HomeMy WebLinkAboutBOH agenda 022719ORANGE COUNTY BOARD OF HEALTH
MEETING AGENDA
DATE: February 27, 2019
TIME: 7:00 P.M.
PLACE: Southern Human Services Center
2501 Homestead Road
Chapel Hill, NC 27516
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 February 27, 2019 Agenda
7:10 – 7:15 IV. Action s Items (Consent)
A. Minutes of January 30, 2019 Timothy Smith
7:15 – 8:15 V. Educational Sessions
A. Campus & Community Coalition Update Elinor Landess
(30 minutes) (relative to BOH Strategic Plan Priority:
Substance Abuse & Mental Health)
B. Orange Resilience Initiative Ennis Baker & Sara Garrison
(30 minutes) (relative to BOH Strategic Plan Priority:
Social Determinants of Health)
8:15 – 8:40 VI. Action Items (Non Consent)
A. FY 2019-20 Budget Request Quintana Stewart/
Rebecca Crawford
B. FY 19-20 Fee Changes Rebecca Crawford
8:40 – 8:55 VII. Reports and Discussion with Possible Action
A. Fluoride Ad Hoc Committee Update Liska Lackey
B. Board of Education Letter of Support Jennifer Deyo
C. Health Director Report Quintana Stewart
D. Media Items
8:55 – 9:00 VIII. Board Comments
9:00 IV. 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 BOARD OF HEALTH
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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 January 30, 2019 at the Orange
County Health Department, 300 West Tryon Street, Hillsborough, NC.
BOARD OF HEALTH MEMBERS PRESENT: Jessica Frega –Vice-Chair, Keith Bagby, Bruce
Baldwin, Barbara Chavious, Jennifer Deyo, Susan Elmore, Commissioner Earl McKee, Liska
Lackey, and Sam Lasris.
BOARD OF HEALTH MEMBERS ABSENT: Timothy Smith and Paul Chelminski.
STAFF PRESENT: Quintana Stewart, Health Director; Coby Jansen Austin, Director of
Programs and Policy; Susan Clifford, Immigrant and Refugee Health Program Manager;
Rebecca Crawford, Financial and Administrative Services Director; Victoria Hudson,
Environmental Health Director; Donna King, Health Promotion & Education Services Director;
Anissa McCall, Patient Account Technician; Pam McCall, Public Health Nursing Director;
Cristina Blasini Melendez (arrived after new employee introductions), Office Assistant I; Kristin
Prelipp, Communications Manager; Gregory Schiltz, Registered Dietitian/Program Manager;
Beverly Scurry, BOH Strategic Plan Manager; La Toya Strange, Administrative Support I and
Trisha Tant, Account Technician I.
GUESTS PRESENT: Amber Henry and Michael Peterson.
I. Welcome New Employees
Jessica Frega, Vice-Chair, called the meeting to order at 7:00pm. Quintana Stewart, Health
Director, introduced the new employees in attendance: Anissa McCall, Gregory Schiltz and
Trisha Tant.
II. Public Comment for Items NOT on Printed Agenda: None.
III. Approval of the January 30, 2019 Agenda
Motion was made by Susan Elmore to approve the agenda, seconded by Keith Bagby and
carried without dissent.
IV. Action Items (Consent)
A. Minutes of November 28, 2018 Meeting
Motion was made by Susan Elmore to approve the minutes of November 2018 with an
edit, seconded by Bruce Baldwin and carried without dissent.
V. Educational Sessions
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A. Affordable Housing Coalition Report
Robert Dowling and Delores Bailey, both of the OC Affordable Housing Coalition (OCAHC),
provided an update on the housing crisis in OC. Below are some highlights.
• OCAHC was formed in 2013 to highlight the needs and opportunities for increasing
housing affordability in OC and to foster communication and collaboration among
housing providers and advocates. OCAHC members include non-profit housing
developers, social service providers, advocacy groups, and local government partners.
• The Affordable Housing Summit occurred in February of 2018. A summit report was
created based on the presentation delivered at the summit and the brainstorming
conversations that followed. The summit report was released this past October. The
report contained the following sections:
o An introduction to the coalition and a description of the purpose of the summit
o An overview of the current state of affordable housing
o A summary of the small group discussions that occurred after the summit
presentation. The group’s discussion generated innovative solutions on how we
can all make a difference. The solutions were organized into the following four
areas:
Collaboration and Partnerships
Imagining New and Creative Ideas
Increasing Communication and Education
Better Utilization of Resources
• Affordable housing is housing in which occupants pay no more than 30% of their gross
monthly household income.
• The Area Median Income, or AMI, is generated by the US Department of Housing and
Urban Development (HUD) to determine who is eligible for certain housing.
o Households making 0-30% of AMI are considered extremely low income.
o Those making 30-50% of AMI are considered very low income.
o Those making 50-80% of AMI are considered low income.
o All households making less than 80% of AMI are eligible for income-based
housing or “affordable housing”.
• 1 in 3 OC households are “cost-burdened” which means they are spending more than
30% of their income on housing.
• There are large income disparities by race and ethnicity as well as disparities for
proportion of income spent on housing based on age. Income for African-Americans and
Hispanic/Latino households are much lower than other groups. For African-Americans,
there is a high percentage of households with incomes less than 30% of the AMI. One-
third of African-American households are making less than 30% of AMI.
• There are large income disparities by age with seniors being the most cost burdened
age group; 28% of senior homeowners and 56% of senior renters are cost burdened.
• Of the 56,474 housing units in Orange County, approximately 1,700 are permanently
affordable (about 3%).
• Types of affordable housing:
o There is affordable housing that is income restricted. This is housing that is
intentionally developed as affordable and is only available to households that meet
specific income limits also known as subsidized housing.
o Market Rate Affordable Housing, also known as Naturally Occurring Affordable
Housing or NOAH, is housing that is not income restricted, but it is affordable based
on the price point. This makes up the majority of affordable housing in the U.S.
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• Orange County, Chapel Hill, Carrboro, and Hillsborough have really shown dedication to
improving affordable housing by using mechanisms that address affordable housing
such as creating Orange County Bonds, dedicated local budget funding, dedicated staff
to advance affordable housing, inclusionary housing policy, the creation of housing
advisory boards, and the Northside Neighborhood Initiative.
The BOH had questions that were addressed by Mr. Dowling and Ms. Bailey.
B. 2nd Quarter Financial Reports & Billing Dashboard Reports
Rebecca Crawford, Financial & Administrative Services Director, gave a report on the 2nd
quarter revenue and billing accuracy. The report is as follows:
• Total Health Department Revenue: Average YTD monthly revenue in FY19 after the
second quarter is $210k/month or $1.3m YTD, representing 36.4% of our overall
budgeted revenue for the year. Multiple factors contribute to the lower than normal
revenue: Electronic Medical Record (EMR) change to Epic, provider on maternity leave
in Dental, and departmental closures due to hurricane Florence, snow, and overall wet
weather negatively impacting onsite well and septic inspections. Allocations of Medicaid
Max funds will not be transferred into our budget until the end of the fiscal year.
Expenses are higher than revenues, but on trend, at 45.5% of the overall budget.
• Total Billing Accuracy: Billing Accuracy is under construction due to the change in
medical EMR. The Informatics team and UNC Epic reporting staff are working diligently
to have this measure for both medical and dental back by the third quarter financial
report.
• Dental Earned Revenue by Source: The FY 18-19 average monthly revenue
($41k/month) for the second quarter is below our budget projection ($45k/month) and
our FY 17-18 average of $42.6k/month due to having a dentist on maternity leave. We
are now able to see our new Hygienist has quickly caught up to our existing Hygienists
in terms of seeing patients and meeting monthly revenue goals and anticipate the
monthly average will increase along with our total revenue to be closer to the budgeted
amount. FY 18-19 dental earned revenue totaled $246k at the end of the second
quarter.
• Medical Earned Revenue by Source: Medical earned revenue is currently below the
budgeted projection for FY 18-19 ($55.6k/month) at $29k/month (although higher than
the first quarter average of $16.3k/month) due to provider turnover (2 new providers
started seeing patients in late July and August) and as clinic staff continue to work
through issues with the new EMR, improved customer service during the EMR transition
with longer appointment times (meaning we saw fewer patients), and have dealt with
clinic closures due to hurricane Florence and snow. We anticipated these issues as they
arise in all new automation projects and have staff dedicated to fixes by increased
training for providers, weekly workflow meetings, a Quality Improvement team called the
“Epic Optimization Team”, and teams devoted to building algorithms with UNC IT to
decrease errors in the billing system build (our state requirements make our billing very
different from a typical UNC outpatient clinic and require much more specificity). Medical
clinic revenue totals $174k for second quarter FY 18-19.
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• Environmental Health Earned Revenue by Source: Environmental Health earned
revenue is currently below the budgeted projection for FY 18-19 ($53k/month) at
$44.1k/month although this is a seasonal trend and has been affected by office closings
and wet weather, which resulted in an inability to perform as many onsite well and septic
inspections. We typically see an increase in revenue during the spring with public pool
and septic inspections and the division is working on a strategy to quickly decrease the
number of pending weather-delayed inspections.
• Grants Fund Revenue: FSA has drawn $100k of the multi-year Kenan grant. We will
receive the second allocation of $100k in third quarter FY 18-19. Expenditures are
steadily increasing as the new Social Work Supervisor II position has been filled and is
implementing her program strategies.
The BOH members had questions that were addressed by Ms. Crawford.
C. Immigration Updates
Susan Clifford, Immigrant and Refugee Health (IRH) Program Manager, shared updates on
data, research, OCHD & community activities, and new policies and practices affecting our
community and clients. Below are highlights.
• The IRH Program has many tasks including language services policies & coordination,
2.5 Staff Spanish/English medical interpreters, 15 contract interpreters, ASL, telephonic
& video interpreters, OC Interagency Coalitions (Latino & Refugee Health).
• Non or limited-English speaking patients seen in each clinic: 31% Medical, 39% Dental
with the top languages being Spanish, Karen, Burmese, Chinese, Arabic
• Refugee Arrivals to OC: 102 people in FY16-17; 22 people in FY17-18; 8 people in the
1st half of FY18-19
• I-693 Process changes –
o Form needs to be signed within 2 months of when Refugee Patient submits
Adjustment of Status (I-485: Green Card) Application to USCIS
o Form is only valid when Health Department Doctor signs form no more than 60
days before the date the Refugee Patient files the complete application package
• Some activities that occurred in 2017-2018 include:
o Termination of Deferred Action for Children Arrivals (DACA) and Deferred Action
for Parents of Americans and Lawful Permanent Residents (DAPA)
o End of Temporary Protected Status Designations
o Refugee Admissions Reduction
o Travel Ban & Extreme Vetting
o Expansion of Enforcement Priorities
o Proposed Public Charge Rule Changes (Public Comment – Dec 2018)
o Citizenship question proposed for Census
The BOH members had questions that were addressed by Ms. Clifford.
D. 474 CLAS Standards Advancing Health Equity AA
Beverly Scurry, BOH Strategic Manager, and Donna King, Health Promotion & Education
Services Director, provided an update on the funding received from the NC Office of Minority
Health and Health Disparities (OMHHD) to address the health status gap between racial/ethnic
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minorities and the general population. The goal is to provide training for agencies and
communities to increase cultural and linguistic competence through adoption of the National
Standards for Culturally and Linguistically Appropriate Services (CLAS) in Health and Health
Care. Below are highlights of the presentation.
• Service period - December 1, 2018 – May 31, 2019
• Award amount is $18,000
• Nine deliverables –
o Identify Health Department Staff that will implement the CLAS program.
o Convene Health Equity Council (HEC) that must meet minimum requirements of
having representation from the health department to include the health director or
designee, a health educator, social worker, nurse, an administrative staff and
translation/interpreter staff. Representation must also be from at least 7
community agencies such as hospital, mental health services, local health
agencies, etc.
o 30% of OCHD staff and HEC members will go through trainings provided by the
NC Office of Minority Health and Health Disparities.
o 30% of OCHD staff, HEC, and new OCHD employees will go through trainings
related to health equity, racial equity, social justice, or cultural competency.
o Collect patient/client demographic data and conduct CLAS-related assessments.
o Conduct a community forum around health equity and CLAS-related data.
o Share progress to the community through social media, print materials,
newsletter, emails, presentations, website postings, etc.
o REC will serve as the materials review team to analyze materials created and/or
distributed by OCHD for high quality, understandability and multiple languages.
• Will be working with consultant, Deitre Epps, to facilitate the community forum that will
occur in May.
• Program plan and budget have been submitted.
• First HEC meeting will be on February 13th.
VI. Reports and Discussion with Possible Action
A. BOCC Work Plan Review
As the BOCC will review the Annual Work Plan reports from advisory boards and commissions
at their April 4th work session, the BOH will need to select a topic from their 2018 Annual
Report/Work Plan to present to the BOCC. After some discussion, the BOH chose the topic of
Adverse Childhood Experiences (ACEs). Reminders will be sent and an invitation was
extended to the BOH members to attend the BOCC work session presentation.
Motion to approve Annual Report/Work Plan for presentation to BOCC and highlight the
topic of Adverse Childhood Experiences and forward to the Clerk to the Board was made
by Liska Lackey and seconded by Jennifer Deyo.
B. Health Director Report
In addition to her report, some of the highlights Ms. Stewart gave are below:
• Ms. Stewart congratulated Victoria Hudson on her appointment as Environmental Health
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Director as of January 5th. Since her leadership as Interim Environmental Health Director,
complaints have been down and customer service has improved.
• The Chapel Hill Campus & Community Coalition Town Hall meeting was rescheduled to
March 20th as they wanted to get feedback from the community before the meeting. The
March 20th meeting will be held at the Chapel Hill Library. Elinor Landess will present
the last 5 years of data at our Board meeting next month.
• On the 2019 legislative front, Ms. Stewart briefly mentioned the Medicaid Expansion,
Communicable Disease funding, Enact Tobacco 21 and the Women’s & Children’s
Health Block Grant.
• Ms. Stewart agreed to serve as a member and co-chair the Education and Awards
Committee for the Health Directors Association. Major tasks include planning the annual
awards luncheon and the new health directors orientation.
• Rebecca Crawford and Ms. Stewart attended the Annual Public Health Leaders
Conference in Raleigh. Health equity was the main topic of discussion with a focus on
social determinants of health. There was much conversation about Healthy People
2030. The disparity gap is getting wider even though health is getting better.
• Ms. Stewart will be orienting Commissioner Sally Green on January 28th.
VII. Board Comments.
Jessica Frega reminded all that next month’s meeting will take place at the SHSC. Keith Bagby
disclosed that he was approached by his former employer, BCBS, to fill in as an underwriter.
Commissioner McKee suggested that Mr. Bagby consult our county attorney to make sure there
wasn’t a conflict of interest. Ms. Frega also mentioned that the OC Board of Education has
recognized that they haven’t done a great job at racial equity. She suggested a possible letter of
support of their efforts to improve racial equity and stated that this matter may be more suitable
for one of the Board’s subcommittees. Bruce Baldwin commended Ms. Frega on her first time
presiding as Chair.
VIII. Adjournment
Bruce Baldwin moved to adjourn the meeting at 8:47pm and Barbara Chavious
seconded.
The next Board of Health Meeting will be held February 27, 2019 at the Southern Human
Services Center, 2501 Homestead Road, Chapel Hill, 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: February 27, 2018
Agenda Item Subject: Campus and Community Coalition Update
Attachment(s):
Staff or Board Member Reporting:
Purpose: ____ Action
_X _ Information only
____ Information with possible action
Summary Information:
Elinor Landess, Director of the Campus & Community Coalition (CCC), will present a
brief overview of the Coalition's history and strategies, and will talk through selected
data points from the Coalition's recently completed 5-year evaluation project. Elinor will
also solicit high-level input on the Coalition's findings in preparation of the March 20th
CCC Community Town Hall breakfast.
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):
Campus &
Community
Coalition
BOARD OF HEALTH
FEBRUARY 27, 2019
The CCC’s background
Former Chancellor + Mayor initiative, 2014
Collaboration: Town + University + County (MOU renewed 2018)
High risk focus
Public health philosophy
3 areas:
1.Downtown
2.Near-campus neighborhoods
3.University
Enforcement Education/Awareness
Policy/Environment
Synergistic Strategies
Theory of Change
CCC Activities
Campus,
Community, &
Downtown
Environment
•Town & University
Policy
•Enforcement of
Alcohol-Related
Policies
•Availability of
Alcohol
•Normative
Environment
Drinking
Behaviors
Alcohol-Related
Consequences
GOAL
Strategies:
Awareness/Education
B the Bee Social Norms
Campaign
A Conversation Worth Having
BARS training
Bar/Restaurant Roundtables
Alcohol Resource Guide
Strategies:
Policy/Environment
Campus Alcohol Policy
Compliance Check Policy
Party Registration Policy
Late Night Carolina
Good Neighbor Initiative N.E.A.T.
Strategies:
Enforcement
•ALERT Operations
•Campus Alcohol Policy
Adjudication
•Fake ID Adjudication
•Compliance Checks
Who, What,
When,
Where, Why,
and How
Who: Town of Chapel Hill, Chapel Hill PD, UNC
PD, UNC Student Wellness, Carolina Housing,
UNC Student Conduct, Chapel Hill-Carrboro
City Schools, Orange County Health
Department
What: Survey data and administrative reports
When: 2013-2018
Where: Chapel Hill, Carrboro, Southern Orange
County
Why: Evidence-based decision-making
How: Collection, Analysis, Reporting
MPH team from Gillings School of Global Public
Health
Availability of alcohol: Location of alcohol
consumption, UNC Students
Population Indicator (simplified) Baseline
(2013-2014)
Year 1
(2014-2015)
Year 2
(2015-2016)
Year 3
(2016-2017)
Year 4
(2017-2018)
Data Source
3.4) Location of student alcohol consumption
Underage UNC students
who drink
Consumed alcohol
from a bar or restaurant -- 42.3% -- 29.3% -- CORE Alcohol
& Drug Survey
UNC students who drink Consumed alcohol in a
residence hall -- 59.6% -- 52.0% --
Consumed alcohol in a
frat/sorority -- 59.6% -- 59.1% --
Consumed alcohol in a
bar/restaurant -- 56.3% -- 49.6% --
Consumed alcohol at
private parties -- 80.7% -- 78.5% --
Availability of Alcohol: Location of alcohol
consumption, High School Students
Population
Indicator (simplified) Baseline
(2013-
2014)
Year 1
(2014-
2015)
Year 2
(2015-
2016)
Year 3
(2016-
2017)
Year 4
(2017-
2018)
Data Source
3.4) Location of student alcohol consumption
High school students who
drink
Consumed alcohol in a car 21.1% -- 8.5% -- 4.7%*
Youth Risk Behavior
Survey
Consumed alcohol in own home or
a friend’s house while parents are
supervising
28.8% -- 46.0% -- 49.1%*
Consumed alcohol in own home or
a friend’s house while parents are
present but NOT supervising
49.2% -- 56.3% -- 56.8%
Consumed alcohol in own home or
a friend’s house when parents are
away
83.6% -- 68.8% -- 67.5%*
Availability of
Alcohol:
Licensed
Establishments
68.00%
70.00%
72.00%
74.00%
76.00%
78.00%
80.00%
82.00%
84.00%
86.00%
Baseline (2013-2014)Year 1 (2014-2015)Year 2 (2015-2016)Year 3 (2016-2017)Year 4 (2017-2018)
Proportion of businesses that pass ABC compliance checks
Normative environment: UNC Students
Population Indicator (simplified) Baseline
(2013-2014)
Year 1
(2014-2015)
Year 2 (2015-
2016)
Year 3
(2016-2017)
Year 4
(2017-2018)
Data Source
4.1) University student perception of the promotion of alcohol use
UNC Students
Believe the campus social
environment promotes
alcohol use
-- 70.5% -- 69.1% -- CORE
4.2) University student perceptions around high-risk drinking
UNC Students
Overestimate how often
(# of days per month) their
peers usually drink
90.6% -- -- -- 89.6%
NCHA Survey UNC Students Overestimate how much
(# of drinks) their peers
usually drink
69.0% -- -- -- 63.7%
Drinking behavior: High School & Middle
School
Population Indicator (simplified) Baseline
(2013-2014)
Year 1
(2014-2015)
Year 2 (2015-
2016)
Year 3
(2016-2017)
Year 4
(2017-2018)
Data Source
5.1) Drinking prevalence among high school and middle school students
High school students
Have ever drank
-- -- 50.5% -- 43.5%
YRBS Middle school
students 8.1% -- 10.3% -- 11.6%
5.2) Drinking frequency among high school and middle school students
High school students
Drank in last 30 days
33% -- 29% -- 23%
YRBS Middle school
students 5.1% -- 2.3% -- 4.8%
5.3) Binge drinking among high school students
High school students Binge drank in the last 30
days 16.8% -- 14.4% -- 10.1% YRBS
5.4) Age of drinking onset
High school students who drink First drink before age 15 24.7% -- 27.4% -- 23.1% YRBS
Drinking behavior: University students
Population Indicator (simplified) Baseline
(2013-2014)
Year 1
(2014-2015)
Year 2 (2015-
2016)
Year 3
(2016-2017)
Year 4
(2017-2018)
Data Source
5.2) Drinking frequency among university students
UNC Students Drank in last 30 days -- 64.7% -- 61.8% -- CORE
UNC Students who drink
Average number of drinks
per episode 4.52 -- -- -- 4.38 NCHA
Average number of drinks
per week -- 6.82 -- 5.34* -- CORE
5.3) Binge drinking among university students
UNC students Binge drank in the last 2
weeks -- 39.5% -- 35.8% -- CORE
UNC students who binge
drink
Binge frequency: average
number of binge drinking
sessions in the last 2 weeks
1.92 -- -- -- 2.11 NCHA
Negative consequences
127
99
61
80
0
20
40
60
80
100
120
140
Baseline (2013-14)Year 1 (2014-15)Year 2 (2015-16)Year 3 (2016-17)Year 4 (2017-18)
Annual alcohol-related Orange County EMS Transports of youth 24 and
under
EMS Transports
Negative Consequences
Population Indicator
(simplified)
Baseline
(2013-2014)
Year 1
(2014-2015)
Year 2
(2015-2016)
Year 3
(2016-2017)
Year 4
(2017-2018)
Data
Source
6.1) Individual alcohol-related consequences
UNC
students
who drink
Did
something
they regret
after
drinking
40% -- -- 39.7% --
NCHA Injured
themselves
after
drinking
16% -- -- 13.8% --
Blacked out
in the last
year
34.4% -- -- 31.2% --
March 20, 2019
8:30-10am
Chapel Hill
Public Library
TOWN HALL MEETING
Agenda Item Number:
ORANGE COUNTY BOARD OF HEALTH
AGENDA ITEM SUMMARY
Meeting Date: February 27, 2018
Agenda Item Subject: Orange Resilience Initiative
Attachment(s): Powerpoint and 3 Handouts
Staff or Board Member Reporting:
Purpose: ____ Action
_X _ Information only
____ Information with possible action
Summary Information:
This educational session is specific to the Social Determinants Subcommittee.
Presenters Sara Garrison and Ennis Baker (see bios below) will inform the Board of
what ACEs (Adverse Childhood Experiences) are and what being a trauma-informed
organization means. They will highlight the importance of health departments becoming
trauma-informed and recommendations on how to achieve that.
---------
Sara Garrison, BSW- Assuring Better Child Health & Development (ABCD) Coordinator
& Early Interventionist, KidSCope
Sara has worked for KidSCope since 2013 in the pediatric office as an ABCD
Coordinator in Alamance and Caswell counties, and now in Orange and Chatham
counties since 2016. There she helps clinicians serve children birth-five years old by
providing assistance with developmental screenings and referrals to early intervention
and other community services. She is also an early childhood therapist, serving
children birth-3 years of age with developmental delays.
Ennis C. Baker, MSW, LCSW - Project Director, Trauma-Informed Infant-Toddler Child
Care project, Duke Center for Child & Family Policy
Ennis is a licensed clinical social worker, specializing in early childhood mental health
and has served in a variety of roles serving high risk children ages birth to 5 and their
families. She began her career as a toddler teacher in San Francisco’s
Bayview/Hunter’s Point neighborhood in 1988 and since 1990 has lived and worked in
various counties in North Carolina focusing on children under 5 as a child care provider,
home visitor, program director and on a multidisciplinary evaluation team. From 1999-
2018, Ennis served as a manager and mental health specialist for Orange County Head
Start/Early Head Start in Chapel Hill, NC. In this role, she provided leadership and early
childhood mental health consultation to program staff and families around issues of
toxic stress, child abuse & neglect, parenting, preventing and managing children’s
challenging behavior, quality child care, adult & child mental health and strengthening
families by promoting protective factors. Ennis is trained as a facilitator/parent educator
in Triple P Level 3, Incredible Years Parenting Program, Circle of Security Parenting
and Darkness to Light/Stewards of Children. She serves on the Board of the North
Carolina Infant and Young Child Mental Health Association and on the Durham ACEs
Task Force. She has co-chaired the Orange/Chatham Early Childhood Mental Health
Task Force since 2012 and co-led the Orange RESILIENCE Initiative since 2017.
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):
Adapted from ACESTOOHIGH.com:
What’s Your ACE Score? And What’s Your Resilience Score?
There are 10 types of childhood experiences measured in the ACE Study. There are, of course, many other types of
childhood experiences and environments that can be traumatic (see the Pair of ACEs). The ACE Study included only
those 10 childhood experiences that were mentioned as most common by a group of about 300 people who had Kaiser
Permanente health insurance; those experiences were also well studied individually in the research literature prior to
the study which was conducted in the early 1990’s. The study’s researchers came up with an ACE score to explain a
person’s risk for chronic disease. Think of it as a cholesterol score for childhood toxic stress and trauma.
The most important thing to remember is your ACE score is NOT your destiny. The ACE score is meant as a guideline to
help us understand how childhood experiences, both positive and negative, affect our health and wellbeing for our
lifetime. There are many proven strategies to prevent ACEs, promote resilience, and help people, families and
communities heal from trauma.
Prior to your 18th birthday (Please CIRCLE YES or NO for each statement):
1. Did a parent or other adult in the household often or very often…
Swear at you, insult you, put you down, or humiliate you? OR
Act in a way that made you afraid that you might be physically hurt?
YES or NO
2. Did a parent or other adult in the household often or very often…
Push, grab, slap, or throw something at you? OR
Ever hit you so hard that you had marks or were injured?
YES or NO
3. Did an adult or person at least 5 years older than you ever…
Touch or fondle you or have you touch their body in a sexual way? OR
Attempt or actually have oral, anal, or vaginal intercourse with you?
YES or NO
4. Did you often or very often feel that …
No one in your family loved you or thought you were important or special? OR
Your family didn’t look out for each other, feel close to each other, or support each other?
YES or NO
5. Did you often or very often feel that …
You didn’t have enough to eat, had to wear dirty clothes, and had no one to protect you? OR
Your parents were too drunk or high to take care of you or take you to the doctor if you needed it?
YES or NO
6. Were your parents ever separated or divorced?
YES or NO
7. Was your mother or stepmother:
Often or very often pushed, grabbed, slapped, or had something thrown at her? OR
Sometimes, often, or very often kicked, bitten, hit with a fist, or hit with something hard? OR
Ever repeatedly hit over at least a few minutes or threatened with a gun or knife?
YES or NO
8. Did you live with anyone who was a problem drinker or alcoholic, or who used street drugs? YES or NO
9. Was a household member depressed or mentally ill, or did a household member attempt suicide?
YES or NO
10. Did a household member go to prison?
YES or NO
Now add up your “Yes” answers: _____ This is your ACE Score (transfer to bottom of page)
What’s Your Resilience Score?
The questions below were adapted from a questionnaire that was developed by the early childhood service providers,
pediatricians, psychologists, and health advocates in Augusta, Maine. The content of the questions was based on a number of
research studies. Its purpose is limited to parenting education. It was not developed for research.
RESILIENCE Questionnaire
Please CIRCLE the most accurate answer under each statement:
1. I believe that my mother (or primary parent) loved me when I was little.
Definitely true Probably true Not sure Probably Not True Definitely Not True
2. I believe that my other parent loved me when I was little.
Definitely true Probably true Not sure Probably Not True Definitely Not True
3. When I was little, other people helped my parents take care of me and they seemed to love me.
Definitely true Probably true Not sure Probably Not True Definitely Not True
4. I’ve heard that when I was a baby someone in my family enjoyed playing with me, and I enjoyed it, too.
Definitely true Probably true Not sure Probably Not True Definitely Not True
5. When I was a child, there were relatives in my family who made me feel better if I was sad or worried.
Definitely true Probably true Not sure Probably Not True Definitely Not True
6. When I was a child, neighbors or my friends’ parents seemed to like me.
Definitely true Probably true Not sure Probably Not True Definitely Not True
7. When I was a child, teachers, coaches, youth leaders or faith leaders were there to help me.
Definitely true Probably true Not sure Probably Not True Definitely Not True
8. Someone in my family cared about how I was doing in school.
Definitely true Probably true Not sure Probably Not True Definitely Not True
9. My family, neighbors and friends talked often about making our lives better.
Definitely true Probably true Not sure Probably Not True Definitely Not True
10. We had rules in our house and were expected to keep them.
Definitely true Probably true Not sure Probably Not True Definitely Not True
11. When I felt really bad, I could almost always find someone I trusted to talk to.
Definitely true Probably true Not sure Probably Not True Definitely Not True
12. As a youth, people noticed that I was capable and could get things done.
Definitely true Probably true Not sure Probably Not True Definitely Not True
13. I was independent and a go-getter.
Definitely true Probably true Not sure Probably Not True Definitely Not True
14. I believed that life is what you make it.
Definitely true Probably true Not sure Probably Not True Definitely Not True
How many of the 14 were “Definitely True” or “Probably True”? _______ = childhood RESILIENCE score
TRAUMA-INFORMED CAREKEY INGREDIENTS FOR10As health care providers become aware of the harmful eects of trauma
on physical and mental health, they are increasingly recognizing the
value of trauma-informed approaches to care.
The Adverse Childhood Experiences (ACE) Study, conducted by
the CDC and Kaiser Permanente, revealed that the more an
individual is exposed to a variety of stressful and potentially
traumatic experiences, the greater the risk for chronic health
conditions and health-risk behaviors later in life.
WHAT IS THE IMPACT OF TRAUMA ON HEALTH?
For more details, read the brief, Key Ingredients
for Successful Trauma-Informed Care Implementation.
Visit www.TraumaInformedCare.chcs.org.
Clinical practices address the impact
of trauma on individual patients:
Organizational practices reorient the
culture of a health care setting to address
the potential for trauma in patients and sta:
Physical, sexual, and emotional abuse
Poverty anddiscrimination
Family memberswith a mental healthdisorder
Suddenseparation from aloved one
Depression
Lung, heart, and liver disease
Substance usedisorder
Autoimmunediseases
Sexuallytransmittedinfections
Lead and communicate about being trauma-informed
Engage patients in organizational planning
Train both clinical and non-clinical sta
Create a safe physical and emotional environment
Prevent secondary traumatic stress in sta
Build a trauma-informed workforce
Involve patients in the treatment process
Screen for trauma
Train sta in trauma-specic treatments
Engage referral sources and partner organizations
ChildhoodneglectThe Substance Abuse and Mental Health Services
Administration (SAMHSA) describes trauma as
events or circumstances experienced by an
individual as physically or emotionally harmful or
life-threatening, which result in adverse eects on
the individual’s functioning and well-being.
WHAT IS TRAUMA?
Trauma-informed care acknowledges that understanding a
patient’s life experiences is key to potentially improving
engagement and outcomes while lowering unnecessary utilization.
In order to be successful, trauma-informed care must be adopted
at the organizational and clinical levels.
HOW CAN PROVIDERS BECOME TRAUMA-INFORMED?
1 7
8
9
10
2
3
4
5
6
Trauma-Informed CareImplementation Resource CenterTraumaInformedCare.chcs.org
Understanding Adverse Childhood Experiences (ACEs)
Exposure to childhood ACEs
can increase the risk of:
Ÿ Adolescent pregnancy
Ÿ Alcoholism and alcohol abuse
Ÿ Chronic obstructive pulmonary
disease (COPD)
Ÿ Depression
Ÿ Early initiation of sexual activity
Ÿ Early initiation of smoking
Ÿ Fetal death
Ÿ Health-related quality of life
Ÿ Illicit drug use
Ÿ Ischemic heart disease (IHD)
Ÿ Liver disease
Ÿ Multiple sexual partners
Ÿ Risk for intimate partner
violence
Ÿ Sexually transmitted diseases
(STDs)
Ÿ Smoking
Ÿ Suicide attempts
Ÿ Unintended pregnancies
What are ACEs?
ACEs are significant childhood traumas as identified below which can result in actual changes in brain development. These
changes may affect a child’s learning ability, social skills, and can result in long-tem health problems. The Centers for Disease
Control and Prevention (CDC) views ACEs as one of the major health issues in the 21st century.
Adverse Childhood
Experiences can include:
1.Emotional abuse
2.Physical abuse
3.Sexual abuse
4.Emotional neglect
5.Physical neglect
6.Mother treated violently
7.Household substance abuse
8.Household mental illness
9.Parental separation or divorce
10.Incarcerated household member
How do ACEs affect health?
Through stress. Frequent or prolonged exposure to ACEs can create toxic stress which
can damage the developing brain of a child and affect overall health.
STRESS & EARLY BRAIN DEVELOPMENT
Reduces ability to respond, learn, or
process effectively which can
result in problems in school
Lower tolerance for stress can result in
behaviors such as aggression,
checking out, and defiance
May have difficulty
making friends and
maintaining
relationships
Problems with
learning and
memory can be
permanent
May cause
lasting health
problems
Increases stress hormones
which affects the body's
ability to fight infection
A Survival Mode Response is one that increases heart rate, blood pressure,
breathing and muscle tension. When a child is in survival mode, self-protection
is their priority. In other words:
“I can’t hear you, I can’t respond to you, I am just trying to be safe.”
Community & Family Services Division
1101 West College Avenue, Spokane, WA 99201-2095
509.324.1640 | TDD 324.1464 | www.srhd.org
The good news is resilience brings hope!
What is Resilience?
Resilience is the ability to adjust (or bounce back) when bad things happen. Research
shows resilience helps reduce the effects of ACEs. Protective factors are internal and
external resources that help us to build our resilience.
What are protective factors?
1.Parental resilience
Increasing parents’ ability to problem-solve and build relationships with
their child and others
2.Nurturing and attachment
Listening and responding to a child in a supportive way and discovering
and paying attention to the child’s physical and emotional needs
3.Social connections
Having family, friends or neighbors who
are supportive and willing to help or
listen when needed
4.Concrete supports
Having their child’s basic needs met,
such as housing, food, clothing and
health care
5.Knowledge of parenting and child
development
Increasing parents’ knowledge of their
child’s development and appropriate
expectations for their child’s behavior
6. Social and emotional competence
of children
Helping their child to interact positively
with others, manage emotions and
communicate feelings
Resilience trumps ACEs!
Parents, teachers and caregivers can help children by:
Ÿ Gaining an understanding of ACEs
Ÿ Creating environments where children feel safe emotionally and physically
Ÿ Helping children identify feelings and manage emotions
Ÿ Creating protective factors at home, schools and in communities
Resources:
Parent Help 123
www.parenthelp123.org
1-800-322-2588
Resilience Trumps ACEs
www.resiliencetrumpsaces.org
Washington Information Network
www.win211.org
1-877-211-WASH (9274)
CDC Adverse Childhood
Experiences (ACE) Study
www.cdc.gov/ace/about.htm
Confronting Adverse Childhood Experiences
(ACEs), Trauma & Toxic Stress
to Promote Resilience
Investing in
Trauma-Informed
Care
and Equity for ALL Ennis C. Baker, MSW, LCSW
Sara Garrison, BSW
Orange County Board of Health
Strategic Plan 2018-2020
Focus Area #1: Serve as a catalyst and advocate for health
outcomes in the Family Success Alliance
Action Step 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 determinants of health and appropriate interventions
Focus Area #2: Advocate for and pursue policies and
practices aimed at improving access to care, with a focus on
cultural and language barriers to access
From “Using Standardized Social Determinants of Health
Screening Questions to Identify and Assist Patients with
Unmet Health-related Resource Needs in North Carolina”,
NCDHHS, April 2018
“The three questions around interpersonal safety are not meant to be a
proxy or replacement for a full ACE screening. Performing a full ACE
screening allows for the timely recognition and efficient management of
the emotional and physical consequences of adverse childhood
experiences. Significant research has shown the relationship between
ACEs and a variety of known risk factors for disease, disability and early
mortality. While the Department recognizes the importance of
performing an ACE screen, it is not the focus of this paper.”
ADVERSE COMMUNITY ENVIRONMENTS
ADVERSE CHILDHOOD EXPERIENCES
THE PAIR OF ACES – the Building Community Resilience (BCR) Model
Adverse Childhood Experiences (ACEs)
6
ACEs describe the actual events and experiences that
a child may face:
•Physical, sexual, or emotional abuse
•Chronic neglect
•Caregiver substance abuse or mental illness
•Loss of caregiver (e.g., incarceration, custody change,
deployment, death)
•Exposure to violence in communities and homes
•Systemic racism/discrimination
•Poverty/homelessness
•Chronic illness or severe injury
•Natural disasters
Prevalence of ACEs – original study
7
Out of over 17,000 survey
respondents:
•64% reported at least ONE ACE
▪26% reported ONE ACE
▪16% reported TWO ACEs
▪9.5% reported THREE ACEs
▪12.4% reported FOUR OR MORE
https://www.cdc.gov/violenceprevention/acestudy/about.html
2018 Average ACE Scores by Race/Ethnicity
8
Merrick, Ford, Ports, & Guinn, 2018 - Nationally representative telephone survey. 214,000 participants.
23 states provided data on ACEs, 11 item survey based on original ACEs survey
-
0
0.5
1
1.5
2
2.5
3
White Black Hispanic Multiracial Other
Average ACE Score
Average ACE Scores by Income
9 Merrick, Ford, Ports, & Guinn, 2018
0
0.5
1
1.5
2
2.5
3
<$15,000 $15,000 -24,999 $25,000 -34,999 $35,000 -49,999 $50,000 or more
Average ACE Score
SAMSHA Building Resilient
and Trauma-Informed Communities
“Building resilient AND trauma-informed communities
is essential to improving public health and well-being.
Communities can be places where traumatic events
occur, and they can also help keep us safe. They can
be a source of trauma, or buffer us against the
negative effects of adversity.
Communities can collectively experience trauma much
like individuals do, and they can be a resource for
healing.”
A service system with a trauma-informed perspective is
one in which agencies, programs, and service providers:
1.Maintain an environment of care for staff that addresses, minimizes, and treats secondary traumatic stress, and that increases staff wellness.
2.Emphasize continuity of care and collaboration across child-service systems.
3.Routinely screen for trauma exposure and related symptoms.
4.Use evidence-based, culturally responsive assessment and treatment for traumatic stress and associated mental health symptoms.
5.Make resources available to children, families, and providers on trauma exposure, its impact, and treatment.
6.Engage in efforts to strengthen the resilience and protective factors of children and families impacted by, and vulnerable to, trauma.
7.Address parent and caregiver trauma and its impact on the family system.
These activities are rooted in an understanding that
trauma-informed agencies, programs, and service
providers:
1.Build meaningful partnerships that create mutuality among
children, families, caregivers, and professionals at an
individual and organizational level.
2.Address the intersections of trauma with culture, history,
race, gender, location, and language, acknowledge the
compounding impact of structural inequity, and are
responsive to the unique needs of diverse communities.
- National Child Traumatic Stress Network (NCTSN)
Trauma-Informed Care Champions:
From Treaters to Healers
•https://youtu.be/8wxnzVib2p4
•4 minutes
Challenge to those investing in equity work and trauma-informed work
Reflect on this statement:
"Being effective at preventing adverse childhood
experiences and trauma and helping people heal and thrive
after experiencing trauma,
REQUIRES
being effective at confronting and eliminating discrimination
and racism AND vice versa."
Agenda Item Number:
ORANGE COUNTY BOARD OF HEALTH
AGENDA ITEM SUMMARY
Meeting Date: February 27, 2019
Agenda Item Subject: FY 2019-20 Budget Request
Attachment(s): Budget Request & Summary
Staff/Board Member Reporting: Quintana Stewart, Health Director
Purpose/Recommended Action: ___ Action/Approve
_X_ Action/Approve & forward to Board of Commissioners
___ Information with possible action
___ Accept as information
___ Revise & schedule for future action
Summary Information:
The proposed FY 2019-2020 budget for the Health Department presents an increase in
expenditures of $20,519 from the FY 18-19 Base Budget; $17,919 of which are related to an
increase in staffing (.5 FTE contract Dental Van Driver, supported by re-allocated county
general funds and fees for service) and an increase in the Environmental Health temporary
staffing ($2,600). Staff projects a $53,094 increase in revenues for FY 19-20, which will fully
offset the expenditure increase. The Health Department will request level county funding for
FY 19-20.
The proposed total budget is $10,575,428.
New Staff Requests
The Health Department requests to convert nine (8.75 FTEs) contract Family Success Alliance
Navigators to permanent employees in order to ensure consistent training, supervision, and
benefits across all Navigators. This conversion will be fully funded with existing contract
services dollars within the FSA budget that were used to pay partner agencies to employee the
Navigators, $34,043 in eligible Medicaid Cost Settlement funds, and $28,272 in Kenan grant
funds. The department also requests to increase the ongoing line item for Environmental
Health Specialist temporary employees. The EHS temps are used to help with an increased
number of WTMP inspections and have also helped decrease overall wait times for well and
septic inspections while contributing additional revenue to the department.
State Funding
The NC Department of Health and Human Services has provided us with the FY 19-20
Consolidated Agreement Addenda. We received increases in the Family Planning, Child
Fatality Prevention, CLAS Standards Advancing Health Equity, and Refugee Health
Assessments programs totaling $34,618. That increase was offset by an anticipated decrease
of $107,407 in the Youth Tobacco program (funding not available in FY 19-20) and in the
Maternal and Child Health mini-grant, Bright Futures grant, and Mosquito Control grant
programs, which were all one time funding sources we received last fiscal year.
Fee Changes
The FY 19-20 requested budget includes fee changes for the Personal Health and
Environmental Health divisions. Staff recommends multiple fee changes for Personal Health,
mainly to adjust vaccine fees to reflect purchase costs and to Environmental Health, which are
mainly to adjust water sampling fees to remain competitive with private sector water sampling
labs. All proposed fee increases are described in more detail in a separate Fee Change
abstract.
Recommended Motion:
To approve the total budget requested in the amount of $10,575,428 for FY 2019-2020 as
presented and forward to the County Manager and Board of County Commissioners for action.
FY 19-20 Base
Budget
FY 19-20
Budget
Request
$ Change from FY
19-20 Base Budget
% Change from
FY 19-20 Base
Budget
$ (3,438,404)(3,491,498)$ 53,094$ 2%
$ 10,554,909 10,575,428$ 20,519$ 0%
$ 7,116,505 $ 7,083,930 (32,575)$ 0%
Health Department's Personnel Requests:
Amount
474,544$
43,955$
518,499$
Operating Budget Drivers
Amount
37,000$
17,919$
18,836$
73,755$
Total
Environmental Health Temporaries -
Ongoing
Personnel:
FSA Navigators 8.75 FTEs County Funds and Kenan Grant
Onsite Well and Septic Fees
Funding Source
Will support entire Health department and act
as a central IT department extension.
Notes
Increase in federal mileage reimbursement
rate from .55 to .585.
Total
Item:
Contract IT Support Analyst
Personal Mileage
Contract Dental Van Driver (0.5 FTE)
Will drive the Dental Van (anticipated to be
complete by November 2019)
Budget Highlights
ORANGE COUNTY HEALTH DEPARTMENT
FY 19-20 Annual Operating Budget
Summary
NET COUNTY
APPROPRIATION
TOTAL EXPENSES
TOTAL REVENUES
Agenda Item Number
ORANGE COUNTY BOARD OF HEALTH
AGENDA ITEM SUMMARY
Meeting Date: February 27, 2019
Agenda Item Subject: FY 2019-20 Fee Schedule
Attachment(s): Fee Schedule & Requested Changes
Staff/Board Member Reporting: Rebecca Crawford, Finance & Administration Director
Purpose/Recommended Action: ___ Action/Approve
_x_ Action/Approve & forward to Board of Commissioners
___ Information with possible action
___ Accept as information
___ Revise & schedule for future action
Summary Information:
In reviewing Health Department fee schedules, which are done on an annual basis, the
Department would like to make multiple fee changes in Environmental Health and Personal
Health. The proposed changes are summarized below with a detailed list of the fees in the
attached fee schedule:
Environmental Health
Environmental Health requests to adjust multiple water sampling, Tattoo Artist, and Pool/Spa
permitting fees and add a Temporary Tattoo permit fee. The water sampling fees will be
adjusted higher and lower in order to remain competitive with both private sector water
sampling services and surrounding jurisdictions. These adjustments should have little to no
impact on the total fee revenue. Fee increases for the Tattoo Artist Annual Permit and Annual
Year Round Pool/Spa will support service level goals of additional inspections besides the
initial permitting inspection to help ensure public safety. The proposed new fee for a
Temporary Tattoo Permit (less than 30 days) will prevent short-term artists from tattooing
without an inspection and encourage apprentices and guest artists to obtain permits. Proceeds
will be used to host a Bloodborne Pathogens certification course for tattoo artists.
The total financial impact from Environmental Health fee changes is projected to be: $9,970.
Personal Health
Personal Health requests to adjust multiple fees for vaccines (to reflect the cost to purchase
the vaccines), to add a fee to perform Department of Transportation physicals now that we
have a provider certified to provide them, to add a fee for emergency contraceptives (to be
charged on a sliding fee scale for self-pay clients or those that do not wish to bill insurance),
and to convert a single minimum fee for colposcopies into four separate minimum fees to
distinguish differing levels of complexity and time involved for the procedures. Finally, the
division requests to implement scheduled adjustments to the fees for 340B drugs (Family
Planning drugs not including birth control pills) to make them match the county’s cost to
purchase them, as required by the state and federal government.
The total financial impact from Personal Health fee changes is projected to be a maximum of
$39,449:
Recommended Motion:
To approve all fee changes for FY 2019-2020 as presented and forward to the Board of
County Commissioners for action.
FY 2019-20 Fee Changes
Environmental Health Fees Changes
Name of Fee 2018-19
Rate
2019-20
Proposed
Rate
Anticipated
Revenue
from Fee
Change
Total Coliform P/A $65.00 $75.00 $ 350.00
Total Coliform MPN $70.00 $75.00 $ -
Fecal Coliform $70.00 $75.00 $ -
Enterococcus, MPN $70.00 $75.00 $ -
Iron Bacteria $70.00 $75.00 $ -
Sulfur/Sulfate - Reducing $80.00 $75.00 $ -
Pseudomonas-MTF or MPN $70.00 $75.00 $ -
Heterotrophic Plate Count $65.00 $75.00 $ -
Full Inorganic Panel $110.00 $100.00 $ -
Anions - FI,CI, Sulf $70.00 $75.00 $ -
Disinfection By-products $70.00 $75.00 $ -
Fluoride $25.00 $75.00 $ -
Nitrate/Nitrite $70.00 $75.00 $ -
Arsenic Speciation $70.00 $75.00 $ -
Hexavalent Chromium $90.00 $100.00 $ 40.00
Coal Ash Inorganic Panel $110.00 $100.00 $ 10.00
Pesticides $110.00 $150.00 $ -
Herbicides $110.00 $150.00 $ -
Petroleum Products $110.00 $150.00 $ -
Volitile Organic Chemicals $110.00 $150.00 $ -
Existing Well Full Well Panel $110.00 $150.00 $ 6,400.00
Tattoo Artist Annual Permit fee $310.00 $350.00 $ 920.00
Temporary Tattoo Permit
(<30days)$0.00 $100.00 $ 500.00
Annual Year Round Pool/Spa
Permit $350.00 $400.00 $ 1,750.00
Personal Health Fees Changes
Name of Fee 2018-19
Rate
2019-20
Proposed
Rate
Anticipated
Revenue
from Fee
Change
Ella/Plan B Emergency
Contraceptive
$ - $ 11.32 $ 371.00
DOT Physical $ - $ 100.00 $ 2,400.00
Bexero Meningococall Vaccine 177.00$ $ 195.50 $ 351.50
Trumemba Meningococcal
Vaccine
$ 248.00 $ 161.00 $ 435.00
Havrix, Adult Hepatitis A vaccine $ 45.00 $ 79.00 $ 1,734.00
Havrix, Pediatric Hepatitis A
vaccine
$ 25.00 $ 37.00 $ 480.00
Twinrix, Hepatitis A/B vaccine $ 102.00 $ 117.00 $ 690.00
Gardisil 9 HPV vaccine $ 180.00 $ 225.00 $ 2,250.00
Fluzone High Dose influenza
vaccine
$ 40.00 $ 53.00 $ 910.00
Prevnar13 Pneumococcal
Vaccine
$ 167.00 $ 217.00 $ 550.00
Imovax Rabies vaccine $ 313.33 $ 357.00 $ 528.00
Rotateq Rotovirus Vaccine $ 99.00 $ 113.00 $ 280.00
Rotatrix Rotovirus vaccine $ 124.00 $ 138.00 $ 280.00
Fluzone Peds influenza vaccine $ 16.00 $ 19.00 $ 30.00
Flublok Influenza Vaccine $ - $ 53.00 $ 2,650.00
Kinrix, DtaP vaccine $ 52.00 $ 57.00 $ 50.00
Quadracel DtaP-IPV vaccine $ - $ 59.00 $ 2,950.00
Pentacel DtaP-IPV-Hib vaccine $ 95.00 $ 101.00 $ 30.00
Daptacel DtaP vaccine $ - $ 30.00 $ 1,500.00
MMR II $ 66.00 $ 101.00 $ 1,400.00
IPOL polio vaccine $ 31.00 $ 34.00 $ 45.00
Varivax varicella vaccine $ 111.00 $ 177.00 $ 3,630.00
Pneumovax 23 pneumococcal
vaccine
$ 80.00 $ 107.00 $ 135.00
Menveo meningococcal vaccine $ - $ 119.00 $ 5,950.00
Energix B Hep B vaccine $ 58.00 $ 67.00 $ 558.00
Heplisav Hep B vaccine $ - $ 132.00 $ 6,600.00
Shinrix Shingles vaccine $ 138.60 $ 166.00 $ 1,370.00
Minimum fee colposcopy of the
cervix $ 30.00 $ 32.00 $ 192.00
Minimum Fee Colposcopy of the
cervix with biopsy and
endocervical curettage $ 30.00 $ 42.00 $ 300.00
Minimum Fee Colposcopy of the
cervix with biopsy $ 30.00 $ 39.00 $ 450.00
Minimum Fee - Colposcopy of
the cervix with endocervical
curettage $ 30.00 $ 37.00 $ 350.00
Medroxyprogesterone acetate, 1
mg (150 units)0.17$ 0.76$ $ 15,488.00
Paragard IUD $ 237.14 $ 237.54 $ -
Skyla IUD $ 375.38 $ 249.00 $ -
Liletta IUD $ 47.04 $ 50.00 $ 9.00
Mirena IUD 310.26$ 249.00$ $ (919.00)
Nexplanon $ 400.50 $ 399.00 $ (46.00)
Agenda Item Number:
ORANGE COUNTY BOARD OF HEALTH
AGENDA ITEM SUMMARY
Meeting Date: February 27, 2018
Agenda Item Subject: Fluoride Ad Hoc Committee Update
Attachment(s):
Staff or Board Member Reporting:
Purpose: ____ Action
__ _ Information only
__X_ Information with possible action
Summary Information:
The BOH Fluoride Ad Hoc Committee will be presenting an update on the status of
securing fluoride experts. The committee will also present various options in moving
forward with the recommendation for OWASA particularly as it relates to the experts.
Recommended Action: ___Approve
___Approve & forward to Board of Commissioners for action
_X_ Approve & forward to Fluoride Ad Hoc Committee
_ __Accept as information
___Revise & schedule for future action
___Other (detail):
Agenda Item Number:
ORANGE COUNTY BOARD OF HEALTH
AGENDA ITEM SUMMARY
Meeting Date: February 27, 2018
Agenda Item Subject: Board of Education Letter of Support
Attachment(s): BOH Equity Policy
Staff or Board Member Reporting:
Purpose: ____ Action
__ _ Information only
__X_ Information with possible action
Summary Information:
During the January 30th Board Meeting, BOH member Jessica Frega asked board
members to consider writing a letter of support for the Orange County Schools (OCS)
Board of Education for the recent approval of their Equity Policy. Jennifer Deyo had a
meeting with OCS Board of Education member Hillary MacKenzie. Jennifer will discuss
the outcome of their meeting and propose next steps with regard to the letter.
Recommended Action: ___Approve
___Approve & forward to Board of Commissioners for action
_X_ Approve & forward to __________________________
_ __Accept as information
___Revise & schedule for future action
___Other (detail):
1st Reading Approval by BOE – 1/28/2019
EQUITY IN EDUCATION Date Reviewed/Approved: Policy Number: 1030
Orange County Schools acknowledges persistent racial intolerance, inequities and academic disparities in
our district. The Board establishes this policy in an effort to eliminate racial intolerance, and other forms
of intolerance, inequities of opportunity, and academic disparities in our district. We see our schools as
centers for culturally diverse learning where all students are educated to their fullest potential and as
centers of our community around which we come together in support of the education of all students.
Equity is critical to the success of our schools, our students, and our community.
A. Definition of Equity
The concept of educational equity goes beyond formal equality to fostering a barrier-free
environment where all students, regardless of their race, class, or other personal characteristics,
have the opportunity to benefit equally in order to succeed and thrive.
An emphasis on equity calls on every adult to treat every student as capable of success and
recognizes the uniqueness and strengths of each student allowing for differences in time,
attention, instruction, and support to ensure that all students can succeed academically and
participate responsibly in our community.
Equity is an interruption of systems, structures, policies, and practices which privilege some
students while discriminating against other students. Strategies that promote equity are intended
to ensure fairness by the following:
1. Countering biased behaviors that cause harm to specific groups.
2. Countering unfair policies, programs, and practices that consistently result in negative
outcomes for groups who are disadvantaged by these actions.
3. Negotiating, re-allocating, and sometimes re-imagining resources, opportunities, and supports
when equal distribution of these things (one size fits all) results in inequitable outcomes that
do not adequately meet specific needs and interests of all groups of students.
B. Mission
Orange County Schools will disrupt all forms of discrimination in our school community by:
1. Challenging intolerant behavior that jeopardizes the safety, well being, or learning of others;
2. Accepting that equity of educational opportunity requires that proactive steps be taken to
address implicit biases and institutional barriers to equity;
3. Recognizing that biases and barriers can result in inequitable opportunities for groups of
students based on their real or perceived personal characteristics such as race, color, ethnicity,
national origin, religion, disability, sex, sexual orientation, gender, gender identity, gender
expression, age, or socioeconomic status;
4. Removing biases and barriers that contribute to achievement gaps which are unacceptable in
a system that strives for equitable educational opportunities for all students. Historically and
currently, in Orange County Schools, such biases and barriers disproportionately affect
students of color.
The Orange County Schools Board of Education is committed to actively and continuously
eliminating disparities in educational opportunities in all its schools, creating and supporting
an environment of equal, equitable, unbiased and culturally responsive learning in a fair and
safe system.
C. BOARD COMMITMENT
1. Orange County Schools shall take active measures to provide an inclusive and emotionally
supportive environment, free from discrimination.
2. All schools in our school system shall take active measures to provide every student with
equal access to high quality and culturally relevant instruction, curriculum, support, facilities
and other educational resources.
3. The Board hereby sets forth a series of expectations with regard to equity in our school
communities. The Orange County Schools will take active measures to:
a. Develop and promote a culture of high expectations for all students;
b. Identify and eliminate inequities in access to opportunities;
c. Continuously raise the level of achievement for all students while eliminating academic
disparities;
d. Ensure that personal characteristics (real or perceived) will not predict any individual’s
educational outcomes;
e. Recognize and aggressively address opportunity gaps;
f. Actively recruit, support, and retain a diverse workforce;
g. Actively train and support all administrators, teachers, and staff in implementing this
policy including creating culturally affirming and relevant classrooms and schools;
h. Engage with staff, students, parents/guardians, and the entire community to build and
sustain a culture emblematic of the ideals of this Equity Policy;
i. Equitably allocate resources to accomplish these goals.
4. In keeping with this policy, the Orange County Schools shall review and revise existing
policies, programs, professional development, and procedures to reflect applicable laws and the
district’s Definition of Equity.
5. The Board and administration shall actively model its commitment to equity to align all new
processes and procedures to applicable law and the district’s Definition of Equity, including but
not limited to:
a. Reports
b. Presentations
c. Decision making at every level
d. The Board as a body will attend racial equity training within one year of the
establishment of this policy and within one year of the election of any new Board
member. Board members will commit to attending subsequent equity trainings of their
choosing offered at the local, state, and national level.
6. The Board shall demonstrate its commitment to equity by directing the Superintendent to
develop an Equity Plan to implement this policy. The Equity Plan will be reviewed annually and
performance metrics will be used to measure progress. The plan will include a communication
plan.
7. The Equity Task Force shall continue to be in place for the purpose of advising the Board and
the Superintendent with regard to matters of equity in Orange County Schools. The Equity Task
Force shall be comprised of a broad group of racially diverse stakeholders including but not
limited to students, parents, administrators, and community members. The Board shall hold an
annual meeting with the Equity Task Force.
Health Director’s Report
February 2019
• February 8, 2019 – Health Department Orientation with Commissioner Jamezetta
Bedford; during the Orientation session with Commissioner Bedford we discussed health
department services, organizational structure, budget and role of the Board of Health. We
completed our session with a tour of the Whitted Health Department facility.
• February 8, 2019 – Racial Equity Commission (REC) and OCHD Leadership Team
participated in a very productive Strategic Planning Work Session. The group worked
through 4 of the 7 recommendations formed as a result of the Racial Equity Assessment
Report. The group will reconvene for an additional half day session in early March to
work on the remaining 3 recommendations.
• February 13, 2019 - The Land Management Central Permitting Software (LMCPS)
Energov project went live as planned. Go Live was a success with no incidents for EH
staff and clients.
• February 15, 2019 – Health Department hosted County Human Resources for a tour and
orientation to health department programs and services. This was an opportunity for staff
to meet some of the fairly new HR staff and share in a little more detail health department
work. The intent of this tour and orientation was to give HR some context around staff
roles and responsibilities so they better understand the Job Description Questionnaires
(JDQ) submitted for reclassification studies and routine job posting activities. Each
division did a great job orienting HR Staff to the various activities of their respective
areas.
Medicaid Transformation Updates (*Orange County is in Region 4*)
• NC DHHS announced the Prepaid Health Plan Contracts. Statewide PHP contracts were
awarded to the following entities, which will offer Standard Plans in all regions in the
State:
o AmeriHealth Caritas North Carolina, Inc.
o Blue Cross and Blue Shield of North Carolina
o United Healthcare of North Carolina, Inc.
o WellCare of North Carolina, Inc.
• Regions 2 and 4 will launch Medicaid Managed Care in November 2019 (Phase I)
• Click link for the PHP Award Fact Sheet:
https://files.nc.gov/ncdhhs/medicaid/Medicaid-Factsheets-PHP-2.4.19.pdf
• OCHD attested as a Tier 3 Advanced Medical Home
• February 1, 2019 – met with staff from Community Care Physician Network (CCPN) to
explore joining their Clinically Integrated Network (CIN) as we prepare for the
November 2019 launch date.
• Health Directors in Region 4 are working together as we begin to review PHP Contracts.
There are still some unanswered questions around the local public health enhanced
payment structure as outlined in the RFP.
Upcoming Events
• February 20, 2019 - Congratulations to Ms. Wanda Crisp, LPN on her Retirement!
Wanda has worked 40+ years as a Nurse and served for the last 6 ½ years as a Lab
Technician for OCHD.
• February 22, 2019 – OCHD will be in collaboration with the SPICE (Statewide Program
for Infection Control and Epidemiology) team from UNC and the Communicable Disease
Branch at the State (more specific the Hospital Acquired Infections team) to create an
Infection Prevention Educational Video. There is going to be a series, one for local health
departments, one for long term care facilities and one for hospitals.
• February 28, 2019 – Annual Review of Outside Agency Funding Applications with
County Manager; this year Health has been assigned 11 applications for review. LaToya
Strange will be communicating more information soon.
• March 1, 2019 – Congratulations to Ms. Iulia Vann, Community Health Services
Program Manager on her New Opportunity! Iulia is leaving us for an awesome
opportunity with the Guilford County Health Department. She has accepted a position as
their Assistant Health Director. As Community Health Services Manager, Iulia has been
responsible for communicable disease outbreak & investigation, oversight of the public
health preparedness program, interpreter services, refugee health, tuberculosis control,
rabies consultation, and immunization registry.
Orange County's Family Alliance Plan works to uplift impoverished families - The Daily Tar Heel
https://www.dailytarheel.com/article/2019/01/family-alliance-plan-0122[2/19/2019 8:12:54 AM]
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1/22/2019, 8:23PM
Orange County's Family Alliance Plan works to uplift
impoverished families
BY ANDREAMARIE EFTHYMIOU
The Orange County Family Success Alliance released their new strategic plan for 2019 until 2022.
Orange County has one of the highest costs of living in North Carolina along with one of the highest rates
of income inequality. According to its new plan, the Orange County FSA hopes to break the cycle of
poverty in Orange County and has begun efforts by working directly with the community.
Orange County's Family Alliance Plan works to uplift impoverished families - The Daily Tar Heel
https://www.dailytarheel.com/article/2019/01/family-alliance-plan-0122[2/19/2019 8:12:54 AM]
This plan lays out the objectives and strategies for meeting its goals.
Starting in 2019, the FSA hopes to be able to connect more families with them and their partners. They
outlined their plans in three goals: to make sure that children are healthy and prepared for school, to ensure
child success in education and to involve families, neighbors and institutions in healthy childhood
development.
FSA plans to meet these goals in specific ways, starting from educating families about how to have
healthy births, supporting early learning for children, developing language skills and making health care
accessible.
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“I think the mission and vision are consistent with what the (Orange County) commissioners initially
identified when we started the FSA," said Coby Jansen Austin, director of programs and policy at FSA.
"What this plan does is focus more explicitly on the desire to uncover family power in driving equity and
systems change. That’s really the most significant evolution. The family empowerment model is growing
to meet families’ needs.”
Orange County's Family Alliance Plan works to uplift impoverished families - The Daily Tar Heel
https://www.dailytarheel.com/article/2019/01/family-alliance-plan-0122[2/19/2019 8:12:54 AM]
The new plan isn't necessarily a change for the FSA, but it is a promise of its commitment to involving
families in decision-making processes, Austin said.
One of the Orange County FSA’s partners is the Compass Center for Women and Families in Chapel Hill.
According to the Compass Center’s website, its mission involves “increasing self-sufficiency and
preventing domestic violence.”
Returning agency to underserved communities in Orange County is a high priority to both the Compass
Center and the FSA, so the Compass Center is excited about the partnership.
“Partnering with FSA has enabled our organization to be responsive and nimble to the needs of those most
impacted by systemic social problems here in Orange County,” said LaKiera Grimes, self-sufficiency
programs director at the Compass Center. “The collaboration has provided a space for natural partnership
and accountability, which has assisted our organization in identifying strengths and gaps in service
provision. FSA also provides a supportive community with shared values that drives important social
change here in our community.”
The FSA wants to give power to the community, including parents, caregivers and youth, according to its
new plan. Jansen said the organization wants those who would benefit from its policies to be involved in
the implementation of them.
The Orange County Literacy Council is another one of the FSA’s partners. Orange Literacy focuses on
helping adults reach their educational goals by offering free services, from tutoring to English classes for
parents with young children.
Orange County's Family Alliance Plan works to uplift impoverished families - The Daily Tar Heel
https://www.dailytarheel.com/article/2019/01/family-alliance-plan-0122[2/19/2019 8:12:54 AM]
The FSA works with organizations like Orange Literacy to ensure they have enough resources and
connections to meet their goals.
“Being part of a collaborative like FSA enables us to work with FSA navigators and to make connections
and referrals for students and their families to other agencies that can link them to needed services and
information,” said Lisa Bobst, family literacy program coordinator at Orange Literacy. “When the
collaborative agencies work together with the families, we have a much better chance of helping families
meet their goals and learn how to help themselves."
@andreaefthy
city@dailytarheel.com
Efthymiou volunteers for the Compass Center as a translator.
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Rural residents can't access health care in a county full of doctors - The Daily Tar Heel
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1/24/2019, 9:31PM
Rural residents can't access health care in a county full of
doctors
BY AIDAN BENNETT
Even though Orange County is home to a major North Carolina hospital, some rural residents still have
limited access to health care.
These rural areas are typically concentrated in the northern part of the county. A 2015 report by the
Orange County Health Department and Healthy Carolinians of Orange County listed lack of medical
insurance, clustered health care resources in the south, inadequate transportation, language barriers and
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perceived discrimination as primary causes of this health care disparity.
“Access encompasses a number of factors including availability, affordability, adequacy and the like,” said
Mark Holmes, director of the Cecil G. Sheps Center for Health Services Research at UNC. “When we talk
about access in Orange County, different elements may impact different parts of that continuum.”
Holmes said while the gap between northern and southern Orange County is not as bad as other health
disparities in the state, the problems occur on a more individual basis.
“There's a lot of areas in the state that have strong health care systems. The problem is reaching the last
mile and also providing baseline primary care,” said John Coggin, director of advocacy at the N.C. Rural
Center. “Even if you have a hospital within an hour or two hours of your home, that doesn't necessarily
mean that you can get that constant level of care you might need.”
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An October 2018 draft of the Orange County Public Transportation Short Range Transit Plan, where the
local governments try to pinpoint what improvements can be made and identify areas of unmet demand,
contained a full section on rural transit services. Nelson\Nygaard Consulting Associates worked on the
Rural residents can't access health care in a county full of doctors - The Daily Tar Heel
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draft and submitted a finalized plan with GoTriangle for November 2018 that cut the section, as well as all
instances of the word “rural.”
The draft suggested a number of options, including expanded bus routes and partnerships with ride-share
services and vanpool programs. Both reports included vanpool programs, but the final draft limited this to
northern Durham County.
Coggin said that even with increased transportation, many people will not have adequate insurance
coverage. North Carolina is part of a minority of states that have not expanded Medicaid coverage under
the Affordable Care Act, but he sees this as a potential solution.
“If we're able to close the health insurance coverage gap in North Carolina, it's going to give access to a lot
more people in our rural areas, and it's going to help stabilize our rural health care system,” Coggin said.
The UNC Center for Latino Health is one program seeking to resolve the issue of language barriers. While
it doesn’t operate in rural Orange County, the center provides specialized care for Spanish-speaking
patients in Chapel Hill.
“If a Latino patient is looking for a doctor and doesn't speak a single word in English, that's a big barrier,”
Program Manager Claudia Rojas said. “We have some pre-med undergrad students learn a little more
Spanish with the Latino community so they seem more confident speaking Spanish with the community.
This is a big plus for non-English-speaking patients.”
Coggin said another potential remedy to this issues is the expansion of telehealth programs. By allowing
patients to connect to doctors online, they can work around language and transportation barriers. He
admits this is not a perfect solution — many areas across the state lack reliable internet, and web programs
can’t deliver all the same treatments that a doctor can in person.
Rural residents can't access health care in a county full of doctors - The Daily Tar Heel
https://www.dailytarheel.com/article/2019/01/rural-health-orange-county-0124[2/19/2019 8:06:31 AM]
Still, these initiatives may alleviate some of the pressures for people in rural areas.
While Orange County has a high ratio of doctors to people, Holmes warns against considering county
statistics as representative of the area.
“What's lost in that is that southern Orange County looks quite different from northern Orange County,
and by considering the county as a whole, we may lose visibility on parts of it that may face different
kinds of challenges,” Holmes said.
@ABennettDTH
city@dailytarheel.com
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