HomeMy WebLinkAboutHealth Dept Annual Plan
Deschutes County Health Department
Local Public Health Authority
ANNUAL PLAN
2008-09
Deschutes County Health Dept.
Comprehensive Annual Plan 2008-09
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DESCHUTES COUNTY HEALTH DEPARTMENT
I. Executive Summary – 2008-09 Public Health Plan
We are pleased, once again, to provide a summary review of local Public Health services and systems
and a look at the condition of health in our communities.
The Deschutes County Health Department continues to provide a comprehensive array of Public
Health services which well meet assurance standards as described in OAR 33-014-055. Services
including:
• Communicable Disease control and all hazards Public Health preparedness
• Family health programs, such as MCH, FP, WIC and Immunizations.
• Vital Records, Health statistics and health trend monitoring.
• Chronic Disease Services: such as the BCC Program & Tobacco Prevention
• Environmental Health Services: (via the Community Development Department)
• Environmental Toxicology Investigation and Intervention:
Key Findings and Recommendations
As in many communities across Oregon we are faced with significant health issues and health
disparities due to demographic, geographic, economic and lifestyle factors. Some of the most
significant of these issues in our communities that we recommend be addressed are as follows:
• Oral Health Status of low income children.
• Access to basic primary care services for low income, uninsured, Medicaid and Medicare
populations – including children.
• Obesity rates on an epidemic scale affecting both children and adults.
• Health system capacity to serve bi-lingual (primarily Hispanic) families.
• Public Health capacity to address increase in prevalence of sexually transmitted infection.
• Public Health capacity to address increase in number of Communicable Disease and Food-
borne illness events requiring epidemiological investigation and follow-up.
• Public Health capacity to address chronic disease via prevention, education and policy
initiatives.
• Health, social and economic impact of Methamphetamine abuse.
• Low Immunization rates for young children.
• Drinking water quality preservation in Southern Deschutes County.
The 2008-09 Plan also recognizes notable progress made and sustained in several key areas:
• Low teen pregnancy rates.
• Low School Exclusion rates for school age immunization.
• Added Capacity across the Primary care safetynet system.
• Exceptional Breastfeeding rates among Deschutes County WIC mothers.
• School Based Health Center in La Pine and planning for two additional sites.
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The Deschutes County Public Health Department recommends continued focus on the long list of
health issues challenging our communities and families. We strongly endorse enhanced State
financial support for activates related to Disease Control and chronic conditions to address the unique
health needs of special populations. 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.
II. Assessment
Community Health Assessment
Community Health Profile – 2007
In March of 2007, the Department issued its third edition of a Community Health Profile Report. A
PDF version of the report is noted 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 bi-annual 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 25,000+
Deschutes County residents lack any form of healthcare insurance and are disenfranchised from the
Health Care System. At 19.1% Central Oregon has the highest uninsured rate in the State. Some
6,300 Deschutes County children remain uninsured. It is estimated that some 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 of March 10, 2008 2,860 Deschutes County Residents had
applied for the new OHP Lottery expansion.
On note are that 92% of all Central Oregon employers employee less than 20 personnel making the
purchase of group insurance unaffordable for most.-2007 statistic?
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 they 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 a Fee-for-service Medicare or 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 see and treat clients with these forms of insurance, citing low
reimbursement rate as the culprit. Added together, we estimate some 33,000+ residents, adults and
children, face serious economic barriers and greatly limited access to primary care services and 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. There is currently a discussion between
this Rural Health Center and the Ochoco Health System (FQHC) to explore opportunities to
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collaborate to better serve the La Pine Community. Also significant is the recent incorporation of the
La Pine Community. We trust this will only help in working with members of this community to
address current and future health care needs.
In September of 2003, a private clinic in La Pine was given the designation as a Rural Health Care
Clinic. This designation has assisted the clinic with its financial stability, due to higher
reimbursement rates. In April of 2004 a new health care clinic called the 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 delivered over 7,500 patient visits in 2007.
The Ochoco Health System expanded their FQHC network to Bend and Madras in 2005, bringing
much needed access to Medicare and low income clients. The Ochoco Health System delivered over
20,000 patient visits across Central Oregon in 2007. The School Based Health Center in La Pine
continues to thrive as a critical access point to health services for many of the school age youth in
southern Deschutes County. The clinic is unique in Oregon in that it readily serves all school aged
students K-12. The FAN (Family Access Network), Wellness Program, co-sponsored by local
schools and the Deschutes County Health Department continues to provide care to approximately
1000 children annually, but will merge with the new School Based Health Centers, should they open
in the Fall.
(Note: The FAN wellness clinics will be discontinued in school year 2008-2009 due to the decrease
in Medicaid Administrative Claim federal funding to the schools. Deschutes County plans to enroll
these students with difficulty accessing medical care into the new school based health centers planned
in Bend and Redmond.)
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 over 162,000 in 2007.
Chlamydia continues to be the highest reported disease in Deschutes County, with a 69% increase in
the since 2001. The cases count for 2007 was 395. Overall, Communicable Disease reports and
investigations have increased over 500% since 1998 creating an increased workload on staff for
follow-up. The Department investigated 7 cases of Gonorrhea in 2006, and 3 cases of early syphilis.
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) and, since the
disease became reportable in 2005, has created an unfunded workload for staff.
It has been a challenge in the local medical community to develop an effective reporting loop with
providers in the community. Due to high provider turnover and a large influx of new providers the
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CD team has found it difficult to educate and remind about reporting standards on a regular basis. In
2007 presentations were done for the emergency room medical staff in hopes of improving the
frequency of contacting the health department about reportable diseases.
The Communicable Disease (CD) team updated the West Nile Virus Plan, implemented surveillance
in 2005, and is preparing for the Spring of 2008. The CD team completed development of a SARS
Plan; is in the process of updating the Pandemic Flu Plan for 2008; as well as participating in health
system preparedness with Cascade Health Systems and numerous community partners.
Cultural Competency
Those of Hispanic origin are a fast growing group as indicated by the fact that over 9% of all 2006
births were 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 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 cultures that access services at the Health Department.
In February 2008, we started a “Males Only Clinic” and have marketed services toward Men Who
Have Sex with Men (MSM). 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 in terms of keeping pace with the increased
demand for Public Health services. Deschutes County, again, ranks near the top in per-capita growth
rate for 2007. The County Population at the end of 2007 is estimated to be over 162,000 citizens.
The increased demand for prenatal services relative to the growth in the Hispanic population is
noteworthy. Of 2000 live births in 2006, 234 (11.7%) were to mothers of Hispanic ethnicity. In
2006 the HealthyStart Prenatal Service (our safety net prenatal program) assured for the delivery of
182 healthy babies. All but 20 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. DCHD continues to work with the
County Emergency Manager to plan County exercise revision. The program hired a full time
coordinator in the Spring of 2007 and since that time has made notable progress in staff training as
well as community and health system readiness.
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Environmental Health & Toxicology
In southern Deschutes County efforts to assure for the preservation of the quality of drinking water
from groundwater sources has received acute attention. A recently completed US 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 code that would address
nitrate sources from septic system effluent. Citizens regularly contact the Health 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 the Spring of 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 1800 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 2663 reported cased of child abuse in the tri-county central Oregon area. Of these apx. 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 Protective services is only addressing cases where the child is believed to be
at imminent risk of harm.
Social service workers state that the number of reports of abuse 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 (1251 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
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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 (IPV), and a growing problem of methamphetamine use.
The Health 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, and will be complete by the spring of 2009.
Food-Borne Illness Reports
2007 witnessed a number of reports of institution-wide Norovirus outbreaks.
In 2007 we saw 18 Salmonella cases, compared to 12 in 2006. There were 14 outbreaks reported in
2007, compared to 11 in 2006. 2006 and 2007 witnessed a number of reports of institution-wide
Norovirus outbreaks perhaps due to increased surveillance. The coordination between Public Health
and Environmental Health is positive and has resulted in the formal assignment of Environmental
Health service into the Public Health Department, which began July 1, 2007.
Health Officer
In the Fall of 2006, the Department matured the vision and scope of the traditional Health Officer role
by securing the services of three Medical Directors. Dr. Richard Fawcett, an infectious disease
physician was named Health Officer and Medical Director of Communicable Disease Services. Dr.
Mary Norburg, an OB/ GYN physician was named Deputy Health Officer and Medical Director of
our Maternal Child Health Services. Dr. Steve Knapp, a family practice physician was named
Deputy Health Officer and Medical Director of our Pediatric and Juvenile primary health care
services. To date, this model has been working famously well.
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 2006 the Department improved the immunization
rate for its 0-2yr old, service population to 66%, off slightly to 64% in 2007. 2008 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.
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 4th 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.
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Lactation Services
The Department is deserving of notable recognition for programs that address breastfeeding including
MCH, WIC (Women and Infant Children), 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 (1062 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 Examiners 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 Health 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 4
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.
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.
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Oral Health
Tooth decay remains the #1 most common chronic disease in children age 5-17 – five times more
common than asthma. Children from low income families have nearly 12 times restricted activity
days due to the pain and suffering of tooth decay than do their counterparts from higher income
families. Between 2005-2006 32.6% of Deschutes County 8th graders reported not having a visit to
the Dentist, higher than the State-wide 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 of those who do 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. Area safety net care clinicians
believe they see very high rates of advanced caries in low-income children. Many OHP enrollees
report being assigned to dentists who are out of the area making if 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 visiting
programs. Eligible families may receive prescriptions for fluoride through Well Child Clinics and
extensive prevention education is offered in all MCH programs including WIC. 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) services
have 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 have 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 DCHD
clinics, home visiting, WIC and the Ready Set Go program.
The Coalition received training in the Cavity Free Kids program and is now using volunteers to
distribute the training into community partners (Head Start, WIC, Ready Set Go, and in MCH home
visiting programs). The coalition has assisted VIM (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 this year. Currently,
the coalition has developed a protocol to inform new dentists of the coalition. DCHD received a
grant from ODS to provide materials and fluoride for a dental screening program to be staffed by
PHNs (Public Health Nurses) to provide referral, education and fluoride varnish to children referred
through WIC. Northwest (NW) Medical van is being scheduled through VIM (Volunteers in
Medicine).
Despite 50 years of scientific and medical research on the health benefits of community water
fluoridation, every city 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
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pregnant women regardless of income or insurance status. A highlight of this system is the
partnership between the local hospital and the Deschutes County Health 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. Our rapidly growing
population is challenging the ability of providers and services to sustain the quality of the existing
system.
There were 2,000 live births in Deschutes County in 2007. Of them, 187 were births whose moms
enrolled in the HealthyStart Prenatal Program. Of note is that 156 of the HealthyStart births were to
Hispanic mothers. The HealthyStart Program processed and assisted 659 program participants with
their application for the Oregon Health Plan. – apx 1/3 of all births in Deschutes County.
The Deschutes County HealthyStart Program was chosen to be one of two pilot projects for the
Perinatal Expansion program which allows CAWEM (Citizen Alien Waived Emergency Medical)
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.
96.8% of pregnant women received adequate prenatal care in 2005 with 90.3% starting care in the
first trimester. The rate for starting prenatal care in the first trimester has increased from 83% since
the implementation of Oregon MothersCare in 1999. 12.9% of pregnant women in Deschutes County
reported using tobacco in 2004. The low birth weight rate was 6.6%. Infant mortality was 6%, up
from 1% in 2001.
Suicide
Sadly, suicide is the second leading cause of death among Oregon youth age 10-24. In Deschutes
County there were 18 confirmed youth (10-17 year 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 and 24 in 2004 and 23 in 2005.
In 2006 The Health 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 patient privacy rights. The program was disbanded in the
Spring of 2007. Some have been trained in using C-CARE and P-CARE tools developed by the
University of Washington. Children and their families will be referred through the emergency rooms
and schools. A Public Health nurse will visit the families and youth, using interview techniques and
tools. Unfortunately, reluctance on reporting to the local Health Department has hampered this
potentially beneficial project.
Unintended and Teen Pregnancy
The Deschutes County Health Department (DCHD) plays an active role in implementing the Oregon
Teen Pregnancy Action Agenda. The teen pregnancy rate (per 1000 Females aged 10-17) in
Deschutes County has decreased from 17.9 in 1996 to 8.6 in 2006. The rolling rate for teen
pregnancies in the 10-17 year old age group for 2007 was 7.7. This is in large part due to the diligent
work of Public Health staff and their collaboration with community partners that assures access to
reproductive health education and services.
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Each year the Health Dept., in collaboration with the schools, provides the STARS program to almost
1,300 middle school students with over 150 high school volunteers as mentors. Our health educators
have taught over 80 classes on reproductive health to over 2000 students in middle schools, high
schools, and at Central Oregon Community College within the past year. They have incorporated
important components like health relationships and communication into their presentations to make
the curriculum more comprehensive.
We have had the Male Advocates for Responsible Sexuality (MARS) Program for the past 3 years
and have taken an active role in male involvement issues. We have offered parent educational
opportunities for the community on an annual basis.
Deschutes County Health Department Family Planning Clinic places emphasis on avoiding
unintended pregnancies. The Deschutes County Family Planning Program provided services to 3,790
unduplicated clients in 2007. 968 of these clients were between the ages of 10 and 19. It is estimated
that these services have averted 624 pregnancies. To make services accessible for Deschutes County
clients we maintain full-time clinics in both Bend and Redmond. We also serve clients in La Pine
two Thursdays a month and operate a clinic called the Downtown Health Center for clients 25 and
under 2 ½ days a week.
Adequacy of Public Health Services ORS 431.416
The Deschutes County Health Department provides quality service at an adequate level of capacity,
given the resources provided through local public funding, Federal/State grants, and billable revenue.
The Department continues to face increased demand for required services at a faster clip 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 MCH Division (Maternal Child Health) of services suffers
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, CD,
FP and EH 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.
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 Disease 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
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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 (CD) team pulls together to offer Tuberculosis 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 seasonal influenza surveillance began. Data collected from provider testing
though local clinics and hospital staff has given DCHD 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.
The Communicable Disease team collaborates regularly with the media to prevent the spread of both
well-known and novel diseases in our area. The team works to ensure that education is both available
for the community when sought after, as well as working with local media to be pro-active with
public education around topics such as tuberculosis, MRSA, Influenza, etc.
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 program currently:
• 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 Environment
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.
• 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 launched in early 2007.
• Rabies immunizations are provided in the jurisdiction.
• The program has generic press releases for outbreak information.
Deschutes County Health Dept.
Comprehensive Annual Plan 2008-09
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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 .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 started prenatal care within two weeks of initial contact.
This function works in close collaboration with our own HealthyStart Prenatal Service - a safety net
clinic were low income women who are ineligible for OHP can and do receive high quality prenatal
care and birth delivery services. This County-Hospital Program 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. The Department intents to
participate in this new project effective April 1, 2008.
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 - Decreasing ability to meet demand
due to decrease in capacity. Service would 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.
Intimate Partner Violence - Services are limited to local shelter and lack an outreach/ education
component.
Mental Health Services - Severe loss of capacity for low-income pregnant women due to cuts in
County Mental Health services.
Alcohol and Drug - Severe loss of capacity for case management and treatment due to cuts in County
Mental Health and Child Welfare programs.
Tobacco Cessation - Inadequate resources for tobacco cessation for pregnant women. LHD 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 verses 11.2% of non OHP moms.
Breastfeeding Support - Losing capacity for in-home nurse visiting service, but remaining strong in
WIC and local hospital outreach programs. Improving with better coordination among perinatal
services and the addition of the WIC Breastfeeding Peer Counselor Program.
Multicultural Service - Growing need for translators and Hispanic service will increase the gap
between need and capacity as medical and human services experience shortfalls in resources.
Deschutes County Health Dept.
Comprehensive Annual Plan 2008-09
13
Child Health Services
The Health 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 safety net primary care and nurse home visiting. Additionally, we provide
assessment of parent/ child interaction (NCAST) and 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.
La Pine School Based Health Center
Deschutes County in its fourth year with a fully certified School Based Health Center (SBHC)
serving grades K-12 in La Pine. This new service will add capacity to the community’s safety net
care system and will provide access to primary care for approximately 1,500 La Pine school students.
Planning is underway to hopefully open new SBHC’s in Bend and Redmond in the Fall of 2008.
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.
The MCH program continues to participate in a Telemedicine project funded through CACOON to
allow Deschutes County special needs children to receive consultation from specialists via
teleconferencing.
Family Planning Services – ORS 435.025
Deschutes County Health Department maintains four family planning clinic sites to serve multiple
areas of the County. We have two full-time clinics in Bend and Redmond, a clinic in LaPine 2
Thursdays a month and for the past 2 years we have been serving youth and adolescents up to age 25
at the Downtown Health Center. The clinics provide reproductive health services under the Title X
program guidelines and contraceptive services under FPEP. All clinics provide care under protocols
and standing orders approved by the Medical Director, Mary Norburg MD.
All Family Planning staff meet on a regular basis to discuss program updates, case studies, and
information exchange. The program delivered service to 3,790 unduplicated clients in 2007 and
averted 624 pregnancies. In 2007 we saw a decrease in clients served by 14.7% when the statewide
decrease in clients served was 19.6%. One of factors affecting our decrease is that starting fiscal year
2007 we separated our FP and STD programs. Clients for STD services were no longer being seen
under the Title X guidelines and we imposed a minimum fee for STD services.
Like many Family Planning services across the State ours too faced substantial financial challenges in
2007. The increase in non-FPEP clientele and the rapid increase in pharmaceutical cost have thrown
a true financial curve ball at the program. Attempts to manage patient mix and verify income for
placement on the sliding fee scale have been met with stiff resistance in the face of Title X
regulations. In economic terms the stiff Title X guidelines result in a significant lost opportunity cost
for those clinics who can foresee options to manage income/ revenue as a means to maintain service
level verses being faced with service reductions.
Deschutes County Health Dept.
Comprehensive Annual Plan 2008-09
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The registered nurses working in reproductive health are required to complete a very comprehensive
training program and have NP 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 or client education materials many of which we have developed ourselves to
meet the educational needs of the clients and are review by our FP 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 Family Planning community outreach and education has grown in the past several years. We
have several health educators who actively participate with community partners. They attend the
school districts Health Advisory Board meetings and are playing an important role in helping the
school district come into compliance with the sexuality education guidelines.
3. Collection and Reporting of Health Statistics
Vital Records work related to birth and deaths are 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 Local Health Department on deaths of
Public Health significance and assisting in monitoring trend data related to injury and death related to
illicit drug use. Collection of vital statistics and Communicable Disease 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 number 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 2000 live births in 2006; 1,783 live births in 2005 and 1,438 in 2000, revealing our
upward trend. This represents a 25% increase in birth numbers over the most recent 5 year period.
There were 1,202 deaths recorded in 2005 compared to 916 in 2000. This represents a 32% increase
over the 5 year period. The Department issued an updated Community Health Profile report in March
of 2007. (Appendix A)
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 over 162,000 in 2007 as compared 116,600 in 2000. This represents
a 30% increase. Current population forecast 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 are
under the age of 18.
Local partners have become increasing 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.
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Comprehensive Annual Plan 2008-09
15
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 also
by selectively profiling the specific health issues, such as Obesity, Access to Primary Care, and the
Oral Health condition of Children. The 2007 Health Profile report is attached as Appendix A.
Currently the Department is engaged in a collaborative community effort to profile the incidence and
impact of Methamphetamine abuse across our communities.
4. Health Information and Referral
Health information and education is provided through Deschutes County Health Department 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 to mold control, to
animal bites, and how to access the Oregon Health Plan. Clinicians and front office staff frequently
serve as broker 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 health 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. The Director personally
handles most calls related to Environmental Toxicology other than calls related to childhood
poisoning which are handled by MCH staff.
We have added FTE to our health promotion staff which created a Community Wellness Coordinator
at 1.0 FTE. This position works closely with community partners, to develop and implement plans
for expanded health promotion and community wellness activities based on community need, as well
as the Public Health Advisory Board.
5. Environmental Health Services
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.
The Deschutes County Environmental Health (EH) program 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
work. 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 control team within the Health
Department.
2006-07 brought a continuation in the number of Environmental Health issues addressed
collaboratively between these two Departments. The Public Health Director has an oversight role in
all critical CD and EH case situations that have human health impacts and will secure a more formal
relationship when Licensed Facility and Drinking water work transfers into the Public Health
Department in July of 2007. Currently a joint governance model for Environmental Health services
and supervision exists between the Public Health Director and the Director of Community
Development. Going forward we plan on including a member of the Environmental Health Team at
planning/strategy meetings in regards to disaster and public health preparedness planning.
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Comprehensive Annual Plan 2008-09
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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 2007 the EH staff inspected 1,850 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 85 new or remodeled restaurants and
provided 1,325 food handler tests. The team also converted from the State DHS database system to
Verizon/Accuterm database which provides for “real time” data. The staff also taught 5 food handler
classes across the communities we serve. 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 30
comprehensive sanitary surveys in 2007 and followed up on 10 deficient surveys. The team also
investigated 31 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 2007. 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. The Deschutes County Health Department worked with State staff to develop public
messages on the Health effects of nitrate consumption associated with Drinking water.
In 2008 the Environmental Health Department is completing a project that will map 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:
The Environmental Health Division assessed 315 sites for feasibility for on-site wastewater treatment
and dispersal systems and issued 1,772 permits and authorizations for new and existing systems.
The program also performed 1880 inspections to ensure proper sitting, installation or abandonment
of on-site systems and permitted and inspected the replacement of 10 substandard trench systems, as
well as helped facilitate the abandonment of 5 sewage dill holes.
Pool, Spa and Tourist Facilities:
The Environmental Health Division performed 350 pool and spa inspections in 2006 and an
additional 50 inspections of tourist accommodations. In addition, the team reviewed 23 pool/spa
plans for new facilities in 2006.
Schools & Childcare Facilities:
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Comprehensive Annual Plan 2008-09
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The EH team conducted 102 National School Lunch Program Inspections in 2007, serving over
19,500 students 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.
Adequacy of Other Key Services – Critical to Public Health
Community Advocacy and Multicultural Health
LHD has provided support to local the community coalitions addressing hunger, homelessness,
methamphetamine abuse, child abuse, access to health care, childhood obesity and asthma. The
Department is proud to support staff and information who need facility access to care for non-English
speaking clients and to be a leader in the community for assisting other agencies to do the same.
(Note: Deschutes County Health Department hosts the Cascades East Learning Center interpreter
students at our site to provide more clinical learning opportunities for the program.)
Breast and Cervical Cancer – Safetynet 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 local Health Department was compelled to
relinquish a regional based system with the promise of a new, more efficient State-wide system in
July of 2006. Expectation of a State-wide system to manage eligibility, provider payment and client
data management has not materialized. After 8 months of attempting to patchwork the various
components to the program the Deschutes County Health 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 across 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 Deschutes County Health Department has prospective BCC clients
scheduled for screening into June of 2007, but has ceased accepting more referrals. We truly hope
the new State-wide system is fully operational by September of 2007, as currently anticipated.
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 was able to fund a part-time position
focused in this arena. Dwindling public and private financial capacity to serve increasing health and
social needs will necessitate community-wide efforts to build and sustain healthy livable
communities.
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. DCHD continues to work with the County emergency
Deschutes County Health Dept.
Comprehensive Annual Plan 2008-09
18
manager to plan County exercises. The Strategic National Stockpile plan was completed in 2005 and
is exercised each year.
Department participated in a mass casualty drill in June of 2006. The team is currently working on
the regional plan with the HRSA BT Coordinator and working with Cascade Health System 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 the 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 Health Department staff to respond to an emergency through ICS/ NIMS training.
Laboratory Services
DCHD provides laboratory services in compliance with CLIA standards. The DCHD lab manager
oversees the laboratory procedures and provides technical services to clinicians. DCHD has a
contract with Central Oregon Pathology to provide those services not conducted at Oregon Public
Health Labs or our local St. Charles 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 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 Health Department maintains a senior resource directory and information is given to clients
regarding diabetes, chronic disease, breast and cervical cancer, and immunization clinics.
Injury related to Senior adult falls is an area needing more attention and community-wide
collaboration. We will explore how to facilitate addressing this in 2007-08.
Primary Health Care Access for Low-Income Residents
As mentioned in a previous section of this Annual Plan, it is estimated some 25,000 plus Deschutes
County residents, or approx. 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. In
2002 there were approx. 3,000 adults, in addition to 300 pregnant women covered under the Oregon
Health Plan. At the end of 2004 there were only 680 adults still covered under the plan, due to
dramatic changes in eligibility.
Deschutes County Health Dept.
Comprehensive Annual Plan 2008-09
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Deschutes County Public Health has been at the forefront of addressing this inequity for the past 10
years. The HealthyStart Prenatal Program, a partnership between St. Charles Medical Center, East
Cascades Women’s Group and the County have provided full obstetrical and delivery care to all
pregnant women with the inability to afford private marked health care. The FAN Wellness program,
operated by the Deschutes County Health Department, provides a minimal level of safety net primary
care services to school age children without any other access to basic care, but this program will be
discontinued next school year due to school funding cuts.
A new Student Based Health Center (SBHC) opened in La Pine in late 2005, followed by a Federally
Qualified Health Center (FQHC) in Bend, The Community Clinic of Bend, operative 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.
From 2002-2004 the Department operated a Community Care Clinic for medically indigent adults
while working closely with other community partners to establish a Volunteer in Medicine Clinic
(VIM). In the Spring of 2004 the Volunteers in Medicine Clinic officially opened and provided
nearly 7,500 patient visits in 2006. In September of 2003, a private clinic in La Pine was designated
has a Rural Health Care clinic.
Limited primary care still exists 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. OHP eligibles are seen until enrollment and then transferred to
private care. The program delivered 159 births in 2005, 182 in 2006, and 187 in 2007. The program
is a close collaboration between the LHD and St. Charles Medical Center, and contracts with local
OB practice, obstetrical and Nurse Midwifery 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.
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. The Collaborative recently received its 501c3 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 was appointed as 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 2008-09 focuses on
Deschutes County Health Dept.
Comprehensive Annual Plan 2008-09
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obesity reduction, increasing physical activity, and increasing breastfeeding rates among clients (see
Appendix B).
III. ACTION PLAN
Epidemiology and Control of Preventable Disease & Disorder
COMMUNICABLE DISEASE 2007-08 Plan
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 152,000 in 2006.
Chlamydia (CT) continues to be the highest reported disease in Deschutes County. CT cases
increased to 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 last 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 25 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 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 on
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 2007.
The program has completed the development of a Pandemic Flu plan, and is in the process of
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 Health System, has planned and practiced a number of table top
exercises, participated in the Strategic National Exercise in 2005, as well as the State wide Pandemic
Influenza drill in November of 2006. Future trends include increased surveillance and awareness of
potential Communicable Disease threats such as Pandemic Influenza, West Nile Virus, Bioterrorist
agents, etc.
The program has completed the development of a Pandemic Flu plan, and is in the process of
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 Health System, has planned and practiced a number of table top
exercises, participates in the Strategic National Exercises, as well as the State wide Pandemic
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Comprehensive Annual Plan 2008-09
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Influenza drills. Future trends include increased surveillance and awareness of potential
communicable disease threats such as Pandemic Influenza, West Nile Virus, Bioterrorist agents, etc.
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 has developed specific plans for a variety of potential threats to
our County, as well as creating and participating in exercises to practice their functionality.
In 2006 the Department was a key player and planner of the Oregon State wide Pandemic Influenza
exercise. It included a variety of partners from around the County, and was a great success in
identifying response strengths and weakness within our Department and community.
All hazard response plans are incorporated in the County Emergency Response Plan. DCHD
continues to work with the County Emergency Manager to plan County exercises. The Strategic
National Stockpile plan was completed in 2005, exercised, and revised again in 2007. The team is
currently working on the regional plan with the HRSA Coordinator, with Cascade Health System 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 for 2006 we received an
average of 3 after hour calls per month from the public. We also continue to meet with Jefferson and
Crook County staff to improve coordination throughout the Region. The staff will be leading the
effort to improve the capability of all Health Department staff to respond to an emergency through
ICS/ NIMS training.
FOOD-BORNE ILLNESS REPORTS
Food-borne illness in Deschutes County remained similar to previous years with four E-Coli 0157
reports and twelve 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 the
production of a food-borne outbreak manual for future events.
Public Health and Environmental Health continue to work together to address outbreaks, health
education in the community, and sharing workload to appropriately 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 2005 and 2006. Each year, as reports increase and staff numbers
remain the same it becomes more and more difficult to thoroughly investigate each Norovirus
outbreak.
IMMUNIZATIONS
The Immunization Program has worked hard to improve rates for two-year olds. In 1999, the County
was ranked thirty-fifth and steadily has moved up the scale State wide. The extensive work with
coalitions, community education, and providers has made a difference in outcomes. We are also
seeing many more infants being vaccinated for Hep B at birth starting in 2006.
The Shots for Tots Program will continue with the sponsorship through 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
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Comprehensive Annual Plan 2008-09
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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 2008. The last two years have been challenging for the program with staff turnover and inability
to do much outreach in the community.
TOBACCO PREVENTION PROGRAM
Tobacco Use: Deschutes County is above State average rates for smokeless tobacco use in both
adults as well as our 8th th and 11 graders. In 2006 we also saw a dramatic increase among our youth
with cigarette smoking, which spiked up to 27.8% of our 11th graders reportedly smoking. Our
tobacco Prevention Coordinator and Tobacco Free Alliance is 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 as well as the Healthy People 2010 objective.
CONTROL OF REPORTABLE COMMUNICABLE DISEASE
CURRENT CONDITION OR PROBLEM
A constant in the realm of Public Health is 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 help prevent the
spread of disease. However, in recent years morbidity and mortality rates are climbing from new
identified diseases and resurgent of old ones. According to the Oregon Health Services the five most
prevalent infectious diseases in Deschutes County for 2006 were:
• Chlamydia
• Hepatitis C
• Campylobacter
• Giardiasis
• Salmonellosis
The sexually transmitted disease, Chlamydia continues to be the highest reported disease in
Deschutes County. The cases have doubled in the last 4 years which has increased workload for our
staff a great deal. Gonorrhea and Syphilis have also established a presence in the last 5 years, and
continue to increase with the population growth.
Deschutes County continues to have high number of waterborne disease cases and increased numbers
of Norwalk-like Viruses in congregated living settings.
Tuberculosis. 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.
Deschutes County Health Dept.
Comprehensive Annual Plan 2008-09
23
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.
ongoing
Provide epidemiological investigations on
100% of reportable diseases with 24 hours.
Deschutes County
Residents
CD Team (Objective #2)
ongoing • 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 proved to 100%
of exposed contacts locally.
• All demographics are completed on the
case reports.
• CD investigations are to begin within
one working day.
• Update CD database as needed.
Medical Providers CD
Coordinator
Outreach
Worker
(Objective #3)
Increase the number of medical providers
reporting Communicable Disease
appropriately through outreach and education.
ongoing
• An emergency system for
communication of CD alert
information will be maintained.
Medical Providers (Objective #4)
CD
Coordinator
A more consistent feedback system, regarding
the outcome of the investigation will be
provided to the health care provider.
11/1/07
Veterinarians (Objective #5)
CD
Coordinator
Develop an improved zoonotic disease
reporting system. Create an e-mail alert
system for veterinarians.
12/1/09
Deschutes County
Residents
CD Team (Objective #6) 01/01/2009
Develop a Hepatitis C Plan that will address
the increase in disease reports and community
follow-up strategy within staffing constraints.
Deschutes County CD Team (Objective #7) Completed
Deschutes County Health Dept.
Comprehensive Annual Plan 2008-09
24
Staff Provide blood-borne pathogen training to staff
each year.
Deschutes County
Residents
CD Team (Objective #9) 12/01/07
Update the Pandemic Influenza Plan and
continue to prepare the community.
EVALUATION:
Objective 1: 24/7 System in place with positive test results.
Objective 2: Completed reports sent to State – monthly evaluation.
Objective 3: Improved reporting and communication with medical community.
Objective 4: Development of a system for provider feedback and implementation.
Objective 5: Development of a system for Veterinarian reporting and implementation.
Objective 6: Completion of the Hepatitis C Plan.
Objective 7: Documented training.
Objective 8: Updating of Pandemic Influenza Planning and develop Health System Preparedness Plan.
EMERGENCY PREPAREDNESS
CURRENT CONDITION OR PROBLEM
Emergency Preparedness in Deschutes County has improved over the last 5 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,
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
(Objective # 1)
Participate with St. Charles Medical Center and
Emergency Management on an area preparedness
planning group.
ongoing
Preparedness
Coordinator -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.
County Partners CD Team 12/01/07 (Objective # 3)
We are still waiting for approval of mutual Aid
agreements for regional area. Hope to complete
this year.
Deschutes County CD Manager ongoing (Objective # 4)
Deschutes County Health Dept.
Comprehensive Annual Plan 2008-09
25
Residents 24/7 contact information as been provided to
DHS, Health Services, and other public safety
agencies.
Mass Immunization
Population
Immunization
Coordinator
(Objective # 5)
Update and review NPS Plan. (CD) 12/01/07
CD
Coordinator
Deschutes County
Residents
Preparedness
Coordinator
(Objective # 6)
Complete/update development of all plans: 12/31/07
• 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
Deschutes County
Residents
CD Team 12/31/07 (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 if ICS
communication structure.
• Local staff has participated in training
for risk communication and how to use
those techniques effectively.
Veterinarians CD
Coordinator
(Objective # 8)
Improve the Animal Surveillance system in
Deschutes County through the Broadcast Fax
system.
Animal Population 11/01/07
Department Staff Preparedness
Coordinator
12/31/07 (Objective # 9)
Training plan for all staff to be ICS and NIMS
compliant.
EVALUATION:
Objective 1: On-going Disaster Planning Group
Objective 2: Integration of all plans
Objective 3: Mutual Aid agreements in place
Objective 4: 24/7 communication intact
Objective 5: Completed NPS Plan
Objective 6: Plans completed
Objective 7: Risk Communication training documented and plan completed
Deschutes County Health Dept.
Comprehensive Annual Plan 2008-09
26
Objective 8: Improved Animal Surveillance System
Objective 9: Staff trained in ICS and NIMS
HIV
CURRENT CONDITION OR PROBLEM
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 Health Department. It is
anticipated that HIV caseloads will grow steadily over the next few years as more people move to the
area.
Future needs include concerns about their 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
IDU use 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 testing. As a Health Department
and prevention team here in Deschutes County we are focusing our outreach on high-risk groups
which include those who use injection drugs and men who have sex with men.
GOAL
To improve/ maintain the health status of the citizens of Deschutes County by preventing/ reducing
the incidence of Communicable Disease through outreach education, counseling, and testing for HIV.
ACTIVITIES
Target Population Who What Timeline
HIV High Risk
Population
HIV Program
staff
(Objective 1)
Organize and reassess the acuity levels of the
client load in HIV Case Management
12/31/07
HIV Women
HIV MSM
HIV High Risk
Population
HIV Program
staff
(Objective 2)
Increase the percentage of high-risk Deschutes
County residents counseling and tested for
HIV by 10% for the 2007-2008 fiscal year.
06/30/08
Women and
Children at risk for
HIV
(Objective 3)
HIV Improve the provider HIV testing of pregnant
women through outreach and education. (New
State law addressed this in 2005)
6/30/08
Program staff
Deschutes County
Residents
Program
Manager
(Objective 4) Complete
Update and improve Prevention Plan based on
new CDC Guidelines. HIV Staff
High Risk HIV Staff (Objective 5)
Deschutes County Health Dept.
Comprehensive Annual Plan 2008-09
27
Population STD Clinician Increase HIV testing numbers in the
community using the new HIV Rapid Test.
(Implemented)
6/30/08
MSM, IDU FP/STD
Coordinator
EVALUATION:
Objective 1: Organize and reassess participants in the HIV Case Management Program.
Objective 2: Increased number of HIV Tests performed for fiscal 07-08.
Objective 3 Survey providers on HIV Testing activity.
Objective 4: Evaluate each HIV Prevention activity and report quarterly to the HIV
Program.
Objective 5: Measure the number of new HIV tests completed.
HARM-REDUCTION (HEPATITIS B AND C AND HIV)
GOALS AND ACTIVITIES
Objective List Resources
Expected
Activities effects/Outputs Context
Reduce
Hepatitis and
HIV infection
in people who
use injection
drugs and
their
networks.
Outreach staff
member,
Health
Department
buildings, and
drop boxes
around the
County.
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.
To prevent new HIV
and Hepatitis
infections, decrease
client needle sharing,
decrease reports of
needles found in the
community.
Facilitating needle
exchange, providing
boxes for people to
drop dirty needles in
after hours
throughout County.
Promotion through
word of mouth,
pamphlets, cards,
websites. Educational
presentations given to
local drug and
alcohol treatment
groups regarding
HIV and Hepatitis
transmission and
prevention in an
effort to increase
awareness.
Increase
testing among
people who
use injection
drugs (IDU)
OHROCS
program
Location of
Health
Department may
be a barrier- not in
a central location
and thus
transportation is a
hindrance.
Promote HIV and
Hep B & C testing
among HD locations,
develop and distribute
informational and
referral materials.
Work with other
community partners
to build OHROCS
program, promote
testing with IDU
clients, STD clinic
clients, jail
counseling and
testing, jail risk
reduction counseling,
promote needle
exchange services,
and increase needle
exchange sites.
-Outreach materials
distributed to 15 IDU
establishments: jail,
parole and probation,
parks, Laundromats,
food banks, shelters,
drug treatment
centers, addiction
Deschutes County Health Dept.
Comprehensive Annual Plan 2008-09
28
recovery support
groups, bars, hotels.
*Target number of
people who use
injection drugs to be
reached with HIV
testing: 25.
Reduce
Hepatitis and
HIV infection
through
education and
peer support
of practicing
safer sex in
the MSM
population
Outreach staff
member,
advertising
resources, word
of mouth
networking
internet
resources, local
PRIDE event,
Drag Show,
LGTBQ
Fashion Show,
Rainbow
Alliance
membership,
State
assistance.
Promotional
material, ads in
local newspaper to
increase interview
opportunities on
how to best reach
the population and
create buy-in from
MSM population.
Outreach through
adult stores.
Conservative
community. Very
difficult to break
into the MSM
network – quite
underground. At
this point we are
focusing most of
our efforts on
networking to
increase our
understanding of
the attitudes,
beliefs, and
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.
Peer supported
interventions have
not been received
very well due to the
community.
-To have a larger
network of contact in
the MSM population
who are passionate
about partnering to
reduce infection and
spreading the word.
-To increase our
knowledge about our
local MSM
population, how best
to reach, network
with, and
interventions that will
be the most
successful.
-Outreach materials
distributed to 5 MSM
establishments: adult
stores, parks, gyms.
-Outreach at 2 events
organized by Human
Dignity Coalition
(PRIDE, Drag Show).
-Staffing and
different offsite
locations to look at
testing
opportunities,
promotional
material, networks
already created to
spread word and
encouragement of
testing.
Increase HIV
testing among
MSM
population
Outreach staff
member,
possible MSM
peer volunteer
Increase testing
among MSM.
Few MSM utilize
the Health
Department for
HIV counseling
and testing
services.
*Target number
MSM to reach with
HIV testing: 25
- Male Only Clinic
will be held twice a
month. This clinic
Deschutes County Health Dept.
Comprehensive Annual Plan 2008-09
29
began 2/28/08 in
efforts to increase
testing among men,
especially MSM.
TUBERCULOSIS
CURRENT CONDITION OR PROBLEM
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 2002 there were 32 clients receiving INH, 2005 the number jumped into the 60s and in
2006 down into the 40s (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, as well as 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 TB awareness and education throughout Deschutes County.
ACTIVITIES:
Target Population Who What Timeline
Deschutes County
Residents
CD
Coordinator
(Objective # 1)
Increase the # of PPD provided through
DCHD to high risk populations, and
decreased to low risk populations
6/30/2008
Deschutes County
Residents
CD
Coordinator
(Objective # 2) ongoing
HIV Testing will be offered to all cases
and suspected cases of Tuberculosis
CD
Coordinator
(Objective # 3) 6/30/08 Deschutes County
Residents
receiving LBTI
through DCHD.
Improve the number of clients completing
LTBI from 60% to 75%.
Medical Providers CD
Coordinator
(Objective # 4)
Increase awareness to medical providers
for active TB cases.
ongoing
Shelter residents CD
Coordinator
Program Mgr.
(Objective # 5)
12/31/07
Explore the Implementation of a screening
program for shelter residents.
Deschutes County
Residents
CD
Coordinator
and Team
(Objective # 6) on-going
Update policies, forms, and protocols
annually. (Completed)
Deschutes County
Employees
Manager and
CD
Coordinator
(Objective # 7) ongoing
Update employee respiratory protection
and screening program annually and
provide fit testing for staff.
Deschutes County Health Dept.
Comprehensive Annual Plan 2008-09
30
EVALUATION:
Objective 1: Target PPD tests provided through DCHD
Objective 2: Documented HIV Testing
Objective 3: Statistics from Oregon Health Services
Objective 4: Number of presentations and information packets to providers
Objective 5: Number of residents from shelter receiving screening
Objective 6: Updated protocols and policies – documentation
Objective 7: Updated policy and documented fit testing
IMMUNIZATIONS
CURRENT CONDITION OR PROBLEM
The Immunization Program needs 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 Dept.
Comprehensive Annual Plan 2008-09
31
Plan A – Continuous Quality Improvement: Increase Up to Date rates for two-year olds
Year 1: July 2007– June 2008
Outcome
Outcome Measure(s)
Objectives Methods / Tasks Measure(s) 1 2ResultsProgress Notes
To be completed
for the FY 2008
report
To be completed
for the FY 2008
report
Increase the up-
to-date
immunization
rates of children
under 24 month
old by 6% over
the next 3 yrs.
Use 2006 Afix data
as the basis of
comparison for
projected change
(66% total 2006)
Increase the up-to-
date rate by 2%
the first year.
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 & make
sure clients with
immunization need
are referred to PMD
or HD immunization
clinic ASAP
(procedure on how
this occurs should
be in place and up to
date).
Hold one training
with WIC staff on
how to best get
clients up to date
via screening and
referrals.
Have procedure
completed on how
WIC screens and
refers.
Give all shots
needed unless truly
contraindicated
Check Hep B shot
dates to insure
spacing is correct
(#3)
Consider recall
and reminders for
subsequent doses.
Promote Varicella
Deschutes County Health Dept.
Comprehensive Annual Plan 2008-09
32
Plan A – Continuous Quality Improvement: Increase Up to Date rates for two-year olds.
Fiscal Years 2008-2010
Year 2: July 2008– June 2009
Objectives
Outcome
Methods / Outcome Measure(s)
2Tasks Measure(s) 1 Progress NotesResults
Compare stats
with 2006 AFIX
report
Increase up-to-date
rates by 2% over last
year
To be completed for
the FY 2009 report
To be completed for
the FY 2009 report
Continue
strategies from
2007 and
Provide
immunization
information to
expecting and new
mothers.
Increase the up-
to-date
immunization
rates of children
under 24 mos old
by 6% over the
next 3 yrs.
Activities were
implemented as
planned.
Missed opportunity
rate in decreased
within HD.
A. Prenatal classes
B. Handouts at
OB clinics.
C. Handouts at
birthing centers
Promote co-
operative working
climate with local
clinics.
A. Hold annual
info Mtgs/
trainings.
1 Outcome Measure(s) Results – please report on the specific Outcome Measure(s) in this table.
2 Progress Notes – please include information about the successes and challenges in completing the
Methods/Tasks, any information that will help us better understand your progress, and any assistance from
DHS that would have helped or will help met these objectives in the future.
Deschutes County Health Dept.
Comprehensive Annual Plan 2008-09
33
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
Outcome
Methods / Outcome Measure(s)
2Objectives Tasks Measure(s) 1 Progress NotesResults
To be completed for
the FY 2010 report
To be completed for
the FY 2010 report
Increase up-to-
date rates by 2%
over previous year
Compare stats with
2006 AFIX report
Continue
strategies from
2008 and
Provide
immunization
information to
expecting and new
mothers.
Activities were
implemented as
planned.
Increase the up-
to-date
immunization
rates of children
under 24 mos old
by 6% over the
next 3 yrs.
D. Prenatal
classes.
E. Handouts at
OB clinics.
F. Handouts at
birthing
centers.
G. Referrals from
hospital.
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
Methods / Outcome Measure(s)
2Objectives Tasks Measure(s) 1 Progress NotesResults
Increase the
number
Use 2006 ALERT
participation data
as baseline.
# of participants in
ALERT increased
To be completed for
the
To be completed for
the FY 2008 report
of ALERT (Contact is FY 2008 report
1 Outcome Measure(s) Results – please report on the specific Outcome Measure(s) in this table.
2 Progress Notes – please include information about the successes and challenges in completing the
Methods/Tasks, any information that will help us better understand your progress, and any assistance from
DHS that would have helped or will help met these objectives in the future.
1 Outcome Measure(s) Results – please report on the specific Outcome Measure(s) in this table.
2 Progress Notes – please include information about the successes and challenges in completing the
Methods/Tasks, any information that will help us better understand your progress, and any assistance from
DHS that would have helped or will help met these objectives in the future.
Deschutes County Health Dept.
Comprehensive Annual Plan 2008-09
34
Marybeth Kurilo
971-673-0294)
participants in
Review current
participation &
identify clinics
needing
improving.
Deschutes
County.
ALERT training
classes held.
Increase amount
of data submitted
and improve
quality of
submissions
Visits to sites
needing in house
training.
Recruit any site
not reporting (talk
encourage
electronic
reporting).
Info submitted to
ALERT within 30
days of
immunization
Arrange for
ALERT users class
& invite players to
attend. Use Alert
video, Invite
Health Educator to
participate.
Deschutes County Health Dept.
Comprehensive Annual Plan 2008-09
35
Local Health Department: Deschutes County
Plan B - Chosen Focus Area: Increase Participation and quality of data to Alert
Fiscal Years 2007-2010
Year 2: July 2008– June 2009
Outcome
Methods / Outcome Measure(s)
2Objectives Tasks Measure(s) 1 Progress NotesResults
To be completed for
the
To be completed for
the FY 2009 report
# of participants in
ALERT increased
over last year
Same plus: Continue with
previous year
objectives.
Review
participation;
determine number
of sites submitting
to ALERT.
FY 2009 report
Quality of data
submitted improved
Increase the
number
of ALERT
Information
submitted within 15
days of
immunization.
Review numbers
submitted and have
area Health
Educator compare
with vaccine
ordering reports.
participants in
Deschutes
County.
Increase amount
of data
submitted and
improve quality
of submissions
Visit 2 clinics to
offer technical
and/or educational
assistance.
Offer assistance to
those sites needing
help.
1 Outcome Measure(s) Results – please report on the specific Outcome Measure(s) in this table.
2 Progress Notes – please include information about the successes and challenges in completing the
Methods/Tasks, any information that will help us better understand your progress, and any assistance from
DHS that would have helped or will help met these objectives in the future.
Deschutes County Health Dept.
Comprehensive Annual Plan 2008-09
36
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 2009– June 2010
Outcome
Methods / Outcome Measure(s)
2Objectives Tasks Measure(s) 1 Progress NotesResults
To be completed for
the FY 2010 report
To be completed for
the FY 2010 report
Same plus: Same plus: Continue with
previous year
objectives…
ALERT
participation
reports have been
reviewed.
Review ALERT
participation
reports and
timeliness of
reports (private
practice clinics)
Increase the
number
of ALERT
participants in
ALERT training
classes and visits
made.
Deschutes
County. Offer assistance
classes or visit
where needed. Sites
delaying
submission advised
to do report more
often.
Increase amount
of data submitted
and improve
quality of
submissions
Immunization rates
should increase.
Promote co-
operative working
climate with local
clinics.
A. Hold annual info
Mtgs/trainings
Recruit for local
clinic
representation on
the DCIC
(Deschutes County
Immunization
Coalition).
1 Outcome Measure(s) Results – please report on the specific Outcome Measure(s) in this table.
Deschutes County Health Dept.
Comprehensive Annual Plan 2008-09
37
Plan B - Chosen Focus Area: Maintain and Enhance the DCIC – Deschutes
County Immunization Coalition
Fiscal Years 2007-2010
Year 1: July 2007– June 2008
Outcome
Methods / Outcome Measure(s)
2Objectives Tasks Measure(s) 1 Progress NotesResults
Continue with
previous year
objectives…
To be completed
for the
To be completed
for the FY 2008
report
Membership
increased
Using 2006
make-up of DCIC
FY 2008 report Maintain the
current
membership
Increased
diversity of
membership is
evident
Maintain and
enhance the
DCIC- Deschutes
County
Immunization
Coalition
A. Add
community
representation
Strategic plans
formulated and
presented
B. Involve child
care providers
C. Recruit school
nurses
D. Recruit
special project
reps (WIC,
FAN)
E. Do
questionnaire
on group’s
main goals.
1 Outcome Measure(s) Results – please report on the specific Outcome Measure(s) in this table.
2 Progress Notes – please include information about the successes and challenges in completing the
Methods/Tasks, any information that will help us better understand your progress, and any assistance from
DHS that would have helped or will help met these objectives in the future.
Deschutes County Health Dept.
Comprehensive Annual Plan 2008-09
38
Plan B - Chosen Focus Area: Maintain and Enhance the DCIC – Deschutes
County Immunization Coalition
Fiscal Years 2007-2010
Year 2: July 2008– June 2009
Outcome
Methods / Outcome Measure(s)
2Objectives Tasks Measure(s) 1 Progress NotesResults
Continue with
previous year
objectives…
To be completed
for the
To be completed
for the FY 2009
report
Membership
maintained or
enhanced with
new members
Same plus:
Review make up
of coalition for
possibly needed
more recruitment
FY 2009 report
Maintain and
enhance the
DCIC- Deschutes
County
Immunization
Coalition
Members
recognized at
County level.
Explore
development of
questionnaire for
community to
help define needs
and gaps, and
where the
coalition.
Strategic plan
approved
Provide
recognition of
members at
annual
public/private
Immunization
meetings
1 Outcome Measure(s) Results – please report on the specific Outcome Measure(s) in this table.
2 Progress Notes – please include information about the successes and challenges in completing the
Methods/Tasks, any information that will help us better understand your progress, and any assistance from
DHS that would have helped or will help met these objectives in the future.
Deschutes County Health Dept.
Comprehensive Annual Plan 2008-09
39
Local Health Department: Deschutes County
Plan B - Chosen Focus Area: Maintain and Enhance the DCIC – Deschutes
County Immunization Coalition
Fiscal Years 2007-2010
Year 3: July 2009– June 2010
Outcome
Methods / Outcome Measure(s)
Objectives Tasks Measure(s) 1 2ResultsProgress Notes
Continue with
previous year
objectives…
To be completed
for the
To be completed for
the FY 2010 report
Membership
maintained or
enhanced
Same plus:
FY 2010 report Review
strategic plan
and update as
necessary for
2011-2013
Member
recognition
achieved
Maintain and
enhance the
DCIC- Deschutes
County
Immunization
Coalition
Review of
strategic plan
completed
Draft of strategic
plan
accomplished for
years 2011-2013
1 Outcome Measure(s) Results – please report on the specific Outcome Measure(s) in this table.
2 Progress Notes – please include information about the successes and challenges in completing the
Methods/Tasks, any information that will help us better understand your progress, and any assistance from
DHS that would have helped or will help met these objectives in the future.
Deschutes County Health Dept.
Comprehensive Annual Plan 2008-09
40
Plan B - Continuous Quality Improvement – Decrease the Late Start Rates in DC.
Fiscal Years 2007-2010
Year 1: July 2007– June 2008
Outcome
Outcome Progress Measure(s)
Objectives Methods / Tasks Measure(s) Results 3 4Notes
Continue with
previous year
objective.
Decrease the
late start date
rate by 1% the
first year.
To be completed
for the FY 2008
report
To be completed
for the FY 2008
report
Use 2006 Afix data
as the basis of
comparison for
projected change
(15% total 2006)
Decrease number
of late starts in
DC by 3% over
the next three
years
Provide
immunization
information to
expecting and new
mothers
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.
Outcome Measure(s) Results – please report on the specific Outcome Measure(s) in this table. 3
Progress Notes – please include information about the successes and challenges in completing the
Methods/Tasks, any information that will help us better understand your progress, and any assistance from
DHS that would have helped or will help met these objectives in the future.
4
Deschutes County Health Dept.
Comprehensive Annual Plan 2008-09
41
Plan B - Continuous Quality Improvement – Decrease the Late Start Rates in DC.
Fiscal Years 2007-2010
Year 2: July 2008– June 2009
Outcome
Methods / Outcome Measure(s)
6Objectives Tasks Measure(s) 5 Progress NotesResults
Continue with
previous year
objectives…
Decrease the late
start date rate by
1% compared to
last years rates
To be completed
for the FY 2009
report
To be completed for
the FY 2009 report
Same plus:
Discuss
changes in rates
at annual
meetings with
local clinics,
Solicit ideas
from them.
Decrease number
of late starts in
DC by 3% over
the next three
years
Plan B - Continuous Quality Improvement – Decrease the Late Start Rates in DC.
Fiscal Years 2007-2010
Year 3: July 2009– June 2010
Outcome
Methods / Outcome Measure(s)
8Objectives Tasks Measure(s) 7 Progress NotesResults
Continue with
previous year
objectives…
To be completed
for the FY 2010
report
To be completed for
the FY 2010 report
Decrease the late
start date rate by
1% compared to
last years rates
Same plus:
Provide QI
training for local
clinics
Decrease number
of late starts in
DC by 3% over
the next three
years
Outcome Measure(s) Results – please report on the specific Outcome Measure(s) in this table. 5
Progress Notes – please include information about the successes and challenges in completing the
Methods/Tasks, any information that will help us better understand your progress, and any assistance from
DHS that would have helped or will help met these objectives in the future.
6
Outcome Measure(s) Results – please report on the specific Outcome Measure(s) in this table. 7
Progress Notes – please include information about the successes and challenges in completing the
Methods/Tasks, any information that will help us better understand your progress, and any assistance from
DHS that would have helped or will help met these objectives in the future.
8
Deschutes County Health Dept.
Comprehensive Annual Plan 2008-09
42
WEST NILE VIRUS
CURRENT CONDITION OR PROBLEM
The Deschutes River Basin is home to the Culex Tarsalis, Culex pipiens, and Aedes vexans mosquito.
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
through
Summer
08
Continue surveillance activities for the
presence of specific mosquitoes throughout
Deschutes County.
Deschutes County
Residents
Four Rivers (Objective #2)
Vector Control Maintain Vector control activities already in
place.
ongoing
Deschutes County
Residents
CD Coordinator
and
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) Spring
Provide public information on personnel
protective measures. Send updated plan to
officials. (Completed for 06)
Summer
2008
Deschutes County
Residents
CD (Objective #5) Spring 08
Coordinator Continue public hotline for Deschutes County
residents on the issues relating to West Nile
Virus.
EVALUATION:
Objective 1: Surveillance activities ongoing through Spring and Summer
Objective 2: Continue current vector control activities through contract with Four
Rivers Vector Control
Objective 3: Dead bird submission information to the public and system in place
Objective 4: Collection of materials and articles to the general public
Objective 5: Completion of community forums and ongoing update of West Nile
Response Plan.
ADDITIONAL REQUESTS: No Revision to the Alert Plan.
Deschutes County Health Dept.
Comprehensive Annual Plan 2008-09
43
Parent and Child Health Services
Including Family Planning – ORS 435.205
A) Immunization
(See Section Above Under Preventable Disease)
B) WIC
(WIC - See Appendix B)
C) Family Planning
FAMILY PLANNING PROGRAM ANNUAL PLAN FOR
COUNTY PUBLIC HEALTH DEPARTMENT
FY 2008-09
July 1, 2008 to June 30, 2009
Agency: Deschutes County Health Department
Contact: Kathleen Christensen/ 541-322-7407
Goal 1: Assure continued high quality clinical family planning and related
preventive health services to improve overall individual and community health.
Problem Objective(s) Planned Activities Evaluation Statement
1) Implement a new
income screening
process with the front
office staff.
¾ Train the front office
staff to gently walk
through the income
screening portion of the
intake form with the
client to get a more
accurate income.
¾ Use the income the client
gave to other internal
programs as a guide
when completing income
screening.
¾ Ahlers data
and fiscal
reports.
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.
42.4% of our clients
are supported by Title
X compared to the
state average of
25.4%. Title X funds
are only 12% of our
budget.
2) Increase knowledge
and understanding of
the FPEP program
within our staff with
¾ Have all FP staff attend
the FPEP Orientation and
the Program Integrity
Plan trainings by
¾ Training logs
are completed.
Deschutes County Health Dept.
Comprehensive Annual Plan 2008-09
44
the end goal of
increasing FPEP
enrollment.
December 08.
¾ Provide incentives for
clients to bring in
paperwork.
3) Explore bringing the
BCC Program back to
Deschutes County
Health Department.
Within the past year
we estimate that 100-
150 of our no charge
clients may have
qualified for BCC.
¾ Meet with the state
program to discuss if the
revamped program would
be feasible at Deschutes
County Health Dept.
¾ Program is
either
implemented
or not.
The front office
reception area at the
Main Office and
Redmond Office are
not very confidential
for clients. This is
uncomfortable for
clients in general and
makes it hard to
obtain information
pertinent to the
check-in and billing
process.
1) Work to create a more
confidential reception
area for both clinic
offices in Bend and
Redmond.
¾ Meet with Building
Services to discuss
possible structural
modifications.
¾ Staff feedback
¾ Client
feedback
¾ Rearrange furniture and
seating.
There is a lack of
community awareness
about Deschutes
County Family
Planning Services.
1) Increase community
awareness through
advertising and
community outreach.
¾ Work with Ana Johnson
the county Public
Communications
Coordinator to establish
an advertising plan.
¾ Alhers data
and fiscal
reports.
¾ Increase the number of
reproductive health
classroom presentations
at the local high schools
and college by 25% over
last year.
¾ Community
Outreach Log.
Deschutes County Health Dept.
Comprehensive Annual Plan 2008-09
45
Goal 2: Assure ongoing access to a broad range of effective family planning
methods and related preventive health services.
Problem Objective(s) Planned Activities Evaluation Statement
Unable to offer
Implanon due to
untrained staff.
1) Will have one NP
trained and ready
to offer Implanon
insertion and
removal by
September 08.
¾ Identify Implanon
trainings and resources
needed for clinic.
¾ Implanon
training
completed.
¾ Support NP/NP’s to
attend Implanon training.
¾ Record # of
Implanon
insertions. ¾ Offer Implanon as a birth
control option.
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.
2) Continue to
provide a broad
range of birth
control methods
while being
thoughtful in how
medications are
dispensed.
¾ If the client chooses oral
contraceptives as their
method they will be
started on low cost pills
first. If high costs pills
are used charting must
support the reason for
starting them on a higher
cost pill.
¾ Financial
Reports
¾ Assure method is
appropriate for the client
before giving large
quantities.
¾ Continue to use the Arch
Foundation for Mirena
IUS’s when possible.
Progress on Goals / Activities for FY 08
(Currently in Progress)
Goal / Objective Progress on Activities
Goal 1, Objective 1 At Deschutes County we do provide high quality culturally
competent care for our non-FPEP qualifying Hispanic women.
Several of our FP clinic staff speak Spanish, our Clinical Assistant
is bi-lingual and most of the front office staff are bi-lingual.
Provide culturally competent
care for undocumented
Hispanic women while
preserving program resources.
We have established several clinic times within each week that are
designated Hispanic Clinics to assure an interpreter is available and
the clients can be seen in a timely manner. We are referring clients
who do not need contraceptive services and who would be better
Deschutes County Health Dept.
Comprehensive Annual Plan 2008-09
46
served through the BCC program to the local provides who provide
access to that program.
Goal 1, Objective 2 The program has increased priority to focus on adolescent clients.
We opened The Downtown Health Center for young adults 25 and
under in a central location that is more convenient. We have
educated the front office staff to prioritize adolescent services and
try to fit them into the clinic that day by calling a back-up staff
person or referring them to The Downtown Health Center when
open. Although we prioritize services for adolescents a number of
these clients do not have access to their birth certificate. This has
been a problem in qualifying them for FPEP and continues to
impact program reimbursement.
Strengthen program priority to
focus on adolescent clients.
Goal 1, Objective 3 There has been a high rate of staff turn-over within the front office
in the past year. We are working very hard to increase staff
retention through team work and job satisfaction. We now have a
full staff that is getting more comfortable with their roles and
responsibilities. The new front office supervisor has worked with
the staff on efficiencies and program understanding. Due to this
we are starting to see more consistency in the education and
message that the staff are giving to the clients. We have developed
some tools to help the clients understand what the FPEP program is
and how it impacts our clinic as well as how it serves them. We
are starting to see a decrease in the number of clients who need to
have their citizenship verified.
Continue to increase the
number of F-PEP clients seen
and maintain resources to
sustain the Family Planning
Program for individuals and the
community.
Goal 1, Objective 4
Maintain a competent
workforce for the Family
Planning Program in order to
continue to provide quality
care.
The county is reviewing positions and salaries.
We continue to work on getting the clients to bring paperwork and
information needed to their appointments- it is a challenge.
Goal 1, Objective 4 Although the Family Planning Program lost part of an FTE last
budget year we combined several positions to create a full time
position rather than several part time positions that are harder to
fill. We are now fully staffed for the first time in 2-3 years. We
have a great
Strengthen program priority to
focus on adolescent clients.
clinic team and barring any unforeseen happenings we
should have the same staff for the next 5 years.
Goal 1, Objective 5 We have seen a slight increase in the number of teen clients we are
serving. There is a Planned Parenthood in Bend that does a lot of
advertising to the younger population and a number of teens are
served at that location.
Increase the percentage of teen
clients seen by 10%.
Goal 2, Objective 1 We have decided not to carry the Ortho Evra Patch and carry the
NuvaRing as a high cost birth control. The nurses have been asked
to confirm that the client is happy and stable on their method
before giving out large quantities.
Continue to provide a broad
range of birth control methods
while improving the ability to
Deschutes County Health Dept.
Comprehensive Annual Plan 2008-09
47
recover the cost of these
methods.
Goal 2, Objective 2 All clients are asked if they would like an ECP for future use. Our
percentage of visits where ECP was dispensed has risen slightly;
however, many of our clients decline using ECP.
Provide ECP to clients for
future use whenever
appropriate.
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
ongoing Review and update birth control methods
with staff; update protocols and best
practices. Added Nuva Ring 3/04
Unplanned
Pregnancy Clients
Family Planning
Staff
ongoing Review and improve client information
regarding using certain birth control
methods. Added NuvaRing 3/04.
Unplanned
Pregnancy Clients
Family
Planning Staff
ongoing Enhance ECP program/ review literature
and methodology.
Unplanned
Pregnancy Clients
Family
Planning Staff
ongoing Review any new research on how to
improve client compliance.
Family Planning
Staff
Family
Planning Staff
ongoing Staff discussions at staff meetings on
success and failures for continued
improvement.
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.
Deschutes County Health Dept.
Comprehensive Annual Plan 2008-09
48
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 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.
D) Maternal Child Health Programs
BASIC SERVICES
The Health Department provided prenatal care to 280 clients in 2007 in the HealthyStart prenatal
clinic, while Oregon MothersCare (OMC) provided OHP assistance and referral to 630 clients. Our
Health Department provides a safety net Well-Child Clinic seeing uninsured, underinsured and rarely
OHP covered children with barriers to service and emergent needs (i.e. new to area, need physical to
begin Head Start). Children are seen for preventative care, sick visits, immunizations, and sports
physicals. Referral is provided to OHP and families are assisted to find a medical home.
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.
Due to collaboration with Bend/ La Pine School District, the FAN (Family Access Network) and the
Health Department, a safety net clinic is offered at the Health Department and staffed by a nurse
practitioner and a school nurse and FAN advocate. A similar safety net clinic is offered in
partnership with Redmond schools and held at the Becky Johnson Center in Redmond.
The increasing numbers of uninsured students created demand for new School Based Health Centers
and the Health Department received planning grants for new centers in Bend and Redmond. As the
FAN Wellness clinics are discontinued this next school year it is hoped the SBHCs will help fill this
gap.
Home visiting programs consist of Maternity Case Management in which 161 clients were served
despite staffing shortages in 2006, and BabiesFirst! which saw 242 clients in 2007 of which some
were also enrolled in CACOON. The Health Department contracts with Child Development and
Rehab Center to provide case management services through the CACOON program to children with a
medical diagnosis.
Deschutes County Health Dept.
Comprehensive Annual Plan 2008-09
49
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.
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 2007, 42 dental screenings were held, with 329 clients seen, 302 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 Health Department.
Oregon MothersCare 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
(.4 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.
The Deschutes County WIC program served 2,714 families (of whom 77.2 % were working families),
2,132 women, 4,634 infants and children under 5 in 2007. 94.4% 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 PHNs to collect data on referral date and first contact date.
4. In-service at WIC staff meeting on new target and brain storm with them how to get earlier
referrals (i.e. at time of call to schedule first pregnancy apt, refer).
Deschutes County Health Dept.
Comprehensive Annual Plan 2008-09
50
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.
2007 MCM clients - Number of referrals received during in 2007, by trimester received:
78
61
23
ENVIRONMENTAL HEALTH
(See Attached Annual Work Plan – Appendix C)
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 Profile 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 requests is to assist in community needs
assessments and consequently 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.
5
0
10
20
30
40
50
60
70
80
90
1st
Trimester
2nd
Trimester
3rd
Trimester
Unknown
Trimester Referral Received
Nu
m
b
e
r
o
f
R
e
f
e
r
r
a
l
s
st
3%
14% 37% 45%
1 and 2nd trimester
combined –82%
Deschutes County Health Dept.
Comprehensive Annual Plan 2008-09
51
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 provisions to maximize the effect of
programming. The Deschutes County Health 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. Before the end of this April, the Department will deliver its second
community report card. This newsletter is intended to bring attention to and stimulate interest in
how local Public Health contributes to the health of our community and to keep us accountable in
doing so.
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 is 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 in-between 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.
In part to respond to the community’s interest in Health Statistics, the Department published its third
Community Health Report in the March of 2007 and will publish a future report in the Spring of
2009. The 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.
GOALS
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. This is planned for the Fall of 2006.
Annual Department Report Card/ Community Newsletter: Our inaugural report was offered to
citizens in late April of 2006 and our second report is due in a matter of weeks. The report intends to
reflect the scope of services provided by local Public Health and how they contribute to the health of
the community. The communication is also intended to help link the Department closer to the
community it serves and also to offer a means of accountability to be outstanding stewards of public
resources.
Center of Emphasis in Health Statistics & 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.
Deschutes County Health Dept.
Comprehensive Annual Plan 2008-09
52
ACTIVITIES
Bi-Annual Health Status Report
Target Population Who What Timeline
Deschutes County 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.
Residents ongoing
Deschutes County Management We will collect data from similar sources used in the
2002, 2004 and 2007 reports and continue with trend
reporting for 2008-09.
Residents ongoing
Deschutes County Management We will closely align the focus of the report to
compliment the Community Priorities as identified in
the Comprehensive Planning Efforts associated with
SB 555.
Residents ongoing
Deschutes County Management We will plan on producing the next report in 2009 Spring
2009 Residents
Center of Emphasis in Health Statistics
Target Population Who What Timeline
Deschutes County Mgmt We will survey the Department to determine the
scope of demand for providing health statistical
information to the public, other community
partners and for internal operations and project
work.
Residents
ongoing
Deschutes County Mgmt Based on this assessment we will gauge the
level of dedicated staff support necessary to
meet this demand.
Residents ongoing
Deschutes County Mgmt We will structure this service to fit within a
Community Health and Prevention area of
focused programming as resources allow.
Residents ongoing
Deschutes County Mgmt We will propose a placeholder in our budget
for the resources necessary to create a center of
emphasis in Community Health, Prevention &
Health Statistical reporting.
2008-09
Budget
Cycle
Residents
Deschutes County Mgmt We will 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.
By Spring
of Residents
2007
Deschutes County Mgmt We will 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.
ongoing
Residents
Deschutes County Health Dept.
Comprehensive Annual Plan 2008-09
53
EVALUATION
Annual Health Status Report
We will conduct a written survey by the Fall of 2007 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.
Center of Emphasis in Health Statistics
We will assess the value of creating this type of new service from a cost verses utility perspective by
the Spring of 2008. 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.
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 the 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 in the summer of 2005. The information disseminated within formal clinical
program activity with specific clients is very accurate, complete, and targeted. However, there is
certain randomness to public request, 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 period basis.
2) Employee Orientation will include training on providing information and referral
advice.
3) Employees will be provided an opportunity to provide input on methods to enhance the
quality of this service.
ACTIVITIES
Target Population Who What Timeline
Deschutes County Management,
Front office
Support Team
We will survey the Department to determine
the scope and frequency of demand for
providing health information and referral to
the general public.
ongoing
Residents
Deschutes County Health Dept.
Comprehensive Annual Plan 2008-09
54
Health Department
support staff.
Management We will continue to develop basic employee
orientation materials and training related to
providing health information and referral
ongoing
Deschutes County
Clinical and Front
office Staff.
All staff We will implement round-table discussion
within and between work teams to elicit
ideas related to enhancing the quality of this
service.
ongoing
We will document ideas and assign specific
tasks as part of an overall Quality
Improvement Process.
EVALUATION
1) We will report to staff and our Public Health Advisory Board the results of our survey related
to measuring the frequency and nature of information and referral call 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.
OTHER ISSUES
(None other than noted in previous sections)
IV. ADDITIONAL REQUIREMENTS
1. An Organizational Chart is attached. (Enclosed as Appendix D)
2. Senate Bill 555: The local Commission on Children and Families stands as a separate
Department within the Deschutes County Organization Structure.
The Deschutes County Health Department continues a close partnership with the
Local 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.
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Comprehensive Annual Plan 2008-09
55
The Health Department Administrator regularly participates in CCF planning work,
is involved in the local Professional Advisory Committee to the CCF, and attends
CCF executive team meetings.
V. UNMET COMMUNITY NEEDS
Primary Care
CURRENT CONDITION OR PROBLEM
There are approximately 25,000 uninsured individuals currently living in Deschutes County. This
compares to estimates of approx. 14,000 just in 2002. Changes in 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. Our fears of a year ago have been realized
as 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 & ACCOMPLISHMENTS
1. Rural Health Clinic: In September of 2003 a Rural Health Clinic in La Pine, Oregon and 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 provider/ practitioner recruitment.
2. La Pine: A financial feasibility study related to establishing an 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 Deschutes County Health 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 delivered over 10,000
patient visits in 2006.
3. The Volunteer’s In Medicine: (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
provided over 3,000 clinic visits in its first year of operation. The clinic has been an invaluable
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Comprehensive Annual Plan 2008-09
56
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.
4. FAN- (Family Access Network): FAN Wellness clinics will be discontinued in fiscal year 2008-
09 due to school funding cuts, but it is planned that the new School Based Health centers will
continue to serve this population. The mission is to serve uninsured children. Children eligible
for OHP are referred to the FQHC (Federally Qualified Health Clinic) for application assistance
and care. VIM continues to have difficulty meeting the adult care need in our community and
does not have capacity to serve children.
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 over 340 women in 2004 and
provided some 120 deliveries – nearly 8% of all deliveries performed in the County.
6. A School Based Health Clinic: (SBHC) has been operating in the La Pine Community since the
Spring of 2005. The clinic is operated as an extension of the Deschutes County Health
Department. The Maternal Child Health Team at the local Health Department, 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 with proposes to expand the
number of clinics in Oregon.
7. NW (Northwest) Medical Teams Dental Van: The local VIM clinic, The Central Oregon Oral
Health Coalition and the 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 Health
Department
Continue participation in community-based
coalitions, counsels, steering committees and
board which are dedicated to addressing
access to health care for low income, and
medically uninsured individuals.
Residents ongoing
Deschutes County Health
Department
Work closely with community health care
leaders from the Hospital and medical clinic
systems to establish a system of care of
Medicaid clients.
ongoing
Residents
Deschutes County Health
Department
Assess the capacity of the mid-level
providers to open their practice to these
Residents ongoing
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Comprehensive Annual Plan 2008-09
57
clients.
Deschutes County Health
Department
Establish an urban setting Federally
supported Community Health Center or
FQHC model in Bend
Residents Completed
Deschutes County Health
Department
Performa financial evaluation of operating a
primary care clinic through the Deschutes
County Health Department. Completed in the
Fall of 2004 – determined to be financially
challenging.
Residents
Completed
Deschutes County Health
Department
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.
Residents ongoing
Deschutes County Health
Department
Develop a broad coalition of support from
the County, Private medical market and Not-
For-Profit hospital system.
Residents ongoing
Establish a Central Oregon Health Care
SafetyNet Coalition. This activity has
recently matured into a 501c3 know 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 as such, its ability to address the 'access to care' issue for an estimated 25,000 – 35,000
individuals.
Methamphetamine Abuse
CURRENT CONDITION OR PROBLEM
The current status of methamphetamine abuse is frequently referred to as “Epidemic”, and yet we
have preciously 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 therapist
and community members it does indeed appear we have an “Epidemic” of sorts on our hands.
At best, the Methamphetamine abuse issue has had a huge negative impact on our courts, our
corrections system, our schools and our communities. Worse, methamphetamine abuse has had 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 mental health services
delivered by County Mental Health. This eclipsed, for the first time ever – alcohol – as the #1
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Comprehensive Annual Plan 2008-09
58
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 official 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 have fostered community discussion, increased
awareness and promoted a call to action to address the methamphetamine abuse issue. The
Methamphetamine 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, the Deschutes County Mental Health Department 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.
Hunger and Nutritional Health
This is a very significant problem for many of our families and children. While the County
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 greater than 60% of their students on public assistance meal programs. Unemployment and
poverty in some areas of our County approaches 25% of the individuals living there. Hunger is a
very real problem.
Tobacco and Drug Addiction
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
programs 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.
Mental Health Services for Uninsured
The elimination of many behavioral health supports for our citizens needing these services present
very real Public Health issues. Untreated behavioral health illness will have a cascading effect on
public safety, employment, stable home environment and personal self-adjustment.
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.
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Comprehensive Annual Plan 2008-09
59
Children With Special Health Care Needs
Services for these very special children once again make the list of 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.
Health and Social Support Assets for Ex-Incarcerated Populations
Studies indicate a lack of basic human support assets stand as a significant barrier to successful re-
entry for ex-incarcerated population. A coalition of community agencies as a group has begun to
look at crafting a program specifically for adult women to aid in this endeavor.
Children’s Oral Health
As of September of 2004, Deschutes County ranked as one of the “10 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 population.
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.
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 State 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 will likely bankrupt an already overtaxed health care financial system.
VI. BUDGET
A copy of our requested budget in attached as Appendix E. Note that at this time the Department
anticipates delivering a balanced budget by working down some contingency funds and emphasizing
collectable revenue in FY 08-09.
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:
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Comprehensive Annual Plan 2008-09
60
Organization
1. Yes _X_ No ___ A Local Health Authority exists which has accepted the legal responsibilities
for Public Health as defined by Oregon Law.
2. Yes _X_ No ___ The Local Health Authority meets at least annually to address Public Health
concerns.
3. Yes _X_ No ___ A current organizational chart exists that defines the authority, structure and
function of the local Health Department; and is reviewed at least annually.
4. Yes _X_ No ___ Current local Health Department policies and procedures exist which are
reviewed at least annually.
5. Yes _X__ No ___ Ongoing community assessment is performed to analyze and evaluate
community data.
6. Yes _X_ No ___ Written plans are developed with problem Statements, objectives, activities,
projected services, and evaluation criteria.
7. Yes _X_ No ___ Local health officials develop and manage an annual operating budget.
8. Yes _X_ No ___ Generally accepted public accounting practices are used for managing funds.
9. Yes _X_ No ___ All revenues generated from Public Health services are allocated to Public
Health programs.
10. Yes _X_ No ___ Written personnel policies and procedures are in compliance with Federal
and State laws and regulations.
11. Yes _X_ No ___ Personnel policies and procedures are available for all employees.
12. Yes _X_ No ___ All positions have written job descriptions, including minimum
qualifications.
13. Yes _X_ No ___ Written performance evaluations are done annually.
14. Yes _X_ No ___ Evidence of staff development activities exists.
15. Yes _X_ No ___ Personnel records for all terminated employees are retained consistently with
State Archives rules.
16. Yes _X_ No ___ Records include minimum information required by each program.
17. Yes _X_ No __ A records manual of all forms used is reviewed annually.
18. Yes _X_ No ___ There is a written policy for maintaining confidentiality of all client records
which includes guidelines for release of client information.
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Comprehensive Annual Plan 2008-09
61
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.
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.
Deschutes County Health Dept.
Comprehensive Annual Plan 2008-09
62
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.
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.
Environmental Health
47. Yes _X_ No ___ Food service facilities are licensed and inspected as required by Chapter 333
Division 12, or more frequently based on epidemiological risk.
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Comprehensive Annual Plan 2008-09
63
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.
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Comprehensive Annual Plan 2008-09
64
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.
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.
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 25 foot smoke free entrance policy to all County buildings.
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.
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65
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
for all of these are available within the local Health Department).
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.
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.
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Comprehensive Annual Plan 2008-09
66
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.
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.
Health Department Personnel Qualifications
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 two years of related experience.
104. Yes _X_ No ___ The local Health Department Supervising Public Health Nurse(s) meets
minimum qualifications:
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Comprehensive Annual Plan 2008-09
67
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.
VIII. SUMMARY ASSURANCE
The local Public Health authority is submitting the Annual Plan pursuant to ORS
431.385, and assures the activities defined in ORS 431.375–431.385 and ORS
431.416, are performed.
________________________ Deschutes County __May 1, 2008_
Local Public Health Authority Date
Deschutes County Health Dept.
Comprehensive Annual Plan 2008-09
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