HomeMy WebLinkAboutBOH agenda 113016ORANGE COUNTY BOARD OF HEALTH
MEETING AGENDA
DATE: November 30, 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 November 30, 2016 Agenda
7:10 – 7:20 IV. Actions Items (Consent)
A. Minutes of September 28, 2016 Nick Galvez
B. Minutes of October 26, 2016 Nick Galvez
C. 2017 Board of Health Schedule Nick Galvez
7:20 – 8:15 V. Educational Sessions
A. 1st Quarter Financial Reports Kimberlee Quatrone
B. 1st Quarter Billing Dashboard Reports Kimberlee Quatrone
C. Town/Gown Alcohol Coalition Update Elinor Landess
D. Accreditation Presentation Colleen Bridger
E. UNC Capstone Presentation Rob Poston, Shivangi Amin,
Hannah Eichner, Charlotte Henry
8:15 – 8:25 VI. Action Items (Non Consent)
A. Elections (Chair & Vice-Chair) Nick Galvez
8:25 – 8:35 VII. Reports and Discussion with Possible Action
A. Health Director Report Colleen Bridger
B. Media Items
8:40 – 8:45 VIII. Board Comments
8:45 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.
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ORANGE COUNTY HEALTH DEPARTMENT MISSION STATEMENT: To enhance the quality
of life, promote the health, and preserve the environment for all people in the Orange County
community.
THE ORANGE COUNTY BOARD OF HEALTH MET ON 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
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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);
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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.
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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
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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 –
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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
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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
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ORANGE COUNTY HEALTH DEPARTMENT MISSION STATEMENT: To enhance the quality
of life, promote the health, and preserve the environment for all people in the Orange County
community.
THE ORANGE COUNTY BOARD OF HEALTH MET ON October 26, 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, Commissioner Mia Burroughs, Susan Elmore, Jessica Frega, Reena Mehta, Sam Lasris
and Timothy Smith.
BOARD OF HEALTH MEMBERS ABSENT: Barbara Chavious, Paul Chelminski and Dan
Dewitya.
STAFF PRESENT: Dr. Colleen Bridger, Health Director; Coby Jansen Austin, Director of
Programs and Policy; Alan Clapp, Environmental Health Director; Rebecca Crawford, Finance &
Administrative Services Division Director; Carla Julian, Dental Clinic Manager; Donna King,
Health Promotion & Education Services Director; Pam McCall, Public Health Nursing Director;
Stacy Shelp, Communication Manager, La Toya Strange, Administrative Assistant II and Allison
Young, Health Informatics Manager.
GUESTS PRESENT: None.
I. Welcome
Liska Lackey, Chair, called the meeting to order.
II. Public Comment for Items NOT on Printed Agenda: None
III. Approval of the October 26, 2016 Agenda
Motion was made by Susan Elmore to approve the agenda, seconded by Timothy Smith
and carried without dissent.
IV. Action Items (Consent)
A. Minutes of September 28, 2016 Meeting
They will be approved at next month’s meeting due to an administrative error.
V. Educational Sessions
A. CHCCS & OCS Physical Activity/PE Update
Coby Jansen Austin began by reminding the Board that part of their Strategic Plan focuses on
physical activity and physical education and that the presentations will offer a look at the
assessments that can be done within schools and give insight into potential policy, system and
environmental changes that can take place in schools. One of those tools that schools can use
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to improve their health and safety policies, the School Health Index, was mentioned in the
Strategic Plan and is used by the Alliance for Healthier Generations. She continued by stating
that the presentations will also look at the resources schools may need to increase their use of
energizers in the classrooms and in-class physical education (P.E.) including aiding in
identifying funding to help support them. Both school districts perform their own assessments
regularly and will present their findings to the Board along with what their priorities are. Lastly,
Ms. Austin noted that, after the presentations, they’ll be open discussion with the Board on how
they might play a role in helping support the schools with their objectives.
Patricia Harris, Director for College and Career Readiness, Orange County Schools, began by
stating that every school district is required to have a School Health Advisory Council (SHAC)
per the policy passed in January 2003 by the NC Board of Education. Ms. Harris presented
results obtained from a survey completed by SHAC in May of 2015 that assessed health and
wellness practices within the schools. All thirteen schools participated. She also spoke of their
ongoing projects such as Red Ribbon Week, Eat Smart Move Smart, and Safe Routes to
School. Their goals included reducing obesity through fostering healthy habits and they are
creating subcommittees that will determine strategies. Ms. Harris stated that another goal is to
get physical activity back into the classroom so that it is disbursed throughout the day and
doesn’t occur solely in P.E. class. Several teachers received professional development training
on “active-based learning” last year, and one of the challenges has been obtaining additional
funds to expand that support to more teachers.
Scarlett Steinart, Director of Healthful Living and Athletics in Chapel Hill-Carrboro City Schools
(CHCCS), began her presentation with examples of the physical activity that students in
CHCCS receive including:
• K-5 students have recess every day with twice a week P.E. class (30 min)
• 6th-8th graders receive P.E. every day
• 9th graders participate in Healthy Living (½ year of P.E., ½ of health)
• 10th-12th graders have a P.E. elective which includes honors
Next, she spoke about some of the CHCCS ongoing projects that included:
• Chartwells Food Service for Child Nutrition and related programming
• District Wellness Policy
• Classroom Energizers
• Youth Risk Behavior Survey (YRBS) every two years
Ms. Steinart mentioned that $500 per school is available for staff wellness. Unfortunately, one
P.E. teacher from the middle schools will be removed next year due to budget cuts, which led to
her next topic – priorities. The priorities for enhancing physical activity/P.E. in CHCCS include:
• Replacing worn equipment (footballs, basketballs, tennis rackets, etc.)
• Infrastructure, including “peaceful playgrounds” and improving walking and biking trails
• New/Updated fitness equipment (treadmills, bikes, ellipticals, etc.)
• Funds for transportation to be able to use Homestead for a swimming unit
• Technology to assess student growth (e.g., iPads)
B. Customer Satisfaction Data
Personal Health Services, Dental Health Services and Environmental Health Services reported
their results of patient and client input surveys as well as their improvement plan.
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The Health Department conducted a 2016 Orange County Health Department Clinical
Services Community Input Survey. 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. The
Health Department will investigate linkages to eye care and better ways to share information
about our services.
Personal Health Services also collected patient satisfaction surveys from mid-July through
August 2016. There were a total of 156 respondents. Not all respondents answered all of
the questions. The results included:
• Satisfaction with most visit elements remained high
• Satisfaction with wait times decreased by 3% overall
• Satisfaction with some elements of staff interaction decreased
• Overall satisfaction showed greatest decrease
• Satisfaction with interpreter services increased in all measures at both clinical sites
Positive and constructive qualitative feedback included:
• Service provided is excellent and staff is very helpful.
• Staff was excellent – very welcoming and professional
• Wait time is too long
• Walk-in appointments would be great
Personal Health Services’ plan for improvement includes:
• Continue quality improvement efforts
• Fill vacant positions
• Pursue training in Client and Family Centered Care
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. There were 52 respondents. Some of their results included:
• 98% strongly agree/ag ree that they receive good treatment and advice
• 97% strongly agree/agree that they are satisfied with payment collection
• 95% strongly agree/agree that they would refer family and friends
A key area for improvement included complaints from adult patients on how long it takes to
get an appointment which is currently 3 months. The Dental Health Services’ strategies to
improve this include:
• Maintain a list of patients that want appointments
• Pursuing a “Patient Relationship Management” service that simultaneously contacts
all patients on that list to assist them with scheduling an appointment when there are
patient cancellations
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Environmental Health Services has used the same feedback tool since 2007. Their survey
consisted of 18 questions and was collected from September 2015 to September 2016.
There were 166 surveys collected. Their results showed improvement in all areas with
satisfaction rates in the 90th percentile including:
• Food and Lodging Feedback - 97% of clients felt they were kept well informed and/or
had a chance to ask questions
• Well and Septic Permitting Feedback – 98% of clients reported an overall satisfaction
with their services
• General Feedback – 94% of clients felt that office staff was professional and
courteous
The Environmental Health staff will continue to work to provide excellent service to the
community.
VI. Reports and Discussion with Possible Action
A. E-cigarette Rule Update
At its April meeting, the Board decided to postpone its vote on the proposed rule to prohibit the
use of E-cigarettes inside restaurants and bars in Orange County as the Surgeon General’s
report was due to be released in fall 2016. Due to the current expected release of the Surgeon
General’s report to occur in early 2017, Dr. Bridger asked the Board on how they wanted to
proceed with the E-cigarette proposed rule After discussion, the Board agreed to wait until the
Surgeon General’s report is released before voting on the proposed rule.
B. Present Chair/Vice-Chair Slate
Liska Lackey, Chair, stated that the nominees for the positions of Chair and Vice-Chair are Nick
Galvez and Dan Dewitya, respectively. BOH members will vote to select the Chair and Vice-
Chair at the November meeting.
C. Health Director Report
Dr. Bridger highlighted some of the items in her report including the nursing shortage which is a
cause for the longer wait times in the clinic. There’s been a lack of applicants to the posted
nursing job announcements. She stated that she’s working with HR and the County Manager’s
office on this issue. Dr. Bridger stated that a market analysis is currently underway and that she
hopes to be able to announce approval of those recommendations. She also mentioned another
ongoing challenge that has been occurring over the last six months involved the transitioning
from Dr. Monaco, Medical Director. There have been multiple physicians from UNC Family
Medicine rotating in our clinics. Dr. Bridger expressed her excitement at the hiring of the new
Medical Director, Dr. Erica Pettigrew, who will be starting December 1st and the level of outside
expertise she’d bring with her.
D. Media Items
Media items were in the packet which focused on Orange County’s events and our
involvement in various efforts.
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VII. Closed Session to Discuss Health Director’s Annual Review
The Board came out of closed session and called Dr. Bridger back into the boardroom.
Liska Lackey announced that the BOH had spoken with all of Dr. Bridger’s direct reports
and the county manager. With that input and their observations, the Board had
determined to award an “Exceptional” rating for her annual performance assessment.
Several BOH members had positive comments to share with Dr. Bridger.
VIII. Board Comments
None.
IX. Adjournment
The Chair adjourned the meeting at 9:05 p.m.
The next Board of Health Meeting will be held November 30, 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: November 30, 2016
Agenda Item Subject: 2017 Board of Health Schedule
Attachment(s): Proposed 2017 Board of Health Schedule
Staff or Board Member Reporting: Nick Galvez
Purpose: __X_ Action
_ __ Information only
____ Information with possible action
Summary Information:
Attached is the proposed meeting schedule for the Board of Health in 2017.
It is recommended that the Board of Health approve the schedule.
Recommended Action: _X_Approve
___Approve & forward to Board of Commissioners for action
___Approve & forward to ___________________________
___Accept as information
___Revise & schedule for future action
___Other (detail):
2017 BOARD OF HEALTH MEETING SCHEDULE
Whitted Human Services Center
Board of Health Conference Room
Building 3rd Floor Room A 305
7:00 p.m. – 9:00 p.m.
Contact Person La Toya Strange 919-245-2411
January 25, 2017
February 22, 2017
March 22, 2017
April 26, 2017
May 24, 2017
June 28, 2017
August 23, 2017
September 20, 2017*moved week earlier due to NCPHA
October 25, 2017
November 29, 2017*moved due to Thanksgiving
All meetings are held on the fourth Wednesday of the meeting months and at the
Whitted Human Services Center, Hillsborough unless noted otherwise.
Agenda Item Number:
ORANGE COUNTY BOARD OF HEALTH
AGENDA ITEM SUMMARY
Meeting Date: November 30, 2016
Agenda Item Subject: 1st Quarter Financial Report FY 16-17
Attachment(s): 1st Quarter Financial Report
1st Quarter Billing Dashboard
Staff or Board Member Reporting: Kim Quatrone
Purpose: ___ Action
_X_ Information only
___ Information with possible action
Summary Information:
Total Health Department Revenue: Average YTD monthly revenue in FY17 after the
first quarter is $193k/month or $579k YTD, representing 18.2% of our overall budgeted
revenue for the year. The total first quarter revenue is slightly skewed down due to an
error made by the central Finance Office. We are working to have this error fixed, which
will bring our total revenue for the first quarter to $672k and 22% of our overall budgeted
revenue. Expenses closely match revenues at 21%.
Total Billing Accuracy: Continuing with the goal of 90% billing accuracy set in FY 14-
15, the average billing accuracy rate for medical after the first quarter is 88% as
compared to 92% in FY 15-16 and the average rate for dental for first quarter FY 16-17
is 99% as compared to 101% in FY 15-16.
Dental Earned Revenue by Source: The FY 16-17 average monthly revenue
($38k/month) for the first quarter is below our budget projection ($48k/month) our FY
15-16 average of $40k/month but is related to lower patient volume in August while the
dental clinic was renovated. FY 16-17 dental revenue totaled $114k at the end of the
first quarter.
Medical Earned Revenue by Source: Medical earned revenue is currently slightly
below the budgeted projection for FY 16-17 ($58k/month) at $56k/month. Medical clinic
revenue totals $168k for first quarter FY 16-17.
Recommended Action: ___Approve
___Approve & forward to Board of Commissioners for action
___Approve & forward to ____________________
_X_Accept as information
___Revise & schedule for future action
___Other (detail):
Orange County Health Department
Profit Loss Budget Performance
2015-2016
TOTAL HEALTH Q1 YTD ACTUAL ANNUAL BUDGET
% OF ANNUAL
BUDGET
Revenue
Donations
Dental Health (338)(338)0 0.00%
Health Promotion & Edu (885)(885)0 0.00%
Personal Health (250)(250)(8,000)3.13%
Donations Total (1,473)(1,473)(8,000)18.41%
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 (28,352)0.00%
Environmental Health 0 0 (60,000)0.00%
Personal Health 0 0 (30,000)0.00%
Internal Allocations Total 0 0 (159,852)0.00%
Service Revenue
Dental Health (114,242)(114,242)(570,183)20.04%
Finance and Admin Services 0 0 (107,646)0.00%
Environmental Health (115,450)(115,450)(542,124)21.30%
Personal Health (167,947)(167,947)(668,906)25.11%
Service Revenue Total (397,639)(397,639)(1,888,859)21.05%
State Allocations
Finance and Admin Services 34,660 34,660 (42,885)-80.82%
Health Promotion & Edu (25,244)(25,244)(102,464)24.64%
Environmental Health (3,945)(3,945)(34,000)11.60%
Personal Health (100,949)(100,949)(390,835)25.83%
State Allocations Total (95,478)(95,478)(570,184)16.75%
Grants Project Revenues
NACCHO Grant 0 0 (15,000)0.00%
Piedmont Hlth Srv - Nutr (5,240)(5,240)(33,800)15.50%
CC4C Accesscare (37,045)(37,045)(149,624)24.76%
PCM Accesscare (36,997)(36,997)(147,651)25.06%
Health Disparities 0 0 (56,916)0.00%
Health Promotion & Edu (5,000)(5,000)0 0.00%
Susan G. Komen Grant 0 0 (46,620)0.00%
Grants Project Revenues Total (84,282)(84,282)(449,611)18.75%
Revenue Total (578,872)(578,872)(3,076,506)18.82%
Orange County Health Department
Profit Loss Budget Performance
2015-2016
TOTAL HEALTH Q1 YTD ACTUAL ANNUAL BUDGET
% OF ANNUAL
BUDGET
Expenditures
Salaries 1,144,228 1,144,228 5,443,084 21.02%
Benefits 386,879 386,879 1,910,294 20.25%
Travel 1,654 1,654 8,997 18.39%
Training 7,380 7,380 36,227 20.37%
Certifications & Licensing 2,899 2,899 10,239 28.31%
Mileage 3,932 3,932 34,977 11.24%
Telephone 8,417 8,417 79,878 10.54%
Postage 3,281 3,281 15,402 21.30%
Motor Pool 12,776 12,776 48,807 26.18%
Equip Repairs 2,166 2,166 9,529 22.73%
Equip Rent 843 843 1,200 70.21%
Duplicating 1,597 1,597 12,244 13.04%
Printing 1,162 1,162 9,001 12.91%
Advertising 1,237 1,237 14,897 8.30%
Dues 425 425 5,370 7.91%
Subscriptions 139 139 1,500 9.27%
Dept Supplies 3,694 3,694 34,154 10.82%
Edu Supplies 885 885 11,825 7.48%
Office Supplies 7,366 7,366 29,200 25.22%
Medical Supplies 33,088 33,088 146,317 22.61%
Bloodborn Path Supplies 429 429 3,000 14.31%
Pharmacy Supplies 46,630 46,630 226,080 20.63%
Comp Supp/Software 1,149 1,149 2,750 41.77%
Contracted Srv 150,443 150,443 587,025 25.63%
X-Ray 2,839 2,839 23,625 12.02%
Lab Srv 29,085 29,085 67,206 43.28%
Bonds & Insurance 0 0 10,347 0.00%
Uniforms 3,114 3,114 8,333 37.37%
Community Proj 1,609 1,609 18,650 8.63%
Innovations Project 2,394 2,394 20,000 11.97%
Accreditation Project 2,750 2,750 2,750 0.00%
Family Success Alliance 20,321 20,321 355,000 5.72%
Credit Card Exp 1,429 1,429 10,000 14.29%
Capital Exp Under $500 3,324 3,324 4,366 0.00%
Nicotine Replacement Therapy 0 0 5,000 0.00%
Grant Project Expenditures
Health Disparities 12,767 12,767 56,916 22.43%
Susan G. Komen Grant 771 771 46,620 1.65%
NACCHO Grant 549 549 15,000 3.66%
Capital Expenditures
IT Equipment 3,600 3,600 3,601 99.98%
Furnishings 969 969 1,101 87.97%
Expenditures Total 1,908,218 1,908,218 9,330,512 20.45%
Total County Revenue (Appropriation)1,329,347 1,329,347 6,254,006 21.26%
BO
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Agenda Item Number:
ORANGE COUNTY BOARD OF HEALTH
AGENDA ITEM SUMMARY
Meeting Date: November 30, 2016
Agenda Item Subject: Town/Gown Alcohol Coalition Update
Attachment(s): The Campus & Community Coalition to Reduce the Negative Impacts
of High Risk Drinking
Staff or Board Member Reporting: Elinor Landess, Campus & Community Coalition
Director
Purpose: ____ Action
_ X Information only
____ Information with possible action
Summary Information:
Elinor Landess will share information about the Campus & Community Coalition
including its work and how the Health Department is partnering with the Coalition.
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 Campus &
Community Coalition to
Reduce the Negative
Impacts of High Risk
Drinking
Elinor Landess
Orange County Board of Health
November 30, 2016
What is the Coalition?
•Context: local conditions in Chapel Hill
•History: Town/Gown Collaborative
•Joint funding/commitment
•The “Report” – 22 strategies
•Comprehensive, public health approach
•Community organizing framework
•Environmental strategies
What is the scope of the challenge?
•Getting community engagement & investment in transforming the culture
•Reduce high risk drinking behaviors & alcohol-related consequences
•Implementing sustainable strategies for addressing:
•Immediate health/safety impacts for students
•Health/safety impacts in downtown area
•Secondary impacts for neighborhoods, e.g. property values, families
•Change student perception of inconsistent enforcement & seeming lack of consequences for “repeat offender” residences
•Develop strategies to maximize consistent training for servers & maximize certainty, timeliness, consistency, & equity in consequences for bar/restaurant violations
What’s already been done?
•Two -year development of Coalition + Study to produce
comprehensive set of 22 recommendations to reduce the negative
impacts of high risk drinking in three areas: The University,
Neighborhoods/Community, and Downtown
•Town hires 2 new code enforcement officers
•UNC re-writes, passes, and implements new alcohol policy
•Coalition hires a director
•Coalition reconvenes
What’s happening now?
•Downtown businesses
•Bars best practices group
•Increased compliance checks + ID checking software
•SOP for compliant and noncompliant businesses
•Social Norms
•Correct misperceptions and reinforce positive behavior
•Streamlining Adjudication
•Increased alignment in philosophy/outcomes
•Off Campus Behavior
•Policy changes to address nuisance properties
•Late Night Programming
•Offer students visible, viable alternatives to socializing with alcohol on weekends
•Parents/Youth
•Educate parents/families about negative consequences of underage alcohol use
The Health Department’s Involvement
•Funding
•Membership in Coalition
•Content expertise
•Connections to community
•Others??
Discussion and questions
Agenda Item Number:
ORANGE COUNTY BOARD OF HEALTH
AGENDA ITEM SUMMARY
Meeting Date: November 30, 2016
Agenda Item Subject: Accreditation Presentation
Attachment(s): Roles and Responsibilities of Boards of Health Related to NCLHDA
Staff or Board Member Reporting: Dr. Colleen Bridger
Purpose: ____ Action
_ X Information only
____ Information with possible action
Summary Information:
Dr. Bridger will share information about the accreditation process including its purpose
and activity requirements.
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):
Roles and Responsibilities of Boards of Health Related to NCLHDA
Version Update: 10.19.16
1.Review of purpose of accreditation 2.Identification of activities related to Board of Health involvement 1.Finance 2.Community Health 3.Health Director/Staff 4.Rules and Ordinances 5.Board Function 3.Questions and Comments
Presentation Overview
2016 View All counties in North Carolina have now been through the accreditation process at least once and all have now been Accredited
•Self-Assessment by the Agency •147 Activities & 41 Benchmarks
•Site Visit •Peer volunteers (Admin, EH, Nursing, BOH) •Review documentation, tour facilities, & conduct interviews •Site Visit Report – recommendation
•Board Adjudication
Basic Components of the Process
•Agency Core Functions and Essential Services
•Assessment: Department must meet 26 of 29 activities
•Policy Development: Department must meet 23 of 26 activities
•Assurance: Department must meet 34 of 38 activities
•Facilities and Administrative Services
• Department must meet 24 of 27 activities
•Governance
•Department must meet 24 of 27 activities
Activities and Scoring Requirements
LHD submits HDSAI and documentation evidence to NCIPH
Site visit
conducted
Reports finalized and sent to LHD with accreditation recommendation
NCLHDA Board votes on accreditation recommendation and awards status
NCIPH notifies LHD that HDSAI is due within 90 days
LHD has 10
days to
provide
written
response to
findings
LHD is between
accreditation
cycles
Preparation
for next
accreditation
cycle begins
Notification to
official
awardance
takes ~ 9.5
months
The Life
Cycle of
Accreditation
Purpose of NCLHDA Program
The focus of NCLHDA is on the capacity of the local health department to perform core public health functions at an affirmed level of quality
Strengthens state and local partnerships
Recognizes an agency’s strengths
Assures a strong public health system is in place
Determines performance capacity
Identifies areas for improvement Benefits of
Accreditation
Brings staff
together
around a
common purpose
Community and
partners see
value of PH
Great things you
already do are
documented &
more visible
Reinforces
emphasis
on CQI
Helps staff
understand other
functions/roles
within agency
Helps to link
agency mission
and community
needs to services
provided
Accreditation provides a framework for a health department to:
•identify performance improvement opportunities,
•improve management,
•develop leadership, and
•improve relationships with the community.
The process is one that will challenge the health department to think about what business it does and how it does that business.
Public Health Accreditation Board, 2013
Being accredited helps position health departments and
give them credibility as a respected player in the future of
integrated healthcare and population health initiatives.
The Law •Senate Bill 804 –Established NCLHDA Board within NCIPH (17 members appointed by NCDHHS Secretary) –Directs Commission to adopt rules establishing standards for LHDs –Mandates all LHDs to obtain (by December 1, 2014) and maintain accreditation •10A NCAC 48B –Defines scoring requirements by core function –Describes Benchmarks and Activities
Important Notes
Italics: requirement may apply depending on governance structure, if other documentation options chosen/not chosen, or if there is a Health Director vacancy *Health Director may serve, or be directed by the Board to serve, as the designee for the BOH for correspondence. However, it is expected that there be some type of link to and from the BOH showing their involvement and engagement.
Board Role 1.Assure you have required policies, procedures, or materials 2.Hear or review LHD reports
3.Discuss issues, components of data or reports, and Health Director personnel topics 4.Approve action plans, budgets, and Health Director personnel components 5.Take other actions or be involved with efforts to assure the health department has what it needs to do its job
Finance
The Board must: •discuss financial reports, fees, and the budget as well as approve the final budget •advocate with a wide array of funders in support of LHD efforts to secure financial resources to provide essential services
Community Health
The Board must: •assure input on community health improvement efforts •hear reports on and approve LHD plans for community health •discuss and support partnership and coordination of resources •educate and advocate with community leaders about community health issues and support for it
Health Director/Staff
The Board must: •if the Health Director position becomes vacant, make and and implement plans to recruit and secure a credentialed and qualified new Health Director •annually review and approve the Health Director’s job description and performance evaluation
Board Function
•Board members must receive initial (within the first year of appointment) and on-going training on BOH roles and responsibilities •Board must have Operating Procedures and an annually updated handbook
Rules & Ordinances
The Board must: •have access to legal counsel and statutes •have policies for rulemaking and appeals and demonstrate it is following said policy •along with the LHD, evaluate the need for additional or amended rules/ordinances •support prohibition of tobacco within 50 ft of all LHD facilities
What can you do to be a “good” BOH member?
1.Attend meetings regularly so quorums are reached and thus, required items can be approved on schedule 2.Document your activities regarding community health and contribute to discussion during Board meetings a.Carefully review meeting minutes to make sure your comments were captured 3.Complete required trainings promptly
Questions & Comments
Roles and Responsibilities of Boards of Health Related to NC Local Health Department
Accreditation (NCLHDA) Guide
Note that this guide is applicable to all Board of Health (BOH) governance structures- unless otherwise stated (such as specific mention/inclusion of the Advisory
Committee on Health (ACH) being able to meet that activity), the activity is required of whatever Board (traditional BOH (single county, district, or authority),
Consolidated Human Services (CHS) Board, or Board of County Commissioners (BOCC)) assumes the powers/duties of the traditional Board of Health. See the
HDSAI and HDSAI Interpretation for more detailed information.
Existence of Policy,
Procedure, or
Materials
Hear or Review Discussion Approval Other Action or
Involvement
Finance
33.1: minutes reflecting
discussion of budget,
specifically local dollars
37.2: policies in
compliance with
LHD’s policy on
policies (related to
administration)
33.2: official approval of
budget from appropriate
authority
33.5: minutes reflecting
discussion of service costs
proposed/ provided by local
health department (LHD)
37.6: BOH minutes or
CHS Director
correspondence
showing discussion &
approval of a budget
process to address
workforce issues
*39.1: BOH/ACH
correspondence with BOCC
and unit of government/
funder in support of LHD
efforts to secure financial
resources
33.6: minutes reflecting
discussion of three financial
reports demonstrating
assessment of financial
accountability
39.3: minutes
reflecting discussion
and approval of
department budget
and fees
*39.1 BOH/ACH minutes
reflecting endorsement for a
grant application or request
for additional funding
Existence of Policy,
Procedure, or
Materials
Hear or Review Discussion Approval Other Action or
Involvement
Community
Health
38.3: policy on broad
community collaboration
for community health
improvement
2.4: annual report
on local disease
incidence and
trends
38.2: BOH/ACH minutes
reflecting discussion of
specific aspects of
Community Health
Assessment (CHA) data
38.2: BOH/ACH
action plans from CHA
38.3: minutes reflecting
public participation or
agenda indicating allotted
time dedicated to
community health
improvement input
14.2: minutes or
written report/
correspondence
reflecting agency
input in public
health priority
setting and
program planning
39.2: receipt and discussion
of reports that demonstrate
provision of fiscal resources
to assure essential services
of public health
*39.4: BOH/ACH
correspondence with BOCC
and unit of government/
foundation in support of
public health programs
and community health
improvement
38.1: annual
reports related to
the community’s
health (statistics/
information)
41.2: BOH/ACH minutes
reflecting discussion of
partnership or letter of
support for partnership
efforts
*40.1: BOH/ACH informs
elected officials and
community boards about
community health issues
38.2: BOH/ACH
annual review of
State of the
County Health
(SOTCH) report
41.3: BOH/ACH minutes
reflecting discussion of
partnerships and
coordination of resources (or
member participation on a
community board/
committee) or reflecting
decision that the Health
Director was the best
representative
*40.2 BOH/ACH
communicates support for
law, rules, and public
health interventions
41.1: BOH/ACH takes
actions to foster
community input
regarding public health
issues
Existence of Policy,
Procedure, or
Materials
Hear or Review Discussion Approval Other Action or
Involvement
Health
Director/
Staff
37.1: minutes reflecting
discussion to seek a Health
Director with appropriate
qualifications
37.4: Health Director
job description that
has been signed, dated,
and reviewed annually
23.1: minutes describing
plan to seek a Health
Director with appropriate
credentials
37.3: BOH minutes or CHS
Director correspondence
showing discussion of
knowledge, skills, and abilities
that must be met by Health
Director candidate
37.5: Health Director
performance
evaluation that has
been signed and dated
annually by Supervisor
37.4: BOH minutes or CHS
Director correspondence
showing discussion of Health
Director job description
annually
37.5: BOH minutes or CHS
Director correspondence
that shows Health Director
performance appraisal done,
that any board member had
the opportunity for input,
and results reported back to
the BOH annually
Board
Training &
Procedures
34.1: Operating
Procedures (not Bylaws)
36.2: dated evidence of
new BOH member
participation in training
during first year
36.1: dated BOH
handbook updated in
past 12 months
36.3: dated evidence of all
BOH members’ on-going
training according to
agency schedule
36.2: new BOH member
training materials on
authority/ responsibility
36.3: all BOH member
on-going training
materials on
authority/responsibility
Existence of Policy,
Procedure, or
Materials
Hear or Review Discussion Approval Other Action or
Involvement
Rules &
Ordinances
34.2: verification of
access to legal counsel
14.4: minutes or
memo reflecting
input of agency in
drafting rule or
ordinance
14.3: minutes, strategic plan,
or notes from public hearing
referencing evaluating need
for additional rules/
ordinance demonstrating
LHD/BOH cooperation
30.10: evidence that the
BOH or BOCC voted to
prohibit the use of tobacco
within 50 feet of all LHD
facilities or that the agency
made such request and the
Board responded in some
way
34.3: policy for rule-
making
34.3: if rule adopted since
last site visit, evidence of
following policy or signed
BOH statement that no rule
was adopted
34.4: member
accessibility to public
health statutes; policy/
procedure manual or
correspondence with
legal counsel regarding
legal authority for
adopting rules
35.1: if appeal or
adjudication action since
last visit, evidence of
following policy or signed
BOH statement that no
adjudication occurred
35.1: policy/procedure
for adjudications
Italics: may apply depending on governance structure, if other documentation options chosen/not chosen, or if there is a Health Director vacancy
* Health Director may serve, or be directed by the Board to serve, as the designee for the BOH for correspondence. However, it is expected that there be some
type of link to and from the BOH showing their involvement and engagement.
Agenda Item Number:
ORANGE COUNTY BOARD OF HEALTH
AGENDA ITEM SUMMARY
Meeting Date: November 30, 2016
Agenda Item Subject: UNC Capstone Presentation
Attachment(s): Over-The-Counter Birth Control Analysis
Staff or Board Member Reporting: UNC Students: Rob Poston, Shivangi Amin,
Hannah Eichner, Charlotte Henry
Purpose: __X_ Action
_ __ Information only
____ Information with possible action
Summary Information:
The 2016-2018 Board of Health Strategic Plan requests research on the appropriate
pathway and necessary partners to pursue policy change to make birth control pills
available over the counter. Over the fall semester, a team of four UNC public policy
undergraduate students prepared a literature review, compiled a series of case studies,
and interviewed a few key stakeholders to weigh the pros and cons of moving this policy
proposal forward and identify key partners be in making that happen. This presentation
will include a summary of their research and their recommendations to the Board of
Health.
Recommended Action: ___Approve
___Approve & forward to Board of Commissioners for action
___Approve & forward to ___________________________
_X_Accept as information
___Revise & schedule for future action
___Other (detail):
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Case Studies 1
CASE STUDIES
California, Oregon, Tennessee, and Missouri
UNC Chapel Hill, PLCY 698, Fall 2016
Shivangi Amin, Robert Poston, Hannah Eichner, and Charlotte Henry
Case Studies 2
Table of Contents
CALIFORNIA .......................................................................................................................................3
POLITICS .................................................................................................................................................... 3
HOW IT WORKS ......................................................................................................................................... 4
CONCERNS ................................................................................................................................................ 4
OREGON ............................................................................................................................................5
POLITICS .................................................................................................................................................... 5
COSTS ........................................................................................................................................................ 5
CONCERNS ................................................................................................................................................ 6
TENNESSEE ........................................................................................................................................7
POLITICS .................................................................................................................................................... 7
HOW IT WORKS ......................................................................................................................................... 7
COSTS ........................................................................................................................................................ 8
CONCERNS ................................................................................................................................................ 8
MISSOURI ..........................................................................................................................................9
POLITICS .................................................................................................................................................... 9
HOW IT WOULD HAVE WORKED ............................................................................................................. 11
CHART: COMPARING AND CONTRASTING CA, OR, & MO ................................................................... 12
APPENDIX ........................................................................................................................................ 13
OREGON: HORMONAL CONTRACEPTIVE SELF-SCREENING QUESTIONNAIRE ........................................................... 13
STANDARD PROCEDURES ALGORITHM FOR OREGON RPH PRESCRIBING OF CONTRACEPTIVES .................................. 14
REFERENCES .................................................................................................................................... 15
Case Studies 3
CALIFORNIA
In September 2013, California Governor Jerry Brown signed SB-493 into law. The bill allows
self-administered hormonal contraceptives (pills, patches, physician-administered injections and
vaginal rings) to be distributed without a doctor’s prescription, only requiring a consultation with
the pharmacist, blood pressure test, and completion of a questionnaire (Karlamangla,
2016). Following nearly 3 years of regulatory discussions, the state of California implemented
this bill in April of 2016. California’s policy followed similar laws in Oregon and Washington,
with proponents of the policies arguing that these laws increase access to birth control and lower
the rate of unplanned pregnancies. As Sarah McBane, president of the California Pharmacists
Association stated, “The easier it is for someone to access medication, the more likely they are to
use it (Karlamangla, 2016)."
POLITICS
California state Sen. Ed Hernandez (D-West Covina) was the lead sponsor of SB-493. Sen.
Hernandez chairs the Senate Committee on Health, and is an optometrist who serves many
patients enrolled in Medicaid. Hernandez sponsored a series of scope-of-practice bills, which
would empower more healthcare professionals to legally perform healthcare procedures, to
address communities with limited access to healthcare. Of this series of bills, SB-493 was the
only one to become law. Hernandez started crafting the bill in 2012 with the help of two
professional organizations, the California Pharmacists Association (CPhA) and the California
Society of Health-System Pharmacists (CSHP) (“The saga of SB 493…” 2014).
The American Pharmacists Association summarizes the bill’s legislative history as follows:
“On May 29, the California Senate approved SB 493, and it went to the California Assembly. On July 19, the
California Medical Association (CMA) became “neutral” on an amended version of SB 493, and soon all organized
opposition (primarily from the California Medical Association) was dropped. On September 11, the California
Assembly voted unanimously to pass SB 493, and the next day, the state Senate completed final approval. On
October 1, Gov. Jerry Brown of California signed SB 493 into law (“The saga of SB 493…” 2014).”
While the bill sparked lobbying battles over the roles of doctors and pharmacists in California,
critics of the bill focused on one specific unintended consequence: women’s lower likelihood to
receive preventative screenings if they no longer have to see a doctor for birth control
prescriptions. This concern is supported to some degree by the literature; f. Regardless, Hopkins
concludes that rather than hindering access to birth control over-the-counter, there is a need to
improve access to preventative screenings for low-income women (Hopkins, 2012).
Advocates for SB-493 countered their critics’ opposition by stressing that the law is a step
forward as opposed to a “silver bullet” to solve all health problems. Further, they highlighted that
there is a lack of a medical connection between birth control and preventive health screenings,
and that to hold birth control “hostage” was “paternalistic” (Karlamangla, 2016). In addition to
the easier access to birth control, the bill’s supporters point to pharmacists’ ability to improve
access to healthcare in areas where there are not enough doctors to meet demand as cause to
empower medical providers other than doctors (Mason, 2013).
Case Studies 4
HOW IT WORKS
On the patient end, the bill simply permits women to obtain birth control pills directly through
their pharmacy after consultation with a pharmacist, without a prescription written by a doctor.
The bill has no age minimum, and the medication should still be covered under insurance. Since
only the federal Food and Drug Administration can determine which medication can be bought
over-the-counter, rather than making contraceptives truly over-the-counter, the law simply
expands the scope of what a pharmacist can do as a health care provider (Karlamangla,
2016). Specifically, SB-493 allows pharmacists to dispense the aforementioned types of birth
control following a questionnaire, blood pressure test, and
consultation.
CONCERNS
Although SB-493 has been signed into law, it has faced many difficulties with implementation,
largely due to lack of take-up by pharmacists. In May of 2016, several weeks after the law had
gone into effect, NPR reporter Kelly O’Mara found that both large national pharmacy chains and
local pharmacies in the San Francisco area were not offering access to birth control as permitted
in SB-493 (O’Mara, 2016). Since pharmacist participation is not mandatory, O’Mara found that
most pharmacists were still waiting to complete state-mandated training or to evaluate the
logistics of the law. One major concern was payment; the law did not indicate how or whether
pharmacist consultations would be reimbursed, particularly as they are not covered by insurance
in CA (although Medicaid covers them in Oregon). The law also did not address the logistical
issue of where consultations would take place. Instead, pharmacists themselves have to
determine where to conduct consultations. Further, some pharmacists interviewed were either
entirely unaware of the law or misunderstood the timing or implications of the policy. O’Mara
consulted Sally Rafie, a pharmacist and medication safety specialist for the University of
California-San Diego Health System, who estimated that four weeks after the law went into
effect, fewer than 100 of the nearly 7,000 pharmacies in California were distributing birth control
through pharmacist consultation (O’Mara, 2016).
For states looking to implement a policy similar to SB-493, recognizing California’s successes
and difficulties is crucial. The policy had support and input from relevant groups across the state,
both in advocacy and academia. However, the implementation process has struggled immensely.
The policy was optional for pharmacists. It left many pharmacies confused, and many
pharmacies were unwilling to participate after performing their own cost-benefit analyses. SB-
493 failed to address the logistical concerns and pharmacists’ self-interest in changing their
business’ offerings associated with expanding scope of practice in the medical field. The bill’s
goal, to increase access, hinges entirely on the actual implementation and adoption of the policy,
a crucial step that did not go according to plan. Moving forward, states must anticipate these
potential barriers to successful implementation.
Case Studies 5
OREGON
On July 6, 2015, Governor Kate Brown signed House Bill 2879, which enables Oregon women
18 years or older in to obtain birth control from pharmacies, without having to visit a doctor's
office (Oregon Pharmacist n.d.). The bill took effect January 1, 2016 and will remain in effect
through 2020. HB 2879 received overwhelming support, passing the House 49-10 and the Senate
24-4 (Committee on Healthcare, 2015) Under the law, women who are 18 and older are able to
obtain hormonal contraceptive methods directly from the pharmacist, without a prior doctor’s
prescription. Women who are under 18 years old are still required to visit their clinician for an
initial prescription. However, if they have evidence of a previous prescription, a pharmacist can
prescribe them hormonal contraceptives. The two types of hormonal contraception available
under this law are the oral contraceptive pill and the hormonal patch (Yang et al., 2016). This
new birth control law reduces barriers to access, which ultimately may reduce unintended
pregnancies. In 2006, 46% of pregnancies in Oregon were unintended (Kost, 2015). Of those
31,000 unintended pregnancies, 32% led to abortion. Further, in 2010, 70% of all teen
pregnancies in Oregon were unintended (Kost, 2015). It is expected that by decreasing the
barriers to hormonal contraceptives, the unintended pregnancy rate will decrease, as will the
number of abortions.
POLITICS
This law was initially introduced the summer of 2015 and gained bipartisan support. Republicans
have been a driving force behind the law, arguing that the law may decrease poverty if it does
reduce unintended pregnancies (Yang et al, 2016). The legislature set HB2879 to expire in 2020,
so that the state can evaluate whether the law has had a positive effect on costs and unintended
pregnancies in its first four years and decide whether the policy should be continued. The driving
force behind these this law was Representative Knute Buehler (Joseph 2015). Also, the Oregon
Medical Association, the Oregon Health and Science University, the Oregon Academy of Family
Physicians, The American Congress of Obstetricians and Gynecologist, the Oregon Nurses
Association, and all the physicians in the legislature supported and endorsed this legislative idea.
A study by ACOG showed that women who are more likely to be at risk for unintended
pregnancies would be in favor and would readily use these contraceptive methods (OSPA, n.d.).
Of the 50 members of the House who voted for the bill, 35 were Democrats and 14 were
Republican. Of the 24 members of the Senate who voted for the bill, 17 were Democrats and 16
were Republican (Committee on Healthcare, 2015). All 10 House members and 4 Senate
members who voted against the bill were Republican.
COSTS
The new birth control law in Oregon aims to reduce overall costs. In 2010, unintended
pregnancies cost the federal government nearly $122.7 million, and an additional $47.2 million
to the state of Oregon. (Kost, 2015). The law is designed to have minimal fiscal impact and no
revenue impact (O.R. Legis. Assemb., 2015). However, overall costs are expected to decrease as
the number of unnecessary doctor visits and the number of unintended pregnancies decreases.
Case Studies 6
HOW IT WORKS
In order to be able to prescribe women birth control, pharmacists must first go through the
Oregon training protocol. Then, women must complete The Oregon Self-Screening Risk
Assessment Questionnaire (Oregon Pharmacist, n.d.). If a woman has any health concerns, the
consulting pharmacists is expected to encourage her to visit a clinician (Yang et al., 2016). The
law does require women to have proper identification. Further, pharmacists must ensure that the
patients visit their clinicians once every three years after the original date of the birth control
being dispensed. It also prohibits pharmacists from requiring patients to schedule an appointment
to receive the hormonal contraceptive from the pharmacy (O.R. Legis. Assemb., 2015)
On June 11, 2015, Governor Brown signed a separate law, House Bill 3833, which requires that
insurance companies cover the cost for hormonal contraceptives for a full year at once. This
includes pills, the patch, or the ring. (Joseph, 2015). House Bill 3833 passed the Senate 28-0 and
the House 55-2.
On June 15, 2015, Governor Brown signed another law, House Bill 2028, which “permits
pharmacists to engage in practice of clinical pharmacy and provide patient care services to
patients (Committee on Health Care, 2015).” A provision of this law allows pharmacists to not
prescribe or dispense birth control if it is against their moral, ethical, or religious beliefs.
Representative Knute Buehler was a driving force behind this law, as he was for the law
allowing pharmacists to prescribe birth control.
CONCERNS
Although this law does increase women’s access to hormonal contraceptives. Planned
Parenthood, the Oregon Nurse Association, and the ACOG believe that the law does not go far
enough. Their position is that birth control pills are safe to use and should be fully over the
counter, rather than requiring a pharmacist prescription. (Committee Opinion, 2012). The age
restriction and requiring identification still act as barriers for vulnerable women (“Oregon's
New,” 2016). There is also a concern that the new laws might discourage women from other,
more highly effective methods of birth control, such as implants and IUDs (Yang et al., 2016).
Further, since the laws require pharmacists to go through training, not all pharmacies have
chosen to participate (Joseph, 2015). Some physicians also are hesitant, noting that by not
requiring women to come into a clinic to get their prescription, they are missing out on
screenings and other preventative care (Joseph, 2015).
Case Studies 7
TENNESSEE
POLITICS
SB1677 was filed for introduction in the state Senate on January 14th, 2016, and the
corresponding bill HB1823 was filed in the state House three days later. In both chambers the
bill was referred to the Health and Welfare Committee. The bill was first up for debate in the
Senate Health and Welfare Committee on March 2nd, 2016. The chief sponsor was Senator
Steve Dickerson, a Republican physician.
Dickerson briefly introduced the bill, and then turned the floor over to Dr. Leonard Brabson, the
Tennessee legislative chair of the American College of Obstetricians and Gynecologists. Dr.
Brabson strongly argued on behalf of the bill, stating that “we believe that the risks of this are
greatly outweighed by the benefits.” He began by making an economic argument, noting the high
rate of unintended pregnancies, and the cost to Medicaid of those pregnancies. He said that while
the ACOG formally endorses making birth control fully over the counter, making it available via
a collaborative practice agreement is a compromise that ACOG found acceptable. He said that
“self-screening by women has shown to be very appropriate” in identifying good candidates for
oral contraceptives, and that while “we would like for people to have annual screenings, or every
other year screenings… the data show that people can take birth control pills without actually
having to do that.” Further, countering the perception that oral contraceptives are overly risky, he
said that “we have riskier medications available over the counter… even Tylenol can kill you.”
Senator Joey Hensley asked Dr. Brabson whether he had proof that this policy would actually
reduce unintended pregnancies. Dr. Brabson replied that ACOG prides themselves on basing
policy recommendations on the available evidence. While Oregon and California’s changes were
too recent to measure effects, he stated that international evidence finds reductions in unintended
pregnancies. Sen. Hensley responded by saying he thinks the law should wait until data from
Oregon and California are available. Further, he thought that the law was likely not necessary
because birth control pills are so readily accessible, and thought that they were too high risk to be
available through a pharmacist. Notably, he also worried that oral contraceptives were too
complex for women to understand without education from a physician, stating that “some people
may just think that they take them one time and that helps,” rather than taking the pill each day.
Despite Senator Hensley’s noted concerns, the bill made it out of committee and was passed on
the floor of the Senate and House 28-1 and 68-22, respectively.
HOW IT WORKS
This bill authorizes pharmacists to provide hormonal contraceptives to patients over the counter
so long as they adhere to a “valid collaborative pharmacy practice agreement.” The bill
empowered the Board of Pharmacy to, along with the Board of Medical Examiners, draft
standard procedures for pharmacists to follow. These guidelines primarily consist of a self-
screening tool and education for pharmacists and patients. Then, pharmacists must partner with a
physician using the collaborative practice agreement. Pharmacists could then treat all women in
the community, not just existing patients of the supervising physician.
Case Studies 8
Most adolescents are excluded from the policy: only patients over the age of 18 and emancipated
minors are eligible. The bill prohibits pharmacists from requiring appointments for the provision
or dispension of the drug. The bill also permits pharmacies to charge patients an administrative
fee, but if the patient has an insurance plan that covers oral contraceptives they can only be
charged their applicable copay. Therefore, while pharmacists can charge the annual
administrative fee, the fee cannot become the burden of insured patients. Further, pharmacies
must disclose the “total cost” of hormonal contraceptives provided to patients over the counter to
patients when requested.
COSTS
“In 2010, 56% of all pregnancies in Tennessee were unintended” (Kost, 2015). At this time, the
federal and state government spent $530.7 million on unintended pregnancies in Tennessee,
$130.7 million of which was paid for by the state (Sonfield and Kost, 2015). The legislature is
hopeful that the law will decrease the number of unintended pregnancies, and therefore Medicaid
costs.
CONCERNS
The biggest concern in Tennessee regarding over the counter birth control sales was whether oral
contraceptives are safe to use without a doctor's approval. However, supporters, which include
the American Congress of Obstetricians and Gynecologists, argued there are more dangerous
medicines available over the counter. Other concerns include paying for over the counter
medications. However, if the oral contraceptives were prescribed by a pharmacist, they would be
covered by insurance just as they would be from a physician. Also, there was concern that
women may not go in to get annual or every other year screenings. However, a study out of the
University of Texas found that approximately 80% of women utilizing over the counter birth
control would still continue to receive preventive screenings (Hopkins, 2012).
There was also a concern that women may lie on their self-assessment screening, and that the
self-assessment may be the only thing pharmacists have to judge whether or not a woman is
safely able to be prescribed birth control. While it is true that people are not always truthful, the
bill’s sponsor responded that it “is not possible to mandate clairvoyance.” There was also a
concern that the bill gives too much discretion to the pharmacist and does not explicitly say that
pharmacists have the authority reject giving high risk women a prescription. Also, there was the
concern that the bill does not give immunity to pharmacists, so they may be at risk of litigation.
Case Studies 9
MISSOURI
The state of Missouri closely mirrors North Carolina in political and demographic
characteristics. Both states have historically been represented in the U.S. Senate by both
Democrats and Republicans and have elected governors from both parties. Both currently have
Republican-controlled state legislatures. As reflected by voting data, large urban centers in both
states, such as St. Louis and Raleigh, are home to diverse and liberal populations, whereas rural
areas are comprised of more conservative and religious residents (Politico, 2012). The states
have nearly identical median annual incomes, uninsured rates, and high school graduation rates
(approximately $45,000, 12% and 87% respectively) (Census.gov, 2015). These similarities
make Missouri a good candidate to compare to North Carolina. Missouri lawmakers have already
attempted to pass legislation that would allow birth control to be purchased over the counter, in a
political environment similar to what NC lawmakers would face. The states faced near identical
situations in terms of unintended pregnancy, teen pregnancy, and public costs of unintended
pregnancy. In 2010, 51% of Missouri pregnancies and 54% of North Carolina pregnancies were
unintended (Kost, 2010). The teen pregnancy rates were 54 and 53 for every 1,000 women in
Missouri and North Carolina respectively (Kost, 2010). Missouri publicly funded 72.2% of
unplanned births, compared to 74.8% in North Carolina (Sonfield, 2010).
In the 2015-2016 legislative session, the Missouri House passed HB 1679, which would have
allowed Missouri pharmacists to prescribe birth control pills. The primary sponsor, Republican
representative Sheila Solon, called the legislation the “ultimate pro-life bill,” saying it would
reduce abortion rates by reducing unintended pregnancies. The bill passed the House on April
26th by a vote of 97-50. There were 57 Republican and 40 Democratic yes votes, and 49
Republican and 1 Democratic nay votes (“Project Vote Smart”, 2016). The bill was sent to the
Senate, where it was referred to the Veterans Affairs and Health committee (HB 1679, 2016).
However, the Senate committee did not take action on the bill before the legislature adjourned
three weeks later (“2016 Dates of Interest”, 2016). Therefore, the bill failed for the session.
POLITICS
Representative Solon introduced the bill in December 2015. It was referred to the Emerging
Issues Committee, where it underwent a public hearing. The American Congress of Obstetricians
and Gynecologists -- Missouri Section, Family Health Council, Teen Pregnancy & Prevention
Partnership, and Planned Parenthood Advocates of Missouri all testified on behalf of the bill
(Committee Bill Summary, 2016). The Missouri Academy of Family Physicians also testified;
while they did not take a position on the bill itself, they stated that do not believe pharmacists are
adequately trained to make a meaningful contribution to prescription decisions (Associated
Press, 2016). No groups testified in opposition to the bill (Committee Bill Summary, 2016).
In committee, one amendment was adopted. The amendment removed the bill’s inclusion of
birth control patches, after anti-abortion groups expressed concerns about safety (Donaldson,
2016). Another amendment was circulated but not voted on or adopted, which would have stated
that notwithstanding any laws to the contrary, pharmacies must not sell emergency
contraceptives over-the-counter (4359H02.1H, 2016). The bill passed the Emerging Issues
Committee unanimously in February 2016. It was then referred to the House Select Committee
on General Laws, where it passed 7-2 at the beginning of April.
Case Studies 10
The bill was then debated by the full House. Representative Solon forcefully advocated
for it, using several arguments:
• She stated that since half of all Missouri births are covered by Medicaid, the bill is
fiscally prudent. She estimated savings to Medicaid of between $47 and $95 million per
year, by reducing unplanned pregnancy by 10% to 20% among Medicaid-eligible
women, and said that this was “an extremely conservative estimate.”
• She argued that the bill would reduce abortions by reducing the rate of unintended
pregnancy.
• She said that the bill “let women have control over their own health issues”(Mo. House
Floor Debate, 2016).
In sum, she stated that the bill was a “pro-life, pro-woman, common-sense approach to bringing
down escalating Medicaid costs.”
Opposition to the bill centered around the risk of blood clots, with some legislators
arguing that the pills were dangerous enough that they should require a doctor’s supervision
(ibid). Representative Solon had several counters to this objection:
• That the risk of blood clots is extremely low, and that the risk of a blood clot is four times
higher while pregnant and twenty times higher after giving birth than when taking oral
contraceptives;
• That pharmacists will be well-trained, and will administer a risk assessment just as a
doctor would;
• That the American Congress of Obstetricians and Gynecologists - Missouri Section
supported the bill;
• And, notably, that legislators should place more trust in women. Rep. Solon said that
“studies have shown that women are actually pretty smart, amazingly… when women do
a risk assessment [for oral contraceptives] with their doctor, they agree with their doctor
95% of the time.” She went on to note that the 5% of the time women disagreed with
their doctor about oral contraceptives, it was because the woman was more conservative
than the doctor, deciding that oral contraceptives were too high-risk even with a doctor’s
clearance. She said that legislators should “give women a little credit here, I believe that
with the pharmacist they can take the risk assessment… and [let] women have control
over their own health issues” (ibid).
The bill passed the House on April 26th, and was sent to the Senate, where it was referred to the
Veterans’ Affairs and Health subcommittee. However, this committee did not take action on the
bill before the legislature adjourned on May 13th (HB 1679, 2016). In subsequent days,
Representative Solon distributed the bill’s text as an amendment to a number of other health-
related House bills (Missouri State Medical Association). Some of these amendments were not
taken up, but she succeeded in at least two cases; the amendment passed the House on HCS SB
635, an omnibus health care bill, by a vote of 90-45 (Journal of the House, April 27 2016) and on
HCS SB 864, a pharmacy regulation (Journal of the House, May 6 2016). However, both bills
then went to conference committees. In SB 635 the amendment was removed from the final bill
(S.B. 635, 2016), and in SB 864 the bill never left conference (S.B. 864, 2016). It is unclear why
the Senate resisted passing this policy; unfortunately, there is no documentation of conference
committee proceedings, which leaves many questions unanswered.
Case Studies 11
HOW IT WOULD HAVE WORKED
The bill would permit pharmacists to prescribe oral contraceptive pills. The pharmacist could
prescribe the pills to women over age 18 regardless of whether the woman has evidence of a
previous birth control prescription, and to women under age 18 who had evidence of a previous
prescription from a primary care or women’s health care provider. However, the woman must
see a primary care or women’s health provider within three years of receiving an initial
pharmacist prescription, and upon prescription the pharmacist is required to refer the woman to
her primary care or women’s health care practitioner. The pharmacist must have undergone a
training program approved by the board of pharmacy and administer a risk assessment (H.B.
1679, 2016).
The bill also included a requirement that health insurance plans cover contraceptives by
reimbursing the health care provider or dispensing entity for dispensing these contraceptives.
The plan must cover an initial 3-month supply, and then a 12-month supply for any subsequent
dispensations of the same contraceptive. This requirement applies to all contraceptive
prescriptions, not just those written by pharmacists (ibid).
Missouri’s passage of HB 1679 would have benefitted numerous women. The state estimated
that 2,648 women covered by Medicaid, which is 10% of Medicaid beneficiaries who use oral
contraceptives, would use this option annually, in addition to other women who have private
insurance or are uninsured (Committee on Legislative Research Oversight Division, 2016). With
a strong advocate in Representative Solon, the bill may pass in future sessions. Regardless, North
Carolina can draw many lessons from the conservative arguments that gained traction in the
Missouri House.
Case Studies 12
Chart: Comparing and Contrasting CA, OR, & MO
Case Studies 13
APPENDIX
Oregon: Hormonal Contraceptive Self-Screening Questionnaire
Case Studies 14
Standard Procedures Algorithm for Oregon RPH Prescribing of Contraceptives
Case Studies 15
REFERENCES
2012 Missouri Presidential Results. (2012, November 19). Retrieved October 07, 2016, from
http://www.politico.com/2012-election/results/president/missouri/
2016 Dates of Interest. (2015, August 31). Retrieved September 21, 2016, from
http://www.house.mo.gov/content.aspx?info=/bills151/dates.htm
4359H02.1H. (2016). Retrieved
from http://house.mo.gov/billtracking/bills161/amendpdf/4359H02.01H.pdf
Associated Press. (2016, February 4). Missouri Republican proposes birth control from
pharmacists. Raycom News Network. Retrieved from
http://raycomgroup.worldnow.com/story/31143932/missouri-republican-proposes-birth-control-
from-pharmacists
Donaldson, L. (2016, February 17). Proposed bill could allow pharmacists to prescribe birth
control. Northwest Missourian. Retrieved September 21, 2016, from
http://www.nwmissourinews.com/news/article_f895baa8-d53d-11e5-9271-d74bb2902714.html
California’s SB 493 implementation: Three, two, one … blast-off! (2015, July 1).
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Committee On Healthcare. (2015). House Bill 2028. Retrieved September 22, 2016,
from http://gov.oregonlive.com/bill/2015/HB2028/
Committee On Healthcare. (2015). House Bill 2879. Retrieved September 22, 2016, from
http://gov.oregonlive.com/bill/2015/HB2879/
Committee on Legislative Research Oversight Division. (2016). Fiscal note. Retrieved October
5, 2016, from http://www.moga.mo.gov/OverSight/Over20161//fispdf/4359-02P.ORG.pdf
Committee Opinion: Over-the-counter access to oral contraceptives. The American College of
Obstetricians and Gynecologists. Obstetrics & Gynecology. 2012; 120(6): 1527-31.
H.B. 1679. (2016). Retrieved September 21, 2016, from
http://house.mo.gov/billsummary.aspx?bill=HB1679
Committee Bill Summary: H.S.C. H.B. 1679
(2016). http://house.mo.gov/billtracking/bills161/sumpdf/HB1679C.pdf
Hopkins, K. (2012, April 23). Reproductive health preventive screening among clinic vs. over-
the-counter oral contraceptive users. Contraception, 86(4), 376-382.
Case Studies 16
Joseph, S. (2015, July 08). Oregon dramatically expands access to birth control with 2 laws.
Retrieved September 17, 2016,
from http://www.oregonlive.com/politics/index.ssf/2015/07/oregon_dramatically_expands_ac.ht
ml
Journal of the House (2016, April 27). Retrieved
from http://www.house.mo.gov/billtracking/bills161/jrnpdf/jrn060.pdf#page=115
Journal of the House (2016, May 3). Retrieved
from http://www.house.mo.gov/billtracking/bills161/jrnpdf/jrn063.pdf#page=33
Karlamangla, S. (2016, February 14). Birth control pills without prescriptions, coming soon to
California under new law. Retrieved September 22, 2016, from
http://www.latimes.com/health/la-me-birth-control-pharmacies-20160214-story.html
Karlamangla, S. (2016, April 8). What you need to know about California's new birth control
law. Retrieved September 22, 2016, from http://www.latimes.com/local/lanow/la-me-ln-birth-
control-law-20160408-story.html
Kost K, Unintended Pregnancy Rates at the State Level: Estimates for 2010 and Trends Since
2002, New York: Guttmacher Institute, 2015,
<http://www.guttmacher.org/pubs/StateUP10.pdf>.
Mason, M. (2013, August 13). Bills on nurse practitioners, pharmacists advance in Assembly.
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nurse-practitioner-bill-advances-20130813
McDonough, K. (2015, July 1). Oregon is on the verge of becoming a super chill birth control
paradise. Fusion . Retrieved from http://fusion.net/story/159809/oregon-is-on-the-verge-of-
becoming-a-super-chill-birth-control-paradise/
Missouri State Medical Association. (2016). 2016 Legislative Report Wrap. Retrieved
September 22, 2016, from http://www.msma.org/2016-legislative-report-wrap.html
Mo. House Floor Debate. 98th Mo. Leg., Reg. Sess. (April 26, 2016), Availible
at: https://soundcloud.com/progress-missouri/42616-debate-on-solons-hb-1679
O'Mara, K. (2016, May 26). It's Still Hard To Get Birth Control Pills In California Without A
Prescription. Retrieved September 22, 2016, from http://www.npr.org/sections/health-
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prescription
O.R. Legis. Assemb. HB2879A. Reg. Sess. (2015)
OREGON PHARMACISTS PRESCRIBING OF CONTRACEPTIVE THERAPY. (n.d.).
Retrieved September 17, 2016,
from http://www.oregon.gov/pharmacy/Pages/ContraceptivePrescribing.aspx
Case Studies 17
Oregon's new birth control law increases access, but more still to be done. (2016, March 28).
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from https://www.ohsu.edu/xd/about/news_events/news/2016/03-28-oregons-new-birth-
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OSPA. (n.d.). Hormonal Birth Control General Information. Retrieved September 22, 2016,
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S.B. 365. (2016). Retrieved from http://www.house.mo.gov/billsummary.aspx?bill=SB635
S.B. 864. (2016). Retrieved
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Insurance Programs in Paying for Pregnancy-Related Care: National and State Estimates for
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unintended-pregnancies-and-role-public-insurance-programs-paying-pregnancy.
Stiefvater, A., & Baessler, S. (2015, May 20). Testimony in Support of -4 Amendment to HB
2879. Retrieved September 20, 2016.
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Yang, Y. T., Kozhimannil, K. B., & Snowden, J. M. (2016). Pharmacist-Prescribed Birth Control
in Oregon and Other States. JAMA, 315(15), 1567-1568.
LITERATURE REVIEW
UNC Chapel Hill, PLCY 698, Fall 2016
Shivangi Amin, Robert Poston, Hannah Eichner, and Charlotte Henry
Literature Review 1
EXECUTIVE SUMMARY
Of the millions of pregnancies annually in the United States, nearly half are unintended. The
rates of unintended pregnancies are substantially higher for low-income and poorly educated
women. Lack of financial resources serves as a barrier to contraceptive access and can prevent
women from having autonomy over their fertility. In most states, birth control pills currently
require a prescription, which typically requires an annual visit to a clinician. Visiting a clinician
can facilitate other services such as Pap smears and preventative screenings. However, the
current recommendation is for women to visit their clinician once every three years to receive a
Pap smear. Therefore, the burden to visit a clinician for a prescription acts as a barrier to
obtaining birth control pills. Other barriers include side effects and costs. Analysis of current
research suggests that birth control pills are safe to be available over the counter. Women and
pharmacists together can effectively screen for contraindications to birth control pills.
Literature Review 2
FREQUENCY OF UNINTENDED PREGNANCIES
The rate of unintended pregnancy can serve as an indicator of a society’s level of reproductive
health. The ability to control when one has a child reflects women’s autonomy, and leads to an
increased likelihood of positive child health outcomes (Finer & Zolna, 2016). Children
conceived unintentionally are less likely to receive adequate prenatal care, and face higher
likelihoods of low birth weight, premature birth, and exposure to toxins while in the womb (Kost
& Lindburg, 2015).
In 2011, 6.1 million pregnancies occurred in the United States. 45 percent of those pregnancies,
or 2.8 million, were unintended (Finer & Zolna, 2016). North Carolina’s rate is even higher, at
an estimated 54% in 2010 (Kost, 2015). While 2011 is the first substantial decline in the national
unintended pregnancy rate since 1981, the United States still has a rate significantly higher than
nations of similar levels of development. For example, Britain’s unintended pregnancy rate is
approximately 16 percent (Wellings, 2013). Further, within the United States’ overall high rate
of unintended pregnancy, substantial disparities exist. Research has found that poverty is the
primary driving force behind these disparities.
THE DISPARITY
Lawrence B. Finer and Stanley K. Henshaw’s 2006 study “Disparities in Rates of Unintended
Pregnancies in the United States…” sought to identify subgroups of the population in most need
of policy reform aimed at improving reproductive health. By combining 2001 data on pregnancy
intention with population data, the researchers determined that rates of unintended pregnancy
were “substantially above average” for women who were 18-24 years of age, unmarried, low-
income, who had not completed high school, and those of minority racial backgrounds. Rates of
unintended pregnancy among low-income and less educated women had actually increased from
1994 to 2001, while other groups’ rates fell in the same time period (Finer & Henshaw, 2006).
While the Finer and Henshaw study utilized data that is now over 15 years old, it illustrates the
trend of how certain adversely affected subgroups of the population, such as low-income and
poorly educated women, experience the highest rates of unintended pregnancy. This trend is
documented before the Finer and Henshaw study, as well as after. In 2011, women earning less
than the federal poverty level experienced an unintended pregnancy rate over 5 times that of
those who earned double the federal poverty level (Unintended Pregnancy in the United States,
2016).
Frost and Lindberg’s research indicates that birth control use helps women to take better care of
their families, support themselves financially, seek or retain a job, and complete their education.
These positive outcomes then translate to children growing up in more stable situations and
women advancing their social and economic statuses, particularly in the realms of education,
labor force participation, and average earnings (Frost & Lindbert, 2013). Autonomy over family
Literature Review 3
planning is a potential path out of cycles of poverty, cycles that facilitate high rates of
unintended pregnancy.
There is a clear association between women of particular demographic subgroups, increased
rates of unintended pregnancy, and cycles of poverty. Through an understanding of the causal
mechanisms between those with low incomes and/or a low level of education and the outcome of
an unintended pregnancy, solutions to this public health problem be crafted. However,
contraceptive access and use appear to be a key component of the solution.
BIRTH CONTROL PILLS: ADVANTAGES AND DISADVANTAGES
On May 9, 1960, the Food and Drug Administration approved oral contraceptive pills, giving
many women more reproductive freedom (“FDA Approves,” n.d.). There are many different pill
options, each with different levels of hormones. Birth control pills prevent pregnancies by
“interfering with ovulation and possible fertilization of the egg” (Birth Control, n.d.).
There are many advantages when it comes to the pill (Anderson, 2013). These include:
· Less than a 1% failure rate with perfect use;
· Reduced heavy bleeding, menstrual cramps, and mood changes during periods;
· Reduces risk of pelvic inflammatory diseases and cancer of the uterus and ovaries;
· Extended cycle pills allow women to have fewer periods, and continuous cycle pills allow
women to have no periods;
· Improved acne and premenstrual dysphoric disorder; and
· Lessens the severity of endometriosis and fibroid tumors.
· Gives women the freedom to limit how many children she wants based on her needs (Shah
et al., 2001).
However, there are also many disadvantages of taking the pill. They include:
· Higher risk for blood clots, heart attack, and stroke. These risks are increased in smokers;
· Side effects, including weight gain, nausea, stomach pain, mood changes, blurred vision,
headache, swelling or pain in legs, breast pain, vaginal dryness, and spotting or breakthrough
bleeding;
· Some women face a monthly cost or copay, which may not be affordable;
· Must be taken at the same time every day to be effective;
· Drug interactions may reduce effectiveness; and
· It may be difficult to start ovulating again for several months after stopping the pill.
It is important to note that birth control pills are most effective when used correctly and
consistently. Under typical use, birth control pills are far less effective than long-acting
reversible contraceptives; annually, 9 out of 100 women who use the pill typically get pregnant.
However, the risk of pregnancy is far lower for women who use the pill at the same time every
day (Birth Control Pill Fact Sheet, n.d.). Women who take birth control pills are three to four
times more likely to develop a blood clot. It is estimated that one in three thousand women on
birth control pills will develop a blood clot (James, n.d.).
Literature Review 4
BARRIERS TO CONTRACEPTIVE ACCESS
Women across America are not using contraceptives due to side effects, costs, and challenges
associated with accessing it. In one study exploring the barriers to contraceptive use, 40 percent
of women reported difficulty using or accessing birth control methods (Grossman, 2015). In
another study, “30 percent of women who had ever tried to obtain a prescription for hormonal
contraception reported difficulties obtaining the prescription or refills” (Grossman, 2015).
Further, a literature review summarized 16 qualitative studies determining reasons why some
women do not use contraceptives, despite not wanting to get pregnant. Over half of the studies
focused on low-income women, who stated many factors, including personal reasons such as fear
of side effects and procedural reasons such as forgetting to take the oral contraceptive every day.
Additionally, some women perceived that they were at low risk of pregnancy, or had personal
beliefs that it is wrong to use contraceptives. Other factors were interpersonal reasons, such as
the male partner’s opposition to contraception, and societal reasons, such as cost, lack of health
insurance coverage, and difficulty accessing contraception services (Ayoola, Nettleman, and
Brewer 2007). Furthermore, another study was conducted in Boston from 2007 to 2009 in which
in-depth interviews and focus group discussions were conducted with 45 low-income women
(Dennis and Grossman, 2012). Overall, while many participants reported that obtaining
contraceptives was easy, others reported that various barriers deterred them from consistently
from using oral contraceptives. These barriers included unaffordable copays, restrictions on the
number of packets of pills they could receive at one time, the time required to go to a clinic or
doctor’s office, and concerns about the safety of contraceptives (Dennis and Grossman, 2012).
COSTS
The biggest barrier for women accessing birth control pills from clinicians was unaffordable
copay and clinic visits (Dennis and Grossman, 2012). Some women reported they had to stop
using birth control pills because they could no longer afford it, even with insurance. One study
done along the border of Mexico showed 40% of women said cost played a big role in
determining why they chose to get pills from a Mexican pharmacy, rather than a clinician (Potter
et al., 2011). Women of different ages and education levels would prefer having over the counter
options, so long as they are available at low costs (Potter et al, 2010). One study showed that
women would pay at most $20, on average, for over the counter oral contraceptives (Grossman
and Grindlay et al., 2013). A concern raised by women was the question of whether insurance
would still cover the cost of oral contraceptives if they become over the counter (ibid). Prior
research has shown that consumers’ costs increase when medications become over the counter
(Sullivan, 2005). However, costs may not increase if birth control pills require a pharmacist
prescription, rather than becoming fully over the counter. Prescription requirements also deterred
women from using the pill (Dennis and Grossman, 2012).
Contraceptives can be extremely costly, both for women who have health insurance and those
who are uninsured. This poses a large barrier to contraceptive use; in a recent study of women
seeking abortion for an unintended pregnancy, nearly one in four reported that they did not use
contraceptives because of cost (Homco, Peipert, Secura, 2009). In 2012, the Center for American
Progress found that for uninsured women, the potential annual cost of oral contraceptives was
$1,210 (Kelberg, 2015). Other methods of contraceptive use, such as contraceptive implants and
IUDs are also extremely expensive. For instance, the average price for an IUD or implant
Literature Review 5
without insurance is around $750-$850 (Eisenberg, McNicholas, Peipert, 2013). Further, the cost
of implants and IUDs do not include the cost of a doctor’s office visit or the insertion procedure.
Women with private insurance are typically in a much better position, because under the
Affordable Care Act most private insurance plans must cover at least one form of each of
eighteen contraceptive methods without copays. However, some women with private insurance
still face difficulties. First, while the insurance plan must cover at least one form of several types
of oral contraceptive pills without copays, they can use “reasonable medical management
techniques” to steer women towards cheaper pills. Therefore, a woman who is prescribed an
expensive brand-name oral contraceptive may still face out-of-pocket costs. Second, some
insurance plans are impermissibly charging women for family planning counseling, for costs
associated with the insertion or removal of long-acting reversible contraceptives, or for certain
contraceptive methods (National Women’s Law Center). Finally, some women are covered by
grandfathered plans or plans offered by religious employers, which are exempt from this policy.
Therefore, “high out-of-pocket costs, deductibles, and copayments for contraception limit
contraceptive access even for those with private health insurance” (Access to Contraceptives,
2015). Additionally, insurance companies can limit the number of contraceptive products
dispensed; 73% of women are unable to obtain more than a month’s supply of birth control pills
at a time, despite the fact that many women do not refill their prescriptions on time each month
(Access to Contraceptives, 2015).
Another barrier to oral contraceptive access is the Medicaid gap. In 2012, the Supreme Court
ruled states could decide whether to expand their Medicaid programs under the Affordable Care
Act to individuals with incomes of up to 138 percent of the federal poverty level (Kelberg,
2015). Thirty-one states have expanded their Medicaid programs, but North Carolina and many
other states have not (Where the states stand on Medicaid expansion, 2016). More than 4 million
Americans are therefore in the “Medicaid gap”, in which they do not not qualify for Medicaid
because of their state’s decision, but do not earn enough income to be eligible for subsidies on
the Affordable Care Act’s private insurance marketplace. Since the beginning of 2016, 129,320
women in North Carolina are in the coverage gap and are left without insurance, which poses a
significant barrier to accessing oral contraceptives (Garfield and Damico, 2016).
Even if contraceptive costs are affordable, many women, particularly low-income women,
cannot take time off work to visit a clinician to obtain birth control because they are not afforded
paid sick leave. The United States is the only one of 22 rich countries that fails to guarantee
workers a form of paid sick leave (United States Lags World in Paid Sick Days for Workers and
Families, 2016). In North Carolina, an estimated 1,462, 772 private sector workers do not receive
a single paid sick day (Institute for Women’s Policy Research & National Partnership for
Women & Families, 2015).
On a collective scale, 65% of 2008 births from unintended pregnancies in the U.S. are funded by
public insurance programs like Medicaid, compared to 36% of intended pregnancies, totaling
$12.5 billion. However, without publicly funded family planning efforts, it is estimated that the
annual public cost of would be $25 billion (Sonfield & Kost, 2013). These figures only include
costs of delivery and essential care for women and newborns, not any future costs associated
with an unintended addition to a family.
Literature Review 6
PRESCRIPTION REQUIREMENT
By removing the prescription requirement, obtaining birth control pills becomes more convenient
to women. This is especially helpful for women when they are traveling, or when they are almost
out of pills. Further, it is much easier for women to coordinate a time to visit their pharmacist
rather than their clinician. Participants of Dennis and Grossman’s study (2012) recommended
making pills over the counter by eliminating the required clinician visit and eliminating the limit
on the supply that can be purchased monthly. Most clinicians required women to check in once a
year, which women noted as being inconvenient and a “hassle”. They felt the visit was
unnecessarily, and that it was often difficult to get an appointment (Dennis and Grossman, 2012).
However, when the women did not visit the clinician annually, they were unable to refill their
prescriptions.
Nearly half of women who use oral contraceptive methods stop use within the first year
(Vaughan, 2008). This greatly increases the risk of unintended pregnancies. Factors that
influence why women give up use include cost, inconsistent use, and side effects. Research
shows that dispensing greater quantities of oral contraceptives, such as a year's worth at a time,
results in greater continuation than does dispensing lower quantities (Foster et al., 2006).
Evidence suggests that over the counter options for oral contraception may improve continuation
rates.
BARRIERS TO ADOLESCENT ORAL CONTRACEPTIVE USE
During the 1970s, adolescents were more prone to use oral contraceptives than condoms.
However, since the 1980s, among adolescents use of oral contraceptives has declined while
condom use has increased (Mosher, 1990). Research has shown that men are more likely to use
contraceptives when their partner participates in the contraceptive decision making process.
(Providers’ Perspective: Perceived Barriers to Contraceptive Use in Youth and Young Adults,
2008). As major influences on their partners, men can pose large barriers when they are
uninvolved with or opposed to contraceptive use. Further, many men are confused by or lack
understanding about contraceptive methods (Providers’ Perspective: Perceived Barriers to
Contraceptive Use in Youth and Young Adults, 2008).
Parents are often barriers for adolescents seeking to access contraceptives. Some teens are
frightened that family members will see them when they go to a gynecologist or pharmacy to
obtain contraceptives (Long-White, 2008). Others are afraid that their parents will find out that
they are taking oral contraceptives if they go to the doctor on their own (Wallace, 2015). Further,
for the adolescents who only see a doctor with their parents, some face a lack of privacy with
their physicians when their parents are allowed to stay in the exam room (Chernick et al., 2014).
Additionally, many adolescent women fear the negative side effects associated with oral
contraceptive use (Chernick et al., 2014). Furthermore, many adolescent women mistrust
contraceptives and believe they may “damage” the body. Some state that using birth control
methods is futile, because one may still get pregnant while taking birth control (Chernick et al.,
2014).
Further, many adolescents have not been taught about contraceptive use in schools, which poses
a barrier to effective contraceptive use. Many states provide sex education to public school
Literature Review 7
students through abstinence-only programs, in which schools do not teach adolescents about oral
contraceptives. However, this barrier was largely eliminated in North Carolina in 2009, with the
passage of the Healthy Youth Act. Under this law, NC school districts must teach an evidence-
based sexuality education curriculum. This curriculum must include all FDA-approved
contraceptive methods and FDA-approved methods for prevention of sexually transmitted
infections. Parents must be permitted to withdraw their child from the course; school districts
may choose to use either an opt-in or opt-out method of enrollment (Healthy Youth Act FAQS,
2016).
EXISTING KNOWLEDGE ON OTC BIRTH CONTROL
A study by Amanda Dennis and Daniel Grossman (2012) observed barriers to contraceptive
access, and examined whether making oral contraceptives over the counter would contribute to
lower levels of unintended pregnancies in the United States. Their study used focus groups of 45
low-income women in the Boston area to explore how these women obtained contraception and
their thoughts on having oral contraceptives available over the counter. 33% of the women
reported using the pill as their primary contraceptive method, although most had reported trying
it. These women, who were on the pill, stated they prefer this method and supported increasing
access. Further, other research has shown that women at risk for unintended pregnancies support
over the counter birth control options (Grossman and Grindlay et al., 2013). The ease of use,
effectiveness, and secondary health benefits of birth control pills all supported why women
appreciate this method. However, women did express their concern about how the pill does not
protect against sexually transmitted diseases (ibid).
A study in Kuwait used multivariate analysis to observe the differences in demographics in
women who use over the counter oral contraception, versus those who visit a clinician. (Shah et
al., 2001). There were no socioeconomic or demographic differences between these two groups,
implying women had equal opportunity and access to visit a clinician (ibid). However, this study
may not be applicable to a United States context.
The Population Research Center at the University of Texas Austin (2011) observed purchasing
patterns when women were given the option to obtain pills from a clinic in the United States near
the Mexican border, or cross into Mexico to obtain over-the-counter pills. Based on this research,
they determined that the potential market of over-the-counter pills would be seventeen to twenty-
two million women (Landou et al., 2006).
SAFETY
Current data indicates that oral contraceptives meet the safety requirements needed for over the
counter medication (McIntosh et al., 2011). The Food and Drug Administration requires that
over the counter medication be non-habit forming, and safe to use without the foresight of a
healthcare practitioner (Grindlay et al., 2013). Both of these requirements are fulfilled by oral
contraceptive methods. Further, while only the FDA can make medications fully over the
counter, states can permit medications to be dispensed with only a pharmacist prescription
without meeting these requirements.
Regular visits with a healthcare provider for birth control refills also serve to enable routine
pelvic exams and Pap smears. However, notably, recommendations for routine Pap smears have
Literature Review 8
recently been modified; the current recommendation is for most women between the ages of 21
and 65 to have a Pap smear every three years, rather than every year (Cervical Cancer, 2012).
Further, although these exams are important, research indicates they are not related to
determining whether a woman is a good candidate for hormonal contraceptives (Landau et al.,
2006). Other concerns the provider-patient relationship; research shows that women place a high
value on the medical services they receive at a clinic (Potter et al., 2010).
By requiring women to visit a clinician before they can obtain birth control pills, women are
informed of potential risk and are typically given a lecture on pill safety. This is especially
important for first time users, women with certain health conditions, and minors. However, this
role could be played by a pharmacist, who can conduct risk screenings and answer women’s
questions. Research has shown that 97% of women feel comfortable asking pharmacists about
any prescription questions they have (Gardner, 2010). Further, domestic studies have shown that
women are able to self-screen and evaluate whether they are a good candidate for hormonal
contraception (McIntosh et al., 2011). This study found that after taking a self-screening
questionnaire, women were better able to find contraindications to birth control than their
providers (ibid). Further, foreign studies have shown that women are able to self-screen
identically to nurses when identifying health issues that could cause contradictions (Grindlay,
2013).
CONCLUSION
High rates of unintended pregnancy nationally are even higher among low-income and poorly
educated women. Financial resources and other barriers, like the requirement for a prescription,
limit these women’s ability to access contraceptives that would provide increased autonomy over
their fertility. Authority over the size of one’s family leads to increased control of education,
workforce participation, and earning potential, all factors that can help break cycles of poverty.
While contact with a clinician does facilitate the administration of preventive screenings,
healthcare professionals only recommend women receive a Pap smear every 3 years, and current
research suggests birth control pills are safe to be available for purchase over the counter. So
long as over the counter birth control remains affordable, policy change that allows the
medication to be accessed in that fashion has the potential to increase access to oral
contraceptives and the positive health outcomes associated with them.
Literature Review 9
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Agenda Item Number:
ORANGE COUNTY BOARD OF HEALTH
AGENDA ITEM SUMMARY
Meeting Date: November 30, 2016
Agenda Item Subject: Elections (Chair & Vice-Chair)
Attachment(s): None
Staff or Board Member Reporting: Nick Galvez
Purpose: __X_ Action
_ __ Information only
____ Information with possible action
Summary Information:
Per the Board of Health Policies and Procedures, the Board shall elect a Chair and
Vice-Chair by majority vote each year at the last meeting of the calendar year.
Proposed for Chair: Liska Lackey
Proposed for Vice Chair: Susan Elmore
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):
Health Director’s Report
November, 2016
• With the help of an MPA student, Sabrina Willard, we have conducted the first phase of our
mental health gap analysis for children and youth ages 0-25. The next phase is to share the
results with community stakeholders and work with them to identify priority issues and identify
potential solutions. That work will be completed in February and we’ll have a presentation to
the BOH then.
• The Manager did approve the HR recommended changes to salaries for nursing and advanced
practice staff. It is a small step in a long journey, but we are so pleased with the support we
received from both HR and the Manager.
• Reminder: The Healthy Carolinians of Orange Task Force Annual meeting will be Friday
December 9th from 9a – 11a with breakfast and networking beginning at 8:30a. The meeting
will be held at Whitted in room 230. The theme/topic for the meeting will be racial equity and
the role of law enforcement in community health.
• Last week I attended the two-day Racial Equity Institute, Phase I training. We are working on
getting the majority of HD staff trained in at least Phase I.
• Friday we spent the day reviewing the documentation for our accreditation
activities/benchmarks. At the end of the meeting, we declared all substantive work related to
accreditation documentation complete. Rebecca and LaToya will work on putting the
documents into the required form/format and will submit December 9th.
• For the first time ever, we had to submit a competitive proposal to the state for our Family
Planning funding. I’m happy to report that we were approved with an exceptionally high score
of 93. This will result is a slight increase in our family planning funding.
• December marks the end of my year as President of the NC Association of Local Health
Directors. This year was both challenging and productive. We successfully negotiated positive
resolutions around most of the cost settlement issues, we saw the legalization of syringe
exchange, a statewide standing order for naloxone and a nearly $15 million allocation to local
public health for cost report losses. We also avoided some dangerous legislation. I’ve enjoyed
this experience and learned a lot about how things get done in Raleigh. I am happy, however, to
pass the gavel on to Jim Bruckner in Macon County at our meeting in January!
Carrboro Police Reverse Fourth Overdose with
Naloxone
By Blake Hodge
Posted November 14, 2016 at 3:27 pm
Carrboro Police have once again used naloxone to reverse a drug overdose.
Police say officers were called to a reported heroin overdose just before 10 o’clock Friday night
where authorities found an “unconscious subject.”
A release says an officer then administered naloxone, which allowed the patient to regain
consciousness, according to police. The subject then walked to a waiting ambulance for
continued treatment.
This is the fourth time Carrboro Police have used the life-saving drug to reverse an overdose.
The first reversal was in January 2015.
Orange County was honored in late 2015 for the Naloxone Project, which was pushed forward
through work from the Orange County Health Department.
Police continue to asked that you call 911 if you suspect someone is in an overdose state and
remain with the individual until assistance arrives. Carrboro Police Captain Chris Atack says the
priority for officers in those situations in public health and not bringing charges related to the
illegal drugs possibly being used.
UNC researchers: Kindergarten
camps bring learning gains
FROM STAFF REPORTS
Nov 2, 2016
CHAPEL HILL – Students in the Family Success Alliance’s Kindergarten Readiness
Camp have shown significant gains in fundamental cognitive and literacy skills.
A team of researchers from UNC-Chapel Hill evaluated the program, which addresses
the effects of generational poverty at four elementary schools in Orange County
Schools and Chapel Hill-Carrboro City Schools.
“The Kindergarten Readiness Camp had a positive effect on attention and basic literacy
skills for all children in English and on language and literacy skills in Spanish,” said
Margaret Burchinal, senior research scientist at UNC’s Frank Porter Graham Child
Development Institute (FPG). “And the children entering with the lowest skills benefited
the most from the program.”
The summer program for low-income children focuses on developing the skills that help
students improve their transitions into school. According to Burchinal, these skills can
enable children to start school on a more equitable playing field with their more affluent
counterparts, helping to close “the achievement gap.”
Previous research has shown that children’s first five years of life are critical to overall
success in school and beyond. Programs for low-income families that improve family
economic security, parental involvement in children’s development, or access to high -
quality child care can substantially reduce the achievement gap.
“By giving kids a leg-up, we believe we can do our part to not only help close the
achievement gap but provide the opportunity for these kids to reach their full potential
as members and leaders of our vibrant community,” said Coby Jansen Austin, director
of programs and policy for the Family Success Alliance. “The Family Success Alliance
has prioritized the need for equity from the onset of a child’s academic career in helping
children feel successful and be successful throughout their educational journey and into
college and career.”
Burchinal said this was the second straight year that students in the Family Success
Alliance’s Kindergarten Readiness Camp continued to show significant gains in school
readiness skills. During the four-week program, 72 students were exposed to the
routines and procedures of kindergarten in a typical school day to help them develop a
positive outlook and a love of learning.
Participating schools included New Hope Elementary, Carrboro Elementary, Northside
Elementary, and Frank Porter Graham Bilingüe Elementary. The evaluation team asked
teachers to rate social skills, and they tested children on attention and academic skills.
The UNC evaluation team includes a partnership with UNC’s Department of Pediatrics,
which will look at health in children in the program and health relationships to FSA
support. The team will continue to assess these children during their kindergarten year,
comparing them to groups of low-income children not involved in Family Success
Alliance, in order to help the program continue to improve.
November 18, 2016 10:53 AM
Anxiety, fear and frustration in Orange County after election
Chapel Hill police responded Monday, Nov. 14, 2016, to anti-Trump graffiti spray
painted on the wall of Hunam Chinese Restaurant on Martin Luther King Jr.
Boulevard and, immediately following the Nov. 8 election, at the Old Chapel Hill
Cemetery on UNC’s campus. Contributed photo
By Tammy Grubb
tgrubb@newsobserver.com
CHAPEL HILL
Mariela Hernandez says she was walking her 9-year-old son to school on Nov. 9 when she saw a group of
men in a white pickup slow down on Hillsborough Road near the Cates Farm community.
“I see this guy with a big smile, and they’re (yelling), ‘You’re going to get sent back to Mexico,’ ” said
Hernandez, who is a legal immigrant seeking her citizenship and a zone navigator helping families in
Orange County’s Family Success Alliance cradle-to-career or college program.
“My reaction was completely surprised. I didn’t think,” she said. “I’ve been targeted, and racist stuff has
been said to me before, but I didn’t think it would happen like that.”
The alleged encounter was among hundreds of incidents, protests and student walkouts reported
nationwide after Donald Trump won the presidential election. UNC students also staged a walkout and
protests, and undocumented students met this week to talk about their fears.
Chapel Hill-Carrboro and Orange County Schools spokesmen said they haven’t had any major issues.
Both sent messages to parents letting them know that schools are safe places and to get in touch with
any harassment or bullying concerns.
Orange County leaders also issued a letter Monday in response to reports of racial, religious and
homophobic harassment, urging victims to call 911.
Trump’s election doesn’t change the county’s values, Carrboro Mayor Lydia Lavelle, Chapel Hill Mayor
Pam Hemminger, Hillsborough Mayor Tom Stevens and Orange County Board of Commissioners
Chairman Earl McKee said in the joint letter.
“As we move forward with this transition, we need to listen to each other and pay special attention to
our values of inclusiveness and respect. While not perfect, this is the way democracy works in our
country, and we believe this ultimately makes us a stronger nation,” they said. “In the meanwhile, we all
need to work hard and keep advocating for our very important community values.”
But listing those “community values” – on immigration, climate change, universal health care and
common-sense gun laws – lit a Facebook firestorm.
More than 100 people responded to an online post from Hillsborough resident and former Town Board
candidate Ashley DeSena about the letter. The post – “Thanks for the reminder that I need to keep my
head down and my conservative mouth shut” – was meant to start a conversation, DeSena said.
The letter is insulting to roughly 23 percent of local voters who supported Trump, she said, because it
conflicts with their values.
“I understand the local elected officials want to do their best to provide good governance to us and they
want to ensure that we have the sort of community that everybody wants to be part of, but when they
get into specific values – what values are welcome vs. what values are not – you start excluding a lot of
people,” DeSena said.
The letter’s advice to call 911 about verbal harassment drew jeers from some. DeSena said it encourages
a climate of fear and victimization.
“I don’t want anybody to feel like they’re not welcome,” she said about Hernandez’s experience. “As
long as they’re peaceful, productive members of society, they should be treated with more respect than
that.”
McKee, who was called out by name on the page, posted that anyone with concerns should call him.
Orange County is a diverse community with views from the far right to the far left, he said later. While
he may not agree with every line in the letter, it was his duty as the board’s chairman to sign it, he said.
“The letter was in some ways intended to calm down the situation, and it seems to have not done that,”
McKee said. “Personally, I think people just need to take a deep breath and calm down. The election is
over; the election is what it is. It’s not going to be the end of the world.”
The letter responded to public concerns they had been hearing, Lavelle said, from Hernandez’s
experience to emails about a spike in anti-gay harassment.
“It’s hearing from those vulnerable communities that they are genuinely, really, not just sad, but scared
and worried, and so we wanted to offer some reassurance to them,” Lavelle said.
And it’s not just Trump supporters who are harassing others, Hemminger and McKee said. She has heard
about notes found on cars and people being yelled at by passing drivers, Hemminger said. McKee said
Trump supporters have had signs in their yards destroyed and defaced; some said their cars were keyed.
Local law enforcement only received one report – of vandalism – since the election.
Chapel Hill’s Town Council put out its own statement Monday, noting that Chapel Hill prides itself on
being a place that encourages and supports differences.
“In coming days, we urge everyone to be patient with one another and to listen with respect,”
Hemminger said. “And, looking to the future, we will continue to work together to advocate for our
values, because we are, truly, stronger as an inclusive community.”
Tammy Grubb: 919-829-8926, @TammyGrubb
Carrboro police respond
The Carrboro Police Department addressed reports of possible harassment since the election in a news
release Friday morning.
The department has always worked to ensure no one in Carrboro is victimized because of gender,
religion, ethnicity, cultural heritage, sexual orientation, or for any other reason, the release stated.
“Carrboro is an open, inclusive, and welcoming community. The Carrboro Police Department shares
these values and will continue to work to ensure all residents and visitors feel safe in Carrboro. We
thank you for helping us keep Carrboro safe and welcoming,” it stated.
Police advise anyone witnessing possible harassment to take these steps:
▪ Report it as soon as possible by dialing 911
▪ Record or otherwise document the incident if it’s safe to do so; documented evidence can help prove a
crime has occurred
▪ Show your support for the victim by talking to them during and after an incident until a police officer
can arrive
Read more here: http://www.newsobserver.com/news/local/community/chapel-hill-
news/article115381733.html#storylink=cpy