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BOH agenda 032818
ORANGE COUNTY BOARD OF HEALTH MEETING AGENDA DATE: March 28, 2018 TIME: 7:00 P.M. PLACE: Whitted Building, 3rd Floor Meeting Room 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 March 28, 2018 Agenda 7:10 – 7:15 IV. Actions Items (Consent) A. Minutes of February 28, 2018 Susan Elmore 7:15 – 8:40 V. Educational Sessions A. El Centro Overview (20 minutes) Pilar Rocha-Goldberg (relative to BOH Strategic Plan Priority: Engagement) B. Cardinal Annual Update (20 minutes) Ric Burton (relative to BOH Strategic Plan Priority: Substance Abuse & Mental Health) C. State of the County Health Review (15 minutes) Ashley Rawlinson (relative to BOH Strategic Plan Priority: All) D. FSA Update (30 minutes) Coby Jansen Austin (relative to BOH Strategic Plan Priority: Social Determinants of Health) 8:40 – 8:45 VI. Reports and Discussion with Possible Action A. Select Topic for Annual Report/Work Plan for BOCC Quintana Stewart B. Health Director Report (5 minutes) Quintana Stewart C. Media Items Quintana Stewart 8:45 – 8:50 VII. Board Comments 8:50 VIII. 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. MINUTES-Draft ORANGE COUNTY BOARD OF HEALTH February 28, 2018 S:\Managers Working Files\BOH\Agenda & Abstracts\2018 Agenda & Abstracts/ February Page 1 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 February 28, 2018 at the Orange County Health Department, 300 West Tryon Street, Hillsborough, NC. BOARD OF HEALTH MEMBERS PRESENT: Susan Elmore – Chair, Timothy Smith – Chair, Johanna Birchmayer, Barbara Chavious, Jennifer Deyo, Liska Lackey and Sam Lasris. BOARD OF HEALTH MEMBERS ABSENT: Bruce Baldwin, Commissioner Mia Burroughs, Paul Chelminski and Jessica Frega. STAFF PRESENT: Quintana Stewart, Health Director; Rebecca Crawford, Financial and Administrative Services Director; Cintia Gevawer, Dental Office Assistant; Henry Green, Community Health Aide; Victoria Hudson, Interim Environmental Health Director; Carla Julian, Dental Clinic Practice Manager,HIPAA Privacy and Security Officer; Donna King, Health Promotion & Education Services Director; Pam McCall, Personal Health Services Director; Kristin Prelipp, Communications Manager; April Richard, Tobacco Prevention and Control; Beverly Scurry, Board of Health Strategic Plan Manager; Ana Salas, Dental Assistant ; La Toya Strange, Administrative Assistant II; Iulia Vann, Public Health Services Manager and Phil Vilaro, Interim Environmental Health Director. GUESTS PRESENT: Kelly Kester and Sara Pequeno. I. Welcome New Employees Liska Lackey, Chair, called the meeting to order. Ms. Stewart welcomed new employees, Cintia Gevawer and Henry Green. II. Public Comment for Items NOT on Printed Agenda: None. III. Approval of the February 28, 2018 Agenda Motion was made by Jennifer Deyo to approve the agenda, seconded by Liska Lackey and carried without dissent. IV. Action Items (Consent) A. Minutes of January 24, 2018 Meeting Motion was made by Jennifer Deyo to approve the minutes of January 2018, seconded by Liska Lackey and carried without dissent. V. Educational Sessions MINUTES-Draft ORANGE COUNTY BOARD OF HEALTH February 28, 2018 S:\Managers Working Files\BOH\Agenda & Abstracts\2018 Agenda & Abstracts/ February Page 2 A. Campus & Community Coalition Update Elinor Landess, Director of the Campus & Community Coalition to Reduce the Negative Impacts of High Risk Drinking (the CCC), presented an update on the status of the Coalition's activities. Below are some highlights: Three focus areas – Policy/Environment, Education/Awareness and Enforcement Policy/Environment • In 2016-17, there were 114 alcohol-related EMS transports in Carrboro/Chapel Hill. Campus alcohol policy cases totaled 217. Chapel Hill Police Department (CHPD) responded to 340 loud party calls for service. • Updates include: o Party Registration Policy was soft launched in January. The program lets students register their off-campus parties. If police get a noise complaint about a registered party, they will call or text the host(s), giving them 20 minutes to lower the volume or end the party. If another noise call comes in about the same party, a police officer will investigate and could issue a citation. Loud parties that aren’t registered may be cited for the first call. Two consecutive warnings result in the loss of their registration privileges for 90 days. They can also lose privileges for one year for a citation. This gives students an opportunity to take responsibility prior to any intervention. Education/Awareness • In 2016-17, the CHPD conducted 24 B.A.R.S. (Be A Responsible Server) trainings. There were 4,254 incoming students that completed Alcohol.edu training module. • Updates include: o Bee Safer was developed by media and journalism students. An Alcohol Resource guide was created which is intended for staff who are new to selling and serving alcohol in Chapel Hill. It includes information such as tips on spotting fake IDs, preventing sales to underage patrons as well as other helpful information. Enforcement • In 2016-17, the CHPD wrote 101 alcohol-related citations. There were 47 alcohol-related incidents/charges recorded by the UNC Police Department. • Updates include: o The new Campus Alcohol Adjudication policy is applicable to all members of the campus community not just the students and all will go through the same adjudication process. Regarding what’s next for the CCC, Ms. Landess stated that it is important that consistency and equity in all the processes remains. The CCC is looking into engaging landlords as partners, possibly having them include provisions in their lease agreements pertaining to being a model tenant. The CCC also wants those people who are doing right to feel good and/or be acknowledge for doing so. The importance of educating the community and students was heavily stressed as the use of alcohol among the college population not only affects the individual but the community as well. The BOH had questions that were addressed by Ms. Landess. MINUTES-Draft ORANGE COUNTY BOARD OF HEALTH February 28, 2018 S:\Managers Working Files\BOH\Agenda & Abstracts\2018 Agenda & Abstracts/ February Page 3 B. Communicable Disease Protocol Iulia Vann, Public Health Services Manager, gave a presentation on the Health Department’s efforts in initiating, managing, and preventing outbreaks in Orange County. Below is a summary of her presentation. Outbreaks Defined as an occurrence of 3 or more ‘epi-linked’ (exposure to same person, same school, showing some commonality) cases Some reasons to Investigate an Outbreak • Identify and describe the source • Describe new diseases, learn more about known diseases • Identify populations at risk • Opportunity to educate public about disease prevention • Address public concern • Develop strategies to prevent future outbreaks • Terminate the outbreak 10 Steps of an Outbreak Investigation • Identify investigation team and resources • Establish existence of an outbreak • Verify the diagnosis – confirm signs, symptoms, test results • Construct case definition – unique to outbreak • Case finding – active and passive • Perform descriptive epidemiology– line list and epi curve • Evaluate hypotheses – agent, source, transmission, exposure • Implement control measures – prevent further exposure, good balance for credibility and reputation. • Communicate findings • Maintain surveillance Vaccine Preventable Disease (VPD) • Mumps cases in Orange County by year o 2015 – 1; 2016 – 0; 2017 – 4 • Pertussis cases in Orange County by year o 2015 – 6; 2016 – 14; 2017 – 10 Vaccine effectiveness • Pertussis vaccines are effective, but not perfect. • Typically offer good levels of protection within the first 2 years after getting the vaccine, but then protection decreases over time. • Public health experts call this ‘waning immunity.’ • DTaP vaccines are 80% to 90% effective. • There is a modest decrease in DTaP effectiveness in each following year. Lastly, Ms. Vann informed the Board that the OCHD CD team collaborates with the school districts, providers, parents and state agencies. The BOH had questions that were addressed by Ms. Vann. C. Strategic Plan Update MINUTES-Draft ORANGE COUNTY BOARD OF HEALTH February 28, 2018 S:\Managers Working Files\BOH\Agenda & Abstracts\2018 Agenda & Abstracts/ February Page 4 Beverly Scurry, BOH Strategic Plan Manager, briefly, presented highlights of the achievements accomplished to date centered around the four priority areas of Social Determinants of Health, Physical Activity and Nutrition, Substance Abuse and Mental Health and Engagement. Highlights of Ms. Scurry’s presentation included successful, not so successful ventures and upcoming/ongoing activities: Social Determinants of Health Success - Patient/Client text messenging • In July 2017, OCHD contracted with Solutionreach to provide a texting service through Eagle Soft (Dental EMR) for clients. o 2000 text confirmed appointments since implementation. o Patient no show rate down from 15% to 12% since implementation. Not so successful - Medical-Legal Partnership • FSA created a working relationship with Legal Aid in 2016. o A referral form was created for residents of Gateway to seek counsel regarding tenant issues. o The program did not generate many referrals due to resident’s fear of possible negative retaliation from management. o There was staff turnover at Legal Aid that created a halt in the program; although, there are plans to follow-up with Madlyn Morreale of Legal Aid. Upcoming Activities – Translation Boot Camp and SDH Clinical Tools to assist with ACE and other screenings Physical Activity and Nutrition Success – School Staff Support • Both schools systems were offered opportunities to apply for and receive funding to support a physical activity and nutrition project in their school. o Orange County Schools applied for Community Project Support funding. o BOH provided funding for 3 Partnership Academy teachers to attend the Action Based Learning and Kidsfit Kinesthetic Classroom Training in July 2017. Not so successful – Nutritional Review of Homestead Aquatic Center • A review of the Aquatic Center revealed they are not providing hot meals which would warrant a nutritional review. • Moving forward, vending machines in county owned facilities will be evaluated for their nutritional content. Upcoming Activities - Collaboration with Orange County Food Council as a food database is being creating by a UNC student that will consist of policies that will address incentives for food retailers and other interventions that address food deserts. We’lll work together to determine ways to effectively disseminate that information to the community. Substance Abuse and Mental Health Upcoming/Ongoing Activities – MINUTES-Draft ORANGE COUNTY BOARD OF HEALTH February 28, 2018 S:\Managers Working Files\BOH\Agenda & Abstracts\2018 Agenda & Abstracts/ February Page 5 • Continued exploration of Screening, Brief Intervention, and Referral to Treatment (SBIRT) options for medical clinic. • Ric Bruton will present on Cardinal Innovations annual report on the use of county dollars in March 2018. • BOH Strategic Plan Manager continues to participate on the Jail/Mental Workgroup and Justice Advisory Council. Engagement We’ll continue to monitor other Boards and present an update twice a year. The next update will be given at the April BOH Meeting. Lastly, Ms. Scurry stated that she’s working with Susie Green, referred by Susan Elmore, to assist with cleaning up/updating the current Strategic Plan. D. Outside Agency Review Process La Toya Strange, Administrative Assistant II, summarized the Outside Agency Review process and the assignments required of Board of Health members for evaluating applications. The Health Department received ten applications to review. Board members are to review the applications assigned to them, record scores on the appropriate scoring cards and send the completed scoring cards back to Ms. Strange by March 22nd. VI. Action Items (Non Consent) A. 2018-19 Budget Quintana Stewart, Health Director, began by acknowledging staff and division directors for their hard and creative work. Rebecca Crawford, Financial and Administrative Services Director, presented the Board with a summary of the proposed FY 2018-2019 budget for the Health Department which shows an increase in expenditures of $150,750 from the FY 18-19 Base Budget; $97,364 of which are expenditure increases related to increases in permanent staffing (1.0 FTE Dental Hygienist, full supported by fees for service) and temporary staffing (Environmental Health Specialist, Graphic Designer, Dentist, and Foreign Language Interpreter).The remaining $53,386 of the expenditure increase is related to service levels increases for the Family Success Alliance and enhanced medical services. This also includes budget increases approved during the FY 17-18 budget process for the Formerly Incarcerated Transitions (FIT) and Youth Tobacco grants. Staff projects a $150,750 increase in revenues for FY 18-19, which will fully offset the expenditure increase. The Health Department will request level county funding for FY 18-19. The proposed total budget is $10,251,749. In relation to new staff requests, the Health Department requests a 1.0 FTE Dental Hygienist, which will decrease patient wait times for routine cleanings from nine months to the industry standard of care of six months. This position will be fully funded by self-pay, Medicaid, and Commercial Insurance reimbursements for our fees for services. The department also requests to make our time limited 1.0 FTE Property Development Tech a permanent employee, funded by Environmental Health fees for services. Finally, the department requests to have an ongoing line item for Environmental Health Specialist temporary employees. The EHS temps used in the current fiscal year to help with an increased number of WTMP inspections have also helped MINUTES-Draft ORANGE COUNTY BOARD OF HEALTH February 28, 2018 S:\Managers Working Files\BOH\Agenda & Abstracts\2018 Agenda & Abstracts/ February Page 6 decrease overall wait times for well and septic inspections while contributing additional revenue to the department. In relation to state funding, the NC Department of Health and Human Services has provided us with the FY 18-19 Consolidated Agreement Addenda. We received a minor decrease in six programs for a total of $12,441, which will be offset by an anticipated decrease in expenditures for the Refugee Health and Youth Tobacco programs. Refugee Health funding is determined based on the number of refugees assigned to Orange County. Since we have seen fewer refugees in FY 17-18, most likely due to decreased immigration in the existing political climate, the FY 18-19 funding allocation was decreased. The FY 17-18 Youth Tobacco program allocation included a one-time $8,000 increase for QuitlineNC services, which was not included in the FY 18-19 allocation. In relation to fee changes, the FY 18-19 requested budget includes fee changes for the Personal Health, Dental Health, and Environmental Health divisions. Staff recommends multiple fee changes for Personal Health to add a new UNC lab test for colorectal cancer screening and adjust the fees for 340B drugs according to state and federal policies around 340B drugs. In addition, Dental Health would like to add a fee for root extractions, which they are currently performing but without an associated fee. Also, Environmental Health would like to add several new swimming pool and Food Service Establishment permit fees. All proposed fee increases are described in more detail in a separate Fee Change abstract. Ms. Crawford facilitated a discussion about the proposed fee changes which touched briefly on making multiple fee changes in Personal Health, adding a fee in Dental Health, and adding several new fees in Environmental Health division. Personal Health requests annually scheduled adjustments to our fees for 340B drugs (Family Planning drugs not including birth control pills) to make them match the county’s cost to purchase them, as required by the state and federal government. This will have very little impact on both the department and patients as only 10% of self-pay patients pay more than $0 for Family Planning drugs or procedures and of that 10% we had no patients in prior years that have had to pay 100% of the cost. Personal Health would also like to add a UNC lab test that is a patient-friendly take-home screen for colorectal cancer. Dental Health requests to add a fee for the removal of the root or a root fragment of a tooth after the tooth itself has previously been removed but not completely. The Dental clinic is performing this procedure but has not had a fee in their schedule for which to charge. We anticipate performing 20 root tip extracts in FY 18-19. Environmental Health requests to add multiple new swimming pool and food service fees and corrections to two other fees. The new swimming pool fees are directly related to year round pools and the increased time required to make no fewer than two annual site visits and the additional visits required for those that do not meet standards. One new Food Service Establishment (FSE) fee also focuses on extra time required for additional site visits when a permit is denied. The final FSE fee addition is used in our surround counties but is new to Orange County. This fee is typically used when a FSE changes ownership; the transitional permit is able to be used until the county determines if a new permit is required. Motion to approve all fee changes for FY 2018-2019 as presented, the total budget requested in the amount of $10,251,749 for FY 2018-2019 as presented and forward to the MINUTES-Draft ORANGE COUNTY BOARD OF HEALTH February 28, 2018 S:\Managers Working Files\BOH\Agenda & Abstracts\2018 Agenda & Abstracts/ February Page 7 County Manager and Board of County Commissioners for action was made by Sam Lasris, seconded by Jennifer Deyo and carried without dissent. The BOH had questions that were addressed by Ms. Crawford. VII. Reports and Disccussion with Possible Action A. Fluoridation Discussion Quintana Stewart, Health Director, began by reiterating that this is a follow-up to the November 3rd OWASA letter to the BOH requesting help with a community review of fluoridation. It was determined, during the November 27, 2017 BOH meeting, that the Board will decide if they wish to create a subcommittee to plan for the Countywide review of fluoridation upon arrival of the new Health Director. Ms. Stewart informed the Board that she had previously spoken with Ed Kerwin, OWASA Executive Director. The subcommittee’s focus will be solely on health concerns and not the ethical. The subcommittee duties will consist of the planning and reaching out to the experts. After the Board reviews the information, they will present it to the public. After some discussion, the Board voted on whether to create a subcommittee. Motion to create a planning subcommittee was made by Liska Lackey and seconded by Sam Lasris. Johanna Birckmayer abstained. B. Health Director Report Ms. Stewart elaborated on the Health Department’s activities that occurred in February as well as the upcoming activities that were in her Health Director’s Report. There were no questions from the Board regarding the Health Director’s Report included in the packet. C. Media Items Kristin Prelipp, Communications Manager, distributed the Annual Report to the Board. Media items were in the packet which focused on Orange County’s events and our involvement in various efforts. VIII. Board Comments None. IX. Adjournment Barbara Chavious moved to adjourn the meeting at 8:55pm and Liska Lackey seconded. The next Board of Health Meeting will be held March 28, 2018 at the Orange County Health Department, 300 West Tryon Street, Hillsborough, NC at 7:00 p.m. Respectfully submitted, MINUTES-Draft ORANGE COUNTY BOARD OF HEALTH February 28, 2018 S:\Managers Working Files\BOH\Agenda & Abstracts\2018 Agenda & Abstracts/ February Page 8 Quintana Stewart, MPA Orange County Health Director Secretary to the Board Agenda Item Number: ORANGE COUNTY BOARD OF HEALTH AGENDA ITEM SUMMARY Meeting Date: March 28, 2018 Agenda Item Subject: El Centro Overview Attachment(s): PowerPoint Staff or Board Member Reporting: Pilar Rocha-Goldberg Purpose: ____ Action _ X Information only ____ Information with possible action Summary Information: El Centro Executive Director, Pilar Rocha-Goldberg, will discuss El Centro and the work they do in the community and with the OCHD. 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): A Model for Change Vision The Hispanic/La8no community strengthening North Carolina Mission El Centro Hispano works to strengthen the community, build bridges and advocate for equity and inclusion for Hispanics/La8nos in the Triangle Area of North Carolina The History of El Centro Hispano 1992: Founded as the Hispanic Resource Center, a joint project of the Catholic and Episcopal churches 1997: El Centro Hispano “ECH” became an independent nonprofit organiza8on blending service, educa8on, leadership development and community organizing. June 2010: ECH opened its branch in the heart of Carrboro 2000: ECH, in partnership with Self-Help Credit Union, State Employees Credit Union, and the NC Minority Support Center, opened the first La8no Community Credit Union in the state of North Carolina April 2015: ECH opened the Center for Employment & Leadership in its branch in Carrboro-Chapel Hill Priority Areas EDUCATION ECONOMIC DEVELOPMENT HEALTH AND WELLBEING Educa8on Economic Development Community Engagement & Advocacy Programs Health & Well being Educa8on Program School Readiness & Achievement Adult EducaDon • English as a Second Language • Literacy in Spanish for Adults • Elementary and secondary Educa8on (Plaza Comunitaria) • Spanish as a Second Language • Computer • Ci8zenship • Reading as a Family • Circle of Parents • Child Enrichment (Preschool) • Tutoring K-12 • College prepara8on • Work skills • Career readiness • Life skills • Leadership development Economic Development • Workforce Training & Development • Income & Job security • Self employment • Worker’s protec8on & Safety • Financial literacy & Asset building Center for Employment & Leadership Health Promo8on & Disease Preven8on Access to Health Care Direct Support Services Health & Well Being Ventanilla de Salud (Health Booth) (Juntos por la Salud- Mobil Unit) HIV Preven8on Alcohol/substance abuse educa8on DWI preven8on Personal navigator for HIV posi8ves Walk in office - Support - Connec8ons - Transla8ons - Interpreta8on - Domes8c Violence - Community Service - Legal Clinic Community Engagement & Advocacy Advocacy & Community mobiliza8on Community Leadership Policy Analysis Policy Analysis Advocacy & Community Mobiliza8on Community Leadership Youth Leaders in Ac8on LGBTQ Support Groups Community Outreach Workers - Immigra8on assistance - Know your rights - No Drivers license Clinic - Faith ID drives Neighborhood Organizing Advocacy and Coali8on Building Civic Engagement Support Services Educa8on Health Direct Services 4,163 people 2,626 Durham 1,537 Carrboro Referrals made 95 Housing 746 Legal 228 Employment 541 EducaCon 93 Health 69 Community Service Community Engagement IMPACT REPORT DURHAM & ORANGE COUNTY July 2016 – June 2017 School Readiness 58 Pre-k Classroom 151 Tutoring 8 Summer Camp Adult Educa8on 32 Literacy/Plaza 176 ESL 45 ParenCng 33 Motheread 14 New Ci8zens Screenings/Preven8on 11,291 Total screenings 1,236 HIV TesCng 1,182 Other STI’s 2,160 Condoms 1,161 Flu Shots Health Ed Outreach Ventanilla/Mobil Unit 58,168 796 Alcohol/drug use 22 Healthcare navigaCon 15 Health Promoters 578 @ Health Fair Economic Development Center for Employment & Leadership - CEL (Workers Center) opened April 2015 124 Workers Registered 134 Employers Registered 18 completed Job skills training Community Leaders 7 Youth Leaders 21 Youth leaders in AcCon parCcipaCon 12 LGBT leaders Community Educa8on & Outreach 2,462 Faith ID issued 15 Faith ID Drives 1,300 people aYended to 7 community forums 385 volunteers 370,317 hours served Board of Directors Judith Montenegro CHAIR Erik Valera CO CHAIR Christa Gibson TREASURER Carol Gallione SECRETARY Ethan Beaje MEMBER Eligio Peña MEMBER Winkie LaForce MEMBER Gabriela Zabala MEMBER Rebecca Reyes MEMBER Lenin Mar8nez MEMBER Jose Alfaro MEMBER Art Ehuan MEMBER Tae Park MEMBER Susan Denman EMERITUS MEMBER Muchas gracias Agenda Item Number: ORANGE COUNTY BOARD OF HEALTH AGENDA ITEM SUMMARY Meeting Date: March 28, 2018 Agenda Item Subject: Cardinal Innovations Annual Update Attachment(s): PowerPoint Staff or Board Member Reporting: Ric Bruton Purpose: ____ Action _ X Information only ____ Information with possible action Summary Information: Cardinal Innovations will give their annual report update focusing on how county funds are used to support Cardinal programming in Orange County. This annual update is an action step in the BOH Strategic Plan. 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): March 21, 2018 Copyright © 2018 Cardinal Innovations Healthcare. All rights reserved. March 21, 2018 § 122C-115 . Duties of counties; appropriation and allocation of funds by counties and cities. (b) Counties shall and cities may appropriate funds for the support of programs that serve the catchment area, whether the programs are physically located within a single county or whether any facility housing a program is owned and operated by the city or county. Counties and cities may make appropriations for the purposes of this Chapter and may allocate for these purposes other revenues not restricted by law, and counties may fund them by levy of property taxes pursuant to G.S. 153A- 149(c)(22). (d) Except as otherwise provided in this subsection, counties shall not reduce county appropriations and expenditures for current operations and ongoing programs and services of area authorities or county programs because of the availability of State-allocated funds, fees, capitation amounts, or fund balance to the area authority or county program. Counties may reduce county appropriations by the amount previously appropriated by the county for one-time, nonrecurring special needs of the area authority or county program. (1977, c. 568, s. 1; c. 679, s. 7; 1979, c. 358, ss. 5, 23; 1981, c. 51, s. 3; 1985, c. 589, s. 2; 1989, c. 625, s. 14; 1995 (Reg. Sess., 1996), c. 749, s. 1; 1999-202, s. 1; 2001-437, s. 1.8; 2004-124, s. 10.26(a); 2006-66, s. 10.32(c), (d); 2007-504, s. 1.3; 2011-264, s. 2; 2012-151, ss. 1, 6; 2013-85, s. 4(a)-(c); 2013-363, s. 4.12(a); 2013-378, s. 11 ; 2013-410, s. 23(a).) Local Maintenance of Effort (MOE) Funding Copyright © 2018 Cardinal Innovations Healthcare. All rights reserved. March 21, 2018 •Orange County contributes ~$1.3 million annually •Divided among over 30 separate line items and over 12 entities Local Maintenance of Effort (MOE) Funding Copyright © 2018 Cardinal Innovations Healthcare. All rights reserved. Freedom House Recovery March 21, 2018 Crisis 60,000 Indigent Labs / Meds 80,500 SA Supplement 40,000 Psychiatric Supplement 38,499 Forensic Screening 1,500 Language Resource Center Interpreting 10,000 Pro- Bono Orange 17,508 Compeer Orange County Funds 9,000 Orange County Services for Latino Community 4,000 Family Advocacy CMH 30,000 Majors / JJSAMHP 5,000 Copyright © 2018 Cardinal Innovations Healthcare. All rights reserved. UNC Dept. of Psychiatry March 21, 2018 Inpatient 31,374 Outpatient 261,450 AMH Housing Subsidies 13,050 Jail services 15,000 Copyright © 2018 Cardinal Innovations Healthcare. All rights reserved. Other Providers / Programs March 21, 2018 Arc of Orange County Volunteer coordination 33,320 Art Therapy Institute Treatment services 17,600 Art Therapy Institute Language interpreting 10,000 Carolina Outreach, LLC School based MH CMH 5,000 Chapel Hill Training Outreach Project, Inc. CMH 15,000 Club Nova Community, Inc. Orange County 163,000 Haven House Housing support 19,000 New Destinations, Inc. Orange County Apartments 35,100 Oxford House Housing supports 15,600 RHA School based MH CMH 5,000 Copyright © 2018 Cardinal Innovations Healthcare. All rights reserved. Other County Managed Items •Orange county also has set aside a portion of the MOE funding for various programs to address community interests •Examples include: –Services to people who are undocumented –Assisting DSS with placements and trauma focused therapy –Flex funds March 21, 2018 Copyright © 2018 Cardinal Innovations Healthcare. All rights reserved. Medicaid and State March 21, 2018 Copyright © 2018 Cardinal Innovations Healthcare. All rights reserved. Medicaid and State March 21, 2018 Copyright © 2018 Cardinal Innovations Healthcare. All rights reserved. Medicaid and State March 21, 2018 Copyright © 2018 Cardinal Innovations Healthcare. All rights reserved. Medicaid and State March 21, 2018 Copyright © 2018 Cardinal Innovations Healthcare. All rights reserved. Questions? March 21, 2018 Agenda Item Number: ORANGE COUNTY BOARD OF HEALTH AGENDA ITEM SUMMARY Meeting Date: March 28, 2018 Agenda Item Subject: SOTCH Report Attachment(s): PowerPoint Staff or Board Member Reporting: Ashley Rawlinson Purpose: ____ Action _ X Information only ____ Information with possible action Summary Information: The Orange County Health Department and Healthy Carolinians of Orange County are pleased to release the 2017 State of the County Health Report (SOTCH). This 2017 State of the County Health Report (SOTCH) provides an update on health concerns and the actions being taken to address them. It uses the most recent data to highlight the leading Orange County (OC) causes of death and disease and progress towards addressing the leading health concerns identified in the 2015 Community Health Assessment (CHA). The prioritized health issues are: 1) Social Determinants of Health with priority around access, transportation and poverty, 2) Physical Activity and Nutrition with priority around chronic disease prevention, and 3) Mental Health and Substance Abuse. This report will educate and inform community members, community leaders, and organizations about Orange County’s progress on these chosen priority health issues. This report will be available electronically on the Healthy Carolinians of Orange County and Health Department’s website, and paper copies will be available at the Health Department. The Orange County Health Department will distribute this report to the Orange County Board of Health, Orange County Board of County Commissioners, the Healthy Carolinians of Orange County membership, Orange County Government employees, and others upon request. 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): Ashley Rawlinson, MPH BOH Meeting March 28, 2018 Purpose Provide updates on health concerns and actions being taken to address them. Uses the most recent data to highlight the: Leading causes of death & disease Progress towards addressing the leading health concerns around: Social Determinants of health with priority around access, poverty and transportation Physical Activity & Nutrition with priority around chronic disease prevention Mental health & Substance Abuse Mortality OC has a lower age-adjusted death rate (per 100,000 population) than North Carolina (NC) averages in all categories. Age Group Rank Cause of Death # of Deaths Death Rate Total: All Ages 1 Cancer 935 146 2 Heart Disease 712 118.2 3 Cerebrovascular Disease 186 31.4 4 Chronic Lower Respiratory Diseases 160 26.8 5 Alzheimer's Disease 149 26.7 6 Unintentional Injuries 154 25.4 7 Diabetes 101 17 8 Septicemia 76 11.8 9 Nephritis, Nephrotic Syndrome, and Nephrosis 65 11.1 10 Pneumonia and Influenza 61 10.6 Social Determinants of Health Poverty 12.8% of our overall population lives in poverty, with 6.2% of all families living below the poverty level. 7.6% of children in Orange County live in poverty, despite a county-wide median income of $66,423. 18.2% of kids in Orange County live in food insecure households, compared to the NC rate of 22.6%. Social Determinants of Health On February 9th HCOC hosted its first ever poverty simulation exercise with 92 participants Shared feelings and experiences were: Frustration Desperation Little to no means Loss of jobs Robbery Lack of community resources Neglecting and/or not being able to afford necessary services Social Determinants of Health Likes Dislikes Was a great way to show the stress of those decisions within a single session It makes people realize what it’s like to live in poverty The tight quarters made it physically difficult to get from place to place and created the stress that one must feel in trying to rush to the bank before it closes. The realness of the situations The facilitator enforced the idea that this program was a simulation, not a game Short time Venue was too small for the exercise, which I think led to even more chaos/confusion Chaotic nature of not knowing "the system" that these families must navigate Lack of instruction about what was happening, but then again those living in these situations have to figure it out for themselves so more realistic Not enough time to visit all the places for resources Social Determinants of Health 0 0 2 0 29 0 10 20 30 40 1 2 3 4 5 Please rate your experience with the Simulation 100% 0% Would you like to see the Simulation offered again? Yes No Social Determinants of Health Transportation Try Transit Week (TTW) was held October 23-28. Partnered with OPT, Go Triangle, CHT, and the DOA. Transportation Academies: October 10th at UNC Hospital and one on October 13th at the Seymour Center. Each Academy taught: The basics of local/regional transit. Connecting to low-cost/no cost transportation services. Serving as a site for an information kiosk. Physical Activity & Nutrition 14% of OC preschoolers are obese and 19% of surveyed high schoolers are getting 60 minutes of physical activity a day. Physical Activity & Nutrition HCOC implemented a 6-month Eat Smart Move More (ESMM) Consistent Messaging Campaign. October – Move More November- Fruits & Veggies December – Prepare More Meals at Home January – Limit Screen Time February – Re-Think Your Drink March – Right Size Your Portions Physical Activity & Nutrition Chronic Disease 2012-2016 mortality rates for cardiovascular disease and diabetes in OC compared to NC Mental Health & Substance Abuse Suicide During the month of September, HCOC’s Mental Health & Substance Abuse committee hosted a few community events to educate and bring awareness to suicide prevention. The events that occurred were: Suicide Prevention Kickoff. Day of Prayer. Be the Light” Suicide Prevention Awareness Walk. QPR (Question, Persuade, & Refer) Training. Mental Health & Substance Abuse Prescription Drug Misuse/Abuse There are 42.1 opioid prescriptions per 100 residents 4.9 million opioid pills were dispensed in 2016 The drug overdose rate is 12.7 per 100,000 persons The opioid rate is 7.8 per 100,000 persons Mental Health & Substance Abuse Prescription Drug Misuse/Abuse OCHD ran radio commercials through Radio One’s K97.5, with messaging about safe syringe exchange as well as naloxone. Commercials ran for 4 weeks between November 20th and December 16th. We : Produced 116 total radio commercials. Reached approximately 182,000 listeners between the ages of 18- 54. Had 116 commercials streamed on the K97.5 app. Had emails shared with 12,321 K97.5 subscribers. Had a Facebook live video done with mid-day radio personality. Mental Health & Substance Abuse Tobacco The State Legislature allocated $500,000 to tobacco use prevention. We accepted $37,500 of these funds to support educational and prevention programming efforts. Funding will be used to: Replace and update the Tobacco-Free School Signs Provide educational opportunities to youth, young adults, and youth influencers Train youth peer educators and their support staff on youth-led advocacy Dissemination Distribution to: NC DPH BOH BOCC HCOC membership, OC Government employees Electronic version available online HCOC and OCHD websites Paper copies are available Accreditation Requirement Benchmark 38 Activity 38.2 Documentation Evidence of BOH or Advisory Committee on Health review of SOTCH reports for each year in between the CHA since the last time the agency was accredited or reaccredited. BOH minutes reflecting discussion of specific aspects of CHA data. Agenda Item Number: ORANGE COUNTY BOARD OF HEALTH AGENDA ITEM SUMMARY Meeting Date: 3/28/18 Agenda Item Subject: Family Success Alliance Update Attachment(s): Staff or Board Member Reporting: Coby Jansen Austin and Erika Cervantes Purpose: ____ Action _ X_ Information only ____ Information with possible action Summary Information: Orange County Board of Health has made a commitment to fighting childhood poverty through supporting the Family Success Alliance (FSA), which launched in 2014. FSA is a “collective impact” initiative modeled on Harlem Children’s Zone and other place- based cradle-to-college/career programs throughout the country. This model entails making a long-term commitment to the community that grows over time as more children are embraced by the pipeline of services and supports provided. This presentation will highlight a few recent successes and share some of our ongoing work. 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): Board of Health Meeting, March 28, 2018 Coby Jansen Austin & Erika Cervantes The Family Success Alliance is… … a group of caring and proactive Organizations Local Government Agencies Community members working together to ensure children in Orange County, whose families struggle to make ends meet, have the opportunity for a healthy, safe, and productive life. Elected Officials Parents Through the power of community collaboration, we have the ability to address structural inequities so that all Orange County families can succeed. Collective Impact Our Partners Neighborhood Poverty Index Orange County Zone 4 Hillsborough Zone 6 Chapel Hill/ Carrboro Where we’re working… https://youtu.be/fDMIcWkq_Qo New “About FSA” video Fiscal Year K Ready Summer Cohort # Zone 4 (OCS) Zone 6 (CHCCS) Total Students per Cohort Cumulative Total (Students) FY 14-15 2015 1 27 39 66 66 FY 15-16 2016 2 29 43 72 138 FY 16-17 2017 3 26 44 70 208 FY 17-18 2018 4 30 60 90 298 FY 18-19 2019 5 30 60 90 388 Summer Enrichment: Ready for K Camp students are provided opportunities for afterschool programming and summer enrichment in subsequent summers – through grade 2. About half of each cohort is recruited into the navigator program. Kindergarten Readiness Camp Zone Navigators Zone 4 Zone 6 •Connection between families and resources •Peer coaches •Help families engage in, and advocate for, educational success Keeping community voice at the center of our work Antonia Mariela Claudia Angela Erika Brittany April Navigator Program Fiscal Year Cohort # # new families/ cohort Total families % Reach (families) Addl Navigator per new cohort Navigator FTE Total FY 15-16 1 34 34 4% 2 2 FY 16-17 2 41 75 10% 1.75 3.75 FY 17-18 3 45 120 15% 2.25 6 FY 18-19 4 45 165 20% 2.25 8.25 Navigator Program Modifications made in FY 17-18: Provided benefits to navigators; adjusted caseload to increase capacity for community organizing and leadership activities; hired Burmese bilingual navigator Communications 2017-18 Educational Partnerships •Innovation grants ($10,000 total) –FPG Elementary: MindUP all-staff training and monthly problem solving; parent sessions (Span &Eng) –Northside Elem & Culbreth: Weekly art therapy groups for refugee & immigrant newcomers –Stanback: Restorative Justice training & support •Afterschool programming (up to $2,500 each) –New Hope Elem, FPG Elem, Carrboro Elem Housing Focus •Strategic Plan Priority •Affordable Housing Coalition •Mobile Home Focus –Work Group –Mobile Home Surveys (countywide) –Community engagement: •Lakeview •Homestead GSK Impact Award Compass Center – Financial Literacy United Way – EY Connect Volunteers Bike Ministry Baby Boxes Holiday Photos Parent Council – launched in February! Advisory Council What’s next? •Ready for K Camp & summer enrichment •FY 18-19 Goal for Enrolled Families: 165 •Injury-Free NC Academy •Strategic Planning •Fundraising/ Development Agenda Item Number: ORANGE COUNTY BOARD OF HEALTH AGENDA ITEM SUMMARY Meeting Date: March 28, 2018 Agenda Item Subject: Review and Approve Annual Report/Work Plan for BOCC Attachment(s): Annual Report/Work Plan Staff or Board Member Reporting: Purpose: __X_ Action _ _ Information only ____ Information with possible action Summary Information: The Board of County Commissioners will review the Annual Work Plan reports from internal and external advisory boards and commissions at their April 26th work session. During that session board representatives and support staff will be able to highlight a topic to present to the BOCC. Quintana and Beverly will be in attendance at that meeting to present. The BOH will need to select a topic from their 2017 Annual Report/Work Plan to present to the BOCC. 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): NAME OF BOARD/COMMISSION_____________Board of Health __________ Report Period_____________2017_____________________ ORANGE COUNTY ADVISORY BOARDS AND COMMISSIONS ANNUAL REPORT/ WORK PLAN FOR THE COUNTY COMMISSIONERS The Board of Commissioners appreciates the dedication of all the volunteers on their boards and commissions and welcomes input from various advisory boards and commissions throughout the year. Please complete the following information, limited to the front and back of this form. Other background materials may be provided as a supplement to, but not as a substitute for, this form. Board/Commission Name: Board of Health Person to address the BOCC at work session- if applicable- and contact information: N/A Primary County Staff Contact: Beverly Scurry, Board of Health Strategic Plan Manager Quintana Stewart, Health Director How many times per month does this board/commission meet, including any special meetings and sub-committee meetings? Board meets once monthly except for July and December Brief Statement of Board/Commission’s Assigned Charge and Responsibilities. The Board of Health is the primary policy-making and adjudicatory body (NCGS 130A-39(a) (powers and duties of the boards of health) and NCGS 130A-24 (appeals), for the health department and is charged to protect and promote the public health of Orange County. Mission and Core Functions of the Health Department: To enhance the quality of life, promote the health, and preserve the environment for all people in the Orange County community. • Prevent and intervene in epidemics and the spread of disease • Protect against environmental hazards • Promote and encourage safe and healthy behaviors • Assure the quality and accessibility of health services • Assure compliance with laws and regulations that protect health and safety What are your Board/Commission’s most important accomplishments? • Successfully filled the Board of Health Strategic Plan Manager vacant position (Beverly Scurry) • Successfully recruited, interviewed and selected a new Board of Health representative (Bruce Baldwin, Johanna Birckmayer, Jennifer Deyo) • Received and discussed the annual communicable disease report for Orange County • Successfully implemented a new text messaging service within the Health Department Dental Clinic. This service is an appointment reminder for clients. • Successfully assembled a team to research, plan, and implement the first translation boot camp that will focus on family planning topics. Implementation will begin 2018. • Began a new collaboration with the Orange County Food Council to research policies that will address food desert issues. • Supported two staff members from Orange County Schools to attend the Action Based Learning/Kinesthetic Classroom National Workshop. Staff were able to learn techniques to implement physical activity at Partnership Academy which is currently absent of structured physical activity. • BOH has representation on the Mental Health/Jail Committee as well as the Justice Advisory Council in order to explore and stay informed of substance abuse and mental health policies, practices, and current activities in the county. • Approved Duke Endowment grant funding for The Formerly Incarcerated Transitions Program (FIT Program). This project provides people released from NC prisons assistance in accessing medical services and other community reentry services. • Successful site visit for Accreditation, January 2017 • Received Youth Tobacco and Prevention Funds from NC Department of Health and Human Services • OCHD completed a thorough Mental Gap Analysis presented to the BOH List of Specific Tasks, Events, or Functions Performed or Sponsored Annually. • Review of State of County Health Report annually • Review and approve new programs for health department • Review and approve budget request for department to forward to county • Review and approve fee schedule and any fee changes and forward to county • Review department strategic plan annually • Review annual activity report for the department • Reviews quarterly and annual fiscal report for department • Reviews annual communicable disease report for the county • Reviews annual Child Fatality Task Force Report • Regular Board of Health Educational Sessions • Reviews biannual Advisory Board Report Summary Describe this board/commission’s activities/accomplishments in carrying out BOCC goal(s)/priorities, if applicable. BOCC Goal: Ensure a community network of basic human services and infrastructure that maintains, protects, and promotes the well-being of all county residents. BOH Goal: Serve as a catalyst and advocate for health outcomes in the Family Success Alliance. *See list of accomplishments Describe the collaboration relationship(s) this particular board has with other advisory boards and commissions? BOH members serve on other boards in the county such as OUTBoard, Healthy Carolinians, Family Success Alliance Advisory Committee, and Animal Services Board. The Board also receives a biannual update of summarizing the work of other local boards/commissions/councils within Orange County. If your board/commission played the role of an Element Lead Advisory Board involved in the 2030 Comprehensive Plan preparation process, please indicate your board’s activities/accomplishments as they may relate to the Comprehensive Plan’s goals or objectives. (The Element Lead Advisory Boards include: Planning Board, EDC, OUTBoard, Commission for the Environment, Historic Preservation Commission, Agriculture Preservation Board, Affordable Housing Board, Recreation and Parks Advisory Council) N/A Identify any activities this board/commission expects to carry out in 2018 as they relate to established BOCC goals and priorities. If applicable, is there a fiscal impact (i.e., funding, staff time, other resources) associated with these proposed activities (please list). In 2018, the BOH will be creating the 2018-2020 Strategic Plan. As it relates to the BOCC goals and priorities, the BOH expects to: • Explore the intersectionality of racial and health inequities to the services provided at Orange County Health Department and community programs. • Continue to support Family Success Alliance specifically in collaboration with Legal Aide (may require funding) • Provide funding support within the two school districts for programming around nutrition and physical activity (will require funding) What are the concerns or emerging issues your board has identified for the upcoming year that it plans to address, or wishes to bring to the Commissioners’ attention? The BOH will continue to pay close attention to issues and concerns on the local, state, and federal level as it relates closely to the Strategic Plan. This includes areas concerning: • Social Determinants of Health – Family Success Alliance, racial and health equity, communication of health information to the public, E- cigarette policies • Physical Activity and Nutrition – Exploration of policies, tools to communicate resources, support provided to the two local school systems • Mental Health and Substance Abuse – Reimbursement around behavioral health, Cardinal Innovation services, screening tools for clients, collaboration with partners within the criminal justice system, follow up on Mental Health Gap Analysis (focus on school- age children) Health Director’s Report March 2018 • March 2, 2018 – attended the Justice Advisory Council; I will continue to attend as a Public Health representative. • March 7, 2018 – attended first State Health Coordinating Council meeting in Raleigh. I was assigned to the Long-Term and Behavioral Health Committee. Committee will meet in April to review methods for projecting need, health service related policies, petitions, and agency reports. • March 9, 2018 – Joined County Manager for Outside Agency Grant Review meetings. Grantees came in to discuss highlights of their application and respond to a brief Q&A session. This was time well spent as I was able to meet several community partners and learn about the work they do in the community and often in coordination with the Health Department. • March 14, 2018 – County Health Rankings released. This year Orange County ranked #2 for Health Outcomes and #1 for Health Factors for overall State Ranking. A complete copy of the NC Health Ranking Summary Report may be found at this link: http://www.countyhealthrankings.org/sites/default/files/state/downloads/CHR2018_ NC.pdf • March 15th – 16th, 2018 – attended the Department Director’s Retreat; Directors and a few department managers completed the Racial Equity Institute (REI) Phase I training; excellent training. Program Updates • March 2, 2018 – Successful Site Visit with staff from NC Department of Public Health PHP&R Division; Preparedness Staff are on track with emergency response plan updates and training and exercise requirements. • March 5th & 14th – HPES Director, Donna King & Dental Assistant, Ana Salas conducted Naloxone training with staff from the Criminal Resource Center. Drug Court Counselors were provided Overdose Rescue Kits; they are now prepared to respond to an opioid overdose. • March 15, 2018- HPES Director, Donna King, Clinic Manager, Robin Gasparini, and Dental Assistant, Ana Salas joined Emergency Management and Sheriff’s Office to provide an Opioid Epidemic overview in-service for Library Staff. • March 16, 2018 – Clinic Staff Retreat; Facilitated by Dispute Settlement Center staff; team completed team building exercises, conflict resolution training and additional skills building work. They also had time to discuss future goals and plans for clinic operations. • March 20, 2018- Contract for new Electronic Health Record System approved by County Commissioners; Clinic Staff will transition to the EPIC Health Record System. • March 23, 2018 – The Healthy Carolinians’ Mental Health and Substance Abuse (MH&SA) Committee hosted a Tobacco Lunch & Learn featuring Dr. Phil Gardiner, the leading expert in the Tobacco Triangulum. Dr. Gardiner is a well-known advocate on health equity and tobacco reduction in communities of color, who has become a sought- after speaker on the “Triangulum” link between e-cigarettes, marijuana, and combustible tobacco products. Upcoming Events • April 3, 2018 – Public Health presentation at the Orange County Government Academy. The academy is designed to educate, inform and engage citizens about the many services and programs Orange County Government provides its residents. • April 4-6, 2018 – Attending the Annual Health Director’s Public Health Legal Conference at UNC School of Government. • April 10-13, 2018 – Health Director and several staff will be in Chicago to attend the Equity Summit. • April 16-17, 2018 – Presenting at the National Preparedness Summit, in Atlanta, GA. I am co-presenting a session on “Integrating Access and Functional Needs Planning into POD Drills” • April 26, 2018 – Library is hosting a Town Hall on the Opioid Epidemic, 8:30am – 12:30pm; invitations to Board of Health Members are forthcoming.