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2014-153-Minutes for Meeting February 26,2014 Recorded 3/17/2014 NANCYUBLANKENSHIP,FCOUNTY CLERKDS CJ 7014.153 COMMISSIONERS' JOURNAL 03/17/2014 08;12,35 AM I II l I lII1 1111111 lIIII III 2014-153 Do not remove this page from original document. Deschutes County Clerk Certificate Page Q Deschutes County Board of Commissioners 1300 NW Wall St., Suite 200, Bend, OR 97701-1960 (541) 388-6570 - Fax (541) 385-3202 - www.deschutes.org MINUTES OF WORK SESSION DESCHUTES COUNTY BOARD OF COMMISSIONERS WEDNESDAY, FEBRUARY 26, 2014 Present were Commissioners Tammy Baney and Alan Unger; Commissioner Anthony DeBone was away on business. Also present were Tom Anderson, County Administrator; Erik Kropp, Deputy County Administrator; and,for a portion of the meeting Judith Ure, Administration; Ed Keith, Forester; Laurie Craghead, County Counsel; and Scott Johnson and Laura Spaulding, Health Services. Chair Baney opened the meeting at 1:30 p.m. 1 . Grant Request from Mock Trial Group. Judith Ure presented an application for a grant in the amount of$600 from the Mock Trial Group. The Commissioners agreed to split it equally. UNGER: Move approval. BANEY: Second. VOTE: UNGER: Yes. BANEY: Chair vote yes. 2. Consideration of Approval of Grant Applications. Ed Keith gave an overview of a grant application for the FireFree media campaign and other outreach. The 5% match can be existing personnel time. He spoke also about a FEMA Fire Prevention and Safety Grant in the amount of approximately $100,000. UNGER: Move approval. BANEY: Second. Minutes of Board of Commissioners' Work Session Wednesday, February 26, 2014 Page 1 of 7 VOTE: UNGER: Yes. BANEY: Chair vote yes. Mr. Keith spoke about the Fire Adaptive Community Hub Network. This involves eight communities around the country; those who exhibit fire adaptive community activities. Fire plans, defensible space, supportive legislation, and forest collaboratives need to be in place. They all share information through the network. There is one conference a year; the rest is done through webinars and. other media. $12,000 is the maximum award, with a 20% match, which could be personnel time. This keeps Deschutes County on the national map with its successes, and open to new ideas. LINGER: Move approval. BANEY: Second. VOTE: UNGER: Yes. BANEY: Chair vote yes. Deschutes County was awarded a grant for $10,200 for weed eradication efforts. The County will match this with personnel time and work being provided by partners such as the Forest Service. Representative of Oregon Emergency Management said that FEMA has secured contactors to start environmental assessments. They meet by the end of March and will kick off the process then. This will involve the three counties and the contractor, and they will go over the scope of work and other aspects. Chair Baney asked about sending them a letter to keep them focused. Every day that goes by is a day that they can't do all they should for the community. She wants to make it clear the County is open and available to assist. No one will care if it was OEM or FEMA or the County causing a backlog if there is another disaster. Someone needs to keep on top of this, and remind them that there needs to be forward movement. Minutes of Board of Commissioners' Work Session Wednesday, February 26, 2014 Page 2 of 7 Commissioner Unger said that maybe a Commissioner should attend the upcoming meeting just to make it obvious there is a lot of interest. Mr. Anderson voiced concern about there being risk in this; he does not want it to backfire. Mr. Keith stated that he will let them know the Board is here and available, if it will help speed up the process. The meeting will be held here, making it easy for a Commissioner to drop by. Chair Baney said that she does not want the problems they had before occurring again. She hopes everyone learned some lessons and will work better in partnership. Mr. Keith stated that they will commit to a timeline and he will check on that on a regular basis. There are still other processes to be worked out between the OEM and the County. They have had some of those conversations, and are trying to remove obstacles to the environmental part first. Mr. Anderson noted that the Oregon Department of Forestry would be plugged in this time, since the OEM does not have the capacity to do much monitoring. It is likely the OEM will contract with the ODF for the on-the-ground monitoring part. Commissioner Unger asked about comments made regarding the weed ordinance. He asked if they should mirror the State language. Ms. Craghead said they would come back next Wednesday in a work session, with a matrix and some ideas to discuss. Chair Baney asked if the website shows what noxious weeds look like. Mr. Keith replied it is under deschutes.org/weeds. This has the draft ordinance, a link to a photo gallery of weeds, a booklet that can be downloaded, and other work the County is doing in this regard. 3. Discussion of Public Health Accreditation Preparation. Scott Johnson provided an overview of the National Public Health Accreditation Board site visit coming up. There are two days of meetings, and a set of national standards to review. It is essential to have a governing board that is active in public health matters. There needs to be evidence shown that the local agency does what they say they are doing. Minutes of Board of Commissioners' Work Session Wednesday, February 26, 2014 Page 3 of 7 Once accredited, this allows for further federal grant opportunities. They review activities on an annual basis, and are re-accredited every five years. Laura Spaulding attended the Marion County process. A primary goal is to prepare the Board in response to questions that will be asked. The Board has to show that it is involved and aware. This time slot is set up for the accreditation board to talk with the Board of Commissioners; others might be present for clarification purposes. Mr. Johnson said he created a packet with the high points. The session is scheduled for March 11. They want to know there is oversight and the Board is supportive of the strategic plan and programs. Ms. Spaulding added that their questions are very generic and meant to deal with all kinds of agencies. Mr. Johnson went over the documents: executive summary, health improvement plan, and the Community Health Assessment and Community Health Improvement; and the strategic plan for local issues. The plan covers multiple years, and they have to break it down by year and by priority. It all ties together. Ms. Spaulding noted that they are big on regional ideas. Chair Baney pointed out that they went to the legislature to be able to do things on more of a regional basis. Mr. Johnson stated they could go bigger on some things, like grant writing and overlapping issues. They are able to compartmentalize for smaller issues. They are more interested in the process to handle specific issues, more than the specific problems. Ms. Spaulding pointed out that they are okay with whatever is being done or not being done, as long as the County takes ownership and have reasons why. She did not know what kind of questions to expect at first. They have had documents since last summer and some questions were very detailed, so they did read them. Mr. Johnson added that they are interested in the work to be done, the workforce development plan, the full range of recruiting, training, retaining and recognizing a qualified workforce. This is a big thing in the health care field. Minutes of Board of Commissioners' Work Session Wednesday, February 26, 2014 Page 4 of 7 The other aspect is cultural competency, which is something that needs more attention. Commissioner Unger said that the Board consistently supports programs with general fund to bolster them and make them sustainable. Maybe they can show the funding levels being consistent or rising over the past five years to keep programs in place, while State and Federal funding has declined in many cases. Chair Baney asked how they compare to other counties. Mr. Johnson replied that they are probably in the top five. Ms. Spaulding said they can show it is funded well here and not so much in other ways. Mr. Johnson added that performance management is important, as is the Board knowing the funds are being well utilized. This group will also be interested in public access and. input. 4. Other Items. Mr. Anderson said there is an evolving discussion regarding whether to prepare an ordinance that would ban or limit medical marijuana dispensaries. Nick Lelack provided a handout with a copy of the Polk County ordinance. He said it is a simple statement. Ms. Craghead stated that they need more direct language than this. Chair Baney asked if marijuana is legalized in the future, what do they do. Ms. Craghead replied they would amend the Code then. Mr. Kropp added that it could be a State law that trumps the County's anyway. It does not seem to be working at the federal level. Mr. Lelack stated there is a bill in the legislature regarding this type of ban. They are not stopping cities and counties from doing something on their own. They can wait for the session to end or, assuming it will die, the County can prepare an amendment, show it to the Planning Commission, and it can be withdrawn if the legislature decides local entities can't ban it. Chair Baney said she is not trying to limit access to medical marijuana, but she does not see a purpose for dispensaries outside the cities. It is easy to get a medical marijuana card. She wants to see the dispensaries limited to inside the cities. Minutes of Board of Commissioners' Work Session Wednesday, February 26, 2014 Page 5 of 7 Commissioner Unger noted that the law allows for this use. This is looking at the business side of things. He asked about hospice situations. He feels there needs to be some control and a normal medical or pharmacy type of environment. Mr. Lelack stated that Jackson County is watching this as well. He is not sure whether they should leave it alone and react later. The concern is mostly about the pharmacy part. Chair Baney said there could be rural pharmacies, such as the Tumalo Pharmacy. She asked if they could meet the criteria and do this. It would be more contained that way. However, to have a store that is open in the middle of the night, selling Advil and Cheetos and medical marijuana doesn't seem right. Ms. Craghead said this would be in commercial zoning in a rural service area. Mr. Kropp said that he does not think commercial pharmacies can or will dispense if it is against federal law. (Note: a web search at this time revealed that pharmacists are licensed through the federal DEA, and are not allowed to dispense marijuana; or they would lose the ability to prescribe or dispense any controlled substance.) Ms. Craghead noted that they could base it on federal rather than state law if I passes, and prohibit it in all zones. Chair Baney said she wants to make a statement that this is not a good place to try to do this. They may have to adjust as things change in the future. Mr. Johnson stated that this goes more towards anticipating the Colorado or Washington situations. There is a lot of focus on anything that might impact youth. Some products are obviously targeting youth. Chair Baney said that the reality is that this is a recreation-based county, and she wants to make a statement that this should not be part of the recreation here. Mr. Kropp said that there were 209 applications submitted for Connie Thomas' position. An interview panel will be convened when they get to that point. There will be a panel for the 9-1-1 Director interviews, to include at least one Commissioner. Minutes of Board of Commissioners' Work Session Wednesday, February 26, 2014 Page 6 of 7 Chair Baney noted that Mark Pilliod's last day is coming up. They want a good transition. He asked if the Board feels the new County Counsel, Dave Doyle, wants Mr. Pilliod here. Mr. Kropp replied that Mr. Doyle said they would talk first and it may not be necessary. Being no further items discussed, the meeting adjourned at 3:05 p.m. � DATED this /J Z -- Day of Gam-. cam— 2014 for the Deschutes County Board of Commissioners. 7 / Tammy Baney, Cr at7:6-7e4defrite Anthony DeBone, Vice Chair ATTEST: " (tit (fiD7/14A/t&i, Alan Unger, Commissioner Recording Secretary Minutes of Board of Commissioners' Work Session Wednesday, February 26, 2014 Page 7 of 7 f JTEs o` fkDeschutes County Board of Commissioners 1300 NW Wall St., Suite 200, Bend, OR 97701-1960 (541) 388-6570 - Fax (541) 385-3202 - www.dcschutes.org I WORK SESSION AGENDA DESCHUTES COUNTY BOARD OF COMMISSIONERS 1:30 P.M., WEDNESDAY, FEBRUARY 26, 2014 1. Grant Request from Mock Trial Group 2. Consider Approval of Grant Applications —Ed Keith 3. Discussion of Public Health Accreditation Preparation (after 2 PM) —Scott Johnson and Laura Spaulding 4. Other Items PLEASE NOTE:At any time during this meeting,an executive session could he called to address issues relating to ORS 192.660(2)(e),real property negotiations;ORS 192.660(2)(h),litigation;ORS 192.660(2)(d),labor negotiations;or ORS 192.660(2)(b),personnel issues;or other issues under ORS 192.660(2),executive session. Meeting dates,times and discussion items are subject to change. All meetings are conducted in the Board of Commissioners'meeting rooms at 1300 NW Wall St.,Bend,unless otherwise indicated. lrvou have questions regarding a meeting,please call 388-6572. Deschutes County encourages persons with disabilities to participate in all programs and activities. This event/location is accessible to people with disabilities. If you need accommodations to make participation possible,please call(541)388-6571,or send an e-mail to honnic.bakcr(d deschutes.org. Ts U Deschutes County Board of Commissioners Q` ^S PO Box 6005,Bend,OR 97701-6005 t .< 1300 NW Wall Street,Suite 200,Bend,OR Telephone: 541-388-6571 Fax: 541-385-3202 ✓ „ Website: www.desdnites.orc, DESCHUTES COUNTY DISCRETIONARY GRANT PROGRAM APPLICATION Today's Date: 111WMPME Project Name: G1 s ;raw? 4 j firojecr Project Beginning Date: Project End Date: ,„1,&,.7.1, 2 o// Amount Requested: , • Date Funds Needed: 57,._5—/ iL Name of Applicant Organization: /( 5çf ,y1 ,4 , ra t'" Address: b ° S £„`-'IG �,1 1. ; �C ��'1 � l oz__ City& Zip Code: POr do" "/ 72& Tax ID#: q 7,o gc/7q`f O Contact Name(s): 4n 1�� -- 61 1! J Telephone#: 541/ _3 0 " I r Fax#: 5L1/ 6,33.- 73 R3 Email Address: i �1C G"fin '! lee..l6t_•e-ey,1`�. On a separate sheet(s), please briefly answer the following questions: 1. Describe the applicant organization, including its purpose, leadership structure, and activities. 2. Describe the proposed project or activity. 3. Provide a timeline for completing the proposed project or activity. 4. Explain how the proposed project or activity will positively impact the community. S. Identify the specific communities or groups that will benefit. 6. Describe how grant funds will he used and include the source and amounts of matching funds or in-kind contributions, if any. Itemize anticipated expenditures*. 7. If the grant will support an ongoing activity, explain how it will be funded in the future. Attach: Proof of the applicant organization's non-profit status. *Applicant may he contacted during the review process and asked to provide a complete line item budget. About Us A non-profit 501(c)(3) organization since 1983, Classroom Law Project (CUP) has emerged as Oregon's leader in preparing youth to become active, engaged and informed participants in democratic society. We offer innovative programs that are relevant to the diverse needs of Oregon's regions and communities. Over the past 25 years, we have built an energetic and cost-effective non-profit organization that unitizes the power of an experienced staff and a large group of committed volunteers to reach hundreds of teachers and schools and thousands of students each year. Data collected in Classroom Law Project's Oregon Civics Survey (2006) minors disturbing trends found nationally. The bad news: young people's knowledge and interest in politics and government is low, particularly at the local level. These surveys show that only 25% of high school students can name Oregon's two U.S.1 Senators and 23% think Ted Kulongoski is one of them. This disengagement is heightened by the belief of many young people that individual votes do not matter or are "thrown away." Oregon's legislative system of initiatives and referendums creates an environment in which every citizen exercises legislative function. The many times that citizens are asked to amend Oregon's Constitution and statutes requires that they have an even greater awareness of civics than elsewhere in the country. It is especially crucial that Oregonians be well-informed, take the time to research the information required to make reasoned, thoughtful, and independent decisions, and put aside their personal interests to ask, "Is it best for Oregon?" Our school systems need help in providing civics education, so CLP works with teachers and school administrators to create integrated curriculum that meets their needs. And this isn't just. about learning history or how the courts work . CLP's innovative programs can be used to help young people to develop positive attitudes about authority,justice, and the rule of law; to prepare students to think about the common good; and to take action to express their commitment through voting, volunteerism and petitioning the government for change. Classroom Law Project has accomplished much in our first 2.5 years, but much, much more remains to be done. Our programs reach some 400 teachers and 12,000 students in Oregon. That is a good thing. But there are 198 school districts and 20 education service districts in our state, educating more than 551,000 students. That means we are meeting just 2 percent of Oregon's need for our programs and services. That is both a humbling and motivating number. As we begin our next 25 years, Classroom Law Project is committed to the teaching and understanding of civics and democracy in our schools with your help, we will go forward teacher by teacher, student by student, and generous supporter by generous supporter. Annual Mock Trial Competition: The mock trial has proven to be an effective learning tool for students of all grade levels. It helps them understand the law, practice critical thinking, and gain greater confidence with public speaking by assuming the roles of attorneys and witnesses in a fictional criminal or civil trial. Participants experience first-hand the difficulties that judges, lawyers and juries f<:r.ce in determining which facts are relevant and what legal arguments are effective. High School Competition Each year, more than 70 teams, totaling some 1,200 students, compete at regional, state and national levels with support from more than 500 attorneys, educators and other community representatives acting as coaches, judges and coordinators. The High School Mock Trial Competition is one of CI,P's most popular and enduring programs. It begins with more than 70 teams competing in regional competitions across the state and culminates with the state finals competition in Portland. Students work together with classmates, teachers and volunteer attorney-coaches on a hypothetical case. They develop and sharpen critical analysis, public speaking and interpersonal skills. They become more poised a..d self confident -- and they learn about the U.S.justice system in the process. Teams of 8-18 students argue a case before 3-judge panels comprised of attorneys and educators or other community representatives. They will put on the case three times arguing each side a.t least once. The top teams from each region compete in the state competition at the Hatfield Federal Courthouse in Portland for the Oregon title. Oregon's winning team will send eight students to the National Mock Trial Championship. Advancing teams will compete in the State Finals in March each year at the Mark Hatfield US Courthouse in Portland, OR. The Case `leans will receive hard copies of the case once they have completed registration and payment. This year the case is a civil matter. The cases rotate between civil and criminal matters each year. A copy of the case has been included in these materials. How the Funds Will be Used: The majority of the funds will be used to feed the student participants lunch (pizza, & cookies, & drinks), provide a continental breakfast to the morning judges, afternoon snacks to the afternoon judges, lunch for volunteer courthouse staff, and volunteer Deputies. It will also cover the cost of plates, cups, napkins, utensils, and drinks. We can also use 2 large coolers to keep the drink cool for the students. Pizza: $300.00 Plates/Napkins/Cups: $50.00 Food for Judges: $7.5.00 Drinks: $50.00 Coolers: $100.00 Ice: $25.00 Total Budget: $600.00 Deschutes County Health Services: National Accreditation Public Health Staff will brief the Commissioners regarding Deschutes County's March 11 and 12 site visit by the National Public Health Accreditation Board. The Board of Commissioners will be asked to participate in the site visit to answer questions and offer perspectives related to the role of Commissioners as the local public health authority. For more information: contact Scott Johnson, Director, Deschutes County Health Services Public Health Accreditation Board Meeting with Board of Commissioners March 11, 2014 Sample questions 1. Describe the relationship of the governing entity with the Health Department. a. Deschutes BOC is the public health authority for Deschutes County(see enclosed PowerPoint, "What is Public Health"). b. BOC adopts County policy and Health Services department's operating budget; also adopts the department's Strategic Plan. c. BOC is represented on regional WEBCO and the C. 0. Health Council (COHC). d. Health Services department operations managed through the County Administrator and appointed Director. 2. Is there any other way of communication besides meetings? Through work sessions, Board hearings, Friday BOC briefs, briefings for County Administrator, meetings with Advisory Boards and periodic Director's Report. 3. Describe the working relationship between the governing entity and the community. Weekly public hearings and community public comment time; appointments to the Public Health Advisory Board; BOC attendance at community meetings; representation on WEBCO, COHC and numerous nonprofit boards. 4. Do you meet with the smaller government entities regularly or with Public Health specifically? Periodic meetings between Deschutes County Board of Commissioners and other local jurisdictions. Examples: meetings with the Sisters City Council discussing the school-based health center; meeting with Redmond City Council re: a government service center in Redmond and a health district in NE Redmond; Robert Wood Johnson Cross Jurisdictional Sharing project with Crook and Jefferson Commissioners and Public Health. 5. How do you get public input? Community input time at hearings and work sessions;topical surveys(e.g., tobacco use and policy in downtown Bend); work through citizen members on Advisory Boards; work with and through local nonprofit organizations; input from County social media outlets. 6. What was the governing body's role in the creation of the department's Strategic Plan? The BOC received, reviewed and adopted the Deschutes County Health Services Strategic Plan based on recommendations from the Board appointed members of the Health Advisory Boards. 7. What is your role in promotion or monitoring of the Strategic Plan? The Strategic Plan forms the basis of the department's annual priority setting and proposed operating budget. The BOC promotes the plan by supporting Strategic Plan priorities and by investing resources to help the department achieve the strategic plan. The BOC reviews progress, submitted with the annual program budget and through quarterly performance measure reports. 8. What was your role in developing the Community Health Assessment and the Community Health Improvement Plan? Both documents are delegated activities with the work prepared by staff, advisory boards and community stakeholders. The BOC did receive and discuss a presentation of the Community Health Assessment. By supporting the department's budget,the BOC also supports our contribution to the Healthier Central Oregon web site. 9. What is the relationship of the health department to the state health system? a. Director or designee participates on both the Conference and Coalition of Local Health Officials (CLHO). b. Commissioner participation on the Association of Counties Health & Human Services Committee. c. State Public Health Division funds and oversees local public health including conducting a Triennial Review. d. Local subject matter experts regularly talk with their counterparts at the State and other local departments. e. State Public Health Division and CLHO support efforts to prepare for and achieve national PH Accreditation. 10. How does the governing entity make decisions on laws that can affect Public Health? Or when a policy or public health issue needs to be addressed? a. Policy or health issues are identified in many ways including community inquiries or concerns. b. State legislative or Executive Branch recommendations or actions or laws or task forces(e.g., Future of PH). c. Work sessions or business meetings e.g.,tobacco free campus policy. d. Approval of plans e.g., Strategic Plan, Ambulance Service Area Plan. 11. How do you bring on a new member to the County Commission? What is the orientation process? a. County College through the Association of Oregon Counties. b. Department orientations for the new Commissioner. c. Informal briefings for the Commissioner by the Administrator, Health Director or others. d. Invitations to attend Advisory Board or all-staff meetings. 12. How do you choose Public Health Advisory Board members? Press releases when we make a broad appeal for members. Targeted solicitation when we have specific needs(expertise,geographic area). Interviews by current Advisory Board leadership. Written recommendations from the local Public Health Advisory Board with candidate information as background. 13. How does the local Public Health Advisory Board communicate with Commissioners? Interaction at Advisory Board meetings, ability to attend and comment during community input time of Board hearings, individual conversations with Commissioners,attendance at a BOC work session or the annual budget presentation. 14. What is brought to the Commissioners re: plans? The BOC reviews, discusses and approves certain plans including the Ambulance Service Area Plan,the Strategic Plan and the County response to the State Health Division Triennial Review. Other plans including the Public Health Quality Improvement Plan and the Workforce Development Plan are delegated operating responsibilities assigned to the County Administrator, the Public Health Director and staff. 15. Do you have questions for the site visitors regarding the Accreditation process? 2/25/2014 What is Public Health? • Public Health is focused on the population NOT the individual • Public health is what we, as a society, do collectively, to assure the conditions in which people can be healthy. Institute of Medicine,1988:The Future of Public Health �� Health Services The community is our client • Health Care Providers diagnose & treat individual patients • Public health asks: what is the impact to health & how can this be prevented? — Assesses the larger picture, monitor trends, identify risk factors -- Convenes partners to listen, teach, & develop prevention action plans — Develops prevention policies & advocates for change — Evaluates the impact of the strategies & interventions & disseminates the results 1 2/25/2014 Top Ten Public Health Achievements of the 21st Century • Vaccine— preventable diseases • Prevention and control of infectious diseases • Tobacco control • Maternal and infant health • Motor vehicle safety • Cardiovascular disease prevention • Occupational safety • Cancer Prevention • Childhood lead poisoning prevention • Improved public health preparedness and response State-Local System of Public Health • Public Health systems are primarily governmental • Public health in Oregon is DECENTRALIZED — Centers for Disease Control and Prevention is the lead federal agency — Oregon Health Authority— state agency — 34 local health departments across Oregon (one district— North Central Public Health District) 2 2/25/2014 ' I Local Authority and Responsibility • Boards of County Commissioners are the Local Public Health Authority according to ORS 431.375 (1) The Legislative Assembly of the State of Oregon finds that each citizen of this state is entitled to basic public health services which promote and preserve the health of the people of Oregon. To provide for basic public health services the state,in partnership with county governments,shall maintain and improve public health services through county or district administered public health programs. (2) County Governments or health districts established under ORS 431.414 are the local public health authority responsible for management of local public health services unless the county contracts with private persons or an agency to act as the local public health authority or the county relinquishes authority to the state. If authority is relinquished,the state may then contract with private persons or an agency or perform the services. Duties/Requirements of Local Public Health Authority ( ._P} -0 "-5) • Enforce public health rules/laws ORS 431.416 —The local public health authority or health district shall: (1) Administer and enforce the rules of the local public health authority or the health district and public health laws and rules of the Oregon Health Authority; (2) Assure activities necessary for the preservation of health or prevention of disease in the area under its jurisdiction as provided in the annual plan of the authority or district are performed. 3 . . . .. ..... 2/25/2014 Required Services of LPHA • ORS 431.416 (2) continued... — These activities shall include but not be limited to: • Epidemiology and control of preventable diseases and disorders(Epidemiology-The branch of medicine that deals with the incidence,distribution,and control of diseases.) • Parent and child health services, including family planning clinics as described in ORS 435.205 • Collection and reporting of health statistics • Health information and referral services; and • Environmental Health Services Minimum Local Public Health Services in Rule (under ORS 431.416) • Communicable Disease Investigation and Control • Tuberculosis case management • Immunizations • Tobacco Prevention • Emergency Preparedness • Maternal and child health services • Family Planning • Women, Infants, and Children services • Vital Records • Environmental Health Services 4 2/25/2014 Statutory requirements cont • ORS 431.440 — public health administrators have police powers — "public health administrators shall possess the powers of constables or other peace officers in all matters pertaining to the public health" (ex: Environmental Health) • 431.530 — in an public health emergency — "the local public health administrator may take any action which the OHA or its director could have taken, if an emergency endangering the public health occurs within the jurisdiction.." (ex: Pole Creek Fire) Conference of Local Health Officials "CLHO" • Shared governance between the local health officials and the state public health division • ORS 431.330 Conference of Local Health Officials is created. (1) The Conference shall consist of all local health officers and public health administrators, appointed pursuant to ORS 431.418 and such other local health personnel as may be included by the rules of the conference. 5 2/25/2014 Emerging Public Health Issues, Opportunities and Challenges • National movement toward the accreditation of local health departments • Rise and cost of chronic diseases • Current Fiscal landscape — federal, state and local • State Health System Transformation Accreditation of Local Health Departments • What is Accreditation - Recognition for a health department to meet nationally recognized public health standards that assure high quality services, accountability and efficiency. • Commissioners, as the Local Public Health Authority, play an important role in the Accreditation process— site visit will require engagement by Commissioners/ Board of Health • 4 major areas of readiness: Community Health Assessment, Community Health Improvement Plan, Strategic Plan and continuous quality improvement 6 2/35/2014 ^ � Why be an accredited local health department? • Training&TA resources available to health departments now • Potential grant opportunities • Potential to become more competitive applicant for other funding opportunities • Potential for a stronger voice at the table in CCO conversations or with other partners • Defines role of Public Health as all these transitions occur • Focus on efficiency and quality improvement essential in current economic environment Central Oregon Regional �� ~~" .�. ~�U «�». ~~ ~°" " U�~.��U~�" ."�U Efforts mrCentnal Oregon Regional Health Assessment mr[uidate Lt-Living Well with Chronic Conditions nr Maternal Child Health CCO Initiative Maternal Mental Health a'Nuram Family Partnership Jeffervo"'mm* 'arRmbert Wood-Johnson Cross-Jurisdictional Sharing Project 7 • 2/25/2014 Conclusions: Public Health landscape is changing: — Accreditation is currently voluntary but including opportunities to improve efficiencies — Less need for public health to provide clinical services since insurance coverage required for all by 2014. BUT, not everyone will be covered. — Rise in chronic diseases are identified but there are no stable funding sources to work to address community prevention of chronic diseases. — State Medicaid reform will have an impact on public health and we will have to engage locally with health care partners — Interest from legislators and Oregon Health Authority in moving to a regional public health system A final plug for Public Health. . . Return on Investment = Cost Avoidance Research shows that investing just $10 per person each year in public health efforts can save the nation more than $16 billion within five years. That's a $5 w`a return for every $1 invested. * 'Source:Trust for America's Health,July 2008 8 2/24/2014 S�@ d . ''.. 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'�•R Y, �"h, � z ar' "k �. ,f. . fir. • 4 s 'I'L,'it,,, ': ■ 101°0° rpikzz.:4 '.1 k rn,,I:.,. r 1,0114.51 i., ,rolicr..„ ofvfos , ,-- , i ,1'L._ ''' ' — 0 a ' Central Oregon Regional Health Report 2012 EXECUTIVE ABOUT THIS HEALTH ASSESSMENT The Central Oregon Regional Health Assessment Ask more questions, dig (CORHA) 2012 is an overview of data related to health in deeper, explore. . . communities and populations. CORHA 2012 aims to engage in conversations provide useful data for three Oregon counties commonly referred to as "Central Oregon" or Central Oregon's "tri-county region": Crook, Deschutes and As you look and dig deeper, consider the Jefferson Counties. Recognizing that many factors weaknesses and limitations of the data. Engage in impact the health of individuals and communities, a conversations with colleagues, peers, friends, range of data from multiple sectors are included in the family, neighbors, community members, and strangers. Seek-out qualitative, personal and report. experiential information to complement the numbers you see. Only when communities engage The Central Oregon in this process can we draw the map to improved I Regional Health Assessment health and well-being for our neighborhoods, our o answer oil is not meant . communities and our region. questions. It is meant to Data provoke them, This health assessment utilizes multiple sources of data. Some of this data is available through the state How to Use of Oregon, some through national government and non-government agencies, and some from local We acknowledge that the Central Oregon Regional organizations. Sources include Centers for Disease Health Assessment, 2012 is not a compendium of all Control and Prevention's Behavioral Risk Factor indicators and analyses applicable in community health Surveillance System (BRFSS), U.S. Census Bureau's assessment. Thus, we highly encourage readers to dig census statistics, Oregon Health Authority deeper, check sources, and pull in additional Department of Public Health's public health and information to help you complete a more in-depth community data, Oregon Department of Education's understanding of our community. school data, and data from local organizations CORHA 2012 is not a static, single point-in-time compiled by Deschutes County Health Services. document. Instead, it is intended to be a first-step in our A Note About Data: There are many great and widely- region's effort to continuously assess data in order to: used data sources available today. Data sets like these identify where to celebrate successes, recognize require significant amounts of labor and resources weaknesses or areas of concern, instigate community before they are made publicly available. This can mean discussions on how to capitalize on strengths and turn unavoidable lag-time where data is many months, often several years old. This lag can present complications weaknesses into opportunities for positive change. when trying to interpret and apply the information for the present day.While the data is still very valuable, it is The CORHA is not intended to answer all questions. important to always look at the data sources' dates and Instead, it should provoke them. We encourage readers time frames, and to become familiar with what and how to ask more questions, dig deeper and explore. Many it is measured.For example,the County Health Rankings data reports and fact sheets on numerous relevant is a great and useful public health resource, but data topics exist for our area —check them out! (See the full used to calculate 2012 County Health Rankings can date report for a list of suggested documents and resources). as far back as 2003 (with 2010 being the most recent year). Similarly, several indicators in this health This Executive Summary calls attention to a fraction of assessment pre-date the recession.These indicators are useful, but cannot help us fully understand how difficult indicators and is a companion — not a replacement —to economic times have impacted our region. the full report. 3 Central Oregon Health Report 2012 OVERVIEW ,a,a1e (.JL t,/i.•;a��ith Ral+riris,, 2r)J J 21)'12: pan e in R n ci^ • OREGON COUNTY HEALTH RANKINGS 2010, 2011 , 8� 2012 Change In Robert Wood Johnson Foundation* Oregon Rankings Crook Deschutes Jefferson CHANGE CHANGE CHANGE FROM FROM FROM 2010 2011 2012 2010 2010 2011 2012 2010 2010 2011 2012 2010 „;,*:,7r!g .w 4w �4" It fl'' -ry�r• ' G� `, a ri�4 A Health 1 a. ;;,''' 4:"..08t:, Imw 14 14 12 ,•,,,, � � � �� , , I�,V�� r i•Outcomes 's h �, '�• ..._.—wv ran ,,r "" a �k'. rub+g 1 , li, ,..0:f-:,;:_li,it:.,:k4.4".'.,,,,,,4,„ „,„,,.,,,,,.;!, Health Factors 21 . ; i y i hr r i, sa , v r't Mortality ! 13 10 10 i ::1464!:''''''. ," i ry t• fi; ,r s �' � �' �'M;rldw,a.1 a�!�t .�. t Morbidity 16 21 9 ,., 9 9 T�J 3 ,, 21 t nod ip' r.�alth 21 21 25 „ , , Behaviors - 7'"�' u �' „ Clinical Care !I 9 20 14 �b;r. 25 T ,.,,,..-,: ' iT,t it Social & a� J � -,,, .;a Economic ` ` t 11 , p;; Factors , r t� r i. ' a, a ,; J1 Physical 17 22 13 11 18 23 43' Environment ., *only y 33 of 36 counties ranked `'' =Bottom Quartile in State Rank of Counties =Top Quartile in State Rank of Counties =State ranking in 2012 lower than 2010 ' =State ranking in 2012 higher than 2010 5.Kingston,Deschutes County Health Services/Public Health Department,04/2012 Robert Wood Johnson Foundation,County Health Rankings:Oregon 2010,Oregon 2011,&Oregon 2011. Retrieved from http://www. data Preliminary Final Draft 10/15/2012 pg. 1 Central Oregon Re ional Health Report 2012 • UMMAR SPECIAL THANKS To these individuals: Muriel DeLavergne-Brown Crook County Health Department Jolene Estimo Confederated Tribes of Warm Springs Health&Human Services Carolyn Harvey Jefferson County Health Department Ken House Mosaic Medical Scott Johnson Deschutes County Health Services Jessica Kelly Deschutes County Children & Families Commission Sarah J. Kingston Deschutes County Health Services Thomas Kuhn Deschutes County Health Services Maggi Machala Deschutes County Health Services Tom Machala Jefferson County Health Department Kat Mastrangelo Volunteers in Medicine Kate Moore Deschutes County Health Services Emily Ogren Minda Morton Jefferson County Commission on Children& Families Hillary Saraceno Deschutes County Children& Families Commission Diane Skinner Deschutes County Health Services Stephanie Sundborg Deschutes County Children& Families Commission Erin Tofte Let's Talk Diversity Coalition (Jefferson County) Kate Wells Kids @Heart,St.Charles Health System And to these organizations: Central Oregon Health Board Central Oregon Health Council Crook Co. Health Department Deschutes Co. Public Health Advisory Board Deschutes Co. Behavioral Health Advisory Board Jefferson County Health Department Let's Talk Diversity Coalition (Jefferson County) Mosaic Medical Oregon Health Authority/Dept.of Public Health PacificSource Saving Grace St.Charles Health System Volunteers in Medicine,Clinic of the Cascades FOR ADDITIONAL INFORMATION, contact: Sarah J. Kingston, MPH Research Analyst Deschutes County Health Services 2577 NE Courtney Drive Bend, OR 97701 sarahk [at] deschutes.org 541-322-7462 22 http://www.healthiercentraloregon.org/ ,..J r{ a 5-,,,. a�" "N`' 5-C "`,, Healthier Central Oregon q i � ddv w 7 F„ IwP ,, .'A N f•t W 1 Select Language . II Powered by Th- H-alth Communities Network Search COMMUNITY DASHBOARD Featured Content I __ View the Legend Central Oregon Health , Council Advanced Search / . 1► r ilirg11 r ♦ ► ,iiiiiii;i'iiiiiilLiii-iliiik.:11.II Foreclosure High School Osteoporosis: Usual Adults with Ra t — Graduation ! Medicare ! Source of Asthma Home - — Health Topic Centers Care:, . 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FWeight: ".- -,0, We invite planners, policy makers, and ry ,„;; community members to use the site as a a -Your BMI: yl ,u tool for community assessment, strategic <, planning, identifying best practices for 1 , improvement, collaboration and advocacy. a '�{'; M '° Get started on Healthier Central Oregon! BMI Categories: 4160{10,. ..w...,. • View more than 100 health and Underweight=X18.5 Normal=18.5-24.9 Jetfmna Count) quality of life indicators for the Overweight=25-29.9 central Oregon region and each of Obesity=30 or greater its three counties: Crook, Deschutes and Jefferson. http://www.healthiercentraloregon.org/ c.d • Compare county indicators to each 000001110* other,as well as to Healthy People O 2020 benchmarks. 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Please read them. Powered by Healthy Communities Institute. Copyright©2014.All rights reserved. 4 2012-2015 CENTRAL OREGON HEALTH IMPROVEMENT PLAN 1 .. :.. :..... .. :•,:„...�Z .e . � b � ' ' �p p i ' r� A 1J' , ym1„ ri 1� . y g e,,y " f yF {t iZ d ,,.. . :, T . w". .., Y �..... Wes ; , ;.,. �• rr' "r ce_ "; .AID ,,, µ• r :fir'9r. ..• Jar • ,.., ...,err ;N, Y He aith• . ps n s, 1 Central Oregon Regional Health Report 2012 EXECUTIVES MMA Regional Health Improvement Plan : 10 Priority Areas CENTRAL OREGON HEALTH COUNCIL (Following items are in not in meaningful order[i.e.,NOT listed in order of importance]) Disparity/ Inequity Comparative mortality ratios in areas of Southern Deschutes County and Northern Jefferson County are significantly higher than state average and this difference is considered a health disparity - geographic area is related to a difference in mortality. But, the disparity can be considered a healt h in equ i ty because it could possibly be avoided or unjust. Central Oregonians are often not surprised to learn that our rural areas have high rates of poverty, less access to services, greater distances to travel for needed care, and many individuals struggle to meet basic needs. What is often overlooked, however, is that these systematic barriers needlessly impact individuals' health. This is just one example of disparity and inequity in our region, but many other disparities exist.Attention must be devoted to uncover disparities unique to Central Oregon and to determine which must be addressed as inequities. Improving our population's health will require working toward health equity—communities where all individuals have the opportunity to attain their full health potential, and no one is disadvantaged from achieving her/his potential because of socially determined circumstances related to rural or urban living, race,socioeconomic status,education, etc. Access to Resources The ability to access resources, services or assistance is impacted by numerous factors, such as transportation, distance and travel time, finances, social and cultural barriers, waiting time, and existing systems of care and program eligibility, availability, location and capacity. For example, an elderly person living alone with no social support and unable to drive may have financial means to see a dentist, but limited access due to transportation issues. Similarly, a working single mother with no car may have access to public transportation, but if she cannot afford taking unpaid time off of work, her access to service diminishes. Similarly, factors related to access impact rural residents differently than urban residents --an important point to consider when planning for programs and services –since more than 41% of Central Oregonians live in unincorporated areas and towns with less than 2,500 people. Early Childhood Wellness A child's growth begins in pregnancy and continues into adulthood. Interacting internal and external factors impact a child's social, environmental, physical, and cognitive potential. Children in surroundings unable to support their healthy growth or meet their needs have increased risk for poor health, safety, development and ability to learn. These unmet needs during childhood pose threats to health long into adulthood and later life. Ensuring early childhood wellness is a short-term investment for today and a long-term investment for business, health,education and social sectors in decades to come. Food Insecurity Crook and Jefferson counties were among the top 5 Oregon counties with highest food insecurity. Deschutes County has the largest total number of food insecure individuals in Central Oregon. In Crook County,the average cost per meal is nearly$1 higher than in Deschutes County and the rest of Oregon. It is estimated that more than 37% of children in Jefferson and Crook Counties may be food insecure. In Deschutes County, of all the food insecure adults and children, 45% are not eligible for SNAP or other federal food programs—a sizeable number of children and adults who may not be able to access much needed assistance. 19 Central Oregon Regional Health Report 2012 ExEcun r Oral Health Oral health is frequently identified by providers,teachers and community members as an area of concern in Central Oregon. Existing data systems do not currently support mechanisms to arrive at accurate and timely estimates of the burden poor oral health causes in the region. Poor oral health can cause pain, discomfort, and disfigurement. It can affect an individual's quality of life, ability to eat and to speak, or interfere with opportunities to learn,work, participate, engage and contribute. What's more, oral health is related to chronic disease in later life. While prevalence and incidence data for the region may be lacking, community and stakeholder input suggests improving the oral health of all Central Oregonians is important and necessary. Safety , Crime & Violence A community's safety impacts the population's health in numerous ways—from victims of violence to post-traumatic stress, from psychological distress to exercise and diet. Exposure to violence is known to increase stress, which is linked to increased hypertension, stress-related disorders and chronic disease. Trauma from violence can have intergenerational effects. Central Oregon's rates of total crime appear to be on the decline since the late 1990s, and more work should be done to continue this trend. Deschutes is in the top 5 Oregon counties with the highest rates (unadjusted 2010 rates) of both total crimes and violent crimes per 10,000. Jefferson County was among the 10 Oregon counties with the fewest number of police per 1,000 population. Last year, more than 1,450 individuals in Central Oregon called an emergency crisis line about domestic violence alone. Healthy populations require safe communities to live, work and play where individuals affected by violence or crime can access necessary support and services to heal. Chronic Disease In the last 65 years, adult chronic disease has grown into the main health problem for industrialized nations. Cardiovascular disease, cancers, diabetes and chronic obstructive pulmonary disease account for at least 50% of the global mortality burden. In Central Oregon, chronic diseases are the leading causes of death for each county. Crook's age-adjusted prevalence of adults with high blood pressure is 46.2%, significantly higher than 25.8% of adults for all of Oregon. Deschutes' age-adjusted prostate cancer incidence rate is higher than the state, while Jefferson's age-adjusted prevalence of arthritis is higher than its neighboring counties and the state. Multiple types of exposures, modifiable behaviors and risk factors are known to play a role in the development of chronic disease in later life, such as personal dietary and exercise choices, chronic stress, exposures in utero and throughout early childhood, income,genetics, and the built environment to name a few. Alcohol , Drug & Tobacco Use Heavy drinking,drug use and tobacco use is associated with higher rates of all-cause mortality, chronic disease,violence and abuse. Excessive alcohol and drug use is also a risk factor for motor vehicle fatalities, fetal alcohol syndrome, interpersonal violence, overdose and sexually transmitted infections. Tobacco use causes multiple diseases such as cancer, respiratory disease, and other adverse health outcomes. in 2009, more than 19% of adult males in Central Oregon reported binge drinking in the last 30 days. In Central Oregon, younger adults have higher rates of alcohol dependence (in past 12 months) than older adults-17% of adults age 18-25 years, compared to 6.8% of adults 26 years and older. Jefferson County has higher rates of death from alcohol-induced disease and motor vehicle fatalities that involve alcohol. Since 2001, Crook's age-adjusted rates of death from drug-induced causes have been higher than Jefferson and Deschutes (Crook –13.7, Deschutes–10.1,Jefferson–10.5 per 100,000). 20 Central Oregon Regional Health Report 2012 vE Behavioral Health Around the world, major depression is a major cause of disability. In Deschutes County, suicide is claiming nearly as many lives as motor vehicle accidents. It is estimated more than 9,000 adults in the tri-county region have serious mental illness. Roughly 1/3 of Central Oregon 11th graders reported having a depressive episode in the last year—high depression scores in youth are associated with poor academic achievement,anxiety, and poor peer and teacher relationships. Central Oregon can improve behavioral health by working to prevent behavioral/mental health issues at the individual and community level, to identify early risk factors and warning signs and to ensure the capacity and infrastructure exists to provide quality, affordable and accessible services for all individuals in need. Healthy Environments There is much to learn about the environmental health characteristics specific to Central Oregon's communities.The ecologies of individuals, families, communities and regions often determine options available for individuals to reach their full potential. Environments exist on many scales–individuals, homes, neighborhoods,geographic regions. Environments simultaneously shape and are shaped by organisms and individuals within them. For example, built and natural environments directly impact human health, and humans directly impact the built and natural environments. Until recent decades, "environments" in public health were most often associated with the natural outdoors–woods, streams, rivers and lakes. Growing bodies of research are showing relationships with environments on other scales to the health of our populations. Locations of stores to purchase affordable fresh fruits and vegetables impact healthy choices. Safe and affordable alternative commute options impact the behaviors of individuals to choose alternatives to driving, thus impacting the environment and the often the individual. Safe and easily accessible places to play outdoors impact the ability of children to play outside,thus impacting their physical activity and health. Central Oregon lacks current and relevant data on multiple scales of environment to uncover relationships between where people live, work and play to their overall health and well-being.This knowledge about the region is expected to expand in coming years, particularly with recent collaborative efforts with local agencies and individuals looking at transportation, commuting options, healthy housing,farmers markets,and healthy spaces for kids and adults to play and exercise. 21 t o r „,„...— -----.................,„.. 10114 Deschutes County Health Services Strategic Plan 2012-2015 April .1.1., 2012 } ja Yin � lw r �9 �✓��J at y F 'r, "W" i Sa dI.J,�' 1'". ex 7 '�d : ,� +M'r 'r 1:,� r a,1 �R+f + a a �,y ys >9 a r � �, e r 9 " � M y�5. qY.. r � a� 4 'V�� a�yy ' � dN by k 1 ., l ar�,' r� „f ,�`� F a.! 3 ° �r4� 4: ,s IZ a L C"•' -','•••••""'l,.,• ti plY i•F1a rJ`#'0'.., ::',•-',":':•;'''.:`:':'•••:"ti r •i 'a , s as r•1'""• � , e r , dar ,i T �. b ii ,�(� � . �� 4: F .a, 1p Y WuS M. L a • y 71,E;, W M m k .74 ,..••'a v M1d • „ wr a�ur x , H<<r r q • ' !,. �err . ..sir wn >' •. :.,.... ... ..„ :' ....• 4i0, • •:.::•:'''. . . H•••••••414111*‘;'::•••.... ..'. ••••••''''''';'•"::::H.— w , '� st ' . ,. 1 ih w Summary This Strategic Plan outlines a vision and set of goals to improve the health of our residents, strengthen our organization and promote community collaboration. It is a plan for action that capitalizes on national, state and regional reform. It is both ambitious and a realistic presentation of our focus and planned actions over the next four years. It is rooted firmly in goals that will lead to better community health, better care and work that will promote health and lessen society's burden for unnecessary human and financial costs. This new plan carries forward a commitment of Deschutes County Health Services to use public health assessment practices and community guidance to frame a clear agenda, mobilize our resources and act. Through this effort,we will continue to ensure County government is accountable and helpful to our County's residents and that we fulfill our mission to promote and protect the health and safety of our community. Over the past five years, we've acted on past plans, sponsored many projects, expanded our services and improved access to care. A sampling of those accomplishments is listed in Appendix iii. In 2009, our department was formed as a consolidation of the County's Public Health and Mental Health departments with Environmental Health added in 2010. In 2012, we will help thousands of residents, offering health and human services at more than 40 locations including schools, clinics, partner agencies and through a variety of outreach efforts. We will also continue to increase our investment in our economy and the workers at many local helping agencies. While we are optimistic and excited by the promise of health reform, a difficult road lies ahead. All signs point to reductions in public funds and rising costs as well as a need to push forward with difficult changes in the way we work and the way people are served. Each fall, with the help of our community advisory boards and the Central Oregon Health Board and Health Council, we will review our progress, reassess health reform and our community and regional needs, and update our priorities to remain current and relevant to the work at hand. With this in mind,we look forward to a healthier Central Oregon in the years ahead. We hope you will take the time to review the 71 goals in this document, to ask difficult questions and to join us in this effort. With adoption of the plan we will move forward immediately on a number of these actions. We do this with gratitude for the work of a talented and dedicated staff,the thoughtful guidance of our community advisory boards and volunteers,the help of community partners and the commitment of our Board of County Commissioners to community health and well-being. In partnership with our community and region - Scott Johnson, Director Deschutes County Health Services Deschutes County Health Services Strategic Plan 2012-2015 4/11/2012 Page 2 of 34 Deschutes County Health Services 2014-2015 Department Goals & Priorities Our 2014-2015 goals are based on our Strategic Plan and regional health reform efforts as well as emerging issues and opportunities facing our County. These priorities will shape our proposed FY 2015 operating budget, our staffing and our focus for the coming year. These priorities have been reviewed with the Behavioral Health Advisory Board, the Public Health Advisory Board and the Deschutes County Board of Commissioners. Adjustments may occur based on final budget adoption. OUR MISSION: To promote and protect the health and safety of our community OUR VALUES: Advocacy: The pursuit of community health, healthy lifestyles and access to care. Collaboration: True partnership with our customers, community agencies and coalitions. Cultural Competence: Awareness and responsiveness to the diversity in our community. Excellence: A commitment to best practice and high quality service to the public. Innovation: A willingness to try new approaches to better serve our community. Professionalism: The highest level of personal integrity, conduct and accountability. Stewardship: The wise, effective and efficient use of public resources. Workplace Health: Work sites that promote respectful interactions and healthy lifestyles. OUR TOP PRIORITIES • Expand our County services where needed in support of Medicaid expansion. • Achieve national accreditation through the Public Health Accreditation Board process. • Strengthen our partnerships with primary care (a COHC1 priority for primary care/public health). • Participate in effective integrated clinics or service hubs in La Pine, the Bend Annex, Sisters and Redmond. Remain open to other opportunities.2 • Create sustainable models for our school-based health centers and maternal child health program. • Achieve successful leadership transitions including the Department Director, Public Health Nurse Manager, Behavioral Health Adult Program Manager and Operations Manager. • Assess health reform in our region and the County's roles and priorities. Update the Strategic Plan to best reflect services, staffing and priorities for FY 2016 forward.3 • Consistently measure and report our accountability and effectiveness. Assure we have the skills, capacity and commitment to objectively measure our performance. • Establish a coordinated and efficient Early Learning Hub childhood service delivery system for the Central Oregon region. 1 COHC is the Central Oregon Health Council,the community board overseeing PacificSource as our Coordinated Care Organization in Crook, Deschutes,Jefferson and northern Klamath counties. 2 Potential examples include Volunteers in Medicine, use of the DCHS Courtney building with Reproductive Health. 3The assessment will be initiated when new leadership is in place and in concert with staff, our Advisory Boards,County leadership and the Board of County Commissioners. 1 Page OUR 2014-15 GOALS: A. Increase Access to Care 1. Assure behavioral health (BH) services for new Oregon Health Plan (OHP) members (i.e., Medicaid expansion) including use of community behavioral health providers. Meet OHP access standards. 2. Assure sufficient BH Access Team and adult treatment capacity for expansion as well as equitable geographic access in La Pine, Redmond and Sisters. Note: Includes better BH facilities in Redmond. 3. Increase access and full utilization of our capacity to help people seeking reproductive health services through improved coordination and collaboration with partner agencies including Mosaic Medical. 4. Assure all school-based health centers have a medical sponsor and sufficient public health and behavioral health services during the 2014-2015 school year. Strengthen our partnerships with primary care, behavioral health'', oral health and public health wherever possible. 5. Assure services for people with intellectual and developmental disabilities by increasing our capacity to implement the Community First Choice State Plan (1915 k) (i.e., community provider capacity development). B. Improve Health 1. Advance population-based health improvement programs. • Annually increase enrollment in the Living Well programs. • Create a plan to prevent intimate partner violence.6 • Sustain our capacity to improve health via preventive strategies that address: a. alcohol, tobacco and other drugs; b. reproductive health; c. suicide/self harm prevention (with the Suicide Prevention Advisory Council)'; and d. prevention of child abuse and neglect. 2. Advance critical specialty programs for community members with complex health needs. • Develop a transition-age youth program for young people age 14-25 including (but not limited to) behavioral health, reproductive health, maternal child health, wellness and prevention.8 • Strengthen the Assertive Community Treatment(ACT)team including needed staffing and expanding the use of peers to coordinate care. Oregon Health Authority(OHA)grant pending. • Increase access to rental assistance for our behavioral health clients as part of supportive housing and support for independent living. OHA grant pending. C. Improve Care 1. Implement improvements as directed by our BH Medical Director and PH Health Officer. Ongoing. • Improve collaboration by easing transitions to/from primary care, referrals, and case consultation with primary care physicians who treat DCHS clients as well as area public safety agencies. • Identify and implement consultative opportunities in public health. 2. Expand our use of peer specialists or community health workers; create internal support in the department. 3. Improve BH client engagement and reduce no shows through provision of at least three appointments in the first month of service. Set a no show reduction target and track performance. 2015 priority 4 Includes implementation of a 2014-15 SBHC expansion grant from the Oregon Health Authority. 5 Living Well is a best practice chronic disease self-management program developed by Stanford University. 6 The plan should focus on the individual,community,agency and policy levels. It should be developed by public and behavioral health staff by convening an intimate partner violence committee. To be achieved by winter 2015. Includes a 2014-15 grant from the Oregon Health Authority. 8 Includes implementation of a "Young Adult Hub"grant from the Oregon Health Authority. 21Pagc 4. Develop and implement strategies to increase referrals and use of alcohol and other drugs treatment services for OHP members based on medical necessity. 5. Improve intensive treatment services for youth enrolled in wrap-around services, reducing psychiatric residential treatment services and costs. D. Reduce Cost and Increase Cost Effectiveness 1. Use certified coding staff to review and strengthen our public health billing practices. 2. In collaboration with the County Finance Department, secure an annual indirect cost rate for support services in compliance with Federal guidelines. 3. Develop an electronic staff training tool to support workforce development. 4. Develop an electronic health record option for our maternal child health home visiting program. E. Increase Health Integration and Collaboration 1. Strengthen primary care/public health partnerships, a COHC priority. • With COPA9 and Mosaic, develop protocols for coordinating care for shared pediatric clients. • Based on demonstrated benefit, sustain our regional maternal child health system for high risk families: a) coordinated care for at-risk pregnant clients with East Cascade Women's Group, b) CaCoon, and c) Nurse Family Partnership. Note: Item a) requires investment by COHC. • Construct and open a comprehensive school-based health center in Sisters; center will include a medical sponsor, school district,oral health, behavioral health and public health participation. • Develop a plan for potential development of a school-based health center at a Bend high school. 2. Improve the coordination of more comprehensive care and wellness for our clients. • With Mosaic, remodel and expand the Annex as a health home for people with serious mental illness including a facility remodel, staff expansion and enhanced programming. • Streamline the process of cross referrals and case coordination for clients between the Behavioral Health and Developmental Disabilities programs, including Public Health. • With regional partners and the Early Learning Hub,develop a five-year plan to ensure children ages birth through six are safe, healthy and enter kindergarten prepared to learn. Develop protocols and strategies to coordinate family support and early childhood services. 3. As directed by the Oregon Health Authority, successfully transition health resources and oversight to our Coordinated Care Organization (CCO) in the areas of a) mental health residential programs(July 2014), and b) public health targeted case management (January 2015). F. Pursue Excellence 1. Achieve national accreditation from the Public Health Accreditation Board. Site visit March 2014. 2. Achieve all State "Quality Improvement Measures" pertinent to DCHS including, at a minimum, a) a mental health and physical health assessment within 60 days for all children in DHS custody, and b) outpatient mental health service within seven days of a behavioral health related hospitalization. 3. Identify and implement a BH therapeutic outcomes tool in consultation with WEBCO and PacificSource. 4. Achieve and maintain BH clinical documentation compliance at 90%and assure encounters are fully documented as close to 100%as is possible based on State Administrative Rules. 5. Successfully implement the Community First Choice State Plan (1915 k) to assure timely services for people with intellectual and developmental disabilities. s COPA refers to Central Oregon Pediatric Associates. 31Page G. Expand Regional Efforts 1. Assure organizational support and participation in the successful design and implementation of the region's Early Learning Hub. 2. Complete and begin implementing a cross jurisdictional action plan for emergency preparedness. 3. Within HIPAA guidelines and Exchange protocols, include County client data in a regional Health Information Exchange 4. Identify and pursue regional resource development opportunities. H. Strengthen Our Organization 1. Assess health reform in our region and the County's roles and priorities. Update the Strategic Plan to best reflect services, staffing and priorities for FY 2016 forward.10 2. Develop and implement a comprehensive approach to cultural competence under the leadership of the DCHS Cultural Diversity Committee and in consultation with our communities. 3. Sustain our capacity to conduct health assessments and update the Regional Health Assessment; with the region,foster the development and utility of the Healthy Central Oregon web site. 4. Develop and implement a workforce development plan as required by Public Health Accreditation. 5. Consistently measure and report our accountability and effectiveness. Assure we have the skills, capacity and commitment to objectively measure our performance. 6. Improve knowledge of importance of whole-person health—integrating public health, behavioral health, intellectual and developmental disabilities—in treatment. 7. Meet meaningful use requirements with our electronic health records. 8. Early in 2015, reassess the organization and structure. 9. Continue to pursue training, practices, protocols and drills to support staff safety. I. Promote Sound Health Policy 1. As opportunities arise, promote and advance policies that support the Triple Aim. Support programs, services, practices and activities that lead to better health, better care and less cost. END 2.19.2014 \\ZEUS\katheh\MY DOCUMENTS\PLANNING\STRATEGIC PLAN\Priorities\2014-2015\Priorities 2014-2015 FINAL Feb 19 2014.docx 1°The assessment will be initiated when new leadership is in place and in concert with staff, our Advisory Boards,County leadership and the Board of County Commissioners. 41Page a. I. The Triple Aim* Our Vision for A Healthy Central Oregon BETTER HEALTH Improve the health of people in Deschutes County and throughout Central Oregon v'9Cr"1n+;d k t .P a f c r �in'' }d r• �r t" I 4. ^' .1k y P ''" 1' ,F ��k..9J r�v i Bdh k�hc4'�r � f ' t G BETTER CARE S ► Improve our service contain Or0,;; t� quality, access, reliability, under plevhtive safety and satisfaction care and offer health education *The "Triple Aim" is a health reform concept developed by the Institute for Healthcare Improvement, an independent, nonprofit organization helping to lead the improvement of health care throughout the world. Triple Aim thinking is intended to improve health and health care. Triple Aim is now part of Oregon law and a founding concept for the Oregon Health Authority. It has been adopted by the Central Oregon Health Council and Deschutes County Health Services. Deschutes County Health Services Strategic Plan 2012-2015 4/11/2012 Page 5of34 !PPF Endorsements and Adoption Adopted March 21, 2012 by the Deschutes County Public Health Advisory Board. / ! r :LAIL a _air/ if /'.- Kim Curley-R 'nolds,C it Deschutes County Public Health Advisory Board Adopted-March 21, 2012 by the Deschutes County Behavioral Health Advisory Board. Darrel Wilson, Chair Deschutes County Behavioral Health Advisory Board endorsed by the Deschutes County Health Officer and Medical Director. 4A 1•7 Lam-- Dr. Richard law ett, Health Officer Dr Marc iiams, Medical Director Adopted April ll , 201? by the Deschutes County Board of Commissioners. oitio Anthony DeBone, Chair Z,14460,11.— Alan Unger, Vice Chair lamm y ^y. Cor Bane nmiss � i er " ' ATTEST: Bonnie Baker, Recording Secretary Health Services'Reception and Support Staff Deschutes County Health Services Strategic Plan 2012-2015 4/11/2012 Page 3 of 34 CHAPTER 40 2014. CURFEW, SOCIAL GAMES,TRUANCY and CONTROLLED SUBSTANCES CURFEW 40.110 MINORS UNDER 15 YEARS. No minor under the age of 15 years shall be in or upon any street, highway, park, alley, or other public places between the hours of 9:30 p.m. and 4:00 a.m. of the following morning, provided that on and during any night immediately preceding a day upon which the public school will be closed, such hours shall be 10:00 p.m. to 4:00 a.m. of the following morning. [Ord. 17, Sec. 1] 40.120 MINORS 15 THROUGH 17 YEARS. No minor of the age of 15 years or over, but under the age of 18 years, shall be in or upon any street, highway, park, alley, or other public places between the hours of 10:30 p.m. and 4:00 a.m. of the following morning, provided that on or during any night immediately preceding a day upon which the public schools will be closed, such hours shall be 12:00 midnight to 4:00 a.m. of the following morning. [Ord. 17, Sec. 2] 40.130 EXCEPTIONS. The provisions of sections 40.110 and 40.120 shall not apply to any minor accompanied by a parent, guardian, or any other person 18 years of age or over and authorized by the parent or by the law to have the care and custody of the minor, or to any minor who is then engaged in a lawful pursuit or activity which requires his presence in such public places during the hours specified in sections 40.110 and 40.120. [Ord. 17, Sec. 3; amended Ord. 95-10] 40.140 J U RISDICTION. The provisions of sections 40.110 to 40.195 shall not apply to any area within an incorporated city in this County. [Ord. 17, Sec. 4] 40.19.5 PENALTY. Any minor who violates the terms and provisions of sections 40.110 to 40.195 shall be taken into custody, as provided in ORS 419C.080, 419C.085, and 419C.088, and may be subjected to further proceedings as provided in ORS Chapter 4190. [Ord. 17, Sec. 5; amended Ord. 95-10] SOCIAL GAMES 40.310 SOCIAL GAMBLING NOT AUTHORIZED. Social games are not authorized under ORS 167.121 within unincorporated areas of Polk County. All forms of gambling, as defined in ORS 167.117, remain subject to prohibition or regulation under state law. [Added by Ord. No. 92-34] 40-1 TRUANCY 40.400 TRUANCY REGULATIONS. (1) Except as provided in subsection (2), all minors between the ages of seven and 18 years who have not completed the 12th grade shall attend regularly a public full-time school, as required by ORS 339.010. For the purpose of this section, "attend regularly" means to attend school during those hours for the full-time school which the minor would attend in the school district in which the minor resides, on any day on which the school is in session. (2) Subsection (1) does not apply to: (a) A minor being taught in a private or parochial school in the courses of study usually taught in grades 1 through 12 in the public schools and in attendance for a period equivalent to that required of children attending public schools; (b) A minor who proves to the satisfaction of the district school board that he or she has acquired equivalent knowledge to that acquired in the courses of study taught in grades 1 through 12 in the public schools; (c) A minor who has received a high school diploma; (d) A minor being taught for a period equivalent to that required of children attending public schools by a private teacher the courses of study usually taught in grades 1 through 12 in the public school; (e) A minor being educated in the minor's home by a parent or legal guardian; (f) A minor excluded from attendance as provided by law; or (g) A minor granted an exemption from compulsory attendance by rule adopted by the State Board of Education pursuant to ORS 339.030(2). (3) When a peace officer has reasonable grounds to suspect a minor may be in violation of subsection (1) above, the peace officer may contact the minor and make such investigation as may be necessary or appropriate to determine if the minor is in violation of subsection(1). 40.401 ACTION TAKEN. If a peace officer has probable cause to believe a minor is in violation of section 40.400(1), the peace officer may: (a) Take the minor into custody and deliver the minor to the minor's school principal or attendance supervisor, or their designees, or to the minor's parent or legal guardian; and (h) Refer the minor to the Polk County Juvenile Department. 40-2 40.402 PARENT/GUARDIAN. Any parent, guardian or person having the care and custody of any minor between the ages of seven and 18 who has not completed the 12th grade shall take reasonable steps to prevent such child from violating section 40.400(1), and shall further send such child to and maintain such child in regular attendance at a public school during the entire school term or comply with the exemptions set forth in section 40.400(2). 40.403 VIOLATIONS. Violation of section 40.400(1) or section 40.402 upon a first and second offense shall constitute a civil infraction. Violation upon a third and subsequent offenses shall constitute a Class C misdemeanor. [Truancy Section Enacted Ord. 13-01] CONTROLLED SUBSTANCES 40.500 CONTROLLED SUBSTANCES The use of any building, structure, location, premises or land for a medical marijuana business is not currently enumerated in the Polk County Code of Ordinances or the Polk County Zoning Ordinance as a permitted use in any zone, nor is the use enumerated as a conditional use in any zone. [Controlled Substances Section Enacted Ord. 14-02] 40-3 POLK COUNTY COUNTY COUNSEL POLK COUNTY COURTHOUSE*DALLAS,OREGON 97338-3177 DAVIT)DOYLE FOLK COUNTY (503)623-8173*FAX(503)623-0596 MEMORANDUM TO: Board of Commissioners FROM: County Counsel DATE: February 4,2014 RE: Chapter 40 RECOMMENDATION:, That the 130C enact Ordinance 14-02 providing a single amendment to Polk County Code of Ordinances Chapter 40. ISSUE:, Should Polk County amend Chapter 40? BACKGROUND: Polk County Code of Ordinances Chapter 40 addresses Curfew and Social Games, The Community Development Department has requested guidance with regard to the current medical marijuana dispensary situation(e.g. can they be sited within unincorporated Polk County?) Staff has determined that due to the uncertain status of legal preemption arguments that the Board does in fact have authority to disallow medical marijuana businesses. - ALTERNATIVES:, (1) NOT enact Ordinance 14-02; (2) Enact Ordinance 14-02 FISCAL IMPACT: none anticipated