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HomeMy WebLinkAboutApproved Minutes of August 28, 2024 MINUTES ORANGE COUNTY BOARD OF HEALTH August 28,2024 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 August 28, 2024, at the Orange County Health Department, 300 West Tryon Street, Hillsborough, NC. BOARD OF HEALTH MEMBERS PRESENT: Alison Stuebe—Vice Chair, Keith Bagby, Brian Crandell, Commissioner Amy Fowler, Davia Nickelson, Lee Pickett, Shielda Rodgers, Rachel Royce, and Tony Whitaker. As Aparna Jonnal was not present, Alison Stuebe served as chair for the evening's meeting. BOARD OF HEALTH MEMBERS ABSENT: Aparna Jonnal — Chair, Bruce Baldwin. STAFF PRESENT: Quintana Stewart, Health Director; Dr. Stephanie George, Dental Services Director; Victoria Hudson, Environmental Health Director; Frederick Perschau, Finance and Administrative Services Director; Dr. Erica Pettigrew, Medical Director; Carla Julian, Public Health Nursing Director; Ashley Rawlinson, Compliance Manager; Libbie Hough, Communications Manager; Thomas Privott, Environmental Health Supervisor; Alex Rimmer, Environmental Health Supervisor; Katie Luedecke, Public Health Nurse Supervisor; Judith Arroyo-Martinez, Bilingual Medical Office Assistant; and Jean Phillips-Weiner, BOH Strategic Plan Manager. GUESTSIVISITORS PRESENT: Stephanie Nixon. I. Welcome New Employees Quintana Stewart, Health Director, introduced the new employee in attendance: Judith Arroyo- Martinez— Bilingual Medical Office Assistant. II. Public Comment for Items NOT on Printed Agenda: None. III. Board Comments Dr. Stuebe congratulated Mr. Bagby for being named WCHL's Hometown Hero for the month of August. Commissioner Amy Fowler Commissioner Fowler mentioned that over the past weekend she attended a meeting of the North Carolina Pediatric Society and encouraged members to contact their local health departments to check on Narcan supplies and learn more about local efforts to address the opioid crisis. She added that the Behavioral Health Committee is investigating the relationship between social media and adolescent mental health; she recommended the book The Anxious Generation by Jonathan Haidt. S:\Managers Working Files\BOH\Agendas &Abstracts\2024 Agenda and Abstracts/ August Page 1 MINUTES ORANGE COUNTY BOARD OF HEALTH August 28,2024 Keith Bagby Mr. Bagby commented that over the summer he attended a health inspection of Jersey Mikes in Hillsborough with Stephen Johnston of Environmental Health Services. He said that he felt he learned a lot from the experience about health and food safety. Dr. Alison Stuebe Dr. Stuebe shared that she has enrolled in the Vot-ER (https://vot-er.orq/) program to help register her patients to vote. She explained that the program sent her a script to help guide conversations and a QR code on a lanyard which her patients can scan with their phones and use to register to vote. She said that a healthy democracy and a healthy community includes civic participation from everyone and asked if the health department was participating in any similar voter registration programs. Ms. Stewart replied that there is not currently a program to help register patients to vote at the health department, but that there has been leading up to past elections and that the health department is open to hosting something for this election if they are approached by any local organizations. IV. Priority Committee Updates Access to Care Committee Dr. Royce provided the update for the Access to Care Committee. She distributed a copy of a logic model about the Photovoice project and explained that the goal of the Photovoice project is to capture qualitative data in the form of photos and words from community members about their experiences encountering barriers to healthcare. She explained that such data gives a more nuanced look at people's experiences and will be foundational to the work of the committee going forward. She provided a brief overview of the logic model and shared that the committee had discussed aims of the project, the target population, how to recruit people, and communities to overrecruit from to ensure their perspectives were captured. Dr. Royce also shared that Medicaid Expansion enrollment numbers are continuing to slow down, with 3,929 (--58% of the target population) currently enrolled in Orange County. She mentioned that the committee is trying to consider a potential intervention to reach more eligible people. Commissioner Fowler said that at her recent North Carolina Pediatric Society meeting, two members of the Department of Health and Human Services (DHHS) were excited and optimistic about the Medicaid enrollment numbers to date, as they had already surpassed their projections. She added that, while it was important to continue looking for missing folks, the enrollment numbers for Orange County may be better than previously believed. Dr. Royce said that it is important to get denominator data about the individuals who are newly eligible for expanded Medicaid to help identify any missing or hard-to-find cases. Dr. Stuebe asked if it was possible to cross-tabulate individuals using other services (such as SNAP or WIC) to get a projection of who might be eligible for Medicaid, to which Ms. Stewart replied that the Department of Social Services (DSS) likely has that information. S:\Managers Working Files\BOH\Agendas &Abstracts\2024 Agenda and Abstracts/ August Page 2 MINUTES ORANGE COUNTY BOARD OF HEALTH August 28,2024 Connections to Community Support Committee Dr. Stuebe provided the update for the Connections to Community Support Committee. She shared that the committee had heard from Blake Rosser, Director of the Housing Department, about what is already being done to address housing in the county and that there is a lot of work being done. She commented that one thing that she noticed was that much of the work was focused on keeping people in crisis housed without a lot of emphasis on long-term solutions, and that the group had brainstormed some ideas for ways to address affordable housing availability in the long term, including changes in zoning policies, reinvestment in public housing programs, mobile home cooperatives, land trusts, and universal basic income. Dr. Stuebe concluded by saying that Mr. Rosser mentioned that in his opinion the biggest need is for mental health support and wraparound services, as many people experiencing homelessness struggle with their mental health to the point that they cannot sustain housing without additional mental health support. Mr. Whitaker added that it was great to get perspective on both short- and long-term issues, and that it seems short term and emergency issues are largely taking precedence, which is lamentable but understandable. In response to Dr. Stuebe's question about the new comprehensive plan/land use policy, Commissioner Fowler mentioned that a policy allowing Accessory Dwelling Units (ADUs) was recently passed to help increase the accessibility of housing and smaller housing, and that they are looking into ways to increase housing more naturally. She shared that much of the funding for eviction diversion was previously provided by American Rescue Plan Act (ARPA) funding, though the BOCC is continuing to prioritize this as best they can. She added that wraparound services are often hard to provide because so many services are siloed. In response to Mr. Bagby's comment about tiny homes as a possible solution, Commissioner Fowler mentioned that Orange County has previously funded the tiny home organization Pee Wee Homes. Mr. Bagby shared that prior to this committee meeting, he'd been under the impression that the housing situation was really bad in Orange County, but he now believes that things are trending in the right direction. Commissioner Fowler agreed that there is progress, but that there isn't enough funding to meet the demand. Mr. Whitaker commented that most housing resources seem to focus on getting people into rental housing, which is inherently less stable than homeownership. Commissioner Fowler mentioned two resources focused on homeownership, which are the Community Home Trust and Habitat for Humanity. Dr. Rodgers mentioned that it's important to ask, "affordable for whom?" when it comes to affordable housing. She said that this is especially true for homeownership, and that many young people are saying that renting is the only option despite the high cost of rent and the comparative instability, as the cost of a down payment and home repairs are not accessible to them. Dr. Royce shared that she'd recently read a viewpoint by Aaron Nelson called "Healthy Schools Demand More Housing," which discussed how housing problems in a community lead to a cascade effect of schools struggling, teachers being unable to afford to live locally, and less S:\Managers Working Files\BOH\Agendas &Abstracts\2024 Agenda and Abstracts/ August Page 3 MINUTES ORANGE COUNTY BOARD OF HEALTH August 28,2024 funding for schools. She said that this viewpoint proposed some solutions, including approving a water/sewer boundary extension in southern Orange to help increase the supply of affordable housing. Commissioner Fowler said that the BOCC did approve this boundary extension, but it also must be approved by the municipalities. She added that most of the loss of students experienced by schools was related to families moving away during the pandemic so she wasn't sure if this would get to the root of the problem. Ad Hoc Committee on Well Rules Mr. Whitaker presented the update on the Ad Hoc Committee on Well Rules. He shared that the committee recently met with Victoria Hudson, Environmental Health Director, and Thomas Privott, Environmental Health Supervisor, who presented information about the Orange County groundwater protection program and provided enforcement examples. Behavioral Health Committee The Behavioral Health Committee will next meet in mid-September. V. Approval of the August 28, 2024 Agenda Motion to approve the agenda of the August 28, 2024 BOH meeting was made by Commissioner Amy Fowler, seconded by Mr. Keith Bagby, and carried without dissent. VI. Approval of June 26, 2024 Minutes Dr. Royce commented that she had been unable to attend the previous meeting, but the detailed minutes allowed her to feel almost like she had been present. Motion to approve the minutes of the June 26, 2024 BOH meeting was made by Dr. Rachel Royce, seconded by Commissioner Amy Fowler, and carried without dissent. VII. Educational Sessions A. Addressing Behavioral Health Issues Through Deflection, Diversion, and Reentry in the Criminal Legal System Caitlin "Cait" Fenhagen, Criminal Justice Resource Director and Interim Deputy Manager, provided a presentation on the Lantern Project and the Police and Mental Health Diversion Collaboration (CCDR). Some highlights of her presentation are below: • Ms. Fenhagen opened her presentation by sharing that the Criminal Justice Resource Department (CJRD) will be opening The Wonderful House on September 91h, which offers temporary supportive housing for people exiting homelessness or incarceration, including wraparound services for up to five months. • Both the Lantern Project and CCDR are currently grant funded; the Lantern Project is primarily funded by Opioid Settlement Funds, while the CCDR is funded by a grant from DHHS. Both programs also offer wraparound services to help address behavioral health needs. S:\Managers Working Files\BOH\Agendas &Abstracts\2024 Agenda and Abstracts/ August Page 4 MINUTES ORANGE COUNTY BOARD OF HEALTH August 28,2024 • Ms. Fenhagen clarified the difference between deflection and diversion, as deflection is keeping an individual from entering the criminal legal system, for example by sending them to a rehabilitation program instead of giving a charge or citation, while diversion is post-arrest and keeps an individual out of prosecution and incarceration, though a citation or charge may still appear on their record. Deflection is preferable, but both are important equity tools. • The Lantern Project and CCDR help to fill an equity niche, as programs focused on diverting young (typically under eighteen) first-time offenders are the easiest to secure funding and support for but leave out crucial populations such as most college students and individuals with behavioral health needs. • The law enforcement chiefs in Orange County are supportive of CJRD's programs, though the department does monitor the referrals to help watch out for potential bias. • The Lantern Project consists of two staff members, a diversion coordinator and a reentry navigator, both of whom have lived experience in addition to addiction training and licensure and provide peer support. Lantern is trauma-informed, focused on educating participants on harm reduction principles, and aims to meet people where they are. • Lantern served 226 people in the past year. The bulk of people served were white (48%) or Black (44%), while the Latinx population is underrepresented. In response to Dr. Royce's question about the demographic makeup of individuals who are in Lantern, Ms. Fenhagen explained that the criminal legal system tends to skew more Black and brown than either the county population or their current service population, but they are working to ensure equitable access. • Ms. Fenhagen shared that there have been no fatal overdoses among participants in Lantern over the past year, largely due to Naloxone distribution efforts. • Though Ms. Fenhagen did not have time to provide a detailed overview of the CCRD program, she shared that there are currently 67 people being served by the CCRD Team. She added that her slides are available to the Board of Health, and she would love to come back and present again in the future. In response to Mr. Bagby's question, she shared that she would be giving an update on CCRD in October, and she'd be happy for Mr. Bagby to attend this presentation. B. Formerly Incarcerated Transitions (FIT) Program Update Tommy Green, Formerly Incarcerated Transitions (FIT) Program Manager and lead Community Health Worker (CHW)for FIT Orange County, and Dr. Evan Ashkin, NC FIT Program Director and Founder, presented an update on the Orange County FIT Program. Some highlights of the presentation are below: • The FIT Program provides free healthcare to formerly incarcerated individuals with a pre-existing chronic condition and helps to cover copays for healthcare and prescriptions. FIT programs are active in eight counties across North Carolina. • FIT works to create a comprehensive reentry plan for individuals exiting incarceration, including access to housing, family reunification, employment, and healthcare services. Mr. Green shared that FIT has a partnership with the Lantern Project, who referred sixteen of their twenty-six new cases over the past year. • Currently, the Orange County FIT program serves 122 individuals, 24% female and 75% male. Clients are 42% Black or African American, 37% white, and 27% another race, while about 50% of individuals incarcerated in the NC prison system are Black. • Dr. Ashkin shared that the typical caseload for a FIT CHW is around 50-60 cases at a time, consisting of 20-30 new and 20-30 established cases. Currently, Mr. Green has a caseload of around 80 people in part due to a staff vacancy in the program. S:\Managers Working Files\BOH\Agendas &Abstracts\2024 Agenda and Abstracts/ August Page 5 MINUTES ORANGE COUNTY BOARD OF HEALTH August 28,2024 • In January, the FIT Program raised $80,000 to help fund emergency housing. • FIT works closely with the Orange County Sheriffs Office and helped bring about the Medication for Opioid Use Disorder (MOUD) program currently offered in the jail. Recently, this program was expanded to allow individuals taking Methadone to continue their medication while incarcerated. Additionally, there is a new bridge program for MOUD, allowing individuals who are transitioning out of the justice system to receive a long-acting dose of MOUD to help prevent post-release overdose and give them time to set up appropriate care outside of the justice system. • Dr. Ashkin shared that they recently launched a new program, FIT Wellness, which identifies and supports formerly incarcerated individuals with severe mental illness. This program received a $5.5M investment from the state and includes funding for a new CHW. • The Transitions Clinic Network, an evidence-based program with a low recidivism rate, is the basis for the FIT Program; results from the FIT program will be published soon and show similar outcomes to this program. • Mr. Whitaker asked how people get into FIT and why there is such a high proportion of women in the program compared to the criminal legal system population, to which Mr. Green replied that people enter the program by word of mouth and by referral through partners such as law enforcement and CRJD programs. He added that women, in his experience, tend to be more compliant and excited to be in the program compared to men. Dr. Ashkin added that the pre-release bridge MOUD program originated in a women's prison, which may have led to increased awareness of the FIT Program among justice-involved women. • In response to Dr. Royce's question about how long people remain involved with the FIT program, Mr. Green said that this fluctuates by case depending on buy-in but is generally around one year. Dr. Ashkin added that there is at least one client who has been in the program for five years and that he continues to see patients even after they end their involvement in the program, as this is primary care. • Commissioner Fowler asked if FIT clients are on Medicaid, to which Dr. Ashkin replied that with expansion, they are now. In response to Dr. Stuebe's question, he added that it is still required that Medicaid be terminated or suspended when an individual is incarcerated, but that new legislation, the 1115 waiver, is being approved to allow re- instatement ninety days before release, and that as soon as they are permitted to, the FIT program will have CHWs assist with pre-release Medicaid enrollment. • Dr. Nickelson asked if FIT patients are limited to specific services, to which Dr. Ashkin replied that they can receive all services available at Piedmont Health Services and FIT will pay for it— behavioral health, dental, nutrition, etc. Mr. Green added that patients can also be referred to OCHD. C. 4th Quarter Financial Reports and Billing Dashboard Frederick Perschau, Finance and Administrative Services Director, presented the 4t" Quarter Financial Reports and Billing Dashboard for Fiscal Year 2023-2024. Some highlights of his presentation are below: • Mr. Perschau began his presentation with an addendum, saying that OCHD ended the fiscal year at 84% of revenue and 95% of expenditures, which was an increase from the prior fiscal year. The main challenge of the year was a cyberattack on Dental Services that prevented claims processing —this has been corrected for private insurance claims but not yet for Medicaid claims. S:\Managers Working Files\BOH\Agendas &Abstracts\2024 Agenda and Abstracts/ August Page 6 MINUTES ORANGE COUNTY BOARD OF HEALTH August 28,2024 • OCHD has many resources for revenue, including Medicaid settlement funds, service revenues, state allocations, grants, and donations. • The goal is to meet or exceed the budget each year. Looking at trends since 2018, there has been overall good progress in service revenues and use across Dental Services, Environmental Health, and Personal Health Services. However, in the past the budget line was higher than it is now which presents some challenges and creates the objective to move that budget line up, which can be justified with increases to service revenue. • Mr. Perschau explained that OCHD spent down its expense budget, which is important because the county will take away funding in future years if the expense budget is not adequately spent down. He shared that the Dental Clinic recently replaced its panoramic machine for 3600 x-rays and that the Medical Clinic purchased new fridges and freezers for vaccine storage. He also commented on the Bioterrorism Prep Truck, which was purchased at the beginning of FY2023-2024, and upgrades to the Environmental Health conference room. • There was a spike of revenue in May related to Medicaid Cost Settlement, which is distributed based on how the money was initially generated. Personal Health Services and Dental Services are eligible for Medicaid Settlement Funds, as they provide services covered by Medicaid. • The FY2024-2025 budget was approved for$9.1 M net, an increase largely related to people-costs (salaries and benefits). Training and travel costs, which had previously largely been supplemented by ARPA, have been reduced significantly and are now limited largely to required licensures and certifications. Additionally, there is a hiring freeze in effect for FY2024-2025, though direct care positions are not affected. • Dr. Crandell observed that OCHD is slightly over budget (101.6%) and asked if this is a big deal, to which Mr. Perschau explained that this is considered within normal range and did not exceed the allotted budget. Ms. Stewart added that for the past few years, the health department has been under budget, largely because of ARPA funding. • Commissioner Fowler shared that it was a painful budget year for all departments and that training and travel was cut across the board. • In response to Dr. Royce's question about recent fee changes impacting Environmental Health Services' return, Victoria Hudson, Environmental Health Director, said that the fee changes were reinvested in the community and didn't affect the bottom line. Ms. Hudson added that fluctuations in Environmental Health Services are usually related to the building and development climate, as it is an on-demand service. • Mr. Whitaker observed that in May there was a spike in both Medicaid Settlement Funds and Environmental Health Services and asked if these were related, but Ms. Hudson explained that the increase for Environmental Health was related to swimming pools. Ms. Stewart added that Environmental Health is not eligible for Medicaid reimbursement, as their services are not covered by Medicaid. Ms. Stewart added that some of the Medicaid Settlement Funds had been set aside over time to help save for a large clinic renovation. Commissioner Fowler commented that during the budget process this year, every department was required to discuss use of any extra funds or savings, as the Medicaid Hold Harmless Agreement was flipped this year and rather than being reimbursed $2M, Orange County owed that amount. • In response to Dr. Stuebe's question about ways to increase service revenue and increase primary care patients, Ms. Stewart said that this is an ongoing challenge, and that the health department is in the process of completing a clinic assessment with AHEC to better understand clinic workflow and staffing capacity. We anticipate the findings will support future requests for additional staffing. • Mr. Perschau concluded his presentation by thanking his team for all their hard work. S:\Managers Working Files\BOH\Agendas &Abstracts\2024 Agenda and Abstracts/ August Page 7 MINUTES ORANGE COUNTY BOARD OF HEALTH August 28,2024 VIII. Actions Items A. Proposed Fee Changes Dental Health Services Dr. Stephanie George, Dental Services Director, presented a proposed new fee of$59.00 for a procedure involving placement of Silver Diamine Fluoride (SDF) to teeth that are at high risk of caries, such as partial erupted permanent teeth and teeth that are difficult to clean. This is a preventative procedure to help prevent development of decay and cavities. This procedure is currently reimbursed by Medicaid at $11.00 per tooth. Environmental Health Services Victoria Hudson, Environmental Health Director, presented five fee requests: three fee increases related to re-inspections of buildings, wells, and pools after a permit denial to appropriately compensate for staff time, a fee increase for total suspended/dissolved solids analyses related to the cost of the lab tests, and a new fee implemented for whenever the Planning and Inspections Department flags a building permit for review by the health department. Ms. Hudson explained that this new proposed fee is a nominal fee of$0.01 per square foot and no less than $25 that will be added when a building permit submitted to the Planning and Inspections Department is flagged as being related to an existing Environmental Health Services permit and requires review from an Environmental Health staff member to ensure agreement between the applications that community members have submitted. She added that the money collected from this fee would be used to fund equity-related projects for community members in need, for example to help pay for water sampling and small household repairs. Mr. Whitaker asked if there was precedent for a new fee like this, to which Ms. Hudson replied that existing building permits in the county include nominal fees for things like copies and technology fees. She added that this fee will only be triggered when Environmental Health is contacted to review a permit. Commissioner Fowler observed that in the request form, the fee for the pool reinspection had decreased rather than increased. Ms. Hudson said that this was an error, as the proposed fee change was an increase, and that the two figures on the form should be inverted for this fee. In response to Dr. Crandell's question about the typical square footage of a building permit, Ms. Hudson said that permits begin to be issued at 20x20ft and that some 8,000 square foot homes have recently been permitted. Dr. Crandell confirmed that a 3,000 square foot home would have an associated fee of$30. Ms. Hudson explained that the Housing Department would collect and utilize the funds to help lower-income residents afford health and safety expenses that may otherwise be cost- prohibitive, such as testing well water samples and conducting minor household repairs. In response to Mr. Whitaker's question, Ms. Hudson explained that the funds would be ledgered to a separate non-zero-balanced account in Environmental Health for use but would be collected by the Planning and Inspections Department. S:\Managers Working Files\BOH\Agendas &Abstracts\2024 Agenda and Abstracts/ August Page 8 MINUTES ORANGE COUNTY BOARD OF HEALTH August 28,2024 Ms. Stewart added that this new fee, if approved, would serve as a pilot and that it may be adjusted depending on how it is received and utilized. Dr. Stuebe observed that since permits for buildings begin at only 400 square feet in size, it seems like the minimum fee being $25 may not be equitable, to which Ms. Hudson replied that unfortunately$25 is the administrative cost of doing business and it's not possible to go lower. Personal Health Services Carla Julian, Public Health Nursing Director, presented a new fee for a Stand-Alone School Health Assessment. Ms. Julian explained that when children enter school there is a 30-day period to ensure they are in compliance with a required health assessment and immunizations. She added that last year the Health Department held several clinics to help local families reach compliance before the cutoff date, but that these shorter visits are not able to be billed as a well- child visit and allow for reimbursement. Therefore, this fee would allow personal health services to charge a $40 flat fee for school health assessments, with the ability to slide or waive the fee when a patient is unable to afford the fee. Motion to approve the proposed fee changes with the corrected pool reinspection fee and forward them to the Board of County Commissioners was made by Dr. Lee Pickett, seconded by Dr. Shielda Rodgers, and carried without dissent. B. Ad Hoc Committee: Annual Board Retreat Planning On behalf of Chair Jonnal, Dr. Stuebe called for the formation of an ad hoc committee to help support planning for the upcoming Board Retreat in the Spring. Ms. Stewart added that for the board retreat in 2022, Chair Baldwin and vice-Chair Bagby were very involved in retreat and Ms. Stewart wanted to give the board the opportunity to have a hand in planning the board retreat and agenda. Dr. Stuebe encouraged board members to reach out to Jean Phillips-Weiner, Board of Health Strategic Plan Manager, and Ms. Stewart if interested in volunteering. Dr. Royce and Dr. Nickelson expressed interest in participating. IX. Reports and Discussion with Possible Action A. Media Items Libbie Hough, Communications Manager, presented the media packet to the board. Topics included Medicaid development and recent changes, a coal/ash project in Chapel Hill that may impact environmental health, a case of rabies recently identified in Orange County, and a recent collaboration between the Health Department and the Safe Kids Orange County program on summer water safety. 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. S:\Managers Working Files\BOH\Agendas &Abstracts\2024 Agenda and Abstracts/ August Page 9 MINUTES ORANGE COUNTY BOARD OF HEALTH August 28,2024 • Ms. Stewart shared that much of July and August was focused on working on the Thriving Hearts project, and the planning phase is nearly complete. Ms. Stewart thanked Dr. Stuebe and the UNC Team for all their work in finalizing the main contract. • The FDA approved the updated COVID vaccine on August 22"d. The Health Department is no longer permitted to administer the 2023 vaccine but has not yet received the updated formula. Ms. Stewart encouraged everyone to get their updated COVID booster. Dr. Royce clarified that the Health Department cannot administer COVID vaccines until they receive the new formula, which Ms. Stewart confirmed. • OCHD vacancy rate is 5%, with 6.5 vacant full-time equivalencies. Environmental Health and Dental are both fully staffed, though Community Health Services has two vacant positions, Finance and Administrative Services has one vacant position, and Personal Health Services has four vacant positions. • Ms. Stewart reminded the board of the Outside Agency Applications process and let them know that there may be some changes to the process forthcoming, which she will keep the board informed about. X. Adjournment A motion was made by Dr. Shielda Rodgers to adjourn the meeting at 8:58 p.m., was seconded by Commissioner Amy Fowler, and carried without dissent. The next Board of Health Meeting will be held September 25, 2024, 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 S:\Managers Working Files\BOH\Agendas &Abstracts\2024 Agenda and Abstracts/ August Page 10