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HomeMy WebLinkAbout2009- March iLE • Jefferson County Board of Health .agenda Ainutes • .March 19, 2009 • JEFFERSON COUNTY BOARD OF HEALTH March 19,2009 Jefferson County Public Health 615 Sheridan Street Port Townsend, WA 2:30—4:30 PM DRAFT AG EN DA I. Approval of Agenda II. Approval of Minutes of February 19,2009 Board of Health Meeting III. Public Comments IV. Old Business and Informational Items 1. Regional Influenza Activity 2. Death with Dignity Act and Vital Records Registrars 3. Public Health Funding Letter 4. Our Kids, Our Business IPV. New Business 1. 2008 Jefferson County Public Health Performance Measures 2. 2009 Activities Update 3. Legislative Update 4. Public Health Heroes Award Nominations 5. Substance Abuse Advisory Board Bylaws—Request for Review and Approval 6. Substance Abuse Advisory Board Appointments VI. Activity Update VII. Agenda Planning VIII. Next Scheduled Meeting: April 16, 2009 2:30—4:30 PM Jefferson County Public Health • • %%*1 • JEFFERSON COUNTY BOARD OF HEALTH %.%*1 MINUTES Thursday, February 19, 2009 2:30 PM—4:30 PM Health Department Conference Room, 615 Sheridan Street, Port Townsend Board Members Staff Members Phil Johnson, County Commissioner District#1 Thomas Locke,MD,Health Officer David Sullivan, County Commissioner,District#2 Jean Baldwin,Public Health Services Director John Austin, County Commissioner,District#3 Julia Danskin,Nursing Services Director Michelle Sandoval,Port Townsend City Council Chuck Russell, Vice Chair,Hospital Commissioner,District#2 Sheila Westerman, Chair, Citizen at large(City) Roberta Frissell, Citizen at large(County) Vice Chair Chuck Russell called the meeting of the Jefferson County Board of Health to order at 2:30 PM. Members Present: John Austin, Roberta Frissell, Chuck Russell, David Sullivan, Michelle Sandoval Excused: Phil Johnson and Sheila Westerman • Staff Present: Jean Baldwin, Dr. Thomas Locke A quorum was present. APPROVAL OF AGENDA Vice-Chair Russell said there would be one change to the order of agenda items under Section V; Item 4 was placed ahead of Item 3. Member Austin moved to approve the agenda; the motion was seconded by Member Sullivan. The agenda was approved unanimously. APPROVAL OF MINUTES Correction: page 1, John Austin was excused from the meeting. Member Sullivan moved for approval of the minutes, as amended; Member Frissell seconded. The minutes of January 15, 2009 were approved, as amended,with abstention by John Austin. PUBLIC COMMENTS There were no public comments. Page 1 of 9 OLD BUSINESS • Draft National Public Health Week Press Release Referring to the draft in the packet, Jean Baldwin said that the intention was to publish this press release and accept nominations for Public Health Heroes during the first half of March. This would allow the Board to approve nominations at the March 19 BOH meeting. Announcements will be made during National Public Health week in the first week of April and the awards will be given at the April BOH meeting. Nomination forms will be available on the web page, at the Courthouse and at the Public Health offices. John Austin suggested that former award recipients be listed in the press releases. Roberta Frissell agreed to work with Julia Danskin again this year to review the nominations and bringing them forward to the BOH. More Retailers Selling Tobacco to Minors Jean Baldwin introduced Karen Obermeyer, Health Educator. Ms. Obermeyer distributed a Fact Sheet on the Burden of Tobacco. Ms. Obermeyer noted that tobacco use costs society and individuals a great deal of money and heartache. She pointed out that each year in Washington state deaths due to tobacco-related illnesses surpass those from alcohol, drug use, car crashes, suicide, homicide, AIDS and fires combined. Tobacco- related illnesses include many types of cancer, heart attack, stroke, pulmonary disease and emphysema, which often involves prolonged • suffering for patients and their families. She said that the good news is that these diseases are preventable and that 85%of Jefferson County adults do not smoke. She noted the disparity within the County that over 20%of pregnant women smoke. Statistics for youth show that less than 1% of six graders smoke, which increases to 10%by eighth grade and to 24%by tenth grade. Smoking rates are higher in populations with lower income and educational levels. Because most people begin to smoke before the age of 18, prevention of smoking by youth is the highest priority. Ms. Obermeyer explained the Project Alert program for sixth and seventh graders in the County, which provides substance abuse education in Port Townsend, Chimacum and Quilcene school systems. The TATU (Teens Against Tobacco Use) program is a partnership involving the ninth grade teacher, Martina Haskins, the American Lung Association, and the Health Department. On March 9, Port Townsend High School students who have undergone the TATU training will visit Mountain View school to train fourth graders in tobacco prevention. Ms. Obermeyer also mentioned the No Stank You program which involves filming students at local schools for participation in a State-wide campaign, web-site and commercials. In Jefferson County last year, out of about 50 compliance checks, there were three sales to under age purchasers. In one case, there was no ID check at all. During January, Ms. Obermeyer focused on visiting retailers in Jefferson County and conveying three messages: it is illegal to sell tobacco to minors; there are resources for them to train staff and help them comply with the • law; and to inform them of the consequences of non-compliance. Page 2 of 9 • Member Sandoval noted that she has observed more teenage girls than boys who smoke. Ms. Obermeyer mentioned that, for males, the rates for chewless tobacco use are also up in Jefferson County. She also talked about the Washington State Tobacco Quit Line at 1-800-QUIT-NOW, as well as the web site, QUITLINE.COM, and the stickers used for advertising these services. Member Austin asked if the practice of publicly reporting illegal sales of cigarettes is actually providing youth with information on where to buy cigarettes. Ms. Obermeyer said that she shares that concern, and believes the stores that are compliant should be publicized instead; those stores that pass compliance checks do receive certificates for posting. Member Russell noted that the Federal S-CHIP program is funded by tobacco taxes. 2008 State Board of Health Annual Report—2008 [Portions inaudible] A copy of the State Board of Health Annual Report was provided in the meeting packet. Jean Baldwin noted that Member Austin serves on the State Board; he is pictured with other State Board members on page 15 of the report. Member Austin stated that the State Board of Health is not on the list of budget cuts, thus far, while the Ferry Advisory and Eco System Council and many other departments have been slated for budget reductions. It was noted that the State Board will meet in Jefferson County in July. Member Austin noted that environmental school rules changes are among the hottest topics for the Board, particularly the balancing of safety and cost. There are pending safety provisions that require annual reviews of programs by the local Medical Director. There was mention of existing water and air quality . assurance measures. He said that new schools must meet the highest standards; there are retrofitting requirements for older schools. The total cost of the proposed program amounts to about $33 dollars per student over three years. New standards for venting of photocopy machines were briefly discussed. National Flu View Dr. Locke referred to the flu surveillance summary graphic included in the packet. He said the more recent full report from the CDC indicates that most of the states on the East Coast have upgraded from regional activity to widespread influenza activity. On the West Coast, Washington and Oregon have gone from sporadic to local outbreaks. The vaccine match with the influenza A strain seems to be a good one. However, the match with the influenza B strain may not be as good. The predominant A strain that is circulating is the one that is resistant to the leading anti-viral drug, oseltamivir(Tamiflu). Member Russell noted that many people were vaccinated early in the season. He asked if it is ever advisable to get more than one shot per season. Dr. Locke said there are no official recommendations for revaccination. He said that the period of protection may be as short as 2 to 3 months for certain individuals; there is no readily available way to test for the immune status of individuals. He said that for those vaccinated in September or October, with a peak season in March,this could be a problem for some individuals. Dr. Locke said a second shot would not be unsafe and may be appropriate, particularly for those with weak immune systems or on dialysis. • Page 3 of 9 In response to a question, he said the mortality rate for seasonal influenza is about 1 per 1000 cases; an annualized average nationally is about 36,000 per years. The vast majority of those . deaths are in the age 75 and older population. He noted that the mortality rate has been holding steady for many years. NEW BUSINESS Legislative Advocacy: Public Health Funding Letter Jean Baldwin first provided information from the most recent WSAC (Washington State Association of Counties)tracking of public health bills. She said there are three funding streams for Public Health that are non-categorical, which means there is local control in prioritizing. There are expected deliverables, but the funds can be allocated to staff or other budget line items. Public Health infrastructure money pays for the Director's salary. In the Governor's budget, these three sources have not been changed. She said that for the Department of Health, there have been few cuts. Some DSHS monies and other billables have been affected. There is an ongoing discussion state-wide about the possibility of having Public Health Departments become taxing authorities. Seattle/King County and some other larger health departments wish to institute local options taxes for Health and Human Services, Public Health and some Sherriff services. Ms. Baldwin said she did not necessarily foresee that approach for Jefferson County, but that the evolving situation should be monitored and considered Dr. Locke added that there is a modified version of the public health funding bill, HB 1985,that • did receive a hearing; this version removes the local option taxing authority and non-supplanting language and consolidates public health funding streams. Ms. Baldwin mentioned several issues that are under discussion: tobacco vendors, school rules and funding,voluntary health practitioners' licenses; children's mental health; exemptions for children's immunizations, petroleum pollution in storm water, etc. There is a Senate bill about monies deposited in local toxins control accounts. Another issue that is of local interest and importance addresses unwanted/unused drug disposal. Member Austin asked about the University of Washington study on the presence of drug compounds, fragrances/soaps etc. in the water. Ms. Baldwin said that the results would be posted on the web site shortly. Dr. Locke said that King County Board of Health is supporting the approach that drug manufacturers be required to accept the unused drugs and properly dispose of them. Ms. Baldwin noted that calls have been received from assisted living centers and other care facilities that have higher volumes than home use regarding proper disposal methods. Health Department advice on disposal methods is posted on the web. Jean Baldwin and Dr. Locke then discussed the draft letter to State legislators Kessler, Van de Wege and Hargrove regarding funding, particularly preservation of the three major funding streams and support for House Bill 1985. They asked the Board to consider and approve the letter; the letter would be signed by the Chair of the BOH on behalf of the entire Board. Dr. Locke said that, given the current economic crisis, there is no expectation of additional resources, but that existing funding lines must be retained. • Page 4 of 9 • Member Austin said that he supports the letter, and would suggest that the key recommendations be presented in bold typeface for emphasis. He moved that the letter,with bold highlighting, be approved and signed by the Chair; Member Sullivan seconded the motion. The motion was approved unanimously. It was agreed that Vice Chair Russell would sign the letter in Chair Westerman's absence. Syringe Exchange Program Report Dr. Locke noted the increasing demand for this program over the years, although there was a slight decrease in the number of syringes exchanged from 2007 to 2008. The volume of syringes exchanged in one year is over 20,000. Dr. Locke said that as of 2006, a national survey revealed that there were 156 syringe exchange programs in the United States and about 10% of those were in Washington State. Dr. Locke said that these programs, although very effective, are relatively rare. These exchange encounters sometimes result in treatment referrals; the best programs have referral rates of 10% at most. Ms. Baldwin said that the exchange rate is greater within the City. In response to questions, Dr. Locke emphasized that this is an exchange program—participants must bring in used syringes to obtain new ones. There was mention that new syringes are usually available at pharmacies and farm co-ops (for veterinary use). Dr. Locke said that the local BOH authority is authorized by law to distribute new syringes under this program, i.e., the local public health authority supersedes the State paraphernalia laws. • Member Frissell stated that she had observed an incident at the hospital where a woman wished to turn in sharps, and was referred to the Health Department. Staff informed her that the proper disposal method for diabetic syringes is to insert syringes into a 2 liter pop bottle, seal the bottle, label it (special labels are downloadable from the website), and place in the trash for pick up. The process for handling materials in the syringe exchange program is much more rigorous. Special disposal containers are provided along with the exchange syringes, so that staff does not need to touch the used syringes. In response to a question about the number of participants in the program, Jean Baldwin said there are about 70 people but many of these are doing secondary exchanges on behalf of others. At this point, the department is not doing indicators by person. There has been consideration of tracking numbers by specific drug types in the future. She said that there are two scheduled times per week for this program, but walk-ins are allowed as staffing permits. Jefferson County Demographic Data Update Dr. Locke explained that the packet materials are an update of demographic measures that are displayed on the web site. He said that although the data can be of interest in its own right, it is most useful when viewed in the context of some issue or problem. For example, if one is attempting to project health care costs for some years into the future, then the age and income distributions of the population become significant. He noted that the epidemiologist who • produces the report is always seeking better ways of presenting the information. Page 5 of 9 • Dr. Locke pointed out the data regarding median household income and per capita income, • which are indicators of a particular economic characteristic of Jefferson County. This county is almost$12,000 below the state level of median household income, but the per capita personal income figures are nearly the same for the County and State. He noted that the median household income figure more accurately reflects the real world. The per capita figure is skewed by the segment of the population with very high incomes. Jean Baldwin pointed out that, in contrast, about 30%of the County population is at or below 185% of the poverty level, compared to 25%of the State population. 16% of children live in homes at 100% of the poverty level, or about $20,000 household income, compared with 13% in the State. Two thirds of County births are covered by Medicaid, versus 47% in the State. Jean Baldwin pointed out that that the housing data is a new measure, although much of the data is from 2006. She pointed out the affordability gap; only 23% of households are at an income level that allows purchase of an average price house versus 34% in Washington State. Dr. Locke said that this data can be very useful in preparing grant applications and in evaluating program needs. Jean Baldwin pointed out the slowing of growth in population and the slight shifting in age. In- migration is staying about the same. She also noted the larger increases in the 50-64 and 85 + age groups during the years from 1990 to 2008. The number of seniors (age 65+)with disability status is comparatively low, 34%versus 43% in the State. With regards to education information, Ms. Baldwin noted that graduation data from high • schools is now required by the State. This particular data is somewhat"soft"now, but will continue to improve. Ms. Baldwin said that the update would be placed on the web site, and that the information usually generates interesting and unexpected questions. She asked BOH members if they wished to have more detail or other views of the data. Member Austin said that the color version is somewhat easier to read. Ms. Baldwin said she would e-mail an updated color version to all BOH members, department heads, and other individuals who may be interested. She added that since epidemiologist Siri Kushner is contracting with OlyCap to do Clallam and Jefferson County data, there is an opportunity for inter-agency exchange of data reviews. There was a brief discussion about the rise in number of Medicaid births and the impact of any loss in Medicaid funding. Dr. Locke mentioned that there is another use of this data: the State is working with various forms of community health report cards. He also mentioned the Washington Health Foundation with its "Healthiest State in the Nation" campaign. Washington State has been rising in comparison to other states and is now ranked as the tenth healthiest state in the nation. He discussed the composite measure, Economic Well Being, that measures median household income,per capita income, and employment divided by population child poverty levels. Washington has a rank of 15 in this category. • Page 6 of 9 Also measured are high school graduation rates; Washington is 32nd in the nation with a • gradation rate of only about 70%. There was a brief discussion acknowledging the complexity of the school situation and of making effective improvements. Jean Baldwin again mentioned the fact that school graduation information is improving but data has been rather soft and difficult to interpret. For example, are youth who drop out in 9th, 10th, 1 lt" or 12th grades all counted in the overall statistic, or just those who drop out at a certain time? Are high school GEDs (General Equivalency Diplomas) accounted for? Dr. Locke noted that, prior to 2000, the percentage of graduates included all those who ever graduated. After that time, the measurement changed to "percentage of on time graduations". He said the new measure was meant to evaluate the high schools on getting youth through all grades on time. John Austin questioned whether these parameters are measuring the effectiveness of the schools. Healthy Youth data is also displayed on the web page; this is derived from a test taken by Port Townsend, Chimacum and Quilcene high school students every two years. This provides a behavioral risk analysis and some demographic data about students. Ms. Baldwin said this has been a key driver for continuance of the school nursing program and school based clinic program. Jean Baldwin also pointed out the Jefferson County Statistic card in the packet. She noted that the number of women, ages 13-44, in need of publicly supported contraceptive supplies and services matches the number who were actually served. She also noted that the numbers have risen and that teen pregnancy rates are only about half of the State rates. In serving about one third of the female population, Public Health is seeing those most in need of services, i.e. those at • the poverty level. Dr. Locke noted that the Chlamydia and Gonorrhea rates are down in Jefferson County compared to neighboring Clallam and Kitsap counties for the third consecutive year. The rates for Kitsap and Clallam are at about State averages, while Jefferson's are substantially lower. Dr. Locke said that there have been great efforts to get providers to screen at risk populations, and in tracing and treating contacts. He added that there is a one in four chance of contracting a sexually transmitted infection between the ages of 15 and 24. Member Austin asked if the rate per thousand shown on the statistics card measures only the 15-24 age range, or the entire population. Jean Baldwin said that she had verified that it is not age specific. Dr. Locke said that the rates for the 15-24 age range are 10 times higher than for the general population. Substance Abuse Advisory Board Report The report was deferred to a future meeting. Jean Baldwin said that there is an SAAB (Substance Abuse Advisory Board) applicant, who will be interviewed before the next BOH meeting. John Austin and Julia Danskin will participate in the interview process. • Page 7 of 9 • Public Health Mutual Assistance Agreements Updates Dr. Locke and Ms. Baldwin provided updated information on the two mutual assistance • agreements that had been discussed at the December 18, 2008 meeting. The multi-county emergency preparedness multi-aid agreement approved by the BOH is currently under review by David Alvarez and will come before the BOCC for signatures within the next few weeks. Dr. Locke also discussed the pilot project, which may become a model for the State. This is a collaborative effort directed toward developing a mutual assistance agreement among the three counties of Public Health Region 2 and seven tribes of the Olympic and Kitsap Peninsulas. A second meeting was held in January. The working draft document, which contains all the potential issues, is about 60 pages long. An example of a simpler version of such an agreement had been included in the packet. This example between the Lummi Nation and the Whatcom County Health Department, dealing with communicable disease control, is more limited in scope. Ms. Baldwin said that it is well for the counties and tribes to work together since tribal jurisdictions often span multiple counties. She mentioned the Makah, Hoh and S'Klallam Tribes as examples. John Austin asked for clarification on the County relationship with the Hoh, who are completely within our County borders, and the Quinault and Queets/Clearwater tribes. Ms. Baldwin said that the Queets/Clearwater group was not included because, for consistency, they are affiliated with the Quinault Nation that share borders with Grays Harbor. Dr. Locke clarified that the Hoh are involved but were unable to attend the meeting due to West End flooding and road outages. • He said it is a real challenge for the Hoh to participate because of their small size and limited numbers. However, they take emergency preparedness very seriously. He said the tribes are taking this opportunity to look at what community health capacity they need to develop within their jurisdictions. Legally,the county health officers have no authority within tribal jurisdictions. The federal government has some authority; for example, the FBI would have authority to investigate a homicide there. Dr. Locke said that the larger tribes are being encouraged to put in place some of the more formal processes and services typically covered at the County level. For example, management of a resort/casino benefits from a formal food code and other safety regulations. In the past, population health issues were the responsibility of the federal Indian Health Service; under self- governance, this has shifted to the individual tribes. ACTIVITY UPDATES Jean Baldwin announced an Open House for the Port Townsend School Based Health Clinic to be held on March 3 from 2:30 to 6:00 PM in the Gael Stuart Building, Port Townsend High School. Ms. Baldwin cited the many business and individual sponsors and contributors who have enabled the opening of this service. There was a brief discussion about the newspaper article on a recent norovirus outbreak. Dr. Locke said that this was formerly known as "winter vomiting disease" and is now known to be • Page 8 of 9 caused by a very small virus. It is highly communicable, has a dramatic onset,but is fairly short- lived. He said 35-75% of exposed people will often get the disease in the first pass. He said that • because of the rapidity, there is often no effective medical response, except sanitary measures to contain the infection and supportive measures for those infected. After having the infection, there is a period of immunity that is fairly short-lived. There are many different genetic variations of norovirus with associated variations in immunity and susceptibility. Dr. Locke explained that this is not a"Notifiable" condition, but that the Health Department will attempt to help, particularly if an institutional outbreak seems related to food service. It can be a serious disease in the elderly and special attention must be paid to maintaining adequate hydration. AGENDA PLANNING The next BOH meeting is schedule for March 19, 2009, location to be announced. Vice Chair Russell adjourned the meeting at 4:07 PM. JEFFERSON COUNTY BOARD OF HEALTH Excused Excused • Sheila Westerman, Chair Phil Johnson, Member Chuck Russell, Vice-Chair Michelle Sandoval, Member Roberta Frissell, Member David Sullivan, Member John Austin, Member • Page 9 of 9 • • JEFFERSON COUNTY BOARD OF HEALTH MINUTES Thursday, February 19, 2009 2:30 PM—4:30 PM Health Department Conference Room, 615 Sheridan Street, Port Townsend Board Members Staff Members Phil Johnson, County Commissioner District#1 Thomas Locke,MD,Health Officer David Sullivan, County Commissioner, District#2 Jean Baldwin,Public Health Services Director John Austin, County Commissioner,District#3 Julia Danskin, Nursing Services Director Michelle Sandoval,Port Townsend City Council Chuck Russell, Vice Chair, Hospital Commissioner,District#2 Sheila Westerman, Chair, Citizen at large(City) Roberta Frissell, Citizen at large(County) Vice Chair Chuck Russell called the meeting of the Jefferson County Board of Health to order at 2:30 PM. Members Present: John Austin, Roberta Frissell, Chuck Russell, David Sullivan, Michelle Sandoval Excused: Phil Johnson and Sheila Westerman • Staff Present: Jean Baldwin, Dr. Thomas Locke A quorum was present. APPROVAL OF AGENDA Vice-Chair Russell said there would be one change to the order of agenda items under Section V; Item 4 was placed ahead of Item 3. Member Austin moved to approve the agenda; the motion was seconded by Member Sullivan. The agenda was approved unanimously. APPROVAL OF MINUTES Correction: page 1, John Austin was excused from the meeting. Member Sullivan moved for approval of the minutes, as amended; Member Frissell seconded. The minutes of January 15, 2009 were approved, as amended,with abstention by John Austin. PUBLIC COMMENTS • There were no public comments. Page 1 of 9 OLD BUSINESS • • Draft National Public Health Week Press Release Referring to the draft in the packet, Jean Baldwin said that the intention was to publish this press release and accept nominations for Public Health Heroes during the first half of March. This would allow the Board to approve nominations at the March 19 BOH meeting. Announcements will be made during National Public Health week in the first week of April and the awards will be given at the April BOH meeting. Nomination forms will be available on the web page, at the Courthouse and at the Public Health offices. John Austin suggested that former award recipients be listed in the press releases. Roberta Frissell agreed to work with Julia Danskin again this year to review the nominations and bringing them forward to the BOH. More Retailers Selling Tobacco to Minors Jean Baldwin introduced Karen Obermeyer, Health Educator. Ms. Obermeyer distributed a Fact Sheet on the Burden of Tobacco. Ms. Obermeyer noted that tobacco use costs society and individuals a great deal of money and heartache. She pointed out that each year in Washington state deaths due to tobacco-related illnesses surpass those from alcohol, drug use, car crashes, suicide, homicide, AIDS and fires combined. Tobacco- related illnesses include many types of cancer, heart attack, stroke, pulmonary disease and emphysema, which often involves prolonged • suffering for patients and their families. She said that the good news is that these diseases are preventable and that 85% of Jefferson County adults do not smoke. She noted the disparity within the County that over 20% of pregnant women smoke. Statistics for youth show that less than 1%of six graders smoke, which increases to 10%by eighth grade and to 24% by tenth grade. Smoking rates are higher in populations with lower income and educational levels. Because most people begin to smoke before the age of 18,prevention of smoking by youth is the highest priority. Ms. Obermeyer explained the Project Alert program for sixth and seventh graders in the County, which provides substance abuse education in Port Townsend, Chimacum and Quilcene school systems. The TATU (Teens Against Tobacco Use)program is a partnership involving the ninth grade teacher, Martina Haskins, the American Lung Association, and the Health Department. On March 9, Port Townsend High School students who have undergone the TATU training will visit Mountain View school to train fourth graders in tobacco prevention. Ms. Obermeyer also mentioned the No Stank You program which involves filming students at local schools for participation in a State-wide campaign, web-site and commercials. In Jefferson County last year, out of about 50 compliance checks,there were three sales to under age purchasers. In one case,there was no ID check at all. During January, Ms. Obermeyer focused on visiting retailers in Jefferson County and conveying three messages: it is illegal to sell tobacco to minors; there are resources for them to train staff and help them comply with the . law; and to inform them of the consequences of non-compliance. Page 2 of 9 • Member Sandoval noted that she has observed more teenage girls than boys who smoke. Ms. Obermeyer mentioned that, for males,the rates for chewless tobacco use are also up in Jefferson County. She also talked about the Washington State Tobacco Quit Line at 1-800-QUIT-NOW, as well as the web site, QUITLINE.COM, and the stickers used for advertising these services. Member Austin asked if the practice of publicly reporting illegal sales of cigarettes is actually providing youth with information on where to buy cigarettes. Ms. Obermeyer said that she shares that concern, and believes the stores that are compliant should be publicized instead; those stores that pass compliance checks do receive certificates for posting. Member Russell noted that the Federal S-CHIP program is funded by tobacco taxes. 2008 State Board of Health Annual Report—2008 [Portions inaudible] A copy of the State Board of Health Annual Report was provided in the meeting packet. Jean Baldwin noted that Member Austin serves on the State Board; he is pictured with other State Board members on page 15 of the report. Member Austin stated that the State Board of Health is not on the list of budget cuts, thus far, while the Ferry Advisory and Eco System Council and many other departments have been slated for budget reductions. It was noted that the State Board will meet in Jefferson County in July. Member Austin noted that environmental school rules changes are among the hottest topics for the Board, particularly the balancing of safety and cost. There are pending safety provisions that require annual reviews • of programs by the local Medical Director. There was mention of existing water and air quality assurance measures. He said that new schools must meet the highest standards; there are retrofitting requirements for older schools. The total cost of the proposed program amounts to about $33 dollars per student over three years. New standards for venting of photocopy machines were briefly discussed. National Flu View Dr. Locke referred to the flu surveillance summary graphic included in the packet. He said the more recent full report from the CDC indicates that most of the states on the East Coast have upgraded from regional activity to widespread influenza activity. On the West Coast, Washington and Oregon have gone from sporadic to local outbreaks. The vaccine match with the influenza A strain seems to be a good one. However, the match with the influenza B strain may not be as good. The predominant A strain that is circulating is the one that is resistant to the leading anti-viral drug, oseltamivir (Tamiflu). Member Russell noted that many people were vaccinated early in the season. He asked if it is ever advisable to get more than one shot per season. Dr. Locke said there are no official recommendations for revaccination. He said that the period of protection may be as short as 2 to 3 months for certain individuals; there is no readily available way to test for the immune status of individuals. He said that for those vaccinated in September or October, with a peak season in March,this could be a problem for some individuals. Dr. Locke said a second shot would not be unsafe and may • be appropriate, particularly for those with weak immune systems or on dialysis. Page 3 of 9 In response to a question, he said the mortality rate for seasonal influenza is about 1 per 1000 cases; an annualized average nationally is about 36,000 per years. The vast majority of those • deaths are in the age 75 and older population. He noted that the mortality rate has been holding steady for many years. NEW BUSINESS Legislative Advocacy: Public Health Funding Letter Jean Baldwin first provided information from the most recent WSAC (Washington State Association of Counties)tracking of public health bills. She said there are three funding streams for Public Health that are non-categorical, which means there is local control in prioritizing. There are expected deliverables, but the funds can be allocated to staff or other budget line items. Public Health infrastructure money pays for the Director's salary. In the Governor's budget, these three sources have not been changed. She said that for the Department of Health, there have been few cuts. Some DSHS monies and other billables have been affected. There is an ongoing discussion state-wide about the possibility of having Public Health Departments become taxing authorities. Seattle/King County and some other larger health departments wish to institute local options taxes for Health and Human Services, Public Health and some Sherriff services. Ms. Baldwin said she did not necessarily foresee that approach for Jefferson County, but that the evolving situation should be monitored and'considered Dr. Locke added that there is a modified version of the public health funding bill, HB 1985, that • did receive a hearing; this version removes the local option taxing authority and non-supplanting language and consolidates public health funding streams. Ms. Baldwin mentioned several issues that are under discussion: tobacco vendors, school rules and funding, voluntary health practitioners' licenses; children's mental health; exemptions for children's immunizations, petroleum pollution in storm water, etc. There is a Senate bill about monies deposited in local toxins control accounts. Another issue that is of local interest and importance addresses unwanted/unused drug disposal. Member Austin asked about the University of Washington study on the presence of drug compounds, fragrances/soaps etc. in the water. Ms. Baldwin said that the results would be posted on the web site shortly. Dr. Locke said that King County Board of Health is supporting the approach that drug manufacturers be required to accept the unused drugs and properly dispose of them. Ms. Baldwin noted that calls have been received from assisted living centers and other care facilities that have higher volumes than home use regarding proper disposal methods. Health Department advice on disposal methods is posted on the web. Jean Baldwin and Dr. Locke then discussed the draft letter to State legislators Kessler, Van de Wege and Hargrove regarding funding,particularly preservation of the three major funding streams and support for House Bill 1985. They asked the Board to consider and approve the letter; the letter would be signed by the Chair of the BOH on behalf of the entire Board. Dr. Locke said that, given the current economic crisis, there is no expectation of additional resources, but that existing funding lines must be retained. Page 4 of 9 • Member Austin said that he supports the letter, and would suggest that the key recommendations be presented in bold typeface for emphasis. He moved that the letter,with bold highlighting, be approved and signed by the Chair; Member Sullivan seconded the motion. The motion was approved unanimously. It was agreed that Vice Chair Russell would sign the letter in Chair Westerman's absence. Syringe Exchange Program Report Dr. Locke noted the increasing demand for this program over the years, although there was a slight decrease in the number of syringes exchanged from 2007 to 2008. The volume of syringes exchanged in one year is over 20,000. Dr. Locke said that as of 2006, a national survey revealed that there were 156 syringe exchange programs in the United States and about 10% of those were in Washington State. Dr. Locke said that these programs, although very effective, are relatively rare. These exchange encounters sometimes result in treatment referrals; the best programs have referral rates of 10% at most. Ms. Baldwin said that the exchange rate is greater within the City. In response to questions, Dr. Locke emphasized that this is an exchange program—participants must bring in used syringes to obtain new ones. There was mention that new syringes are usually available at pharmacies and farm co-ops (for veterinary use). Dr. Locke said that the local BOH authority is authorized by law to distribute new syringes under this program, i.e., the local public health authority supersedes the State paraphernalia laws. • Member Frissell stated that she had observed an incident at the hospital where a woman wished to turn in sharps, and was referred to the Health Department. Staff informed her that the proper disposal method for diabetic syringes is to insert syringes into a 2 liter pop bottle, seal the bottle, label it (special labels are downloadable from the website), and place in the trash for pick up. The process for handling materials in the syringe exchange program is much more rigorous. Special disposal containers are provided along with the exchange syringes, so that staff does not need to touch the used syringes. In response to a question about the number of participants in the program, Jean Baldwin said there are about 70 people but many of these are doing secondary exchanges on behalf of others. At this point, the department is not doing indicators by person. There has been consideration of tracking numbers by specific drug types in the future. She said that there are two scheduled times per week for this program, but walk-ins are allowed as staffing permits. Jefferson County Demographic Data Update Dr. Locke explained that the packet materials are an update of demographic measures that are displayed on the web site. He said that although the data can be of interest in its own right, it is most useful when viewed in the context of some issue or problem. For example, if one is attempting to project health care costs for some years into the future, then the age and income distributions of the population become significant. He noted that the epidemiologist who • produces the report is always seeking better ways of presenting the information. Page 5 of 9 Dr. Locke pointed out the data regarding median household income and per capita income, • which are indicators of a particular economic characteristic of Jefferson County. This county is almost $12,000 below the state level of median household income, but the per capita personal income figures are nearly the same for the County and State. He noted that the median household income figure more accurately reflects the real world. The per capita figure is skewed by the segment of the population with very high incomes. Jean Baldwin pointed out that, in contrast, about 30% of the County population is at or below 185%of the poverty level, compared to 25% of the State population. 16% of children live in homes at 100% of the poverty level, or about $20,000 household income, compared with 13% in the State. Two thirds of County births are covered by Medicaid, versus 47% in the State. Jean Baldwin pointed out that that the housing data is a new measure, although much of the data is from 2006. She pointed out the affordability gap; only 23% of households are at an income level that allows purchase of an average price house versus 34% in Washington State. Dr. Locke said that this data can be very useful in preparing grant applications and in evaluating program needs. Jean Baldwin pointed out the slowing of growth in population and the slight shifting in age. In- migration is staying about the same. She also noted the larger increases in the 50-64 and 85 + age groups during the years from 1990 to 2008. The number of seniors (age 65+)with disability status is comparatively low, 34%versus 43% in the State. With regards to education information, Ms. Baldwin noted that graduation data from high • schools is now required by the State. This particular data is somewhat"soft" now, but will continue to improve. Ms. Baldwin said that the update would be placed on the web site, and that the information usually generates interesting and unexpected questions. She asked BOH members if they wished to have more detail or other views of the data. Member Austin said that the color version is somewhat easier to read. Ms. Baldwin said she would e-mail an updated color version to all BOH members, department heads, and other individuals who may be interested. She added that since epidemiologist Siri Kushner is contracting with OlyCap to do Clallam and Jefferson County data, there is an opportunity for inter-agency exchange of data reviews. There was a brief discussion about the rise in number of Medicaid births and the impact of any loss in Medicaid funding. Dr. Locke mentioned that there is another use of this data: the State is working with various forms of community health report cards. He also mentioned the Washington Health Foundation with its "Healthiest State in the Nation"campaign. Washington State has been rising in comparison to other states and is now ranked as the tenth healthiest state in the nation. He discussed the composite measure,Economic Well Being,that measures median household income, per capita income, and employment divided by population child poverty levels. Washington has a rank of 15 in this category. • Page 6 of 9 Also measured are high school graduation rates; Washington is 32"d in the nation with a gradation rate of only about 70%. There was a brief discussion acknowledging the complexity of 41) the school situation and of making effective improvements. Jean Baldwin again mentioned the fact that school graduation information is improving but data has been rather soft and difficult to interpret. For example, are youth who drop out in 9th, 10th, 11th or 12th grades all counted in the overall statistic, or just those who drop out at a certain time? Are high school GEDs (General Equivalency Diplomas)accounted for? Dr. Locke noted that, prior to 2000, the percentage of graduates included all those who ever graduated. After that time, the measurement changed to "percentage of on time graduations". He said the new measure was meant to evaluate the high schools on getting youth through all grades on time. John Austin questioned whether these parameters are measuring the effectiveness of the schools. Healthy Youth data is also displayed on the web page; this is derived from a test taken by Port Townsend, Chimacum and Quilcene high school students every two years. This provides a behavioral risk analysis and some demographic data about students. Ms. Baldwin said this has been a key driver for continuance of the school nursing program and school based clinic program. Jean Baldwin also pointed out the Jefferson County Statistic card in the packet. She noted that the number of women, ages 13-44, in need of publicly supported contraceptive supplies and services matches the number who were actually served. She also noted that the numbers have risen and that teen pregnancy rates are only about half of the State rates. In serving about one third of the female population, Public Health is seeing those most in need of services, i.e. those at 411 the poverty level. Dr. Locke noted that the Chlamydia and Gonorrhea rates are down in Jefferson County compared to neighboring Clallam and Kitsap counties for the third consecutive year. The rates for Kitsap and Clallam are at about State averages, while Jefferson's are substantially lower. Dr. Locke said that there have been great efforts to get providers to screen at risk populations, and in tracing and treating contacts. He added that there is a one in four chance of contracting a sexually transmitted infection between the ages of 15 and 24. Member Austin asked if the rate per thousand shown on the statistics card measures only the 15-24 age range, or the entire population. Jean Baldwin said that she had verified that it is not age specific. Dr. Locke said that the rates for the 15-24 age range are 10 times higher than for the general population. Substance Abuse Advisory Board Report The report was deferred to a future meeting. Jean Baldwin said that there is an SAAB (Substance Abuse Advisory Board) applicant, who will be interviewed before the next BOH meeting. John Austin and Julia Danskin will participate in the interview process. • Page 7 of 9 Public Health Mutual Assistance Agreements Updates Dr. Locke and Ms. Baldwin provided updated information on the two mutual assistance • agreements that had been discussed at the December 18, 2008 meeting. The multi-county emergency preparedness multi-aid agreement approved by the BOH is currently under review by David Alvarez and will come before the BOCC for signatures within the next few weeks. Dr. Locke also discussed the pilot project, which may become a model for the State. This is a collaborative effort directed toward developing a mutual assistance agreement among the three counties of Public Health Region 2 and seven tribes of the Olympic and Kitsap Peninsulas. A second meeting was held in January. The working draft document, which contains all the potential issues, is about 60 pages long. An example of a simpler version of such an agreement had been included in the packet. This example between the Lummi Nation and the Whatcom County Health Department, dealing with communicable disease control, is more limited in scope. Ms. Baldwin said that it is well for the counties and tribes to work together since tribal jurisdictions often span multiple counties. She mentioned the Makah, Hoh and S'Klallam Tribes as examples. John Austin asked for clarification on the County relationship with the Hoh, who are completely within our County borders, and the Quinault and Queets/Clearwater tribes. Ms. Baldwin said that the Queets/Clearwater group was not included because, for consistency,they are affiliated with the Quinault Nation that share borders with Grays Harbor. Dr. Locke clarified that the Hoh are involved but were unable to attend the meeting due to West End flooding and road outages. ID He said it is a real challenge for the Hoh to participate because of their small size and limited numbers. However,they take emergency preparedness very seriously. He said the tribes are taking this opportunity to look at what community health capacity they need to develop within their jurisdictions. Legally,the county health officers have no authority within tribal jurisdictions. The federal government has some authority; for example, the FBI would have authority to investigate a homicide there. Dr. Locke said that the larger tribes are being encouraged to put in place some of the more formal processes and services typically covered at the County level. For example, management of a resort/casino benefits from a formal food code and other safety regulations. In the past, population health issues were the responsibility of the federal Indian Health Service; under self- governance, this has shifted to the individual tribes. ACTIVITY UPDATES Jean Baldwin announced an Open House for the Port Townsend School Based Health Clinic to be held on March 3 from 2:30 to 6:00 PM in the Gael Stuart Building, Port Townsend High School. Ms. Baldwin cited the many business and individual sponsors and contributors who have enabled the opening of this service. There was a brief discussion about the newspaper article on a recent norovirus outbreak. Dr. Locke said that this was formerly known as "winter vomiting disease"and is now known to be • Page8of9 caused by a very small virus. It is highly communicable, has a dramatic onset, but is fairly short- • lived. He said 35-75% of exposed people will often get the disease in the first pass. He said that because of the rapidity, there is often no effective medical response, except sanitary measures to contain the infection and supportive measures for those infected. After having the infection, there is a period of immunity that is fairly short-lived. There are many different genetic variations of norovirus with associated variations in immunity and susceptibility. Dr. Locke explained that this is not a"Notifiable" condition, but that the Health Department will attempt to help, particularly if an institutional outbreak seems related to food service. It can be a serious disease in the elderly and special attention must be paid to maintaining adequate hydration. AGENDA PLANNING The next BOH meeting is schedule for March 19, 2009, location to be announced. Vice Chair Russell adjourned the meeting at 4:07 PM. JEFFERSON COUNTY BOARD OF HEALTH • Excused Excused Sheila Westerman, Chair Phil Johnson, Member Chuck Russell, Vice-Chair Michelle Sandoval, Member Aatted- Roberta Fris ell, Member David ui`va , e er Ji hn Austin, Member • Page 9 of 9 • Board of HeaCtfi Old Business .agenda Items # IV., 1 • Regional lnfluenza .activity avlarch 19, 2009 From CDC — Influenza (Flu) web site. http://www.cdc.gov/flu/weekly/ 2008-2009 Influenza Season Week 8 ending February 28, 2009 data are preliminary and may change as more reports are received.)•ll Synopsis: During week 8 (February 22-28, 2009), influenza activity in the United States remained at approximately the same level as in the previous week. • One thousand four hundred eighteen (21.2%) specimens tested by U.S. World Health Organization (WHO) and National Respiratory and Enteric Virus Surveillance System (NREVSS) collaborating laboratories and reported to CDC/Influenza Division were positive for influenza. • The proportion of deaths attributed to pneumonia and influenza (P&I) was below the epidemic threshold. • Five influenza-associated pediatric deaths were reported. • The proportion of outpatient visits for influenza-like illness (ILI) was above the national baseline. ILI increased nationally and in five of the nine regions compared to the previous week. All nine surveillance regions reported ILI above their region-specific baselines. • Thirty-one states reported widespread influenza activity, 16 states reported regional activity; the District of Columbia and two states reported local influenza activity; and Puerto Rico and one state reported sporadic influenza activity. • One human infection with a novel influenza A virus was reported. National and Regional Summary of Select Surveillance Components Data for current week Data cumulative for the season • Out- % Number of A A A B Pediatric patient positive jurisdictions reporting (H1) (H3) Unsub- Deaths ILI* for flut regional or widespread typed Region activity* Nation Elevated 21.2 % 47 of 51 3513 379 6963 3501 22 New Elevated 25.1 % 6 of 6 300 51 778 339 1 England Mid-Atlantic Elevated 16.8 % 3 of 3 328 31 736 369 3 East North Elevated 48.2 % 5 of 5 578 49 92 234 0 Central West North Elevated 24.8 % 6 of 7 560 21 540 205 0 Central South Elevated 23.5 % 7 of 9 620 49 1005 655 4 Atlantic East South Elevated 29.9 % 4 of 4 142 6 24 66 1 Central West South Central Elevated 24.7 % 4 of 4 329 23 3026 1403 6 Mountain Elevated 13.8 % 7 of 8 196 100 502 76 5 • Pacific Elevated 13.5 % 5 of 5 460 49 260 154 2 * Elevated means the%of visits for ILI is at or above the national or region-specific baseline t National data is for current week; regional data is for the most recent three weeks. * Includes all 50 states and the District of Columbia http://www.cdc.gov/flu/weekly/ 3/13/09 • Board of 3-leaCth 0 C Business Agenda Items # 117., 2 • Death with Dignity Act & 'Vital Records Registrars March 19, 2009 • Death with Dignity Act • Frequently Asked Questions about Completing the Death Certificate DRAFT Question: Who completes the cause of death section of the death certificate? Answer: The attending physician may sign the patient's death certificate. He or she must list the underlying terminal disease as the cause of death. Funeral directors are directed by law to present the death certificate to the physician last in attendance of the deceased. The physician has two business days to complete the cause of death portion of the death certificate. Question: What is the acceptable cause and manner of death on a death certificate for a decedent who has chosen to end their life with a lethal dose of medication? Answer: The Death with Dignity states the "patient's death certificate shall list the underlying terminal disease as the cause of death." The Act also states that "Actions taken in accordance with this chapter do not, for any purpose, constitute suicide, assisted suicide, mercy killing, or homicide, under the law." To ensure compliance with the strict requirement i ,the Act: • The manner of death shall be marked as "Ntuiraa • • The underlying terminal disease shall be listed as the cause of death. • The cause of death section shall not include any language that does not support the conclusion that the terminal illness was the cause of death. Therefore, the cause of death section shall contain no reference to actions that would indicate participation in the Death with Dignity Act. Question: What will be the response of the State Registrar to death certificates that do not comply with the Death with Dignity Act? Answer: Under state law, the State Registrar of Vital Statistics "shall prepare and issue such detailed instruction asmay be required to secure the uniform observance of its provisions and the maintenance of a perfect system of registration. ... The State Registrar shall carefully examine the certificates received monthly from the local registrars, county auditors, and clerks of the court and, if any are incomplete or unsatisfactory, the State Registrar shall require such further information to be furnished as may be necessary to make the record complete and satisfactory." RCW 43.70.160. The State Registrar will reject any death certificate that does not properly adhere to the strict requirements of the Act. If a death certificate contains any reference to actions that would indicate participation in the Act, Deputy Registrars will be instructed to reject the death certificate and require correction before a permit to proceed with disposition will be issued. Revised March 1, 2009 • Board of Health Ord-Business Agenda Item # IV., 3 Public 3-(ealtfi Funding Letter 1 March 19, 2009 JEFFERSON U PUBLIC HEALTH 615 Sheridan Street • Port Townsend •Washington • 98368 www.jeffersoncountypublichealth.org • February 19,2009 Senator Jim Hargrove 411 Legislative Building PO Box 40424 Olympia, WA 98504-0424 Dear Senator Hargrove: We,the members of the Jefferson County Board of Health,are writing to express our priorities for the upcoming 2009-2011 Biennial budget. As you are all too aware, Washington State is faced with an unprecedented economic crisis and the need to drastically reduce state expenditures in the upcoming Biennium. Many difficult choices will have to be made about the priorities of government,the needs of vulnerable populations,and the likely adverse consequences of budget cutbacks. As you face these hard choices,we would like to share our priorities for legislative action this year. Local health departments across Washington State have already made substantial staff and service reductions in line with local budget realities. It is crucial that the three state funding streams that support local public health—Motor Vehicle Excise Tax(MVET) backfill funding($48 million per biennium),funding through the 2007 SB 5930($20 million per biennium),and 411 Local Capacity Development Funding($16 million per biennium)—be preserved as recommended in Governor Gregoire's budget. We also ask that you support the public health funding goals of HB 1985. While this bill does not offer the increased local revenue options we will need for the future, it does consolidate and equitably distribute existing funding and updates accountability standards for public health programs. There is a growing national consensus that expanded investments in preventive health services and public health infrastructure are among the highest priorities for successful health reform. Until these resources become available,however, it is crucial that we preserve as much of our essential public health infrastructure as possible. Here in Jefferson County, local government has risen to this challenge and is maintaining core public health services. It is our urgent request that you do likewise and support existing state public health funding streams for the duration of our current economic crisis. Sincerel , Chuck Russell Vice Chair,Jefferson County Board of Health • COMMUNITY HEALTH ENVIRONMENTAL HEALTH DEVELOPMENTAL DISABILITIES PUBLIC HEALTHWATER QUALITY MAIN: (360)385-9400 ALWAYS WORKING FOR A SAFER AND MAIN: (360)385-9444 FAX: (360)385-9401 HEALTHIER COMMUNITY FAX: (360) 379-4487 • Board of 3feaCth Old Business .agenda Item # r7., 4 • Our Xids, Our Business March lg, 2009 • April is National Child Abuse Prevention and Sexual Assault Awareness Month. "Our Kids: Our Business" is a social awareness and prevention campaign. Many community partners are �, collaborating to highlight the things we can do as individuals, organizations, agencies, and businesses to prevent child abuse and sexual assault. It is our community's commitment to protect Our and nurture our children. kids: No one person can do everything, Our business but everyone can do something, and together we can create change for the better. Presented by: Jefferson County Community Network and Jefferson County Public Health Also Sponsored by: City of Port Townsend —All Department, Jefferson County —All Departments, Jefferson County Domestic Violence and Sexual Assault, Jefferson County Historic Society, Jefferson County METH Action Team, Jefferson County 4-H, Jefferson County YMCA, Developmental Disability Advisory Board, the Boiler Room, Safe Harbor Recovery Center, Substance Abuse Advisory Board, Jefferson Teen Center, Department of Children and Family Services/Children's Administration, Jumping Mouse Children's Center, Big Brother Big Sister, • Jefferson Mental Health Services, OLYCAP, Brinnon School District, Chimacum School District, Port Townsend School District, Quilcene School District, PT Kiwanis, The Rose Theatre, the Elks Lodge and The Port Townsend & Jefferson County Leader. 2009 "Our Kids: Our Business" activities and events tentatively planned for March and April (This is as of 3-13-09. More is developing everyday.): • A "Call to Action" for the residents of Jefferson County inviting citizens to pledge an action that will make Jefferson County a more nurturing and safe environment for children. (The pledge is asking for action, not money.) Please see attached "Pledge"form. We invite you to sign. • The City of Port Townsend and Jefferson County Commissioners are proclaiming April to be National Child Abuse Prevention Month. • The Jefferson County Public Health is sponsoring a kick-off luncheon on Friday, March 27th at the Elks Lodge from 12:00 to 1:30 pm. Speakers will be Dr. Claudia Black (a Jefferson County girl) and Chief Gil Kerlikowske, the Chief of Police in Seattle (recently nominated by President Obama to be the new Director of the Office of National Drug Control Policy. Projected cost will be between $15 and $18. Tickets must be purchased in advance. Seating for 100 only. Tickets will be available the week of March 2nd online at www.jeffcocommunitynetwork.org • Jefferson County Community Networks will be hosting two "Adverse Childhood • Experiences: Opening the Conversation"trainings with a discussion luncheon to follow on Tuesday,. April 14th and Tuesday, April 28th. For information go to www.ieffcocommun itynetwork.orq • Jefferson County Historic Society is sponsoring a Free Family Fun Day at the • Museum Old City Hall Museum on Saturday, April 4th from 11:30 to 3:30 pm Opportunities to make a pinwheel, help decorate a family play museum bingo, and win a prize are open to all. • The Food Co-Op will have a week long celebration of "Grow Health Kids." • The Developmental Disability Advisory Board is sponsoring a campaign to encourage pregnant women not to drink alcohol to prevent Fetal Alcohol Spectrum Disorders. Fetal Alcohol Syndrome is the number one preventable disability. • Domestic Violence and Sexual Assault will make a presentation at the Boiler Room, date and time TBA., will air video programs on PTTV on sexual assault and tie teal ribbons around the tree at the PT Community Center. • Michele Bartl will be facilitating a series of "Love and Logic" parenting class at Grant Street Preschool on Thursday evenings from April 16tn through May 13th Interested parties please contact ca;; 360-301-2894 or email michelebartl(@gmail.com • Businesses, agencies, and organizations that provide services for children, youth and families will display pinwheels to represent the children and families served by their programs. • Sound Experience, The Wooden Boat Foundation, PT Sea Scouts, Schooner Martha, Schooner Alcyone, Puget Sound Explorers, the NW School Wooden Boat Building, will sponsor "Learn about Maritime Opportunities for Youth", date, time and location TBA • Jefferson County 4-H youth have and will continue to produce videos about "Our Kids: Our Business" by youth in 4-H News. For details go to Jefferson County 4-H website. • PROJECT SUCCESS is sponsoring a presentation by Elizabeth Turner titled "The Exuberant Mind: The Adolescent Brain" on Wednesday, April 29, 2009 from 7:00 to 8:30 pm at the Port Townsend High School Library. • Washington State Patrol is sponsoring a presentation titled "Street Smart" at Quilcene High School at 10:15 am on Tuesday, April 28, 2009. • An ad will run at The Rose for the month of April. • Articles in the Port Townsend & Jefferson County Leader, both the newspaper and online.. S Our (Kids: Our Business My Call to Action Our Kids: Our Business Pledge: My Call to Action: I believe our children are owed a safe community; a nurturing environment where all kids can become connected to the resources they need to live healthy and fulfilling lives as caring and competent citizens. In furtherance of my commitment to this mission, I support the"Our Kids: Our Business" campaign and agree in the coming year to take specific action in support of the Five Promises. Five Promises to our Children 1. Caring Adult 2. Safe Places and Constructive Activities 3. A Healthy Start and Future 4. Effective Education for Marketable Skills 5. Opportunities to Serve Actions can be big or small and can address any one of the above promises, such as: * Be a caring adult who asks a neighbor about their school activities. *Serve an organization that supports healthy youth and families. * Donate time or money to a cause that supports healthy youth and families. *Allow youth opportunities to serve in your organization. • For details look for the pinwheel logo or go to www.jeffcocommunitynetwork.org; www.jeffersoncountypublichealth.org; www.ptleader.com or read The Leader. The names of all those signing this Call to Action will be printed in The Port Townsend Leader in the month of May. Name: City: Signature: OPTIONAL: If you wish to have your contact info forwarded to a local group or agency, please fill out the address section below. This information will not be printed in the newspaper. Your pledged activity: Your Name: Address: Phone Number: Agency/organization preference(s): Mail or deliver this form to: Or fill out online at: • Our Kids: Our Business www.jeffcocommunitynetwork.org Jefferson County Public Health 615 Sheridan Street Port Townsend, WA 98368 Or fax to 360-385-9401 • Board of Health Netiv Business .Agenda Item #17., 1 2008 Jefferson County • Public 3-CeaCtfi Performance Measures Mare 19, 2009 Jefferson County Public Health —Performance Measures 2008 (Year End Report) • FAMILY SUPPORT PROGRAMS COMMUNITY HEALTH BUDGET/PROGRAM: 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,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 mission of the Family Support Program is to offer health education and support to all Jefferson County pregnant women and families with young children as they build a secure foundation for a lifetime of health, learning, and community contribution. The Family Support Team consists of public health nurses, registered dietician, social worker, and support staff. Our goals are: -To honor the diversity of all Jefferson County families with young children. -To support and guide families by building on their strengths in order to create a safe, Healthy and hopeful future for their children. -To collaborate with community partners in our shared goal of improving health, • Preventing adverse childhood experiences, and creating a seamless continuum of services. -To provide high quality services through community assessment, commitment to best practices, professional continuing education, and program evaluation. GOALS FOR FY 2008: 1. Maintain the current number of clients served through the Family Nurse Partnership Program (Best Beginnings) for Jefferson County residents. 2. Monitor Nurse Family Partnership Program replication by tracking data on program fidelity. 3. To assess the percentage of pregnant and parenting women receiving Jefferson County Public Health(JCPH) Family Support services, in which depression is an issue. 4. Continue to provide breastfeeding education and support so that all county mothers can provide their children with the physical and emotional benefits of breastfeeding. 5. Prevent nutritional related problems for pregnant women and children under five in Jefferson County. 6. Identify children with special health care needs in Jefferson County and assist families with health and development interventions and referrals as needed. 7. Provide services and information in Jefferson County aimed at preventing Child Abuse and Neglect. OBJECTIVES FOR FY 2008: 1. 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. Performance Measures 2008 1 OF 3 Year End Report 03/12/09 2. Send client data monthly to Nurse-Family Partnership program head office for assessment and evaluation. 3. 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. 4. Through universal screening of newborns and their families identify those who may need referral to 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. 5. Provide WIC nutrition education and support to all eligible county women and children. 6. Provide developmental and health screening through JCPH programs including community outreach to providers and the schools to identify children with special health and development needs and assist families in getting further evaluation and intervention services. 7. 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. 8. 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: 2006 2007 2008 2008 Actual Actual Planned Actual 1. Number of depression screenings completed _ 65 87 90 85 411) 2. Number of newborn screened 145 130 100 116 3. Number of Home and Office visits provided for NFP, 1144 1170 1150 1363 MSS, MCM, MCH and Breastfeeding consultation 4. Yearly report from Family-Nurse Partnership ** ** ** ** 5. Total number of women infants and children served by 829 872 870 881* WIC in Jefferson County(from CIMS report) _ 6. Number of children with special health care needs 81 70 40 85 receiving Public Health Nurse intervention through JCHHS. 7. Number of families served through CPS/DSHS contract. 20 30 20 40 ** Report yearly *From state WIC office Calendar year 2008, Federal Fiscal year number 867 SUMMARY OF KEY FUNDING/SERVICE ISSUES: Jefferson County Health report published in May 2003 confirmed what the staff in the Family Support Programs has observed in their work in the community: `families with young children are very vulnerable'. Multiple factors contribute to this status: poverty, mental illness, substance abuse, and family abuse/violence. For many families these challenges have been transmitted across generations and now the newborns are vulnerable to these risk factors. Over the years of providing services through programs such as MSS/MCM, WIC, and for the last 8 years,Nurse-Family Partnership, staff has worked to increase knowledge and skills in a committed effort to prevent and reduce the effects of these conditions. We are now able to effectively serve clients and families who previously were resistant, or too entrenched in complex psychosocial problems to accept services. Working effectively with these families requires a high degree of skill and support. These families, • Performance Measures 2008 2 OF 3 Year End Report 03/12/09 with multi-generational challenges, respond best to consistent, intensive services delivered over a • long period of time. 2008 STUDY/ANALYSIS RESULTS: The overall number of contacts (office/home visits)has increased due to an increase in CPS referrals. The past several years JPCH Family Support staff have working in increasing collaboration with all agencies serving at risk Families. One of the projects that is ongoing is writing Jefferson County's Drug Endangered Child Protocol. Protocols are now written how Law enforcement, Jefferson Health Care and other agencies will work together to keep children safe. Hopefully funding for CPS contract will continue but at the moment there is risk of contract changes at the State that will reduce funding for needed services. WIC case load has increased especially in the last quarter of 2008. The Federal, state and local government are committed to this program to provide needed nutritional support for Women, Infants and children as the economy has gotten worse. We are creating a more detailed report of WIC case load increases by month to share with the BOH in the near future. In 2008 the JCPH started Electronic Medical Record to do data collection on services and interventions with Family Support clients. With this information and the support of Assessment staff, Family Support programs will increase knowledge of specific populations and evaluate interventions for positive outcomes. A more detailed report of client load for all clinic services is being worked on to share with the BOH in the near future. • Fee for services revenue from the State and Federal Funds continue to decrease. Medicaid Administrative Match funding continues to be used to maintain the level of services in Family Support Programs in 2008. March 1, 2009 report • Performance Measures 2008 3 OF 3 Year End Report 03/12/09 Jefferson County Public Health —Performance Measures 2008 (Year End Report) TARGETED CLINICAL HEALTH SERVICES • COMMUNITY HEALTH BUDGET/PROGRAM: Targeted Clinical Health Services Community Health Family Planning, Breast and Cervical Health Program, and Foot Care MISSION: The purpose of the Targeted Clinical 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 2008: 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 2008: 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: 2006 2007 2008 2008 Actual Actual Planned Actual Number of unduplicated clients served in Family Planning 1257 1195 1200 1128 _ Number of adolescents under 19 served in Family Planning 332 312 300 300 Number of Breast & Cervical screening exams 122 111 100 110 Number of foot care contacts 2765 2946** 2400 3131** ** Foot Care Senior Center and Home Visits • Performance Measures 2008 1 of 2 Year End Report 03/12/09 SUMMARY OF KEY FUNDING/SERVICE ISSUES: Preventing unintended pregnancies is a local, state, and national Public Health Goal. Jefferson County Public Health (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 2007 Family Planning Clinic is seeing a major decrease in revenue from State and Federal Fee for services programs (Take Charge). Management continues to look at restructuring staffing and clinic efficiencies Family Planning as a way to decrease expenses. Client numbers are staying level or slightly decreasing. In 2007 and in 2008 more County Funds are being used to support services Family Planning JCPH to maintain the Critical Health Services of Family Planning in Jefferson County. The Breast and Cervical Health Program addresses the need for Cancer screening and early treatment to decrease deaths from breast and cervical cancer in Jefferson County. With continued community support and level funding from Washington State in 2008 we hope continue Breast and Cervical.Health exams at the same level in 2008. Jefferson County has a high percent of over age 85 citizens. JCPH Foot Care Program helps this population maintain independence and mobility in a rural community. The Foot Care program continues to provide needed services to the senior population in Jefferson County. 2008 STUDY/ANALYSIS OF RESULTS: Family Planning number of clients has decreased slightly along with the number of teens. School enrollment has decreased slightly which would account for the decrease in the number of teens. JCPH continues to provide needed Family Planning services to about a third to half of the teen girls in Jefferson County based overall county population numbers in that age group. Based on Assessment data from the Healthy Youth Survey and the needs identified by students, JCPH • applied for a School Based Clinic Planning Grant spring 2008. With information from the Planning Grant we have proceeded with establishing a School Based Clinic at Port Townsend High School winter 2009 and at Chimacum High School March 2009. Also based on the Health Youth Survey and needs identified by students JPCH applied for 1 10th of 1% to get Mental Health Services in East Jefferson County High Schools. Part of the SBC planning grant included looking at other services and programs to share the space at the High Schools. The Mental Health services now available in the schools uses the same clinic space as the SBC on alternate days. Breast and Cervical Health programs numbers are level. In the fall of 2008 it was decided to commit clinical staff to do a Mobile Mammogram in South County the fall of 2009. Also there is continued Community Support for BCHP based on continued donation to the program. Increase outreach will begin by summer 2009 for the October 10th Mobile Mammogram in Quilcene. Foot Care numbers are up probably from the increase in Jefferson County's older population and increased health needs of that population. It has been difficult to find and maintain JCPH Foot Care staff. JCPH continues to look for staff and support to continue this needed service. • Performance Measures 2008 2 of 2 Year End Report 03/12/09 Jefferson County Public Health —Performance Measures 2008 (Year End 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 2008 1. Maintain the low rates of active TB in Jefferson County(TB) 2. Timely investigation of reportable conditions(CD) 3. Providers will be informed about current communicable disease trends and new communicable disease control recommendations(CD) 4. Support universal access to State supplied vaccines for all children (Imm) 5. Continue to support immunization registry in Jefferson County, promoting use by all immunization providers (Imm) 6. Assess childhood immunization rates for children served by Primary Care Clinics receiving State supplied vaccines 7. The Family Planning and STD clinics will assist in controlling Chlamydia transmission in Jefferson County (STD) 8. Federally funded HIV testing and counseling clinic resources are focused on persons at risk for HIV • infection(HIV) 9. Case management services will assist HIV positive clients in accessing primary care and medications, dental services and adhering to treatment. 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 and other emergency response capacity OBJECTIVES (INTERVENTIONS)FOR 2008 1. Encourage appropriate screening&treatment for latent TB infection(TB) 2. Develop& update protocols for investigation of reportable conditions(CD)using the new electronic reporting systems, Public Health Issue Management System (PHIMS)and Public Health Reporting of Electronic Data(PHRED). 3. Provide updates, outreach and training to providers about local, state and national communicable disease outbreaks and disease control recommendations. Provide reminders about reporting notifiable conditions and using the Regional Duty Officer for after hours contact. (CD) 4. Maintain an efficient system for supplying State supplied vaccine and vaccine recommendation up-dates to private Health Care Providers in Jefferson County, including training for, and transitioning to, direct shipment of vaccines from manufacturer to clinic through new Washington State VMBIP program. (Imm) 5. Continue to provide private Health Care Providers support and updates on the Child Profile Immunization Registry. (Imm) 6. Perform an assessment of childhood immunization rates, using AFFIX software, every other year, for each clinic receiving State supplied vaccines. (Imm) 7. Clients seen in Family Planning and STD clinics who are at higher risk for Chlamydia(age criteria)will be • screened for Chlamydia. (STD) 8. 75% of clients who receive HIV testing through the Washington State Public Health Lab will be high risk. (HIV) Performance Measures 2008 1 of 4 Year End Report 03/12/09 9. Case management services will continue to provide services that assist HIV positive clients in accessing primary care, medications,dental services and adhering to treatment.(HIV) 10. Promote utilization of syringe exchange program services. (SEP) 11. Develop and update regional Public Health Emergency Preparedness and Response Plan, coordinating with • Region II partners, local emergency response agencies and Jefferson Healthcare, local health care providers and agencies. PERFORMANCE INDICATORS 2006 2007 2008 2008 Actuals Actuals Planned Actuals (TB)Number of clients started on preventive therapy for 4 3 3 3 latent TB infection (CD)Number of communicable disease reports confirmed, 125 103 90 164 interventions applied and processed for reporting to the State (CD) (CD)Number of alerts/updates/newsletters faxed or New for New for 10 13 mailed to providers about communicable disease outbreaks 2008 2008 or other urgent public health information. (Imm)Number of doses of publicly funded vaccine, 3,822 4,604 3,500 5,167 administered by private health care providers and Public Health clinics, supplied and monitored through Public Heath's immunization program Number of providers trained in VMBIP vaccine ordering 5 5 5 5 and receiving system (Imm)Number of providers participating in the statewide 1 2 5 6 _Child Profile Immunization Registry (Imm)Number of Jefferson County children<6 with 1 or 82% 84% 85% 88% III more immunization in Child Profile system (Imm)Number of Jefferson County children <6 with 2 or New 74% 70% 82% more immunization in Child Profile system 2007 (Imm)Number of clinic site visits to assess childhood 1 1 2 1 immunization rates, using AFFIX software/number of NA NA 6 technical assistance, training or education visits (STD) Percent of at risk FP and STD clinic clients at risk for 100% 100% 100% 100% Chlamydia screened (age criteria 14 - 24). Number of clients New 272 300 312 in risk group screened for Chlamydia, Ahlers report. 2007 (HIV)Number of persons counseled and tested for HIV DOH Lab:68 DOH Lab:59 80 DOH Quest Lab:49 Quest Lab:72 Lab:73 infection Total: 117 Total: 131 Quest Lab:52 Total: 125 (HIV) Percent of persons counseled and tested for HIV 85% tested 85% tested 75% 90% tested through DOH through DOH through infection through the Public Health Lab that were in high- DOH risk category (HIV)Number of face-to-face encounters between case New 55/341 45/200 NA* manager and client. Number of collateral encounters with 2007 client's representative or other encounters per quarter. (SEP)Number of visits to SEP 54 65 50 70 (SEP)Number of syringes exchanged 17,905 24,585 15,000 21,330 • (BT) Develop and update bioterrorism response plan 1 1 1 1 *In the first quarter of 2008 HIV Case Management services were transferred to Clallam County Department of Health and Human Services by Clark County Public Health/Region 6 AIDSNET. Performance Measures 2008 2 of 4 Year End Report 03/12/09 SUMMARY OF KEY FUNDING/SERVICE ISSUES: *These programs address locally identified and defined local public health problems. All communicable disease prevention is a locally funded program, 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, this vaccine is provided to primary care clinics that care for children. County funded services provide a professional staff that prevent, identify and respond to disease outbreaks and immunization staff that work with health care providers,the schools and local groups sponsoring trips abroad for students. Immunization staff provide routine immunization clinics and international travelers clinics. Substantial staff time is spent on responding to public requests for information about communicable diseases and screening for reportable illnesses in the process. The proposed mid-2009 change in the Washington State Universal Vaccines for Children Distribution system to one in which those with private insurance will not qualify for State supplied vaccine will require stocking a privately purchased supply of all pediatric vaccines. This will affect JCPH,Jefferson Healthcare and the five clinics currently administering State supplied vaccines. HIV services are funded from the state and federal government to provide basic communicable disease prevention, HIV testing and counseling of high-risk community members, partner notification and focused high-risk interventions.The syringe exchange program success is not easily measured in disease numbers but the number of clients seen and syringes exchanged reflects the disease transmission prevention capacity of this program. Starting in 2002 federal funding was received originally for developing the capacity for bioterrorism response and now for all hazards emergency response. Response capacity is being developed in coordination with our Region 2 Public Health Emergency Preparedness and Response(PHEPR)partners Kitsap and Clallam Counties,our local emergency response agencies,Jefferson Healthcare and other health care providers. For 2008 projects involve participating in drills to test the appendices and procedures that go with the local Public Health Emergency Ikreparedness and Response Plan that was first drafted in 2003.This involves continuing to update the basic plan, the Strategic National Stockpile plan and the Pandemic Flu plan. Public Health staff have been trained in and use National Incident Management System protocols during communicable disease outbreaks. The roles,responsibilities and training have been invaluable. JCPH participates in the Regional Duty Officer 24/7 contact system for Public Health with Kitsap and Clallam counties' staff, responding to after hours calls and triaging them to the appropriate Public Health professional if necessary. This allows JCPH to share call time and standardizes regional response to Public Health issues.Federal funding for emergency preparedness activities is expected to decrease in 2009. Increased funding was received in 2008 from the Washington State Department of Health(DOH), specifically for Communicable Disease surveillance and improving immunization uptake in children. The two performance measures that are being reported to the DOH are: 1. Increase the uptake of new and under-used child and adolescent vaccines; specifically focusing improvement efforts and reporting on Varicella, Rota Virus, HPV, and Pediatric Influenza. 2. Improve the timely, complete identification and standard,effective investigation of notifiable conditions per WAC 246-101. This funding continues through 2009. Future funding will depend on State Legislative decisions. Decreased funding for any program would result in scaling back on services. The Board of Health would be involved in deciding which services would be impacted. • Performance Measures 2008 3 of 4 Year End Report 03/12/09 2008 STUDY/ANALYSIS OF RESULTS: The number of communicable disease reports filed with the State has increased in 2008 in part due to a more efficient system for getting required information for chronic hepatitis C reports from providers. The Communicable Disease team continues to assess the sharing of important information with Jefferson Healthcare and the medical providers, • ideally sharing what they need/want to know without sending too much information that is not needed or wanted. The team is currently discussing this with the Infection Control Nurse at Jefferson Healthcare. The number of doses of publicly funded vaccine administered to children in Jefferson County over the past 3 years has increased primarily due to new vaccine options being added to the schedule and new school immunization requirements. The transition to direct shipment of vaccines from manufacturer to clinic through new Washington State VMBIP program has gone smoothly. This requires ongoing efficient communication between JCPH Immunization Program staff and the private clinics each month for the inventory and order placing process. In mid 2005 four out of five providers using the Child Profile Immunization Registry stopped entering data into the registry because the hospital/clinics' new electronic medical records(EMR) system caused this to require double entry for each immunization. We were hoping that an EMR upgrade would allow the downloading of data into CP in 2006. This upgrade came late in 2006 and the testing for compatibility with Child Profile was delayed until 2007. Unfortunately this upgrade did not solve the compatibility problem. JCPH Immunization Program staff continued to discuss the advantages of using Child Profile with the clinics. In mid 2008 JCPH Immunization Program staff facilitated a training provided by State Child Profile staff for the three largest Jefferson Healthcare associated clinics. Staff from two other small clinics were then trained in the use of Child Profile by staff from one of the larger clinics. All clinics are now participating in Child Profile even though this requires double entry of immunization data by clinic staff. The JCPH Immunization Program staff continue to provide technical assistance to the clinics, immunization updates, vaccine refrigeration incident follow-up,training of new vaccine coordinators in the clinics,and immunization program assessment using AFFIX software. The visit numbers do not reflect the work being done with the clinics, many contacts are by phone and information is often faxed or mailed to clinics. The Family Planning and STD clinics consistently follow the Center for Disease Control's STD screening recommendations for the high risk age groups. Clients tested for HIV are screened for risk factors and the State Public Health Lab is used for those in the high risk category. Clients in the high risk category can be tested through the State lab without being billed for the lab fee,thus high risk clients who have no medical coverage and are low income can be tested. Lower risk clients requesting this test are tested through the Quest lab and the cost of the testing is billed to the client. The Syringe Exchange Program has seen a gradual increase in the number of client visits over the past two years. Of the 70 visits in 2008, six were clients new to the program, 64 were returning client visits with clients being counted multiple times. There were 9 new clients in 2007 and 8 new clients in 2006. Performance Measures 2008 4 of 4 Year End Report 03/12/09 • Jefferson County Public Health—Performance Measures 2008 (Year End Report) POPULATION & PREVENTION Wo'UDGET/PROGRAM: Population & Prevention Programs bacco (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 2008: 1. Improve identified social and health indicators for school-age youth (S/H) 2. Improve overall health of 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. Reduce favorable attitudes toward problem behavior within the youth and adult communities. (DA) 6. Delay age of initiation of problem behavior. (DA) 7. Reduce adverse childhood experience as measures by reduced CPS referrals (DA) OBJECTIVES FOR FY 2008: 1. Maintain delivery of school in-service/trainings, student health screenings, student health consults, student health care referrals (S/H) 2. Provide tobacco specific education and resources to employers to support employee cessation(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. Increase the perception of risk for youth regarding alcohol and marijuana use, especially for 6th, 8th, and 10th grade students.(DA) 6. Increase access to adults with healthy beliefs and clear standards for 4th through 6th grade students in Jefferson county.(DA) 7. 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: 2006 2007 2008 2008 Actual actual Planned actual Number of student health screenings 1398 1135 1400 1124 Number of employers receiving tobacco specific technical assistance(TP/C) * 3 5 4 Number of Peer-In educational presentations 50 60 50 44 Number of school health classes 200 200 200 218 Number of phone calls to WA State Tobacco Quit line from Jefferson Co. 75 63 75 93* Number of classroom presentation/interventions(Drug and Alcohol preventions) 140 144 130 134 Number of students served in the class room presentations 350 475 310 404 eklew in 2007 ** July 2007 to June 2008 Performance Measures 2008 1 of 2 Year End Report 03/12/09 SUMMARY OF KEY FUNDING/SERVICE ISSUES: Jefferson County Public Health(JCPH) delivers programs that promote healthier communities and individuals. Focusing public funds on prevention programs have proven to be cost effective. JCPH hopes to continue in 2008 to continue to collect Assessment data to assist in determining community needs and prioritize services (assess to health care, substance abuse, domestic violence and child abuse and neglect). The Juvenile Justice • Grant, Healthy Communities grant, started in 2001 ended in October 2007. These services include work in the schools and getting Big Brother/Big Sister program started in Jefferson County. Big Brother/Big Sister is continuing with other sources of funding including fund raising. The above programs provide universal prevention programs available to all in the community. State prevention health services monies come with extensive evaluation components. Tobacco 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 which should remain the same in 2008. Decreasing enrollment may decrease the number of classroom presentation and the number of students served. Drug and Alcohol prevention program continues to work with Community Health programs providing integrated prevention services. In 2007 the Drug and Alcohol Prevention program wrote a 6 year strategic plan to address the identified prevention needs in the community. State and local funds are utilized primarily through the school based Best Practice education Programs. These funds allow prevention specialist to reach the vast majority of middle school students. JCPH applied for and received a Grant from the University of Washington to do an innovative abstinence education program within the High school population. This grant supported the Peer-in program through 2007. Again, in 2008 funding and staff is unknown for Peer-in at this time. 2008 STUDY/ANALYSIS OF RESULTS: • Jefferson County School enrollment is decreasing reflecting in a decrease in the number of 2008-09 Healing/Vision screenings. Of those 1124 students screened 105 were referred for further hearing or vision referrals. School Nursing contracts continue with all 4 school districts to provide this service. Tobacco Coordinator is doing more outreach to businesses to encourage cessation resources for employees. Advertising of Washington States Quit line has increased Jefferson County resident's use of Tobacco Cessation resources identified with increase use of the number. Outreach and advertising efforts will continue. Peer-in has switched to the University of Washington"Take It Serious: Sex and Media" (TSIAM) program. Outcomes of the new curriculum have been positive. Drug and Alcohol Prevention staff continues to use Project Alert in the school. Staff would like to find a new Best Practice program for school interventions but have been limited in their choices of other curriculums that will fit with the school's schedules. • Performance Measures 2008 2 of 2 Year End Report 03/12/09 Jefferson County Public Health —Performance Measures 2008 (Year End Report) FOOD SAFETY • MISSION: The mission of the Food Safety Program am is to minimize the risk of the spread of disease p from improperly prepared, stored or served foods handled in commercial settings. GOALS FOR FY 2008: 1. Provide classroom food safety instruction for all food service workers. 2. Assure minimum sanitary standards are observed in all food service establishments. 3. Provide basic food safety information to the general public. 4. Proctor ServSafe exams to food service establishment managers. 5. Establish technology enhancements to further educational outreach efforts. OBJECTIVES FOR FY 2008: 1. Offer food safety training at a frequency and in locations convenient to food service workers. 2. Review all new food service establishments for compliance with state and county requirements. 3. Inspect all food service establishments at a frequency adequate to assure compliance with state and local regulatory requirements. 4. Offer educational materials and technical assistance to non-regulated community groups and organizations where requested. PERFORMANCE INDICATORS: 2004 2005 2006 2007 2008 • (Actual) Number of food workers trained 1,500 1,044 1,100 1,100 1314 Number of food worker classes at Health 60 52 52 52 52 Department Number of food worker classes at other 30 20 25 30 31 locations Number of food establishment permits 260 265 270 275 237 Number of required inspections completed 300 352 352 355 217 Number of inspected establishments that 20 33 70 70 0 required repeat inspections due to critical violations. Number of establishments receiving 50 41 30 35 N/A Outstanding Achievement Awards Number of temporary food service permits 78 75 80 90 89 Number of complaints received and 30 25 35 30 17 resolved SUMMARY OF KEY FUNDING/SERVICE ISSUES: Food Safety Program activities are funded solely through permit fees. LINKS TO COUNTY STRATEGIC OBJECTIVES: • Addressing locally identified and defined public health problems. • Operating within a business plan based on sustainable resources, measured performance, and • outstanding customer service. Performance Measures 2008 1 oft Year End Report 03/12/09 2008 STUDY/ANALYSIS OF RESULTS Food Worker Training • The number of off-site classes is climbing in the last 2 years, and the number of food workers is climbing at a similar rate indicating that this is an area of growth. Class size is stable and workable for the limited classroom capacity. We have 3 staff who can run the English classes (Alison, Trish, and Dana) with Dana doing most classes. Maira conducts classes in Spanish. No changes are needed at this time, however it is requiring more time and adjustments in food program hours may be needed. Food Establishment Permits and Inspections Permit numbers are down 11% from 2007. This number is expected to remain the same or decline due to the economy. Program workload may be balanced by the increase in food worker training. Also, complex facilities need 2 inspections per year now, keeping the inspections required close to the same. Inspections were down in 2008 due to staff changes. Staff hours are down so inspections will continue to be prioritized by risk status and history of compliance. Phone and in-person contacts with the public seem to be up as more people try to survive the economic times by considering start-up food businesses. Shifting more of the public response duties to front desk staff and referring to the website may help. Critical violations requiring re-inspection are down. However, complaints are down,too. It may reflect success with raising the standard of food safety. Previous inspectors tended to instruct rather than penalize,as often points were not assigned to violations. It bears evaluating annually to see how • differences in emphasis affect food safety practices in the community. Outstanding Achievement Awards were not issued due to staff changes at the time with a resultant shift in priorities to keep essential program functions. There was no public response to this change. The award system will be evaluated this year. On the Spot Awards (a little used existing award system) will be used to recognize achievements in food safety performance by food workers. Temporary Permits continue to be stable at a high level. This may be an area where back-up staff can help. Inquiries seem to be up. Clients are reporting use of the website to obtain permit information and more use of this resource is expected as we refer people to it and keep it updated. • Performance Measures 2008 2 of 2 Year End Report 03/12/09 Jefferson County Public Health —Performance Measures 2008 (Year End Report) DRINKING WATER MISSION: The mission of the Drinking Water Program is to assure that the residents and visitors to Jefferson County have access to the best quality drinking water that is reasonably available in order to minimize the threat of waterborne disease. GOALS FOR FY 2008: 1. Assure that all new wells are constructed in accordance with requirements established by the Washington Department of Ecology. 2. Provide technical assistance when requested so that individual water supplies are safe. 3. Limit public exposure to water systems with known deficiencies. OBJECTIVES FOR FY 2008: 1. Inspect at least 50% of all new wells constructed and 90% of all wells being de-commissioned. 2. Maintain high rates of compliance with state well drilling regulations. 3. Review all building permits and project applications to assure that potable water supplies meet basic public health standards as well comply with state statutory and regulatory requirements. 4. Provide technical guidance to any residents requesting assistance with their individual or small water systems to deliver safe drinking water. 5. Continue contracting with DOH for public water supply projects as long as adequate funding is provided. • PERFORMANCE INDICATORS: 2004 2005 2006 2007 2008 (Actual) Number of well applications received&reviewed, includes 165 144 166 146 98 carry forward from previous years(USR's) Number of new wells start notification(drilled) 90 92 131 108 79 Number of wells decommissioned 9 5 13 16 16 Number of applications with no well drilled(carry forward) 14 38 19 22 8 Number of new wells inspected(start notification received) 47 50 70 67 49 Percent of new wells(starts) inspected 52% 54% 53% 62% 62% Number of decommissioned wells inspected 9 5 13 16 16 Percent abandoned well inspected 100% 100% 100% 100% 100% SUMMARY OF KEY FUNDING/SERVICE ISSUES: Increased tracking will be done within existing databases such as permit plan and the food service database. Databases, including the water quality database, will be updated as necessary to add new fields to track performance indicators. LINKS TO COUNTY STRATEGIC OBJECTIVES: • Protecting and enhancing water quality. • Addressing locally identified and defined public health problems. • Operating within a business plan based on sustainable resources, measured performance, and outstanding customer service. Performance Measures 2008 1 of 2 Year End Report 03/12/09 2008 STUDY/ANALYSIS OF RESULTS: O • In keeping with economic forecasts and analysis of past years activities in well applications and well starts, it would appear that our statistics match the trends in development very accurately. The statistic indicates a steady rise in the number of wells drilled from 2004 until it peaked at which time the number of wells drilled has declined. • We anticipate a possible increase in well applications and drilling activity in the Water Resource Inventory Area 17 (WRIA 17) as a result of some anticipated Department of Ecology in stream flow rule planned for implementation toward the fall or winter of this year. The press related to the proposed in-stream flow rule will likely cause land owners to feel the need to drill wells in order to vest their property for water into the future under existing rules. Whether or not this drilling activity will actually vest the well will have to be clarified by Ecology as a part of the "beneficial use" criteria. • Decommissioning of wells have shown a steady increase since 2004. It is believed that this is a result of two possible scenarios. First is the extension of public water on Marrowstone Island with subsequent redevelopment or repair of on-site septic systems which required decommissioning of wells where setbacks could not be maintained. Secondly is the data entry process that has been fine tuned to define decommissioning as any well that is decommissioned. In the past, if a new well was drilled, didn't have adequate volume or didn't meet quality standards and was then decommissioned right after drilling, we did not create a process to count these. • We are maintaining adequate surveillance of drilling activities as required by our contract with Ecology. However, critical consultation, code interpretation and enforcement has been hampered by a long standing vacancy in Ecology's regional engineer position for this area. • On January 1, 2009, as a result of budgetary issues, DOH notified this office that they will no longer• provide potable water review for building permit applications requesting connection to public water systems. As a result, this department will need to develop a water system database to affectively process building permits without the benefit of DOH's assistance. We anticipate that this is only the beginning of impacts to staff that will result from the Federal and State budget problems. We are trying to be flexible, creative and at the same time accountable, as we are forced to take on new responsibilities. Performance Measures 2008 2 of 2 Year End Report 03/12/09 Jefferson County Public Health—Performance Measures 2008 (Year End Report) WATER QUALITY PROGRAM • MISSION: Monitor and respond to threats to water quality for protection of human health and fish habitat by using available local, state and federal funding effectively and efficiently. GOALS FOR FY 2008 1. Continue to implement a lake monitoring program to protect the public from the threats of toxic blue green algae and bacterial contamination. Actual: JCWQ continued to monitor and report to the public health hazards associated with toxic blue green algae. 2. Secure funding to conduct a study of local lakes to determine causes of toxic blue-green algae blooms. Actual: JCWQ secured a grant from the state freshwater algae control program (through Ecology) to assess the condition of lakes in Jefferson County and determine causative factors leading to blooms. 3. Ensure healthy beach water quality at heavily used saltwater beaches. Actual: JCWQ continued to monitor three heavily used beaches, Quilcene Marina, Camp Parsons and Fort Worden for entercoccus, through the Washington State BEACH program. 4. Institute actions under a Clean Water District that monitor, protect and enhance water quality. Actual: JCWQ instituted actions concurrent with the Clean Water District in areas that we have received funding under the State's Centennial Clean Water Fund. These efforts are geographically limited to Hood Canal, south Discovery Bay and Chimacum Creek. Although these are high priority areas, a need remains for countywide comprehensive funding of Clean Water District actions. • 5. In cooperation with Environmental Health and the Conservation District use awarded state funds to improve water quality in Chimacum Creek, Discovery Bay and Hood Canal, Actual:JCPH has continued to work with EH and JCCD to identify and correct sources of pollution in these watersheds. This has included fixing failing septic systems and implementing agricultural best management actions to keep waste out of waterways. 6. Monitor actions to assure that goals for each project are being met. Actual:JCWQ continues to monitor this on a quarterly basis through the grant reporting process. OBJECTIVES FOR FY 2008 1. Continue to implement a detailed written lake monitoring program and secure state funding to determine the causative factors involved in local blue-green algae blooms. -Objective met 2. Monitor swimming beaches on a weekly basis during the swimming season. -Objective met 3. In partnership with the Jefferson County Conservation District and North Olympic Salmon Coalition complete the tasks outline in the scope of work for the year two of the Chimacum Creek Centennial Clean Water Grant. -Objective met • 4. Hire and train staff to meet the demands of the clean water projects in Discovery Bay and Hood Canal. -Objective met Performance Measures 2008 Year End Report 03/12/09 1 of 2 2008 PERFORMANCE INDICATORS: 2005 2006 2007 2008 Actual Ak Lakes Monitored 0 9 9 9 9 Swimming Beaches Monitored 0 0 2 2 3 JCPH funded water quality stations on 0 0 40 40 40 Chimacum Creek Percentage of program budget represented by 0 0 14.00% 18.56% state and federal funds *First year separated Water Quality and Habitat Enhancement& Protection Programs SUMMARY OF KEY FUNDING/SERVICE ISSUES: This program implements the following objectives for the 2008 Budget: • Protecting and enhancing natural resources and water quality. • Protecting human health and welfare. • Operating within a business plan based on sustainable resources, measured performance, and outstanding customer service. SUMMARY OF ACCOMPLISHMENTS FOR 2008: • Continued to utilize state and local funding to improve water quality in the Chimacum Creek watershed in partnership with EH and JCCD. • A downgraded commercial shellfish growing area was upgraded to "Approved" in southern Discovery. Bay, a key objective of the Discovery Bay Clean Water Project funded by State Centennial Clean Water Fund and local funds. JCWQ in cooperation with JCCD will continue to monitor this area's water quality and identify and correct any sources of pollution found. • Began the Hood Canal Clean Water Project, several failing septic system have already been identified and corrected as a result. • Secured a Centennial Clean Water Fund Grant to fund a project in Mats Mats Bay, a threatened shellfish growing area, to identify and correct sources of water pollution. • Started work on the Jefferson County Lakes Assessment project to identify causative conditions behind toxic blue green algae blooms in heavily used lakes. • Received approval and funding to expand the swimming beach monitoring program to two additional heavily used saltwater beaches in Jefferson County. • Performance Measures 2008 Year End Report 03/12/09 2 of 2 Jefferson County Public Health —Performance Measures 2008 (Year End Report) Solid and Hazardous Waste 4111 Mission: The mission of the Solid Waste Code Compliance and Education Program ram is to enforce p g Washington State and Jefferson County solid and hazardous waste code, educate the community about ways to reduce solid and hazardous waste, and to promote the goals and objectives for solid waste reduction and recycling outlined in the Jefferson County Comprehensive Solid Waste Management Plan. Goals for FY 2009: 1. Investigate all solid and hazardous waste complaints. 2. Resolve solid and hazardous waste violations through voluntary compliance or citations and legal action when necessary. 3. Reduce the incidence of illegal dumping. 4. Assure all permitted facilities (past& present) meet current regulation standards. 5. Increase awareness of small quantity generator and household hazardous waste (HHW) disposal requirements and options through education and outreach efforts. 6. Promote re-use, recycling, and a reduction in consumption to decrease annual tonnage of solid waste and illegal dumping. 7. Continue to facilitate the removal, recycling, and proper disposal of junk vehicles, appliances, tire piles, and other specific waste items. Objectives: 1. Coordinate with other agencies to resolve more difficult solid waste violations. 2. Obtain more motion-activated cameras to monitor well-known illegal dump sites and • work with property owners to reduce site access. 3. Research feasibility of tip fee vouchers for low-income people. 4. Maintain staff technical expertise to enable professional monitoring of permitted solid waste facilities. 5. Educate consumers at point of purchase about proper disposal of HHW and non-toxic alternatives. 6. Work with Public Works to coordinate HHW collection days and educate participants about non-toxic alternatives. 7. Promote reduction of consumption and re-use, that recycling is not enough, in schools and community. 8. Organize "Amnesty Days" for particular waste items. • Performance Measures 2008 1 of 4 Year End Report 03/12/09 PERFORMANCE INDICATORS: 2007 2008 2008 2009 Actual Projected Actual Projected Total number of solid waste complaints received 184 150 114 120 III Total number of solid waste violations resolved 135 140 117 120 Number of illegal dumps complaints received 27 20 12 15 Number of illegal dumps complaints resolved 23 20 11 15 Tons/cubic yards of solid waste removed/recycled 50+tons ? >450 cu ? through compliance efforts(not including junk yards vehicles) Total number of solid waste violations awaiting 2 2 2 2 legal action/abatement Number of Jeff. Co..permitted facilities meeting 6 of 8 - 8 of 9 12 current regulation standards (out of 9) (1) Number of HHW collection/education events with - 1 0 4 Public Works Total number of active EnviroStars businesses 10 13 10 13 (Out of100 eligible in Jefferson County) Number of new EnviroStar businesses 2 3 1 3 Number of Junk Cars removed/recycled 701 500 279 250 Number of"Amnesty Day" events 0 1 1 1 Tons/yards of solid waste recycled/disposed of 300+ 2000 tires 2500 Category during"Amnesty Day". tons(2) tires undecided Plus 601 tons(2) Notes: • (1) At the end of 2008 JCPH broke out several facilities that had previously been lumped together. (Jefferson County Transfer Station, Recycling Center, and closed Municipal Landfill.) This will enable clarification for the purposes of monitoring and permitting. (2) JCPH worked with Washington Department of Ecology to remove and properly dispose of 904 tons of tires from 5 large sites, at no cost to Jefferson County. Initial numbers from 2007 were 300 tons. Final numbers for the project by the end of 2008 were 904 tons. JCPH then sponsored a one-day tire recycling event for county residents which collected an additional 2500 tires. SUMMARY OF KEY FUNDING/SERVICE ISSUES: The Solid Waste program will continue to assure that all solid waste facilities and issues under Jefferson County Public Health jurisdiction are in compliance with Washington state and Jefferson County codes. Continued staff education and enforcement funding is needed in order to meet the current workload. LINKS TO COUNTY STRATEGIC OBJECTIVES: • Addressing locally identified and defined local public health issues • Protecting and enhancing natural resources. • Operating within a business plan based on sustainable resources, measured performance, and outstanding customer service. . Performance Measures 2008 2 of 4 Year End Report 03/12/09 2008 STUDY/ANALYSIS RESULTS • The number of solid waste complaints reported and resolved, including illegal dumps, has fallen since its peak in 2007. We saw an initial spike in complaints reported and resolved after the 2005 code revision that allowed for the issuance of citations and other legal action. The cases closed in 2008 include a higher percent of difficult, long-term cases that date from, or pre-date,the 2005 code revisions. These required a greater amount of time and resources to resolve (eg: multiple citations, court hearings, and warrants of abatement.) It is anticipated that 2009 will see a continued drop in the overall number of cases, with a relatively high percentage of time-intensive cases. This should drop in time as the backlog of these cases is resolved. 2009 is also anticipated to see a shift towards more hazardous waste casework due to referrals from the Local Source Control (LSC)program begun in 2008. LSC is an Ecology funded program where JCPH proactively visits businesses that utilize or produce toxics and hazardous materials. Guidance and education is offered regarding the proper disposal of these materials. Sites found to be in gross violation of the law and/or apparently contaminated, are referred for site hazard assessment and clean-up. JCPH is also working through a backlog of Site Hazard Assessments (SHAs) inherited from Ecology in 2005 when responsibility for investigations was shifted to the counties. 2008 saw a decrease in illegal dump complaints. Several large, popular dump sites were closed and cleaned-up as property-owners restricted access with gates and ecology blocks. Citations were issued by JCPH where three pieces of identification could be found in dumped goods. It is unclear if word has gotten out and illegal dumping is decreasing, or if the sites have moved further out into the • woods and have not been discovered yet. Early 09 cases show a shift to more yard debris. This may be due to the implementation of a disposal fee at the transfer station for yard waste, and the misconception that dumping yard waste is not a crime. The number of junk vehicles removed/recycled decreased from its peak in 2007 when JCPH obtained a grant to remove them for free. There was no such grant in 2008, but scrap prices were high enough that hauling by local businesses was free. Prices dropped significantly at the end of 2008, leading to a decrease in people's willingness to part with JV's second to cost of removal/towing and no monetary incentive. Another reason for the decrease is that the largest JV sites have already been resolved, (eg: 2007 had one site with 300 vehicles)though there may be a few out there lurking that we are not aware of. JCPH still assists with junk Vehicles affidavits. JCPH is approaching its 1000th junk vehicle removed from Jefferson County since 2007! Tires: JCPH facilitated the removal of over 904 tons of tires from 5 large sites, at no cost to Jefferson County. Initial numbers from 2007 were 300 tons. Final numbers for the project by the end of 2008 were 904 tons. JCPH then sponsored a one-day tire recycling event for county residents which collected an additional 2500 tires. JCPH hopes to focus on a different solid waste component every year as grants/funding allows. Future possibilities include mattresses, white goods/appliances, trailers? 2008 saw a high degree of inter-agency cooperation between JC Sheriff's Office, Public Health, Animal Services, and Child Protective Services. This allowed for resolution of some very difficult cases, shortening of resolution time on other cases, and cost savings (eg: JCSO can refer some cases to JCPH for follow-up.) Performance Measures 2008 3 of 4 Year End Report 03/12/09 JCPH has also developed community allies whose help is incalculable. One ally approaches property owners who are recalcitrant and/or anti-government, befriends them, and buys their junk vehicles from them or tows them for free. Vehicles are towed to a neutral location where JCPH then does the • paperwork on them. On one site he was confronted with four men with shotguns. He ended up removing over 15 junk vehicles. Other allies are former"clients" who now talk their friends into cleaning up their properties, and/or referring them to JCPH for junk vehicle affidavits. • • Performance Measures 2008 4 of 4 Year End Report 03/12/09 Jefferson County Public Health —Performance Measures 2008 (Year End Report) HABITAT ENHANCEMENT & PROTECTION • MISSION: Protect and restore high quality habitat for fish and wildlife using available local, state and federal funding most effectively and efficiently. GOALS FOR FY 2008 1. Implement priorities for habitat acquisition and restoration based on recently completed studies. Actual: Took steps to restore habitat in the Lazy C area along the Dosewallips River in a flood hazard area. Began assessment for acquiring other high quality habitats along the Dosewallips River. 2. Obtain state and federal funds to leverage local funds for habitat preservation and enhancement. Actual: Received State Salmon Recovery Funding Board grant to acquire and restore properties along the Dosewallips and Duckabush Rivers. These actions are consistent with the Summer Chum Recovery Plan. 3. Monitor actions to assure that goals for each project are being met. Actual: We are on schedule with grant project deliverables. OBJECTIVES FOR FY 2008 1. Use Eastern Jefferson County refugia study and the WRIA 16 and WRIA 17 Limiting Factors Analysis as the basis for determining priorities for protection, enhancement and restoration of habitat in eastern Jefferson County. Actual: We are also using the Summer Chum Recovery Plan and Puget Sound Chinook Recovery Plan to guide our actions and consider future projects. 2. Obtain non-local revenue to leverage available local funding such as the Conservation Futures tax and Secure Rural Schools Title III funding to preserve and protect the most potential high quality habitat. Actual: Worked with the Jefferson Land Trust to obtain state Farmland Preservation funds to match conservation futures funds for Glendale, Brown and Finnriver Farms. Received a State Salmon Recovery Funding Board grant to protect and restore high quality habitat along the Duckabush and Dosewallips Rivers. PERFORMANCE INDICATORS: 2008 2005 2006 2007 2008 Actual Complete technical habitat assessments for 1 1 0 1 0 _ fish and wildlife Acres of restored or protected sensitive habitat 10 15 2 14 20* Percentage of program budget represented by 0 0 *3.48% 16.07% state and federal funds *20 acres of habitat protected in the Conservation Futures funded Tamanowas Rock conservation easement. • Performance Measures 2008 I of 2 Year End Report 03/12/09 • SUMMARY OF KEY FUNDING/SERVICE ISSUES: This program implements the following objectives • for the 2008 Budget: • Protecting and enhancing natural resources. • Operating within a business plan based on sustainable resources, measured performance, and outstanding customer service. SUMMARY OF ACCOMPLISHMENTS FOR 2008: 1.) Participated in watershed planning and implementation for WRIAs 16, 17, and 20 including: a. Progress towards development of instream flow rule for WRIA 17 b. Completion of detailed implementation plan for WRIA 16; publishing WRIA 16 newsletters. c. Completion of watershed management plan for WRIA 20 2.) Initiated a grant with DFW to explore formation of a coastal Marine Resources Committee for western Jefferson County in collaboration with Clallam County (through June 2009). 3.) Supported the creation of the North Pacific Coast Lead Entity for salmon recovery in WRIA 20 and efforts to create the Washington Coast Sustainable Salmon Partnership (pending). 4.) Collaborated with the Jefferson Land Trust to acquire state funding for the LandWorks Collaborative and its efforts to protect farmland. Attended meetings and provided input with funding from the grant. 5.) Continued staff support of the conservation futures program, its citizen advisory board and meetings, application and ranking process, outreach to the public, and implementation of projects. 6.) Collaborated with the Jefferson Land Trust to secure additional state funding to support the acquisition of a conservation easement for Glendale Farm. 7.) Provided comments to Community Development on the Pleasant Harbor Draft EIS. • • Performance Measures 2008 2 of 2 Year End Report 03/12/09 • Board of Health Netiv Business .agenda Item #`V., 2 • 200.9 .activities Update NLarch 19, 26009 • Board of 3-fealth Wow Business .Agenda Item #1/., 3 • LegisCative rL(pdate Marc( ig, 2009 ' r HOUSE BILL REPORT • ESHB 1703 As Passed House: March 9, 2009 Title: An act relating to child immunization exemptions. Brief Description: Concerning child immunization exemptions. Sponsors: House Committee on Health Care & Wellness (originally sponsored by Representatives Cody, Pedersen, Green, White, Wood, Bailey, Moeller, Morrell, Walsh, Nelson and Kenney). Brief History: Committee Activity: Health Care & Wellness: 2/3/09, 2/13/09 [DPS]. Floor Activity Passed House: 3/9/09, 77-19. Brief Summary of Engrossed Substitute Bill • • Requires a parent or guardian to provide specified information, including an explanation of the reason for the request, on certifications to exempt a child from school immunization requirements when the exemption is based on a philosophical or personal objection to immunization. HOUSE COMMITTEE ON HEALTH CARE & WELLNESS Majority Report: The substitute bill be substituted therefor and the substitute bill do pass. Signed by 8 members: Representatives Cody, Chair; Driscoll, Vice Chair; Green, Hinkle, Kelley, Moeller, Morrell and Pedersen. Minority Report: Do not pass. Signed by 3 members: Representatives Ericksen, Ranking Minority Member; Bailey and Herrera. Staff: Chris Cordes (786-7103) Background: This analysis was prepared by non-partisan legislative staff for the use of legislative members in their deliberations. This analysis is not a part of the legislation nor does it • constitute a statement of legislative intent. House Bill Report - 1 - ESHB 1703 "+ Before or on the first day of attendance, children at Washington's public or private schools (preschool through the 12th grade) or licensed daycare centers must provide proof of immunization against certain vaccine-preventable diseases as determined by the Washington • State Board of Health (BOH). However, a parent or guardian may exempt a child for one of several reasons: • a physician certifies that a particular vaccine is not advisable; • the parent or guardian certifies that his or her religious beliefs are contrary to the required immunization measures; or • the parent or guardian certifies that he or she has a philosophical or personal objection to the child's immunization. Under the BOH rules, the required immunization schedule includes immunization against 10 diseases, with another disease, pneumococcal, added beginning July 1, 2009. Nearly all states allow medical and religious exemptions from their school immunization requirements. According to a 2005 Centers for Disease Control and Prevention report, 20 states allow exemptions based on philosophical or personal objections. Summary of Engrossed Substitute Bill: Modifications are made to the certification that a parent or guardian must present to exempt a child from school immunization requirements when the exemption is based on a philosophical or personal objection to immunization. For this exemption, the parent or guardian must present the following certifications: • a certification requesting the exemption, stating the vaccines for which an exemption is requested, providing an explanation of the reason for the request, and • acknowledging that the child may be prohibited from attending school during an outbreak of a disease for which the child has not been immunized; and • a certification from a health care practitioner stating that the parent or guardian has received information about the benefits and risks of immunization. In addition to physicians, health care practitioners who may provide either a medical exemption or the certification that the parent received information about the risks and benefits of immunization include naturopaths, physician assistants, and advanced registered nurse practitioners. Appropriation: None. Fiscal Note: Not requested. Effective Date: The bill takes effect 90 days after adjournment of the session in which the bill is passed. Staff Summary of Public Testimony: (In support) In the last 10 years, the number of children claiming exemptions has risen from 2.7 percent to 6.3 percent. Often the exemption is an issue of convenience for the parent, when the exemption should be more thoughtful. This issue came about because of a • House Bill Report -2- ESHB 1703 resolution before the Washington State Medical Association. It is intended to make clear that • parents have a responsibility for making an informed decision. Most parents, when properly informed about the risks and benefits of immunization, will choose immunization. Recent research showed that states with easy exemptions had an increased use of them, but both medium and difficult exemption states were holding steady on exemptions. Suggested changes include: removing the requirement for notarizing the documents, which does not add any value, requiring some additional explanation from the parent, and clarifying the list of health care providers who can participate in requesting exemptions. (Opposed) None. Persons Testifying: Mary Selecky, Department of Health; Craig McLaughlin, State Board of Health; Rupin Thakkar, Washington Chapter of American Academy of Pediatrics; and Susie Tracy, Washington State Medical Association. Persons Signed In To Testify But Not Testifying: None. • House Bill Report -3 - ESHB 1703 • Board of aCealth Netiv Business .agenda Item #17., 4 Public gCealth Heroes Award Nominations • Nlarch 19, 2009 Jefferson County Public Health is Celebrating • National Public Health Week beginning April 6, 2009 Jefferson County, February 25, 2009 - Jefferson County Public Health (JCPH) is celebrating National Public Health Week. This year the National Public Health Week theme is "Building the Foundation for a Healthy America" and will be April 6th-12th. JCPH asks you to join us in nominating local Public Health Heroes by telling us their story. JCPH began honoring Public Health Heroes as a way to locally celebrate National Public Health Week. The annual public health awards honor people who live or work in Jefferson County and promote Public Health in their daily lives. Nominations are open to the public through Thursday, March 17th. Please submit a nomination for an individual, agency or group you feel is making a difference in the health of Jefferson County. What is Public Health?: Public Health helps communities to be healthy places to live, work and play. Public Health provides reliable information you can use to make healthy choices and protects our communities from hazards in the environment. Public health works to prevent health problems before they occur. The focus is on improving an entire community's health through achieving healthier lifestyles. What is a Public Health Hero? A Public Health Hero is a person or organization that promotes public health in their daily lives. Public Health Hero awards could represent the following categories but are open to others: • The Community Health Promotion award honors individuals or groups whose efforts increase the quality of life in the county. • The Public Health Leadership award honors those in our community who have provided leadership in creating policy solutions that assure, promote, and protect the community health. • The Business Merit award recognizes a companies for environmentally sound practices but many make healthy choices in what they sell, how they support employees, and how they promote community health. • The Community Based Organization award recognizes those who provide infrastructure and services that promote public health in a variety of ways. • The Special Recognition for the Public Health Hero honors individuals or organizations who help identify a problem and then help the community work towards its resolution, e.g. planting trees, building trails, promoting physical exercise or health diets, or fitting children's car seats. I know someone in my community who is a Public Health Hero. How do I nominate them? • Nomination forms may be picked up at the JCPH office, 615 Sheridan St., Port Townsend, or • Download form, or • Request that a form be mailed to you by calling (360) 385-9400 How do I return the completed nomination form? • Drop off or mail completed forms to: JCPH c/o Public Health Heroes, 615 Sheridan Street, Port Townsend, WA 98368, or • Email completed form to publichealthhero@jeffersoncountypublichealth.org,jeffersoncountypublichealth.org, or • Fax completed form to (360) 385-9401 • Can I nominate more than one person or group? You can nominate as many deserving people or groups as you like. The deadline for submitting nominations is Thursday, March 17th. Winners will be announced at the April 16th Jefferson County Board of Health meeting. 411 Learn more about National Public Health week and "Building the foundation for a health America" at www.nphw.org. ### Jefferson County Public Health is always working for a safer and healthier Jefferson County. ### • • Board of 3fealth Netiv Business .Agenda Item #17., 5 Substance .A6use .advisory Board Bylaws - • Request for Review and .Approval 314arch 19, 2009 1 JEFFERSON COUNTY PUBLIC HEALTH 615 Sheridan Street • Port Townsend •Washington • 98368 . www.jeffersoncountypublichealth.org March 12, 2098 To: Board of Health From: Fran Joswick, Chair, Substance Abuse Advisory Board (SAAB) Written by Julia Danskin, Staff to SAAB Re: March 10, 2009 SAAB action request to BOH Minutes of Substance Abuse Advisory Board not available as of March 12, 2009 1. SAAB request Jefferson County Board of Health approved revised Bylaws approved by SAAB 3/10/09. See attached new Bylaws 2. SAAB request Jefferson County Board of Health remove Nicole Black from SAAB for not fulfilling her obligations to the SAAB per Bylaws. • COMMUNITY HEALTH ENVIRONMENTAL HEALTH DEVELOPMENTAL DISABILITIESPUBLIC HEALTH WATER QUALITY MAIN: (360)385-9400 ALWAYS WORKING FOR A SAFER AND MAIN: (360)385-9444 FAX: (360) 385-9401 HEALTHIER COMMUNITY FAX: (360)379-4487 i JEFFERSON COUNTY SUBSTANCE ABUSE PROGRAMS • ADVISORY BOARD BYLAWS ARTICLE I: NAME The name of this organization is the Jefferson County Substance Abuse Advisory Board, hereafter referred to as "the Advisory Board." ARTICLE II: PURPOSE The purpose of the Advisory Board is to provide advice and support to the Jefferson County Board of Health, in order to meet its legal responsibility to protect public health within Jefferson County. In particular, it is to provide advice and support to the Board of Health in matters pertaining to substance abuse and chemical dependency. ARTICLE III: DUTIES . Will be to comply with all state and county laws pertinent to the Advisory Board in compliance with RCW 70.96A.300, it shall be the duty of the Advisory Board to: In conjunction with Jefferson's County Public Health conduct public hearings and other investigations to determine the needs and priorities of county citizens. Monitor the implementation of the Six Year Strategic Plan 2007 Advise the Board of Health and the Jefferson County Alcohol and Drug Program Coordinator on matters relating to programs and services provided, including prevention, intervention, treatment and aftercare; Nominate individuals to the Board of County Commissioners for the position of Jefferson County Alcohol and Drug Abuse Services Program Coordinator when a vacancy occurs. The nominees should have training and experience in the administration of alcoholism, other drug addiction services and shall meet the minimum qualifications established by rule of the state. The Program Coordinator cannot be employed by, or have a financial interest in Drug Treatment Programs. If, during the tenure of the appointment, the County Program Coordinator fails to meet the conditions of appointment, then he/she must resign immediately or provide current written approval from Department of Social and Health Services Secretary as required by RCW 70.96A.310. . • Jefferson County Substance Abuse Programs Advisory Board Bylaws Approved Substance Abuse Advisory Board March 10,2009 Page 1 Carry out such other duties as the Department of Social and Health Services may • prescribe by rule. ARTICLE IV: MEMBERSHIP Members of the Advisory Board shall be Jefferson County residents who are appointed by the Board of County Commissioners. Appointments of members shall be made from a list of applicants who submit a "Letter of Intent" to the Board of Health stating their qualifications for serving on the Board. Any vacancies shall be advertised, at least twice, in the local newspaper encouraging qualified county residents to apply. In accordance with State statute, the Advisory Board shall be composed of not fewer than seven or more than fifteen members, who shall be chosen for their demonstrated concern for alcoholism and other drug addiction problems. Members of the Advisory Board shall be representative of the community, including at least one-quarter recovering alcoholics or other recovering drug addicts and shall include minority group representation. No more than three elected or appointed city/county officials may serve on the Advisory Board, at the same time. Regular and alternate members shall serve a term of three years or until a successor has been appointed. Members shall not be compensated for the performance of their duties on the Advisory Board. They may be reimbursed for travel expenses. ARTICLE V: OFFICERS Officers of the Advisory Board shall consist of a Chair, Vice Chair and Secretary. The Chair, Vice Chair and Secretary shall be elected annually, at the first regular meeting of the new calendar year. The Chair of the Advisory Board shall: preside at all meetings and execute the agenda of such meetings in an orderly manner. When appropriate and necessary, establish committees and appoint members and officially represent the Advisory Board before other organizations/groups. The Vice Chair shall officiate as chair in the Chair's absence and be prepared to replace Chair should that position become vacant for any reason. In the absence of both Chair and Vice Chair at a meeting, the Secretary may perform the Chair's duties for that meeting. Jefferson County Substance Abuse Programs Advisory Board Bylaws Approved Substance Abuse Advisory Board March 10,2009 Page 2 The Vice Chair shall succeed as Chair when the term of Chair is vacated by completion of • term or resignation. When the Vice Chair becomes Chair, he/she may serve a maximum of three years in that position. The Board shall elect, by majority vote, a Vice Chair to fill the vacancy created in either event. The Secretary reviews for grammatical accuracy and submits meeting minutes to the Advisory Board for approval. Prepares correspondence to media, legislatures, etc. and submits to the Advisory Board for approval. The Chair, Vice Chair and Secretary shall be elected by a majority vote. Nominees must be active members who have consented to serve. All elections shall be by ballot unless dispensed with by a majority vote. ARTICLE VI: STAFF ROLES An administrative secretary shall be provided by the Alcohol and Drug Program Coordinator. That Administrative Secretary shall ensure that a record of the proceedings, of all Advisory Board meetings, is generated and retained. The Program Coordinator shall attend all Advisory Board meetings and prepare, with the chair, distributing agendas for meetings and other Advisory Board events. The Program Coordinator shall provide notice of meetings and other Advisory events, to members and the community. The Program Coordinator shall also develop plans, studies and reports, as NIF directed by the Advisory Board, providing technical information to members. ARTICLE VII: VACANCIES Resignations: A member may resign by submitting written notice to the Board of Health and the Advisory Board Chair. Members who no longer qualify shall resign immediately. Upon receipt of a resignation, the Advisory Board shall consider the resignation at the next regularly scheduled meeting. The Advisory Board shall then accept the resignation by formal action declaring the position vacant, unless the resignation is withdrawn any time prior to the Advisory Board's action. Leave of Absence: The Advisory Board may grant a leave of absence for a member, not to exceed three consecutive months, per term of membership. Removal: Advisory Board members are expected to attend all meetings and, if possible, to notify the Chair in advance if unable to attend. A member may be removed from the Advisory Board if absent from three consecutive meetings, without good cause. A member with two consecutive absences shall be notified of the policy, regarding removal from membership, and determine whether he/she wishes to continue as a member. A member may also be removed for not carrying out assignments or for failure to support Advisory • Jefferson County Substance Abuse Programs Advisory Board Bylaws Approved Substance Abuse Advisory Board March 10,2009 Page 3 Board Bylaws. The Advisory Board may; by majority vote of the total membership, recommend the removal of a member to the Board of Health, provided that thirty days notice of the pending action has been provided to the member. ARTICLE VIII: MEETINGS The Advisory Board shall hold regular meetings, a minimum of four times a year, and notify the public pursuant to the open meeting law. Notification of the public meetings shall appear in the countywide local newspaper, not less than seven days before the meeting. Regular public meetings shall always be held in Jefferson County. The Advisory Board may conduct special meetings and emergency meetings when deemed to be in the best interest of the Advisory Board and the community. Public notice shall be properly given for special meetings, and whenever a regular meeting must be re-scheduled or re-located. Minutes: Approved minutes of all meetings shall be promptly recorded with Jefferson County Public Health and a copy mailed or emailed to each Advisory Board member at least seven days prior to the next scheduled meeting. A file of permanent minutes of all Advisory Board meetings shall be maintained by the Program Coordinator. Voting: Shall be restricted to the regular Advisory Board members. Alternate members may vote, only when they are filling in for regular members. Voting shall be conducted by voice or show of hand. Quorum: A quorum shall be at least 50% of the members then serving. All actions of the Board shall be determined by a majority vote when a quorum is present. In the event that the membership of the board drops to nine members or less, approval of an action will require a unanimous vote of all serving members in order to have the decision reached be more representative of the community. Conflict of Interest: Once appointed, a member may not participate, in a discussion or vote, upon a matter in which he or she has a direct or indirect financial interest. A conflict would arise when: 1) the member; 2) any immediate family; or 3) an organization, which employs or is about to employ any of the above, has a financial or other interest in a firm or organization selected for award. If a conflict of interest arises, the member will notify the chair, abstaining from any discussion and vote. Rules of Order: All regular and committee meetings shall be conducted by the Chair or Vice Chair, in a manner designed to arrive at consensus on Advisory Board actions. The Advisory Board may operate in accordance with the newly Revised, Roberts' Rules of Order. Jefferson County Substance Abuse Programs Advisory Board Bylaws Approved Substance Abuse Advisory Board March 10,2009 Page 4 Agenda: The agenda shall indicate the order of Advisory Board business. A majority of • Advisory Board members may approve changes to the agenda. Board members may suggest changes to the agenda, if submitted in a timely fashion, to the Board secretary. Board members are encouraged to create/submit agenda items. Copies of the agenda and relevant supporting materials shall be mailed or emailed to Advisory Board members, at least seven days prior to the meeting. Time shall be scheduled on the regular meeting agenda for public comment. ARTICLE IX: AMENDMENT OF BYLAWS These Bylaws may be amended by a two thirds majority vote of total membership, insofar as such amendments do not conflict with State Code. Proposed amendments must be provided to members at least fourteen days prior to the meeting, at which the amendment is voted on, and must be included on that meeting's agenda. Approved by Jefferson County Board of Health Chair: Sheila Westerman Date le Jefferson County Substance Abuse Programs Advisory Board Bylaws Approved Substance Abuse Advisory Board March 10,2009 Page 5 0 Board of Health Media Report 1 3V1 arch 19, 20199 • Jefferson County Public Health February/March 2009 NEWS ARTICLES 1. "Conference focusing on toxic algae," Peninsula Daily News, February 17th, 2009. 2. "Norovirus outbreaks hit facilities," Port Townsend Leader, February 18th, 2009. 3. "Stomach flu reported in assisted living facilities," Peninsula Daily News, February 19th, 2009. 4. "More use syringes in 2008," Peninsula Daily News, February 23rd, 2009. 5. "School-based clinic opens at PT High School," Peninsula Daily News, February 25th, 2009. 6. "School clinic open house March 3," Port Townsend Leader, February 25th, 2009. 7. "Seeing smoking's effects," Peninsula Daily News, March 3`d, 2009. 8. "Nominations sought for public health heroes," Port Townsend Leader, March 4th 2009. 9. "State ruling limits banks," Port Townsend Leader, March 4th, 2009. 10. "New rule affects county banking," Peninsula Daily News, March 9th, 2009. 11. "Interest income missing mark," Port Townsend Leader, March 11th, 2009. 12. "PTHS teens teach tobacco dangers," Port Townsend Leader, March 11th, 2009. • • Conference . • . Research, said the entirenutrient- ,coast needs better' alert. ',loaded water is exposed to focusing on and response systems to 'Sinilight, the phytoplank- ., t , manage the growing threat ton bloom. ,. ., , I : ' of harmful algal blooms. ', The.tiny•plants are a Magnien said the source of food for zooplank- t ox I C algae Wooing,ban pose a risk to ton and other marine ma- human. health, disrupt 'tures, which are eaten by fisheries.and coastal econlarger animals in the food • omies:.and "don't respect .chaithr,,, , :, , .....-, •.,. Experts meet .., ., state borders." $10 million loss ;: .; • • • • • At a public session dur- Human influence.. .. . , . One bloom in 2002-08' ing the. meeting, leaders . '•, . tO d1SCUSS caused .:.razor clam and, presented their plans for a There is growing,evi Dungeneis -crab .closureS -regional monitoring net- derice that humans could bloom effects in Washington state that work that will employ new be influencing blooms •resulted in losses of More. technologies to ,identify through sewage and fertil- than $10 million. ' • and forecast . dangerous 'izer. releases, climate PENINSULA DAILY NEWS • A closure of the razor, algae bloomschange or by transporting NEWS SERVICES ::. 4 clam ifigherY in Clatsoe:, 1The plans include .algae..species':from one area to another. ss ' PORTLAND -- Scien- Coiii4tY, 0i,•e",' cosf; lopity ,installing ' • reinote-con- tists and fishery managers 66iiiilitaifes"4 ' if terf 'trolled sensors in the ocean ' 114,144 Despite. . a growing awareness: of the impacts • are planning a new West $4.8',Millien.' ,,.i. ' •.! . ,to test for toXins coast7iide Coast monitoring network Toxic algae also have and deliver instant alerts of harmful algae, experts luilttlbt for detecting and forecast; been. blamed. for' 14 000 to managers on land. ow ie aouwhat , , 7 ing toxic algae blooms to sick or causes specific blooms to ::.dead seals, sea . The new testing meth- protect the public and try lions, sea otters, dolphins, ods could give managers occur and how to predict to reduce damage to the• birds 'arid gray whales earlier notice of harmful where they are headed. • environment., • Algae blooms are criti-' along the West Coast over blooms, more precise fore- -,., , , . ' ' v 1.-' casts of their specific loca- the years. :, • ,. c Long-term, the coast-wide network of test ing could help determine Other.algae blooms can tions and speedier deci- cal to the ocean food chain, , what is causing the and most are not harmful. choke out marine' life,.by, sion-making in closing Some of them produce depleting oxygen supplies, coastal fisheries, increase in harmful algae toxins that accumulate"in creating underwater"dead blooins, which scientists ,, said might.be tied to cli- • razor , clams and ,other, zones. . '. Upwelling off coast shellfish that oi,ion"peo.:' Last week, 80 leading , - . mate change, cyclical El pie who consume them. - scientists, managers and , Peter Strutton, an Nifio events,an increase in - The damage 'is also industry representatives • oceanographer with Ore- monitoring or transport of gon State University and algae through ship ballast financial. - • gathered for,the first time , The federal 'Environ= for a West Coast Harmful . organizer of the summit, water.• mental Protection Agency Algal Bloom Summit in said algae -- or phyto- • - estimates harmful algae Portland. .plankton -,-- blooms, are normal along the West blooms costs the U.S.econ- .. omy. $40 million every Alert system .• f ,.., Coast after spring and year. summer winds bring cold, • At risk is a West Cobert Magnien, direc- deep, nutrient-rich water aquaculture industry vaoast . tor of the National Oceanic to the surface of the ocean l- ued at$100 million. • -. and Atmespheric•Adminis- in a process called upwell- . 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"We see this every few tions to take in order to stop The reports of norovirus years in schools and care the spread and contraction — the technical term for a , facilities., of the virus include frequent stomach flu—are no more "People get sick. It just hand washing, careful numerous than usual, said happens." cleaning of foods, cleaning Lisa McKenIie, communi- Seaport Landing, an of all surfaces and complete cable disease program coor- assisted living facility in cleanup of any possible dinator for county health. Port Townsend, is one loca- infected stool or vomit. "We have had a few tion that has confirmed "The virus is very conta- assisted living locations call cases of the virus. gious,"McKenzie said. and ask for recommenda- Signs on the entrance to "It's not airborne. It's tions with dealing with the building ask individuals some people who are ill," to make visits.only if it is an spread by contact, but McKenzie said. emergency to help stop the because its winter. and "Because of the age of spread of the disease. more people are inside the individuals,the possibly Sunya Grantham, a together, it is easier to frail condition they are manager at the facility, spread.' in,and the proximity they didn't say how many people4111 have to one another,it could showed symptoms of the Jefferson County reporter Erik be considered an outbreak," virus but did say they were. Hidle can be reached at 360-385- she added. taking every precaution to 2335 or at erik.hidle@peninsula McKenzie said that the stop the spread. dailynews.com . • 1 :i.L'(°::'')). •F+ t18�/1 y� SalN •FJ = N O Obi 1 f-549.11841 •-�)in .0 ay �; a " � "43 caal � � +' 'b O ; y � 4) myF 05 �g 2 0o- , a) y f 3=2L.042 .5E . 0F,r..00 4 Ficla45 ii:.->f.s 14 c,.. 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W Nom W Ort .nU.G ax)co 2 c°, ~ m� tion .o oki��-5 co).0.2ao-.5 i A6 TUESDAY,MARCH 3,`LOOS orthwest • Seeing .penintS .:,.„?.,,,,,,,,5„.444,,.,:tv.f.w..4,,A...,,,,,,,at.s.,,,.,..i.., ,,,,,,,,,....„'„,.4.,,..v.,. .. , ,,,,,,,,,e,;71141"7.1.1„.„,4„„tmg , ,., ....„,,,,,.,, Students , . ... .,,,,,,.„„..4,,,,,,,,,,eozitza.,004 .ow,,,,,,,,,,„4.:,...:,:w„,,14%.41,t,41.1.., a , yam • teach, learn s v F,:i.,,J1 �'. z� .,.� , dangers � -* . � '-alma BY Ems.Hm s gr r b ;,13apy ';. PENINSULA DAILY NEWS ren is `. . �:. PORT TOWNSEND :s .�qv; Port Townsend High School ` 'r l k xP 4- students are learning to y E. a,' � ,w,;.,..`:-.-;,°5“A.,,>:, y s ;;, teach students at Mountain :. nr4. ! ;s z . < 5 View Elementary students . ; � .acx r about the danger of •ciga '`gra p11- . rette3. ss ,r�t �Y� .� �"Sa -�� Last week, a group of s C, about 30 high school stu � � 3 'M.; S 1" � 'x Y Y 4C�u'" k S'.;: e4W,..- G,` �3`7y-. dents gathered in a cp n ',� . f -'",''':',';',.''''''''',---4•71"44".4 ' -1a g�f . room fora full day of learn- b z �_� '` z nig how cigarette smoking , ' z 2, f affects the body and how to _ .-k-•y i. ,k pass that information.on to h "4 1 E& ,,., ..,,f,;..5' • younger kids. zzr <3 . A big key to the teaching `; ��A' 4 ?., is p"Phe i lungsshow ""c„" 5>,v, , � - - Pg what happens t0 your lungs � �. "��"�'°� ������i"���� �� ^� when they are healthy and k 1 when Youth, said Alyx � c� what h rath, a high"schoolle t , '_ senior who is organising; rganizing the fi . , lesson as her senior project. a • "One shows a healthy ft lung and the other has been ;" = -;` ' sed to smoking for 10 •• �� ,� r - qa t YV'' yearsl Yes,pig lungs are being r f°� l �" a Inflated in front of Students ',y .u�y �s-. »art sa tti. ,v to show them a picture o •f k '� a, smoking. :'r _. s 5-s k � . -: '"' ,cw And it seems to be work 0`;':'-g-,.'-.-= ing on the high school stu ' dents �. ,- "That's cancer,and there Y�� ,k is a tumor here as well :,., + -TF said Laura Firkins,a an' a� 5 C more, as she inflated the g s : k,":„ ; --, black, clearly injured lung �, 's , j� �_` , .t ' a T - ` . e sed to smoke. The lung only partially " `� ci m....� inflates because part of it has 'died from the smoke, EKIK HinI2JPEHu+suu DAILY NEws � 1 � Alyx Coppenrath,a senior at Port Townsend High School,hooks up a It's not a healthy lung," smoke-exposed pig lung to a manual breather that fills it with air. she said. Tobacco Use,or TATU. Obermeyer said the pro- presenters so they can use Fir Lessons scheduled "It's a project with the gran is both a learning les- these skills for this particu- The high school students American Lung Association,. son for the high schoolers lar project but also for later will take their lessons — and we're doing it here at and a great introduction to on in life. and pig lungs—to fourth PortTownsend High School," non smoking education for "It's a great thing for the graders on March 9. said F:aren Obermeyer of the younger students. resume, and a great thing The program, the lungs the health department. "TATU trains high for job skills. • and the training comes from We're doing it here schoolers in the risks and a Jefferson County Public because we think they are consequences of tobacco Reporter Erik Hidle can be Health Department pro- great role niudel, (or use,"she said. reached at 360-385-2335 or at erik. gram, Teens Against younger kids." "It also trains them to be hidle®peninsuladailynews.aom. 10 0 " ' ‘'''' ‘-'''''''4,.. -: i• - L,,;:k. E,-; ,,, ,,, , 4,,,,,.,,,#4147.... „..:.,,,,__ "' )i .) `� O ■® aF ._ m ,. I:E� y,; .p {C(p0i'C Lc k M ,, ;t.V.i,.',-1. "` X •.= CL i scv i.!iii1!iII ;, la, : A kl, , 4„,, g 4.4 r. 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PI2 qs yc.yygq4 ��A q • roa vc 5 to ig F -6r $ ai p ~c '�q� oCN0 3ci _, _, Q-,� U _ % 3b •roLq1g,,s., � � � sc � '�y�� cdoO� o ; Cc'_ „ � j r E� m ›, i' E2 ,,° ; Rc• . 5) rog �/ ,...tc' CSow ,-3; . t y $Aq ^ � qC0p. .p �• n . c . �ao� --g - ii-6,- C) 8• -,0.4 , H v aqaa'y c '" AE cE= _tig - ppvr. d3U 1. iti C ' cccc+ 5al" � .aa�ig + . -�� - ywx 5 n v. WCcp. 0.0 MO Mq CP to c. 0 _, ..,(::rIZ ✓ �nZ m aa D Jq �+ e m. a 3 xo q dTG ■ ■ -Vu C pgSc C c 3 pio X yo 3 ,. gcx A . .,., s :- 3..c J stiC ;..4 h) �® C4{-� .4_5- -. oO L , d� q v 1••• z a o= v , 0 ° �c3a � aq � ° qCc= 0nO :" . ,, ° 3 c CW Od�—tct y Wp .4 .). - tz ?...ja� S i C+3 E 3 a4-9,- .c! 5 yoq Ti « Oc . Ea a�v p5\ G '' w .5v . F33^ 7wG. . aJ � CC a. m z a. slim r. (11 • School clinicopen- house March 3 p • The Jefferson School-based later this year. Townsend and Chimacum school Health Center hosts an open The school-based health districts. house from 2:30 to 6 p.m. center services focus on health Local businesses and organi- Tuesday, March 3 at the north prevention. Medical and mental zations helped open the center, end of the Gael Stuart Building at health providers are trained to including the Boeing Bluebills, Port Townsend High School. understand and treat the health- Friends of Chimacum Schools, Students,parents and commu- care needs of teens. Peninsula Floors and Furnishings, nity members are welcome to Nurse practitioner Susan McCrorie's Carpet One, Dean learn more about the program, O'Brien and mental health thera- Burton, Kevin Nighswonger, which is one of 18 school-based pist Patricia Flowergrowing will Jim Reynolds, Group Health health centers in Washington and be on hand to talk to people. Cooperative, Henery Hardware, the first to open on the Olympic The center is a partnership Peninsula Paint .Co. and Port Peninsula. A second clinic will between Jefferson Public Health, Townsend High School's ASB open at Chimacum High School Jefferson Healthcare and Port and carpentry classes. / • • • , • tl n • o�nina o s sought . • health heroesor uI �c Jefferson County Public Health ture and services promoting pub- Port Townsend, 615 Sheridan seeks nominations for local"pub- lic health.Special Recognition for St., at 'www.jeffersoncountypub- lic health heroes" as a .way to those who help identify a prob- lichealth.org, or by calling 385- celebrate National Public Health lem and then help the community 9400. Completed forms can be Week,April 6-12. work toward its resolution, for dropped off or sent to JCPH The annual public health example, planting trees, building c/o Public Health Heroes, 6I5 awards honor those who live or trails, promoting physical exer- Sheridan St.,Port Townsend,WA work in Jefferson County and pro- cise or health diets,or fitting chil- 98368;emailed to publichealthhe- mote public health in their daily dren's car seats. ro@jeffersoncountypublichealth. lives. Nominations can be made Nominations are due by org,or faxed to 385-9401. for individuals and organizations. Tuesday, March 17; residents Winnerswill be announced The awards could represent can nominate more than one at the April 16 meeting of the the following categories but hero. Forms can be obtained Jefferson .County Board of are open to others: Community at the Public Health office in Health. Health Promotion for those whose efforts increase the quality of community life. Public Health Leadership for those who pro- vide leadership in creating policy solutions that assure, promote and protect community health. • Business Merit award for compa- nies using environmentally sound practices or making healthy choices in what they sell, how. they support employees,and how they promote community health. Community Based Organization for those that provide infrastruc- . • • ?raj ieied_c, %/679 . . State • ruling limits sured public deposits," McIntire interest and other revenue loss- this week to talk to state officials wrote es,"said Morris.First,the state 'in hope of convincing them to Banks And that's what has treasurers Department of Natural Resources phase in that 100 percent rule. h �s such as Morris worried. announced last month it expects As it is now,the new rule will they are to earn $175,000 less this year impact how much money banks "My options are: If y YContinued from page 1 100 percent,I just continue busi- because there's no market for have to lend to communities, Treasurer No.2009-1 on Feb.18 in an effort ness as usual. If they opt for a timber in a housing slump.Now, Broughton agreed. to ensure that public monies are portion of funds and I can fit into the banks also will return less to For example,if a bank had SI fears impact safe as the result of a single that portion,that's a viable option. the county on investments. million from county or city funds, bank in Clark County failing In If they say,'No,we're not going to "If DNR isn't going to cut Rim- in the past it had to collateralize January. go with 100 percent as of July 1; bet], it's snowballing," Morris only 10 percent, or $100,000. It By Allison Arthur of The Leader After the Bank of Clark County \,I can pull my money out or put it said of possible revenue losses ,could loan out the other$900,000 failed, the state Department of in,a non-interest-bearing account this year-losses that later could to Brotcommunity. n noted that the 90 Jefferson County Treasurer Judi Financial Institutions closed the And.I haven't made that decision translate into budget cuts. Morris recently has been kept awake bank and appointed the Federal yet because I don't want to dev- "Some counties are going percent is covered by the Public at night worrying about a new state astate a bank," to be devas- Deposit Protection Act of 1969, g yi g Deposit Insurance Corp. (FDIC) tated," Morris and members of the pool are rule that puts huge constraints on as its receiver. The FDIC sold Morris said of "I have to weigh community banks that hold public predicted. assessed an amount in proportion the battle's accounts and assets, , what could hap- Morris said to the amount of public funds they money. and the bank resumed business , pen if she sud- the interest I she is disap- hold if a bank fails. And, she says,she's not the only under new ownership, McIntire denly withdrew county treasurer who's worried. explained in his letter to county .all of JeffersonCan earn for pointed that When the bank in Clark County The new rule,set to go into effect treasurers Feb.19. County's the commis- failed,leaving$15 million not cov- July 1,requires banks that hold pub- But under the terms of money .from the.county sion didn't ered by the FDIC to be picked up lic money to be able to collateralize the sale, the new bank wasn't a bank that consult with by other banks,Frontier was hit their uninsuredpublic deposits at 100 against the county treasur- with paying$383,000,its share of Ptrequired to honor the unin- couldn't, or era before it the$15 million. percent-up from the 10 percent they sired portion of public depos- didn't want to, state treasure has putent edict ma currently hold in funds. its - deposits greater than comply with relationship with cdput out the 100 The nee it,ew as he wan c In layman's terms:All banks that $250,000,And.since the.bank the new rules, the community cI under- money to le safe. hold public money will be required was required only to maintain 10. "I have to stand why Broughton agreed with orris by July 1 to prove they have enough percent collateral on its public weigh the inter- bank and What going to 100 that to guarantee the money is cash to cover whatever the public has deposits, there was$15 million est I can earn "_ percent•is a safe,the county would earn less invested in their banks-or bow out of in public money that needed to for the county • a doing business with public money. be paid by all those banks in the againsttherela- it-will do to the prudent move, interest At the end of January, some 91 pool of banks doing business in tionship with » but I would If the banks have to buy trea- commercial.banks and 12 thrifts Washington that hold the$7 bil- the community community have liked to sury certificates to collateralize doing busin'e'ss in Washington held lion in public funds. bank and what discuss this the public funds,Broughton says $7.6 billion in public funds, accord- "Bank of.America's share of it will do to the going into banks would have to lower their Judi Morris below what they are ing to Public Deposition Protection the $15 million was just shy of community," Treasurer,Jefferson County said.phases,' she rates inssto thltreasurycrtificates. earn- Commission (PDPC) Administrator $4.1 million, and U.S. Bank was she said. Nancy Adams. right behind them,"PDPC admin- Morris said - ' , For the So instead of paying 2.5 percent As of last week,Jefferson County istrator Adams explained. one treasurer has learned no record, that $13 million Morris and 3.5 percent interest, the had $8.1 million in Frontier Bank, The commission decided to bank in her county can meet the handles isn't all county money banks might offer 0.50 percent or $3,750,000 in American Marine Bank, play.it safe and change the rules . new 100 percent rule. it's money the county holds and 0.60 percent on the money. $1,250,000 in Sterling Bank and $1 to keep public tax dollars safe. 1n short, if Morris and trea- invests for itself as well as for "It's a very conservative deci- million in First Federal. 'This important step is intend- surers across the state have to junior taxing districts, including sion on the part of the state Only First Federal has said it can ed to increase the commission's withdraw money from small com- fire,school,library and public util- treahardshipstreasurer that t does impose the meet that new rule.by July 1,Morris capacity for monitoring financial mutiny banks because the banks ity districts. said.The othewbs are still look- institutions to better protect pub- won't collateralize deposits at In the City of Port Townsend, earnings of public entities," ing at the new i'i ei.4 ome might stop lic deposits and reduce the likeli- 100 percent, there's a concern Finance Director Michael Broughton said. handling public money, and others hood for additional assessments 'that it could pose a hardship on Legarsky said yesterday he has Because so many things are ' might reduce the amount of money should more public depositaries the banks. Moreover, the banks already made arrangements happening right now,Broughton they accept to meet that new 100 fail,"McIntire wrote in a letter to likely will haveless money to loan to.move a $1 million CD that said Frontier wants to wait until percent rule.. county treasurers. to the communities if they have matures in August to another pool the dust settles to determine how Morris,who was elected president "You should be aware that all to guarantee that 100 percent of of money managed by the state to proceed in terms of holding of the Washington State,Association deposits in non-interest-bearing_ the public funds they have in the .that is safe. public money. of Counties last October,was headed accounts are fully covered by vaults are safe. to Olympia yesterday to talk to newly FDIC insurance.During this diffi- And there's yet another side BANK MANAGER TAKE elected state Treasurer James. L. cult financial time,some financial effect for the county: Earnings Joan Broughton, manager of . McIntire,who serves as chairman of institutions may be experiencing from those new'safe accounts the Port Townsend branch, of the PDPC. Gov. Christine Gregoire constraints in liquidity as they likely will be significantly lower Frontier Bank,said yesterday the and Lt.Gov.Brad Owen also sit on the work toward the 100 percent col- than in the past a lot lower. . issue seems to be a moving target, three-member commission. lateral requirement for all unin- "I'm looking at $500,000 in with treasurers going to Olympia The commission issued Resolution • See BANKS,Page 5' • J n 20 1o 3 -F ro y tcw tO ` Vi N QY� ^L/ ro12113 � y 04 o p dWYF..+ 4.'U w -4V v .m�1 >,t0 y ti). ::'>•:.5 g o 05 to,...,-,1,- .0y 1 'Ca ' a>' > � a a m F, Cu�.� N .b ~ . 4.4,4i m p A 0 c ° z.> yuuar, ro0 y .,..ac0.a) avrn`° g ° c a �' 0Ayp � t 00E m 5 14 vv ' dv � nwi..1-.6,' ''',.a.7). y- �� ti aW r` '�-i $ tlQroo:'-cly ' 0 o� x� NaE sa . � ym � a H u I.0 b � �_ a.dF 0 .o� D bti � y , o.� 0 � 'ti 0 $ roo ao \vy0g � x . r. a t. bga .� b $ Cy• cm■� °D�� " acY � m a^ ggy ^ 0n £c., _ " 0yro ooz ro-o- 6 -, a.. ix,_ >, mo25 / 46 ^J .>wcktua> mg.. 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QvbEl -5 aam) y =y.Tv.,;-, � 'Fy1 [ p ' rf• ' t 4cW , Ofn :'r .af it mra I�- ; � .n O'3 *1. / NQG : V b44. t -*.-.0r:”,F ', aI,t ktrN •L',':`` y, ", ¢iris:.+fir • .f "b r°�S! f�' "k.{f .► 1 W !, fih..-.7,14 ) C fi k ',,,,,PO Y{ r�d8. 3 ®' p 4' • PTHS •teens teach_ By Melanie Lockhart of The Leader , s� �r� - ( - t• Elevating their heart rates " with jumping jacks. Plug Yxtw f < / er' Lx ta > .�° J ./' ging their noses and breath- ,A ,yrs t'"-fl �' t [•,if k ing through tiny straws was a ` w i'"" lit t' "+ MARCH `. 3 "scary" experience for a num- g ' �" *s ' 4;.. --� ber of fourth-graders, but the + r r't,'b.l , .;;,'1, I lesson was well received. '- " % 1. , ' y.`, The demonstration was part . '3� s. of the Teens Against Tobaccoill t ! Use (TATU) program e, a 4. g put on ® ,. . j, . i-. L •tet , , by Port Townsend High School �� ® , +s,.-- f ,•I students at Mountain View h t. #� t rYJ1 .:,::,..:,"" Elementary on March 9. The f 'h a ,} s ' Za` straw exercise gave students a `c l : RW brief example of what it's like , ; 'hafj/°� , fit X to have shortness of breath s t wr hf'4 , 'a '\ ,V.-,;', " caused by emphysema. T `'�}� x k• \ iti a k n1. t� , . P ,14•. TATA art of a ,1, x e yx1(f- 't £_ • • w P partner ,r ti s, ship between the high school, d/ .� :a , ac n '"I► + ,"b... '�• v ;_ ' Jefferson County Public +.j' t€'�, } - , ; ` t° `4' 4 t ..P1 Raft • Health and the American Lung �"`aa: [ a ' t Association - is in its second t i - xSt i{ �3 A • i *^+•..._-.• WWig year, though PTHS health H4 { s £ i i s teacher Martina Haskins said " x•k°-sf +r4 , - � °-r (` last year was a learning period. ' ' a£k - .. •''''.1 x, r.` ,3 ftgt. G1AI W10 $` 'Thus is the first year we've s 1 s really pulled off the presenta- �t-.-'1,;.--.. .,-,4. • ti '' tions,"she said • }$e A . Nineteen teens from PTHS �' �sr �;' "� are part of the TATU program. x • " �,. t € ,, Each student filled out an appli- i"t , o- ,5 s,'� Scation to explain why they r, anted to participate and what "-" .onnectmns they have to smok- - .,, - ing that stakes them want to Samantha Richards(left),free Wheeler(holding a jar of tar)and Alyx Coppenrath are three of the Teens Against Tobacco Use who spoke to Mountain View teach younger kids about it. Elementary fourth-graders on March 9 about the dangers of tobacco.Nineteen Port Townsend High students are part of the TATU program as part of a partner- "I like teaching kids and I ship between the high school and Jefferson County Public Health.Photo by Melanie Lockhart want them to be able to make good choices," ninth-grader They showed off toilet Unrue. "I like knowing that tor from the American Lung - expressed the importance of Quinn Stanton said. "In many cleaner,mouse poison,nail pol- we're explaining the harmful Association of Washington,vis- staying healthy and smoke-free. cases it's a life-or-death situa- ish remover and other familiar costs of tobacco use,"she said. ited PTHS and asked if any "I want to make the right deci- twn. I've had relatives die from items as examples of ingredi- Despite their apparent disgust seniors needed a senior prof- sions and also make sure other tobacco-related diseases." ents found in cigarettes. Each at the idea of smoking, multiple ect. That's when Coppenrath teenagers know their choices All of the students went item was met with a chorus of students admitted knowing smok- hopped on board with TATU. before they get sucked into through a six-hour training pro- "ewww"from the kids. ers close to their own age. "Smoking runs through my the advertisement of how'cool' cess on Feb. 25. It was fun and That reaction wasn't nearly "It's amazing how many of family and it's something I don't smoking is,"she wrote. not too difficult, Stanton said. as big as when the present- them know teenage smokers," want to be a part of," she said. In addition to the March 5 Ott Nlarch 9, TATU presented ers brought out a healthy lung Unrue said. "It's good to inform the kids when presentations, Coppenrath wi: to five classes - primarily in and along that has 10 years of On the other hand, when they're young so when they come help with a special March I i groups of three. smoking damage. They were Jason Lynch's class was asked to high school they are prepared presentation for '25 fifth-grad When fourth-graders in pig lungs, but as the teens how many students wanted to be for the pressures." ers.The students will break ini,., Mary Manning's class were attached each lung to an air part of the TATU program in high In her senior project paper, smaller groups to learn mor, asked what they already knew pump to demonstrate breath- school, "everyone in the class Coppenrath - a I'TIIS athlete about tobacco from T:\TL. about tobacco,most associated ing,the kids clearly had a pref- raised their hands,"Unrue said. it with lung cancer, breathing erence over which one they problems and death. But the wanted in their own bodies. SENIOR PROJECT teens provided plenty of new The reactions on the kids' For senior Alyx Coppenrath, information,is well. faces during the presentation; the program holds extra mean- is what makes it all worthwhile. ing. Todd Dent, the Olympic said ninthgrider Chriav Penin>ul,i l':\Tt coordina- s P7"