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HomeMy WebLinkAboutApproved Minutes of November 20, 2024 MINUTES ORANGE COUNTY BOARD OF HEALTH November 20, 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 November 20, 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, Shielda Rodgers, Rachel Royce, and Tony Whitaker. BOARD OF HEALTH MEMBERS ABSENT: Lee Pickett. STAFF PRESENT: Quintana Stewart, Health Director; Dana Crews, Community Health Services Director; Dr. Stephanie George, Dental Services Director; Victoria Hudson, Environmental Health Director; Carla Julian, Public Health Nursing Director; Ashley Rawlinson, Compliance Manager; Frederick Perschau, Financial and Administrative Services Director; Libbie Hough, Communications Manager; Thomas Privott, Environmental Health Supervisor; Alex Rimmer, Environmental Health Supervisor; Minerva Lara, Dental Hygienist; Gregory Schiltz, Registered Dietician Program Manager; leesha Colbert, Family Success Alliance Navigator; and Jean Phillips-Weiner, BOH Strategic Plan Manager. GUESTS/VISITORS PRESENT: Jason Lee. I. Welcome New Employees Quintana Stewart, Health Director, introduced the three new employees in attendance: Minerva Lara — Dental Hygienist, Gregory Schiltz— Registered Dietician Program Manager, and leesha Colbert— Family Success Alliance Navigator. II. Public Comment for Items NOT on Printed Agenda: None. III. Board Comments: Tony Whitaker Mr. Whitaker shared that he and Dr. Nickelson had recently attended an Association of NC Boards of Health (ANCBH) Governance Webinar focused on emergency preparedness and disaster management. The webinar was presented by Raul Gomez, Director of Emergency Operations in Guilford County, and discussed the public health implications of disaster preparedness. Mr. Whitaker added that emergency preparedness is necessary for community health. Dr. Nickelson commented that one of the key takeaways of the webinar is that it's important to build strong relationships with community partners and agencies before an emergency occurs. Commissioner Amy Fowler Commissioner Fowler said that she had recently attended a Justice United meeting focused on affordable housing, particularly preserving existing affordable housing and creating S:\Managers Working Files\BOH\Agendas &Abstracts\2024 Agenda and Abstracts/ November Page 1 MINUTES ORANGE COUNTY BOARD OF HEALTH November 20, 2024 permanent supportive housing for individuals transitioning out of incarceration or behavioral health support. She added that Justice United is also planning a meeting to discuss Medicaid Expansion and help promote Medicaid to individuals who are reluctant to enroll, especially in rural areas, and that she thought this may be of interest to the Access to Care committee. Dr. Aparna Jonnal Dr. Jonnal commented that one of the hospitals at which she works, Person Memorial Hospital, has a social worker who has won some awards for the number of people she has enrolled into Medicaid, and that she is very persistent and will follow patients to the parking lot to have a conversation about Medicaid. She suggested that Orange County could invite this social worker to speak with them in the future. Dr. Rachel Royce Dr. Royce provided an update on Orange County's current Medicaid enrollment numbers, saying that the county is up to 63% of the projected enrollment target and continues to inch up at a slow rate of increase month to month. She added that she still would like the denominator data for the projected target to assist with identifying the missing individuals. Ms. Stewart said that we would continue to follow up with Department of Social Services (DSS) about obtaining this data, and changes in leadership have likely delayed the ability to get it. Dr. Rodgers commented that there are some new commercials promoting Medicaid Expansion. Dr. Alison Stuebe Dr. Stuebe shared that over the weekend she attended a meeting focused on infant feeding in emergency situations, and that often it is difficult or impossible to bottle feed babies during emergencies because bottles cannot be cleaned or sanitized without clean water. She explained that birthing parents who have stopped breastfeeding are often able to re-lactate by beginning the breastfeeding process, and that they will generally begin to express and resume their prior supply within a week or two. Agencies can distribute bottle sanitizing kits that use chemicals instead of water and disposable bottles can be used for parents who are unable to breastfeed, but breastfeeding at the breast is the safest option to feed babies in an emergency. She added that in an emergency situation it is important for formula donations to all go through the emergency team to ensure the formula is safe (e.g., not expired, not powdered because that cannot be prepared without clean water). Dr. Jonnal commented that it feels strange to hear about people navigating these kinds of situations in such an affluent country. Keith Bagby Mr. Bagby spoke about his recent visit to his former high school, John Marshall High School in Richmond Virginia, to provide career preparedness consulting for the students. He shared that he made a video, which he shared with the students, and that he spoke with them about some of his own career experiences and motivations. He explained that it is an inner-city school and is under resourced, and that he feels it's important to help as much as he can. He added that he plans to go back for career preparedness counseling next year as well. S:\Managers Working Files\BOH\Agendas &Abstracts\2024 Agenda and Abstracts/ November Page 2 MINUTES ORANGE COUNTY BOARD OF HEALTH November 20, 2024 Dr. Jonnal concluded board comments by saying that this is her final meeting as Chair. She thanked the board members and staff for helping make the experience a delight. IV. Priority Committee Updates Behavioral Health Committee Commissioner Fowler provided the update for the Behavioral Health Committee. The committee learned more about the existing cell phone policies in the two school systems in Orange County (Chapel Hill/Carrboro City Schools and Orange County Schools) and discussed ideas for programs or initiatives to encourage people to spend more time screen free. Ideas discussed included collaborating with Chapel Hill/Carrboro City School System to provide education about the impact of screen use, empowering parents with ideas for how to help control child screen time, promoting screen-free activities, and putting up educational billboards. Commissioner Fowler shared that the committee had discussed ways to equitably reach the most people with education and screen-free programing, agreeing that going through the schools would increase reach. The group agreed that any events that the committee hosts should be planned with equity in mind, for example by hosting events during accessible times and along public transit routes. Commissioner Fowler said that the group had also discussed the idea of hosting education about screens for parents both online and in-person to increase reach and accessibility, especially for those folks who may be less technologically savvy. The next meeting will be used to further explore the intended audience for an educational campaign and to determine the intended message and timeline. The Behavioral Health Committee will next meet in late February. Connections to Community Support Committee The Connections to Community Support Committee will next meet in early January. Access to Care Committee The Access to Care Committee will next meet in late January. Ad Hoc Committee on Well Rules The Ad Hoc Committee on Well Rules will next meet in early February. V. Approval of the November 20, 2024 Agenda Motion to approve the agenda of the November 20, 2024 BOH meeting was made by Dr. Alison Stuebe, seconded by Dr. Rachel Royce, and carried without dissent. VI. Approval of October 23, 2024 Minutes Motion to approve the minutes of the October 23, 2024 BOH meeting was made by Commissioner Amy Fowler, seconded by Dr. Alison Stuebe, and carried without dissent. S:\Managers Working Files\BOH\Agendas &Abstracts\2024 Agenda and Abstracts/ November Page 3 MINUTES ORANGE COUNTY BOARD OF HEALTH November 20, 2024 VII. Educational Sessions A. Family Success Alliance (FSA) Update Crystal Kelley, Health and Human Services Manager, and Erika Cervantes, Family Success Alliance Connections Program Manager, presented an update on the Family Success Alliance (FSA) program over the past year. Some highlights of their presentation are below: • Ms. Kelley began with a recap of the FSA program and its objectives. She reminded the board that the goal of FSA is to help connect families, especially those below the poverty line, to resources, and briefly reviewed the various components of FSA: System of Care/partner network, the Gateway initiative, the Navigator program, and the Connections program. • FSA staff helped draft mission and vision statements for the FSA program, which Ms. Kelley shared with the board. She explained that FSA follows a "teaching people to fish" model and aims to work with families for 6-9 months before sending them on their way, though this doesn't always happen. The Navigator program offers more concentrated support for a shorter period, while the Connections program offers a lighter level of support for as long as it's needed. • Feedback from FSA Navigator program clients is overwhelmingly positive and reflects that the health of families and their access to resources and healthcare improves after being involved with FSA. Most families self-refer to FSA. • All FSA navigators are certified Community Health Workers (CHWs) and are trained in Mental Health First Aid (MHFA) and in working with neurodiverse individuals. Additionally, two FSA staff members are now trained to safely install car seats for families. Each case manager works with approximately 18-21 families, and each family has about four children on average. • Ms. Kelley shared that FSA has increase its partnership with maternal healthcare at the health department and has connected more closely with the Family Home Visiting program, as Family Home Visiting works only with children under five, while FSA is not limited by the age of children. Additionally, the Mobile Dental Clinic recently came out to Gateway Village for two days and provided services there. • The Connections program is being expanded, and Ms. Cervantes has been promoted to program manager. Ms. Cervantes shared that the Connections program offers wraparound support to anyone in Orange County and serves many families who have graduated from the Navigator program. There are almost 300 families currently served by the Connections program, which has two navigators and a program manager on staff. However, it is a softer touch than the Navigator program and does not offer home visits, though people can seek support in person, online, or over the phone. Families who graduate from the FSA Navigator program have a "warm handofff' where their navigator introduces them to a Connections navigator who helps explain the Connections program and how to utilize it. Connections also offers a newsletter about available community support programs and is exploring promoting more resources through social media. • The Connections program has four components: intake/needs assessment, case management, satisfaction surveys/data management, and community engagement/Community Council. The Community Council meets for nine months out of the year and offers the opportunity to apply for mini grants. These programs both allow for community improvement and empower families to understand grant writing for initiatives they may wish to apply for in the future. Ms. Cervantes shared several S:\Managers Working Files\BOH\Agendas &Abstracts\2024 Agenda and Abstracts/ November Page 4 MINUTES ORANGE COUNTY BOARD OF HEALTH November 20, 2024 examples of mini grants that have been awarded over the past year, including installing a picnic table at a local mobile home park and a program Ms. Cervantes assisted with, which taught families of children with autism how to use essential oils to help manage mental health and soothe emotions. Ms. Kelley added that some landlords will offer matching funds for community improvement projects, for example by installing a grill to go with a picnic table. • Ms. Cervantes mentioned some new initiatives FSA is interested in exploring, such as incentivizing attending prenatal care visits by offering "baby bucks" as a reward —these "baby bucks" accrue as patients attend healthcare appointments and can be redeemed at the clinic for things like diapers, bottles, and car seats. Additionally, Ms. Kelley shared that there is a desire for more father-centered programming and a need for new software and methods to adequately manage the data about FSA's impact. • Dana Crews, Community Health Services Director, added that the newest FSA Navigator, leesha Colbert, is a community health worker based full time in the Gateway Village Hub as a response to community need for more direct support. VIII. Actions Items A. Elections (Chair & Vice-Chair) The Board members shall elect a Chair and Vice-Chair by majority vote each year at the last meeting of the calendar year. Motion to elect Dr. Alison Stuebe as 2025 Chair was made by Dr. Aparna Jonnal, seconded by Dr. Bruce Baldwin, and carried without dissent. Dr. Stuebe recused herself from the vote. Motion to elect Mr. Tony Whitaker as 2025 Vice-Chair was made by Dr. Aparna Jonnal, seconded by Dr. Rachel Royce, and carried without dissent. Mr. Whitaker recused himself from the vote. Dr. Jonnal commented that she is excited to see Dr. Stuebe as Chair. Dr. Baldwin expressed that he feels Mr. Whitaker is a great selection for Vice-Chair, as this is his second time serving on the Board of Health and he has served as Chair in the past. B. 2025 BOH Meeting Schedule Ms. Stewart shared the proposed schedule, clarifying that APHA has not yet confirmed the date of their Fall Leadership Conference, so the proposed date of the September meeting (September 17th) may need to be changed. Regarding the date for the Board Retreat, Dr. Royce said March 22Id would not work for her. Commissioner Fowler said that she could not do March 1st. Dr. Baldwin mentioned that UNC and Duke will be playing each other in basketball on the 8th, and Ms. Stewart commented that several members of OCHD staff may be on call for the emergency operations center related to the game. Though initially several people were in favor of March 15th, Dr. Nickelson expressed that she might have a conflict with the 15th and the 8th would be preferable. S:\Managers Working Files\BOH\Agendas &Abstracts\2024 Agenda and Abstracts/ November Page 5 MINUTES ORANGE COUNTY BOARD OF HEALTH November 20, 2024 Dr. Crandell commented that he would not be able to attend June 25' or January 22nd; Dr. Jonnal asked if anyone else had other conflicts and said that unfortunately rescheduling for one person was likely not practical. Dr. Jonnal reminded the board that the meeting schedule can be amended as long as there is at least 30 days' notice before any given meeting. Motion to approve the proposed 2025 BOH Meeting Schedule with the Board Retreat scheduled for Saturday, March 81 was made by Commissioner Amy Fowler, seconded by Dr. Shielda Rodgers, and carried without dissent. C. Debt Write-Off and Debt Set-Off Frederick Perschau, Financial and Administrative Services Director, presented the proposed debt write off and debt set off for FY2023-2024. In 2013, the Orange County Board of Health declared that patients of the Orange County Health Department would not be refused medical services due to inability to pay. Therefore, debts from Personal Health Services are not pursued through debt set off. Mr. Perschau explained that debts of$50 or more from Environmental Health Services or Dental Health Services which have been on the books for at least sixty days are pursued through the debt set-off program —first, an attorney sends letters seeking payment, and if the debt is not paid in a timely manner then the debt is sent to the state Debt Set Off Program, where tax refunds and lottery winnings can be garnished to settle the debt. For FY2023-2024, the health department has so far received $3,373.16 in repayments through the debt set-off program. Debts below $50 which have been outstanding for over a year are considered uncollectible. In response to Dr. Baldwin's question, Mr. Perschau explained that this debt is considered "bad debt" and is too much of a risk to be considered an asset, so from an accounting perspective, it is best practice to "write off' the debt without any plan to recoup it. For FY2023-2024, the health department has $10,008 in uncollectible debt across Dental Health Services, Environmental Health Services, and Personal Health Services, which needs to be written off—that is, transferred from active status to inactive status. Mr. Perschau clarified that if a client returns to the health department seeking nonmedical services within three years, their debt will be reactivated. Dr. Crandell asked if there were any debts excluded from this total, as it seemed low for the debts of a health department. Victoria Hudson, Environmental Health Director, explained that the figure only includes uncollectible debt, as collectible debt is pursued through the set-off program. Dr. Baldwin said that he also thought the debt seemed low but observed that the health department offers a sliding scale which can slide to zero for some services, meaning that most people who truly can't afford to pay likely do not have much debt; Ms. Stewart agreed that this was likely a factor. Motion to approve the transfer from active to inactive status of$10,008 in bad debt, thus writing it off without collection, was made by Dr. Alison Stuebe, seconded by Commissioner Amy Fowler, and carried without dissent. S:\Managers Working Files\BOH\Agendas &Abstracts\2024 Agenda and Abstracts/ November Page 6 MINUTES ORANGE COUNTY BOARD OF HEALTH November 20, 2024 D. Wastewater Rules Revisions Victoria Hudson, Environmental Health Director, presented proposed revisions to the Orange County Wastewater Rules based on recent state legislation changes. Mr. Whitaker commented that most of the changes seemed definitional, with a few new items adjusting setbacks or design numbers and flow rates. Ms. Hudson said this revision is legally considered to be "technical corrections." Mr. Whitaker also asked about the revision to setbacks for both wells and wastewater systems/saprolite, which seems like an error as wells and wastewater systems are intrinsically different and it seemed strange to combine them in a single setback requirement. Ms. Hudson agreed that this was odd but explained that this was the way the state had decided to combine those items at this time. Dr. Jonnal clarified that these changes are mandatory, as the revisions are based on legislative changes, but that individual counties still have the option to issue or retain requirements that are more conservative than the state requirements, which Ms. Hudson affirmed. Dr. Royce asked if there were any changes which affected health department functioning; Ms. Hudson said no, but that there was one revision she didn't like, which removed the need for a second septic tank for quiescence for households with a garbage disposal. She added that Environmental Health is now planning an educational campaign promoting composting. Motion to approve the proposed revisions to the wastewater rules was made by Dr. Shielda Rodgers, seconded by Dr. Alison Stuebe, and carried without dissent. E. BOH Annual Workplan Jean Phillips-Weiner, BOH Strategic Plan Manager, presented the annual workplan report draft. Each spring, the chair of the BOH presents this report to the BOCC, which helps keep the commissioners up to date on the board's activities and the priorities that the board is working to address. Board members had a few revisions and suggestions for the report, including: • Dr. Royce and Dr. Nickelson commented that they each sit on additional boards that can be added to the report. • Dr. Royce recommended that concerns about changes to the public health ecosystem under the upcoming presidential administration should be added to the concerns and emerging issues section of the report. Some specific concerns highlighted included fluoridation, vaccination, monitoring infectious disease, chronic disease, changes to Medicaid, immigrant wellbeing, impacts to mental health related to changes to public health ecosystem, and changes in CDC structure. Commissioner Fowler agreed that proactive messaging to the community about believing science and trusting in vaccines would be important. Dr. Stuebe commented that framing public health within the Vital Conditions Framework (for example, "humane housing" vs. "affordable housing and homelessness") may be a good strategy under a changing administration. Ms. Stewart suggested that the upcoming board retreat would be a good opportunity for the board to discuss a plan to address these concerns. • Mr. Bagby commented that the presentation to the BOCC is very brief—generally only the highlights and newest things, as there isn't time to go more in depth. Commissioner Fowler said that the commissioners do read the whole document, but the presentation is only a few points of pride and concerns. S:\Managers Working Files\BOH\Agendas &Abstracts\2024 Agenda and Abstracts/ November Page 7 MINUTES ORANGE COUNTY BOARD OF HEALTH November 20, 2024 Ms. Phillips-Weiner invited board members to submit any additional feedback or revisions to her by email. The workplan will be formally approved at the meeting in January. IX. Reports and Discussion with Possible Action A. Media Items Libbie Hough, Communications Manager, presented the media packet to the board. Topics included: the Orange Partnership initiative Bridging the Gap to reduce adolescent vaping, Digital Literacy class offerings at local libraries, the Horizons program and maternal mortality, the reopening of an urgent care location in Hillsborough, and a recent rabies case identified in Orange County. Ms. Hough also let the board know that the webpage for FSA has been updated. 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. • The annual outside agencies application process has been revised, and board members will no longer be required to review applications (though the health director still will). Ms. Stewart added that she does not currently have details for the funding outcomes for the 2024 applications, but she will share those in the future. • Ms. Stewart met with Dr. Hamlett, the superintendent for the Chapel Hill/Carrboro City School (CHCCS) District, on November 13'h. They discussed the school system's new aligned cell phone policies ("away for the day" in lockers for the middle schools, and out of sight during class for the high schools) and ways to collaborate to reduce screen time among students. Ms. Stewart shared that CHCCS implemented a screen-free week last spring and that, anecdotally, staff are already saying that students seem to be socializing more under the updated phone policies. Additionally, Dr. Hamlett connected Ms. Stewart to a digital wellness expert, Mary Beth Roche. Commissioner Fowler clarified that Orange County Schools (OCS) do not yet have a standardized phone policy, which Ms. Stewart affirmed. Ms. Stewart shared that Dr. Jones conveys interest in drafting a cell phone policy for the district. As a fairly new Superintendent for the district, she currently has multiple competing priorities. • Orange County Health Department has contracted with an outside vendor, The Carden Group, to assist with leadership and cultural development of the department. The consultants recently hosted three roundtable discussions with staff to get a sense of the baseline culture. They expect to be working with the health department for the next six months. • A court date has been scheduled to hear the Gurlitz Hearing Appeal in District Court— the case will be heard on Friday December 61" at 9am. At this point, no staff or board members have been summoned for the court hearing. S:\Managers Working Files\BOH\Agendas &Abstracts\2024 Agenda and Abstracts/ November Page 8 MINUTES ORANGE COUNTY BOARD OF HEALTH November 20, 2024 X. Closed Session to Discuss Health Director's Annual Review A motion to enter closed session at 8:48 p.m. to discuss the health director's annual review was made by Commissioner Amy Fowler, seconded by Dr. Davia Nickelson, and carried without dissent. During the closed session, the Board of Health discussed Quintana Stewart's job description and annual performance review. A motion to end the closed session at 9:39 p.m. was made by Commissioner Amy Fowler, seconded by Dr. Shielda Rodgers, and carried without dissent. XI. Adjournment A motion was made by Dr. Alison Stuebe to adjourn the meeting at 9:39 p.m., was seconded by Dr. Bruce Baldwin, and carried without dissent. The next Board of Health Meeting will be held January 22, 2025, 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/ November Page 9