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HomeMy WebLinkAboutBOH minutes 022719MINUTES ORANGE COUNTY BOARD OF HEALTH February 27, 2019 S:\Managers Working Files\BOH\Agenda & Abstracts\2019 Agenda & Abstracts/ February Page 1 ORANGE COUNTY HEALTH DEPARTMENT MISSION STATEMENT: To enhance the quality of life, promote the health, and preserve the environment for all people in the Orange County community. THE ORANGE COUNTY BOARD OF HEALTH MET ON February 27, 2019 at the Orange County Health Department, 2501 Homestead Road, Chapel Hill, NC. BOARD OF HEALTH MEMBERS PRESENT: Timothy Smith, Chair, Jessica Frega, Vice- Chair, Keith Bagby, Bruce Baldwin, Paul Chelminski, Jennifer Deyo, Susan Elmore, Liska Lackey and Sam Lasris. BOARD OF HEALTH MEMBERS ABSENT: Barbara Chavious and Commissioner Earl McKee. STAFF PRESENT: Quintana Stewart, Health Director; Rebecca Crawford, Financial and Administrative Services Director; Dominika Gazdzinska, Community Outreach Specialist; Alexandra Gunn, Temporary Communication Specialist; Victoria Hudson, Environmental Health Director; Donna King, Health Promotion & Education Services Director; Lisa Lowe, Public Health Nursing Supervisor II; Zin Lyons, Public Health Nurse I; Pam McCall, Public Health Nursing Director; Kristin Prelipp, Communications Manager; Beverly Scurry, BOH Strategic Plan Manager; and La Toya Strange, Administrative Support I. GUESTS PRESENT: None. I. Welcome New Employees Timothy Smith, Chair, called the meeting to order at 7:00pm. Quintana Stewart, Health Director, introduced the new employees in attendance: Alexandra Gunn and Zin Lyons. II. Public Comment for Items NOT on Printed Agenda: None. III. Approval of the February 27, 2019 Agenda Motion was made by Susan Elmore to approve the agenda, seconded by Jessica Frega and carried without dissent. IV. Action Items (Consent) A. Minutes of January 30, 2019 Meeting Motion was made by Keith Bagby to approve the minutes of January 2019 with an edit, seconded by Jennifer Deyo and carried without dissent. V. Educational Sessions A. Campus & Community Coalition Update Elinor Landess, Director of the Campus & Community Coalition to Reduce the Negative Impacts MINUTES ORANGE COUNTY BOARD OF HEALTH February 27, 2019 S:\Managers Working Files\BOH\Agenda & Abstracts\2019 Agenda & Abstracts/ February Page 2 of High Risk Drinking (the CCC), presented an update on the status of the Coalition's activities. Below are some highlights: • The CCC was formed in 2014 as a collaborative effort with the Town of Chapel Hill, UNC Chapel Hill, the Orange County Health Department and the Orange County ABC Board. • The CCC focus is high risk drinking in Chapel Hill. High risk drinking is defined as alcohol consumption that results in ill affects on a person's health and safety, and also often results in a wide variety of community-related harms. • The CCC’s Theory of Change focuses on the drinking behaviors that lead to the alcohol- related consequences. The CCC wants to change the environment/circumstances that cause people to get the alcohol vs taking the alcohol out of their hands. • There are 22 recommended strategies to address high risk drinking in Chapel Hill that were created by way of a report that resulted in the review of data, focus groups, etc. • Some strategies include: o Awareness/Education  Bee Safer – targeted toward students; it was created by students for students.  Alcohol Resource Guide – created for staff who are new to selling and serving alcohol in Chapel Hill; includes information such as tips on spotting fake IDs, preventing sales to underage patrons as well as other helpful information. o Policy/Environment  Carolina After Dark – goal is to increase social options on weekends without alcohol; this results in less negative impacts of alcohol.  Good Neighbor Initiative – to promote positive living experiences in those neighborhoods where students and non-students live in close proximity. o Enforcement  Campus Alcohol Adjudication policy – applicable to all members of the campus community not just the students and all will go through the same adjudication process.  Fake ID Adjudication – persons found guilty using a fake ID must also surrender their real ID for 60 days • Some of the data reviewed by various agencies from the Fall of 2013 through June 2018 was presented. Ms. Landess asked the BOH to choose from eight pieces of data with the purpose of getting feedback that would be helpful at the upcoming Town Hall meeting at the Chapel Hill Public Library on March 20th from 8:30-10am. The BOH chose the data about drinking behavior amongst high and middle school students. The BOH provided feedback regarding some of the factors that could contribute to the downward trend of their drinking behavior as well as what’s keeping the data the same. The BOH had questions that were addressed by Ms. Landess. B. Orange Resilience Initiative Ennis Baker, Project Director for Duke’s Center for Child & Family Policy’s Building Capacity for Trauma-Informed Infant & Toddler Care, and Sara Garrison, Assuring Better Child Health & Development (ABCD) Coordinator, gave a presentation on ACEs (Adverse Childhood Experiences) and what being a trauma-informed organization means. The highlights are below. MINUTES ORANGE COUNTY BOARD OF HEALTH February 27, 2019 S:\Managers Working Files\BOH\Agenda & Abstracts\2019 Agenda & Abstracts/ February Page 3 • NCCARE360 is the first statewide coordinated care network that includes a source of shared resources and connects healthcare and human services providers together to collectively provide the opportunity for health to all North Carolinians. • ACEs are significant childhood traumas 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-term health problems. Examples of ACEs that a child may experience include physical & emotional neglect, homelessness, and poverty. • The risk for negative health and well-being outcomes increases as the number of ACEs a person experiences increases. • ACEs are the most preventable cause of serious mental illness, drug and alcohols abuse in women and are a significant contributor to chronic diseases such as heart disease and diabetes. • 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 effects on the individual’s functioning and well-being. • SAMHSA states that building resilient and trauma-informed communities is essential to improving public health and well-being. Resilience is the ability to adjust/ bounce back when bad things happen. Research shows resilience helps reduce the effects of ACEs. • 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. • 10 key ingredients for trauma-informed care are 1)lead and communicate, 2)engage patients in planning, 3)train all staff, 4)create a safe environment, 5)prevent secondary trauma, 6)build an informed workforce, 7)involve patient in treatment, 8)screen for trauma, 9)use trauma-specific treatment and 10)engage partners. • Some strategies for encouraging staff wellness in trauma-informed organizations include o Encouraging and incentivizing self-care activities like counseling, meditation and exercise. o Fostering a culture that encourages staff to seek support, keeps caseloads manageable, and provides sufficient mental health benefits. The BOH members had questions that were addressed by Ms. Baker and Ms. Garrison. VI. Action Items (Non Consent) A. FY 2019-20 Budget Request Quintana Stewart, Health Director, and Rebecca Crawford, Financial and Administrative Services Director, presented the Board with a summary of the proposed FY 2019-2020 budget for the Health Department which shows 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. MINUTES ORANGE COUNTY BOARD OF HEALTH February 27, 2019 S:\Managers Working Files\BOH\Agenda & Abstracts\2019 Agenda & Abstracts/ February Page 4 In relation to 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 employ 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. In relation to 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. In relation to 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. B. FY 2019-20 Fee Changes The proposed fee changes in Environmental Health and Personal Health 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 MINUTES ORANGE COUNTY BOARD OF HEALTH February 27, 2019 S:\Managers Working Files\BOH\Agenda & Abstracts\2019 Agenda & Abstracts/ February Page 5 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. The BOH had questions that were addressed by Ms. Crawford and Quintana Stewart. Motion to approve the total budget in the amount of $10,575,428 for FY 2019-2020 and to approve all fee changes for FY 2019-2020 as presented and forward to the County Manager and Board of County Commissioners for action was made by Liska Lackey, seconded by Keith Bagby and carried without dissent. VII. Reports and Discussion with Possible Action A. Fluoride Ad Hoc Committee Update BOH and Fluoridation Subcomittee member, Liska Lackey, gave an update on the status of recruitment of fluoride panel experts. Three experts were requested – an expert in toxicology, dental and medical/endocrinology. So far, only a dental expert has been obtained. Discussion followed regarding the best methods to ensure the goal of attaining a panel of 3 experts including paying consultants and the promotion of these requested experts. It was determined that various BOH members will reach out to their colleagues and professional organizations with the added paid benefit to the panel experts of $125/hour in hopes of obtaining the additional experts needed to complete the panel. B. Board of Education Letter of Support Earlier this month, BOH member, Jennifer Deyo, met with Orange County Board of Education (OC BOE) member, Hillary MacKenzie, to discuss the BOH’s letter of support for their equity policy. Historically, the OC BOE wasn’t happy with how it has handled racial equity. All of the OC BOE members will have to complete racial equity training. Ms. Deyo reported that the OC BOE recently voted and approved the equity policy this month. Discussion followed including whether it would be helpful to fulfill OC BOE’s request to have a letter of support from the BOH. The proposed requested letter of support would point out the benefits to the county employees, the students and the teachers as well as applaud the approval of the equity policy. Motion to move forward to write the letter of support for the OC Board of Education’s Equity Policy was made by Liska Lackey and seconded by Bruce Baldwin and carried without dissent. C. Health Director Report In addition to her report, some of the highlights Ms. Stewart gave are below. • Ms. Stewart gave a brief update on Medicaid Transformation . The NC DHHS announced the four Prepaid Health Plan (PHP) contracts (AmeriHealth Caritas North Carolina, Inc., Blue Cross and Blue Shield of North Carolina, United Healthcare of North Carolina, Inc. and WellCare of North Carolina, Inc.) that will serve the entire state of North Carolina. The Health Department has attested to tier 3 – Advanced Medical MINUTES ORANGE COUNTY BOARD OF HEALTH February 27, 2019 S:\Managers Working Files\BOH\Agenda & Abstracts\2019 Agenda & Abstracts/ February Page 6 Home. The Health Department is in region four which will go live in November. The health directors in region four will begin reviewing PHP contracts. • Ms. Stewart announced that Wanda Crisp has retired as of February 20th. She also shared that Iulia Vann will be leaving the OCHD as she has accepted the position of Assistant Health Director with the Guilford County Health Department. D. Media Items Kristin Prelipp, Communications Manager, briefly mentioned articles regarding the Family Success Alliance’s new Strategic Plan and rural residents lack of access to healthcare which 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. VII. Board Comments. La Toya Strange reminded the Board that the scorecards for the Outside Agencies Funding Applications are due March 22nd and that weekly reminders will be sent. VIII. Adjournment Jessica Frega moved to adjourn the meeting at 9:06pm and Paul Chelminski seconded. The next Board of Health Meeting will be held March 27, 2019 at the Whitted Human Services Center, 300 West Tryon Street, Hillsborough, NC at 7:00 p.m. Respectfully submitted, Quintana Stewart, MPA Orange County Health Director Secretary to the Board