HomeMy WebLinkAbout2001- February File Copy
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Jefferson County
Board of Health
Agenda
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Minutes
• February 12 , 2001
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JEFFERSON COUNTY BOARD OF HEALTH
Monday, February 12, 2001
2:00—4:00 PM
Main Conference Room
Jefferson County Health and Human Services
AGENDA
I. Approval of Minutes of Meeting of January 18, 2001
II. Public Comments
III. Old Business
IV. New Business
1. Community Health Indicators Follow-up Jean (30 min)
2. Best Beginnings Update Jean (30 min)
3. Report on Future of Rural Health Colloquium Tom/Roberta
. (15 min)
4. Legislative Update Tom (10 min)
5. Policy Relating to Building Permit Applications Linda A (20 min)
V. Adjourn
Next Meeting: March 15, 2001
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JEFFERSON COUNTY BOARD OF HEALTH
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DR P'‘ MINUTES
Thursday,January 18, 2001
Board Members: Sta{i-M emberr:
Dan Harboie,Member- County Commissioner District#1 Jean Baldwin,Nursing Semites Director
Gien Huntingford, Member- County Commissioner District#2 Lary Fa;,Environmental Health Director
Richard IT""oit.Member- County Commissioner District#3 Thomas Locke,MD, Health Officer
Geob-e_yy Masci,Member-Port Townsend City Council
Jill Buhler, L-ice-Chairman -Hospital Commissioner District#2
Sheiia 'Fetterman, Citizen at Large(City) bRAFT
Roberta Frissell, Chairman, Citi en at Large (Count)
Chairman Frissell called the meeting to order at 2:30 p.m. All Board and Staff members were present
with the exception of Vice Chairman Buhler. Commissioner Wojt arrived shortly after the meeting
began.
ELECTION OF 2001 CHAIR AND VICE CHAIR
•1ember Westerman moved to elect Member Buhler as Chairman. Member Masci seconded the motion,
which carried by a unanimous vote. Member Masci moved to elect Member Westerman as Vice
Chairman. Member Frissell seconded the motion, which carried by a unanimous vote.
APPROVAL OF MINUTES
Member Frissell noted that at the top of page two, second sentence, "increasing income tax" should be
changed to "establishing an income tax. " Member Masci moved to approve the minutes as corrected.
Commissioner Wojt seconded the motion, which carried by a unanimous vote.
OLD BUSINESS
Internal Assessment Report: Dr. Tom Locke distributed copies of the Health and Human
Services Internal Assessment Report, which the County Commissioners received yesterday. He
commented that useful information was generated from the assessment and the raw data can be used as a
baseline for future assessments. He thanked Chairman Frissell for her assistance with the survey.
NEW BUSINESS
2000-2001 Influenza Season Update: Jean Baldwin introduced Public Health Nurse Jane Kurata,
ho is in charge of immunizations. Ms. Kurata reported that due to production problems the target age for
vaccine was increased to 55. Although there were delays in receiving the vaccination and clinics were
rescheduled. the Health Department eventually received 1,300 doses, of which about 40 remain.
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HEALTH BOARD MINUTES - January 18, 2001 Page: 2
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Member Masci asked what number of the population was being targeted as "at-risk?"
Jean Baldwin said she would try to provide these figures by the January 25 Workshop.
Child Health Profile Implementation in Jefferson County: Communicable Disease and
Immunization Program Coordinator Lisa McKenzie explained that the two main components of Child
Health Profile are the health promotion materials and the immunization registry. This information is
derived from the database of birth certificate information. She reported that King, Pierce and Snohomish
Counties have been using the registry for five years, but the Peninsula has yet to participate. The
expense of this service is often a deterrent for rural health departments and local physicians. A two-year
trial period is being offered in which subscribing providers get access to a statewide immunization
registry at no cost. State and local jurisdictions are interested in the registry to ensure children are not
over-immunized due to lost records, to quickly identify those not immunized during a disease outbreak,
to target under-immunized areas, and measure immunization rates.
Jean Baldwin said the Health Department has signed up for the free two-year trial period. Information
taken from Medicaid records show that, 31.5% of children under age six are already in Jefferson
County's database. The Health Department has budgeted for a clerical support person to assist local
physicians by entering four or five years of data into the system. The governor's budget includes an
additional S2 million for Child Health Profile. Staff will continue to move forward with this project as a
priority.
Substance Abuse Treatment in Jails —Public Health Issues: Dr. Locke said this item was
suggested by Commissioner Titterness to better understand the long-range public health implications of
incarcerating people without intervention or treatment. Dr. Locke said this has been a big public health
issue for some time. He pointed to the two drugs that have the most widespread adverse effect—tobacco
and alcohol. The combination of those two account for 500,000 preventable deaths per year compared
with 20,000 for all illegal drugs combined. The issue of treatment for drug addiction in County jails is
one that overlaps jurisdictional boundaries (i.e., Sheriff's Department, County Commissioners, and
Health Departments). The report from the Department of Justice provided in the agenda packet is
reflective of the situation in Washington State, where 70% of inmates are either addicted to one or more
substances or are incarcerated because of a drug-related offense, or both. Drug addiction is not their only
health problem, but is a contributing factor in their incarceration. Despite this fact, very few get treated
for their addiction while incarcerated (roughly 10%) and a very high percentage of addicts will return to
their primary addiction once released. The report also indicates that drug use while incarcerated is not a
rare phenomenon.
Member Masci pointed out that the report did not mention the number of staff arrested for providing drugs
to inmates.
Vice Chairman Westerman mentioned California's recent initiative guaranteeing treatment for first and, •
in some cases, second-time offenders. With law and justice using an increasing amount of the state and
local budgets. she asked if it is time for Health Boards to take action toward treatment? One of the
reasons she supported expanding the Board of Health was to provide a forum to address issues that may
HEALTH BOARD MINU 1'LS - January 18, 2001 Page: 3
iike too controversial for elected officials to take on alone.
Jean Baldwin said the Health Department does not want to compete with Mental Health for funding in
finding a solution to these problems. She suggested the Health Board assist the Substance Abuse Board
by setting a vision and standards. That Board, by statute, is required to be configured with a high
percentage of people in recovery and is also charged with helping the Commissioners lay out a vision for
disbursing funds.
Member Masci asked if it would be helpful to appoint a Substance Abuse Board liaison with the Board
of Health?
County Administrator Charles Saddler talked about the County's development of a Health and Human
Services Advisory Committee to look at the human condition and perhaps create subcommittees to take
on certain tasks or responsibilities such as Substance Abuse. A task force comprised of the Health and
Human Services Committee and the Law and Justice Council could address methamphetamine, a
problem which is consuming more and more resources outside of health, law and justice.
Member Masci suggested that this committee include a representative from the City.
Vice Chairman Westerman said she supports the objective of broadening people's vision. She is
concerned that current Boards would be disbanded. As a long-time Developmental Disabilities Board
*ember, she hopes Board members continue to have a place to provide their input and expertise.
When asked if the Board of Health has a recommendation to begin addressing the issues in the jails, Dr.
Locke responded that the role of Public Health is in keeping track of the statistics and pointing out that
addiction is a disease for which there are effective treatments if they are, in fact, utilized. He added that,
under state law, the human service component is the responsibility of the Board of County
Commissioners, not the Board of Health.
Member Masci asked whether there could be mandatory drug testing of inmates entering the jail system,
so that there could be a focused effort on drug addiction?
Charles Saddler suggested that the Board of Health, as a neutral party, could be the arbitrator of effective
treatment methods. While the Sheriff would like to see an in-jail drug treatment program, there is a great
deal of resistance from others in law enforcement.
Jean Baldwin agreed to ask Dick Gunderson, Substance Abuse Coordinator of DASA whether anybody
is doing treatment in jails.
Charles Saddler said the County has a stable jail population with recurring offenders. Opportunities for
intervention, even late in the game, may prevent re-entering or the next generation from entering the
criminaljustice system at all. While it may not be prevention in the truest sense of the word, it has the
•tential to have a significant preventive element.
While the Board did not regard this topic as an action item, there was interest in further discussion about
HEALTH BOARD MINUTES - January 18, 2001 Page: 4
possible additional requirements or mandatory testing.
Dr. Locke said that a fairly complex body of law already exists that specifies what testing is permissible
(such as for TB) and what is sometimes permissible (such as HIV).
Legislative Update—Meeting With 24th Legislative District Representatives: As requested
by the Board at the last meeting, Dr. Locke said he and Member Buhler inquired about the possibility of
a meeting with legislators in February. Jefferson General, the Clallam Board of Health, and several other
agencies also expressed interest. However, the legislators are each offering different alternatives to a
meeting. Representatives Buck and Hargrove are going to be attending a State Hospital Association
meeting. Representative Buck offered to do a telelink with the Olympic Medical Center. Representative
Lynn Kessler has agreed to come to Port Angeles and participate in a town hall meeting, Saturday,
February 10 or 17, part of which could be devoted to health issues. It is hoped that if a town hall meeting
is scheduled that Senators Buck and Hargrove will also attend.
Dr. Locke asked that the Commissioners provide encouragement for these meetings. He sees a benefit to
having a health-related meeting where not only Boards of Health and Hospital Commissioners, but
medical providers and healthcare workers can tell their stories. He is convinced that the healthcare crisis
has finally hit Jefferson and Clallam Counties.
Member Masci said he believes that a clearly-articulated position needs to first be outlined. Legislators .
know that each group is going to ask for more money.
The Board agreed that a letter be written to legislators listing Jefferson County's priority issues and
presenting ideas for what legislators can do to maintain or improve access.
Jean Baldwin mentioned that her priorities for the Rural Health Summit would be MVET replacement
and additional child health tracking. She will let the Board know whether Representative Kegy was
going to ask for the Olds project to be replicated in more Counties or at least continue the funding for the
four Counties that are currently participating.
Dr. Locke suggested focusing on three key areas: (1) no additional cuts to Medicaid funding, (2)
alternatives for health care, and (3) public health funding, which he believes includes the areas Jean
Baldwin mentioned. He agreed to work on drafting a letter with assistance from Member Buhler and will
circulate an initial draft to the Board.
Commissioner Huntingford said he received an email about further cuts in mental health,which will be
discussed at the Steering Committee meeting tomorrow. He will try to find out more information and
provide an update to Jean Baldwin.
Policy on Design Standards For Site-constructed Elevated Fixed Media Filter Vessels:
Larry Fay pointed out that the draft policy statement included in the agenda packet has not been •
modified since the last meeting. Although no written material is available for today's discussion,
industry representatives for pressure treated lumber have confirmed there are specifications for different
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HEALTH BOARD MINUTES - January 18, 2001 Pane: 5
finds of exposures. The engineer would be able to specify what kind of materials they are using to
construct the vessels. The draft policy was reviewed by an engineering firm. designers, and a statewide
committee and indicated that the language is clear. It appears that as a result of the case in Jefferson
County. Glendon Technology is working to change their business practices, moving to a modular kit
with standardized materials, with which their distributors are required to work.
Member Masci moved to approve the Fixed Media Filter Vessel Policy as submitted. Commissioner
Huntingford seconded the motion, which carried by unanimous vote.
Policy on Review of Building Permit Applications — Second Draft: Larry Fay noted that the
policy statement provided in the agenda packet incorporated changes resulting from the last meeting. He
then distributed another version of the policy, which is basically the same, however it reflects staff's
recommended changes. The new ordinance has two provisions in different sections that deal with
inspections of on-site systems for when a building permit application is submitted.
Under Applicability, if the system is currently in the inspection program and up-to-date with inspections,
a building permit application inspection would not be needed. A second tier of inspection applies to
building permit applications that are either for new construction that involve plumbing or an expansion
of use. This policy is written so that it applies to any new construction, remodel or addition. What he is
proposing is that this policy apply to any site that has an on-site sewage system in the ground, whether it
�be a new construction or additions/remodels that are expansions.
`fin an expansion that significantly the house so that it affects
g Y changessewage flows and the potential
performance and reliability of that system, it is proposed that the permit be tied to the building code.
When the work of remodeling the house is equivalent to some percentage of the assessed value of the
property, the whole building will need to be brought up to code. In other words, when the building
official requires a complete upgrade of a house the septic system would be included.
Member Masci invited Larry Fay to the next City's Smart Code committee meeting January. The City
has received a state grant to explore Smart Coding and he believes the County may be able to use the
method by showing on a matrix the combination of things that trigger septic compliance.
Commissioner Huntingford would like to know more about the threshold in the building code. He asked
at what point does that building permit trigger new compliance standards? He is concerned that property
owners with septic systems approved by the County under the code of that period, will now be required
to upgrade their systems. Some lots may no longer be buildable under the current code.
Vice Chairman Westerman said when you buy property, there is a risk that you may be able to build on
the property and you may not. You cannot always allow citizens to operate their systems under 20 and
30-year old regulations.
Member Frissell said the Board has to be concerned about the health issues associated with these systems.
itmmissioner Huntingford said he questions the prosecutor's interpretation of what the state law
requires. While he does not want to see property owners having problems with their well, for instance,
HEALTH BOARD MINUTES - January 18, 2001 Page: 6
there may be other options available to them such as moving their well. He is not aware of health issues I
with systems approved in the early 1980s.
Larry Fay provided a recent example of a property owner that installed two septic systems and had two
mobile homes on the property. At some point, they removed one home and then recently applied to add
another mobile home using the old system. Because of the density on that particular site, there may not
have been an immediate environmental or health problem, but the system is not functioning up to current
code since it is discharging septic effluent into that shallow water table. There will be situations where
currently unused fields would nbt perform in accordance with modern standards.
The policy stipulates that when the County determines there is the adequate 3 feet of vertical separation,
etc., the owner is required to establish a reserve area to proceed with a building permit application. If
there is between three feet and one foot of vertical separation, the system can still be used, but instead of
being on a 3- or 6-year monitoring schedule, the system is placed on a 1-year monitoring schedule. The
concern being that with the reduced vertical separation, failure is of a higher consequence. An upgrade
would be requested when a system is 12 inches or less from a water table. Even then, the owner can still
use the drain field, but a treatment standard will be added in front of the drain field so effluent is treated
before leaving the system.
Commissioner Huntingford asked about elimination of wording on pg. 3, item 4, "owner may install
curtain drain or make other site improvement and keep monitoring."
410
Larry Fay agreed to follow up on this item. If there is a site that is logical for a curtain drain and there is
a place to discharge that does not interfere with anything, it ought to be an option to improve the
system's performance. He said it is allowed in the on-site sewage code.
Larry Fay said if a septic system was installed sometime after 1987 and the owner submitted the
building permit applications consistent with the terms and conditions of that permit, enough information
is available and the standards have not changed, that it is likely the permit would be approved. However,
between 1983 and 1987, the Board of Health indicated to the public that if a septic system was in the
ground you would be able to build. While a reserve area will need to be designated, it will not be a big
problem until the lot in question is small enough where there cannot be both a reserve area and a place to
build a house.
Commissioner Titterness said in that situation, there has to be a contingency for them to agree to an
alternative system of some kind, should their system fail.
Larry Fay said situations where there is no reserve area would be candidates for pretreatment to provide
high-quality effluent in the drain field and make such failure improbable. In the case of a sand filter or a
package treatment plan, it would provide a repairable component if failure did occur.
Vice Chairman Westerman commented that this seems to be a reasonable response.
•
Member Masci said because there are always going to be gray areas he would like to see a regulatory
structure that included a customer service component. He suggested that a grid of priority mitigation
HEALTH BOARD MINUTES - January 18, 2001 Page: 7
iisponses be developed.
Larry Fay said the biggest challenge is preserving water quality and balancing real and perceived
expectations. Differentiating between a real health problem and a problem with design standards is often
a judgment call. Applications submitted before this policy is in place will be dealt with on a case-by-case
basis. If someone had a septic permit and the system was installed and permitted for a 3-bedroom
sometime between 1983 forward. it is fairly predictable that they are going to use that system and build a
house. However, if there is no reserve area. an alternative system needs to be considered.
Commissioner Huntingford suggested the O&M program offers safeguards.
Larry Fay said while the O&M program will pick up the kind of failures where there is effluent running
across the surface of the ground, it will not uncover the treatment failures in the soil. The concern is
where there is not vertical separation and untreated effluent is moving through the shallow water table
and showing up 100 or 200 feet away from the drain field in an untested area and feeding into some of
the other tributaries. A system may drain for 10 years, but what is happening in the soil is also a concern.
Member Masci asked if it is possible to create the policy and then educate the real estate community that
septic tank inspection is a contingency of the sale.
Charles Saddler said this is occurring, but the County needs to come up with a more comprehensive,
(yore formalized process because of the entire Unified Development Code (UDC).
Larry Fay summarized that while he believes the Department can deal with the 1983 permits and small
lots and vertical separation, he does not yet have clear direction on a 3-bedroom septic system
irrespective of when those applications are made.
Commissioner Huntingford asked staff to find out how many old permits are still on the books.
Larry Fay responded that is difficult unless someone reviewed the files to see if there was a ',uilding
permit issued or go through the Assessor's records and see if there is a building on the property.
Commissioner Titterness said while he guesses there are not many systems from that period, there needs
to be consistency. At the time the owner requests a permit, it is our responsibility to let them know of
potential problems for which they will be responsible. He asked if something that accomplishes a
perimeter check on those few systems could be added to the annual inspection?
Larry Fay said site-specific ground water sampling is challenging at best and would not provide water
quality information that could be counted on to determine a failure. The question is what do we do if
there is 12 inches or less of vertical separation?
Commissioner Titterness said he believes a permit would still be issued. In the annual inspection, if
("ere are signs of failing, you make it clear to the owners that an advanced system was recommended.
HEALTH BOARD MINUTES - January 18, 2001 Page: 8
AGENDA CALENDAR/ ADJOURN S
FUTURE PLANNING TOPICS: Update on Building Permit Applications and the Internal Assessment
Report and Recommendations.
1. CONTINUED STABLE FUNDING TO REPLACE MVET
ACCESS HEALTH CARE
3. PROGRAM MEASURES (Genetic Research and Public Health Implications)
4. METHAMPHETAMINE SUMMIT
5. PERFORMANCE STANDARDS & COMMUNITY ASSESSMENT
6. TOBACCO PREVENTION AND COALITION
7. FLUORIDE
8. TRANSIT AND PUBLIC HOUSING
9. BIOTERRORISM READINESS & PLAN
10. AGING POPULATION
11. WATER
12. MATERNAL CHILD PREVENTION GOALS (0-3)
Meeting adjourned at 4:30 p.m. Due to a lack of a quorum the next meeting will be held on MONDAY,
FEBRUARY 12, 2001 AT 2:00-4:00 P.M. •
JEFFERSON COUNTY BOARD OF HEALTH
(Excused Absence)
Jill Buhler, Chairman Geoffrey Masci, Member
Sheila Westerman, Vice-Chairman Richard Wojt, Member
Glen Huntingford, Member Roberta Frissell, Member
Dan Titterness, Member
S
Board of Health
February 12 , 2001
New Business
Agenda Item # IV. , 1
al
Community Health Indicators
Follow-up
Jefferson Counts Communitcj health Indicators Meeting
WS(.I Spruce Room
4D Januar9. 2.5, 2001
AGENDA
Dr. Tom Locke- Assessment shapes good decisions
Dr. Chris Hale — Overview Discussions:
• What do we know about data in Jefferson County? Families & Young Children
• Economic Data Youth 15 to 25
• Health Indicators Adults 25 - 64
• Birth Seniors
• Death Environmental Health
• Communicable Diseases Tobacco / Substance Abuse
• Quality of Life
• Quality of Life
Defining the gaps / What would we like to know?
• What is the Behavior Risk Factor Surveillance Survey?
o When is it coming?
o What is available?
o Who uses it?
o Morbidity
• Upcoming Census Data
Break to review data
Where do we go/ How do we track what is important to Jefferson County citizens?
• Build partnerships — County wide / Regional data users group/ web sites
• Establish committee that is a clearinghouse of quality
•
di Board of Health
Follow-up Report of January 25th and 26th
Jefferson County Health & Human Services Looks At
County Health Indicators
Dr. Chris Hale. of Hale Associates.joined us on January 25th and reviewed health indicators from vital
records, other health indicators and demography. Dr. Hale provided energy and excitement while the
community looked at somewhat overwhelming numbers. The numbers became stories as they were
reviewed. For those of you unable to attend, I have enclosed a copy of the agenda. the data and
Behavioral Risk Factor Surveillance Survey (BRFSS) sheet. The current data is available for the
community at: http://www.co.jefferson.wa.us/health/default.htm
The general consensus of the meeting is that participants want reliable assessment data.
• There is great interest in the BRFSS that will happen in Jefferson County throughout 2001.
• There is interest in other data that is not compiled and possibly not easily available
• There is also interest in continuing partnership to improve the accuracy of data—Olycap came
forward at the training and said that they would like to partner and gather data
• • The city of Port Townsend will provide $50,000 funding over two years to review the social law
and justice issues that result in incarceration or juvenile justice system services. Existing data
will be analyzed and new data gathered so that coherent science based policy development and
program recommendations can be available. JCHHS will enhance their contract with Dr. Hale for
this data analysis, program research and recommendations.
These partnerships exceeded the expectation of the staff in beginning this project. As policy makers,
you. The Board of Health, must look at assessment data to determine priorities. Dr. Hale and JCHHS
will have a series of quarterly meetings that specialize in topics of substance abuse, law and justice,
birth to age five, school age. youth 15 to 24, aging adults and 70 +years and service needs. Short
quarterly meetings will run two hours at WSU. The challenge will be to invite the number of people
who are most likely to be interested. An e-mail list will he established and we will send out reports to
everyone who attended, as well as those who were invited.
Ill 2001
Behavioral Risk Factor Surveillance
System Questionnaire
Introduction iii
CDC CORE QUESTIONS 1
Section 1: Health Status 1
Section 2: Health Care Access (& CDC Optional Module) 2
Section 3: Exercise 4
Section 4: Hypertension Awareness 4
Section 5: Cholesterol Awareness 4
Section 6: Asthma 5
Section 7: Diabetes (& CDC Optional Module) 6
Section 8: Arthritis 9
Section 9: Immunization (& Washington State-Added Questions) 10
0 Section 10: Tobacco Use 11
Section 11: Alcohol Consumption 12
Section 12: Firearms 12
Section 13: Demographics 13
Section 14: Disability 18
Section 15: Physical Activity (& Washington State-Added Questions) 18
Section 16: Prostate Cancer Screening 21
Section 17: Colorectal Cancer Screening 23
Section 18: HIV/AIDS 24
WASHINGTON STATE-ADDED QUESTIONS 27
Section 19: Health Care Coverage and Use 27
Section 20: Unmet Health Care Needs 28
Section 21: Oral Health 29
Section 22: Asthma History 31
Section 23: Cardiovascular Disease 34
Section 24: Tobacco Indicators 37
Section 25: Other Tobacco Products 39
Section 26: Family Planning 39
Section 27: Family Violence 43
•
WA 2001 BRFSS December 15 2000 12.14.2000
•
Board of Health
February 12 , 2001
New Business
Agenda Item # IV. , 2
EN
Best Beginnings
Update
•
State of
Washington
House of
Representatives
•
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RECEIVED
January 31, 2001 FEB 0 5 2001
Jefferson County
Health&Human Services
Jean Baldwin
615 Sheridan
Port Townsend, WA 98368
Dear Jean,
The House Health Care, House Children and Family Services, Senate Health Care, and Senate
Human Services and Corrections Committees will be holding a joint work session on home
visiting on February 15th. We would like to invite your project, along with the three other
projects around the state, to make a brief presentation before committee members.
David Olds will present for the first half hour. Then, the legislative committees would like to
• hear from the four pilot programs implementing his model about the families they serve and how
the individual programs operate. It would be wonderful if you or a representative of your project
could speak for 2-3 minutes. We will also have a brief presentation from WCPCAN on
community-based home visiting. We will then open the session up for questions and discussion.
The work session will take place from 12-lpm on February 15th in House Hearing Room A of the
John L. O'Brien Building. Please let us know if someone from your project will be able to speak
for a few minutes. We look forward to hearing from you.
Sincerely,
Ruth Kagi Shay Schual-Berke, M.D.
Co-Vice Chair, Co-Vice Chair,
House Children &Family Services Committee House Health Care Committee
Memorandum
Date: February 6, 2001
To: Board of Health & County Commissioners
From: Jean Baldwin / Carol Hardy
Cc: Bill NeSmith, Jude McClure. Charles Saddler
RE: Update
Jefferson County' Report on Maternal Child Health Year 11
History
The goal of the Washington State First Steps program. authorized by the Federal Maternity
Access act of 1989. was to provide "maternity care necessary to ensure healthy birth outcomes
for low-moderate income families". The legislation called for removal of unnecessary barriers to
receiving prenatal care and provided for increased access to care and expanded Medicaid
services for these pregnant women.
The First Steps Program includes the following components:
• Expanded Medicaid eligibility to 185% of the federal poverty level for pregnant/postpartum
women and infants less than one year old (a family of three, mom, dad and unborn child,
can make $2182.00 per month or $26,168.00 per year).
• Provided Maternity Support Services (MSS) during pregnancy and two months
postpartum by a multidisciplinary team consisting of a Public Health Nurse, Social Worker
and Nutritionist. These 10 visits were to be provided by an approved agency and consisted
of home and/or office visits.
• Maternity Case Management (MCM) during pregnancy and for one year postpartum for
the women in MSS who were identified as high-risk for poor outcomes (specific high-risk
criteria was designated by the state, see Attachment A). Increased the number of MSS
visits for MCM designated clients to 20 visits for the pregnancy and two months
postpartum.
Jefferson County Health and Human Services began to offer these programs in January of 1990.
Referral to this program is made by all of the local OB/GYN family practice doctors, other
clinics, nurse practitioners/midwives, DSHS welfare office, family planning, WIC, The Life
Center, Jefferson General Hospital. the school counselors and word of mouth. Over the last
eleven years Jefferson County Health and Human Services has worked very hard at building
relationships in order to receive the referrals for all pregnant women who qualify for Medicaid.
In 1997 Jefferson County had 201 births and 104 were Medicaid reimbursed (see Attachment
B). Of the Jefferson County pregnant women Medicaid reimbursed, MSS/MCM program was
providing services to 85%, second in the state. The state average is about 65% of the Medicaid
• reimbursed births (see Attachment C).
1
Jefferson County Health and Human Services Maternal Child Services
Maternity Support Services (MSS) is offered to any medicaid eligible pregnant woman.
Services include 10 visits for assessment, education and consultation provided by an
interdisciplinary team of professionals from each of the three disciplines of Public Health
Nursing. Nutrition and Psychosocial Services. It can also be provided by a community health
worker under supervision. These services also include development, implementation and
evaluation of plans of care for pregnant women and their infants up to two months postpartum.
The intent of the program is to provide MSS interventions as early in a pregnancy as possible in
an effort to promote positive birth and parenting outcomes.
MCM is offered to MSS clients who meet the state high-risk criteria (see Attachment A) who
request services; it is also voluntary. The services are the same as in MSS. however, more
intensive and a caseworker is chosen for each woman. The woman is allowed 20 prenatal and
two months postpartum visits rather than 10 and can be followed until the infant is 1 year old.
Best Beginnings (BB). the Dr. David Olds Project replication project began in Jefferson County
in July of 1999 with three nurses attending a weeklong training in Denver. Colorado. This
project will continue for at least three years along with the other three counties that make up the
Washington State Consortium in collaboration with the University of Washington. University
of Washington currently gathers the data from the four consortium sites in Washington that are
implementing this program, and sends the data to the University of Colorado where the data is
analyzed for types of visit, acuity of maternal and infant mental health, tobacco use,
demographics, parenting risks, environmental health and substance use, as well as other risks.
The data is also being analyzed in relation to the "fidelity" to the original research protocols. At
some point, we are hoping to provide the same services without the University providing
supervision.
A major focus of the BB project is a local attempt to decrease the number of families in the
child protective service system. Dr. Olds' research, based on the combination of brain
development, attachment theory and object relations theory, has documented decreases in court
involvement substance abuse infant and child injuries. Therefore the long-term intervention is
striving for long-term generational changes in self-competency, family dynamics and parenting
style. Since the first pregnancy in a woman's life offers a unique opportunity for change. it is
the first time mothers that come from backgrounds at risk or from families at risk that we are
targeting for the BB intensive series of visits. These visits have been proven to be the most
effective up to, and including, the child's second birthday. Visits are made on an every two
weeks schedule with increased visits (weekly) upon initiation of the program and around the
birth of the infant. This frequency and consistency of visits allows the mother to develop a
trusting relationship with the care provider and then for the mother to develop a trusting
relationship with her child. Dr. Olds' longitudinal studies have shown that by the child's fourth
year there is a cost reimbursement pay back to communities for those programs who follow the
protocols and when the nurses providing the visits have ongoing administrative support and
clinical supervision, as well as a limit on their caseload to 25 families per 40 hour week.
S
For Jefferson County residents who do not qualify for Medicaid. as well as those that do. there
are other services offered by JCHHS:
1. Childbirth Education
Childbirth education is offered at Jefferson County Health & Human Services in
collaboration with Jefferson General Hospital. This is a 6-week series of 2-hour classes
focusing on healthy pregnancy. the birth process. options for pain relief immediate
postpartum. breastfeeding. birth control and other resources. Most first time families who
deliver either in Jefferson County or out of the county do take childbirth education classes
here. This is funded by First Steps for First Steps eligible moms and private fees for others.
2. Newborn Follow Up:
Harrison Hospital. Olympic Memorial and Jefferson General, as well as Swedish,
University. Mary Bridge and Tacoma General, contact JCHHS upon births of new babies.
Phone call follow-up is offered to all new parents just to see if there are problems with
breastfeeding. sleeping,jaundice and any for any concerns that they may have. Problem
solving and referrals for services are provided if needed. Home visits or clinic visits.
breastfeeding consultation and telephone follow-up are offered for those families who wish
them. Some families meet the nurse, many are never seen by the nurse but have a series of
follow-up phone calls. None of these are billable services. They are paid for in the JCHHS
budget by Maternal Child Health (MCH) block grant money and county general funds.
3. Postpartum Breastfeeding Tea Party:
The Postpartum Breastfeeding Tea Party meets weekly and has averaged five to twelve
mothers a week, usually attending for six to eight months. The attendee profile varies, but
very often includes mothers with income and insurance and those on Medicaid. Issues of
baby care, feeding_, depression. domestic violence. drugs. alcohol, changing relationships,
birth control within their family. crisis intervention, discipline, different feelings and
parenting styles, appropriate childcare, self care and sibling issues are just some of the topics
that come up universally with each new group of women and babies. This is a peer support
group. Referral to resources is ongoing. There has been no funding for this at all.
Alternative Response System (ARS) and Early Response Program (ERP) are JCHHS programs
that are in conjunction with the Child Protective Services and are for families designated at risk
by Department of Child and Family Services (DCFS) or Child Protective Services (CPS) and
referred by DCFS or CPS. The JCHHS Maternal Child Health nurses do see these clients for as
long as 90 days. The Child Protective Service caseworker is the case manager rather than the
JCHHS nurse. These visits are usually around specific problems and not relationship based
long-term interventions. DCFS or CPS has referred specific high-risk families that need a high
intensity short-term intervention.
Community Plans
Jefferson County will be eligible for Early Head Start. JCHHS has met with Olycap and
collaborated in their application for Early Head Start in this county. Early Head Start will be
isable to serve ten or fewer families a year who have income at 100% of poverty level. The hope
is that they will serve those families who have another toddler in the home so that both the
3
toddler, the mother and the newborn can be served in the same visit. One of the real gifts of this
is that families who had a first baby while in MSS could have a different provider for the next
child who could be involved with both children and help with the transition into school for
potentially high need families. The JCHHS provider focus is health, growth and development.
The Early Head Start focus is education and family systems. The small shift in focus may
provide families with a deep enrichment and the plan is that JCHHS will be the gatekeeper and
referral point for Early Head Start.
Kitsap, Tacoma and Snohomish counties have used the Healthy Start (Hawaii) family model.
There has been discussion of starting it here. In light of the already existing services that are
outlined above. it seems that in order to follow families with children until the age of five
utilizing the Healthy Start model there are some important considerations:
1. Funding
Funding for any potential new program is needed, as well as fill-in funding for the second
and third year of BB. Maternity Support Services only pays up until the infant is two
months old and case management until infant is 1 year. There are no public dollars
available to follow a family the length of time required by either Best Beginnings or
Healthy Start. Currently the 45 families being followed by Best Beginnings are using the
entire Maternal Child Health contribution of county general fund money, a March of
Dimes grant, Medicaid administrative match outreach dollars and the carryover from the
prior year of MSS/MCM.
• 2. Collaboration
JCHHS could potentially provide the Healthy Start Program (Hawaii model) in
conjunction with their other services as well as supervise professional peer home visitors
working with families up until the child's 5th birthday. However, collaboration would be
important in order to provide for easy transitions and continuity of care as well as to
avoid duplication of services and resources. Working closely with the existing JCHHS
programs would be essential to avoid confusing offerings and competition for funding.
3. Assessment
JCHHS will be conducting a yearlong Pre Natal Risk Assessment Matrix (PRAM) study
in which a series of 45 questions is asked of all mothers after the birth of their baby.
These questions include tobacco use, domestic violence, support of mother, income, etc.
The PRAM study is currently being used in every county in Washington and the survey
is being conducted by the Department of Health (DOH). In Jefferson County only 5 to 6
women a year are questioned yearly. Since we have such a small number of births per
year and this rate has remained stable for the last 10 plus years, it is reasonable to involve
all of the women who deliver in Jefferson County, thereby giving information that
accurately reflects our county rather than the larger counties within the State of
Washington. It is a very simple survey to conduct and we can conduct it in a similar
fashion to doing the newborn follow-up, in a non-invasive way, with the State DOH's
help.
S
4
• 4. Plan
With Dr. Chris Hale. epidemiologist, the plan is to conduct a PRAM survey on all births
•
in 2001. With this information we will have a better profile of how extensive an early
intervention/home-visiting program Jefferson County needs. Best Beginnings is
attempting to serve all first time high-risk families that qualify for Medicaid (about 44 to
45 first time families). MSS/MCM currently serves another 60 to 70 families. That will
be our maximum BB/MSS/NICM caseload unless hours change within staff and we were
to discover that there are more Medicaid families wishing our services. Early Head Start
will be able to provide services for ten families. With additional money, the Hawaii
model could serve additional families if a need were to be demonstrated. However. the
PRAM survey could evaluate the county need for new programs and/or expansion of
existing ones.
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Attachment B
Medicaid
•dicaid.paid delivery",
Jefferson County and Washington State, 1992-1999
Jefferson County
Year All Births Medicaid Year Jefferson County Washington State
1992 228 113 1992 49.6% 30.9%
1993 224 120 1993 53.6% 34.3%
1994 204 92 1994 45.1% 34.1%
1995 210 113 1995 53.8% 32.2%
1996 195 95 1996 48.7% 33.4%
1997 201 104 1997 51.7% 32.3%
1998 195 103 1998 52.8% 31.3%
1999 211 115 1999 54.5% 32.5%
'Based on births for which payment source was known.
Medicaid-paid Delivery,
Jefferson County and Washington State, 1992-1999
100.0%
90.0%
io80.0%
70.0%
60.0%
53.6% 53.8% 528•/. 54.5%49.6% p I 51.7/.
50.0% as.r�.
Fl" i,,,,
�g45.1%
40.0% ,Iii1 €. { I.
30.0•/. ;:Ii
Y 4:,
3•/.
20.0% +rij �. [- I If.,,, •
ii
10.0°/. ij- x . .a
ri
t. 4
,- ,•
0.0% �' .,.+ lL.:, Li
1992 1993 1994 1995 1996 1997 1998 1999
III ®Jefferson County ❑Washington State
Attachment C STATE OF WASHINGTON - FIRST STEPS DATABASE 3/3/99ES
Maternity Support Services and Maternity Case Management Use
1111
by Total Women with Medicaid-paid Births in 1997
Skaman�a r—- »�
Jefferson
Island
Cowlitz
King ~
Pend Oreille
Chelan _. . .. _ ... ._� _.._..... _
Douglas
J
Grays Harbor
Whatcom
.4 I
San Juan
J
Kittitas _ _ _ _ .
Clallam {
Pacific
Ferry i
Skagit
Kickitat -
Okanogan
• Lewis
Franklin
Snohomish
N.-STATE TOTAL
Yakima _
Stevens
-4
Thurston
Adams
Grant _ - _. .- - - - -=y
Columbia - -_-
Benton
Walla Walla
Whitman ....
a
Carle _ .** < 2e ..42.11
Pierce -- -
taml
Mason {
Kitsap
J
Wahkiakum
Spokane 4
Asotin
SLincolnUnknown i
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
;•Both MSS&MOM 0 MSS ONLY ■MCM ONLY
DSHS Research and Data Analysis Laurie Cawthon, MD, MPH (902-0712) MS:45204
DRAFT
'1. Intake to MSS Forums
Consent
• ROI
Baseline Assessment
?. Baseline Assessment Includes:
a. The client's knowledge of pregnancy,childbirth, and parenting
b. Client cultural or religious beliefs/practices regarding pregnancy and childbearing
c. The client's knowledge of major health risks,danger signs of pregnancy, and healthy vs. unhealthy behaviors
d. Medical factors relating to pregnancy risk and health behaviors. This includes HIV risk,availability of counseling
and testing.and if applicable. use of AZT to reduce perinatal transmission
e. Signs and symptoms of personal drug/alcohol use and/or drug/alcohol use in the client's environment
f. Personal tobacco use and/or consistent exposure to tobacco use
g. The client's communication skills, primary language. literacy,ability to communicate feelings. maturity.decision-
making ability
11. Family structure,support system, physical/sexual/emotional abuse, roles and relationships,coping ability,stress
level
i. Home and work environment, including housing,safety and security, occupation, transportation and access issues,
and financial resources
j. Dietary patterns and intake, resources for obtaining and preparing food, and evaluation of nutritional needs
k. Pregnancy and postpartum related changes in activities of daily living such as activity/exercise, elimination,self-
concept/body image. sexuality
1. Understanding and utilization of health care resources, including dental and vision services
m. Screen for MCM eligibility
n. Need for child care
o. Infant eligibility and linkages to pediatric primary care, parent-infant relationship, infant care concerns,parenting
resources, infant safety, immunizations and infant health status
p. Knowledge of and understanding of family planning services and birth control methods
q. Knowledge of breastfeeding as an option
3. Team Meeting to:
• a. Determine Further Assessment
b. Develop Interdisciplinary Plan
i. Client focused integrating professional assessment and client concerns,needs
c. Confer on MCM Potential
i. Assign case manager
ii. or Primary contact person
MSS MCM --> BB
Up to 10 Visits(office or home including intake visit)
Initial review by ALL team members,either face to
Review by ALL team face with client or in team meeting. Documentation
Ongoing review Ongoing review
• Preparation for parenthood
recommended for all
• CBED
Child Care Screen
Transportation
Implementation of Plan
MSS Team Concerns Referrals Client's Concerns
WIC
ADTSA
CSD
Prenatal
DV
Housing
• Mental Health
Dental
Vision
Parenting Classes
Family Planning
CBED
I
• COMMUNITY NETWORK POSITION PAPER
Summer, 2000
Are you aware that 50%a of Jefferson County's General Funds are spent on Law and
Justice services? These services include the Sheriff's Department, the Courts,Juvenile
Services, and the Prosecuting Attorney's Office. The activities of these departments
mainly are related to handling crime in one form or another, be it vandalism, domestic
violence and other assault, child abuse, and illegal activity related to substances. In our
county, we are spending half of our general funds on responding to and processing
criminal activity. In our community and most others, criminal activity and the funds
needed to respond to it are continually on the rise.
Many communities have responded to the trend by building large law and justice
complexes. These complexes provide state of the art security; single-site locations for
agencies, courts, and often incarceration facilities; and convenient access for the public.
We are poised to build just such a complex in Jefferson County. It will come about via a
bond issue whose time, we agree, has come. Our county courthouse is unsafe by a
number of different benchmarks, and obsolete for handling the extent and nature of the
crime we face at this time.
One unfortunate reality is that the new law and justice complex—needed as it is—will
. come at a cost to our other 'bond issue' institutions such as recreational facilities,the
hospital, the libraries and our schools. We may indeed be heading for a time in which
more of our public funds are spent maintaining our safety than promoting our growth and
well-being. The fact that it costs more annually to house a prisoner than to pay for a
college education lends some legitimacy to this idea.
A second unfortunate reality is that the new center represents a response to, and not a
solution to, damage already done to our community. It is needed because we have
somehow failed to adequately safeguard our citizens, or to ensure that our community
members –whatever their ages—are capable of making healthy, legal choices. Current
trends being what they are, we will only pay more and more to respond to crime if we do
not start investing in solutions.
The Community Network poses these questions to our leaders and our citizens:
Are we comfortable as a community spending an enormous amount of our taxes to
process' social problems, with no safeguards consistently in place to help solve these
problems?
Couldn't our tax resources be invested more effectively if at least a portion of them were
devoted to preventing social problems—such as violence in the home or school and
substance abuse—before they do their damage and progress to the legal system?
Tsn't it time to develop a community plan for reducing the levels of these problems, as a
solution to reversing the ever-expanding industry that the criminal justice system is
becoming?
We are talking about making solid investments at the front end in creating healthier
community, while we simultaneously maintain the necessary mechanisms for responding
to social problems and crime.
Research has proven that prevention and early intervention programs can be highly
effective, and result in huge savings to communities. As examples:
--Home visitation programs that offer intensive support to mothers at risk of
abusing their newborns have produced a 75% reduction in cases of child abuse and
neglect, thus breaking a violent cycle in which the abused too often grow up to become
violent offenders;
--Programs that introduce at-risk youth to positive environments can have a
significant impact. Boys and Girls Clubs in 64 at-risk neighborhoods across the country
have reduced juvenile crime in these areas by 13%;
--Strategies that encourage commitment to school and academic success reduce
. delinquency among high-risk students. For example, promoting reading skills helps
reduce delinquency. Reading failure as early as the first grade has been found to be a
predictor of later delinquency.
Communities across the country are building prevention programs into their local budgets
and reaping the rewards. For example, Deschutes County, Oregon has significantly
reduced costs of incarceration by designating a portion of its juvenile justice funds for
prevention. The money saved by the State has been fed back into the system to create
more programs that intervene early with at-risk children.
Jefferson County has a number of model programs in place that we know reduce violent
behavior, substance abuse, and other social problems. One is the Best Beginnings Nurse
Visitation project currently in place with grant funding at the Health Department.
Another is the YIPPEE program, founded on the successful Best Self model in Skagit
County, which offers low-cost after-school and summer programs to children and youth
in the south county. YIPPEE is a good example of a prevention program that began with
local commitment from the Law and Justice Council and the Commissioners, and is now
supported by a combination of local and state grant funds. YIPPEE and the Best
Beginnings project have the potential for significant positive impact if they are in place
over the long-term. Their longevity will take a solid commitment from local government
and our community. We have proof that these programs work: it is time to make that
kind of commitment.
The Community Network asks the citizens and leaders of Jefferson County to commit to
preventing the sorts of problems that we otherwise will continue to pay for more and
. more dearly. It means making a local financial commitment that may not yield
immediate, tangible results. It means investing in prevention programs that have
demonstrated long-term social gains in rural communities such as ours.
We believe that it is time for our citizens and government officials to commit to building
a safety net of programs in Jefferson County that will help ensure the well-being of our
community. We ask this not only to stem the rising costs of the criminal justice system;
but to help ensure that all children,youth, and families are given the opportunities to
thrive and reach their positive potential.
•
•
•
Board of Health
February 12 , 2001
Media
• Report
•
• Jefferson County Health and Human Services
JANUARY 2001
NEWS ARTICLES
These issues and more are brought to you every month as a collection of news stories regarding
Jefferson County Health and Human Services and its program for the public:
1. "They call it puppy love" —Peninsula Daily News, January 12, 2001
2. "Saddler: PT not being taxed twice" — Peninsula Daily News, January 14, 2001
3. "Agency adds to hepatitis protections"— Peninsula Daily News, January 19, 2001
4. "Jefferson, PT services pact is near" —Peninsula Daily News, January 23, 2001
5. "Flu vaccine still available" — P.T. LEADER, January 24, 2001
6. "Jefferson's health due for survey" —Peninsula Daily News, January 26, 2001
• 7. "City, county settle spat over fees"—Peninsula DailyNews,, January 30, 2001
8. "Back jail bills dropped as city, county achieve regional services agreement" —P.T.
LEADER, January 31, 2001
•
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PENINSULA DAILY NEWS
• Agencyadds
to hepatitis
t on
protes i
s
Peninsula health Locke said.
"Our goal is not to generate
offices welcome lists of names."
Some people are more likely
reporting rules to contract hepatitis C than
others. Approximately 4 mil-
BY KEN SHORT lion have the disease nation-
FOR THE PENINSULA DAILY NEWS wide, Locke said.
Health-care providers in Hepatitis C is spread pri-
Health-care
and rovimanly through direct contact
ties now must Jeffersonrepont coun-inci- with the blood or body fluids of
an infected person,Locke said.
dences of patients dia
with two forms of chronic .
hepatitis to state health How it spreads
authorities. Rabies, animal bites,
The contagious hepatitis B anthrax, smallpox, diseases
and hepatitis C conditions associated with the human
have been added to a revised immunodeficency virus,
• list of 63 notifiable conditions measles and plague are among
reportable to the state Depart- other previously notifiable
ment of Health. conditions.
Hepatitis is a liver-scarring Prior to Dec. 22 when the
disease that comes in seven new regulations became effec-
forms beginning with type A. tive, only four hepatitis C
The conditions is caused by a diagnoses were reported
parasitic virus that scars the between 1995 and 1999 in
host's liver. Clallam County, Locke said.
Tom Locke, chief health Two cases were reported in
officer for the two counties, Jefferson County during the
• said the regulations, revised same time period.
last December, are intended to Locke said new treatments,
unify a previously complex interferon and ribavirin, have
system of reporting. increased the cure rate to 40
'Compelling benefits' percent.
But in some cases where a
Locke said he helped craft patient refuses to be treated
the new reporting require- for a reportable disease the
ments because of the "com- county can take legal action to
pelling health benefits" of force treatment.
tracking the contagious dis- "We have some public
ease. health police power," Locke
Hepatitis was notifiable in said.
the past, but only the initial The regulations give the
diagnosis. counties' health department a
"The rules were frag- wide range of protocols includ-
mented, confusing and scat- ing notifying and tracing part-
tered through a myriad of ners of patients diagnosed
state laws," Locke said. with some infectious or sexu-
"You had to look up a dozen ally transmitted diseases.
different laws." For example, when a
But patients shouldn't patient diagnosed with tuber-
worry about breaches of confi- culosis refuses treatment,
• dentiality—the data are used county health officials on rare
• only by the state in part to occasions can force the patient
stop the spread of the disease. into quarantine and trigger an l
"We have a perfect record of investigation of the outbreak, 4 `�— /
Q
maintaining confidentiality," Locke said.
Edition January 23, 2001
i
J effercon ,
PT se a
pact is near
Health coverage three years — a mere 20 minutes —
the six council members at the special
sticking point meeting Monday unanimously
approved three resolutions authoriz-
ing Timmons to execute contracts for
in ongoing talks law and justice services, including
District Court,jail services and emer-
gency dispatch, health and human
BY PHILIP L. WATNESS services including animal services
PENINSULA DAILY NEWS and substance abuse programs, and
PORT TOWNSEND — Several computer services.
issues concerning money are still out- The council previously budgeted
• standing, but Port Townsend should $400,000 to pay for the regional ser-
soon have a regional services contract vices, which included $17,000 for a
with Jefferson County joint study concerning the equity of
Port Townsend City Manager the contract.
David Timmons was authorized by Jefferson County counted on
the City Council on Monday to sign receiving $495,000 from Port
the agreement, although he will con- Townsend when the commissioners
tinue to work out the details regard- approved the 2001 budget. However,
ing the municipality's contribution the county budget included the
for health services. $80,000 municipal contribution pro-
•
County Administrator Charles posed for health services.
Saddler had proposed that Port Timmons said the disparity
Townsend ante up $80,000 for the between the amounts will be
county Health Department. addressed through a supplemental
budget once the contract has been
20-minute council meeting finalized. He said the city budget
includes a larger reserve than needed
He has maintained that Port
Townsend used to contribute money for just khat reason.
for health services before the state Agreement over jail
Legislature enacted a law that had
cities contribute a portion of the The two governments have also
motor vehicle excise tax to counties to reached agreement on the details of
support county health departments. what information the Jefferson
When Initiative 695 passed in 1999, County Jail will provide Port
that funding evaporated. Townsend regarding inmates housed
That is one issue that still must be there on misdemeanor municipal
resolved. Timmons said Monday that charges.
he will meet with Saddler on Thurs- Past records haven't included such
day to discuss that and the other out- details, leading to a disagreement
standing issue of jail services billing between Port Townsend and Jeffer-
• from previous years. son County regarding how much
In the shortest meeting of the past money the former should be billed.
' J
•
A 8•Wednesday,January 24,2001
Flu vaccine
•
still avOilabie
Jefferson County Health and serious chronic health prob-
Human Services still has flu lems, including asthma.
vaccine available. • persons who are less able
Anyone who wishes to be to fight infection because of
vaccinated to lessen the chance of HIV infection, other immune
catching influenza may come to system disorders, long-term
the department's walk-in immu- treatments with steroids or can-
nization clinics at its office at 615 cer treatment.
Sheridan St. in Port Townsend. • children and teenagers on
• Regular immunization clinics are long-term treatment with aspirin,
1-3 p.m. "Tuesdays, Wednesdays who, if they catch influenza,
and Thursdays throughout January. could develop Reye's syndrome.
Immunizations are $8. No •women who will be in the
insurance other than Medicare second or third trimester of
will be billed. Those who are pregnancy during the flu season
on Medicare should bring their (beyond three and one-half
cards with them. months pregnant).
• Influenza vaccine is indi- • health care providers and
cated for: close friends and familyof
•persons age 65 and older. sons at high-risk per-
for flu, to -
•residents of nursing homes. duce the possibility of spreading
•adults and children,includ- the flu to these persons.
ing pregnant women,who have • anyone wanting to de-
chronic heart, lung or kidney crease their chance of catching
disease, diabetes or other influenza.
•
•
Jefferson ' s
E c a •� � oy . 6.� a .
.,° •� .
n1 c ro N .moi b +.--, 'Cj ..� `� 'o
\`11�// JUl11
i1I11i1H cil
Aealth due E
r.
,ti 2 'o 1 cii o o 3 �,^ 0.'g C v
``ice�J for survey
.D - 0 [ r-, Q. v1 .D 5 ,-C O c.
c c O C'73 y ;. c 70 is E• -o „ r
la) uromEroUt, oo � 51o . o � •w
3 'ET) z c N'z N O O— L 2
O N c .'C% O .�Oa Y ca O O u p 5 -
•j .,� c c ” a a r)-c O .2Ep � '
District reviewed the information -'
•:-, o -,`"`i Q' Q o'e. ° ro a-'"�
Population Thursday for about 40 representa- o b-° 0 o „ a c S ° 7
tives from Jefferson health, social . °0"° E °
.a O 7 y tq .0.,'O al v .,co- O U J
agog' but
by services, education and government G o �' ? ,>,,c > °:x -' n, c
l!1 agencies gathered in Port Hadlock. °z „= c _ E o a' c° ; 73 c ci
The data will finally allow local En ; t �' o"" <!-. c v� 3 4 3 x s
how much policy makers to make informed deci-
sions.
0 0 a ° a 3 e ; 0:v c c
Bions. .c o'z-° ro ° °' o o y 3 t '" t
O •w,cNF+0, .Euw >, c .r-cc - 1 .4
3 o•-•G p > c . ._.c 0 3.a 3 ,... -
PENINSULA
P�L.Wa'rxEss Good data, better decisions -
PENINSULA DAuY NEWS "Good data drives better decisions 0 -c-c • as o c y 0 •J
Local social service organizations and better decisions drive more effec- E ` ti 8 a o'g w ° >. o a 3
tiveprograms," ~
haven't had accurate data about the said Dr. Tom Locke, c +» c -- ; ° o o �s•=
demographics and health issues of public health officer for Jefferson and � ) :N u� ° o o
residents of Jefferson County. Clallam counties. "We
dark have
d make -...s w"°?.,- o b s v 2 a� °•GC o C.-
That will change beginning in �� 0 0 c a -0 cv, 0 cs c > �._ cc 0-
when 600 residents will be impairs the effectiveness. I o o _o o
to provide information onev hing from Hale said the data clearly show U • m_a °-0 ro a.?- ro-`0 3 ,>-, 7
what man in Jefferson County have • •- l' ro o a) o as o-" 2 ro °
domestic violence. tobacco use to y experience: �, a`- �' p c o c ° 3
divined from subjective 0 >, c y a s
The Jefferson County Health The county is aging dramaticallyCli x o °' •>'_ c 3 `
Department has already madelignif with childrn fewer young families bearing .n o o 0 , a o- o--ooo -- U °•it" _
icant progress in weeding through E 0 8 E x ° > ro 0 3
mounds of data to provide a snapshot Inflating house prices also makes �j c o 0 0 [ o c
of county residents. Jefferson County one of the most (� 1 0 ,>ti E 0 0 v0• o c a
Epidemiologist Dr. Chris Hale of expensive places to live,especially for �✓ a .� >-a i~cu o 0
the Universi of Washington the same young families at the low w >,cn a: '-- a o -c
-University gton and the end of thew a scale. Cr) o eD c4 ` on ttol a >,
Bremerton-Kitsap County Health 'J c , c`' 0 3 E,o ''
"You've become an exceedingly old
o c
•_ , - - ..._.«, county,'.' Hale said. "..That._do sn't ro g 0 c—zs c`�'a 0 0
mean there's no' young people:You J 3 E N-c -'U
have two worlds, the young families (�' E > b c v °7,1" D
o._
•.m• , that are increasingly disadvantaged o-r �; >z 0 v. b 3
. i.',., because it's an extraordinarily expen- N .6. n n - ��-c c av
r' �' sive place to live" and an expanding
�' ; o > ; o E
t c: �i e,
1 4.,`,':,•44",spopulation of people 55 and older. n____,..( ;; a o o E� 7 -U
lit v U E a n U a'�
� ?• Jefferson ages
Hale said 20 years ago Jefferson ■ ■ a o c o 4 N y
R ` County had 200 people ages 85 and o o "O rob ,aro ro
' - ,, ; ,, older,while it now has more than 700. w 0.)
U•c> a y,
; ; The county with a 7 percent.rate 0 0 0 c c ° v
,t ; t outstripped Washington state's 3.7 a a. occi o `° �' a x c
, percent growth rate. The two reali- t"'_ I.o ° ^"
• :2• ,t, ,',";•`..:.•;:•••1;•••,!.• .+ ties mean more older people are mov- z .o, °a .c ro 3 x
is.` t ?�r'1 j 1� :t ., ing into the area.The median age has i U° as° a, c o c a) ,,, a o
�.t i, •;•,-i!. ,., steadily grown from 35 years of age in a� c o o o[
• ,+ ...;.•,.. 1980 to 42.4 in 1999. = -0•a4 0 w-I' t' °' a)
• 'pit'91,,,,.r.,1,+ ' +,i "You are now the classic popula- .° c, d.w ° w
04: `i tion in which deaths outstripbirths," Cl) >o �' o•� °= 3 x
E a o � -o>"';.-10
a ti
.iii t i � x �,'`�i she said. "Only countries iWestern � � to
'.__._._ r '.°' .-.:-'" Europe is where you see that kind of
Dr. Chris Hale aging in-migration."
Jefferson "exceedingly old county" TURN TO SURVEY/A2
?b /—a4-o/
City,
settle spat
over fees
$ 160 ,000 for $50,000 over the next two years for a
county study to identify methods for
alleviating jail overcrowding. That
jail services will be in lieu of payments under-
billed in the first half of last year.
"This is an imperfect solution,
in dispute but it reflects that they're getting
equity and we're getting return for
our contribution," Timmons said.
BY PHu.ip L. WATNESS The agreement comes after sev-
PENINSULA DAILY NEWS eral months of' wrangling over the
•
jail billing.
Jefferson County won't seek pay "We found mutual ways to satisfy
ment of past jail fees from Port both our needs without getting
Townsend City Hall after all. stuck on the contentious issues,"
County Administrator Charles Saddler said.
Saddler and City Manager David Timmons agreed to contribute
Timmons worked out an agreement $40,000 for health services, half of
during a two-hour session Friday. the amount Saddler proposed for the
The county had sought payment regional services contract between
• for an estimated $160,000 that was the governments.
n't billed to Port Townsend last year.
Saddler discovered the accounting Other county services
mistake in November and deter-
mined that the county might have Timmons said he is still wary of
underbilled the city since 1998. setting a precedent for paying for
But Timmons and Saddler agreed Health Department services, but the
that Port Townsend will identify contribution will at least resolve the
• municipal jobs that could be filled by issue for this year.
developmentally disabled persons in Timmons and Saddler will also
exchange for the county forgiving continue discussions about Port
jail fees for 1998 and 1999. Jail Ser- Townsend contracting with Jeffer-
vices Administrator Carla Schuck son County for building inspector
won't have to do a thorough review and fire marshal services. That
the incarceration records to set the would lessen the financial burden of
amount underbilled. each government in individually
Port Townsend will also chip in providing those services.
• • ,
-I
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