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HomeMy WebLinkAboutApproved Minutes of August 23 2023 MINUTES-Draft ORANGE COUNTY BOARD OF HEALTH August 23,2023 ORANGE COUNTY HEALTH DEPARTMENT MISSION STATEMENT: To promote and protect health, enhance quality of life, and preserve the environment for everyone in Orange County. THE ORANGE COUNTY BOARD OF HEALTH MET ON August 23, 2023, at the Orange County Health Department, 300 West Tryon Street, Hillsborough, NC. BOARD OF HEALTH MEMBERS PRESENT: Keith Bagby- Chair, Aparna Jonnal -Vice- Chair, Bruce Baldwin, Lee Pickett, Shielda Rodgers, and Rachel Royce. Commissioner Jamezetta Bedford and Alison Stuebe arrived later. BOARD OF HEALTH MEMBERS ABSENT: Brian Crandell and Tony Whitaker. STAFF PRESENT: Quintana Stewart, Health Director; Dana Crews, Community Health Services Director; Victoria Hudson, Environmental Health Director; Carla Julian, Public Health Nursing Director; Ashley Rawlinson, Compliance Manager; Thomas Privott, Environmental Health Supervisor; Kimberlee Quatrone, Business Officer II; Crystal Kelley, Health and Human Services Manager; La Toya Strange, Administrative Support I; and Jean Phillips-Weiner, Senior Public Health Educator. GUESTSIVISITORS PRESENT: Gayane Chambless. I. Welcome New Employees Quintana Stewart, Health Director, introduced the new employees in attendance: Kimberly Collins- Dental Hygienist, Shamicka Nichols - Dental Assistant, Diana Martinez Vargas - Family Navigator, Diana Perez Espinosa -Accounting Technician I, Frederick Perschau - Finance and Administrative Services Director, and Alexandria Rimmer- Food and Lodging Supervisor in Environmental Health. April Thompson - Office Assistant II in the Nutrition Program arrived later. II. Public Comment for Items NOT on Printed Agenda Mr. Bagby mentioned that he had invited Gayane Chambless to speak. Gayane shared an idea she had developed with Dana Crews to address gaps in tobacco intervention and cessation efforts. Her organization, Orange Partnership for Alcohol and Drug-Free Youth (Orange Partnership) received a large Substance Abuse and Mental Health Services Administration (SAMHSA) grant (Partnership For Success) approximately one year ago. As they still have 25% of the grant (-$92K) left, they are hoping to increase Orange County's intervention capacity and use some of those funds to train at least one additional health department or school staff member in cessation intervention skills to close some of the gaps in services. Gayane gave board members a one-page proposal summarizing her comment. III. Board Comments Dr. Aparna Jonnal Dr. Jonnal expressed interest in exploring the impact of screentime (time spent looking at a screen, e.g., TV, iPad, computer) on children. Dr. Jonnal said that new data is emerging suggesting that increased screentime correlates with increased risks to children's physical and mental health, and she would like the board to review this emerging concern and make a S:\Managers Working Files\BOH\Agenda&Abstracts\2023 Agenda&Abstracts/ August Page 1 MINUTES-Draft ORANGE COUNTY BOARD OF HEALTH August 23,2023 recommendation to the schoolboard for ways to help manage and limit this risk, as schools generally do not have limits on screentime. In response, Mr. Bagby asked if Dr. Jonnal felt the board could address this alone or if they would need outside help. Dr. Jonnal answered that Dr. Royce and the board could likely review data and get an idea of the risk and quality of existing data, but that the board should also look for a local expert to speak on the topic. Dr. Royce seconded the idea of finding a local expert to assist with this topic and said that she'd be happy to help look for an expert to help. Dr. Alison Stuebe Dr. Stuebe shared the Vital Conditions model, which she compared to the Social Determinants of Health but with a larger focus on conditions of wellness vs. illness. She stated that while acute services will always be needed, without community and wellness, people will not thrive. She feels that it's important to consider what conditions are needed for community members to really thrive, especially with the CHA coming out soon. Dr. Stuebe also shared a personal story about a pregnant patient who recently came into the emergency department after being hit by a car while walking in an area without a sidewalk. While the patient and baby are both okay, Dr. Stuebe expressed that she would like the board to consider things like safe environments and reliable transportation, including access to sidewalks. Dr. Rodgers asked if there was a citation for the model, to which Dr. Stuebe replied there was more information online. Dr. Jonnal asked what organization had adopted this model, to which Dr. Stuebe replied that The Ripple Foundation introduced it, and it has been adopted by the Office of Disease Prevention and Health Promotion. Dr. Jonnal added that she feels we are so focused on treatment in this country rather than prevention, which she feels is a detriment to overall well-being. Dr. Stuebe agreed that we need to create civic muscles to cultivate positives in communities. Dr. Rachel Royce Dr. Royce expressed that she would like to hear regular Community Health Assessment (CHA) updates during board meetings going forward, for example as a standing agenda item. She also shared that there is a new variant of COVID-19 (EG.5) emerging, with 35 mutations on the spike protein, making it more likely to evade existing immunity. While the existing vaccines will help protect people, she said it's as big a change as from the Wuhan variant to the Omicron variant and that wastewater and hospitalization data suggest that new cases are beginning to trend upwards. She recommended that board members use Your Local Epidemiologist or The People's CDC to follow the new variant. Mr. Bagby asked if Dr. Royce would like an update on the CHA tonight, to which she replied that she did not want to put anyone on the spot. Ms. Stewart said that CHA updates will be added to future meetings and that she would add a brief update to her Health Director's Report tonight. Dr. Bruce Baldwin Dr. Baldwin referenced Dr. Jonnal's previous comment about screentime and added that there is an established relationship between high levels of screentime and an increased risk of developing myopia, which could potentially impact mental health. S:\Managers Working Files\BOH\Agenda&Abstracts\2023 Agenda&Abstracts/ August Page 2 MINUTES-Draft ORANGE COUNTY BOARD OF HEALTH August 23,2023 In response, Dr. Stuebe shared a metanalysis on the relationship between myopia and screentime. Dr. Jonnal commented that it seems screentime really impacts a lot of things — developmental, emotional, behavioral, and physical (including cardiovascular) health. Keith Bagby Mr. Bagby shared that Orange Partnership has set up a Lunch and Learn addressing youth mental health concerns on September 20' from 1-2pm on Zoom. Alliance Health, El Futuro, Freedom House Recovery Center, and Mindful Development are collaborating. In reply, Commissioner Bedford apologized for being late and added that Orange County and Alliance have been selected as part of a group of ten of the Carolina Across 100 Suicide Prevention, which she shared earlier that day on WCHL radio. She said she would forward the email she received about this to the group. Mr. Bagby added that Orange Partnership will also be hosting a series of radio programs on WCHL discussing mental health concerns and resources. IV. Approval of the August 23, 2023, Agenda Motion to approve the agenda of the August 23, 2023, BOH meeting was made by Dr. Aparna Jonnal, seconded by Dr. Bruce Baldwin. Mr. Bagby clarified that the CHA update would be covered under the Health Director's Report rather than made its own item, which Ms. Stewart confirmed. The motion was then carried without dissent. V. Action Items (Consent) A. Minutes of June 28, 2023 Motion to approve the minutes of the June 28, 2023, BOH meeting was made by Dr. Lee Pickett, seconded by Dr. Alison Stuebe, and carried without dissent. VI. Educational Sessions A. Youth Mental and Behavioral Health Tamara "Tami" Pfeifer, Youth Behavioral Health Liaison and Youth Deflection Coordinator for Orange County Criminal Justice Resource Department, gave a presentation on Youth Mental and Behavioral Health in Orange County. Ms. Pfeifer shared that she works with young people who are at risk of or have gotten in trouble with the criminal justice system. Her role involves providing referrals for treatment, crisis management services, and otherwise helping to connect young people with other resources with the goal of improving outcomes for youth and preventing incarceration and recidivism. Below are some highlights of her presentation: • In response to Dr. Royce's question about the average number of children deflected from the court system per year, Ms. Pfeifer reported that since the program's inception in 2021, approximately 75 children have been deflected from juvenile detention (i.e., met with Ms. Pfeifer rather than going into the courts). S:\Managers Working Files\BOH\Agenda&Abstracts\2023 Agenda&Abstracts/ August Page 3 MINUTES-Draft ORANGE COUNTY BOARD OF HEALTH August 23,2023 • Ms. Pfeifer shared risks and needs in Orange County based on young people who are currently in the system, highlighting several statistics (e.g., felony referrals, school attendance, prior drug or alcohol use) where Orange County is scoring worse than the state rate. She stated that in Orange County, 80% of the young people currently in the system are at high risk of remaining in the system due to their behaviors. She also discussed racial and ethnic disparities in the justice system, drawing attention to the fact that youth of color in Orange County are 5x more likely to receive a delinquent complaint compared to their white peers and that Black students in Chapel Hill are 11.8x more likely to be suspended from school than their white peers. • Ms. Pfeifer discussed mental health concerns and school support in Orange County, mentioning that since the COVID-19 pandemic there has been an increase in mental health risk assessments, suicidal ideation, and suicide risk among young people. Ms. Pfeifer mentioned that LGBTQ+ youth were disproportionately at risk for suicide, with higher risk of experiencing ideation (44% vs. 16% of non-LGBTQ+ peers) and higher risk of attempting suicide (22% vs. 8% non-LGBTQ+ peers). On behalf of Dr. Crandell, Ms. Stewart asked about poisoning as a method of self-inflicted injury and if it was known what substances young people were using to induce poisoning. Dr. Pickett and Dr. Stuebe suggested Tylenol was a common method of overdose, and Dr. Rodgers echoed that Tylenol or a family member's medication are commonly used to induce poisoning. Ms. Pfeifer agreed that this sounded likely, though she wasn't 100% certain. • Ms. Pfeifer highlighted some specific issues that she felt were critical to improving youth mental and behavioral health outcomes, including difficulties accessing health insurance, a lack of access to mental health services, unstable/unaffordable housing situations, limited services for undocumented youth, few rehab facilities available to minors, and transportation barriers. Ms. Pfeifer emphasized that many of these issues are intergenerational and cyclical, where young people cannot find positive ways to meet their needs and so turn to negative ones instead. She recommended building up community strengths and wellness and promoting restorative justice in the county. • Board members and Ms. Pfeifer discussed possible ways to support young people in Orange County. Dr. Pickett asked about Restorative Justice Durham, a program operating in Durham County, and Ms. Pfeifer stated that a similar program was not currently active in Orange County, but she hoped would be in the future. Dr. Stuebe mentioned Dr. Shawn Ginwright's work on Healing Centered Engagement vs. the tenets of trauma-informed care, specifically highlighting the idea of"what's right with you" as opposed to "what's wrong with you?" Ms. Pfeifer commented that the justice system creates further trauma rather than healing it. Dr. Rodgers recommended educating school staff about racial disparities and specifically comparing disciplinary rates for the same infractions for white vs. Black students to draw attention to the problem. Mr. Bagby shared a recent back-to-school event he attended celebrating young people and asked if there were further opportunities to get involved; Ms. Pfeifer invited him to speak with her after the meeting about the Youth Deflection program. B. Family Success Alliance Update Crystal Kelley, Health and Human Services Manager, and Dana Crews, Community Health Services Division Director, presented the Family Success Alliance (FSA) program update. Ms. Kelley gave a summary of the structure and goals of the FSA program and shared an update on recent work and achievements. Below are some highlights of the presentation: S:\Managers Working Files\BOH\Agenda&Abstracts\2023 Agenda&Abstracts/ August Page 4 MINUTES-Draft ORANGE COUNTY BOARD OF HEALTH August 23,2023 • Ms. Kelley shared that FSA has done away with the zone model in the county and that all residents that meet program criteria are welcome to join FSA. She added that there has been a 25% increase in diversity among the approximately 70 families (around 210 children) currently served by the FSA Navigator program. There are also around 205 families currently served by the FSA Connections program, including former FSA Navigator clients. Currently about 80% of families served have access to medical and dental care. • Ms. Kelley mentioned that there are typically about 5-6 new referrals per week, but that the program is generally able to manage this volume. She stated that there has only been a waitlist to enroll once or twice in the past, and only due to a staffing shortage (i.e., being down a navigator). • In response to Dr. Jonnal's question about how families are referred to the program, Ms. Kelley replied that there is a simple referral form that is used to introduce potential clients to the program, which Dr. Jonnal is encouraged to use and share among her colleagues. Ms. Kelley also mentioned that no one is ever turned away, and that those who do not meet the eligibility criteria for the Family Navigator program are referred to the FSA Connections program. Ms. Crews added that if someone in the program leaves Orange County, FSA will set them up in their new county so that they remain supported. • In response to Dr. Stuebe's question about referrals for pregnancy care management, Ms. Kelley said that individuals would be eligible to enroll in the FSA Navigator program once they give birth or if they already have one or more children, but that they would be able to receive support from the FSA Connections program immediately. • Ms. Kelley mentioned that FSA collaborates frequently with community partners, including nonprofit, faith-based, and local government organizations. She specifically highlighted an upcoming collaboration with the Chapel Hill Public Library, who will be offering computer literacy classes specifically to FSA families. Dr. Royce asked if FSA also collaborates with the Orange County Public Library, to which Ms. Crews replied yes and Ms. Kelley added that while they collaborate with both libraries, the Chapel Hill Public Library is generally more proactive about the partnership. • Ms. Kelley shared an update on the Gateway Village and Community Hub project and specific goals, including building stronger relationships with property managers as property management is a common concern among FSA families, completing a community needs reassessment as the COVID-19 pandemic winds down, and organizing community events. • Dr. Pickett asked if FSA collaborates with the DEGA (Determined for Everyone to Gain Access (to veterinary care)) program, as it can help low-income pet owners ensure their pets are healthy, in turn promoting the health of the family. Ms. Kelley asked Dr. Pickett to connect with her after the meeting. • Ms. Stewart commented specifically on the FSA restructure and changes made during COVID to increase accessibility, including opening eligibility for the Connections program to all and removing zone restrictions. • Ms. Kelley and Ms. Crews ended their presentation with photographs from a recent FSA trip to the Lazy 5 Ranch in Mooresville, NC. S:\Managers Working Files\BOH\Agenda&Abstracts\2023 Agenda&Abstracts/ August Page 5 MINUTES-Draft ORANGE COUNTY BOARD OF HEALTH August 23,2023 VII. Action Items (Non-Consent) A. Semi-Annual Financial Review Frederick Perschau, the new Finance and Administrative Services Director, presented a review of the Health Department finances for the 2023 (July 2022-June 2023)fiscal year. Key points included: • Total health revenue (including all service revenue, state allocations, donations, and grants) was under budget (-64% of expected total) due to various operational issues (e.g., seeing fewer patients, understaffing, Southern Human Services being closed for HVAC repairs). o The greatest gap in revenue was in the Dental department due to personnel/staffing issues. Because the Health Department has recently hired a new dental assistant and three new half-time hygienists, it is anticipated that this issue will resolve. • Overall budget was $5M, of which $3.2M was spent. Most of the expenses were personnel costs and cost of supplies, which increased due to inflation. • COVID funding was allocated at $1.4M, of which $505K has been spent down (on vaccines, school portions, enhanced detection, Regional Infection Prevention Services). Approximately $200K will roll over and need to be spent down by the end of 2024. Dr. Stuebe asked whether the financial review accounted for reimbursement from Medicaid. Mr. Perschau replied that delays in reporting are common with reimbursement and that the figures may need to be adjusted in a later period. Ms. Stewart added that the Medicaid reimbursement period has returned to 365 days (having been shortened to 90 days at the onset of the transformation) which will also cause these figures to improve. Furthermore, two new positions in the billing unit have been added to the health department, which will also help address these gaps. B. New Fee Proposals Mr. Perschau provided an overview of the updated fee proposals, stating that most of the proposed changes are recommended because of updates to UNC lab fees, with the changes to post-partum care being adjusted to be in line with the Medicaid reimbursement rate. Dr. Jonnal asked how these fees are being charged (i.e., private insurance, Medicaid, self- payment), as she was concerned that some seemed expensive and might negatively affect access to care for self-pay patients. Ms. Stewart replied that for most patients these fees would be billed to insurance or Medicaid, which would increase Health Department revenue, and that for self-pay patients a sliding fee scale, which can slide as low as $0 if needed, would be available. Motion to approve the new fee proposals was made by Dr. Shielda Rodgers, seconded by Dr. Alison Stuebe, and carried without dissent. C. Board of Health Policy Review Ms. Stewart reviewed the proposed policy changes with the board members. The proposed changes were as follows: S:\Managers Working Files\BOH\Agenda&Abstracts\2023 Agenda&Abstracts/ August Page 6 MINUTES-Draft ORANGE COUNTY BOARD OF HEALTH August 23,2023 1.0 Mission Statement and Scope of Services • Replaced old mission Statement with new one adopted at the April 26,2023 meeting. • Added the new Vision Statement to the policy. I.A. Requests for Environmental Services and Assessments • No Changes 1.13 — Fee and Eligibility Policy • No Changes; policy was reviewed and updated by the Board at the June 28, 2023 meeting in response to follow up corrective actions from the May NCDHHS Administrative & Clinical Monitoring Visit. LC - Community Assessment Policy • Changed Health Promotion & Education Services Division to Community Health Services Division throughout the policy • Added detail about the newly formed CHA Leadership Team throughout the policy I.D. — Review of Reports and Documents • Revision on page 1, Procedures 2f. Fiscal Oversight— Change frequency of financial reports to Board from quarterly to semi-annual I.E. Operating Procedures BOH Manual IV. New Board Member Tasks • ( Page 3) V. Training • Board members shall complete New Board Member Orientation training with the Health Director within their first year of service. The Orientation training will provide an overview of the health department and highlight the authorities and responsibilities of the local board of health. • In accordance with North Carolina Local Health Department Accreditation Standards, Board members shall also complete ongoing training related to the authorities and responsibilities of local boards of health. At a minimum training shall occur at least once in between Accreditation site visits. Added new section on training as recommended by Accreditation Standards; the BOH has always completed training for new members and ongoing training for the full board, this practice was not spelled out in the Operating Procedures. I.E. Operating Procedures BOH Manual —Appendix H — Confidentiality and Conflict of Interest • No Changes Ms. Stewart reminded the board that these changes would be voted on at the September meeting, and that they would have a month to review and submit revisions as needed. In response to Dr. Royce's question about how to submit potential revisions to the proposed policies, Ms. Stewart responded that any desired edits could be submitted via email and adjusted in real time. The proposal to scale financial reports back from quarterly to semi-annually (i.e., twice per year) generated a lot of discussion. Ms. Stewart clarified that these semi-annual reports would be S:\Managers Working Files\BOH\Agenda&Abstracts\2023 Agenda&Abstracts/ August Page 7 MINUTES-Draft ORANGE COUNTY BOARD OF HEALTH August 23,2023 given in January and August and would be separate from the annual budget presentation occurring in February of each year. In response to Dr. Pickett's question of how much of a burden creating the financial reports presents to staff, Kimberlee Quatrone, Business Officer II, replied that there is little extra work, as the Finance Department already completes monthly profit/loss statements. Dr. Baldwin proposed that the Finance Department could draft and share out quarterly reports online, but only present to the board twice per year. However, in response several board members expressed that they would likely forget to review these updates. Dr. Stuebe suggested the provision that the financial review be semiannual unless there was variance in the budget beyond a certain threshold. There was then some conversation about how to set the margins for such variance, and it was agreed that the Finance Department should propose the benchmark for what constitutes a significant budget deviation. In response to Dr. Royce's question as to if remaining COVID funds could be used to make improvements to schools, such as upgrading the ventilation systems, Ms. Stewart replied that they could not, because schools had received their own funding separate from the health department. Additionally, Ms. Quatrone added that the COVID funds have a provision that they cannot be used to pay for any construction or structural work. Dr. Baldwin asked how long the accreditation cycle is and, as it is four years, why not enact the policy that the required trainings be completed every four years. Ms. Stewart replied that it presents more consistency for the policy to go by accreditation periods rather than years, as another pandemic or a revision to the accreditation period length would force the board to further revise the policy. VII. Reports and Discussion with Possible Action A. Media Items Ms. Stewart briefly summarized the articles, as Lena Wegner, Communications Manager, had recently left the department. Article topics included Medicaid expansion, an emerging COVID-19 variant (EG.5), and the approval of a new Respiratory Syncytia Virus (RSV) vaccine. The article about Medicaid expansion led to a robust discussion, in which Ms. Stewart explained that there is no definite date or plan for expansion, but the hope is that it will begin on October 1It (contingent upon legislation being passed by September 1 St). Ms. Stewart added that OCHD is prepared to educate the community about new eligibility requirements, but that due to a desire to avoid confusion, no actions will be taken until there is a definite date. In response to Dr. Baldwin's question about new eligibles, Ms. Stewart replied — and Commissioner Bedford echoed —that there would be approximately 6,000 new eligible beneficiaries in Orange County. There was an extended discussion about awareness of eligibility and ways to help newly eligible beneficiaries get enrolled, including the extent to which hospitals might assist individuals with Medicaid enrollment. While the board reached the conclusion that it seemed unlikely that hospitals will be heavily involved in the enrollment process, Ms. Stewart stated that the OCHD will coordinate with DSS, who will really push the news of the expansion to community members. Commissioner Bedford shared that four (of six) new temporary employees have been hired to assist with enrollment during the expansion. Dr. Stuebe, Commissioner Bedford, and Dr. Jonnal suggested sharing news of the expansion anywhere people may congregate, including PTA meetings, through school social workers, and at grocery stores. S:\Managers Working Files\BOH\Agenda&Abstracts\2023 Agenda&Abstracts/ August Page 8 MINUTES-Draft ORANGE COUNTY BOARD OF HEALTH August 23,2023 Regarding the EG.5 COVID-19 variant, Ms. Stewart shared that there has been an increase in hospitalizations but no increase in deaths at this time, and that at this time there is no change in COVID protocol at OCHD. Additionally, the health department has masks and tests available to distribute to community members. The FDA has extended the expiration date for the tests by one year. Media items were in the packet, which focused on Orange County's events, our involvement in various efforts, and various public health topics. B. Health Directors Report Ms. Stewart presented her report to the Board. Below are brief highlights of her report. • There is an upcoming community event, Building Community & Health, in Northern Orange County. The event will take place on September 24' from 2-4pm and will provide education around opioid and substance use disorders, including distribution of Narcan and a CPR demonstration. • At the end of September, the North Carolina Public Health Association will host its Fall Educational Conference in Concord, NC, which many OCHD staff members will be attending. • The OCHD's vacancy rate is 7.9%, with about 10 open positions. • Board of Health Subcommittee meetings will begin reconvening in September, with meetings for two of the three subcommittees scheduled. • The Health Promotion and Education Services (HPES) department is actively working on the CHA and are currently working to schedule listening sessions to review the primary data with community members. Ms. Stewart added that if any board members chose to attend a listening session it would serve as an accreditation benchmark (for engagement with community members). Ashley Rawlinson, Compliance Manager, added to the update on the CHA. She shared that primary data collection is winding down and that we have received approximately 350 convenience responses and around 110 household/random responses for roughly 450 total responses. She shared that there have been several diverse focus groups held for the CHA, including with formerly incarcerated individuals, Gateway residents, Spanish-speaking individuals, and an upcoming one with individuals with substance use disorders. Ms. Rawlinson also reiterated that the county is in the process of scheduling listening sessions for the fall, adding that the department is performing preliminary analysis on the collected data and will schedule the sessions once this analysis is complete, and added that the final document will be written during the winter. Vill. Adjournment A motion was made by Dr. Aparna Jonnal to adjourn the meeting at 9:03 p.m., was seconded by Dr. Bruce Baldwin, and carried without dissent. The next Board of Health Meeting will be held September 20, 2023, at the Orange County Health Department, 300 West Tryon Street, Hillsborough, NC at 7:00 p.m. S:\Managers Working Files\BOH\Agenda&Abstracts\2023 Agenda&Abstracts/ August Page 9 MINUTES-Draft ORANGE COUNTY BOARD OF HEALTH August 23,2023 Respectfully submitted, Quintana Stewart, MPA Orange County Health Director Secretary to the Board S:\Managers Working Files\BOH\Agenda&Abstracts\2023 Agenda&Abstracts/ August Page 10