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BOH agenda 052516
ORANGE COUNTY BOARD OF HEALTH MEETING AGENDA DATE: May 25, 2016 TIME: 7:00 P.M. PLACE: Whitted Building, 3rd Floor Meeting Rooms 300 West Tryon Street Hillsborough, NC 27278 TIME ITEM 7:00 p.m. I. Welcome New Employees 7:00 – 7:05 II. Public Comment for Items NOT on Printed Agenda Public Comment for Items ON Printed Agenda will be handled during that agenda item (Please sign up for both on sheet near the entrance to room.) Please limit your comments to 3 minutes. 7:05 – 7:10 III. Approval of May 25, 2016 Agenda 7:10 – 7:15 IV. Actions Items (Consent) A. Minutes of April 27, 2016 7:15 – 7:35 V. Educational Sessions A. Innovation Grant Update Meredith Stewart B. Child Fatality Task Force Report Pam McCall C. 3rd Quarter Financial Reports Rebecca Crawford D. 3rd Quarter Billing Dashboard Reports Rebecca Crawford 7:35 – 8:10 VI. Action Items (Non Consent) A. 2016-2018 Strategic Plan Meredith Stewart 8:10 – 8:25 VII. Reports and Discussion with Possible Action A. Health Director Report Colleen Bridger B. Media Items 8:25 – 8:30 VIII. Board Comments 8:30 IX. 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 April 27, 2016 S:\Managers Working Files\BOH\Agenda & Abstracts\2016 Agenda & Abstracts/ April 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 April 27, 2016, at the Orange County Health Department, 300 West Tryon Street, Hillsborough, NC. BOARD OF HEALTH MEMBERS PRESENT: Liska Lackey, Chair, Nick Galvez, Vice Chair, Commissioner Mia Burroughs, Barbara Chavious, Paul Chelminski, Dan Dewitya, Susan Elmore, Jessica Frega, Sam Lasris, Reena Mehta and Timothy Smith. BOARD OF HEALTH MEMBERS ABSENT: None. STAFF PRESENT: Dr. Colleen Bridger, Health Director; Coby Austin, Senior Public Health Educator; Christy Bridges, Family Nurse Practitioner II; Krista Burnette, Nursing Assistant; Alan Clapp, Environmental Health Director; Rebecca Crawford, Finance and Administrative Services Director; Wanda Crisp, Licensed Practical Nurse; Donna King, Health Promotion & Education Services Director; Pam McCall, Public Health Nursing Director; Stacy Shelp, Communications Manager; Meredith Stewart, Public Health Program Manager; La Toya Strange, Administrative Assistant II; Jacqueline Stewart, Property Development Technician and Hannah Welch, Temporary Clinical Social Worker Intern. GUESTS PRESENT: Dr. Lou Turner. I. Welcome New Employees Dr. Bridger introduced new staff members: Krista Burnette, Nursing Assistant and Jacqueline Stewart, Property Development Technician. II. Public Hearing: Board of Health Rule on E-cigarettes Use in Restaurants and Bars: Liska Lackey, Chair, informed all that the public comment period will last an hour with everyone limiting their comments to three minutes. The following people spoke in favor of the Board of Health rule: Kintwon Pettiford Justin Byron Sophie Jin Pam Seamans Rob Tarran Allison Myers The following people spoke in opposition of the Board of Health rule: Sherwin Mena Charles Harris Amy Stevens Ben Stevens Jason Joyner Victoria Sylvestre Mark Sylvestre Ashley Desena Derek Mullis MINUTES-Draft ORANGE COUNTY BOARD OF HEALTH April 27, 2016 S:\Managers Working Files\BOH\Agenda & Abstracts\2016 Agenda & Abstracts/ April Page 2 Motion to close the public hearing was made by Barbara Chavious, seconded by Paul Chelminski and passed unanimously. III. Break IV. Approval of the April 27, 2016 Agenda Motion was made by Susan Elmore to approve the agenda, seconded by Reena Mehta and carried without dissent. V. Public Comment for Items NOT on Printed Agenda: None. VI. Action Items (Consent) A. Minutes Approval of March 23, 2016 Meeting Motion to approve Consent Agenda without correction to the March 23, 2016 minutes was made by Mia Burroughs, seconded by Nick Galvez and carried without dissent. VII. Action Items (Non-Consent) A. BOH Rule on E-Cigarette Use in Restaurants and Bars a. Results of survey/public comment Coby Austin, Senior Public Health Educator, began by reporting that there were a total of 155 respondents that gave comment by using the various formats (online survey, telephone message, snail mail and email) during the public comment period of April 10th through 24th. She continued by providing a map of the Online Survey respondents regionally by zip code, as well as showing the distribution of Orange County respondents by zip code. Online Survey responses were also reported and categorized by perspective, such as medical provider and owner/manager of a restaurant or bar, along with respondents’ stance regarding the rule. Ms. Austin presented a summary of comments comprised of those who opposed, supported, and supported with reservations or held another position on the proposed Board of Health rule. A qualitative analysis of the comments highlighted the most common themes, including: Key Themes: Opposing comments • Decision should be left up to local businesses • Believes the risks are minimal or non-existent • E-cigarettes can promote cessation • Research showing harms of e-cigarettes is flawed or insufficient Key Themes: Supportive comments • Concern regarding secondhand exposure • Precaution should be taken because of unknown effects • Worried about use among youth MINUTES-Draft ORANGE COUNTY BOARD OF HEALTH April 27, 2016 S:\Managers Working Files\BOH\Agenda & Abstracts\2016 Agenda & Abstracts/ April Page 3 • Important for protecting vulnerable populations Key Themes: Supportive with reservations and “Other” comments • Prohibit in restaurants, but allow it in bars • Encourage harm reduction (smokeless tobacco, e-cigs) • Focus on enforcing existing smoke-free rules • “I am a daily user of vapor products and would not Vape in a public place because not all people want to be bombarded with vapor when they're trying to enjoy a time out.” Ms. Austin reminded the Board that a copy of all of the public comments had been sent to them earlier in the week along with links to research articles and other documents referenced in the public comments. She ended by stating that the Surgeon General’s report is due out sometime this year. The BOH members had questions that were addressed by Ms. Austin and Dr. Bridger. b. Deliberation and Vote Dr. Bridger addressed the Board and informed them the staff’s recommendation to the Board is to postpone the vote until after the Surgeon General’s report comes out. She expressed that while it is important to hear the public’s opinion, the only criteria a Board of Health can consider during rule making is the rule’s effect on public health. The BOH members had questions that were addressed by Dr. Bridger. Motion to table the vote until the Surgeon General’s report comes out and is reviewed and discussed by the Board was made by Susan Elmore, seconded by Barbara Chavious, and carried without dissent. B. Board Reappointments Liska Lackey, Chair, conveyed that there were three Board members whose term will be ending soon. The Board of Health will vote to recommend Paul Chelminski to his 3rd term; Dan Dewitya to his first full term; and Sam Lasris to his 2nd term. Motion to reappoint Paul Chelminski, Dan Dewitya, and Sam Lasris was made by Jessica Frega, seconded by Nick Galvez, and carried without dissent. VIII. Reports and Discussion with Possible Action A. Health Director Report The BOH members did not have any questions. B. Media Items Media items were in the packet which focused on Orange County’s events and our involvement in various efforts. IX. Board Comments MINUTES-Draft ORANGE COUNTY BOARD OF HEALTH April 27, 2016 S:\Managers Working Files\BOH\Agenda & Abstracts\2016 Agenda & Abstracts/ April Page 4 No additional comments were given. X. Adjournment A motion was made by Jessica Frega to adjourn the meeting at 8:35 p.m., was seconded by Mia Burroughs and carried without dissent. The next Board of Health Meeting will be held May 25, 2016 at the Orange County Health Department, 300 West Tryon Street, Hillsborough, NC at 7:00 p.m. Respectfully submitted, Colleen Bridger, MPH, PhD Orange County Health Director Secretary to the Board Agenda Item Number: ORANGE COUNTY BOARD OF HEALTH AGENDA ITEM SUMMARY Meeting Date: May 25, 2016 Agenda Item Subject: 2016 Innovation Grant Mid-Year Update Attachment(s): Innovation Grant Update_2016 Mid Year Staff or Board Member Reporting: Meredith Stewart, OCHD Purpose: ____ Action _ x_ Information only ____ Information with possible action Summary Information: The 2016 Innovation Grant Cycle is half-way complete. Meredith Stewart will provide updates on the progress on the ten projects to date. Background: The Innovation Grant Fund was established when the Board of Health passed their Innovation Resolution in August 2012. Each year, staff submit innovative proposals to provide better care, better health, and reduced healthcare costs for Orange County residents. The 2014 cycle funded eight (8) projects, as listed below. Innovator(s) Proposal Title Proposal Description Victoria Hudson Food Establishment Excellence Program The innovation grant will be used to design and to disseminate food safety information through a series of infographic stickers. The 4” x 4” or 6” x 6” OCHD vinyl-coated stickers in three styles will feature infographics that address gaps in English proficiency in Orange County’s multicultural, food service workforce. Meredith McMonigle & Allison Young Supporting Transportation Solutions for FSA families This innovation grant will support a pilot project to explore using Uber as a transportation solution for low-income families in Orange County. The pilot will be with families enrolled with FSA. Kathleen Goodhand, Rebecca Crawford and Pam McCall Mindfulness Training Research has shown that Mindfulness Training and learned techniques can have a positive effect on reducing employee work stress and increasing morale. Excessive work stress and low morale can lead to employee absenteeism, turnover and poor customer service, all of which affect our clinical staff. We propose to contract with a certified Mindfulness Instructor to offer training to clinical staff for a period of 8 sessions. Melissa James Nutrition Services: Client Feedback as a Marketing Tool This project is an innovative way to extend the Kudos concept by developing a note card that Medical Nutrition Therapy (MNT) and/or Diabetes Self-Management Education (DSME) clients can write a message to his/her referring medical provider explaining how he/she benefited from these Health Department services. This card will serve as a cue to medical providers to remind them to continue referring and will also serve as a tool to inform medical providers of client satisfaction. Teresa Martin, Christy Bridges, Jean McDonald Technology Access for Patient Education and Satisfaction Funding is requested to cover the cost of technology dedicated to prenatal, postpartum, and newborn-care patient education in English and Spanish. Low literacy levels identified and addressed in traditional education modalities have not reduced ED admissions of our newborns and unnecessary visits to UNCH by our MH patients. Victoria Hudson Corrective Action Stickers These infographic stickers will be affixed in food service establishments as an education tool and a corrective action for violations of risk factors associated with hand sink usage, cross-contamination in refrigerated storage, and cooling foods. Tracey Langley and John Davis Double Handle Lift Tool Grant to create/modify a lifting tool for heavy concrete lids (septic tank lids) for environmental health staff. Ana, Sallie, Stephanie Prenatal Oral Health Incentive Program Create incentive program to encourage families to complete recommended initial and follow-up prenatal dental visits. LaTosha and Shelley Project Safe Sleep Exploring the option of safe co sleep and SIDS awareness for families actively participating in home vising programs. Patients whom complete evidence based training and newborn post-partum home visit will receive safe sleep certificate and infant basket to support healthy co-sleeping. Tracey Langley and John Davis Septic Maintenance App Develop a Smartphone Application that includes information for homeowners on basic tank maintenance, effluent filter cleaning (majority of homeowners don’t even know their system has a filter), biosolids or septage removal guidance, drainfield maintenance, inspection, etc. The app would also allow the operator to set up reminders of when various maintenance items are due and connect to additional resources, how to videos, etc. 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): 2016 MID -YEAR INNOVATION GRANTS MINDFULNESS TRAINING Mindfulness classes for OCHD employees, held on- site on Friday afternoons Budget: $1,500 Spent: 100% Staff regularly attended Friday sessions TRANSPORTATION SOLUTIONS FOR FSA FAMILIES Provide funds to do feasibility trial of using Uber for transportation for FSA families Budget: $3,105 Spent: 35% Mar ‘16 - Trialed with FSA Navigators Apr ‘16 - Trained sample of FSA cohort families Availability of Uber in N. Orange is biggest challenge FOOD ESTABLISHMENT EXCELLENCE PROGRAM Design and disseminate food safety information through infographic stickers Budget: $750 Spent: 100% Stickers designed and being distributed NUTRITION MARKETING TOOL Develop a “Kudos” card for OCHD nutrition patients to send to their referral provider Budget: $900 Spent: 100% Cards being designed! TECHNOLOGY ACCESS FOR PATIENT EDUCATION Trial and purchase mobile devices for patient education and pre/post tests in clinic Budget: $2,500 Spent: 24% Two Chromebooks being purchased for trial use Partnership with Duke AHEC to develop educational model and testing software CORRECTIVE ACTION STICKERS Infographic stickers for food establishments Budget: $1,800 Spent: 67% Stickers created and printed, using with establishments DOUBLE HANDLE LIFT TOOL Create or modify a lifting tool for septic tank lids for EH staff Budget: $750 Spent: 50% Ideating, fabricating and testing! IDEATING (©OCHD 2016) Septic tank lids are 50-150lbs A one handled lift hook (made for single handed lifting) does not allow a safe and stable 2 hand grip. Have you tried a 150 lb. 1-handed deadlift and curl lately? PRENATAL ORAL HEALTH INCENTIVE PROGRAM Create incentive program for families to complete pre-natal dental visits Budget: $4,200 Spent: 62% Incentive structure established Community info. event held May 6, 2016 PROJECT SAFE SLEEP Provide supplies for parents to practice safe co- sleeping and provide education on SIDS awareness Budget: $650 Spent: 90% 10 cribs purchased May ‘16 SEPTIC MAINTENANCE APP Develop a Smartphone Application that includes information for homeowners on septic maintenance Budget: $4,000 Spent: 0% TBD INNOVATION @ OCHD 100% of funds spent this fiscal year – first time! Working out kinks with IT New grantees learning the Innovation Grant process Agenda Item Number: ORANGE COUNTY BOARD OF HEALTH AGENDA ITEM SUMMARY Meeting Date: May 2 5, 2016 Agenda Item Subject: Child Fatality Prevention Team Annual Report Attachment(s): 2015 Child Fatality Prevention Team Annual Report Staff or Board Member Reporting: Pam McCall Purpose: ____ Action _ X_ Information only ____Information with possible action Summary Information: The report is a review of CFPT in Orange County North Carolina. Included is a description of membership, duties, procedures and activities. 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 Child Fatality Prevention Team 2015 Annual Report I. Introduction: The 1991 General Statute 7-B-Article 14 of the North Carolina Juvenile Code established a Community Child Protection Team (CCPT) in every county in North Carolina. In 1993 the legislature added Child Fatality Prevention Teams (CFPT) in every county. The charge of these two teams is to reduce preventable deaths in our state. Since the mandates and purposes of these teams are so similar, the Orange County’s CFPT and CCPT have functioned as one interagency review team since 1998. The general statutes require that CFPT/CCPT membership include the Department of Social Services (DSS) Director, DSS Staff, *DSS Board, the Health Department Director, Law Enforcement, Superintendent of each School System, Mental Health, Guardian ad Litem Program, Health Care Providers, Emergency Medical Services, Medical Examiner’s Office, Parent of a deceased child, *District Attorney’s Office, Day Care/Head Start, *Community Action organization, *District Court Judge, and up to five at-large community members (* no current representation on CFPT/CCPT). The general statute grants the CFPT/CCPT access to all medical, hospital, mental health, social service, and law enforcement records as well as records maintained by any state, county or local agency as necessary to carry out its duties. The local health director assures that the local CFPT completes mandated services while the local social services director assures that the local CCPT mandates are met. The CFPT/CCPT operates under strict confidentiality requirements; therefore, meetings are not subject to the Open Meetings Law. Both teams are required by statute to submit reports annually to the State of North Carolina, the local Boards of Health/Department of Social Services, and the local County Commissioners. In 2015, the Orange County CFPT/CCPT functioned as a cohesive group of professionals with good attendance and participation. The Orange County CFPT/CCPT is comprised of excellent collegial professionals and community volunteers in keeping with the requirements of the governing statute. II. Child Fatality Prevention Team A. Purpose: The CFPT meets at least quarterly to review deaths of children 0 through 17 years of age that occurred in the same quarter of the previous year for the following purposes: 1. To identify child death patterns, 2. To identify system problems or gaps in services to children and families, and 3. To make and carry out recommendations for change that will prevent future child deaths. B. Activities—the CFPT met three times and reviewed a total of 10 fatalities in 2015: 1. Findings included: • 6 yr. old died from malignant neoplasm of the brain • 2 yr. old died from malignant neoplasm of the adrenal gland and respiratory failure • 1 hr. old died from extreme immaturity • 3 day old died from respiratory distress syndrome of newborn and unspecified pulmonary hemorrhage • newborn (36 min.) affected by incompetent cervix • 15 yr. old died from acute lymphoblastic leukemia, other specified disorders of white blood cells and unspecified renal failure • 2 day old died from anencephaly • 27 day old died from necrotizing enterocolitis of newborn • 1 day old died from hypoplasia and dysplasia of lung and extreme immaturity • 6 yr. old died from neuronal ceroid lipofuscinosis 2. Potential System Problems identified: • Undiagnosed genetic disorders • Prenatal tobacco use contributing to the premature birth III. Recommendations by CFPT/CCPT: A. The team recommended that new and potential parents be counseled and screened for genetic disorders. The CFPT Chair contacted the UNC Public Health Maternity Coordinator asking about services and resources for families. B. The team recommended that pregnant women be encourage and supported in stopping tobacco use. The CFPT Chair discussed partnering with the OCHD Tobacco Cessation Health Educator in future interventions. IV. Actions and Accomplishments of the Orange County CFPT/CCPT: A. Met 3 times in 2015 to review child fatality and child protection cases. Thoughtful discussion with identification of system problems and subsequent recommendations occurred. B. Provided a clearinghouse through e-mail for member agencies to share information on community events, pertinent news articles and data, and training opportunities on child health, safety, and protection issues. Agenda Item Number: ORANGE COUNTY BOARD OF HEALTH AGENDA ITEM SUMMARY Meeting Date: May 25, 2016 Agenda Item Subject: 3rd Quarter Financial Report FY 15-16 Attachment(s): 3rd Quarter Financial Report 3rd 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 3rd Quarter is $230k/month or $2.8 million YTD, representing 70.6% of our overall budgeted revenue for the year. This is an increase from an average of $218k/month in FY15. Expenses were slightly lower than revenues at 67.8%. Total Billing Accuracy: Continuing with the goal of 90% billing accuracy set in FY 14- 15, the average billing accuracy rate for medical three quarters of the way through FY 15-16 is 86% as compared to 92% in FY 14-15 and the average rate for dental for FY 15-16 is 93% as compared to 94% in FY 14-15. Dental Earned Revenue by Source: The FY 15-16 average monthly revenue ($40k/month) is slightly below our budget projection ($45k/month) but still above our FY 14-15 average of $36k/month. FY 15-16 dental revenue totaled $483k at the end of the third quarter. Dental earned revenue will most likely continue to increase each month as our new dentist adds more clients to her schedule. Medical Earned Revenue by Source: Medical earned revenue is currently below the budgeted projection for FY 15-16. The monthly average after the third quarter ($46k/month) is lower than FY15 ($50k/y) and our budget projection ($50k/month). This was mainly due to holding Maternal Health encounters for Global Billing (billing multiple encounters at the end of the pregnancy) and holding multiple program encounters until we come to a resolution with Medicaid of an acceptable method to bill same day appointments, which we resolved in late December. March and April showed monthly revenue totals of $50k and $57k respectfully and we anticipate these monthly totals will stay at this level for the remainder of the fiscal year. 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 Q3 YTD ACTUAL ANNUAL BUDGET % OF ANNUAL BUDGET Revenue Donations Dental Health (338)(338)0 0.00% Finance and Admin Services 0 0 (30,000)0.00% Health Promotion & Edu (1,000)(2,000)(1,000)200.00% Personal Health (2,639)(2,639)(24,014)10.99% Donations Total (3,977)(4,977)(55,014)9.05% Internal Allocations Dental Health 0 0 (18,000)0.00% Finance and Admin Services 0 0 (23,500)0.00% Health Promotion & Edu 0 0 (25,000)0.00% Internal Allocations Total 0 0 (66,500)0.00% Service Revenue Dental Health (125,868)(380,394)(536,847)70.86% Environmental Health (121,840)(349,439)(450,880)77.50% Personal Health (144,991)(417,393)(606,484)68.82% Service Revenue Total (392,699)(1,147,226)(1,594,211)71.96% State Allocations Dental Health (367)(367)(16,000)2.29% Finance and Admin Services (12,513)(33,382)(42,885)77.84% Health Promotion & Edu (13,392)(26,403)(55,832)47.29% Environmental Health (480)(1,876)(34,000)5.52% Personal Health (116,378)(419,741)(514,511)81.58% State Allocations Total (143,129)(481,769)(663,228)72.64% Grants Project Revenues NACCHO Grant 0 (3,021)(6,521)46.33% Piedmont Hlth Srv - Nutr (5,097)(13,051)(28,938)45.10% Meaningful Use Incentive 0 (40,250)(40,250)100.00% CC4C Accesscare (36,056)(110,302)(149,624)73.72% PCM Accesscare (35,662)(115,176)(155,952)73.85% Health Disparities (44,829)(44,829)(87,170)51.43% Dental Health 0 (1,500)(1,500)100.00% Personal Health 2,710 0 0 0.00% Susan G. Komen Grant 0 (24,812)(24,812)100.00% Medicaid Maximization 0 (287,697)(340,998)84.37% Grants Project Revenues Total (118,934)(640,637)(835,765)76.65% Revenue Total (658,739)(2,274,608)(3,214,718)70.76% Orange County Health Department Profit Loss Budget Performance 2015-2016 TOTAL HEALTH Q3 YTD ACTUAL ANNUAL BUDGET % OF ANNUAL BUDGET Expenditures Salaries 1,192,252 3,748,633 5,131,664 73.05% Benefits 434,106 1,299,109 1,819,498 71.40% Travel 1,544 4,032 11,495 35.08% Training 5,893 24,480 35,567 68.83% Certifications & Licensing 2,227 6,563 14,756 44.48% Mileage 5,358 20,818 34,210 60.85% Telephone 14,740 43,792 75,714 57.84% Postage 2,144 8,864 16,157 54.86% Motor Pool 6,282 28,080 48,807 57.53% Equip Repairs 2,467 3,798 10,175 37.33% Equip Rent 228 706 1,200 58.82% Duplicating 2,967 8,251 13,065 63.15% Printing 494 4,454 16,756 26.58% Advertising 1,100 2,643 6,296 41.98% Dues 2,872 5,102 6,434 79.29% Subscriptions 366 865 2,827 30.60% Dept Supplies 3,822 11,681 42,161 27.71% Edu Supplies 4,477 7,401 22,680 32.63% Office Supplies 8,365 21,301 41,477 51.36% Medical Supplies 35,762 95,803 156,652 61.16% Bloodborn Path Supplies 308 191 9,001 2.12% Pharmacy Supplies 25,563 118,442 216,766 54.64% Comp Supp/Software 0 574 1,576 36.43% Other Supplies 0 420 488 86.06% Contracted Srv 95,841 274,306 551,371 49.75% X-Ray 1,710 5,276 25,625 20.59% Lab Srv 24,323 55,476 72,502 76.52% Bonds & Insurance 0 0 10,602 0.00% Uniforms 1,495 5,487 10,699 51.29% Community Proj 4,705 10,881 56,665 19.20% Employee Wellness 0 0 0 0.00% Innovations Project 3,365 5,171 20,000 25.85% Accreditation Project 0 2,750 2,750 100.00% Preparedness BT 0 0 0 0.00% Family Success Alliance 35,411 105,557 279,008 37.83% Credit Card Exp 9,137 14,257 10,000 142.57% Capital Exp Under $500 540 1,418 2,322 61.07% Nicotine Replacement Therapy 2,395 2,395 5,000 47.90% Grant Project Expenditures Health Disparities 22,745 70,342 70,810 99.34% Meaningful Use Incentive 13,072 38,801 46,997 82.56% Susan G. Komen Grant 1,299 11,766 49,624 23.71% Capital Expenditures Equipment 0 3,175 3,175 100.00% IT Equipment 282 7,343 9,515 77.17% Grand Total 1,969,658 6,080,403 8,962,087 67.85% Total County Revenue (Appropriation)1,310,919 3,805,795 5,747,369 66.22% BO H GO V E R N A N C E DA S H B O A R D Q3 FY15‐16 * NO T E : FY 1 5 ‐16 Bi l l i n g Ac c u r a c y no lo n g e r co m b i n e s de n t a l an d me d i c a l pa i d cl a i m s & un p a i d cl a i m s . Be c a u s e tw o di f f e r e n t ac c o u n t i n g sy s t e m s ar e be i n g us e d (M e d i c a l : Ac c r u a l ; De n t a l : Ca s h ) the two clinics are shown separately. Bi l l i n g Ac c u r a c y Fo r m u l a s : Me d i c a l = Pa i d cl a i m s / ( # en c o u n t e r s mi n u s no ch a r g e cl a i m s ) . Un ‐cl a i m e d ap p o i n t m e n t s ar e no lo n g e r fa c t o r e d in ; De n t a l = Pa i d Cl a i m s / # ke p t ap p o i n t m e n t s . Cl a i m s ca n ta k e a qu a r t e r to re a l i z e pa y m e n t ‐ bi l l i n g ac c u r a c y fo r al l mo n t h s in c r e a s e s wi t h ti m e as cl a i m s ar e fi n a l i z e d an d er r o r s ar e re w o r k e d . 36 40 43 40 35 42 37 36 54 0204060 JA S O N D J F M A M J Thousands DE N T A L EA R N E D RE V E N U E BY SO U R C E vs . bu d g e t pr o j e c t i o n & pr i o r ye a r ME D I C A I D IN S U R A N C E SE L F PA Y To t a l Ea r n e d Re v e n u e ($ 3 6 2 k YT D ) Bu d g e t Pr o j e c t i o n ($ 4 5 k / m , $5 3 7 k / y ) YT D Mo n t h Av g ($ 4 0 k / m , ~$ 4 8 3 k / y es t ) FY 1 4 ‐15 D Re v e n u e ($ 4 2 8 k / y ) FY 1 4 ‐15 D Re v e n u e ‐ Av g ($ 3 6 k / m ) 46 36 48 41 54 46 38 5057 020406080 JA S O N D J F M A M J Thousands ME D I C A L (P H ) EA R N E D RE V E N U E BY SOURCE vs . bu d g e t pr o j e c t i o n & pr i o r ye a r ME D I C A I D INSURANCE SE L F PA Y Total Earned Revenue ($416k YTD) Bu d g e t Pr o j e c t i o n ($ 5 0 k / m , $6 0 0 k / y ) YTD Month Avg ($46k/m, ~$555k/y est) FY 1 4 ‐15 M Re v e n u e ($ 5 9 8 k / y ) FY14‐15 M Revenue ‐ Avg ($50k/m) 18 2 20 1 38 6 21 4 20 9 22 1 16 3 21 5 28 2 (5 0 ) ‐ 50 10 0 15 0 20 0 25 0 30 0 35 0 40 0 45 0 JA S O N D J F M A M J Thousands TO T A L HE A L T H DE P A R T M E N T RE V E N U E vs . bu d g e t pr o j e c t i o n s & pr i o r ye a r Pe r s o n a l He a l t h De n t a l En v i r o n He a l t h Gr a n t s St a t e Ot h e r To t a l OC H D Re v e n u e ($ 2 . 1 M YT D ) YT D Mo n t h Av g ($ 2 3 0 k / m , ~$ 2 . 8 M / y ) FY 1 5 ‐16 Bu d g e t Pr o j e c t i o n ($ 2 6 0 k / m , $3 . 1 M / y ) Pr i o r : FY 1 4 ‐15 To t a l OC H D Re v e n u e ($ 2 . 6 M / y ) Pr i o r : FY 1 4 ‐15 Re v e n u e ‐ Av g ($ 2 1 8 k / m , $2 . 6 M / y ) 94 % 92 % 89 % 93 % 89 % 88 % 87 % 8 7 % 89% JA S O N D J F M A M J Me d i c a l Bi l l i n g Ac c u r a c y * vs pr e v i o u s ye a r & go a l M FY 1 6 To t a l Ac c u r a c y (Y T D av g 90 % ) M FY 1 5 Av g Ac c u r a c y (92%)Accuracy Target (90%) 10 2 % 96 % 94 % 10 4 % 97 % 93 % 91 % 77 % 84% JA S O N D J F M A M J De n t a l Bi l l i n g Ac c u r a c y * vs pr e v i o u s ye a r & go a l D FY 1 6 To t a l Ac c u r a c y (Y T D av g 93 % ) D FY 1 4 Ac c u r a c y ‐ Av g (86%)Accuracy Target (90%) Agenda Item Number: ORANGE COUNTY BOARD OF HEALTH AGENDA ITEM SUMMARY Meeting Date: May 25, 2016 Agenda Item Subject: Strategic Plan Approval Attachment(s): 2016-2018 BOH Strategic Plan Staff or Board Member Reporting: Meredith Stewart and subcommittee representatives Purpose: __x__ Action ____ Information only ____ Information with possible action Summary Information: Subcommittee representatives will provide their recommended focus areas and action steps for inclusion in the 2016-2018 Board of Health Strategic Plan. The Board will consider the recommendations and approve the final action steps for the 2016-2018 Strategic Plan. The draft plan is included as an attachment to this abstract. Background Based on the Community Health Assessment completed in 2015, the Orange County Board of Health identified three priority areas to work on over the next four years. They are: 1) Social Determinants of Health 2) Physical Activity & Nutrition 3) Substance Abuse & Mental Health Three subcommittees of Board of Health members and OCHD staff determined the action steps based on progress in the 2014-2016 plan and the community’s priorities, and will work over the next two years to complete the activities on the new plan. 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): O ra n ge C o u n t y B oard o f Hea l t h Strate g i c Pla n 2 0 1 6 -2 018 Well-c hild exams Disease Screening Imm unizations Family Planning Primary Care Ser vices Mater nal Health Nutrition Counseling Smoking Cessation Dental Exams & Cleaning Fillings & Extractions Sealants Infant Oral Care Medical Clinics in Chapel Hill & Hillsborough - Pediatric & Adult Dental Clinic in Hillsborough (919) 245-2400 www.Or angeCountyNC.gov/Health Orange County Board of Health Strategic Plan 2016-2018 Charge The Board of Health is the primary policy-making and adjudicatory body for the Health Department. It is charged to protect and promote the public health of Orange County. Every two years, the Board of Health establishes a new strategic plan based on community health priorities and research on policies proven to improve community and individual health. Introduction Contents Pgs. 1-4 Priority: Social Determinants of Health Pg. 5 Focus Area #1: Serve as a catalyst and advocate for health outcomes in the Family Success Alliance. Focus Area #2: Advocate for and pursue policies and practices aimed at improving access to care, with a focus on cultural and language barriers to access. Priority: Physical Activity & Nutrition Pg. 6 Focus Area #1: Advocate for and pursue policies, practices, and partnerships aimed at increasing access to healthy foods and safe places for physical activity. Focus Area #2: Advocate for and pursue evidence-based policies, practices, and partnerships that increase physical activity and improve nutrition in schools. Priority: Substance Abuse & Mental Health Pgs. 7-8 Focus Area #1: Serve as a catalyst and advocate for policies and practices that promote integrated care in the Orange County Health Department and other medical providers in the county. Focus Area #2: Advocate for and pursue policies, practices, and partnerships that improve substance abuse and mental health services in Orange County, especially to vulnerable populations such as the homeless and those connected with the criminal justice system. Engagement Pg. 8 Focus Area #1: Actively engage with local government, advisory boards, and the community on Board of Health strategic plan priority areas. Timeline Pg. 9 Indicates new focus area 2 3 Introduction Every four years the Orange County Board of Health commissions a Community Health Assessment (CHA) to identify pressing and emerging community health issues. The latest Community Health Assessment was completed in December of 2015. As in years past, the Board adopted the community’s top three health priorities from the CHA to focus the Board’s next policy-focused Strategic Plan. The three priorities: 1) Social Determinants of Health; 2) Physical Activity & Nutrition and 3) Substance Abuse & Mental Health were the community’s top three health priorities. More detailed information on the most recent CHA is available on the Health Department website here. To oversee the work of this extremely ambitious Strategic Plan, the Board of Health has three oversight committees—one for each priority—that meet regularly to ensure action steps and deliverables meet the deadlines established in the plan. 2014—2016 Strategic Plan Highlights Full report accessible on Board of Health website Access to Care Active participation by Board of Health Chair, Liska Lackey, as the Vice -Chair of the Family Success Alliance Two successful years of OCHD Innovation Grants, with a record number of applicants (24) during the 2016 Innovation Grant Cycle. Projects from 2015-2016 included: Food safety quick reference cards Video Remote Interpretation (VRI) equipment and software Feasibility study of Uber and other ride-sharing apps for community transportation Development of new Environmental Health tools for septic tank lid lifting Substance Abuse & M ental Health * Trained and equipped over 161 first responders with naloxone, including the first law enforcement agency in North Carolina to deploy naloxone Established the Orange County Safe Syringe Initiative * Completed a gap analysis of mental health and the criminal justice system in Orange County Child & Family Obesity Regular Health Department participation on the Transportation Advisory Board * Provision of technical assistance, in partnership with the NAP SACC team, for two childcare centers to successful ly complete the new online GO NAP SACC tool and improve physical activity and nutrition practices * Partnered with Orange County Schools to identify equipment needed to increase breakfast participation at elementary schools 4 Strategic Planning in Context The Board of Health Strategic plan is situated in a broader context of purposeful planning and actions that provide the Board, Health Department staff, and the Orange County community with a clear picture of local health goals, plans and strategies to achieve these goals, and the measures used to monitor progress. These plans not only communicate how we will address the community’s health priorities, but also how our values as an organization drive our work. Current strategic plans focus on three different levels of impact: population, service, and workplace priorities. Population priorities focus on policies and programs that improve the health of the Orange County population. The Board of Health Strategic Plan focuses on population level impact through policy. Service priorities focus on improving the services provided by the OCHD. Workplace priorities focus on improving the OCHD workforce and the working environment. Population Priorities Board of Health Strategic Plan & Community Health Assessment Physical Activity & Nutrition Substance Abuse & Mental Health Social Determinants of Health Service Priorities OCHD Vision Plan Environment Technology Engagement Workplace Priorities OCHD Internal Strategic Plan Staff Recognition Organizational Enlightenment Advancement Opportunities Workplace Priorities 5 Priority: Social Determinants of Health Health is much more than what happens within the walls of a clinic or hospital. Health is influenced by our homes, schools, jobs, and access to social and economic opportunities. These impacts on health are known as the Social Determinants of Health (SDH). Issues such as poverty, access to care, employment and transportation were all discussed as important SDH in Orange County by residents during the 2015 Community Health Assessment. The Board of Health will work to address these issues through two focus areas: 1) Serve as a catalyst and advocate for health outcomes in the Family Success Alliance. 2) Advocate for and pursue policies and practices aimed at improving access to care, with a focus on cultural and language barriers to access. Action Steps Focus Area #1 – Serve as a catalyst and advocate for health outcomes in the Family Success Alliance 1) By May 2018, the SDH Subcommittee and Board will recommend a pilot medical-legal partnership with Legal Aid of North Carolina to address legal care needed for Family Success Alliance cohort families to be healthy. 2) By October 2017, Health Department staff will explore the use of clinical tools, such as ACEs screening, to use in OCHD clinics to identify important social determinants of health and appropriate interventions. Focus Area #2 – Advocate for and pursue policies and practices aimed at improving access to care, with a focus on cultural and language barriers to access. 1) By May 2017, Health Department staff will explore the use of text messaging to provide reminders, education, or self-management for OCHD programs and clinic services. 2) By February 2017, the Health Department will host at least two “translation boot camps” with the Healthy Carolinians Access to Care committee, on specific health topics to translate clinical language and recommendations about that health topic into culturally and linguistically relevant and motivational messages. 3) By February 2018, the SDH Subcommittee will receive a report on Health Department staff’s research on the appropriate pathway and necessary partners to pursue policy change to make birth control pills available over the counter. 6 Priority: Physical Activity and Nutrition Obesity remains a top health concern for Orange County adults and children. Chronic diseases are the leading cause of death in Orange County, and heavily influenced by physical activity and nutrition. Prevention is the most effective way to address obesity and the chronic diseases related to it. Effective prevention means ensuring safe places for physical activity and access to healthy foods in all communities. The Board of Health will work to address these issues through two focus areas: 1) Advocate for and pursue policies, practices, and partnerships aimed at increasing access to healthy foods and safe places for physical activity. 2) Advocate for and pursue evidence-based policies, practices, and partnerships that increase physical activity and improve nutrition in schools. Action Steps Focus Area #1 – Advocate for and pursue policies, practices, and partnerships aimed at increasing access to healthy foods and safe places for physical activity. 1) By May 2018, the PAN Subcommittee will explore providing incentives to food retailers to locate in and/or offer healthier food and beverage choices in underserved areas (food deserts) with the newly formed Orange County Food Policy Council. 2) By January 2018, Health Department staff will conduct a nutritional review of the Homestead Aquatic Center and provide policy and food labeling recommendations to increase availability and choice of healthy food options. 3) By May 2017, the PAN Subcommittee will explore the creation of a health app, like Be Healthy Rockingham County, to highlight safe places for physical activity, programs, trails, and other physical activity and nutrition options in Orange County. Focus Area #2 – Advocate for and pursue evidence-based policies, practices, and partnerships that increase physical activity and improve nutrition in schools. 1) By August 2017, Health Department staff will conduct an assessment of physical activity options in both school districts, including the # and % that provide in -class activity breaks, require daily PE, and have formal joint-use agreements to allow students and families to use facilities after school and on weekends (School Health Index). 2) By December 2016, Health Department staff will seek a local funding partnership to provide small grants for school staff to implement in-class or other short activity breaks during the school day. 7 Priority: Substance Abuse & Mental Health Substance abuse and mental health issues permeate local public health. From exposure to environmental tobacco smoke causing an increase in cardiovascular disease to the challenges associated with ensuring medication compliance in a depressed patient with a communicable disease, mental health and substance abuse have far -reaching health and economic impacts. Addressing these problems will take a fully engaged and active presence by all organizations serving these clients. The Board of Health will address this issue through two focus areas: 1) Serve as a catalyst and advocate for policies and practices that promote integrated care in the Orange County Health Department and other medical providers in the county. 2) Advocate for and pursue policies, practices, and partnerships that improve substance abuse and mental health services in Orange County, especially to vulnerable populations such as the homeless and those connected with the criminal justice system. Action Steps Focus Area #1: Serve as a catalyst and advocate for policies and practices that promote integrated care in the Orange County Health Department and other medical providers in the county. 1) By January 2017, the Board will receive report on progress of OCHD’s integrated behavioral care program. The Board will also share this report with the Board of County Commissioners. 2) By June 2017, Health Department staff will investigate reimbursement barriers for primary care providers to provide and bill for Screening, Brief Intervention, and Referral to Treatment (SBIRT), telephone and face-to-face consultation with behavioral health providers, and care provided by a behavioral health and primary care provider on the same day in the same clinic. 3) Based on the lessons learned from 1) and 2), the Health Department will provide a presentation/training on strategies for implementation, possibly at the annual Orange County Provider breakfast, together with partners such as the NC Center of Excellence for Integrated Care and UNC Center for Excellence in Community Mental Health by April 2018. 8 Focus Area #2: Advocate for and pursue policies, practices, and partnerships that improve substance abuse and mental health services in Orange County, especially to vulnerable populations such as the homeless and those connected with the criminal justice system. 1) By January 2017, the Board will receive an annual report on the use of county dollars invested in Cardinal Innovations Healthcare Solutions, including specified indicators of interest to the Board of Health. 2) By June 2017, the SAMH Subcommittee will explore with Cardinal Innovations Healthcare Solutions and other local mental health stakeholders the evidence-base and feasibility of mental health screening and referral kiosks in target community locations. 3) By June 2018, Health Department staff will partner with criminal justice and jail partners to explore a pilot system to ensure continuity of behavioral health care during and after incarceration. Engagement The Board of Health plays a key role in advocating for policies and activities that positively impact the health of Orange County residents. As a part of building an active culture of health within our county, the Board aims to have engagement with and from the community at large. The Board of Health will work to address this issue through one primary focus areas: 1) Engaging with local government, advisory boards, and the community on Board of Health strategic plan priority areas Action Steps Focus Area #1: Actively engage with local government, advisory boards, and the community on Board of Health strategic plan priority areas. 1) The Board will receive summaries on the activities of applicable local boards or governing bodies at meetings two times per year, or as necessary for timely board action. Timeline – See website for real-time updates Social Determinants of Health 16 17 18 #1: Family Success Alliance (FSA) J A S O N D J F M A M J J A S O N D J F M A M J J Pilot a medical-legal partnership for FSA Explore screening tools for social determinants of health at OCHD clinics #2: Increase Access to Care Explore use of text messaging for OCHD programs and services Host 2 “translation boot camps” with HCOC Access Committee Research how to make birth control pills available OTC Physical Activity & Nutrition 16 17 18 #1: Policy & Practices for Healthy Foods and Safe Places J A S O N D J F M A M J J A S O N D J F M A M J J Support Food Policy Council to explore incentive structure for healthy food retailers Review of nutrition and labeling at Homestead Aquatic Center & reccs. Explore creation of health app (e.g. Be Healthy Rockingham County) #2: Physical Activity & Nutrition in Schools Assessment of physical activity policy & practices in OC school districts Seek local funding partnership for grants for school staff projects Substance Abuse & Mental Health 16 17 18 #1: Policy & Practice for Integrated Care J A S O N D J F M A M J J A S O N D J F M A M J J J Report on OCHD’s integrated behavioral care program Investigate reimbursement barriers for PCP to provide integrated care Provide presentation/training on integrated care in OC #2: Policy & Practice for SAMH Receive report on use of local dollars for SAMH services Explore mental health screening and referral kiosks Explore system for continuity of care before/after incarceration Engagement 16 17 18 #1: Engage with Policymakers & Community J A S O N D J F M A M J J A S O N D J F M A M J J Summaries on policy actions of local boards 2x per year . Health Director’s Report May, 2016 • Thanks to the leadership of our Animal Services Director, Bob Marotto, Orange County is on the leading edge to resolve a conflict between national rabies control recommendations and state law. Essentially new national recommendations shorten the recommended quarantine period for a dog or cat exposed to a rabid/potentially rabid animal from 6 months to 4. These new recommendations also allow a rabies booster in exposed/potentially exposed dogs and cats behind on their rabies shots whereas NC State law requires quarantine for those animals. The Health Director’s Association is working closely with the Department of Health and Human Services to introduce legislation to adopt these national recommendations by reference so that state law always matches national recommendations. Because this is a short session, it is a bit tricky, but we think there is a good chance this will happen. In the meantime, in consultation with the County Attorney’s Office, Orange County has changed our rabies control policy to match the national recommendations. • We were sad to receive Meredith Stewart’s resignation last week. She has done an amazing job both with BOH strategic plan management and managing the Family Success Alliance for the last two years. Her last day working here will be June 3rd. She has an amazing opportunity to attend Duke Law School in the fall and we absolutely wish her the best. I’ve asked Coby Austin to fill Meredith’s position in the interim. Many of you had the opportunity to work with Coby when she was interim FAS Division Director, so you know we’re in quite capable hands. The position reclassification we requested for this position is included in the Manager’s recommended budget, so we hope to post the position at the higher classified level in the next couple weeks. We will post internally first as that is the general county policy and will involve the Governing Council of the Family Success Alliance in the selection process. Coby has already started working with Meredith on a transition plan, so I expect that to be a seamless experience. • Speaking of the Manager’s recommended budget, I forwarded you an email about where we are with that. Essentially, the Manager is recommending 1 additional FTE for the Health Department to focus on Healthy Homes and Community Outreach. She also recommended the $105,000 increase for the Family Success Alliance. Next stop is the Board of County Commissioners. We have our budget discussion with them on June 14th. • We have been interviewing for the Integrated Behavioral Health Specialist position. Many of the extremely qualified applicants are bi-lingual and we hope to have the selected person in place no later than July 1st. • Carla Julian has agreed to run point on our transition to electronic communications (texting and emailing) with patients, in both Dental and Medical. Our goal is to go live with this August 1st. I’ll keep you posted on our progress as there are many moving parts that could slow this down. • Finally, I’m pleased to announce that the Orange County Health Department won the second annual “Walk for the Health of it” competition. We beat out both Durham and Alamance Counties. We hope to grow the event again next year and include a few more counties. Orange County Delays E-Cigarette Decision By Joey DeVito SHARE THIS: Posted April 27, 2016 at 10:31 pm E-Cigarette. Photo via Vaping360.com The Orange County Board of Health will delay the vote on a resolution that would ban all use of electronic cigarettes in bars and restaurants across the county. “Because the science is so incredibly important to this decision, I would recommend you wait and let some national vetting of this emerging science occur,” said county health director Colleen Bridger. The Surgeon General is scheduled to release a report on the effects of e-cigarettes in the fall and the board will wait for the results of that report before making a decision. They will also have an expert look at the report and share their thoughts. “Little is known about the long term effects of vaping on the lung,” said director of the UNC Center for Tobacco Regulatory Science Rob Tarran. “However, e-cigarettes appear to cause changes in the lung in the gene and protein level consistent with immunosuppression.” Tarran was in favor of the ban, but his voice was far from the only one heard, as people on both sides of the argument addressed the board. Those opposed to the ban said the county should let individual businesses choose their own policies and that there was not enough evidence to prove that vapor from these products are harmful. Vaping products are also commonly used to help tobacco users move away from normal cigarettes. One resident said the ban would force people trying to quit smoking to be exposed to the cigarettes they are trying to get away from. “By banning vaping products from area businesses, it forces me outside to be around the smo kers, continue the health issues that I already have,” she said. Those in favor of the ban said allowing it in restaurants and bars would renormalize smoking and influence children to try tobacco products. East Chapel Hill High School student Sophie Jin said there has been a rise in young people using e- cigarettes and the ban would help solve the problem. “This rule would restrict health risks in public areas and prevent our future generations to start experimenting with a dangerous product,” she said. “Alt hough advertised as safe and reliable, more and more research has been published that documents harmful effects.” No date has been set for the next time the board will look at this issue. Orange County Commissioner Named Public Health Hero By Joey DeVito Posted April 28, 2016 at 6:12 pm Bernadette Pelissier Commissioner Bernadette Pelissier has been named Orange County’s 2016 Public Health Hero. Pelissier was given the inaugural award because she has served on a number of boards, as well as worked in the fields of mental health and substance abuse. “Whether she is working on issues of environmental protection or homelessness, Bernadette always brings a health lens to the conversation,” said director of public health Colleen Bridger. “We have truly appreciated having such an amazing public health advocate serving as a county commissioner.” The Public Health Hero Award is a recognition given by the Orange County Health Department during National Public Health Month to honor community members who champion public health causes in the county. This is the first year of the award. The Health Department plans to recognize a different individual annually. Orange County Board of Health tables vote on proposed e-cig ban Keith Upchurch Updated Apr 30, 2016 Vaporizers, sometimes called e-cigarettes, are being sold to underage consumers online despite laws against it. (Associated Press/Nam Y. Huh) HILLSBOROUGH -- The Orange County Board of Health delayed a vote this week on a proposal to ban electronic cigarette smoking in enclosed areas of restaurants and bars. The board heard from the community on the proposed rule and reviewed comments submitted from an online survey, voicemail, email and U.S. mail, according to Stacy Shelp, communications manager for the Orange County Health Department. At the end of the meeting at Hillsborough’s Whitted Building, the board decided to table the vote until after the U.S. surgeon general releases a report this summer or fall about the health impact of so-called e-cigs. "Ultimately, the Board of Health will continue to read the existing research, weigh the public opinions shared, and then assess the most up-to-date data from the surgeon general's report to make their decision on this as a public health issue in Orange County," Shelp said. According to a statement by the Board of Health, board members became concerned about e-cigs because of what it described as their "alarming popularity among youth." "Although most adults who use e-cigarettes are looking for an alternative to conventional cigarettes or are trying to quit smoking, e-cigarettes are contributing to an overall increase in tobacco use among youth," according to the board. Figures from 2015 show that about four of 10 local high school students have tried an e-cig, and two of 10 are current users. The board said there's a misperception that the aerosol emitted by electronic cigarettes is just water vapor, but added that it often contains nicotine and can contain chemical flavorings and additional toxins known to irritate the lungs or cause disease. Existing laws prohibit smoking tobacco in enclosed areas of restaurants and bars, but don't address use of e-cigs. May 1, 2016 2:00 AM Refugees, immigrants study for citizenship tests Mark Schultz mschultz@newsobserver.com Mark Schultz mschultz@newsobserver.com Mark Schultz mschultz@newsobserver.com By Julia Sendor Paw Pleh, at age 9, escaped her village in Burma just before soldiers burned it to the ground. “I remember the Burmese soldiers killed my relatives and killed other people in my village,” Pleh said. “We had to flee to the jungle, and sometimes we had to go back to the house to get some food.” After over 14 years in Thai refugee camps, Pleh applied for refugee status in 2007, and was settled North Carolina with her five children and husband. She arrived with just one year of formal education, when she learned her alphabet. Last month, however, Pleh’s most immediate challenge was remembering to stand up when her name was called for a citizenship interview. On spring break from her UNC dining services job, Pleh sat in the Refugee Support Center waiting area, pretending it was a U.S. Citizenship and Immigration Services office. Flicka Bateman, director of the Refugee Support Center, played the interviewer: “Why are you here today?” she asked. “How long have you been in the U.S.?” “When did you come?” Pleh was one of 54 students from Orange, Durham and Alamance counties who studied for citizenship tests this spring, through the Orange County Literacy Council. The council and Church World Services funded the classes through a federal grant and hope to enroll 200 students under the two-year grant. Orange County’s students hailed from Burma, China, Guatemala, Mexico and El Salvador – 16 of those students refugees from Burma and China. All told in Orange County, 13.1 percent of the population is foreign-born, 31.2 percent of whom are naturalized citizens and able to vote – according to the U.S. Census Bureau and N.C. Justice Center. Since 2005, 936 refugees have resettled in Orange County, by Orange County Health Department records. Green card required Immigrants and refugees can earn citizenship status, in general, if they are permanent residents, 18 or older, and have lived in the U.S. for five years – or for three years if married to a U.S. citizen. The federal grant required all students to present their green card when they enrolled for the classes, to verify their legal status, said Elgiva Wood, Civics Education Program Coordinator with Orange Literacy. “For citizenship class, students should be at or approaching five years of permanent residency in the US – meaning, they can prepare a little in advance of their five years of permanent residency,” Wood said. But first the residents must pass a gauntlet of requirements. For adults still grappling with English – some of whom are not fully literate in their first language – even ordinal numbers (“fifth,” “ninth”) and potential interview questions like “Are you a terrorist?” can trip up their quest for citizenship. Applicants must pass an interview, English and civics tests covering U.S. history and government. They must correctly pledge an Oath of Allegiance. Students committed to attending two-hour classes two- three times per week, at sites in Chapel Hill, Carrboro, and Hillsborough. At the Hillsborough classes, teacher Lisa Bobst described how daunting the classes can seem. “I think the most challenging thing is keeping (the students) motivated, because they are very nervous. It’s an intense process, and they don’t want to screw it up,” Bobst said. ‘To show my kids’ For Rogelio Najero Galeano, his four children and sense of community keep him motivated. Galeano, from Mexico, lives in Hillsborough and works at a swim and tennis club. “We feel like we’re kind of visitors, now, and I want to feel like a part of this country,” he said. “I wanted to show my kids they have to work hard. My daughter helps me. She’s proud of me, because I said I’m not good in school, but I’m trying.” In class, Galeano and his fellow students took turns dictating sentences for others to write down. The mood was playful. “Slow, please,” Galeano said, laughing. This interactive learning style makes a difference, Jose de Jesus Martinez-Rodriguez said. “Two or three years ago, I tried to read the book, and I said, ‘It’s very boring,’ but now that I’m taking the class, it’s very fun,” he said. I wanted to show my kids they have to work hard. Rogelio Najero Galeano, father of four For Claudia Esparza, the citizenship classes represent one more step to making her own life decisions. Growing up in Mexico, she felt the pressured to stop her education early. “I tell my mom, ‘I’d like to go to high school,’ and she said, ‘Oh, no, you’re going to get married.’” Finally, three years ago, she earned her GED. Citizenship is next. The class’s comfortable atmosphere, where personal stories like Esparza’s weave in and out, helped boost the students’ morale, Bobst said. “We talk about the strengths and weaknesses of each student, and how they can help each other. Some are good at speaking, some good at writing, but … they’re helping each other.” “Like Rogelio just applied for naturalization. They’re cheering him on.” The class was also making sure to include Esparza, when she left for two weeks in Mexico care for her her father, who has cancer, after losing his wife to cancer. Claudia had planned to keep attending the citizenship class, via Facetime. Checks and balances In a recent class, the conversation revolved around elections. “Who will be a citizen in September?” teacher Forrest Johnson asked. A few students raised their hands; others paused more tentatively. “If you become a citizen in September, you can do what?” “Register to vote,” the student chorused. Students learned about a citizen’s duty to serve on a jury. Burmese students Bue Plo Wah and Mu Nwe jumped up to join hands in a ring with Johnson and pull back – demonstrating the three branches of government and its system of checks and balances. Some are good at speaking, some good at writing, but … they’re helping each other. Teacher Lisa Bobst Han Min Thein and Yuh Wah Thein, husband and wife, compared their new knowledge of the U.S. Constitution with their memories of Burma. Both survived student revolutions in Burma and fled to Thailand. “What is really interesting is the Constitution of the U.S., because for me this is the first thing I learned,” Han Mon Thein said. “I am 48 years old. In our country, over 60 years the military government controlled our country. We don’t know about the Constitution.” “And the Bill of Rights,” Yuh Wah Thein added. “And then in the U.S., they protect everyone by the law. In our country, they don’t protect everyone by the law,” her husband said. Yet even after students master their rights, history dates, and the branches of government – mundane- seeming details can derail them from passing the tests. “What I find is that they can’t answer all the questions that some people ask … such as, ‘Raise your right hand and put your left hand on the Bible,’” Bateman said. But Paw Pleh could. She passed her interview, and her history and civics test in late April. Last week she raised her right hand, put her left on the Bile, and was sworn in as a U.S. citizen. Sendor: julia.b.sendor@gmail.com Read more here: http://www.newsobserver.com/news/local/community/chapel-hill- news/article74467812.html#storylink=cpy CACUQ ELECTRONIC CIGARETTE FOCUSES ON ELECTRONIC CIGARETTE WHOLESALE. Orange County Health Officials Punt on E- cigarette Decision 3rd May 2016 cacuq Relative News 0 Usually, just a handful of people show up to meetings of the Orange County Board of Health, if they show up at all. But last week’s open meeting in Hillsborough on whether or not to include electronic cigarettes in the county’s ban on tobacco in restaurants, bars and public buildings drew several dozen people and provided emotional testimony both for and against the proposal. The board heard, at times, emotional testimony from more than a dozen Orange County residents, along with a presentation on an online survey and a review of the science around e-cigarettes. In the end, county Health Director Colleen Bridger chose to hold off on a decision, citing the incomplete science on e-cigarettes, until the U.S. Surgeon General publishes a long-awaited report sometime later this year. “I’d really like our government to come out and say something before putting my board out on a limb,” Bridger said. Bridger also cited her concern that in the wake of the General Assembly’s controversial decision to preempt a Charlotte city ordinance on the use of bathrooms by transgender people, lawmakers in Raleigh might also move to preempt her board if they moved to put e-cigarettes under the county’s bar and restaurant tobacco ban. “I don’t think we do anything without worrying about the legislature coming in and preempting us,” she said. It’s happened before There’s precedent for legislative preemption of county smoking bans: That’s what happened in 1993, when Democrats still held sway in Raleigh. Several municipalities in the state, Asheville among them, had moved to ban smoking from restaurants and bars. State legislators passed a law forbidding local governments from passing any smoking ordinances stricter than state law. That ban was only overturned in 2009. More recently, the state has been roiled in controversy over HB2, passed during a special session in March of this year. The law overturns a Charlotte city ordinance that would allow transgender people to use the bathroom of their choice, and also preempts municipalities from passing anti-discrimination laws that are stronger than a state standard. The specter of HB2 was raised last week by several opponents of the proposed e-cigarette ban. “Local boards making ordinances that deal with private business … is something I’ve heard a lot about recently,” said Jason Joyner, the lobbyist for the North Carolina Vaping Council. “I certainly would not like to see draconian-level policies come back from Raleigh because of a good faith effort made in Orange County.” Harm reduction Currently, state law classifies e-cigarettes as a tobacco product, which means the devices are forbidden in public schools, state and county buildings and vehicles and other state-run buildings, such as UNC athletic facilities, where tobacco products are banned. While state law bans smoking in restaurants and bars, now it’s up to counties to decide whether or not to extend that ban to e-cigarettes. More than 150 people had responded to a survey on whether or not to ban e-cigarettes in Orange County’s eating and drinking establishments. According to Bridger, more than 81 percent of those respondents supported the ban. But Bridger said she’s sympathetic to people who have used e-cigarette to wean themselves from smoking tobacco, a strategy known as harm reduction. Many vapers have not weaned themselves from nicotine, which has negative health effects, but the harm- reduction argument holds that at least they’re not breathing in cancer-causing products of combustion, such as tar and soot, and are thus reducing negative health effects. Most of those who testified in opposition to the proposed ban were vapers who have quit smoking. Several of them choked back tears as they told of smoking-related health problems for themselves and family members that have diminished now that they’re vaping. “The day my mom died, I swore to her I’d quit. And now, two years later, I can say I’m smoke free,” said Amy Stevens. “If you can’t smoke in restaurants and bars, it won’t devastate me, I’ll continue to vape. “But if there is a place I can go and they say, ‘Yes, we have these four tables over here where we’ll allow you to do it,’ that will be a place where I will go. That’s where I will take my husband on our date nights. It will allow us to go out and stay away from the smokers.” Stevens’ husband, Ben, among others, testified that vaping had “saved my life.” Emerging science The science around vaping, however, is unclear. One thing that is clear is there has been a more than 880 percent increase in the number of North Carolina kids who have tried vaping since 2011. But the U.S. has been slow to regulate the liquids used by vapers. The contents of the liquids vary widely, complicating research. Rob Tarran, director of the Tobacco Center of Regulatory Science at UNC-Chapel Hill, told the board that his researchers have found e-cigarettes have “significantly different effects in the lung.” “These changes appear consistent with immune compromise, so an increased chance of getting infections,” Tarran said. Tarran also drew a comparison between the testing performed on medicines, such as asthma inhalers, and electronic cigarette, noting medications have to undergo “rigorous toxicology and clinical testing” before being released onto the market. In contrast, the liquids used in e-cigarette devices have had none of this sort of scrutiny. “Their effects for inhalation are largely unknown,” he said, both for people vaping and those around them. It was this uncertainty that eventually won the evening. “Because the science is new, because the science is emerging, because there’s lots of disagreement about the science, I would feel more comfortable if we looked at what the Surgeon General had to say about the science surrounding e-cigarette use,” Bridger told the board after all the presentations were done. She reminded the board that the only thing they were allowed to consider in their decision-making process is the scientific evidence. “Let some national vetting of this science occur before you take any action,” Bridger said. Afterward, she reiterated her concerns about the state legislature overriding a board decision made on the basis of incomplete science. “There is the risk of the General Assembly saying, ‘Well, they’re just being politicians and that’s not what they’re supposed to do, so we’re going to just abolish them,’” Bridger said. “So that’s why we just want to be super, super safe on that.” repost:http://www.northcarolinahealthnews.org/2016/05/03/orange-county-health-officials-punt-on-e-cigarette- decision/ Orange County Health Officials Punt on E-cigarette Decision MAY 3, 2016 by EDITOR in FEATURED, PUBLIC HEALTH, STATE HEALTH POLICY, SUBSTANCE USE with 0 COMMENTS By Rose Hoban Usually, just a handful of people show up to meetings of the Orange County Board of Health, if they show up at all. But last week’s open meeting in Hillsborough on whether or not to include electronic cigarettes in the county’s ban on tobacco in restaurants, bars and public buildings drew several dozen people and provided emotional testimony both for and against the proposal. The board heard, at times, emotional testimony from more than a dozen Orange County residents, along with a presentation on an online survey and a review of the science around e-cigarettes. Some e-liquids from Liberty Flights and a 510N e-cigarette device. Many e-liquids are still mixed by local distributors and have remained regulated. Photo by wstryder, flickr creative commons In the end, county Health Director Colleen Bridger chose to hold off on a decision, citing the incomplete science on e-cigarettes, until the U.S. Surgeon General publishes a long-awaited report sometime later this year. “I’d really like our government to come out and say something before putting my board out on a limb,” Bridger said. Bridger also cited her concern that in the wake of the General Assembly’s controversial decision to preempt a Charlotte city ordinance on the use of bathrooms by transgender people, lawmakers in Raleigh might also move to preempt her board if they moved to put e-cigarettes under the county’s bar and restaurant tobacco ban. “I don’t think we do anything without worrying about the legislature coming in and preempting us,” she said. It’s happened before There’s precedent for legislative preemption of county smoking bans: That’s what happened in 1993, when Democrats still held sway in Raleigh. Several municipalities in the state, Asheville among them, had moved to ban smoking from restaurants and bars. State legislators passed a law forbidding local governments from passing any smoking ordinances stricter than state law. That ban was only overturned in 2009. More recently, the state has been roiled in controversy over HB2, passed during a special session in March of this year. The law overturns a Charlotte city ordinance that would allow transgender people to use the bathroom of their choice, and also preempts municipalities from passing anti-discrimination laws that are stronger than a state standard. The specter of HB2 was raised last week by several opponents of the proposed e-cigarette ban. “Local boards making ordinances that deal with private business … is something I’ve heard a lot about recently,” said Jason Joyner, the lobbyist for the North Carolina Vaping Council. “I certainly would not like to see draconian-level policies come back from Raleigh because of a good faith effort made in Orange County.” Harm reduction Currently, state law classifies e-cigarettes as a tobacco product, which means the devices are forbidden in public schools, state and county buildings and vehicles and other state-run buildings, such as UNC athletic facilities, where tobacco products are banned. In this commercial, actress Jenny McCarthy says, “I get to have a blu without the guilt, because there’s only vapor, not tobacco smoke.”Many children’s health advocates worry these images will serve to “normalize” use of e-cigarettes. Image via youtube screen shot While state law bans smoking in restaurants and bars, now it’s up to counties to decide whether or not to extend that ban to e-cigarettes. More than 150 people had responded to a survey on whether or not to ban e-cigarettes in Orange County’s eating and drinking establishments. According to Bridger, more than 81 percent of those respondents supported the ban. But Bridger said she’s sympathetic to people who have used e-cigarettes to wean themselves from smoking tobacco, a strategy known as harm reduction. Many vapers have not weaned themselves from nicotine, which has negative health effects, but the harm- reduction argument holds that at least they’re not breathing in cancer-causing products of combustion, such as tar and soot, and are thus reducing negative health effects. Most of those who testified in opposition to the proposed ban were vapers who have quit smoking. Several of them choked back tears as they told of smoking-related health problems for themselves and family members that have diminished now that they’re vaping. “The day my mom died, I swore to her I’d quit. And now, two years later, I can say I’m smoke free,” said Amy Stevens. “If you can’t smoke in restaurants and bars, it won’t devastate me, I’ll continue to vape. “But if there is a place I can go and they say, ‘Yes, we have these four tables over here where we’ll allow you to do it,’ that will be a place where I will go. That’s where I will take my husband on our date nights. It will allow us to go out and stay away from the smokers.” Stevens’ husband, Ben, among others, testified that vaping had “saved my life.” Emerging science The science around vaping, however, is unclear. One thing that is clear is there has been a more than 880 percent increase in the number of North Carolina kids who have tried vaping since 2011. But the U.S. has been slow to regulate the liquids used by vapers. The contents of the liquids vary widely, complicating research. Rob Tarran, director of the Tobacco Center of Regulatory Science at UNC-Chapel Hill, told the board that his researchers have found e- cigarettes have “significantly different effects in the lung.” “These changes appear consistent with immune compromise, so an increased chance of getting infections,” Tarran said. Tarran also drew a comparison between the testing performed on medicines, such as asthma inhalers, and e-cigarettes, noting medications have to undergo “rigorous toxicology and clinical testing” before being released onto the market. In contrast, the liquids used in e-cigarette devices have had none of this sort of scrutiny. “Their effects for inhalation are largely unknown,” he said, both for people vaping and those around them. It was this uncertainty that eventually won the evening. “Because the science is new, because the science is emerging, because there’s lots of disagreement about the science, I would feel more comfortable if we looked at what the Surgeon General had to say about the science surrounding e-cigarette use,” Bridger told the board after all the presentations were done. She reminded the board that the only thing they were allowed to consider in their decision-making process is the scientific evidence. “Let some national vetting of this science occur before you take any action,” Bridger said. Afterward, she reiterated her concerns about the state legislature overriding a board decision made on the basis of incomplete science. “There is the risk of the General Assembly saying, ‘Well, they’re just being politicians and that’s not what they’re supposed to do, so we’re going to just abolish them,’” Bridger said. “So that’s why we just want to be super, super safe on that.” Tagged e-cigarette, NC General Assembly, Orange County, tobacco, US Surgeon General, youth tobacco use Bat tests positive for first rabies case of the year in Orange Co. CBS North CarolinaPublished: May 5, 2016, 11:55 am Updated: May 5, 2016, 11:57 am Rapid bat. (AP File Photo) HILLSBOROUGH, N.C. (WNCN) – A dead bat, discovered next to a cat Wednesday in Hillsborough, has tested positive for rabies. It’s the first case of rabies this year in Orange County, reports the North Carolina State Laboratory of Public Health. Orange County recorded a total of 10 positive cases last year and 23 the year before. The cat involved in this case was currently vaccinated against rabies and has received a booster shot pursuant to North Carolina’s rabies laws. An unvaccinated animal must either be destroyed or quarantined for a period up to four months. A Communicable Disease Nurse from the Orange County Health Departme nt is evaluating whether humans are at risk of rabies exposure. Of concern is the possibility of secondary exposure from the owners having contact with the cat after the incident. “Prevention is the best measure for effective rabies control for pets and people alike,” said Bob Marotto, director of Animal Services. “Quarantines are done at the cost of the owner and can be expensive, so ensuring cats, dogs, and ferrets have had their rabies vaccinations and can receive a booster instead is always preferable f or the pets and people involved.” Of the few cases of rabies in humans in the United States in recent years, most have been traced to bats. A low-cost rabies vaccine clinic is schedule for Thursday, May 12 from 5 p.m. to 7 p.m. at the Eno river Farmer’s Market, located at 144 E. Margaret Lane in Hillsborough. It is a law in North Carolina that dogs, cats and ferrets older than four months must have a current and valid rabies vaccination at all times. The cost for rabies vaccinations is $10. For more information, please call Orange County Animal Services at (919) 942-7387.