HomeMy WebLinkAboutDoc 334 - Public Health Authority Annual Plan■AJ'CES
0 {
Deschutes County Board of Commissioners
1300 NW Wall St., Suite 200, Bend, OR 97701 -1960
(541) 388 -6570 - Fax (541) 385 -3202 - www.deschutes.org
AGENDA REQUEST & STAFF REPORT
For Board Business Meeting of July 22, 2009
Please see directions for completing this document on the next page.
DATE: July 15, 2009
FROM: Scott Johnson Health Services 322 -7502
TITLE OF AGENDA ITEM:
Consideration of Board signature of Document 2009 -334, Deschutes County Health Services Local
Public Health Authority Annual Plan 2009 - 2010.
PUBLIC HEARING ON THIS DATE? No
BACKGROUND AND POLICY IMPLICATIONS:
By State requirement each "Local Public Health Authority" in Oregon, including Deschutes County. i
required to submit an annual plan which assesses community needs and describes how the departme it
will provide public health services. The plan covers a broad range of public health programs includ ng
but not limited to Communicable Disease, Emergency Preparedness, Immunizations, Women & Infani
Children (WIC), Maternal Child Health, Family Planning and Environmental Health.
FISCAL IMPLICATIONS:
None.
RECOMMENDATION & ACTION REOUESTED:
Approval and signature of Document 2009 -334, Deschutes County Health Services Local Public Beal h
Authority Annual Plan 2009 -2010, is requested.
ATTENDANCE: Scott Johnson
DISTRIBUTION OF DOCUMENTS:
Original mailed to: Tom Engle RN, Oregon Public Health, 800 NE Oregon St., Ste 930, Portland
Oregon 97232, (Phone 971 -673 -1222)
Copy to Kathe Hirschman, Health Services (phone 322 -7504)
DESCHUTES COUNTY DOCUMENT SUMMARY
(NOTE: This form is required to be submitted with ALL contracts and other agreements, regardless of whether the document is to be
on a Board agenda or can be signed by the County Administrator or Department Director. If the document is to be on a Board
agenda, the Agenda Request Form is also required. If this form is not included with the document, the document will be returned to
the Department. Please submit documents to the Board Secretary for tracking purposes, and not directly to Legal Counsel, the
County Administrator or the Commissioners. In addition to submitting this form with your documents, please submit this form
electronically to the Board Secretary.)
Please complete all sections above the Official Review line.
Date: July 15, 20091 Department:
Contractor /Supplier /Consultant Name:
Contractor Contact:
Tom Engle
Health Services
Department of Human Services, Public Health
Contractor Phone #:
(971) 673 -1222
Type of Document: Local Public Health Authority Annual Plan 2009 -2010
Goods and /or Services: The Annual Plan is a description of public health services
offered by Deschutes County Health Services.
Background & History: By State requirement each "Local Public Health Authority" in
Oregon, including Deschutes County, is required to submit an annual plan which
assesses community needs and describes how the department will provide public
health services. The plan covers a broad range of public health programs including but
not limited to Communicable Disease, Emergency Preparedness, Immunizations,
Women & Infant Children (WIC), Maternal Child Health, Family Planning and
Environmental Health.
Agreement Starting Date:
July 1, 2009
Annual Value or Total Payment:
N /A1
Ending Date:
Insurance Certificate Received (check box)
Insurance Expiration Date:
Check all that apply:
RFP, Solicitation or Bid Process
Informal quotes ( <$150K)
Exempt from RFP, Solicitation or Bid Process (specify — see DCC §2.37)
June 30, 2010
Funding Source: (Included in current budget? ® Yes No
(Staff time needed to-prepare document.)
If No, has budget amendment been submitted? 1 1 Yes 1 1 No
Is this a Grant Agreement providing revenue to the County? 1 1 Yes ® No
Special conditions attached to this grant:
6/22/200(
Deadlines for reporting to the grantor:
If a new FTE will be hired with grant funds, confirm that Personnel has been notified that
it is a grant- funded position so that this will be noted in the offer letter: ❑ Yes ❑ No
Contact information for the person responsible for grant compliance: Name:
Phone #:
Departmental Contact and Title:
Department Director Approval:
Scott Johnson
Phone #:
322 -7502
.23.E
Date
Distribution of Document: Who gets the original document and /or copies after it has
been signed? Include complete information if the document is to be mailed.
Original mailed to: Tom Engle, RN
Oregon Public Health
800 NE Oregon Street, Suite 930
Portland, OR 97232
Copy to: Kathe Hirschman
Health Services
Official Review:
County Signature Required (check one): ❑ BOCC ❑ Department Director (if <$25K)
❑ Administrator (if >$25K but <$150K; if >$150K, BOCC Order No.
Legal Review Date
Document Number
)
6/22/2009
Deschutes County Health Services
Local Public Health Authority
ANNUAL PLAN
2009 -2010
TABLE OF CONTENTS
I. EXECUTIVE SUMMARY 1
II. ASSESSMENT 2
A. Community Health Assessment 2
B. Adequacy of Public Services, ORS 431.416 9
C. Provision of Basic Public Health Services 9
D. Adequacy of Other Key Services Critical to Public Health 15
III. ACTION PLAN
A. Epidemiology and Control of Preventable Disease and Disorder
1. Communicable Disease 18
2. Emergency Preparedness 25
3. Food -Borne Illness Reports 27
4. Immunizations 28
5. Tobacco Prevention 40
B. Parent and Child Health Services, Including Family Planning
Clinics as Described in ORS 435.205
1. Women, Infants & Children (WIC) 40
2. Immunizations 53
3. Maternal Child Health 53
4. Family Planning 55
C. Environmental Health 60
D. Health Statistics 63
E. Information and Referral 65
F. Public Health Emergency Preparedness 66
G. Other Issues 66
IV. ADDITIONAL REQUIREMENTS 67
V. UNMET COMMUNITY NEEDS
A. Primary Care 68
B. Methamphetamine Abuse 70
C. Hunger and Nutritional Health 71
D. Tobacco Use 71
E. Mental Health Services for the Uninsured 71
F. Family Violence 71
G. Children with Special Health Care Needs 71
H. Health and Social Support Assets for Ex- Incarcerated Populations 71
I. Children's Oral Health 72
J. Childhood Obesity 72
VI. BUDGET 73
VII. MINIMUM STANDARDS
A. Organization 76
B. Control of Communicable Diseases 77
C. Environmental Health 78
D. Health Education and Health Promotion 78
E. Nutrition 79
F. Older Adult Health 79
G. Parent and Child Health 79
H. Primary Health Care 80
I. Cultural Competency 80
J. Health Department Personnel Qualifications 80
APPENDICES
A. Deschutes County Health Report 2007 82
B. Organizational Structure 106
I. EXECUTIVE SUMMARY
This 2009 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 County Health
Department and the County 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 better integrate our services for the benefit of our County and
its residents. The new Department is titled Deschutes County Health Services (DCHS).
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: BCC program & tobacco prevention;
• Environmental health services through the Community Development Department; and
• Environmental toxicology investigation and intervention.
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);
• The health, social and economic impact of substance abuse including methamphetamine;
• Low but improving immunization rates for our young children; and
• Drinking water quality preservation in southern Deschutes County.
Progress —The 2009 -2010 Plan also recognizes notable progress in:
• Low teen pregnancy rates;
• Low school exclusion rates for school age immunization;
• Added capacity across the primary care safety net system;
• Exceptional breastfeeding rates among Deschutes County WIC mothers and
• Expansion of school based health centers capacity in La Pine, Redmond and Bend.
We also look forward to the fall 2009 completion of our 2009 Public Health Community Report.
The 2007 report was well received and the new, expanded report will support our work in the
community and strengthen our County's education and public health action agenda.
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
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 2009 -2010
II. ASSESSMENT
A. Community Health Assessment
Community Health Profile: In March of 2007, the Department issued its third edition of a
community health profile report. A PDF version of the report is attached as Appendix A.
The report summarizes the major health issues and trends across Deschutes County.
Please refer to the report for a comprehensive assessment of the health of the community.
The Department will continue to support the collection of health data and reporting in this
format on at least a biannual basis. In addition to the findings in the report, a few of the
major health issues affecting our communities are noted below.
Access to Health Care /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. In reality, a crisis has arrived. It is estimated that approximately 25,000
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 6,300 Deschutes County children remain uninsured. It is
estimated that 13% of our children live below the poverty line. It is uneasy knowing these
are many of the children facing the most significant health and dental issues.
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 14% in Deschutes County.
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 the
individual 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. Added together, we
estimate approximately 33,000 residents — adults and children —face serious economic
barriers and greatly limited access to primary care services. They are likely to struggle to
find a medical home. One glimmer of good news is that a Rural Health Clinic in La Pine
has remained committed to serving that community. By the summer of 2009, the clinic will
begin operations as a Federally Qualified Health Clinic (FQHC), complementing the work of
Mosaic Medical Center in the central and north parts of the County. Also significant is the
recent incorporation of the La Pine community. This will only help in working with
members of this community to address current and future health care needs.
In 2004, a new health care clinic, Volunteers in Medicine Clinic of_ the Cascades (VIM),
opened its doors, providing an access point for low- income, uninsured residents of
Deschutes County. The VIM clinic received over 7,500 patient visits in 2008.
Mosaic Medical expanded their FQHC network to Bend and Madras in 2005, bringing much
needed access to Medicare and low- income clients. The Mosaic Medical system received
more than 30,000 patient visits across Central Oregon in 2008.
Deschutes County Health Services 2
Local Public Health Authority Annual Plan 2009 -2010
The School Based Health Centers 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 Oregon in that they readily serve all school aged students, grades K -12.
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 Oregon Healthy Teens Survey reveals that 19.5% of our 8th graders and
18.6% of our 11th graders are overweight. There has been a startling rise in obesity rates in
children in the past two decades.
Communicable Disease: The Communicable Disease Program in Deschutes County
continues to grow with increased numbers of disease cases, food -borne outbreaks, and
requests for information from the community. The County population growth has
increased from 115,367 in the year 2000 to 167,015 in 2008. Chlamydia continues to be
the highest reported disease in Deschutes County, with an increase of more than 70% since
2001. The cases count for 2007 was 395 and 438 for 2008. Overall, communicable
disease reports and investigations have increased more than 500% since 1998, creating an
increased workload on staff for follow -up. The Department investigated 7 cases of syphilis
and 6 cases of gonorrhea in 2008.
Deschutes County continues to have higher rates of giardiasis, the number of
campylobacter continues to rise, and the number of food -borne illness outbreaks (Norwalk)
have increased. Deschutes County is also averaging 20 -25 cases of Hepatitis C a month
(non- acute) which, since the disease became reportable in 2005, has created an unfunded
workload for staff.
It has been a challenge to develop an effective reporting loop with local medical providers in
the community. Due to high provider turnover and a large influx of new providers, the
Communicable Disease team has found it difficult to educate and remind about reporting
standards on a regular basis. In 2007 and 2008, presentations were done for the
emergency room medical staff and local medical providers in hopes of improving the
frequency of providers contacting the Department about reportable diseases.
The Communicable Disease team updated the West Nile Virus Plan, implemented
surveillance in 2005, and is preparing for the spring of 2009. The team completed
development of a SARS Plan and is in the process of updating the Pandemic Flu Plan, as
well as participating in health system preparedness with Cascade Healthcare Community
and numerous community partners.
Cultural Competency: Those of Hispanic origin are a fast growing group. Of 2,000 live
births in Deschutes County in 2006, 234 (11.7 %) were to Hispanic mothers. In 2007, we
saw 2,083 live births with 287 (13.8 %) to Hispanic mothers. 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 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, including Family Planning and STD, 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 cultureE
that access services at the Department. In February 2008, we started a "Males Only Clinic'
Deschutes County Health Services
Local Public Health Authority Annual Plan 2009 -2010
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.
Demographic Population Changes: The County is challenged by a rapid population
growth, making it difficult to keep pace with the increased demand for public health
services. Deschutes County, again, ranks near the top in per- capita growth rate for 2008.
The County Population at the end of 2008 is estimated to be over 167,000 citizens. The
increased demand for prenatal services relative to the growth in the Hispanic population is
noteworthy. Of 2,083 live births in 2007, 287 (13.8 %) were to mothers of Hispanic
ethnicity. In 2008 the HealthyStart Prenatal Program (our safety net prenatal program)
assured for the delivery of 143 healthy babies; 95% were to Hispanic mothers.
Of note is the rate of growth in our over 65 senior population. Estimated to be 19,988
persons in 2006 (13.1% of the population), this figure is expected to grow to over 27,000 by
2010 and over 45,000 by 2025 a 143% increase from 2005 -2025.
Emergency Preparedness: Program staff have developed a Pandemic Flu Plan,
collaborated with community partners, and incorporated the plan into the County
Emergency Response Plan. Deschutes County Health Services continues to work with the
County Emergency Manager. The program hired a full -time coordinator in 2007 and since
that time has made notable progress in staff training as well as community and health
system readiness.
Environmental Health & Toxicology: In southern Deschutes County efforts to assure for
the preservation of the quality of drinking water from groundwater sources have received
acute attention. A recently completed U. S. Geological Survey indicates nitrates will
continue to accumulate in the shallow water aquifer unless remediation efforts are
undertaken. The County is still considering adopting new development codes that would
address nitrate sources from septic system effluent. Citizens regularly contact the
Department with concerns related to environmental toxicology. We anticipate more
attention to health effects from West Nile Virus in 2008, given we had our first avian case in
late 2006. We added a part -time position to the Department in 2008 to help address these
growing areas of concern.
Family Violence: Family violence includes child abuse, domestic violence (intimate
partner violence), sexual assault, and elder abuse.
Child Abuse: In 2001, the reported child abuse case rate in Deschutes County had
increased from 10.8 to 11.6 and was considerably worse than the Oregon rate (344
substantiated victims). The rate decreased to 9.4 in 2002 (292 victims), fell further to 8.8
in 2003 (282 victims) and lowered to 8.2 in 2004 (276 victims); but remember the loss of
public staffing dedicated to this area of concern. In 2003 there were approximately 1,800
calls to the local DHS Child Abuse Hot Line. The State of Oregon Benchmark for 2005 was
6.2 confirmed cases per 1,000 children. If we were to achieve this benchmark, then we
would expect to avert 83 children from suffering as victims of reported and substantiated
child abuse, based on a child population of 31,926 for 2004.
Unfortunately, the rate of confirmed child abuse in Deschutes County in 2005 was up 16%
over 2004. The rate in 2005 is 9.6 per 1,000 children. In 2005 there were 32,821 children
under the age of 18 in Deschutes County. This translates to 314 cases of confirmed child
abuse in 2005. In 2006 there were 2,663 reported cases of child abuse in the tri- county
Central Oregon area. Of these, approximately 2/3 were from Deschutes County. While the
"substantiated" case rate for 2006 lowered slightly to 9.0 cases per 1,000 children -216
substantiated cases of abuse out of 758 investigated cases —it is worthy to note that Child
Deschutes County Health Services
Local Public Health Authority Annual Plan 2009 -2010
4
Protective Services is addressing only those cases where the child is believed to be at
imminent risk of harm.
Social service workers state that the number of reports of abused children has not
decreased much over time, even though the numbers might suggest this. The lower case
rate numbers may well reflect a tightening of the definition of confirmed child abuse. DHS
tightened the definition of a founded /confirmed child abuse case, specifically in the area of
"threat of harm." The end result has been a lower number of founded cases as compared to
previous years.
It is worthy to note there has been a significant increase in children ages 0 -2 who are born
to parents with known substance abuse problems, especially methamphetamine. A
recently completed Healthy Teens Survey revealed that 20% of Deschutes County 11th grade
females have been victims of sexual contact from an adult at some point during their life.
Domestic Violence: In 2001, an estimated 762 women and 489 men (1,251 total) were
subjected to physical violence by an intimate partner. For 2002, the local women's shelter
for battering and rape reports 302 women were sheltered for a total of 4,894 nights, and
there were a total of 2,624 hot line calls. In 2003 the numbers increased to 386 women
and children sheltered for a total of 4,086 nights and 3,311 hot line calls. In 2004 the
numbers leveled off somewhat to 320 women and children sheltered for 4,072 nights and 2,
704 hot line calls. Current community factors that impact the problem include increasing
unemployment, lack of basic family resources for a growing number of people (putting
greater stress on the family unit), a growing Hispanic population with cultural acceptance
of intimate partner violence, and a growing problem of methamphetamine use.
The Department received a $4,700 grant to improve the screening, reporting and referral
process with our clientele. This will provide the resources to enhance the current level of
service we are providing in this area. Staff were trained and policies revised in February,
2009.
Food -Borne Illness Reports: In 2007, we saw a number of reports of institution -wide
Norovirus outbreaks, perhaps due to increased surveillance. There were 11 outbreaks
reported in 2008 compared to 14 in 2007 and 12 in 2006. In 2008 we saw 11 Salmonella
cases, compared to 18 in 2007 and 12 in 2006. The coordination between public health
and environmental health is positive and has resulted in the formal assignment of
environmental health service into the Department, which began July 1, 2007.
Health Officer: The Department fills the Health Officer role with the services of three
Medical Directors. Dr. Richard Fawcett, an infectious disease physician, is the Deputy
Health Officer and Medical Director of communicable disease services. Dr. Mary Norburg,
an OB/ GYN physician, is the Health Officer and Medical Director of our maternal child
health services. Dr. Stephen Knapp, a family practice physician, is Deputy Health Officer
and Medical Director of our pediatric and juvenile primary health care services. To date,
this model has been sufficient to meet our needs.
Immunizations: Despite providing immunization to nearly 9,000 children in our Shots -
For -Tots program, the rate for Deschutes County overall fell to last in the State with barely
at 51% of our two -year olds fully covered with recommended vaccines in 2005. In 2008 the
Department improved the immunization rate for its 0 -2 years service population to 69 %, up
from 64% in 2007. 2009 will bring an acute focus to this issue and an affirmative plan to
increase our rates. The program recently made significant progress by working with
Central Oregon Pediatrics Associates to install the ALERT Immunization registry. We
anticipate that this will help capture more accurate immunization status data and alert
practitioners to the opportunity to vaccinate their young patients.
Deschutes County Health Services
Local Public Health Authority Annual Plan 2009 -2010
Injury Morbidity and Mortality: Injury remains the leading cause of death among
Oregon's children aged 1 -17 and young adults up to the age of 44. Injury is the fourth
leading cause of death overall if all age groups are combined. Among all age groups,
unintentional injuries resulted in 47 deaths in 1998, 45 in 2000, 43 in 2001, 56 in 2003
and 58 in 2004. Most injury related deaths occur as a result of motor vehicle accidents
(38 %), falls (29 %), poisoning (10 %), drowning (3 %), firearm shootings, fires, suffocation and
water transport incidents. Injuries are not "accidents" in that "injuries" can be predicted
and prevented. The 2000 HRSA Community Health Status Report indicated that Deschutes
County's rate of motor vehicle accidents (MVA) to be 26.1 compared to a national rate of
15.8 (1997 data). HRSA data reveals that 313 injuries were from falls, 135 from MVA, and
40 from other methods of transportation.
Lactation Services: The Department is deserving of recognition for programs that address
breastfeeding including Maternal Child Health (MCH), Women, Infants & Children (WIC),
Prenatal Care Clinic, and Oregon MothersCare. The agency seeks to improve coordination
among these services for the purpose of consistency for clients as well as maximizing
resources. A chief strategy is the revision of the WIC Breastfeeding Coordinator position to
incorporate a leadership component to facilitate coordination and to provide shared
training to all staff who provide breastfeeding services. The breastfeeding initiation rate
among Deschutes County WIC clients is 94.4% based on 2007 data from CDC (Centers for
Disease Control and Prevention). This data ranks Deschutes County as third highest
among all Oregon WIC agencies.
Leading Causes of Death 2005 — Deschutes County (1,062 deaths):
1. Cancer -23.7% (252)
2. Heart Disease -22.6% (240)
3. Cerebrovascular Disease -6.8% (72)
4. Unintentional Injuries -6.3% (67)
5. Chronic Lower Respiratory Disease -5.9% (63)
6. Diabetes -3.4% (37)
7. Alzheimer's Disease -3.4% (36)
8. Suicide -2.2% (23)
9. Alcohol Induced Deaths -1.7% (18)
10. Parkinson's Disease -1.2% (14)
11. Flu & Pneumonia -1.2% (13)
Note: Tobacco use contributed to an estimated 218 deaths in 2005.
Medical Examiner - Coroner: The Deschutes County Medical Examiner is housed within
the office of the District Attorney for criminal investigative work. Other work is coordinated
between the State Medical Examiner's office and the local Medical Examiner. The Medical
Examiner is playing an increasingly important role in our Public Health system. A Medical
Examiner, Dr. Chris Hatlestad, was hired in the fall of 2003 and has demonstrated a strong
interest in working collaboratively with the Department on health trend analysis and
deaths of public health significance. Thanks to Dr. Hatlestad's keen observations, we
recently identified a death related to Hantavirus. Dr. Hatlestad is also an active participant
in our health system effort to prepare for pandemic flu and participates regularly in local
Child Fatality Review Board meetings.
Mental Health Services: The National Institute of Mental Health estimates that 26.2% of
Americans 28 and older (1 in four adults) suffer from a diagnosable mental health disorder
in a given year. When applied to the 2006 population estimate, this figure translates to
over 30,000 Deschutes County residents. While resources for mental health assessment
and treatment have diminished, Deschutes County is strong in provider partnerships which
enhance the efficiency of existing services through coordination efforts.
Deschutes County Health Services 6
Local Public Health Authority Annual Plan 2009 -2010
Oral Health: Tooth decay remains the most common chronic disease in children age 5-
17 —five times more common than asthma. Children from low income families have nearly
12 times the number of restricted activity days due to the pain and suffering of tooth decay
than do their counterparts from higher income families. In 2005 -2006, 32.6% of Deschute;
County 8th graders reported not having a visit to the dentist, higher than the statewide rate
of 26.3 %.
These same populations also have barriers to obtaining dental care including extremely
limited safety net services, limited numbers of local dentists who accept OHP and limited
capacity to cover the total plan enrollment for the region. A local safety net dental clinic
reports they see an average of 50 uninsured school age children per month. Local
emergency rooms report a significant number of visits for complications of untreated dental
problems. Many OHP enrollees report being assigned to dentists who are out of the area,
making it difficult for them to access care. Local dentists report low income and OHP
populations are difficult to serve because of higher levels of dental problems and
complications poorly covered by OHP.
Limited screening for children is provided in well child clinics as well as nurse home visitin €,
programs. Eligible families may receive prescriptions for fluoride through well child clinics,
and extensive prevention education is offered in all MCH programs. Pregnant women
receive minimal screening and referral or case management to access a dentist.
The OHP population of pregnant women served in Maternity Case Management (MCM) has
been identified as having high rates of dental problems and poor access to care.
Participation in local oral health initiatives such as a new coalition and a prevention project
in WIC has led to improved access to dental care as well as a better system of providing oral .
health prevention messages to pregnant women. The Oral Health Coalition continues to
provide leadership in advocating for underserved populations in Deschutes County, and in
2005 developed teaching brochures to use with high -risk populations. The brochures
continue to be distributed through our clinics, home visiting, WIC and the Ready Set Go
program.
The Coalition is using volunteers to disseminate Cavity Free Kids training to community
partners. The coalition has assisted Volunteers in Medicine (safety net clinic) and the
community college in development of an adult dental clinic staffed by dental hygiene
students and volunteer dentists. Give Kids A Smile Day was very successful in helping
young children access free care. Currently, the coalition has developed a protocol to inform
new dentists of the coalition. The Department received a grant from ODS 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.
Northwest Medical van is being scheduled through Volunteers in Medicine.
Despite 50 years of scientific and medical research on the health benefits of community
water fluoridation, every city water supply in Deschutes County remains 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 Cascade Healthcare
Community and the Department to provide a safety net prenatal care clinic for uninsured
pregnant women known as the HealthyStart Prenatal Service. 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.
Deschutes County Health Services 7
Local Public Health Authority Annual Plan 2009 -2010
Preliminary data show there were 1,948 live births in Deschutes County in 2008. Of them,
143 were births whose moms enrolled in the HealthyStart Prenatal Program. Of note is
that 136 of the HealthyStart births were to Hispanic mothers. The HealthyStart Program
processed and assisted 589 program participants with their application for the Oregon
Health Plan. The HealthyStart Program was chosen to be one of two pilot projects for the
Perinatal Expansion program which allows Citizen Alien Waived Emergency Medical
(CAWEM) eligible pregnant women to be enrolled in CAWEM Plus. This program provides
prenatal coverage through a County match via SCHIP funds. The pilot program will extend
for a 15 -month period, until September, 2009.
97.9% of pregnant women received adequate prenatal care in 2008. The rate for starting
prenatal care in the first trimester has increased from 83% since the implementation of
Oregon MothersCare in 1999 to 87.8% in 2008 (compared to a state rate of 78.5 %). The
low birth weight rate was 6.5% in 2008. Infant mortality was 0.6% in 2008, compared to
1% in 2001.
Substance Abuse: Methamphetamine use is on the rise and difficult to intervene. A local
grass roots effort called the Meth Action Coalition has achieved tremendous community and
business recognition of this devastating substance abuse.
Suicide: Suicide is the second leading cause of death among Oregon youth age 10 -24. In
Deschutes County there were 18 confirmed youth (10 -17 years old) suicide attempts in
1999. That figure rose to 63 in 2003, prompting community -wide attention and discussion.
There were 42 confirmed attempts in 2004 and 42 again in 2005. While 2/3 of youth
suicide attempts are among females, 82% of youth suicide deaths are among males. For
every suicide death among youth under the age of 18, there are an estimated 134 suicide
attempts that are treated in hospital emergency rooms. Suicide for all ages accounted for
24 deaths in Deschutes County in 2002, 21 in 2003, 24 in 2004 and 23 in 2005.
In 2006 the Department attempted to launch the Connecting Youth pilot project to prevent
second attempts of suicide in children under 18. Unfortunately this program failed to
launch due to concerns raised at the local hospital over patients' privacy rights and was
disbanded in the spring of 2007. The local Suicide Prevention Coalition remains active and
is seeking grant funding to expand community outreach.
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 saw a slight rate increase
in the past year. The teen pregnancy rate (per 1,000 female population 10 -17) in
Deschutes County was 8.6 in 2007 and 9.1 in 2008. The newest 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. Each year the Reproductive Health Program, in
collaboration with the schools, provides the STARS (Students Today Aren't Ready for Sex)
program to almost 1,700 middle school students with over 160 high school volunteers as
mentors. Within the past year our health educators have taught more than 215 classes on
reproductive health to almost 6,000 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. In the coming year we
will be working closely with our State partners to implement the Oregon Youth Sexual
Health Plan in our community.
Deschutes County Health Services
Local Public Health Authority Annual Plan 2009 -2010
8
B. Adequacy of Public Health Services ORS 431.416
Deschutes County Health Services provides quality service at an adequate level of capacity .
given the resources provided through the County's general fund, Federal/ State grants, and
billable revenue. The Department continues to face increased demand for required service;
at a faster pace than resources can match. This is particularly challenging in our
Communicable Disease cluster of programs where State funding remains weak and the
expectations surrounding epidemiological investigation and follow -up are high. Our
Maternal Child Health (MCH) services suffer much the same fate where, despite excellent
talent and skills across the team, the demand for services outpaces capacity nearly 2:1.
The Department provides exceptional services in its WIC, MCH, Communicable Disease,
Family Planning and Environmental Health divisions. The Department will work to improve
the efficiency and the cost profile of Family Planning services in 2008 and will address
community -wide public health preparedness with renewed vigor.
The Department has added a new emphasis in health promotion and chronic disease
prevention by clustering tobacco, asthma and obesity prevention efforts under one roof.
The Department continues to be in need of capacity to address issues related to
environmental toxicology and the link between environment and human health.
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 Communicable Disease team pulls together to offer tuberculosis (TB) screening and
testing to various local partners in the medical community and first responders. In
2007 the TB coordinator focused on screening our homeless shelters. Blood -borne
pathogen outreach training is facilitated on request when staff is available.
In the fall of 2007, the Department began 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.
In 2008 there has been a greater 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 to prevent the
spread of well -known and novel diseases in our area. The team works to ensure that
education is available for the community when sought after and works with local media
to be proactive with public education around topics such as tuberculosis, MRSA,
influenza, etc.
Deschutes County Health Services 9
Local Public Health Authority Annual Plan 2009 -20W
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 Division transferred into the Public
Health Department on July 1, 2007.
• 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 early 2007.
• Rabies immunizations are provided in the jurisdiction.
• The program has generic press releases for outbreak information.
2. Parent and Child Health Services
Perinatal Services:
Prenatal Care Access — Reestablishment of the Oregon MothersCare system has resulted
in significantly more OHP enrollments. Our Oregon MothersCare staff was reduced to
0.4 FTE in 2006 yet still served 577 women in 2007, with 90.4% receiving prenatal care
in the first trimester and 66.0% of late contact clients starting prenatal care within two
weeks of initial contact.
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 Cascade Healthcare Community and has now reached capacity,
having served over 300 women in 2006 and performed 182 birth deliveries. The
program will be challenged in meeting the needs of Hispanic and non - English speaking
pregnant women. A shortage of qualified translators makes it difficult for these women
to get comprehensive services. A new opportunity exists with the CAWEM -OHP
eligibility pilot project.
Dental Care —While OHP enrolled pregnant women have coverage for dental care; most
area dentists refuse to provide care during the pregnancy. Home visiting nurses
estimate that nearly 97% of women on their caseloads have serious dental problems yet
are unable to access care. Our local Dental Plan (Northwest Dental) is in the process of
carrying out a training agenda for participating dentists with the objective of increasing
dental care provided during pregnancy. Significant improvements have occurred with
access to care and prevention efforts (see Oral Health Section).
Case Management and Social Services —Nurse Home Visiting —We are experiencing a
decreasing ability to meet demand due to a decrease in capacity. The service will be in
jeopardy if Medicaid reimbursements decrease. Population growth has caused demand
for services to greatly exceed staff capacity. Currently staff cannot handle all high -risk
referrals.
Deschutes County Health Services
Local Public Health Authority Annual Plan 2009 -2010
10
Intimate Partner Violence — Services are limited to the local family violence shelter and
lack an outreach /education component.
Mental Health Services — County services have been reduced for indigent individuals,
while OHP clients can receive assistance based on medical necessity.
Alcohol and Drug Treatment —With the exception of co- occurring disorders, most
County 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.
Tobacco Cessation — Inadequate resources for tobacco cessation for pregnant women.
The Smoke -Free Mother Baby project is limited and the only service available. It is
noteworthy that nearly 40% of OHP mothers smoke during their pregnancy versus
11.2% of non OHP moms.
Breastfeeding Support —We are losing capacity for in -home nurse visiting service but
remain strong in WIC and local hospital outreach programs. Support is improving with
better coordination among perinatal services and the addition of the WIC Breastfeeding
Peer Counselor Program.
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.
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
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. The demand for screening and follow -up of high -risk infants (Babies
First) exceeds capacity. Approximately 40% of current referrals will not receive services.
Coordination of community services has decreased leading to inconsistency of referrals
from partners and making it difficult to track needs. The Department recently
participated in submission of a LAUNCH grant application to the Substance Abuse and
Mental Health Services Administration (SAMSHA) to address this concern.
La Pine School Based Health Center: Deschutes County is in its fifth year with a fully
certified School Based Health Center (SBHC) serving grades K -12 in La Pine. This
service adds capacity to the community's safety net care system and provides access to
primary care for approximately 1,500 La Pine school students. In May of 2009, two new
SBHCs were fully certified. The SBHC at Ensworth Elementary School in Bend serves
the Bend -La Pine School District, and the SBHC at Lynch Elementary School in
Redmond serves the Redmond School District.
Children with Special Health Care Needs: Children with physical, cognitive, and
social disabilities are case managed by a MCH nurse specialist. The LHD contracts with
Child Development and Rehab Center to provide the CACOON program.
Family Planning Services - ORS 435.025: 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 two years we have been serving youth and adolescents up to age 25 at the
Deschutes County Health Services 11
Local Public Health Authority Annual Plan 2009 -2010
Downtown Health Center two days a week and have expanded those services to three
and a half days a week currently.
All clinics provide care under protocols and standing orders approved by the Medical
Director, Mary Norburg MD. Reproductive health staff meet on a regular basis to
discuss program updates, case studies, and information exchange. The program
delivered service to 3,177 unduplicated clients in 2008 and averted 546 pregnancies.
Family Planning Expansion Project (FPEP) qualification and enrollment changes along
with the increase in clients who are seen at no charge or partial fee threatens the ability
of this program to maintain our current levels of service. Front office staff will work to
get every client's citizenship verified at their first encounter at the clinic. If the client
was born in Oregon, the client completes the Oregon Birth Match Form. if the client
was born out of state and does not have access to his /her birth certificate, the client
completes the Birth Certificate Request Form for the state where the client was born;
the completed form is sent to the appropriate state. This minimizes the number of
clients who qualify for FPEP but are not verified.
The registered nurses working in reproductive health are required to complete a very
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 STDs 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 members 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 related to illicit drug use. Vital statistics and
communicable disease (CD) information is received and recorded in a timely manner.
The communicable disease information is forwarded to the State 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.
There were 2,083 live births in 2007, 2,000 in 2006, 1,783 in 2005 and 1,438 in 2000,
revealing our upward trend. This represents a 25% increase in birth numbers over the
most recent five -year period. There were 1,202 deaths recorded in 2005 compared to
916 in 2000. This represents a 32% increase over the five -year period. The Department
issued an updated Community Health Profile report in March of 2007 (see Appendix A).
Deschutes County Health Services 12
Local Public Health Authority Annual Plan 2009 -2010
Deschutes County once again earns the distinction of being Oregon's fastest growing
county per capita. According to Portland State University's Center for Population
Studies, Deschutes County's population was estimated to be more than 167,000 in
2008 as compared 116,600 in 2000. This represents a 30% increase. Current
population forecasts project the County population to increase steadily to 170,800 by
2010 and near 250,000 by 2025. 22.5% of our population, or 34,318 individuals, is
under the age of 18.
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 its own 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 bi- annual community
health profile reports and by selectively profiling specific health issues such as obesity,
access to primary care, and the oral health condition of children. The 2007 Health
Report is attached as Appendix A. The 2009 Health Report will be released this fall.
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 ranging
from primary care and mold control to animal bites and how to access the Oregon
Health Plan. Clinicians and front office staff frequently serve as brokers of information
to clients and make referrals for additional health and social services.
The Deschutes County Public Health Advisory Board has taken a keen interest in
health promotion and education and is working closely with the Central Oregon Health
Council on a health promotion initiative related to reducing the impact of obesity and
diabetes.
We have added to our health promotion staff by creating a Community Wellness
Coordinator at 1.0 FIE. This position works closely with community partners and the
Public Health Advisory Board to develop and implement plans for expanded health
promotion and community wellness activities based on community need.
5. Environmental Health
Deschutes County is fortunate to have a staff of highly trained and dedicated licensed
sanitarians who do an outstanding job of assuring for the safety of public food
establishments, pools, spas, daycare facilities, drinking water systems and septic
systems.
Deschutes County Environmental Health (EH) currently operates through the
Community Development Department of the County and provides licensed facility and
food safety inspection, on -site sewage disposal permitting, and public water system
inspection and assurance. The team is crossed - trained in a number of aspects of
environmental health services to take advantage of workflow often dependent upon the
local winter climate. A close working relationship exists between the EH program staff
and the communicable disease (CD) control team within the Department.
Deschutes County Health Services 13
Local Public Health Authority Annual Plan 2009 -2010
In recent years, there has been a number of environmental health issues addressed
collaboratively between these two programs. The Health Director has an oversight role
in all critical CD and EH case situations that have human health impacts. Currently, a
joint governance model for environmental health services and supervision exists
between the Health Director and the Director of Community Development. It is
expected that coordination between the departments will be enhanced in the coming
year. A member of the Environmental Health Team also participates in disaster and
public health preparedness planning.
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. In 2008 the EH staff inspected 1,680 food service establishments, temporary
and mobile food units, commissaries, warehouses, and bed and breakfast
establishments. In addition, the Licensed Facility team conducted a plan review on 90
new or remodeled restaurants and provided 1,019 food handler tests. The team also
worked to make restaurant scores and inspection results available to the public via the
County's web site; 7,696 hits to this web site were recorded in 2008. Staff works in an
"education" mode as much or more than an "overseer" mode when they conduct routine
inspections, providing collegial relationships with the vendors.
Safe Drinking Water: The Environmental Health Division continues to provide
professional technical and regulatory assistance to all 184 public water systems in
Deschutes County. The team conducted 40 comprehensive sanitary surveys in 2008.
The team also investigated 36 water quality alerts associated with bacteriological
and /or chemical contamination and responded to and resolved 3 significant non -
compliers (systems not meeting EPA standards). The operators of the water systems
follow the procedures for sampling and providing the population with safe drinking
water. The County makes sure the sampling protocols are followed and follows up on
samples which do not meet the Federal Safe Drinking Water Standards. The team is
deserving of commendation for their continued efforts to reduce the number of systems
on the EPA Significant Non - Compliant list from 60 in 2000 to just 3 in 200487.
Security and emergency response plans are reviewed.
Currently, the County is engaged in an action plan to preserve the quality of the
groundwater— drinking water source —in southern Deschutes County. The plan
addresses nitrate reducing technology associated with homeowner septic systems. A
U. S. Geological Study recently revealed the high probability of increased nitrate
contamination if a remediation strategy is not adopted and implemented. Deschutes
County Health Services worked with State staff to develop public messages on the
health effects of nitrate consumption associated with drinking water.
In 2008 the Environmental Health program completed a project that mapped all County
drinking water sources. This will ensure that if a source is contaminated residents can
be immediately notified and directed to the appropriate alternative water source.
On -Site Wastewater Treatment: Environmental Health assessed 151 sites for
feasibility for on -site wastewater treatment and dispersal systems and issued 1,223
permits and authorizations for new and existing systems. The program also performed
1,345 inspections to ensure proper siting, installation or abandonment of on -site
systems. Environmental Health permitted and inspected the retrofitting of 8
conventional septic systems and the installation of 8 new systems with denitrifying
technology, bringing the total to 65 homes now treating their wastewater to standards
necessary to ensure safe drinking water in southern Deschutes County.
Deschutes County Health Services
Local Public Health Authority Annual Plan 2009 -2010
14
Pool, Spa and Tourist Facilities: Environmental Health performed 317 pool and spa
inspections in 2008 and an additional 37 inspections of tourist accommodations. In
addition, the team reviewed 9 pool /spa plans for new facilities in 2008.
Schools and Child Care Facilities: Environmental Health conducted 104 National
School Lunch Program Inspections for 52 schools in 2008, serving over 19,000 meals
per day. Related to inspection of day -care facilities, the EH team conducted 70
inspections of licensed child care facilities, giving the team a 100% inspection rate.
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 and asthma. Note: Deschutes County Health
Services hosts the Cascades East Learning Center interpreter students at our site to
provide more clinical learning opportunities for the program.
Breast and Cervical Cancer — Safety Net Services: Sadly, the Oregon Breast and Cervical
Cancer Program has not done a good job of its recent transitions at the State or local level,
and access to care for this critical service has been progressively and greatly reduced in the
past 20 months. After several years of providing the administrative and case management
components of the program the Department was compelled to relinquish a regional based
system with the promise of a new, more efficient statewide system in July of 2006.
Expectation of a statewide system to manage eligibility, provider payment and client data
management has not materialized. After eight months of attempting to patchwork the
various components to the program, the Department realized the inability of sustaining this
system.
We made a difficult administrative decision to phase out participation in this program and
are no longer accepting patient referrals from our community. Prospective patients are now
being referred back to the State hotline. Bend Memorial Clinic continues to accept patient
referrals for screening and clinical follow -up. The Community Clinic of Bend has recently
elected to curtail accepting patient referrals but will continue to screen and enroll eligible
women from within their established patient clientele. The Department has prospective
BCC clients scheduled for screening into June of 2007, but has ceased accepting more
referrals.
Emergency Preparedness: Since the fall of 2005, the Department has taken a keen focus
on health system readiness and capacity to respond to large -scale health events such as
what might be expected during a pandemic influenza event. This endeavor concerns
preparedness across the entire community health system, not just the local public health
department. The Department has a part -time position focused in this area.
Emergency Preparedness in Deschutes County has improved with the Bioterrorism Grant
and re- structuring of the Department focusing on a Communicable Disease Center.
Program staff have developed smallpox plans, improved CD response times, developed a
Pandemic Flu Plan, collaborated with community partners, and developed a new
Bioterrorism Response Plan incorporated in the County Emergency Response Plan. The
Department continues to work with the County emergency manager to plan County
exercises. The Strategic National Stockpile Plan was completed in 2005 and is exercised
each year.
The Department participated in a mass casualty drill in June of 2006. The team is
currently working on the regional plan with the HRSA Coordinator and working with
Deschutes County Health Services 15
Local Public Health Authority Annual Plan 2009 -2010
Cascade Healthcare Community and the community on preparedness. The program will
continue to develop materials on mass casualty and improve surveillance with providers.
The 24/7 system through an answering service improved the capability of staff to respond
immediately to a public health issue. We also continue to meet with Jefferson and Crook
County staff to improve coordination through the region. The staff will be 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 manager oversees the laboratory procedures and provides
technical services to clinicians. The Department has a contract with Central Oregon
Pathology to provide those services not conducted at Oregon Public Health Labs or our local
Cascade Healthcare Community laboratory. This arrangement provides for full - service
laboratory services for family planning and sexually transmitted disease services.
Arrangements are made with other local full - service medical labs to perform diagnostic lab
work outside the scope of our internal labs. Local labs also report conditions reportable to
the Communicable Disease team.
Nutrition: Screening, education, and assessment are provided extensively in MCH and
WIC programs and are also offered to pregnant women in prenatal care clinic. Targeted
screening and assessment are provided to adults in Family Planning and safety net primary
care clinic. 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.
Older Adult Health —Flu, Pneumonia, Norovirus, Falls: Prevention messages are
provided to seniors through the Immunization and Communicable Disease Program. Media
events promoting adult immunizations are provided yearly, and the Immunization staff is
working with private medical providers to improve the adult immunization rates in offices.
The Department maintains a senior resource directory; and information is given to clients
regarding diabetes, chronic disease, breast and cervical cancer, and immunization clinics.
Primary Health Care Access for Low- Income Residents: It is estimated some 25,000
plus Deschutes County residents, or approximately 18% of the population, is 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 35,000- 40,000 residents suffer from an economic barrier to basic health services.
Many of these are children, working adults and new Hispanic families.
The Department has been at the forefront of addressing health care inequity for the past 10
years. The HealthyStart Prenatal Program, a partnership between Cascade Healthcare
Community, East Cascades Women's Group and the County has provided full obstetrical
and delivery care to all pregnant women with the inability to afford private market health
care.
A new School Based Health Center (SBHC) opened in La Pine in late 2004, followed by a
Federally Qualified Health Center (FQHC) in Bend —The Community Clinic of Bend,
operated by the Ochoco Health System. The Department is working closely with and
supports the efforts of Ochoco FQHC clinic in Prineville to establish this Expansion -site
Clinic. In April of 2007 the County granted $56,000 to the Ochoco Health System to add
staffing capacity to help explore the feasibility of expanding services to the La Pine area.
Recently a decision was made by the Ochoco Health System to forego expanding into La
Pine at this time.
Deschutes County Health Services 16
Local Public Health Authority Annual Plan 2009 -2010
From 2002 -2004 the Department operated a Community Care Clinic for medically indigent
adults while working closely with other community partners to establish a Volunteers in
Medicine (VIM) Clinic. In the spring of 2004 the Volunteers in Medicine Clinic officially
opened and received nearly 7,500 patient visits in 2006. In September of 2003, a private
clinic in La Pine was designated as a Rural Health Care Clinic.
Limited primary care is still an issue for both OHP and Medicare patients. Many local
primary care physicians have severely limited their practice to these patient populations.
Indigent Care for Pregnant Women: Low income and uninsured women receive prenatal
care and delivery services through the HealthyStart Prenatal Program. Those eligible for
OHP are seen until enrollment and then transferred to private care. The program delivered
159 births in 2005, 182 in 2006, 187 in 2007, and saw a drop to 143 in 2008 with the
declining Central Oregon economy. The program is a close collaboration between the
Department and Cascade Healthcare Community, and contracts with a local OB practice
for delivery services. The demographic profile of our clients has shifted towards Hispanic
women, who do not have OHP coverage. We estimate there are, on average, 250+ pregnant
women per year who fall between 100 -185% of FPL. A loss of eligibility for OHP would
simply overwhelm our local safety net program. The Perinatal Expansion Pilot has been
key in program sustainability as community support lags in this economy.
Central Oregon Health Collaborative —Now Named Health Matters: This is one of
Oregon's community based action groups attempting to address system reform aimed
at improving health and access to care. Health Matters recently received its 501(c)(3)
status and may soon attempt to model a suite of services similar to CHOICE Health
out of Olympia, Washington. Other interests of the collaborative involve employee
health and worksite wellness as well as community development initiatives that
enhance the opportunity for residents to exercise, walk, bike and socialize. Most
recently the collaborative has begun an initiative looking at medical home placement
for children with special health care needs. Alisha Hopper is the Executive Director.
WIC— Women, Infants and 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. The WIC Nutrition Education Plan for 2009 -10 focuses on key nutrition
messages related to the new food vouchers, incorporating participant centered services into
counseling and classes, and increasing duration and exclusivity of breastfeeding.
Deschutes County Health Services
Local Public Health Authority Annual Plan 2009 -2010
17
III. ACTION PLAN
A. Epidemiology and Control of Preventable Disease & Disorder
1. COMMUNICABLE DISEASE
The Communicable Disease Program in Deschutes County continues to grow with
increased numbers of disease cases, food -borne outbreaks, and requests for
information from the community. The County population growth has increased from
115,367 in the year 2000 to over 167,000 in 2008. Chlamydia (CT) continues to be the
highest reported disease in Deschutes County. CT cases increased to 438 in 2008 from
395 in 2007. The cases have nearly doubled in four years, which creates an increased
workload on staff for follow -up. Gonorrhea case rates are below the State average but
have increased over the past few years, primarily in middle -aged white men. The
County has also had several syphilis cases over the past few years.
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. In 2006 we had 44 individuals with LTBI (latent tuberculosis infection) and two
active TB cases to manage. The Communicable Disease (CD) team updated the West
Nile Plan, implemented surveillance in 2003 which has continued to date, and is
preparing for the spring of 2009.
The program has completed the development of a Pandemic Flu Plan and is working
with other employers and organizations to continue building an infrastructure that can
address the threat of community -wide disease outbreaks. The program is participating
in health system preparedness with Cascade Healthcare Community, has planned and
practiced a number of table top exercises, and has participated in the Strategic National
Exercises and state -wide Pandemic Influenza drills each year. Future trends include
increased surveillance and awareness of potential communicable disease threats such
as pandemic influenza, West Nile virus, bioterrorist agents, etc.
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 2008 were:
• Chlamydia (438)
• Hepatitis C (196)
• Campylobacter (44)
• Giardiasis (38)
• Salmonellosis (11)
Deschutes County Health Services
Local Public Health Authority Annual Plan 2009 -2010
18
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
included several new cases of both active TB, and inactive infections (LTBI). Also, 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.
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 with 24
hours.
Ongoing
Deschutes County
residents
CD Team
Objective 2:
• Case investigations are complete ( >100 %).
• 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 more consistent feedback
system regarding the outcome of the
investigation will be provided to the health
care provider.
Ongoing
Deschutes County Health Services
Local Public Health Authority Annual Plan 2009 -2010
19
Target Population
Veterinarians
Who
CD
Coordinator
Deschutes County
residents
CD Team
Deschutes County
staff
CD Team
What
Objective 5: Develop an improved zoonotic
disease reporting system. Create an e -mail
alert system for veterinarians.
Timeline
12/1/09
Objective 6: Develop a Hepatitis C Plan that
will address the increase in disease reports
and community follow -up strategy within
staffing constraints.
Objective 7: Provide blood -borne pathogen
training to staff each year.
Deschutes County
residents
Evaluation:
Objective 1:
Objective 2:
Objective 3:
Objective 4:
Objective 5:
Objective 6:
Objective 7:
Objective 8:
CD Team
Completed
Objective 9: Update the Pandemic Influenza
Plan and continue to prepare the community.
Completed
Ongoing
24/7 system in place with positive test results.
Completed reports sent to State — monthly evaluation.
Improved reporting and communication with medical community.
Development of a system for provider feedback and implementation.
Development of a system for veterinarian reporting and implementation.
Completion of the Hepatitis C Plan.
Documented training.
Updating of Pandemic Influenza Plan and develop Health System
Preparedness Plan.
Current Condition Or Problem —HIV:
The number of HIV positive individuals continues to grow in Deschutes County with the
increase in population. The incidence and prevalence of reported AIDS cases have been
low, with no unusual aspect to the demographics. 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 individuals in Deschutes County still find difficulty living in a community
with fears around HIV. There are currently 55 HIV positive clients enrolled in the HIV
Case Management Program with the Department. It is anticipated that HIV caseloads
will grow steadily over the next few years as more people move to the area.
Future considerations include concerns about the need for medical care and medication
with the loss of the Oregon Health Plan programs. The program has seen an increase in
positive women and new individuals moving to the area from out of state. Future
trends and concerns also include the rising injection drug use (IDU) in the County and
Hepatitis C cases which have a high co- morbidity rate with HIV. There is a new State
law supporting the testing of pregnant women for HIV. We are focusing our outreach
on high -risk groups which include those who use injection drugs and men who have
sex with men (MSM).
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.
Deschutes County Health Services 20
Local Public Health Authority Annual Plan 2009 -2010
Activities:
Target Population
Who
What
Timeline
HIV high -risk
population
HIV women
HIV MSM
HIV Program
staff
Objective 1: Organize and reassess the
acuity levels of the client load in HIV Case
Management.
Ongoing 7
HIV high -risk
population
HIV Program
staff
Objective 2: Increase the percentage of
high -risk Deschutes County residents
counseled and tested for HIV by 10% for the
2007 -2008 fiscal year.
Completed
Women and
children at risk
for HIV
HIV Program
staff
Objective 3: Improve the provider HIV
testing of pregnant women through
outreach and education. (New State law
addressed this in 20051
Completed
Deschutes County
residents
Program
Manager
HIV Staff
Objective 4: Update and improve prevention
plan based on new CDC Guidelines.
Completed
High -risk
population
MSM, IDU
HIV Staff
STD Clinician
FP/ STD
Coordinator
Objective 5: Increase HIV testing numbers
in the community using the new HIV Rapid
Test. (Implemented.)
6/30/08
Evaluation:
Objective 1:
Objective 2:
Objective 3:
Objective 4:
Objective 5:
Organize and reassess participants in the HIV Case Management
Program.
Increased number of HIV tests performed for fiscal year 2007 -08.
Survey providers on HIV testing activity.
Evaluate each HIV prevention activity and report quarterly to the HIV
Program.
Measure the number of new HIV tests completed.
Deschutes County Health Services
Local Public Health Authority Annual Plan 2009 -2010
21
- Reduction (Hepatitis B and C. and HIV) Goals And Activities:
Objective
List
Resources
Outreach staff
member,
Health Services
buildings, and
drop boxes
around the
County.
Activities
Facilitating needle
exchange,
providing boxes
throughout the
County for people
to drop dirty
needles. Promoting
through word of
mouth, pamphlets,
cards, websites.
Educational
presentations given
to local drug and
alcohol treatment
groups regarding
Expected
Effects /Outputs
To prevent new HIV
and Hepatitis
infections, decrease
client needle
sharing, decrease
reports of needles
found in the
community.
Context
Conservative
community that
is just now
starting to adopt
harm reduction
principles for the
safety of the
community at
large. We are
now seeing more
people use the
exchange and
drop boxes than
the previous
year.
Reduce
Hepatitis and
HIV infection
in people who
use injection
drugs and their
networks.
HIV and Hepatitis
transmission and
prevention in an
effort to increase
awareness.
Increase
OHROCS
Work with other
Promote HIV and
Location of
testing among
program
community
Hepatitis B 86 C
Department may
people who use
partners to build
testing among Dept.
be a barrier —not
injection drugs
(IDU)
OHROCS program,
promote testing
locations, develop
and distribute
in a central
location and
with IDU clients,
STD clinic clients,
jail counseling and
testing, jail risk
reduction
counseling,
informational and
referral materials.
• Outreach
materials
distributed to 15
IDU locations:
transportation is
a hindrance.
promote needle
exchange services,
and increase needle
exchange sites.
jail, Parole and
Probation, parks,
laundromats,
food banks,
shelters, drug
treatment
centers,
addiction
recovery support
groups, bars,
hotels.
*Target number of
people who use
injection drugs to be
reached with HIV
testing: 25.
Deschutes County Health Services
Local Public Health Authority Annual Plan 2009 -2010
22
Deschutes County Health Services
Local Public Health Authority Annual Plan 2009 -2010
23
List
Expected
Objective
Resources
Activities
Effects /Outputs
Context
Reduce
Outreach staff
Promotional
• To have a larger
Conservative
Hepatitis and
member,
material, ads in
network of
community.
HIV infection
advertising
local newspaper to
contact in the
Very difficult to
through
education and
resources,
word of mouth
increase interview
opportunities on
MSM population
who are
break into the
MSM network- -
peer support of
practicing safer
networking,
internet
how best to reach
the population and
passionate about
partnering to
underground. At
this point we are
sex in the MSM
population
resources,
local PRIDE
create buy -in from
MSM population.
reduce infection
and spreading
focusing most of
our efforts on
event, Drag
Outreach through
the word.
networking to
Show, LGTBQ
adult stores.
• To increase our
increase our
Fashion Show,
Rainbow
Alliance
knowledge about
our local MSM
population, how
understanding of
the attitudes,
beliefs, and
membership,
State
assistance
best to reach,
network with,
and interventions
that will be the
most successful.
• Outreach
materials
distributed to 5
MSM
establishments:
adult stores,
parks, gyms.
behaviors of
local MSM.
Barriers include
closeted, non-
gay identifying,
and down -low
MSM. Building
relationships
with MSM is also
an on -going
project of the
outreach worker.
• Outreach at 2
events organized
by Human
Dignity Coalition:
PRIDE, Drag
Show.
Peer supported
interventions
have not been
received very
well due to the
community.
Increase HIV
Outreach staff
Staffing and
Increase testing
Few MSM utiliz(
testing among
member,
different offsite
among MSM.
the Department
MSM
possible MSM
locations to look at
*Target number
for HIV
population
peer volunteer
testing
MSM to reach with
counseling and
opportunities,
promotional
material, networks
already created to
spread word and
encouragement of
testing.
HIV testing: 25.
testing services.
Male Only Clinic
will be held twice a
month. This clinic
began 2/28/08 in
efforts to increase
testing among men,
especially MSM.
Deschutes County Health Services
Local Public Health Authority Annual Plan 2009 -2010
23
Current Condition Or Problem — Tuberculosis:
Deschutes County has seen an increase in the amount of active TB cases, as well as
LTBI cases. The result of new cases has increased the need for additional staff to assist
in the Communicable Disease Program. In 2008 there were 36 clients receiving INH. In
2005 this number had jumped into the 60s and dropped into the 40s in 2006 (partly
due to staff ability to do more outreach to treat). There has been a trend of Hispanic
clients receiving LTBI in the past three years. The program 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.
tivities:
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 from 60% to
75 %.
6/30/08
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.
Completed
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:
Objective 2:
Objective 3:
Objective 4:
Objective 5:
Objective 6:
Objective 7:
Target PPD tests provided through the Department.
Documented HIV testing.
Statistics from Oregon Health Services.
Number of presentations and information packets to providers.
Number of shelter residents receiving screening.
Updated protocols and policies— documentation.
Updated policy and documented fit testing.
Deschutes County Health Services
Local Public Health Authority Annual Plan 2009 -2010
24
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
(WNV), 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
County -wide vector control district.
Goal:
Decrease the 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
activities for the presence of specific
mosquitoes throughout Deschutes
County.
Completed
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. Send
updated plan to officials. (Completed for
2006.)
Completed
Deschutes County
residents
CD
Coordinator
Objective 5: Continue public hotline for
Deschutes County residents on the issues
relating to West Nile Virus.
Completed
Evaluation:
Objective 1:
Objective 2:
Objective 3:
Objective 4:
Objective 5:
Surveillance activities ongoing through spring and summer.
Continue current vector control activities through contract with Four
Rivers Vector Control.
Dead bird submission information to the public and system in place.
Collection of materials and articles to the general public.
Completion of community forums and ongoing update of West Nile
Response Plan.
2. EMERGENCY PREPAREDNESS
Emergency Preparedness in Deschutes County has improved with Preparedness Grant
dollars and re- structuring of the Department focusing more on how we will pull together
as a team to address community disasters. Program staff have developed specific plans
for a variety of potential threats to our County, as well as creating and participating in
exercises to practice their functionality.
The Department is a key player and planner of the County Pandemic Influenza Plan. It
includes a variety of partners from around the County and is exercised to identify
response strengths and weakness within our Department and community.
All hazard response plans are incorporated in the County Emergency Response Plan.
The Department continues to work with the County Emergency Manager to plan County
exercises. The Strategic National Stockpile Plan was completed in 2005, exercised and
Deschutes County Health Services 25
Local Public Health Authority Annual Plan 2009 -2010
revised again in 2007. The team is currently working on the regional plan with the
HRSA Coordinator, with Cascade Healthcare Community and the community on
exercising plans, working together as a community to clarify roles, pool resources and
staff. The program will continue to develop materials on mass casualty, participate in
County and State exercises and improve surveillance with providers.
The 24/7 system works via an answering service, where a nurse can be reach at all
times to receive disease and disaster reports of public health significance. On average
we receive 3 -5 after -hour calls per month from the public. We also continue to meet
with staff from Jefferson and Crook counties to improve coordination throughout the
region. The staff will be leading the effort to improve the capability of all Department
staff to respond to an emergency through ICS /NIMS training.
Current Condition Or Problem:
Emergency Preparedness in Deschutes County has improved over the past five 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 CD response times, collaborated with community
partners, developed a basic disaster response plan, and continue to work with the
County Emergency Manager to implement all the information into the County response
plan. Needs include completion of materials on mass casualty, increased activity on the
planning group and development of a health focused planning group.
Goal:
To improve the response to communicable disease and public health emergencies
throughout Deschutes County.
Activities:
Target Population
Who
What
Timeline
Deschutes County
residents
CD Program
Manager
Preparedness
Coordinator
Objective 1: Participate with Cascade
Healthcare Community and Emergency
Management on an area preparedness
planning group.
• To 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.
Objective 4: 24/7 contact information as
been provided to DHS, Health Services and
other public safety agencies.
Objective 5: Update and review NPS Plan
(CD).
Completed
Ongoing
Ongoing
Deschutes County
residents
CD Program
Manager
Mass
immunization
population
Immunization
Coordinator
CD Coordinator
Deschutes County Health Services
Local Public Health Authority Annual Plan 2009 -2010
26
Target Population
Who
What
Timeline
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
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 state -wide
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
Ongoing
Deschutes County
residents
CD Team
Veterinarians
Animal population
CD Coordinator
Objective 8: Improve the Animal
Surveillance System in Deschutes County
through the Broadcast Fax System.
01/01/10
Department staff
Preparedness
Coordinator
Objective 9: Training plan for all staff to be
ICS and NIMS compliant.
Completed
Evaluation:
Objective 1:
Objective 2:
Objective 3:
Objective 4:
Objective 5:
Objective 6:
Objective 7:
Objective 8:
Objective 9:
Ongoing Disaster Planning Group.
Integration of all plans.
Mutual aid agreements in place.
24/7 communication intact.
Completed NPS Plan.
Plans completed.
Risk Communication training documented and plan completed.
Improved Animal Surveillance System.
Staff trained in ICS and NIMS.
3. FOOD -BORNE ILLNESS REPORTS
Food -borne illness in Deschutes County remained similar to previous years, with four
E -Coli 0157 reports and eleven Salmonella reports. At the end of 2005 there was a very
large E -Coli -0157 outbreak, in which we had an opportunity to use the incident
command system, as well as producing a food -borne outbreak manual for future events.
Deschutes County Health Services 27
Local Public Health Authority Annual Plan 2009 -2010
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 in both 2007 and
2008. Each year, as reports increase and staff numbers remain the same it becomes
more and more difficult to thoroughly investigate each Norovirus outbreak.
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. The extensive work with coalitions, community education, and providers has
made a difference in outcomes.
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.
Issues in Deschutes County include prevention of Pertussis with an increased number
of parents choosing not to immunize, Hepatitis B vaccinations implemented in the
hospital, and the growing population of young children with no health care. The
Immunization Coordinator will be continuing to work on a state -wide project to improve
the status of the 4th DTap, as well as improve our birth to two -year old immunization
rates for 2009. The past two years have been challenging for the program with staff
turnover and inability to do much outreach in the community.
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 continues 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 also
include prevention of Pertussis, with an increased number of parents choosing not to
immunize; and the growing population of young children with no health care. 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 2009 -2010
28
Local Health Department: Deschutes County
Plan A— Continuous Quality Improvement: Increase Up -to -Date Rates for Two -Year Olds
Fiscal Years 2007 -2010
Year 1: July 2007 -June 2008
Objectives
Methods /Tasks
Outcome
Measure(s)
Outcome
Measure(s)
Results
Increase the up-
to -date
immunization
rates of children
under 24
months by 6%
over the next
three years
within the Dept.
Use 2006 AFIX
data as the basis
of comparison for
projected change
(62% total 2006).
Fully screen each
patient for
immunizations at
every visit.
Assure every shot
is entered in
ALERT from clinic
and off -site.
Screen for
immunizations at
all WIC appts. and
make sure clients
with immunization
needs are referred
to PMD or HD
immunization
clinic ASAP.
(Procedure on how
this occurs should
be in place and up
to date.)
Give all shots
needed unless
contraindicated.
Check Hep B shot
dates to insure
spacing is correct
( #3).
Promote Varicella.
Increase the up-
to -date rate by
2% the first year.
Hold one
training with
WIC staff on how
best to get
clients up to
date via
screening and
referrals.
Have procedure
completed on
how WIC screens
and refers.
Consider recall
and reminders
for subsequent
doses.
2007 AFIX data is
61% UTD for
4:3:1:3:3:1 series.
Every shot within
Dept. and offsite
clinics, including
Shots for Tots
clinics, is entered
into IRIS.
Progress Notes
In 2007, there were
staffing issues
within the
immunization
program, and fewer
immunization
clinics were held.
As of January,
2008, there is an
Immunization
Program Coordi-
nator and Clinic
Coordinator. The
Department is
offering more
immunization
clinics.
Deschutes County Health Services
Local Public Health Authority Annual Plan 2009 -2010
29
Local Health Department: Deschutes County
Plan A— Continuous Quality Improvement: Increase Up -to -Date Rates for Two -Year Olds
Fiscal Years 2007 -2010
Year 2: July 2008 -June 2009
Objectives
Methods /Tasks
Outcome
Measure(s)
Outcome
Measure(s)
Results
Progress Notes
Continue
strategies from
Compare stats with
2006 AFIX report.
Increase up -to-
date rates by 2%
2008 AFIX up -to-
date rate is 69%
Beginning in 2008,
the immunization
2007 and
over past year.
for 4:3:1:3:3 :1
program was fully
Provide
series. This is an
staffed. This
Increase the up-
immunization
Activities were
increase of 8%
enabled us to
to -date
information to
implemented as
over the past year.
provide more
immunization
expecting and new
planned.
This objective has
immunization
rates of children
mothers.
been met.
clinic hours and do
under 24
A. Prenatal classes
more outreach and
months by 6%
B. Handouts at OB
2008 missed shot
education to
over the next
clinics.
Missed shot rate
rate decreased by
providers and the
three years
C. Handouts at
decreased.
11 %: 28% in
community.
within the Dept.
birthing centers
2007 to 17% in
2008.
Promote co-
operative working
Quarterly
climate with local
At least one
immunization
clinics.
vaccine update
meetings were
A. Hold annual
meeting is held
held for Dept.
information
meetings/
trainings.
for Dept. staff.
staff. Meetings
have been
scheduled for
B. Provide updates
and education
via e -mail to
clinic liaisons.
2009.
Conduct outreach
and education
through:
A. Media
B. Information
tables at events
C. Vaccine update
trainings for
clinicians.
Deschutes County Health Services
Local Public Health Authority Annual Plan 2009 -2010
30
Local Health Department: Deschutes County
Plan A— Continuous Quality Improvement: Increase Up -to -Date Rates for Two -Year Olds
Fiscal Years 2007 -2010
Year 3: July 2009 -June 2010
Objectives
Methods /Tasks
Outcome
Measure(s)
Outcome
Measure(s)
Results
Progress Notes
Continue
Compare stats
Increase up -to-
To be completed
To be completed
strategies from
with 2006 AFIX
date rates by 2%
for the FY 2010
for the FY 2010
2008 and
report.
over previous
year.
report.
report.
Increase the up-
Provide
to -date
immunization
Activities were
immunization
information to
implemented as
rates of children
under 24
months by 6%
over the next
three years
within the Dept.
expecting and
new mothers.
A. Prenatal
classes.
B. Handouts at
OB clinics.
planned.
C. Handouts at
birthing
centers.
D. Referrals from
hospital.
Deschutes County Health Services
Local Public Health Authority Annual Plan 2009 -2010
31
Local Health Department: Deschutes County
Plan B— Chosen Focus Area: Increase Participation and Quality of Data to ALERT
Fiscal Years 2007 -2010
Year 1: July 2007 -June 2008
Outcome
Outcome
Measure(s)
Objectives
Methods /Tasks
Measure(s)
Results
Progress Notes
Use 2006 ALERT
participation
data as baseline.
Number of
Central Oregon
Pediatric
Associates (COPA),
the largest
Review current
participants in
pediatric clinic in
participation and
ALERT increased
Central Oregon, is
Increase the
identify clinics
(contact is
now participating
number
needing
Marybeth Kurilo
in ALERT.
of ALERT
participants in
improvement.
971 -673- 0294).
Deschutes
Recruit any site
ALERT training
County.
not reporting
classes held.
(talk, encourage
Increase
electronic
Visits to sites
amount of data
submitted and
improve quality
reporting).
Arrange for
needing in -house
training.
of submissions
ALERT users
class and invite
players to
attend. Use
ALERT video,
invite Health
Information
submitted to
ALERT within 30
days of
immunization.
Educator to
participate.
Deschutes County Health Services
Local Public Health Authority Annual Plan 2009 -2010
32
Local Health Department: Deschutes County
Plan 8— Chosen Focus Area: Increase Participation and Quality of Data to ALERT
Fiscal Years 2007 -2010
Year 2: July 2008 -June 2009
Objectives
Methods /Tasks
Continue with
previous year
obj ectives.
Increase the
number of
ALERT
participants in
Deschutes
County.
Increase
amount of data
submitted and
improve quality
of submissions
Same plus:
Review
participation;
determine
number of sites
submitting to
ALERT.
Review numbers
submitted and
have area Health
Educator
compare with
vaccine ordering
reports.
Offer assistance
to those sites
needing help.
Outcome
Measure(s)
Number of
participants in
ALERT increased
over past year
Quality of data
submitted
improved
Information
submitted within
15 days of
immunization.
Visit two clinics to
offer technical
and /or educational
assistance.
Outcome
Measure(s)
Results
ALERT training
and technical
assistance were
provided to COPA,
Bend Memorial
Clinic (BMC),
Mosaic Medical
and High Lakes
clinics.
COPA and BMC
are submitting
electronically.
Other clinics are
converting to e-
transfer. Overall,
the quality and
quantity of ALERT
data for
Deschutes County
has dramatically
improved.
Progress Notes
Much time and
effort by the
Immunization
Coordinator was
given to increa sing
provider
participation in
ALERT in 2008.
As a result,
providers and
schools are now
more confident in
the data and a
the
ALERT website
into their
practices.
ALERT was also
very beneficial to
schools and the
Dept. during
primary review.
Deschutes County Health Services
Local Public Health Authority Annual Plan 2009 -2010
33
Local Health Department: Deschutes County
Plan B— Chosen Focus Area: Increase Participation and Quality of Data to ALERT
Fiscal Years 2007 -2010
Year 3: July 200
9 -June 2010
Objectives
Methods /Tasks
Outcome
Measure(s)
Outcome
Measure(s)
Results
Progress Notes
Continue with
previous year
objectives.
Increase the
number
of ALERT
participants in
Deschutes
County.
Increase
amount of data
submitted and
improve quality
of submissions.
Same plus:
Review ALERT
participation
reports and
timeliness of
reports (private
practice clinics).
Offer assistance
classes or visit
where needed.
Sites delaying
submission
advised to report
more often.
Promote
cooperative
working climate
with local clinics.
A. Hold annual
information
meetings/
trainings.
B. Recruit for local
clinic
representation
on the
Deschutes
County
Immunization
Coalition
(DCIC).
Same plus:
ALERT
participation
reports have been
reviewed.
ALERT training
classes and visits
made.
Immunization
rates should
increase.
To be completed
for the FY 2010
report.
To be completed
for the FY 2010
report.
Deschutes County Health Services
Local Public Health Authority Annual Plan 2009 -2010
34
Local Health Department: Deschutes County
Plan B— Chosen Focus Area: Maintain and Enhance the Deschutes County Immunization
Coalition
Fiscal Years 2007 -2010
Year 1: July 2007 -June 2008
Objectives
Methods /Tasks
Outcome
Measure(s)
Outcome
Measure(s)
Results
Progress Notes
Continue with
Using 2006 make-
Membership
Both COPA and
The DCIC met )nly
previous year
objectives.
up of DCIC,
maintain the
increased.
BMC Pediatrics are
now participating
once in 2007 due
to staffing issues.
current membership
Increased
in the DCIC.
Maintain and
A. Add community
diversity of
The first 2008
enhance the
representation
membership is
One child care
meeting was held
Deschutes
B. Involve child
evident.
provider and
on March 18, and
County
care providers
NeighborImpact
there were 13
Immunization
C. Recruit school
Strategic plans
(provides training
participants.
Coalition
nurses
formulated and
for child care
Dates have been
(DCIC).
D. Recruit special
presented.
providers) are new
set for the
project reps
members of the
remainder of 2008.
(WIC, FAN)
DCIC.
E. Do
questionnaire on
group's main
goals.
A survey was
conducted in
March, 2008,
assessing the
barriers to
immunization and
the :rou.'s goals.
Deschutes County Health Services
Local Public Health Authority Annual Plan 2009 -2010
35
Local Health Department: Deschutes County
Plan B— Chosen Focus Area: Maintain and Enhance the Deschutes County Immunization
Coalition
Fiscal Years 2007 -2010
Year 2: July 2008 -June 2009
Objectives
Methods /Tasks
Outcome
Measure s
Outcome
Measure(s)
Results
Pro l ress Notes
Continue with
Same plus:
Membership
Three new clinics
The coalition's
previous year
maintained or
have become
focus has changed
objectives.
Review make up
of coalition for
enhanced with
new members.
coalition
members: Mosaic
in the past year,
with greater
Maintain and
possible
Medical, High
emphasis on
enhance the
recruitment.
Members
Lakes Health, and
clinical
Deschutes
recognized at
Dr. Burket's
immunization
County
Immunization
Explore
development of
County level.
clinic. There are
currently 26
education,
updates, and
Coalition (DCIC).
questionnaire for
Strategic plan
members.
sharing best
community to
approved.
practices and
help define needs
and gaps.
The coalition met
bi- monthly in
issues.
Provide
recognition of
members at
annual public/
private
immunization
meetings.
2008 -09.
Participation from
clinics has
increased.
Based on positive
feedback from
members, they feel
the coalition is
very useful for
their work.
Deschutes County Health Services
Local Public Health Authority Annual Plan 2009 -2010
36
Local Health Department: Deschutes County
Plan B— Chosen Focus Area: Maintain and Enhance the Deschutes County Immunization
Coalition
Fiscal Years 2007 -2010
Year 3: July 2009 -June 2010
Outcome
Outcome
Measure(s)
Ob'ectives
Methods /Tasks
Measure s
Results
Pro: ress Notes
Continue with
Same plus:
Membership
To be completed
To be completed
previous year
maintained or
for the FY 2010
for the FY 2010
objectives.
Review strategic
plan and
enhanced.
report.
report.
Maintain and
update as
Member
enhance the
necessary for
recognition
Deschutes
2011 -2013.
achieved.
County
Immunization
Coalition (DCIC).
Review of
strategic plan
completed.
Draft of strategic
plan
accomplished for
years 2011 -2013.
Deschutes County Health Services 37
Local Public Health Authority Annual Plan 2009 -2010
Local Health Department: Deschutes County
Plan B— Continuous Quality Improvement: Decrease the Late Start Rates in Deschutes
County
Fiscal Years 2007 -2010
Year 1: July 2007 -June 2008
Outcome
Outcome
Measure(s)
Ojectives
Methods /Tasks
Measure(s)
Results
Progress Notes
Continue with
Use 2006 AFIX data
Decrease the late
Late start rate
In 2007, there
previous year
as the basis of
start date rate by
remained at 15 %.
were staffing
objective.
comparison for
projected change
1% the first year.
issues within the
immunization
Decrease
number of late
(15% total 2006).
program. Fewer
immunization
starts in
Deschutes
Provide
immunization
clinics were held,
and outreach was
County by 3%
over the next
three years.
information to
expecting and new
mothers
minimal.
A. Prenatal classes
B. Handouts at
birthing
centers.
Provide
immunization
information tapes
to hospital, birthing
centers.
Present this as a
topic for discussion
meeting with local
clinic staff.
Deschutes County Health Services
Local Public Health Authority Annual Plan 2009 -2010
38
Local Health Department: Deschutes County
Plan B— Continuous Quality Improvement: Decrease the Late Start Rates in Deschutes
County
Fiscal Years 2007 -2010
Year 2: July 2008 -June 2009
Outcome
Outcome
Measure(s)
Objectives
Methods /Tasks
Measure s)
Results
Progress Notes
Continue with
Same plus:
Decrease the late
Late start rate
previous year
start date rate by
decreased by 1%
objectives.
Discuss changes in
rates at annual
1% compared to
previous year's
in 2008.
Decrease
meetings with local
rate.
Education
number of late
clinics, solicit ideas
materials were
starts in
Deschutes
County by 3%
over the next
three years.
from them.
given to the
hospital birthing
center and
distributed to
birthing classes.
Immunization
Coordinator
presented to two
new mom's groups
about
immunizations.
Local Health Department: Deschutes County
Plan B— Continuous Quality Improvement: Decrease the Late Start Rates in Deschutes
County
Fiscal Years 2007 -2010
Year 3: July 2009 -June 2010
Objectives
Methods /Tasks
Outcome
Measure(s)
Outcome
Measure(s)
Results
Continue with
previous year
objectives.
Decrease
number of late
starts in
Deschutes
County by _3%
over the next
three years.
Same plus:
Provide Quality
Improvement
training for local
clinics.
Decrease the late
start date rate by
1% compared to
previous year's
rate.
To be completed
for the FY 2010
report
Progress Notes
To be completed
for the FY 2010
report
Deschutes County Health Services 39
Local Public Health Authority Annual Plan 2009 -2010
5. TOBACCO PREVENTION PROGRAM
Tobacco Use: Deschutes County is above state average rates for smokeless tobacco use
in adults as well as our 8th and 1 lth graders. In 2006 we also saw a dramatic increase
in cigarette smoking among our youth, which spiked up to 27.8% of our 1 lth graders
reportedly smoking. 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. Our County has had success in preventing pregnant
women from using tobacco, which is reflected in the 11.1% use, lower than both the
state average and the Healthy People 2010 objective.
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)
FY 2009 - 2010 WIC Nutrition Education Plan Form
THIS PLAN WAS SENT TO SARA SLOAN MAY 1, 2009.
County /Agency: Deschutes County
Person Completing Form: Laura Spaulding
Date: April 28, 2009
Phone Number: 541 - 322 -7450
Email Address: laura_spaulding @co.deschutes.or.us
Return this form electronically (attached to email) to: sara.e.sloan@state.or.us
by May 1, 2009
Sara Sloan, 971 - 673 -0043
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
Assignment Module by December 31, 2009.
Resources: Food Package Assignment Module to be released summer 2009.
Implementation Plan and Timeline:
All Deschutes County WIC staff will complete the appropriate sections of the Food
Package Assignment Module by December 31, 2009.
Deschutes County Health Services
Local Public Health Authority Annual Plan 2009 -2010
40
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.
Resources: Sessions on Infant Feeding Cues at the WIC Statewide Meeting June 22-
23, 2009.
Implementation Plan and Timeline:
All Deschutes County staff available will attend SWM sessions on Infant Feeding Cues
on June 22 -23, 2009.
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.
Example: Pregnant women will no longer be able to routinely purchase whole milk with
their WIC FIs. If the nutrition education materials your agency uses indicates all
pregnant women should drink whole milk, those materials would need to be revised.
Implementation Plan and Timeline:
All NE lesson plans will be reviewed by the Coordinator and adjusted to be consistent
with the Key Nutrition Messages by August 1, 2009.
Activity 4: Identify your agency training supervisor(s) and projected staff in- service
training dates and topics for FY 2009 -2010. Complete and return Attachment A by
May 1, 2009.
Implementation Plan and Timeline:
Please see attachment A for training supervisors, dates and topics.
Goal 2: Nutrition Education offered by the local agency will be appropriate to the
clients' needs.
Year 3 Objective: During planning, each agency will develop a plan for incorporating
participant centered services in their daily clinic activities.
Activity 1: 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.
Examples: Use state provided resources such as the Counseling Observation Guide to
identify participant centered skills staff are using on a regular basis. Use state provided
resources such as self evaluation activities done during Oregon WIC Listens onsite
visits to identify skills staff are working on and want to improve on.
Implementation Plan and Timeline:
By October 31, 2009, we will use the state provided resources such as the Counseling
Observation Guide to identify skills staff are using on a regular basis. We will also use
the self - evaluation activities done during OWL onsite visits to identify skills staff want
to improve on.
Deschutes County Health Services 41
Local Public Health Authority Annual Plan 2009 -2010
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.
Examples: Using the information from Goal 2, Activity 1, schedule quarterly staff
meeting time to review Oregon WIC Listens Continuing Education activities related to
participant centered skills staff identified they want to improve on. Schedule time for
peer to peer observations to focus on enhancing participant centered services.
Implementation Plan and Timeline:
By December 31, 2009, using information from Goal 2, Activity 1, we will incorporate
time at staff meetings each month to review OWL - related case studies we have seen in
clinic and wanted to handle better. We will also schedule time for peer -to -peer
counseling to provide feedback on participant centered counseling skills.
Goal 3: Improve the health outcomes of clients and 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.
• Breastfeeding is a gift of love.
• Focus on fruit.
• Vary your veggies.
• Make half your grains whole.
• Serve low fat milk to adults and children over the age of 2.
Activity 1: Each agency will implement strategies for promoting the positive changes
with Fresh Choices with community partners by October 31, 2009.
Example: Determine which partners in your community are the highest priority to
contact such as medical providers, food pantries, breastfeeding coalitions, and /or Head
Start programs. Provide a staff in- service, written materials or presentation to those
partners regarding Fresh Choices.
Implementation Plan and Timeline:
By October 31, 2009, WIC staff will provide inservices or written materials regarding
Fresh Choices and Key Nutrition Messages to local public health nursing staff, the
Breastfeeding Coalition of Oregon, Head Start and the Healthy Start Prenatal Program.
Activity 2: Each agency will collaborate with the state WIC Research Analysts for
Fresh Choices evaluation by April 30, 2010.
Example: Your agency is a cooperative partner in a state led evaluation of Fresh
Choices such as hosting focus groups or administering questionnaires with
participants.
Implementation Plan and Timeline:
We will collaborate with the state WIC Research Analysts for Fresh Choices evaluation
by April 30, 2010. Prefer to administer questionnaires to participants.
Deschutes County Health Services
Local Public Health Authority Annual Plan 2009 -2010
42
Goal 4: Improve breastfeeding outcomes of clients and staff in the local agency
service delivery area.
Year 3 Objective: During planning 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.
Resources: State provided Oregon WIC Breastfeeding Study data, the breastfeeding
promotion assessment tool and technical assistance for using the tool. Technical
assistance will be provided as needed from the agency's assigned nutrition consultant
and /or the state breastfeeding coordinator.
Implementation Plan and Timeline:
We will assess our breastfeeding promotion and support activities to identify strengths
and weaknesses and identify possible strategies for improving breastfeeding support for
exclusivity and duration by December 31, 2009.
Activity 2: Each agency will implement at least one identified strategy from Goal 4,
Activity 1 in their agency by April 30, 2010.
Implementation Plan and Timeline:
We will implement at least one strategy from Goal 4, Activity 1 in our agency by
April 30, 2010.
"Attachment A"
FY 2009 -2010 WIC Nutrition Education Plan
WIC Staff Training Plan - 7/1/2009 through 6/30/2010
Agency: Deschutes County WIC
Training Supervisors & Credentials: Laura Spaulding, RD, Coordinator /Supervisor;
Janet Harris, MS, RD
Sherri Tobin, MS, RD, IBCLC.
Staff Development Planned:
Based on planned new program initiatives (for example Oregon WIC Listens, new WIC
food packages), 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, 2009 - June 30, 2010. State
provided in- services, trainings and meetings can be included as appropriate.
Deschutes County Health Services 43
Local Public Health Authority Annual Plan 2009 -2010
Quarter
Month
September, 2009
Inservice Topic
Inservice Objective
1
Oregon WIC Listens
Strength & Weakness
Assmt.
To identify further training needs as
related to Participant Centered
Services.
2
December, 2009
Food Package
Assignment Module,
group
All staff will be able to assign correct
food packages to clients.
3
March, 2010
Infant Feeding Cues
Update
To review ways to incorporate infant
feeding cues into counseling sessions
and classes.
4
April, 2010
New strategies for
supporting
breastfeeding
All staff will be able to identify new
ways DC WIC supports exclusivity
and increased duration of
breastfeeding.
EVALUATION OF WIC NUTRITION EDUCATION PLAN
FY 2008 -2009
WIC Agency: Deschutes County
Person Completing Form: Janet Harris, Laura Spaulding
Date: April 29, 2009 Phone: 541 - 322 -7450
Return this form, attached to email to: sara.e.sloan(Zistate.or.us by May 1, 2009.
Please use the outcome evaluation criteria to assess the activities your agencies did for
each Year Two 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 2 Objective: During plan period, through informal discussions, staff in- services
and or /targeted trainings, staff will be able to describe the general content of the new
WIC food packages and begin to connect how these changes may influence current
nutrition education messages.
Activity 1: By October 31, 2008, staff will review the WIC Program's Key Nutrition
Messages and identify which ones they need additional training on.
Outcome evaluation: Please address the following questions in your response.
• How were the WIC Program's Key Nutrition Messages shared with staff in your
agency?
• Which messages did staff identify as needing additional training on?
• How did this training occur?
Deschutes County Health Services 44
Local Public Health Authority Annual Plan 2009 -2010
Response:
• A copy of the "Key Nutrition Messages for the Oregon WIC Program" was given to
each certifier. We reviewed them as a group at the October 2nd Nutrition Education
Meeting and targeted the ones that staff felt they would like more training on. The
WIC RD (JH) presented an inservice on the new AAP Guideline for 2% milk in some
children after 1 year. *Lipid Screening and Cardiovascular Health in Childhood -
www.pediatrics.org /cgi /content /full/ 122/ 1/ 198
• The key nutrition messages that staff needed additional training on were:
1. Dental Care and Pregnancy
2. Training cups for Infants
• Inservices:
1. Inservice on Oral Health During Pregnancy and Baby's First Year (Oregon WIC
Program) was presented by WIC RD's (JH and ST) at the December 4th Nutrition
Education Meeting.
2. Facilitated discussion led by GK on Sippy, Tippy, and Training Cups at the
January 8th Nutrition Education Meeting.
Activity 2: By March 31, 2009, staff will review the proposed food package changes and:
• Select at least three food package modifications (for example, addition of new foods,
reduction of current foods, elimination of current foods for a specific category).
• Review current nutrition education messages most closely connected to those
modifications, and
• Determine which messages will remain the same and which messages may need to
be modified to clarify WIC's reasoning for the change and /or, reduce client resistance
to change.
Outcome evaluation: Please address the following questions in your response.
• How did staff review the proposed food package changes?
• Which nutrition education messages were identified that need to be modified?
• How will these messages be shared with participants?
Response:
• We have been completing the State Provided Inservices per the State required
training guidelines. The inservices use Power Point, facilitated discussion, etc.
1. Lower Fat Milk Inservice for all WIC Staff on January 15th and January 20th,
2009 presented by the WIC RDs. Included a "milk challenge taste test."
2. Infant Feeding Inservice for all WIC Staff was presented by WIC RD (LS) and WIC
IBCLC (JC) on March 12th and March 26th.
3. Whole Grains Inservice will be presented to all WIC Staff by the WIC RDs in May.
• Our nutrition education messages will continue to be the same (increase whole
grain and fiber consumption, increase fruit and vegetable consumption, to decrease
saturated fat in the diet, and to continue to support breastfeeding). With Fresh
Choices we will be able to provide a food package that is consistent with these
messages!
• We have been using the State provided participant education materials to educate
our participants during one -on -one appointments, Quick WIC workshops, and
Bulletin Boards.
Activity 3: Identify your agency training supervisor(s) and staff in- service dates and
topics for FY 2008 -2009.
Deschutes County Health Services 45
Local Public Health Authority Annual Plan 2009 -2010
Outcome evaluation: Please address the following questions in your response.
• Did your agency conduct the staff in- services you identified?
• Were the objectives for each in- service met?
• How do your staff in- services address the core areas of the CPA Competency Model?
Response:
• Yes, we have conducted the staff inservices identified and met our objectives for
each one. Records of topics and attendance for Nutrition Education Meetings are
kept on file. The inservices addressed the following Core Competencies:
1. Review of Oregon WIC Key Nutrition Messages
Principles of Life -Cycle Nutrition
Nutrition Assessment Process
Multicultural Awareness
Nutrition Education
2. Changing NE messages based on new food packages
Principles of Life -Cycle Nutrition
Nutrition Assessment Process
Communication
Multicultural awareness
Critical Thinking
3. Mid -year evaluation of staff physical activity objective
Program Integrity
4. State training on new food packages
Principles of Life -Cycle Nutrition
Communication
Multicultural Awareness
Critical Thinking
Technology Literacy
Goal 2: Nutrition Education offered by the local agency will be appropriate to the
clients' needs.
Year 2 Objective: During plan period, each agency will assess staff knowledge and skill
level to identify areas of training needed to provide participant centered services.
Activity1: By September 30, 2008 staff will review the assessment steps from the Dietary
Risk Module and identify which ones they need additional training on.
Outcome evaluation: Please address the following questions in your response:
• Did staff review the assessment steps from the Dietary Risk Module?
• Which steps did staff identify as needing additional training on?
• How did this training occur?
Response:
• Yes, staff reviewed the assessment steps from the Dietary Risk Module and
identified steps needing Additional training using the WIC Nutrition Education Plan
Goal 2, Activity 1 - Staff Assessment (see attached results -- Attachment 1).
1. The training occurred at the November 6th Nutrition Education Meeting by
sharing the results of the assessment and reviewing appropriate sections of the
Dietary Risk Module for manually assigned risks and documentation and
probing questions.
Deschutes County Health Services 46
Local Public Health Authority Annual Plan 2009 -2010
Activity 2: By November 30, 2008, staff will evaluate how they have modified their
approach to individual counseling after completing the Nutrition Risk and Dietary Risk
Modules.
Outcome Evaluation: Please address the following questions in your response.
• How have staff modified their approach to individual counseling after completing the
Nutrition Risk and Dietary Risk Modules?
Response:
• Please see the results of the WIC Nutrition Education Plan Goal 2, Activity 2 - Staff
Evaluation (see attached results -- Attachment 2).
Goal 3: Improve the health outcomes of WIC clients and WIC staff in the local
agency service delivery area.
Year 2 Objective: During plan period, in order to help facilitate healthy behavior change
for WIC staff and WIC clients, each local agency will select at least one objective and
implement at least on strategy from the Statewide Physical Activity and Nutrition Plan
2007 -2012.
Activity 1: Identify your objective and strategy to facilitate healthy behavior change for
WIC staff.
Outcome Evaluation: Please address the following questions in your response.
• Which objective and strategy did your agency select?
• How did your agency decide on this objective and strategy?
• Did the strategy help meet the objective?
• What went well and what would you do differently?
Response:
• We selected Objective III - By 2012, increase by five percent the number of
employees who are physically active for 30 minutes a day, at least five days per
week.
• We selected Strategy C - Provide and promote flexible time policies to allow for
opportunities for increased physical activity.
• We choose this objective and strategy because several staff members shared that
they do not have time to exercise before or after work. We wanted to support staff in
planning time throughout their workday to fit physical activity in and to support
them as they overcome barriers to daily exercise.
• Both the option of adjusting templates to accommodate breaks for physical activity
and having an "Exercise Tool Box" on site have enhanced a culture that values
physical activity. Both have been utilized by a variety of staff and have contributed
to a team attitude towards being active. We don't think we would do anything
differently at this time.
Activity 2: Identify your objective and strategy to facilitate healthy behavior change for
WIC clients.
Outcome Evaluation: Please address the following questions in your response.
• Which objective and strategy did your agency select?
• How did your agency decide on this objective and strategy?
• Did the strategy help meet your objective?
• What went well and what would you do differently?
Deschutes County Health Services 47
Local Public Health Authority Annual Plan 2009 -2010
Response:
• We choose Objective IV - By 2012, decrease television and other screen time for
children. Specifically, reduce by two percent the number of children ages 2 -18 who
have more than two hours a day of screen time and work to ensure children two
years and younger have no screen time.
• We choose the following strategy - We will promote Turn Off the TV Week in April
2009. In 2008, we will have at least one of our Quick WIC class themes by "Less
Screen Time."
• We decided on this strategy because we participated in the state "screen time"
survey a couple of years ago and all of our staff were shocked to learn how much TV
kids watch and how many very young children (< 2 years old) have TVs in their
bedrooms. We hoped to decrease screen time and increase physical activity.
• We will administer the "Family TV Viewing Questionnaire" again in May 2009 to
assess if we have met our objective.
• The "Reduce Screen Time" education handouts have been well received by Quick
W1C participants.
Goal 4: Improve breastfeeding outcomes of clients and staff in the local agency
service delivery area.
Year 2 Objective: During plan period, in order to help improve breastfeeding outcomes
for W1C participants, each local agency will select at least one objective and implement
at least on strategy from the Statewide Physical Activity and Nutrition Plan 2007 -2012.
Activity 1: Identify your objective and strategy to improve breastfeeding outcomes for WIC
clients.
Outcome Evaluation: Please address the following questions in your response.
• Which objective and strategy did your agency select?
• How did your agency decide on this objective and strategy?
• Did the strategy help meet your objective?
• What went well and what would you do differently?
Response:
• We chose Activity 1 in the Home /Household setting. The objective: Objective 1. By
2012, maintain the current level of breastfeeding initiation and increase by two
percent a year the number of mothers who breastfeed exclusively for the first six
months of a child's life.
• We decided on this objective because although we have very high breastfeeding
initiation rates in Deschutes County, we have lower 6 -month exclusively
breastfeeding mothers /babies. We have found that often times this is due to the
mother returning to work and not having adequate time and facilities for pumping
breast milk.
• One of our IBCLCs held four trainings on the Business Case for Breastfeeding. The
first, in August 2008, was held with our own employer, Deschutes County. The
second was a Toolkit training in September, 2008, on supporting working mothers
and using the Toolkit for outreach; attendance included hospital and community
nurses, Department nurses, WIC certifiers, OSU extension agents, Deschutes Co.
benefits coordinator and La Leche League leader. The third was to representatives
of the Old Mill shopping district in November, 2008. The fourth was for public
information officers for many Central Oregon entities including Bend Chamber of
Commerce, Bend -La Pine School District, Central Oregon Community College, Bend
Parks and Recreation, and Cascade Healthcare Community. This meeting was to
"inform the informers" about the program and let them know where to get answers.
Deschutes County Health Services 48
Local Public Health Authority Annual Plan 2009 -2010
• I believe education on the new law has helped Deschutes County, the employer, stay
focused on the needs of breastfeeding staff (DC was already very supportive!) and
also introduced the concept to other businesses. We are not sure if it has had a
direct impact on exclusivity rates in our area.
• A different IBCLC conducted several breastfeeding related educational segments at
our staff meetings in which medical office assistants were in attendance. These
occurred on the following dates:
August 28, 2008
September 25, 2008
October 9, 2008
November 13, 2008
February 26, 2009
Topics included post - partum scheduling /formula requests, pump requests, new
food packages /formula requests, milk bank update, world breastfeeding month.
• I think the strategy that worked the best was having the medical office assistants
receive education from our IBCLC. She not only did formal education at staff
meetings but also does 1:1 education as the front office staff receive requests from
clients, come to her office with questions, and bring up other breastfeeding
longevity /exclusivity concerns. We will continue having our IBCLC present regular
education topics for staff both formally and informally.
Deschutes County Health Services
Local Public Health Authority Annual Plan 2009 -2010
49
Attachment 1
WIC Nutrition Education Plan
Goal 2, Activity 1 —Staff Assessment
What are some questions you are using to ask participants about their feeding
behaviors?
• Tell me about how you are eating...
• What do you like about the way you eat?
• How do you feel about your diet?
• What are mealtimes like for your family?
• What does "your child" do to let you know she's hungry/full?
• How do you feel about the way "your child" is eating?
• What word(s) describes the way your son eats?
• Tell me about your eating pattern...
• Tell me about feeding "your child "...
• What do you normally drink during the day?
• What have you heard about breastfeeding?
• What new foods is your baby /child eating?
What are some probing questions you are using to find out more information from
participants?
• How do you feel about "your child" drinking from a bottle?
• Tell me more about "your child's" picky eating...
• Tell me more about how you are eating...
• How are you managing the heartburn?
• Tell me more...
• What are the barriers to...?
• What ways is this a concern for you?
• What have you heard about...?
• What are your plans for introducing solids to your baby?
• How has being pregnant changed the way you eat?
• What does your doctor say about 7
Where in TWIST are you documenting manually assigned dietary risks?
• Progress notes /SOAP notes
What are some ways critical thinking skills can help with the diet assessment
process?
• Helps you address possible dietary risks and what to do for their follow -up.
• Making sure the data collected matches the information from the client.
• Any more information needed in order to complete diet assessment
• It helps evaluate the entire "picture "...for example, ranges of formula intake per age
can be used but not solely as a way to assess dietary needs are being met. We can
also calculate weight gain and evaluate health status.
Which of the diet assessment steps are you comfortable with?
• 1St 4 steps...I don't always have time to ask all mandatory questions.
• Introduction - "meet and greet"
• Asking about feeding behaviors
Which of the diet assessment steps would you like additional training /practice
with?
• Manually assigned risks and documentation
• Probing
Deschutes County Health Services 50
Local Public Health Authority Annual Plan 2009 -2010
Attachment 2
WIC Nutrition Education Plan
Goal 2, Activity 2 —Staff Evaluation
Use this tool to evaluate your approach to individual counseling.
Refer to: Section S -1 Introduction - Nutrition Risk Module
Section 1 -1 Introduction to Dietary Risk - Dietary Risk Module
There are several steps involved in the WIC certification process. The first phase is the
full assessment which consists of:
• Income screening /client demographics
• Anthropometric measurements
• Biochemical measurements
• Nutrition risk assessment
• Diet assessment
The second phase is counseling which consists of:
• Nutrition education
• Referrals
• Food package assignment
• Voucher issuance
• Second nutrition education contact plan
Think about some recent individual counseling sessions you had with WIC participants.
Please answer the following questions.
How do you think your approach to individual counseling has changed, if at all, since
you completed the Nutrition Risk and Dietary Risk Modules?
• It's not an exact science and I am able to use my "critical thinking" more often.
Also, I'm trying to focus more on gathering information before rushing into
education.
• I really try and "be open" to what the client is thinking? I guess more considerate.
• I try to honor what the client already knows and build from there
• More open -ended questions
• Asking client of their health issue is Dr diagnosed
• My counseling has changed more in relation to MI, not the modules. However, with
infants, I don't default to diet as much as I used to. I tend to let them discuss the
child more as a whole person rather than just being diet focused.
• The changes I am making in my counseling are so tied to MI, that it is difficult to
think about it in terms of just the modules. I no longer focus so much on serving
sizes but more on frequency, offerings, etc.
• I feel I am having "conversations" with clients, rather than "telling" them what to do.
• Not always but after telling them what we need to do, like weight, hemoglobin, etc., I
now ask them permission to do so.
What are some specific things you are doing differently?
• I'm looking more closely at the risk codes and whether or not they will need further
documentation.
• Not talking as much
• Asking more open -ended questions
Deschutes County Health Services 51
Local Public Health Authority Annual Plan 2009 -2010
• I am working on validating to positives I see, asking permission before sharing
information, asking what concerns the client has, asking what they understand
about the "concern, etc" rather than just spewing information at them.
• I'm "offering" handouts but not just "giving" them
• I'm working on recapping /summarizing what we've talked about or what they plan
to do.
• Verifying risk codes - actually clicking on code to see if code is correct.
• Assessing the entire situation before educating
• Asking client
• Asking more probing and open -ended questions to find out what the client already
knows.
• Less handouts and I ask what their concerns are, if any.
• Of course, MI is also affecting how I use the modules.
• I use the section in the Nutrition Risk Module - "More Information about Medical
Conditions" - for assigning correct risk code
• I feel that I still need to narrow it all down to what the client is truly concerned
about rather than covering too much. I want to work on finding ways to share the
concerns and letting the client "mull it over" and decide what they want to focus on
or work on.
Deschutes County Health Services
Local Public Health Authority Annual Plan 2009 -2010
52
2. Immunizations (See Epidemiology and Control of Preventable Diseases and Disorders
section, page 25.)
3. Maternal Child Health
Basic Services:
The Department provided prenatal care to 316 clients in 2008 in the HealthyStart
prenatal clinic, while Oregon MothersCare (OMC) provided OHP assistance and referral
to 688 clients in 2008.
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. Family planning services
are not offered due to the School Board's refusal to support it in the School Based
Center.
New School Based Health Centers 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.
Home visiting programs consist of Maternity Case Management in which 196 clients
were served despite staffing shortages in 2008, and BabiesFirst! which saw 265 clients
in 2008 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.
Public health nursing staff are current on NCAST training and use these tools to assess
attachment and provide parent training. Our CACOON Coordinator also participated in
the Hawaii Telemedicine Grant in which local children with a medical issue were seen in
Bend via teleconference and received case consultation from genetic specialists at
OHSU. This grant ended in 2008.
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.
In 2008, 42 dental screening clinics were held, with 275 clients seen; 258 fluoride
varnish applications were applied. Our dental grant is over and staff are looking for
additional funds. Currently, we are working on a collaboration with the Family Drug
Court to host the Medical Teams International dental van at the Department.
Oregon MothersCare (OMC) continues to be offered and has assisted pregnant women
with OHP assistance and referral to prenatal care. 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 (0.5 FTE), 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 which has greatly
benefited coordination of care and access to services.
Deschutes County Health Services 53
Local Public Health Authority Annual Plan 2009 -2010
The Deschutes County WIC program served 2,918 families (of whom 73.6 % were
working families), 2,148 women, 5,007 infants and children under 5 in 2008. 93.0% of
our moms started out breastfeeding.
Perinatal
A. Problem:
Maternity case management is most effective if services begin early in pregnancy,
but Deschutes County often receives second and third trimester referrals from
community partners. Effective outcomes like smoking cessation, entrance to
substance abuse treatment, adequate weight gain can be impacted most effectively
with early entrance to public health home visiting services.
B. Goal:
The goal is to increase the number of women served before the third trimester of
pregnancy and thereby improve pregnancy outcomes. The target is for 75% of
referrals received to be first and second trimester and for the first contact to be
made within three weeks of receiving the referral.
C. Activities:
1. Teach Family Planning staff and front office to refer all pregnant clients with risk
factors at the time of pregnancy test to Maternity Case Management.
2. Visit OB /GYN providers, Planned Parenthood and other providers of pregnancy
tests to explain services and simplify the referral process.
3. Create a tracking system for public health nurses to collect data on referral date
and first contact date.
4. Inservice at WIC staff meeting on new target and brainstorm with them how to
get earlier referrals (i.e., refer at time of call to schedule first pregnancy
appointment).
All activities were completed in 2008.
D. Evaluation:
Perform data collection, data analysis to see if additional measures are needed.
Program outcomes for MCM (Maternal Case Management) 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 or second trimester
and number receiving full MCM package as appropriate to their risk factors.
Deschutes County Health Services 54
Local Public Health Authority Annual Plan 2009 -2010
4. Family Planning
FAMILY PLANNING PROGRAM ANNUAL PLAN FOR
COUNTY PUBLIC HEALTH DEPARTMENT
FISCAL YEAR 2009 -2010
July 1, 2009 to June 30, 2010
THIS PLAN WAS SENT TO STATE FAMILY PLANNING PROGRAM MAY 1, 2009.
Agency: Deschutes County Health Services
Contact: Kathleen Christensen, 541 - 322 -7407
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 requirements (Specific,
Measurable, Achievable, Realistic, and Time - Bound). In order to address state goals in
the Title X grant application, each agency must identify how they will address each of
the following two goals:
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.
Please include the following four components in addressing these goals:
1. Problem Statement —For each goal, 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. Please
use the attached "Writing Objectives" for each goal in order to assure your agency
objectives are SMART.
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. Keep this simple as in the
example below.
Goal 1: Assure continued high quality clinical family planning and related
reventive health services to improve overall individual and community health.
Problem Statement
Objective(s)
Planned Activities
Evaluation
FPEP qualification
and enrollment
changes along with
the increase in
clients who are seen
at no charge or
partial fee threatens
the ability of this
agency to maintain
our current level of
service.
1)
Increase number of
clients who could
qualify for FPEP to
a verified status.
> Assign staff members to
audit all FPEP charts
for completeness and to
follow -up with clients
for proper
documentation.
➢ Implement changes to
get more information
over the phone for
Oregon Birth Match.
>
Ahlers data and
audit reports.
Deschutes County Health Services
Local Public Health Authority Annual Plan 2009 -2010
55
Problem Statement
Obje tive(s)
Planned Activities ...
: - "Evaluation'
39.5% of our clients
2) Increase
➢ Continue to work with
D. Data from Intake
are supported by
community
Anna Johnson, County
Form. "Where did
Title X compared to
awareness of
Public Communications
client hear about
the state average of
services through
Coordinator, to
our services ?"
25.4 %. Title X
advertising and
establish an ongoing
➢ Ahlers data and
funds are only 16%
community
advertising and
fiscal reports.
of our budget.
outreach.
promotion plan.
➢ Community
➢ Continue to provide
community outreach at
the same level for the
coming year.
Outreach Log
Deschutes County is
1) Provide
➢ Continue to offer
➢ Continue to monitor
a rural county with
geographically
reproductive health
the number of clients
residents spread
over 3,055 square
accessible services.
services in Bend,
Redmond and La Pine
seen at each clinic
and appointment
miles.
locations on a regular
utilization.
Transportation to
basis.
➢ Continue to monitor
services can be a
D. Conduct a needs
length of time
barrier for many
assessment for services
between request and
residents.
in the Sisters area
within the next year.
appointment
➢ Needs assessment
completed.
Deschutes County Health Services 56
Local Public Health Authority Annual Plan 2009 -2010
Goal 2: Assure ongoing access to a broad range of effective family planning
methods and related preventive health services.
Problem Statement
Progress on Activities
Objectives)
Planned Activities `
New forms were developed that are easier for the client to
understand and fill out. The client is asked to sign the incon e
form stating that to the best of client's knowledge the information
is accurate.
Evaluation
With an increase in
1)
Continue to
➢ If the client chooses
➢
Monthly budget
birth control prices
provide a broad
oral contraceptives as
reports.
and more high -cost
birth control methods
being made available,
it is hard to keep the
medication costs
within budget.
range of birth
control methods
while being
thoughtful of how
medications are
dispensed.
the method, client will
be started on low -cost
pills first. If high -cost
pills are used, charting
must support the
reason for starting
client on a higher cost
pill.
➢
Chart audits
➢ Counsel all clients
wanting an IUD or
Implanon about the
potential side effects
and costs to prevent
premature removal of
the method.
➢
Track the number
of these methods
removed
prematurely.
➢ Continue to use Arch
Foundation for Mirena
IUS's when possible.
➢
Track income
qualifications a -id
the number of
approvals.
83% of our clients
are uninsured for
primary care
1)
All family planning
clients will
understand where
they can receive
primary care and
access to
preventative
health services
within the
community.
➢ Provide every family
planning client
information on primary
care services and
preventative health
services as indicated.
➢
Chart audits
FAMILY PLANNING PROGRAM ANNUAL PLAN FOR
COUNTY PUBLIC HEALTH DEPARTMENT
FISCAL YEAR 2008 -2009
July 1, 2008 to June 30, 2009
Currently in Progress
Goal /Objective
Progress on Activities
Goal 1, Objective 1
Implement a new income
screening process with the
front office staff.
➢
New forms were developed that are easier for the client to
understand and fill out. The client is asked to sign the incon e
form stating that to the best of client's knowledge the information
is accurate.
Goal ;1, Objective 2
Increase knowledge and
understanding of the FPEP
program within our staff with
the end goal of increasing
FPEP enrollment.
➢
➢
The plan was to have all FP staff attend the FPEP Orientation and
the Program Integrity Plan trainings by December 2008. We ■vere
able to have over 90% of our clinical, front office, medical reci 'rds
and billing staff attend both trainings.
The plan was to provide incentives for clients to bring in
paperwork. Although we tried hard to implement this objecti 'e
we were not allowed to purchase incentives in the end.
Deschutes County Health Services
Local Public Health Authority Annual Plan 2009 -2010
57
Goal /Objective
Progress on Activities
� '� „1; Objeetiue
Explore bringing the BCC
Program back to Deschutes
County Health Services.
Within the past year we
estimate that 100 -150 of our
no- charge clients may have
qualified for BCC.
➢
Inquiry was made with Rian Frachele at the State Family
Planning Program. She said she would put Deschutes County
Health Services on a list of clinics interested in being a provider
for the program. We do not expect to hear anything until closer
to July 1, 2009.
Goal I., Objective-4 , ,
Work to create a more
confidential reception area for
both clinic offices in Bend and
Redmond.
➢
➢
We were able to remodel the front office and reception area at the
Redmond Becky Johnson Center which has increased
confidentiality for clients.
At the Bend office we met with Building Services and discussed
structural modifications. An architectural plan was drawn up
and dates were set for the remodel. At the same time we were
planning to purchase new waiting room furniture and rearrange
the seating to create a more confidential check -in area. Then,
because of a number of concerns about economic crisis and
funding issues, the projects were put on hold.
Goal °1, Objective 5.::..
➢
➢
We worked closely with Anna Johnson, County Public
Information Officer, to establish an advertising plan which
included:
• Outreach to businesses that do not provide insurance to
their employees.
• Advertising in several local publications.
• The Chamber of Commerce wrote an article about access to
family planning services that went to businesses in their
newsletter.
• Hanging flyers at local coffee shops, businesses and Central
Oregon Community College.
• Created a bookmark to give to clients to share with others
who might need our services.
Increase the number of reproductive health classroom
presentations within the community. We far exceeded our goal of
increasing the number of students receiving classroom
presentations by 25 %.
• School year 2006 -2007 we presented to 777 students.
• School year 2007 -2008 we presented to 3,838 students.
• School year 2008 -2009 we project 5,800 students will receive
classroom presentations.
Increase community
awareness through
advertising and community
outreach.
Goal 2, Objective 1'”
Unable to offer Implanon due
to untrained staff.
➢
We did not meet our goal of having Implanon available by
September 2008, but we did get a clinician trained and were able
to start offering Implanon February 2009. We were able to get a
second nurse practitioner trained in March and can now offer
Implanon at multiple sites.
Goal 2, Objective 2 .
With an increase in birth
control prices and more high-
cost birth control methods
being made available, it is
hard to keep the medication
budget at a manageable level.
➢
>
➢
Clients have consistently been started on low -cost pills first.
High -cost pills are used only if they are the best choice for the
client and it is clearly documented. Staff are assessing how the
client is managing the method and how well it is working for the
client before giving large quantities.
We received and inserted 65 Mirenas from the Arch Foundation
since July 1, 2009.
Medication costs have stayed within budget so far this fiscal year.
Deschutes County Health Services
Local Public Health Authority Annual Plan 2009 -2010
58
UNPLANNED PREGNANCIES
Current Condition Or Problem:
In the process of assessing the issue of unintended pregnancies, it is clear that 5% of
our continuing clients are still having positive pregnancy tests/ unplanned pregnancy.
Goal:
Improve the number of continuing clients with unplanned pregnancy to 2.5% in the
coming year.
Activities:
Target Population
Who
What
Timeline
Unplanned
pregnancy clients
Family
Planning staff
Increase access to walk -in clinics.
Improve triage so high -risk clients are
not inadvertently turned away.
Ongoing
Unplanned
pregnancy clients
Family
Planning staff
Review and update birth control
methods with staff; update protocols
and best practices. Added Nuva Ring
3/04.
Ongoing
Unplanned
pregnancy clients
Family Planning
staff
Review and improve client
information regarding using certain
birth control methods. Added
NuvaRing 3/04.
Ongoing
Unplanned
pregnancy clients
Family
Planning staff
Enhance ECP program /review
literature and methodology.
Ongoing
Unplanned
pregnancy clients
Family
Planning staff
Review any new research on how to
improve client compliance.
Ongoing
Family Planning
staff
Family
Planning staff
Staff discussions at staff meetings on
success and failures for continued
improvement.
Ongoing
Evaluation:
We did not meet our goal of improving the number of continuing clients with unplanned
pregnancy to 2.5 %. The number of unduplicated continuing clients with positive
pregnancy tests /unplanned is 3 %. Although close to goal, we will continue to evaluate
our initiatives and act upon what we learn to reduce this rate. This rate is established
by taking the number of continuing contraceptive clients divided into the number of
positive pregnancy tests /unplanned, Region X Data System Report Table AL -5.
2005 Update: The Ahler's data system made a change to the reports available due to an
Oregon State request. Therefore, an exact measurement cannot be applied to this
problem. Using Ahler's data report #AL -2C, continuing clients plus unplanned
pregnancies from AL 26, the rate is 4 %. This is an increase of 1% from last year if the
data is comparable. Efforts need to continue to improve the number of unplanned
pregnancies occurring in continuing clients and particularly our teen clients. Plans are
underway to open a teen specific clinic late spring or summer 2005. The intent is to
provide education and support to teens in a location which might be more appropriate
and during hours when teens are more available.
2006 Update: Although we cannot compare rates due to change in data, we know that
according to Ahler's data report AL -5, reports indicate that of the clients using "no
method" and are pregnant (unplanned), we note a reduction from 41.5 to 32.8. We
Deschutes County Health Services 59
Local Public Health Authority Annual Plan 2009 -2010
have increased our use of ECP, attempting to give our clients at risk ECP for future use.
We are hopeful the addition of the Downtown Health Center for young adults will
eliminate more barriers to education, information and contraception for our clients.
C. Environmental Health
The Environmental Health Division (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 Division also regulates public
water systems to provide safe drinking water and works with the Department on a variety of
epidemiology programs and issues. In addition, EH is engaged in the proactive pursuit of
protection of the groundwater in southern Deschutes County through grant funding. A
staff of eight provides this range of services.
ADMINISTRATION
GOAL: Maintain a healthy work environment, which promotes an atmosphere of
collaboration, education, and high morale among the Environmental Health staff.
Objectives:
63. 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.
64. Continue to learn and fine tune the processes required for licensing and tracking all
EH functions through our data bases.
65. Continue to update the web site to provide useful information to the public about
EH programs.
66. Explore alternative work scheduling to better serve the customers and alleviate the
stress of the seasonal workload.
67. Enter into contract with Lake County to do site evaluations in Lake County.
ON -SITE WASTEWATER TREATMENT
Goal: To provide homeowners who are served by on -site wastewater treatment systems
with an operation and maintenance (O &M) oversight program that is practical and effective.
Operation and maintenance tracking and reporting is mandatory as per OAR 340 -071 for
Alternative Treatment Technology (ATT), which the County is contracted to regulate.
Objectives:
68. Continue to refine database and office processes to efficiently track O &M activities.
69. Create a document detailing the processes of how the O &M activities are tracked.
70. Develop a plan for follow -up of time of sale transfers and non - compliant systems as
required by OAR 340.071.
71. Hold a meeting with the O &M providers to find ways to more efficiently track annual
inspections, fees, ownership changes, and contract extensions.
Goal: Maintain a service turn around average of 10 calendar days for issuance of
approximately 1,200 annual permits; 30 calendar days for approximately 250 annual site
evaluations; and 2 days for the 1,800 annual field inspections.
Objectives:
72. Become more efficient in our permit review and standardized inspection processes.
73. Develop checklists to help front counter technicians ensure a more efficient
operation.
Deschutes County Health Services
Local Public Health Authority Annual Plan 2009 -2010
60
Goal: To communicate better with our customers
Objectives:
74. Attach the standardized inspection procedures flyer with permits.
75. Implement the use of the application questionnaire to better understand what the
applicant is proposing.
76. Develop an electronic mail list for installers and distributors to improve information
transfer.
77. Create an information sheet concerning recreational vehicle (RV) waste.
78. Research ways to provide treatment and disposal of low volumes of animal
enclosure waste and water softener waste, which are not now regulated.
Goal: Communicate better with each other.
Objectives:
79. Provide two sets of southern Deschutes County water table maps for staff reference.
80. Create a complete book of all Alternative Treatment Technology information.
81. Create a collection of approved product and application information for easy staff
reference.
Goal: Develop an on -site storm water review process to coordinate with on -site wastewater
permit review and planning site plan review.
Objective:
82. Ensure that all water dispersal needs are met, particularly conflicts between storm
water and on -site wastewater dispersal.
GROUNDWATER PROTECTION PROGRAM FOR SOUTHERN DESCHUTES COUNTY
Goal: Apply the tools, experience, and information gained from the La Pine National
Demonstration Project and the County Regional Problem Solving Project to identify and
implement solutions to protect and improve the quality of the sole source of drinking water
in southern Deschutes County.
Objectives:
83. Assist the Department of Environmental Quality (DEQ) in achieving a sustainable
solution to the public health hazard in southern Deschutes County.
84. Provide homeowners and installers with updated information about denitrifying
technologies.
85. Evaluate newly approved technologies for nitrogen reduction capabilities.
86. Assist planning with "High Groundwater Lot Work Plan" as provided in their work
plan.
87. Implement the financial assistance program in coordination with the Planning
Division.
FOOD SERVICE FACILITIES
Goal: To provide operators of food service facilities with the education and tools to protect
the public from food -borne illness.
Objectives:
88. Create and implement on -line Temporary Restaurant License application and
issuance.
Deschutes County Health Services 61
Local Public Health Authority Annual Plan 2009 -2010
89. 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.
90. Update all existing handouts, brochures and information on the Web site.
91. Add the mobile food unit inspection reports to our on -line database.
92. Perform either self- assessment or baseline survey for the Food and Drug
Administration's (FDA) Voluntary National Food Regulatory Standards Program.
93. Send a newsletter to licensed restaurant and mobile food unit owners annually and
explore other methods of informing food service operators of current events.
94. Perform 100% of required inspections on all licensed food service establishments.
95. Implement the complete Temporary Restaurant changeover by correcting language
and fees in fee schedule.
POOLS AND SPAS
Goal: Provide oversight and education to all public pool and spa operators and to protect
the public from water -borne disease.
Objectives:
96. 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.
a. Provide educational material to pool operators about changes to the wading pool
rules.
b. 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
97. Create an educational approach to routine inspections.
98. Provide EH staff with opportunities to:
• Gain pool and spa inspection experience,
• Add to the diversity of understanding of pool management and chemical
handling through continuing education, and
• Learn effective communication methods targeting pool and spa operators.
99. 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.
100. Ensure Deschutes County representation to any State committee is well informed
and up -to -date on industry and code changes.
101. Work with the Information Technology section to modify the exiting license facility
data base to link facilities with multiple interdisciplinary licenses (i.e., hotel with
food service and pool /spa).
DRINKING WATER
Goal: 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:
102. Maintain current level of customer service for public health and drinking water
inquiries.
103. Continue to keep the number of Significant Non - Complier (SNC) systems to a
minimum.
104. Continue working on the additional 42 small public systems recently added to
inventory.
Deschutes County Health Services 62
Local Public Health Authority Annual Plan 2009 -2010
105. Maintain sanitary survey rate of 41 per year to meet increased inspection frequency
and the addition of new water systems.
106. Earn 80% or more of the Drinking Water State Revolving Fund allocation.
107. Complete the Drinking Water Mapping Project working with GIS staff.
108. Maintain immediate response time for water quality alerts.
109. Continue to train additional staff in this growing program.
110. Identify and inventory public water systems not currently regulated.
HEALTH SERVICES
Goal: To aid Deschutes County Health Services (DCHS) in their mission to provide public
health services to the community.
Objectives:
111. Maintain the high level of communication with DCHS by continuing to attend
meetings with them to discuss public health needs and how we can work together to
meet those needs.
112. Assist DCHS in food -borne illness investigations.
113. Assist DCHS and 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 third bi- annual Community Health Report in March of 2007. 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 63
Local Public Health Authority Annual Plan 2009 -2010
In part to respond to the community's interest in health statistics, the Department
published its third Community Health Report in March of 2007. Our 2009 report will be
published in the fall of 2009. The 2007 report, included as Appendix A, covers a wide
variety of subject matter ranging from population statistics, infectious disease, chronic
disease, child and adolescent health and preventable disease.
Goal: Bi- Annual Health Status Report: Continue with the excellent work done in 2002
and 2004 by producing 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 an annual report.
Ongoing
Deschutes County
residents
Management
We will collect data from similar sources used
in the 2002, 2004 and 2007 reports and
continue with trend re.ortint for 2008 -09.
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 will plan to produce the next report in 2009.
Spring 2009
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
• Commission on Children and Families
• Educational Service District Team (ESD)
• Central Oregon Health Council
• State Human Service Agency Partners
Goal: Center of Emphasis in Health Statistics and Community Health: 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
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
Ongoing
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 Health Services
Local Public Health Authority Annual Plan 2009 -2010
64
Target Population
Who
Deschutes County
residents
Management
Deschutes County
residents
Management
Deschutes County
residents
Management
What
Propose a placeholder in our budget for the
resources necessary to create a center of
emphasis in community health, prevention and
health statistical reporting.
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.
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.
Timeli ne
2008 -09
Budget
Cycle
By spring
2007
Ongoing
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 proving 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. A very handy brochure from our local Family Resource
Center contains a wealth of service referral information and is frequently used by reception
staff.
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
Deschutes County
residents
Who
Management
Front Office
Team
Health Services
support staff
What
We will survey the Department to determine
the scope and frequency of demand for
providing health information and referral to
the general public.
Management
We will continue to develop basic employee
orientation materials and training related to
providing health information and referral.
Timeline
Ongoing
Ongoing
Deschutes County Health Services 65
Local Public Health Authority Annual Plan 2009 -2010
Target Population
Health Services
clinical and front
office staff
Who
All staff
What
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.
Timeline
Ongoing
Evaluation:
1. We will report to staff and our Public Health Advisory Board 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.
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 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 2009 -2010
66
IV. ADDITIONAL REQUIREMENTS
1. An organizational chart is attached; see Appendix B.
2. 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 Plan itself contains sections relevant to public health and consistent with the
Oregon Benchmark Project. Assurance for childhood immunizations, teen pregnancy
prevention, hunger prevention, oral health care, primary health, smoking cessation,
and cultural competency are just a few examples.
• The Department Director regularly participates in CCF planning work, is involved in the
local Professional Advisory Committee to the CCF, and attends CCF executive team
meetings.
Deschutes County Health Services
Local Public Health Authority Annual Plan 2009 -2010
67
V. UNMET COMMUNITY NEEDS
A. Primary Care
Current Condition Or Problem:
There are approximately 25,000 uninsured individuals currently living in Deschutes
County. This compares to approximately 14,000 just in 2002. 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- Categorical 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, mental health care, or oral health care.
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),
established in 2003, has struggled financially in this market.
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 practice, owned by Dr. Lisa Steffey, is
estimated to have the capacity to serve approx. 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. La Pine: A financial feasibility study related to establishing a Federally Qualified Health
Center (FQHC) in La Pine was conducted by the Ochoco FQHC clinic in Prineville. This
study determined that an FQHC would be fiscally challenged with a new Rural Health
Clinic just established.
3. Community Clinic of Bend FQHC: The Department supported planning and a grant
request to HRSA by the Ochoco FQHC clinic to establish an FQHC "expansion" site in
Bend. The Department made an official request to HRSA to designate an area of
southeast Bend a Medically Underserved Area. The designation was granted, and soon
our friends at the Ochoco Clinic were drafting an FQHC grant request for the Bend
community. In October of 2004, HRSA provided notice of a grant award to establish a
fully operational FQHC in Bend. The clinic has opened at 409 Greenwood Avenue
(April, 2005) and received over 10,000 patient visits in 2006.
4. The Volunteers In Medicine (VIM ): The VIM clinic in Bend opened for clients in early
April, 2004, with a mission of serving low income uninsured residents of the County.
The VIM clinic will have received over 3,000 clinic visits in its first year of operation.
The clinic has been an invaluable resource to our communities. The Department's own
Community Care Clinic closed up shop in the late summer of 2004 as the VIM clinic
became fully operational.
5. 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 demise of the OHP plan may result in a
significant increase in demand for this safety net health service. The program served
more than 340 women in 2004 and provided some 120 deliveries — nearly 8% of all
deliveries performed in the County.
Deschutes County Health Services 68
Local Public Health Authority Annual Plan 2009 -2010
6. A School Based Health Center (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. The Maternal Child Health Team, under the leadership of Elaine
Severson, worked tirelessly with local school officials, school nurses and community
partners to bring this clinic into fruition. Continued operation of the clinic is largely
dependent upon legislative support from the Governor's budget which proposes to
expand the number of clinics in Oregon. Two new fully certified SBHCs opened in
2008, one in Bend and one in Redmond.
7. 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.
8. 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.
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
Establish an urban setting Federally
supported Community Health Center or
FQHC model in Bend.
Completed
Deschutes County
residents
Health
Services
Performa financial evaluation of operating a
primary care clinic through the Department.
Completed in the fall of 2004 - determined
to be financially challenging.
Complete i
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 Health Services
Local Public Health Authority Annual Plan 2009 -2010
69
Target Population
Who
What
Timeline
Deschutes County
Health
Develop a broad coalition of support from
Ongoing
residents
Services
the 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.
Evaluation:
The time line 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, and its ability to address the "access to care"
issue for an estimated 25,000- 35,000 individuals.
B. Methamphetamine Abuse
Current Condition Or Problem:
The current status of methamphetamine abuse is frequently referred to as "epidemic," and
yet we have precious little hard data upon which to draw that conclusion. Yet, with the
hard data we do have and given the real life testimonials of corrections officers, court
officials, mental health therapists and community members it does indeed appear we have
an "epidemic" of sorts on our hands.
At best, the methamphetamine abuse issue has a huge negative impact on our courts, our
corrections system, our schools and our communities. Worse, methamphetamine abuse
has a tragic impact on our families, our children, our health, our economy and may be the
single most "urgent" issue impacting our communities. Methamphetamine abuse impacts
us as parents, spouses, educators, employers, public officials and community members,
and appears to have a pervasive presence in many if not most of the serious social issues
facing us citizens.
In 2004, methamphetamine abuse accounted for 43% of all substance abuse treatment
services delivered by Deschutes County Mental Health. This eclipsed —for the first time
ever — alcohol as the #1 substance for which clients sought services. Local law enforcement
estimates well over 80% of all property crimes are related to methamphetamine abuse.
From October of 2003 to February of 2005 the amount of methamphetamine seized by local
law enforcement officials increased a whopping 649 %. Our colleagues with State Child
Protective Services indicate methamphetamine is involved in far too many child abuse and
neglect cases and in nearly all cases where parental rights are terminated.
Community Call to Action:
Since early 2004 a group of dedicated volunteers has fostered community discussion,
increased awareness and promoted a call to action to address the methamphetamine abuse
issue. The Meth Action Coalition was formed on the heels of a community summit held in
the spring of 2004 to increase knowledge and interest in the community about
methamphetamine abuse. Since that time, community leaders and public officials have
taken a much keener interest in addressing this issue. Recently, Deschutes County Mental
Health submitted a sizable HRSA grant intended to add capacity in addressing this
substance abuse issue. Planning is currently underway to try to establish a formal
community -wide prevention and education effort to curb this epidemic.
Deschutes County Health Services 70
Local Public Health Authority Annual Plan 2009 -2010
C. 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.
D. Tobacco Use
The elimination of the Measure 44 funded Tobacco Prevention Program presented an
immediate and significant public health issue. The success of the program was well
documented, and we are now faced with regaining lost ground as the incidence of tobacco
use by youth has risen in the face of the program's demise. Fortunately, Deschutes County
is one of several that have received partial re- funding of the Tobacco Prevention Program.
Much more could be done to prevent the health effects of exposure to tobacco products.
E. Mental 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 illness will have a
cascading effect on public safety, employment, stable home environment and personal self-
adj ustment.
F. 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.
G. 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, in terms of medical care access, respite care,
treatment and durable medical equipment to help meet the needs of these children.
H. 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.
Deschutes County Health Services 7
Local Public Health Authority Annual Plan 2009 -2010
L Children's Oral Health
As of September of 2004, Deschutes County ranked as one of the ten worst counties
statewide for untreated dental disease in children. In schools where more than 30% of
students are on free /reduced lunches, decay rates are generally 400% higher than in the
more affluent student populations. This situation applies to many of our area schools,
most especially in La Pine. This fact speaks miles to the relationship between poverty and
oral health care in our children. In Deschutes County, 55% of 6 -8 year olds have a history
of dental decay and a full 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 currently underway.
J. Childhood Obesity
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. In a 2004 report, 28% of Oregon 8th graders were
identified as overweight. 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 financial
system.
Deschutes County Health Services 72
Local Public Health Authority Annual Plan 2009 -2010
VI. BUDGET
Budget location information: Sherri Pinner, Business/Operations Manager
Deschutes County Health Services
2577 NE Courtney Drive
Bend, OR 97701
(541) 322-7509
FENANCIAL ASSISTANCE AWARD
— — State f
Drooartrnorm Of
Po bat H0aitho
Hurnart Srortricei*
Sarvite*
Pj a
1) oranttiurii
2) 1:**440 Dar* 1 TN* Action
'Nan e. newIndes i.3nurity Health De.p.t.
April 10 2000 i ORIGINAL.
FY2010
Slyeel.• 2577 N 0 DoPortney
3) Award Par loll
City Bend
From duly 1, 2009 Thus:mall June all, 2010
IState OR lin eixieT 9770
4} OHS Putat lit F1.1 n *.A.porovio .
Previouti Increase/ Grunt
Award (Deuease: Award
,Prograrn
'PE. 01 t..itare Sux.11:011 for Pi..11:Ac Health
10.9,4;3,6
IPE 03 TB Case Management
-1,200
IPL 07 HIV Prevention Services
203332
111v PfeVeilli0,1 Ea•O•C* ■:.7,narn Snit
•
Ryan Whke Tale 11 HIV !AIDS Semces
1
1PE 00 Ryan White-Case Manalemem
I PE 00 Ryan V.Vhaf.I.--04.inr1 ft 5 eftrices
21,1182
IFEL 12 Pub-. Health Emergency P3eparedness4July-Aug. ',:.,,)
15.040
a :1
IPE 12 Pub. Health Emergency Prepark-xinessuu 10-11ine30)
1:21,0i74
IPlE 13 Timam0 Prevention & IE:.:1'..luc43i1im'i
l
:
55, OW
'`E it Healthy Oommunities
t......-..„„....-__
PE 0 E1 Maternity Case tvlanagemem
1000
FAMILY .i-,1EA.LTF.1 SERVICES
'i:-:. 40 Women Intontfi. wid Ghrkiten
671.606
FAMILY HEALTH SERVICES
1 5) FOOTNOTES:
ii JuVAugut::1. 90 'i owariao fni.Wg be vent toy 90?3909 .ir'A :.:1. i:E.v.50 submitted ibt that peri( ci
b) July-Sept grant is 11t1,5,402 and includes s,am of minimum NutntiOn Education and 07,42 1
far Breastrveding Promotion
r..) Oct -June grant is S41020C and inclactes S93,241 ti minimum Nutrilson Education and .71;22,250
tar Breagtfeeding Promotico
' rtil JUN - Setriterilher cion le S5,749 Calober - Are tit 9.1-11 g; $17,220
ei S1,000 rrlk.at be i,.4>erui LI 0ei.;.rriber 31, 2009.
rj The Funding nom ) mularies 5 .1..:i:R.,:nt.ie-.41Ciirry,t-A.,f.,1:hure,.-1,14:0;etl00*. KlanW11& Tva.':,hif'001.,
with increased awards that are cc,,,rningent on successful enimplerian of May 2009 initial .SBHC
certfication visit.
41.1,01CH Funds. WO nal he shifted between categories or fund types. The same program may be
fiirta0 by mute than or* livid to&., however, teiletal hinds may trot be..i.45'ed 4:-.i rnalkli for
ogrt,,,c 0d ,I rurii.b. ( .,1.4.c;h ir,:s 11,0,....u1 )
) Capital Outlay Ro.ctuintd in T1us Action' -
VI l01 optiroval ta, reiwired- 9)1 (.>.:04u1Outky. Caor:0 Outfay 4%3 <Owed as an eVehdiri.ite trrr btibop
rly-mr- with a Purchase price in cxLe-ss a V:i,C400. and a life expectancy grealAzr: thou one year.
PROG.
PRQGRAM ITEM 0:ESA:RIP-RON . • COT APPROV
1a0S-21-ie Itawfcaterat.zeol. Aari-oca= fee taa .1%M.2=11112 itePubl:e 1i,L Szt-Aczn
1:2KS pgem Deschme,...Comety
N. 10 flf.l pas..
Deschutes County Health Services 7 3
Local Public Health Authority Annual Plan 2009-2010
Stoto of Oregon
Dot:mitten of Human Services
Public Health Servicos
POCI, 2 Of 3
1) Grantee
Wrne: Dcluries r,77;clwry +1dri Dept
Street: 2577 N. E. Courtney
City: Bend
Stale: L Zip Cocte: 97701
2) Issue Date
April 10, 2009
3) Award Poriod
From July 1,2009 Through
This Action
ORIGINAL
FY2010
2010
June :30,
4) CMS Public Health Funds Approved
Program
PE 4') 40 WIC — PEER Courv,eling
FAMILY HEALTH SERVICES
PreviOPS
Award
Inure
(Decrease)
Grant
Award
22,9Era
( d )
PE 41 Family Planning Agency Grant
FAMILY HEALTH SERVICES
142.11)9
PE 42 NICHTilieV -- Flexible Funds
FAMILY HEALTH SERVICES
41,171
( g )
PE 42 MCH-TriteV -- Child & Ad cwt Health
FAMILY HEALTH SERVICES
PE 42 tv1(11-11Peonal4 ideant) --13.1)eral Purx1
FAMILY HEALTH SERVICES
17 644
ei,f1a2
( d )
PE 42 MCI-VChilil & Acinle4:c.ent Health — Gent:,1* Forid
FAMILY HEALTH SERVICES
PE 42 Babies First
TIAMILY HF ALTH SFRVICE.S
____
r
,..._...........,
11,337
( 9,.)
19:131
' ,
'5-.5d-i:
_ _
v:APAILy I-IEALTR SERVICES
PE 43 Immunization SPedial Paymenls
FAMILY HEALTH SERVICES
44,7,5.1
_
PE 44 Sc-M01 Baser,' Heant) c.,eriters
FAMILY HEALTI i SERVICES
12o.c100'
( f 1
5) FOOTNOTES:
l Oulay is
a if exppclancy
rco euoir,
PROG.
APPROV
6) Ca pitAl Oullay Requested in This Action:
P.ric -44)1(pial Ls r.-xruire.(1 for (vial Outlay (pill
;rent with a purchase :price in excess of $5,00-0 and
PROGRAM ITEM DESCRIPTION
dehoud its .111
art?mer
roP:'t!vditwe
than one gear
COST
r-
-
1 1
.2:CC42 LC- 11:7407.v.r.o..zazit11...4-sownioat 5:c. -FLrzr_ri Publ): ic
2Sitlt pgm - Conats.-
.Palp. 1.1,3 )1150 pagw;
Deschutes County Health Services 74
Local Public Health Authority Annual Plan 2009-2010
State of Oregon Pa 3 of 3
Department of Human Services
Public Health Services
1) Grantee 2) Issue Date
I
;Name Deschutes Caunty Health LI)ept Agri 10.2009
I
This Action
ORIGINAL
FY2010
iSitreiet; 2577 N. E G.-ow-trey 3) Award Period
Ci,,,- Fiend From „kity 1,2009 Through June 30, 2010
'Stare OR Z p Code 077C1
4) tillS Public H alth Funds Approved
Pievicius Increas& Grant
Prm Akiik-gd -*ueas ) AwaiiI
-
i
'
,
_
TOTAL e,
5) FOOTNOTES;
1
Did ' I (1D-.4
6) Capital Outlay Requested in This Action:
I Prior apprcryal iF., required for Cipital Outiay Capital Oiltlay ii5ite,fineit a.5 an eXpendirk,re for fq
' inert %vitt.: a purc.haiie price in excess as 51-...000 arid a :Ito PXF,20:ancy oreater than one yoar
PROG
PROGRAM ITEM DESCRIPTION COST APPROV
)-:
i
IIIJ
...4
"4-2!1.1 Ascraziaeat foz ti,a.Fizazclus oE.Publa: Hula
IZSM puss - Ceamty
P!Ifl 4154 Fasin
Deschutes County Health Services 7 i
Local Public Health Authority Annual Plan 2009-2010
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
budget.
8. Yes X No
funds.
9. Yes X No
public health p
10 Yes X No
Local health officials develop and manage an annual operating
Generally accepted public accounting practices are used for managing
All revenues generated from public health services are allocated to
rograms.
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 76
Local Public Health Authority Annual Plan 2009 -2010
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 77
Local Public Health Authority Annual Plan 2009 -2010
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 78
Local Public Health Authority Annual Plan 2009 -2010
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. The County has
recently adopted a 30 foot smoke free entrance policy for all County buildings.
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. (Limited)
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 79
Local Public Health Authority Annual Plan 2009 -2010
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
Administrator Name: Scott Johnson
103. Yes X No The local health department Health Administrator meets minimum
qualifications:
A Master's degree from an accredited college or university in public health,
health administration, public administration, behavioral, social or health
science, or related field, plus far more than two years of related experience.
Deschutes County Health Services
Local Public Health Authority Annual Plan 2009 -2010
80
104. Yes X No The local health department Supervising Public Health Nurse(s)
meets minimum qualifications:
Licensure as a registered nurse in the State of Oregon, progressively
responsible experience in a public health agency;
AND
Baccalaureate degree in nursing, with preference for a Master's degree in
nursing, public health or public administration or related field, with
progressively responsible experience in a public health agency.
105. Yes X No The local health department Environmental Health Supervisor meets
minimum qualifications:
Registration as a sanitarian in the State of Oregon, pursuant to ORS 700.030,
with progressively responsible experience in a public health agency
OR
A Master's degree in an environmental science, public health, public
administration or related field with two years progressively responsible
experience in a public health agency.
106. Yes X No The local health department Health Officer meets minimum
qualifications:
Licensed in the State of Oregon as M.D. or D.O. Two years of practice as
licensed physician (two years after internship and /or residency). Training
and /or experience in epidemiology and public health.
The Department has recently matured to a Medical Director model of
oversight with two physicians designated with equal
responsibility /authority over specific programmatic areas. Dr. Richard
Fawcett is our lead Health Officer, Dr. Mary Norburg is Deputy Health
Officer.
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.
Local Pub is Health Authority
DATED this day of
Board of Commissioners.
ATTEST:
Recording Secretary
DESCHUTES June 1, 2009
County Date
2009, for the Deschutes County
TAMMY BANEY, Chair
DENNIS R. LUKE, Vice Chair
ALAN:UNGER, Commissioner
S: \Mental_Health \Scott \Reports & Plans \2009 \DCHS Local Public Health Authority Annual Plan 2009- 2010.doc
Deschutes County Health Services 81
Local Public Health Authority Annual Plan 2009 -2010
Appendix A
DESCHUTES COUNTY
HEALTH REPORT
2007
The Deschutes Coun:y '-leolth Department
presents this repor; to the resicents of Desch ute!-; County t,o they may be
better informed abo.,t the ,-ealtn f°351.,e5 ano behav,ot.5 that affect ilei/
Deschutes County Health Services
Local Public Health Authority Annual Plan 2009-2010
82
1 DESCHUTES COUNTY Hit.1%., H hi.:2,•1 2002
INTRODUCTION
The Deschutes County Health Department is pleased to present
dio „nr.m.tit,tes county fleithdli Repot, a compilation of key health
indicators '-irt our. onunly Ti e gind cf the repott .■5 w pi-codex limIth
data 11.77I1 C411‘ .Y71.:' used by Rixl government and community agencies,
healtli care provick:rs. and other iriteitcsted commonly metnbers
o(11 ;11%7•415 7/77 help identify and better oddness the Idealitt. 17tett+ 01'
DeSCII17.1{5 COUllry
The health indkators vaunted in ttik• report are wed tor reprment
mends )T4 t77:11;king .cricasatrable changes over time M much .as
pirsAble we i.o established am:it:el:al and statewide goals, such as
the U :flotsam CeneraPs tierakhy People 2010 objectives and the
Oregon Pit•preatt Doard.-s 2005 benchmark. t tigic QUr progtese.
Our onitori hcalih is brod., a• indicated by the locittort of data
reptaling ite•tte• 51.01 5.75 poverty, horneletnirrets, and violent .ittjary,
The Clekinitter County .i.trahh &Ton identifies several lawman! areas
where :Ile urunty meets national lath objectives or has tinproted
4NCT c 11,74 w.3r. nc eTren?(Ca. are:"
• fir.q trimester prenatal cant Detid17.11I15 Gourry ttat:
consistently ranked among Cris: highest m Oregon,
• Teen pregnancy rates - dttappIng to an all rittai loitt fl
DI7751:11.111e5 1:11111111y
• Itrerisateetting lainatim - Oregon's 1•,:0rzaten„ mitarati, und
Children (WIC) proptrit rid es :Etat to aw ni.too for
inutian on.. The: Deschutes. Coon ry r:1117 is t',vt•:n lrietra
IretriAt s1i posits to at east %vitae. atgatikara work •ail nexd!„, hit
done. Example$ ate:
romg obiesary rates, dillii didn
• komonmaiton rate; far below the stare :Ivor
• Alcohol; Lotiwco, old imhe.: d.11.18 11,71irnotig i:lei3is
• Ht.ghpefeentage, ifAidt:1111.: Wu/ 11■''',4111.1
• 1.14.1 Wa;et siiplis 11 II05113 f111)315 de) ay
ant: 1:11;110V0 :7131
is our hope thut the iattfitiP4itill1irksvidi3j by 3h1 molt: w3)I ot
113i'.11,,gfiV17:,11L'Ili.171,,C011411°,1.141ry ottvncvA, aid oiizoiis inc.cilabOrtivt: I y
,idd-9:-is the. gow-211g nted.sv:rh,
1-*731114 et our restitledits, strerin;t1aert 3h cc:mint-nay re; a,
NOTE ON DATA ANDBENCHIVIARKS '
90 tiT 31 2010 i)Ner,,iTN 1,14i c)regorz 203) 5 13 cir30
3. ■T■iel 1,:111,1 olit:l!f: ;31. 7,■;-3
.1'); .`1
ak,n11.4■1,, 71.ntl . hper
I11:11e,..131:.5 1,1 11,.." j1 1.,111 ' ,t ,Z4.1:: by
TABLE OF CONTENTS
Demographics „ • „ , pg 2 Maternal, Child & Adolescent Health ..... ..pg 9
Economy . , . , • pg 3 Unintentional Injury p9 14
Access-to Healthcare • , „ . • pg 4 Substance Abuse p 9 1 6
Pok.terq,, Hunger, Homelessness.. , pg 5 Alcohol & Illicit Drug Use P9 17
Adult Chronic Disease ...... . . • . „pg 6 Environmental Health pg 19
Oral Health pg 8 Communicable Disease • ,, . ..... .pg
Mental Health _ ... pg 8 Data Sources p 9 22
■
Deschutes County Health Services
Local Public Health Authority Annual Plan 2009-2010
83
,Itlfavt
DESCH r Es COuNTY REPC:Ny 2(X17 2
DEMOGRAPHICS
Deschutes County Population by Age, 2006
ForA,mticiavretatirell
(7.0 .5%)
MO= g63
MCCENNIEMIN
b
Oregon Population by Age, 2006
+.+10(gtil g:ts:NO. r9:"V,
Deschutes County Population 969-2006
140,0C°
120,000
100,003
MOW
60,003
40,000
mar
0
VA
pop,a4,aat'. .a.106.: 152,615, De-WiWk..1 ticeos.m,ke,
kha (A1014Y CVO*, VI:ti 32.1`k.',;:,-,4,7tast at popala:kal. ft.
:71V,S -1:0y
Education Level - 2005'
10-n4A
nr,*
,9*.04**16,10,60**aa*
-**-..44*APArA,045,0.
Fersrp1 4 4 dtolili
Deschutes County Health Services 84
Local Public Health Authority Annual Plan 2009-2010
(23.6V
t 3 CM)
(12.5N
+.+10(gtil g:ts:NO. r9:"V,
Deschutes County Population 969-2006
140,0C°
120,000
100,003
MOW
60,003
40,000
mar
0
VA
pop,a4,aat'. .a.106.: 152,615, De-WiWk..1 ticeos.m,ke,
kha (A1014Y CVO*, VI:ti 32.1`k.',;:,-,4,7tast at popala:kal. ft.
:71V,S -1:0y
Education Level - 2005'
10-n4A
nr,*
,9*.04**16,10,60**aa*
-**-..44*APArA,045,0.
Fersrp1 4 4 dtolili
Deschutes County Health Services 84
Local Public Health Authority Annual Plan 2009-2010
3 DESCHISTES COUNTY ATH 2007
Births & Deaths, Deschutes County, 20,000-2005
es'ait:
t-
Race f Ethnicity of Mother,
Oreoon arths, 2005
Iv., Q0.0 UMW= Alt4“,
Race / Ethnicity of Mother,
Deschutes County Birdis, 2005
Median Household Income
rirssettutesctuntv
sahmiti-
t40,003t
$36,211
$20,211
C,
R NUS
ECONOMY
5
Unemployment Rates
gc.....ust.n Ilitzflme LIN
2006 Atmust 2035, 2006 ,COotsw 2326
Deschutes County Health Services 85
Local Public Health Authority Annual Plan 2009-2010
DESCHUTES COUN97 HEALTH REECTET 20Q?
ACCESS TO HEALTH CARE
Uninsured:
individuals with No Health insurance, 2004
20%
15%
1
IIII Contra Orton`
t:t4'
Ages 0-17
re444:ol ,lisLub,:s rig
*err
Ages 18-65
(2I06- OfetleAl
kaotark (e%)
tlealltv Peat:At
oUtel 0,btacttrac
if
Thr. ittztrttntwge c4 unaisared :Central Cr o:itn Iiow LN:11.re N k
titpratcartately 32.43(1 people.. at thtase, 6,120 .are children undo'
the. age ni .1"8 }um.
thr t:corisertinttncrs of high prinin5ured rates cart he dv,I44,113.ting The:
l'4*ierr Gurruntwitnt n Medieuici ;And the Untrtsutvd conctucwti a
lnartntgh f the th ra 25 years al htalth services reszailzh or>
th ilittis o tvgkh hI1aTwr covrragr, The results. demanterated
Otto t ul1 a pi-name cui, ire titsgrwsed at morc
ad:von:et] ttittges, anti note clArh-rosed, r,V7-4i to receive 'less thempe-tii lc
tale tiu. id SI111113;
MEDICARE
Projected Change in Oregon & U.S. Population
65 t Year of Age
•.,n-,,,,,A.', Z1,,d,
w,•-'0,-',1
,,,',;:,,,,Y,'1'
44,444m
WO,<'■';,,
1 OW-VV..) 2000-2020
r pU 1ttT pTtr hoid nj the. treat tut Tttitcknts
yurs r-tiag 11 attschtse5. Courtly will be s0 wt r heiV. t.. :1441•
tO > 01110.74171:N[ wheee thet'se. people ■Aall 1t.t Cak4
Central Oregon Population
by Source of Coverage
15
OEIP from tA)ti. iiri
pfmac :<.xcult• =Id "Atiasautd th Itfl)l led
:!5,4
'414ThRT".`r
• ,H,.:7,-1Crri, •
•
la 17 tt
ii T1 1
,
. .
" • '
Deschutes County Health Services
Local Public Health Authority Annual Plan 2009-2010
86
DESCHUTES COUNTY ' 2307
POVERTY, HUNGER & HOMELESSNESS
Poverty: Individuals Living in Poverty, 2000 vs 2005
'D-ttri.o,fAC-t-otgitY MOIrettor
2000
PoptifaUon VIildrant),t't
2
IS%
ta%
DIISChtfiete Ckturoty NO S
Erdire Pespdation Chlktoon 0-17
Fn DhuK Gairr,y, t.c.,rk'd of U7 1 , S22 .t:ittidreti, IMny, ii i..i..-41.tety :in 2035.
ft
HUNGER
CtTCgptft; I tt"tnr)11.3.'t tvungu h In g rtli
m affcradlit; Elie Uri; imFt7rie! ci A 1
char,ge th.ougm to b thc trsltit. CI mpwtsatti frAml !4ar..r..p....:uticoaell nod
al,:tta3ed:brichrig t`or ancl 0...T Of einr 1p:7x-7 coml. V‘Thilc r Iced
lilipa'oved, it is Intport„wx. to no•,,;.. fist'
,afAtt.Z. iorccd Initvireri fc.rxi 111(1
Fond Bank Prograrns,„ 2005
ii ri Covaity ;:korallitLoi in-c...mt-c.1 111, fm1„
2 iV0-20,Y,5 , hi uiithcro opkccon (coil hnl titfogra3m ad!
iinwd 4..5%. Tins tray IX: re.•ite-ctiorl :of tht:.
0).v.. of living it IK.,•cal wages th hatt't .r101 kr.pt Nta
elite.TEL: COE.L.
it Moral& tWitnIgt o U-4.1.11/41datititt
614 Fall: 1111 DeFth.v.F.75 499E,1
Deschutes County Health Services
Local Public Health Authority Annual Plan 2009-2010
87
DESCHt ES COO TY i i=ei.—
r. 29 7
ADULT CHRONIC DISEASE
Ninny factor: contribute to developing chronic c1t °ash.. Many of these
factorsaw West yrlei haviors that Gan be rundifieci. By alit ring lrehavir;ria,
xr. On reclaim the task of de vlcping heart ai ea ., stroke, catu:: r.
diabetes, king disease and arthritis. For people diagnosed with chronic
conditions. gond fl*r maniagement. incin ling changes in n zari-i;m
anal physical activity. dramatically reduces the risk of complications.
Rates* of Cancer Cases, 1996 -2003
crontrabrinieo, _chcols, worLites and health care sites can suppci
arJ. promote healthy behaviors through policies Attd .tiViedlltt:t'nr$
l savoke -free avogksite:s,1•lssltltp cafeteria meals. sidewalks aryl like.
paths, Incentives for bicycle. and pedestrian cornrrtur rs, vsa:s les ic.
health promotion programs, rs, an;1 insurance t.overx, a for preventive
eairiikas such ss. rrrd nautit;r nphy and t _tibar c.c cessation.
Cardiovascular
Coitraty
t l rn ®tiaa:k
Disease
( rem Eirutst,p• People
21010 Objective
VEM17 :4E7
rats rat- t 1 1 l 165
:a assit s r • ± .Ih.. - -a lL ..i.9<...a::1414,e.
tread
.:,... i :: r ; _ix'un? ,eaa,a ri -... t....i r ....: -.1c T..
arditc .L . ar.:r ditseasc ,;t:' a'r tl-1 :des coronary twilit dotter,".,
.tier ;scle ,_ v, snake and high Weh pre_ s:,ri: 11 ihe recut air one
cause of death and t r the tinned 7'a1C :$ ;lad itt .. L :. n..
4:,,erf ''k:a.t Cif a se Y.�3Se::Y.-?nma P.v +c
The Economic Impact of Cardiovascular Disease
There wee over 40,000 hiraiarrrlirations of Oregonians for
carclic,,f;av ular disease :in 2004 (State : osgr ral Discharge ardeer,
restaking in more than $.1.1 billion in hospital. costs for heap
rlrseeee, e rake, and related '1.aG.r7Sti..z. Card €iem -as: Uirr div.aae- re1ared
lirispitalimations greatly exceeded the CAMS l ether chronic. disease-
relater) ra trees of frospnalilratt rn l'aee graph below is is, Lin nana.
in r Ci:'. nne CitiU ). Spiiz'tlization coats r Ilee. ". only a porr.on of the
r.11 fsn;rrrral burden of cardiovascular disease. Other errpendi'ture=,
include inectactaitons, rehabilitation, outpatient rA.se. 1 -re ar °: a:arc,
and k+tis c:t prod it- LISMr_
Hospitalization Costs
Ely Principal DiaclrioS:s, 2004
;,tea .. _......_......... _......:.. �...�. . _..�..,.... _.
,irner
uR mJr'zR i.. �su'a+d 3'i' ' F R^xS i_yP0 5 •r rir4:3,x.
- v?
Deschutes County Health Services
Local Public Health Authority Annual Plan 2009 -2010
88
7 OESCHUTLS: COUNTY HA. lEF"tl:RT 2007
Overweight and Obesity* among Aciuts, 2005
Dikritss Cower scm.n.
:CMOVe#011 Otx,ae
*In ida Oebrot M,:6
EM; .127,1:00. 01 4VX,-",.. hr. itt
oda;
Ovtriweight and obesity an .majot contributors -ter treaty pmccotable
eatosta. de-mh. Fte‘Trig...7a,MWrir,„iht r3r eitik or
dineES rrOIE ht<XXJ prewl:te, fogiiclu.tie3wroLl -Iv 2 that:ales, heart
iiise2aa and stroke, -gallbladder diatraa!, arthOtis.f;lerp diMattretor awl
Irtoble as: tactatt*.-4. ancicCrtain Alin -or timitcts:
$22,2;.arae. SkAr 4,1j* AAA, •
VOA , Fi05.1
IIID4wktes Cr ty Nirws.p, NUS.
Diagnosed with Oilthe:tea, 21:11)5
!„.
Nutrition and Physical Activity
AdUltS, 2002,2005
10%
ac,
tor;
* 13ftdlit.es Catty isorafiv, stu.s.
n.avr
mu.
ce..1,12..yre Ilgist %,*v•Imsexgr,Irrtv4
Vdlis clltf P,t1,14CV
Vawrlables pre( Mir' trati
pepi.vreingr n ti 0tt
maMly X41°,6-.11,
na fpr 'tior,*true2.aarg tflt3fli rnootaa ”ep.
Chrome &masers am licavity imp:tea by poor :Erattiattra ar.-4
ol Oval Cal Deschmes-Couniy falls far :shun. or the Ittia 1,41.y
People 20.10 objective tor taaprnianirmintion .Alti& . calls f2:ir 73%
01 di e. popaladott to consume. ilia inniunom stirvings ot
4svo daily aervinei and 50%t0 file minimum R:Tvngs
vea;Allatea (duet dally soivings walla at least 1.13 latitne.;
goerVdtap-yartow). iictwoevr,fita County CKL'tedS ileatthy Rio*
2r) LO abioctive rot -daily pltrical :activity levels.
ro-,2aa r....ar.,,kl:rs-tar,
*2,
:ffin
714
rIWArilt4 04,17-4 WW1 L:
AWWWI Prlannst, ekilitti. 230
Deschutes County Health Services 89
Local Public Health Authority Annual Plan 2009-2010
Df...:1; CHUTES CO9NT11;-?E,ALIt'7: ti!EPOt? t 2001 8
ORAL HEALTH
Aki".,,e, wrath tirt;ly loryty p-Tern table, i he MOSt
(111•0-jc tItt.9.7ase chikiren age 9 lo 17 yeAri--5 tiaras Molt
kni1MCMIltrt trstatria, tlatrtercd dtcay curt lead t(3 illfeCilQ11, pain, and
the totto of teeth Poor chi] 'Uten Ittai,r wady 12 tillit3 MON:. TesTkA-
activIty (1.0,y; btoutie of timud-related illricss than child:ea% lrc.qb turtle hitnilles, Pin and suffering due to untreatod tooth decay can
2411
1,2,VititgiVX*MaWiAl.1..4.4tetti*
Fluoridated Water
.01,;70.,qty tbc, gagje 1.7115171 efletekt.
pubLi 11i Irle;:imtre ; vtrvent t?.??...;t1h dr coy and improw 07Ai
I sra ovr1 LiFrlitiwe Fatirr hrL5O, of yzientific 7-e9L'arh
11117, mtkil n ctatilL111.1nittttt With hitondkurd
watra [Kett it Lirj tL'el it and fcsvet zirdttett t1.1an thosehvitt„g
whe-a 'wow noi ELor: dated While ?rainy ,zarornur,:fle??
noon ally txing Elotarade stofficisirrt t
prevtmt tooth deo.try. LherV Art :Itit.histincLs tta ;ttorarnunitits
w ibey mitutaily oeciaralty11;loride. 1trrt l ts trt
CaitStit places thAt ..tarGiC. X.:W:4114S thrott;:k tvive herr; atittfot:,
fa dEllkale VL:LILL,t mtp(Kieti- trt,t171trtt it tIrt-tr..;'m/L.; rnt
oeth de,tay Witzto floontiatton r 01
E% dollsa: at; tottatorstar %tat iltweid;10,7?-. jvt
Liclarl I LO S42. itt tLnL drixridilg hir.a:
the ULTSLILMAILP,,L
[1,11,1,1C.,1
114.11s
lead. probl-Nn3 Etatin, speitkittp„ anti krning Moray at:I1,1have unire-med iCalth dee;ty hi dtr tS, 27% uf tlutt?e AI to +4 yit;rs
old and let'S, t'.a1 a/k* ... yttiig? itod oltiott haittogfalg evitlersT prints
10 hyik tePATt`r, tir,A[
.and ty,ot hdh ookoairts.
AVANSWhaNevevo,y6„
Dental Care During Pregnancy
Few,: Ehan hail the wtmttr, m (1g071 ZT.Ck needed dental
tats dt.altig putxttainLy, hti ?n,:y uric thrd fl iv c-duattron
how to ult;;;., for their tieltralt, t?,t,th.
aVII, 0,3 P130..
Deschutes County Health Services 90
Local Public Health Authority Annual Plan 2009-2010
9 DEScHUTES COUNTY FFALIF T Z007
MATERNAL CHILD & ADOLESCENT HEALTH
CWT. ramaiiM ta.rts. UMW thOis
-4a
1.4,e4; •4.
etelloweor ,s inNj 3+ ,mi....):Writimt
-CePo.o.:ii-,,,,ktl411l.ki-.1 [To' 41. Af !kin
1:to.ehute:, C.0.11y .Wn 14T 1 roretinv FIC41.thy People
2.L2L2 0.1=leX2ne tene hirthwei,la Infant.% per 1,000
Low bighwtgitt InleAs 31e. ipezeikved r4it fee
lerobierl.$ rrj1 iremi Ii uin ii
Crew. Cterte.d.Ce,to, - teeitad alkb/Ni
. -
et% 19c4, 2 MOS
pr.r iirtlAof
An,
the ( ij Lui eveltisity met has :beer.
lowtr than n rol i i 5:gni fkamly vjw..r
Uein 1174 itafthy Pck 4.5 •per 1 p.10
iu Harr ••r!.h4E-11 ,m7a1-47:i incloek Vabenre
APer, [COI' 1.wncion,laek irc—natat 047.0. merlical Terobleren.,anP
cii7 1.11AN6 E.aly co rvi1wx15 prtmtal help identifr
crnLiti. ;eild betowr i2it niAnt apetn...
ASKO&
704:is
Teen Pregnancy
Rote of fern Pregnancy per 1,000 Females Ages 10-17
f0,t
UntImique.
4: 3
0
Zara:W. 1.8,61..,:4 arilee4 As oh :.,xgq, 7,7r,rs
311,i41. feluts1
VAXIMONV 10.* e',,fgaiSV310,MORMOMEalii-Matt.
j
Percent of Women Receiving First Trimester Care
9.39 2.000 2001 20k11 103 2041. 2.005
ft,:f4*TAIVT;44%-*Afkgittigff?;ICNAV
;A: 11. 1 11 4e,
;A:fraiikAgORW*40$043vok;gt47,AigV;WWW.fa
aR 1005 t€.'
*.tlitOfifttoN;MlaRA;AWFX:7,P.M,;'rrief-1:4!*iek'
12i Ii pOPiis,10.1.11 runked Amon; thA. 7.012, f'eetver
h the nighem ?ALS 01 Prr. iskticier prelikaA
peenAal evx Impal.t.nt h r,; nnther,
-,revere Ad74t birth mrxillet.
Sexual Intercourse
with Two or More Partners, 2305-2006
lineselA4s CourtY SOMM
Etth Graftr5 11th emeif,rt
VII A
Deschutes County Health Services
Local Public Health Authority Annual Plan 2009-2010
91
DESCHUTES COUNTY .H,F."'d .11H 2007 14._
ADOLESCENT SUICIDE
ZOL)4, widdc Imd On fives of f:7 C3r,r.g.Drp pouth -.*./...cd
ye.41.1'5. SIW;idt v:V* I hr. Venal leading cam dth rno rewnia.7.
aged 10,24 yrilos„..03-9on'u youth sold:at:Mt ihs bum 1ugher than the
utluandl. rale k dtlx4ikk.$. rkET .0,Vry :;•0.11■167, deith ar1111g youth unaN
1.8 yeal.L. there ate mtittlyted. 134 dr krls.zropts Ow ore
hapital i:.:ruetrur4 monis, ii OTtgon to 81% of t5u1631,..
4C
in
Deschutes Co. Adolescent
Suicide Attempts*
4o.05,sym-no
ikz:1-2,.. tr. youth 2,q .‘and under two- uihqng 117,4k!,. vik 1,9X+
ATM' altonv 11W41 ,t1 14% (1-1 Orgho youth
KLIcAdt: Orde.- icud prior
l'alCiC11:`;%1Laripl, hmory of derevston, sidy4.3tirr ubw, fon* tastury
i--c4oLcrinion. f.nwrn acct,-sr.. id fedir...gi hniu4e,5suess
1441 :4,4e Nzo, Afttio
Oregon Adolescent
Suicide Attempts*
1,044, fAIV4,<<,64,4rott
1 it
Deschutes County Health Services 92
Local Public Health Authority Annual Plan 2009-2010
11 DESCHUTES COUNTY RE.TORT 2007
Percentage of Adolescent Sulcicle Attempts by Age, 2000-2004
20%
Adolescent Mental Health
8'h and 'it Grade, 2005-20D6
INACtutes Crutty roarewm uo, IF etyuie ihin Inn Nrrillo
Btri °radars lith GroTiors
II1 In eh!" Pc 12 it.,”th
Eith Gaolers. it 1/1. ckader*-
Atki■i401-Siiw*: A ;hi P.4.0 I Mg,KeltP4
Reasons given
for Suicide Attempts.,
Cre9on tvlinors., 2004
rsni,-,17kft;
It
lilt-au:0 arid t1igicrr,
'141. clisnyurvx
fre.01.v,4,04-0;,40.Fiz torgteu.
7.4(411„-.00i■dbf,011:4! :1;$
45, 4
=atta
Deschutes County Health Services 93
Local Public Health Authority Annual Plan 2009-2010
DESCHUTES COuliT t '3l b'_71E l 7D.7,P1 21103
J
Sexual Contact from an Adult Intentional Physical Harm by an ACult
at Any 7irrle During Life
Q NOUN Cmkr r wed Remo Iatni► 5% ....
emir Ardor aOnorf,Tanif
Grdtisfs 11th Gracie
desNUlbe camp • Oars
1
8th Graders
1h-
-pw d > „WC 7c+ti&!urre x
CHILDHOOD CHRONIC DISEASE
Asthma in Children
Diagnosis of Asthma, 200,2006
[rnyhyt A Cz,u4s, • Oriacti Childhood esil leci is a dri«: tilet
1)rri igxa
_
yy'Kls'IiL. z- 0i5i :;i14"Z, a man
[t5 tai praaxaii FLilllre.ea with
:04,11.0a have $101# cat11 a1'acr eS.
AaLhwi . thro.y 1 the
1TII d3:radar.
propel rISC ,( !Vat Cati . :arid :he
yedu -c icm of exposure 10 a;.h11
Elinel
53xt �:'Pbs�> srrB:sa'iYy ii L'- „`..a..
Overweight & Obesity in Children
Overweigi `nt or At. Risk for Overweight, 2005 -2006
38% - ...
20% —
15%
10%
s 1'—
G
acttsclutermtg Mum. /Wow Mertes* SUMAIR 11,414741
8111 t radefe
11th Graders
-. -F4 Ittlp P;4
2010 O1 jEctive isvo
Deschutes County Health Services
Local Public Health Authority Annual Plan 2009 -2010
94
13 DESCHUTES cototrY 21:10
Nutrition and Physical Activity in Children
Phys cwly Achve Four or More Days Consumption of 5 Fruits and
During the °ast Week', 2005-2006 Vegetables Da,cy, 7005-2006
1 04,415, X C1199I■I
NI
hrt i in &Joel,.
er'.1 :rut per 4bre
er, Iltrsr.. 4
Qui,thwa4 cowry
tilt' Groom ntirvode,,T,
40%
Spend 2+ Hours
Watching TV Daily*
2005-2006
elh arathers 111k, Ik11
w,5rItr /II4y
461:4,
Spend 2+ Hours on Internet
or Video Games Dailr
2tX35-2006
DI%
• Deo crtu rea Gaul t remo
Graders ilI 3tadar.6
r, r
.reeere I rra.
Deschutes County Health Services
Local Public Health Authority Annual Plan 2009-2010
95
tlf7541:111.)TtiS COUNTY 1 Ff."2";"1" 2001
UNINTENTIONAL INJURY
Inpar boils violent and tiraituentkxial, sonikant
pi:bite health issue, According to the Centitts for Pistase Control anti
ilevention, injuries claim wort reittrl year s. of II Ct lost ttettraitiatill
before ag e ;35 than arty other c 'MAW: (iftleatth. 'While injury is the Intath
Leading cause of death -tn the United &atm it it: the loading testst
oldeath for children and young adults between 1 and 44 yeets
age.. Extensile: research lias-shaten tlhat intones are steal:lal. tit
m that ninnies are not accidents, do not ex.:rats et rentioni. nod have
tilenutie.d rile protectilit factors making .trittin prevencibie.
Unintentional tnjury Deaths
Dchotes County, 2004
fke Rums
flectivning
Drormitit
.4%
Water transport
•-,34.4,4*
• ,
41:jtor Vrticr„,
• •
Unintentional Injury Deaths
Oregon, 2004
bitten:km
2%
%late, Transport
t%
fjeii,art '74
•.•!.
riot's YI
34
aiettiti
ar
f or c, hildren tilnatittniar. risk OCCU rsprinteri lybozaftscof emittettrient
where hea.ey neighborhood traffic 1113kCS 01:J6:Mr play are unsafe OT
afety devices, such as bicycle Itc;ariets, car ixsts, or smoke
cletootors, arc unafirtrdsli:c or rto seem less important than other
nexessales. ainAtteeiving plover:: interiter.ttions, such as child car
envirounetual measures to lessen traffic speed and tittiorte
lierghliorticiocE„ hicyde helmets, and not clete,rtors, trniry deaths
ilmong chibirt n can be IOd ytgroir:Aintly
01 me .270 imintent r4 jr"Ory d 113 3.,,o (-.! due
tnoltot t(;11(.1.e. deu (17.7%). wcre chte to fel 1,2
200.
150
100
Unintentional Fatal Falls
by A9e, Oeegon, 2004
7
i. 'MA h=7.9 F-544 61,17 7f-M g*,
aid
Deschutes County Health Services
Local Public Health Authority Annual Plan 2009-2010
96
' 15 DESCHUTES .couurr HEALT.-4.] 3EPORI 2007
Rarely or Never Wore a Bike Helmet
Durirg Past 12 n',0whs', 2005 -2006
De/mimes Canty St Oregon
•-, -V
70°%
131110oiders 11th Gratiorz
.feetst tAtit bitycht eigrirte, Iteat 11>114>
tfl Ave
Concussion in Teen Sports
MiI1 i'falliftYlie Brain 1mjvO.1TI. onto liwylsat
ari=e5, fifitti Mum z.tiltitila >4>4.40111-10>i dectler utioti
",. r01:ty - uul 4;1'01 I:044w, r - ray nor
hiptty stab:els,- ii irily ts -lex up to il‘k.
t eterit card Moos I in adifaion re it It
wEo ir A; tioll Triiiro o pkry laritier hetolirig ha*
oitatatrred air trt timer man^ Ithrly r murthcr
cam nagr., nlc11 bram
>21111a 0., 'ft> btaill aattlagr, 4..s-Ardy'„ twerl
Orre&)rL 11.u, itewy oat's ttori !aid'; i ft1:10(lei1
lite Co ig of hr 1..Atvr-ri. jttly
ritosuo ci:diEire,44.%1 t217a ;it trte,t 8:setr) truftthrig
woe erivri,enctli by 0 >117.:011 .1114100 .,11ht0r!.. 41.
..qJ^,..Doi war
1,,
4,4
Sport.
1741-1;, :;ottcr.
GI
Ek
012mtincs
Estimated
COLICAL5SIOILS
Violent Injury Fmm DeatiM, 1997 - 2004
le rd. r16> at4:rabik !O.> 200)
shr :07f-imam deaties lartaltutc, Cu:a mti.199,7.2:,..cc4 (Exiimbitg tit mimic Jti Outtgota c•-f till: .3,1 ie.,- E7-t:arm
_49 wete due sutelde f.t!'9.10
Deschutes County Health Services 97
Local Public Health Authority Annual Plan 2009-2010
DESCHUTES COUNTY H.7..e!,1'n 2007 16
SUBSTANCE ABUSE
S
JU Use („sreekfng), Adots, ANDS
qrkie.ftunif intrt MOW 'So 111 MA by Nyvirltrimirtix
N,9,44.At0.tf+NI
DO
1
.45,,,,,m.t• A
Pregnant Women Who Use Tobacco (Srrok(rg)
Rpm. 11=44,F, Wet.* I a lutt.~-.4w NOw5ea
4,,r4 r-k,vam,L4.! tau.1x a4-144.744 Afty,
■";,1,4 sva
V and 11" Graders who Smoked Cigarettes
in the Past 30 Days, 2005-2006
3
10%
5.4
„ •., • ,• v •- .
T 'WI Graders
fi otsoTA4r44 ry
W*00.
16ft44 ,k.ontavi,
waif 4, Pio:vb•
2A 0 Olziem., %I
:Anew! iv,e,c1rE
Smokeless Tobacco*, Adult5, 2005
Descleet cuunt,. Nampa
ta4,41fa,...^.11varn
and 11"' Graders Who Used
Smokeless Tobacco in the Past 30 Days,
2005.2006
Slesfottti Gite
h Mow,
11t4 r423r4-
Deschutes County Health Services
Local Public Health Authority Annual Plan 2009-2010
98
17 D E SC H UT ES COU NTY
ALCOHOL AND ILLICIT DRUG USE
Alcohol is the most constriottly used and abused drug among youth in
the United SIXe*, Age at filar tt4aletilsol itt:portorp: indtiutga-
o[ ULUJ COI"OUltIpLiOn. Youth who tt,se Wore the ogt. 415
a tve liltely o dvelop Moho' tigpmdenee As tort *hilt.
8th and 1 Vh Graders:
Use of Alcohol at Least Once
in the Past 30 Days, 2005-2006
WY.
W.
5555.... Wolt MI 55 .5 0105...555.45.5.
';';
Z.k..1.555 15th G55.155.
5w. w w55r.
m5s5r5 C5.5551.5,1
Ilacte youth ilrt 0.15.0 OWN likly o Cklitibp other dtptildertLy
probknas. Prevention. and lalgrvientiort,catri help to reduce cask lactom
and boost prOteCtiVe lionrs .1/tat guatti againsa initiation
and titng u.
555....C55555.5.1,54N.5.0550555MMA.5.554.
Elth and 11* Graders:
Binge Drinking*
;n the Past 30 Days, 2005-2006
Ilachtea Caratt OX0.14
.45 5
.5,4,4 1,14 %ar
8th and 11th Graders:
Use of Illicit Drugs within
the Past 30 Days, 2005 2006
..:55.55, 5 115.5ty
Treatment by Primary SJbstance Abused
RI% — Desanutes County _ _ _
70ht. -
60%
1998 2000 2003
,;;,■ 5.75,5514, n5.5,5 tv,05.
5
56550555
8O%
Oreaon
1
X.Saltatorega
MCPS '400 )�x1
5.55,w
Deschutes County Health Services 9'
Local Public Health Authority Annual Plan 2009-2010
DESCHU FL' COUNTY A' 11 REPt.:111 2107 113
METHAMPHETAMINE
,r,;111-44-, -,'"' ' 1"s:hl',. 'D';.11cflit,,,:r.:,414:11 -1'4.-4;:.!,,,-..4.i,7'..:4y,,,...;-'.:311,....,,'--'.,=--L':':.'..f.,.,Ac-;:-,..i•-.,',,„..jr. '4:'-','....r..
,...„........-,„,.......,,,,,,..,.,..-'-::...--.:.,•., - ' ,.,-.. ,......., :..,_,::.....,, ,....... ,.., ,.4,,b,„;,,,,, ,,,,,,,,,...:„..,,,,,...„,,,,,,3,.,,_„....„,
m.: ,,,:,,,-,....,:::,,,,itr...v.--,.,,,,....1, ?7";',' -''..„ ....^,.: .:,. zt_,..,- ,..,,_,,: _,..,:i,,.2.'1;;-;};ZI 7
44-4:.......,-_-,.. • -,....: . 4'4; ,:',.;,' " '', ..::., ' ,Li :..:...;-:,,....1.-,-.1-,i0,1,) :})-,v.,L-1.%::■4:2:0=';'.1''ZF.-7.-,.•'!-4 ''.''-'.,-
:1",:-..-i4:-'4.-;a4,4,-j56,,i:j.1'-..'.:'-`7'::11- :`'. '' '''":'. '''.1''1j.',L....'''•:-.::,:, . • • ,:".-:::: ''. ,,t- .',./:.Ifiti,;;;;:,,;.'1,-4;1:11;-,,,.',,,,,:,':!•11-,,:*•.:-.1.',.1;.1
1 t ''.` ',:...."::'''.; --,,,,-. ,.-:..i:,i'!, .1, ,1; ,it''',4ii.;:fdli-,7:.:. 7'0(.,.,2,ilt,.1?2,P1;,F.,:e.:7'Lr.--,,!-.,.,,..
Y:'44:1''''1';1'4'.-1)-..''f'''''12`1.- 141/' r'''--'''' '''-', '' ..'",'" .....' -; ,.''..•;;-- 1...qt:-„-f.,:r.;ilt.,":.:: f P,.;:"_,,,,.111t1,1:-.":":_ii..-!}.4,-.:;-..1.1:;!gi-trc,i,.q.,,,...',.r.,1'.;;;;,,,r,a,,,Dr:
4 '-..'"'',1,:l'''',i''.:''''.',;'''',...-.i'i4',..;r-i-i-Ai.(7,,:.,-.■:.1:trt)•-;,;'''..':."1 ;'.').',--.''''rP-' '''; '-7:-.1" .. ' -,•,. ..-. - ' . - .,„„...,,.,:..,....,,,,.., ,,,;., 1 ,..,
..'47,4',..-';c4•-',..id:;-k;ii .:.-w,..ril,1+1,;:,,.1,,,■,, ;,-,, 7,,,..,`,.1:':5.-,,I:r.ip,.."=:::::••::,1"...1.'-''......e'-'-:;,.%•Y''s*:-'',.-'- '-:-- '. • .-,.::,,„1,,-,--:;."-:;=';;;,-;.,•..,-4:
..: ,t-lis-'F1-):t;',F:'-1:.`..:.',''., .,,,1..L.ViL:,,,i1-.1:..,.:.:,,i.:,,-,,,..,:;......i,--rifrii:-:...,-_-',1,,,";,;.'i:iLl-L:--?,:"}!'::,C.,...'---.L.:-:::.';',-::::',-,-:::.;:;::',
LL.wT-■•,.:'ji -'i":.-'-' ' '1' ' ,- -.r:, ,
4,',,ij,,,.,„,:;;,:,,C.3..,1',11'6,4_.(,11V;5..':.:4)t ."-!`'.": ' : ' ' • *
0: 4 -: -' '':..1'.: ,.. .7P'- '',7' 1 (- -
,a'.,: ., P'a '.''7;, 4,,` 1, ...L';'. ,1 --.4;a7 . 411,-4ii-: . .-,1.-, :'..:,?a,,,.,,:' -:', .:, : a..,.'.:. . s''..i:,2.'.■ ,.1 M:--.!,,'.; :b
1:z3i,111, 13;1 ,, t1 ;L t',11 X'(j)%7''.. 4 1.'': ' '-.,-'.. lqt:-!„-;_:a. ''. . F
, ■c1 , -: ,'-L .4: --„- ' 4, 4. : :': :,.'....." :. :: .".- .; ;; ,' -„.:.,.:- „ ..: . ,4..4-„',--'..:4-;:::-.-..;, ..... , ,. ' • '. .,, '.-4'.a !: - . ;'L.:-"'4. :- ', ,;a,a--1,'.,':,e'1;',b,'.,,;.,,'--.4 -i . ;
._:..,,,>,::-.:-:. •"::-:,.....-1::..- ' '',';...:,
,"...,:.-
•.' Trt-erY,.tfort r ;t:.„. : (-::7'. .. -.;...'.. ',' .:;-. ',,,,:c::....-.
f ItItIl'a.),'' 5P:,-1:'.JrrtCn:-=;`-1--4.H- '1";'.-''-'''1.4 "''''''''''''.11'''..-4"'''''-7.7'1.14-.7._:'4'''''':'''''''''7'''' '.'-',,. ,--'1I':,-L--,V.:-:- ”,
t.1)
. ..,:sp„..,,,,,,,,,,,,, • ,,,,c,..,-,'-,,..1:-,,.',,-,,!;::-?..A.,,,-;-..?.,,C,..2 .-9-'--1''',;:- ''' Li '''''''''', ---:1.
'- - ' ' ' "' ' -'' - • • '-‘''' ---"''' 4 '-_"", ,„', I: ' /i '--- . - 1 - .,„,1;1•-;,..--.---',-i3 :-...... ,-: 1:: ...-.,,,,71,1-., If. ., • .....1 .0 i - 11L1 311.
'1 ti14 -1334 3
:',";-";:' I r•',.7 51
•
' ''':1:1---...,.--,,,'.'''.:-.-L.:-:t_i-c...,-rv..-.2c-r:;.p61.'f'."..!:.,:-,.1.■!;,..--2 ., :
;■ 4-;-.. .r. h -..-..t.:::..1;:11;•.T.:-,;"1--"it ' ).:.,3 7 -.- . ' , ,7 - ,.. ' • --"'''''-'7-.... -' '....- ..
. . . .
. . .
2P
Purity* of Meth seized
;rt Certra Orego^
cvn
20(117 2005
rtrAIV 1 , 4 1 , I . iVf I Itt
punt, r LtIv. kuii
-111 ! 11 l prriiltir n1::):
1. 1113. 1lL 1il..it,1 ..71C h m (cult rid 11.-1-r 1- .1.1W .1314311: uct-i
111:13-11.4:‘,Ird
8th & 11th
Graders:
Use of
Methamphetaroines
wizhin the
Past 30 Dlys,
2005 - 2006
the 1-I17/Center
,Ty.1 r,.
: • : - :• :
• 11:4;1' 11 JI
Deschutes County Health Services
Local Public Health Authority Annual Plan 2009-2010
100
DESC 4UTES COUNTY 4-iF.'a6: P R Fr +KT 2
ENVIRONMENTAL HEALTH
Drinking Water
1
PloixtV frs ettl :Ater,.
rt I E4. r A 1 et)11!1.1 ' clic tidy,
me. l41141'tsg't3
County (l •ierh;dt4
c.deit1^11 it 2,..r ale _Y:9, S''. a: LTC letttn
sciloae:d tl'.ret1re cAlce.te .1!':. R .,51,k11
n,e'eeeFA'tbmr.nam-
C pl e
al
at and Il It",14' v »'re- 11{1 1)x.;7
food Safety
+ .1,a.- err11•; has 1pp prate
Ait51 a eY;.I.re -1 rte?, &tslishrrltu 1 '.',r 4:t':i'.&'=e
r e-,?Ateetii rrl :ester' 4Ct th aa . [ c trtdlt tl, .;.
the, c.,rttir. °•r wee.90 .1_ettt4e c7 3+jj 4aesn s+rnr
°4` 1. I11S is l :'1.51 e.rait.. 1:? '7^; tG:i:ll:.
r1r..1l :-4 5f:.anr. P;hlir. and TWtion:ffe`11
rvet.,: C atcd, el 'r 1I',.I bred tc°!°te il.trr,_s t._lerlllai. -tb its
•
Pounds of Municipal
i}yC I
77`73
I't
T
Ii ,,itre
11Y'ri' CY4 rt "e,2 Zt
-etcas t C' 11n.Y.6
c
14.4
n* 4.;m
Ste'J=SPOsed Pet Cap 'VP./ 70175
}
Haardaus Waste
r:lratr; " °rtv :t1ba°z are tC3? ts?PfC 13rrLYSta' Arnie •t
1f�reti.q$I ;
X171 na•frt'YI 4x,4'.14,:•,'4' '1 .14': ;l'I4thelLet,31i.iba
leev .4Te t7 b'.e1 eillt4.11- '11
S'I1^t fitl 1 31' 'r1Ev rte tb3.'',A zl.ytt- e-t,.11li' wire ._ i
u:ee- r^a� nn;>•_= as.a+, , e . '�,a_s°r.. a,r -atr s ma .. �'.a., rie h .. .4. d51s1F.
4 eellele Recreational l flier hall a1w Green Algae
KO, Mom 1 5 &PC harrales..i, but elitrc. a.t,iic1,4E.,. ;ie. elf blew :gce -,,i •
;Opt !ho- gay prceclO _ beinthai ItaxI;: retetaliw.. e.A.a oot i *a.a1hcr.
,rr Mb, �1a.- ,6111 algae Eoorr.;.ee ^t4 l'.' .e1:: t *7171101.111
15. Ad . a74s are isalicalektecitecelt C1111W1, 1'110 1 " TOM °1Milt"
a)yh3,rtreet4j1 .41_4'ebeti ,lone et evec,,A aiiyas. +Yc:r,:
•
tr4cltt }h11t „l Yc't11 aat4r1 r1a.n
1r. lyss Ie-q a r ir.1z itt -Lei II iregt ar trfz A
mid tong tcem hod de 1 an a a411k'r ree
c 4. itici June. N04, hi .Ith ad. <ti ; teatr Ixjr 1t.•e11e t ;;e;f 14x'
ite:etilt'I in: IDeschat e•• Colin iL(..'a: I_.... ..14C 11irie 1aeet. 171t;eetl1e:'.
1 hleiceg cn .aig e . L3P.R Fak'_ C zlle 1 l l ru. P.I:_a x-.111, 1,, elftta
ut-
eavr
IB: ti
7utr oar Air: Quality
at^+ 1fu rtSttYSlly
1'st_ to ,.5`,; OfpolliattrI_ le4Ot'r rhiecleaafe rtspat17 1'Ilrnsrl'
'a:i:rree eltdir '4' e,lirinn. +::n t irctilti.;::`R 4..'
..9°„"4.4' $;..111 r., .J.s. _-. retrtf;�;t. r
it ?rry ?,,,,1 K_._ir r ✓. ;s*,' -r. Ste Il i,.e�571L ! .;nC£°•,i'.ir.'Y ?Lti?i 1J,tr, ,r''
;?Il1rr iitettgc a,1P_-'se t „''''..t,1::.,: aft t 1 v " 1 : . e i e k e l 4: i h , ., 4' M . 4 --
,1 1 r l lever; ra.2 ra '1, 4' 7 ]x: ._, p:4lI'ta. .I ei.1 4; a ^atwsrlr:
;mtei ,rat..a:il 41 tang..ln f1)5, De' clieiti tr v:4'. I:j1 ' .1t a1;lb°
=-z-e_el.r (tic ht.;1x4sr, f5'.. .t4' Mr "4, 4;t; 1 a,;'g; ttd Jdi.etl
Tztr cd ear, MtiA. do flee,"`
11;?.J4 !U tCa 'enF�,i51: S 1 t £uric 1
S te.Wa ,.._
'..+ I' ' 11,4;rskr,..,. b]L r. mong t11t. � itCS:r
40 .$;1 ,hart $443 pc1:1[1C»''x;tti 11111311''1pa1 '41.Ttta.-
4' ;. rlc P1,1[t'f.I° ;r „.le _(�- :°t+"t *,i0d Tleverttttrlt3'tL'Us
w .' rcx1,lttr;�t mran?dr.r'I.Iariaa ; la
+ [te.slaiat.' terime1tt t'ae10. d1•,rt'th '+u: (3
waled '1«3111 c11t,
1'a8 s¢,an.i.:. %('13;'1
as 5dtlar .Y.1
the,'
GpU;1 1:`xkS aft
ri1
1.:Ilse,aft.l't. Yi+dupTtt eee.ir,
PeeeeeV I1,..1
>1 t
•3t 12111(" '4rrlr�a 1N+1'+, {`(lt"lartt3tK1 rra tlttjat:m: rtaJ ,1e;;�s- ?;t ±s.
4e h the I rk 4s tstl t, d irez� r�l. aew The
st bf ri h t1'K ve4s 1:431 3) '3 3: tar ,:Ns 11: h l 1 111-14
x4111 ft1� ;R.ri ..rl hem , x14._, 1111 :. *a3u *1.11s.yawrrcrple.fltiee;
1n u_di!-°n' utiote. f r a2, harm', kr 'ic. xt. AVNY..e,e'elet tirel •;1r , .' ti
itee4gc a n 4a ..24. )1 with inetteari, bore- r, aria. hied
t r1 -re "'id 'en -tine hldnea t death* tt 200'6: There: r : orm 11e rt.
t, t„„telatt ;:'� t i, twd�_1,1aC1" °3'
+tent,
14111 h t11e 14St3
West rtas. F ;
1[1 •i1
;woe
111 f4 :,E 4 'C}tdua'.t a ?�i tea
s1c"h J411C,ai1 '1x <1x4 11'. _
K l:.Erirlr'3.1Y eu 111x1.
Deschutes County Health Services
Local Public Health Authority Annual Plan 2009 -2010
101
IARly
DESCHUTES CO UNTY rJTH PJT'T.,7T 2G07 20
WHY RECYCLE?
britia 17.r.O.',1-;,- -;21-14110,:. Li L tiair-Laa to itaaria,...,:aa r-1-, I n,ir
COMMUNICABLE DISEASE
Sexually Transmitted Infections (STIs}
The nurnbrt 31T bc tiepraiol and requiring clinical follow-up in
Drathutta County bat‘ Increased ity 11 1% since 1 WEL
CHLWYDIA
20E16., Crilantyclu . acootittrod rot <wet -01% of -cite.. STD diagnosis
in .Dzsdnugs Conlay CNIatrirdta, a bacterial t1fl, trartsmgred
throutab orgl, stag.,1tia3 Aria Anak Ahh(AighC.I.n'llbk., it can ZIAVil:
COns. rrpi cutlet .including acitatilini and pniiti1oras in newborns ca kind
mothers_ tiirtuptittn 1itiii 1TI Mild Or absent, which can
delay ditignosta lontezyone,11 Cis: nqions complications.
Desanitos County STI Cases, 199-KLY)
314
Cornmunica ble Disease Cases
Requir•o9Fpiderniotc,;;Ical nvestigatiOn, Lc uding ST1
8 1 9 26:CO 2C174 213112 -401,
The 1nm:bet of corartuniu6le c:JA,5 veep Irnlg
epdt:17::,ological -..mcsng:ition .11 tra,ed
licAriy 2001 tii-ncir Ct0iii
I-ITV/AIDS
Oregon instituted 1111V reporting it OcIPbr7 010 r4tImIA1
it lion to bencr track initiation nuns ai1L1 ott parnant A 7t107t:
epiderraultatcal picture of th u. problem in OUT MAVe. Plicn 11)V
repuning„ only diagniac.cd Ala!: cascs van' impotactil to the State. Sinte
111V reporting etgon. Deacbuio Cuttrity has 4tra3niid a total of 32
confirtnen, 11V pci,--ititin tatira 'while the numbers niay twit= sattall, tt
1:1'9„YniInf. 1.17: at they be uratlemorid i,y the Vilpropr,:ile ixTuteid. They
rit ccirtraticordo nor picturn of 1 11V it this cortratitoity rut :it .4,141
rcascris. 111V irporting bcggn frai yrAl.;agn TnAry
for Dint es County and Lin rI,or Irle7r at A laft3
date, and only about half of all piersorten, it d ,`,..aatiati, aig,it 1 Km
having been tested for 111V, meaning that th-y is .1 si grit fican t n rithii
ij, parauaa living with 1 (La: 'alio do not 'c buova
There are mantray 59 tilv pt wan• a entulird in d°11...• iu
1Nhax togr,Neme!nt rmgram sanlh tner Drsvh.aet. CII1i -Health
13eptuttrient C;* amogerti. help doer r in ■116•110.1,14, pre..c lott
dru, hcalt:rr imuramr, 1-1mAirig And dental raw
orrd mantal 'watch rut aniarling h is ilia ictiptiod iIttia casdocatis !,,e01
gnyw At,o(11:7,, cyver Olt qtri ItrA, ynirs af; mot move /WA) the
OTt3 and local opportunitiett for teatittg become, I riattnaising1y atrailabLe.
Ac1faitionally, the truolcrectit anon ol named not-tong uf HIV trim-rain
sct 13 AFK...°A 111 P.X13lle4- cb3crnining hL optdersat and
e lfitctively slew aa s?reatl ihrctiet nl mrliottaa. The
Gmitr-,;,hr .iimzr,1 and 1*.rtvc.rii ton itcorfinvmds !hal Elytine
▪ riowSly “171011t1 id fiW liiV at kast Dace, as there are
eat; r toted rti nvel 27Xl0:11) 1 1 ct, citiaktia< 1 WO ewer
await, ihry bare the vials
KW/AIDS, Deschutes County and Oregon, 2900-2035
200 t
MS
1111==11111111111E111
1111121111111111M11111111.111111
MBE 11111111
143
21
'HIV* qrry.ting began 200.1
Deschutes County Health Services
Local Public Health Authority Annual Plan 2009-2010
102
DESCHUTES COUNTY HEAL.T1-,,,PC.;RT 2007
GIARDIASIS
CoArth.w.,-11: ,s ilLalfhoat psiasite,
one ti-tf the alum WItIVV.AU CAISeg Wgtft:0111r.
,11,,r;kW (Art rilithi8 and rottittatiorial) i Iiiiinittrs in the Uhttitil :sixes
ikithI hogict 1-2 week-staid tier/ 'tng in rcri rri tirq
Giordiasis Cases, 1191 2005
111111111111111111111
111111151111111111
CAMPYLOBACTERIOS1 5
iitateptilohairiit
the bziaertif4 crOi9; rii:Dram:A thc
Moa. a*,.*% ,:xtur Ar.* (.7..cws 313rnmr-mon.rh,-.;.and
.40. pat ilia huge ittstiOnsik. it::: a itnpitylo e1 4i1.
that affects the tircesiiithris aid, on Tom occasior s:. the hicsitisiream.
C.:taro Np telt eil,7!yy i rig cirinlita g con iti thiciatard fond
r.7..11i5.yony:hmt:-imra4 ,.hroitgh 134.1.(1 V,ritf; k.:1.°A.cd pzoillc or
Syr:ITitvroz,gt1.y dan after .h! Ua0 11 mad.
jc mimic mil itoiiiiritr without any fnitmal irej.taKTIL
Campylobatter, 199E-2005
flr
1001
- .
2001
2003
1001
OTHER COMMUNICABLE DISEASES
• ,..-;-v c,,.71-4.4g,ious, nti ran spread easily
tram pittson :dote MOrl Sy7713A(04.:,. it-1611(k nui1, va itr, diarrhea,
aidnt mi.:i-11 cramping In 01.05: peopk the ist sett
itit sty raptairs idatiitgfot about 1 Of 2 ci.torl with leitg-terth.
effects related tit ft 1"..T 61ritty; rat Tr74.3,7toble ri L'17cgc.r, by taw,
tho Deschutes (Amay Health Dittparartrot investigates numehmts
ithithimokiithriatighrtut the raT
• pitiwiatitt, ar n.0:,pipg r(Y-Agrp, k. a highly cit.:magic respitraiory
Li-mined by horle tram founiti in thr mouth, rditie sind thou of
infietl pconssis pc sitigncani rIO or hesriialionricin
and ckathicrinlanis (less th,on riscinths) In 2Ci4Ogon eiceiricnited
on upsWing 1l Ric number of pertustais cues, trachinp; tide highest
smot 1959 Mort thin 1fe% roI to Welt
i)M1444,,, 4ad Cbci...m.,4.5,;ountk5 Dc.-KhAts ;toil LW0
titan...firmed eases
• Erzsij CRUSTti hyl vines spread t07,41
7..1.,ti...d2-Sharitif_7, occupational neediestioks. jno b.childhrth by infected
mei
Iirro While FRY% of infected. people have ati symptoms, chit infitteiim
can lead to 5.tri0.1.1 P.ATT disease A nrw reporting pricess, hogton in
',I005 lo o id,io o proatide a 171.DIC irCUralit [Oolitic ci ci :nov,,tri
oi iktschuteiCiinaly. There weir 25,0 ;tiettrii ice lab criatirs ittif littpiamis
C 2005.
• :111iirowia, On average. 5%-200 of Ox An-mite:in popular:on
10 10 fht eac:h yezi, result:in:gin 36,000 deaths nationwide Deschines
(-minty hod 15 deaths dug to infliyamttaititteourndnia 1 Q4
PANDEMIC PLANNING
to cooperaiinn with and statewide pa rthat is„ the. 17a:titillates 0A.Y1A.y
Health Department chnducted pandemic- catentlso on Nutticatbstir
1-2, 21306. The Health Depaitmeat is conithuitta10y improt.ttng plaus
for preparedness. by vomiting with the Deschutes Cetamy ErniergetiKy
Manager tri ccorditriate resprin.• to &dents Prirtriers in. that protest
riJIJ0 stittinitiliii health systems. II.P:11,7.1.1:11. bnsine-s:i4.r.5tabh5.hurra.;
Deschutes County Health Services
Local Public Health Authority Annual Plan 2009-2010
10:
DESCHUT S COUNTY 1 [. sLTt 7.:F PORT 707 22
a Tenn* S
tiaef3Ct; the Yratuii Fisk Petrak�Yaa
}alisSchaaltt 1lie -Suzy tibiaFw.n
actual siiF7l " .�i'C :7bi1 aithy Tersts•'l ip
tnet-tut'rt tip
DATA SOURCES
ehavi Vital R+!
ktr fsel r a, a Ftr l
c t t rr.i im d a{ a l
*u xt ` lap: �i b S'a cti the 13]
t �= ti�..�s€ �kart�iareJ �ta� iar�a ^e�'
a}iiale+ l
eYC iI'! l ''r°ie.5�"Ct.O>�kta"at6CalTLS�i
•a tY Cttu,: V �v'
ara fNraria'a 3 ttE ntnzr tfrxlr,
c,s r.scrtr xV ii1i
}geti scthrrL'r51t olh
.S,
1?
;ti tki ,� rr.gsn
Eata 4E rtit a .00.(4le
t g c 4tr,'azJ-
ya; .t'!I4- aa¢Iktj41 C'.�i•
is
I
�'•;'i" xrtJ j LE:la:k
., :441 liti
:ITU I i. I„1I,...
TL
1t, =;rA4[
,taut LJ L.V • tata..z,
iu;ac c k ai Jt! ind 1La t x .
J> haw i etararJ sai;lst°
r4 tic tal. Centre for t'Eraatth Stttlst}es,
.7h s inh l Ctai er r. - t lt}I St rtl t, ,. -,;vc, t wl _ Ow; Not acS
la`Eas 1I. 1 he lt,t asilc a rZ_e \f_ ty rraltrrr II L . t`rtatra ka19h ..
�aaii 13 1111. w i,I ,;ira z iclI IC_ . arI; 1.r LtVL 7, cau� }tr. a „4�a '
�ilm1. L.•—t it` H ° °�.i4,} [`%::%iY4- is `!CS Ir' t','.la'..L ;r �NJ�lly t�.i tail Gir 1. faU . ?::�R!
yzd tct_ art rite i ti sf a Ta_ T S n tk t, Et1 �f x xati nt c t;tE#t
1 i i : z� arc: L}E,S a asry r r n �sFth tt }v fit lrEie is €hh
iri s is tr 4'iclrr rra a^tt- ridfwa: l alt .t 11 trr:Jtlaa1
Eh
}1St{ flee tif- Eliseas ,P event an and a a aEo}ogyr
a a,lt7 a t.l Ji i E 5x�latuarr to ;71)14 t, l • idcntiilrs,
rbtt iI Nrat we.eitlq to cC, iYQ} tIi 'fix to t',N.a t 3.t as
ski 0 t [ "}ii *• . II t., Ific Office i� ..otrprt ei of
It tr.agji t 1101.14y err aonir.i !a ar t t741,,deatxir1i4. °,.
l 'rxt8t ktk. } a}tti PIPt atio . ru$L. t -. Z. ,.' .:
ra,t r t *a, .atd'A .'tau° • ird t: i turt cah "e.,l t aec,
5111
t1
tll
F�1
4i
d
rr
1a
rf
Deschutes County Health Services
Local Public Health Authority Annual Plan 2009 -2010
104
DESCHUTES COUNTY -FAI 11111 2007
DESCHUTES COUNTY
HEALTH REPORT
Services and Information
• •4•-•kt,..
HEALTH DEPARTMENT
CONTACT INFORMATION
Bend
Er ondtPJTVIRTI SLT:CCS Flu ildirq;
2577 N. E, Courwcy Drive
Ikrni, Oror. 97701
5'-1-3.12-74-0C•
Downtown Health Center
wing. youlf, rfzircolgh.
1 .7e- NW 1131717-an
112md. Orrpn 9774)1
5'1: -322-7457
Redmond
i•Ircky
415 gth Strcv
11cdtrond., ():n 97756
5-H -61.7477.5
La Pine •fTror:lays
Ttnft. Communt,•,•Canipus•
1635 Coach Rd
1.4, 00,1-7.1n 97771',2
51: •322-7400
Heatth Department Website
°V.1.104- dr,'5,C111!"...!,;01 rorginr3ith.
Communicable Disease Reporting
71-1-3-0-7418
MISSION STATEMENT
315,i02. I!' k !".■ i 11,4 ! 10' 1 N. p.,.17 CI • •,311' r010,0,001 per 01K, r! 1100.11 ":07
: , d=0 tzlia 11: ■."i'll:00■, 411 .01" -17% 7-7679 110,:01,0" .,10
'-4
Deschutes County Health Services
Local Public Health Authority Annual Plan 2009-2010
Appendix B
DESCHUTES COUNTY HEALTH SERVICES
ORGANIZATIONAL STRUCTURE
Public Health Advisory Board
Addictions & Mental Health
Advisory Board
Local Developmental Disabilities
Planning Committee
Board of County
Commissioners
Health Services
Director
Medical Directors/ Health
Officers
Community Health
• Chronic Disease
• Communicable
Disease
• Emergency
Preparedness
• HIV Case
Management &
Prevention
• Immunizations
• Juvenile Justice
• Living Well
• Self- Sufficiency
• Tobacco
Reproductive
Health
• Family planning
• STD
Maternal Child
Health
• Babies First
• Maternal Case
Management
• CaCoon
• Drug Court
• Oregon Mothers'
Care
• School Based
Health Centers
Healthy Start
Women, Infants &
Children
1
Environmental Health
• Licensed Facility
Inspections
• Drinking Water
• Environmental
Toxicology
1
Child & Family Program
(Behavioral Health)
Adult Treatment
Program
(Behavioral Health)
Developmental
Disabilities & Seniors
Mental Health Program
Business Services
Quality Improvement
(Behavioral Health)
Chemical Dependency
Organization
Deschutes County Health Services 106
Local Public Health Authority Annual Plan 2009 -2010