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HomeMy WebLinkAboutBOH agenda 102616 ORANGE COUNTY BOARD OF HEALTH MEETING AGENDA DATE: October 26, 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 October 26, 2016 Agenda 7:10 – 7:15 IV. Actions Items (Consent) A. Minutes of September 28, 2016 7:15 – 7:50 V. Educational Sessions A. CHCCS & OCS Physical Activity/PE Update Scarlett Steinert & Patricia Harris B. Customer Satisfaction Data Pam McCall/Carla Julian/Alan Clapp 7:50 – 8:30 VI. Reports and Discussion with Possible Action A. E-cigarette Rule Update Colleen Bridger B. Present Chair/Vice-Chair Slate Liska Lackey C. Health Director Report Colleen Bridger D. Media Items 8:30 – 8:55 VII. Closed Session to Discuss Health Director’s Annual Review Closed Session (ref. NCGS 143-318.11(a)6) to consider the qualifications, competence performance, fitness, conditions of appointment, of an individual public officer or employee, or prospective public officer or employee; or to hear or investigate a complaint, charge, or grievance by or against an individual public officer or employee. 8:55 – 9:00 VIII. Board Comments 9:00 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 September 28, 2016 S:\Managers Working Files\BOH\Agenda & Abstracts\2016 Agenda & Abstracts/ September 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 September 28, 2016, at the Orange County Health Department, 300 West Tryon Street, Hillsborough, NC. BOARD OF HEALTH MEMBERS PRESENT: Liska Lackey, Vice Chair; Nick Galvez – Vice- Chair, Barbara Chavious, Paul Chelminski, Jessica Frega, Sam Lasris, Reena Mehta and Timothy Smith. BOARD OF HEALTH MEMBERS ABSENT: Commissioner Mia Burroughs, Dan Dewitya and Susan Elmore. STAFF PRESENT: Dr. Colleen Bridger, Health Director; Coby Austin, Director of Programs and Policy; Judy Butler, Communicable Disease Nurse/Public Health Nurse Supervisor; Alan Clapp, Environmental Health Director; Rebecca Crawford, Finance & Administrative Services Division Director; Donna King, Health Promotion & Education Services Director; Nancy Largent, Temporary Communications Specialist; Amber Majors, Social Work Intern; Pam McCall, Public Health Nursing Director; Ashley Mercer, Healthy Carolinians Coordinator; Andrea Mulholland, Family Nurse Practitioner II; Kiana Redd, Public Health Educator; Stacy Shelp, Communication Manager and La Toya Strange, Administrative Assistant II. GUESTS PRESENT: None. I. Welcome Liska Lackey, Chair, called the meeting to order. Dr. Bridger introduced the new employees in attendance: Nancy Largent, Amber Majors and Kiana Redd. II. Public Comment for Items NOT on Printed Agenda: None III. Approval of the September 28, 2016 Agenda Motion was made by Barbara Chavious to approve the agenda, seconded by Sam Lasris carried without dissent. IV. Action Items (Consent) A. Minutes Approval of August 24, 2016 Meeting Motion to approve Consent Agenda without corrections to the August 24, 2016 minutes was made by Jessica Frega, seconded by Nick Galvez and carried without dissent. V. Educational Sessions A. Showcase of Recent OCHD Presentations MINUTES-Draft ORANGE COUNTY BOARD OF HEALTH September 28, 2016 S:\Managers Working Files\BOH\Agenda & Abstracts\2016 Agenda & Abstracts/ September Page 2 Various staff shared abbreviated versions of some of their recent presentations. Below are some of the highlights. Andrea Mulholland – Clinic Staff Adherence to the CDC’s STD Treatment Guideline: A QI Initiative in a Local Health Department The OCHD has adhered more closely to state standards versus the CDC’s guidelines. Ms. Mulholland’s objective was to assess clinic staff adherence to CDC’s STD Treatment Guidelines for treatment and follow up of chlamydia, gonorrhea and syphilis which are the three most prevalent reportable STDs. Low rates of patient return for rescreening were determined; although, OCHD had high levels of adherent treatment. Various factors were the provider, patient and organizational. The data collection methods included a chart review of clients screened and treated at both OCHD clinics during the period of July 1, 2014 through July 1, 2015 and a survey designed via Qualtrics that was sent to clinic staff on February 3, 2016. Based on the results, discussion emerged including having high levels of guideline adherence by OCHD staff for treatment of chlamydia and gonorrhea and a lack of provider awareness/need for staff education. Two out of 58 clients with chlamydia were not able to be reached for treatment. There was a need for strategies for communicating with difficult to reach populations. It was also noted that there was 100% treatment rates for syphilis. As a result of the findings, five recommendations were made: 1. Staff education – OCHD staff have knowledge of CDC’s guidelines, less knowledge of North Carolina Administrative Code (NCAC §46 0214 & §41A 0204); Educate all levels of employees; More staff engagement and appointment availability. 2. Patient Education – Different types of staff provide STD services; Regardless of staff type: concise and consistent patient education; Timeframe results will be ready, risk reduction and need for 3 month rescreen. 3. Technology – Effectively used for STD risk reduction and education; Harness power of technology with guidance from authorities to communicate with hard to reach and anonymous clients; Text message, web based notification and email reminders. 4. Ongoing QI – Evaluating numbers of STDs and level of adherent therapy; Improve efficiency, reduce errors, improve practice; Communicate with front line staff to stimulate shared decision making 5. Public policy and funding – Public health spending (NC:$14.16/person, US:$30.61/person); MINUTES-Draft ORANGE COUNTY BOARD OF HEALTH September 28, 2016 S:\Managers Working Files\BOH\Agenda & Abstracts\2016 Agenda & Abstracts/ September Page 3 STDs on the rise, need for advocacy of LHDs to legislators; Increased funding; expansion of services, messaging systems. Andrea Mulholland – OCHD & PrEP: Past, Present & Future Pre-exposure prophylaxis (or PrEP) is when people at very high risk for HIV take HIV medicines daily to lower their chances of getting infected. The FDA approved Truvada for PrEP use in 2012. The costs of labs (HIV and Hepatitis B), whether non-infectious disease providers should be dispersing Truvada and whether the disbursement of this medication encourages high risk sex were topics of discussion. The in-house protocol was written by Ms. Mulholland. The first year rollout was during FY 2014-15. A timeline of events was detailed including the BOH presentation and press releases. During the FY 14-15 and FY 15-16, there were 23 patients total (6 in 2014-15 and 17 in 2015-16) that received Truvada. The population mostly served were young MSM (men having sex with men), Caucasian professionals. Most had private insurance. FY 16-17 has had 3 patients partake in PrEP. Lastly, Ms. Mulholland spoke on the future of PrEP. Patient level education, promoting PrEP, primary prevention and how to get it to more minority patients were some topics that will continue to be discussed. The BOH members had questions that were addressed by Ms. Mulholland. Stacy Shelp – Making Friends with the Media Ms. Shelp began by stating that traditional media isn’t dead or dying – it’s modifying. The points Ms. Shelp gave for dealing with the media and getting your story in the news were: • Develop relationships. • Create high-quality, informative press releases and media advisories. • Have talking points and a variety of ways to say them. • Don’t be intimidated. • Make their (media) job easy. Set up a media space at your event. Ms. Shelp continued by providing tips on how to strengthen your ‘brand” by being accessible, building relationships and providing photo ops. Other tips given for when you’re being interviewed included: • Answer the question asked. • Be concise and avoid jargon. • Stand up for a telephone interview. Your voice will sound better. • Use a landline whenever possible. • Don’t cross your arms or rock. • Don’t perpetuate myths. • Avoid filler words such as “sure” and “um”. • Speak slowly and clearly. MINUTES-Draft ORANGE COUNTY BOARD OF HEALTH September 28, 2016 S:\Managers Working Files\BOH\Agenda & Abstracts\2016 Agenda & Abstracts/ September Page 4 Coby Jansen Austin – Healthy Homes Pilot Program Ms. Austin stated the goals of the pilot which were to improve asthma control by reducing exposure to triggers and improving medication management. The measures of success were determined by factors including ED/urgent care visits, hospitalizations, missed school and self-reported control. During the pilot, the Healthy Homes visits consisted of the Environmental Health Director, Alan Clapp and a nurse (from UNC, CCNC, CC4C or school nurse). Early on, Family Success Alliance (FSA) zone navigators attended visits as they had a valuable connection with the families in their communities. The assessment tools used included the EPA Asthma Home Checklist and the NC Healthy Homes Assessment. Resources available to the clients were a free green cleaning kit, use of a HEPA vacuum and a Quit Kit with free NRT for those wanting to cease smoking. Sample testing of well water was also offered. To be eligible, it was required that the child be between 0-17 years old, live in Orange County and meet certain asthma control criteria. In the beginning, priority was given to those in FSA zones, insured with Medicaid or uninsured. Referral sources varied and were comprised of UNC Health Care, both school districts and CC4C. After four weeks, there was a decrease in reported asthma symptoms. During the three month follow up, a slight increase occurred, possible due to many factors – change in weather, etc. Emergency room visits dropped tremendously. Participant satisfaction results reported that 100% felt that the program was helpful to decrease their child’s asthma symptoms. This information is with its limitations due to factors such as response and recall biases. Colleen Bridger – Naloxone Statewide Standing Order and Cost Settlement Update Briefly, Dr. Bridger touched on a few highlights from each presentation. • On June 20, 2016, Gov. McCrory signed legislation authorizing state health director to issue statewide standing order for naloxone. Pharmacies are able to dispense Naloxone without a prescription through insurance. Patients without insurance can get naloxone kits at a lower price through their local health department. • In July, the General Assembly appropriated $14.8 million to local health departments to offset reduced Medicaid reimbursement rates on the delivery of direct patient service. Our health department will receive around $220,000. VI. Action Items (Non-Consent) A. 2016-19 HCOC Action Plan Ashley Mercer, Healthy Carolinians Coordinator, presented the action plans that address health related goals. Each subcommittee of Healthy Carolinians created individual action plans to address the recommendations suggested by community members during the 2015 Community Health Assessment data collection process. In addition to the community’s input in their MINUTES-Draft ORANGE COUNTY BOARD OF HEALTH September 28, 2016 S:\Managers Working Files\BOH\Agenda & Abstracts\2016 Agenda & Abstracts/ September Page 5 development, each action plan involves 3-4 interventions and will be led by a subcommittee which will partner with other community agencies/organizations to accomplish each intervention over the four year time span. The three areas of priority and their interventions are as follows: 1. Social Determinants of Health with priority around Access and Poverty  Increase awareness and access to local county resources to those who live and work in Orange County, as it pertains to medical, dental and mental health care.  Identify safety net providers to serve as medical homes for the under/uninsured.  Encourage and support partner agencies to pilot a transportation access improvement activity within their agency. 2. Mental Health and Substance Abuse  Decrease tobacco use among youth as it relates to e-cigarettes.  Reduce prescription drug overdose, increase and encourage use of the Controlled Substances Reporting System (CSRS) and increase and encourage use of prescription drug lock boxes.  Suicide Prevention Social Marketing/Media Campaign. 3. Physical Activity and Nutrition  Increase the number of physical activity opportunities available to rural Elementary and Middle School families by promoting and recruiting for 10 existing Girls on the Run programs.  Increase the number of healthy food options provided to rural and low-income students and families, enrolled with Orange County Schools, by providing bags of fresh fruits and vegetables to 200 eligible students.  Increase knowledge and influence behavior change related to eating smart and moving more by encouraging 10 agency partners to promote a county-wide, consistent messaging campaign that will distribute messages through a variety of established channels and media, over 6-months.  Increase the number of healthy eating opportunities available to Orange County students and adults by supporting and advocating for 3 Share our Strength’s Cooking Matters educational classes per year, in addition to other nutrition education curriculums. The BOH members had questions that were addressed by Ms. Mercer and Dr. Bridger. Motion to accept the 2016 Healthy Carolinians Community Action Plans was made by Paul Chelminski, seconded by Barbara Chavious and carried without dissent. VII. Reports and Discussion with Possible Action A. Advisory Board Update Coby Austin, Director of Programs and Policy, gave a brief summary of the Orange County advisory boards’ activities as they pertained to the BOH. • Orange County Schools Board of Education – MINUTES-Draft ORANGE COUNTY BOARD OF HEALTH September 28, 2016 S:\Managers Working Files\BOH\Agenda & Abstracts\2016 Agenda & Abstracts/ September Page 6 o The Board modified its formulas for Title 1 designation and for allocating federal money to those schools. This was done to shift the approach from “equality” to “equity” approach. o Universal Breakfast Pilot. This program will reduce the stigma for low-income students who are receiving free breakfast. All elementary students will eat breakfast at no charge on school days. B. Annual Communicable Disease Report Judy Butler, Communicable Disease Nurse/Public Health Nurse Supervisor, gave an overview of the communicable disease data for the year 2015. She also gave an update on September 28th which is the 31st day of the school year also known as “kick out day”. Children without complete immunization records or new children without completed Health Assessments are to be dismissed from school. Orange County Schools had reported 20 students lacking immunizations; while, Chapel Hill/Carrboro City Schools reported 81. This information does not include data for 2 schools that hadn’t yet provided a report. Ms. Butler noted other communicable disease-related activities performed by her staff including documenting health law violators, quarantine orders, control measure orders, outbreaks that occurred and bloodborne pathogens exposure. Some of the highlights from the information she gave during her presentation include: • Annual STD data for 2015 – There were a total of 853 cases which was comprised of182 cases of gonorrhea, 634 cases of chlamydia, 15 cases of syphilis, 14 cases of HIV and 8 cases of AIDS. • There were a total of 115 cases of communicable diseases including 38 newly identified/confirmed reports of hepatitis B and 6 pertussis cases. The BOH members had questions that were addressed by Ms. Butler and Dr. Bridger. C. Foreshadow Chair/Vice-Chair Selection Liska Lackey, Chair, stated that the positions of Chair and Vice-Chair are open. She also prefaced that by stating that it is customary for the current Vice-Chair to occupy the Chair position because of the experience gained as Vice-Chair. Ms. Lackey informed the BOH members that interested persons should send her an email within the next week. BOH members will vote to select the Chair and Vice-Chair at the November meeting. D. Health Director Annual Evaluation Liska Lackey, Chair, reviewed this year’s process for the annual review referring to the BOH Policies and Procedures for guidance. The annual review will occur during a closed session at the November 2016 meeting. Ms. Lackey will survey direct reports and share the results with the Board in the closed session in November. E. Health Director Report In addition to the Health Director’s report, Dr. Bridger mentioned that she’s unsure of when the Surgeon General’s report will be released. As the Board’s vote was MINUTES-Draft ORANGE COUNTY BOARD OF HEALTH September 28, 2016 S:\Managers Working Files\BOH\Agenda & Abstracts\2016 Agenda & Abstracts/ September Page 7 postponed until fall which is when the Surgeon General’s report was expected to be released, she notified the Board that next month’s agenda will include a discussion on the E-cigarette issue as there are people anticipating the Board’s decision and wondering where we stand. Dr. Bridger also mentioned the multiple awards that the OCHD won at the North Carolina Public Health Association’s annual meeting and acknowledged the winners that were present. She also recognized the OCHD’s Healthy Homes Program that won the GlaxoSmithKline Child Health Recognition Award which came with a $5,000 prize. The BOH members had questions that were addressed by Dr. Bridger. F. Media Items 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 A motion was made by Reena Mehta to adjourn the meeting at 8:50 p.m., was seconded by Nick Galvez and carried without dissent. The next Board of Health Meeting will be held October 26, 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: October 26, 2016 Agenda Item Subject: CHCCS & OCS Physical Activity/PE Update Attachment(s): Staff or Board Member Reporting: Scarlett Steinert (CHCCS), Patricia Harris (OCS) Purpose: ___ Action _X_ Information only ___ Information with possible action Summary Information: The Board of Health’s 2016-2018 Strategic Plan aims to assess 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. Staff from both school districts will present data related to this objective and related priorities and plans for the district, especially related to policies/systems changes, and what recommendations/requests they have for the Board of Health to support them in this work, if any. 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): The Orange County School Health Advisory Council (SHAC) In January of 2003, the North Carolina State Board of Education passed a policy, The Healthy Active Children Policy HSP-S- 000 requiring all school districts to “establish and maintain School Health Advisory Councils to represent the eight components of a Coordinated School Health Program”. Requirements Safe Environment Physical Education Health Education Staff Wellness Health Services Mental and Emotional Health Nutrition Services Family/Community Involvement What is SHAC? SHAC is an advisory group composed primarily of school and community representatives who act collectively in advising the school district on a Coordinated School Health Program. Functions consist of: Program Planning Parent and Community Involvement Advocacy for Coordinated School Health Recruitment of Community Health Resources Evaluation 2014-2015 Evaluation A survey was given in May of 2015 to assess our health and wellness within the schools. 13 out of 13 schools participated Survey Results 0 2 4 6 8 10 12 14 Question 1 Question 2 Question 3 Question 4 Question 5 Question 6 Question 7 Question 8 Yes No Survey Results Continued Questions 9 - 17 Question 9 Curriculum, No Fast Food, Store Bought Question 10 3 periods to one Question 11 20 minutes to 1 hour Question 12 Posters/Notices Question 13 Not organized physical activity Question 14 and 15 All schools have qualified PE teacher except Partnership; Students have opportunity for PE Question 16 and 17 Not used as punishment; Physical Acitivity at least 20 min/day. 2015-2016 Ongoing Projects Red Ribbon Week Eat Smart Move More Safe Routes to School Family Success Alliance Health Dept for Food Safety in schools Orange County Food Council Goal for 2015-2016 Goal: Reducing obesity in our community through fostering healthy habits Subcommittees will focus on the 8 components and determine strategies for the goal Meetings: September 24, December 8, January 28, March 17, May 26 Questions ?? Members F R E E ! FAMILY RESOURCE FAIR AND MANY MORE! VACCINATIONS ARE YOUR FIRST LINE OF FLU PNEUMONIA TETANUS We i nvi t e your f ami l y t o t ake advant age of t hi s FREE opport uni t y t o meet wi t h Local Communi t y Part n ers. Joi n us as we navi gat e t hrough t opi cs such as: Safet y, Nut ri t i on, Wel l ness, Chi l d Care, Fi t ness, Fun and Mor e! I mmuni zat i on s admi ni st er ed on si t e wi t h proof of i nsurance compl i ment s of: DEFENSE 24t h Sept ember 10am -2pm Orange Hi gh School 500 Orange Hi gh School Rd Hi l l sborough F R E E ! DRAFT School Health Advisory Council Action Plan Time Frame: ___ 3 months, ___ 6 months, ___ 12 months Steps or Strategies Team Members' Roles and Responsibilities Resources Timeline Offer high quality physical education taught by certified teachers. Train classroom teachers in Energizers, Take 10, or other curriculum- Expand physical activity in out-of-school time/after-school time Support Joint Use of recreational facilities Transfer physical activity skills taught in the classroom to the home environment; Family webpage, PTO promotion, P.E. Home work kits Weigh and Measure students twice a year Work closely with Child Nutrition Services regarding food and beverage policies LEA or School Name: Orange County Schools PE Committee PERSON COMPLETING THE O Goal: Prevent or Reduce Obesity by Promoting Physical Activity Objective 1: Increase the percentage of school age youth getting the recommended amount of physical activity Objective 2: Increase the percentage of Elementary and Middle School students who are neither Overweight nor Obese Evaluation: Track time spent in structured physical education, classroom activity, recess, and out-of-school.after-school. Track BMI bi-annually Steps or Strategies Team Members' Roles and Responsibilities Resources Timeline Identify programs and community resources for use and implementation Planning for the Rollout Guidelines and Project Name Projected date: February 1, 2016 New deadline: TBD NC EFNEP, Cooperative Extension, Health Dept, OCS- Child Nutrition and School Community Relations, UNC Health Care and OCS Nurses Identify School for Pilot Guidelines- Feb.15 Deadline- Mar. 14 Final Decisions- March Meeting Announcement- April Implementation in the 2016/2017 School Year September 2016 Goal: Reducing Obesity in our community through fostering healthy habits Objective: Recommend a health/nutrition education program for implementation in an Elementary school as a pilot, to later go system wide, to serve parents, staff and the larger community Evaluation: Will use various assessment tools and data to track change in healthy Habits, healthy attitudes, and healthy living. Indicate the goal to be addressed. Describe a school health objective that is specific, measurable, appropriate, and realistic and time specific for yo ur district that addresses changes in policy or programs. Include an evaluation for the objective. How will you know when the objective is achieved? List measurable steps or strategies for accomplishing the objective. Include activities like assessment, partnering, organizing, resource development, information sharing, making available and promoting, seeking alternative funding sources and media promotions. Delegate roles and responsibilities to council members. Be specific about who will do what. Determine available resources from the school district or community that could be used to help you carry out the step or strategy or if you need additional resources. Determine when the step or strategy will be carried out. LEA or School Name: PERSON COMPLETING THE FORM: Health Services and Nutrition ACTION PLAN TEMPLATE Steps or Strategies Team Members' Roles and Responsibilities Resources Timeline School Health Advisory Council Action Plan Time Frame: ___ 3 months, ___ 6 months, ___ 12 months LEA or School Name: PERSON COMPLETING THE FORM: Goal: Objective: Evaluation: Steps or Strategies Team Members' Roles and Responsibilities Resources Timeline Steps or Strategies Team Members' Roles and Responsibilities Resources Timeline Plan a kickoff event for the community All Team members Connecting with schools, community agencies/partners, local gyms (i.e., Planet Fitness, Sportsplex and Millenium), local businesses (i.e, Sports Endeavor) and area businesses and stores. Plan all this year and kickoff in the fall Advertise the event All Team members Have a student spokesperson talk on Hillsborough Radio Station, newspaper, school newsletters and Alert Now messages. Advertise at the Health Department and doctors’ offices. Banner on the Court House Lawn. Last Friday table. Winter/spring/summer Locating the journals and apps All Team members Research and check with agencies or businesses that might donate journals Winter/spring/summer Provide locations where folks can exercise and walk safely. Volunteer Team captains for neighborhoods. All Team members Research safe walking areas for community members. Create a document that we can give community members delineating local areas for exercising and walking. Winter/spring/summer Goal: Prevent Obesity and Increase Healthy Living Habits Objective: To incorporate exercise and healthy eating into daily/weekly activities, i.e. walking with friends and family Evaluation: Have an accountability coach or partner or team – Food diaries – Online and/or written journaling documenting exercise and mood. LEA or School Name: PERSON COMPLETING THE FORM: Aviva Scully SHAC Subcommittee Members: Kim Kelleher, Charlene Campbell, Maile Williams, Aviva Scully ACTION PLAN TEMPLATE School Health Advisory Council Action Plan Time Frame: ___ 3 months, ___ 6 months, ___ 12 months Steps or Strategies Team Members' Roles and Responsibilities Resources Timeline Goal: Objective: Evaluation: Agenda Item Number: ORANGE COUNTY BOARD OF HEALTH AGENDA ITEM SUMMARY Meeting Date: October 26, 2016 Agenda Item Subject: Customer Satisfaction Survey 2016 Attachment(s): Personal Health Client Input Surveys 2016 Staff or Board Member Reporting: Pam McCall, PHSD Director; Alan Clapp, EH Director; Carla Julian, Dental Clinic Manager Purpose: ____ Action _ _X Information only ____ Information with possible action Summary Information: Per Board of Health Policy and Accreditation standards, each year the Board of Health will receive from the staff of the Health Department the results of patient and client input on services received, including any corrective actions deemed necessary to improve services. Personal Health: The majority of the measures in the 2016 Personal Health client input surveys show continued or increased levels of satisfaction as compared to the 2014 results. The surveys showed client satisfaction with wait times decreased by 3%. Three measures related to staff interactions with clients indicated a 3% or greater decrease in satisfaction. Clinic leadership surmises this could be due to several issues related to staff vacancies including the transition of the medical director and coverage by multiple MDs that were new to clinic; maternity leave for one nurse practitioner and coverage by contract provider; and nursing and clinician staff vacancies. Plans to improve include continuing to assess and streamline clinic processes for greater efficiency as well as filling vacant positions as soon as possible. UNC Family Medicine has agreed to have one main back-up for the medical director. The surveys will be re-administered in December 2016 and the staff will brainstorm ways to increase participation. Future plans include pursuing alternative surveying methods and training staff in patient and family centered care. Dental Health: The Dental Health Services patient satisfaction survey in June 2016 continues to reflect continued satisfaction with the dental care and education received as well as the payment collection process. Staff have worked hard to improve the scheduling and payment processes, but there continues to be moderate dissatisfaction verbalized by our adult population in the amount of time it takes to get an appointment. We are currently scheduling new patient appointments 3 months ahead, which is an improvement from the previous 6 month average. Our main strategy to improve this is to more aggressively fill cancelled appointments with patients who request to be seen sooner. A forthcoming option to use a patient reminder/contact system will hopefully help us meet this goal. Environmental Health: Environmental Health has used the same 18 question survey tool since 2007. The survey is collected using Survey Monkey software. The data collection period is one year before new survey is started. The survey runs from September to September. The survey is delivered to clients via all email correspondence. The survey has 4 questions that allow for free form comments. Two questions allow comments on services. Two questions allow for comments on staff. The other 14 questions are check box type questions. The feedback received on the September ’15 to September ’16 period was very positive. Environmental Health management reviews the comments and results. The yearly results are shared with the entire Environmental Health staff during a staff meeting. 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 Board of Health Meeting October 26, 2016 Personal Health Client Input Surveys 2016 Surveys Collected mid-July through mid-August 2016 from clients N=156. WHSC-59; SHSC-97 Not all respondents answered all questions Compared to results from 2014 surveys Community Clinical Services Surveys were administered to the public in the DSS waiting room for two days in September 2016. Community Input Surveys Respondents overwhelmingly felt the Dental and Medical Clinic hours were convenient. As a result, there will be no change to the Dental or Medical Clinic hours. Most respondents felt the services currently provided were sufficient, while some suggested increased information about services and access to eye care.  Orange County Health Department will investigate linkages to eye care and better ways to share information about our services. Results Satisfaction with most visit elements remained high Satisfaction with wait times decreased by 3% overall % Agree WHSC 2014 2016 SHSC 2014 2016 Total 2014 Total 2016 Total Trend Convenient Location 99% 97% 96% 99% 98% 98% No change Convenient Hours 99% 95% 97% 97% 98% 96% -2% change Easy to Contact Clinic 96% 97% 93% 93% 95% 95% No change Easy to Make Appointment 97% 93% 96% 95% 95% 95% No change Appropriate Wait Time 80% 75% 79% 76% 79% 76% -3% change Results Satisfaction with some elements of staff interaction decreased Overall satisfaction showed greatest decrease % Agree WHSC SHSC Total Total Total Trend 2014 2016 2014 2016 2014 2016 Staff Explained My Care 100% 96% 98% 99% 99% 98% -1% change Staff treated me with respect 97% 98% 99% 99% 98% 99% +1% change Staff listened to me 99% 90% 99% 99% 99% 95% -4% change Understood staff explanations 100% 96% 98% 99% 99% 98% -1% change Overall satisfaction 96% 91% 97% 86% 97% 89% -8% change Would recommend to family and friends 92% 88% 97% 96% 95% 92% -3% change Results Satisfaction with interpreter services increased in all measures at both sites % Agree WHSC SHSC Total Total Total Trend 2014 2016 2014 2016 2014 2016 Interpreter was professional 88% 100% 91% 85% 90% 93% +3% change Interpreter clearly interpreted for staff 89% 92% 91% 92% 90% 92% +2% change Interpreter clearly interpreted for me 80% 85% 87% 92% 84% 89% +5% change Qualitative Feedback Positive* •Everything good •Service provided is excellent and staff is very helpful. •Staff was excellent – very welcoming and professional. We love coming here. •Friendly staff * Each mentioned multiple times Qualitative Feedback Constructive Doctor available more days. Learn new things Wait times too long (n=8) Walk-ins would be great! Send email to me for some news. Let the Hillsborough bus come here. Make the doctors listen to what you are telling them the first time and it won’t cause problems! (I want) Play room back. I was not satisfied with the waiting area. Plan Increase number of survey participants Pursue alternative surveying methods Re-administer survey in December 2016 Continue quality improvement efforts Fill vacant positions Pursue training in Client and Family Centered Care JUNE 2016 TOTAL RESPONDENTS: 52 (INCLUDES ENGLISH AND SPANISH) DENTAL HEALTH SERVICES PATIENT SATISFACTION SURVEY DENTAL HEALTH SATISFACTION SURVEY Key Positive Responses 98% strongly agree / agree receive good treatment and advice 97% strongly agree/ agree satisfied with payment collection 95 % strongly agree / agree would refer family and friends Key Area for Improvement Satisfied with ability to schedule new pt appointment 2% strongly disagree 6% disagree 6% neutral Complaints from adult patients New adult appointment 3 months out unless emergency New child appointments in 1 to 2 weeks unless emergency DENTAL HEALTH IMPROVEMENT PLAN Wait time for new patient appointment ongoing challenge Demand > Capacity Decreased from 5 to 3 months with 2nd fulltime dentist Maintain list of patients that want sooner appointment OCHD pursuing “Patient Relationship Management” service – simultaneously contacts all patients on list by telephone, text, or email ENVIRONMENTAL HEALTH CUSTOMER FEEDBACK RESPONSES Alan Clapp Environmental Health Director Survey Facts •Environmental Health has used the same feedback tool since 2007 •The survey consists of 18 questions •The surveys are collected September through September (1 year period) •Surveys are distributed via email correspondence with clients •Survey Monkey is used as the collection tool •Two questions allow for free form comment on services •Two questions allow for staff recognition Responses: General Feedback Food and Lodging Feedback Well and Septic Permitting Feedback Agenda Item Number: ORANGE COUNTY BOARD OF HEALTH AGENDA ITEM SUMMARY Meeting Date: October 26, 2016 Agenda Item Subject: E-Cigarette Update Attachment(s): Staff or Board Member Reporting: Colleen Bridger Purpose: ___ Action _X_ Information only ___ Information with possible action Summary Information: At its April meeting, the Board of Health decided to postpone its vote on a proposed rule to prohibit the use of electronic cigarettes inside restaurants and bars in Orange County until the US Surgeon General released a report on the products, which at the time was anticipated in fall 2016. Our understanding is that the SG office has focused on releasing a report on opioids this fall and that the report on e-cigarettes is now expected in early 2017. Staff are not aware of any Cochrane reviews or other systematic reviews that have been published since April that would inform this decision. Staff is requesting guidance on how to the Board would like to proceed with considering this rule. 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): Agenda Item Number: ORANGE COUNTY BOARD OF HEALTH AGENDA ITEM SUMMARY Meeting Date: October 26, 2016 Agenda Item Subject: Elections (Chair and Vice-Chair) Attachment(s): Staff or Board Member Reporting: Liska Lackey Purpose: ____ Action ____ Information only _X__ Information with possible action Summary Information: Per the Board of Health Policies and Procedures, the Board shall elect a Chair and Vice-Chair by majority vote each year at the last meeting of the calendar year. This discussion’s purpose will include getting nominations for each position for a vote that will take place at next month’s meeting. We will be presenting the slate of officers of Nick Galvez as Chair and Dan Dewitya as Vice-Chair. Recommended Action: ___Approve ___Approve & forward to Board of Commissioners for action ___Approve & forward to ___________________________ ___Accept as information ___Revise & schedule for future action ___Other (detail): Health Director’s Report October, 2016  Family Success Alliance o I presented at the joint Board of County Commissioners, Boards of Education meeting about the Family Success Alliance, at their request. It was an extremely positive meeting and all attendees were complimentary of the FSA staff, and work in general. o A group from the FSA staff/Board attended the Collective Impact training in San Antonio this week. We are looking forward to learning from them. o Coby will be giving a presentation at the November 1 BOCC meeting to share some 5- year budget projections specific to FSA. o Coby also has individual meetings scheduled with each Board of Education to discuss the FSA. o I gave a presentation in Raleigh about FSA and there was some discussion about how the state could modify their funding to support collective impact projects like ours.  We had another fun and delicious Health Department Staff Appreciation Annual Picnic. Copies of pictures of my dress up experiences were featured prominently.   We are in the middle of our “90 day letter” preparation period for Accreditation. We’ll update you on our progress at the November BOH meeting and the site visit is scheduled for the second week of January.  We are in the middle of painting/floor replacement/minor renovations at Whitted. What has been done so far looks great!  We continue to work with HR to develop and implement an improved nursing retention and recruitment plan for the Health Department. We are close to announcing a few important changes to staff (once we receive approval from the Manager’s Office).  We are thrilled to announce the hiring of our new Medical Director. Erica Pettigrew will be joining us December 1st. Chapel Hill News September 26, 2016 11:11 AM Bat is Orange County’s 5th case of rabies this year CHAPEL HILL A state laboratory confirmed Orange County’s fifth case of rabies this year, when a bat was removed from a home in Mebane last week. The county had 10 confirmed cases last year and 23 the year before. The latest incident happened Wednesday when a bat was spotted inside the fireplace of a Mebane residence. The residents immediately got out of the house and called Animal Control to remove the animal for rabies testing. Two dogs and a cat were in different parts of the house when the bat was discovered, but because no one saw the bat enter, there was no way to rule out the possibility of exposure, officials said. Because of the vaccination history of the pets, they were all able to receive booster shots under North Carolina’s rabies laws. When there is “a reasonable suspicion of exposure,” a dog, cat, or ferret with a valid vaccination history must receive a booster shot within 96 hours. By contrast, an unvaccinated animal must either be killed or quarantined for a period up to four months. A Health Department nurse contacted the residents to evaluate their risk of rabies exposure and whether they needed post-exposure treatment to protect themeselves from rabies. Of the few cases of rabies in humans in the United States in recent years, most have been traced to bats, officials said. Because bat bites can be undetectable to the human eye, officials say it is critical that a bat inside an occupied dwelling be safely contained without human contact and that people immediately contact their animal control program or 911 if there is any possibility of exposure. Orange County Animal Services will holds two low-cost rabies vaccination clinics this week: ▪ Thursday, Sept. 29, from 5 to 7 p.m. at the Eno River Farmers Market, 144 E Margaret Lane in Hillsborough ▪ Saturday, Oct. 1, from 9 a.m. to noon at the Animal Services Center, 1601 Eubanks Road in Chapel Hill. The cost for rabies vaccinations is $10. Clinic dates for the rest of 2016 are posted at http://orangecountync.gov/departments/animalservices/rabies.php For more information, call Animal Services at 919.942.7387. Read more here: http://www.newsobserver.com/news/local/community/chapel-hill- news/article104210511.html#storylink=cpy Carrboro Police Again Successfully Use Naloxone to Reverse Overdose By Blake Hodge Posted September 26, 2016 at 12:54 pm Carrboro Police have once again utilized naloxone to reverse a drug overdose. Officials say the patient in this case was transported to UNC Hospitals for treatment. Administering naloxone reverses the effects of overdose, which allows an opportunity for medical intervention to save the life of the user. Carrboro Police have been on the forefront of the wave of law enforcement carrying the reversal drug. CPD partnered with Orange County EMS, the Orange County Health Department and the North Carolina Harm Reduction Coalition to go forward with the program. Authorities say this marks the third time an officer has used naloxone since officers began carrying the drug in October 2014. The first instance was a successful overdose reversal in January 2015. Just a few weeks later, in late February 2015, the second use of naloxone was during the reversal of a triple overdose. Law enforcement officials have been more open to carrying naloxone and thinking about overdose as a health problem rather than a law-enforcement issue, even though illegal drugs or illegal use of prescription drugs is the cause of some overdoses. Police continue to ask that you call 911 if you suspect someone is in an overdose state and remain with the subject of concern. Police, Campus Health carry Naxolone, a drug that can reverse an overdose HARRIS WHELESS AND SAMANTHA SCOTT | PUBLISHED 09/30/16 12:40AM At 4:31 a.m. on Sept. 23, Carrboro Police received a 911 call reporting a drug overdose on the 500 block of Jones Ferry Road. Officer Lori McLamb was first to report to the scene, where she found a 20 -year-old woman unconscious with labored breathing. Because the woman used a combination of drugs, her friends were unsure which she overdosed on. McLamb, deciding the woman overdo sed on opioids, administered two milligrams of Naloxone. EMS later administered another two milligrams, saving the victim’s life. Naloxone reverses the effects of an opioid overdose by temporarily binding to the same brain receptors as the opioids. It has now been administered by police six times in Orange County — three times by the Orange County Sherriff’s Department and three times by the Carrboro Police Department. Capt. Chris Atack, spokesperson for the Carrboro police, said annual Naloxone training for police officers is vital to saving lives. “Opioids have surpassed other drugs, alcohol, guns and car crashes among other things in causes of death,” Atack said. “Law enforcement’s role is public safety and life - saving, and I think this is a niche tool for law enforcement to create better outcomes for those involved in overdose.” The Carrboro Police Department began training officers to use Naloxone nasal spray during opioid overdoses in October 2014. In January 2015, it became the first police department to use Naloxone in North Carolina. “When you’re in an opioid overdose, seconds can count – you’re depriving your brain and body of oxygen, which is certainly a medical emergency,” Atack said. “If law enforcement arrives first, we want to be sure we can do everything possible to reverse the effects of this overdose quickly.” From 2009-2013, 161 drug overdoses occurred in Orange County. UNC Campus Health Services now stocks Naloxone, too. Stacy Shelp, spokesperson for the Orange County Health Department, said UNC’s pharmacy will begin to train the public to administer Naloxone on Oct. 12. Campus Health Services has also taken the initiative to spread awareness. Amy Sauls, the director of pharmacy for Campus Health Services, said the office began providing free Naloxone kits for students without a prescription one month ago. “It’s been a drug that we’ve kept here at Campus Health for a long time to reverse any kind of opioid overdose,” she said. “It’s been a drug that’s been around a long time and has been used in hospitals and clinics, but it’s just now in the last several years coming into the spectrum of public use.” Naloxone is often administered as an injection, but after students said they would prefer a nasal spray, Campus Health went with that option. Sauls said students can ask for a Naloxone kit at any time without questioning. “The main purpose is just to save a life,” she said. Under North Carolina’s Good Samaritan Law, people who witness an overdose can call 911 without risking prosecution against the witness or victim, although the law doesn’t provide immunity for every drug offense. Dean Blackburn, director of Student Wellness, said opiate abuse goes through increases and decreases every four to six years. He said Naloxone has an enormous number of advantages with no conceivable drawbacks. “There’s really no potential for abuse, misuse or misadministration of any kind,” he said. “So the risks are near zero and the benefits are tremendous.” Asthma Intervention Program Helps Keep Homes Healthy By Steph Beckett SHARE THIS: Posted October 10, 2016 at 1:24 pm Orange County Health Department Almost 12 percent of Orange County residents reported having asthma in 2011. Only six percent of that number reported earning more than $50,000 per year. That’s why the Orange County Health Department created Healthy Homes. It’s an asthma intervention program that lets the health department assess the air and safety of a given home environment. “What Healthy Homes looks like is an environmental specialist and a nurse coming to a family’s home both to do a medication review with them and to do some in-home assessments to empower the family to do things that they can—that are within their control to prevent some of the asthma exacerbations,” said Coby Jansen Austin. She’s the Director of Programs and Policy for the Family Success Alliance, and the Board of Health for the Orange County Health Department. She said the purpose of the program is to reduce emergency room visits and improve asthma symptoms in Orange County homes. Healthy Homes is a pilot program, and won the GlaxoSmithKline “Child Health Recognition Award” in September. The award comes with $5,000 to buy resources needed for it to continue working. “With it being a pilot program, we started small,” she said. “And I’m hopeful that now we’ll be able to have a much larger reach.” Austin said much of what Healthy Homes does is provide homes with affordable methods to get health hazards out. They also often provide residents with mattress and pillow covers, eco- friendly cleaning kits and smoking cessation materials. They also work with community partners such as the UNC Pediatric Pulmonary Clinic to give nurses asthma safety trainings at schools. “We try and provide a comprehensive service for the families,” Austin said. “And also think about the ways that we can support our community in being better able to support those families.” Austin said, overall the best part about the program, and the reward was that it came from different parts of the community working together. “We just live in a community that has such great resources that there’s no reason we shouldn’t be able to support these families,” she said. “And you know, all of the partners in the community bring something unique to this, either in terms of data or perspective or skills.” Specialists from Healthy Homes have visited over 20 family residences so far. They are currently conducting research afterwards with follow-up calls after one, three and six months to see what asthma symptoms remain and whether there have been any emergency department visits after the review. Chapel Hill Coalition Aims to Reduce High Risk Drinking By Joey DeVito Posted October 13, 2016 at 11:57 am A new town-gown coalition is working to reduce high risk drinking in Chapel Hill. In a recent survey, 71 percent of college students and 47 percent of high school seniors here reported using alcohol in the previous 30 days. The Campus and Community Coalition to Reduce the Negative Impacts of High Risk Drinking are taking on the problem of high-risk drinking that exists in Chapel Hill and various communities. The origins of the group started in 2013 when former Chancellor Holden Thorp and former Chapel Hill Mayor Mark Kleinschmidt convened a group to tackle the issue of binge drinking. Under the name of “The Town Gown Collaborative,” spokesman Elinor Landes says they are focused on the environment in which students make decisions about drinking. “The coalition recommended that the university update its alcohol policy,” said Landes. “They’ve updated it to make it a campus-alcohol policy instead of a student-alcohol policy. That new policy went into effect on August 1st.” The group is also working on a social norms campaign that would promote healthy behaviors and correct incorrect perceptions about campus alcohol culture. In regards to high school drinking, Landes says they want parents to get the conversation started earlier with their kids. “Research has proven the impact of having a conversation with your student before they arrive on campus can reall y have positive effects on decisions that students make around drinking,” said Landes. Landes says there’s been a change with the pace and amount of time that students are drinking, particularly before football games. “The phenomenon of ‘pregaming’ is gaining popularity,” said Landes. “Drinking a high volume of alcohol in a short amount of time is different. One of the messages that the university is sending to parents in their communication at their orientation sessions it’s different today.” Coalition membership includes agency partners from the university, town, and county, university students, community members, and downtown bar and restaurant owners. Strategies to address high risk drinking and its impact on the community include public education and updates and additions to policies related to high risk drinking. Town-gown coalitions to curb drinking on college campuses are nothing new. There are similar groups at Michigan State, Ohio State and the University of Massachusetts. Landes says what makes the Chapel Hill group unique is support from the town. “The town has committed funding and resources in terms of time and dedication and staff,” said Landes. “The university has done the same, but we also have the county health department on board. And the Orange County ABC board. So we have this coalition of folks that includes some unique partners in the health department and in the ABC board.” Landes says the fact that many of these organizations are pitching in shows that Chapel Hill is taking the issue of binge drinking seriously. Community coalition will address high-risk drinking Elle Kehres | 10-19-16 Fighting high-risk drinking in Chapel Hill is a team effort. The Orange County Health Department, the Orange County ABC Board, UNC and the town of Chapel Hill formed a coalition this year to address potentially dangerous drinking in the community. The coalition, formally known as the Campus and Community Coalition to Reduce the Negative Impacts of High Risk Drinking, is a joint-funded effort to combat high-risk drinking by implementing several recommendations. Efforts to create the coalition began in 2014, when a group of stakeholders from UNC and the surrounding community met to analyze data, conduct focus groups and research best practices related to alcohol use in college towns. Their efforts culminated in a report that recommends 22 strategies to address high-risk drinking. Colleen Bridger, director of the Orange County Health Department, said these recommendations, along with community involvement, will make the coalition effective. “Research has proven that the most successful approach to addressing alcohol misuse in communities is an ecological or public health approach, and that’s what the coalition is doing,” Bridger said. In line with one recommendation, Elinor Landess was hired as director of the coalition. She will work on the adoption and implementation of the recommendations. “The whole framework is unique because we’re addressing the environment rather than the individual,” Landess said. “Our work is part of a larger conversation that is part of the community.” The coalition discovered that 71 percent of UNC students and 47 percent of high school seniors reported using alcohol in the past 30 days. Their findings also noted that the Chapel Hill Police Department responds to 40-50 alcohol overdose calls every semester, most of which involve UNC students. “We recognized alcohol misuse as a public health issue and supported the approach the coalition was taking to address the issue in a comprehensive manner,” Bridger said. Evan Lauterborn, a junior at UNC, is skeptical about the coalition’s influence but is hopeful about its future. “The culture of partying accompanied by heavy alcohol consumption is one that is deeply ingrained in colleges everywhere,” he said. “However, I also believe that having further advocation against high-risk behaviors certainly can’t do more harm than good, and it’s a worthy endeavor even if it deters just a few students.” The first recommendation from the coalition has already gone into effect — UNC passed a new alcohol policy in June and implemented it on Aug. 1, Landess said. This year’s fall orientation program was the result of the past efforts of the 2014 research group that created the recommendations and new alcohol policy, she said. Parent orientation was revamped to educate families about alcohol awareness. Landess said the coalition is a long-term process, and they’re focusing on planning this year.