The URL can be used to link to this page

Home My WebLink About2006-March File Copy • Jefferson County Board-of HeaCtFt .Agenda • .Minutes March 16, 2006 • • JEFFERSON COUNTY BOARD OF HEALTH Thursday, March 16,2006 Main Conference Room Jefferson County Public Health 2:30—4:30 PM AGENDA I. Approval of Agenda II. Approval of Minutes of February 16,2006 Board of Health Meeting III. Public Comments IV. Old Business and Informational Items 1. Solid Waste/Junk Cars Public Meeting Report 2. Immunization Program Site Visit Report 3. Region 2 Public Health Newsletter—Winter 2006 4. Swamp Nurse 5. 2005 Community Health Performance Measures V. New Business • 1. Methamphetamine Abuse—A Public Health Approach 2. Tobacco—Next Steps 3. Joint Board Assessment Project Proposal 4. Legislative Session Summary 5. Substance Abuse Advisory Board Reappointments VI. Activity Update VII. Agenda Planning VIII. Next Scheduled Meeting: April 20,2006 2:30PM—4:30 PM Main Conference Room Jefferson County Public Health • • JEFFERSON COUNTY BOARD OF HEALTH MINUTES Thursday, February 16, 2006 Board Members: Staff Members: David Sullivan, Chairman— County Commissioner District#2 Jean Baldwin, Public Health Services Director Patrick M. Rodgers, Vice Chairman—Couny Commissioner Julia Dans kin,Nursing Services Director District#3 Thomas Locke,MD, Health Officer Phil Johnson— County Commissioner District#1 Mike McNickle, Environmental Health&Natural Jill Buhler—Hospital Commissioner District#2 Resources Director Geoff Masci—Port Townsend Ciy Council Sheila Westerman—Citizen at Large(City) Roberta Frissell—Citizen at Large (Couny) Meeting called to order at 2:30 pm by Chair David Sullivan in the conference room of Jefferson County Public Health Department. Board Member's Masci, Westerman, and Buhler were excused; all other members were present. There was a quorum. APPROVAL OF AGENDA • Motion was made to approve the agenda by Board Member Frissell and seconded by Board Member Johnson. A vote was taken and passed unanimously. APPROVAL OF MINUTES Motion was made to approve the Minutes as corrected, by Board Member Frissell. Board Member Johnson seconded the motion. A vote was taken and passed unanimously. PUBLIC COMMENTS Chair Sullivan called on the public for comments. A request was made for the Board to make substance abuse prevention treatment a priority. The Health of Jefferson County report that came out in 2003 has been a valuable resource. There is new community health information that has not yet been analyzed and released. OLD BUSINESS Hood Canal Project Update Mike McNickle explained that the letter included in the packet was hand delivered to • Representative Kessler. House Bill 3039 was taken out of consideration by Representative Eikmeyer. A letter explaining why is included in the packet. In its place House Bill 3287 was introduced and is responsive to requests for more scientific study of • sources of Hood Canal nitrogen loading and the impact on on-site sewage systems on the Canal. It was recommended that the BOH write a letter in support of 3287. Three public meetings were held about Hood Canal and the public was interested in the information. Mike explained to the public why we are conducting the water quality survey and what we hope to achieve. Mr. McNickle attended the Hood Canal Coordinating Council meeting. The Dosewallip's State Park, Twanoh State Park, and the Michigan Creek Correction Center are all going to install the Membrane Bio Reactor(MBR) system. As the Health Department we would have a unique ability to require samplings of these systems. Board Member Rodgers requested a motion to draft a letter in support of House Bill 3287. Board Member Johnson seconded the motion. After further discussion the motion was amended to have Dr. Locke draft the letter. The vote passed unanimously. NEW BUSINESS Jefferson County Clean Indoor Air Regulation Kellie Ragan explained that we are in Phase Two of the process. She reported that we have received a total of 15 complaints about establishments that are in potential violation of the smoking ban. Our process is to educate businesses about the requirements of the new law and their responsibility to abide by it. We are responding to the complaints that Ill we receive and are not doing spot checks. Mike McNickle reported that as part of this process we notified all the food establishments through a newsletter that reiterated the changes made to air quality statutes by I-901 and gave the date for a public meeting. The question was asked whether a variance could be granted to allow smoking in a bar. Mr. McNickle responded that this is now prohibited by state law and local health departments have no authority to grant variances. Mr. Sullivan asked about the huts that some establishments are placing 25 feet away. Mr. McNickle reported that the state law says smoke can not enter the building through windows and defines a 25 foot setback as the minimum distance between smoking areas and building entrances. Business owners can request consideration of distances less than 25 feet but must prove that this reduced setback will still prevent smoke exposure in public places and places of employment. Public Hearing Chair Sullivan opened the public hearing at 2:55 p.m. on the Clean Indoor Air Regulation. Public Comment- one community member spoke in support of the proposed regulation and the need for strict standards protecting the public. Chair Sullivan closed the public hearing at 2:56 pm Board Discussion - Possible Action Board Member Frissell pointed out necessary corrections. IIII • Discussion followed concerning enforcing the law consistently, for example, in clubs that are occasionally, but not always, open to the public. Mr. McNickle stressed that many outstanding questions will be answered in the up coming Attorney General's opinion. Board Member Frissell made a motion to approve the "Jefferson County Clean Indoor Air Regulation Ordinance." Board Member Johnson seconded the motion. A vote was taken and passed unanimously. Proposed Fee Schedule for Indoor Air Regulation Mike McNickle reported that in order to do the required work we need to have these fees in place as they are not a part of the regular fee schedule. The fees are generated on an hourly base to cover 100% of costs. Public Hearing Chair Sullivan opened the public hearing at 3:09 p.m. on the Clean Indoor Air Regulation Enforcement Fee Schedule. No comments by the public. Chair Sullivan closed the public hearing at 3:09 pm Board Discussion—Possible Action Board Member Rodgers made a motion to add the fees to the existing schedule for the rebuttal application. Board Member Johnson seconded the motion. A vote was taken • and passed unanimously. Mike McNickle requested that Sara Murphy be added to the list of enforcement officers. This will be done administratively. Legislative Session Update The Senate Bill 6366 passed unanimously. More good news for our Department is that the Coordinating Prevention Grant(CPG) for Solid Waste Education and Enforcement grant will provide an additional $20,000 annually above the amount the current CPG grant allows. Dr. Locke updated the Board on the pandemic influenza preparedness bill. Originally $20 million was targeted for this effort. He was told that the Senate sponsor advocating this full funding but there is resistance in the House. Jean Baldwin stated the Methamphetamine Omnibus Bill is coming out of the Governor's and Attorney General's office. There may be the possibility that counties who have increased their taxation for mental health and substance abuse treatment have a bonus for some methamphetamine prevention money. The Bill is under consideration by the Legislature. Chair Sullivan stated the Senate Bill 6793 that helps correct some of the problems with mental health are still being resolved. Another budget issue is the Department of Ecology matching funds for Jefferson County and Skagit County for ongoing United • States Geological Survey (USGS) work. This funding is anticipated for the next two years and will help with watershed planning. Pandemic Influenza Preparedness Planning Dr. Locke stated being prepared for a severe influenza pandemic is a complex task. It is a major challenge to the health care system, schools, law enforcement agencies, grocery stores, gas stations and other businesses. These and other essential services will need to be maintained for the 3 to 6 month period that the pandemic is causing high rates of job absenteeism. A meeting with the Olympic Education Services District(OESD) with school superintendents from Clallam, Jefferson, Kitsap, and N. Mason to discuss pandemic influenza planning efforts is scheduled for February 24. Drs. Lindquist and Locke will be giving the presentation in Bremerton. In the event of an influenza pandemic it is highly likely that schools would need to be closed for 3 months or longer to slow down the spread of the virus. The goal would be to slow down the spread of the virus, allowing the health care system more time to manage the surge of patients requiring care. If we are prepared for a health emergency of this scale we will be well prepared for most other natural disaster that could happen. The general public has to know that it influenza pandemics are inevitable and that pre-pandemic planning and organization can significantly improve our response capabilities. The more people know what to do and are prepared to do it, the less likely they are to panic. Agenda item added • Jean Baldwin requested adding a new item regarding the Substance Advisory Abuse Board nominees. Four candidates were interviewed. Board Member Rodgers nominated John Barth and Dean Roberston to be appointed as members of Substance Abuse Advisory Board. Board Member Frissell seconded the motion. The vote was passed unanimously. Activity Update/Agenda Planning A public meeting about solid waste enforcement and junk cars will be held at the WSU Extension on February 23, 2006 from 5:00 to 7:00 p.m. Board Member Rodgers has requested for the solid waste ordinance to have the same definitions as state statutes. Jean Baldwin is starting an internal planning process with staff, managers, and BOH members that would take place in April or May. This would be a four hour discussion looking at services and the structures of the department. Chair Sullivan adjourned the meeting at 3:58 p.m. Next Board of Health meeting is March 16, 2006. • • JEFERSSON COUNTY BOARD OF HEALTH Excused David Sullivan, Chairman Jill Buhler, Member Excused Patrick M. Rodgers, Vice Chair Sheila Westerman, Member Roberta Frissell, Member Phil Johnson, Member Excused Geoff Masci, Member • • • Board of 3-(ealth 0C Business .agenda Item # IV., 2 • Immunization Program Site 'Visit Report Nlarch 16, 2006 • f STAT E• (jig 406 1889'' • STATE OF WASHINGTON DEPARTMENT OF HEALTH IMMUNIZATION PROGRAM PO Box 47843.Olympia, Washington 98504-7843 (360)236-3595• FAX(360)236-3590• TDD Relay Service: 1-800-833-6388 December 16, 2005 11 C fl_ r` �lil ir Jane Kurata, PHN i! DEC 21 Jefferson County Health and Human Services 615 Sheridan Street } Port Townsend, WA 98368 i& er;c; c,,,,-- 1 Feelth r ----n Services Dear Jane, Thank you for taking the time to discuss Jefferson County's Immunization Program with me. Attached is a summary of my visit with you and Lisa McKenzie on December 12th, 2005. 110 Please feel free to contact me at (360) 236-3579 or garv.gant@doh.wa.gov if I can be of assistance. Sincerely, ca7617 c2P:44-- Gary D. Gant, MPH Quality Assurance Coordinator Cc: Janna Bardi, Program Manager Karen Arbogast, Clinical and QA Unit Manager • Apt Ska O �a Washington State Department of Health t11,\Hel th Immunization Program Site Visit Summary Report IMUNIZE It All Ages LHJ: JEFFERSON COUNTY HEALTH AND HUMAN SERVICES Review Date: December 12, 2005 SITE:PORT TOWNSEND,WA DOH Reviewer: Gary Gant,MPH Quality Assurance Coordinator LHJ Staff Participating: Jane Kurata, PHN and Lisa McKenzie, RN, MPH Procedures/Systems Reviewed: 1) Standards For Pediatric Immunization Practices 2) Consolidated Contract Requirements 3) Vaccine for Children Requirements Program Components: • Program Administration Disease Surveillance. Assessment Activities Provider Quality Assurance Registry/Record Systems Consumer Information Service Delivery Vaccine Management Summary: Program Administration ■ All enrolled providers receive a comprehensive immunization policy/procedure manual which they are asked to review. • Current signed/dated standing orders. • The health department charges a vaccine administration fee of$5.00 to non-Medicaid children; fee is waived if a non-Medicaid VFC eligible patient is unable to pay. • The health department charges a maximum office visit fee of$20.00 if a child comes in for immunizations only. This is a sliding fee based on parental/guardian income. Disease Surveillance ■ Denis Langlois and Lisa McKenzie oversee communicable disease investigations, tracking, and • triage. • Report not available for Perinatal Hepatitis B babies reported this year(available late December). Assessment Activities • Have completed all required VFC Provider site visits (1 required) for the year. • The clinic staff screens patients for VFC eligibility at every immunization visit and during benchmarking. Provider Quality Assurance • • Five (5) VFC enrolled providers in Jefferson County. • All VIS forms utilized and distributed are current. • . Staff from Jefferson County Health and Human Services provides ongoing immunization training to providers during educational visits which include vaccine storage and handling and vaccine administration techniques. • Jefferson County collaborates with Clallam and Kitsap health departments on a regular basis in regards to continuing education on vaccine management protocols and best practices. Registry/Record Systems • Using KIPHS computer system. • Participates and has exchanged immunization registry information from health department. Consumer Information • Provides VIS to each parent/guardian for each vaccine administered. • The vaccine administration fee is waived if parent/guardian cannot pay. • Bilingual English/Spanish staff member at health department. • A Lifetime Immunization Record is given to the parent/guardian following the administration of vaccine. • Other brochures and handouts given to parents/guardians include Parent's Guide to Childhood Immunizations and Plain Talk. • The health department sends a reminder postcard to the patient for vaccinations that are due. Vaccine Management 1111 • Vaccine is picked up from health department, except for the clinic in Quilcene which picks up its vaccine from Jefferson Healthcare which is the local hospital located directly across the street from the LHJ. • There has never been an issue with providers not turning in accountability forms; therefore, vaccine has always been distributed on a normal basis to providers in the county. • There is a manual that contains written procedures for vaccine management,retrieval, storage, and transportation and a list of all responsible parties. • Procedures are clearly outlined and readily accessible to staff. • Physical inventory of stored VFC vaccine is conducted at a minimum of once a month. VFC vaccines are ordered on a monthly basis. • Physical review of refrigerator and freezer showed that temperatures were in acceptable range. • All vaccine was properly labeled(private vs. state), rotated according to expiration date, and none were expired which is indicative of good immunization management practices. • Bottles of water were placed in the refrigerator and ice packs in the freezer to maintain the internal temperatures of the storage area. All vaccines were stored in the body of the refrigerator. • "DO NOT DISCONNECT" stickers were placed on refrigerator/freezer outlets and on the circuit breaker. • A new back-up generator has been installed at the health department. In case of complete power failure, staff has been trained and instructed to move all vaccine to the freezer at Jefferson Healthcare Pharmacy which is the hospital located directly across the street. • r Comments: • ✓ Jefferson County Health and Human Services Immunization Program is in full compliance with State Immunization Program requirements. ✓ The Jefferson County health department immunization staff is experienced,knowledgeable, and conscientious in every program component that was assessed. ✓ LHJ program staff provides continuous ongoing monitoring and education to providers in their county. ✓ No follow-up VFC Review Visit is needed for Jefferson County Health and Human Services Immunization Program. • • • • Board of 3-Cealth OCdBusiness .agenda Item # IV., 3 • Region 2 Public 3-fealth Newsletter 'Winter 2006 .March 16, 2006 • Winter 2006 • III ........ ,..,-,....,,---- 4,„,:„,,, Region 2 ,, d�tisKfiL_______,-----, ublic Health fothe Peninsulas ninsulas When business is not usual Imagine if your practice had to of essential functions? Make sure , M _ function with 25 to 30 percent no individual is indispensable. IR of your staff sick or caring for sick family members. Do you ✓Operations requirements Is is it a or the Flu? have a your critical inventory adequate? businessplan Develop a Cold Ru Not since 1 918 have we had to checklist of that deal with a major health ates disaster in the Pacific what you can't anticipates function usually mild (100-102 F; all hazards Northwest. Have we been occasionally including good?Or have we been lucky? without and _ghat, fire, keep it in pungchldren); earthquake and an influenza stock. lasts 300 4 days pandemic?Have you /Alternative work sites What Headache Occasionally Common anticipated the impacts services can your employees do specific to your business—the off site?Establish policies and General Slight LJ rat ollen IIIbusiness of health care? tools to help them work at home if laches Pacts severepossible. Fatigue, Sometimes IJsuat can last 2 Steps your business Weakness to3weeks can take NOW ` Services online or by phone What services can your employees &nmK Never Usuatatthe ✓Contingency plans Would deliver online or over the phone? 6dtaustlon begIrring o your emergency plan work for Start phone and online nurse/ the Mess an influenza pandemic as well doctor consulting now. as for any other hazard? Study Nose Common Samevmes Develop a plan that will. /Employee awareness Do your ✓ employees know about your Sneezing t m Saedrnes Core business activities emergency plans?Are they What activities must happen in informed about pandemic flu? Sone Throat Common Sometimes your clinic in order to serve Educate them now! patients?Identify what you Commort can absolutely can't do without. /Leave policies What about your Dimomfort, moderate benome e sick leave and family leaves hacking /Essential services How will policies?Update them now. Your cough you handle interruptions of employees may be too concerned water,power,and sanitation? about lost wages to stay home Preverkbn ~your Washyour Identif back-upsolutions to hands often harsh Identify when they are sick. Annual keep your staff and patients vacdnadon. safe. For more information about business preparation go to these websites Treatment /Cross training Can your www.cdc.gov/flu/pandemic/ cam. Cate. III employees perform a variety checklists.htm; www.healthyamericans.org/ 11r1Hrlral drugs The Region 2 Public Health Emergency&Preparedness Program(PHEPR)endeavors,through this newsletter,to keep you,our health care providers in Clallam, Jefferson,and Kitsap Counties,informed about Public Health issues that affect you and the patients you serve.If you have questions,comments or need more information about items in this newsletter,please contact the editor,Ruth Westergaard,by phone at(360)337-5752,email wester@health.co.kitsap.wa.us or at 345 Sixth Street,Suite 300,Bremerton,WA 98337.Winter 2006 edition published 2/15/06. Winter 2006-Page 2 17* Region 2 s,S 7 • Communicable Disease 1 yet`° °°x` Surveillance Data o1y�� /' 0.° s`-�s`S '.5 <4°°ZS° s�S ��x ��,oe December 2005 °c0 xd•° �e `2$a� e9 e*.o•e �w3 `x(C' W to 5 C, C7 4` ge .`0 C,r V Kitsap Current Quarter(Oct-Dec) 1 9 2 0 0 0 8 1 159 19 2005 Cases 6 21 28 11 0 1 48 6 608 76 2004 Cases 4 14 24 11 3 2 8 2 672 70 *Incidence Rate per 100,000 residents 2.1 7.3 10.8 4.6 ** ** 11.7 1.7 266.7 30.4 (2004-05) National Goal(cases per 100,000) 1.0 13.2 N/A 13.2 N/A 13.2 13.2 1.0 170.0 19.0 Jefferson Current Quarter(Oct-Dec) 0 1 4 7 0 0 3 1 6 0 2005 Cases 0 2 9 7 0 0 4 1 57 2 2004 Cases 0 2 2 2 0 0 19 0 37 3 *Incidence Rate per 100,000 residents 0.0 ** 20.1 16.5 0.0 0.0 42.1 ** 172.2 9.2 (2004-05) National Goal(cases per 100,000) 1.0 13.2 N/A 13.2 N/A 13.2 13.2 1.0 170.0 19.0 Clallam Current Quarter(Oct-Dec) 1 1 2 2 1 0 0 0 28 3 2005 Cases 1 2 7 4 3 ** 2 0 135 18 • 2004 Cases 0 5 2 8 0 0 2 0 151 8 *Incidence Rate per 100,000 residents ** 5.3 6.8 9.0 ** ** ** 0.0 215.5 19.6 (2004-05) National Goal(cases per 100,000) 1.0 13.2 N/A 13.2 N/A 13.2 13.2 1.0 170.0 19.0 *2004 population:Kitsap (239,500),Jefferson (27,000),Clallam(65,900) *2005 population: Kitsap (240,400),Jefferson(27,600),Clallam (66,800) **Incidence rates not calculated for<5 cases. Data source: Public Health Issues Management System(PHIMS);Washington State Department of Health Monthly Morbidity Data Region 2 Public Health Kitsap County Health District 345 Sixth Street,Suite 300 Bremerton,WA 98337 072 -1/1-Thanks to Harrison Medical Center, ,r respiratory etiquette kits 0 are now available by calling "'"""SI* the Region 2 Public Health at a` (360)337-5752 or (360)337- � t' 5254. We encourage you to offer the kits to patients s with a cough illness. • The kits include a mask, tissues and hand sanitizer gel. • Board of Health OCcI Business .Agenda Item # 1"V., 4 Swamp Nurse • Nlarch 16, 2006 • a• A REPORTER AT LARGE -SWAMP NURSE What's the best hope for thefirst child ofa poor mother? BY KATHERINE BOO Tn the swamps of Louisiana, late au- her impending delivery. She ended up nurses'preposterously difficult assign- tumn marks the end of the hurricane with both the Medicaid and Luwana. ment.In regular visits until a baby is two and the sugarcane seasons—a time for As a rule, Cajun families don't wel- years old,they try to address,simultane- removing plywood from windows and come government intervention, espe- ously,the continual crises of poverty and burning residues of harvest in the fields. cially when it occurs inside their homes, the class-transcendinganxietyof new Then begins the season of crayfish and, involves their infants, and means the maternity:this creaturs inexplicable to nine months having passed since the presence of a dark-skinned person. To me. Despite its ambition, the program revelry of Mardi Gras,a season of new- some parents,Alexis among them,Lu- is rooted in a pessimistic view of the fu- born Cajuns.Among the yield of infants wana was a spy in the house of mater- ture that awaits an American child born in the autumn of 2004 was a boy named nity,and so she now and again had to lie poor—a sense that the schools,day-care Daigan James Plaisance Theriot, and, in wait for reluctant beneficiaries. centers, and other institutions available on the morning of Daigan's thirtieth Alexis maneuvered herself and Dai- to him may do little to nurture his tal- day of life,he was seated next to a bag of gan past the toilets, from which cacti ents. Shrewder, then, to insulate him raw chickens in the back of an Oldsmo- had started to grow, and pushed open by an exercise of uncommon intrusion: bile Cutlass. His mother, a teen-ager the front door with her hip.She entered building for him,inside his home,a bet- named Alexis, was in front, squeezed a combined living room,dining room, ter parent. between her younger sister and her kitchen, laundry, and storage facility Thus, no matter how chaotic the sister's latest beau, a heavily tattooed that was home to five people, a dying scene—no matter that Alexis's sister man who had just been released from cockatoo named Tweety, and multi- had taken a break from hacking chicken maximum-security prison.The car came tudes of flat silver bugs. Luwana fol- parts by the kitchen sink in order to sat- down a road that begins with a bayou lowed Alexis, Daigan, little sister, and isfy the ex-inmate's sexual needs in the and ends in dented trailers,and stopped boyfriend inside. That morning, feel- next room—Luwana's first task is to cre- at a small wooden house. ing the onset of flu symptoms,Luwana ate an aura of momentousness around When Alexis's sister leaned into the had decided to avoid contact with the the new baby. As she moves through a back seat to fetch the poultry,the young infants she called her "little darlings." household,giving advice about routine- man, grinning, slipped a hand down In the field,though,calculations of risk building, breast-feeding, and storing the back of her jeans. Alexis stared at were subject to change. She dropped shotguns out ofreach,she attempts to win the couple for a moment, then pushed her satchel, slathered het hands with over not just a young mother but a typ- them aside to pick up Daigan. Alexis's Purell disinfectant, and reached out. ically unwieldy cast of supporting play- hair was long and streaked with pink, Alexis handed over Daigan and wrapped ers,from the baby's father to the great- and her face was a knot of frustration. her arms tightly around herself."So,tell grandmother getting high in a tent be- As Daigan began to cry,she crossed the me," the nurse began with practiced hind the house. What Luwana tells yard denouncing in absentia his father, tranquillity as she scanned a body in a each family may seem,on the face of it, whom she called Big Head: "If I see playsuit for damage. "Not the happiest fiction:that in this infant enormous pos- him, I will hurt him—Big Head ask- dayyour life?"of sibilities inhere.But such fictions can be ing for it now."When she reached the strategic,especially in cultures in which porch, which was crammed with auto lexis and nineteen other girls in the act of becoming a mother is honored parts and porcelain toilets,she fell silent, Luwana's caseload call her their far more than what the mother subse- then forced a smile. Amid the fixtures "nurse-visitor,"a term whose genteel ring quently does for her child. stood a tall black nurse. seldom comports with the details of her Alexis,who wore a tight red T-shirt, The nurse, Luwana Marts, holds job.She is one of eight nurses,all moth- would have been striking even without one of the stranger jobs in the Louisiana ers themselves,who work the parishes the pink improvements she'd made to state bureaucracy: she is a professional of Terrebonne and Lafourche,persuad- her caramel-colored hair,and since fifth • nurturer in a program called the Nurse- ing poor first-time mothers-to-be to ac- grade,when she'd lost interest in school- Family Partnership,which attempts to cept assistance.The Nurse-Family Part- work, most of her opportunities had improve the prospects of destitute ba- nership model is currently being tried in come from men who'd taken note of her bies.A few months earlier,Alexis,eigh- Louisiana and nineteen other states on looks. Lately, she'd been wishing that teen and pregnant,had arrived at a local the basis of promising preliminary re- she'd had a longer, simpler childhood, 6 government office seeking Medicaid for sults—results achieved in the face of the but, in the childhood that she had, full 54 THE NEW YORKER,FEBRUARY 6,2006 I , N. hips and breasts and lips had served her "No way!"Luwana said."Keep your Her state job pays thirty-five thousand well.They served her less well now.To legs dosed: embed that in your brain. dollars a year, half of what she'd make in Luwana's questions about Daigan's feed- Tell him to keep his hands to himself the emergency room of a private hospi- ing schedule, she responded monosyl- And if you can't stand up for yourself, tal."Oh,I have my material longings— labirally while studying her manicured stand up for Daigan.You've got a lot of every so often 'never throwhaa p tyshpaid. fingers.She'd received the manicure,plus work ahead,giving him what he needs. for the house I'll some blue balloons and a.chocolate-chip Look around,Alexis.You need another "But quite a few of us nurses are work- cake, on what she called the"heartful" baby in this picture?" ing,you could say,in the context of our occasion of Daigan's birth.The days "No," Alexis said dully. Then she own memories." preceding his arrival had not been happy. brightened:"Miss Luwana,maybe you "How he doing?"Alexis asked uneas- Alexis lived with her mother and father, can write me an excuse note, like for ily,as Luwana's fingers explored Daigan's a grocery clerk and a construction worker gym?" soft spot."You're the mama," Luwana re- who were in constant conflict.When Alexis was eight months pregnant, the T uwana s church friends smiled know- sponded."You tell me." fights grew so fierce that she fled the L/ingly when they learned that she "He's got a big head like his father," household altogether.Her recent return worked for the state.They pictured cubi- Alexis said under her breath.Then she testified less to domestic reconciliation des,potted plants,and cushy hours.She rallied: "He's not as cranky as he was. than to the impact that a squalling baby seldom corrected this impression, nor And one thing I learned already is how has on the sleepover invitations a girl did she say that some mornings,driving he cries different when he's hungry than receives. her six-year-old Maxima toward some when he's wet." Luwana bestowed on As Luwana tried to draw Alexis out, difficult case,she wanted to turn north Alexis a dazzling smile that she had thus the phone rang,and Alexis covered her and spend the rest of her working life far reserved for Daigan. "Making that ears. "I'm guessing this is Daigan's dad in more high-minded quarters.But Lu- distinction is important,"she said."You're who keeps on calling," Luwana said, wana's efforts were invigorated by the listening to him,and in his own way he's after the third round of unanswered fact that twenty years ago she was her- explaining what he needs. Pretty soon rings.Alexis met her eyes for an instant, self a poor,pregnant teen-ager in these now hell be making other sounds,and then burst into tears."O.K., now," the swamps. "I know now that there were when he does you'll want to make that nurse said, "spell it out for Miss Lu- government programs on the books de- noise right back.He'll babble,and then wana."Between sniffles,the proximate signed to help girls in my situation,but you'll talk to him, and that's how you'll cause of distress became dear.Daigan's back then,especially if you were black, develop his language.Now,what y dli father, a sturdy twenty-six-year-old you didn't hear about them," she said. may also find,around five to eightwee , named James,worked on a tugboat on She is now thirty-eight,with two sons is that he'll be crying even more—it's the Mississippi River.That weekend, and a husband who has spent most of his a normal part of his development,but he would be returning to shore and ex- working life in a mill that makes paper it can also stress out the mom, so well pected to have sex with Alexis, though cups.It took her fourteen years,between want tto b prepared form..AndThif inn she was not healed from childbirth,nor child-rearing and stints as a nurse's aide, thing keeping Y was she using contraception. to earn a bachelor's degree in nursing. just can't keep calm—if you find yourself getting all worked up and frustrated— ! well,then what?" "Put him down?So I dont hurt him, shake him,make him brain-dead?" "Put him down and . . . ?" Luwana drilled her girls hard on this particular I AK11,-. "112---err► point. : inx "Call someone who isn't upset?Let Alt do � 11 _ i MI— the baby be,and get help." I ( °°� � Luwana turned to Daigan and clapped. i.; t � `, y i s. % C ' "See,your mama is getting it," she said, «f � w� 1 using the high-frequency tones that ba- Pe - 1 bies hear best."She's surely going to figure , • � ( you out" i py There was a trick that Luwana relied -.. onto stave off dejection:imagining how A _- dr of A ill a given scene would unfold if she weren't 4 �' in it.In Alexis's case—one that,in to � y of degree of difficulty,fell roughly in NI '�* . . middle of her caseload—she knew that —____— c 4,-"N",ecslight improvements had already been "I'd never go out with him,but he does give great cubicle." made. At Luwana's urging,Alexis had • stopped drinking and smoking when she not. The nurse-visiting program aims, Dionne,picture books, a raft of devel- was pregnant and had kept her prenatal in a fashion, at equalization. The ter- opmental checklists,and, above all,her appointments. So she wasn't incapable ritory that Luwana and her colleagues trade's bleak knowledge: babies can get of changing her life on Daigan's behalf; cover begins an hour's drive southwest used to almost anything—as many of • the odds were just long, of New Orleans,down fog-prone high- those babies'mothers ha Sitting cross-legged on the floor now, ways lined with cypress trees which lead d Luwana sang"Clementine"and made to the Gulf of Mexico. On the shoul faces at Daigan,and for a moment Alexis ders,turkey vultures pause,flicking mud 1 ram m began ' Partnership enty-eighf pro ears studied this demonstration of engage- from their wings.Mississippi River sedi- ago athe sobsession of deve omens ment with her child. But then her gaze ment shaped this marshy delta,to which tal psychologist named David Olds.He drifted over to her sister and the ex-con, eighteenth-century French Acadians, is fifty-seven years old,with clear blue who had emerged from the bedroom to expelled by the British from Nova Scotia, eyes and a tendency to fidget not unlike chop the rest of the chicken.The young laid a claim not hotly contested.The ter- that of Luwana's adolescent mothers. man, whose tattoos included white- rain now occupied by the exiles'descen- He grew up in a working-class house- supremacist ones,put on mirrored sun- dants is muggy,heavily wooded,and vis- hold and as a young man taught in an glasses for this task,a fashion choice that ited so often byhurricanes that Katrina, inner-city day-care center, an expe- made Alexis giggle. Luwana's primary which made landfall near here, failed rience that led him to suspect that by subject that day was infant attachment, to register as a main event. Residents age four or five some children are al- a topic she tailored to fit Alexis's limited have another,steadier battle with nature, ready gravely damaged.In the nineteen- aa attention span."A funny thing about the because they've built their lives on one seventies,after earning at C axe murderers,"she said casually. "Usu- of the fastest-sinking landmasses on nell under the late child psYgiycholo ist st ally something missing in the love link" earth. began Bronfenbrenner, he began work- And,indeed,axe-murdering seemed to The social demographics are al- ing with colleagues to translate this grim ,...:--i.. ..:4register with both Alexis and the former most as fragile. Louisiana literacy rates view into an elaborate scheme of pre- prisoner, who set down his knife and are among the nation's lowest, infant- vention.At the time, scientific knowl- came over."I need to hear, too—mines mortality and child-poverates— is horrible,"he said."We whup him but per cent of all children are poor—are the importance oabout early brain child's fir t tors z since he turned two he don't do noth- among the very highest,and almost half of learning was more limited than it is ing we say,probably'cause his mama on of allbirhs are to single mothers. His- now.But for Olds,who has one biolog- drugs and sleeping around and getting torically, the swamp region's topogra- ical child and two adopted children,in- k locked up—well,she's a whore." py " t "You hit a two-year-old?" Luwana but drawbridges from thoroughfares have thats the rescue much as effort shoulddence suggested n be- asked, her eyes narrowing. "You teach been erected in recent years, and cane fore birth,sand ufold in the sett ng him how to fight and are surprised when fields now give way to Wal-Marts.Still, where an infant would spend most of he turns around, starts fighting you?" idiosyncratic child-re She then fixed her stare on Alexis,who a baby will become csg bpad if held low-income eliefs endure: his time. syoun for hwoman miat sort of ght trust a began examining the brown linoleum by a menstruating woman; formula is inside her home, he and his colleagues floor. healthier than breast milk; giving an settled on nurses, who in poor c - "The love link,"Luwana began again. infant a haircut before his first birth- munities have high status and medical Now the room was still. "It's a cycle. day will stunt his growth and hurt his expertise that man re nant worn When there's no safe base for the baby— brain. Y P g en t when you're not meeting his basic needs, The cases that Luwana and her twant est ns978,Olds used a federal grant t satisfying his hunger, keeping him out fellow-nurses take typically begin with ically depressed, mostlyea in Elmira, white com- of harm's way—there will be no trust, a referral from a public-health or pre- munity in New York's Southern Tier, no foundation for love.And that's when natal clinic: a form indicating the age which had the highest rates of child you might just get the axe murderer, and address of an expectant mother abuse and neglect in the state. Maybe sometimes we have a baby and and the baby's due date. Occasionally, expect that baby to comfort us?Well, a nurse shows up at the given address alls,Swhicome this isn't,"policymakers' said Olds cure- `,"-7., who sorry, it works the other way around. to find a mother-to-be converting Su- continues to study his protocol's effects It's on you now to comfort him,earn his dafed to methamphetamine on a hot as the director of the Prevention Re- trust,because that's how Daigan is going plate. Other times, a pregnant girl's fa- search Center for Family.and Child to learn how to love." ther is hostile because he's the probable Health, at the University of Colorado, father of his daughter's child. But the in Denver. "We keep refining how we Infant-development strategies, like nurse's typical commission is to work do this as the nurses report back on their • p other forms of social capital, are withwhat she finds.And while Luwana- experiences, because there's still a lot erversely distributed in America—fe- believes that some tishized in places where babies are fun- are instinctual,what he teachepects of s ishmore best to erinthatwe don'smothers whoknow—fornstance,are batte ew d damentally secure and likely to prosper, like applied science.Her tools include a or mentally ill."Nonetheless, when he undervalued in places where babies are polystyrene demonstration baby named conducted random-assignment evalua- THE NEW YORKER,FEBRUARY 6,2006 57 _ tions about the long-term outcomes in _ �_ Elmira,Olds decided to recalculate his data using seven different evaluation - methodologies,grasping that such a test might undercut his life's work He lad r6 - `' -- reported that some of the original fin 71.1..�wit ih �� ings—for instance,those about Elmira _ i,' 11 11' < ;, teen-agers drinking and running away 7 less than their counterparts—weren't �I �'' / �} E ,�, � % holdingupunder a preliminary_ �° �, _ ., 4' _ "" /// anal- ysis. He was so dismayed by these re '''" UO �� F� sults that he seemed oblivious of the 1 I E I', \ �?_ �;,.' , , ; /,i fact that other evidence of the improved � ,j. ' _ d \ / `�j I1 futures of nurse-visited children and / lr; �� l ��— their mothers was now about as solid as A /7 "l.;. s j findings can be when the subject is social — — , '�'� Sof� 1).-friti:.'-'1 d '_'`,�� lrpolicys impact on human behavior. VIL I" ��_ Ti-.e nurse-visitor approach makes = _ �►t �� , some liberals uneasy,because they fear `-� st PR t�SS that its focus on good parenting will un- "Did we mention that we spent last summer in Maine?" dermine the fight for decent schools, " quality day care,and other institutional supports for poor children.Libertarians recoil at a government-funded program that meddles in private lives,and child- tions (among the most strenuous tests the children aided by the nurses nerd re- by welfare advocs atesint.haveIn beir view,en frustrated rae d of a social program's effect) to gauge quired fewer expensive social how the Elmira mothers and children such as foster care and hospitalization. fi allvisiting pproven"haapaproach like bipartisan program, faring at the completion of the program,he found more improvement he early optimism surrounding pro- support and been widely implemen than he had expected.One of his chief grams meant to help poor children years ago, if its creator had more e concerns had been child abuse, and it is often dispelled by the rigorous assess- phatically promoted it. turned out that children whose mothers ments that come later. Children Od's cautiousnessf personal isfabased not but just had finished the nurse-visiting program make startling intellectual andfinon a s n were far less likely to be abused or in- tional gains in the hothouse of a model what he considers the faltering of Head jured than their counterparts in a con- program—say,a preschool run by skilled Start in the late sixties and seventies. trol group. He also discovered that by and idealistic teachers—but those gains A rapid, politically driven expansion the time the nurse-visited children were tend to vanish when the children inove k pedgpublic ram standards; y the eighties, e dilut- four,their mothers were more likely to on to their communities' hospitableg be employed,off public assistance,and institutions.This phenomenon,known conservative policymakers were using in stable relationships with their part- as"fade-out," is one of the great Head nn of modest results ernmtnj antipthe ners. Evaluations of two subsequent trations of antipoverty policy,and I was pilot programs—with primarily black first drawn to Olds's work because his erty programs. Olds wants his protocol families in Memphis and a racially di- long-term findings seemed to defy the to expand incrementally,as he fine-tunes 1!I'. verse group in Denver—showed less regressive trend.By the time the Elmira ofpublicCurrently, t y, thanks futo nders,hohodgepodge g podge dramatic results against control groups children turned fifteen,.they were still but suggested additional possibilities.By monstrably better off than their control- visitors in places as diverse as Los Angeles, age six, for instance, the nurse-visited group peers. For instance,they'd been Fargo,Allentown,Tulsa,and Bedford- Memphis children had larger vocabular arrested far fewer times, one of several Stuyvesant serve an annual twenty thou- . ies,fewer mental-health problems,and findings that inspired the U.S.Depart- sand of the United States'2.5 million low- slightly higher I.Qs. In all three sites, ment of Justice ocite Oas'sinfnt- incmechildren ldenand of two. the mothers had fewer subsequent chit intervention pogrcit as modforelrI decier the ded to watch dren and longer spaces between them. the prevention of juvenile crime.I won- Olds's ideas at work over the course of An economic analysis of the Olds exper- dered,however,about the objectivity of a year, is one of nurse-visiting's most iment commissioned by the state of the Olds studies,since,regardless ofc- d�ntsuffit caen ly impressed ss d wrs re h - th0 Washington concluded that the ap- ceptance by peer-reviewed publications proach—which currently costs around like the Journal of the American Medical program to more than double its size in four thousand dollars per year per fam- Association, he is essentially grading his fouryears, dollars.B thein a shelp oftef f ed erae Med - ily—was cost-effective as well,because own work When I raised specificq ues-58 THE NEW YORKER,FEBRUARY 6,2006 often run out of breath when recountingIn the bayou region,which is tradi- then,wanting to die,"Maggimoth the disadvantages of their clients("The tionally Catholic, no doctors admit to whgose name is Tammy, recalled. "I'd mom I'm working with now is a sixteen- performing abortions. Home remedies, been played the fool by a man I thought year old unmedicated,bipolar rape vic- though, are highly evolved: blue co- wanted a wife."Though mother nd • tima and crack-addicted prostitute with a hosh root,a belly flop from bed to floor, daughter shared malnourishment de- pattern of threatening to kill her social the placenta-rupturing magic of co- pression, and very close quarters, they Y worker, who recently abandoned her came. ("Is the baby shaking yet?"prac- seemed to exist in separate spheres. baby at her ex-boyfriend's sister's, and titioners of this late-stage strategy asked One afternoon before Christmas, who has an attempted murder charge in when they entered the local emergency the effects of Luwana's yearlong another situation—well,I think I've got room; they knew the drill better than paign against hopelessness were easy I all the risk factors,"a colleague ofLuwa- the doctors did.) But most re nanew na's said one day), nurse-visiting is un- des here were not terminated;as Mag- was an e.xubebrant�babbler with ose name is Maia,h likely to be mistaken fora cure-all. a paunch 1gie's mother liked to say,"God doesn't so magisterial that her patchwork jeans l make mistakes."Maggie concurred with were left unbuttoned. Maggie's mother In the bayou,every schoolchild knows this theory.Still,when Luwana first ap- was rounder, too, thanks to antide res- that a shrimp's heart is in its head, peared on her broken front porch, she sants, and she was workingalongsideP and that now it's cheaper to buy that was relieved to have a fresh pair of eyes Maggie at the cleaning company.E shrimp from China. So last winter, in on her life. gie was buoyed by her recenMag- .' a neighborhood called Upper Little David Olds and his researchers like to José,whom Maia plainly adl,o d.He 4 Caillou, people who once worked on findings that can be quantified,and Lu- had moved into the house shortlybefore ore the water were trawling for a service- wana has learned to report her experi- his daughter's birth,and he,Maggie, and L, sector niche. On homemade signs in ences accordingly. The forms she filled Maia now occupied a sweltering groom n yards,the inventory of salable goods con- out,however, didn't always capture the the rafters. tinually evolved: "Shrimp/Alterations/ extent of a family's despair. The first As Maggie discussed her l -budget x, Vinyl Blinds";"Turtle Meat,Adult Nov- time she'd come to Maggie's house,she wedding plans with Luwa elties&Bail Bonds."Maggie Lander,a had found an intelligent,underfed tenth bounced her dark-skinned dau g h he seventeen-year-old client of Luwana's, grader in her second trimester who was gently, while her fingers traced shapter es was among the residents hawking what sick with untreated hepatitis B and was on the baby's thigh.Maggie had become she imagined rich people might want, also trying to care for her mother,who a diligent student of child-developmentilome such as her mother's cache of Harlequin was bedridden and wei hed eighreaty- m novels.In the interest of clarity of mes- two pounds. "I was in another world the parenting handouts aloud u anal had sage,though,the front of her home bore just one sign—"No smoking"—on be- half of her one-year-old daughter. "...,V., In a few years, Maggie figured, her daughter would perceive the deficiencies ' of her home, as Maggie did—under- standing, for instance, that a sheet sta- 4` pled to the ceiling wasn't what people usually meant by an interior wall. But • s -' she chose to believe what Luwana hada 1 e; told her:that babies didn't care about the ` ii. £` surface of things. Their standards were deeper,Maggie believed, than those of some grownups she knew. In addition to selling secondhand ' goods, Maggie worked for a janitorial �� - service.She has a lisp,a vulpine face,and � ' .., .:,,,.;:,, auburn Bair that she parts down the mid r 4 1 : a 'a� ' Imo.< � � die and often lets fall over her eyes.When p Luwana came around, though,Maggie� �� ' � � � -4 '� � , tucked the strands behind her ears, re 4,i ° $ , 4 �� vealing the sallow beautyof a Victorian �� consumptive. For a half-Mexican half- `` ti • Native American schoolmate named Josef Hernandez, the sexual attraction had ,�. been intense.It wasn't entirely an accident '� when,after a year and a half of courtship, �'> she got pregnant. "This is the part of religion we could do without." given her that she got on Jose's nerves. "She's,`Listen to this on early brain de- velopment,'and Pm like'O.K.,I was here TRANSLATING AMERICAN POETS when Luwana went over it,I know,"he III said. "But she has to memorize this They might not care for such a change of place— stuff." Luwana, of course, found the from Long Island Santa Barbara the City Lights bookstore habit agreeable,and privately gave Mag- in San Francisco gie her highest praise: "The girl's an from a trapper's shack on a dear stream in Pate Valley overcomer."But,in the swamps,a mas- from beds where they lie still half asleep sively improved life is not the same as a from smoke-filled taverns and dubs good one. from motels where they throw off shoes after a dais hike in a day valley Maggie was now weak from the in- from a seduded farm in Missouri from a well-to-do house in Washington terferon that Luwana pressed her to from a night bar in New York City— take for her hepatitis. Maggie didn't they rebel against this uncalled-for move know whether she had caught the dis- to Eastern Europe which they know so little ease from the twenty-five-year-old to though it's not you but your poems that have wandered over to us whom she lost her virginity,at age thir- You don't even know what a warm welcome met them here teen, or whether she had been born for reasons I can only guess without certainty: with it. But the combined pressures because you honored in them your anxieties and vanities of infirmity and maternity had led her to a decision with which Luwana took strong issue: dropping out of school "I mean, I'm not going to be just then the little blue house we couldn't after Maia was born. some dropout,"Maggie promised Lu- afford,either—had to give it back.Then "Pm just trying to see that we're tak- wana now, gathering conviction. She a trailer park, then my auntie's trailer ing logical steps here," the nurse said reminded the nurse of a pact she'd made when we couldn't afford the trailer,then gently.A fiercer iteration of her argu- with José,who worked nights with her back to the trailer park,then straight to ment—that bearing a child as an un- on the cleaning crew and spent his days a little bitty camper behind my aunt's married teen-ager and failing to finish in high school. He'd get his diploma trailer—now,that was tiny,you walk in high school were matchless predictors while she took care of Maia, then it the door,there's a mattress and a table of lifetime poverty—had just brought would be her turn for school. and that's it.Then we moved in with tears to Maggie's eyes. 'You have too "So he's going to be the main one uncle, then with my mom's boyfrien much to lose, and I know you don't keeping Maia,is that what you're say- then back to the trailer park,then back want to clean houses all your life. Re- ing?" Luwana said skeptically. "You're to the boyfriend,then back to my uncle, member when I met you?It was one of going to trust him with her next year and then here." the first things you said—how adamant when you don't trust him now—when Luwana had bettered her own cir- you were about finishing?" he doesn't wake up when she's crying?" cumstances with the help of caring "I will go back, Miss Luwana, I In the year that Luwana and Mag- . teachers and strong parents, neither of promise,"Maggie replied."It's just now, gie had spent together, Luwana had which Maggie seemed to have.Her fa- with my job and Maia doing so many grown alert to the girl's romantic hab- ther, an illiterate as well as an addict, new things—I don't know.. .."Luwa- its of mind. beat her mother when Maggie was I no's concern with diplomas,career plans, When Maggie and José cleaned young,and then his neck was broken in and jobs with benefits wasn't shared by houses for lawyers and car dealers,José a car wreck. Afterward, he got sober, many people Maggie knew.In a sinking enjoyed discoveries of drug stashes and found religion, and separated from region,land and housing came cheap, signs of affairs. "Wife large," he'd say Tammy. Both parents are devoted to and dinner could be yanked from the with a broken-toothed smile,brandish- Maggie,but their leverage is minimal."I brown water, so uneducated people ing a find. "Panties behind the trash hear Luwana saying to Maggie,It's not could in fact"work the odd one," "do can in the bathroom, petite." Maggie about you,you're making decisions for for themselves,"and get by. preferred to dwell on other evidence."I your daughter now,'"Tammy once said, Luwana,like many of her clients, is like dirty kitchens more than the fancy "and I can almost see it on the tip of good at suppressing emotion. Among spotless ones,"she said,"because in the Maggie's tongue,'But you didn't,Mom. her cases were a young mother who had dirty ones you can picture the homey You didn't look out for me.'"Tammy attempted suicide in her third trimester, wife and the father and kids all eating thought often about a day,shortly before two others who'd been violently abused, together and talking like a family." She Maggie got pregnant,when her daugh- and one who was paraplegic and men- hoped to replicate this scenario with ter told her she was suicidal. "I didn't tally disabled. Maggie's case troubled Jose and Maia. want to hear it," Tammy said. "I jugik the nurse differently.She saw in the girl "Let's see," she said one day of the wanted to believe that Maggie was something of her younger self—"You family life she had personally experi- one thing in my lousy life Pd done right." know, that caged bird singing"—and enced. "In the last few years,we stayed NowMaggie considered Maia one thing feared the potential was going to be lost. in that trailer park we couldn't afford, that she was doing right. GO THE NEW YORKER,FEBRUARY 6,2006 memorable one. At noon the day be- your maladies and follies your cars and flowers fore, as she drove through Terrebonne your travels and landscapes gathered along the way Parish to a local diner,a young woman IIIyour hatred of big cities and rapture over them in a skullcap yelled in her open window, Chicago New York New Orleans the Golden Gate Brooklyn Bridge ou going to carjackyou!""You skipped names dreamed for years by European teen-agers `your birth control appointment! Clau together with hopes for great change and fame dette barked back, unfazed, as the girl, this is the dowry you bring a client from four years ago, smiled sheehly and retum to the in poems not aiming at greatness but showing the calendar of ordinariness clinicc..1A few menu es l a err,as the nurse seen through the eyes of a farmer a neurotic and hypochondriac ate lunch, a little girl across the diner a dipsomaniac a nymphomaniac and a tramp brimming with life trampled by a gang of misfortunes and failures started gesturing wildly in her direction. "One of mine," Claudette said. "Inter proud of democracy and cursing its abuses It is wonderful to be able to look at one's own country estingh how,years later,they still react to as at a man whose virtues and vices can be discussed without fear i '^ Now Claudette's bifocals slid down her nose as she ripped through orders i —Julia Hartwig g of business,one item of which was the (Translated from the Polish,by john and Bogdaruz Carpenter) resignation of a nurse, who had taken a less stressful job. Then she turned to Luwana: 'Which of your wonder- Luwana crouched to study the teen- King"DVDs that they can't watch,be- ful cases ager as she and Mania played with a set of cause the television has been repos- today?" do you want to tell us about ' plastic blocks. Some adolescents were sessed.For Luwana,the rest of the win- Luwan ,Claudettehinshe'd hied twobe reaon rs reluctant to play with their babies be- ter is mo uyears before. At the time, Luwana had en- cause it violated their code of noncha- One morningin February, Luwana visioned a job that left time for her hus- lance.Maggie,though,played zealously and six other nurses gathered at the band, children, and the teen-agers she until Maia lost interest and tried to crawl Terrebonne Parish Health Unit, in a tutored and counselled at her away.When Maggie picked her up,Lu- low-slung concrete building situated But in a place where resistance to nurse- wana objected:"She's at an age where it's between a shabby neighborhood and an visiting was great,and sixty-four per cent good for her to explore.You want to let oil rig.A space shortage meant that the of mothers abandoned the program be- her learn to be independent" nurses conducted their weekly meet- fore their children turned two,Claudette "House isn't safe,"Maggie said,run- ings in a storage area, but to Luwana expected--and in Luwana's case eventu- Hing her hand across a patch of rough the hours there were luxurious—a time ally got—passionate commitment. plywood. "I gotta keep her in one of reassurance that she wasn't work- Although passion is tricky to sustain place." ing alone. "Your authorityis her safe too," in the winter,Luwana took solace in two safety, Waiting for the late arrivals, the girls she called"my model moms"and Luwana said, then whispered excit- nurses discussed the deficiencies of the in the unexpected stability of Alexis.On �r wily in Mania's ear, "Let's see You walk! You want to walk? Y Atkins diet and the doings of their own Valentine's Day, the teen-ager had ac I think you want to adolescent children. Luwana's younger cepted a marriage proposal from Daigan's walk!" son was a smart and willful twelve-year- father,who had a steady income from "She doesn't want to,she's not ready," old,and the other nurses nodded know- tugboat work. They'd moved into an Maggie protested. Luwana raised an ingly at her assertion"I'm better with apartment down the street from her par- 4 ' eyebrow,and then they both laughed.It other people's kids than I am with my ents,which Alas planned to decorate in was Maggie who wasn't ready.She said, own." "purples Its like sto here where its ha be- The meeting came to order with ents'home,she seemed happier and mar- blues."Away from her par- « , P happy, cause what if the rest ain't this good?" the appearance of Claudette McKay, ginally more attentive to Daigan;she was the unit's fifty-seven-year-old supervi- also, finally, on birth control. So today t r Every December,Santa Claus comes sor; she'd been one of the first nurse- Luwana solicited her colleagues' advice down the bayou on a shrimp boat visitors in the region—apparently a on a different case:a household in which, twinkling with lights,at which time bit- terness begins to rise in a swamp nurse's as she worked with the mother and baby, heart.This is the season when families ,,, 1 a libidinous grandmother kept trying to whose financial and emotional prob- SID�.111 Hilt feel her up."I try not to make a big deal lems she's been working for months to , • i_i��, rite about it,because I don't want to lose the • unravel go deep into debt,drink them- m: Iiim,lll trust I've gained with the family,"Lu- selves into oblivion,and beat each other I��r�� Lu- wana said."But I have to say,Eeeeeee!I up with more than usual frequency.On ;' i y �` � don't like it." Christmas Day, their babies get"Lion I ,� ° S As the other nurses burst into laugh- ter, Claudette,who happened to know THE NEW YORKER,FEBRUARY 6,2006 61 telling her the grandmother in question,suggested That week, state officials were vow-- a messaana genell off the not tomaicome. and that a confrontation wouldn't be as coun- ing to reform the child-protection sys- as Luwana feared."Next tem, after a t shaking left an in a nearby town cerove ll-phone phone signal.Firsgravel t she called Alexs in search of a time she tries,you just say,`Honey,back eight-month-old boy had it up,'"she advised. "She'll get that sort brain-dead.B unsaid:though stateut the nurses rchild- into sister, informa to andrwhotreport ofy turt language, since she's all in your face herself" abuse deaths were rising, a shortage of that Alexis and James,her fiancé,had The discussion moved on to several child-protection workers, family ser- been brawling. "Look,Alexis,I'm not mentally retarded mothers who,inex- vices,and foster parents meant that at- trying to get in your business,"she was plicably, had been cut from disability risk children were often stuck in dan-- saying a few minutes later,"but Daigan 4 rolls. The nurses sometimes had to gerous homes. The nurses eventually is my business. O.K., O.K., can I see scramble to prevent retarded mothers decided that the safety of the seventh you tomorrow? No, I need to see you and their children from being evicted grader�eacnneltoption,"ted amvo Bcalled an"ape saidl do't fe 1 good about hen she �sup, she while convincing the bureaucracy that back now mas- the person who had an LQQof sixty last hew womenathetic grabbedtheir satchele.s and tired the gooden Although ymotherAscript—"Iha can't Iyear had roughly the same LQ now. � I And then the nurses turned to a case headed out down the bayous, to fresh stand leaving Daigan,he's developing that worried them all:a withdrawn sev- troubles they would keep to themselves so fine and I don't want to miss noth- enth grader in a violent household who until they met the following week t e- the bat y seeHem wast six m is and onths, i appeared, in her third trimester,to be starving her baby. "u ow many centimetres?"Luwana close to obese, which Luwana attrib- I One of the nurses said,"I'm at that 1 lsaid into her cell phone one day uted to Alexis's discovery that over- door every day,but they won't open it, as she drove ' ighi ` nshe will make le and now she's not going to school.Pm baby,teh thee i s for,you ll, feeding dcell phonesleep mes t also ves you rang in. afraid she'll try to abort the baby on her don't feel readyforithat1 IT be�there as said na voi eigonsiderably brighter centimetres?" she own."The nurses hoped to get the girl chills, into a Baton Rouge home for expectant soon as I can."Luwana s niece was about than her mood. "Baby,I'll be there as s I mothers—and quickly,because when to g longest after nancy, eme otionally cl led soon an s I c ."sit of the afternoon was last seen she had-been bloody from a g Pre g fight with her mother.This abuse had speaking,on record," and Luwana had with an introverted young woman n been reported to child-protection au- been at the hospital most of the heght.act the bayostal. u are named Many teen-age mothers or thorities,who concluded that the girl Her fatigue was exacerbated by was safe where she was. that her next client,Alexis,had just left Alexis, after feuding characters in the television show"Dynasty, which was popular when they were born.) Four - months earlier,when Krystal's son was , I I I two weeks old, the young mother had 1 - seemed overwhelmed by her baby,and t r further rattled by a belief that, after a ; ^ i 1 1 i Cesarean, the obstetrician had left his 1 1 instruments in her belly. Since then, 111.11111111111111.11111111111 --�- �- a I I ' I 1 I I - Krystal had become improbably adept - with her son."My pa be saying,`There's ;t something wrong with your baby, all �� ' • m� 4 these noises he's making,'"she now told v E . e /e > Luwana,laughing."I told him,Pa,you � a �`� tirain't know about preverbal—my baby is .. '� talking." Krystal,like most of the liter- �` liter- ate mothers in Luwana s caseload,was � now reading to her baby as well as talk- ing to him, and had become obsessed o5,„5 ' with his developmental progress.That a, day was her son's four-month evalua- tion, and Krystal watched solemnly as " the nurse explained the neurologic auditory,and visual cues she was lo ing for,and jotted estimations in a note- "Well, it's official.Any chance for candle-in-the-wind book After esevMaminutes, a she, theannonurse notoriety has pretty much passed us by." upstraight. "He's on task!"Relief flooded Krystal's "You saw?"Luwana asked,uneasy. upand began face. "My own eyes." to sing a Metallica song By the time Luwana left the house, "James, did you react?Maintain.. into her ear: another impoverished baby had joined composure?" I have lost the will moreto live • the citizenry of Louisiana: her niece'smy Simply nothing to give Lu- six-pound-ten-ounce son.Outside Ter- wanarI did.It wash d but composure,Miss." Lu There is nothing more for me rebonne General Hospital,the new fa- " Need the end to set me free. they was waiting to dramatize the day's Just get up,get out?" "Look," Luwana said, temporarily high points: "Man, I be gettingsick He nodded. ignoring the domestic drama."You guys "Takes a big man,James,"she said, have got to step up,make the doctors with they snipping her little bits to get exhaling."Takes a big man." explain.Never the baby out.But guess what,"he added Tears filled the man's eyes. "I don't understand what'sVgo that office until you likemischievously,"he got a hairy back just know what happened," he said. "I'm have to say, `I,et metheon,even if like his mama."In the recovery room, moving out today.Dude probably up in they'reyour re see arecords'— s Luwana hugged her niece and dropped there so I got to go." your baby. If she's sick,Y cords, because going a gift bag on the table:condoms and con- "But you have to work out some ar- have to fight for her, you're going tog traceptive foam. "This is wonderful," rangements,James. Because whatever to have to ave the information Luwana told the couple, shaking her happens, Daigan still needsyou to be Luwanaand you're going head. "Ano 's going to a Icon long her note- g, the dad." wrote for a minute in note- _ before you do it again." book, then looked up. "O.K., I'm all -- "Iwill," know, I he said, in a tone ears: What is up with you two?And that said he wouldn't, and as he rode Maggie,what's the deal with the hair?" Luwana waited again on Alexis's off Luwana shuddered. She tended to The deal ' porch. "I knew she would do me think of a given child's circumstanceswith thehair witht was thntMag like this,"she said, rising on tiptoe to as the product of many generat onsskunk-s eaks because - check a bedroom window.By now,she sometimes,thou h the s eee had d ed it black with two platinum skunky was how r was expert in the ruses of thepoor al- though, speed ofchange she was feeling. "It's over—we're not 7' though they couldn't afford staystunned her.In the time it took to smoke getting married," she told Luwana. "I long,they were co often away a cigarette,children could be stripped of just blew up my life, right there."Jose q good at hid- their fathers."And in the middle of this nodded, leaving Maggie to ex ing. After a few minutes, she gave up is the poor. . .Dai and got back into her car,at which time she said as she how she and Jose had fought,and how pulled back onto the roadway, "and I she'd had sex with one of his friends; something down the road caught her at- can't talk to Alexis,can't see where her how the next daJose's �h tention.She swallowed hard and hit the head is at,I just. . ." gas, onSha strapping, She took a wroneg Y� high-school overtaking pp ng, sunburned turn, braked at a dead end, and rested friendchad tipped offered the m off,ndeetai s guilty man on a motorcycle. her forehead on the steering wheel. "I had promptly abandoned Jose "James!"she yelled, leaning out the don't know what I am doing" crew job, stP o his leaning window.Daigan's father turned around, Then she sat up straight,shifted into buttons to the household,s fiand w c mov- surprised. reverse,and repeated theword she'd just ing out.M e's mother and was d th He climbed off the bike, removed said to Daigan's father "Composure. couple, listeningwith her head er sat behind the his helmet, and stared past the nurse Composure." in her toward Alexis's little wooden house. hands.She'd been working sixteen-hour "Well,"he said, "she broke myheart. shifts to compensate for the lost income; And you know all what I did for her— Over the winter,Maggie had stopped pped still, her bank account was overdrawn. you saw." ting her hepatitis medicine,as it "The pressures,"Maggie said miser made her too tired to work Jose may ably. Luwana got to the point "Where's have contracted the disease as well, but they get what they wanthe men come at they and don't my baby?" "The new had decided that ignorance was prefera- n t like guy got no job, on drugs, you for it. I mean, I know that's how ble to treatment.Luwana had ruled out it works. And I know that Jose is the on parole,got warrants out for his arrest. ignorance in the case of their daughter, person I want to — .^ And"—James's tone suggested this fail- however, and arrived at the house one three of us to grow 1 wanted the ing was the greatest—"ain't got no stormy afternoon to hear the results of `�'up together." car." 'Well, I don't do forgiveness," the toddler's test. "AndJose "And • • • Daigan?You know that's said. I don't do nice,either.Maybe my main concern." les all messed up, Maggie in- logical, maybe even humane. But nice formed her. "We have to do the test doesn't help for nothing in this world." "My first thought is that Alexis is over, but I don't know why—maybe Luwana bringing that boy around people he they don't tell me stuff because they courage Jose from shouldn't be around,you know,but ain't think Pm a kid." immediately set out to lis Aiik nothing I can do about it Igot def- J doing what theDbaby lir "You are a kid,"Jose snapped at Mag- father had done: abandon baby mite proof But, uh .". . He hesitated gie. He was staring at her from the far this angeralong outon Maia,the mother. " can't takem for a minute,then told the nurse that he end of the room, a black look in his with some heat. "This girl had caught Alexis and the young man eyes. � she told him together. Y When their one-year-old daugh- hasubonded ter ambled toward him,he scooped her hard you You see it,e you hear her P call you Daddy.And if she has hepatitis THE NEW YORKER,FEBRUARY 6,2006 63 that Luwana could help her get her head straight about sex and win José back But there was little chance that their daughter �" was going to have a normal life.The test results had confirmed it:Mafia s liver already damaged by hepatitis, and li,..,„ i j�NONDA 4. Gl6WSUle, 1 ," odds were one in four that she would de- ' VT ?MON velop potentially fatal complications. When Maggie was seven months pregnant, Luwana had asked her to write down the qualities she hoped to j pass on to her daughter. "How to be a lady," Maggie wrote first, and then "What love is."She wasn't thinking then about the worst parts of herself,and how 1 those,too,could be transmitted. 4a n the summer of 2005, the Census In reported that poverty had increased in the United States for the fourth straight year;and the Nurse- III Family Partnership produced an empir- 77-::::::::::::7 ical snapshot of the one thousand moh- p ers and children in Louisiana who had finished the nurse-visiting program. By some measures, the nurses' efforts seemed to have been trumped by local it's ad that much more important that ushered them out into the storm."No forsaken mya formula to attempt o the breast-feed- to mothers hd- youklyP keep the bond strong.She is going point in postponing Maia's test," she for instance. Other findings w to need both of you for a long, long said way of goodye.better we pr more encouraging,though.By the t. time." know if she's sick,theplan." almost sixty "She's a smart girl,"José said,rubbing Maggie drove to the hospital,tense their children turned two, his forearms and looking at his daugh- and wincing.Rain pummelled wild per of forty-one over per nt twentyof were ter,who now stood in an open cup- irises that had come into bloom board blowing kisses around the room roadsides, traffic was slow, and hornsr highwho hchool diploma orequivalencyad started the without a like a film star."We're trying to keep it drivers were being de- fromt was her but I think she already knows.I "You were the coolest,"Jose hissed into gree had one in hd. d though too soon to determine whether itheir mean,I'm not thinking straight,all I can her ear,mindful f wht thew daughter my sports, children's intellectual capacities had been think about Maggie is bad names.But was music, my video groerhearing."You es and hen strengthened,one of the studys findings if I let myself get angry. . ''He paused, y then concluded,"Well,that would be it" you went and acted like any o heir stu- Viers hgges tiv ed Thirty pop cent of tof a "When we have a child,sometimes we pid girl. . .m„ By Y feel like being a parent,and sometimes we they were sick f then argument their dtt� But national Lutest anao language ang tahelp development. of don't,"Luwana said."And when we don't other, and they od- feel it we act our way through it,because tion on Maia. As the baby had her the mothers and babies who hadn't \\I sweateryou bought at Wal- blood drawn,they hovered over her,de- flourished,and the battle of wills she was Maia is no g Martr and change your mind Maggie a gie daarne Street Band-Aid.Then they went ed her brave,exclaimed over a Ses- nowLuwana with Alexis. had pushed Alexis to There was a silence then, and Maggie sup- looked away.Atop the cupboard was an their separate ways:José with Maia to port herself instead of counting on men, old photo of Maggie in eyeglasses do- hang out at his of double shiftsnd at teedm teen n-ager took a full-time job as ay this wish was d.The nated by the Lions Club—"back when I Maggie to a weekorder cook,earning six dollars an hour. short- was ten andnerdful and smart."If she had work latest do over,she wouldn't have brought In the month that followedand a And he while her have coveridn't have criminal record, it to "garbageJ Maia into the world and tried to make a girl's janitorial specialties, famil with Jose.But this belated realiza- floors," brought her almost unsettling either, and sometimes babysat w Y • made her feel more ashamed than comfort; it was only when she'd put she 11 rten-mon hd.But e o dn ere was with eyes tion up the mops that Metallica's"lost thejolly she already felt. missed "So fake it," Luwana said, "start- to live" song ibeigan nd.here wahigh chance he was unable to crawl.body so large that ing now."She hugged them both,then through her 64 THE NEW YORKER,FEBRUARY 6,200 As Luwana held him, her trusty old Maia around in an empty diaper storms were gathering, and the Gulf mind-trick—would this scene have box. Since they lived in a community waters felt to them weirdly warm.They been worse without me in it—didn't with a particularly high death rate in the sensed another hurricane, Rita,which provide the comfort it sometimes did. war,Maggie saw the Marine Corps and would arrive the following week and "I think she'll keep making small marriage as equally distressing proposi- obliterate thousands of fragile dwellings • M1 changes in the months ahead,but now tions. But the couple had made a hard in Luwana s territory.Among the home- I don't expect a transformation," Lu- calculation, and there were two things less would be Maggie and Maia. wana said of Alexis."She doesn't want they wanted for their daughter that they But now the bride,waiting for her for herself what I want for her, and didn't know another way to get:good, mother to find the tape with the wed- that's something I have to make myself possibly life-extending medical care and ding music on it,leaned into a mirror to accept." a habitable dwelling in which she might see if her tube of lipstick had met its Alexis concurred with the nurse's grow up. target despite her shakes. She'd seen forecast, and decided to quit the pro- A few days later, Katrina came enough movies to know that such trem- gram. One evening in August, she sat through the swamps,damaging homes bling was normal, and that these mo- on the couch and looked at Daigan, but sparing lives.As Luwana cared for ments before the vows were for dream- who was on the floor in a"Motor Speed- injured New Orleaneans in a triage unit, ing. "Three bedrooms someday," she ` way Heavy Duty"T-shirt,staring back. Maggie,Jose,and their families under- said as Luwana came to escort her across "Luwana really cares about me," she took a familiar ritual in this hurricane the field."And two baths." said. "And she's helped me a lot—I alley:taping together broken windows, Afterward,Luwana tried to feel op- learned stuff, like how old they gonna eating from cans, and waiting for the timistic—to see, in the tough choices i get and what they gonna go through electricity to return. One day,Maggie, of two teen-agers,real hope for an im- and how they gonna grow. But what whose skin was mottled with poison ivy poverished American child. And if Luwana says to do—well, basically, I after bundling up fallen branches,real- the sacrifice and exertion required to just do it my way."She had recently mis- ized that there were just enough food secure that tenuous possibility struck carried her new boyfriend's baby, she stamps left to buy a wedding cake at her as outsized,well, she was a prac- said as Daigan emitted a single high Wal-Mart tical woman,and she had a fresh obli- shriek As she reflected on the miscar- The ceremony would take place on gation in a hamlet named Cut Off— riage, sadness softened her face, until a building site that Maggie's father a newborn whose parents had met in another thought hit her,and she broke mowed for pocket money.There was a court-ordered drug rehab and then into a beautiful smile. Her boyfriend gazebo on the field and, one rainy eve- broke up. k was eager to try again, she said. "And ning shortly before Jose left for boot "So beautiful, Miss Alaysia, even 2-=e_ next I want a little girl." camp, a silver cloud of mosquitoes as when you cry,"Luwana sang off-key to well. The wedding guests assembled, Cut Off's newest resident,a dark-haired - Afew days later, Luwana arrived the shrimpers among them watching girl in a soiled white dress."Real tears al- at Maggie's house to find that a the sky as they slapped and scratched. ready?Baby,you're quick!Now Mama, tropical storm had blown off part of the Heat lightning flashed;somewhere,new are you reading to her yet?"• roof She scarcely noticed, as she had come to celebrate a battle that she'd • won. The day before,Maggie had re- 1 fi ,_. turned to high school. The girl spir- V 1�' ' -►��i ...„.:,.,„ itedly shared some newfound knowl- �� 1 edge:"In Rome,the invaders came and tried to wipe out all the intelligent peo- / / ple—all the teachers and libraries—be- ��0 .l 4114111 cause they didn't want the competition,, but then everyone ended up kind of stu . pid."Jose,who was with her,then took VI4 s, ��131 ' her hand.Together,they informed Lu- wana that decisions bigger than high �' school had also been made.Jose was joining the Marines,and he and Mag- ...-• gie had decided to marry. In the tell- `1 .1 1 ing, their mouths were straight lines. Love and patriotism were not much on their minds. lalk2 • "I'm less nervous about Iraq than I am about marrying Maggie,"José told the nurse as he and Maggie took turns pushing the talkative eighteen-month- "I'm a vegetarian who eats meat." • Board of Health OCdBusiness Agenda Item # r/r., 5 • 2005 Community 3fealth Performance _Measures _March 16, 2006 • Jefferson County Public Health: Community Health 2005 Report Performance Measures: Targeted Community Health Services IIIBUDGET/PROGRAM: Targeted Community Health Services Family Planning, Breast and Cervical Health Program, and Foot Care MISSION: The purpose of the Targeted Community Health Services is to provide outreach, access, health education, support treatment to specific populations in Jefferson County in order to improve the health of the community. Specific program purposes are: • Family Planning: to provide reproductive health, clinics, outreach and education for Jefferson County residents in order to promote health and well-being and reduce unintended pregnancies. • Breast and Cervical Health Program: provide public education and health screening services to women age 40-64 with low incomes and no or limited health insurance in order to assure early detection and treatment of breast and cervical cancer. • Foot Care: provide foot care and health outreach to Jefferson County seniors to prevent health complications. GOALS FOR FY 2005: 1. Insure access to breast and cervical health exams to women age 40 to 65 years old. 2. Decrease unintended pregnancy rates in Jefferson County (measure)/Assure Family Planning Services are provided in every community 3. Support seniors' independence by maintaining their mobility •OBJECTIVES FOR FY 2005: 1. Track Family Planning usage patterns and produce annual report 2. Maintain breast and cervical health program in Jefferson County 3. Emergency contraception to be provided under standing orders, 5 days per week, and expand community education and clinical services 4. Maintain the current level of community foot care and continue expanding into home care PERFORMANCE INDICATORS: 2004 2005 2005 Actuals Planned Actuals Number of unduplicated clients served in Family Planning 1330 1600 1242 Number of adolescents under 19 served in Family Planning 342 330 314 Number of Breast& Cervical screening exams 148 90 116 Number of foot care contacts 2470 2400 2594 SUMMARY OF KEY FUNDING /SERVICE ISSUES: Preventing unintended pregnancies is a local, state, and national Public Health Goal. JCPH provides the only Family Planning program in east Jefferson County. Family Planning is considered a Critical Health Service by the State Board of Health. In July 2001 Washington State started a 5 year federal waiver program called Take Charge which increased funding and clients for Family Planning Services in Jefferson County. The number of clients served increase dramatically the first year of Take Charge. JCPH anticipates maintaining the increased numbers of clients with only minimal increases now. Increases in expenses are being off set by reorganizing the clinic schedule in 2004 and looking for efficiencies. The Breast and Cervical Health Program addresses the .geed for Cancer screening and early treatment to decrease deaths from Breast and cervical Cancer in Jefferson County. With decreased federal BCHP funding starting in 2003 JCPH will need to limit the number of clients who can receive services. Jefferson County has a high percent of over age 85 citizens. JCPH foot care program help this population maintain independence and mobility in a rural community. January 27, 2006 Jefferson County Public Health: Community Health 2005 Report Performance Measures: Family Support Programs S3UDGETIPROGRAM: Community Health: Family Support Programs Maternal Child Health(MCH) including newborn follow-up, Child Birth education and Breast Feeding Support, Maternity Support Services (MSS)/Infant Case Management, Best Beginnings/Nurse-Family Partnership (NFP), Children with Special Health Care Needs (CSHCN), Women Infants and Children(WIC), and the Child Protective Services (CPS) Contract Programs: Alternative Response System (ARS), Early Intervention Program (EIP), and Passport. MISSION: The purpose of the Family Support Programs is to provide health and parenting education, skill building, support, and referrals to community resources to pregnant women and families with children. Services also include voluntary home visits to prenatal, post partum families, and families at risk of Child Protective Services involvement. These services are provided so county babies are born with the best opportunity to grow and thrive, the impact of health problems are minimized, and children receive the care and nurturing they need to become functional adults. GOALS FOR FY2005: 1. All newborns and their families will receive Newborn Health Screening to identify needs for Family Support Services including: intensive home-visiting, case management, lactation support, special health and child development support, nutrition education and parenting education. 2. Maintain the current number of clients served through the Family Nurse Partnership Program (Best Beginnings) for Jefferson County residents. • 3. Monitor Nurse Family Partnership Program replication by tracking data on program fidelity. 4. To assess the percentage of pregnant and parenting women receiving JCPH services, in which depression is an issue. 5. Continue to provide breastfeeding education and support so that all county mothers can provide their children with the physical and emotional benefits of breastfeeding. 6. Prevent nutritional related problems for pregnant women and children under five in Jefferson County. 7. Identify children with special health care needs in Jefferson County and assist families with health and development interventions and referrals as needed. 8. Provide services and information in Jefferson County aimed at preventing Child Abuse and Neglect. 9. Increase awareness and support of the Family Support Program mission through community presentation on the relationship of adverse childhood experiences and adult health problems. OBJECTIVES FOR FY 2005: 1. PHN's will provide Universal Newborn Screening to all Jefferson County families of new babies through telephone calls and office or home visits in order to identify early intervention needs and offer services and referrals. 2. Support the Nurse-Family Partnership PHN's maintaining caseload intensity by providing opportunities for ongoing support and education both within JCPH and limited travel for other offerings such as the Washington State Consortium for Nurse-Family Partnership. 3. Send client data monthly to Nurse-Family Partnership program head office for assessment and evaluation. 4. Depression screening and education will be offered to all pregnant and parenting women who are participating in JCPH programs and appropriate referrals will be made for those who have a positive • screen. 5. Through universal screening of newborns and their families identify those who may need referral to Children with Special Health Care Needs, breastfeeding tea party or lactation consultation telephone, office or home-visits. Ongoing collaboration with Jefferson Health Care staff for lactation support will help ensure all families receive the services they need. 6. Provide WIC nutrition education and support to all eligible county women and children. • 7. Through universal newborn screening, other JCPH programs and community outreach to providers and the schools children with special health and development needs will get referred for evaluation and intervention services 8. Awareness and assessment of risk for child abuse and neglect is an integral component of all Family Support Service Programs. Referrals to CPS/DCFS will be made as appropriate and services will be provided to families at risk or involved in CA/N through the ARS and EIP contracts. 9. Continuing Best Practice Nurse family Partnership (NFP)program to prevent Adverse Childhood experiences in at risk families to reduce youth and adult tobacco, drug and alcohol use. See Felitti Study. PERFORMANCE INDICATORS: 2004 2005 2005 Actual Planned Actuals 1. Number of depression screenings completed 75 70 77 2. Number of newborn screened 145 120 135 3. Number of those screened receiving continuing Family 70 90 Support Services(2002 no MCH add) 4. Number of Home and Office visits provided for NFP, 1217 1500 1280 MSS, MCM, MCH and Breastfeeding consultation 5. Yearly report from Family-Nurse Partnership ** ** ** 6. Total number of women infants and children served by 953 900 871 WIC in Jefferson County(from CIMS report) 7. Number of children with special health care needs 64 60 89 receiving Public Health Nurse intervention through JCHHS. 8. Number of families served through CPS/DSHS contract. 16 20 16 ** report yearly SUMMARY OF KEY FUNDING/SERVICE ISSUES: Major issues is 2005 was funding changes. Maternity Support Services and Infant Case Management revenues were decreased over all and case load was slightly lower overall. On the positive, DSHS Deputy Secretary, Dennis Braddock gave JCPH $25,000 for 6 months to continue providing Nurse Family Partnership. The Jefferson County Community Network also received a grant from the Weyerhaeuser Foundation to fund an additional 50 home visits in 2005. Children's Administration's Alternative Response System and Early Intervention Program was cut for the months of May and June. The contract starting July 2005 was changed and the budgeted Revenue was reduced in half. JCPH continues to see some of the Child Protective Services families referred but with less revenue. WIC case load which has been at about 500 clients a month was down to 450 for most of the year. WIC staff did outreach to the food banks but the numbers stayed the same. JCPH provided Farmers Market checks to WIC clients for the first time in 5 years. See attached WIC report. With the reduction of staff in 2004 Maternal Child Health nurses integrated Children with Special Health Care Needs services to the birth to three populations in 2005. Breast Feeding Tea Attendance increased in 2005 and universal New Born Follow-up continued as funding and staff allowed Child Birth Education program increased collaboration with Jefferson Health Care and community educators. Attendance increased in 2005. Maternal Child Health staff worked on Outreach to Medical community. Two meetings were scheduled with Slocal physicians and the physicians canceled those meetings at the last minute. Staff continues to work other ptions for out reach and continue to work one on one with physicians as needed. March 9, 2006 4, I. Jefferson County Public Health: Community Health • 2005 Performance Measures Report: Communicable Disease BUDGET/PROGRAM: Community Health Communicable Disease TB, Communicable Diseases, Immunization, Travelers Immunization, Sexually Transmitted Disease, HIV, Syringe Exchange Program. MISSION: Communicable Disease The purpose of the Communicable Disease Health program is to protect Jefferson County residents from serious communicable diseases by providing disease surveillance, investigation and reporting, along with education, screening,treatment and immunization services. The program interacts with community members, medical providers,the Washington State Department of Health and other agencies while working toward this purpose. GOALS FOR 2005 1. Maintain the low rates of active TB in Jefferson County(TB) 2. Timely investigation of reportable conditions (CD) 3. Support universal access to State supplied vaccines for all children(Imm) 4. Continue to support immunization registry in Jefferson County, promoting use by all immunization providers (Imm) 5. Assess childhood immunization rates for children served by Primary Care Clinics receiving State supplied vaccines 6. The Family Planning and STD clinics will assist in controlling Chlamydia transmission in Jefferson County(STD) IP7. Providers will be informed about current communicable disease trends and new communicable disease control recommendations 8. HIV testing and counseling clinic resources are focused on persons at risk for HIV infection (HIV) 9. Case management services will be easily accessed by new HIV clients who seek these services (HIV) 10. Prevent the spread of blood borne communicable diseases among injecting drug users and their partners (SEP) 11. Annual report to BOH for CD, TB, Immunization Programs, STD 12. Develop bioterrorism response capacity OBJECTIVES (INTERVENTIONS) FOR 2005 1. Encourage appropriate screening &treatment for latent TB infection(TB) 2. Develop &update protocols for investigation of reportable conditions (CD) 3. Maintain an efficient system for supplying State supplied vaccine and vaccine recommendation up-dates to private Health Care Providers in Jefferson County (Imm) 4. Continue to provide private Health Care Providers support and updates on the Child Profile Immunization Registry 5. Perform an assessment of childhood immunization rates, using AFFIX software, every other year, for each clinic receiving State supplied vaccines 6. Clients seen in Family Planning and STD clinics who are at higher risk for Chlamydia (age criteria)will be screened for Chlamydia(STD) • 7. Provide updates, outreach and training to providers about local, state and national communicable disease outbreaks and disease control recommendations 8. 75% of clients who receive HIV testing will be high risk(HIV) 1 so 9. 95% of new HIV clients who seek case management services will have an assessment within 1 week of the date requested(HIV) • 10. Promote utilization of syringe exchange program services (SEP) 11. Develop regional bioterrorism plan, coordinating with regional bioterrorism partners, local emergency response agencies and Jefferson General Hospital PERFORMANCE INDICATORS 2004 2005 2005 Actuals Planned Actuals (TB)Number of clients started on preventive therapy for latent 4 3 2 TB infection (CD)Number of communicable disease reports confirmed, 111 70 129 interventions applied and processed for reporting to the state (Imm) Number of doses of publicly funded vaccine, 4001 3,500 3,748 administered by private health care providers and Public Health clinics, supplied and monitored through Public Heath's immunization program (Imm) Number of providers participating in the Child Profile 5 5 5 immunization registry (Imm)Number of Jefferson County children<6 in with one or 76% 85% 77% more immunization record in Child Profile system' (Imm) Number of clinic site visits to assess childhood New 2 1 immunization rates, using AFFIX software 2005 (STD) Percent of at risk FP and STD clinic clients at risk for 100% 100% 100% • Chlamydia screened(age criteria 14 - 24) (HIV)Number of persons counseled and tested for HIV 88 60 116 infection (HIV) Percent of persons counseled and tested for HIV infection 77% 75% 65% that were in high-risk category (HIV) Percent of new HIV clients seeking case management 100% 95% NA2 services who have an assessment within 1 week of the date requested (SEP)Number of clinics 136 100 88 (SEP)Number of SEP clinics utilized 52 50 35 (SEP)Number of syringes exchanged 18,060 15,000 13,716 (SEP)Number of prevention/educational materials provided 7,313 25 7617 (SEP)Number of referrals to other services4 11 5 11 (BT) Develop bioterrorism response plan 1 1 1 ' In mid 2005 4 out of 5 providers using Child Profile stopped entering data into the registry because the new electronic medical records (EMR) system caused this to require double entry for each immunization. We are hoping that the EMR upgrade will allow the downloading of data into CP in 2006. 2 In 2005 there were no new clients who requested case management services and followed through on appointments. 3 Prevention Materials include: tourniquets, cookers, cottons,water, sharps containers, alcohol 411 preps, antibiotic ointment, band-aids, hygiene (toothbrushes/razors). Educational Materials include: Do Not Share, Overdose Prevention, Health alerts. 'Referral include: Drug Treatment, Health Care, Hepatitis Screening, HIV Counseling& Testing, and Mental Health. 2 fte • SUMMARY OF KEY FUNDING/SERVICE ISSUES: These programs address locally identified and defined local public health problems. Communicable disease prevention is a locally funded program since the county milage was returned from the state to counties for TB control. Immunization funds from the state have been primarily in the form of vaccine. County funded Services provide a professional staff that prevent, identify and respond to disease outbreaks. Substantial staff time is spent on responding to public requests for information about communicable diseases and screening for reportable illnesses in the process. HIV services are funded from the state and federal government to provide basic communicable disease prevention, HIV positive client case management, testing and counseling to high-risk community members, and focused high-risk interventions. Funds are highly programmatic and based on federal case numbers, which may not represent Jefferson County epidemic profile. Volatile program funding is based on formulas re-negotiated with Region VI AIDSNET every year. Starting in 2002 federal funding was received for developing the capacity for bioterrorism response. This response capacity is being developed in coordination with our Region 2 Public Health Emergency Preparedness and Response (PHEPR)partners in Kitsap and Clallam Counties, our Department of Emergency Management and other local emergency response agencies, Jefferson Healthcare and other health care providers. For 2005 this project involved continuing to complete and expand the appendices and procedures that go with the basic Local • Health Department Emergency Response Plan that was first drafted in 2003. In March of 2005 a region wide multi-agency emergency drill was executed to test the various County and agency plans that have been under development over the past three years. A new appendix to the plan addressing Pandemic Flu was developed and continues to be expanded. We do not expect any increases in funding for 2006. However, increased funding would allow for increased Communicable Disease surveillance, outreach, and resource development with the Health Care Providers in the community. Decreased funding would result in scaling back on services. The Board of Health would be involved in deciding which services would be impacted. 3/10/2006 S 3 • Jefferson County Public Health: Community Health 2005 Report Performance Measures: Population and Prevention Programs IIIBUDGET/PROGRAM: Population & Prevention Programs Raising Healthy Community Grant (HC), Tobacco (TP/C), School Health(S/H), Childcare health and Safety (CC), Peer-In (PI), Oral Health (OH), and Drug and Alcohol prevention(DA) MISSION: The purpose of the Population& Prevention Programs is to provide health education and public health interventions to county residents in order to promote a healthier community, prevent disease and unintentional injury, improve the quality of life and reduce disparities in health. GOALS FOR FY 2005: 1. Improve identified social and health indicators for school-age youth (S/H) 2. Improve indoor air quality for Jefferson County residents (TP/C) 3. Enhance the quality of child care provided in Jefferson County (CC) 4. Enhance the overall health& safety of Jefferson County children (PI) and (OH) 5. Improve Healthy Youth Coalition functioning (HC) 6. Reduce favorable attitudes toward problem behavior within the youth and adult communities. (DA) 7. Delay age of initiation of problem behavior. (DA) 8. Reduce adverse childhood experience as measures by reduced CPS referrals (DA) OBJECTIVES FOR FY 2005: 1. Maintain delivery of school in-service/trainings, student health screenings, student health consults, • student health care referrals (S/H) 2. Maintain number of restaurants participating in smoke free campaign; number of mothers who do not smoke during pregnancy (TP/C) 3. Maintain child care provider consultation re: health, immunizations, safety and child development (CC) 4. Peer educators will provide school health classes to middle & high school students (PI); health education classes will be provided to elementary, middle &high school students; and increase Oral Health prevention interventions. 5. Maintain number of Healthy Youth Coalition meetings annually 6. Increase the perception of risk for youth regarding alcohol and marijuana use, especially for 6th, 8th, and 10th grade students.(DA) 7. Increase access to adults with healthy beliefs and clear standards for 4th through 6th grade students in Jefferson county.(DA) 8. Provide Early Intervention services to at risk families to prevent adverse childhood experiences. (DA) See Felitti study showing how adults who had reported greater than 2 Adverse Childhood Experiences had increased health problems including tobacco, drug and alcohol use. See Family Support services program performance measures. PERFORMANCE INDICATORS: 2004 2005 2005 Actual Planned Actual Number of student health screenings 1773 1800 1559 Number of restaurants offering 100% Indoor Smoke Free Dining (TP/C) 62 62 Number of Peer-In educational presentations 50 50 50 �1�lumber of school health classes 268 250 208 Number of phone calls to WA State Tobacco Quit line from Jefferson Co. 80 80 73 Number of Healthy Youth Coalition Meetings 8 8 8 Number of classroom presentation/interventions (Drug and Alcohol 150 150 136** preventions) 41 ) Number of students served in the class room presentations 406 300 431 *December 8, 2005, all indoor public places were required to be 100% smoke-free which means that all restaurants in Jefferson County were smoke-free December 31,2005 ** Due to lost of staff in Oct., Nov. and Dec. 2005 classroom presentation was less than planned. SUMMARY OF KEY FUNDING/SERVICE ISSUES: JCPH delivers programs that promote healthier communities and individuals. Focusing public funds on prevention programs have proven to be cost effective. JCPH continues to use Local Health Data profiles to determining community needs and prioritize (substance abuse, domestic violence and child abuse and neglect). See "Health of Jefferson County 2003". The Juvenile Justice Grant, Healthy Communities grant continues in 2005 with in-kind services providing intervention and prevention programs to identified children in vulnerable families. These services include work in the schools and supporting Big Brother/Big Sister program. Besides the Healthy Communities grant, the above programs provide universal prevention programs available to all in the community. State prevention health services monies come with extensive evaluation components. Tobacco, Peer-In and Healthy Communities funding have community specific goals and measures that must be met to maintain funding. School funding is based on State School Nurse corp. funds and contracts with school districts. School enrollment is decreasing slightly anticipating less health screening. Drug and Alcohol prevention services moved into Community Health programs when the contract for treatment services moved to Safe Harbor Recovery Center in 2004. Prevention funds are utilized primarily through the school based, proved effective, Best Practice Programs. These funds allow prevention specialist to reach the vast majority of middle school students. January 27, 2006 • III Board of Health Netiv Business Agenda Item # 17., 1 • Nlethamphetamine Abuse .�l Public .wealth Approach .larch i6, 2006 • AI- 4 ' I' • Figure 2. Treatment Admissions, Primary Drug = Methamphetamine,Jefferson County 1997-2004 Jefferson County Washington State County County State Adult Adult Youth Youth Adult State Youth Youth Number Rate Number Rate Number Adult Rate Number Rate 1996 21 85.9 1 4.1 2439 43.8 200 3.6 1997 7 27.9 0 0 2218 39.2 166 2.9 1998 31 121.8 0.0 0.0 3617 62.9 314.0 5.5 1999 38 148.1 3.0 11.7 3955 67.8 199.0 3.4 2000 32 123.3 3.0 11.6 4510 76.5 368.0 6.2 2001 32 122.6 1.0 3.8 5700 95.4 523.0 8.8 2002 28 105.3 4.0 15.0 5930 98.2 673.0 11.1 2003 28 104.9 2.0 7.0 5994 98.3 631.0 10.3 2004 60 222.2 2.0 7.0 6512 105.6 1540.0 25.0 Figure 2. Adult and Youth Treatment Admissions*, Primary Drug = Methamphetamine, Jefferson County 1996-2004 I Source: Tobacco,Alcohol,and Other Drug 2005 Abuse Trends in Washington State,WA State Department of Social and Health Servcies-Division of Alcohol and Substance Abuse 250 • � ''''County Adult Rate - - - County Youth Rate 222.2 State Adult Rate 200 - - - -State Youth Rate I I 150 148.1 123.3 121.8 22.6 105.3 100 _i, • 105.6 85.9 95.4 98.2 6.5 50 43.8 62.9 67.8 lif 39.2 3.6 27.9 11.7- q - 25.0 5.5 2.9 1 6 _ g_gr r.�1 .0 _ _a8'3 0 -4.1- ` �' - --- 4 .r - _- 1. ' - r3'g 11.1' .0• - 7.0 1996 1997 1998 1999 2000 2001 2002 2003 2004 • *Admission rate per 100,000 population. Excludes detox,transitional housing,group care enhancement,private pay and Department of Corrections. Includes total admissions-counts may be duplicated for an individual based on multiple admissions or multiple modalities of care. 2/22/2006-DRAFT Criminal Justice Treatment Account - Client Primary Substance by County July 1, 2003 through January 31, 2005 Primary Substance Total 410gion County Alcohol Cocaine Heroin Marijuana/ Meth Other/ Number of Cannabis Unknown Clients „ ride' Ta yl, . 43:,7°10 aiLLIANAlliLlaCtiarirA3, i 3 Sao - I7 at ;3 .: Ta ,,• ;. X41:8/0 12.810 1 *. ..". Adams 98.0% 0.0% 0.0% 1.0% 0.0% % % % 1.0% 99 Ferry 77.8% 7.4% 0.0% 11.1% 3.7% 0.0% 27 Lincoln 81.1% 0.0% 0.0% 5.7% 13.2% % 0.0% 53 , £ \ ". �a ms le r-, 14°W. 1e .R 7 s;7010 U 90 t c 15 5010 ,. o° 9°o �0. t Pend Oreille 74.5% 0.0% 3.6% 9.1% 9.1% 3.6% % 55 a ae 1A10100 \ 1 7 910 l 1 1/o _ 17.7/0 Q. �A 0 0 bl 21.1.174.u,' 11 Stevens 81.9% 1.3% 0.0% 9.4% 5.0% 2.5% 160 c � ^3\ car yv. �. p \` - Q, x, (. a.� 4.... , ,�. . .. Z, q:_. f v� 'e�' lit ��•'. 7 ° � ,a . .. 2 1 '+.^.,"k',.,��, ,. :_ ,+.�., „ ,,r, .,. ,.. .•ass. .. ,..kn \ t. .. ...3 Z p lignattal Asotin 79.1% 0.8% 0.8% 12.4% 6.2% 0.8% 129 _,..rt cil Y '.e. .\; tl lie Columbia 79.8% 0.0% 0.0% 15.6% 1.8% 2.8% 109 110. ' tit !NIIIIEWIIII. 3II 1.11v•:L1°lo 41101a 110111111114 Kittitas 69.3% 0.0% % 0.0% 16.5% 9.7% 4.5% 176 ` i % ;' A' g ,.. \ ` : I \fi0f° fi .• 19 X010 3 J% t . ' ; . Walla Walla 75.5% 1.4% 0.0% 11.6% 10.9% 0.7% 147 I ff 1 1 ° 4 M .., , ,.y , II ,ate .,, ..�!! ... ,. J��u .., ._, � lik Regipn ., 'eta r.;;, 47:9% '\ l A ;l I.''.•.o. ,._•_, . _ , k 4123 Island % % % % 51.6% 12.9% 0.0% % 16.1% 12.9% 6.5% 31 San Juan 673% '`, sx % n;, t :-'',i.,1141.14121,; i Skagit 59.0% 4.9% 5.6% 11.8% 16.7% % 2.1% 144 ' Whatcom 67.1% 5.8% 3.9% 12.2% 8.8% 2.2% 362 King 10.3% 38.1% 20.5% 8.9% 19.1% 3.1%1 575 Kitsap 10,0% 8.6% 2.1% 20.0% 53.6% 5 7%� 140 y"*'�\`.`'�^\\ S "�.� �'uufr, rte• a � � 8 � k:�l .�' �.' Piercer 9.2010 ._ ' : g, as ... �lv, ,. ^� ;3c4 ... , t. z\, Clallam 30.7% 3.5% 2.6% 21.1% 37.7% 4.4%I 114 arattaidi w �tifil e,'E4,f\.��ar f ag.:p \` 0 'I`e t ..i H•a ly�"\k.. (S.aY�A\az�-3i§,'> `�'n ffi,w:r Cowlitz 10.2% 4.1% 16.2% 18.3% 48.2% 3.0% 197 lib�r $ R , .,. a &. aeg& *«,:;,,i4 ' f.,. \ , ,^..,t t 1104 Jefferson 15.1% 5.7% 0.0% 17.0% 50.9% 11.3%I 53 ,r ,Y 0 72111111111101 IIi ' .2 Mason 32.9% 5.3% 5.3% 23.7% 28.9% 3.9% % 76 R r ,..: : .. �.,. m., ..��, E,a �:A '\t=\, �: 1..�.>, ,.:\ n.�`�axs.�... ..... . ' ice.. ..._, . tt Thurston 9.2% 1.6% 6.5% 28.3% 49.5% 4.9%I 184 a. 7 0 Figure 1. Drug Lab Clean-Up,Jefferson County 1997-2001 Jefferson County Washington State 1997 1 203 1998 2 349 1999 5 789 2000 1 1454 2001 5 1890 2002 5 1693 2003 12 1480 2004 2 1339 2005 1 809 Figure 1 . Drug Lab Clean Up, Jefferson County and Washington State, 1997-2005 Source: Washington State Depaertment of Ecology http://www.ecy.wa.gov/programs/spills/hottopics/druglabs 20 T MIMI Jefferson County —a—Washington State — 2,000 18 — 18•: IIII16 — 16" 14 — 1454 - :0 N Q ui 2 z,12 — 12 39 5 m d m O V J U c10 c0 _fI o ac a, 0 d 2 c w i- 6 8 - 789 w .a 809 ° E d z' 6 — E 5 5 5 z 4 - 3 2 — 03 Iii 2 1 1 0 i - • 0 1997 1998 1999 2000 2001 2002 2003 2004 2005 III 2/2/2006-DRAFT • How to improve access to treatment for methamphetamine abuse/dependency Eliminate! • Impediments to treatment ) such as r \y False expectations » Expense .Fnlseperceptions • 0 � iNowMmstmeAddress the Methamphetamine Epidemic? ' Methamphetamine Epidemic in Jefferson County k II based on At--/ Is not from failed ( Judicial/Legal system 1 11 (Desired Public Health Outconfe (A-ggressive Public Health Response ) • -----.___ _ implements Established Epidemic �-- -'~ sstoh|i»hedEpidemiological ` `~.""/�cu,orr, / Principles/Practices ) / )\''-- ---_ � �--_-_- / / ```` . // requires calls for Lead to \ ` \ �ornrrTnooune,t Improvedprevendon ` ! 101 ' ` � ' m `^� ,/- ``-~-___ ___-__ ~� • Methamphetamine Abuse/Dependency \ ■ A Central Nervous System Disease Significant Psychiatric & Medical with pathology f" t ---. l, establ5he• - Z ,_,..1:*, needs /�_ Causes 7__________._______ ___ 111111111111111111hry 4Warrants t Treatment and Chronic relapse prevention IILIJ • Public Health Res/ ,, ponse leads to f) generates/ (--- :,,,, +Better Prevention ,_ ,irti 1--- t involves Clear and measurable sup!Dort ° benefits to m imili ti, � ' �,F community & patients It N, Policy Makers 1 Community 1 Families lead to \ /i #' \` may influence /Significant savings in `� Legal/7udical costs , II • What is Involved in Treatment & Relapse Prevention? Chemical Dependency Treatment consists of Ait—'// �� results in Cognitive-Behavioral "�� requires '''....,.....A y constrained by Support Self Help Groups 1 ' i\ l Fewer complications/1 sequelae Medical/psychiatric Social/Spiritual Reduced Recidivism support Support 1 means promotes An expectation/requirement for perfection rather than progress • _. speaks to h��Better Healtm Better _ , -----„,,,.... , -----4. Perception treatment is ineffective I Ongoing Prevention of& treatment for leads to this Chronic Relapsing Disease Is. Justifies? (Fewer Crimes - , Belief same treatment Imply Goal of Public Health) required for everyone AZ ac,,--- , are neutralized by Expense of Treatment Community [Fewer arrests and Individual savings I assure Si( gnificant savings in Legal/Judical costs ,,i • • Board of Health Netiv Business .agenda Item # T., 2 Thbcicco • Next Steps March 16, 2006 • Jefferson County Tobacco Workplan Rationale (excerpted from 2006-2007 Tobacco Workplan) • 2004 BRFSS-Tobacco Survey: Current Tobacco Use among county residents: • The current cigarette smoking prevalence is 18.4% (+7.3%). • The current smokeless tobacco prevalence is 1.8% (+2.5%). • Current tobacco use (all types) is 21.6% (+9.1%) (Note: Additional detail about current tobacco users (gender, age, education) was not available due small numbers). Among former county tobacco users: • 5% of former smokers quit within the past 12 months • 32% (+10.7%) reported that a Doctor or healthcare provider advised them to quit. • 16% (+8.6%) reported that a Dentist advised them to quit. • 0.5% (+1.0%) reported that a Pharmacist advised them to quit. Rules about Smoking in the home • 82% (+8.2%) of county respondents reported that 'no one' is allowed to smoke anywhere inside their home. • 73.3 % (+8.9%) of county respondents reported that there are no current smokers in the household. Secondhand Smoke • 83% of county respondents think that breathing secondhand smoke is 'somewhat' or 'very' annoying. • 93% of county respondents think that breathing secondhand smoke is 'somewhat' or 'very' harmful. • 96% of county respondents 'strongly' or 'somewhat' agree that all children should be protected from secondhand smoke • • 51% of county respondents 'strongly' or 'somewhat' agree that smoking should not be allowed in outdoor public areas where children may be present. Enforcement • 73% of county residents think that law enforcement officials should place a high priority on enforcing laws that ban possession of tobacco products by minors. Jefferson County 2001 BRFSS data: • About 3 out of 10 (28%) of county respondents age 18-34 were current smokers and about 1 out of 5 (19%) county respondents age 35-64 were current smokers. State rates are 24% and 22% respectively. • Quit rates among current county smokers age 18-34 were significantly lower than the state rate; 28% of county 18-34 year olds had tried to quit in the past 12 months compared to 55% of their peers statewide. • In comparison, the quit rate among county smokers age 35 and older was significantly higher than the state (72% and 42% respectively). Although 18-34 year olds rise up as a possible target population, older adults appear more motivated to quit. Healthy Youth Survey 2004 data: • About 1 in 5 Jefferson County 8th grade students reported that they had smoked a whole cigarette in their lifetime. The county 10th grade rate is significantly higher than the state. • About 2 in 5 Jefferson County 10th and 12th grade students reported that they had smoked a whole cigarette in their lifetime. The county 8th and 10th grade rates are significantly higher than the state. ID • About 2 in 5 Jefferson County 8th, 10th and 12th grade students reported that they might smoke a cigarette if offered by a friend within the next year. County 6th, 8th, and 10th rates are significantly higher than state rates. • About 1 in 10 Jefferson County 8th grade students reported that they had smoked a whole cigarette within the past 30 days. The county 10th grade rate is significantly higher than the state. • • About 1 in 5 Jefferson County 10th and 12th grade students reported that they had smoked a whole cigarette within the past 30 days. The county 10th grade rate is significantly higher than the state. • About 1 in 6 Jefferson County 10th and 12th grade students reported that they had used smokeless tobacco within the past 30 days. • About half(52%) of Jefferson County 8th grade students think it is very wrong for someone their age to smoke cigarettes. About 2 in 5 (42%) of Jefferson County 10th grade students think it is very wrong for someone their age to smoke cigarettes. These rates are significantly lower (worse) than the state. • Over half of Jefferson County students in grades 6, 8, 10 and 12 'definitely' think that smoke from other people's cigarettes is harmful to them. County and state rates are similar. • About 1 in 4 county 8th, 10th and 12th grade students 'definitely' think that rules about using tobacco at school are NOT enforced. County and state rates are similar. SYNAR Compliance Check data • In 2004, about 1 in 3 (35.4%) county retailers sold to a minor operative; this is a significant increase form 2002 and 2003, where 5.9% of retailers sold to a minor operative. Quitline Summary data • Jefferson County residents comprise about 0.4% of the population of Washington; conversely, the percent of Quitline calls from Jefferson County has averaged 0.64% over the past 2.5 years. In 2003 and 2004, nearly 60% of Jefferson County Quitline and Washington State callers were 35 and older. 2005 reflected a shift in the age of callers-50% were less than 35 years old. About half the callers report that they heard about the Quitline through • healthcare providers or family or friends. During the past 2.5 years, no callers reported that they heard about the Quitline through employer/worksite. Summary: • The overall current tobacco use prevalence is most likely concentrated in the young adult population (2001 BRFSS/HYS data). • The vast majority of county residents think that breathing secondhand smoke is harmful and annoying. County residents also reported that children should be protected from secondhand smoke exposure. However, they did not go so far as to say that cigarette smoking should be banned in outdoor public places where children are present. • County youth attitudes toward smoking and tobacco-specific health risk behaviors appear to be significantly worse than the state. • Doctors, healthcare providers and dentists appear to be an under-utilized messenger in assessing readiness to quit. • Employers/worksites also appear to be under-utilized in supporting cessation efforts. In light of the above, the Jefferson County SFY 2006-2007 plan will focus on: 1) Contractor-required activities 2) Enforcement of 1-901 regarding protecting indoor air. 3) Developing a sustainability plan to address 'messenger' populations. 4) Collaborate with OSED 114 and local schools to coordinate efforts to prevent initiation and support cessation. • Board-of 3-fealth Netiv Business .agenda Item (V., 3 • Joint BoardAssessment Project ProposaC Nlarch 16, 2006 • r JEFFERSON COUNTY PUBLIC HEALTH \`� 5,+ 615 Sheridan Street • Port Townsend •Washington • 98368 • „, ,- www.jeffersoncountypubiichealth.org February 23, 2006 Vic Dirksen CEO, Jefferson Healthcare 834 Sheridan Avenue Port Townsend, WA 98368 Dear Vic, We are writing to formally submit a project proposal to you and the Jefferson Healthcare Board of Commissioners regarding the Joint Board assessment project that has been under discussion for some time. We have made periodic reports to the Jefferson County Board of Health on this project and the Board remains enthusiastic about a partnership involving the Public Hospital District and Local Health Jurisdiction. We have taken the liberty of drawing up a brief project proposal to highlight the major goals, project activities, timeline, and funding sources. Each of these topics could be • expanded in greater detail. We would be happy to incorporate other goals and project activities that project partners are supportive of. In order to reassign staff to this project, perform the necessary data analysis, reconvene and staff the Data Steering Committee and prepare materials for review by the Joint Board, we will need to secure funding as soon as possible. Thank you for reviewing this project proposal. We are looking forward to your comments and support. Sincerely, J an Baldwin Tom Locke • COMMUNITY HEALTH PUBLIC HEALTH ENVIRONMENTAL HEALTH DEVELOPMENTAL DISABILITIES �, 'WORKING RESOURCES MAIN:360-385-9400 ALWAYS CORKING FORA SAFER AND MAIN:360-385-9444 FAX:360-385-9401 HEALTHIER COMMUNITY FAX:360-385-9401 • Joint Board Community Health Assessment Project Proposal Goal: To provide an ongoing source of accurate, current community health information for review by the Jefferson Health Care Board of Commissioners and Jefferson County Board of Health("Joint Board") for use in policy making,priority setting, and program evaluation. Project Activities: During calendar year 2006, the project will accomplish the following tasks: • Develop a set of core community health indicators. These indicators will be based on the 9 indicators previously chosen by the Healthy Jefferson Report's Data Steering Committee and will be supplemented by additional indicators as needed • Analyze and prepare reports on existing data sources such as the Healthy Youth Survey, vital records (birth and death certificates), and notifiable conditions reporting data • Reconvene and staff a new Data Steering Committee made up of Joint Board members and other project partners to guide and review specific assessment efforts • Explore new sources of data regarding access to health care, tobacco-related 1111 illness, and co-occurring disorders prevalence and include them, as feasible, in updated community health reports • Perform focused analysis of issues of high priority to the Joint Board or individual project partners • Reconvene and staff a minimum of two Joint Board meetings Timeline: Mid-March, 2006: First Data Steering Committee meeting to analyze first batch of assessment reports May, 2006 First Joint Board Meeting October, 2006 Second Joint Board Meeting Needed Funding: Jefferson County Public Health $30,000 Jefferson Health Care $35,000 City of Port Townsend To be determined • • Board of Health New Business .agenda Item # 1l, 5 • Substance Abuse Advisory Board Reappointments .Marc( 16, 2006 • • , „,,, JEFFERSON MENTAL HEALTH SERVICES Community Supported Outpatient Care for East Jefferson County Children,Adolescents,Adults and Older Adults-24 Hour Crisis March 6, 2006 Jefferson County Board of Health 615 Sheridan Port Townsend, WA 98368 Dear Board, Thank you for reminding me that my three year term on the Substance Abuse Advisory Board ended on January 28, 2006 how time flies! I would like to extend this appointment. At this time the SAAB is developing an exciting community education program—for which I am literally in the midst of applying for funding—that I would like to see through to conclusion. I have really enjoyed my work with the Board. Thank you for your kind consideration. Sinc _rely, � - Board of Directors Laurie Strong President Z.Jack Randall Vice President Quentin Goodrich Secretary W.C.Henry Members Doris Hardyman Rex Whipple Mike Beers Sandra Stewart Dee Dee Spann Cheryl Bozarth Executive Director Laurie Strong,MSW,LCSW PO Box 5651884 W.Park Port Townsend,WA 98368 Phone:360-385-0321 Fax:360-379-5534 110 800-659-0321 Email:general@jmhs.info www.jmhs.info • Board of 3-fealth ivleclia Report • .March 16, 2006 • Jefferson County Health and Human Services FEBRUARY — MARCH 2006 NEWS ARTICLES 1. "Bush plan could cost Jefferson millions",Peninsula Daily News, 2/10/06 2. `Drawing the line in the sand' (enforcement of smoking ban), Peninsula Daily News, 2/10/06 3. "Septic systems might not be the worst source of contamination in Hood Canal", PT Leader, 2/15/06 4. "No guns,but SSNW can do office work",PT Leader, 2/15/06 5. "Jefferson health board to discuss junk car rules",PT Leader, 2/15/06 6. "County won't relax no-smoking rules",PT Leader,2/15/06 7. "Smoking ban good for health, bad for business", (2 pages) PT Leader, 2/15/06 • 8. "Health Board puts teeth into smoking law",Peninsula Daily News, 2/17/06 9. "Brinnon man convicted of harassment", Peninsula Daily News, 2/22/06 10. "Avian flu's dire threat", (2 pages) Peninsula Daily News, 2/28/06 11. "Businesses urged to add drug-free programs",Peninsula Daily News, 2/28/06 12. "County glass recycling goes green",PT Leader, 3/1/06 13. "Tri-Area sewer system proposal gains support",Peninsula Daily News, 3/3/06 14. "Families getting a boost",PT Leader, 3/8/06 15. "What should I do with my food?", PT Leader, 3/8/06 • ' yr-• ba.) md oda r. p . ' m�+g' � � ° ~ 'ti ° mNw°^ jii.'O � Hfl (s+OdC000x •.,x O F. ti 8ch:g 0 1 4 ° • iJ " ti^� aa ° aa I • �ffiffi ° 8 pOUVDiu " "5 71 U� y 00 •GSm= 7 ° So '4 gOyaffi �^ � C a' c � ," aooCM„ 5 Saa> c. • .: c yamU01oom ° a0 � P � ° u < .0 , . Ca °3 za� °' C, ��W ° °w0>. aoy �0 o a� a ' 0 � nE a^ Q' - ” a' v . E-•• oo O a LmmI"111 g '6,g-a )- w &'s O,� t m g .4...) 8•2 : A Cc . 814 ' 0 "'CN'.° Q._Nz14 i ° C dOn, oGUCH 7 n• .,E,.°� 5bN m tdtu m • ^ .E tffi885P88 �� mOo m , >,Gq0o ) Fa•v oy 4 ° ° pO ° cel C A .. O t, , -5 '-• .0 °N . ,C • yc5 ' *' \ . vi mA C LLypa " C . 40 eg E 0) 3 C 0 '''', °C co u w. °,° C sm 0oc g co > Euxa) y " u= m -5 E �oAya0Ga 2 d o ..m O ... Do >om � � .yv , ° `— C 8 t i >,- gF,a0 ° mon., -op.a °o -- am" 8 °z3 . ° aaai a c ,co C o C $. cxt,,..;.:-., ---.- v0 § F, v v NUn � VA .� V o °. q ° '0mWn mU °.g M qoo vo aA .� u ° c7Pq x a a4• aNo. cv. 0 co c= CD ` O >0 C -E-° °.-~ °v Cip • °h- o' '4 66 o -C .c >,C Gr ,0N .5 u ° Oc0 ° `. os.., ,..,end � " a:b5 , 30 , mo,°AO • _ c �Ocpj IrJ F. of a) 6y> . C) u -,.5..51.,- a) 7QOC > O r .0C C :=,',1908.,o02' 8 ,,07`" "" .-i-aA ° ; owoEg Gu850.� M Xe x � � o a• .00 ' ' 'Oi ,-. Ca dC 0 cn0's ..g,:q. .211 aC' . WO 0z � C 0 m . OwyC Lcc ^ .0Ocl 'o' ' •gm NOC.oto—'=."'3ffi Ty �,60 C .4 ..... ,e,.` C OO"ay O7 OO a5,6• 6 'O & .p ° • � N Ooo .he0 ...,ma° C6, 1° ° ��.� . E�3o FCm. 6.5.•o,o U adG o m 0 (,) m°� a CUP m.g8'a' Swffi °. 7 e0.. O a' CI: m:0 m 0 2 C " pp" 62 >, o topwx °�yC � Cr)O) ' i N' o EmsO ) 0y ^i ' ° aa ° ° •uue�. . r4fob P rdiq � mp pLa2 0]c,31,_`6' wd3bg• xY ••r +;2a -'+, , ter � 'm0 § p 4) EC a` [o0. da E WN o m pO y ) C. ;-o o,G 4, %Ci) -0 , on gl 1.1= ci tf, a 4, 2 ,-. .2 in a° UNo °A U o� m .� • °^ .' ami y 40� U 0o a P i = ' N �i 00 O m a'-'y Gni 4--, P 7. • .- E E ,(5. ,,e3 ...5 ti.,1,1 . --.' 4 0.6 0 ,0 = 0 ° C y• y p 8 CID ` -0 '3 ^-,• 8 8• —0.A C -^-. holes"O.2 F.."C.a •' • 3 ° ^ � o $ �" 0� b C . a . 4pN ,•,- � CI) U j-2' `i!nJ Sy j � aO •8.0a 7t •Cu c0., ml ° ,E a , wEm w -a' a� coo3 . . 46 `4 VI --4z Um . U drziowt to a -L,-; uo v ° o QQ � 8SAF �• „ hn eW 0an0a ° g; .4 ▪ '-,"j. ° w ai 6,m w^ � � r � 0 . > w > Cmw�vs 6 g °� 0 > ^ W . m C za° ro�cF"t�o44°) E4'. §71 o• 3 eo8ob " w� ° o -c� Sct . Smo'tiffi' 41'z '-g a 0-4L c'e Ca E A it 0, 6 O ILUQ8 v.0 a iquj-t . mow' °� wqr. ° G • Oa '.-E; p h, s > aiCm U Egy, p'v<° C m u,- , . C ❑ L •O °+' °0 (11) 4_) n1NCJ ° g-0 S '^ co . a' ,O O ° b N u 0 T C .s. u CO m > 6 �.,(1) a Ecom E t d c an ° . ° ” mQ O = 73 -4—) C 0 0 0p a) V.r.,C• m O t, U •� p .O .� p 2 O 0 CO M 13 4--) 4 aIflfl? °,-..a w ....• ° v .a a>)'� m A m.07 o U W .�U — co o oo ,-,. tt ,.. rots 2) ,-- III% llIi:th . h:bI x 0 cc• W ,0 " O Z tll 0"f')a.Uiwr b ° '- ZI.• `, Hilt on co mZ'� ocno ,iy ti R 0'1 -m q..0 cp 'v.- i5*te co a-i P 0 0 ' cp .... . . a • CD G.a: p p 5' °.C'•cp 0..p cD ,, r c CA t IA = 2) owi CD * 0 ., . .•,,,,to cm . .• ,.,,...-3 K � 5 Cn0g0 0 o- -O'c , mG4 I LJ Z imil mi n �' cr .�.(D mac* ° �* OO �`�(D C• f.i -. o waq o K ai m' 'd c* 0 0 5V co 'd W o (7 O m p o o .. p K ] 'c1 . C G --c0 0 I lii fD (DFi 0 pi o' ''¢ ,* cn � em" - CD� wwo5, -- S "' ' o� run x� co mac 91 . c_CD w ncD J' aqtD G. m'8' 5 r•1 v T34S.o ° L90 o 2 i-s cr. aL.,.,..6, ° g y( 3 (7. , 5.g IIL1fl g,g,� ,- 0 o° o'(D ',-E,-“D � K7a -' wo , p - wE -o4 25. . ti ,� 7 ir- 2 O �,0° -' �(0DW O (D 'w � ^��.0 zto E2,--7 -' 0.-4. 99,cG* ^f 8 O 2,..5.rg(, g O p§ .E 4 .D f.E. ti w K,F .: m 4.0 m Pi n (1) .c"°- 8• " sr °..,— - .G. �,.'C, 8�'.ry a coD o F' r. c� yw aFoco F ` w c 'o .-. o-c Sc 7w --• a 2-0 B '-'-°Crn. z 0 zo < 7n• m X2,5 w e C). •c a �e . z g• 3 z'F-.5.2 • ° ° F <-,u) x z w w cD R R 2 ' °cp .d < o• r.E,°-. ,< R- �' v 5,."y a, p O w�az" =•z• o ° 0 r r i cp g. ,_cD '.7 'T"' Efz g m �e CD cD w~ c, � N r. rn . �o w r. R F� c 1 R co w E. D C� "ri x..5 O O- . �.3 7 <•G °< p o �Eo~'o o-�.� ti ° 0 3 6 o M v 3 0° o F, � �� a0° l °00 v-,'e m o °� x`��-px c 01 a 2 S.3 1 .--: 7C .6'� �''x] P off° a�.acD ( > 7 tr. ? O cn ,, O ° r ,D 2 `0)-t o K z ° w 7 cD `.' 'in.r'Lon 7 7'C 0° UT U E.C c I . . 0 .7 �a o �'f 7:Jw ., 3 O'° • S y )r• O_7 EI A — EL`4. SSS — �r• o, m 5-. R / , RQ �/y RO ., O0 07 ) 2 3 Y2. 33 ° d3 c c r f R° ° S . CJ O ?w P-•R < r—t- VI 0 O a PC C X r. R ._,- E ^C P-: (,.:i. S - 3c cc 7.• 2a a 'R a T w —ID 75 O • `c (: R a y2. 8,SC ,0 ''.0 2 N U E T 3 oo it, _zt c °' °" ro o w 5 v c c a > w t� 5 � 2 � � o o Ex t ctCH u a - o �+ a� z is 0 c y0 w U,. c a� y U O F. a.v y N U G O ° ii .D 41 .2'. cAd °° 3 L 3 0 •L �RGt ,� U $ 3 ° 3 o x u C w0 •, o « u m o •5 0 $ � 'S a ra G ° a• "i S � Cl)V/ txcl r1 ;-du ▪ ,0 . 8 ,7,§ 5 U 'J °� Zi. > $ '$ U § Q o U "" W 3 � `� e � w w u u u . ) 5 u' 3 .5 Ti, u w x > 0 .5 > oris a c a , o K.- 3 .5 o c P u � y u w c c 2.'u o u •y 5 E 5. E a o o .4 ,.. *Fd 0 5 yu ��a a 5 0 E bra v °,3 O ° 4 y y 2 O w H •4 E 6 pd ° `,, 'fl c ev E.c c Fii 'u O 00 V•[y ', O go' V, H Qi •� .G c� V O 00• 4. u T, taAdd O C Fn Imm a>'i u o .E •, 6 u 5 P a� u1 o 'c • IN u �p ,� b 2—. v N e •u .5 ° O « cn vi _ u 5 C •� A. wra c p0. . u a.2 c EcU E ° " :5 w° > c u ° c 'c #t " o - �' ' c v o o u m u� N E u to S N ° u E o new° E o H 8 � S c u 8 y t'7 u u o " •D .5 c 3 n o u n u o H I ! i ! uu o ?" ri °" �' o ,. u .= u � S u l 5 � o° Pi 0 u >,.v 5 8i- per../ ° • i "0O , 1 #9g — $ 1, > ti ;n E �' a (NI g u 2Eu Q -Sv a >,N �._ .. *g. •yE, is `v .o �, • r"'4 c o uc rrd c °' N F `4u'� ti 3 °? ani �' 5 �� ° $? u co ,� 'n o o s� ' oo Q y U N u y '« 00 >' o E N D N of W '1 N U ►+ •.r-� ... U N •a E ?� .5 a IIi . yu m tiEEoo ° •cg .0 o G ^ y w $ o w w° •�3 31 0 0 0 A °' c -2 1:3 N o nix .^ � 5 c� � � � 5 $ F� 8. ra � v 8 .n a ° - o° .x u p• F g of •fl ,d �i O w V '« 'y N U O v c0b0 $ 'o `� c aui U HN '° 8 >, 2 ! 8. A 3o 1 • r44•41( m A • > 8 3 c o0 00 0 0 u > oQo tC� 3 0 u w .}.., •4 H L y t•Q g w C c O ca c X.5 A SOC L� tj ea tea•'_ow t� 'c}� ra • C".U v •y w u ° .O. �— v e° aVi n. `� O itl C.1,O 5•e3 V 't1 ;:gi .;°4.d S �'.�E .o •��' 10 t ,/ t) q .c .c 'v ° � � = uvu0 ° 50 �; `«� _ a „ 3 S.cEg ,S-5 • �..4 • O o Q N 5 E g c c x O �n� •• C `� o ,? }y o s.p 3 q co .= JD .E to V 1 .°c n 3 ? c S u t>i i ,Y, . • o ' . c ° °a. IA - >,'p g g • p, CC55Gg . Q �S p a o y F .,•i L t"k 'k Mxr. 4, t v C \) 1 1 o �X.f >, 2E q d ��37I u r�//�� Ct -3, ,S f .. ,t'a& s ;. a!.,„,. ; it j �/ Q i yJ g� O U N w� .O+ .8.1 3 , o - . O ]4J O .. V 1 <, '+e. A g�, . :' c o ri o� 3 o o o 8 a u � •gu• E • ..,..,..1, . , 0 O A. • � a !iiipfl:fl itu k 2 g N � '_yo W OWC. 1-[ •3'15 O g u . Q A 0g0 � ,-... .>a , C a* d • 1,�. YJ M a • 'J :Q p8 •Q �, uu $ iiiii) CA O , ' r � ; 'q .'.. ;; u E o •� 1.< ' ,o '`' g o 3• c o -).5 gu U � ? o U 151 0° 4 • 'w ' ifl % . ! ��1 ^` j1 W V 3 to'o p Z 0 0 od6.4s c ti � •y 3 .^ 8 o;v ul o V Q aT g c '8 71 7 3 • U t c9..'N 'Va ? tONNO •ti {.a '° U -13 aGzQ . . O • 79 iit) o ; O .8.0° u fi.ti3 EE 181 w4-' Hz: 8..4 • mN N -A •�'N 'X1 U h ••'• ° c � z •fi o cv° c 6 - . • = 3 7 O wJ .= op.- az,paOtU. 'b > s. _ ' owoa21 V :5 � 2N S -8 c fljj 2OU ° Epoa m 0 G ' 4 4 .5 ? •= 8.5 'a U C N ten = LA j..1•v°- � ba 4,1 .d N cw- c0 . cO >> ° 2 E .� 'S.° .U'L� ° 4 • •,g H 5 g D w 8100 '8E2 9. 2 "S ,.00 v Ll 8 .4:> cin 4.00 e O• 1-0Eg ; t m6•4 gig ; l o,,nat,2 _ *14 V 3 `: lin ,,, . ate' c G E � -v a3i , 5up1 o �'E p. o > w U .Q U G. O .. 1 O 'C U O y4: V1 .; -0 .P 8•r5 t 0 - 5 — -0 g 0 x.1 x U J +'7 = H ::e air ° ° ¢ a� .� o �3 5.5 9 - Q co ` .° u- *� � $ c= E°C o `' off c a.'° E c8 t c eN E 7 �yys3. `° ^ x c = c_ ' e' �... 'go '? >, ° > g'N8 CA VI yt4 ' .-5.a � c.°- o N a .Cv > ys off•° E LI i ao ,-E 0w- .u3o cN E U c ,-go o .,..•-l rii g 3 3 8 O .,'a = ii. •o c w° c8 'b �E v 8 o ��^ o a § : W N " v �? _ pop- a.)i �. t N >' - o v• •� o •° aUi v 43)` 2 3 ." o y 8 •p °0 g E 0 8 r'�..Eg 8.....--8 N o / -' • 5 V p0 aq c o, •w U o ° p U O c $ O W � "' � � ° fid � °4Qv ,�£' Uov �b ° aEy e v > 'R 0 Z'C = _. E a }°pp� , O „i'dc tet., m J •C�4 O coo U �.C5 � +'9• " �+ 4 ° ., C.Y'b C �o 8Ib v8i a •y 8 a.o •15 B cd o E 0 1 41) Wednesday,February 15,2006•B 3 Jefferson health board ' to discuss junk car rules The Jefferson County Board to public and environmental of Health has set a public meet- health and, therefore, needs to ing on issues concerning junk be dealt with. However,due to vehicles in the county,5-7 p.m. high public interest about this Thursday,Feb.23 in the Spruce subject, the Board of Health Room at WSU Extension in directed health department staff Port Hadlock. to schedule a public meeting to In October 2005, the Board discuss the issues surrounding of Health approved new solid junk vehicles. • waste regulations. Included in The county has heard from these regulations was language people who collect and restore that defines junk vehicles as cars,for example,that penaliz- solid waste. ing them for having more than The Washington State two non-operating vehicles Department of Ecology has on their property is not fair. demonstrated that the accu- Officials have said the goal is mulation of junk vehicles not to target people actively can pose a significant threat working on cars. I "7= (.1-0/2-124C Vlsr o� a 3 3 5Au o-5. o > u 2 •b 2 i e d ° °-x a ti �y p o o ° ° C ° � 'Sx �`d 217 74 0 .0 Pa ° � " oq be) .10,...4 Naq uoo o ° co u ° uo COO en o .- a•. NN I. :' JU(n a- ° 00$ ` oSAYd 5 q0" 40 . A .5 • V :a I1flhU .a 2a aen om° o mHu � . a 0 co tia ' .mom N 0•O qc, ' ' U .+ Oi �1 :v5 � O 7 ° o d 'g a O y.'y A O ^ 0 R7 ° i 45 2-a , N act g UL w w (Li d3 'ThiP1il a. • at dA . .5 e .5 to, .. 1) a5p • 0c / E H - 2 wO 1...aZi n Cr) C! c) ) E �y OD. eE o�e1`-' -54t '3° .3 4,4A4, ouy ou g ; .5yu ;d.� � ° a 5 ' t72 5 5ti .v O q .q q° . o u 8 aL •.5 ° .d� 5 t° i 00No da > •o ,° _ -0 H b v ° 3 0oN ° u m x ' 5 .5 5a aA u ° o ° , ° '5 046,5 N ° ° oo � ai ° ° `"TV^ u ` .. a° 00'II ` 6 o o ° dO ° E ? oGm y o v, ou 2 � u N0H ^ O 0Up� . Z ° C' d •e{ O Uqry ' w P co en . o N q .5 a 0 ° . tu 5 n.G a ❑ Tu u u q 0 • 9 u� u yu ua $ ° uub uo° . 0H O �, Y, Em x .g Ll g 4 s . I ma `° b i e•••' 4; o " 2 ° ay1T 3I 5 CIO" ° u 'bb • PI vi a a a a a ° 't '-'61, 'Sm ' 8vu 43? 751 °p 4 aB � b � u a � o Lt.g3 • a a3. ° 82 . SaL; a.. m ox auxe.® u vu $ ouee . au ° a •.go uo .. .. u aw •2ouT uvnu, oey a ° o 'b a, o . ° � ° ou § ° .. wuc . u0 g :�, � 3u 3 03 V. ay "° 146 Oc = a Qa - $2. .2 •vy yv � ° .� a2 -8 -0 ,.2 .2 :_. 5 � iqNolc ai . 5 , ,,, -.3 . 40 u ..r.6 a,� a u ° ° q .0 -ce > oo 3 T ; qa ° b , c 0 00gr .4 o 015.9 a .. ; N N q 0O k ti $ Tu I 5, a44, o u y 0 8oo 2u •C 0a •. co5 _ 2g.aoa r ., Jc mOdw a.Y31 0 :,. "5'51i N Iv tie ° Zao 0 u .c en en c u ,o E Jn OR 5 ° u 7a2 u Z 00 ,S, U w 0 .0 5 'd58g ° -S Aa•.2 n 1 d T .5 . a 000 ,. 8g2t d eE5 -� -w " U � '', •ad a 5. a s `*8 t-•`!• fm yoo •q5 a � u w 5 be > asn °t 5en2o° > G 0pb a • ( � a qo2., w ° x " rn ° o' u ° u °'5 .g 4 °° , d TV0 hu vi 5 vN a d d uuy a � .„ > >o o ,, a u " ,q, Q -=`..aa,T 5 6,0 o 0x a o 0 E 004 .5 a ° a 3 A tO° T '4 uC Y � ra � yxZ ' u.1u d . u u 3 > 5e 3 co yu qaa eq q ii O g 3 ' u O op ° 5 � u " 0 O '� .9vqu '° q7 p•d ue•. U UGr O .t ❑ + d . „ o1a > y , g ° u .: Av .° 4- 10 , .2p." .�G A ^C5 O Q° U ... - U C b U g o cE ["• N 'C e ':.*-4"5-.- . >„„ T8 qC + , v 5 g M m oob •� C C G Nq0 5 ato � lu •Tu � b 2 ' � ] o uO ° op 5 �g 5 4) ° F n � i `" , pu .5025wuoou uv ow 5 0 ` u . q a s8a) •aru 4 u .m yxti � O ° •= ayoN Ty0U . O t.. U -0 "g g 0aea ,qv . uoaium8 uub , ° qu .ao °° xQ IilP ..W.74 Co .ay�, H a.. ux � .5 c� x xs > v TO y a IVII w ux au1 2J apd ao u .. - oo a • zr- 0 -53 g 2 777 .43 v' q ed U j! 11411H 7 H N p qqq,,, 2 .5 ° .5 •2 "' A 3 ys Li. .V '3 a I o 'The Port Townsend Leader OnLine I Smoking ban good for health, bad for business Page 1 of 2 PRINT a—. 1110 OM clip ! '''''\ ,. , ,, ilii 5.'TheLEDER* Wednesday,February 15,2006 Smoking ban good for health, bad for business By Erin Hendricks Leader Staff Writer Wednesday,February 15,2006 The county is pushing ahead to solidify policies for enforcing the smoking ban, while some restaurants and bars hE 30 percent drop in business. With one person in attendance at a Feb. 9 meeting, Jefferson County Public Health Director Mike McNickle said hE • that nobody showed up." McNickle said, "It's good [because it indicates] people are complying." Although most businesses have complied with the new statewide ban on smoking in public places and businesses that are feeling the effects—not of second-hand smoke, but of a drop in clientele. Judy Lundgren, co-owner of the Hilltop Tavern, has noticed a 30 percent loss in business since December. "It's be said. "What I have found is that some of them still come in but just don't stay," Lundgren said. She said that they are chc at the store and stay home, where they can smoke. She mentioned that although December and January are typically quiet months, there has been a "significant" drol nights, as attendance has been cut by half. Quilcene complaint John Helgens, owner of the Logger's Landing restaurant and bar in Quilcene and the single attendee at last week' meeting, wanted to find out if there was"any chance of getting a variance." He mentioned that his business has drt percent. McNickle made it clear that there is"not a chance" that businesses can seek a variance to the smoking rules, leavi a bit hopeless and aggravated. "They kinda irritated me," Helgens told The Leader. "The comments made were very uncouth and downgraded sm Although Helgens has considered putting up a permanent structure for smokers— like the "butt hut" accessed throi garden area outside the Valley Tavern—he feels that not only are there too many steps involved but it also takes 0 Landing as it was prior to the ban. Unfortunately, Helgens said, "It's the government and there ain't too much I can Chuck Russell of the Valley Tavern said the"butt hut,"which customers helped to build at his business, is simply a skids with no wiring — it's not a building and not subject to the ban. The 27-year local businessman resents having smoking rules. http://ptleader.com/print.asp?ArticlelD=14329&SectionlD=10&SubSectionlD=10 2/16/2006 The Port Townsend Leader OnLine I Smoking ban good for health, bad for business Page 2 of 2 , "My whole issue is that it's my business and I think I should be making the choices," Russell said. "I don't consider place, it's my place." • Russell noted, "Smokers are some of the most persecuted people in the country." Statewide change Statewide, 63.24 percent of voters approved the anti-smoking rules. Jefferson County passed the measure with 6c approval. Kellie Ragan, the health department's assessment coordinator, said 85 percent of food-and-drink establishments (- strict smoking limits, so the rule change had a more narrow impact. As of last week, the county had received 13 complaints— most about smoking on decks—covering the 225 county establishments. There has not been much effort to try to enforce the rule that people cannot stand and smoke with doorways, windows or vents, Ragan noted. "People are really not doing much about the 25-foot rule," said Ragan. With Washington the fifth state to implement a statewide law prohibiting smoking in all workplaces, including restat Ragan said, "This is a huge change in social norm." The local Public Health Department plans to support employers as they adapt to having staff that use tobacco. "We have to be compassionate and supportive to the people in this change," Ragan said. Some businesses had expressed concerns about needing to hire alternate staff to keep things going while other ei are now more time-consuming smoke breaks 25 feet from the building. McNickle said that the goal is"not to make people go out of business" but to simply "promote public health." Ultim2 • have to do what we need to do." Public hearing Last Thursday's meeting was primarily to lay some ground rules and answer any questions the people had regardi The next step is a public hearing at 2:30 p.m. Thursday, Feb.16 at the health department office, 615 Sheridan St. i during which officials hope to have the Board of Health approve the enforcement regulations. For more information contact Jefferson County Public Health at 385-9400. Related Links Content©2006 Port Townsend Publishing Company,Inc. Software©1998-2006 lop!Software,All Rights Reserved http://ptleader.com/print.asp?ArtiClelD=14329&SectionlD=10&SubSection1D=10 2/16/2006 a c0 O '-z' 0,.K Q 0 50 y • , IiIi itall 14.° m o o ts rn b a5,c d mro xuEOUuE 03.Ea'i,--,•-•—,,KmocOZooo INN C „ ,„ „,--c . 0° >,°G) bD K K a> O a N +> o y O a� al .a > w K E Eb >�,n° v - 0 ooh �j'� •o:.x" s, m U �� KK� Eo °oaGLy > co Obb, to N. 4."y m K y 00 tv�� p 0. a0- 2 >'i K to p E-� 4� m .L] • C' ,H, bA D G> :; m 0%2.4 0 a� f' 3 .., y.- o.W.K -,•C Z E c.�..,' bD> c. O a) K C EC O '�•., c0 K ,a a. S O q K a .K.0 Cal �+ „ 0 �j . ct a4. O",,,.K OaS.� co w', E.K � O w%C ° 3 K K W.0.E.3 .K s.'..,_„ C '-K' <o E w: E-, 0.Ca'yE'CbnO.cyiCluE� t''' c4) y;,cKC7 >Q� +° 'd m.0 CA cc' N (I) = K K �i d d c o o -[Z of cd O C > c O coOQ.y3 U(1..) ct ... axida.., �«. a� tiKO � > •^� O a) +' '.� �' O W miC 4, ■_ .w O O ,�Ur1 6. i y -r m d�$ y ilmQ> s.`�' p •>^� Co ° _>p c N ��-° y� E �ayi�Z1 ��= tib, ¢ r--+ N•� f-. N '�• ° K 07 co 4j ...Z/-r.G z ."O N Ca 0 f�n111CL) 1 E , oam' o C•d c-. ° $(I 0 EO �L/ A w .c.. o.^ K 'O 1v E� 0 al >'u O �'°" .�� O O C 4 0 wise O i.J ,..1 ›- co C'U $-. C c.°r c-Fj.. 0``,a K O 3^O 4].a IR N C- 'C = = Sts L, .�wmnCo° NoKO7 r co K - 3KOKp � O S-i H OUB ti �.�" o.[., o ro-a.K 0 „O 5 O.� o vc,.., ..� O p+ K.-1 0.A"c3 "-' K.i, L s. N GL' K a) • o 1C.) l/1 0 om.5 x E PX.d O. 30 0 `� y o v q o cC c a) CO o 0 o a) mAt? V le , siikl , 4 E 70"6 K = v7 U .c tc::31 e 1 o a i, 4.1 4- y a 3 o a`�i is �a w ttO O !. v t0 O T� c�C L� U e�,,, fN F� U]. .sG G ai c).u a,'O h 2f m j C raimmi 0 O 'FL) 0 C O 0 6 � Y :- 4 : 09 r a � 0 a 0 a ° w e a'., ,� :r cu[ � � a� t9 w 46 b � �.. 03 i E �_ K 7: .a o CD W w.a a .o , ,, ,7,--"- _d t . 4 t f,iv " I �9 d �hO 3O �, 0.� iyy. y 0. s c r�� r *; F..•x I d.m 1111.1 _ 1:4 K O O O'C .� 7 C/73 o yr, o COO E co y C p E R. 4 K Cz. r co cp .r i i : ra{ah li.::;1-p.d., ' 6 E 0 r-, ',�3.5 a� ..� O 3 ,.: 3 aC O O 0m +� c �.,�+..}ar rsf 0 0 3 kt4s. co ' E ' CVmw`o� c--t.` «« m ° '' i 19 a, aa � gig-, . m iia' .5 o^o E 3 poo O �+' 8 m cN a '.. m fs 3 G. d 4 c0 a3 • )O 0 y a d 3 a y3yp �,x ;q 5'C a M cay,°'''m ca..t rE i Cl) w U'a'C.' C,,5 6 .44a. s Cq Fi w �P9 ia a- Q 40'& x o�i o ...5.•0 03 C .4 +q ty 0 p m a a co 0^'So) xg A21 w .' 44 as m •b 4, �� EI c>.o . � .0.a " o 3.'d �'0Za • C > a) 3 a) >,4) E� , .0 c.p-,1 0-0 0 "4 �.' 4 f•.3 g-a y y-"b y dr 0 3 0 sq'd 3 q0 ^Safi3a)W 2 4-csEiF, y $ a > ��or 0 500. (1) 0 t!'. 'E.E iq-1 z - " 8'4 2*s 0 g E .0d a ".xIni.5 A a>o, A ad 4• ., w'b a a " "O c �3' U00-_d•y - 00 2 QS d a) w.> a�4 '> p 11112 a 4.3 c }. U EO y -..i • 0 g-02x2 ,,,"ts, F2boas'..qeic47.). ID .,4.,4-0 0 °' ax $ �a t�� a�� ° ° "ga � iao ° dx0 d . o ; "xq a 6 •� 2EEx abo i4 o • . Ili 0 .7.).4.1 t! 0.0 a .040.5. a p C m eo+ b . m aa5 ° x ° o21% C °c40.Ca3 a 9. + .� . V p 000a) U o � •b m ›,-C (IS0. o ^O 0 d t „w " yoaacz ) 8apaKA50a 'al' IO 0 bE m, $ 4141-00.) -0' ww� ° •a 5 ". .'.0 acsas .„.--; . . `01.3.21.°4101:1-3,-5 ��,. b.. a a et 40) "c'1 g 2..e.„ ,,,>-,clo r4,6,'>c'''.Z.vi-2.:01-...gct°'!"-.,,4.a)"•..-2:2..' 1 teo"-'.;."'7 5,1 gi:1 r " Oil v-, 2te4.4 § , 8.oy3Pox DI C x y °t t. w m g •.44 1 0 34 .4.2 S .? pew CU "W a-p • 03 ,a . a .DAl. caIv! O, i„dti> ? U �'e pa)Ss E �. b0.a;b � � a 8aa4 >7,gxis'db F y,) .°ax .00 •o esa � am12x o m b u Am" 8 — 0• 4—) .5,3 aj4 ° 0''''' CO"g,, g 4 0 t'>)•P.,il s.....t)j--.° 'cl c3-1 % gea' awbe ,,E b as y 0 S--I oww0.-. 3�.' xa�n ° oI - cd w a " o �v.5aCI) o •' 0 cil t.1:2•3tfai4.94 2 • ■- .moi • 0g g A OF ob 1 a'm�•W xx„ aai�<0 3 a 11.11 C aoEg aup 0x � 4,10E.,"1 N �' fi ° 281 § 8oati4TD''' 0:44.k1 CO �i U k A ag6V 8 2¢ .04A. §.i Avian flu 's dire threat \ 1 lat looms for "This is a virus designed for mutation. Peninsula if ` °�} It's been evolving the ability to cause le � � .:' global epidemics for millions of years." pandemic strikes �� ' DR. Tom Loci BY JIM CASEY ;i health officer for Jefferson,Clallam counties PENINSULA DAILY NEWS.. "' + :}, � I { medications or IV solutions. Avian influenza is advancing toward a , �' Furthermore, Clallam and Jefferson ^ pandemic like the slow-motion segment of \ ,,. , a horror movie, a dreadful progress whose helpcounties won't be able will ask fork outside creeping pace may '� � ;�T help. The outsiders be too sick to petrify its victims— `` '' respond and too busy coping with their or lull them into inaction. own troubles. That the H5N1 virus will arrive is If H5N1 is no more virulent than ordi- almost certain. Just when and how hard it will hit is anbod 'snary influenza, it will reap its victims y y guess' from the very young and the very old, The onset may be as mild as an ordi- Locke said. nary flu season, killing one in 1,000 to -_' But if it copies the 1918 strain, it 10,000 it strikes. HT Or it could be as catastrophic as the Simple surgical masks are adequate would kbl people e to 40 years old. They q 1918 flu pandemic that killed 600,000 to keepwill die because their own immune sys- 1918 people safe from flu-laden tems overreacted. Americans—2.5 percent of its victims— droplets from sneezes or coughs. *scores of millions more around the To come in waves d. • be absent on sick leave or caring for loved Dr. Tom Locke, health officer for Clal- ones. And when it's over, it won't be over— lam and Jefferson counties, said scientists ■ Schools will be closed and public just the end of the first of three or four are watching the bird flu virus mutate gatherings will be banned. waves that may follow each other months daily beneath their microscopes. So far IIIAbout 5.000 people may die in Wash- apart. the strain has spread among birds, and it The illness could spread like seasonal has sickened humans who handled ington state alone. flu, moving from the eastern seaboard of infected fowl. ■ Between 500,000 and 1 million peo- the United States and spreading slowly pie in the state could need outpatient west. Eventually—like its World War I-era precursor—it will mutate to a strain medical care. However, it could enter the country ■As many as 24,000 people might through a Northwest port like Seattle— that's contagious among humans. And if people aren't prepared, they will require hospitalization. or Port Angeles. reap more than a deadly illness. Similar "Once it's in outbreak mode, it is going to the aftermath of a hurricane or flood, a Not enough beds to be extremely difficult to prevent pandemic may spawn civil disorder. On the North Olympic Peninsula, the entry," Locke said. Consider these likely results of a pan- region's four hospitals haven't the beds to You needn't be Adrian Monk to be demic: accommodate all the victims, Locke said, alarmed. ■ Up to 35 percent of employees could nor do they have sufficient respirators, TURN TO FLU/A7 f 7DA a- 24-0,C, , w .> y aV y o- � .50'4090 " a''' ti ,.. L'>' �It.g cQ� td -S-4"E2 O � a 11*E 11! I Mg t . w •'Cf , Y-�fi r`C y : �:� �` z •� W rd $ �.. .L.ate.. N`> c0 0.y U 3 �y m �O0 q Q, d .3[ s ° n,�p'^,°°Ti- r� 44.r4 'c�^deo- os_ m $ '_ �u /s is •,•� ' 'u. $ .'0o, a, cam, '�' a~,.°3_'a T�'•>,.� y,ti.c E..' [w".�2,4 rig c ❑ ?; o= > c �y a o �- . y c = � $o• la ;: ii C O y ' `-• C y I ., , mm E d 0,:::"ri-r.`"Ii aaO' rQNv �c� 3:°VJbr UHUkIHU oUy o W. ..9 l' 71.4.,..441:* rk _ ,,,,i. szie.a. • I ;.�ws' IIL 1diiiij o -4 .41,7:, ,,„.:-';' .., -. --,s„, 't‘,..:it ' 1 -ii W m TQ O y Qoi. A �, ° �¢,1 wi6 T- W�. . al' j Q Wj ;i �i,..i7 CO t an C a Q.) E ` y y C L , l't %,,,,,„6-t',- ,, . ---(4, ,--.:„ .t....,_ . VJ p + s�' ! : -,tis S „ , ® <, _ a'ys t vy • .;. 608°, 40 g� _> -.'";-.;..\- q i i r p C a�3 3- E E ;,..� 1s«fit { � s' , c. y•E 8 d�: °y.S- t s EE 4�u ' id « a > aN�v� 3 r 41 j syrE , i .x\ a .—i , ° I ( I 7 a a a 0 € y ° � 3 h r'� � ` >� �x �' co "II'ld 1, tt ''. p C .°] E ; a, .0 is T i Vce L S ( ' . Yt •E m y y- o,: 0 a 4 c v i �` sr W 6 a 3 m fy-� u 2 E c CD > O VJ \ r� W E o L _ " � E_ y � O C U4,44 ' ! ' &0 z'C7 >ec C. - .�- Qyy 4y O � 3E<... oqy c y ti >,-�v m >,>, y vc yxv E °qas >'� °3 ...-.. ..1 -co� N^ o-o o c°.��. 03 - .yx �° Q,' Ct .t u;-= a C C '> y y 8j.-.L y C V C C t W s a^ - .D'E ty �. `v .+ V O O >i '8 yLt a,«. �. W— td O �. O. 2 al ayi O O y t� u cis., �. A h .s 0. C atl -.A +..� O-p 3 > -!1-,,' 4 L rr.'9 C C E aC E ,C 0 a0 �''�n p as W..7 V ›,- V, ° i N-5, a� ,Ii >.y g„ o 0 ,6-c, .2 g as �t. y.,_c O._2 1.' m-0`- c.) l�,j 1 O W rn ao. ` 03 w O 0. v, a Wil,.q y Oa t.;•U C Plilihil! �—-VVI 0- .. G V � y... O � U � atl c �._ y 8 w w y N E ro V ' -O�' y.� ; > E mE Ej ° > � , rpi 2c - ° w o y Lyc-• 0 .4...m c y4o ac c >,u �_ 9' Lies- ,vzd3L n� C•�"coi- g,. L.� ^0 � ao> 140H1 cy $o �.fl ... c > &43 ° � N 'd y Eo� y sE■ c d -..-- = v,!.., y a`, $ c v eo-� SLEV° Cc5 v, m . , 0 "ro -• o �C mcy c ys U lug-E' oocc � g 02 �.> �.am y,, cI °' � E00 2 0 , 0.Wacoc`v 42-g.rOEoN� � e cEc 5 � ^L ...S'..-,,e06-.1" x ° _ 3 m y ..- > 0 ar y c y N Eye _ �y 0 0 3 a m � c - c m. yA �.? tp A Q w �A 3 y , '^ > c y z yo ya ye.3 c �,.°° Eornyym -G q ha'^ e c LUIIII pp > Wr ,. y OOCyC ^ C LO^ 00aE d° °c. c 6aii �' w cE z cr �.� ° aa a E PENINSULA DAILY NEWS 4, E 111 , . ,, .„. , . Drugs Ti CONTINUED FROM Al a° That includes substance *040 p3c 8 ;,,G g oo abuse policy development, O l o p o supervisor training, drug and <. o,° C alcohol testing, random selec- v '3-." o v o m tion services and employee Int - •a >A w A assistant programs. -4 a.o i �ccq a 0')n,o o The nonprofit organization � � d y Co �t c � % does not count on grants or gov- uO E°. -`a' o:e 2 > ,Q w c ernment support — just the c o o 'r ° support of its 1,500-member CD •ti - o .E 5 E' a companies, including Hadlock d c 4- o4 A eo Building Supply. ,o ° w crod o o i - .. "I don't care if you et ,s o c w E [ together only once a year and MI $ 0 w c cS m smoke a joint with your old -0 > o a on a o a,-P boyfriend,"Pool said.ilas x ° 0n d d•, ° d �''V He said he was concerned P. y 0 A no 0 d that 8 percent of the U.S.popu- lop ° a A a a A o a'A^ai lation was found to routinely m ; v 3 ,4 abuse drugs and work full time. eo 0 0 . o v o Showing that Washington °•o' • 3 a was one of the highest drug- 6 %3 0 2 V N 5 -0 using populations in the United '� States, Pool said the construc- UM "a 0 w goo. tion industry used to harbor the w i c j_1 , >, '..� most drug abusers. 2 cZA $ 3 I V M [ That has changed,however. K.' . to.,t hnt0104\I ,m, (hr � V ai � g +-' 4� � ��, d �� Iota IJ�r:ua'Uru�tr.,uccg. Icr > oo y-- >,° > g ° said. Wm 0 . o g g.y 2 g 'Almost old hat' C- o; to :b " ��," o'" He said with 98 percent of 8'2 3 2 Fortune 200 companies drug- _ od pE'm t,c, ec,o testing employees as "almost 0 o E 2 a1 8 x -E'-' old hat to them," it's the small O companies with employers who overlook the problem that are IIIIRIP 4, F 0 0.;'w, ' 0 still targeted by the "drug 0 2'� o, ° b m underground. d � .a C o 6 c >' Alcoholics and drug users ti,atm w U° 0 EA, can cost employers between a ° ..-.0 8 E $12,000 and $25,000 a year in o ='o° e4 6 rj S lost productivity or other probgoo - lems,$ lems, such as on-the-job acci- °•0 a ab'n ., -oE) CD -0 dents,he said. >3 p0•C.0 c o o "You may not pay for it the Iwo a) reE c g > U 3 5 first years,but those premiums �o d,ti o, ° . 3 a c^t� are going to go up,"he said. P ,, >,a N$ �, He said the most effective >, cn 4, 0-0 p ry e programs also target alcohol n• v o c e abuse as much as drugs. a H a d oo ° a)E� Inconsistency in promoting a co Z ,, o� , f:1.3 drug-free program is"to say it's cn ...�' Cr) aai p° OK to have a shot of whiskey with your employees after work Z ti v >;• but to say it's not OK to let a a p°' O a janitor smoke a joint." a " m a 3 James said it is well-known a��°, oo° a�� td that Hadlock Building Supply is 7)U CO {J c d 3 a drug free business, from its CD •„ E a^" �,o_ job applications to its advertise- ments. It's even posted on the 07-Z&- O / A t u a °o x business'front door,he said. s� W ° o ti c" E m Today, he said, the com- pany's• ■ m p a,c, S• ,b employees never know z g o S R.151 8 g Q when drug testing can happen. 00b,30-5 8� o U A F a.w•C I= A"':-D.2 Jefferson County Editor Jeff Chew can F ra a �, be reached at 360.385-2335 or at 5 .t ,c Jeff.chew@peninsuladaitynews.com Ca .. ° z O A ti '0 a- a�' a4 >a' 7_ g zu : TO est .8 t � A°' 1s I * A . o88 8ZypIq • w •o c aa 2 (:114 u>, Er a til:CID rA , ?, ...,.r�m. R.A.'.I Y rn ,� C w .,� E V -`a y L O . ' .. ge. . M Y. I i N d ..N. t Y �Af^ • r q O ._ O75 $111111:1 ) / .P. k 1 y V, - C vaucaa,.... • /" Y q O U pU A • 11)O ; U O • V C A• N C.)• u 5 g It kid lig -I m c > w,rr+ , H u v,p0 y C V U •0 ▪ Yj C .. : C C Y O to ry L wa 2 3 y z o wk Z A L '0 5 y O '+ '.' CZCi) d v ..= .2 • Me i i = Clog0 .. > l3., v ti:, .v = N U i ...-e..... ._:.... '' • :`? \ ,^+ a• mi �Ui,• i ' u O'- ' �.- I C O V ACOCA s { r \ L• AN_. Lr - E .i C/ C � y O '0 O A t V C N 00 a) X C .n a) y C a) .y O0- .a w 00 pU O 7 C_ .U/ to C '0 •.E .." 0 ..)e -6 q O O L H 0 b0 ca H f0 C' 'd ^ a c N N 7 a) L a 4; C W L '- y w a 5 a ~ w `u 'n A o ct y m C c' q o ,,, U ^ Aow y o 00 oq0 o pv E . v . . TN y qtY � _ — " ,... - 04 ,.. 4.) 05 ,,,,,, A O -, . v ▪ � 3O v) q >, q 03 Y C O � w to — aU) C O w �ty 0 'a tO xO 0 2. ,-6 p N y ` . CJ aa 'O C0 ` 05 a O O .... (1) >, C :,,,,,..) C .. O „ .0pH N ,ap - U — tic0dQvOo 't" wx=b0•ayiVC sN .yc . :„8- 0, Q :7,71:iNNvM.V`> li ° rc •'a _• ax7 ` .-yc� V ' O co::IO U ` C 0 — 7C1. A 0 cu i inn) C �t= u I O UV j O 3 � C •�aLO .V. z- AN .1 CE w . Av ou § - aA -I O > U U <a y ; ca 04 C)rt3 . LN, Q). NX y > O o U1/411 o410 . V 3w 5 p N ' Li) 1:: .ovl(::) (K3 . aaag UL EuOwT CS) y C • w ax a)c 4..JC .1) F34-' ''" x ' G, yO CO 3 co) 0 aa)) y C eD .0 V) N y C A O .k V) .� �„ 0_ 0. v u y y y 1.. 0 ti Q) a E .O. b0 C O V 00 J0 0. t00 fi t. V) . . . III • — .. — A6 FRIDAY,MARCH 3,2006 Peninsula Tn -Area Sealer system pro osalgains support Businesses say it since 1969.It's really time to Jefferson County could not have a positive outlook on this. show substantial funding for "Yes, it's going to cost the Port Hadlock-Irondale project needed money, but it's inevitable." urban growth area sewer sys- for expansions talkednimedaboutusifuture plansnessers to at on tern, woflc the urba the c build out their facilities, but area. growth BY EVAN CAEL with current zoning regula- Tetra Tech's work is to PENINSULA DAILY NEWS tions and the amount of drain- ensure a sewer plan is in place field required for septic sys- the county could afford for a PORT HADLOCK — Busi- tems,'expansion is not a possi- 20-year time period. ness owners and others with bility until a sewer system is The plan should be corn- vested interest in the Port in place. pleted b Au • Hadlock-Irondale urban With a proposed expansion ber. y gust or Septem- growth area and proposed to the Jefferson County Public Every person at Wednes- sewer system overwhelmingly Library in 2011, Library day's meeting supported the supported the project Wednes- Director Ray Serebrin said, urban growth area and sewer day before the Jefferson "The sewer is very critical for system in Port Hadlock. County Planning Commission. the library Kyle Alm, county Depart About 20 people met at the "Our septic system is at ment of Community Develop- Washington State University capacity. We're counting on ment assistant planner, acted Extension Learning Center for the sewer." as moderator during the meet- an informal gathering to dis ing, expressing a certain cuss the "need" for the urban Study being Conducted . amount of empathy for the growth area and sewer system Seattle based consultant attendees. that would allow the expan- Tetra Tech/KCM, under a attendees."This is has been an ongoing ongo- sion of Tri-Area businesses policy issue and it's still and the communityin general. $424,110 county contract, is ing,"Aim said. g conducting a study to deter- "These problems weren't "The question is, `Why mine the most viable sewer made in a day, and they won't don't we have a sewer?"' said plan for the area that the go away in a day" Craig Smith, owner of Penin- county can afford. sula Video, 842 Ness Corner In May 2005, the Western Growth Man e_ Reporter Evan Cael can be reached Road. Washington "We've been talking about wpent Hearings Board decided 385-2 5 or evan.cael® eninsuladailynews.com. i - What should I do w thy food? Food safety advice forp ower outages freezer will hold food safely for • If food is cold to touch,; 48 hours. and you know it has not been: Many people have been salad dressing, ketchup, mus- • For the refrigerator: Pack above 45 degrees Fahrenheit for_ affected by power outages due tard, etc.), butter and breads are milk,other dairy products,meat, more than on hour or two, it is' to windy conditions this winter. usually safe. fish, eggs, gravy and spoilable probably safe to keep, use or, Dangerous food storage condi- Jefferson County Public leftovers into a cooler surround- refreeze. tions can occur when the power Health offers the following guide- ed by ice. - • Even under proper refrig is out for more than two hours. lines from the Washington State • Discard any perishable eration, many raw foods should; Dairy products, meats and Department of Health and the foods (such as meat, poultry, be kept only two to three days. fish, eggs, tofu and cooked left- Centers for Disease Control and fish, eggs, and leftovers) that before they are cooked, frozen, overs are just some examples of Prevention if the power is out for have been above 41°F for two or thrown away.Never taste sus foods that are especially danger- more than a two-hour period: hours. pect food.It may look and smell, ous when they are not kept at • For the freezer: A freezer •Keep refrigerator and freez- fine, even though the bacteria' 41°F or cooler. Uncut fruits-and that is half full will hold food er doors'-closed conserve"cold that cause foodborne illness are vegetables, condiments (bottled safely'for up to 24 hours. A full air. present. •Keep a thermometer in your refrigerator and use a digital quick-response thermometer to check the temperature of your. food. •Foods in the freezer may be- safely refrozen if the food still contains ice crystals or is at 40°F. or below.You will have to evalu-,• • ate each item separately.Be sure to discard any items in either the freezer or the refrigerator that have come into contact with raw meat juices. Partial thawing and refreezing may reduce the qual- ity of some food, but the food will remain safe to eat. Health officials advise to always remember the golden; rule of food safety: "If in doubt, throw it out." r • Wednesday,March 8,2006•B 3 Families getting a boost New program tarts March 20 tos strengthen, Jefferson Coon 's Strength-gth- and set limits;we are helping our care for younger siblings are 4485, for location, sign-up and ening Families Program is geared kids become responsible young provided at no cost to partici- more information. to opening communication lines adults;we are strong young peo- pants. The program is limited Funding for the program is between parents and their chil- pre with a great future; we are to 10 families. Interested parties through a DASA Reduction of dren,ages 10 to 14 years old making good decisions so we should contact Shena Kellewea Underage Drinking grant with Participants meet on seven reach our goals; we are strong at Jefferson Public Health, 379- Jefferson County Sheriff's Office. Mondays beginning March 20 families who care about each for a community dinner followed other and have fun together." by the evening's program. Strengthening Families is a Parents and youths meet sep- nationally recognized"best prac- arately, then jointly, to discuss tice" program in prevention of several topics—having goals and substance abuse.The program is cams, setting house rules or designed to help parents build on 4#11 'ts and the consequences of their strengths in showing love eaking them,developing.com- and setting limits and to help munication skills, and handling youths develop skills in handling conflict and stress. peer pressure. Most importantly, Strengthening Families' it helps families grow together, creeds are: "We are strong and say organizers. caring parents who show love Program, dinner and child- • • Why the methamphetamine epidemic in Jefferson County? (Addendum to other handouts and c-maps) BOH meeting 3/16/06 James K. Rotchford, MD MPH The answer is surely complex and multifactorial. My conjectures are: 1. Socio-Economic Historically epidemics were often related to widespread socio-economic disadvantaged. Given our relative wealth and affluence in Jefferson County, I only have one conjecture regarding socio-economic issues: Could it be because that logging as a source of work has largely become financially untenable? Consequently, unemployment and or lack of meaningful work has become endemic. a. Epidemic seem to be more widespread in areas of our State where logging was once prevalent. b. Public health has been shown to correlate strongly with greater job opportunities/income. c. Methamphetamine is significantly cheaper than cocaine and historically there were ample opportunities to make some money by producing it locally. • 2. The nature of methamphetamine a. When smoked or injected it is highly addictive. It seems, taken in this way,to be at least as addictive as heroin. Oral pharmaceutical grade methamphetamine while a Class 2 Narcotic still can be prescribed for a number of albeit uncommon diseases. This mode of intake is less addictive. b. It not only impairs but often causes neuronal cell death in many areas of the brain including those involved in judgement, attention, emotion control, and inhibitory control. So the effects on the brain remain long after the intoxication. The natural appeal coupled with poor judgement and lack of impulse control is a set up for continued compulsive or out-of-control use ie: addiction. c. Physical health can rapidly deteriorate which compromises self-esteem and aggravates the inevitable depression that follows use. The depression can be quite severe and consequently can trigger further cravings. d. Use and withdrawal is associated with mild to overt paranoia. This paranoia often contributes to the lack of asking for help from others. The exception being other users. Consequently, meth users seem to be more isolated from "normal" family/friends/acquaintances than other addicts. e. Multiple short term benefits of use. For example it is cheaper to treat depression with methamphetamine than obtaining professional support. Likewise if one is dealing with weight concerns it is a quick and efficient way albeit quite harmful in the • long run. It also can boost some sorts of work productivity, again,just for the short term. 3. Accessibility Besides the historical high prevalence of"cooking labs" in the area, I have been given some credible input from"users" that the Mexican mafia with strongholds outside of Forks has been active in assuring access to high grade methamphetamine. 4. Treatment is limited. The perception in the community is that treatment rarely works unless you are rich and/or it involves jail. Recovery is often slow because the brain deficits linger. From the meth addict's perspective, the only viable option is to continue to use while perhaps trying to cut down. This is coupled with the paranoia and sometimes legitimate concern about being attacked by users who, afraid of being ratted on, attack anyone no longer part of the using "clan". 5. Methamphetamine dependency is a chronic relapsing disease as are all chemical dependencies. It appears that one can never be sure that one is entirely free of the possibility of using again. Hence,there is a pool of highly susceptible individuals which remains high even after treatment. 6. Social tolerance toward chemical dependency and a tendency to assume this epidemic is likely to be just a passing fad. This coupled with a social belief that methamphetamine abuse represents a moral/character/criminal deficiency and so should be addressed solely through the legal or other cultural shaming approaches. • 7. High prevalence of other chemical dependencies within the county? Chemical dependency seems to beget other chemical dependencies. This increased incidence of other dependencies in patients with a known dependency also applies to family members. 8. Other .. One needs to include all the multitude of factors that are known to promote chemical dependency within a community. Although there are known reasons and risk factors for the Methamphetamine epidemic, it is time to get out of the problem and into the solution. This is a common adage in chemical dependency treatment, Meanwhile, better preventive measures need to be found and implemented. • Jefferson County Community Network • March 16,2006 Jefferson County Board of Health 615 Sheridan Street Port Townsend, WA 98368 Dear Board of Health, In the fall of 2004,the biannual Healthy Youth Survey was conducted in Jefferson County and across the State of Washington. The results of that survey were released to stakeholders in February 2005. The Governor made a statewide announcement about the data in March, 2005. Other counties released their local data following the governor's announcement. As a stakeholder, the Community Network received Jefferson County schools' results in February. We chose not to release that data to the media or our community partners. We were told that Jefferson County Public Health planned to analyze the data and put it in a community context—as they have in years past—and we decided to wait for their analysis. It has now been over a year, and the data still has not been released to the public. With another Healthy Youth Survey planned for this fall,it is questionable whether the 2004 data is even relevant. In addition, a Community Readiness Survey was conducted by Jefferson County Public Health in the Summer of 2005. Media coverage of the survey was quite thorough, and several community • partners expressed interest in hearing the results. The survey measured adult attitudes regarding substance abuse. The results were received by Public Health in October 2005. Those results still have not been released to the media. After speaking to the Board of Health one month ago, Network Program Manager Beth Wilmart received a copy of the Community Readiness Survey results from Public Health. After reviewing it, she drafted a press release that Public Health could use to communicate the results to the media and community partners. A copy is attached. As of today, Public Health has not released these results. The Community Readiness Survey was paid for through the Healthy Youth Coalition portion of Public Health's Drug Free Communities grant. As the conveners of the Healthy Youth Coalition, the Network has a vested interest in seeing this project completed. As community partners in prevention, we rely on data to guide our decisions. The Jefferson County Community Network requests a response from the Board of Health regarding these two data issues, and the board's commitment to health data in general. Thank you, Holley Carlson, Chairperson Jefferson County Community Network • Encl. •615 Sheridan•Castle Hill Center•Port Townsend,WA 98368• •360/379-4495•FAX 385-9401 • r . FOR IMMEDIATE RELEASE 4.4 February 23, 2006 f i .r Contact: Kellie Ragan Survey Shows Jefferson County is Ready to Address Drug Problem PORT TOWNSEND, Wa—A random survey of Jefferson County residents conducted last fall shows that people recognize there is a problem with alcohol,tobacco and other drugs and they are ready to do something about it. The "Community Readiness Survey" developed and administered by the Minnesota Institute of Public Health measures a community's readiness for prevention services regarding alcohol, tobacco, and other drug use problems. "This is the first time we have gathered data on adult perceptions of alcohol,tobacco, and other drug use problems,"said Jean Baldwin,Director of Jefferson County Public Health. "Now we are able to tie the results of our Healthy Youth Survey into the perceptions of the larger community. This will allow us—and our community partners -- to make better decisions about the type and quantity of prevention programs we implement." The -question survey was mailed to 600 randomly selected households throughout • Jefferson County. A $3 cash incentive was included. Fifty-nine percent of the surveys (323)were returned. The survey was funded through Jefferson County Public Health's federal Drug Free Communities grant. Survey highlights included: • 80% of respondents believe alcohol use by teens is a moderate or serious problem • 66% of respondents believe alcohol use by adults is a moderate or serious problem • 52%of respondents believe drugs and alcohol contribute quite a bit or a great deal to crashes and injuries • 22% of respondents believe it is OK for 18-21 year olds to drink alcohol • 52% of respondents believe it is OK for adults to offer alcohol to teens in their own home • 95% of respondents believe it is never OK for adults to offer alcohol to teens in their home (other than to their own children) • 70%of respondents favor law enforcement spending more time enforcing laws prohibiting sales of tobacco to teens and enforcing the minimum drinking age • 75%of respondents agree that the community has the responsibility to set up prevention programs to help people avoid problems • 51%of respondents would be willing to increase taxes on alcohol to pay for prevention services For complete survey results, please contact Kellie Ragan at m wmm m o coon � n y a C) 'p n .� 2 �- O 'fl (� 0 Er. m cn m o rt (p o 3. .. O O O g cc @ co m m — - v CD CD p O = _ N a" C < AA o N o ? C ti '~ O W rt rt W 0 s- -P.oho n c oho o O O 3 `( O O _ `< p `� �' O CD ekt o p CD n n rt s N 3 n 3' n C a' G CO CD O N a n 3 C i o .1 3 ottcD 3 CD -0 FP C o r+ n —� 3 74 3 3 3 <' 3 c a �D <D .C: fn O CD N 3 y O_ fA Njj ty CD N y 3 C O O u w S H 7 - - S - .. = O 1:1) (� A J O W y N .N-. -. J f N N -. Co H Cl) L.-D. m V' N m 1 Cl)NCO .._. -D. ,.., CD N N) H co H ,4 W N) -. N C V' N U O W c,3 ,d N) N W - Q W N .c N) H CD O W G• .W-. - J w _ O J O W W-. -P JJ O W Cl) W --, NCo .p J H N) I I Cr I GN) - H N NV' N) L.',H Co c. 77c. yr N W77 J O W 'T1 O N) - V' N) Cl) N) O H Cs W U N) NJ A J U s.. N LP H 00 .-. N CO A Ci) C N H. to N V' ..-. ; G• V N O C. W c. N ,7" Cr N : : ,7.,, N N w G� ; O G. V' N J O W 7 C co A J O W ``EH J O W C, H �N N H J y Q • • NJ --) H -D. N) Lrt ctu N cn VN' N Cn co ,-j W 0. N r-j N N H c, Hi W H N HI N H C+' H J O W O A J O Co H A J ✓' -4 J O W W co H -ID. V) O Z W N .-. .. N) Vr L N) .-. �T Cn '/: Cn ` c. b N o O W Gs C Gs V N 3 Di 3 J O W 4 ri= Cr W ✓ J ' cNr, D. N J .-i IZI N w C G�N .-. ..-. v' C N N Go .-. 'V N 0 N V, (\A� O W V' N H J O W H W N N Hj ` O W c. 4D. J O W7- N .N-. -.J "-. .wN .-I WHi A A J O GNCr, B CoOo H VN' N u-, HN . H. A ��\�{ n co O 1I ^W` .? J O W J O W O W 0. V' N (/J D n C U, 00W .-. '� N 3 N - .-. J �,, 1 3 a a J o — GNB 'C N cy .-a W C N)NJ In Hy t.,-, co H y N) O W C w N V' N !.' N) cc O W c.. C 'C N) co H ,p J H .w-. ? J O W H N) N) W C H • O W GL V N) Cl) ..+ N N Cn co HP V N) Cl)Cn eT\j) ,� • r Z P ;___, m tA Dv c 73'S .. m cncn CO 0 7 13v . E Eo F Z • e 63 m -4. - D r 1n m -0 —1 4 -).. k to 1 • Q O r m ? m z . G) C v I Cr O 0 C' "' O o o a O 0 Z H A 5 E -6 W*' S r1111 m 7