HomeMy WebLinkAboutFinal Minutes of August 24, 2022 MINUTES
ORANGE COUNTY BOARD OF HEALTH
August 24,2022
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 August 24, 2022 at the Orange
County Health Department, 300 West Tryon Street, Hillsborough, NC.
BOARD OF HEALTH MEMBERS PRESENT: Bruce Baldwin — Chair, Keith Bagby—Vice-
Chair, Brian Crandell, Commissioner Jean Hamilton, Aparna Jonnal, Sam Lasris, Lee Pickett,
Alison Stuebe, and Tony Whitaker.
BOARD OF HEALTH MEMBERS ABSENT: Shielda Rodgers.
STAFF PRESENT: Quintana Stewart, Health Director; Dana Crews, Community Services
Director; Micah Guindon, Financial and Administrative Services Director; Victoria Hudson,
Environmental Health Director; Carla Julian, Compliance Manager; Renee Kemske, Nutrition
Program Manager; Thomas Privott, Environmental Health Supervisor; and La Toya Strange,
Administrative Support I.
GUESTS PRESENT: None.
I. Welcome New Employees: Ms. Stewart introduced Jason Baird, Gianny De Jesus,
Stephen Johnston, Katie Luedecke, Camille Mackler, Kaniqua Outlaw and Sarah Thompson.
II. Public Comment for Items NOT on Printed Agenda: None.
III. Approval of the August 24, 2022 Agenda
Motion was made by Aparna Jonnal to approve the agenda, seconded by Alison Stuebe
and carried without dissent.
IV. Action Items (Consent)
A. Minutes of June 22, 2022 Meeting
Motion to move the approval of June's minutes to September's Board meeting was made
by Keith Bagby, seconded by Tony Whitaker and carried without dissent. There was a
technical issue with the uploading of June 2022s minutes.
V. Educational Sessions
A. OC Schools' Youth Risk Behavior Survey (YRBS) Data Findings
Caroline Pruitt, Data Analyst Intern in the OCHD's FAS Division, provided a summary of results
from the 2021 Youth Risk Behavior Survey (YRBS) for Orange County Schools. Below are brief
highlights.
In the early 1990s, the CDC created a national survey to be administered, bi-annually at
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both the middle and high school level, by school districts to monitor trends related to
national health objectives such as unintentional injury and violence, sexual behaviors,
substance use and dietary patterns and physical activity.
• Parents receive the waiver from the school and send it back in order for the student to
participate in the YRBS survey.
• Disclaimers/Limitations
➢ Before revealing the results, Ms. Pruitt provided a disclaimer stating that there were
not enough students surveyed to ensure that these occurrences are representative
of the larger student population. She continued by stating that these results can be
used for additional data collection and that they represent the sample of students
who were surveyed.
➢ A comparative analysis was unable to be conducted. The results are non-
representative of the entire student body's true behaviors/perceptions due to the
small sample size.
• Results
➢ High school
o There were 58 respondents out of a total 2500 high school students.
o The majority of respondents were White consisting of two-thirds being female
and two-thirds identifying as heterosexual. Another restriction that came up in the
analysis involved the LGBT students as the CDC recommends having a sample
size of at least 30 students who identify as LGBT in order to conduct any
analysis. Since that did not occur, further analysis in whether LGBT students
participated in any of these behaviors at a higher rate than their peers could not
be conducted. That is also why it was decided not to conduct any comparative
analysis for various race/ethnic groups.
o Mental Health and Suicide — highest percentage of students (63.7%) reported
poor mental health "sometimes", "most of the time" or"always" in the past 30
days; 5.2% reported making a suicide attempt in the past 12 months
o High risk and violence — highest percentage of students (10%) reported
experiencing sexual or dating violence
o Substance Use — highest percentage of students (17.2%) reported ever trying
alcohol; 6.9% reported having at least 1 drink in the past 30 days, having ever
tried marijuana, and/or having used prescription drugs not prescribed to them
o Weight Control and Diet— 52% of students reported trying to change their weight
(either losing or gaining weight)
o Sexual Behaviors — 5% reported having ever had sexual intercourse; 3.5%
reported using a condom or a form of birth control during intercourse
o Other Health Markers —86% reported visiting a dentist in the past 12 months;
36% reported regularly getting at least 8 hours of sleep; 7% reported ever being
test for HIV; 7% reported ever being tested for an STD
o Risk perception — high school students' perceived risk was highest in regards to
daily tobacco and prescription drugs
o Parental acceptance — high school students' stated that their parents would not
be accepting of their usage of alcohol, marijuana, tobacco and prescription drugs
➢ Middle schools
o There were 77 respondents with 75% White and 62% male.
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o Mental Health and Suicide — highest percentage of students (75%) reported poor
mental health "sometimes", "most of the time" or"always" in the past 30 days;
12% reported making a suicide attempt in the past 12 months
o High risk and violence — highest percentage of students (97%) reported wearing
seatbelts "most of the time" or"always"
o Substance Use — highest percentage of students (9%) reported having used
prescription drugs not prescribed to them; 8% reported ever trying alcohol (more
than few sips); 7% reported trying inhalants
o Weight Control and Diet—40% of students reported trying to change their weight
(either losing or gaining weight); 32% reported eating breakfast less than 4 days
a week
o Risk perception — middle school students' perceived risk was highest in regards
to daily tobacco and prescription drugs
o Parental acceptance — middle school students stated that their parents would not
be accepting of their usage of alcohol, marijuana, tobacco and prescription drugs
The BOH had questions and comments that were addressed by Ms. Pruitt and Ms.
Stewart.
B. Nutrition Services Update —Access to Care Initiatives
Renee Kemske, Nutrition Program Manager, gave an update on the OCHD's Nutrition Services
section. Ms. Kemske began with definitions of the licensures, RD and LDN. The RD defines
someone as a Registered Dietitian, nationally. The LDN stands for Licensed Dietitian
Nutritionist, which means the practitioner is legally licensed to practice in their state. Below are
some highlights of her presentation.
• Nutrition Counseling
➢ Nutrition counseling also known as Medical Nutrition Therapy (MNT) is a service
provided by a RD who works with a referring medical provider to improve a variety of
conditions such as diabetes, heart disease, and obesity. Referrals are received from
medical providers within and outside of the OCHD. The RDN conducts a review of
the medical history, medications, diet, and lifestyle patterns and together with the
referred client or family member, if the client is a young child. More children with
eating disorders have been seen lately. A personalized plan is developed to help
them meet their nutrition goals. There were 636 encounters in FY 2021-22 at a visit
rate of 25% in-person to 75% telehealth. Telehealth MNT appointments have
allowed for increased accessibility. Self-management/behavior change tools and
scales are mailed to clients. The payment types for these visits are insurance at
25%, Medicaid at 31% and self-pay at 44%. The rate of self-pay visits has doubled,
as there are vouchers available that have waived fees.
• Diabetes Self-Management Education Services (DSME)
➢ DSME is an American Diabetes Association (ADA) recognized program in which a
client receives 10 hours of education on the basics of diabetes prevention and
management. There is an initial health assessment. They also sign up for two four-
hour group education classes on the basics of diabetes care. Then the client will
come back in 3 months for a follow-up appointment where knowledge is measured
as well as any change in blood sugar management. Nutrition Services have
collaborated with local experts in the different areas of diabetes management
including Walgreens pharmacy and the Department of Aging. DSME class
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evaluations have reported that 100% of clients reported that the classes gave them
new knowledge and skills about diabetes; while, 89% reported that they would not
have made changes if they were not enrolled in the program.
➢ DSME classes were also offered virtually via Zoom and in Spanish with Zoom
Simultaneous Interpretation. Zoom is an ADA-approved telehealth format for the
DSME classes. Some positive outcomes of using Zoom were that it helped to
reduce barriers such as transportation, time and mobility. Some negatives included
the mailing costs of materials and possible connectivity issues and low technical
knowledge.
• Community Health Grant (CHG)
➢ In 2017, the CHG was awarded by the Office of Rural Health. A second CHG was
awarded for an additional 3-year period, ending June 30, 2022. The purpose of this
award was to increase access to primary care and self-management support
services for residents with chronic disease. Groups specifically targeted include
adults who are uninsured, on Medicaid or Medicare.
➢ The voucher program helped many clients by covering the minimum fee for Nutrition
Services. Diabetes tests and supplies are offered at no cost to help clients manage
their diabetes. The voucher led to a 5x time increase in the number of clients seen
(not referred). Chatham County Public Health Department has replicated the
program.
➢ Specific objectives and outcomes of the CHG include:
o The continuation of the transportation assistance program for adults and
pregnant women. There were 204 scheduled rides during FY 21-22.
• Primary care bag initiative
➢ The goal is to help people that have hypertension or diabetes self-monitor at home.
Funds are used to purchase blood pressure cuffs and diabetes testing supplies, etc.
to help them keep well at home. Participants receive necessary labs and are
scheduled for a MNT telehealth appointment.
• Community partnerships include establishing relationships with people individually to
better help them linked to services and working with agencies including the OC
Department of Aging, UNC Family Medicine — Living Healthy, as they wanted more
health promotion and nutrition services. Nutrition Services is also working to enhance
the community health worker (CHW) role.
• New NCCARE360 Grant
➢ It is the first statewide coordinated care network to better connect individuals to local
services and resources. The NCCARE260 Health Equity Grant from Foundation for
Health Leadership & Innovation was awarded for FY 22-23. Nutrition Services staff
will begin sending and receiving referrals through the NCCARE260 platform.
• Diabetes Prevention Program (DPP)
➢ DPP is a 16-week class for people with prediabetes or who are at risk for Type 2
diabetes make realistic and achievable lifestyle changes that can cut their risk of
developing Type 2 diabetes by 50%. The goal is to help them lose at least 5% of
their body weight and/or to achieve 150 minutes or more physical activity per week.
Grant funding is used to provide prizes to aid in behavior change.
➢ There has been an average of 5.3% weight loss amongst the class. There has also
been an average of 164 physical activity minutes completed per week.
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➢ In January 2022, the OCHD DPP was awarded Full Class Plus Recognition from the
CDC.
• Employee Wellness
➢ Background — Human Resources (HR) agreed to give a portion of their wellness
funds to pay for one of the OCHD's registered dietitian's salary. A small portion of
that allows the nutrition services to be able to provide services to employees that are
not covered under the employee county health plan.
➢ The program had to decrease services due to low HR and Nutrition staffing. A variety
of topics including meal planning and weight management are offered as well as
department-specific presentations conducted. Currently, Nutrition Services is
developing and implementing a new outreach plan to reach employees at the
County's New Employee Orientation.
The BOH had questions and comments that were addressed by Ms. Kemske.
C. Family Success Alliance (FSA) Update
Dana Crews, Community Health Services Director, presented an update on the Family Success
Alliance (FSA). Below are some brief highlights.
• FSA Staff
➢ There are 8 navigators, an FSA manager and an NC Integrated Care for Kids
Collaboration (NC InCK) Integration Consultant.
o The NC InCK Integration Consultant provides training, guidance and support to
the FSA Navigators.
➢ The FSA Navigators complete a Community Health Worker course, are eligible for
certification in NC and undergo continuous training to support professional
development in case management.
• Navigator Program
➢ Has expanded beyond the initial 2 zones
➢ Serves at-risk families with a child in the home between the ages of 0-18.
o RedCap is the database used to manage and track navigators' work.
o Tier, time-limited services are provided based on family needs and progress.
■ High-touch families —all at-risk families are enrolled at this tier with core
health goals and specific needs identified within the initial 1-3 months;
monthly contact required
■ Low-touch families —families are now linked to resources and are
maintaining the resources obtained; ensured there are no barriers to
maintaining engagement with services; bi-monthly contact required
■ FSA Connections —family completes case management program and is no
longer assigned a navigator; Connection navigator surveys the family
annually
➢ Works to ensure that all families have access to services that address their physical,
behavioral and developmental needs by using their knowledge and connections to
link the families to resources.
➢ Determines which families are at-risk by collaborating with entities who serve at-risk
families most often such as Department of Social Services (DSS), medical facilities,
school social workers. Self-referrals also occur.
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➢ The FSA Navigators are currently serving 95 families with include approximately 230
children. FSA Connections program is currently serving 135 individuals and families.
• Partner Network
➢ Identifies innovations to support families; determines what services should be scaled
up, down or maintained; agencies include both OC school districts, Kidscope, El
Futuro, UNC Health Care, Freedom House, Alliance Health, and the Town of
Hillsborough.
• FSA Advisory Council
➢ Meets monthly; consists of a group of OC stakeholders that come together to make
advisory recommendations on program planning and policy changes to ensure high-
quality services to reduce the detrimental effects of poverty for families and children
living in OC.
• FSA Community Council
➢ Meets monthly; consists of leaders from various OC communities working to make a
difference in their own neighborhoods; community-led improvement projects (able to
write for grants to fund these projects)
o Community Innovation projects include Bridging the Gap of Technology, Timbers
Community Gathering, STEM Night, and a Mental Health Art Day.
• Gateway Village Collaborative
➢ It was formed in November 2021 and consists of OC Schools, DSS, Housing, OCHD,
Human Rights & Relations, the Town of Hillsborough and the Hillsborough Police.
➢ It was determined that relationships needed to be formed with the tenants, property
managers, etc.
➢ Gateway Community tenants have voiced their concerns regarding their needs via a
Community Needs Assessment that was sent to tenants asking for their input.
Feedback received included:
o No place for youth activities, substance use, safety concerns, violence and drug
dealing occurring in the community
o Building structure issues in the community including rodents, pests, and mold
➢ Gateway Village Hub
o DSS and OCHD collaborated to lease a 2-bedroom apartment in the community
as a resource center for the residents with office hours currently on Tuesdays
and Thursdays from 10am-3pm. Appointments are available as needed.
o Various partners including New Hope Elementary, Orange Literacy (will have 1:1
tutoring) and the Hillsborough Police Department have already committed to the
project. OCHD's Environmental Health Division has also helped with pest
management, etc.
• FSA Goals for 2022-2023 include:
➢ Ensuring that children and adults enrolled in the program have access to equitable
care to address physical health, dental, behavioral and developmental needs
➢ Increasing the number of community partnerships and identifying metrics to measure
our work with the Gateway pilot to potentially do the same in other communities.
The BOH members had questions and comments that were addressed by Ms. Crews and
Ms. Stewart.
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D. 4th Quarter Financial Reports and Dashboards
Micah Guindon, Finance and Administrative Services Director, gave a report on the 4th quarter
revenue and billing accuracy. Her report is as follows:
• Total Health Department Budget vs. Actuals:
Average YTD monthly revenue in FY 21-22 after the fourth quarter is $329k/month or
$3.9M projected for the year, representing 93% of our overall projection for the year.
Revenues are higher than this point last fiscal year due to increased service levels for
patients and residents. Service Revenue in the Environmental Health, Personal Health,
and Dental Divisions are all up from the previous fiscal year. Expenses at the end of the
fiscal year are at 88% of the overall budget.
• Dental Earned Revenue by Source:
The FY 21-22 average monthly revenue ($43.2k/month) for the fourth quarter is above
our budget projection of$41 k/month and above the FY 20-21 average of$37.1 k/month.
Revenue increases are due to a number of factors including only leaving confirmed
patients on the schedule in order to decrease the number of no-show appointments.
Revenue slowed a bit in Q4 compared to Q3 due to staff vacancies, but still remains
higher than FY 20-21. FY 21-22 dental earned revenue totals $519k at the end of the
fourth quarter compared $445k at the end of FY 20-21.
• Medical Earned Revenue by Source:
Medical earned revenue is currently above the budgeted projection for FY 21-22
($33k/month) at $47.3k/month due primarily to Medicaid Transformation's per member
per month rates for Primary Care. Family Planning, Child Health, Adult Health, Diabetes
Self-Management Education, and Refugee Health programs are all also bringing in
higher than expected revenue. Medical clinic revenue totals $568k through fourth quarter
FY 21-22 compared to $489k in FY 20-21.
• Environmental Health Earned Revenue by Source:
Environmental Health earned revenue is above the budgeted projection for FY 21-22
($53k/month) at $55.2k/month. We are continuing to see the relationship between
weather and housing growth and applications submitted to Environmental Health. There
is also a trend in applicants changing their plans, which requires new applications. FY
21-22 fourth quarter YTD revenue ($662k) is higher compared to FY 20-21 ($612k).
• Multi Year Grant Fund Revenue:
Family Success Alliance (FSA) has expended all of the Kenan Grant dollars although the
revenue was received in the previous fiscal year. The NC IncK grant has expended
$5,230 in Q4, but revenue has not yet been received.
The BOH members had questions that were addressed by Ms. Guindon.
VI. Action Items (Non-Consent)
A. Board Appointment
Dr. Bruce Baldwin, Chair, led the BOH in its discussion of the proposed replacement for the
dentist representative.
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Motion to appointment Dr. Allessandra Lowery to fill the dentist representative seat and
forward to the Board of County Commissioners was made by Alison Stuebe, seconded
by Dr. Lee Pickett, and carried without dissent. Commissioner Jean Hamilton abstained.
B. OC Groundwater Rules Section IIIB Revised
NCGS 130A grants Boards of Health the general authority to adopt rules necessary to protect
public health. The Orange County Board of Health (BOH) adopted local rules in 1980 for the
protection of the groundwater and the Orange County community that drinks groundwater.
Victoria Hudson, Environmental Health Director, presented and reviewed the proposed
changes, which were included in the Board's agenda packet. The BOH will be asked to
approve the proposed changes at the September 21 It
Board meeting. Ms. Hudson will send the
Board a final draft on Monday that will also be posted, as there is a 10-day public comment
period required. Below are summaries of the proposed rules.
• GROUTING: Recent changes to the legislation governing the construction of water wells
in North Carolina require a revision to local grouting policy.
• MONITORING WELLS: NCDEQ has statutory and regulatory authority to assess and to
remediate groundwater contamination, including exercising professional judgement to
instruct responsible parties where monitoring wells should be placed on affected
properties. Sometimes, these Rules have come into conflict with Orange County's
setback requirements. NCDEQ's authority for groundwater assessment and remediation
requirements comes from 15 NCAC 2L .0404, .0405, .0406, and .0407 which otherwise
meet the requirements of 15 NCAC 2C .0108 (the State's construction Rules). The local
Rules will reflect their authority but remain as local standards of construction.
The BOH members had questions that were addressed by Ms. Hudson.
VII. Reports and Discussion with Possible Action
A. Media Items
In lieu of the absent Communications Manager, Kristin Prelipp, Quintana Stewart, Health
Director, presided over the media items portion of the agenda. In the interest of time, Ms.
Stewart asked the Board if there were any questions about the articles in the Board packet.
There was none.
Media items were in the packet which focused on Orange County's events and our
involvement in various efforts.
B. Health Director Report
Quintana Stewart, Health Director, chose to highlight the following items from her report.
• COVID-19 related in OC:
➢ COVID-19 cases are decreasing. Wastewater surveillance has shown that SARS-
CoV-2 viral levels are decreasing. Hospital admissions are still increasing. Per UNC
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Health, approximately 50-60% of new COVID+ admissions are being admitted for
reasons other than COVID.
• Monkeypox
➢ Currently, there is 1 confirmed case in OC. The CDC is performing the contact
tracing.
• International Overdose Awareness Day—Wednesday, August 31, 2022
➢ An event will be held on August 31It from 9am-6pm at the Peace and Justice Plaza
in Chapel Hill to bring awareness to drug overdose. The OCHD has been involved in
the planning of this event.
Vill. Board Comments
Dr. Bruce Baldwin, Chair, stated that the BOH subcommittee is looking at 6 applicants for the
vacant At-Large seat. He conveyed that all Board members are welcome to provide input and
suggested that any new applicants be forwarded to all Board members. Dr. Baldwin stated that
the goal is to have all new members onboarded by the October Board meeting as the Board will
partake in training during that meeting.
IX. Adjournment
Commissioner Jean Hamilton moved to adjourn the meeting at 9:18pm and Dr. Lee
Pickett seconded.
The next Board of Health Meeting will be held September 21, 2022 at 7:00pm at the
Orange County Health Department, 300 West Tryon Street, Hillsborough, NC at 7:00 p.m.
Respectfully submitted,
Quintana Stewart, MPA
Orange County Health Director
Secretary to the Board
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