent
primary care services will be provided to clients regardless of any outstanding balance
due.
B. Otherwise, services may be denied if the department does not have the resources needed
to provide a quality non-mandated service or the individual does not meet the residency
or financial requirement.
1 The Matrícula Consular de Alta Seguridad (MCAS) (Consular Identification Card) is an identification card issued by
the Government of Mexico through its consulate offices to Mexican nationals residing outside of Mexico. Retrieved from
http://en.wikipedia.org/wiki/Matr%C3%ADcula_Consular on October 14, 2012.
Comment [L4]: Added by Alan Clapp. WTMP
and mobile home park fees are billed on a different
schedule than other fees and should be referenced.
ORANGE COUNTY HEALTH DEPARTMENT
Board of Health Policy and Procedures Manual
Section I: Board Adopted Policies
Policy E: Fee and Eligibility Policy
Reviewed by: Financial Review Committee, Health Director
Approved by: Board of Health, Health Director
Page 4 of 13
Original Effective Date: January 25, 2001
Revision Dates: 6/28/01; 2/26/04; 11/16/06; 10/24/07; 3/26/09, 3/23/12, 10/15/12, 2/4/13, 8/12/13, 10/22/14, 9/22/15
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C. Family Planning clients will never be refused service due to an outstanding balance or
inability to provide proof of income.
D. Maternal and Child Health clients who are at 60% to 100% pay status may have services
limited or denied for failure to make payments based on designated Payment Plans
(“good faith” effort).
E. Falsification of eligibility by the client may result in denial or limitation of services.
F. The Health Department shall not deny a service due to religion, race, national origin,
creed, sex, marital status, familial status, sexual orientation, veteran status or age.
G. The Health Department shall assure that no otherwise qualified handicapped individual,
solely by reason of his/her handicap, be excluded from participation in, be denied the
benefits of, or be subjected to discrimination under any program or activity covered by
this agreement.
H. The Health Director can override any decision to deny or limit services to a client in
accordance with the existing fee waiver process.
VI. Fees for Services
A. In order to facilitate early entry into prenatal care or family planning services, pregnancy
tests will be provided free of charge unless they are required as part of another service.
B. In order to facilitate early identification of and referral for hypertension, two blood
pressure screenings will be provided in the clinic free of charge. Borderline readings will
be checked free until determined to be normal or the client is referred for further
evaluation. Follow-up of clients with a diagnosis of hypertension will be charged
according to the fee policy.
C. Fees are not charged for diagnosis and treatment of sexually transmitted diseases, or
investigation and control of communicable diseases. There is also no charge to clients for
any State-provided vaccine.
D. Fees are charged for health and dental services provided to individuals unless prohibited
by law or regulation. Fees are established based upon cost analysis, Medicaid and
Medicare rates, comparable provider rates and/or state or contractual agreements. The
Health Director shall inform the Board of Health and the Orange County Board of
Commissioners of these adjustments in a timely manner.
E. Fees may be charged to clients for “non-program” specific services without being
adjusted on a sliding fee scale (flat fees).
Formatted: Indent: Left: 0.5", No bullets or
numbering
Formatted: Outline numbered + Level: 1 +
Numbering Style: I, II, III, … + Start at: 1 +
Alignment: Left + Aligned at: 0" + Tab after:
0.5" + Indent at: 0.5"
Comment [L5]: Per Judy, we don’t purchase any
vaccines from the state. Changed this language from
purchased to provided.
ORANGE COUNTY HEALTH DEPARTMENT
Board of Health Policy and Procedures Manual
Section I: Board Adopted Policies
Policy E: Fee and Eligibility Policy
Reviewed by: Financial Review Committee, Health Director
Approved by: Board of Health, Health Director
Page 5 of 13
Original Effective Date: January 25, 2001
Revision Dates: 6/28/01; 2/26/04; 11/16/06; 10/24/07; 3/26/09, 3/23/12, 10/15/12, 2/4/13, 8/12/13, 10/22/14, 9/22/15
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F. Fees may be charged for education, community-based limited clinical services (such as
influenza shots) and screening services provided to individuals or groups. The following
applies to these services:
1. They include orientation, field training, dental screening and education, and/or other
health promotion activities such as infant and toddler car seats, bike helmets, or
equipment rental.
2. The Health Director will negotiate fees for services where fees have not been
previously determined.
3. Income eligibility requirements do not apply to these services.
G. Per NC General Statute Chapter 7B, Subchapter 4, Article 35, and confidentiality
regulations, emancipated minors and other individuals requesting confidential services
will be considered a family of one for determination of charges. Private insurance will
also not be billed for minors receiving services for which they can consent unless
permission is received from the minor.
H. Persons requesting any program services may be encouraged to apply for Medicaid, as
applicable.
I. The Personal Health Services Division clinical and nutrition services will use the
appropriate sliding fee schedule for services when adjustable fees are allowed; all other
fees will be charged at 100%.
1. Clients, who require services provided on the sliding fee schedule, are expected to
pay the appropriate fee in full based on sliding fee guidelines.
2. This schedule will require assessment of the client’s financial status on an annual
basis or when a financial status change occurs, as specified in section III.
J. Dental Health Services, Primary Care Services, and Nutrition Services will use a sliding
fee schedule for all services, with a minimum charge to be established at the annual fee
review during the budget preparation process.
1. The minimum charge for dental, primary care, and nutrition services will apply
regardless of the determination of the client’s financial status.
2. If a client is determined to fall at the 0% pay level, the minimum charge will be the
only charge levied and collected.
3. Minimum charge is due at time of service.
K. Fee schedules will be reviewed annually during the budget process and adjusted as
appropriate; a complete cost analysis for purposes of fee adjustments will be performed
every five years. The process for this cost analysis includes a review of the following
elements:
a. Most recent vaccine and drug purchase costs
b. Most recent lab pricing lists
c. Most recent Medicaid Cost Settlement data for procedure costs
Comment [L6]: Recommended by Family
Planning Auditors
Formatted
ORANGE COUNTY HEALTH DEPARTMENT
Board of Health Policy and Procedures Manual
Section I: Board Adopted Policies
Policy E: Fee and Eligibility Policy
Reviewed by: Financial Review Committee, Health Director
Approved by: Board of Health, Health Director
Page 6 of 13
Original Effective Date: January 25, 2001
Revision Dates: 6/28/01; 2/26/04; 11/16/06; 10/24/07; 3/26/09, 3/23/12, 10/15/12, 2/4/13, 8/12/13, 10/22/14, 9/22/15
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d. Environmental Health equipment, labor, and staff costs
e. Review of fee schedules of surrounding jurisdictions
f. Analysis of existing self-pay client base and how increased costs would affect
their ability to get necessary care
L. Based on G.S. 130A-41, the Health Director is authorized to enter into contracts, which
may include negotiated reimbursement rates.
M. The Health Director may not make exceptions to the Fee Policy except to accommodate
specific situations through the fee waiver process (Attachment C).
N. Any minimum administrative fee or flat fees shall be applied without discrimination to all
patients.
O. There will be no “schedule of donations”, bills for donations, or any other implied
coercion for donations from clients as a condition for being seen at the Health
Department. Donations to the health department can be made through the Orange County
Community Giving Fund. Fees for services will not be waived because of client
donations.
VII. Fee Collection
A. Environmental Health service fees are paid before an appointment is scheduled. Field
staff cannot accept fees in the field.
B. Fees collected from Medicaid and Medicare and other third party insurance for a covered
service, combined with payment of any applicable co-pays and co-insurance, constitutes
full payment for that service.
C. A co-payment, deductible, or balance of charge can be collected at the time of service
from individuals covered by other third party insurance plans when OCHD is a member
of their provider panel (exception family planning). For Family Planning clients, family
income should be assessed before determining whether co-payments or additional fees
are charged; if their family income is verified to be at or below 250% FPL, they should
not pay more (in copayments or additional fees) than what they would otherwise pay
when the schedule of discounts is applied. With regard to other insured clients, payments
towards a deductible for clients whose family income is verified to be at or below 250%
FPL should have the appropriate sliding fee schedule applied.
D. If OCHD is not on the insurance provider panel, the client will be charged for the
service(s) based on the Health Department’s fee schedule. The client will be provided
with documentation of services for submission of a claim to their insurance company.
Formatted: List Paragraph, No bullets or
numbering
Formatted: Indent: Left: 0.75", No bullets or
numbering
Formatted: Outline numbered + Level: 1 +
Numbering Style: I, II, III, … + Start at: 1 +
Alignment: Left + Aligned at: 0" + Tab after:
0.5" + Indent at: 0.5"
ORANGE COUNTY HEALTH DEPARTMENT
Board of Health Policy and Procedures Manual
Section I: Board Adopted Policies
Policy E: Fee and Eligibility Policy
Reviewed by: Financial Review Committee, Health Director
Approved by: Board of Health, Health Director
Page 7 of 13
Original Effective Date: January 25, 2001
Revision Dates: 6/28/01; 2/26/04; 11/16/06; 10/24/07; 3/26/09, 3/23/12, 10/15/12, 2/4/13, 8/12/13, 10/22/14, 9/22/15
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E. At the time services are received, the client will be given a statement showing the cost of
services for that visit as well as their total account balance.
F. Payment is due at the time services are rendered.
G. When the client is unable to pay in full at the time services are rendered, a payment plan
is established, and the client must sign a “Payment Agreement Form” (Attachment D)
except for minimum-fee or flat-fee charges. Client must then make a payment in any
amount in order to activate the payment plan.
H. When a client requests “no mail”, discussion of payment of outstanding debt shall occur
at the time the service is rendered. A remark regarding “no mail” is entered into the
medical data system. No letters or other correspondence concerning insurance or past
due accounts will be sent to any client that requests “no mail”. Reasonable efforts will be
made to collect charges without jeopardizing client confidentiality.
I. The Billing Cycle for the Health Department (by Division) is as follows:
1. Personal Health & Dental Health Divisions
a. Bills will be sent monthly by the tenth of the month for two months after services
have been rendered indicating a statement of balance due. Every quarter, all
accounts with a balance $50 or more that are more than 60 days past due will be
forwarded to the County Attorney Office and pursued through debt set-off in
accordance with the county policy. Accounts with a balance of less than $50 will
remain delinquent until paid or written-off.
b. If a debt is not paid, when the client attempts to make another appointment, the
client will be told they have a previous balance, and they must have an active
payment plan or make a payment at time of next service except for Family
Planning clients.
2. Environmental Health Division
a. An initial invoice for additional or miscellaneous Wastewater Treatment
Management Program (WTMP) charges is mailed with the inspection form.
b. If no payment is received within 90 days, a second notice is mailed.
c. If no payment is received after an additional 30 days and the debt is $50 or
greater, the account is forwarded to the County Attorney’s Office, which will
pursue it through the county’s debt set-off procedure.
d. Debt owed by a corporation or non-individual is dissolved upon sale of property.
e. The county attorney’s office has deemed debt that becomes part of an estate will
become dissolved.
f. If the client presents and voluntarily wishes to pay on the account, any amount
the client offers will be accepted, documented in the client file, and a receipt will
be provided.
g. Mobile Home Parks are billed annually on the calendar year. The procedure is
the same as noted above.
Comment [L7]: Actual bill recommended by
Family Planning auditors
Comment [L8]: Clarification added since the
client must actually make a payment in order to
make the payment plan active.
Comment [L9]: As recommended by Family
Planning auditors
Comment [L10]: Added by Alan Clapp
Comment [L11]: Added by Alan Clapp –
clarifying that mobile home parks are billed on an
annual basis.
ORANGE COUNTY HEALTH DEPARTMENT
Board of Health Policy and Procedures Manual
Section I: Board Adopted Policies
Policy E: Fee and Eligibility Policy
Reviewed by: Financial Review Committee, Health Director
Approved by: Board of Health, Health Director
Page 8 of 13
Original Effective Date: January 25, 2001
Revision Dates: 6/28/01; 2/26/04; 11/16/06; 10/24/07; 3/26/09, 3/23/12, 10/15/12, 2/4/13, 8/12/13, 10/22/14, 9/22/15
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J. Insurance and Third Party Billing
1. Where a third party is responsible, bills are to be submitted to that party;
2. Third parties authorized or legally obligated to pay for clients at or below 100% FPL
are properly billed
3. Third party bills (including Medicaid) show total charges without any discounts
unless there is a contracted reimbursement rate that must be billed per the third party
agreement.
4. The health department will bill insurance and managed care organizations for which
provider approval has been established. The patient will be responsible for all
deductibles, coinsurance and non-covered charges.
5. Patient or parent/guardian signature is required to give authorization to file claims
and provide necessary information to the insurance company (Attachment E).
6. Patients, or the accompanying parent/guardian of an un-emancipated minor with
appropriate insurance benefits, who receive public health services will be given the
opportunity to choose whether to have insurance filed in order to avoid breach of
confidentiality or pay the associated fee according to where the patient falls on the
sliding fee scale..
II.VIII. Review and Approval
A. This Policy shall be reviewed annually by members of the Financial Review Committee.
The committee shall have representatives from each division, and must also include the
Health Department’s Finance and Administrative Services Director
B. Any policy revisions must be approved by the Health Director and the Board of Health.
VI.IX. Service Limitation/Denial
A.I. Services will not be denied based solely on the inability to pay, with the exception of
those services that require a flat or minimum fee. Emergency dental services and urgent
primary care services will be provided to clients regardless of any outstanding balance
due.
B.J. Otherwise, services may be denied if the department does not have the resources needed
to provide a quality non-mandated service or the individual does not meet the residency
or financial requirement.
C.K. Family Planning clients will never be refused service due to an outstanding balance
or inability to provide proof of income.
D.L. Maternal and Child Health clients who are at 60% to 100% pay status may have
services limited or denied for failure to make payments based on designated Payment
Plans (“good faith” effort).
E.M. Falsification of eligibility by the client may result in denial or limitation of services.
Formatted: Outline numbered + Level: 1 +
Numbering Style: I, II, III, … + Start at: 1 +
Alignment: Left + Aligned at: 0" + Tab after:
0.5" + Indent at: 0.5"
Formatted: No bullets or numbering
ORANGE COUNTY HEALTH DEPARTMENT
Board of Health Policy and Procedures Manual
Section I: Board Adopted Policies
Policy E: Fee and Eligibility Policy
Reviewed by: Financial Review Committee, Health Director
Approved by: Board of Health, Health Director
Page 9 of 13
Original Effective Date: January 25, 2001
Revision Dates: 6/28/01; 2/26/04; 11/16/06; 10/24/07; 3/26/09, 3/23/12, 10/15/12, 2/4/13, 8/12/13, 10/22/14, 9/22/15
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F.N. The Health Department shall not deny a service due to religion, race, national origin,
creed, sex, marital status, familial status, sexual orientation, veteran status or age.
G.O. The Health Department shall assure that no otherwise qualified handicapped
individual, solely by reason of his/her handicap, be excluded from participation in, be
denied the benefits of, or be subjected to discrimination under any program or activity
covered by this agreement.
H.P. The Health Director can override any decision to deny or limit services to a client in
accordance with the existing fee waiver process.
III. Fees for Services
A. In order to facilitate early entry into prenatal care or family planning services, pregnancy
tests will be provided free of charge unless they are required as part of another service.
B. In order to facilitate early identification of and referral for hypertension, two blood
pressure screenings will be provided in the clinic free of charge. Borderline readings will
be checked free until determined to be normal or the client is referred for further
evaluation. Follow-up of clients with a diagnosis of hypertension will be charged
according to the fee policy.
C. Fees are not charged for diagnosis and treatment of sexually transmitted diseases, or
investigation and control of communicable diseases. There is also no charge to clients for
any State-purchased vaccine.
D. Fees are charged for health and dental services provided to individuals unless prohibited
by law or regulation. Fees are established based upon cost analysis, Medicaid and
Medicare rates, comparable provider rates and/or state or contractual agreements. The
Health Director shall inform the Board of Health and the Orange County Board of
Commissioners of these adjustments in a timely manner.
E. Fees may be charged to clients for “non-program” specific services without being
adjusted on a sliding fee scale (flat fees).
F. Fees may be charged for education, community-based limited clinical services (such as
influenza shots) and screening services provided to individuals or groups. The following
applies to these services:
Comment [L12]: Per Judy, we don’t purchase
any vaccines from the state.
ORANGE COUNTY HEALTH DEPARTMENT
Board of Health Policy and Procedures Manual
Section I: Board Adopted Policies
Policy E: Fee and Eligibility Policy
Reviewed by: Financial Review Committee, Health Director
Approved by: Board of Health, Health Director
Page 10 of 13
Original Effective Date: January 25, 2001
Revision Dates: 6/28/01; 2/26/04; 11/16/06; 10/24/07; 3/26/09, 3/23/12, 10/15/12, 2/4/13, 8/12/13, 10/22/14, 9/22/15
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1. They include orientation, field training, dental screening and education, and/or other
health promotion activities such as infant and toddler car seats, bike helmets, or
equipment rental.
2. The Health Director will negotiate fees for services where fees have not been
previously determined.
3. Income eligibility requirements do not apply to these services.
G. Per NC General Statute Chapter 7B, Subchapter 4, Article 35, and confidentiality
regulations, emancipated minors and other individuals requesting confidential services
will be considered a family of one for determination of charges. Private insurance will
also not be billed for minors receiving services for which they can consent unless
permission is received from the minor.
H. Persons requesting any program services may be encouraged to apply for Medicaid, as
applicable.
I. The Personal Health Services Division clinical and nutrition services will use the
appropriate sliding fee schedule for services when adjustable fees are allowed; all other
fees will be charged at 100%.
1. Clients, who require services provided on the sliding fee schedule, are expected to
pay the appropriate fee in full based on sliding fee guidelines.
2. This schedule will require assessment of the client’s financial status on an annual
basis or when a financial status change occurs, as specified in section III.
J. Dental Health Services, Primary Care Services, and Nutrition Services will use a sliding
fee schedule for all services, with a minimum charge to be established at the annual fee
review during the budget preparation process.
1. The minimum charge for dental, primary care, and nutrition services will apply
regardless of the determination of the client’s financial status.
2. If a client is determined to fall at the 0% pay level, the minimum charge will be the
only charge levied and collected.
3. Minimum charge is due at time of service.
K.
L. Fee schedules will be reviewed annually during the budget process and adjusted as
appropriate; a complete cost analysis for purposes of fee adjustments will be performed
every five years.
M. Based on G.S. 130A-41, the Health Director is authorized to enter into contracts, which
may include negotiated reimbursement rates.
N. The Health Director may not make exceptions to the Fee Policy except to accommodate
specific situations through the fee waiver process (Attachment C).
Formatted: No bullets or numbering
ORANGE COUNTY HEALTH DEPARTMENT
Board of Health Policy and Procedures Manual
Section I: Board Adopted Policies
Policy E: Fee and Eligibility Policy
Reviewed by: Financial Review Committee, Health Director
Approved by: Board of Health, Health Director
Page 11 of 13
Original Effective Date: January 25, 2001
Revision Dates: 6/28/01; 2/26/04; 11/16/06; 10/24/07; 3/26/09, 3/23/12, 10/15/12, 2/4/13, 8/12/13, 10/22/14, 9/22/15
S:\MANAGERS WORKING FILES\BOH\Policies and Procedures\BOH Policy Manual\2014 BOH P&P Review
O. Any minimum administrative fee or flat fees shall be applied without discrimination to all
patients.
P. There will be no “schedule of donations”, bills for donations, or any other implied
coercion for donations from clients as a condition for being seen at the Health
Department. Donations to the health department can be made through the Orange County
Community Giving Fund. Fees for services will not be waived because of client
donations.
IV. Fee Collection
A. Environmental Health service fees are paid before an appointment is scheduled. Field
staff cannot accept fees in the field.
B. Fees collected from Medicaid and Medicare and other third party insurance for a covered
service, combined with payment of any applicable co-pays and coinsurance, constitutes
full payment for that service.
C. A co-payment, deductible, or balance of charge will be collected at the time of service
from individuals covered by other third party insurance plans when OCHD is a member
of their provider panel (exception family planning). For Family Planning clients, family
income should be assessed before determining whether co-payments or additional fees
are charged; if their family income is verified to be at or below 250% FPL, they should
not pay more (in copayments or additional fees) than what they would otherwise pay
when the schedule of discounts is applied. With regard to other insured clients, payments
towards a deductible for clients whose family income is verified to be at or below 250%
FPL should have the appropriate sliding fee schedule applied.
D. If OCHD is not on the insurance provider panel, the client will be charged for the
service(s) based on the Health Department’s fee schedule. The client will be provided
with documentation of services for submission of a claim to their insurance company.
E. At the time services are received, the client will be informed of the cost of services for
that visit as well as their total account balance.
F. Payment is due at the time services are rendered.
G. When the client is unable to pay in full at the time services are rendered, a payment plan
is established, and the client must sign a “Payment Agreement Form” (Attachment D)
except for minimum-fee or flat-fee charges.
H. When a client requests “no mail”, discussion of payment of outstanding debt shall occur
at the time the service is rendered. A remark regarding “no mail” is entered into the
medical data system. No letters or other correspondence concerning insurance or past
due accounts will be sent to any client that requests “no mail”.
ORANGE COUNTY HEALTH DEPARTMENT
Board of Health Policy and Procedures Manual
Section I: Board Adopted Policies
Policy E: Fee and Eligibility Policy
Reviewed by: Financial Review Committee, Health Director
Approved by: Board of Health, Health Director
Page 12 of 13
Original Effective Date: January 25, 2001
Revision Dates: 6/28/01; 2/26/04; 11/16/06; 10/24/07; 3/26/09, 3/23/12, 10/15/12, 2/4/13, 8/12/13, 10/22/14, 9/22/15
S:\MANAGERS WORKING FILES\BOH\Policies and Procedures\BOH Policy Manual\2014 BOH P&P Review
I. The Billing Cycle for the Health Department (by Division) is as follows:
1. Personal Health & Dental Health Divisions
a. Bills will be sent monthly by the tenth of the month for two months after services
have been rendered indicating a statement of balance due. Every quarter, all
accounts with a balance $50 or more that are more than 60 days past due will be
forwarded to the County Attorney Office and pursued through debt set-off in
accordance with the county policy. Accounts with a balance of less than $50 will
remain delinquent until paid or written-off.
b. If a debt is not paid, when the client attempts to make another appointment, the
client will be told they have a previous balance, and they must have an active
payment plan or make a payment at time of next service except for Family
Planning clients.
2. Environmental Health Division
a. An initial invoice for additional or miscellaneous Wastewater Treatment
Management Program (WTMP) charges is mailed with the inspection form.
b. If no payment is received within 90 days, a second notice is mailed.
c. If no payment is received after an additional 30 days and the debt is $50 or
greater, the account is forwarded to the County Attorney’s Office, which will
pursue it through the county’s debt set-off procedure.
d. Debt owed by a corporation or non-individual is dissolved upon sale of property.
e. If the client presents and voluntarily wishes to pay on the account, any amount
the client offers will be accepted, documented in the client file, and a receipt will
be provided.
J. Insurance and Third Party Billing
1. Where a third party is responsible, bills are to be submitted to that party;
2. Third parties authorized or legally obligated to pay for clients at or below 100% FPL
are properly billed
3. Third party bills (including Medicaid) show total charges without any discounts; and
4. Bills to third parties (including Medicaid) show total charges without applying any
discount unless there is a contracted reimbursement rate that must be billed per the
third party agreement.
5. The health department will bill insurance and managed care organizations for which
provider approval has been established. The patient will be responsible for all
deductibles, coinsurance and non-covered charges.
6. Patient or parent/guardian signature is required to give authorization to file claims
and provide necessary information to the insurance company (Attachment E).
7. Patients, or the accompanying parent/guardian of an unemancipated minor with
appropriate insurance benefits, who receive public health services will be given the
opportunity to choose whether or not to have insurance filed in order to avoid breach
of confidentiality.
ORANGE COUNTY HEALTH DEPARTMENT
Board of Health Policy and Procedures Manual
Section I: Board Adopted Policies
Policy E: Fee and Eligibility Policy
Reviewed by: Financial Review Committee, Health Director
Approved by: Board of Health, Health Director
Page 13 of 13
Original Effective Date: January 25, 2001
Revision Dates: 6/28/01; 2/26/04; 11/16/06; 10/24/07; 3/26/09, 3/23/12, 10/15/12, 2/4/13, 8/12/13, 10/22/14, 9/22/15
S:\MANAGERS WORKING FILES\BOH\Policies and Procedures\BOH Policy Manual\2014 BOH P&P Review
V.II. Review and Approval
A. This Policy shall be reviewed annually by members of the Financial Review Committee.
The committee shall have representatives from each division, and must also include the
Health Department’s Finance and Administrative Services Director
B. Any policy revisions must be approved by the Health Director and the Board of Health.
Agenda Item Number:
ORANGE COUNTY BOARD OF HEALTH
AGENDA ITEM SUMMARY
Meeting Date: November 18, 2015
Agenda Item Subject: Elections (Chair & Vice-Chair)
Attachment(s): None
Staff or Board Member Reporting: Susan Elmore
Purpose: __X_ Action
_ __ Information only
____ Information with possible action
Summary Information:
Per the Board of Health Policies and Procedures, the Board shall elect a Chair and
Vice-Chair by majority vote each year at the last meeting of the calendar year.
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):
Agenda Item Number:
ORANGE COUNTY BOARD OF HEALTH
AGENDA ITEM SUMMARY
Meeting Date: November 18, 2015
Agenda Item Subject: Radon Action Month
Attachment(s): Resolution
Staff or Board Member Reporting: Alan Clapp
Purpose: _X_ Action
_ _ Information only
___ Information with possible action
Summary Information:
January is National Radon Action Month. Each year, nationally, more than 22,000 people die
from radon-induced lung cancer. Roughly 54 percent of those diagnosed with early-stage lung
cancer are expected to live no more than five years after diagnosis. Lung cancer can strike
anyone, even a nonsmoker.
The North Carolina Department of Health and Human Services Division of Health Service
Regulation Radiation Protection Section has asked that the Board of Health recognize January
as National Radon Action Month. The proposed resolution is attached.
The Orange County Health Department 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 radon test kits are being made available locally January 11 through January 29, 2016 through
Environmental Health. Approximately 15,000 kits are being distributed statewide. Only one kit
per home is needed to determine if a home has a high level of radon.
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):
RADON ACTION MONTH
RESOLUTION
WHEREAS, radon is a colorless, odorless, naturally occurring radioactive gas
that threatens the health of our citizens; and
WHEREAS, according to the U.S. Environmental Protection Agency, radon
causes more than 20,000 deaths each year, making it the second leading cause of lung
cancer deaths in the United State and the number one cause among non-smokers; and
WHEREAS, a national health advisory was issued by the U.S. Surgeon General in
2005 because breathing indoor radon over prolonged periods can present a significant
health risk; and
WHEREAS, according to the U.S. Environmental Protection Agency, one in 15
homes across the country has an elevated radon level; and
WHEREAS, in North Carolina, based on data collected by the Radiation
Protection Section in the Division of Health Service Regulation, radon is present at
elevated levels in about seven percent of homes; and
WHEREAS, indoor elevated levels of radon is a preventable and correctable
problem; and
WHEREAS, testing for radon is simple and inexpensive, ranging from $6 to $30
for do-it-yourself tests with costs of repairs by a professional to reduce the radon level
ranging from $1,500 to approximately $2,500; and
WHEREAS, the State’s Radon Program and the U.S. Environmental Protection
Agency are encouraging Americans to test their homes for radon, mitigate elevated levels
of radon, and build new homes with radon-resistant materials and features;
NOW, THEREFORE, the Orange County Board of Health, do hereby recognize
January 2016 as “RADON ACTION MONTH” in Orange County, North Carolina and
urge our citizens and interested groups to promote awareness of the hazards of radon
exposure, encourage citizens to test and mitigate their homes for radon levels and
visit www.ncradon.org for additional radon information
Orange County Vaccination Rates High
Throughout Schools
By Blake Hodge
SHARE THIS:
Posted November 6, 2015 at 10:29 am
Outbreaks of preventable diseases across the country in recent months prompted debate over childhood
vaccinations.
Nearly 150 Americans, most of them Californians, were sickened earlier this year in a measles outbreak
that began at Disneyland.
California Governor Jerry Brown has now signed legislation that bans non-medical exemptions for
parents.
In North Carolina, parents can opt out of vaccinating their children through medical or religious
exemptions.
Orange County health officials released immunization records this week detailing vaccination rates in
public and private schools.
Judy Butler is the community health services supervisor for the Orange County Health Department, and
she says this information was compiled from an annual communicable disease report.
She says outbreaks of preventable diseases are up in some cases simply because there are more
children who are not fully vaccinated.
“For one thing, we have more children who are not vaccinated because of parental choice,” Butler says.
“Not a large number, the vast majority of our kids are vaccinated.
“[Outbreaks] just bring more attention to the fact that children who are not vaccinated are definitely at
greater risk if they’re exposed to these diseases.”
Butler adds the risks for children who have been vaccinated also goes up as the percentage of
unvaccinated children increases.
“Because the vaccines are not 100 percent effective,” she says, “the more often they are exposed, the
more likely they are to become ill with one of the vaccine-preventable diseases as well. Even though
they’re fully vaccinated.”
99.2 percent of students in Orange County Schools are vaccinated and 98.78 percent of Chapel Hill –
Carrboro City School students are vaccinated. But that number drops to just below 96 percent for charter
schools and just over 93 percent for private schools.
Those figures line up with Butler’s expectations.
“Because I’ve worked in the county for so long, I knew that we had a couple of private or charter schools
where we had more parents who are not as inclined to vaccinate their children,” Butler says. “So, no, I
can’t really say there was any surprise. Not to me anyway.”
Emerson Waldorf has the lowest vaccination rate throughout public and private schools in Orange County
at just over 62 percent of student vaccinated. A reason for the dramatic drop at Emerson Waldorf is
because 84 of the 222 students claim religious exemptions.
Butler says there is not verification required to justify a religious exemption in the Tar Heel state.
“North Carolina does not require any specific information,” she says. “All they require is that a parent say
that they choose not to vaccinate their children for religious reasons.”
Butler adds there are medical exemptions to not vaccinate children as well.
“And we’re not talking because they didn’t feel good after their last vaccine or because they often ran a
fever after a vaccine,” she says. “We’re talking about kids with serious medical problems that prohibit
them from getting vaccines.”
Butler says a new tendency among parents has been to not vaccinate children due to fear of vaccinations
causing other medical problems. But Butler says these have been proven to be nothing more than
medical myths.
“A lot of the fears and a lot of the misinformation that parents had about vaccines causing certain
disorders, such as Autism, has been disproven,” Butler says.
All rules governing vaccination rates are regulated at the state level.
You can find information regarding schools in the Orange County School System, Chapel Hill – Carrboro
City School System and Orange County private and charter schools through these links.
Chapel Hill News
November 3, 2015
Most students in Orange County vaccinated
Highlights
County has posted immunization data from all schools on its website
Emerson Waldorf reports lowest immunization rate at 62.2 percent
Goal is to raise public awareness and give parents important information
State laws require all students to receive several vaccinations before starting at a child-care center or public, private or charter
school. Local officials recently shared those immunization numbers with parents and the public on the Orange County Health
Department website. Harry Lynch hlynch@newsobserver.com
By Tammy Grubb
tgrubb@newsobserver.com
CHAPEL HILL - County health officials have released student immunization rates from local schools to
raise awareness and inform parents about their child’s potential for exposure to infectious diseases.
Eight schools countywide reported that 100 percent of their students meet immunization requirements
this year, Orange County Health Department records show. Nearly all local schools reported
immunization rates of 95 percent or higher, health officials said.
State law requires all children to be vaccinated before starting a child-care program or a public, private
or charter school. Homeschooled children do not have to meet those requirements.
Parents can ask for an exemption based on genuine religious beliefs or a physician’s medical advice.
North Carolina does not recognize a philosophical objection to vaccinations; parents with those
concerns typically claim a religious objection, officials said.
Nearly all states – except California, Mississippi and West Virginia – offer religious exemptions, while
only 19 offer philosophical exemptions.
Children who do not have an exemption or the required vaccinations can be suspended after 30 days
and return to school after their parents get an exemption or proof they were vaccinated.
Emerson Waldorf School outside Chapel Hill reported Orange County’s lowest immunization rate – 62.2
percent of the K-12 students are immunized. The school, which has had previous outbreaks of pertussis
and measles, reported 84 out of 222 students had religious exemptions.
The school’s policy is to meet all state requirements, Emerson Waldorf administrator Christina Wise
said. A number of families have made a different choice, she said, and the school chooses to respect
their decisions.
“We consider it a private matter for the family to make decisions, and then we observe all North
Carolina laws regarding it,” Wise said.
Emerson Waldorf’s immunization rate lowered the overall rate for six local private schools to 93.2
percent, health officials reported. Those schools reported 96 religious and two medical exemptions.
Two charter schools – Orange Charter and Expedition School – had a 95.8 percent vaccination rate.
Those schools reported 22 religious exemptions and none for medical reasons.
The Orange County Schools district led the county with the most vaccinated students at 99.2 percent,
reports show, followed by the Chapel Hill-Carrboro City Schools with 98.78 percent. The county schools
reported five medical and 57 religious exemptions, compared with 15 medical and 127 religious
exemptions in the city schools.
Exemptions bill
The state Senate considered a bill this year that would have ended religious exemptions; it’s still in the
Committee on Health Care.
Chapel Hill-Carrboro schools also attempted to eliminate the religious exemption a few years ago, said
Judy Butler, the Health Department’s public health nursing supervisor.
“They found out legally that they probably could not do that,” she said. “The concern about having the
legislature do away with religious exemptions ... was that it might backfire, and they may actually pass a
law that allows personal exemptions, which a lot of states have done.”
Orange County has the second-highest number of religious exemptions in the state, Butler said, after
Buncombe County. Roughly 4 percent of Buncombe’s school-age children are not immunized, state
reports show.
Unvaccinated students can be asked to stay home for up to 21 days if an infectious disease strikes a
school with low immunization rates, Butler said. The incubation period varies from one disease to
another.
“If we had a pertussis case in a school that is 99 percent vaccinated,” Butler said, “we may not need to
exclude the unimmunized students, because of the herd immunity in the population.”
“Herd immunity” means the school has enough vaccinated students that it also provides some
protection to unvaccinated students.
The state reported 780 cases of pertussis, or whooping cough, in 2014 – the highest number reported
since 1991. Twelve cases were reported in Orange County, state records show; Durham County had 20
cases, and Wake County had 53.
Orange County reported 13 pertussis cases in 2012, and one confirmed case of the measles in a local
private school in 2013. A 14-year-old student at East Chapel Hill High School died from meningococcal
disease in 2014.
Public fears
Public health experts worry the fear that vaccinations may be linked to autism and other disorders, plus
the number of unvaccinated homeschool students, may be causing resurgence in some diseases that
have been eradicated for years in the United States.
Since 1988, more than 16,000 claims of adverse vaccination effects have been filed with the National
Vaccine Injury Compensation Program. More than $3 billion was paid in 4,277 of those claims,
government records show.
Orange County’s health department works with medical providers to address those fears, Butler said,
and encourages parents to consider science-based research that says the vaccines are safe.
Tammy Grubb: 919-829-8926, @TammyGrubb
Read more here: http://www.newsobserver.com/news/local/community/chapel-hill-
news/article42266670.html#storylink=cpy
Family Success Alliance fills gaps in community
Rachel Herzog | November 2, 2015 Photo by José Valle / The Daily Tar Heel
When Alecia Gattis thought about her son starting kindergarten in the fall, she felt panicked.
His daycare and preschool hadn’t had a lot of supervision, Gattis said, and allowed her son, Melvin
“Trey” Babbs, to wander from room to room.“
Every time I picked him up, he was in another classroom, or he was in (the director’s) office,” she said.
Gattis was worried this freedom would translate to him not being able to sit in one place and learn in
kindergarten at Northside Elementary School. But then, Trey attended a three-week kindergarten
readiness program from the Family Success Alliance.
“I was really, really worried he would not be able to settle in and not be in trouble and not be such a
busybody, and that program, it worked,” Gattis said.
“Like, wonders.”
While Trey attended preschool, lots of kids in Chapel Hill-Carrboro City Schools and Orange County
Schools do not. Many also lack other resources that help them succeed in school.
Kids who enrolled in the Family Success Alliance kindergarten readiness program went from 9 percent to
67 percent proficiency in literacy, math and social skills by the end of the summer program.
Additionally, the Alliance seeks to address community needs throughout the school year by matching
families with the resources they need.
Staffed by the Orange County Health Department and funded by the Orange County Social Justice Fund,
the group began its work in August 2014. But its programs didn’t start until July, spokesperson Stacy
Shelp said.
“In the first year, a lot of the work was information gathering,” Shelp said.
The group spent the first four months identifying pockets of poverty in Orange County and identifying
their needs. This school year, the program is working with two pilot zones, in central Orange County and
downtown Chapel Hill.
During the school year, the group’s “navigators” work directly with families from these zones to connect
them with whatever resources they need. These include tutoring, parenting classes, literacy help and
substance abuse counseling. The group partners with local organizations including the Orange County
Literacy Council and the Carrboro organization Volunteers for Youth.
“I like to say that we’re navigators because we’re guides,” said Beatrice Parker, the program’s Zone 6
navigator.
“Parents with jobs and long hours might not be able to investigate the best after-school program
themselves,” Parker said.
Gattis, who is studying to be a registered nurse, said she is working with the program now to find
tutoring for Trey’s older brother and for Trey, who’s adapting well to kindergarten.
“I have had no complaints from the teachers — she said she has no idea who that child that I explained
was,” Gattis said.
Read more: http://www.dailytarheel.com/article/2015/11/family-success-alliance-fills-gaps-in-
community
The News of Orange County
Kindergarten readiness program finds success
Two students work on an assignment during a kindergarten readiness program held this
summer in three schools, including New Hope Elementary School, which was made
possible by the Family Success Alliance.
Posted: Friday, October 23, 2015 4:04 pm | Updated: 4:44 pm, Fri Oct 23, 2015.
by Amanda VanDerBroek
Just a few months after Family Success Alliance launched, the group along with the county’s school
districts are making strides.
On Monday, Oct. 19, FSA announced it has seen an early victory through a summer kindergarten
readiness program.
“After working with community members and organizations in our two zones, the Family Success
Alliance felt the best place to start work in our pipeline was with a kindergarten readiness program,
which is early in the pipeline of success from birth through first job or early college,” said Dr. Michael
Steiner, chief of General Pediatrics and Adolescent Medicine at UNC Health Care and chair of the Family
Success Alliance Advisory Council. “These programs were developed using best practice and enrolled
children from low-income families as well as children identified as needing additional support. Those
children participated in programs that would help them prepare for kindergarten. Programs were held in
three elementary schools that are present in the two zones [chosen by FSA]—New Hope Elementary
School, Frank Porter Graham Elementary School and Carrboro Elementary School.”
Steiner said a total of 66 families and their children participated in the programs that lasted two to three
weeks. The aim was to prepare the children socially, emotionally and academically for when they
entered school.
“We’re thrilled to report that we saw significant improvements in the assessment scores of children that
participated in this first year of the kindergarten readiness program,” Steiner said. “As I said in the
beginning, this is the start of multiple interventions that will carry these children on a pipeline to young
adult success.”
The achievement in numbers
Sheldon Lanier, director of equity for Chapel Hill-Carrboro City Schools, said overall students enrolled in
the program at the three schools, moved from 9 percent to 67 percent in proficiency.
“When we talk about proficiency, we’re talking about leveling the playing field and having students
ready to move into kindergarten and actually, I don’t want to say compete, but basically be able to
achieve on the same level of students who may have gotten some of those resources,” Lanier said.
Students at New Hope Elementary went from 0 to 63 percent in proficiency while Carrboro Elementary
went from 33 percent to 61 percent. Frank Porter Graham saw the largest gain in proficiency from 0 to
74 percent.
Forty-eight percent of the children enrolled came into the program with no prior education experience
and 70 percent of the group qualified for free or reduced lunch.
Seventy-five percent of participants were a race other than white with 62 percent identifying as
Hispanic.
“In terms of the teachers that were working with the program over the summer, 100 percent of the
teachers surveyed felt that the program was extremely beneficial for their students,” Lanier said. “And
64 percent said students made substantial gains while 36 percent indicated that students made
moderate gains.”
All of the families involved with the program reported feeling satisfied with kindergarten readiness and
84 percent felt their child was ready for kindergarten following participation.
Setting kids up for success
Ambra Wilson, assistant principal at New Hope Elementary who served as the administrator of the
kindergarten readiness program at New Hope, said numerous parties were involved in making the
program happen at the school.
“As we began planning for this camp, we didn’t have as much time as we hoped to have in the upcoming
year,” she said. “So we started out by talking with our kindergarten teachers—who had met these
children who were coming into kindergarten—and asked them to give us their expertise.”
From there those involved knew which students should be focused on for kindergarten readiness.
“We then reached out to all of the families who were recommended because we knew all of them
would not respond or be able to participate,” she said. “We were hopeful to get 30 participants.
However, due to people moving or vacations that were already planned and things of that nature, we
ended up with 21 students who participated consistently throughout the program.”
Wilson said when it came to recruiting teachers, many came from across the spectrum K-5, each
wanting to be a part of the program bringing a passion of helping kids get ready for their grade school
career.
Wilson said involving parents in an informational session was also key to making the students successful.
“We wanted to provide parents with specific questions to engage in meaningful conversation with their
kids about the learning that was taking place and also use that as an opportunity to provide them with
strategies that could then be intertwined to their daily activities—utilize that time traveling in a car and
reading a book at night before they went to sleep and questions to go a long with that text,” she said.
Wilson said part of the goal was inspiring children to want to learn.
“We wanted those children to develop a love of learning and feel successful because they were going to
be successful when they came to New Hope,” she said. “Now that these children are at New Hope and I
see their shining faces everyday, it’s funny because I’ll ask them, ‘Who was your teacher last year?’ and
you know they count last year as summer camp. … It’s developing that passion in our kids and our
teachers.”
Wilson said she’s starting to collect data on children involved in the program.
“We are beginning to track data on these children as we move into the beginning of the year
assessments,” she said. “So I’m beginning to compile that data so I can look and see is this an alignment
with the assessments that we used in the summer program? Are we seeing this carryover into the
assessment that we use throughout the school year? I will continue to monitor the data on the children
that were in the program as well as the students who did not participate that were invited, so we’ll still
have that controlled group to monitor.”
Magda Parvey, assistant superintendent for Instructional Services for Chapel Hill-Carrboro City Schools,
said the district has been working on an achievement gap for some time.
“And we feel like the kindergarten readiness program really aligns very nicely with the work that we’re
doing in addressing the achievement gap, specifically in terms of pre-teaching and preparing students in
advance of being in school,” Parvey said. “It aligns very much with our K-12 initiatives in terms of
strategies that are evidence based. So we really appreciated the ‘it takes a village’ approach that the
Family Success Alliance provided and we’re really honored to be a part of that.
“The gains that Mr. Stiener and Mr. Lanier have talked about really mean a lot to students. We’re talking
about not only kindergarten readiness, but also college and career readiness, putting them on the right
trajectory for success in school. It starts with kindergarten readiness.”
From the parents’ perspective
Claudia Yerena and Eddye Morrison know about the success of the kindergarten readiness program first
hand.
Yerena said she is the mother of two sons, ages 7 and 5, and the youngest participated in the New Hope
kindergarten readiness camp.
“I can see the difference between my two boys,” Yerena said. “It’s a huge difference between them. My
older boy was very scared and shy and refusing to go to school. It’s totally different from my second boy.
He was totally excited. He was ready to go. He has more confidence.”
Yerena said her youngest son started school with more academic skills even though she works with him
at home.
“At school, I think he takes it more seriously,” she said.
Morrison, a grandmother of a student who participated at the camp at New Hope, agreed with Yerena
and said she wished her own children could have participated in a similar program when they were
young.
Morrison said kindergarten readiness helped her grandchild get familiar with the school and meet some
of her classmates and make friends.
“Therefore it lowered the anxiety level and settled her a little bit more so she’s willing to pay attention
more,” Morrison said.
Steiner said FSA hopes to continue the kindergarten readiness program in the coming years and learn
from the initial program.
“This program is currently the entry point into this long pipeline,” he said. “We promise to continue to
developing programs that will build the pipeline, strengthen partnerships and make resources available
to children and their families as they successfully move through their school years with early college and
early career being the end goal of our work.”
Officials: FSA kindergarten
readiness program a success
Katie Jansen
Updated Oct 24, 2015
HILLSBOROUGH — The new kindergarten readiness program launched this summer is
meeting its goals, the Family Success Alliance announced this week in conjunction with
two local school districts.
The program rolled out this summer after the Family Success Alliance collected surveys
and held community listening sessions to help in prioritizing the communities’ needs.
“This is the start of multiple interventions which will carry these children on a p ipeline to
young adult success,” said Michael Steiner, chairman of the Family Success Alliance
advisory council.
The program, which was held at three elementary schools and served 66 families,
hoped to provide academic, social and emotional support for underserved families and
for students who didn’t have previous school experience.
Of this summer’s participants, about 48 percent didn’t have prior school experience, and
70 percent of families qualified for free and reduced lunch.
The students were given pre- and post-tests to measure their level of readiness for
kindergarten. By the end of the 15- to 16-day program, many of the students moved
from the bottom two levels — beginning and in progress, to the top two levels — basic
or full proficiency.
At New Hope Elementary, 63 percent of students exhibited basic proficiency — up from
0 percent during the pre-tests.
At Frank Porter Graham Elementary, 26 percent of students fell in the basic proficiency
level and 48 percent of students were fully proficient — both up from 0 percent two
weeks prior.
Magda Parvey, assistance superintendent for instructional services for Chapel Hill-
Carrboro City Schools, said the readiness program aligns nicely with other steps the
district is taking to close the achievement gap the district has struggled with for years.
Some students entered the program with little to no English. At each of the three sites,
the majority of students were Hispanic.
“Language and vocabulary put students at a deficit,” Parvey said. “So when you give
them the exposure to read-alouds where they’re hearing language and learning to have
that listening comprehension, it very much helps them in terms of school readiness …
Coming in with some language, coming in and understanding what school is about, that
puts them on equal footing.”
Ambra Wilson, New Hope Elementary’s assistant principal and site administrator for the
kindergarten program, said the program was not only about helping the students adjust
to school, but about helping the parents feel comfortable, too.
“And really, we’re a family at New Hope,” she said. “So now (the students are) a part of
that family, and we want the parents to feel a part of that family. And they did tell us at
the end of this program 100 percent of them felt welcomed and ready to be a part of our
school. So we really feel like the kindergarten readiness camp provided us with that
springboard that we needed to really launch this school year in the right direction.”
Wilson also said that although some program participants needed beh avioral
interventions during the summer program, incidents have been few and far between
since they’ve started school.
“The benefits to this program go outside the data that can be put on paper,” she said.
Steiner said the Family Success Alliance hopes to continue offering the program in the
future, as well as expand enrollment.
This year’s program was funded by $75,000 from the social justice fund, which was
allocated by the Orange County Board of Commissioners. Steiner said the alliance
plans to continue working with the commissioners and both school districts to secure
future funding.
The organization is also working toward implementing other programs along the pipeline
to continue working with these students.
Parvey said the district looks forward to working with the Family Success Alliance in the
future.
“We have really appreciated the ‘it takes a village’ approach that Family Success
Alliance provided, and we’re honored to be a part of that,” she said.