HomeMy WebLinkAboutBOH agenda 082819ORANGE COUNTY BOARD OF HEALTH
MEETING AGENDA
DATE: August 28, 2019
TIME: 7:00 P.M.
PLACE: Whitted Human Services Center
300 West Tryon Street
Hillsborough, NC 27278
TIME ITEM
7:00 p.m. I. Welcome New Employees
7:00 – 7:05 II. Public Comment for Items NOT on Printed Agenda
public Comment for Items ON Printed Agenda will be
handled during that agenda item
(Please sign up for both on sheet near the entrance to room.)
Please limit your comments to 3 minutes.
7:05 – 7:10 III. Approval of August 28, 2019 Agenda
7:10 – 7:15 IV. Actions Items (Consent)
A. Minutes of June 26, 2019 Timothy Smith
7:15 – 7:50 V. Educational Sessions
A. Orange County Schools Equity Update Dr. Dena Keeling &
(20 minutes) (relative to BOH Strategic Plan Priority: Michele Woodson
Social Determinants of Health)
B. 4th Quarter Financial and Billing Dashboard Rebecca Crawford (15 minutes)
7:50 – 8:25 VI. Action Items (Non-Consent)
A. Child Fatality Prevention Team (5 minutes) – Pam McCall
Health Care Rep Appointment
B. BOH Policy Review (20 minutes) Beverly Scurry
C. BOH Subcommittees (10 minutes) Beverly Scurry
8:25 – 8:40 VII. Reports and Discussion with Possible Action
A. Fluoride Update Jessica Frega
B. NALBOH Annual Conference Jessica Frega
C. Health Director Report Quintana Stewart
D. Upcoming Events Quintana Stewart
E. Media Items Kristin Prelipp
8:40 – 8:45 VIII. Board Comments
8:45 IX. Adjournment
BOARD MEMBERS: To ensure a quorum, SEND E-MAIL to lstrange@orangecountync.gov advising her of your
attendance at this meeting OR CALL 919-245-2411.
Compliance with the “Americans with Disabilities Act” and Title VI - Interpreter services and/or special sound equipment are available on
request. Call the Immigrant and Refugee Health Program Manager at 919.245.2387 to request an interpreter or other accommodation.
Conforme a la “Ley sobre Estadounidenses con Discapacidades” (ADA) y el Título VI – los servicios de intérprete y/o equipo de sonido
especial están disponibles a solicitud. Llame a la Administradora del Programa de Salud para Inmigrantes y Refugiados al 919-245-2387 para
solicitar un intérprete u otros arreglos o adaptaciones.
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ORANGE COUNTY HEALTH DEPARTMENT MISSION STATEMENT: To enhance the quality
of life, promote the health, and preserve the environment for all people in the Orange County
community.
THE ORANGE COUNTY BOARD OF HEALTH MET ON June 26, 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, Liska Lackey,
Commissioner Earl McKee and Sam Lasris.
BOARD OF HEALTH MEMBERS ABSENT: None.
STAFF PRESENT: Quintana Stewart, Health Director; Rebecca Crawford, Financial and
Administrative Services Director; Michael DeFranco, Public Health Services Manager; Henry
Green, Community Health Aide; Victoria Hudson, Environmental Health Director; Donna King,
Health Promotion & Education Services Director; Pam McCall, Public Health Nursing Director;
Kristin Prelipp, Communications Manager; Jennifer Riddle, Patient Account Technician; 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. Quintana Stewart, Health Director, introduced
Jennifer Riddle, the new employee in attendance.
II. Public Comment for Items NOT on Printed Agenda: None.
III. Approval of the June 26, 2019 Agenda
Motion was made by Jessica Frega to approve the agenda, seconded by Jennifer Deyo
and carried without dissent.
IV. Action Items (Consent)
A. Minutes of May 22, 2019 Meeting
Motion was made by Jennifer Deyo to approve the minutes of May 2019, seconded by
Sam Lasris and carried without dissent.
V. Educational Sessions
A. Public Health 3.0
Vaughn Upshaw, professor at UNC Gillings School of Public Health, gave a presentation on the
evolution of public health and future opportunities for public health leaders under Public Health
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3.0. Below are some highlights.
• Public Health 1.0 – Late 19th to 20th Century
o The 1st wave of public health preventative services emerged during this period. The
goal was to prevent and reduce communicable diseases by use of vaccinations,
chest x-rays, clinical inspections, etc.
o Mobile vans were used as a method to deliver vaccinations to people.
o In the 1960 state budget, only 9% of the budget was allocated to health care.
o During this period, epidemiology and laboratory science was expanded, food and
water safety was improved and systemized sanitation introduced.
• Public Health 2.0 – 1980s to Now
o The 10 essential health services emerged during this period. The goal was to
promote and contribute to the highest level of health possible by way of policy
development and patient education.
o The Community Health Assessment became a standard. Accreditation, policies and
prevention, management and treatment of diseases were the focus. Performance
standards were established.
o In the 1990 state budget, the health care budget doubled from 30 years prior to 18%
of the budget.
• Public Health 3.0 – Now to the Future
o The goal is to address the determinants of health by screening for unmet health-
related resources such as food insecurity, housing and transportation.
o Fiscal year 2020 state budget allocates 32% of state spending to health care.
o To strategically address the public’s needs, we should:
act as Chief Health Strategists,
engage with cross-sector partnerships,
ensure that every person is served by a nationally accredited health department
provide quality data and clear metrics so that all partners (school systems, public
safety, etc.) can understand the data, and
enhance funding.
• Evolution of the Public Health System
o Traditional Clinical Prevention
Examples include preventive services such as routine health screenings, weight
monitoring, scheduled immunizations.
o Innovative Clinical Prevention
Examples include health fairs, workplace health assessments.
o Community-wide Prevention
Examples include thinking about the policies, being held to certain standards,
ecology, pollution, living wages.
• Health determinants compared to health spending in the U.S.
• When determining one’s health status in the US:
o Environment equates to 36%
o Medical care equates to 11%
o Genetics/biology equates to 22%
o Social circumstance equates to 24%
o Individual behavior equates to 7%
• When comparing the elements that determines one’s health status to the percentage of
spending in the US:
o Environment equates to 5%
o Medical care equates to 60%
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o Social circumstance equates to 28%
o Individual behavior equates to 7%
• 3.0 Opportunities for Public Health Leaders
o Emphasize health for people, places and the planet
o Apply data and analytical tools
o Address disparities and inequalities
o Protect individuals, families, neighbors and communities
o Engage policy, practice and regulatory partnerships to protect and promote the
public’s health
The BOH had questions that were addressed by Ms. Upshaw.
B. Formerly Incarcerated Transition Program (FIT) Update
Henry “Tommy” Green, Community Health Aide, gave an update on the FIT program. He began
by defining the FIT program and its purpose. Below are some highlights:
• FIT program was designed to connect formerly incarcerated people with a chronic
condition to health care services via the help of a community health worker (CHW). It
mirrors the Transitions Clinic in California and involves CHWs that were more easily able
to relate to the clientele due to having had similar circumstances.
• Other community re-entry resources are available to help with a comprehensive re-entry
plan. The FIT program works with its partners and assists clients with finding housing,
employment and getting into substance abuse programs.
• FIT program partners include OC Local Reentry Council, Community Empowerment
Fund, NC Works, Interfaith Council and Dr. Bill Price.
• Currently, Orange, Durham, Wake and Mecklenburg counties have FIT programs.
• Some data given included:
o Serious mental illness is 2 to 4 times higher in state prisons than in the community.
o Out of a study of 1,100 people exiting imprisonment, 80% of men and 90% of
women had a chronic disease that required management including heart disease,
diabetes, HIV, Hepatitis C and kidney disease.
• To be eligible for the FIT program, one must be an Orange County resident, recently
released from prison or jail within the last 2 years and diagnosed with a chronic illness to
include mental health and substance abuse/misuse.
• Some of the challenges faced are homelessness, recidivism, food insecurity,
unemployment and mental health problems. Mr. Green stated that the FIT program has
a psychiatrist, Dr. Bill Price, who sees his clients for free.
• Current case load is 32 clients with 3 new intakes coming soon of which 26 are active
cases. The recidivism rate is almost 10%.
• Some of the desired outcomes to decrease recidivism for the FIT program include;
improve client health outcomes, empower clients to become knowledgeable about their
health and take control, and increase adherence to use of medications and treatment
plans.
• Some future goals for the FIT program include:
o By 2020, County Funds will represent 100% of the funding for the program.
o The Governor’s Reentry Council has taken a special interest in the FIT program.
There is the expectation that the FIT program will be included on the Final Reentry
Report as a top recommendation for the Statewide Reentry Effort.
o OC FIT CHW to be the lead FIT CHW for NC.
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The BOH had questions that were addressed by Mr. Green.
C. Annual Communicable Disease (CD) Report
Michael DeFranco, Public Health Services Manager, gave an overview of the communicable
disease data for the year 2018. Mr. DeFranco began with an overview of the CD department in
the OCHD. He also noted that this meets Accreditation Benchmark 2.5. Some of the highlights
from the information he gave during his presentation include:
Foodborne Illness – There was a 20% increase in Salmonella cases which was attributed to
home chicken coups.
Vaccine Preventable Diseases – There was an increase in Pertussis cases as there was a
school-age outbreak in which about 90% of the cases were fully vaccinated.
Vectorborne Illnesses – There was an increase in Rocky Mountain Spotted Fever cases;
however, the numbers may be somewhat inaccuate as most physicians don't test before
starting treatment if Rocky Mountain Spotted Fever is strongly suspected based on the patients’
symptoms.
Waterborne Illnesses – Cases of Cryptosporidium were attributed to foreign travel and exposure
to others with the illness.
Sexually Transmitted Diseases – There was a drop in chlamydia and gonorrhea. There were no
new HIV cases. We’ve pushed the use of PrEP in our clinics.
Outbreaks – The Pertussis outbreak took place in multiple middle and high schools in Orange
County and occurred from January to May 2018. There were 23 confirmed cases.
Other Relevant Data – Rabies investigations are plentiful. There were 2 TB cases last year; 1
resulted in death. The state has mandated that we report any cases of the Carbapenem-
resistant Enterobacteriaceae (CRE) superbug.
Mr. DeFranco briefly mentioned the Meningoccal outbreak that occurred during the tenure of his
predecessor that resulted in a mass vaccination of 16,000 people. He also spoke of a Hepatitis
A initiative in OC jail and prison that’s in its infancy that gives 1 free dose of the Hepatitis A
vaccine to high risk population. There’s 95% immunity after the 1st dose. Usually , the vaccine
is given as in 2 doses; they’re monitoring the initiative for its impact. Two weeks ago, there was
a Measles symposium attended by our medical director as well as providers and schools that
involved discussion around how to prepare and handle any outbreaks.
D. Innovation Grant Update
Victoria Hudson, Environmental Health Director, provided updates on the 2018-2019 projects,
the status on the 2019-2020 process and the sustainability of former projects. Below is a
summary:
• Trauma-Informed Services for Immigrants & Refugees Trainings
o Trauma & Resilience - There were 57 evaluations collected from the 104 people that
attended this service provider training. Comments included that there is a need for
more of this type of training.
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o Breaking Silence: Interpreting for Victim Services – There were 25 interpreters in
attendance which represented 15 different agencies and spoke 15 different
languages. A pre- and post-test was given with an average improvement of 34
points after the training.
• Intraoral Cameras
o They have been extremely helpful in treating our patients or any patient who has a
more complicated issue that would be better explained or documented with a photo.
It also adds a historical record.
• Transportation Assistance
o This project was to address the Access to Care component; however, the grant was
not fully implemented and is seeking new funding. There are important aspects
involving equity, maintaining confidentiality and HIPPA.
• Patient Education Toolkit
o This kit would be an accompaniment to the treatment patients receive in our clinics
helping to alleviate fear while building self confidence in their ability to control their
own health. It would involve mostly OTC products.
• 41 or below
o All of the Environmental Health staff were involved with this educational campaign to
inform food service establishments of the new requirement for refrigerated
temperatures effective 1/1/19. There has been a 10% reduction in violations for food
establishment for having temperatures over 41 degrees.
• Art for OCHD
o The common areas in OCHD have undergone aesthetic changes to make it more
appealing to staff, visitors and clients. A video of the changes was shown.
Next, Ms. Hudson spoke about the 2019-2020 cycle.
• The call for ideas resulted in 11 being submitted.
• All 11 were selected for full applications.
• Grant announcement early July.
• Implementation can begin early July.
• Mid-year progress is due December 31.
• Final report is due June 30.
Ms. Hudson briefly went over the 2019-2020 proposals and their leads are listed below.
Transportation Assistance - Renee Kemske, et al
Readiness Kits - Kristy Bassili & LaTosha Scott
Cell Phone Study - Angela Sowers
Randomized Lunch -Beverly Scurry
WTMP Repair Cost Share -Tracey Langley &John Davis
REC Library - Ashley Rawlinson
Mapping with Drone - John Davis
Decorative Lighting for Dental - Dr. George
Digital Questionnaire -Karen Kyes and Christy Bridges
Language Justice Summit - Susan Clifford
Exercise Subsidy - Karen Kyes, et al
Lastly, Ms. Hudson informed the BOH of those past ideas that have sustained over time.
They are Fitness Trackers, Baby Box, Septic Assist, Employee Health Cards, Suicide
Prevention, REI, and FOH Food Safety Training.
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E. Strategic Plan Update
Beverly Scurry presented changes to the BOH Strategic Plan Action Steps for the Board’s
approval that included:
• PAN Subcommittee – Changes were made to the first Focus Area and a third focus area
was added to address racial equity as discussed in meetings.
• SDH Subcommittee – Changes were made to the first Focus Area regarding trauma-
informed care. Minor changes made Focus Area #2 and a 3rd Focus Area was added to
address racial equity.
• SAMH Subcommittee – Minor change made to the first Focus Area. Changes were
made to Focus Area #2 regarding mental health screenings and a third Focus Areas was
added to address racial equity.
Motion was made by Liska Lackey to approve the changes to the 2019-2020 BOH
Strategic Plan Action Steps, seconded by Jessica Frega and carried without dissent.
VI. Reports and Discussion with Possible Action
A. Current BOH Recruitment
Jessica Frega, Co-chair, stated that the physician seat recommendation, Dr. Aparna Jonnal,
was approved by the BOCC. The BOH was hoping to interview to fill Barbara Chavious’ At-
large seat but time was an issue. The BOCC opted to fill her seat with Dr. Allison Stuebe.
Susan Elmore, Bob Marotto and Quintana Stewart will meet on July 5th to discuss the
Veterinary seat and the specifications needed for whomever fills that seat.
It was agreed by the BOH to form a subcommittee to fill the Veterinary seat. Bruce Baldwin,
Jessica Frega and Timothy Smith volunteered to serve.
B. Health Director Report
In the interest of time, Ms. Stewart asked if there were any questions regarding her report. None
were asked.
VII. Board Comments.
Keith Bagby would like a separate list of upcoming events. Timothy Smith mentioned that San
Francisco has banned the sale of e-cigarettes. Mr. Smith then presented Paul Chelminski with
a plaque of appreciation as this is his last Board of Health meeting after serving for over 9 years
which included 3 three-year full terms and a partial term. Dr. Chelminski was thanked for his
service. While acknowledging that the BOCC possesses the appointing power, Liska Lackey
mentioned recent BOH appointments by the BOCC which led to a short discussion about the
need to communicate BOH needs to ensure BOH priorities and general statutues are met.
VIII. Adjournment
Jessica Frega moved to adjourn the meeting at 9:19pm and Liska Lackey seconded.
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The next Board of Health Meeting will be held August 28, 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
Agenda Item Number:
ORANGE COUNTY BOARD OF HEALTH
AGENDA ITEM SUMMARY
Meeting Date: August 28, 2019
Agenda Item Subject: Orange County Schools Equity Update
Attachment(s): PowerPoint presentation
Staff or Board Member Reporting: Michele Woodson & Dena Keeling
Purpose: ____ Action
_ X Information only
____ Information with possible action
Summary Information:
Michele Woodson, Chief Academic Officer with Orange County School System will be
presenting updates on the progress OCS has made regarding creating an equitable
school system.
Dr. Dena Keeling, OCS’s first Chief Equity Officer, will also be in attendance.
Recommended Action: ___Approve
___Approve & forward to Board of Commissioners for action
___Approve & forward to ___________________________
_X_Accept as information
___Revise & schedule for future action
___Other (detail):
Orange County
Schools Equity
Equity- Year One
●Identifying disparities, inequities, and barriers
○Quantitative data- conversations with community and faith-based organizations, parents,
students, staff
○Qualitative data- disaggregated by race; LEP; SWD, EDS; gender
●Prioritize list
●Develop, implement, and monitor strategies to address disparities,
inequities, and barriers
Racial Equity
Professional
Development
Building capacity
Courageous Conversations
●Purpose: To develop and accelerate the district’s capacity to engage in
systemic equity transformation and eliminate racial barriers
●Beyond Diversity: understanding the impact of race
○District leadership/ Cabinet members
○Principals
○Assistant Principals
○Directors, and Executive Directors
●Next steps: Continued monthly sessions with Cabinet and every other
month with Principals
Equity Teams
Building coalition
Equity Teams
●Students Organized for Anti-Racism: Empower students to address issues of race ○Teacher leaders ○Student groups ○Equity conference
●School Based Equity Teams ○Staff teams ○Parent teams/committees
●Equity Task Force ○Consist of Orange County Schools staff members, parents, community members, and students
New Code of
Conduct
Launch: January, 2020
Goals of the Code of Conduct
●Create a blueprint for promoting good conduct, good citizenship, and good character for every student in
the district.
● Implement a district-wide approach to discipline and student support that is restorative, accountable, and
equitable for students, families, and staff.
● Amend current disciplinary policies and practices in order to reduce over use and disproportional use of
referrals and suspensions that adversely impact students of color and students with disabilities.
● Ensure equitable treatment of every student, recognizing the uniqueness and strengths of each student
and allowing for differences in time, attention, instruction, and support so that every student can succeed
academically and participate responsibly in our shared community.
● Implement consistent consequences, interventions, and classroom disciplinary practices across schools.
●Support students’ development of social and emotional competencies linked to readiness to learn,
academic engagement, and college, career, and life success.
Major Shifts in the Revised Code Include:
●An introduction that serves as a guiding vision for supporting every student in Orange County
Schools.
●Clear descriptions of rights and responsibilities for students, staff, and families.
●Greater emphasis on accountable and restorative interventions(from mediation, to problem
solving and planning conferences, to restorative group conferences) that support students’
development of Learning and Life Competencies (self-awareness, self-management, social
efficacy, and academic efficacy).
●More precise descriptions of disciplinary infractions aligned to consistent consequences and
interventions across the district that are fair, timely, and predictable.
●Greater emphasis on promotion of social skills and prevention of disciplinary problems through
effective classroom management (the teacher toolbox).
The Ask
What health and health care access disparities
and barriers contribute to racial inequities within
the district?
Agenda Item Number:
ORANGE COUNTY BOARD OF HEALTH
AGENDA ITEM SUMMARY
Meeting Date: August 28, 2019
Agenda Item Subject: 4th Quarter Financial Report FY 18-19
Attachment(s): 4th Quarter Financial Report
4th Quarter Billing Dashboard
Staff or Board Member Reporting: Rebecca Crawford
Purpose: ___ Action
_X_ Information only
___ Information with possible action
Summary Information:
Total Health Department Budget vs. Actuals: Average YTD monthly revenue in FY19
after the fourth quarter was $275/month or $3.3 million for the entire fiscal year,
representing 91.7% of our overall budgeted revenue for the year. This was a decrease
of $161k from FY 17-18. Expenses were higher than revenues at 93% of the total
overall budget but lower than the percentage of total budget expenditures from FY 17-
18, which reflects department-wide efforts to decrease expenditures in anticipation of
lower revenue. The total overall expenditures were $10.2 million compared to year end
FY 17-18, which were $9.7 million.
Total Billing Accuracy: Continuing with the goal of 90% billing accuracy set in FY 14-
15, the average billing accuracy rate for dental for FY 18-19 was 90% as compared to
101% in FY 17-18. Please note the change in billing accuracy from FY 17-18 to FY 18-
19 is because of the change in calculations to connect payments made back to the date
of service (accrual basis of accounting) rather than the date of payment (cash basis of
accounting) to help staff track true billing accuracy and compare to the medical billing
accuracy measures. The medical billing accuracy measure continues to be a challenge
as we work with UNC to improve the accuracy of the reporting system for Health
Department revenue and is not included in this quarter’s dashboard.
Dental Earned Revenue by Source: The FY 18-19 average monthly revenue
($46/month) for the fourth quarter was above our budget projection ($45k/month) and
above our FY 17-18 average of $42.5k/month. FY 18-19 dental earned revenue totaled
$552k at the end of the fiscal year, compared to $511k at the end of FY 17-18.
Medical Earned Revenue by Source: Medical earned revenue for the fiscal year was
below the budgeted projection for FY 18-19 ($55.6k) at $40.6k due to weather related
county office closings, extended appointment times, and system billing delays with the
Epic Electronic Medical Records system. FY 18-19 medical earned revenue totaled
$487k at the end of the fiscal year, compared to $618k at the end of FY 17-18.
Environmental Health Earned Revenue by Source: Environmental Health earned
revenue for the fiscal year was below the budgeted projection for FY 18-19
($53.1k/month) at $49.5k/month) due to weather related county office closings this past
fall and wet weather this past spring, which resulted in an inability to perform as many
onsite well and septic inspections. Environmental Health earned revenue totaled $594k
for FY 18-19, compared to $616k at the end of FY 17-18.
Grants Fund Revenue:
FSA has drawn $200k of the multi-year Kenan grant. We will receive the third allocation
of $100k after third quarter FY 19-20. Expenditures totaled $61.5k at the end of FY 18-
19.
Recommended Action: ___Approve
___Approve & forward to Board of Commissioners for action
___Approve & forward to ____________________
_X_Accept as information
___Revise & schedule for future action
___Other (detail):
Orange County Health Department
Fourth Quarter Financial Report
FY 2018-2019
General Fund
TOTAL HEALTH Q4 YTD ACTUAL ANNUAL BUDGET % OF ANNUAL
BUDGET
Revenue
Donations
Dental Health 0 (1,000)(1,000)100.00%
Finance and Admin Services 0 (6,000)(6,000)100.00%
Health Promotion & Edu (885)(33,025)(18,283)180.63%
Personal Health (6,290)(8,791)(18,000)48.84%
Donations Total (7,175)(48,816)(43,283)112.78%
Internal Allocations
Dental Health (18,000)(18,000)(18,000)100.00%
Finance and Admin Services (37,144)(37,144)(37,144)100.00%
Health Promotion & Edu (244,756)(244,756)(244,756)100.00%
Personal Health (30,000)(30,000)(30,000)100.00%
Internal Allocations Total (329,900)(329,900)(329,900)100.00%
Service Revenue
Dental Health (154,734)(551,176)(542,217)101.65%
Environmental Health (170,069)(593,600)(637,494)93.11%
Personal Health (135,562)(486,901)(667,625)72.93%
Service Revenue Total (460,365)(1,631,677)(1,847,336)88.33%
State Allocations
Environmental Health (57,942)(67,477)(72,339)93.28%
Finance and Admin Services (7,941)(43,676)(42,921)101.76%
Health Promotion & Edu (45,522)(103,916)(104,446)99.49%
Personal Health (140,870)(558,123)(580,095)96.21%
State Allocations Total (252,275)(773,192)(799,801)96.67%
Grants Project Revenue
AFDO Grant 0 (2,500)(5,500)45.45%
CC4C Accesscare (34,948)(143,075)(147,686)96.88%
Community Health Grant (71,933)(138,176)(145,914)94.70%
Dental Health (4,000)(4,000)(4,000)100.00%
MDPP (6,380)(11,134)(11,134)100.00%
PCM Accesscare (37,577)(154,286)(167,334)92.20%
Personal Health (16,381)(33,069)(59,864)55.24%
Piedmont Hlth Srv - Nutr (12,220)(25,998)(33,800)76.92%
Grants Project Revenue Total (183,438)(512,236)(575,232)89.05%
Revenue Total (1,233,152)(3,295,822)(3,595,552)91.66%
Orange County Health Department
Fourth Quarter Financial Report
FY 2018-2019
General Fund
TOTAL HEALTH Q4 YTD ACTUAL ANNUAL BUDGET % OF ANNUAL
BUDGET
Expenditures
Benefits 585,990 2,153,311 2,326,951 92.54%
Travel 13,868 24,083 26,585 90.59%
Training 16,496 45,950 72,279 63.57%
Certifications & Licensing 2,767 14,090 10,430 135.09%
Mileage 7,820 30,424 38,199 79.65%
Telephone 19,296 102,200 104,825 97.50%
Postage 5,231 16,094 14,055 114.51%
Equip Repairs 2,808 8,107 7,925 102.30%
Equip Rent 73 1,147 1,200 95.62%
Duplicating 1,987 9,228 11,350 81.30%
Printing 10,578 14,467 23,519 61.51%
Advertising 18,635 31,444 39,293 80.02%
Dues 1,397 5,568 6,225 89.45%
Subscriptions 228 842 1,700 49.53%
Dept Supplies 19,003 34,173 37,988 89.96%
Edu Supplies 6,394 9,714 20,150 48.21%
Office Supplies 9,033 26,282 27,866 94.31%
Medical Supplies 37,685 127,064 149,756 84.85%
Bloodborn Path Supplies 352 1,205 1,200 100.43%
Pharmacy Supplies 20,379 131,639 156,304 84.22%
Comp Supp/Software 987 5,742 5,933 96.79%
Contracted Srv 362,796 1,343,337 1,743,204 77.06%
X-Ray 2,419 10,847 24,625 44.05%
Lab Srv 47,150 115,501 150,690 76.65%
Bonds & Insurance 0 0 10,815 0.00%
Uniforms 2,493 9,905 11,000 90.05%
Community Proj 14,969 32,629 48,934 66.68%
Innovations Project 2,995 12,129 15,005 80.84%
Accreditation Project 0 2,750 2,750 100.00%
Credit Card Exp 2,847 10,443 11,800 88.50%
Capital Exp Under $500 6,060 17,001 18,569 91.56%
Equipment 26,570 35,181 36,268 97.00%
IT Equipment 14,158 14,740 16,197 91.00%
Nicotine Replacement Therapy 1,806 5,015 5,111 0.00%
Hurricane Florence 0 147 0 100.00%
Expenditures Total 2,947,576 10,205,612 10,951,240 93.19%
BOH GOVERNANCE DASHBOARDQ4 FY18‐19211219195228241200242268258317363554$0$100$200$300$400$500$600JASONDJFMAMJThousandsTOTAL HEALTH DEPARTMENT REVENUEvs. Budget Projections & Prior YearPersonal HealthHPESFASEnviron HealthDentalTotal OCHD Revenue ($3.3/y)YTD Mth Avg ($275k/m, ~$3.3M/y)FY18‐19 Budget Proj ($300k/m, ~$3.6M/y)434933544030494753516045$0$10$20$30$40$50$60$70JASONDJFMAMJThousandsDENTAL EARNED REVENUE BY SOURCEvs. Budget Projection & Prior YearSELF PAYINSURANCEMEDICAIDTotal Earned Revenue ($552k YTD)Budget Proj ($45k/m, $542k/y)YTD Mth Avg ($46.k/m, ~$552k/y est)FY17‐18 Mth Revenue ($511k/y)FY17‐18 Mth Revenue ‐ Avg ($42.5k/m)402825365420495049485433$0$10$20$30$40$50$60$70$80JASONDJFMAMJThousandsMEDICAL (PH) EARNED REVENUE BY SOURCEvs. Budget Projection & Prior YearSELF PAYINSURANCEMEDICAIDTotal Earned Revenue ($487k YTD)Budget Projection ($55.6k/m, $668k/y)YTD Mth Avg ($40.6k/m, ~$487k/y est)FY17‐18 Mth Revenue ($618k/y)FY17‐18 Mth Revenue ‐ Avg ($51.5k/m)485331465434446053597041$0$10$20$30$40$50$60$70$80JASONDJFMAMJThousandsENVIRONMENTAL (EH) EARNED REVENUE BY SOURCEvs. Budget Projection & Prior YearWellsTattoo ParlorsSepticSamplesPublic PoolsFood and LodgingFeesTotal Earned Revenue ($594k YTD)Budget Projection ($53.1k/m, $637k/y)YTD Mth Avg ($49.5k/m, ~$594k/y est)FY17‐18 Mth Revenue ($625k/y)FY17‐18 Mth Revenue ‐ Avg ($52.k/m)
Notes:There are new Billing Accuracy Formulas. For Dental (Eaglesoft) billing accuracy is calculated as the count of visits with payments divided by the count of visits with a charge.Revenue graphs may change over time because claims sometimes take a quarter or more to realize payment. Billing accuracy graphs may also change over time because payments are applied to the month the services were rendered. 87%89%91%88%89%83%94%93%92%89%90%94%90%JASONDJFMAMJDental Billing Accuracyvs. goalAccrual MethodBilling Accuracy (YTD avg 90%)Accuracy Target (90%)
Agenda Item Number:
ORANGE COUNTY BOARD OF HEALTH
AGENDA ITEM SUMMARY
Meeting Date: August 28, 2019
Agenda Item Subject: Child Fatality Prevention Team – Healthcare
Representative Appointment
Attachment(s): Holly Warren CV
Staff or Board Member Reporting:
Purpose: __X_ Action
_ _ Information only
____ Information with possible action
Summary Information:
NC General Statutes - Chapter 7B Article 14 North Carolina Child Fatality Prevention
System, 7B-1407. Local Team Composition - the local board of health shall appoint a
local health care provider.
Holly Warner, FNP, has been a nurse practitioner on the UNC Beacon Child Protection
Team since 2014. From 2011-2013 she served as a Child Medical Evaluator at the
SAFEchild Advocacy Center in Raleigh. Holly has specialized in pediatrics during her
career as a Family Nurse Practitioner since 1999. She is board certified in Advanced
Forensic Nursing and as a Family Nurse Practitioner by the American Nurses
Credentialing Center. Holly is involved in several projects at UNC Healthcare related to
childhood safety and injury prevention.
Ms. Warner has served on the Orange County Child Fatality Prevention Team since
January 2016. Staff request that the Board officially appoint Ms. Warner to the health
care provider position.
Recommended Action: _X__Approve
___Approve & forward to Board of Commissioners for action
___Approve & forward to ___________________________
___Accept as information
___Revise & schedule for future action
___Other (detail):
Holly Warner FNP-BC, AFN -BC
Nurse Practitioner, UNC Beacon Child Protection Team
Adjunct Clinical Instructor, UNC Chapel Hill School of Nursing
holly.warner@unchealth.unc.edu
Education
Master of Science: Nursing, Family Nurse Practitioner 1999
University of North Carolina - Chapel Hill
Bachelor of Science: Nursing 1994
University of North Carolina - Chapel Hill
Professional Experience
Nurse Practitioner, UNC Beacon Child Protection Team 01/2014 to Current
UNC Hospitals Chapel Hill, NC
• Conduct inpatient medical evaluations when concerns for child abuse, neglect or safety have
been identified. Provide recommendations for medical testing, follow up, and referrals to
community agencies. Counsel families on safety related to reducing maltreatment risk and
prevention of accidental injuries.
• Provide medical consultation for all children under 24 months of age admitted to the UNC Burn
Service. Assess for unmet pediatric needs such as incomplete well child care, developmental
delays, difficulty accessing care, and unmet mental health needs of the family. Provide
anticipatory guidance and counseling on prevention of accidental injuries and recommendations
for referrals to community agencies.
• Facilitate weekly multidisciplinary child abuse rounds and case review.
• Preceptor for UNC resident physicians’ child abuse clinical rotation.
• Provide expert medical testimony in criminal and family court proceedings when required.
Child Medical Evaluator 07/2011 to 12/2013
SAFEchild Advocacy Center Raleigh, NC
• Conducted comprehensive medical evaluations for children when a concern for sexual abuse,
physical abuse, or neglect had been identified.
• Provided recommendations to child protective services regarding medical and mental health
treatment and the safety of the child.
• Participated in multidisciplinary team meetings for case review.
• Offered consultation to other medical providers and investigating professionals as requested.
• Provided expert medical testimony in criminal and family court proceedings when required.
Nurse Practitioner, Pediatric Hospitalist Service 09/2008 to 12/2013
WakeMed Health and Hospitals Raleigh, NC
• Managed the medical care of inpatient pediatric patients as a part of the pediatric hospitalist
service.
• Responsibilities included admitting and discharging patients, ordering and interpreting lab and
diagnostic tests, consulting subspecialists, and communicating with patients, families and primary
care providers.
Nurse Practitioner 09/1999 to 09/2008
Wake Forest Pediatrics Wake Forest, NC
• Provided primary medical care for pediatric patients from birth through adolescence including well
childcare, developmental evaluations, patient education, and anticipatory guidance for parents.
• Managed care for patients with common childhood illnesses, minor injuries, and chronic pediatric
medical conditions.
Projects
UNC Children’s Hospital No Hit Zone project, member of steering committee (July 2019)
Child Maltreatment Simulation Training Project, in partnership with (CACNC) Child Advocacy Centers of
North Carolina (May 2017 to September 2019)
Early Head Start Safety Education and Unintentional Injury Prevention Project (March 2017)
In partnership with NC State School of Veterinary Medicine, established and currently facilitate UNC
PUPPIES Task Force (Providers United for the Prevention of Pediatric dog bite InjuriES), July 2016
Publications
Co-Author: APSNA Position Statement on Dog Bite Prevention in Children, submitted to American
Pediatric Surgical Nursing Association, February 2018.
Co-Author: Dog bite injuries associated with complex surgical care in younger pediatric patients.
Research Abstract .13th Annual Academic Surgical Congress Jacksonville, Florida, January 2018.
Warner, H. & Schilling, S. (2017). When interactions between young children and dogs become
dangerous: Case Review. Journal of Pediatric Surgical Nursing 5(4).
Winder, M., Ingram, D., Vaughn, L. & Warner, H. (2012). Chromobacterium Violecium Hepatic Abscesses
in a Previously Healthy Child, Infectious Disease in Clinical Practice 20: 219-220.
A Nurse Practitioner-Centered Care Delivery Model for Hospitalized Pediatric Patients, (Practice
Innovation), NAPNAP Conference, Poster Presentation, San Antonio, Texas (March 2012).
Presentations
2019
• Physical Abuse Simulation Lab Training for Multidisciplinary Teams, Facilitator/Speaker
(April 2019)
• Sexual Abuse 101 (Invited speaker) CACNC Symposium on Child Abuse and Neglect, Kitty
Hawk, NC (April 2019)
• Physical Abuse Simulation Lab Training for Multidisciplinary Teams, Facilitator/Speaker
(February 2019)
• Understanding Child Neglect, Inservice for UNC pediatric nurses (January 2019)
2018
• Child Physical Abuse Case Studies, Pediatric SANE Training, UNC School of Nursing
(December 2018)
• Adolescent Physical Abuse and Non-fatal Strangulation Injuries, Adult –Adolescent SANE
Training, UNC School of Nursing (December 2018)
• Introduction to the Child Maltreatment Team, UNC pediatric nurses (December 2018)
• Child Physical Abuse and Neglect: Recognition, UNC PA students (November 2018)
• Child Neglect: Principles and Practice, UNC pediatric residents, Noon Conference (October 2018)
• The Case of the Missing Hymen and Other Medical Myths Surrounding Child Sexual Abuse,
CACNC Symposium on Child Abuse and Neglect, Lake Junaluska, NC (September 2018)
• Practice Your Techniques for Sexual Abuse Examinations (Facilitator) CACNC Symposium on
Child Abuse and Neglect, Lake Junaluska, NC (September 2018)
• Recognizing and Responding to Child Abuse and Neglect: The role of a hospital based child
maltreatment team, Inservice for UNC pediatric nurses (September 2018)
• Sexual Abuse 101 (Invited speaker) CACNC Symposium on Child Abuse and Neglect, Kitty
Hawk, NC (April 2018)
• Child Neglect: Principles and Practice, UNC pediatric residents, Noon Conference (April 2018)
• Physical Abuse Simulation Lab Training for Multidisciplinary Teams, Facilitator/Speaker
(February 2018)
• Adolescent Physical Abuse and Non-fatal Strangulation Injuries, Adult –Adolescent SANE
Training, UNC School of Nursing (January 2018)
• Introduction to Child Physical Abuse, UNC medical students (January 2018)
2017
• Child Physical Abuse: Assessing Injuries, UNC PA students (November 2017)
• Recognizing and Responding to Child Abuse and Neglect: The role of a hospital based child
maltreatment team, 3rd Annual Southeastern Pediatric Trauma Conference (September 2017)
• Beacon TOP Case Review, Nash County ED and DSS (August 2017)
• Identification and Reporting Child Maltreatment Concerns, UNC pediatric residents, Noon
Conference (July 2017)
• Beacon TOP Case Review, Nash County ED and DSS (June 2017)
• Introduction to Child Physical Abuse, UNC medical students (May 2017)
• Adolescent Physical Abuse and Non-fatal Strangulation Injuries, Adult –Adolescent SANE
Training, UNC School of Nursing (March 2017)
• Secondary Trauma, UNC Pediatric Schwartz Rounds (March 2017)
• Introduction to Child Sexual Abuse, UNC medical students (February 2017)
• Imaging Studies in Child Maltreatment, Neuroradiology Grand Rounds (February 2017)
2016
• AHT Case Presentation and Medical Evaluation, UNC PICU Fellows Lecture Series (November
2016)
• Child Physical Abuse: Assessing Injuries, UNC PA students (November 2016)
• Medical Neglect Case Presentation, UNC CMEP Webinar (October 2016)
• Child Physical Abuse Case Studies, Pediatric SANE Training, UNC School of Nursing (October
2016)
• Evaluation of Genital Complaints, PNP students, UNC School of Nursing (April 2016)
• Evaluations of Child Physical Abuse in the Emergency Department, NC IAFN Chapter Meeting
(February 2016)
• Introduction to the Medical Evaluation of Child Maltreatment, UNC Medical Students Pediatric
Interest Group Conference (January 2016)
2015
• Overview of Child Maltreatment, Pediatric SANE Training, UNC School of Nursing (December
2015)
• Evaluating Child Maltreatment in Inpatient Psychiatric Patients, UNC Pediatric Psychiatry
Conference (October 2015)
• Child Abuse Emergencies, UNC Pediatric Residents, Noon Conference (August 2015)
• Child Abuse Case Presentation, UNC CMEP Webinar (May 2015)
• Investigating Child Maltreatment MDT Family Feud, Wake County MDT Training (May 2015)
• Revictimization in Foster Care, UNC Pediatric Residents Noon Conference (May 2015)
• Medical Evaluation of AHT, UNC PICU Fellows Lecture Series (May 2015)
• Evaluation of Genital Complaints, PNP students, UNC School of Nursing (April 2015)
• Child Abuse Evaluation in a Patient with Primordial Dwarfism, Child Abuse Case Review Webinar
(February 2015)
• The Role of the UNC Child Protection Team, UNC Pediatrics Collaborative Practice Meeting
(January 2015)
• Ophthalmologic Findings in Child Abuse, UNC Ophthalmology Case Conference (January 2015)
Licensures and Certifications
August 2017 Advanced Forensic Nursing, board certification by the American Nurses Credentialing
Center (ANCC)
May 2013 to present. Sexual Assault Nurse Examiner-Pediatric (SANE-P), certified by the International
Association of Forensic Nurses (IAFN)
June 2011 to present. Rostered Child Medical Evaluation Program (CMEP) Provider
1999 to present. Family Nurse Practitioner, board certified by the American Nurses Credentialing Center
(ANCC)
1999 to present. Family Nurse Practitioner, licensed by the North Carolina Board of Nursing
1994 to present. Registered Nurse, licensed by the North Carolina Board of Nursing
Committees and Appointments
January 2016. Awarded Adjunct Clinical Instructor Appointment, UNC Chapel Hill School of Nursing
January 2016 to present. Orange County Child Fatality Prevention Team and Child Fatality Review
Professional Organizations
Pediatric Trauma Society (PTS)
International Association of Forensic Nurses (IAFN)
American Professional Society on the Abuse of Children (APSAC)
National Association of Pediatric Nurse Practitioners (NAPNAP)
NAPNAP Child Abuse and Neglect Special Interest Group (SIG)
Conferences
• 24th Annual APSAC Colloquium New Orleans, Louisiana (June 2016)
• Fifth Annual Penn State Hershey International Conference on Pediatric Abusive Head Trauma
Medical, Forensic, and Scientific Advances and Prevention Park City, Utah (July 2015)
• CACNC Annual “Reflections” Symposium on Child Abuse and Neglect, Lake Junaluska, NC
(Attended yearly September 2011-2018)
• CACNC Symposium on Child Abuse and Neglect, Kitty Hawk, NC (April 2018, April 2019)
Agenda Item Number:
ORANGE COUNTY BOARD OF HEALTH
AGENDA ITEM SUMMARY
Meeting Date: August 28, 2019
Agenda Item Subject: BOH Policy Review
Attachment(s): Five policies and one appendix with track changes
Staff or Board Member Reporting: Beverly Scurry
Purpose: __X_ Action
_ _ Information only
____ Information with possible action
Summary Information:
It is time for annual review of BOH Policies and Procedures. The policies will be
presented in groups. The first five policies up for review include:
1A - Compliance with Public Health Laws/Regulations
1C - Confidentiality Agreement and Conflict of Interest Statement
1F - Community Assessment Policy
1G - Community and Public Input Policy
3A – Operating Procedures
Staff Recommendations for Consideration:
1A - Compliance with Public Health Laws/Regulations
• Rescind Policy
o The policy is fully summarized in Policy 3A Operating Procedure under
section XVl
1C - Confidentiality Agreement and Conflict of Interest Statement
• Rescind Policy
o The policy is fully summarized in Policy 3A Operating Procedure under
section lV and Appendix ____
1F - Community Assessment Policy
• Section 1b – formatting updated and included community-based organizing
groups to show support to the community
• Section 1d – updated link to Community Health Assessment Guidebook
• Section 1g – OCHD staff and community volunteers added to assist in collection
of primary and secondary data
• Section 1h – *New Section* states - Primary and secondary data collected
should be disaggregated by race, ethnicity, gender, sexual identity, etc. when
possible to account for racial and health disparities among marginalized groups.
• Section 1k – *New submission date for CHA* –- first Monday in March following
the year of assessment
• Section 1m –
o Link updated for Community Health Assessment Action Plan
o *New submission data for CHA Action Plan* - first Monday in September
following the year of assessment
• Section 2b - *New Section* states that the SOTCH report should include – A
review of disaggregated data by race, ethnicity, gender, sexual identity, etc. to
account for health disparities in the county among marginalized groups.
• Section 2d – wording change to reflect when SOTCH report is due – during the
years a CHA is not submitted
1G - Community and Public Input Policy
• Rescind Policy
o The policy is fully summarized in Policy 3A Operating Procedure under
section 12B
3A – Operating Procedures
• ll Charge to the Board – This section was updated to explain policy-making, rule-
making, and adjudication.
• lll Composition – This section was updated to list the specific positions of BOH
members
• lV Confidentiality and Conflict of Interest – This policy was rescinded and folded
into the Operating Procedures for streamlining efforts.
o This section has an appendix which is the Statement of Confidentiality and
Conflict of Interest that all board members must sign
• V Terms of Office –
o A - wording change to reflect composition of board in section lll
o B – wording change
• Vl Removal from the Board - *New Section* - This section added to reflect
process of BOH member removal
• Vll Compensation - *New Section* - This section reflects BOH member per diem
received
• Vlll – C Committees – formatting change – The statement: .All standing
committees are subject to the North Carolina open meetings laws and shall
comply with the provisions of those laws – was moved up from Vlll – C.5.
• lX – Meetings
o B Special Meetings - *New Section* - This section was added to outline
instances in which the BOH may need to call a special meeting
o D Presiding Officer – wording change to reflect proper pronoun usage –
Will now simply state - The Chair of the Board shall preside at Board
meetings if present.
o G Minutes – link updated to reflect new online locations for minutes
o H Closed Session - *New Section* - This section added to reflect BOH
procedure for closed session
• Xll – Other Procedural Matters
o A - Parliamentary Procedures - *New Section* - This section added to
reflect Robert’s Rule of Order used at BOH meetings
o B – Public Comment - *New Section* - This policy was rescinded and
added to Operating Procedures to explain process for getting public input
• XVl – Compliance with NC Law – Sections B & C were part of rescinded
Compliance with Public Health Laws/Regulations and added to this section to
reflect legal consult options for the BOH and location of manuals for laws and
regulations in the department.
Recommended Action: _X_Approve
___Approve & forward to Board of Commissioners for action
___Approve & forward to ___________________________
___Accept as information
___Revise & schedule for future action
___Other (detail):
Agenda Item Number:
ORANGE COUNTY BOARD OF HEALTH
AGENDA ITEM SUMMARY
Meeting Date: August 28, 2019
Agenda Item Subject: BOH Subcommittees
Attachment(s): PowerPoint Presentation
Staff or Board Member Reporting: Beverly Scurry
Purpose: __X_ Action
_ _ Information only
____ Information with possible action
Summary Information:
Due to the loss and gain of BOH members, we are revisiting subcommittee
assignments. There are currently 3 subcommittees which align with the Community
Health Assessment Priority Areas: Substance Abuse and Mental Health, Social
Determinants of Health, and Physical Activity and Nutrition. Membership on any one
subcommittee is limited to no more than 5 BOH members. This keeps us in compliance
with public meeting rules.
BOH members may continue working on their current subcommittee if they choose. Any
member can participate on multiple subcommittees of interest as long as there are 5 or
less members per subcommittee.
Recommended Action: _X_Approve
___Approve & forward to Board of Commissioners for action
___Approve & forward to ___________________________
___Accept as information
___Revise & schedule for future action
___Other (detail):
BOH
SUBCOMMITTEES
AUGUST 2015
SOCIAL DETERMINANTS OF
HEALTH SUBCOMMITTEE
Action Steps:
By June 2020, the Board of Health will continue to further explore
policy and funding options to support the Family Success Alliance
Strategic Plan.
By June 2020, the Health Department will explore trauma informed
options designed to increase staff awareness and improve the work
environment.
Annually the Board of Health will offer support to the efforts
engaged in by the Healthy Carolinians Access to Care Committee.
By June 2020, the SDH Subcommittee will support racial equity
work in the Orange County by collaborating with community
partners who are working to address drivers and determinants of
health through an equity lens.
PHYSICAL ACTIVITY AND
NUTRITION SUBCOMMITTEE
Action Steps:
By June 2020, the BOH will explore and/or support food policies that are feasible
to implement in the Orange County community.
By June 2020, the PAN Subcommittee will support the Orange County Food
Council (OCFC), Department of Environment, Agriculture, Parks and Recreation
(DEAPR), and other organizations in the county and NC that work to improve
nutrition and physical activity for residents. Examples of support include, but is not
limited to:
Letters of Support
Sharing information online and/or social media
Attending community events
Attending organizational meetings of OCFC, DEAPR, and others as applicable
Each fiscal year for the school systems in Orange County, the Board of Health will
offer a formalized small grant opportunity to all schools to implement in-class or
other physical activity programs.
By June 2020, the PAN Subcommittee will support racial equity work in the
Orange County community by collaborating with partners who are working to
address food systems issues.
SUBSTANCE ABUSE & MENTAL HEALTH
SUBCOMMITTEE
Action Steps:
By June 2020, Health Department staff will investigate the feasibility,
follow -up referral options, and reimbursement barriers for primary care
providers to provide and bill for Screening, Brief Intervention, and Referral
to Treatment (SBIRT), telephone and face-to-face consultation with
behavioral health providers, and care provided by a behavioral health and
primary care provider on the same day in the same clinic.
By June 2020, the SAMH Subcommittee will explore options for mental
health screening for OCHD clients with the Local Management Entity and
other local mental health providers.
By June 2020, the Health Department staff will continue to partner with
criminal justice and jail partners to explore options for collaborative
opportunities.
By June 2020, the SAMH Subcommittee will support racial equity work in
the Orange County community by collaborating with substance abuse and
mental partners who are also working on equity within their organization
and community.
BOARD OF HEALTH STRATEGIC PLAN
CLICK FOR MORE DETAILS ON THE BOH STRATEGIC PLAN.
Agenda Item Number:
ORANGE COUNTY BOARD OF HEALTH
AGENDA ITEM SUMMARY
Meeting Date: August 28, 2019
Agenda Item Subject: Fluoride Ad Hoc Committee Update
Attachment(s): N/A
Staff or Board Member Reporting: Jessica Frega
Purpose: ____ Action
_X Information only
____ Information with possible action
Summary Information:
Updates on the Fluoride process include information on:
• Experts
• Survey response numbers
• Analysis of survey responses using UNC students
• Timeline for Completion
Recommended Action: ___Approve
___Approve & forward to Board of Commissioners for action
___Approve & forward to ___________________________
_X_Accept as information
___Revise & schedule for future action
___Other (detail):
Agenda Item Number:
ORANGE COUNTY BOARD OF HEALTH
AGENDA ITEM SUMMARY
Meeting Date: August 28, 2019
Agenda Item Subject: NALBOH Update
Attachment(s):
Staff or Board Member Reporting: Jessica Frega
Purpose: ___ Action
_X_ Information only
___ Information with possible action
Summary Information: Jessica Frega will give an update on the NALBOH 2019 Annual Conference
that was held in Denver, CO on August 14-16, 2019.
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):
Health Director’s Report
August 2019
• The Health Equity Council held a successful Health Equity Forum on June 21, 2019 at
Southern Human Services Center in Chapel Hill. Great attendance from elected officials
and community members. The forum was facilitated by Deitre Epps, CEO & Founder of
Race for Equity, LLC. There was engaging discussion about health equity data, impact
of social determinants on current health outcomes and action steps needed to change the
current situation. Special Thanks to Board Members Sam Lasris and Jessica Frega for
attending.
• July 22, 2019 – Mark Benton became the new Director of the Division of Public Health. He
was previously the DHHS Deputy Secretary for Health Services. Ben Money now serves as the
DHHS Deputy Secretary for Health Services.
• I am serving on the Complete Count Committee. The committee is charged with
developing a 2020 Census Awareness Campaign to encourage residents to respond. As a
health department representative, I will serve on the subcommittee with a focus on hard-
to-reach communities. The U.S. Census Bureau recently released results from a survey
designed to identify barriers that keep people from participating in the Census. Five
primary barriers were reported:
o concerns about data privacy and confidentiality
o fear of repercussions
o distrust in all levels of government
o feeling that it doesn’t matter if you are counted
o belief that completing the census might not benefit you personally.
The committee will work hard to educate the community on the purpose, content and
process of the Census. There may be an ‘ask’ of the Board of Health to help in some
capacity as we will need trusted voices in the community to assist.
• I continue to work closely with the Family Success Alliance staff during the interim time
of a vacant program director position. This has given me an opportunity to attend Partner
meetings, project team meetings and interact with all program staff more. At the last
Advisory Council meeting, the team received approval from the Council to expand their
efforts beyond serving families that attend one of the zone schools to serving families that
live in either of the two zones (Zone 4 – Hillsborough & Zone 6 – Chapel Hill) currently
served by the program. Implementation of the new Family Empowerment Model, which
uses a tiered approach to working with families in the Navigator program, should
increase capacity a little to allow for this moderate expansion.
• July 25-26, 2019 I assisted the Cumberland County Health Department with their
interview process for a New Health Director.
• The Department hosted 18 students from the Norfolk Academy on August 2, 2019 at the
Whitted Building. Students from the Global Health Fellows program were interested in
talking with public health professionals about their work, specifically things related to
access issues, disparities and innovations. Several staff from the department came to
present and answer questions from the students.
• I continue to work with the Campus & Community Coalition (CCC) to support efforts to
reduce the negative impacts of high-risk drinking. The Coalition Leadership, (Chapel Hill
Town Manager, Vice Chancellor of Student Affairs at UNC-CH and myself), recently
submitted a letter to UNC Leadership to express our support for gradual implementation
of changes to HB381, which allows alcohol sales in athletic facilities on game days, so
that we can study its effects in our community. The work of the Coalition has resulted in
the implementation of several evidence-based public health strategies geared towards
reducing high risk drinking and its related impacts. We have invested substantial time and
resources into changing the alcohol culture in our community. We are committed to this
work and we look forward to continued dialogue with UNC as we all work
collaboratively to create a safe campus and community environment.
• New BOH Member Orientation – I met with Dr. Alison Stuebe on August 12, 2019 and
Dr. Aparna Jonnal on August 20, 2019.
• Well Care of NC – Hugh Johnson, Sr. Manager of Government Affairs, came to meet
with County Manager and I to introduce himself. He shared contact information with us
and explained how we (staff) and beneficiaries (patients) contact Well Care if we have
questions about anything.
• Medicaid Transformation Update: Beneficiaries received their enrollment packets July 8,
2019. We are currently in the open enrollment phase where beneficiaries are choosing
their Health Plans and Primary Care Provider (PCP). We are not yet listed on the provider
list because our contracts are not finalized. This is not unique to OCHD. Several counties
and hospitals have not yet signed the PHP contracts because the original agreements were
in need of amendments to ensure compliance with State Laws and our operations as a
government entity. As of August 15th, I am happy to report that 3 of the 4 Health Plans
have submitted the needed amendments and we are moving forward with signing
contracts. As patients ask staff questions I recommend we do/communicate the
following:
• Encourage patients to revisit the enrollment site, App and/or call the line often as it is
updated daily as contracts are finalized; https://ncmedicaidplans.gov/enroll
• Patients have until September 13th to choose a plan. After this date, patients will be
auto assigned to a plan.
• Medicaid Transformation does not affect Dental Services. Nothing will change with
regard to dental services as a result of choosing a health plan.
• Maximus is the official enrollment broker, but we can pass along information to
patients to help them as they make a decision about their Managed Care Health Plan.
See link below for a comparison of the Health
Plans: https://ncmedicaidplans.gov/sites/default/files/Documents/NC%20EB_Comp%
20chart-5%20plan-ENG_v30WEB_073019.pdf
• Encourage patients to visit Social Services if they need assistance. An enrollment
broker from Maximus is onsite each day, 9am – 4pm to assist.
• August 22, 2019 - The department hosted International Delegation from Egypt to discuss
Human Trafficking and the role of a local health department in NC. There were 8
emerging leaders with backgrounds ranging from media, law, religion and human rights
and relations advocacy. We shared information about Orange County Health Department,
training for health department staff, and state & local resources for addressing human
trafficking. There was robust information sharing and learning by all in the room. Special
thanks to Communications Manager, Kristin Prelipp and Environmental Health Director,
Victoria Hudson for participating in the presentation and discussion. Thank you to Board
Member, Sam Lasris for making the connection between OCHD and the International
Visitor Leadership Program. It was truly an honor to host the delegation.
Upcoming Events
• August 28 – 29, 2019 – Orange County Director’s Retreat
• September 24 – 27, 2019 – NCALHD Meeting & NC Public Health Association Fall
Education Conference, Greensboro, NC
• September 30, 2019 – Orange County Opioid Task Force Meeting
Upcoming Events
Orange County Health Department
• September 18, 2019; 1pm – 3pm
Pool Operator’s Meeting
Southern Human Services Center
2501 Homestead Road, Chapel Hill, NC
• September 20, 2019; 6pm – 7:30pm
“Be the Light” 3rd Annual Suicide Prevention Walk
Carrboro Town Commons
301 W. Main Street
at Carrboro Town Hall
• September 25 – 27, 2019
2019 NCPHA Fall Education Conference
Grandover Resort & Conference Center
1000 Club Road
Greensboro, NC 27407
How healthy, wealthy is Alamance County? Here are the numbers. - News - The Times-News - Burlington, NC
https://www.thetimesnews.com/news/20190721/how-healthy-wealthy-is-alamance-county-here-are-numbers[8/19/2019 10:57:33 AM]
How healthy, wealthy is Alamance County? Here are the numbers. - News - The Times-News - Burlington, NC
https://www.thetimesnews.com/news/20190721/how-healthy-wealthy-is-alamance-county-here-are-numbers[8/19/2019 10:57:33 AM]
Isaac Groves Times-News @TNIGroves
How healthy, wealthy is Alamance County? Here are the numbers.
Jul 21, 2019 at 10:00 AM
The 2018 Alamance County Community Assessment paints a picture of a growing county with economic challenges and disparities among racial groups
contributing to health problems and a need to focus on education, access to healthcare, exercise, good food and poverty.
The Alamance County Health Department, Impact Alamance, Healthy Alamance, Alamance Regional Medical Center and Cone Health and the United Way
of Alamance County collected data for the report, which is done every four years. It’s available at Alamance-nc.com/health.
The county’s population is older than the state as a whole. Statewide and locally, 45- to 54-year-olds make up the largest age group, but the county’s
percentage of the middle-aged, at 13.5 percent, is nearly a third of a percentage point higher than the state’s, according to the CHA. While statewide 25- to
44-year-olds — at more than 25 percent of the population — make up a larger proportion of the population than in Alamance County, which is less than 24
percent.
Other demographics:
57 percent of the county is occupied by single-family homes on five acres or less with heavy growth in the Southeast.
39 percent is agriculture.
Population: 162,000, a nearly 7-percent increase since 2010.
68 percent white.
19 percent black.
13 percent Latino.
2 percent Asian.
Less than 1 percent American Indian.
43,554 families, a 9-percent increase over 2010.
64,205 households.
Economics
Largest employment sectors as of 2016:
21 percent of Alamance County workers are in education, government or non-profits;
20 percent manufacturing;
17 percent retail and services;
17 percent medical and healthcare; and
13 percent leisure and hospitality.
More about our incomes:
$42,463 median income, more than $9,000 less than the state median.
$57,308 — the “self-sufficiency standard,” which is the minimum estimated income to realistically support a family of four in Alamance County without
public assistance.
118 families per average week get help at Allied Churches of Alamance County.
28 percent of children lived in poverty from 2012 to 2016, about 4 percent more than the state’s child poverty rate.
53 percent of students eligible for free-or-reduced school lunches.
59 percent of households with children receive food stamps, compared to the state rate of 54 percent.
Poverty is concentrated in the northeast part of the county where 17 to 29 percent of families with children live below the poverty line, though the
area along the Orange County line is much better off with 3 percent or less living below the poverty level. Southeast Alamance also has a high
poverty rate, at 12 to 17 percent, while northeast Alamance near the Guilford County line is fairly affluent.
13.8 percent of families living below the poverty level in 2016 was a lot higher than the 11.7 percent in 2011, but also a decline from the 2011 to 2015 peak
of 14.4 percent. It’s also higher than the state’s 12.4 percent rate.
27.8 percent of local children live below the poverty level, putting it among the higher rates in the state compared to the state level of 23.9 percent.
12,007 families, or 25,055 individuals, got assistance through SNAP (food stamps) in 2017.
24 percent of recipients were working.
Health
The 2017 infant mortality rate was 5.2 deaths per 1,000 live births younger than 1 year old — a big drop from 8.7 in 2003. The statewide infant mortality
rate was 7.1 deaths per 1,000 births.
How healthy, wealthy is Alamance County? Here are the numbers. - News - The Times-News - Burlington, NC
https://www.thetimesnews.com/news/20190721/how-healthy-wealthy-is-alamance-county-here-are-numbers[8/19/2019 10:57:33 AM]
Though minority infant mortality rates have fallen by 50 percent since 1999, it was still high, at 13.4 deaths per 1,000 births among black women.
Sixteen out of 1,000 births in 2012 to 2016 were to 15-to-17-year-old girls, though it was closer to 24 per 1,000 among African American and Hispanic
girls, while white girls were closer to 12. Those numbers are higher than the state and national averages.
Causes of death:
1,609 people died locally in 2017.
20 percent died from heart disease, also the leading reason for hospitalization.
19 percent from cancer.
40 percent of cancers diagnosed were related to obesity.
28 percent were forms of lung cancer.
Diabetes became the seventh leading cause of death in Alamance and statewide in 2007.
Sexually transmitted infections reported in 2017:
905 chlamydia cases;
273 gonorrhea cases;
22 HIV cases; and
22 syphilis cases.
Free screenings are available:
Alamance Cares – 3025 S. Church St., Burlington
Open Door Clinic of Alamance County – 319 N. Graham-Hopedale Road, Burlington
Opioid crisis
49 opioid deaths were reported in Alamance County between 2013 and 2016
19 were reported in 2017
369 doses of naloxone countering opioid overdose were administered by Alamance County EMS in 2017.
Quality of life
3.8 – days per month the average Alamance County resident experiences poor health, which is higher than the state rate of 3.6 days and an indication of
worsening quality of life in Alamance County with the county’s rank going from 47th out of 100 counties for poor health affecting quality of life in 2015 to
63rd last year.
44 percent of adults had permanent teeth removed due to gum infection as of 2016. Dental problems have a huge impact on general health, while dental care
is expensive and often neglected.
Exercise makes a big difference in obesity and heart health.
Eighty-six percent of people lived near a park with things like trails and other ways to exercise last year compared to a little more than 77 percent in 2014,
which is better than the state average.
About $4 million has been spent on those facilities since 2015. Much of that came from Impact Alamance grants, and the school system made its tracks and
fields available for the public, municipalities built more sidewalks and bike lanes, and the county opened about 20 miles of hiking trails with more planned.
Food
Seven percent of Alamance County residents in 2018 didn’t have easy access to nutritious, fresh food either because they lived too far from a grocery store
and didn’t have reliable transportation, or simply didn’t have enough steady income. That percentage is higher than the state’s and has grown from a little
more than 6 percent in 2015.
Fifty-seven percent of respondents to the Elon Poll said they lived more than a mile from a place to get fresh produce.
Food swamps — areas with four or more unhealthy options, like fast food and snacks rather than healthy options in grocery stores, is a local problem. One
option the report suggests is limiting the number of fast-food restaurants allowed in a particular area with zoning ordinances.
How healthy, wealthy is Alamance County? Here are the numbers. - News - The Times-News - Burlington, NC
https://www.thetimesnews.com/news/20190721/how-healthy-wealthy-is-alamance-county-here-are-numbers[8/19/2019 10:57:33 AM]
Healthcare
48 medical care providers per 100,000 people in Alamance County last year is considered a low ratio, according to the report, though a significant increase
from 22 in 2015.
18 percent of adults didn’t have health insurance as of 2017. That’s a steady drop from about 26 percent in 2011, but still nowhere near the best rates in
North Carolina.
12 percent of 18- to 64-year-olds — most likely to be ineligible for Medicaid or Medicare — had no insurance in 2016, a 2-percent decrease just from the
year before, thanks at least in part to efforts to enroll people in the Affordable Care Act, according to the report.
95 percent of children in Alamance County were insured in 2016, which is in the top half of North Carolina counties.
Distrust of the healthcare system keeps people, especially minorities, from seeking healthcare. Those who do find they have to work harder than they should
to get care, according to a focus group cited in the assessment.
More people in Alamance County used the emergency department to diagnose diabetes and stroke than in neighboring counties, indicating that people
aren’t getting regular care from general practitioners.
Education:
Education correlates to health with those who go farther in school living longer and suffering fewer serious illnesses, though there are still dramatic
differences in the health among educated minorities and whites, according to the report.
82 percent high school graduation rate is lower than the state average of nearly 87 percent, but an improvement over 81 percent in 2016.
Graduation rates still vary widely by race and ethnicity:
85 percent white;
82 percent black; and
75 percent Hispanic.
Reporter Isaac Groves can be reached at igroves@thetimesnews.com or 336-506-3045. Follow him on Twitter at @tnigroves.
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Orange County has 3rd Positive Rabies Case of 2019 Confirmed by State
https://chapelboro.com/news/safety/state-lab-confirms-3rd-positive-rabies-test-for-orange-county-in-2019[8/19/2019 11:07:44 AM]
The Music in My Head – 7/30/19 Adopt-A-Pet: Mason from Orange County Animal Services
State Lab Confirms 3rd Positive Rabies Test for Orange
County in 2019
Posted by Blake Hodge | Jul 30, 2019 | Safety | 0
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The North Carolina State Laboratory of Public Health has confirmed the third positive rabies test of 2019 for
Orange County, officials said on Tuesday.
The case originated in southwest Orange County near Ford Road and Angel Way on Friday, July 26. A resident’s dog
“called her attention to a small raccoon that appeared lethargic,” according to a release from the county.
Animal Control crews responded and removed the raccoon, which did test positive for rabies.
The dog at the home had a current vaccination and is able to receive a booster rabies vaccination, which is required
within four days. An unvaccinated animal must either be destroyed or quarantined for up to four months.
A communicable disease nurse from the Orange County Health Department is also working to assess the rabies risk
of the individuals involved because the dog was bathed after coming into contact with the raccoon.
Raccoons and bats are the host species for rabies in our community. Other animals carrying rabies are likely
infected through “spillover effect” from one of the two host species.
This is the third positive rabies case for Orange County this year, following four last year and nine the year before.
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