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 Deschutes County Health Services Local Public Health Authority Annual Plan 2010-2011 1 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); Deschutes County Health Services Local Public Health Authority Annual Plan 2010-2011 2 • 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. Deschutes County Health Services Local Public Health Authority Annual Plan 2010-2011 3 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). Deschutes County Health Services Local Public Health Authority Annual Plan 2010-2011 4 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. Deschutes County Health Services Local Public Health Authority Annual Plan 2010-2011 5 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 Deschutes County Health Services Local Public Health Authority Annual Plan 2010-2011 6 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 Deschutes County Health Services Local Public Health Authority Annual Plan 2010-2011 7 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. Deschutes County Health Services Local Public Health Authority Annual Plan 2010-2011 8 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 Deschutes County Health Services Local Public Health Authority Annual Plan 2010-2011 9 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 Deschutes County Health Services Local Public Health Authority Annual Plan 2010-2011 10 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 Deschutes County Health Services Local Public Health Authority Annual Plan 2010-2011 11 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. Deschutes County Health Services Local Public Health Authority Annual Plan 2010-2011 12 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 13 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. Deschutes County Health Services Local Public Health Authority Annual Plan 2010-2011 14 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. Deschutes County Health Services Local Public Health Authority Annual Plan 2010-2011 15 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. Deschutes County Health Services Local Public Health Authority Annual Plan 2010-2011 16 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. Deschutes County Health Services Local Public Health Authority Annual Plan 2010-2011 17 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. Deschutes County Health Services Local Public Health Authority Annual Plan 2010-2011 18 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 Deschutes County Health Services Local Public Health Authority Annual Plan 2010-2011 19 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. Deschutes County Health Services Local Public Health Authority Annual Plan 2010-2011 20 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 Deschutes County Health Services Local Public Health Authority Annual Plan 2010-2011 21 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 ƒ Deschutes County Health Services ƒ Downtown Health Center, Male Clinic, Fridays 2:00-4:00 p.m. Persons Who Inject Drugs (PWID) 120 ƒ Deschutes County Health Services ƒ Deschutes County Adult Jail ƒ Work Release Center ƒ Pfeifer & Associates Treatment ƒ BestCare Treatment Center ƒ Mobile Health Services van MSM/PWID 5 Targeted HIV Counseling and Testing Partners of People Living With HIV/A (PLWH) 10 ƒ Deschutes County Health Services ƒ Downtown Health Center MSM 70 ƒ Bend PRIDE ƒ Downtown Health Center, Male Clinic, Fridays 2:00-4:00 p.m. ƒ National HIV Testing Day ƒ Adult stores PWID 100 ƒ Mobile Health Services van ƒ Homeless Event ƒ Presentation MSM/PWID 0 Outreach to CTRS Partners of PLWH 40 ƒ Case management services ƒ 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 ƒ Deschutes County Health Services ƒ Mobile Health Services van OHROCS Outreach PWID 100 ƒ Deschutes County Adult Jail ƒ Work Release Center ƒ Presentations ƒ BestCare Treatment ƒ 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. Deschutes County Health Services Local Public Health Authority Annual Plan 2010-2011 35 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? Deschutes County Health Services Local Public Health Authority Annual Plan 2010-2011 36 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 Deschutes County Health Services Local Public Health Authority Annual Plan 2010-2011 37 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 38 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 Local Public Health Authority Annual Plan 2010-2011 39 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. Deschutes County Health Services Local Public Health Authority Annual Plan 2010-2011 40 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 41 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.) Deschutes County Health Services Local Public Health Authority Annual Plan 2010-2011 42 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. Deschutes County Health Services 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: Deschutes County Health Services 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. Deschutes County Health Services Local Public Health Authority Annual Plan 2010-2011 47 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. Deschutes County Health Services Local Public Health Authority Annual Plan 2010-2011 48 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: ƒ 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. ƒ Continue to learn and fine tune the processes required for licensing and tracking all EH functions through our data bases. ƒ Continue to update the web site to provide useful information to the public about EH programs. ƒ 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: ƒ Create and implement on-line Temporary Restaurant License application and issuance. ƒ 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. ƒ Update all existing handouts, brochures and information on the web site. ƒ Perform either self-assessment or baseline survey for the Food and Drug Administration’s (FDA) Voluntary National Food Regulatory Standards Program. ƒ Send a newsletter to licensed restaurant and mobile food unit owners annually and explore other methods of informing food service operators of current events. ƒ 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: ƒ 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 ƒ Create an educational approach to routine inspections. ƒ 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. ƒ 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. ƒ Ensure Deschutes County representation to any state committee is well informed and up-to-date on industry and code changes. Deschutes County Health Services Local Public Health Authority Annual Plan 2010-2011 49 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: ƒ Maintain current level of customer service for public health and drinking water inquiries. ƒ Continue to keep the number of Significant Non-Complier (SNC) systems to a minimum. ƒ Continue working on the additional 42 small public systems recently added to inventory. ƒ Maintain sanitary survey rate of 41 per year to meet increased inspection frequency and the addition of new water systems. ƒ Earn 90% or more of the Drinking Water State Revolving Fund allocation. ƒ Maintain immediate response time for water quality alerts. ƒ Continue to train additional staff in this growing program. ƒ 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: ƒ Assist DCHS in food-borne illness investigations. ƒ 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. Deschutes County Health Services Local Public Health Authority Annual Plan 2010-2011 50 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 Deschutes County Health Services 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. Deschutes County Health Services Local Public Health Authority Annual Plan 2010-2011 52 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. Deschutes County Health Services Local Public Health Authority Annual Plan 2010-2011 53 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 54 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 Deschutes County Health Services Local Public Health Authority Annual Plan 2010-2011 57 Deschutes County Health Services Local Public Health Authority Annual Plan 2010-2011 58 Deschutes County Health Services Local Public Health Authority Annual Plan 2010-2011 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. Deschutes County Health Services Local Public Health Authority Annual Plan 2010-2011 60 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. Deschutes County Health Services Local Public Health Authority Annual Plan 2010-2011 61 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. Deschutes County Health Services Local Public Health Authority Annual Plan 2010-2011 62 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. Deschutes County Health Services Local Public Health Authority Annual Plan 2010-2011 63 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. Deschutes County Health Services Local Public Health Authority Annual Plan 2010-2011 64 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 Deschutes County Health Services Local Public Health Authority Annual Plan 2010-2011 65 Appendix A Deschutes County Health Services Local Public Health Authority Annual Plan 2010-2011 66 Deschutes County Health Services Local Public Health Authority Annual Plan 2010-2011 67 Deschutes County Health Services Local Public Health Authority Annual Plan 2010-2011 68 Deschutes County Health Services Local Public Health Authority Annual Plan 2010-2011 69 Deschutes County Health Services Local Public Health Authority Annual Plan 2010-2011 70 Deschutes County Health Services Local Public Health Authority Annual Plan 2010-2011 71 Deschutes County Health Services Local Public Health Authority Annual Plan 2010-2011 72 Deschutes County Health Services Local Public Health Authority Annual Plan 2010-2011 73 Deschutes County Health Services Local Public Health Authority Annual Plan 2010-2011 74 Deschutes County Health Services Local Public Health Authority Annual Plan 2010-2011 75 Deschutes County Health Services Local Public Health Authority Annual Plan 2010-2011 76 Deschutes County Health Services Local Public Health Authority Annual Plan 2010-2011 77 Deschutes County Health Services Local Public Health Authority Annual Plan 2010-2011 78 Deschutes County Health Services Local Public Health Authority Annual Plan 2010-2011 79 Deschutes County Health Services Local Public Health Authority Annual Plan 2010-2011 80 Deschutes County Health Services Local Public Health Authority Annual Plan 2010-2011 81 Deschutes County Health Services Local Public Health Authority Annual Plan 2010-2011 82 Deschutes County Health Services Local Public Health Authority Annual Plan 2010-2011 83 Deschutes County Health Services Local Public Health Authority Annual Plan 2010-2011 84 Deschutes County Health Services Local Public Health Authority Annual Plan 2010-2011 85 Deschutes County Health Services Local Public Health Authority Annual Plan 2010-2011 86 Deschutes County Health Services Local Public Health Authority Annual Plan 2010-2011 87 Deschutes County Health Services Local Public Health Authority Annual Plan 2010-2011 88 Deschutes County Health Services Local Public Health Authority Annual Plan 2010-2011 89 Deschutes County Health Services Local Public Health Authority Annual Plan 2010-2011 90 Deschutes County Health Services Local Public Health Authority Annual Plan 2010-2011 91 Deschutes County Health Services Local Public Health Authority Annual Plan 2010-2011 92 Deschutes County Health Services Local Public Health Authority Annual Plan 2010-2011 93 Appendix B Organizational Structure Deschutes County Health Services Local Public Health Authority Annual Plan 2010-2011 94