HomeMy WebLinkAboutHealth Dept Annual Comprehensive Plan
Deschutes County Health Services
Local Public Health Authority
COMPREHENSIVE
ANNUAL PLAN
2010-2011
TABLE OF CONTENTS
I. EXECUTIVE SUMMARY 1
II. ASSESSMENT
A. Community Health Assessment 4
B. Adequacy of Public Services, ORS 431.416 15
C. Provision of Basic Public Health Services 15
D. Adequacy of Other Key Services Critical to Public Health 21
III. ACTION PLAN
A. Epidemiology and Control of Preventable Disease and Disorder
1. Communicable Disease 22
2. Emergency Preparedness 27
3. Food-Borne Illness Reports 29
4. Immunizations 29
5. Tobacco Prevention 36
B. Parent and Child Health Services, Including Family Planning
Clinics as Described in ORS 435.205
1. Women, Infants & Children (WIC) 36
2. Immunizations 42
3. Maternal Child Health 43
4. Family Planning 44
C. Environmental Health 49
D. Health Statistics 50
E. Information and Referral 52
F. Public Health Emergency Preparedness 53
G. Other Issues 53
IV. ADDITIONAL REQUIREMENTS 54
V. UNMET COMMUNITY NEEDS
A . P r i m a r y C a r e 54
B. Hunger and Nutritional Health 56
C. Behavioral Health Services for Uninsured 56
D. Family Violence 56
E. Children with Special Health Care Needs 56
F. Health and Social Support Assets for Ex-Incarcerated Populations 56
G Children's Oral Health 56
H. Obesity and Chronic Disease Prevention 56
VI. BUDGET 57
VII. MINIMUM STANDARDS
A . O r g a n i z a t i o n 60
B. Control of Communicable Diseases 61
C. Environmental Health 62
D. Health Education and Health Promotion 62
E. Nutrition 63
F. Older Adult Health 63
G. Parent and Child Health 63
H. Primary Health Care 64
I. Cultural Competency 64
J. Health Department Personnel Qualifications 64
APPENDICES
A. Deschutes County Health Report 2009 66
B. Organizational Structure 94
I. EXECUTIVE SUMMARY
This summary provides an introduction to Deschutes County’s Health Services
Department (DCHS), the programs we offer and systems in which we work, the
community we serve, our health and safety priorities and our financial resources.
Deschutes County Health Services offers care at more than 40 community locations
including 26 public schools, health clinics in east Bend, downtown Bend, Redmond and
La Pine, five School Based Health Centers in four communities, agencies such as the
KIDS Center and State Department of Human Services, area hospitals, care facilities and
homes. Services are also provided through mobile outreach. For more information, go to
www.deschutes.org/health-services or contact us at 541-322-7400.
This overview will form the basis of our 2010-2011 Public Health Plan as well as the
2011-13 Behavioral Health Plan. Both are required by the State of Oregon. The material
will also be used in setting priorities for the County, preparing annual budgets and
updating the Strategic Plan (Health Improvement Plan) in 2011.
This 2010 Deschutes County Health Services Plan includes a summary of our local public
health services and systems and a look at the condition of health in our local
communities.
Noteworthy is Deschutes County’s February, 2009, merger of the former Health
Department and the Mental Health Department into a single, integrated department. The
goals associated with this action are to increase our efficiency, our cost effectiveness, our
performance and our ability to integrate our services for the benefit of our county and its
residents.
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 health care.
Collaboration – True partnership with our customers, community agencies and coalitions.
Cultural competency – 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.
Public Health: Deschutes County Health Services' Public Health Division consists of six
program areas: Community Health, Reproductive Health, Maternal Child Health, Women,
Infants & Children (WIC) Nutrition Program, Environmental Health (a July, 2010, transfer
from the County Community Development Department), and Business and Program
Support Services.
The Public Health Division has a primary responsibility to address issues related to the
basic health and wellness of Deschutes County residents. The Division budget totals
$8.7 million with 69 FTE. The Division assesses, preserves, promotes and protects the
public’s health. A number of direct services are provided, including immunizations,
family planning, prenatal care and School Based Health Centers as well as nutrition to
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young children and their mothers. Other services include disease control, disaster
preparedness, tobacco prevention, health education and community health monitoring.
DCHS continues to provide a comprehensive array of public health services which meet
the assurance standards described in OAR 333-014-055. Our services include:
• Communicable disease control and all hazards public health preparedness;
• Family health programs: maternal child health, family planning, WIC and
immunizations;
• Vital records, health statistics and health trend monitoring;
• Chronic disease services and tobacco prevention;
• Environmental health services
• Environmental toxicology investigation and intervention.
Service levels (visits and contacts) continue to rise. Projected levels for 2009-2010:
General health care services 18,876
WIC (Women Infants Children) 18,000
Immunization Shots for Tots clinics 438
BabiesFirst! and CaCoon 1,260
Vital records: birth, death requests 2,660
Total estimate as of March 2010 41,234
These numbers are not reflective of our mobile services (harm reduction), nor our mass
immunization/TB testing clinics outside of Shots for Tots. Patient visits and public
contacts are projected to total more than 42,000 in FY 2011.
Behavioral Health: Deschutes County Health Services' Behavioral Health Division's
projected budget totals $15.5 million with 106 FTE. The division helps county residents
who are dealing with serious mental health and addictions issues. Staff and contracted
agencies also help people with developmental disabilities and their families. Priority
populations include Oregon Health Plan members, uninsured county residents with
nowhere else to turn and people in crisis, who are often in unstable situations or are a
danger to themselves or others. The division also coordinates services for county
residents in care at the State Hospital or served through other agencies or facilities.
These services alleviate community problems, assist people in need, promote client health
and prevent more costly care and intervention. Behavioral Health will help more than
4,000 county residents in FY 2011. Behavioral Health consists of five program areas:
Child and Family, Adult Treatment, Seniors Mental Health, Developmental Disabilities,
and Business and Program Support Services.
Key Findings and Recommendations: As in other Oregon communities, we face
significant health issues and health disparities due to demographic, geographic, economic
and lifestyle factors. Our most significant issues include:
• The oral health status of low income children;
• Access to basic primary care services for low income, uninsured county residents as
well as those with a Medicaid or Medicare benefit, including children;
• Obesity rates in both children and adults;
• Our health system’s capacity to serve bilingual (primarily Hispanic) families;
• Our public health capacity to address sexually transmitted infection;
• Our public health capacity to address communicable disease and food-borne illness
events that require epidemiological investigation and follow-up;
• Our public health capacity to address chronic disease (prevention, education, and
policy);
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• The health, social and economic impact of substance abuse including
methamphetamine;
• Low but improving immunization rates for our young children;
• Drinking water quality preservation in southern Deschutes County; and
• Reduced life span for people with a serious mental illness or addiction.
Progress: The 2010-11 Annual Plan also recognizes notable progress in:
• Low teen pregnancy rates;
• Added capacity across the primary care safety net system;
• Exceptional breastfeeding rates among Deschutes County WIC mothers;
• Expansion of School Based Health Centers capacity in La Pine, Redmond and Bend;
and
• Child immunization – dramatic improvement in the up-to-date rate for two-year-olds.
Deschutes County Health Services recommends continued focus on the long list of health
issues challenging our communities and families. Though realistic about our state’s
financial resources during a down economy, we continue to endorse enhanced state
financial support of our public health capacity to control diseases and address chronic
conditions in our population. The department enjoys the support and active participation
of our local Public Health Advisory Board, our Board of County Commissioners and a
strong collegial relationship with our state public health partners as well as many local
coalitions and agencies.
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II. ASSESSMENT
A. The Community We Serve
This section describes the communities we serve and the condition of health in our
local communities and across the Central Oregon region.
Demographics: As of July 2009, Deschutes County had 170,705 1 residents and is
the fastest growing of Oregon’s 36 counties. The population is likely to exceed
178,000 by July 2011. The county includes 36,781 children (ages 0-17; 21.5%),
110,110 adults (ages 18-64; 64.5%) and 23,814 seniors (ages 64 and up; 14%). The
county grew by 2.2% (3,690 residents) from 2008 to 2009 compared to a State growth
of 0.9%. Deschutes County cities include Bend (82,280 residents), Redmond
(25,803), Sisters (1,925) and La Pine (1,625). Another 60,000 people live in rural
areas outside these jurisdictions. Our Central Oregon region of 220,605 residents
includes Crook and Jefferson counties.
Of note is the rate of growth in our senior adult population. Estimated in 2008 at
over 35,000 persons in the tri-county region, this figure is expected to grow another
10,000 before the end of 2010 and to more than100,000 over the next 30 years 2 . The
Medicare population in Deschutes County is expected to triple between 2010-2040,
and there is serious reason to be concerned about where these people will receive
care.
County Health Report: Deschutes County Health Services produces a County
Health Report every two years as a community service. The fourth edition of this
report was issued in January, 2010. The report offers regional data to assist local
governments, community groups, health care providers, school districts and others in
identifying and addressing health needs in our community. The report also helps
inform our County Commissioners and county health boards as we complete our
strategic and annual plans and set service and budget priorities. Please refer to the
report (Appendix A) for a comprehensive assessment of our county’s health. We will
continue to produce this report and support the collection of health data and
reporting on biennial basis.
Progress: Areas where Deschutes County meets state or national health objectives or
has improved significantly over the past several years (examples only):
a. Child immunization – dramatic improvement in the up-to-date rate for two-year-
olds;
b. Breastfeeding initiation rate – exceptional nationally among WIC programs at 93%;
c. Air quality – ranked at the highest level of the Air Quality Index 96% of the time
(2008);
d. Harm reduction: injection drugs – successful programs for people using injection
drugs;
e. Prenatal care: first trimester – continuing to rank among the highest counties in
Oregon;
f. Smoking rate: adolescents – the rate has declined from 27% to 19.1%; and
g. Contraceptive services – 78% of women needing publicly funded services are
served compared to the Oregon average of 58.5%.
1Demographic data was obtained from the Portland State University's Population Research Center. Most population
data reflects figures for July 1, 2009, as certified by the Center in December, 2009 (http://www.pdx.edu/prc).
2Source: Central Oregon Council on Aging (www.councilonaging.org).
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Significant Work Remains: Areas where more progress is needed include (examples
only):
a. Economic vitality declining – unemployment rates, housing foreclosures,
bankruptcies;
b. Families needing assistance – an increase in need for help: housing, food and
health care;
c. Dental health – lack of fluoridation in community water supplies;
d. Health care access – a rise in number of residents without health care 3 ;
e. Cancer – rates that are statistically significantly higher than the statewide
average 4 ;
f. Sexually transmitted infections – cases have risen dramatically over the past 10
years;
g. Tobacco – number of pregnant women who smoke during their pregnancy;
h. Tobacco – adolescent use of tobacco exceeds Oregon averages; and
i. Suicide – ideations and attempts continue to be high among adolescents.
For more information, see the Deschutes County Health Report 2009 at
www.deschutes.org\health (Quick Link). Presentations and copies of the Health Report
are also available by calling 541-322-7400.
County Health Rankings: The University of Wisconsin Population Health Institute
(PHI), in collaboration with the Robert Wood Johnson Foundation, has produced
County Health Rankings, ranking each county within the 50 states according to its
health outcomes and the multiple health factors that determine a county’s health. The
summary report, “County Snapshots,” and the detailed information available in the full
report are available on a new web site at www.countyhealthrankings.org. Based on the
2010 report, Deschutes County ranks sixth (of 33 participating counties) in health
outcomes and second in health factors.
Health Outcomes: As reported by PHI, “health outcomes in the County Health Rankings
represent how healthy a county is. We measure two types of health outcomes: how
long people live (mortality) and how healthy people feel while alive (morbidity).” For the
purpose of this project, mortality is measured through premature deaths (deaths before
age 75). Morbidity is the term that refers to how healthy people feel while alive. The
report ranks counties based on health related quality of life measures and birth
outcomes.
Ranking of Central Oregon Counties:
Central Oregon Mortality Morbidity
Deschutes 5 (of 33) 8
Crook 13 16
Jefferson 32 31
Health Factors: As reported by PHI, “health factors in the County Health Rankings
represent what influences the health of a county. We measure four types of health
factors: health behaviors, clinical care, social and economic, and physical environment
factors. In turn, each of these factors is based on several measures. A fifth set of
factors that influence health (genetics and biology) is not included in the Rankings.”
3Predates potential benefit associated with 2010 federal legislation and greater access through an expansion of the
Oregon Health Plan and the new Oregon Healthy Kids Connect Program.
4Higher cancer rates for malignant melanoma, prostate, thyroid, and the “all cancer” rate.
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Ranking of Central Oregon Counties:
Central Oregon
Health
Behaviors
Clinical
Care
Social &
Economic
Physical
Environment
Deschutes 1 3 6 5
Crook 21 9 27 17
Jefferson 31 28 33 2
Health behaviors: Tobacco use, diet and exercise, unsafe sex, alcohol use
Social & economic factors: Education, employment, income, family and social
support, and community safety
Clinical care: Access to care, quality of care
Physical environment: Environmental quality, built environment
Important caution: While the University of Wisconsin data allows for a comparison
between counties within a given state, all counties, including Deschutes, can make
significant progress in improving the health of our communities and county residents.
See the Health Report for numerous examples of areas where significant improvement is
needed in Deschutes County.
Access to Health Care and Safety Net Health Services: Access to basic primary,
dental and behavioral health care and medical services remains one of the foremost
needs across our communities. It is estimated that approximately 37,000 Deschutes
County residents lack any form of healthcare insurance and are disenfranchised from
the health care system. Central Oregon, at 19.1%, has the highest uninsured rate in
Oregon. Approximately 8,900 Deschutes County children remain uninsured, though
the new Healthy Kids initiative should help significantly. It is estimated that 13% of our
children live below the poverty line. Many children face significant health and dental
issues 5 .
As reported in 2008, it is estimated that 92% of all Central Oregon employers employ
less than 20 personnel, making the purchase of group insurance unaffordable for
most. In addition, unemployment exceeds 15% (February, 2010) in Deschutes County.
Recent initiatives by the Chamber of Commerce coupled with the new coverage product,
SharedCare, through HealthMatters of Central Oregon should prove helpful.
A significant percent of the uninsured are the working poor as well as Hispanic families
who have migrated to the region in recent years. In safety net services, it is not
uncommon to find the medically disenfranchised have gone many years without care
and present with advanced health conditions that might have been easily treated or
avoidable had these individuals been able to access health services earlier. These
problems present a considerable challenge in the safety net care setting.
Since 2003 we have also seen an increasing barrier to health care services for those
insured individuals who have fee-for-service Medicare or Oregon Health Plan (OHP)
coverage. This form of insurance is by no means a guarantee to health care services.
An ever increasing number of physicians and practice groups are limiting and even
refusing to treat clients with these forms of insurance, citing low reimbursement rates.
Safety net services include the following clinics that continue to serve our uninsured
and underinsured populations. The La Pine Community Clinic, which began operations
as a Federally Qualified Health Clinic (FQHC) in the summer of 2009, complements the
work of the Mosaic Medical system which operates clinics in Bend, Prineville and
5Source: Profile of Oregon’s Uninsured, 2006
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Madras and cared for 30,000 patients across Central Oregon in 2008. Volunteers in
Medicine Clinic of the Cascades (VIM) also provides an access point for low-income,
medically uninsured residents of Deschutes County. The VIM clinic in Bend receives
approximately 8,000 patient visits annually.
The School Based Health Centers (SBHC) in La Pine, Redmond and Bend thrive as
critical access points to health services for many of the school age youth in Deschutes
County. The clinics are unique in that they readily serve all children, ages 0-20,
regardless of their insurance status or ability to pay. In the 2008-2009 fiscal year, a
total of 1,741 patients were seen at the clinics. Planning grants are in process to open
two new SBHCs in the 2010-2011 school year at Redmond and Sisters High Schools.
Healthy Kids Connect is low- to no-cost major medical insurance coverage for children
ages 0-18 who live in Oregon. In addition to covering primary care, vision, dental and
mental health care, this plan is non-exclusionary; no child will be denied coverage
based on a pre-existing medical condition. Healthy Kids Connect is aimed at the
working poor, families who have incomes that prohibit them from qualifying for OHP
but not enough to purchase private health insurance.
Childhood Chronic Disease: Childhood asthma, diabetes and obesity are drawing
increased attention at the local level. A coalition has been formed called Healthy Active
Central Oregon (HACO) to identify and implement strategies aimed at addressing
inactivity and obesity. The 2007-2008 Oregon Healthy Teens Survey reveals that 21.2%
of our 8th graders and 20.8% of our 11th graders are overweight or at risk for becoming
overweight. The Centers for Disease Control and Prevention estimate that 1 out of every
3 children born in the United States after the year 2000 will develop diabetes in their
lifetime as rates of obesity and overweight continue to rise among youth.
Communicable Disease: The Communicable Disease Program in Deschutes County
has seen an increase in reportable diseases steadily each year with the population
growth. 2009 was an exception to the last decade of trends, where we have seen a
small decline in reportable diseases, perhaps due to the decline in our population due
to the shortage of employment options. The program has seen increased numbers of
disease cases, food-borne outbreaks, and information requests from the community.
Sexually transmitted infections continue to be the most reported communicable disease
with between 400-500 cases per year. The cases have nearly doubled in four years,
which creates an increased workload on staff for follow-up.
Deschutes County continues to have slightly higher than average rates of Giardiasis
(compared with other counties in Oregon). The number of Campylobacter continues to
be our main waterborne disease, and rates are on the high end compared to other
Oregon counties. The number of food-borne illness outbreaks (Norwalk) has increased
dramatically with the growth of the community and retirement homes in the area.
Deschutes County averages 15-20 cases of Hepatitis C a month (non-acute), and since
it became reportable in 2005 we are continuing to see numbers rise.
After several years of no reported active tuberculosis (TB) disease, in the past three
years we have seen a substantial increase in the number of suspect TB cases in our
area. Each year we manage between 40-80 cases of Latent Tuberculosis, and 0-3 active
cases.
The program has completed the development and activation of the Pandemic Flu Plan
through the H1N1 Pandemic and is working with other employers and organizations to
continue building an infrastructure that can address the threat of community-wide
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disease outbreaks. The Communicable Disease Program continues to work closely with
the Immunization Program and Preparedness Program to build relationships and to
ensure lessons learned are applied to successful response initiatives in the future.
Disease rates over the past three years:
2009 2008 2007
Chlamydia 402 439 390
Gonorrhea 7 6 8
Syphilis 7 7 2
HIV 6 3 5
Hepatitis C 195 196 185
Giardiasis 19 38 35
Campylobacteriosis 30 43 56
Salmonella 10 11 18
Norovirus 8 11 6
E.Coli 3 5 4
Totals 687 759 709
In July, 2010 the environmental health team is moving into Health Services where the
other Public Health programs are located. The environmental health specialists will be
integrated into the communicable disease program area to maximize shared expertise
around disease prevention and environmental toxicology efforts.
Immunizations: Nearly 9,000 children have been served in our Shots-For-Tots
program, and our up-to-date immunization rate for two-year olds has increased
dramatically from 51% in 2005 to approximately 75% in 2007-2008. Reasons for the
rate change include an increase in the amount of local vaccine data reported to the
statewide immunization registry and a change by some clinical practices to provide
doses closer to the recommended intervals.
Areas of priority to address are the rising rates of religious exemptions with Deschutes
County which have grown in recent years to levels significantly higher than the
statewide average. Additionally, the immunization team is focusing on increasing the
rate of adolescents (11-12 year olds) receiving Tdap, HPV and Meningococcal vaccines,
with an emphasis on Tdap, to decrease pertussis in our community.
In 2009, we expanded our Deschutes County Immunization Coalition to include major
pediatric and family practice clinics.
Cultural Competency: Currently, the Latino population is the county’s largest and
fastest growing minority group. Many of these families are non-English speaking and
require translators to ensure they receive safe, effective care and services. Hispanic
mothers have good access to prenatal care regardless of their insurance status through
the HealthyStart Prenatal Clinic. The service also offers childbirth and car seat safety
classes in Spanish. Translation and cultural needs for Hispanic mothers are also well
met in the Women, Infants & Children (WIC) program.
The reproductive health programs have front office and clinical staff who are bilingual.
An interpreter is available for clinicians who do not speak Spanish. All educational
materials and forms are available in English and Spanish. The clinic uses a certified
translator to translate or review all Spanish materials. The staff has had cultural
competency training and works very hard to meet the needs of all cultures that access
services at the department.
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In February, 2008, we started a “Males Only Clinic” and have marketed services toward
men who have sex with men. The staff who work this clinic are well trained in the
needs of this community. Deschutes County is committed to providing equal access
and eliminating barriers to care for all clients.
Emergency Preparedness and Immunizations: The H1N1 pandemic response was
an excellent opportunity to put our emergency preparedness plans into action. Program
staff, community partners, volunteers and many others collaborated and incorporated
the past five years of preparation to launch a successful response in regard to both
medical capacity and a massive community vaccination effort. The expertise of our
staff, strong agency partnerships, and a coordinated statewide response proved effective
in mass distribution, public communication, and disease mitigation throughout the
H1N1 event.
Environmental Health and Toxicology: In July, 2010, the environmental health team
is moving to the Health Services department where the other Public Health programs
are located. The environmental health specialists will be integrated into the
communicable disease program area to maximize shared expertise around disease
prevention and environmental toxicology efforts.
Family Violence: Family violence includes child abuse, domestic (intimate partner)
violence, sexual assault, and elder abuse.
Child Abuse: In the tri-county region in 2009, there were 2,3366 reports of child abuse
and neglect; 1,071 reports were referred for investigation and 265 of these were
confirmed; 186 of these confirmed reports were in Deschutes County. In 2009, the
reported child abuse case rate (per 1,000) in Deschutes County has decreased to 6.4
(from 7.4 in 2008 and 7.7 in 2007) and was considerably better than the State rate of
12.5. Neglect (39%) was the largest type of maltreatment, followed by threat of harm
(37%) which includes: exposure to domestic violence, exposure to sexual abuse and
other physical abuse (17%) and sexual abuse (10%). When you combine exposure to
physical abuse and sexual abuse, it represents approximately 22% of all maltreatment.
The top three stressors present in child abuse and neglect are drugs and alcohol,
criminality (including domestic violence) and mental health issues. Although we follow
a nationwide downward trend in abuse cases and Deschutes County does have the
second lowest child abuse rate in Oregon, we are still above the 2010 Oregon
Benchmark of 5.6 confirmed cases per 1,000 children.
Domestic Violence: In 2009, Saving Grace, the local organization for support, services
and shelter for women and children, reports that 10,564 crisis services were provided
for 4,249 people; 242 women and children were protected, fed, clothed and lodged for
2,811 days; and 2,511 hotline calls were answered.
Current community factors that impact the problem of family violence include
increasing unemployment rates; lack of basic family resources for a growing number of
people to address issues such as inadequate housing; financial stress; and drug and
alcohol use.
6Source: State of Oregon Department of Human Services, compiled by Deschutes County Child Abuse System Task
Force
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Injury Morbidity and Mortality: Injury is the third leading cause of death in Oregon
and claims more potential years of life lost than cancer, heart disease, or stroke. For
persons under 44 years of age, injury is the leading cause of death in Oregon.7
Unintentional Injury Deaths, Deschutes County, 1999-2006:8
1999 2000 2001 2002 2003 2004 2005 2006
39 45 42 39 56 58 67 78
Of the 424 unintentional injury deaths listed above, 192 were due to motor vehicle
accidents (45.3%). 102 were due to falls (24.1%).
Lactation Services: The department is deserving of recognition for programs that
address breastfeeding including Maternal Child Health (MCH), Women, Infants &
Children (WIC), HealthyStart Prenatal Care Clinic, and Oregon Mothers' Care. The
agency seeks to improve coordination among these services to provide consistency for
clients and maximize our resources. The WIC Program employs two International
Board Certified Lactation Consultants (IBCLC) who conduct in-services with other
departments to keep them updated on the latest breastfeeding information. The
breastfeeding initiation rate among Deschutes County WIC clients is 93.3% based on
2009 state WIC data. This data ranks Deschutes County as third highest among all
Oregon WIC agencies. In 2010, advanced breastfeeding education will be offered to
MCH, WIC, HealthyStart and Oregon Mother's Care staff so our clients get the best
information.
Behavioral Health: The National Institute of Mental Health estimates that 26.2% of
Americans 28 and older (1 in 4 adults) suffer from a diagnosable mental health disorder
in a given year. When applied to the 2009 population estimate of 170,705, this figure
translates to over 44,000 Deschutes County residents.
Individuals Served by DCHS in 2009:
Adult Program 2,805
Child and Family Program 1,401
Alcohol and Drug Treatment 275
By action of the 2009 legislature, there will be a major expansion of Oregon Health Plan
eligibility and, with that, an additional 105,000 Oregonians who will be able to access
OHP’s behavioral health benefits when needed.
There are barriers within Oregon’s mental health care system that make access a
challenge for many. Clients within Oregon’s Medicaid program are typically able to find
reasonable care when needed; however, those who are not Medicaid-eligible often face
challenges in accessing treatment that is not focused solely on crisis services. Because
of this gap in care, the numbers of individuals with serious mental illnesses who end up
in emergency rooms, jails, and prisons continue to grow.
Oral Health: Dental decay remains a serious public health problem for Deschutes
County residents. While tooth decay is largely preventable, it remains the most
common chronic disease of children aged 5 to 17 years—five times more common than
asthma—and is also a serious concern for many adults. Untreated decay can lead to
7Source: State of Oregon Department of Human Services' Oregon Injury Prevention and Epidemiology Program
8Source: State of Oregon Department of Human Services' Oregon Center for Health Statistics
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infection, pain, and the loss of teeth. Emerging evidence points to a strong link between
oral disease, many medical conditions and poor health outcomes.9
Many of the same barriers to obtaining medical care also apply to dental care including
limited safety net services, limited numbers of local dentists who accept OHP clients,
limited capacity to cover the total plan enrollment for the region and assignment of out-
of-area dental providers to OHP clients. Local emergency rooms report a significant
number of visits for complications of untreated dental problems. In addition, local
dentists report low reimbursement rates for OHP clients. These clients are inherently
more difficult to serve because of higher levels of dental problems and complications
poorly covered by OHP.
Limited screening for children is provided in DCHS well child clinics and nurse home
visiting programs. Eligible families may receive prescriptions for fluoride through well
child clinics, and extensive prevention education is offered in all Maternal Child Health
programs.
The OHP population of pregnant women served in Maternity Case Management has
been identified as having high rates of dental problems and poor access to care. Head
Start is re-organizing the Oral Health Coalition. A request by DCHS to participate in a
prevention project in WIC (funded by the Oregon Dental Society) could improve access
to dental care as well as create a better system of providing oral health information to
WIC clients. The brochures developed by the original Oral Health Coalition continue to
be distributed at our clinics, home visits, WIC and School Based Health Centers.
The department received a grant from the Oregon Dental Society to provide materials
and fluoride for a dental screening program to be staffed by public health nurses to
provide referral, education and fluoride varnish to children referred through WIC.
Fluoridation of community water supplies is the single most effective public health
measure to prevent tooth decay and improve oral health over a lifetime. More than 50
years of scientific research has found that people living in communities with fluoridated
water have healthier teeth and fewer cavities than those living where the water is not
fluoridated. Despite this evidence, water sources in Deschutes County remain
unfluoridated.
Prenatal Services: Deschutes County has developed a strong perinatal service system
involving multiple community partnerships. A shared value among partners is
prioritizing early access to prenatal care for all pregnant women regardless of income or
insurance status. A highlight of this system is the partnership between St. Charles
Health System and the department to provide the HealthyStart Prenatal Program, a
safety net prenatal care clinic for uninsured pregnant women. The elements of the
system are interdependent and reliant on each other to make an optimal contribution to
the continuum of need for pregnant women and their families.
Preliminary data show there were 2,131 live births in Deschutes County in 2009. Of
them, 135 were births whose moms enrolled in HealthyStart. Of note is that 102 of the
HealthyStart births were to Hispanic mothers. The HealthyStart program saw 182
births in 2006, 187 in 2007, 143 in 2008, and a drop to 135 in 2009 with the declining
Central Oregon economy. Pregnant women who are eligible for the Oregon Health Plan
are seen in the HealthyStart Program until enrollment and then transferred to private
care. Program staff processed and assisted 692 participants with their application for
the Oregon Health Plan.
9Source: State of Oregon Department of Human Services' Oral Health Program
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Local Public Health Authority Annual Plan 2010-2011
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HealthyStart is a pilot project for the Perinatal Expansion program that allows Citizen
Alien Waived Emergency Medical (CAWEM) eligible pregnant women to be enrolled in
CAWEM Plus, which covers their prenatal care. The demographic profile of our clients
has shifted slightly as some CAWEM eligible clients have left our area, and the newly
low-income and unemployed are increasing in the clinic.
Overall, 97% of pregnant women received adequate prenatal care in 2009. The rate for
starting prenatal care in the first trimester has decreased from 83% since the
implementation of Oregon MothersCare in 1999 to 81.1% in 2009, compared to a state
rate of 71.6%. This decrease is despite vigorous efforts in outreach to community
partners in 2009-10. The department has seen a shift in our demographics to include
more Caucasians who are recently uninsured due to loss of employment and who may
not know how to access assistance obtaining OHP or prenatal care. The low birth
weight rate was 6.0 % in 2009 which is a reduction from 6.7% in 2008. Infant mortality
was 7.0% in 2009 compared to 0.6% in 2008.
Illicit Drug Use: Illicit drug use in Oregon exceeds the national per capita average,
with higher rates of methamphetamine, marijuana, and illicit use of prescription drugs.
A 2008 study by ECONorthwest puts total direct economic costs from illicit drug abuse
at $2.7 billion. Arrests for drug violations increased 44% from 2003-2007; and 27% of
the Oregon corrections population is in the system due primarily to drug offenses,
nearly three times higher than any other primary offense category.
Deschutes County has been designated a “High-Intensity Drug Trafficking Area”
(HIDTA), one of seven in Oregon. This is a federal designation for areas within the
United States that exhibit serious drug trafficking problems. Data from the HIDTA
program and the Central Oregon Drug Enforcement team indicate continued high rates
of methamphetamine abuse and growing rates of marijuana and prescription drug
abuse. Heroin use among younger populations also seems to be on the rise.10
Methamphetamine: Although there has been a significant decline in the number of
methamphetamine lab seizures due to restrictions on the availability of
pseudoephedrine, methamphetamine continues to be widely abused and trafficked
throughout the Central Oregon region. Large-scale drug trafficking organizations,
primarily from Mexico and California, typically distribute methamphetamine throughout
the region after transporting it up the I-5 and Highway 97 corridors. Serious
methamphetamine related crime includes identity theft, abused and neglected children,
and other serious person and property crimes.
Prescription Drug Abuse: Recent data indicate prescription drug abuse is the fastest
growing type of substance abuse in Oregon. Treatment admissions for non-prescribed
use of prescription drugs increased by 332% in Oregon from 1997-2006. Internet sites
advertising and selling controlled prescription drugs increased by 70% between 2006
and 2007. Most of the sites selling these drugs (84%) did not require a prescription.
Oregon is fourth among states leading the country in teen abuse of prescription pain
relievers. In Deschutes County, 9.2% of 11th graders reported abuse of prescription
pain relievers in the past 30 days.11
10Sources: Oregon HIDTA Programs, 2008 Drug Threat Assessment, Deschutes County Sheriff's Office
11Sources: State of Oregon Department of Human Services' Addictions and Mental Health Division; Oregon HIDTA
Program, 2008 Drug Threat Assessment, Oregon Healthy Teens Survey, 2007-2008.
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Suicide: Suicide is the second leading cause of death among Oregon youth ages 10-24.
In Deschutes County there were 18 confirmed youth suicide attempts in 1999 resulting
in hospitalizations or deaths of children ages 10-17. That figure rose to 49 in 2007—35
female and 14 male—prompting community-wide attention and discussion. While the
majority of youth suicide attempts are among females, 82% of suicide deaths are among
males. For every death among youth under the age of 18, there are an estimated 136
suicide attempts that are treated in hospital emergency rooms. Sadly, this data does
not reflect the true magnitude of suicide attempts by Oregon youth, since the
Adolescent Suicide Attempt Data System (ASADS), from which data this report is based,
collects data from only those attempts where youth subsequently present to hospital
emergency rooms.12 Suicide for all ages accounted for 26 deaths in Deschutes County
in 2007 and 32 in 2008.13
Deschutes County Health Services is partnering with the Oregon Public Health Division,
Commission on Children and Families and area school districts to provide suicide
prevention programs in four selected high schools. The new program, Caring
Connections, is funded by the Garrett Lee Smith Memorial Act and will implement the
RESPONSE curriculum for 9th grade students and will provide suicide intervention
skills training to school staff in each of the four high schools. The three-year grant is
providing staff training in ASIST (suicide intervention training) this school year with
RESPONSE scheduled for implementation in the 2010-2011 school year. A community
awareness campaign along with some opportunity for community members to receive
training is also being implemented.
Unintended and Teen Pregnancy: Deschutes County Health Services continues to
place high priority on teen pregnancy prevention. Although the teen pregnancy rate has
decreased significantly in the past ten years, Deschutes County may see a slight rate
increase for 2008. The teen pregnancy rate (per 1,000 females ages 10-17) in
Deschutes County was 8.6 in 2007 and 9.2 in 2008. Preliminary 2009 data is showing
that the rate may be going back down this year.
Public health staff collaborate with community partners to assure access to
reproductive health education and services. This year the Reproductive Health
Program, in collaboration with the schools, is providing the My Future-My Choice
program (a comprehensive sexual health and life skills curriculum) to almost 2,000
middle school students with over 150 high school volunteers as mentors. Within the
past year our health educators have taught more than 235 classes on reproductive
health to almost 6,500 students in middle schools, high schools, Central Oregon
Community College and at several facilities with high-risk youth. They have
incorporated important components like healthy relationships and communication into
their presentations to make the curriculum more comprehensive. We are currently
working closely with our state partners to align our community objectives and outcomes
with those of the Oregon Youth Sexual Health Plan.
2010 Priorities Adopted by our Advisory Boards: In addition to ongoing operation of a
wide range of public health, behavioral health and support services, we have identified a
number of critical projects that require special effort in 2010:
Accreditation Pilot Public Health: Selected as one of 19 counties nationwide, DCHS is
using the new Public Health Accreditation tool to assess our operation and strengthen
12Source: State of Oregon Department of Human Services' Oregon Injury Prevention and Epidemiology Program,
“Youth Suicide Attempts in Oregon, 2007 Data Report”
13Source: State of Oregon Department of Human Services' Oregon Center for Health Statistics
Deschutes County Health Services
Local Public Health Authority Annual Plan 2010-2011
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our agency. Deliverables: completed assessment; improvement priorities, quality
improvement project.
Budget FY 2011: Prepare the 2011-12 budget based on operating costs and emerging
priorities, adjusting for potential funding reductions. Deliverable: adopted budget.
Electronic Record Project: Begin a multi-year project to convert most DCHS operations
to an electronic system. Deliverable: 2010 request for proposal, selection and early
implementation.
Environmental Health Transfer: Integrate the Environmental Health Unit in the
Community Development Department into DCHS. Deliverable: transfer of budget and
staff July 2010. Note: also requires relocation of DCHS services to another Bend site.
Health Report: Publish the new 2009 Report early in 2010. Deliverables: with the
Advisory Boards, review and select 1-3 projects for attention; disseminate the report;
educate the public.
Integration: A major collaborative regional project through 2015, develop a model to
integrate primary care and behavioral health services throughout Central Oregon.
Deliverables: single point of accountability; infrastructure development; improve health
outcomes, client satisfaction and cost containment.
Launch Development: As a major project through 2015, kick off our new child abuse
prevention and child wellness initiative (5-year Federal grant). Deliverable: expand
integrated services at a minimum of three school-based health centers.
New Manager: Successfully hire a new manager for Program Support Services with an
emphasis on strengthening our quality improvement, initiating our new service
integration project, and supporting our planning and evaluation activities. Deliverable:
hire in first quarter.
County Goals & Objectives: The County asks each department to develop these
measures as part of the budget process. Deliverables: Post quarterly updates of our
progress in achieving 2009-10 objectives; propose 2011-12 goals and objectives.
Behavioral Health Biennial Plan: The State requires this plan every two years.
Deliverable: develop and submit the adopted 2011-2012 plan to the State.
Public Health Triennial Plan: The State requires this comprehensive plan every three
years. Deliverable: develop and submit the adopted 2010-2012 plan to the State.
Policy Manual DCHS: Review prior behavioral health and public health policies guiding
our operation; update as needed. Deliverable: policy manual.
Residential Development: Consistent with our housing continuum, increase affordable
housing for people with mental illness by 32 slots / units. Deliverable: 4 projects
completed by December 2010 including three in Bend and one in Redmond.
Redmond 2011: With the County, explore the feasibility of creating a Redmond Service
Center including a range of community based DCHS programs and services.
Deliverable: a plan of services to be offered in Redmond in 2011 or later.
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School-Based Health Centers: Continue efforts to expand school based centers
throughout the county. Deliverable: open a second center in Redmond and the first
center in Sisters in the fall of 2010.
Strategic Plan: The department currently has two adopted strategic plans. Deliverable:
integrate and streamline the material into a single plan early in 2011.
Web Site Update: Recreate the current web sites into a single informative site that is
easy to navigate and serves the public well. Deliverable: launch of new site early in
2011.
B. Adequacy of Public Health Services
Deschutes County Health Services provides quality service at an adequate level of
capacity, given the resources provided through the County's General Fund, federal and
state grants, and billable revenue. The department continues to face increased demand
for required services at a faster pace than resources can match. This is particularly
challenging in our Community Health (and communicable disease) Program, in our
expansion of the number of School Based Health Centers (integrated model with
primary care and behavioral health), and in Maternal Child Health (MCH). While the
new 5-year Federal Launch Program begins providing client services in May 2010, we
will also need to consider methods to sustain that work as part of our long-term
financial plan.
The department provides exceptional services in its WIC, MCH, Communicable Disease,
Family Planning and Environmental Health programs. The department has also added
a greater emphasis in health promotion and chronic disease prevention by clustering
tobacco prevention and education, Living Well with Chronic Conditions and chronic
disease prevention efforts under one roof. Completion of the 2010 State Triennial
Review process coupled with a planned 2011 national accreditation (through the Public
Health Accreditation Board) are also expected to strengthen programming and
operations.
C. Provision of Basic Public Health Services
The Department provides the five basic services outlined in statute (ORS 431.416) and
related rule, OAR Chapter 333, Division 14:
1. Epidemiology and Control of Preventable Diseases and Disorders
The minimum standards for communicable disease control are met, and the system
for enhanced communicable disease control has improved. With the increased
population and preparedness requirements, the need for additional staff is great.
The Communicable Disease Program responds 24/7 to information requests and
currently sends a request to physicians who report Hepatitis C for permission to
send educational information to the client. The program provides blood-borne
pathogen training throughout the county and Hepatitis B vaccines for occupational
purposes.
The department provides seasonal influenza surveillance. Data collected from
provider testing though local clinics and hospital staff has given the department a
better picture of the effects of seasonal influenza in the community, as well as
enhancing our ability to share local statistics with the public.
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Local Public Health Authority Annual Plan 2010-2011
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There is also a focus on integrating planning among our Immunization,
Communicable Disease and Preparedness programs to increase effectiveness and to
decrease duplication of programming efforts.
The Communicable Disease team collaborates regularly with the media as a means
to prevent the spread of disease in our area. The team works to ensure that
education is available for the community when sought and works with local media
to be proactive with public education around topics such as tuberculosis, MRSA
and influenza.
Currently:
• The program has a Communicable Disease Program Manager, CD
Coordinator, CD Health Educator, STD/CD backup RN, Immunization
Coordinator, Public Health Preparedness Coordinator, HIV Case Manager,
and support staff.
• There is a mechanism in place for 24/7 calls for communicable disease
reporting and public health emergencies.
• Evaluations of facilities implicated in a food-borne outbreak are assessed by
Environmental Health working in close collaboration with CD team staff.
The Environmental Health Licenses Facilities Program will transfer into the
department on July 1, 2010.
• Investigations are completed in a timely manner, control measures are
taken, and reports are completed and sent to the state in the specific time
frame.
• The program provides access to prevention, diagnosis, and treatment
services to protect the public.
• Communicable disease trends are evaluated on a regular basis by the CD
team, and objectives are developed.
• Immunizations are provided to the public.
• A needle exchange program was launched in 2005 and has grown
exponentially since that time.
• Rabies immunizations are provided in the jurisdiction.
• The program has generic press releases for outbreak information.
2. Parent and Child Health Services
Prenatal Care Access: Reestablishment of the Oregon MothersCare system has
resulted in significantly more OHP enrollments and referral to prenatal care. Our
Oregon MothersCare staff was increased to 0.5 FTE in 2009 and has been able to
increase services substantially. In 2006 our OMC program began faxing referrals to
local dentists to assist women in access to dental care. The need for OMC is much
greater than our current capacity, but our worker is also a WIC employee and has
been able to help women with WIC certification during OMC appointments and with
OHP assistance during WIC appointments. This has greatly benefited coordination
of care and access to services. Oregon Mothers Care provided OHP assistance and
referral to 688 clients in 2008, and in 2009 in 665.
This team works in close collaboration with our own HealthyStart Prenatal Service—
a safety net clinic where low income women who are ineligible for OHP receive high
quality prenatal care and birth delivery services. The clinic is a collaborative
program of the department and St Charles Health System. Prenatal care was
provided to 316 clients in 2008 in the HealthyStart prenatal clinic, but in 2009 the
economic decline resulted in an exodus from our county with 269 clients being
served in the clinic.
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Dental Care: While OHP enrolled pregnant women have coverage for dental care,
some area dentists refuse to provide care during pregnancy. OHP providers set
pregnant women up with their first appointment for cleaning and X-rays, and the
second appointment sometimes comes after their OHP coverage has ended. Women
on the CAWEM Plus program have an open dental card and cannot find a dentist to
serve them. Home visiting nurses estimate that nearly 97% of women on their
caseloads have serious dental problems yet are unable to access care. Significant
improvements have occurred with access to care and prevention efforts (see Oral
Health Section).
Dental screening was provided by public health nurses for pregnant women and
infants referred from WIC and our Latino Community Center. During the screening,
clients received education on oral care, fluoride varnish if indicated, referral to OHP
and dental care, and a dental kit containing educational materials in English or
Spanish, toothbrush, toothpaste, and Xylitol gum. The supplies were purchased
with a small grant from the Oregon Dental Society which was renewed in 2009.
In 2009, 29 dental screening clinics were held, with 205 clients seen; 203 fluoride
varnish applications were applied. Currently, we are working on a collaboration
with the Family Drug Court to host the Medical Teams International dental van at
the department. Funding is provided by the Drug Court, but the van staff has had
difficulty finding volunteer dentists, so the van has been unable to come monthly.
The department maintains a three-page list of clients unable to access dental care
elsewhere. Dental issues continue to be an insoluble problem despite the expansion
of OHP for both children and adults.
Maternal Case Management and Social Services: Population growth has caused
demand for services to greatly exceed nurse home visiting capacity. Administrative
staff is participating with state staff in workgroups to redesign home visiting
services.
Home visiting programs consist of Maternity Case Management in which 178 clients
were served despite staffing shortages in 2009, and BabiesFirst! which saw 385
clients in 2009 of which some were also enrolled in CaCoon. The department
contracts with Child Development and Rehabilitation Center to provide case
management services through the CaCoon program to children with a medical
diagnosis. Major work will be focused on development of the new home visiting
framework guidance from recent state/county workgroups.
Public health nursing staff are current on NCAST training and use these tools to
assess attachment and provide parent training. This year three staff will be trained
on Promoting First Relationships.
Intimate Partner Violence: Services are limited to the local family violence shelter
and lack an outreach/education component.
Behavioral Health Services: Behavioral health services are offered at many
locations in the community including 26 public schools, agencies such as the KIDS
Center and Oregon State Department of Human Services, area hospitals, care
facilities and homes, and through mobile outreach. With the exception of co-
occurring disorders, most county alcohol and drug treatment services to eligible,
priority populations are provided via contracting with private agencies in Deschutes
County. Services are limited; OHP penetration rates are in need of improvement
statewide.
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Tobacco Cessation: In Oregon, 19% of adults smoke cigarettes and 6% of adult
males use smokeless tobacco. Among youth in the state, 9% of 8th graders and 17%
of 11th graders smoke cigarettes. In Deschutes County, the past several years have
seen a decline in the number of pregnant women who smoke. The most current
data, 2007, indicates a rate of 12%, down from 18% in 1997.14
WIC—Women, Infants & Children: The WIC program offers nutrition counseling,
referral services, breastfeeding education and food vouchers to women who are
pregnant, post-partum and/or breastfeeding. The program also serves children
from birth to five years old. In 2010, advanced breastfeeding education will be
offered to MCH, WIC, HealthyStart Prenatal Program and Oregon Mother's Care staff
so all our shared clients get the best information. Breastfeeding support remains
strong in WIC and local hospital outreach programs. Support has improved with
better coordination among perinatal services and the addition of the WIC
Breastfeeding Peer Counselor Program as well as a strong Breastfeeding Coalition.
The WIC program served 2,971 families (of whom 68 % were working families),
2,129 women, 5,224 infants and children under 5 in 2009. 93.3% of our moms
started out breastfeeding, which is a reflection of the commitment and level of
education on breastfeeding issues in our WIC department.
Multicultural Service: The growing need for translators and Hispanic service
results in an increasing gap between need and capacity as medical and human
services experience shortfalls in resources. The department has placed a strong
emphasis on bilingual hires in key positions and invested in cultural sensitivity
training.
Child Health Services: The department provides education, screening and follow-
up for growth and development, hearing, vision, lead, and symptoms of illness for
high-risk infants and children. These services are provided through School Based
Health Centers (SBHC) in La Pine, Bend and Redmond; and nurse home visiting.
Additionally, we provide assessment of parent/child interaction (NCAST) and
Sudden Infant Death Syndrome (SIDS) follow-up.
Our La Pine School Based Health Center (SBHC) is located in the parking lot of the
La Pine High School and within walking distance of the middle school and
elementary school. Once registered, students are able to walk in for sick visits
without missing school or requiring parents to miss work to accompany them. New
SBHCs opened in Bend and Redmond in 2009 and are fully certified. Our safety net
well-child clinic has been rolled into the respective SBHCs to provide care to
children birth to age 20. Two new planning grants were obtained for centers at
Sisters High School and Redmond High School in 2009 and, if successful, the
centers will be certified in 2010. The existing centers served over 1,747 students in
the 2008-2009 school year.
Deschutes County was chosen as a pilot site for Oregon’s Launch Project under a
federal grant which continues five years. Launch uses the SBHCs as a hub to
provide integrated health, behavioral health, parent training and referral to children
birth to age eight at risk for child abuse and neglect. The project funds a media
campaign to raise community awareness of the importance of holistic preventive
care for young children. Launch also drives collaborative efforts among providers of
child health services locally and at the state level and will inform improvements in
the service continuum of care.
14Source: Tobacco Prevention and Education Program. Deschutes County Tobacco Fact Sheet 2009.
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Local Public Health Authority Annual Plan 2010-2011
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Family Planning Services: Deschutes County Health Services maintains four
reproductive health clinic sites to serve multiple areas of the county. We have two
full-time clinics in Bend and Redmond, and within the past year we have expanded
our services in La Pine from two Thursdays a month to every Thursday. For the
past three years we have been serving youth and adolescents up to age 25 at the
Downtown Health Center and have expanded those services to three and a half days
a week. We offer a broad range of contraceptive methods and reproductive health
services to clients who qualify. Of the family planning clients seen in 2009, 76%
had no private insurance or Oregon Health Plan coverage.
All clinics provide care under policies, procedures, protocols and standing orders
approved by the Medical Director, Mary Norburg, MD. Reproductive health staff
meet on a regular basis to discuss program updates and case studies and to
exchange information. The program delivered services to 3,559 unduplicated clients
in 2009, with 5,949 clinic visits, and averted over 150 teen pregnancies.
The registered nurses working in reproductive health are required to complete a
comprehensive training program and have nurse practitioner back-up available.
The support staff are given training materials on the fundamentals of family
planning that are based on up-to-date research and current guidelines. The
training modules focus on birth control methods, anatomy and physiology, and STIs
as well as communication skills, informed consent, and client education. We use a
broad range of client education materials, many of which we have developed
ourselves to meet the educational needs of the clients. These materials are reviewed
by our Family Planning Advisory Committee. The materials are kept current and
are available in Spanish and English. Materials are selected or developed for
prevention as well as for education regarding specific conditions.
Our reproductive health community outreach and education has grown in the past
several years. We have several health educators and AmeriCorps volunteers who
actively participate with community partners. They attend the Bend-La Pine School
District's Health Advisory Board meetings and play an important role in helping that
school district come into compliance with the sexuality education guidelines.
3. Collection and Reporting of Health Statistics
Vital records work related to births and deaths is well organized, highly accurate
and extraordinarily efficient thanks to a small staff of highly trained and dedicated
professionals. The local Medical Examiner is now compiling and sending
information to the department on deaths of public health significance and assisting
in monitoring trend data related to injury and death due to illicit drug use. Vital
statistics and communicable disease information is received and recorded in a
timely manner.
The communicable disease (CD) information is forwarded to the State of Oregon
through the new CD database; and immunization data entry is completed daily.
The numbers of births and deaths continue to increase related to a rapid increase in
overall county population. In the past two years we have witnessed an explosive
rise in birth numbers.
Local partners have become increasingly reliant upon up-to-date and accurate
population and birth forecast information for program and facility planning
purposes. The department has improved access to vital statistics through links in
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its website. Reportable disease has increased consistently with increased
population and improved communication with local physicians and laboratories.
Recently, the Department has worked to inform the community of the condition of
health across the community. This has been done by producing community health
profile reports every two years and by selectively profiling specific health issues such
as obesity, access to primary care, and the oral health condition of children. The
2009 Health Report is attached as Appendix A.
4. Health Information and Referral
Health information and education is provided through Deschutes County Health
Services in each program. On a typical day, 125 or more calls are received from the
public wanting information on health related matters. Callers seek information
about a wide range of topics such as primary and behavioral health care, mold
control, animal bites, how to access the Oregon Health Plan, current blue-green
algae advisories, etc. Clinicians and front office staff frequently serve as brokers of
information to clients and make referrals for additional health and social services.
5. Environmental Health
Deschutes County is fortunate to have a staff of highly trained and dedicated
licensed environmental health specialists who do an outstanding job of assuring the
safety of public food establishments, pools, spas, child care facilities and drinking
water systems.
The Environmental Health Program (EH) provides plan review, consultation and
inspection of regulated public facilities (restaurants, pools, tourist facilities, schools
and child care centers) and on-site wastewater and dispersal systems. The program
also regulates public water systems to provide safe drinking water and works with
the department on a variety of epidemiology programs and issues. A close working
relationship exists between the EH program staff and the communicable disease
(CD) control team within the department. In recent years, there has been a number
of EH issues addressed collaboratively between these two programs.
In July, 2010 the EH team will transfer to the Health Services department which
will greatly expand capacity in all facets of EH, from food borne disease
investigations to toxicology to emerging diseases. There will be location
management changes with this July 1, 2010, transfer. Maintaining service
productivity and quality of current programming will be a priority while looking for
new ways to integrate into public health programming.
Licensed Facilities—Food Inspection Protection Program: Deschutes County,
once again, holds the distinction of having the most licensed facilities to inspect per-
capita in Oregon. Each year the EH staff inspects about 2,000 food service
establishments, temporary and mobile food units, commissaries, warehouses, and
bed and breakfast establishments. In addition, the Licensed Facility team conducts
plan reviews on nearly 100 new or remodeled restaurants and provides about a
thousand food handler tests. The team built a Verizon/AccuTerm database which
provides for “real time” data. The staff also taught five food handler classes across
the communities we serve. EH staff works closely with the County CD and State
Department of Human Services teams on outbreak investigations and is on a
legislative workgroup to reform the temporary restaurant requirements.
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Local Public Health Authority Annual Plan 2010-2011
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Safe Drinking Water: Environmental Health continues to provide professional,
technical, and regulatory assistance to over 200 public water systems in Deschutes
County. The team conducts dozens of comprehensive sanitary surveys and
investigates about 30 water quality alerts associated with bacteriological and/or
chemical contamination each year. The team makes sure the sampling protocols
are followed and follows up on samples which do not meet the Federal Safe Drinking
Water Standards. Security and emergency response plans are reviewed regularly.
The Environmental Health program has mapped all drinking water sources in
Deschutes County. This will ensure that if a source is contaminated residents can
be immediately notified and directed to the appropriate alternative water source.
Pool, Spa and Tourist Facilities: Environmental Health performs about 350 pool
and spa inspections annually and an additional 50 inspections of tourist
accommodations. In addition, the team reviews pool and spa plans for new
facilities.
Schools and Child Care Facilities: Environmental Health conducts about 100
National School Lunch Program Inspections each year, serving over 19,500 students
per day. In 2009, the EH team conducted 80 inspections of licensed child care
facilities.
D. Adequacy of Other Key Services Critical to Public Health
Community Advocacy and Multicultural Health: The department has provided
support to local community coalitions addressing hunger, homelessness,
methamphetamine abuse, child abuse, health care, childhood obesity, asthma,
transportation, domestic violence, and public safety. Note: Deschutes County Health
Services hosts the Cascades East Area Health Education Center's medical interpreter
students at our site to provide more clinical learning opportunities for the program.
Emergency Preparedness: Deschutes County emergency preparedness has improved
with an infusion of grant money and a restructure of the department which emphasizes
a team approach to disaster preparedness. Program staff have developed specific plans
for a variety of potential threats and have initiated a new Citizen Corps program
(comprising health professionals and law enforcement), engaging volunteers to assist
with exercise development and real life threats such as the H1N1 event.
The department is a key player and lead planner of the Deschutes County Pandemic
Influenza Plan and H1N1 Pandemic response initiatives. Planning partners who include
school, health care, and first response leadership are engaged in planning and response
activities and have identified areas for improvement. All hazard response plans are
incorporated in the Deschutes County Emergency Response Plan.
The Department continues to work with the Deschutes County Emergency Manager to
plan county exercises. We also continue to meet with Jefferson and Crook county
leadership to improve regional preparedness coordination. Preparedness staff are
leading the effort to improve the capability of all department staff to respond to an
emergency through ICS/NIMS training.
Laboratory Services: The department provides laboratory services in compliance with
CLIA standards. The lab director oversees the laboratory policies, procedures and
quality assurance while providing technical services to clinicians. The department has
a contract with Central Oregon Pathology to process our conventional pap smears,
surgical biopsies and high risk HPV tests. Most other lab services are conducted at
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Local Public Health Authority Annual Plan 2010-2011
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Oregon Public Health Lab or the local lab at St. Charles Medical Center. This
arrangement provides for full laboratory services for communicable disease, prenatal,
family planning and sexually transmitted infection services. Local labs report
conditions reportable to the Communicable Disease team.
Nutrition: Screening, education, and assessment are provided extensively in MCH and
WIC programs and are offered to pregnant women in the prenatal care clinic. Targeted
screening and assessment are provided to adults in family planning and safety net
primary care clinics. An acute focus on school nutrition has been developing over the
past two years; and Bend, La Pine and Redmond schools are well ahead of state
mandates when it comes to the nature of foods served and sold on their campuses.
Currently the SBHCs are partnering with the schools, Oregon State University
Extension services and Parks & Recreation to try to develop a comprehensive program
to assist families of children identified as overweight or obese. A group has formed to
explore the Rx for Play research project and see if we can bring it to our community as
another resource for these families.
Primary Health Care Access for Low-Income Residents: Approximately 37,000
Deschutes County residents are without health insurance coverage. In addition, those
with fee-for-service Medicare and Oregon Health Plan coverage suffer from a private
market health care community which has greatly limited or closed their practice to
these individuals, citing low reimbursement rates. We estimate that nearly 40,000
residents suffer from an economic barrier to basic health services. Many of these are
children, working adults and Hispanic families. DCHS continues to work in close
collaboration with the local medical providers and community organizations to address
the health care needs of our underserved populations.
HealthMatters Central Oregon—Health Services Hub: This is one of Oregon’s
non-profit, community based action groups that serves as a central clearing
house to address system reform aimed at improving health and access to care.
Initiatives of the collaborative involve employee health and worksite wellness, self
management of chronic conditions, and community development initiatives that
enhance the opportunity for residents to exercise, walk, bike and socialize. Most
recently the collaborative has begun an initiative called SharedCare, which is a
multi-share health coverage program currently being developed to provide health
coverage for uninsured, low-income workers in Crook, Deschutes and Jefferson
counties.
Deschutes County Health Services
Local Public Health Authority Annual Plan 2010-2011
22
III. ACTION PLAN
A. Epidemiology and Control of Preventable Disease & Disorder
1. Communicable Disease
Current Condition Or Problem—General: A constant in the realm of public health
is that communicable diseases have long been known to be the primary cause of
morbidity and mortality in man. Over the past hundred years, the incidence and
prevalence of communicable disease has diminished. These declining rates were due
to improved systems of sanitation and hygiene practices as well as the development of
vaccines to help prevent the spread of disease. However, in recent years morbidity
and mortality rates are climbing from newly identified diseases and resurgence of old
diseases. According to Oregon Health Services, the five most prevalent infectious
diseases in Deschutes County for 2009 were:
• Chlamydia (405)
• Hepatitis C (195)
• Campylobacter (30)
• Giardiasis (19)
• Salmonellosis (10)
Chlamydia continues to be the highest reported disease in Deschutes County. The
cases have doubled in the past four years, which has increased workload for our staff
a great deal. Gonorrhea and syphilis have also established a presence in the past five
years and continue to increase with the population growth.
Deschutes County continues to have a high number of waterborne disease cases and
increased numbers of Norwalk-like viruses in congregated living settings.
After several years of no reported active tuberculosis disease, the past two years saw
several new cases of both active TB and inactive infections (LTBI). Due to the large
geographical area, it has been difficult for nurses to travel daily to do directly
observed therapy. The travel and time allotted has put a strain on other program
priorities.
Goal: To improve/maintain the health status of the citizens of Deschutes County by
preventing/reducing the incidence of communicable disease through outreach
education, epidemiological investigation and surveillance activities.
Timeliness of Disease Investigation: Deschutes County Health Services continues
to respond quickly to reportable diseases, within the necessary window period, and
typically all diseases are initiated in the first day and completed as soon as possible.
In regard to working with the current database to ensure that the data is housed in
the correct places to receive credit for reporting timeliness, the team will continue
undergoing quality assurance processes to maximize accuracy.
Deschutes County Health Services
Local Public Health Authority Annual Plan 2010-2011
23
Activities:
Target
Population
Who What Timeline
Deschutes
County
residents
CD
Coordinator
Objective 1:
• Mechanism in place to receive, evaluate,
respond to urgent disease reports 24
hours a day, 7 days a week.
• Provide epidemiological investigations on
100% of reportable diseases within 24
hours.
Ongoing
Deschutes
County
residents
CD Team Objective 2:
• Case investigations are complete.
• 100% of reported cases are reported to
DHS by end of the calendar week of the
completion of the investigation.
• Information and recommendations on
disease prevention are provided to 100%
of exposed contacts locally.
• All demographics are completed on the
case reports.
• CD investigations are to begin within one
working day of report
• Update CD database as needed.
Ongoing
Medical
providers
CD
Coordinator
Outreach
Worker
Objective 3: Increase the number of medical
providers reporting CD appropriately
through outreach and education.
• An emergency system for communication
of CD alert information will be
maintained.
Ongoing
Medical
providers
CD
Coordinator
Objective 4: A consistent system to provide
feedback regarding the outcome of the
investigation to the health care provider.
Ongoing
Deschutes
County
staff
CD Team Objective 5: Provide blood-borne pathogen
training to staff each year.
Ongoing
Deschutes
County
residents
CD Team Objective 6: Update the Pandemic Influenza
Plan based on lessons and feedback from the
H1N1 Pandemic.
Ongoing
Evaluation:
Objective 1: 24/7 system in place with positive test results.
Objective 2: Completed reports sent to State—monthly evaluation.
Objective 3: Improved reporting and communication with medical community.
Objective 4: Development of a system for provider feedback and implementation.
Objective 5: Documented training.
Objective 6: Updated Pandemic Influenza Plan based on lessons and feedback from the
H1N1 Pandemic.
Current Condition Or Problem—HIV: The number of HIV positive individuals
continues to grow in Deschutes County with the increase in population. In 2009 we
had 7 newly diagnosed cased of HIV. During the first year of the new HIV testing
statistics, there were 16 reported cases of HIV in Deschutes County with 6 cases of
AIDS. HIV positive individuals still find difficulty living in a community with fears
around HIV. There are currently nearly 60 HIV positive clients enrolled in our HIV
Deschutes County Health Services
Local Public Health Authority Annual Plan 2010-2011
24
Case Management Program. It is anticipated that HIV caseloads will grow steadily
over the next few years as more people move to the area and with the downturn in the
economy.
Future considerations include concerns about the need for medical care and
medication with the loss of the Oregon Health Plan programs. In addition, nationally
39% of persons diagnosed with HIV received an AIDS diagnosis within the first year of
diagnosis, whereas in Deschutes County over 50% of our newly diagnosed HIV clients
have progressed to AIDS within the year. This is a sign that people are getting
diagnosed later in their disease than in other areas of Oregon and the United States.
Future trends and concerns also include the rising injection drug use in the county
and Hepatitis C cases which have a high co-morbidity rate with HIV. We are focusing
our outreach on high-risk groups which include those who use injection drugs and
men who have sex with men.
Goal: To improve/maintain the health status of the citizens of Deschutes County by
preventing/reducing the incidence of communicable disease through outreach
education, counseling and testing for HIV.
Activities:
INTERVENTION
NAME
TARGET
POPULATION(S)
PROJECTED
NUMBER OF
TESTS
SITES
Men Having Sex with
Men (MSM) 40
Deschutes County Health
Services
Downtown Health Center, Male
Clinic, Fridays 2:00-4:00 p.m.
Persons Who Inject
Drugs (PWID) 120
Deschutes County Health
Services
Deschutes County Adult Jail
Work Release Center
Pfeifer & Associates Treatment
BestCare Treatment Center
Mobile Health Services van
MSM/PWID 5
Targeted HIV
Counseling and
Testing
Partners of People
Living With HIV/A
(PLWH)
10
Deschutes County Health
Services
Downtown Health Center
MSM 70
Bend PRIDE
Downtown Health Center, Male
Clinic, Fridays 2:00-4:00 p.m.
National HIV Testing Day
Adult stores
PWID 100
Mobile Health Services van
Homeless Event
Presentation
MSM/PWID 0
Outreach to CTRS
Partners of PLWH 40 Case management services
Positive Self-Management Class
Deschutes County Health Services
Local Public Health Authority Annual Plan 2010-2011
25
INTERVENTION
NAME
TARGET
POPULATION(S)
PROJECTED
NUMBER OF
TESTS
SITES
OHROCS Needle
Exchange (NEX) 100
Deschutes County Health
Services
Mobile Health Services van
OHROCS Outreach
PWID
100
Deschutes County Adult Jail
Work Release Center
Presentations
BestCare Treatment
Pfeifer & Associates Treatment
Current Condition Or Problem—Tuberculosis: Deschutes County has seen an
increase in the amount of active TB cases, as well as LTBI cases in the past five years.
There has been a trend of Hispanic clients with LTBI in the past three years. The
amount of people receiving LTBI treatment, which ranges from 45-100, depends on
the amount of screening outreach the program can provide. Staff hopes to work more
with the homeless population and other high-risk groups to treat inactive infections
before they become contagious.
Goal: To provide comprehensive services to the community for the prevention and
treatment of tuberculosis, while focusing on awareness and education throughout
Deschutes County.
Activities:
Target
Population
Who What Timeline
Deschutes
County residents
CD Coordinator Objective 1: Increase the number of PPD
provided to high risk populations, and
decrease to low-risk populations.
Ongoing
Deschutes
County residents
CD Coordinator Objective 2: HIV testing will be offered to all
cases and suspected cases of tuberculosis.
Ongoing
Deschutes
County residents
receiving LBTI
from
Department.
CD Coordinator Objective 3: Improve the number of clients
completing LTBI to a consistent 75%.
Ongoing
Medical providers CD Coordinator Objective 4: Increase awareness to medical
providers for active TB cases.
Ongoing
Shelter residents CD Coordinator
Program
Manager
Objective 5: Explore the implementation of a
screening program for shelter residents.
By 2012
Deschutes
County residents
CD Coordinator
and Team
Objective 6: Update policies, forms, and
protocols annually. (Completed.)
Ongoing
Deschutes
County
employees
CD Coordinator
Program
Manager
Objective 7: Update employee respiratory
protection and screening program annually
and provide fit testing for staff.
Ongoing
Evaluation:
Objective 1: Target PPD tests provided through the Department.
Objective 2: Documented HIV testing.
Objective 3: Statistics from Oregon Health Services.
Objective 4: Number of presentations and information packets to providers.
Objective 5: Number of shelter residents receiving screening.
Objective 6: Updated protocols and policies—documentation.
Objective 7: Updated policy and documented fit testing.
Deschutes County Health Services
Local Public Health Authority Annual Plan 2010-2011
26
Current Condition Or Problem—West Nile Virus: The Deschutes River Basin is
home to the Culex tarsalis, Culex pipiens, and Aedes vexans mosquitoes. These
mosquitoes all have the potential to carry West Nile Virus, and this will pose a threat
for animals and humans in Deschutes County. The current problem includes lack of
information to the general public and lack of a countywide vector control district.
Deschutes County has had very few case reports, and each year it becomes less and
less important to community members as risk seems more remote. The reality is that
West Nile Virus is still very much a risk due to the likeliness of low community
immunity levels.
Goal: Maintain a low morbidity and mortality of West Nile Virus through the
development of an updated West Nile Virus response plan.
Activities:
Target Population Who What Timeline
Deschutes County
residents
Four Rivers
Vector Control
Objective 1: Continue surveillance for the
presence of specific mosquitoes throughout
Deschutes County.
Ongoing
Deschutes County
residents
Four Rivers
Vector Control
Objective 2: Maintain vector control
activities already in place.
Ongoing
Deschutes County
residents
CD Coordinator
Environment
Health staff
Objective 3: Solicit dead bird submissions
for testing from the public and appropriate
local agencies.
Ongoing
Deschutes County
residents
CD Team Objective 4: Provide public information on
personal protective measures.
Ongoing
Deschutes County
residents
CD
Coordinator
Objective 5: Continue public hotline for
Deschutes County residents on the issues
relating to West Nile Virus.
Ongoing each
spring
Evaluation:
Objective 1: Surveillance activities ongoing through spring and summer.
Objective 2: Continue current vector control activities through contract with Four
Rivers Vector Control.
Objective 3: Dead bird submission information to the public and system in place.
Objective 4: Dissemination of materials and articles to the general public.
Objective 5: Completion of community forums and ongoing update of West Nile
Response Plan.
2. Emergency Preparedness
Current Condition Or Problem: Emergency preparedness in Deschutes County has
improved over the past eight years with grant support and staff who are dedicated to
helping the department and community prepare for hazards that could overwhelm the
county. Program staff have developed numerous plans, improved communicable
disease response times, collaborated with community partners, developed a basic
disaster response plan, and continue to work with the Deschutes County Emergency
Manager to integrate DCHS plans into the County's Emergency Operations Plan.
Goal: To improve the response to communicable disease and public health
emergencies throughout Deschutes County.
Deschutes County Health Services
Local Public Health Authority Annual Plan 2010-2011
27
Activities:
Target Population Who What Timeline
Deschutes County
residents
CD Program
Manager
Preparedness
Coordinator
Objective 1: Participate with Cascade
Healthcare Community and Emergency
Management in area preparedness planning.
• Complete state requirements on drill
development and practice, engaging
community partners in the process.
• Pandemic planning ongoing.
Ongoing
Deschutes County
residents
CD Team Objective 2: All hazards plans are integrated
into the Local Emergency Operations Plan.
Ongoing
County partners CD Team Objective 3: Mutual aid agreements are in
place for the tri-county region.
Completed
and Ongoing
Deschutes County
residents
CD Program
Manager
Objective 4: 24/7 contact information has
been provided to DHS, Health Services and
other public safety agencies.
Ongoing
Mass immunization
population
Immunization
Coordinator
CD Coordinator
Objective 5: Update and review SNS Plan
(CD).
Ongoing
Deschutes County
residents
Preparedness
Coordinator
Objective 6: Complete/update development
of all plans:
• Mass Prophylaxis
• Smallpox Response
• Pandemic Flu
• Lab and provider reporting
• Mass Casualty
• Mechanisms for receiving and responding
to CD reports
• Identification and planning for meeting the
needs of special populations
Ongoing
Deschutes County
residents
CD Team Objective 7: Health risk information is
communicated and disseminated through,
but not limited to, the following measures:
• Individual chosen to carry primary
responsibility for coordinating aspects of
public information communication has
been designated.
• The LHD Communication Officer actively
participates in statewide planning and
coordination of public health messages.
• The LHD Communication Officer is
educated in the concept of ICS
communication structure.
• Local staff has participated in training for
risk communication and how to use those
techniques effectively.
Ongoing
Department staff Preparedness
Coordinator
Objective 8: Training plan for all staff to be
ICS and NIMS compliant.
Completed
Evaluation:
Objective 1: Ongoing Disaster Planning Group.
Objective 2: Integration of all plans.
Objective 3: Mutual aid agreements in place.
Objective 4: 24/7 communication intact.
Objective 5: Completed SNS Plan.
Objective 6: Plans completed.
Objective 7: Risk communication training documented and plan completed.
Objective 8: Staff trained in ICS and NIMS.
Deschutes County Health Services
Local Public Health Authority Annual Plan 2010-2011
28
3. Food-Borne Illness Reports
Food-borne illness in Deschutes County remained similar to previous years, with 3
E.coli, 10 Salmonella cases, and 30 Campylobacteriosis cases reported in 2009.
Public Health and Environmental Health continue to work together to address
outbreaks, health education in the community, and sharing workload to address
community concerns. There has been an increase in the number of Norwalk-like
illnesses, with multiple nursing home and school outbreaks reported. Each year it is
challenging for staff to keep up with the growing number of Norovirus outbreaks in
congregate settings reported to the County.
4. Immunizations
The Immunization Program has worked hard to improve rates for two year olds. In
1999, the County was ranked thirty-fifth in Oregon and steadily has moved up the
scale to exceed state average in 2008. The extensive work with coalitions, community
education and providers has made a difference in outcomes. The H1N1 Pandemic has
been a challenge for all public health programs, with immunization programming
being at the forefront of the response initiatives. Strong community relationships,
committed staff members, and tri-county planning were necessities in the
successfully coordinated response.
The Shots for Tots Program will continue with the sponsorship of the High Desert
Rotary Club. The club has chosen the Shots for Tots Program as their project with
funding each year through the Rotary Duck Race and numerous fundraising projects.
The Immunization Program is also working closely with School Based Health Centers
to increase immunization services.
Current Condition Or Problem: The Immunization Program needs to continue to
grow with the increasing population in Deschutes County. The lack of providers who
will see children with Oregon Health Plan is a concern, and the poverty level has
increased with the increased unemployment. Shots for Tots and School Based Health
Centers continue to fill a gap, but the gap is growing. The Immunization Program has
worked hard to improve rates for two year olds, though there are still improvements to
be made. The extensive work with coalitions, community education, and providers
has made a difference in outcomes. Issues in Deschutes County include prevention of
Pertussis and the need to increase Tdap vaccination among adolescents and adults;
an increasing number of parents choosing not to immunize or to delay needed
immunizations; Hepatitis B vaccinations implemented in the hospital, and the
growing population of young children with no health care. Staff will continue to work
with providers to increase Tdap vaccination rates among new parents and
adolescents, and those who are in close contact with infants. We are seeing more
physicians vaccinating infants at birth for Hepatitis B, which is an improvement from
previous years.
Goal: To improve the mortality and morbidity rates of Deschutes County citizens by
reducing vaccine preventable diseases.
Deschutes County Health Services
Local Public Health Authority Annual Plan 2010-2011
29
Plan A - Continuous Quality Improvement: Reduce Vaccine Preventable Disease
Objectives Activities
Date Due /
Staff
Responsible
Outcome Measure(s)
Outcome
Measure(s)
Results
Increase the up-
to-date rate for 2
year olds
(431331) seen at
Deschutes
County Health
Services by 1% a
year over the
next 3 years
• Use most recent AFIX
assessment data as the
baseline
• Work with Clinic Coordinator to
provide a yearly staff in-
service(s) to review
immunization best practices,
new immunizations, and
education.
• Give immunization updates at
monthly clinic meetings and
SBHC meetings.
• Fully screen each patient for
imms at every visit and
immunize as needed.
• Assure every shot is entered in
IRIS/ ALERT from clinic and
other sites within 14 days of
administration.
• Baseline set
• Yearly in-service held
on: ___
o Topics covered:
o # attendees @ in-
service
• Monthly updates
given at clinic and
SBHC meetings.
• Screening & imms at
every visit by all staff
12/10 HK
• Training held for
WIC staff on new IIS:
___.
• All staff trained to
talk with parents
and able to answer
questions about
vaccine safety
• BabiesFirst! CHNs
now providing imm
education at home
visits.
• Yearly training for
data input/clerical
staff initiated on ___
• Screen for imms at all WIC
appts & ensure clients are
referred to medical home or
LHD immunization clinic
To be
completed
for the CY
2010 Report
Deschutes County Health Services
Local Public Health Authority Annual Plan 2010-2011
30
Outcome
Measure(s)
Results
Objectives Activities Date Due /
Staff
Responsible
Outcome Measure(s)
12/11 HK Increase the up-
to-date rate for 2
year olds
(431331) seen at
Deschutes
County Health
Services by 1% a
year over the
next 3 years
• Baseline set Continue to:
• Yearly in-service held
on: ___
• Use most recent AFIX
assessment data as the
baseline o Topics covered:
o # attendees @ in-
service
• Work with Clinic Coordinator to
provide a yearly staff in-
service(s) to review
immunization best practices,
new immunizations, and
education.
• Monthly updates
given at clinic and
SBHC meetings.
• Screening & imms at
every visit by all staff • Give immunization updates at
monthly clinic meetings and
SBHC meetings.
• Training held for WIC
staff on new IIS: ___.
• Fully screen each patient for
imms at every visit and
immunize as needed.
• All staff trained to
talk with parents and
able to answer
questions about
vaccine safety
• Assure every shot is entered in
IRIS/ ALERT from clinic and
other sites within 14 days of
administration.
• BabiesFirst! CHNs
now providing imm
education at home
visits.
• Screen for imms at all WIC
appts & ensure clients are
referred to medical home or
LHD immunization clinic
• Yearly training for
data input/clerical
staff initiated on ___
To be
completed
for the CY
2011 Report
Deschutes County Health Services
Local Public Health Authority Annual Plan 2010-2011
31
Outcome
Measure(s)
Results
Objectives Activities Date Due /
Staff
Responsible
Outcome Measure(s)
Increase the up-
to-date rate for 2
year olds
(431331) seen at
Deschutes
County Health
Services by 1% a
year over the
next 3 years
Continue to:
• Use most recent AFIX
assessment data as the
baseline
• Work with Clinic Coordinator to
provide a yearly staff in-
service(s) to review
immunization best practices,
new immunizations, and
education.
• Give immunization updates at
monthly clinic meetings and
SBHC meetings.
• Fully screen each patient for
imms at every visit and
immunize as needed.
• Assure every shot is entered in
IRIS/ ALERT from clinic and
other sites within 14 days of
administration.
• Screen for imms at all WIC
appts & ensure clients are
referred to medical home or
LHD immunization clinic
12/12 HK • Baseline set
• Yearly in-service held
on: ___
o Topics covered:
o # attendees @ in-
service
• Monthly updates
given at clinic and
SBHC meetings.
• Screening & imms at
every visit by all staff
• Training held for WIC
staff on new IIS: ___.
• All staff trained to
talk with parents and
able to answer
questions about
vaccine safety
• BabiesFirst! CHNs
now providing imm
education at home
visits.
• Yearly training for
data input/clerical
staff initiated on ___
To be
completed
for the CY
2012 Report
Deschutes County Health Services
Local Public Health Authority Annual Plan 2010-2011
32
Plan B – Community Outreach and Education
Calendar Years 2010-2012
Objectives Activities
Date Due /
Staff
Responsible
Outcome
Measure(s)
Outcome
Measure(s) Results Objectives
Increase the
number of
participants
using the new
ALERT IIS in
Deschutes
County over the
next three years
in:
• Private
provider
offices
• Schools
• Childcare
settings
• Commit staff time and
resources to project.
• Assess the level of use of
ALERT in schools, private
practices and day cares
using ALERT participation
data.
• Determine which type(s) of
agencies to contact and
focus effort on
• Offer assistance to those
sites needing help with
the new IIS.
• Encourage clinics to do
electronic transfer.
• Recruit any clinics not
reporting
• Collect promotion
materials to be used when
contacting & working
with facilities
• Compare numbers of
ALERT users post
recruitments and training
to determine yearly
increase.
Due
12/10
HK
• A portion of the
Immunization
Coordinator’s time
committed
throughout the
year
• Number of
schools, clinics
and day care
facilities using and
not using ALERT
to forecast
• Provide ALERT
training at one of
the coalition
meetings.
• Number of clinics
not submitting
shot records to
ALERT determined
• Visit a minimum of
3 clinics/year to
offer technical
assistance.
• Promotion
materials
distributed to
clinics, schools
and daycare
facilities
• Number or
percentage
increase of ALERT
participants
Maintain strong
membership in
the Deschutes
County
Immunization
Coalition (DCIC).
• Commit staff time and
resources to the coalition
• Identify & assess local
immunization issues &
concerns
• Identify possible new
members and invite them
to join.
• Organize and host a
minimum of four coalition
meetings a year plus a
yearly immunization
training for clinics.
• Gain input from members
on agenda items.
12/10 HK • A portion of the
Immunization
Coordinator’s time
committed to
organizing the
coalition.
• Four meetings are
held throughout
the year with
planned agendas
that include
immunization
issues and
education.
• One immunization
training is held in
August for clinics.
To be
completed
for the CY
2010 Report
Deschutes County Health Services
Local Public Health Authority Annual Plan 2010-2011
33
Objectives Activities
Date Due /
Staff
Responsible
Outcome
Measure(s)
Outcome
Measure(s) Results Objectives
Increase the
number of
participants
using the new
ALERT IIS in
Deschutes
County over the
next three years
in:
• Private
provider
offices
• Schools
• Childcare
settings
• Commit staff time and
resources to project.
• Assess the level of use of
ALERT in schools, private
practices and day cares
using ALERT participation
data.
• Determine which type(s) of
agencies to contact and
focus effort on
• Offer assistance to those
sites needing help with
the new IIS.
• Encourage clinics to do
electronic transfer.
• Recruit any clinics not
reporting
• Collect promotion
materials to be used when
contacting & working
with facilities
• Compare numbers of
ALERT users post
recruitments and training
to determine yearly
increase.
Due
12/11
HK
• A portion of the
Immunization
Coordinator’s time
committed
throughout the
year
• Number of
schools, clinics
and day care
facilities using and
not using ALERT
to forecast
• Provide ALERT
training at one of
the coalition
meetings.
• Number of clinics
not submitting
shot records to
ALERT determined
• Visit a minimum of
3 clinics/year to
offer technical
assistance.
• Promotion
materials
distributed to
clinics, schools
and daycare
facilities
• Number or
percentage
increase of ALERT
participants
Maintain strong
membership in
the Deschutes
County
Immunization
Coalition (DCIC).
• Commit staff time and
resources to the coalition
• Identify & assess local
immunization issues &
concerns
• Identify possible new
members and invite them
to join.
• Organize and host a
minimum of four coalition
meetings a year plus a
yearly immunization
training for clinics.
• Gain input from members
on agenda items.
12/11 HK • A portion of the
Immunization
Coordinator’s time
committed to
organizing the
coalition.
• Four meetings are
held throughout
the year with
planned agendas
that include
immunization
issues and
education.
• One immunization
training is held in
August for clinics.
To be
completed
for the CY
2011 Report
Deschutes County Health Services
Local Public Health Authority Annual Plan 2010-2011
34
Objectives Activities
Date Due /
Staff
Responsible
Outcome
Measure(s)
Outcome
Measure(s) Results Objectives
Increase the
number of
participants
using the new
ALERT IIS in
Deschutes
County over the
next three years
in:
Due HK
• Private
provider
offices
• Schools
• Childcare
settings
• Commit staff time and
resources to project.
• Assess the level of use of
ALERT in schools, private
practices and day cares
using ALERT participation
data.
• Determine which type(s) of
agencies to contact and
focus effort on
• Offer assistance to those
sites needing help with
the new IIS.
• Encourage clinics to do
electronic transfer.
• Recruit any clinics not
reporting
• Collect promotion
materials to be used when
contacting & working
with facilities
• Compare numbers of
ALERT users post
recruitments and training
to determine yearly
increase.
12/12
• A portion of the
Immunization
Coordinator’s time
committed
throughout the
year
• Number of
schools, clinics
and day care
facilities using and
not using ALERT
to forecast
• Provide ALERT
training at one of
the coalition
meetings.
• Number of clinics
not submitting
shot records to
ALERT determined
• Visit a minimum of
3 clinics/year to
offer technical
assistance.
• Promotion
materials
distributed to
clinics, schools
and daycare
facilities
• Number or
percentage
increase of ALERT
participants
To be
completed
for the CY
2012 Report
Maintain strong
membership in
the Deschutes
County
Immunization
Coalition (DCIC).
12/12 HK • Commit staff time and
resources to the coalition
• A portion of the
Immunization
Coordinator’s time
committed to
organizing the
coalition.
• Identify & assess local
immunization issues &
concerns
• Identify possible new
members and invite them
to join.
• Four meetings are
held throughout
the year with
planned agendas
that include
immunization
issues and
education.
• Organize and host a
minimum of four coalition
meetings a year plus a
yearly immunization
training for clinics.
• Gain input from members
on agenda items. • One immunization
training is held in
August for clinics.
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5. Tobacco Prevention Program
Deschutes County is above state average rates for smokeless tobacco use in adults as
well as our 8th and 11th graders. We have seen a dramatic increase in cigarette
smoking among our youth over the past five years, which spiked up to 27.8% of our
11th graders reportedly smoking in 2007. Though still above state average, our rates
did improve in this area for the 2009 Healthy Teens collection period. Our Tobacco
Prevention Coordinator and Tobacco Free Alliance are focusing on key areas that
involve access to smoking cessation resources, reaching youth, promoting tobacco
prevention resources in minority populations, and addressing second hand smoke
exposure. Smoke-free public grounds, smoke-free multi-unit housing, cessation
messaging, adequate resources, and best practice policies continue to be the primary
focus areas of our Tobacco Prevention Program.
ADDITIONAL REQUESTS: No revision to the Alert Plan.
B. Parent and Child Health Services, Including Family Planning Clinics as Described in
ORS 435.205
1. Women, Infants & Children (WIC)
EVALUATION OF WIC NUTRITION EDUCATION PLAN
FY 2009-2010
This plan was sent to Sara Sloan on April 19, 2010
Please use the following evaluation criteria to assess the activities your agencies did for each Year Three Objectives.
If your agency was unable to complete an activity please indicate why.
Goal 1: Oregon WIC staff will have the knowledge to provide quality nutrition education.
Year 3 Objective: During planning period, staff will be able to work with participants to select the food package
that is the most appropriate for their individual needs.
Activity 1: Staff will complete the appropriate sections of the new Food Package module by December 31, 2009.
Evaluation criteria: Please address the following questions in your response.
• Did staff complete the module by December 31, 2009?
• Were completion dates entered into TWIST?
Response: WIC staff completed this module in July, 2009. All completion dates have been entered into TWIST.
Activity 2: Staff will receive training in the basics of interpreting infant feeding cues in order to better support
participants with infant feeding, breastfeeding education and to provide anticipatory guidance when implementing
the new WIC food packages by December 31, 2009.
Evaluation criteria: Please address the following questions in your response.
• How were staff who did not attend the 2009 WIC Statewide Meeting trained on the topic of infant feeding
cues?
• How has your agency incorporated the infant cues information into ‘front desk’, one-on-one, and/or group
interactions with participants?
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Local Public Health Authority Annual Plan 2010-2011
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Response: All staff except Janet Harris attended the sessions at the state meeting. Janet reviewed the notes and
asked questions for clarification. She also attended our Nutrition Ed meetings where she got more information. Our
CPAs and even some MOAs/clerks (the ones who are also CLEs) are using the information in 1:1 counseling
sessions to help parents understand their infant.
Activity 3: Each local agency will review and revise as necessary their nutrition education lesson plans and written
education materials to assure consistency with the Key Nutrition Messages and changes with the new WIC food
packages by August 1, 2009.
Evaluation criteria: Please address the following questions in your response.
• Were nutrition education lesson plans and written materials reviewed and revised? The lesson plans have
been reviewed and some revised.
• What changes, if any, were made?
--In "Baby Signs for Mealtime" we will incorporate using the "more" sign for fruits and vegetables and
discuss the importance with parents.
--In "No Battles, Better Eating" we will discuss how decreasing juice and sweetened beverages can
improve a child's appetite. Will also discuss how changing to lower fat milk (thus decreasing saturated
fat) can help.
--In "Fit Kids, Fit Families" will incorporate messages of increasing fruits/vegetables/whole grains and
fiber as keeping fit inside.
--In "Breastfeeding" and "Back to Work" will incorporate message that exclusive breastfeeding gives baby
the most benefit.
Activity 4: Identify your agency training supervisor(s) and staff in-service dates and topics for FY 2009-2010.
Evaluation criteria: Please use the table below to address the following question in your response.
• How did your staff in-services address the core areas of the CPA Competency Model (Policy 660,
Appendix A)?
• What was the desired outcome of each in-service?
FY 2009-2010 WIC Staff In-services
In-Service Topic and Method of
Training
Core Competencies Desired Outcome
Addressed
Example: Example: Example:
Providing Advice This in-service addressed several
competencies in the core areas of
Communication, Critical Thinking
and Nutrition Education
One desired outcome of this in-
service is for staff to feel more
comfortable asking permission before
giving advice. Another desired
outcome is for staff to use the
Explore/Offer/Explore technique
more consistently.
Facilitated discussion during October
2009 staff meeting using the
Continuing Education materials from
Oregon WIC Listens.
Food Package Assignment Module:
done as a group. Facilitated
discussion
Addressed the core area "WIC
Program Overview" regarding
assigning food vouchers
Staff is able to correctly assign new
food packages based on category,
needs and preferences.
Oregon WIC Listens Strength &
Weakness Assessment: facilitated
discussion. Used 'Glowing, Growing,
Sowing' assessment
Addressed the core area
Communication
Staff was able to decide which areas
of PCE they were comfortable with
(glowing) and which they needed
more practice on (sowing and
growing)
Infant Feeding Cues Update:
facilitated discussion lead by IBCLC
Addressed the core area "Principles
of Life-Cycle Nutrition" specifically
breastfeeding
Staff is more able to counsel clients
on normal baby behavior with regard
to crying and sleeping so parents
don't always think the baby is
hungry.
New Strategies for Supporting
Breastfeeding"; facilitated discussion
lead by IBCLC
Addressed the core area "Principles
of Life-Cycle Nutrition" specifically
breastfeeding
Staff will be able to identify new
ways DC WIC supports exclusivity
and increased duration of
breastfeeding
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Local Public Health Authority Annual Plan 2010-2011
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Goal 2: Nutrition Education offered by the local agency will be appropriate to the clients’ needs.
Year 3 Objective: During plan period, each agency will develop a plan for incorporating participant centered
services in their daily clinic activities.
Activity1: Each agency will identify the core components of participant centered services that are being consistently
utilized by staff and which components need further developing by October 31, 2009.
Evaluation criteria: Please address the following questions in your response:
• Which core components of participant centered services are used most consistently with your staff? What
has made those the most easiest to adopt?
• Which core components have the least buy-in? What are the factors that make these components difficult
to adopt?
Response: Staff rated themselves as "Glowing" in the areas of asking permission, opening the conversation (greet,
introduce self, agenda, time), open-ended questions, affirmations. They have been easiest to adopt because they
seem the most natural and many staff had these as part of their routine anyway. They are also very specific and
quick so they were easy to add to an appointment. I am not comfortable stating that the following have the "least
buy-in" because staff really want to adopt all techniques--they have "bought in" to all of it. The ones they rated
most difficult to adopt were reflections, completing the assessment before educating, summarizing, focusing on
participants' interests (specifically using circle charts). These are more difficult because they are the least natural
and changed the way we do business most dramatically.
Activity 2: Each agency will implement at least two strategies to promote growth of staff’s ability to continue to
provide participant centered services by December 31, 2009.
Evaluation criteria: Please address the following questions in your response.
• What strategy has been implemented to maintain the core components of participant centered services
during a time of change?
• What strategy has been implemented to advance staff skills with participant centered services?
Response: To maintain the core components we have incorporated times at most monthly staff meetings to focus on
a component of PCE. We then choose one component to focus on over the next month and then at the following
staff meeting we discuss successes and challenges of implementing that component, and then move on to another
one for the next month. To advance staff skills we have started conducting peer-to-peer observations and giving
feedback to one another. We find this a bit daunting but it still provides better and more immediate education than
any other form of review. This really provides focus on those items we still find the most difficult to incorporate.
Goal 3: Improve the health outcomes of WIC clients and WIC staff in the local agency service delivery area.
Year 3 Objective: During planning period, each agency will develop a plan to consistently promote the Key
Nutrition Messages related to Fresh Choices thereby supporting the foundation for health and nutrition of all WIC
families.
Activity 1: Each agency will implement strategies for promoting the positive changes with Fresh Choices with
community partners by October 31, 2009.
Evaluation criteria: Please address the following questions in your response.
• Which community partners did your agency select?
• Which strategies did you use to promote the positive changes with Fresh Choices?
• What went well and what would you do differently?
Response: We selected our public health nursing staff, the Breastfeeding Coalition of Oregon, Head Start and our
Healthy Start Prenatal Program. We provided inservices at their meetings to inform them of the food voucher
Deschutes County Health Services
Local Public Health Authority Annual Plan 2010-2011
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changes and how that would support the health of our clients. They were all extremely receptive to the information
and we got very little negative feedback except the occasional "good luck with changing to low-fat milk." But,
overall, the reception was very good. We will choose this same method of information delivery for other changes as
well as it worked out nicely to have all staff together to ask questions and it allowed us to dispel myths, etc., all at
once.
Activity 2: Each agency will collaborate with the state WIC Research Analysts for Fresh Choices evaluation by
April 30, 2010.
Evaluation criteria: Please address the following questions in your response.
• How did your agency collaborate with the state WIC Research Analysts in evaluating Fresh Choices?
• How were you able to utilize, if appropriate, information collected from your agency?
Response: N/A
Goal 4: Improve breastfeeding outcomes of clients and staff in the local agency service delivery area.
Year 3 Objective: During plan period, each agency will develop a plan to promote breastfeeding exclusivity and
duration thereby supporting the foundation for health and nutrition of all WIC families.
Activity 1: Using state provided resources, each agency will assess their breastfeeding promotion and support
activities to identify strengths and weaknesses and identify possible strategies for improving their support for
breastfeeding exclusivity and duration by December 31, 2009.
Evaluation Criteria: Please address the following questions in your response.
• What strengths and weaknesses were identified from your assessment?
• What strategies were identified to improve the support for breastfeeding exclusivity and duration in your
agency?
Response: We found that we were strong all-around in breastfeeding knowledge, attitudes and education level of
staff. We have strong coalition representation at the local and state level and have been a BF Mother Friendly
employer for several years. We incorporate PCE into our breastfeeding counseling but may lack when it comes to
discussing the health risks of formula. Our current job descriptions do not address attitudes nor knowledge related to
breastfeeding. Anecdotally, we realized that many mothers supplement with formula or stop breastfeeding
altogether because of their misinterpretation of their infants cues which makes them think they are not satisfying the
baby. We have had our IBCLC, Jean Clinton, teach us about infant cues at several meetings and have one more in-
service coming up on 4/22/2010. Our staff are able to share this information with clients so they begin to understand
what their babies are trying to tell them and that the message isn't always "I'm hungry!" With this information,
mothers are more confident in their breastfeeding, and less frustrated, both of which support duration and
exclusivity.
Activity 2: Each agency will implement at least one identified strategy from Goal 4, Activity 1 in their agency by
April 30, 2010.
Evaluation criteria: Please address the following questions in your response.
• Which strategy or strategies did your agency implement to improve breastfeeding exclusivity and duration?
• Based on what you saw, what might be a next step to further the progress?
Response: Per above, we have been being trained on infant cues and how to share this information with parents. A
next step we are hoping to achieve is to develop a class on infant cues and baby behavior (once USDA releases the
information).
Deschutes County Health Services
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FY 2010 - 2011 WIC NUTRITION EDUCATION PLAN FORM
This form was sent to Sara Sloan on April 19, 2010
Goal 1: Oregon WIC Staff will continue to develop their knowledge, skills and abilities for providing
quality participant centered services.
Year 1 Objective: During planning period, staff will learn and utilize participant centered
education skills and strategies in group settings.
Activity 1: WIC Training Supervisors will complete the Participant Centered Education e-
Learning Modules by July 31, 2010.
Implementation Plan and Timeline: All WIC Training Supervisors, Laura Spaulding, Janet
Harris, Sherri Tobin and Jean Clinton will complete the PCE e-Learning Modules by July 31,
2010.
Activity 2: WIC Certifiers who participated in Oregon WIC Listens training 2007-2009 will
pass the posttest of the Participant Centered Education e-Learning Modules by
December 31, 2010.
Implementation Plan and Timeline: WIC Certifiers who participated in OWL training 2007-
2009 will complete the PCE e-Learning Modules and pass the posttest by August 31, 2010 (in
order to be able to take the group PCE training in the fall).
Activity 3: Local agency staff will attend a regional Group Participant Centered Education
training in the fall of 2010.
Note: The training will be especially valuable for WIC staff who lead group
nutrition education activities and staff in-service presentations. Each local
agency will send at least one staff person to one regional training. Staff
attending this training must pass the posttest of the Participant Centered
Education e-Learning Modules by August 31, 2010.
Implementation Plan & Timeline including possible staff who will attend a regional training:
Staff will attend a regional training on Group PCE in the fall of 2010. Any or all of the following
staff will attend (depending on space available; the more the better because we all provide group
education): Laura Spaulding, Jean Clinton, Theresa Reiter, Susan Christensen, Janet Harris, Grace
Kennedy, Sherri Tobin, Maria O'Neill, Erin Hoar, Shannon Robles.
Goal 2: Oregon WIC staff will improve breastfeeding support for women in the prenatal and post
partum time period.
Year 1 Objective: During planning period, each agency will identify strategies to enhance their
breastfeeding education, promotion and support.
Activity 1: Each agency will continue to implement strategies identified on the checklist
entitled “Supporting Breastfeeding through Oregon WIC Listens” by March 31,
2011.
Note: This checklist was sent as a part of the FY 2009-2010 WIC NE Plan and
is attached.
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Local Public Health Authority Annual Plan 2010-2011
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Implementation Plan and Timeline: By March 31, 2011, the WIC Coordinator and Lactation
Specialist will review all WIC job descriptions and change them to include breastfeeding
promotion knowledge, skills and attitudes as appropriate per position.
Activity 2: Local agency breastfeeding education will include evidence-based concepts
from the state developed Prenatal and Breastfeeding Class by March 31, 2011.
Note: The Prenatal and Breastfeeding Class is currently in
development by state staff. This class and supporting resources will
be shared at the regional Group Participant Centered Education
training in the fall of 2010.
Implementation Plan and Timeline: Deschutes County breastfeeding education will include
evidence-based concepts learned at the Group PCE training in the fall of 2010. These concepts
will be incorporated by March 31, 2011.
Goal 3: Strengthen partnerships with organization that serve WIC populations and provide
nutrition and/or breastfeeding education.
Year 1 Objective: During planning period, each agency will identify organizations in their
community that serve WIC participants and develop strategies to enhance partnerships with these
organization by offering opportunities to strengthen their nutrition and/or breastfeeding education.
Activity 1: Each agency will invite partners that serve WIC participants and provide
nutrition education to attend a regional Group Participant Centered Education
training fall 2010.
Note: Specific training logistics and registration information will be sent out
prior to the trainings.
Implementation Plan and Timeline: Deschutes County WIC will invite local Head Start staff
and local public health nursing staff to the Group PCE training in the fall of 2010. Chosen partners
will also be invited to attend a one-day workshop on January 20, 2011 on Motivational
Interviewing lead by Steven Berg-Smith.
Activity 2: Each agency will invite community partners that provide breastfeeding
education to WIC participants to attend a Breastfeeding Basics training and/or
complete the online Oregon WIC Breastfeeding Module.
Note: Specific Breastfeeding Basics training logistics and registration
information will be sent out prior to the trainings. Information about accessing
the online Breastfeeding Module will be sent out as soon as it is available.
Implementation Plan and Timeline: Deschutes County WIC will invite members of the public
health nursing staff and Healthy Start prenatal program to attend a Breastfeeding Basics training as
well as complete the online Oregon WIC Breastfeeding Module. We will offer the on-line module
several times throughout the year beginning June 2011, or as soon as available. We will offer the
Breastfeeding Basics class when we are informed that it is available.
Goal 4: Oregon WIC staff will increase their understanding of the factors influencing health
outcomes in order to provide quality nutrition education.
Year 1 Objective: During planning period, each agency will increase staff understanding of the
factors influencing health outcomes.
Deschutes County Health Services
Local Public Health Authority Annual Plan 2010-2011
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Activity 1: Local agency staff will complete the new online Child Nutrition Module by
March 31, 2011.
Implementation Plan and Timeline: Deschutes County staff will complete the on-line Child
Nutrition Module by March 31, 2011.
Activity 2: Identify your agency training supervisor(s) and projected staff quarterly in-
service training dates and topics for FY 2010-2011. Complete and return
Attachment A by May 1, 2010.
Agency Training Supervisor(s): Deschutes County training supervisors are
Laura Spaulding, RD, WIC Coordinator; Janet Harris, MS, RD; Sherri Tobin, MS,
RD, IBCLC; Jean Clinton, RN, BSN, IBCLC. See Attachment A for in-service
training topics and dates.
Attachment A
FY 2010-2011 WIC Nutrition Education Plan
WIC Staff Training Plan – 7/1/2010 through 6/30/2011
Agency: Deschutes County
Training Supervisor(s) and Credentials: Laura Spaulding, RD, WIC Coordinator, Janet Harris, MS, RD, Sherri
Tobin, MS, RD, IBCLC, Jean Clinton, RN, BSN, IBCLC.
Staff Development Planned
Based on planned program initiatives, your program goals, or identified staff needs, what quarterly in-services and
or continuing education are planned for existing staff? List the in-services and an objective for quarterly in-services
that you plan for July 1, 2010 – June 30, 2011. State provided in-services, trainings and meetings can be included as
appropriate.
Quarter Month In-Service Topic In-Service Objective
1
Dental Update (if picked for
grant) and
Dental: review of dental grant, how to refer,
services available, timeframe, etc. September 2010
Group PCE Training PCE training: how to provide PCE in a group
setting
Review/completion To increase our understanding of factors
affecting health outcomes 2 December 2010 of Child Nutrition Module
To increase our knowledge and ability to use
Motivational Interviewing techniques 3 January 2011 PCE workshop/
Steven Berg-Smith
Infant Cues Update To increase our knowledge in order to assist
mothers in increasing duration and exclusivity
of breastfeeding
4 April 2011 1:1/Class
2. Immunizations (See Epidemiology and Control of Preventable Diseases and Disorders
section, page 25.)
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Local Public Health Authority Annual Plan 2010-2011
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3. Maternal Child Health
Perinatal
Problem: New home visiting framework requires engaging pregnant women by 28
weeks gestation, but many of our referrals are for women later in pregnancy who are
now encountering elevated stress for basic needs.
Goal: The goal is to receive referrals right after the pregnancy test, or at least in
first trimester, in order to maximize the length of service delivery and thereby have
greatest impact on health and life course of client.
Activities:
1. Oregon Mothers Care (OMC) outreach worker to visit community agencies who
provide pregnancy tests to inform of new program need to engage clients who
are low income, teen parents by 28 weeks gestation.
2. Host a breakfast for Adult Self Sufficiency workers to inform of referral system
via fax, new programming.
3. Host breakfast for each obstetrical practice in area and invite our Health Officer
(who is OB/Gyn MD) to come along and act as resource person.
4. Inform department staff at general staff meeting.
5. Staff retreat to train on practice changes during transition
6. Continue to maximize productivity.
7. Meet with important community partners to inform about program changes,
including Healthy Families, teen parent programs, others.
8. Explore implementation of Nurse Family Partnership as an evidence based
model which is lacking currently in current model of Maternity Case
Management.
Evaluation: Perform data collection, data analysis to see if additional measures are
needed. Program outcomes for Maternal Case Management (MCM) will be collected
in Perinatal Data sheet and analyzed at state level. Effectiveness of the referral
system will be measured by percentage of clients entering MCM in first trimester
and number receiving full MCM package as appropriate to their risk factors. OMC
data will also be tracked.
Child Health
Problem: Children First 2009 data reports Deschutes county has a rate of 18.1%
uninsured children, which is worse than Oregon overall by 40%. The
unemployment rate and foreclosure rate have placed a huge burden on families and
the agencies trying to support them.
Goal: The goal is to help children in our community access health care, and assist
with applications to insurance coverage through Oregon Health Plan and Healthy
Kids Connect.
Activites:
1. Expand School Based Health Center (SBCH) network to Sisters High School and
Redmond High School to reach teen populations.
2. Offer OHP and Healthy Kids Connect application assistance at SBHCs.
3. Inform department staff on venues in community to access health care and
receive application assistance.
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Local Public Health Authority Annual Plan 2010-2011
43
4. Open all SBHCs to children birth to age 20 as an access point. Assist children
to find medical home and refer to supportive services to stabilize families.
Problem: Department struggles to get referrals to CaCoon program immediately
after medical issues are identified in infant, therefore family is not properly
supported during the stressful time of new diagnosis.
Goal: The goal is to connect with family with medically high risk infant as soon as
possible to offer maximum assistance and referral.
Activities:
1. Department PHNs will screen in collaboration with local Healthy Families of the
High Desert (HFHD) program to identify high risk deliveries, network with
HFHD, and outreach to NICU, hospital social workers and nurses.
2. Meet with HealthMatters leadership regarding their Links 4 Health Program to
coordinate care, decide flow of referrals, minimize duplication of services.
3. Inform community partners and department staff of changes and expansion in
CaCoon program target children.
4. Cooperate with START initiative to encourage community-wide developmental
screening with standardized screening tool, and inform attendees of CaCoon
expansion.
5. Participate on state CaCoon workgroup.
Evaluation: Perform data collection, data analysis to see if additional measures are
needed. Program outcomes for Maternal Case Management (MCM) will be collected
in Perinatal Data sheet and analyzed at state level. Effectiveness of referral system
will be measured by percentage of clients entering MCM in first or second trimester
and number receiving full MCM package as appropriate to their risk factors.
4. Family Planning
FAMILY PLANNING PROGRAM ANNUAL PLAN
FOR FISCAL YEAR 2011
July 1, 2010 to June 30, 2011
As a condition of Title X, funding agencies are required to have a plan for their Family Planning Program, which
includes objectives that meet SMART (Specific, Measurable, Achievable, Realistic, and Time-Bound)
requirements. In order to address state goals in the Title X grant application, we are asking each agency to choose
two of the following four goals and identify how they will be addressed in the coming fiscal year:
Goal 1: Assure continued high quality clinical family planning and related preventive health services to
improve overall individual and community health.
Goal 2: Assure ongoing access to a broad range of effective family planning methods and related
preventive health services.
Goal 3: To promote awareness and access to Emergency Contraception among Oregonians at risk for
unintended pregnancy.
Goal 4: To direct services to address disparities among Oregon’s high priority and underserved
populations, including Hispanics, limited English proficient (LEP), Native Americans, African
Americans, Asian Americans, rural communities, men, uninsured and persons with disabilities.
The format to use for submitting the annual plan is provided below. Please include the following four components
in addressing these goals:
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Local Public Health Authority Annual Plan 2010-2011
44
1. Problem Statement – For each of two chosen goals, briefly describe the current situation in your county
that will be addressed by that particular goal. The data provided may be helpful with this.
2. Objective(s) – Write one or more objectives for each goal. The objective(s) should be realistic for the
resources you have available and measurable in some way. An objective checklist has been provided for your
reference.
3. Planned Activities – Briefly describe one or more activities you plan to conduct in order to achieve your
objective(s).
4. Evaluation – Briefly describe how you will evaluate the success of your activities and objectives, including
data collection and sources.
This document is being forwarded electronically to each Family Planning Coordinator so that it can be completed
and returned via file attachment. Specific agency data will also be included to help with local agency planning. If
you have any questions, please contact Carol Elliot (971 673-0362) or Cheryl Connell (541 265-2248 x443).
Deschutes County Health Services
Local Public Health Authority Annual Plan 2010-2011
45
FAMILY PLANNING PROGRAM ANNUAL PLAN FOR
COUNTY PUBLIC HEALTH DEPARTMENT
FISCAL YEAR 2011
July 1, 2010 to June 30, 2011
Agency: Deschutes County Health Services Contact: Kathleen Christensen
Goal #1 Assure continued high quality clinical family planning and related preventive health services to improve
overall individual and community health.
Problem Statement Objective(s)
Planned Activities Evaluation
There are some areas within
the Family Planning Program
at Deschutes County Health
Services that we believe
could be improved through an
evaluation of current clinic
scheduling and
reception/clinical practices.
We want to make the best use
of the funding and resources
provided to this program so
we can increase the number
of “women in need” served
within our county.
The clinic supervisor and office
supervisor are currently
participating in the Clinic
Efficiency Learning Group
through the Center for Health
Training and the Center for
Disease Control. We will
continue to participate in the
Learning Group throughout the
year completing projects that
include production estimates,
monitoring, goal setting and
training.
¾ Regular monitoring of no-show
rates and brainstorming how to
improve those rates.
¾ Regular monitoring of slot
utilization.
¾ Rearranging schedules for best
clinic flow and optimum clinic
availability.
¾ Research ways to streamline
“Supply Visits.”
¾ Conduct a “Flow Analysis.”
¾ Research alternative forms of
communication with our younger
clients.
¾ Attend 2-day Clinic Efficiency
Training in Seattle.
¾ Monthly no-show
and slot utilization
reports.
¾ Monthly budget
report.
¾ Documenting
increased available
clinic appointment
slots.
¾ Client and staff
satisfaction.
¾ Flow Analysis
results.
¾ Increased show rates
for our confidential
clients.
Only 7.6% of the teen
population of Deschutes
County is being served at
Deschutes County Health
Services compared to 11.9%
statewide. (There is a
Planned Parenthood clinic in
Deschutes County that serves
a number of teens who are
not counted in the above
statistics.)
To increase the number of teens in
need of birth control services who
are seen at our clinics within the
coming year.
¾ All high school students who
attend one of our classes (BC/
Communication or STI/ Healthy
Relationships) will receive
information on how to access
services.
¾ Provide outreach and resource
information to high school
teachers and counselors and the
local community college.
¾ Research increasing hours at the
Downtown Health Center and
having a walk-in teen clinic
schedule in Redmond.
¾ Alhers data and fiscal
reports.
¾ Data from the Intake
Form. “Where did
you hear about our
services?"
Pregnancy rates for 10-17
year olds in Deschutes
County have decreased since
1990 (15.5%) to 2007
(8.6%). Preliminary data
shows a potential increase to
9.1% in 2008.
Deschutes County Health Services
Local Public Health Authority Annual Plan 2010-2011
46
Goal #2 Assure ongoing access to a broad range of effective family planning methods and related preventive health
services.
Problem Statement Objective(s) Planned Activities Evaluation
With an increase in birth
control pricing and the
availability and demand for
high cost birth control, it is
hard to keep the medication
costs within budget.
During the next fiscal year we
will continue to provide a
broad range of birth control
methods, while monitoring
costs and being thoughtful of
how medications are being
dispensed.
¾ Set as generous a limit as
possible, based on the budget,
for IUDs and Implanon
inserted within Title X.
¾ Adjust the budget and reduce
costs in other areas (medical
supplies, etc.) to offset the
increased costs of medications
within the budget.
¾ All clients will be counseled
thoroughly on the potential
side effects to prevent
premature removal of the
chosen method.
¾ Monitoring of
revenue and
expenses.
¾ Track the length of
time that high cost
methods are used.
The number of women in
need of pap follow-up has
increased at Deschutes
County Health Services in
the past year.
Clients who have had a
HGSIL pap at our clinic and
subsequent colposcopy visit
often need further services
(LEEP) and have a hard time
accessing affordable services
within the community.
Within the next year, all
women with abnormal pap
results will receive appropriate
and timely follow-up
recommendations and will be
referred to colposcopy clinic
as needed.
¾ Evaluate the current pap
tracking system for efficiency
and timeliness by 9/10.
¾ Increase the number of
colposcopy visits available
based on the number of clients
on the waiting list.
¾ Staff report more
efficiency in the
system.
¾ Clients will wait
no longer than
one month for a
colposcopy
appointment. ¾ Refer all clients with a HGSIL
pap to Mosaic Medical Clinic.
A relationship has been
formed with the FQHC
Mosaic Medical Clinic, and
they have agreed to see all
Deschutes County Health
Services clients with HGSIL
pap results for colposcopy and
follow-up to assure access for
low income clients.
¾ Monitor
appointment
waiting time and
completeness of
care with the
clients referred to
Mosaic.
Progress on Goals / Activities for Fiscal Year 10
(Currently in Progress)
Goal / Objective Progress on Activities
Assure continued high quality clinical family planning and related preventive health services to improve overall
individual and community health.
Goal 1, Objectives 1-2 With efforts from the Office Supervisor and Front Office Staff we have greatly
increased the number of clients who are approved for FPEP services.
Implementation of a new form has occurred and it is easy to monitor where the
clients are in the process of becoming verified. Our FPEP income has increased
significantly in the past 6 months.
Increase number of clients who could
qualify for FPEP to a verified status.
Goal 1, Objective 2 With social marketing funding from Administration we were able to produce and run
a commercial on local television for 6 months. We also advertised in several local
publications. We have established an ongoing advertising and promotion plan.
Increase community awareness of
services through advertising and
community outreach.
Goal 1, Objective 3 We have continued to offer services in 4 clinic locations and have increased services
to the La Pine area to weekly instead of 2 times per month. We have not yet
completed a needs assessment for the Sisters area.
Provide geographically accessible
services.
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Goal / Objective Progress on Activities
Assure ongoing access to a broad range of effective family planning methods and related preventive health services.
Goal 2, Objective 1 Thorough counseling has helped clients make a more informed decision about having
an IUD or Implanon inserted. A chart audit found that most of our clients receiving
an IUD are leaving them in place at least 3 years. Calendar year 2009 we were able
to get 53 Mirena IUDs through the ARCH Foundation for our Title X clients.
Continue to provide a broad range of
birth control methods while being
thoughtful of how medications are
dispensed.
Goal 2, Objective 2 All clients are given information on primary care services, and clients with urgent
primary care needs are fast tracked into care through the FQHC Mosaic Medical
Clinic.
All Family Planning clients will
understand where they can receive
primary care and access to preventive
health services within the community.
Progress on Title X Expansion Funds:
Also, a reminder that supplemental “expansion funds” were awarded as part of your agency’s regular Title X grant
again this year. These funds were awarded for the purpose of increasing the number of new, low-income clients by
expanding the availability of clinical family planning services. Please report any progress on the use of these funds
for the following purposes:
□ Increase the range of contraceptive methods on your formulary and/or the available number of high-end
methods (IUDs and Implanon):
This past year we were able to have two of our clinicians trained on Implanon insertions and inserted 48
Implanons during the calendar year.
□ Increase the hours of your clinic(s), the number of staff available to see clients, the number of days services are
available or offer walk-in appointments:
Due to the very large decrease in Title X funds for Deschutes County this fiscal year we have not been able
to increase staff, number of service days or increase walk-in appointments.
□ Add other related preventive health services, such as diagnosis and treatment of STIs:
In Deschutes County the number of Chlamydia cases has risen 620% since 1998, and the population has
increased only 70%. Within our Reproductive Health Clinic we test and treat a number of clients for
Chlamydia. We also have a tracking system for the clients seen within the Family Planning Program and
notify clients of the need to rescreen at three months.
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C. Environmental Health
Goal—Administration: Maintain a healthy work environment which promotes an
atmosphere of collaboration, education, and high morale among the Environmental Health
staff.
Objectives:
Continue to cross train staff in all areas of Environmental Health to provide back-up
and allow for a shifting workload during these uncertain times.
Continue to learn and fine tune the processes required for licensing and tracking all EH
functions through our data bases.
Continue to update the web site to provide useful information to the public about EH
programs.
Explore alternative work scheduling to better serve the customers and alleviate the
stress of the seasonal workload.
Goal—Food Service Facilities: To provide operators of food service facilities with the
education and tools to protect the public from food-borne illness.
Objectives:
Create and implement on-line Temporary Restaurant License application and issuance.
Allow for one Environmental Health Specialist per year to train and be certified as a
Standardized Inspection Officer by the Department of Human Services (DHS) to ensure
greater consistency in licensed facility inspections.
Update all existing handouts, brochures and information on the web site.
Perform either self-assessment or baseline survey for the Food and Drug
Administration’s (FDA) Voluntary National Food Regulatory Standards Program.
Send a newsletter to licensed restaurant and mobile food unit owners annually and
explore other methods of informing food service operators of current events.
Perform 100% of required inspections on all licensed food service establishments.
Goals—Pools and Spas: Provide oversight and education to all public pool and spa
operators, and to protect the public from water-borne disease.
Objectives:
Provide clear and detailed handouts to help educate pool and spa operators on relevant
issues regarding pool and spa maintenance; best management practices; and local,
state and federal rule changes.
o Provide educational material to pool operators about changes to the wading pool
rules.
o Provide educational material to pool operators about changes required to submerged
main drain grates and the Federal Virginia Graeme Baker Pool and Spa safety act
Create an educational approach to routine inspections.
Provide EH staff with opportunities to:
o Gain pool and spa inspection experience,
o Add to the diversity of understanding of pool management and chemical handling
through continuing education, and
o Learn effective communication methods targeting pool and spa operators.
Investigate the need for a specific county ordinance to regulate continuing non-
compliers and other rule abuses not addressed by state pool and spa codes.
Ensure Deschutes County representation to any state committee is well informed and
up-to-date on industry and code changes.
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Goal—Drinking Water: Assure citizens of Deschutes County safe drinking water by
implementing and enforcing drinking water standards through professional, technical, and
regulatory assistance to all public water systems.
Objectives:
Maintain current level of customer service for public health and drinking water
inquiries.
Continue to keep the number of Significant Non-Complier (SNC) systems to a minimum.
Continue working on the additional 42 small public systems recently added to
inventory.
Maintain sanitary survey rate of 41 per year to meet increased inspection frequency and
the addition of new water systems.
Earn 90% or more of the Drinking Water State Revolving Fund allocation.
Maintain immediate response time for water quality alerts.
Continue to train additional staff in this growing program.
Identify and inventory public water systems not currently regulated.
Goal—Health Services: To aid Deschutes County Health Services (DCHS) in their mission
to promote and protect the health and safety of our community.
Objectives:
Assist DCHS in food-borne illness investigations.
Assist DCHS and Deschutes County disaster preparedness teams by becoming a part of
the emergency response plans.
D. Health Statistics
Current Condition Or Problem: The process and activity of conducting community health
needs assessment and planning continues to evolve as an area of focus for the department.
We are proud to have delivered our fourth biennial community health report in January of
2010. Service planning and resource allocation decisions are increasingly dependent upon
current, relevant and accurate baseline data specific to the local community. The essential
purpose of these reports is to assist in community needs assessments and service
planning. More recently the department and community partners have recognized the
value of monitoring health indicators as a means to measure the success or impact of
various human service programs.
Dynamic change in the social and economic environment has created an increased need for
health and social support services at a time when public revenues are limited and the
health system budget is strained. This climate necessitates highly targeted service
provision to maximize the effect of programming. The department is a proud partner in this
effort and has served as a leader to stimulate dialog, planning and resources dedicated to
meeting the public health needs of our community.
The department has not yet developed a true center of emphasis on health statistic
monitoring and reporting but has increasingly relied upon the abilities of a few key staff to
produce regular updates in the form of health profiles. Frequent requests for specific
information are assigned to the program or staff who seem most closely associated with the
nature of the data being requested. This frequently results in staff having to fit the work
into their other routine duties.
The department has intranet and web technology at its disposal in addition to several staff
who demonstrate strong technical skills in this area. A challenge is to restructure work
assignments to better accommodate for this growing area of need.
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The 2009 Health Report, included as Appendix A, covers a wide variety of subject matter
including population statistics, infectious disease, chronic disease, child and adolescent
health and preventable disease.
Goal: Continue to produce a periodic health status report which monitors the priority
health issues affecting the community.
Activities:
Target
Population
Who What Timeline
Deschutes
County
residents
Management We will survey our staffing capacity and talent then
assign a lead role to a member of our team who can
best assure managing the logistics of producing the
report.
Ongoing
Deschutes
County
residents
Management We will collect data from similar sources used in the
2002, 2004, 2007, 2009 reports and continue with
trend reporting for 2011-2012.
Ongoing
Deschutes
County
residents
Management We will closely align the focus of the report to
complement the community priorities as identified in
the comprehensive planning efforts associated with
SB 555.
Ongoing
Deschutes
County
residents
Management We plan to produce the next report in 2011. Spring 2011
Evaluation: We will conduct a written survey to determine the opinion of key community
partners related to the value, need for, content and quality of the report. This will include:
• Our own Public Health Advisory Board and Addictions & Mental Health Advisory Board
• Commission on Children and Families
• Educational Service District
• Central Oregon Health Council
• State human service agency partners
Goal: Develop resources (staff and time) dedicated to monitoring health trends and
producing reports. The Director’s vision includes integrating community health promotion
and prevention work with health statistics and monitoring.
Activities:
Target
Population
Who What Timeline
Ongoing Deschutes
County
residents
Management Survey the department to determine scope of demand
for providing health statistical information to the
public, other community partners and for internal
operations and projects
Deschutes
County
residents
Management Based on this assessment, gauge the level of staff
support necessary to meet this demand.
Ongoing
Deschutes
County
residents
Management Structure this service to fit within a community health
and prevention area of focused programming as
resources allow.
Ongoing
Deschutes
County
residents
Management Propose a placeholder in our budget for the resources
necessary to create a center of emphasis in
community health, prevention and health statistical
reporting.
2008-09
Budget
Cycle
Management Develop a location on our department web site which
serves as a place to post and update critical health
statistical information specific to Deschutes County.
Deschutes
County
residents
By spring
2007
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Local Public Health Authority Annual Plan 2010-2011
51
Target
Population
Who What Timeline
Ongoing Deschutes
County
residents
Management Coordinate with the Central Oregon Health Council
and the Commission on Children and Families to
identify a plan of action for maintaining a wide variety
of social and health performance measures.
Evaluation: We will assess the value of creating this type of new service from a cost verses
utility perspective. This will involve an internal assessment of the value/efficiency of work
redesign as well as assessing the value of providing data on our web site, determined by the
number of “hits” to the system.
E. Information And Referral
Current Condition Or Problem: A significant volume of health information and referral is
made across all programs and services on a daily basis. A Hepatitis scare in 2003 resulted
in over 300 phone calls from the public in just four hours. The flu vaccine shortage of
2004 resulted in a similar demand for public information. We fear these examples may
pale in comparison to the daily demand for information should West Nile Virus materialize.
The information disseminated within formal clinical program activity with specific clients is
very accurate, complete, and targeted. However, there is a randomness to public requests,
by phone or in person, that is difficult to measure. The department does not track the
frequency of requests or their nature but has become quite adept at referring callers to
resources outside the public health domain.
Goals:
1. The department will survey for the frequency and nature of calls on a periodic
basis.
2. Employee orientation will include training on providing information and referral
advice.
3. Employees will be given an opportunity to provide input on methods to enhance
the quality of this service.
Activities:
Target
Population
Who What Timeline
Ongoing We will survey the department to determine the
scope and frequency of demand for providing
health information and referral to the general
public.
Management Deschutes
County
residents
Front Office
Team
Health Services
staff
Management We will continue to develop basic employee
orientation materials and training related to
providing health information and referral.
Ongoing
Ongoing Health Services
staff
All staff We will implement round-table discussion within
and between work teams to elicit ideas related to
enhancing the quality of this service. We will
document ideas and assign specific tasks as part
of an overall quality improvement process.
Evaluation:
1. We will report to staff and our advisory boards the results of our survey related to
measuring the frequency and nature of information and referral calls from the general
public.
2. We will implement a tool to measure the satisfaction and quality of orientation materials
and training from the perspective of our staff.
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Local Public Health Authority Annual Plan 2010-2011
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3. We will implement a tool to measure the satisfaction and quality of service from the
perspective of our clients/public.
4. We developed a new employee orientation checklist to assure we are preparing
employees to provide information and referral as appropriate.
5. We will incorporate staff recommendations for enhancing the quality of this service into
a formal quality improvement initiative for the department. The Program Support
Services Manager will be charged with oversight on this activity.
F. Public Health Emergency Preparedness (See Epidemiology and Control of
Preventable Diseases and Disorders section, page 25.)
G. Other Issues
None, other than noted in previous sections.
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IV. ADDITIONAL REQUIREMENTS
An organizational chart is attached; see Appendix B.
The Public Health Advisory Board is established to enhance community relations with
Deschutes County Health Services (DCHS) to increase public knowledge about public health
issues and assist in the betterment of services provided by DCHS. The Board also advises the
Board of County Commissioners concerning matters of public health and the operation of the
public health system.
Senate Bill 555: The local Commission on Children and Families stands as a separate
department within the Deschutes County organization structure.
• Deschutes County Health Services continues a close partnership with the Commission on
Children and Families (CCF) in the development of many components of the local
Comprehensive Community Plan.
• The Community Plan contains sections relevant to public health and behavioral health, and
consistent with the Oregon Benchmark Project.
• The DCHS Director regularly participates in CCF planning work, is involved in the local
Professional Advisory Committee to the CCF, and attends CCF executive team meetings.
. UNMET COMMUNITY NEEDS V
A. Primary Care
Current Condition Or Problem: There are approximately 37,000 uninsured
individuals currently living in Deschutes County. This compares to
approximately 27,000 just one year ago. Changes in Oregon Health Plan (OHP)
eligibility made between 2002 and now have significantly worsened this problem.
To compound this situation, many local medical care providers have simply closed
their practices to the few remaining adult OHP clients and fee-for-service
Medicare clients. Nearly 30% of our total population has severely limited or no
access to basic physical health care services, behavioral health care, or oral
ealth care. h
La Pine, Oregon, is geographically isolated from most health care services in the County
and has a population of approximately 14,000, with a median family income of about
$24,000 and an estimated 24% unemployment rate. The area has a high percentage of
older adults (over the age of 65) at 22%. Recent years have seen the demise of private
practice medical practices in this community. Even a Rural Health Clinic (RHC),
stablished in 2003, has struggled financially in this market. e
Goals And Accomplishments:
1. Rural Health Clinic: In September of 2003 a Rural Health Clinic in La Pine, Oregon,
was formally designated by HRSA. This clinic has the capacity to serve
approximately 6,000 to 8,000 clients, many of whom are Medicare/Medicaid. The
clinic continues to experience cash flow challenges as well as difficulty with
provider/practitioner recruitment.
2. Mosiac Medical: The department supported planning and a grant request to HRSA
to establish a Federally Qualified Health Center (FQHC) “expansion” site in Bend.
Mosaic Medical operates the clinic, which received more than 10,000 patient visits
in its first full year of operation.
3. The Volunteers In Medicine (VIM): The VIM clinic in Bend, serving low-income
uninsured residents of the county, received over 3,000 visits in its first year of
operation and has been an invaluable resource to our communities.
Deschutes County Health Services
Local Public Health Authority Annual Plan 2010-2011
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4. HealthyStart Prenatal Clinic: The department continues to operate the HealthyStart
Prenatal Clinic, which serves to offer universal access to prenatal and obstetrical
care for all women regardless of ability to pay. The program served more than 269
women in 2009 and provided 135 deliveries.
5. School Based Health Centers (SBHC): An SBHC has been operating in the La Pine
community since the spring of 2005. The clinic is operated as an extension of the
department. Two new fully certified SBHCs opened in 2008, one in Bend and one in
Redmond. The department currently has two planning grants—one to open a new
center at Sisters High School and one to open a new center at Redmond High
School.
6. Northwest (NW) Medical Teams Dental Van: The local VIM clinic, Central Oregon
Oral Health Coalition and La Pine Community Action Team have been instrumental
in bringing the NW Medical Teams mobile dental service to Central Oregon for
repeated visits. This service targets low income uninsured residents of Central
Oregon and is staffed by volunteer dentists and hygienists. The van has struggled
to find volunteer dentists despite a huge demand for services, funding from the
Deschutes Family Drug Court, and a location at the department offering scheduling
support.
7. Kemple Dental Clinic: For more than 10 years Dr. H. M. Kemple has operated a free
dental clinic for the disadvantaged children of Deschutes County, serving several
thousand children to date. The clinic is currently housed at the Juvenile
Corrections facility in Bend. The clinic is also struggling to find volunteer dentists.
Activities:
Target
Population
Who What Timeline
Deschutes
County
residents
Health
Services
Continue participation in community-based
coalitions, councils, steering committees
and boards which are dedicated to
addressing access to health care for low
income and medically uninsured
individuals.
Ongoing
Deschutes
County
residents
Health
Services
Work closely with community health care
leaders from the hospital and medical clinic
systems to establish a system of care for
Medicaid clients.
Ongoing
Deschutes
County
residents
Health
Services
Assess the capacity of the mid-level
providers to open their practices to these
clients.
Ongoing
Deschutes
County
residents
Health
Services
Confirmation of the level of financial,
medical, specialty support, and lab/
radiology support across the medical
community to assist with delivery of
comprehensive health care to these
individuals.
Ongoing
Deschutes
County
residents
Health
Services
Develop a broad coalition of support from
Deschutes County, private medical market
and not-for-profit hospital system.
Establish a Central Oregon Health Care
SafetyNet Coalition. This activity has
recently matured into a 501(c)(3) known as
the Central Oregon Health Collaborative.
Ongoing
Deschutes County Health Services
Local Public Health Authority Annual Plan 2010-2011
55
Evaluation: The timeline for preliminary evaluation of the components related to
creating a system of care for the uninsured and Medicaid-OHP clients is ongoing
as the situational needs and opportunities evolve. The ultimate test of success
will be measured by the number of individuals who can be served by this system.
B. Hunger and Nutritional Health: This is a very significant problem for many of our
families and children. While Deschutes County's population increased 24% from 2000-
2005, the number of people accessing food bank programs each month increased by
45% during this same period. School district data suggest some primary schools have
more than 60% of their students on public assistance meal programs. Unemployment
and poverty in some areas of our county approach 25% of the individuals living there.
Hunger is a very real problem.
C. Behavioral Health Services for Uninsured: The elimination of many behavioral health
supports for our citizens needing these services presents very real public health issues.
Untreated behavioral health issues will have a cascading effect on public safety,
employment, stable home environment and personal self-adjustment.
D. Family Violence: The rapid rise in family violence incidents speaks loudly to the
unmet need in this area. Deschutes County’s rate of family violence well exceeds recent
state averages. It is a system crying out for resources, at a time when social service
supports in this area are being de-funded.
E. Children With Special Health Care Needs: Services for these very special children
once again make the list as one of the most tragically under funded needs in our
communities. Public and school health nurses continually struggle to find resources
such as medical care access, respite care, treatment and durable medical equipment to
help meet the needs of these children.
F. Health and Social Support Assets for Ex-Incarcerated Populations: Studies indicate
a lack of basic supports stands as a significant barrier to successful re-entry for ex-
incarcerated populations. A coalition of community agencies has begun to look at
crafting a program specifically for adult women to aid in this endeavor.
G. Children’s Oral Health: In Deschutes County, 55% of 6-8 year olds have a history of
dental decay and 29% of these children have untreated dental decay. Dental disease
accounts for 5.7 missed days of school for every 100 of our Deschutes County school
children. Efforts to raise community awareness, to reach high-risk populations, and to
discuss the merits of community water fluoridation are ongoing.
H. Obesity and Chronic Disease Prevention: The increasing prevalence of overweight
children and adults across the United States and in Deschutes County is a major public
health concern. Approximately 70% of Oregon deaths are due to chronic disease in
which obesity is a primary risk factor. Since 1970 there has been a 200% increase in
the prevalence of obesity among all children and a whopping 300% increase among
teens. Per capita soft drink consumption has more than doubled in the past 30 years,
and one fourth of all vegetables eaten in the United States are French fries. If we are
unable to get our arms around this large problem, we face dire health consequences in
the years ahead. The burden of this morbidity will impact not only the health of the
nation but also will likely bankrupt an already overtaxed health care system.
Deschutes County Health Services
Local Public Health Authority Annual Plan 2010-2011
56
VI. BUDGET
Budget location information: Sherri Pinner, Business and Operations Manager
Deschutes County Health Services
2577 NE Courtney Drive
Bend, OR 97701
(541) 322-7509
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59 Deschutes County Health Services
Local Public Health Authority Annual Plan 2010-2011
59
VII. MINIMUM STANDARDS
To the best of our knowledge we are in compliance with these program indicators according to
the Minimum Standards for Local Health Departments:
A. Organization
1. Yes X No ___ A Local Health Authority exists which has accepted the legal
responsibilities for public health as defined by Oregon law.
2. Yes X No ___ The Local Health Authority meets at least annually to address public
health concerns.
3. Yes X No ___ A current organizational chart exists that defines the authority,
structure and function of the local health department; and is reviewed at least
annually.
4. Yes X No ___ Current local health department policies and procedures exist which
are reviewed at least annually.
5. Yes X No ___ Ongoing community assessment is performed to analyze and evaluate
community data.
6. Yes X No ___ Written plans are developed with problem statements, objectives,
activities, projected services, and evaluation criteria.
7. Yes X No ___ Local health officials develop and manage an annual operating
budget.
8. Yes X No ___ Generally accepted public accounting practices are used for managing
funds.
9. Yes X No ___ All revenues generated from public health services are allocated to
public health programs.
10. Yes X No ___ Written personnel policies and procedures are in compliance with
federal and state laws and regulations.
11. Yes X No ___ Personnel policies and procedures are available for all employees.
12. Yes X No ___ All positions have written job descriptions, including minimum
qualifications.
13. Yes X No ___ Written performance evaluations are done annually.
14. Yes X No ___ Evidence of staff development activities exists.
15. Yes X No ___ Personnel records for all terminated employees are retained
consistently with State Archives rules.
16. Yes X No ___ Records include minimum information required by each program.
17. Yes X No ___ A records manual of all forms used is reviewed annually.
18. Yes X No ___ There is a written policy for maintaining confidentiality of all client
records which includes guidelines for release of client information.
19. Yes X No ___ Filing and retrieval of health records follow written procedures.
20. Yes X No ___ Retention and destruction of records follow written procedures and
are consistent with State Archives rules.
21. Yes X No ___ Local health department telephone numbers and facilities' addresses
are publicized.
22. Yes X No ___ Health information and referral services are available during regular
business hours.
23. Yes X No ___ Written resource information about local health and human services
is available, which includes eligibility, enrollment procedures, scope and hours of
service. Information is updated as needed.
24. Yes X No ___ 100% of birth and death certificates submitted by local health
departments are reviewed by the local Registrar for accuracy and completeness per
Vital Records office procedures.
25. Yes X No ___ To preserve the confidentiality and security of non-public abstracts,
all vital records and all accompanying documents are maintained.
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26. Yes X No ___ Certified copies of registered birth and death certificates are issued
within one working day of request.
27. Yes X No ___ Vital statistics data, as reported by the Center for Health Statistics,
are reviewed annually by local health departments to review accuracy and support
ongoing community assessment activities.
28. Yes X No ___ A system to obtain reports of deaths of public health significance is in
place.
29. Yes X No ___ Deaths of public health significance are reported to the local health
department by the medical examiner and are investigated by the health department.
30. Yes X No __ Health department administration and county medical examiner review
collaborative efforts at least annually.
31. Yes X No ___ Staff is knowledgeable of and has participated in the development of
the county’s emergency plan.
32. Yes X No ___ Written policies and procedures exist to guide staff in responding to
an emergency.
33. Yes X No ___ Staff participate periodically in emergency preparedness exercises and
upgrade response plans accordingly.
34. Yes X No ___ Written policies and procedures exist to guide staff and volunteers in
maintaining appropriate confidentiality standards.
35. Yes X No ___ Confidentiality training is included in new employee orientation. Staff
includes: employees, both permanent and temporary; volunteers; translators; and
any other party in contact with clients, services or information. Staff sign
confidentiality statements when hired and at least annually thereafter.
36. Yes X No ___ A Client Grievance Procedure is in place with resultant staff training
and input to assure that there is a mechanism to address client and staff concerns.
B. Control of Communicable Diseases
37. Yes X No ___ There is a mechanism for reporting communicable disease cases to
the health department.
38. Yes X No ___ Investigations of reportable conditions and communicable disease
cases are conducted, control measures are carried out, investigation report forms are
completed and submitted in the manner and time frame specified for the particular
disease in the Oregon Communicable Disease Guidelines.
39. Yes X No ___ Feedback regarding the outcome of the investigation is provided to the
reporting health care provider for each reportable condition or communicable disease
case received.
40. Yes X No ___ Access to prevention, diagnosis, and treatment services for reportable
communicable diseases is assured when relevant to protecting the health of the
public.
41. Yes X No ___ There is an ongoing/demonstrated effort by the local health
department to maintain and/or increase timely reporting of reportable communicable
diseases and conditions.
42. Yes X No __ There is a mechanism for reporting and following up on zoonotic
diseases to the local health department. (For some yes, others no.)
43. Yes X No ___ A system exists for the surveillance and analysis of the incidence and
prevalence of communicable diseases.
44. Yes X No ___ Annual reviews and analysis are conducted of five-year averages of
incidence rates reported in the Communicable Disease Statistical Summary, and
evaluation of data are used for future program planning.
45. Yes X No ___ Immunizations for human target populations are available within the
local health department jurisdiction.
46. Yes X No ___ Rabies immunizations for animal target populations are available
within the local health department jurisdiction.
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C. Environmental Health
47. Yes X No ___ Food service facilities are licensed and inspected as required by
Chapter 333 Division 12.
48. Yes X No ___ Training is available for food service managers and personnel in the
proper methods of storing, preparing, and serving food.
49. Yes X No ___ Training in first aid for choking is available for food service workers.
50. Yes X No ___ Public education regarding food-borne illness and the importance of
reporting suspected food-borne illness is provided.
51. Yes X No ___ Each drinking water system conducts water quality monitoring and
maintains testing frequencies based on the size and classification of system.
52. Yes X No ___ Each drinking water system is monitored for compliance with
applicable standards based on system size, type, and epidemiological risk.
53. Yes X No ___ Compliance assistance is provided to public water systems that violate
requirements.
54. Yes X No ___ All drinking water systems that violate maximum contaminant levels
are investigated and appropriate actions taken.
55. Yes X No ___ A written plan exists for responding to emergencies involving public
water systems.
56. Yes X No ___ Information for developing a safe water supply is available to people
using on-site individual wells and springs.
57. Yes X No ___ A program exists to monitor, issue permits, and inspect on-site
sewage disposal systems.
58. Yes X No ___ Tourist facilities are licensed and inspected for health and safety risks
as required by Chapter 333 Division 12.
59. Yes X No ___ School and public facilities food service operations are inspected for
health and safety risks.
60. Yes X No ___ Public spas and swimming pools are constructed, licensed, and
inspected for health and safety risks as required by Chapter 333 Division 12.
61. Yes X No ___ A program exists to assure protection of health and the environment
for storing, collecting, transporting, and disposing solid waste.
62. Yes X No ___ Indoor clean air complaints in licensed facilities are investigated.
63. Yes X No ___ Environmental contamination potentially impacting public health or
the environment is investigated.
64. Yes X No ___ The health and safety of the public is being protected through
hazardous incidence investigation and response.
65. Yes X No ___ Emergency environmental health and sanitation are provided to
include safe drinking water, sewage disposal, food preparation, solid waste disposal,
sanitation at shelters, and vector control.
66. Yes X No__ All license fees collected by the Local Public Health Authority under
ORS 624, 446, and 448 are set and used by the LPHA as required by ORS 624, 446,
and 448.
D. Health Education and Health Promotion
67. Yes X No ___ Culturally and linguistically appropriate health education components
with appropriate materials and methods will be integrated within programs.
68. Yes X No ___ The health department provides and/or refers to community
resources for health education/health promotion.
69. Yes X No ___ The health department provides leadership in developing community
partnerships to provide health education and health promotion resources for the
community.
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70. Yes X No ___ Local health department supports healthy behaviors among
employees.
71. Yes X No ___ Local health department supports continued education and training of
staff to provide effective health education.
72. Yes X No ___ All health department facilities are smoke free.
E. Nutrition
73. Yes X No ___ Local health department reviews population data to promote
appropriate nutritional services.
74. The following health department programs include an assessment of nutritional
status:
a. Yes X No ___ WIC
b. Yes X No ___ Family Planning
c. Yes X No ___ Parent and Child Health
d. Yes ___ No X Older Adult Health
e. Yes X No ___ Juvenile Corrections Health
75. Yes X No ___ Clients identified at nutritional risk are provided with or referred for
appropriate interventions.
76. Yes X No ___ Culturally and linguistically appropriate nutritional education and
promotion materials and methods are integrated within programs.
77. Yes X No ___ Local health department supports continuing education and training
of staff to provide effective nutritional education.
F. Older Adult Health
78. Yes X No __ Health Department provides or refers to services that promote
detecting chronic diseases and preventing their complications.
79. Yes X No ___ A mechanism exists for intervening where there is reported elder
abuse or neglect.
80. Yes X No ___ Health department maintains a current list of resources and refers for
medical care, mental health, transportation, nutritional services, financial services,
rehabilitation services, social services, and substance abuse services.
81. Yes X No __ Prevention-oriented services exist for self health care, stress
management, nutrition, exercise, medication use, maintaining activities of daily living,
injury prevention and safety education. (These exist within the private and/or
non-profit community but not all of these are available within the local health
department.)
G. Parent and Child Health
82. Yes X No ___ Perinatal care is provided directly or by referral.
83. Yes X No ___ Immunizations are provided for infants, children, adolescents and
adults either directly or by referral.
84. Yes X No ___ Comprehensive family planning services are provided directly or by
referral.
85. Yes X No ___ Services for the early detection and follow-up of abnormal growth,
development and other health problems of infants and children are provided directly
or by referral.
86. Yes X No ___ Child abuse prevention and treatment services are provided directly or
by referral.
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87. Yes X No ___ There is a system or mechanism in place to assure participation in
multi-disciplinary teams addressing abuse and domestic violence.
88. Yes X No ___ There is a system in place for identifying and following up on high
risk infants.
89. Yes X No ___ There is a system in place to follow-up on all reported SIDS deaths.
90. Yes X No __ Preventive oral health services are provided directly or by referral.
91. Yes X No ___ Use of fluoride is promoted, either through water fluoridation or use of
fluoride mouth rinse or tablets. (Limited to MCH programs & WIC via dental
varnish.)
92. Yes X No ___ Injury prevention services are provided within the community.
H. Primary Health Care
93. Yes X No ___ The local health department identifies barriers to primary health care
services.
94. Yes X No ___ The local health department participates and provides leadership in
community efforts to secure or establish and maintain adequate primary health care.
95. Yes X No ___ The local health department advocates for individuals who are
prevented from receiving timely and adequate primary health care.
96. Yes X No ___ Primary health care services are provided directly or by referral.
97. Yes X No ___ The local health department promotes primary health care that is
culturally and linguistically appropriate for community members.
98. Yes X No ___ The local health department advocates for data collection and analysis
for development of population based prevention strategies.
I. Cultural Competency
99. Yes X No ___ The local health department develops and maintains a current
demographic and cultural profile of the community to identify needs and
interventions.
100. Yes X No ___ The local health department develops, implements and promotes a
written plan that outlines clear goals, policies and operational plans for provision of
culturally and linguistically appropriate services.
101. Yes X No ___ The local health department assures that advisory groups reflect the
population to be served.
102. Yes X No ___ The local health department assures that program activities reflect
operation plans for provision of culturally and linguistically appropriate services.
J. Health Department Personnel Qualifications
The local health department Health Administrator meets the minimum qualifications.
The local health department Supervising Public Health Nurses meet minimum
qualifications.
The local health department Environmental Health Supervisor meets minimum
qualifications.
The local health department Health Officer meets minimum qualifications.
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The local public health authority is submitting the Annual Plan pursuant to ORS 431.385
and assures the activities defined in ORS 431.375–431.385 and ORS 431.416 are
performed.
DESCHUTES
Local Public Health Authority County Date
DATED this ___________ day of __________________________ 2010, for the Deschutes County
Board of Commissioners.
_____________________________________
D E N N I S R . L U K E , C h a i r
________________________________
A L A N U N G E R , V i c e C h a i r
________________________________
T A M M Y B A N E Y , C o m m i s s i o n e r
ATTEST:
_____________________
Recording Secretary
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Appendix A
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Appendix B
Organizational Structure
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