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ORANGE COUNTY BOARD OF HEALTH
MEETING AGENDA
DATE: June 27, 2018
TIME: 7:00 P.M.
PLACE: Whitted Building, 3rd Floor Meeting Room
300 West Tryon Street
Hillsborough, NC 27278
TIME ITEM
7:00 p.m. I. Welcome New Employees
7:00 – 7:05 II. Public Comment for Items NOT on Printed Agenda
public Comment for Items ON Printed Agenda will be
handled during that agenda item
(Please sign up for both on sheet near the entrance to room.)
Please limit your comments to 3 minutes.
7:05 – 7:10 III. Approval of June 27, 2018 Agenda
7:10 – 7:15 IV. Actions Items (Consent)
A. Minutes of April 25, 2018 Susan Elmore
7:15 – 8:05 V. Educational Sessions
A. Innovation Grant Update (15 minutes) Victoria Hudson
B. Annual Communicable Disease Report (15 minutes) Iulia Vann
C. Fluoride Ad Hoc Committee Update (15 minutes) Jessica Frega
(relative to BOH Strategic Plan Priority: Engagement)
D. NALBOH Annual Conference (5 minutes) Quintana Stewart
8:05 – 8:15 VI. Action Items (Non-Consent)
A. Strategic Plan 2018-2020 (10 minutes) Beverly Scurry
8:15 – 8:25 VII. Reports and Discussion with Possible Action
A. Health Director Report (5 minutes) Quintana Stewart
B. Media Items Kristin Prelipp
8:25 – 8:30 VIII. Board Comments
8:30 IX. Adjournment
BOARD MEMBERS: To ensure a quorum, SEND E-MAIL to lstrange@orangecountync.gov advising her of your
attendance at this meeting OR CALL 919-245-2411.
Compliance with the “Americans with Disabilities Act” and Title VI - Interpreter services and/or special sound equipment are available on
request. Call the Immigrant and Refugee Health Program Manager at 919.245.2387 to request an interpreter or other accommodation.
Conforme a la “Ley sobre Estadounidenses con Discapacidades” (ADA) y el Título VI – los servicios de intérprete y/o equipo de sonido
especial están disponibles a solicitud. Llame a la Administradora del Programa de Salud para Inmigrantes y Refugiados al 919-245-2387 para
solicitar un intérprete u otros arreglos o adaptaciones.
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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 May 23, 2018 at the Orange County
Health Department, 300 West Tryon Street, Hillsborough, NC.
BOARD OF HEALTH MEMBERS PRESENT: Susan Elmore – Chair, Timothy Smith –Vice-
Chair, Bruce Baldwin, Johanna Birchmayer, Commissioner Mia Burroughs, Barbara Chavious
Paul Chelminski, Jennifer Deyo, Jessica Frega, Liska Lackey and Sam Lasris.
BOARD OF HEALTH MEMBERS ABSENT: None.
STAFF PRESENT: Quintana Stewart, Health Director; Coby Jansen Austin, Director of
Programs and Policy; Kristy Bassili, Public Health Nurse II; Steven Campbell, Information
Technology Analyst; Rebecca Crawford, Financial and Administrative Services Director; Dr.
Stephanie George, Dentist; Kathleen Goodhand, Home Visiting Services Supervisor; Donna
King, Health Promotion & Education Services Director; Kristin Prelipp, Communications
Manager; April Richard, Tobacco Prevention and Control Coordinator; Beverly Scurry, BOH
Strategic Plan Manager; La Toya Strange, Administrative Assistant II; and Allison Young, Health
Informatics Manager.
GUESTS PRESENT: None
I. Welcome New Employees
Susan Elmore, Chair, called the meeting to order. Ms. Stewart welcomed new employee, Kristy
Bassili.
II. Public Comment for Items NOT on Printed Agenda: None.
III. Approval of the May 23, 2018 Agenda
Motion was made by Sam Lasris to approve the agenda, seconded by Jessica Frega and
carried without dissent.
IV. Action Items (Consent)
A. Minutes of April 25, 2018 Meeting
Motion was made by Barbara Chavious to approve the minutes of April 2018 with edits,
seconded by Jennifer Deyo and carried without dissent.
V. Educational Sessions
A. Orange County Schools – Child Nutrition Overview
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Valerie Green, Director of Orange County Schools (OCS) Child Nutrition Services informed the
Board on the program. Below are highlights.
• There are 13 schools with 12 child nutrition managers. Breakfast is taken to one school
with those students walking over for lunch.
• Approximately 1,700 breakfasts and 3,115 lunches are served daily.
• Child Nutrition Services (CNS) must maintain a non-prof it food service and observe the
limitation on food service revenues in 7 CFR 210.14(a). They are responsible for their
own budget. The costs are $3.31 per meal, $2.09 per breakfast and $0.88 per snack.
• CNS’s revenues must cover the cost of food and supplies, staff salaries and benefits,
equipment and other departmental expenses. They also pay negative meal balances.
• Their financial needs are met by cooperative purchasing, receiving grants, assessing
menu costing with new products and controlling labor, equipment and food costs.
• The OCS employs a trained chef, has Tryday Friday in which new foods are introduced
and are looking to do an afterschool snack service that would distribute snacks around 4
or 5pm. There are also grab and go kiosks that allow students to grab breakfast and go
to their classes versus going to the cafeteria.
• CNS programs include the Universal Free Breakfast Program for prekindergarten
through 5th grade and Summer Food Service Program which operates from June
through August.
• New ideas include introducing a concept of a later breakfast for high schoolers and
offering both hot and cold items in breakfast programs.
• CNS will continue to offer additional healthy lunch options for middle and high schools
and continue to work with local government and agencies to procure local growers
produce.
• Community support is crucial. CNS currently engages with local restaurants and
churches.
The BOH had questions that were addressed by Ms. Green.
B. Child Fatality Task Force Report
Kathleen Goodhand, Home Visiting Services Supervisor, gave the highlights of the 2017 Child
Fatality Prevention Team (CFPT) Annual Report. In 2017, the CFPT reviewed 11 child deaths
and identified 2 system problems.
The 2 system problems with cause of death (cod) identified were:
• child with poorly controlled asthma playing sport (hypercarbic respiratory failure due to
status asthmaticus)
• possible undiagnosed mental health issues (homicide)
The recommendations by the CFPT were:
• more detailed sports physical form is created to identify poorly controlled asthma
• require athletic trainer for all school sports
• mental health first aid training for front line human services workers
The BOH members had questions that were addressed by Ms. Goodhand.
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C. Racial Equity Commission Presentation/Equity Summit Video
Steven Campbell and Beverly Scurry, Chair and Co-Chair, respectively, presented information
on the newly created Racial Equity Commission (REC). Below is a summary of the
presentation.
• Formed in 2017, REC was established after staff members attended the Racial Equity
Institute (REI) trainings held at various locations in Chapel Hill and Durham and the four
OpenSource Leadership Strategies-led sessions held at the OCHD. It was a means of
continuing racial equity work starting internally at the OCHD. The REC is comprised of
members from all OCHD divisions.
• The REC concept includes a diverse group of staff coming together to be a catalyst for
racial equity at the OCHD to create an environment that allows coworkers to analyze
workplace norms, structures, power dynamics and culture while operating from a lens
that considers equity, diversity and inclusion.
• To ensure the REC is viewed as an official health department entity, a charter was
developed, signed and supported by Dorothy Cilenti and Quintana Stewart, the interim
health director and current health director, respectively. The REC’s charter is comprised
of a defined vision, mission, goals and membership requirements.
• The Inclusionary Practices Policy was derived from the Diversity Policy. Awareness is
raised by using language such as racial equity, health equity and cultural humility.
Intentionality with language is created by ensuring that leadership and management is
reflective of the diversity of the population, encouraging the use of caucusing and
requiring completion of at least one training (e.g. REI, Groundwater, Latinx). Over half
(57%) of the OCHD has undergone at least one training.
• A small delegation of 26, comprised of OCHD staff, FSA navigators, Human Relations
and Human Resources staff, attended the Equity Summit that occurred in Chicago. The
delegation met for pre- and post-Summit convenings. There were 4200 people in
attendance at the Equity Summit.
Kristin Prelipp, Communications Manager, produced a powerful Equity Summit video which
provided highlights of the conference. The video included clips and pictures that were
submitted by delegation participants as well as showcased some of the speakers from the
conference. It was received well by the BOH members.
The BOH members had questions that were addressed by Mr. Campbell, Ms. Scurry and
Ms. Prelipp.
D. Dashboard Review
Allison Young, Health Informatics Manager, presented the 2018 annual public health
dashboards for OC. The topic areas of the six dashboards were:
• Substance Abuse and Mental Health,
• Chronic Disease and Obesity,
• Social Determinants of Health: Poverty Mitigation and Access to Care,
• Sexually Transmitted Infections,
• Maternal and Infant Health, and
• Injury and Violence.
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The dashboards are published yearly and posted on the website. Some of the highlights from
the topics they presented on are as follows:
• Drug and High School substance use decreased from 2015 to 2017
• Orange County saw more than 400 ED visits related to Medication/Drug poisoning in
2017. More than a quarter of these were related to opioids, heroin, or benzodiazepines
(25.4%).
• Orange County is ranked #1 (best) in the state when it comes to the number of Opioid
prescriptions (.52) or pills prescribed per resident (34.5) in 2016, which represents an
average. This puts Orange County on par with the lowest quartile state averages in the
US in 2014 (.52‐.71).
• While Orange County performs well compared to peers and NC when it comes to
chronic disease, the county has vast health disparities, particularly regarding chronic
diseases. Black (Non‐Hispanic) residents in Orange County die from avoidable chronic
diseases such as Heart Disease and Stroke at more than two times the rate of their
White (Non‐Hispanic) peers (77.1 vs 31.5 deaths per 100,000).
• Orange County consistently falls short of the nation, state, and/or peers when it comes
to Social Determinants of Health. In particular, affordable housing, food insecurity, and
income inequality are key and pressing issues for our County. 14% of children in Orange
County live in poverty, and 36% of students are eligible for free or reduced lunch. In
addition, 1 in 5 residents are experiencing serious housing problems such as
overcrowding or a need for repairs. Half of Orange County renters pay unaffordable
rates for housing at 30% or more of their income. And of those facing food insecurity,
40% are ineligible for SNAP benefits.
• The incidence of most STIs increased in 2016 for Orange County. Gonorrhea,
Chlamydia and HIV Infection Rates in particular are higher for Orange County than our
peers, and increasing at a significant rate.
• Alcohol related vehicle indicators showed improvement from 2015 to 2016, which was
identified as an area of concern on previous dashboards. Both alcohol related crash
rates and reported drinking and driving behaviors among youth saw a decrease.
However, texting and driving is rising among youth (21% in 2017, compared to 17% in
2015).
• Orange County performs well on most indicators of Maternal and Infant Health, however
many disparities exist for these indicators by race and ethnicity. In 2016, Orange County
also saw an increase in the teen pregnancy rate and % of teen pregnancies that are
repeat.
The BOH members had questions that were addressed by Ms. Young.
VI. Reports and Discussion with Possible Action
A. Strategic Plan 2018-2020 Review
Beverly Scurry, BOH Strategic Plan Manager, presented an overview of the updates and
revisions that occurred as a result of the three subcommittee (Social Determinants of Health,
Physical Activity & Nutrition and Substance Abuse & Mental Health) meetings. At those
meetings, the subcommittees provided their recommended focus areas and action steps for
inclusion in the 2018-2020 Board of Health Strategic Plan. The Board will vote on its approval
at next month’s meeting.
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B. Health Director Report
In addition to her report, Ms. Stewart provided highlights of the New Health Director Orientation
she attended that fulfilled a requirement of her position. She also mentioned that the Family
Success Alliance (FSA) was awarded a grant from the Kenan Charitable Trust in the amount of
$300,000 ($100,000/year for the next 3 years). Lastly, Ms. Stewart stated that the Medicaid
Cost Settlement payment for 2016 had been received.
C. Media Items
Kristin Prelipp, Communications Manager, briefly mentioned the article topics of the FSA,
whooping cough and poverty simulation that Ashley Rawlinson brought to Person County that
were included in the Media Items packet.
Media items were in the packet which focused on Orange County’s events and our
involvement in various efforts.
At 8:50pm, Paul Chelminski motioned to close the open session and Jennifer Deyo
seconded.
VII. Closed Session to Consult with Attorney
Paul Chelminski motioned to go into closed session and Mia Burroughs seconded.
VIII. Board Comments
None.
IX. Adjournment
Sam Lasris moved to adjourn the meeting at 9:32pm and Bruce Baldwin seconded.
The next Board of Health Meeting will be held June 27, 2018 at the Orange County Health
Department, 300 West Tryon Street, Hillsborough, NC at 7:00 p.m.
Respectfully submitted,
Quintana Stewart, MPA
Orange County Health Director
Secretary to the Board
Agenda Item Number:
ORANGE COUNTY BOARD OF HEALTH
AGENDA ITEM SUMMARY
Meeting Date: June 27, 2018
Agenda Item Subject: 2018 Innovation Grant Update
Attachment(s): PPT Presentation
Staff or Board Member Reporting:
Purpose: ____ Action
_ X Information only
____ Information with possible action
Summary Information:
Victoria Hudson, Innovation Grants Manager, will discuss updates to the 2017-2018
Innovation Grant projects, adjustments to the process, and the status of the process for
2018-2019.
Recommended Action: ___Approve
___Approve & forward to Board of Commissioners for action
___Approve & forward to ___________________________
___Accept as information
___Revise & schedule for future action
___Other (detail):
Innovation Grant
Fund Update 2018
Victoria Hudson
Innovation Grants Manager
Purpose
•The Orange County Health Department strives
to empower all staff to identify, study, and
solve problems that impede quality services
delivery and access for clients and the public.
•The Innovation Fund is a great tool that
provides a way for staff to identify innovative
potential solutions and receive funding to
pilot that solution.
History – funding
•Medicaid Cost Settlement dollars were set aside by the
Board of Health, at the request of the Health Director
Colleen Bridger, in order to create a fund for new,
innovative projects. This was formalized in the fall of
2012, with the first year of projects starting in 2013.
History – projects
IMPLEMENTATION YEAR GRANTS
2014 4
2015 5
2016 10
2017 (1/2) 1
2017-2018 3
Adjustments to the Process
•Encourage team approach
•Know technological limitations
•Be realistic about time for implementation
•Develop stronger evaluations
•Fiscal accounting methods
•Develop a rubric for grading grant proposals
2017 (1/2)
•One grant for a Pre-k Tooth Brushing Initiative
finished full implementation in June 2017.
•There was slow resistance to implement the
program, through education and
compromising on the timing, the teachers
were pleased with the project.
•The parents were excited to be part of this
project and showed interest. The students
have enjoyed our visits and also seem to be
excited about brushing during school.
2017-2018 – projects
Name Lead
Be the 1 To Suicide
Prevention Campaign
Ashley Rawlinson
FOH Food Safety
Training
Victoria Hudson
Onsite Water Protection
Calendars
Barbara Hawksworth
Innovation Success- BeThe1To
•Multiagency involvement
•Suicide prevention month activities: kickoff
event, awareness walk, and QPR prevention
training
•2 focus groups among High School students
•Meeting with the Director of Healthful Living
& Athletics, in Chapel Hill Carrboro City
Schools and student advisors at high schools
to discuss support groups
OSWP Calendars Ready for 2019
Front of the House Food Safety
•Video production and booklet production
required more time than expected
•Excellent cooperation from volunteers,
videographers, printers, and photographers
•The first measure of implementation will be in
July with training provided free of change to
every establishment in OC
•The link to the video will be made public after
the initial measures
2018-2019 Cycle
•Call for ideas- 9 ideas submitted
•5 selected for full applications
•Grant announcement late June
•Implementation can begin as early as July 1
•Mid-year progress is due December 31
•Final report is due June 30
2018-2019 – proposals
Name Lead
Transportation
Assistance
Renee Kemske, et al
Patient Education Julie Johnson, Meghann
Johnson
Intraoral Cameras Dr. Stephanie George
41 or Below Angela Sowers, et al
Art for OCHD Kristin Prelipp
Questions?
www.OrangeCountyNC.gov/Health
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ORANGE COUNTY ENVIRONMENTAL HEALTH
131 W MARGARET LANE, HILLSBOROUGH, NC 27278
919-245-2360
Food Safety for Front
of the House
Welcome to OCHD FOH Food Safety.
This training is self-led.
There are pre-test and post-test mate-
rials available. View the accompany-
ing video and follow along in this book-
let. Space is provided for note-taking.
The plan of the project is to focus edu-
cation on food handlers who prepare
beverages and garnish foods. The
objective is to control the points where
food safety is unknown, forgotten, or
ignored, specifically cross-contamination observed during FOH
inspections activities.
Orange County Environmental Health believes there are two pos-
sible deliverables: (1) increased protection of the public; and (2)
reduced violations during inspections.
Acknowledgments and Funding
Statement
Thanks to the EHS of Orange County who designed, developed, pro-
grammed, trained, and cared to implement FOH food safety training.
The FOH Food Safety Program has been brought to your establish-
ment by the Innovation Grant of the Orange County Health Depart-
ment.
Innovation Grants allow Orange County Health Department employ-
ees to develop solutions for identified problems in ways that improve
the health of Orange County residents or create efficiency on the job.
Truly innovative ideas with positive results are often sustained by
County and continue their implementation after the grant has ended.
Please let the Orange County Health Department know the benefits
of this program.
http://www.orangecountync.gov/departments/health/kudos.php
Our mission is to enhance the quality of life, promote the health, and
preserve the environment for all people in Orange County.
The Orange County Health Department welcomes all clients seeking
health services, regardless of their immigration status. We are com-
mitted to the health of our entire community, and want our clients to
know that we follow all medical confidentiality laws, which protect their
information.
Hand Washing 3
Personal Hygiene 5
Bare Hand Contact 7
Clean Utensils 9
Miscellaneous Contamination 11
Test Your Knowledge 13
Contents
2 15
HINT: Talking
Points to FOH
Staff
A quick tool for
employers to
use to enhance
existing train-
ing
An easy tool
for employers
to start a train-
ing that is
needed
Increase sani-
tation scores
Prevent food-
borne illness
Why Food Safety Training for FOH?
Front-of-the-house (FOH) food and beverage em-
ployees traditionally have been held to different
standards than kitchen staff. However, the NC
Food Code (2012) does not make that same dis-
tinction. As a matter of fact, the Code considers
anyone who may come into contact with food,
clean utensils and equipment, linens, and single
service a “food employee.” Often FOH staff are not
only in contact with food, they are in direct contact
with ready-to-eat foods and the last place in the
flow of food before the consumer eats the food.
The Orange County Health Department wanted to
provide quick training that can be used to help FOH
staff identify the steps in their tasks where they can
do their part to prevent a food borne illness or inju-
ry to the consumer. Even though the Code is clear
about what is expected and who are responsible,
violations of bare hand contact per-
sist and are being attributed to FOH
food employees.
A typical food protection manager’s
certificate course does not specifi-
cally address bartending or bever-
age preparation. An out-of-the-box
employee training has been difficult to find, one that
serves this purpose exclusively.
This FOH training is designed to be brief; to supple-
ment other trainings of the employer; and to ad-
dress the five most common violations of the NC
Food Code observed during the inspection of FOH
activities.
As FOH staff may be aware, they are also the staff
that the most visible to the public. The appearance
of demonstrating food safety knowledge ensures
good public relations.
References
1. Dane A. Jensen, David R. Macinga, David J. Shumaker, Roberto Bellino, James W. Arbogast, and Donald W.
Schaffner (2017) Quantifying the Effects of Water Temperature, Soap Volume, Lather Time, and Antimicrobial Soap as
Variables in the Removal of Escherichia coli ATCC 11229 from Hands. Journal of Food Protection: June 2017, Vol. 80,
No. 6, pp. 1022-1031.
2. Laura R. Green, Vincent Radke, Ryan Mason, Lisa Bushnell, David W. Reimann, James C. Mack, Michelle D.
Motsinger, Tammi Stigger, and Carol A Selman (2007) Factors Related to Food Worker Hand Hygiene Practices.
Journal of Food Protection: March 2007, Vol. 70, No. 3, pp. 661-666.
3. James F. Meadow, Adam E. Altrichter, Jessica L. Green. (2014). Mobile phones carry the personal microbiome of
their owners PeerJ. 2014; 2: e447. Published online 2014 Jun 24.
8. Where can a wiping cloth can be stored?
A. In the bucket of sanitizer in between uses.
B. In the apron strings or in the back pocket on a FOH staff person.
C. In the hand sink.
D. With the soiled linens.
9. When gloves are inconvenient, they can be substituted by utensils
that employees use to handle food instead of touching it directly.
A. True
B. False
10. Towel drying and polishing are the same activity when cleaning
glassware.
A. True
B. False
1-A, 2-C, 3-B, 4-D, 5-A, 6-C, 7-B, 8-A, 9-A, 10-B
14 3
Hand Washing
How to Wash Hands
1. Use a hand sink intended for hand washing by food employees.
2. Rinse hands under clean, warm running water.
3. Apply soap.
4. Rub hands together vigorously for 10 to 15 seconds, while clean-
ing also fingernails, wrists, and arms.
5. Thoroughly rinse hands under clean, running water.
6. Dry hands immediately using single-use disposable towels or
hand drying device.
7. Turn the water off with the towel: never use those clean hands.
When to Wash Hands
The Code states that employees are to wash their hands and any ex-
posed parts of the arms in the below situations:
Before donning gloves for working with food and changing gloves for
changing tasks
Immediately before working, such as bar prep, bread prep, and setting
tables.
After touching one’s body parts, one’s phone, one’s hair and face, pull-
ing up pants, etc.
After using toilet facilities (wash them in the toilet room AND when re-
turning to task).
After coughing, sneezing, using a handkerchief or tissue, using tobac-
co, eating or drinking.
After bussing, cleaning tables and menus, and washing bar
ware.
Where to Wash Hands
...Only in a designated hand washing sink or an approved automatic
hand washing facility. Employees cannot clean their hands in a sink
used for food preparation, in a ware washing sink, or a utensil sink for
utensils, implements, dishes, and pans.
4. Which of the following is true about hand washing?
A. The mechanical action of scrubbing reduces the microorganisms.
B. Warm water is more comfortable and encourages hand washing
and the Code requires water no less than 100 °F.
C. The use of single-use paper towels aids in the reduction of bacte-
ria. Complete hand drying and friction with the towel are critical to
reduce recontamination.
D. All of the above.
5. Polished nails, gel nails, acrylic nails, and longer nails must be cov-
ered when handling food, clean utensils and equipment, linens, and
single service.
A. True
B. False
6. Which of the following is NOT true of employee beverages?
A. It may be in the front of the house area.
B. It must be stored down and away from food prep and storage.
C. The beverage must be covered, A screw-top drink is approved.
D. It must be consumed in a manner that does not contaminate the
hands.
7. The NC Food Code prohibits all jewelry including necklaces and
dangling earrings and piercings.
A. True
B. False
4 13
A Word About Gloves
Gloves are UTENSILS
and they can be just as
significant a source of
contamination as hands.
Gloves tend to be
changed less frequently than actually needed.
Do You Have Obstacles?
Inadequate food employee training
Hand sinks that are not supplied
Not enough hand sinks
Hand sinks in bad locations
Hand sinks being used for
something else
Too busy
Hand Washing Facts
The mechanical action of scrubbing reduces the microorganisms.
Although washing in warm water has not been proven to remove
more microorganisms1, it’s more comfortable and encourages hand
washing. The Code requires water no less than 100°F.
The presence of rings on the fingers may result in greater bacterial
counts on the hands after washing.
Hand sanitizers do not clean hands.
The use of single-use paper towels aids in the reduction of bacteria.
Complete hand drying and friction with the towel are critical to re-
duce recontamination. Buttons, levers and crank-on towel dispens-
ers are sources of recontamination.
Notes:_______________________________________________________
_____________________________________________________________
_____________________________________________________________
1. Long ponytails and unkempt beards present a significant risk of
contacting exposed food.
A. True
B. False
2. Unused preset tableware may be re-used if:
A. Tableware is removed at the seating of patrons at the table.
B. The tableware is rolled where no part of the mouth-contact surface
is exposed.
C. Both A & B
D. Neither. Preset tableware may not be re-used.
3. ___ are potentially the worse source of hand related contamination
that a FOH staff person will contact without washing his/her hands.
A. Knives
B. Cell phones
C. Bar towels
D. Drink cups
Test Your Knowledge
12 5
Bare Hand Contact
According to the FDA, bare hand contact can transfer dangerous
pathogens from hands to food, spreading foodborne illness2. In
fact, bare hand contact with ready-to-eat foods is responsible for 30%
of restaurant foodborne illness outbreaks. Bare hand contact is espe-
cially problematic with ready-to-eat foods because they are intended
to be eaten without any additional washing or cooking. That’s why the
NC Food Code prohibits bare hand contact with ready-to-eat foods.
FOH Bare Hands, Where?
A bar back preparing bar garnishes including washing and juicing
fruit, trimming herbs like mint or basil, and refilling garnish centers
and rimmers
A bartender garnishing skewers, garnishing glasses, and bruising
herbs, etc.
A wait staff person cutting baguettes or refilling chips basket
A wait staff person touching diners’ food while putting it in the take-
out box
A wait staff person refilling the parmesan grinder
Scooping with the Glass
This should be common sense. Never use the glass as a scoop. The
glass may break which is a physical contaminant (and broken glass
looks quite a bit like ice). Hands may come into contact with the ice
while scooping.
Refills
Use care to never touch the rim of a diner’s glass with the refilling ves-
sel, pitcher, soda gun, etc.
POS, Debit and Credit Cards, and Currency
FOH staff act in the cashier capacity. The “touchscreen” is not clean.
Money is not clean. Debit and credit cards are potential sources of con-
tamination from the consumers’ hands, pockets, wallets, and purses
and, of course, everywhere else they have presented their cards previ-
ously. Hand washing is the best, only defense for the FOH handling the
point-of-sale computers and tablets, and currency and card payments.
Storage on the Floor
Storage is never permitted on the floor. This includes bus pans and
chemical supplies. These items may be on the lowest shelf of a table
or cabinet rack. The Code also states that sanitizer buckets may not be
stored on the floor. The reasons are very simple. The floor may ap-
pear clean but it is not cleaned and sanitized like other surfaces in the
FOH area. One may transfer unknown contamination from the floor to
a clean surface by moving an item from the floor.
Employee Beverages
Food employees may have beverages in the FOH work area such
that the beverage is:
-Covered,
-Stored in an area away from food preparation or food storage (down
and away), and
-Consumed in a manner that does not contaminate the hands of the
food employee. No screw-caps.
Sport bottles, sippy cups, and disposable cups with a lid and straw
that can be used for consumption without touching the mouth-contact
part are perfect for this.
6 11
HINT: Open kitchens
and Expo areas are
very trendy. Managers
working Expo can
sometimes send the
wrong message by
using their bare hands
when they should not
and by not correcting
the staff.
Fixing Bare Hand Situations
Prepare as much garnish in advance, using
pre-made skewers, slices, and twists.
Prepare pre-made garnishes in kitchen, not
in the FOH.
Use tongs and kitchen shears to handle
and to cut herbs for garnish or muddling.
Use tongs for melon, berries, cherries, ol-
ives, and pearl onions.
Use a scoop for ice.
Use small deli paper for sliced fruit and rim-
ming.
Use tongs for rolls, biscuits, and pastries.
Use scoop for the chips.
Use clean linen to hold loaf breads.
Use gloves when no utensil is appropriate.
More About Gloves
Gloves are a great solution for
avoiding bare hand contact, but
they can be inconvenient. When
gloves are inconvenient, they can
be substituted by utensils that
employees use to handle food
instead of touching it directly.
Notes:_________________________________________________________
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
Miscellaneous Sources of Contamination
This page is dedicated to specific, yet miscellaneous, sources of
contamination that may be associated with the operation of the
front of the house.
Cell Phones
Cell phones are potentially the worse source3 of hand related contami-
nation that a FOH staff person will contact without washing his/her
hands. It is important for employers to designate and area and a time
for cell phone usage. Need to know the time: Hang a wall clock and
use timers.
Bar Towels
A bar towel must always be clean to sight and touch.
A bar towel maybe (1) dry and in use; (2) damp and in use; (3) in the
bucket of sanitizer in between uses; or (4) in the soiled linen storage.
A bar towel may not be stored in the apron strings or in the back
pocket on a FOH staff person.
A bar towel may not be rinsed in the hand sink.
HINT: Employers must des-
ignate an area for food
employees to eat and drink
and store personal items
like cell phones, purses,
backpacks, lunchboxes,
medicines, and clothes.
10 7
Personal Hygiene
Hair Restraint
The Code says effective hair restraint must be worn.
This means all body hair that may
come into contact with food.
If preparing garnish, hair on the arms
and upper chest must be covered with
clothing.
Food employees who only serve bev-
erages, wait staff, and hostesses are
not required to wear hair restraint IF
they present a minimal risk of contam-
inating exposed food.
Long ponytails and unkempt beards do present a significant risk of
contacting exposed food.
No one wants a hair in his/her drink or on their tableware.
The Code requires pre-requisite per-
sonal hygiene of all food employees.
Because FOH staff come into contact
with food, clean utensils and equipment,
linens, and single service, it is very im-
portant to enforce a uniform policy on
personal hygiene. Adhering to a clear
uniform policy can help avoid awkward
conversations with staff about personal
cleanliness. Clothes (if no outer covering
like a smock or chef coat, is required) and
outer coverings, like aprons, must be
changed at least daily and appear clean.
Personal “appearance” is not usually the
problem for FOH staff. Actually, the chal-
lenge is to keep personal appearance,
apparel, and accessories aligned with the
Code.
HINT: Your employer
should review Employee
Health Policy frequently
with the FOH employees
because they come into
direct contact with the
public and their personal
items.
How to use a 3 compartment bar sink
1.Dump beverage remnants in an approved sink for dumping. This
may be done in the first or second vat of bar sink in batches. Then
set up the sink to wash.
2. Wash in water no less than 110°F.
3. Rinse adequately.
4. Check the sanitizer strength and temp.
5. Sanitize with approved sanitizer by immersion.
6. Verify that the mechanical dish machine operates at the temps/
sani on the data plates.
6. Air dry. Never towel dry.
7. Polish only after glass is dry. Use a clean wiping cloth that has
never been used for another purpose.
HINT: If your bar or wait station does
not have an approved dump
sink, STOP. Do not dump in
the hand sink. Do not dump
in a bucket. Glasses with
leftover drink go to the
kitchen.
Menus
FOH must consider the menus as a “de facto” utensils that must be
cleaned. Although it is not a food contact surface, menus transfer
microbes from person to person. Clean the menus at least daily and
remember, you can only wash your own hands.
8 9
Jewelry
The Code prohibits food employees from wearing wrist jewelry. That
includes threaded bracelets, inspirational bracelets, metal jewelry,
wrist watches, smarter watches, and fitness
trackers. NOTHING is allowed on the wrists.
Finger jewelry is limited to one plain band.
One ring. That is plain. No bezeling, etching,
engraving, and stones are allowed.
These are considered obstacles to hand
washing and possible physical contaminants
if jewelry fails into food and beverage. The Code does not address
piercings, ear rings, necklaces, and bejeweled attire.
It is highly recommended to address these other accessories early
because they can be risks that are easily eliminated with a good uni-
form policy.
Notes:_______________________________
____________________________________
____________________________________
____________________________________
____________________________________
Fingernails
Using the same rationale as jewelry, nail length and nail polishes
may be obstacles to hand washing and may pose physical con-
tamination risks.
For FOH employees, there are really only two options.
Natural nails must be trimmed and unpolished.
Polished nails, gel nails, acrylic nails, and longer nails must
be covered when handling food, clean utensils and equip-
ment, linens, and single service. This means dipping the
soup, plating butter, rolling silverware, and packing take-out.
Clean Utensils
Great care goes to ensure that all tableware and glassware are
cleaned and sanitized in between uses.
Clean Utensil Storage
If clean utensils are stored in the FOH
areas, they must be transported in a san-
itary manner. They must be carried in
dish racks or placed on carts. Avoid
stacking glasses and plates against the
body or carrying stacks by hand.
Use trays or baskets to transport table-
ware to wait stations where tableware is
rolled.
Preset tables
Dining tables may be preset where the table has been cleaned.
Unused preset tableware may be re-used if:
-the exposed tableware that is not needed is removed at the seating
of patrons at the table, or
-the tableware is rolled where no part of the mouth-contact surface is
exposed.
Tableware that is not removed must be bussed with the table.
There are many ways to roll silverware that is acceptable.
Do not preset bar seating unless tableware is fully rolled.
Clean the exterior of condiments daily.
Do refill condiments without cleaning and sanitizing the containers.
Never refill single-use containers.
Innovation Grant
Fund Update 2018
Victoria Hudson
Innovation Grants Manager
Purpose
•The Orange County Health Department strives
to empower all staff to identify, study, and
solve problems that impede quality services
delivery and access for clients and the public.
•The Innovation Fund is a great tool that
provides a way for staff to identify innovative
potential solutions and receive funding to
pilot that solution.
History – funding
•Medicaid Cost Settlement dollars were set aside by the
Board of Health, at the request of the Health Director
Colleen Bridger, in order to create a fund for new,
innovative projects. This was formalized in the fall of
2012, with the first year of projects starting in 2013.
History – projects
IMPLEMENTATION YEAR GRANTS
2014 4
2015 5
2016 10
2017 (1/2) 1
2017-2018 3
Adjustments to the Process
•Encourage team approach
•Know technological limitations
•Be realistic about time for implementation
•Develop stronger evaluations
•Fiscal accounting methods
•Develop a rubric for grading grant proposals
2017 (1/2)
•One grant for a Pre-k Tooth Brushing Initiative
finished full implementation in June 2017.
•There was slow resistance to implement the
program, through education and
compromising on the timing, the teachers
were pleased with the project.
•The parents were excited to be part of this
project and showed interest. The students
have enjoyed our visits and also seem to be
excited about brushing during school.
2017-2018 – projects
Name Lead
Be the 1 To Suicide
Prevention Campaign
Ashley Rawlinson
FOH Food Safety
Training
Victoria Hudson
Onsite Water Protection
Calendars
Barbara Hawksworth
Innovation Success- BeThe1To
•Multiagency involvement
•Suicide prevention month activities: kickoff
event, awareness walk, and QPR prevention
training
•2 focus groups among High School students
•Meeting with the Director of Healthful Living
& Athletics, in Chapel Hill Carrboro City
Schools and student advisors at high schools
to discuss support groups
OSWP Calendars Ready for 2019
Front of the House Food Safety
•Video production and booklet production
required more time than expected
•Excellent cooperation from volunteers,
videographers, printers, and photographers
•The first measure of implementation will be in
July with training provided free of charge to
every establishment in OC
•The link to the video will be made public after
the initial measures
2018-2019 Cycle
•Call for ideas- 9 ideas submitted
•5 selected for full applications
•Grant announcement late June
•Implementation can begin as early as July 1
•Mid-year progress is due December 31
•Final report is due June 30
2018-2019 – proposals
Name Lead
Transportation
Assistance
Renee Kemske, et al
Patient Education Julie Johnson, Meghann
Johnson
Intraoral Cameras Dr. Stephanie George
41 or Below Angela Sowers, et al
Art for OCHD Kristin Prelipp
Questions?
www.OrangeCountyNC.gov/Health
Agenda Item Number:
ORANGE COUNTY BOARD OF HEALTH
AGENDA ITEM SUMMARY
Meeting Date: 6/27/2018
Agenda Item Subject: 2017 Annual Communicable Disease Report
Attachment(s): Communicable Disease Report
Staff or Board Member Reporting: Iulia Vann, Community Health Services Manager
Purpose: ____ Action
_ x_ Information only
____ Information with possible action
Summary Information:
Prevention, Investigation and Surveillance of Communicable Diseases is part of the Orange
County Health Department’s mandated services. The Communicable Disease team in the Health
Department monitors true and potential threats at all times, during business hours, after hours
and on weekends. The Annual Communicable Disease Report presented by the Community
Health Services Manager, will highlight the number of Communicable Disease cases that were
investigated in 2017 and more information will be provided on the trends that have been
observed over the years in some of these diseases.
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 Communicable Disease Report
January-December, 2017
Number of Cases
Disease/Condition 2012 2013 2014 2015 2016 2017
Campylobacter 31 25 21 16 13 29
Cryptosporidium 3 8 7 4 4 3
Dengue 0 0 0 0 1 0
E.coli 2 4 5 9
Ehrlichiosis 4 4 4 2 10 7
Encephalitis (arboviral) 0 0 2 0 0 0
Group A Strep (invasive) 1 5 5 3 2 3
Haemophilus influenza,
invasive
0 1 2 2 5 4
Hepatitis A 1 1 0 0 2 0
Hepatitis B (Acute) 0 0 0 3
Hepatitis B (Chronic)* 24 17 12 38 74 22
Hepatitis B (Perinatal) 12 1 10 6
Influenza Death** 0 0 0 2 3 Adult 4,
peds 0
Legionellosis 0 1 2 3 3 2
Lyme 3 3 5 1 6 6
Malaria 2 1 3 2 0 0
Measles 0 8 0 0 0 0
Meningococcal Disease 0 0 1 0 0 0
Pertussis 23 4 10 6 16 10
Rocky Mtn. Spotted
Fever
24 16 19 12 7 8
Salmonellosis 21 21 27 17 40 31
Shigellosis 0 4 1 1 2 5
TB 2 2 1 1 0 1
Vibrio 0 0 1 0 1 1
TOTAL 153 126 138 115 115 154
Table 9: Sexually Transmitted Disease Cases among Orange County residents by year 2013-2015 [i]
2013 2014 2015 2016 2017
Gonorrhea cases 114 112 183 163 229
Chlamydia cases 470 472 684 636 768
Syphilis cases 3 17 13 11 33
Newly reported HIV infections
among OC residents
16 14 12 11 11
Newly reported AIDS cases among
OC residents
8 10 8 4 0
*The above numbers are preliminary and were obtained from the 2015 fourth quarter report, annual numbers were not available.
Outbreaks 2017
Date Cases
Noro Virus Like Illness at Sorority
House
August
2017
35
Noro Virus Like Illness at
Fraternity House
December
2017
15
Influenza/Influenza-Like Illness at
School
December
2017
38
Pertussis Community Outbreak December
2017
20
Historical Information
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
Rabies Contacts 15 27 17 4 36 241 398 358 370 268 303 301 333 418 523 466 407 404
Pertussis Cases 0 4 0 4 2 0 2 0 11 18 2 4 23 4 10 6 16 10
TB cases 7 5 2 5 (Jail) 5 4 2 7 (Jail) 7 (Jail) 1 4 3 2 3 1 1 0 1
Latent TB Infections
Treated
11 24 32 29 44 53 35 85 72 65 41 64 53 59 50 37 41 41
Refugee Arrivals/
CD Screenings
227 118 51 87 78 73 76 58* 146 23
Annual Communicable Disease
Report
2017
Iulia Vann, MPH
Community Health Manager
Purpose
∗To reduce morbidity and mortality resulting from
Communicable Diseases that are a significant threat to the
public health in Orange County.
∗Investigate events in a timely manner so that needed control
measures can be rapidly identified and applied.
Communicable Disease Program
∗Best practice – share with involved stakeholders and with the
Board of Health
∗LHD Accreditation Benchmark 2.5 – it is the LHD responsibility
to take reports of CD, look at the incidence and note aspects
that may need to be communicated to the stakeholders,
public and the BOH when the reports indicate a disease or
level that is outside the normal incidence.
Annual CD Report
21
5
0
27
1 1
16
5
0
17
1 0
13
2 2
40
2 1
29
9
0
31
5
1
0
5
10
15
20
25
30
35
40
45
2014 2015 2016 2017
Foodborne Illnesses
10
0
12
2 6 2
38
2
16
3
74
5 10 4
22
4
0
10
20
30
40
50
60
70
80
Pertussis Influenza Deaths Hepatitis B - Chronic Haemophilus
Influenza
2014 2015 2016 2017
Vaccine Preventable Diseases
5
3
19
4
1 2
12
2
6
0
7
10
6
0
8 7
0
5
10
15
20
Lyme Malaria RMSF Ehrlichiosis
2014 2015 2016 2017
Vectorborne Illnesses
7
2
4
3
4
3 3
2
0
1
2
3
4
5
6
7
8
Cryptosporidium Legionellosis
2014 2015 2016 2017
Waterborne Illnesses
472
112
17 14 10
684
183
13 12 8
636
163
11 11 4
768
229
33 11 0 0
100
200
300
400
500
600
700
800
900
Chlamydia Gonorrhea Syphillis New HIV New AIDS
2014 2015 2016 2017
Sexually Transmitted Diseases
Date Cases
Noro Virus Like Illness at Sorority House August 2017 35
Noro Virus Like Illness at Fraternity House December 2017 15
Influenza/Influenza-Like Illness at School December 2017 38
Pertussis Community Outbreak December 2017 20
Outbreaks 2017
523
1 50 76
466
1 37 58
407
0 41
146
404
1 41 23
0
100
200
300
400
500
600
Rabies
Investigations
TB cases LTBI Refugee Arrivals
2014 2015 2016 2017
Other relevant data
Agenda Item Number:
ORANGE COUNTY BOARD OF HEALTH
AGENDA ITEM SUMMARY
Meeting Date: June 27, 2018
Agenda Item Subject: Fluoride Ad Hoc Committee Update
Attachment(s):
Staff or Board Member Reporting: Jessica Frega
Purpose: ____ Action
_X Information only
____ Information with possible action
Summary Information: An update on the first ad hoc fluoride committee where the
preliminary review process was discussed.
Recommended Action: ___Approve
___Approve & forward to Board of Commissioners for action
___Approve & forward to ___________________________
_X_Accept as information
___Revise & schedule for future action
___Other (detail):
Agenda Item Number:
ORANGE COUNTY BOARD OF HEALTH
AGENDA ITEM SUMMARY
Meeting Date: June 27, 2018
Agenda Item Subject: NALBOH Annual Conference
Attachment(s): PowerPoint
Staff or Board Member Reporting:
Purpose: ____ Action
_ X Information only
____ Information with possible action
Summary Information: An overview of the 2018 NALBOH conference scheduled for
August 8-10, 2018 at the Marriot Raleigh Crabtree Valley in
Raleigh will be presented.
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):
NALBOH 2018 Annual Conference
“Strengthening the Public Health Voice”
Attendees will have the opportunity to :
•Network with others so we can:
–Identify methods for integrating the Six Functions of
Governance within the Public Health System
–Discuss success stories in public health governance with
other local and state board members
–Evaluate successful Board of Health experiences and
application of the Six Functions
–Apply the Six Functions of public health governance to
strengthen the public health voice
•Form Partnerships and share resources
•Learn Governance best practices for boards of health
(for both new and seasoned board members).
NALBOH 2018 Annual Conference
“Strengthening the Public Health Voice”
Registration Rates
•Full Conference ( Wednesday – Friday)
–Members - $400
–Non-Members - $500
•One Day Registration (Thursday or Friday)
–Members - $250
–Non-Members - $350
•Pre-Conference (Wednesday Only)
–Members - $150
–Non-Members - $250
Agenda Item Number:
ORANGE COUNTY BOARD OF HEALTH
AGENDA ITEM SUMMARY
Meeting Date: June 27, 2018
Agenda Item Subject: Board of Health Strategic Plan
Attachment(s): Board of Health Strategic Plan
Staff or Board Member Reporting: Beverly Scurry
Purpose: __X__ Action
_ _ Information only
____ Information with possible action
Summary Information:
The finalized Board of Health Strategic Plan will be presented. The Board previously
gathered in their subcommittees to discuss their parts of the plan. They also had an
additional overview of the plan during the May board meeting. Tonight the board will
vote to accept the finalized plan.
Recommended Action: _X__Approve
___Approve & forward to Board of Commissioners for action
___Approve & forward to ___________________________
___Accept as information
___Revise & schedule for future action
___Other (detail):
Orange County Board of Health
Strategic Plan 2018-2020
Social
Determinants
of Health
Physical
Activity Nutrition
Mental
Health
Racial
Equity
Community
Engagement
919.245.2400
www.OrangeCountyNC.gov/Health
Charge
The Board of Health is the primary policy-making and adjudicatory body for the Health
Department. It is charged to protect and promote the public health of Orange County.
Every two years, the Board of Health establishes a new strategic plan based on
community health priorities and research on policies proven to improve community
and individual health.
Contents
Orange County Board of Health
Strategic Plan 2018-2020
INTRODUCTION ......................................................................................................................... 1-2
Priority: SOCIAL DETERMINANTS OF HEALTH ...................................................................... 3
Focus Area #1: Serve as a catalyst and advocate for health outcomes in the Family
Success Alliance.
Focus Area #2: Advocate for and pursue policies and practices aimed at improving
access to care, with a focus on cultural and language barriers to access.
Priority: PHYSICAL ACTIVITY AND NUTRITION .................................................................. 3-4
Focus Area #1: Advocate for and pursue policies, practices, and partnerships aimed
at increasing access to healthy foods and safe places for physical activity.
Focus Area #2: Advocate for and pursue evidence-based policies, practices, and
partnerships that increase physical activity and improve nutrition in schools.
Priority: SUBSTANCE ABUSE AND MENTAL HEALTH ........................................................ 4-5
Focus Area #1: Serve as a catalyst and advocate for policies and practices that
promote integrated care in the Orange County Health Department and other
medical providers in the county.
Focus Area #2: Advocate for and pursue policies, practices, and partnerships that
improve substance abuse and mental health services in Orange County, especially to
vulnerable populations such as the homeless and those connected with the criminal
justice system.
ENGAGEMENT .............................................................................................................................. 5
Focus Area #1: Actively engage with local government, advisory boards, and the
community on Board of Health strategic plan priority areas.
TIMELINE ...................................................................................................................................... 6
Every four years the Orange County Board of Health commissions a Community Health
Assessment (CHA) to identify pressing and emerging community health issues. The latest
Community Health Assessment was completed in December of 2015. As in years past,
the Board adopted the community’s top three health priorities from the CHA to focus the
Board’s next policy-focused Strategic Plan.
The community’s top three priorities:
1) Social Determinants of Health
2) Physical Activity & Nutrition and
3) Substance Abuse & Mental Health
More detailed information on the most recent Community Health Assessment (CHA) is
available on the Health Department website HERE. To oversee the work of the Strategic
Plan, the Board of Health has three oversight committees—one for each priority—that
meets to ensure action steps and deliverables are met.
2016—2018 Strategic Plan Highlights
Full report accessible on Board of Health website
SOCIAL DETERMINANTS
• The Orange County Dental Clinic implemented a text messaging service in July 2017.
Since implementation, 2360 appointments have been confirmed through the messaging
system, 3132 email addresses have been enabled and confirmed valid, 5060 unduplicated
cell phones have been enabled and confirmed valid, and the patient no show rate has
decreased from 15% to 12% since July 2017.
• The Board of Health received a report, found HERE, on Over-the-Counter Birth Control.
PHYSICAL ACTIVITY AND NUTRITION
• The BOH supported three teachers of the Partnership Academy in the Orange County
School System to attend the Action-Based Learning Training. Partnership Academy has
implemented movement activities into all core classes. These activities serve to build
cooperative and relationship skills, teamwork and a sense of belonging in a fun, move-
ment-oriented atmosphere.
SUBSTANCE ABUSE AND MENTAL HEALTH
• OCHD’s integrated behavioral health program improves patient health outcomes by
integrating mental health and substance abuse services into OCHD clinical services.
Services include annual screening of all teen and adult patients for depression, alcohol
and other substance use; brief therapeutic clinical interventions; and referrals. Since
2016, the program has served 731 patients.
• The BOH received a report by Cardinal Innovations Healthcare Solutions that outlines
how Orange County Government contributes approximately $1.3 million annually to the
INTRODUCTION
Page 1
Local Maintenance of Effort (MOE) Funding that is divided among over 30 separate line
items and 12 entities to address mental health and substance abuse. That presentation can
be found HERE.
• The Orange County Health Department has a designated seat on the Orange County
Justice Advisory Council (JAC). The JAC’s goals include examining the County’s justice
system through collaborative efforts and research, promoting safety, improving the just
and efficient treatment of offenders and reducing crime rates, incarceration rates and
recidivism.
ENGAGEMENT
• Twice a year the board is presented with a summary report of local boards within
Orange County. The report is based on the work of local boards as it pertains to the top
priorities of the Board of Health.
Strategic Planning in Context
The Board of Health Strategic Plan is a tool created by the Board to implement new
policies, conduct research, and create recommendations and guidelines, for its members,
OCHD staff, and community partners to address the top health priorities in the county.
These plans not only communicate how we will address the community’s health priorities,
but also how our values as an organization drive our work.
In the last year, the Orange County Health Department (OCHD) has
undergone a significant leadership change. In December 2017, new
Health Director, Quintana Stewart, MPA was hired to lead the
organization forward and guide the board in a strategic direction of
innovation and accreditation accountability. “My vision for Orange
County Health Department is that we operate as innovative Health
Strategist building deliberate community partnerships, implementing
evidence-based practices, and addressing social determinants of
health as we take a holistic look at our community,” states Stewart.
In 2019, OCHD will undergo the next Community Health Assessment (CHA) process and
in 2021, the next Accreditation process. These mandated processes greatly inform the
strategic direction and leadership of the Board of Health. Closely aligning the Boards
strategic plan with the CHA and Accreditation processes will allow the board to implement
policies, recommendations, and guidelines that align with the state mandated responsibilities
of the department and needs of the greater community. BOH Chair Susan Elmore states,
“We’re excited to take the time between now and the next strategic plan to really dive into
alignment of all strategic planning processes that occur within the OCHD. This will help
ensure that we are meeting crucial benchmarks, valuing the input of our staff, and
aligning our efforts with the needs of the community.”
Page 2
Quintana Stewart, MPA
Efficiency, customer-centered, innovation, and high quality are values that drive the staff,
services, and programs within the OCHD. The department is examining itself internally
and externally through a racial equity lens to ensure those values are upheld for all who
come in contact with OCHD. We recognize that systems can be responsible for
perpetuating racism in the community; therefore the department is working to dismantle
racism by reviewing all policies, programs, services, and work culture to ensure that all
clients receive the services that they need most and that staff have an work environment
in which they feel valued.
Priority: Social Determinants of Health
Health is much more than what happens within the walls of a clinic or hospital. Health is
influenced by our homes, schools, jobs, and access to social and economic opportunities.
These impacts on health are known as the Social Determinants of Health (SDH). Issues
such as poverty, access to care, employment and transportation were all discussed as im-
portant SDH in Orange County by residents during the 2015 Community Health Assess-
ment. The Board of Health will work to address these issues through the focus areas and
subsequent action steps below.
Focus Area #1: Serve as a catalyst and advocate for health outcomes in the Family
Success Alliance.
1) By January 2019, the Board of Health will further explore policy and funding
options to support the updated Family Success Alliance Strategic Plan.
2) By August 2019, Health Department staff will explore the use of clinical tools,
such as ACEs screening, to use in OCHD clinics to identify important social deter-
minants of health and appropriate interventions.
Focus Area #2: Advocate for and pursue policies and practices aimed at improving
access to care.
1) Annually, the Board of Health will offer support to the Healthy Carolinians Access
to Care Committee to raise awareness and utilization of transportation and NC 211
in Orange County.
Action Steps
Page 3
(Left) REC logo (Pictured Center) In April 2018 Orange County Government sponsored a delegation to attend
the Equity Summit 2018 in Chicago, Illinois. (Right) The Racial Equity Commission (REC) is a nine-member
committee that serves as a catalyst to ensure that racial equity is an active agent throughout all organziational
processes and to improve the work environment for all staff members.
Priority: Physical Activity and Nutrition
Obesity remains a top health concern for Orange County adults and children. Chronic
diseases are the leading cause of death in Orange County, and heavily influenced by
physical activity and nutrition. Prevention is the most effective way to address obesity
and the chronic diseases related to it. Effective prevention means ensuring safe places for
physical activity and access to healthy foods in all communities. The Board of Health will
work to address these issues through the focus areas and subsequent action steps below.
Focus Area #1: Advocate for and pursue policies, practices, and partnerships aimed at
increasing access to healthy foods and safe places for physical activity.
1) By December 2018, the BOH will collaborate with the Orange County Food
Council and UNC Students to explore food policies that are feasible to implement
in the Orange County community.
2) By June 2019, the PAN Subcommittee will explore the creation of a health app, to
highlight safe places for physical activity and nutrition options in Orange County.
Focus Area #2: Advocate for and pursue evidence-based policies, practices, and
partnerships that increase physical activity and improve nutrition in schools.
1) Each fiscal year for the school systems in Orange County, the Board of Health
will offer a formalized small grant opportunity to all schools to implement in-class
or other physical activity programs.
Priority: Substance Abuse & Mental Health
Substance abuse and mental health issues permeate local public health. From exposure
to environmental tobacco smoke causing an increase in cardiovascular disease to the
challenges associated with ensuring medication compliance in a depressed patient with
a communicable disease, mental health and substance abuse have far-reaching health
and economic impacts. Addressing these problems will take a fully engaged and active
presence by all organizations serving these clients. The Board of Health will address
this issue through the focus areas and subsequent action steps below.
Focus Area #1: Serve as a catalyst and advocate for policies and practices that promote
integrated care in the Orange County Health Department and other medical providers in
the county.
1) By March 2019, Health Department staff will investigate the feasibility, follow-up
referral options, and reimbursement barriers for primary care providers to provide and
bill for Screening, Brief Intervention, and Referral to Treatment (SBIRT), telephone and
face-to-face consultation with behavioral health providers, and care provided by a be-
havioral health and primary care provider on the same day in the same clinic.
Focus Area #2: Advocate for and pursue policies, practices, and partnerships that
improve substance abuse and mental health services in Orange County, especially to
Action Steps
Page 4
Action Steps
vulnerable populations such as the homeless and those connected with the criminal
justice system.
1) By October 2019, the SAMH Subcommittee will explore with Cardinal Innovations
Healthcare Solutions and other local mental health stakeholders the evidence-base,
feasibility of, and follow-up referral options for mental health screening and referral
kiosks in target community locations.
2) By March 2020, Health Department staff will partner with criminal justice and
jail partners to explore a pilot system to ensure continuity of behavioral health care
during and after incarceration.
Engagement
Focus Area #1: Actively engage with local government, advisory boards, and the
community on Board of Health Strategic Plan priority areas.
1) The Board will receive summaries on the activities of applicable local boards or
governing bodies at meetings two times per year, or as necessary for timely board
action.
2) By August 2019, the Board will support racial equity work in the Orange County
community by collaborating with and establishing partnerships with local community
partners who are also working on racial equity within their organization and community.
Action Steps
Page 5
The Board of Health is the primary policy-making
and adjudicatory body for the Health Department
and is charged to protect and promote the public
health of Orange County. The Board is mandat-
ed by state law and is composed of profession-
als representing specified health related fields in
addition to several at-large members and attend
regularly scheduled meetings.
Timeli ne for Comp letion
2 018 2019 2 020
Social Determinants of Health Q
3
Q
4 Q1 Q
2
Q
3
Q
4 Q1 Q
2
Focus Area # 1: Support for Family Success Alliance
Explore policy and funding to support the FSA Strategic Plan
Explore screening tools for social determinants of health at OCHD
clinics
Focus Area #2: Increase Access to Care
Support Health Carolinians in the areas of transportation and NC 211
Physical Activity and Nut r ition
Focus Area #1: Increase access to healthy food and safe place for
physical activity
Explore food policies in collaboration with the Orange County Food
Council
Explore the creation of a health app
Focus Area #2: Physical Activity & Nutrition in Schools
Provide small funding opportunity for schools to increase PAN
opportunities
Substance Abuse & Mental Health
Focus Area #1: Polices & Practices to Promote Integrated Care
Investigate reimbursement barriers for PCPs to provide integrated
care
Focus Area #2: Policies & Practices for SAMH services in Orange
County
Explore mental health screening and referral kiosks
Explore system of continuity of care before/after incarceration
Engagement
Focus Area #1: Engage with Policymakers and Community
Summaries on policy actions of local boards twice a year
Establish collaborative relationships with organizations working on
racial equity
Page 6
TIMELINE
919.245.2400
www.OrangeCountyNC.gov/Health
Health Director’s Report
June 2018
• June 1, 2018 – Met with Finance & Administrative Service (FAS) Supervisors.
• June 2, 2018 – Via invitation from Orange Resilience Initiative (ORI), participated as a
Panelist for the film viewing RESILIENCE: The Biology of Stress & The Science of Hope at
the Silver Spot Theatre in Chapel Hill.
• June 4, 2018 – Final transition meeting with former Interim Health Director, Dorothy Cilenti.
• June 5, 2018 – Campus & Community Coalition (CCC) Work Group Meeting; gave the
purpose and charge to a new CCC Work Group tasked with using a public health philosophy
to inform policy/systems level change; co-facilitated with Chapel Hill Town Manager, Roger
Stancil.
• June 6, 2018 – BOH Ad-hoc Fluoridation Review Committee
• June 7, 2018 – Orange County Department Director’s Meeting
• June 7, 2018 – BOCC Human Services Budget Work Session
• June 8, 2018 – Joint DSS/Health Management Team Meeting; great meeting full of program
information sharing; staff from both departments express interest in continued meetings.
• June 18, 2018 – Family Success Alliance Advisory Council Meeting
• June 20, 2018 – Meeting with Triad AIDS Group to discuss potential collaborative work with
OCHD.
• June 20, 2018 – Meeting with UNC Maternal & Infant Health staff to discuss collaboration
on project “Designing Resilient Systems for Collaborative Maternal Mental Health”.
• I have been selected to participate in the 2018 North Carolina Public Health Leadership
Institute (NC PHLI). This is initiative is co-sponsored by the North Carolina Division of
Public Health, the North Carolina Public Health Association and the North Carolina Institute
for Public Health at the UNC Gillings School of Global Public Health. The program includes
on-site and distance learning activities from July 2018 to June 2019.
Program Updates
HPES
• Multiple program areas are working on Strategic Planning during Summer 2018 – Family
Success Alliance and Board of Health
• Healthy Homes Program is exploring video conferencing technology to enable staff to
conduct home visits when EH staff and/or nurses are unable to physically join them at the
home; video conferencing will allow the patient to receive the services from EH/Nursing
in lieu of their physical presence onsite.
• Family Success Alliance hosted two Family Fun Day Events during the month of June for
program participants and community residents in Zones 4 & 6. Both events were well
attended.
PHS
• EPIC Go-Live scheduled for June 26th; staff have spent the bulk of June training
• New Clinic Manager, Lisa Lowe, joined the team on June 4th.
• New Part-Time Advanced Practice Practitioner, Jane Grace, joined the team on June 18th.
Communications Manager & Communicable Disease
• Kristin is working on Ebola signage for Clinics; in response to the outbreak of Ebola in
the Democratic Republic of Congo (DRC), the NC Communicable Disease Branch
advises local health departments to obtain travel history from all patients that come in for
care.
Environmental Health
• Search continues for an EH Director.
FAS
• New Informatics Manager hired; Ms. Juliet Sheridan will join the team on Thursday,
June 28, 2018. Juliet was a CDC Fellow with the Health Department last year.
Upcoming Events
• June 27, 2018 – Meeting with Jeff Strickler, Vice President, UNC Hospital Hillsborough
Campus
• July 11 & 25, 2018 – State Health Coordinating Council Public Hearings on the NC
Proposed 2019 State Medical Facilities Plan (SMFP).
Parents warned of possible chickenpox at East Chapel Hill High School | The Herald Sun
http://www.heraldsun.com/news/local/education/article211926759.html[6/20/2018 11:36:08 AM]
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Parents warned of possible
chickenpox at East Chapel
Hill High School
This patient with chickenpox developed lesions on the
skin of his chest and torso. Chickenpox is an infectious
disease caused by the varicella-zoster virus resulting in
an itchy blister-like rash, tiredness and fever. It appears
first on the trunk and face, but can spread over the entire
body causing between 250 and 500 itchy blisters. Centers
for Disease Control
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Parents warned of possible chickenpox at East Chapel Hill High School | The Herald Sun
http://www.heraldsun.com/news/local/education/article211926759.html[6/20/2018 11:36:08 AM]
HILLSBOROUGH —
BY GREG CHILDRESS
gchildress@heraldsun.com
May 25, 2018 03:28 PM
Parents are urged to be
vigilant after a possible case of chickenpox was
reported at East Chapel Hill High School this
week.
The Orange County Health Department sent
parents a letter Wednesday, warning them
about their children's possible exposure to the
contagious disease.
The student in question also attended East
Chapel Hill High's combined musical concert
performance Tuesday with Phillips Middle
School.
"If your child develops any symptoms of
chickenpox, contact your child’s pediatrician or
local health department to discuss his care.
Please call ahead if you are planning to visit any
type of healthcare facility," Quintana Stewart,
the Orange County health director wrote
parents.
Chickenpox is a contagious disease caused by
the varicella-zoster virus (VZV). Symptoms
include a blister-like rash, itching, tiredness,
and fever lasting an average of four to six days.
Most children recover without any problems.
The disease is spread through the air from an
infected person’s coughing or sneezing or by
direct contact with the blisters. A person with
chickenpox can spread the disease one to two
Parents warned of possible chickenpox at East Chapel Hill High School | The Herald Sun
http://www.heraldsun.com/news/local/education/article211926759.html[6/20/2018 11:36:08 AM]
days before they get the rash until all of their
blisters have formed scabs. It takes from 10 to
21 days after exposure to a person with
chickenpox for a person to develop chickenpox.
People with questions or concerns are asked to
call their medical provider or Iulia Vann, the
Orange County public health services manager,
at 919-245-2425.
Greg Childress: 919-419-6645, @gchild6645
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