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HomeMy WebLinkAboutApproved Minutes of March 2, 2024 Board Retreat MINUTES-Draft ORANGE COUNTY BOARD OF HEALTH RETREAT March 2, 2024 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 March 2, 2024, at the Southern Human Services Center, BOCC Board Room, 2501 Homestead Rd, Chapel Hill, NC 27516. BOARD OF HEALTH MEMBERS PRESENT: Aparna Jonnal — Chair, Alison Stuebe—Vice- Chair, Bruce Baldwin, Brian Crandell, Commissioner Amy Fowler, Davia Nickelson, Lee Pickett, Rachel Royce, Shielda Rodgers, and Tony Whitaker. Keith Bagby arrived later. BOARD OF HEALTH MEMBERS ABSENT: None. STAFF PRESENT: Quintana Stewart, Health Director; Dana Crews, Community Health Services Director; Victoria Hudson, Environmental Health Director; Carla Julian, Public Health Nursing Director; Dr. Stephanie George, Dental Services Director; Ashley Rawlinson, Compliance Manager; Frederick Perschau, Finance and Administrative Services Director; Thomas Privott, Environmental Health Supervisor; Alexandria Rimmer, Environmental Health Supervisor; Daniel Tani Ferreira Da Silva, Environmental Health Specialist; Caroline Shumaker, Dental Office Manager; La Toya Strange, Administrative Support I; and Jean Phillips-Weiner, BOH Strategic Plan Manager. GUESTS/VISITORS PRESENT: None. Welcome Quintana Stewart, Health Director, called the retreat to order. Ms. Stewart welcomed everyone and encouraged all to participate and to express their thoughts and ideas. She provided a quick overview of the items the board members had received for the day, let everyone know where to find the restrooms, and passed around the sign in sheet. She then introduced Jean Phillips- Weiner, Board of Health Strategic Plan Manager, to begin the day. Public Comment for Items NOT on Printed Agenda: None. Approval of the Retreat Agenda Motion to approve the agenda of the March 2, 2024 Board Retreat was made by Dr. Lee Pickett, seconded by Dr. Alison Stuebe, and carried without dissent. S:\Managers Working Files\B0H\Agendas&Abstracts\2024 Agenda and Abstracts/130H Retreat Page 1 MINUTES-Draft ORANGE COUNTY BOARD OF HEALTH RETREAT March 2, 2024 Retreat Purpose & Objectives and Overview of the Day Ms. Phillips-Weiner reviewed the purpose for the retreat. She affirmed that the goals for the day include allowing board members an opportunity to get to know one another outside regularly scheduled monthly meetings, to find alignment between the board, Health Director, and Senior Leadership Team on priorities for the next four years that connect to the Department's mission, to review Board Governance and any desired changes, and to explore emerging issues, address concerns, review and clarify roles and responsibilities, set goals and priorities, and develop a cohesive board. Next, Ms. Phillips-Weiner provided an overview of the retreat, which aligned with the agenda that had just been approved. She shared that there will be an presentation introducing the Association of NC Boards of Health, time to establish shared guidelines for the day, an icebreaker activity and introductions, a tour of the Mobile Dental Unit, training on the adjudication process, lunch, a presentation of some Community Health Assessment (CHA) data and the finalized CHA priorities, evaluation and selection of priorities by the board for the BOH strategic plan, and that the retreat will conclude with a review of administrative items. Dr. Stuebe shared that early voting for the NC Primary on March 5t" is being held at the Seymour Center next door in case anyone wanted to use time during a break or lunch to vote. Mr. Bagby arrived during this time. Introduction to the Association of North Carolina Boards of Health Merle Green, Executive Director for the Association of North Carolina Boards of Health (ANCBH), introduced the ANCBH, explained how the organization helps support local boards of health, and shared some opportunities to get involved. Some highlights of her presentation are below: • Ms. Green provided a brief history of the ANCBH and shared that the organization is an independent 501(c)(3) nonprofit that has been volunteer-run since 1986. She explained that the organization is currently in a rebuilding phase. The goal of the ANCBH is to provide a resource that unites and assists the various local health departments across NC's 100 counties. • In response to Dr. Crandell's question about specific controversial topics the ANCBH has weighed in on, Ms. Green provided examples such as masking in schools during the pandemic, prescribing birth control to teenagers, and health department pharmacies stocking Plan B/Morning After Pills. She said that it is important for the ANCBH to remain diplomatic but that they are still able to advocate for evidence-based health policies. Ms. Green added that the ANCBH is always on the side of local health departments and boards of health and that, in her experience, all health departments are trying to do the same work but may have different resources and priorities. • Ms. Green shared several examples of work the ANCBH has completed in the past, including providing guidance to a local health department which was dealing with S:\Managers Working Files\B0H\Agendas&Abstracts\2024 Agenda and Abstracts/130H Retreat Page 2 MINUTES-Draft ORANGE COUNTY BOARD OF HEALTH RETREAT March 2, 2024 community members opposing their reaccreditation (which could cause them to lose their state funding), advocating for important issues and supporting health-promoting legislation (such as restricting PFAS) through letter-writing campaigns, and promoting friendly collaboration and competition between local health departments. She gave an example of a past initiative where Durham and Orange counties competed to be the first to implement smoke-free bus shelters. She added that growing the public healthcare workforce and providing trainings is another important aspect of the work that the ANCBH does. Dr. Stuebe asked if the ANCBH had been involved in the recent Medicaid expansion, to which Ms. Green replied that they attend the monthly health director's meetings and had supported it there, though she could not remember for sure whether they wrote any letters on the topic. Shared Guidelines for the Day Next, the shared guidelines were read to the board. Guidelines included participate fully; open communication, respect one another, be willing to listen and understand different points of view, be objective; discuss the issue not individuals, disagree without being disagreeable, and avoid assumptions, generalizations, and speaking for others by the use of"I" statements. Ms. Phillips-Weiner asked the board if they had anything to add. Board members did not have any additional suggestions and agreed that the list was comprehensive. Ms. Phillips-Weiner reminded retreat participants that the guidelines would be displayed for the duration of the retreat on a flip chart in the front of the room for their reference. Icebreaker Activity/Introductions Ms. Phillips-Weiner engaged retreat participants in an icebreaker activity. Board Retreat participants were given an option of three different icebreaker questions to choose from: • What is a recent achievement you're proud of, big or small? • As a teenager, what did you want to do when you grew up?Are you able to incorporate any of that role into your life now? • If you could only eat one ice cream flavor for the rest of your life, which would you choose and why? All board members and OCHD staff present introduced themselves and answered one of the three questions. The icebreaker was an enjoyable activity that allowed everyone to learn something new about each other. Tour of Mobile Dental Unit Dr. Stephanie George, Dental Health Director, and Caroline Shumaker, Dental Office Manager, invited retreat participants to come view the Mobile Dental Unit and have their questions answered. S:\Managers Working Files\B0H\Agendas&Abstracts\2024 Agenda and Abstracts/130H Retreat Page 3 MINUTES-Draft ORANGE COUNTY BOARD OF HEALTH RETREAT March 2, 2024 Because of space restrictions in the Mobile Dental Unit, only about 3-4 individuals were able to tour the space at a time. This allowed time for retreat participants who were not actively touring the unit to socialize, stretch their legs, or to have some breakfast. Some questions answered about the Mobile Dental Unit included: • How many patients could be seen per day—Three staff members staff the unit during shifts, and there are two operating theaters. Dr. George said that about seven patients can be seen in each theater per day, for a maximum of fourteen patients who can be served by the mobile unit per day. • How fees are handled — Ms. Shumaker shared that, prior to the appointment, a staff member guides patients through the fee schedule over the phone and explains resources to defray costs when needed. The mobile unit itself does not display the costs for services and only accepts payment by card. • How long are wait times—Ms. Shumaker said that the wait time for an appointment at the mobile dental unit are currently around one month, which is shorter than wait times for an appointment at the Whitted dental clinic. Adjudication Training The adjudication training was hosted by Morgan Pierce, County Attorney, and four staff members from Environmental Health Services: Daniel Tani, Environmental Health Specialist; Alexandria Rimmer, Environmental Health Supervisor; Thomas Privott, Environmental Health Supervisor; and Victoria Hudson, Environmental Health Director. To help make the content more relatable, the presentation was structured around considering the adjudication process as a metaphorical game of Monopoly. Some highlights from the presentation are below: • Adjudication is the process of an aggrieved party, which is someone who may have suffered monetary or property damages (henceforth called the appellant), appealing a decision that they didn't agree with, typically a decision by the Environmental Health Services Department staff. • The Board of Health (BOH) is responsible for enforcing three sets of local rules: the Orange County Groundwater Protection/Well rules, the Orange County Rules for Onsite Wastewater Treatment and Dispersal/Septic rules, and the Orange County Rules for Smoke-Free Places. • In response to Dr. Pickett's question about the expected level of preparation for the average appellant, Mr. Privott explained that in a recent near-miss the appellant had already retained an attorney before they were able to come to an agreement. He went on to say that while adjudication is infrequent and thus the preparation of appellants may be a spectrum, he would recommend anticipating appellants being quite prepared as it is a big deal when a complaint goes to adjudication. • Commissioner Fowler asked if adjudication is a quasi-judicial process, to which Mr. Privott replied yes. Ms. Pierce then explained that it is a court case, in which the appellant and health department staff present evidence and witnesses, held before a board rather than a judge with slightly different rules but a similar judicial process. S:\Managers Working Files\B0H\Agendas&Abstracts\2024 Agenda and Abstracts/BOH Retreat Page 4 MINUTES-Draft ORANGE COUNTY BOARD OF HEALTH RETREAT March 2, 2024 • Ms. Hudson explained the timeline of the adjudication process, emphasizing that the deadlines are strict and tight. The process begins with a denial, which gives the appellant thirty days in which to appeal to the Health Director. There are often many background conversations attempting to resolve the issue and documentation of the process taking place behind the scenes during this time. Once the appellant appeals to the Health Director, the Health Director has five calendar days to schedule the hearing and share information about the appeal with the board. The hearing must be scheduled within fifteen days of receiving the appeal and allowing ten days of notice to the appellant. The BOH must issue a written decision at the next scheduled board meeting after the hearing. This written decision must include instructions for how to appeal the decision if desired. If the appellant is dissatisfied with the board's decision, they have the right to appeal to a district court judge within thirty days. Records of the hearing should be kept by the health department for approximately ninety days to allow adequate time for the appellant to make any further appeals, as these documents allow the district judge to evaluate the process and determine if the board's decision was fair. Failure to adhere to this timeline is a violation of NC statute and may result in penalties. • Ms. Pierce outlined some best practices for the hearing process, which includes the board being provided a case overview written by health department staff in advance of the hearing (including who the appellant is, what the initial decision was, and what resolution the appellant is seeking), presentation of the case by the appellant (at minimum, the appellant wants to feel that they have been heard), deliberation by the board (generally in open session for transparency), and a decision by majority vote, with the written decision due at the next scheduled BOH meeting. Ms. Pierce explained that it is best practice to make the decision on the day of the hearing, rather than take a continuance and schedule an additional meeting, and that the written decision should be based on findings of facts and conclusions of law based on the evidence presented. Ms. Pierce clarified that in the event of a continuance, the written decision will still be due at the next scheduled board of health meeting after the initial hearing. In response to Dr. Royce's question, Ms. Pierce explained that the chair and co-chair facilitate the hearing, but all board members can ask questions. • Commissioner Fowler asked whether the hearings are timed, to which Ms. Pierce replied that hearing lengths are not prescribed, but it is good practice to ask in advance how long the appellant expects the hearing to take and adhere to that. She added that, unlike in some courts, there are no objections for hearsay (e.g., "My soil scientist said...") but it is appropriate to ask an appellant to move to their next point if they become repetitive. Mr. Whitaker asked if it is appropriate to dismiss information that is not corroborated by a witness, and Ms. Pierce replied that the board can ask for supporting evidence (e.g., affidavits, written records) and then put little weight on claims that cannot be substantiated, but unsubstantiated claims do remain on the record and are considered evidence. She added that all witnesses are put under oath before testifying. • In response to Dr. Pickett's question about whether there is a script to guide appeals for the health department, as the Animal Services Board has a template for their appeals, Ms. Pierce explained that there is unfortunately not one, but she is happy to share best practices in the event of an appeal. S:\Managers Working Files\B0H\Agendas&Abstracts\2024 Agenda and Abstracts/130H Retreat Page 5 MINUTES-Draft ORANGE COUNTY BOARD OF HEALTH RETREAT March 2, 2024 • Dr. Stuebe asked who is responsible for drafting the written decision, to which Ms. Hudson clarified that La Toya Strange, Administrative Support, and Ms. Phillips-Weiner are responsible for producing the transcript of the hearing and written decision with support from Ms. Pierce. • Dr. Royce asked how far in advance the board members can get a copy of the information related to the case, to which Ms. Pierce replied this will be a spectrum depending on the appellant and the scale of their appeal. Ms. Hudson suggested that Ms. Phillips-Weiner could share the health department's side of the case when the board is notified of the hearing date (within five days of the appeal to the health director and at least ten days before the hearing) and Ms. Pierce added that the Health Director would have, at a bare minimum, the name of the appellant, their address, and the decision that they are disputing at the time the BOH is notified of the appeal. • Ms. Hudson and Ms. Pierce reviewed some possible variants to the adjudication process, including what happens if the Health Director is on vacation at the time of the appeal (there will be a designee to facilitate the process) or situations where there may be a hearing panel of-3 board members rather than a full quorum. However, Dr. Royce wondered if an appellant would still feel heard if they spoke to a panel of only 3-4 members rather than the full board. • Ms. Hudson shared that over the past six months there have been many near misses of cases going to adjudication. In response to Dr. Stuebe's question about this recent uptick in appeals, Ms. Hudson explained that there is a sense of immediacy being instilled by the building community that is contributing to a view of the health department as a permit factory rather than a protector of public health. Dr. Stuebe suggested holding conversations with the community to help explain why the environmental protection rules are important. • In response to Frederick Perschau, Finance and Administrative Services Director's, question about whether the state could overturn a county's rules, Ms. Pierce explained that the state allows more stringent policies at the county level so this would be very unlikely and would involve going through the judicial system if so. • Mr. Privott told the board that the decisions made about an adjudication hearing have significant policy impacts, as they become De Facto guidance documents for future laws and rulings. • Ms. Rimmer concluded the presentation by reminding the board that everything the health department does must be considered through the lens of equity, and there may be times when the rules cannot be followed for the board and staff to be equitable. During the presentation, retreat participants were broken into three small groups of 7-8 people. Each group was given a series of three exercises based on a previous near-miss case and guided through a mock adjudication. This allowed board members the opportunity to practice considering evidence and ruling on an adjudication proceeding. The small groups then reconvened to compare results from the mock adjudication and discuss. Some highlights of the discussion are below: • Commissioner Fowler mentioned that construction blueprints are a bit cumbersome to read if you're not used to them. Mr. Perschau said that the measurements for the mock case were inconsistent, and Ms. Hudson explained that some agencies issue permits S:\Managers Working Files\B0H\Agendas&Abstracts\2024 Agenda and Abstracts/130H Retreat Page 6 MINUTES-Draft ORANGE COUNTY BOARD OF HEALTH RETREAT March 2, 2024 without measuring the space first, which means that Environmental Health Services must be very deliberate about measuring, which they now perform with GPS technology. • Dr. Baldwin asked whether the deadlines for adjudication include weekends, to which Ms. Hudson replied that the adjudication timeline is in calendar days, not working days (meaning yes, weekends are included). • Dr. Crandell recommended that, because many appellants want to be heard, it is important for board members to remain nonchalant about any information that seems spurious, to ask questions, and to show interest in the appellant's case. Mr. Whitaker also suggested that questions about evidence that seems irrelevant could focus on how the evidence and claims being presented align with what the appellant is requesting. Dr. Jonnal added that it's important for the board to present themselves as they are, which is a group of people who are looking out for the public's health. • Ms. Royce noted that it must be difficult for the Environmental Health Services staff to be on the front lines and to deal with people who are experiencing disappointment about their plans not working out and expressed her support and appreciation. • Ms. Hudson shared that for the real-life case that the small groups discussed, they were able to work with the builder to reach a conclusion to abandon the current well and drill a new one to accommodate the desired construction. The retreat resumed after a 45-minute lunch break. Because early voting was available at the Seymour Center next door, some retreat participants took the opportunity to vote during the break. Presentation of CHA Data and CHA Priorities McKayla Creed, Healthy Carolinians of Orange County Program Coordinator, presented the priority areas selected for the Health Department for the next four years based on the data from the Community Health Assessment (CHA). Some highlights of her presentation are below: • Ms. Creed presented the selected priorities based on data gathered during the CHA. The top four concerns expressed by community members and the CHA leadership team included affordable health care, mental health, affordable housing, and the cost of healthy food. The three priority areas chosen were Access to Care, Behavioral Health (including mental health & substances of any kind), and Connections to Community Support (connecting community members to resources, etc.). Ms. Creed reviewed these priorities along with some indicators that align with the state health improvement plan and examples of potential goals. However, Ms. Creed clarified that these potential goals may change after the retreat, as the strategic planning process has not yet begun. • Ms. Creed explained that the priority area Connections to Community Support focuses specifically on the Social Determinants of Health and on strengthening partnerships with community resources. She specifically highlighted the topics of housing, unemployment, Adverse Childhood Experiences (ACEs), and access to exercise opportunities and healthy food. S:\Managers Working Files\B0H\Agendas&Abstracts\2024 Agenda and Abstracts/130H Retreat Page 7 MINUTES-Draft ORANGE COUNTY BOARD OF HEALTH RETREAT March 2, 2024 • During the listening sessions, rural residents of Orange County frequently expressed that they feel like people don't care about them and they don't have the things they need —transportation, places to buy healthy food, places to exercise, etc. • Dr. Pickett asked about elevated rates of infant mortality in Orange County related to Access to Care, specifically wondering if teen pregnancy and infant mortality may be related, as the outcomes are similarly racially disparate. She asked if teen pregnancy might be covered under Access to Care, to which Ms. Creed replied that this is a definite possibility. • Dr. Jonnal congratulated Ms. Creed on completing the CHA and expressed that she's never before seen public health content focusing so much on the holistic human experience. She went on to say that many public health issues are related to money or its lack. Dr. Jonnal continued, saying that while Orange County is an affluent county, it has the highest level of income inequality of any county in the state, and income inequality is a strong predictor of poor public health. Ms. Creed replied that there are several maps within the CHA that examine the county's racial makeup, showing heavy racial segregation and that health disparities are consistent with the lines of racial segregation. • In response to Dr. Crandell's question about the BOH strategic planning process and prioritization, Ms. Phillips-Weiner chimed in to say that selecting BOH priorities would be the next task on the agenda but confirmed that the priorities presented by Ms. Creed are the priorities for the Healthy Carolinians and that, while they can, the priorities for the BOH do not have to align with these. Ms. Stewart added that board members are invited to participate in Healthy Carolinians initiatives if they desire. • Dr. Royce asked when the BOH could receive and review the completed CHA, to which Ms. Stewart replied that they would receive printed copies at the March BOH meeting but, if desired, a digital copy could be shared by email after it was submitted to the state. • In response to Dr. Royce's expression of uncertainty about how the CHA data had been weighted and finalized to reach the priority areas, Ms. Creed explained that they made charts based on the data from the main CHA survey, ranked the results from the priority survey, and compared these results to confirm that they were in alignment. Once the priorities of the community were confirmed, staff looked at secondary data to confirm that it supported the concerns of community members. Based on this, staff members developed the final three priority areas. Ms. Stewart added that while there wasn't a formal methodology that was applied, the team tried to make sure the secondary data was being coupled with what the community members were saying and that they were looking at commonalities. She added that community concerns that are being addressed by other partners, such as the County Strategic Plan, were considered less important for the health department to address. Evaluation of Priorities for BOH Strategic Plan Based on the priority areas that board members have already been working on (Access to Care, Health Equity, Substance Use Disorders) and the priority areas identified in the 2023 CHA (Access to Care, Behavioral Health, Connections to Community Support), there are a total of S:\Managers Working Files\B0H\Agendas&Abstracts\2024 Agenda and Abstracts/130H Retreat Page 8 MINUTES-Draft ORANGE COUNTY BOARD OF HEALTH RETREAT March 2, 2024 five potential focus areas for Board of Health strategic planning over the next four years. Board members discussed which priority areas they wished to focus on and, once the likely priorities had been decided, who would serve on each priority committee. Some highlights of this discussion are below: • Dr. Crandell asked if there were other priority areas that could be focused on or if the board was limited only to these focus areas. Ms. Phillips-Weiner clarified that the board could choose any priority areas that they agree upon, but she had organized the discussion around the five potential areas to help keep things focused. Ms. Phillips- Weiner opened the floor to other suggestions for priorities. Dr. Crandell suggested youth and teen health, including topics like screen time, adolescent vaping, and possibly prenatal care. Dr. Royce suggested civic engagement as a possible priority. Mr. Bagby expressed concern that a committee focused on young people's health might be duplicative, as Orange Partnership is already doing a lot of work focused on the health of young people. • Dr. Baldwin commented that he felt that two of the 2023 priorities were the same as the existing areas (Access to Care and Access to Care; Substance Use Disorders and Health Behaviors). He also suggested that Connections to Community Support could merge nicely with Health Equity, and it might be possible to simply keep the existing areas and do work that covers both priorities. • Dr. Royce said that she feels torn and would kind of like to get rid of Health Equity as its own priority area to ensure that instead each committee is being intentional about incorporating health equity in their work. Mr. Bagby expressed concern that if health equity was not a priority on its own then it might be swept under the rug and not made a priority in committee work going forward. Dr. Royce clarified that she meant that health equity should be elevated and made a significant part of all strategic planning efforts for each priority area. Ms. Stewart added that at a county level, organizations are moving away from siloed efforts to address health equity, and instead to incorporate equity considerations into every action, giving the example of the health department budget. She agreed that if health equity were not its own priority going forward then there would be deliberate efforts to make sure it was being addressed by all committees. Mr. Bagby was still concerned that equity might be pushed off to the last minute and end up not being addressed if committees ran out of time; Ms. Phillips-Weiner assured him that she and Ms. Stewart have discussed this and would be intentional about including health equity in any strategic planning efforts. Ms. Stewart also shared her concern that keeping health equity as a separate priority focus might prevent other committees from considering it, as they assume it is being taken care of by the health equity committee. Because the board wanted to build in concrete accountability for themselves to ensure that equity did not become an afterthought, this activity concluded with a brainstorming exercise by the board on ways to build health equity checks into their activities. • Dr. Stuebe mentioned an infographic that explains the difference between equality, equity, and justice (shared below). She said that many of these potential priorities are human rights issues (a right to healthcare, a right to mental health and support) and that she wonders if the board should instead focus on justice rather than equity. Dr. Rodgers echoed that justice is removing the barriers while equity is providing supports. Ms. Stewart expressed her support for this idea, saying that Orange County is often a S:\Managers Working Files\B0H\Agendas&Abstracts\2024 Agenda and Abstracts/130H Retreat Page 9 MINUTES-Draft ORANGE COUNTY BOARD OF HEALTH RETREAT March 2, 2024 trailblazer, and she likes the idea of pushing the county to think beyond equity. Dr. Pickett suggested using the language "health equity and justice" to help advance thinking to beyond equity while also using the county's preferred language. The differences between Equality and Equity Equality Equity Justice The assumption is that Everyone gets the All 3 can see the game everyone benefits from supports they need without supports or the same! supports.This (this is the concept of accommodations because is equal treatment- "affirmative action"),thus the cause(s) of the producing equity. inequity was addressee? The systemic barrier has been removed- In response to Dr. Pickett's question as to whether Behavioral Health is the same thing as Substance Use Disorders/Mental Health, Ms. Phillips-Weiner explained that Behavioral Health has a broader scope, and while it includes things like mental health and substance use, it could also include things like exercise and nutrition. Dr. Crandell expressed concern about how broad the priority areas appear to be and said that he felt trying to cover everything might be setting the board up for failure. Dr. Royce echoed that she wasn't sure there would be enough information from which to build interventions without being able to get more precise on the health issues and learn specific data about what's causing those issues. Ms. Stewart chimed in to clarify that a broad priority area would not mean that committee members are required to address everything related to that priority, but instead gives them a wider umbrella under which to choose their focus. She added that the early work for each committee would involve gathering information about the data and drivers of their focus area and then from there honing in on the specific work they wish to complete. • Mr. Whitaker clarified that whatever priorities are selected would be how the BOH is categorizing their focuses for the next four years (until the next CHA). Ms. Phillips- Weiner replied yes and gave the example of an initiative to address screen time among young people as something that would fall under Behavioral Health but not under Substance Use Disorders. Dr. Royce asked if the board would be stuck for four years if S:\Managers Working Files\B0H\Agendas&Abstracts\2024 Agenda and Abstracts/130H Retreat Page 10 MINUTES-Draft ORANGE COUNTY BOARD OF HEALTH RETREAT March 2, 2024 they chose not to focus on equity at this time and then realized they aren't paying adequate attention to equity a year in, to which Ms. Stewart replied no, they can always adjust if needed. Dr. Rodgers pointed out that if the committees are internally accountable then remaining focused on equity should be a non-issue and cited that she knows that she and Mr. Bagby will both hold their committees accountable. Mr. Bagby suggested creating some kind of alarm clock system to periodically make sure the board is centering health equity. • Dr. Stuebe requested an example of what is expected from the BOH in terms of work completed in a year, to which Ms. Stewart explained that it depends on the board and how active they are, but generally 2-4 campaigns or projects from each committee within four years would be reasonable. In response to Dr. Stuebe's question about funding, Ms. Stewart explained that the Health Department will help support the work of the board, and that especially if the priorities align with other initiatives (e.g., Healthy Carolinians of Orange County) then it would be easier to divert funds to support the board's work. • Dr. Jonnal summarized her understanding that, based on the conversation, it seemed that the board agreed that there should be an Access to Care committee, that they could combine the Substance Use Disorders and Behavioral Health areas into one broad priority, and if all committees are intentionally working through a lens of health equity then the Health Equity committee is not needed, meaning the third priority area would be Connections to Community Support. The two new priorities would each have a broader scope and thus might need some additional time to gather information and settle on specific topics to address and actions to take within their focus area. • Dr. Crandell suggested taking a poll to ensure that there was enough support for each of the proposed priority areas, as he felt that a successful committee needs 4-5 dedicated members and that if most of the interest fell in 1-2 of the proposed priority areas then it might make more sense to split one of the proposed priority areas into two committees instead. • Commissioner Fowler asked what the BOH can do to help with connections to community support—that is, would an example goal be creating a unified resource page or actually providing funding to things like affordable housing. This reminded Dr. Jonnal of when she was a resident, and that there was a resource guide at the hospital with many resources that were out of date, so they were not helpful to her patients. • Dr. Jonnal asked about activism that the board can take regarding community issues, for example affordable housing. Commissioner Fowler gave examples of supporting zoning laws, providing free education that helps people make living wages, and advocating for policies at the state level to address affordable housing. Dr. Stuebe mentioned building political will to address issues, giving the example of redlining and zoning strategies to address historical segregation as a health issue. Ms. Stewart agreed and said that to her, the role of the BOH is to link the health impacts to the social determinants of health. • At Dr. Pickett's suggestion, Ms. Phillips-Weiner took a show of hands of those who were potentially interested and willing to serve on each committee. For Connections to Community Support, Dr. Stuebe, Mr. Bagby, Dr. Pickett, Mr. Whitaker, and Dr. Jonnal were interested. For Behavioral Health, Commissioner Fowler, Dr. Nickelson, Dr. Royce, Dr. Jonnal, Dr. Baldwin, and Mr. Whitaker were interested. For Access to Care, Dr. Royce, Dr. Rodgers, Dr. Pickett, Dr. Nickelson, and Dr. Stuebe were interested. S:\Managers Working Files\B0H\Agendas&Abstracts\2024 Agenda and Abstracts/130H Retreat Page 11 MINUTES-Draft ORANGE COUNTY BOARD OF HEALTH RETREAT March 2, 2024 • Dr. Royce expressed concern about the lack of Span ish-speaking/Hispanic/Latino/a/e representatives on the board given the makeup of the communities and school populations. Select Priorities and Divide into Priority Committees Before voting to confirm the priority areas, Ms. Phillips-Weiner asked members to show their willingness to commit to serve on one potential committee each by show of hands. • Connections to Community Support: Mr. Bagby, Mr. Whitaker, Dr. Stuebe, and Dr. Jonnal. • Access to Care: Dr. Royce, Dr. Rodgers, and Dr. Pickett. • Behavioral Health: Dr. Nickelson, Dr. Crandell, Dr. Baldwin, and Commissioner Fowler. A motion was made by Dr. Lee Pickett to establish three committees:Access to Care, Behavioral Health, and Connections to Community Support, with membership outlined above, was seconded by Commissioner Amy Fowler, and passed without dissent. The board took a short break before resuming discussion. Because of the board's concerns about holding themselves accountable for maintaining a focus on health equity and justice, the board spent about thirty minutes brainstorming ways to incorporate a health equity/justice lens into various areas of their work. Ideas for strategies included a bulletin board in the health department where committee members who did not address health equity/justice are displayed, including health equity on committee agendas, including guiding questions about equity/justice at the top of documents, disaggregating statistics, using the One Orange Racial Equity Toolkit to check equity/justice on specific initiatives, including a time to consider health equity/justice in all committee meeting agendas, opening committee updates at BOH meetings with equity/justice reports, notifying speakers that the board wishes to hear specifically about health equity and health disparities, including equity impact on the agenda abstracts, considering how the committee priorities affect the health issues (e.g., morbidity, mortality, health disparities) that are impacting community members, quantifying impact and the magnitude of the problem and gauging which initiatives will create more health and address disparities within the community, putting a reminder to consider health equity/justice in personal calendars, conducting periodic surveys (quarterly) among the board to assess board efforts on equity/justice and then holding an educational session/discussion to review and discuss the results, and being sure to consider both health equity (providing supports to make sure everyone has access to what they need) and justice (removing barriers). Dr. Rodgers clarified that the term "marginalized" may not be appropriate to use to describe racial groups, as it implies being on the outside looking in and that many folks of racial and ethnic minorities may not identify with that term and might feel that it's othering. The board briefly discussed other terms that might be more appropriate but weren't ideal (historically S:\Managers Working Files\B0H\Agendas&Abstracts\2024 Agenda and Abstracts/130H Retreat Page 12 MINUTES-Draft ORANGE COUNTY BOARD OF HEALTH RETREAT March 2, 2024 marginalized, underserved). Mr. Privott suggested "insufficiently served" as an option, in part because it leaves the door open to increase services and thus improve equity/justice. Administrative Items Ms. Stewart briefly reviewed the major roles and responsibilities of a local BOH member, including making and approving policies, and adjudicating appeals, all of which was summarized in a one-page document which she provided to board members. Dr. Baldwin provided a short presentation covering several unusual situations related to board operations, such as what to do if a board member needs to leave during a meeting, how to handle a situation where neither the chair nor vice-chair can be present for a meeting, or how to call and coordinate a special or emergency meeting. The guidance provided was based on Fleming Bell's Suggested Rules of Procedure for Small Local Government Boards. Ms. Stewart announced that while preparing the adjudication training, the team realized that the BOH policy manual needs to be amended to clarify the adjudication timeline —due to a typo, the policy manual erroneously states that the window to begin or respond to an adjudication request is in working days, but the text should read that the window to begin or respond to an adjudication request is in calendar days. A motion was made by Dr. Alison Stuebe to correct the wording of the BOH policy manual from "business"to "calendar"in the four places where this typo was made, was seconded by Dr. Aparna Jonnal, and carried without dissent. Finally, Ms. Stewart asked the board members to review and sign their conflict of interest form, which they review annually. She reminded board members that they would need to self-disclose if a new conflict emerged over the course of the year. Wrap Up &Adjournment A motion was made by Dr. Shielda Rodgers to adjourn the retreat at 3:53 p.m., was seconded by Dr. Lee Pickett, and carried without dissent. Respectfully submitted, Quintana Stewart, MPA Orange County Health Director Secretary to the Board S:\Managers Working Files\B0H\Agendas&Abstracts\2024 Agenda and Abstracts/BOH Retreat Page 13