HomeMy WebLinkAboutHealth 2008-09 Annual PlanDeschutes County Board of Commissioners
1300 NW Wall St., Suite 200, Bend, OR 97701-1960
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AGENDA REQUEST & STAFF REPORT
For Board Business Meeting of May 14, 2008
Use "tab" to move between fields, and use as much space as necessary within each field. Do not leave anyfelds
incomplete. Agenda requests & backup must be submitted to the Board Secretary no later than noon of the
Wednesday prior to the meeting to be included on the agenda.
DATE: April 24, 2008.
TO: Deschutes County Board of Commissioners
FROM: Dan Peddycord, Health Department, 322-7426
TITLE OF AGENDA ITEM:
Consideration and signature of Document # DC -2008-209 - the State 2008-09 Annual Plan for the
Health Department.
PUBLIC HEARING ON THIS DATE? no.
BACKGROUND AND POLICY IMPLICATIONS:
The DC Health Department Annual Plan for 2008 - 09 is attached for review and approval. This plan
is a requirement of the State associated with grant funding. The plan intends to assess community
needs associated with specific Public Health Programs and then to describe how we will provide these
services. The plan covers a broad range of Public Health topics including but not limited to:
- Perinatal Health - Babies First
- Adolescent Health - Family Planning
- Newborn Hearing Screening - Immunization
- Women and Infant Children.
FISCAL IMPLICATIONS:
None, there is no money associated with this plan.
RECOMMENDATION & ACTION REQUESTED:
Approval and signature of Document # DC -2008-209, the State 2008-09 Annual Plan for the Health
Department is requested.
ATTENDANCE: Dan Peddycord
DISTRIBUTION OF DOCUMENTS:
Tom Engle RN, Oregon Public Health, 800 NE Oregon St., Ste 930, Portland, Oregon 97232
Phone 971-673-1222 Fax 971-673-1299; and a copy to Jill Fox (Health Dept., 2577 NE Courtney Dr.,
Bend, OR 97701).
TSS
Deschutes County Health Department
Local Public Health Authority
ANNUAL PLAN
2008-09
Deschutes County Health Dept. 1
Comprehensive Annual Plan 2008-09
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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Comprehensive Annual Plan 2008-09
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
Deschutes County Health Dept.
Comprehensive Annual Plan 2008-09
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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Comprehensive Annual Plan 2008-09
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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Comprehensive Annual Plan 2008-09
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
Deschutes County Health Dept. 6
Comprehensive Annual Plan 2008-09
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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Comprehensive Annual Plan 2008-09
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— l.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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Comprehensive Annual Plan 2008-09
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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Comprehensive Annual Plan 2008-09
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%1n2001.
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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Comprehensive Annual Plan 2008-09
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 %2 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
Deschutes County Health Dept. I
Comprehensive Annual Plan 2008-09
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.
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Comprehensive Annual Plan 2008-09
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.
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Comprehensive Annual Plan 2008-09
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. 14
Comprehensive Annual Plan 2008-09
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
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.
Deschutes County Health Dept. 16
Comprehensive Annual Plan 2008-09
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:
Deschutes County Health Dept. 17
Comprehensive Annual Plan 2008-09
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. 18
Comprehensive Annual Plan 2008-09
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. 19
Comprehensive Annual Plan 2008-09
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. 20
Comprehensive Annual Plan 2008-09
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
Deschutes County Health Dept. 21
Comprehensive Annual Plan 2008-09
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
Deschutes County Health Dept. 22
Comprehensive Annual Plan 2008-09
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 and 11th 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 Targe
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. 23
Comprehensive Annual Plan 2008-09
GOAL
To improve/ maintain the health status of the citizens of Deschutes County by preventing/ reducing
the incidence of Communicable Disease through outreach education, epidemiological investigation
and surveillance activities.
ACTIVITIES:
Target Population
Who
What
Timeline
Deschutes County
Residents
CD
Coordinator
(Objective 1)
Mechanism in place to receive, evaluate,
respond to urgent disease reports 24 hours a
day, 7 days a week.
Provide epidemiological investigations on
100% of reportable diseases with 24 hours.
ongoing
Deschutes County
Residents
CD Team
(Objective #2)
• Case investigations are complete
(>100%).
• 100% of reported cases are reported to
DHS by end of the calendar week of
the completion of the investigation.
• Information and recommendations on
disease prevention are 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.
ongoing
Medical Providers
CD
Coordinator
Outreach
Worker
(Objective #3)
Increase the number of medical providers
reporting Communicable Disease
appropriately through outreach and education.
• An emergency system for
communication of CD alert
information will be maintained.
ongoing
Medical Providers
CD
Coordinator
(Objective #4)
A more consistent feedback system, regarding
the outcome of the investigation will be
provided to the health care provider.
11/1/07
Veterinarians
CD
Coordinator
(Objective #5)
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)
Develop a Hepatitis C Plan that will address
the increase in disease reports and community
follow-up strategy within staffing constraints.
01/01/2009
Deschutes County
CD Team
(Objective #7)
Completed
Deschutes County Health Dept.
Comprehensive Annual Plan 2008-09
24
Staff
Who
Provide blood-borne pathogen training to staff
each year.
Timeline
Deschutes County
Residents
CD Team
(Objective #9)
Update the Pandemic Influenza Plan and
continue to prepare the community.
12/01/07
EVALUATION:
Objective 1: 24/7 System in place with positive test results.
Objective 2: Completed reports sent to State — monthly evaluation.
Objective 3:
Objective 4:
Objective 5:
Objective 6:
Objective 7:
Objective 8:
Improved reporting and communication with medical community.
Development of a system for provider feedback and implementation.
Development of a system for Veterinarian reporting and implementation.
Completion of the Hepatitis C Plan.
Documented training.
Updating of Pandemic Influenza 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
Preparedness
Coordinator
(Objective # 1)
Participate with St. Charles Medical Center and
Emergency Management on an area preparedness
planning group.
-to complete State requirements on drill
development and practice, engaging community
partners in the process.
- Pandemic Planning ongoing.
ongoing
Deschutes County
Residents
CD Team
(Objective # 2)
All Hazards Plans are integrated into the Local
Emergency Operations Plan.
ongoing
County Partners
CD Team
(Objective # 3)
We are still waiting for approval of mutual Aid
agreements for regional area. Hope to complete
this year.
12/01/07
Deschutes County
CD Manager
(Objective # 4)
ongoing
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
CD
Coordinator
(Objective # 5)
Update and review NPS Plan. (CD)
12/01/07
Deschutes County
Residents
Preparedness
Coordinator
(Objective # 6)
Complete/update development of all plans:
• Mass Prophylaxis
• Smallpox Response
• Pandemic Flu
• Lab and provider reporting
• Mass Casualty
• Mechanisms for receiving and
responding to CD reports
• Identification and planning for meeting
the needs of special populations
12/31/07
Deschutes County
Residents
CD Team
(Objective # 7)
Health risk information is communicated and
disseminated through, but not limited to the
following measures:
• Individual chosen to carry primary
responsibility for coordinating aspects of
public information communication has
been designated.
• The LHD communication officer
actively participates in 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.
12/31/07
Veterinarians
Animal Population
CD
Coordinator
(Objective # 8)
Improve the Animal Surveillance system in
Deschutes County through the Broadcast Fax
system.
11/01/07
Department Staff
Preparedness
Coordinator
(Objective # 9)
Training plan for all staff to be ICS and NIMS
compliant.
12/31/07
EVALUATION:
Objective 1:
Objective 2:
Objective 3:
Objective 4:
Objective 5:
Objective 6:
Objective 7:
On-going Disaster Planning Group
Integration of all plans
Mutual Aid agreements in place
24/7 communication intact
Completed NPS Plan
Plans completed
Risk Communication training documented and plan completed
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 Women
HIV MSM
HIV Program
staff
(Objective 1)
Organize and reassess the acuity levels of the
client load in HIV Case Management
12/31/07
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
HIV
Program staff
(Objective 3)
Improve the provider HIV testing of pregnant
women through outreach and education. (New
State law addressed this in 2005)
6/30/08
Deschutes County
Residents
Program
Manager
HIV Staff
(Objective 4)
Update and improve Prevention Plan based on
new CDC Guidelines.
Complete
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
6/30/08
MSM, IDU
FP/STD
community using the new HIV Rapid Test.
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.
To prevent new HIV
and Hepatitis
infections, decrease
client needle sharing,
decrease reports of
needles found in the
community.
Coordinator
(Implemented)
OHROCS
program
EVALUATION:
Objective 1:
Objective 2:
Objective 3
Objective 4:
Objective 5:
Organize and reassess participants in the HIV Case Management Program.
Increased number of HIV Tests performed for fiscal 07-08.
Survey providers on HIV Testing activity.
Evaluate each HIV Prevention activity and report quarterly to the HIV
Program.
Measure the number of new HIV tests completed.
HARM -REDUCTION (HEPATITIS B AND C AND HIV)
GOALS AND ACTIVITIES
Objective
List Resources
Activities
Expected
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.
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.
To prevent new HIV
and Hepatitis
infections, decrease
client needle sharing,
decrease reports of
needles found in the
community.
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.
Increase
testing among
people who
use injection
drugs (IDU)
OHROCS
program
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.
Promote HIV and
Hep B & C testing
among HD locations,
develop and distribute
informational and
referral materials.
-Outreach materials
distributed to 15 IDU
establishments: jail,
parole and probation,
parks, Laundromats,
food banks, shelters,
drug treatment
centers, addiction
Location of
Health
Department may
be a barrier- not in
a central location
and thus
transportation is a
hindrance.
Deschutes County Health Dept.
Comprehensive Annual Plan 2008-09
28
Deschutes County Health Dept.
Comprehensive Annual Plan 2008-09
29
recovery support
groups, bars, hotels.
*Target number of
people who use
injection drugs to be
reached with HIV
testing: 25.
Reduce
Outreach staff
Promotional
-To have a larger
Conservative
Hepatitis and
member,
material, ads in
network of contact in
community. Very
HIV infection
advertising
local newspaper to
the MSM population
difficult to break
through
resources, word
increase interview
who are passionate
into the MSM
education and
of mouth
opportunities on
about partnering to
network — quite
peer support
networking
how to best reach
reduce infection and
spreading the word.
underground. At
this point we are
of practicing
internet
the population and
_To increase our
focusing most of
safer sex in
resources, local
create buy -in from
knowledge about our
our efforts on
the MSM
population
PRIDE event,
Drag Show,
LGTBQ
MSM population.
Outreach through
adult stores.
local MSM
population, how best
to reach, network
networking to
increase our
understanding of
Fashion Show,
Rainbow
with, and
interventions that will
the attitudes,
beliefs, and
Alliance
be the most
behaviors of local
membership,
State
assistance.
successful.
-Outreach materials
distributed to 5 MSM
establishments: adult
stores, parks, gyms.
-Outreach at 2 events
organized by Human
Dignity Coalition
(PRIDE, Drag Show).
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.
Increase HIV
Outreach staff
-Staffing and
Increase testing
Few MSM utilize
testing among
member,
different offsite
among MSM.
the Health
MSM
possible MSM
locations to look at
*Target number
Department for
population
peer volunteer
testing
MSM to reach with
HIV counseling
opportunities,
promotional
material, networks
already created to
spread word and
encouragement of
testing.
HIV testing: 25
and testing
services.
- Male Only Clinic
will be held twice a
month. This clinic
Deschutes County Health Dept.
Comprehensive Annual Plan 2008-09
29
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
began 2/28/08 in
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
efforts to increase
Deschutes County
Residents
CD
Coordinator
(Objective # 2)
HIV Testing will be offered to all cases
and suspected cases of Tuberculosis
ongoing
testing among men,
CD
Coordinator
(Objective # 3)
Improve the number of clients completing
LTBI from 60% to 75%.
6/30/08
Medical Providers
especially MSM.
(Objective # 4)
Increase awareness to medical providers
for active TB cases.
ongoing
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)
HIV Testing will be offered to all cases
and suspected cases of Tuberculosis
ongoing
Deschutes County
Residents
receiving LBTI
through DCHD.
CD
Coordinator
(Objective # 3)
Improve the number of clients completing
LTBI from 60% to 75%.
6/30/08
Medical Providers
CD
Coordinator
(Objective # 4)
Increase awareness to medical providers
for active TB cases.
ongoing
Shelter residents
CD
Coordinator
Program Mgr.
(Objective # 5)
Explore the Implementation of a screening
program for shelter residents.
12/31/07
Deschutes County
Residents
CD
Coordinator
and Team
(Objective # 6)
Update policies, forms, and protocols
annually. (Completed)
on-going
Deschutes County
Employees
Manager and
CD
Coordinator
(Objective # 7)
Update employee respiratory protection
and screening program annually and
provide fit testing for staff.
ongoing
Deschutes County Health Dept.
Comprehensive Annual Plan 2008-09
30