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HomeMy WebLinkAboutApproved Minutes of September 25, 2024 MINUTES ORANGE COUNTY BOARD OF HEALTH September 25, 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 September 25, 2024, at the Orange County Health Department, 300 West Tryon Street, Hillsborough, NC. BOARD OF HEALTH MEMBERS PRESENT: Aparna Jonnal — Chair, Alison Stuebe—Vice Chair, Keith Bagby, Bruce Baldwin, Brian Crandell, Commissioner Amy Fowler, Davia Nickelson, Lee Pickett, Shielda Rodgers, Rachel Royce, and Tony Whitaker. BOARD OF HEALTH MEMBERS ABSENT: None. STAFF PRESENT: Quintana Stewart, Health Director; Dr. Stephanie George, Dental Services Director; Victoria Hudson, Environmental Health Director; Carla Julian, Public Health Nursing Director; Ashley Rawlinson, Compliance Manager; Thomas Privott, Environmental Health Supervisor; Alex Rimmer, Environmental Health Supervisor; Marcy Williams, Health Promotion and Education Services Manager; Chinyere Ekenna, Communicable Disease/Refugee Health Nurse; Kathryn Schain, Environmental Health Specialist; Joseph M. Aguilar, Environmental Health Specialist; Leidy Velasquez, Medical Office Assistant; and Jean Phillips-Weiner, BOH Strategic Plan Manager. GUESTS/VISITORS PRESENT: None. I. Welcome New Employees Quintana Stewart, Health Director, introduced the three new employees in attendance: Leidy Velasquez— Medical Office Assistant, Joseph M. Aguilar— Environmental Health Specialist, and Kathryn Schain — Environmental Health Specialist. II. Public Comment for Items NOT on Printed Agenda: None. III. Board Comments Keith Bagby Dr. Jonnal congratulated Mr. Bagby for being named WCHL's Hometown Hero for the month of August and invited him to comment on the experience. Mr. Bagby shared that his energy and drive to volunteer and invest in young people comes from his parents; his father coached high school football, his mother was a schoolteacher, and while he was growing up their house was always full of both extended family and friends. Mr. Bagby said that he carries on this family value of taking care of other people and giving back. He added that in November he will be going to two high schools, including his own, to offer career counseling to young people. Dr. Jonnal commented that she finds Mr. Bagby inspirational and that he makes her want to reconsider her own retirement plans. S:\Managers Working Files\BOH\Agendas &Abstracts\2024 Agenda and Abstracts/ September Page 1 MINUTES ORANGE COUNTY BOARD OF HEALTH September 25, 2024 Dr. Rachel Royce Dr. Royce inquired about the process for the board to create a resolution, which Ms. Stewart explained would involve getting consensus as a board, finalizing a draft resolution, approving it, and submitting it to the Board of County Commissioners (BOCC) for review and support. Dr. Royce clarified that fact-finding for a resolution could be done within an existing committee if the goal aligns with their priority or that she could call for the formation of an Ad Hoc Committee. She said that she would share more details at a future meeting. Dr. Jonnal commented favorably on the fact that so many board members seem interested in doing substantive work to improve the community's health. Dr. Royce shared that she had signed up to assist with Medicaid Enrollment but had experienced difficulties connecting with anyone who could give her actual tasks to do. She shared that she finally connected with Sierra Elrahal from Legal Aid, an organization which works to connect folks who are eligible for Medicaid with resources, support, and even actual healthcare. She said that she has become a volunteer with this group and has helped share flyers about Medicaid expansion with more than 250 individuals through PORCH and by canvassing for voter registration. Dr. Stuebe expressed appreciation for the idea of leveraging existing community organizations such as PORCH to share resources and wondered if the Connections to Community Support Committee could explore something similar. Dr. Royce suggested that the board could invite someone from Legal Aid to speak in the future, and Ms. Stewart encouraged her to reach out to Jean Phillips-Weiner, Board of Health Strategic Plan Manager, to facilitate this. Tony Whitaker Mr. Whitaker asked how to make a request for further support, for example from health department staff, for initiatives that the board is interested in. Ms. Stewart said that board members should reach out to Ms. Phillips-Weiner first and she would help connect them to the appropriate people. IV. Priority Committee Updates Behavioral Health Committee Dr. Crandell provided the update for the Behavioral Health Committee. He shared that the committee had met in mid-September and heard from Dr. Karl Johnson, a professor at UNC Gillings, about the impact of social media and screen use on youth mental health. Dr. Crandell mentioned that Dr. Johnson is involved in an initiative in the Granville County School System to evaluate the impact of phone bans in schools on youth mental health. Commissioner Fowler mentioned that several counties in North Carolina have now implemented phone bans. Dr. Crandell shared that Ms. Stewart is seeking to reestablish relationships with the schools post- COVID. Regarding equity, much of the presentation focused on the differences in mental health outcomes related to gender, with girls and young women much more negatively impacted by screen time and social media use compared to boys and young men. Dr. Crandell also shared that the committee reviewed racial data on EMS calls in Orange County related to suicide and noted that Black people are overrepresented in suicide-related calls while white people are underrepresented. S:\Managers Working Files\BOH\Agendas &Abstracts\2024 Agenda and Abstracts/ September Page 2 MINUTES ORANGE COUNTY BOARD OF HEALTH September 25, 2024 Because of the board's interest in youth mental health and screen use, Dr. Crandell suggested that the minutes from the Behavioral Health Committee Meeting be shared with the full board. Connections to Community Support Committee The Connections to Community Support Committee will next meet in early October. Access to Care Committee The Access to Care Committee will next meet in mid-October. Ad Hoc Committee on Well Rules The Committee on Well Rules will next meet in late October. V. Approval of the September 25, 2024 Agenda Motion to approve the agenda of the September 25, 2024 BOH meeting was made by Dr. Bruce Baldwin, seconded by Dr. Rachel Royce, and carried without dissent. VI. Approval of August 28, 2024 Minutes Motion to approve the minutes of the August 28, 2024 BOH meeting was made by Commissioner Amy Fowler, seconded by Mr. Tony Whitaker, and carried without dissent. VII. Educational Sessions A. Screen Time and Children Aparna Jonnal, Physician Representative and Chair of the Board of Health, provided a presentation on the existing data and information about the effects of screen time on the health and wellbeing of young people. Some highlights of her presentation are below: • The prevalence of screen use is at least a factor in the recent uptick of pediatric mental illness. Anecdotally, as an ER Doctor, Dr. Jonnal said that she is now frequently seeing pre-teens aged 8-11 in the emergency psychiatric ward. She shared that she has witnessed infants in the ER who are experiencing pain and distress pushing their parents away from them and instead seeking a screen to soothe themselves. • Dr. Jonnal shared that there is limited data on screen use by young people in Orange County, as the Youth Risk Behavior Survey (YRBS) has not been conducted in the Orange County School (OCS) System or the Chapel Hill Carrboro School System (CHCSS) in several years. Additionally, the last time it was conducted in OCS, it was opt-in rather than opt-out, meaning the data was not robust and did not tell a clear story of the health of students. However, Dr. Jonnal argued that the burden of proof that screens are harmful should not be put on public health experts, and instead it should have been on technology companies to prove that they are safe for kids to use. S:\Managers Working Files\BOH\Agendas &Abstracts\2024 Agenda and Abstracts/ September Page 3 MINUTES ORANGE COUNTY BOARD OF HEALTH September 25, 2024 • Sleep deprivation has increased dramatically since the introduction of smartphones. Dr. Jonnal shared that phone-related sleep deprivation may be a bidirectional process or even a positive feedback loop: that is, being sleep-deprived may increase the desire to soothe with a screen, which keeps a person awake, thus increasing sleep deprivation. • Increased risk of obesity is one of the most well-documented hazards associated with screen use, with ample data suggesting even one hour of screen time per day increases the odds ratio of being overweight or obese. • Dr. Jonnal also shared that there is evidence that screen use may change the structure of the brain, for example by reducing white matter. She mentioned "digital dementia," a condition where heavy screen use at any age reduces attention span and memory over time. There is concern that heavy screen use may actually contribute to the development of dementia later in life, which would be a public health disaster. • Evidence suggests that screen time can impact mental health, increase depression and anxiety, and worsen language acquisition and development of social skills. There is also evidence that looking at screens raises blood pressure, while looking at trees can lower it. • Randomized Controlled Trials (RCTs) suggest that reduction of leisure time screen use over a period of two or more weeks can improve youth mental health. However, interventions to reduce screen use are generally not very effective, as screens are particularly addictive. • Dr. Jonnal mentioned that she had children later in life, and that her friends with children universally warned her away from giving her kids screens, saying that once screens are introduced, the kids inevitably want more of them and it becomes a constant struggle. • Potential public health actions Orange County can take on screens include resuming collection of YRBS data in schools, banning cell phones in schools, and joining the class-action suit against Meta. Ms. Stewart commented that, while there is potential legislation coming from state senators related to a school cell phone ban, policies for Orange County are being led by the school boards. Commissioner Fowler expressed a desire to collaborate with schools, host community conversations related to phone and social media use, and rally up community support for implementing school cell phone policies. • Dr. Jonnal said that no one should be shamed for using screens and that it should be a gentle conversation. She shared that when she tells parents in the ER that screens are bad for their kids, most are receptive but struggle with setting boundaries. She mentioned that culturally, the US is built to encourage using screens as babysitters, as households are typically only nuclear families with one to two parents, while many other countries have multiple generations and six+ potential caregivers living under one roof. • Dr. Royce commented that using screens and cell phones can offer a prosocial effect, allowing kids to connect to each other and that when kids are not allowed a phone, they may feel like they are missing out. She noted that it's also important to also take stock of what screens are crowding out, for example many young people don't know how to fix a bike or cook a meal. Mr. Whitaker echoed this, observing that kids today don't retain as much information mentally since they always have the option to look things up. • Dr. Jonnal mentioned that she's campaigning for a return to landline phones; Dr. Rodgers said that she still has a landline, but it's very difficult to find a replacement wall phone when your current one breaks. • Mr. Bagby mentioned that there are many screen-free activities to help kids build social connections, noting Boy Scouts and organized sports as two activities he participated in during his own youth. He also shared that when he was raising his own kids, they had a S:\Managers Working Files\BOH\Agendas &Abstracts\2024 Agenda and Abstracts/ September Page 4 MINUTES ORANGE COUNTY BOARD OF HEALTH September 25, 2024 rule of one hour of TV per night, and that he once had a child try to continue watching TV after bedtime, so he shut down the circuit breaker to that room. • Dr. Rodgers mentioned that her daughter is outdoorsy and regularly takes her kids camping, and that other parents have offered to pay her to take their kids on camping trips, too. She noted that parents need to find a way to take control of screens again. Dr. Jonnal said that a culture shift is necessary to change things, because it's developmentally difficult for children and adolescents to feel left out and screens are so ubiquitous. Commissioner Fowler commented that during the Behavioral Health Committee meeting, Dr. Karl Johnson of UNC Gillings shared that young people said that they would pay up to $20 a month to get their friends to quit social media, so kids are ready for a culture shift too. • Dr. Stuebe commented on the systems drivers for rampant screen use — in two-parent households where both parents are working, sometimes multiple jobs, and don't live near extended family, it's difficult to avoid using screens to placate your children. She wondered what needs to change to allow people to have enough community to care for their children without needing to supplement with screens. • Dr. Jonnal commented that many young people don't know how to regulate their emotions without using screens, as it has become the norm for parents to use screens to calm toddlers during tantrums, even though tantrums are an important part of socioemotional development and allow children to learn how to self-soothe. • Ms. Stewart noted that with school phone bans, it is often parents providing the most pushback due to anxiety over school shootings and fearing not being able to reach their children in an emergency. • Dr. Jonnal concluded by saying that she would love to speak with the BOCC or the school superintendent about the impact of screens on the health of young people. Commissioner Fowler said that she could bring up the topic at the next school board meeting. B. Annual Immigrant/Refugee Health Update Chinyere Ekenna, Communicable Disease/Refugee Health Nurse, presented an update on the health status and health screening process for refugees and asylees in Orange County. Some highlights of her presentation are below: • Ms. Ekenna defined refugees and asylees — a refugee being an individual who has fled their home country due to violence or persecution, while an asylee is a refugee who has been granted legal entrance and protection (asylum) into the US. • The number of refugees arriving in Orange County has been decreasing since 2021. In FY23-24, 37 refugees were screened upon their arrival to Orange County. • Ms. Ekenna provided an overview of the refugee health screening process, which includes identifying any infections and/or chronic conditions that may affect settlement or pose a public health risk, bringing refugees up to date on any required vaccinations, screening for tuberculosis infection, and helping connect refugees to the US healthcare system for further care. The initial health screening takes place at one of the partnering Piedmont Health Centers and should take place within thirty days of arrival, but sometimes it is delayed —for example, interpreters for some languages may be difficult to find. • Data on refugee health is reported to the state quarterly. • Required tests and vaccines change frequently. Currently, Sexually Transmitted Infection (STI) screening is recommended for certain high-risk populations. However, many refugees arrive in family units, which is considered low risk for STIs, and therefore S:\Managers Working Files\BOH\Agendas &Abstracts\2024 Agenda and Abstracts/ September Page 5 MINUTES ORANGE COUNTY BOARD OF HEALTH September 25, 2024 these groups are not screened. In response to Dr. Steube's question, Ms. Ekenna explained that pap smears are not done as part of the initial health screening and must be scheduled as part of a separate physical exam. • Ms. Ekenna shared that in the past year, they have assisted 62 refugees in the process of adjusting their legal status to permanent residency. • Ms. Ekenna reviewed the major challenges and barriers related to health screenings and some possible solutions. While language barriers are a problem, interpreters can help. For individuals who lack transportation, they recommend using buses and other transportation and offer flexible appointment times depending on arrival. The required screenings also serve as an opportunity for education about the US healthcare system. • Dr. Stuebe asked if the health department could take on responsibility for these screenings, refugee primary care, and family planning if additional staff were to be hired and create more of a `one-stop-shop' for refugee health. Ms. Stewart explained that this is a possibility, especially as these services would be covered by Medicaid reimbursement, but short staffing is an issue, and the health department would need to be granted funding to hire more staff. • Dr. Pickett asked if there were any health reasons that a refugee might be expelled from the US to which Ms. Ekenna replied that there is a well screening conducted prior to admission to the US, so if an individual passed this screening and were admitted, it is very unlikely that they would then be ejected for any health-related reason. • In response to Dr. Royce's question, Ms. Ekenna explained that trauma screening is offered as part of the physical examination, but not the initial health screening. C. Annual Board of Health Policy Review Jean Phillips-Weiner, Board of Health Strategic Plan Manager, reviewed the recommended changes to the Board of Health Policies and Procedures Manual with the board. The recommended policy changes are as follows: 1.0 Mission Statement and Scope of Services • No Changes. I.A. — Requests for Environmental Services and Assessments • No Changes. I.B. — Fee and Eligibility Policy • Some minor updates to wording and punctuation throughout. • Section 11111.113.1 Updated income verification window to be in line with current practice (10 days or less rather than 30 days or less). • Section VI.1.2: Updated wording to reflect the minimum fee for Dental services, which does not slide to the 0% pay level and stops at 20%. • Section VII.J.1.a: Updated billing statement cycle to reflect current practice (sending out bills monthly rather than no more than three days after charges post). I.C. — Community Assessment Policy • The policy was updated throughout to reflect changes in the State of the County Health (SOTCH) reporting requirements. • Several broken links were removed or replaced. I.D. — Review of Reports and Documents S:\Managers Working Files\BOH\Agendas &Abstracts\2024 Agenda and Abstracts/ September Page 6 MINUTES ORANGE COUNTY BOARD OF HEALTH September 25, 2024 • No Changes. I.E. — Operating Procedures BOH Manual • IX. Officers and Committees C. 3. & 5: Updated the Priority Committees to reflect new priorities identified in 2023 CHA. • X. Meetings G. Minutes: Updated broken link to access minutes. • XVI. Adjudication Procedures A: Defined days as "Calendar days" (update made at BOH Retreat in March 2024). • XVII. Annual Review of the Health Director: Added updated guidelines to detail Board members use of County HR PERFORM program in NeoGov. I.E. — Operating Procedures BOH Manual —Appendix H — Confidentiality and Conflict of Interest • No Changes. There were no comments or further modifications recommended during the meeting. The board will vote to approve these changes at the October meeting. Vill. Actions Items A. Community Health Improvement Plans (CHIPs) Marcy Williams, Health Promotion and Education Services Manager, presented the proposed Community Health Improvement Plans (CHIPs). Some highlights of her presentation are below: • Ms. Williams reviewed some of the highlights from the most recent Community Health Assessment (CHA), including that suicide is the ninth leading cause of death in the county, the African American infant mortality rate in Orange County is six times higher than the rate for white infant mortality, Orange County is one of the five least economically equitable counties in North Carolina, and that top community concerns include affordable housing and access to mental health resources. • Orange County Health Department operates using the Results-Based Accountability Framework; Ms. Williams provided a brief overview of this process and the concept of "Turn the Curve" thinking. • For each of the three priority areas identified by the CHA—Access to Care, Behavioral Health, and Connections to Community Support— Ms. Williams reviewed the results statements (i.e., what it would look like if we perfectly solved this problem), measures to track progress towards the goals (i.e., indicators), and provided a list of things that are known to work to help address each priority area. • Ms. Williams concluded by providing a link to the Healthy NC 2030 Scorecard for Orange County (which can be found at https:Hembed.clearimpact.com/Scorecard/Embed/80939) and a brief overview of how the dashboard can be used to track progress on the CHIPs. • In response to Dr. Pickett's question about one Behavioral Health peer education program, "Seize the Awkward," Ms. Williams explained that this is a program that encourages young people to embrace the awkwardness of growing up and to discuss mental health struggles with their peers. • Dr. Crandell asked about the purpose of indicators, to which Ms. Williams explained that the state requires each priority area of a CHIP to have at least one indicator that aligns with the Healthy NC 2030 Report, allowing comparisons between the county and the S:\Managers Working Files\BOH\Agendas &Abstracts\2024 Agenda and Abstracts/ September Page 7 MINUTES ORANGE COUNTY BOARD OF HEALTH September 25, 2024 state. Dr. Royce added that indicators provide objective measures to help track trends and progress and determine if an initiative is working. • Dr. Jonnal thanked Ms. Williams and McKayla Creed, Healthy Carolinians Coordinator, for their incredible work on the CHIPs. She noted that the slide detailing efforts to address Access to Care was extremely robust, which is a shame because universal healthcare would be a more efficient solution than spending so much time and effort just to get people healthcare under the current system. • In response to Mr. Bagby's question about ways to get involved, Ms. Stewart said that board members are always welcome to participate in the Healthy Carolinians committees. • Dr. Stuebe commented that she'd love to hear more from the Community Health Workers (CHWs) Group and suggested inviting them to a future meeting. Ms. Williams mentioned that they recently had a meeting with many local agencies with CHWs, including Heather Pack, a UNC student and CHW. Ms. Stewart chimed in to share that the Health Director's Association is lobbying with state personnel to create an official job classification for CHWs; she added that the FSA Navigators would fall under the CHW title, and that much of the work being done for public health requires CHWs to help bridge gaps and make connections with communities. Dr. Stuebe asked if the board could consider drafting a resolution to support this designation, which Ms. Stewart agreed would be a great idea. Motion to approve the proposed Community Health Improvement Plans was made by Dr. Lee Pickett, seconded by Dr. Alison Stuebe, and carried without dissent. IX. Reports and Discussion with Possible Action A. Health Director Annual Review Dr. Jonnal reminded the board that the annual performance review for Ms. Stewart is coming up. Dr. Jonnal will be meeting with Travis Myren, County Manager, to discuss Quintana's performance, while Vicki Jones, Human Resources Program Manager, is in the process of surveying staff for the evaluation. During the month of October, board members will receive a link to complete an evaluation of Ms. Stewart's performance over the past year. Dr. Jonnal urged board members to complete the evaluation in a timely manner and come to the next meeting prepared to discuss Ms. Stewart's performance in closed session. Dr. Jonnal agreed to share a summary of her conversation with the county manager and the results of the staff survey with the board members via email to help guide their evaluation. B. Media Items As Libbie Hough, Communications Manager, was on vacation, Ms. Phillips-Weiner presented the media packet to the board. Topics focused on news connected to the health department's work and included: a case of West Nile virus detected in Durham County; a new institute at UNC focused on risk management and the connection between extreme weather, cybersecurity, and the economic health of communities; a recent interview by Alliance Health related to their efforts to improve mental healthcare access in the Latine community; a recent legal charge in Carrboro related to an overdose death; and the opening of a new surgical hospital. S:\Managers Working Files\BOH\Agendas &Abstracts\2024 Agenda and Abstracts/ September Page 8 MINUTES ORANGE COUNTY BOARD OF HEALTH September 25, 2024 Media items were in the packet, which focused on Orange County's events, our involvement in various efforts, and various public health topics. C. Health Directors Report Ms. Stewart presented her report to the Board. Below are brief highlights of her report. • The annual Suicide Prevention Walk was hosted on September 12th at Leigh Farm Park. This walk was a joint effort between Orange and Durham County Health Departments and involved many community partners including 988 and Insight. • Last week was the North Carolina Public Health Association (NCPHA) Fall Leadership Conference, which was held in Cherokee and attended by various members of the health department. Several members of Environmental Health staff and a provider from the medical clinic gave presentations. • The updated COVID vaccine formulation is now available at the health department for children and adults regardless of insurance status. In response to Dr. Rodger's question, Ms. Stewart shared that it is the Moderna vaccine. Ms. Stewart confirmed that the health department also has the RSV vaccine available after Commissioner Fowler asked. • There has been a small decrease in COVID case numbers and a decrease in COVID- related hospitalizations, suggesting the new vaccine booster may be having a positive impact. • Unfortunately, the first Measles case has been reported in NC, in Mecklenburg County on September 9th. No additional cases have been reported at this time. • The first Opioid Settlement Funds Impact Report will be submitted at the end of this week. This will help summarize the impact of the first round of Opioid Settlement funding. • The annual Health Department All-Staff Meeting is being held on Friday October 18th at Fairview Park, and Board of Health members are invited to attend. X. Adjournment A motion was made by Commissioner Amy Fowler to adjourn the meeting at 8:58 p.m., was seconded by Dr. Shielda Rodgers, and carried without dissent. The next Board of Health Meeting will be held October 23, 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/ September Page 9