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HomeMy WebLinkAbout2011- February File Copy • Jefferson County Board-of a feaCth Agenda & iv1 mutes • February 17, 2011 • • JEFFERSON COUNTY BOARD OF HEALTH February 17, 2011 Jefferson County Public Health 615 Sheridan Street Port Townsend, WA 2:30—4:30 PM DRAFT AGENDA I. Approval of Agenda II. Approval of Minutes of January 20, 2011 Board of Health Meeting III. Public Comments IV. Old Business and Informational Items 1. Letter to the Editor: American Journal of Public Health 2. Issue Brief: Responding to Vaccine-Hesitant Parents 3. Letters to Legislative Delegation: Medication Take Back and Vaccine • Exemption V. New Business 1. Community Health Services in South County 2. Board of Health Guidelines for Adoption of Policies, Procedures, and Protocols 3. JCPH Strategic Planning and Quality Improvement: Past, Present, and Future 4. WA State 2010-11 Supplemental Budget Update 5. Legislative Update 5. Influenza Update VI. Activity Update: Data Steering Committee, February 24, 2011: Health Care Access VII. Agenda Planning Calendar: VIII. Next Scheduled Meeting: March 17, 2011 2:30—4:30 pm Jefferson County Public Health • JEFFERSON COUNTY BOARD OF HEALTH OR • MINUTES 4pk Thursday, January 20, 2011 - 2:30 PM—4:30 PM Public Health Conference Room, 615 Sheridan Street, Port Townsend Board Members Staff Members Phil Johnson, Vice Chair, County Commissioner District#1 Thomas Locke,MD,MPH 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 Roberta Frissell, Citizen at large(County) Stuart Whitford,Environmental Health Services Director Kristen Nelson,Chair, Port Townsend City Council Sheila Westerman, Citizen at large(City) Chuck Russell,Hospital Commissioner,District#2 Chair Chuck Russell called the meeting of the Jefferson County Board of Health to order at 2:31 PM. A quorum was present. Members Present: Phil Johnson, David Sullivan, John Austin, Roberta Frissell, Kristen Nelson, Sheila Westerman, Chuck Russell Staff Present: Dr. Thomas Locke, Jean Baldwin, Julia Danskin, Veronica Shaw • Substance Abuse Advisory Board: Frances Joswick Guests: Phillip Morley, County Administrator APPROVAL OF AGENDA Jean Baldwin asked to move Environmental Health Policy Revisions to the last item of New Business. Member Frissell moved to approve the agenda as amended; Member Sullivan seconded. The motion was approved unanimously, as amended. APPROVAL OF MINUTES A motion was made to approve the December 16, 2010 BOH meeting minutes, as written. The motion was seconded and approved unanimously. PUBLIC COMMENTS Mr. Thomas Brotherton, Quilcene, made suggestions for changes to the Quilcene Clinic. Mr. Brotherton suggested the closure of the Quilcene Clinic due to the limited number of clients served. He recommended that patients who qualify for Public Health services be provided with a voucher to use another medical clinic. • Page 1 of 7 BOH Minutes January 20,2011 OLD BUSINESS and INFORMATIONAL ITEMS s February 2011 Standards for Public Health Practice Ms. Danskin informed the Board that JCPH will be completing submission of documents for the upcoming Public Health Standards review on February 15, 2011. Among the items to be reviewed will be BOH Minutes, community health assessment work, and strategic planning work. The State will be on site to review the Public Health standards on April 28, 2011. The State will send a report of their findings in August or September. Presentations to City of Port Townsend Ms. Baldwin discussed the option of continuing presentations to the City of Port Townsend with possible topics as, local source control and identification of pollutants, recycling of chemicals, and shellfish protection. Interest was expressed to continue educating the City of Port Townsend about Health Department programs; however the question was raised whether funds are available in the budget to continue the education. Ms. Baldwin responded that after discussion with the City of Port Townsend, funds are available and the City is in the process of negotiating a Regional contract. It was decided that Ms. Baldwin would contact the City regarding scheduling further • presentations. MMR Vaccine Study Fraud Update Dr. Locke reviewed the latest news on the 1998 studies that alleged a link between the MMR vaccine and autism. The British Medical Journal,the original publisher of these studies, now characterizes them as an "elaborate fraud". There have been several large studies since that time looking at vaccinated and unvaccinated children that show no differences in autism rates. Dr. Locke pointed out that MMR and the preservative thimerosol (used in some vaccines) have been conclusively shown not to cause Autism. Dr. Locke commented that this news item and the legislation dealing with vaccine exemption that is before the State Legislature presents an opportunity to educate the public about two key vaccine issues 1)declining vaccine exemption rates for school aged children and 2) the need for increased use of the pertussis vaccine in adolescents and adults. Washington State is seeing more pertussis (Whooping Cough) outbreaks with 2 deaths in children occurring this past year. The key to protecting young children from pertussis exposure is greater levels of vaccination in adolescents and adults, who tend to be the carriers of the disease. • Page 2 of 7 BOH Minutes January 20 2011 A member suggested that more efforts be made locally to publicize that the Wakefield study was • proven to be fraud. Jefferson County BOH 2009-2010 Summary of Board Activities Ms. Baldwin briefly reviewed the Summary of the 2009 and 2010 action items for the BOH included in the packet for review. This report is an overview of the actions taken by the Board. This summary will be placed on the Jefferson County Website along with previous years. SBOH Notifiable Conditions Rule Takes Effect February 4,2011 Dr. Locke reported that a comprehensive revision of Washington State's Notifiable Conditions rule has been enacted and takes effect soon. One of the most contentious issues in the new rule is the reporting of animal bites. In the past all animal bites had been reported to local health departments, leading to many unnecessary reports. Reporting requirements have been amended so that only animal bites that are being treated for rabies are being reported. NEW BUSINESS Election of New BOH Officers for 2011 Member Russell called for nominations to elect new Board of Health Officers. Member Russell . nominated Kristen Nelson to serve as Chair. With no other nominations made, Member Russell moved to elect Kristen Nelson as Chair. Member Austin seconded the motion. The vote passed unanimously. Member Austin nominated Member Johnson as Vice Chair. With no other nominations made, Member Austin moved to elect Member Johnson as Vice Chair. Member Frissell seconded the motion. The vote passed unanimously. Member Russell announced he will be leaving the Board and his position will be filled by Jill Buhler, a fellow hospital commissioner and former Board of Health member.. Adoption of Policies and BOH Role Dr. Locke reviewed a draft of the updated Guidelines for Adoption of Policies, Procedures and Protocols which was included in the packet. A similar policy was adopted in 1988, but does not adequately address the broad range of policy, protocol, and guideline documents the JCPH is required to produce. The Board is required to adopt policies that have to do with their statutory powers and duties, including the enforcement of state and local public health codes. Administrative policies, clinical protocols and guideline documents may be of interest to the Board but generally do not require formal Board adoption. The draft policy attempts to categorize the different types of policies and standardizes their review and adoption process. S Page 3 of 7 BOH Minutes January 20,2011 - r Member's requested a copy of the 1988 Policy and example policies to review. Public Records Requests 2010 Volume and Time Veronica Shaw reviewed the 2010 public records request tracking sheet that was provided in the packet. She reported that in 2010 there was a total of 366 hours spent on fulfilling public record requests at a cost of about$11,000 in staff time. She stated that simple document requests provided by Environmental Health are not accounted for in this total. The tracking sheet also provides the number of documents gathered compared to the number of documents copied by request. Research time was not tracked previously,but will be tracked starting in 2011. Member Westerman raised the question,whether it would be beneficial to also track whether anything resulted from the information that was provided. A brief discussion followed. 2011 WSALPHO Legislative Agenda Dr. Locke reminded the Board that WSALPHO is the Washington State Association of Local Public Health Officials, a division of the Washington State Association of Counties. Dr. Lutz of the Spokane Regional Board of Health sent an e-mail to Boards of Health around the state requesting that they review the WSALPHO 2011 Legislative Agenda. Dr. Lutz noted that there is an on-going effort to facilitate communication between Boards of Health across the State. Dr. Locke responded that he sees this as a positive step toward improvement in communication between local Boards of Health. • Dr. Locke reviewed the 2011 WSALPHO Legislative Agenda with the main focus on public health funding. The top priority is to retain non categorical funding. The specific non- categorical funding source being looked at is the Back Fill Funding, which was used to make up the city's share of public health funding that was lost when the Motor Vehicle Excise Tax was repealed in 1999. Continuation of this funding is in the Governor's budget,but is reduced by approximately 14%. Ms. Baldwin mentioned the HB5930 and Blue Ribbon funding, which pays for communicable disease services, has seen a cut of 22% in the past 4 years and will now see a further 15% cut in the Governors budget.. Member Austin noted that he did not see support of legislation for reduction of teen tobacco use on the agenda. Ms. Baldwin responded that this is a newer item and the issue is still alive. Ms. Joswick reported that on January 17th, Jefferson County established two drug take-back sites; one at the Jefferson County Sherriff's Office and the other at the Port Townsend Police Station. It is the Substance Abuse Advisory Board's goal to increase from two sites to four. She informed the Board that there are two Bills; HB1370 and SB5234 that would require the pharmaceutical companies to pay for the installation and maintenance of drug take-back sites. Ms. Joswick requested that the BOH write a letter in support of these two Bills. • Page 4 of 7 BOH Minutes January 20,2011 Member Austin moved to direct the Health Department to draft a letter to be signed by the Chair on both issues. Member Johnson seconded the motion. The motion was approved unanimously. Member Frissell expressed interest in showing support on the issue of an on-going effort to facilitate communication between Boards of Health across the state. Dr. Locke suggested contacting Dr. Lutz and he offered to make that contact and inquire about efforts that are underway. Ms. Baldwin announced she received a survey from the National Board of Health for the Chair to complete. Ms. Baldwin offered herself and Dr. Locke to do a first draft of the survey for the Chair's review. Environmental Health Policy Revisions: Food Safety Program Mr. Whitford presented four Environmental Health policies to be brought before the Board for approval: Mobile Food Service Establishments, Waiver from a Temporary Food Establishment Permit, Food Establishment Inspection Frequency and Destruction of Hazardous Foods. Susan Porto, Environmental Health Specialist, presented a summary of each policy. She referred to the four policies, provided in the packet. The Mobile Food Service Establishment policy reiterates that the establishment must be readily moveable within a matter of hours, it must retain its wheels, and has defined menu items. The Waiver from a Temporary Food Establishment • Permit states that a temporary food permit expires at the end of the calendar year. The Food Establishment Inspection Frequency policy will allow for a reduced number of inspections on food establishments, when a risk assessment justified this reduced inspection frequency. The Destruction of Potentially Hazardous Foods policy establishes a process for the destruction of hazardous foods that are found during an inspection. She reiterated that all the policies are designed to promote consistency in the performance of staff duties. A brief question and answer period followed Ms. Porto's presentation. Member Austin made a motion for the Chair to approve all four documents. Member Westerman seconded the motion. The motion was approved unanimously. ACTIVITY UPDATE Region 2 Public Health Emergency Preparedness and Response Statewide Exercise: January 25-27,2011 Ms. Danskin reported that there will be an emergency preparedness exercise taking place January 25-27, 2011 at Jefferson County Public Health, which will trigger the communicable disease team to go in to an investigation. Also participating in the drill is Jefferson Health Care, their lab and Jefferson County Department of Emergency Management (DEM), Kitsap County Health District and Clallam County Health Department and both counties DEMs. • Page 5 of 7 BOH Minutes January 20,2011 AGENDA PLANNING CALENDAR i Board of Health Meeting Calendar for 2011 The Next scheduled BOH meeting will be held Thursday, February 17, 2011 from 2:30-4:30 PM at the Department of Public Health, 615 Sheridan Street, Port Townsend, WA. Ms. Baldwin stated that she will include 3 examples of the Policies, Administrative Codes and Procedures, along with a copy of the 1988 Policy in February's packet. It was requested that there be further information at next month's meeting on the Quilcene Clinic. Ms. Baldwin said she would bring the statistics on the Quilcene Clinic. Member Westerman moved to have a letter written in support of the legislation addressing the vaccine exemption problem. The motion was seconded and passed unanimously. Dr. Locke stated he will be meeting with our legislative delegation on January 24th and he will notify them that the Board voted in favor of supporting the vaccine exemption and The Drug Take Back programs and will follow up with written letters. Ms. Baldwin agreed to follow up on the press releases regarding the Wakefield MMR Vaccine fraud. Ms. Baldwin announced that February 24, 2011 is a Data Steering Committee meeting. More • information from the Data Steering Committee can be found on the Jefferson County Website, www.jeffersoncountypublichealth.org ADJOURNMENT Chair Nelson adjourned the BOH meeting at 4:17 PM. S Page 6 of 7 BOH Minutes January 20,2011 JEFFERSON COUNTY BOARD OF HEALTH Chuck Russell Phil Johnson, Vice-Chair Kristen Nelson, Chair, John Austin, Member Roberta Frissell, Member David Sullivan, Member Sheila Westerman, Member S Page 7 of 7 BOH Minutes January 20,2011 r • JEFFERSON COUNTY BOARD OF HEALTH MINUTES Thursday, January 20, 2011 - 2:30 PM—4:30 PM Public Health Conference Room, 615 Sheridan Street, Port Townsend Board Members Staff Members Phil Johnson, Vice Chair, County Commissioner District#1 Thomas Locke,MD,MPH 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 Roberta Frissell, Citizen at large(County) Stuart Whitford,Environmental Health Services Director Kristen Nelson, Chair,Port Townsend City Council Sheila Westerman, Citizen at large(City) Chuck Russell, Hospital Commissioner,District#2 Chair Chuck Russell called the meeting of the Jefferson County Board of Health to order at 2:31 PM. A quorum was present. Members Present: Phil Johnson, David Sullivan, John Austin, Roberta Frissell, Kristen Nelson, Sheila Westerman, Chuck Russell Staff Present: Dr. Thomas Locke, Jean Baldwin, Julia Danskin, Veronica Shaw • Substance Abuse Advisory Board: Frances Joswick Guests: Phillip Morley, County Administrator APPROVAL OF AGENDA Jean Baldwin asked to move Environmental Health Policy Revisions to the last item of New Business. Member Frissell moved to approve the agenda as amended; Member Sullivan seconded. The motion was approved unanimously, as amended. APPROVAL OF MINUTES A motion was made to approve the December 16, 2010 BOH meeting minutes, as written. The motion was seconded and approved unanimously. PUBLIC COMMENTS Mr. Thomas Brotherton, Quilcene, made suggestions for changes to the Quilcene Clinic. Mr. Brotherton suggested the closure of the Quilcene Clinic due to the limited number of clients served. He recommended that patients who qualify for Public Health services be provided with a voucher to use another medical clinic. • Page 1 of 7 BOH Minutes January 20,2011 OLD BUSINESS and INFORMATIONAL ITEMS • February 2011 Standards for Public Health Practice Ms. Danskin informed the Board that JCPH will be completing submission of documents for the upcoming Public Health Standards review on February 15, 2011. Among the items to be reviewed will be BOH Minutes, community health assessment work, and strategic planning work. The State will be on site to review the Public Health standards on April 28, 2011. The State will send a report of their findings in August or September. Presentations to City of Port Townsend Ms. Baldwin discussed the option of continuing presentations to the City of Port Townsend with possible topics as, local source control and identification of pollutants, recycling of chemicals, and shellfish protection. Interest was expressed to continue educating the City of Port Townsend about Health Department programs; however the question was raised whether funds are available in the budget to continue the education. Ms. Baldwin responded that after discussion with the City of Port Townsend, funds are available and the City is in the process of negotiating a Regional contract. It was decided that Ms. Baldwin would contact the City regarding scheduling further presentations. MMR Vaccine Study Fraud Update Dr. Locke reviewed the latest news on the 1998 studies that alleged a link between the MMR vaccine and autism. The British Medical Journal,the original publisher of these studies, now characterizes them as an "elaborate fraud". There have been several large studies since that time looking at vaccinated and unvaccinated children that show no differences in autism rates. Dr. Locke pointed out that MMR and the preservative thimerosol (used in some vaccines) have been conclusively shown not to cause Autism. Dr. Locke commented that this news item and the legislation dealing with vaccine exemption that is before the State Legislature presents an opportunity to educate the public about two key vaccine issues 1) declining vaccine exemption rates for school aged children and 2)the need for increased use of the pertussis vaccine in adolescents and adults. Washington State is seeing more pertussis (Whooping Cough) outbreaks with 2 deaths in children occurring this past year. The key to protecting young children from pertussis exposure is greater levels of vaccination in adolescents and adults, who tend to be the carriers of the disease. • Page 2 of 7 BOH Minutes January 20,2011 A member suggested that more efforts be made locally to publicize that the Wakefield study was • proven to be fraud. Jefferson County BOH 2009-2010 Summary of Board Activities Ms. Baldwin briefly reviewed the Summary of the 2009 and 2010 action items for the BOH included in the packet for review. This report is an overview of the actions taken by the Board. This summary will be placed on the Jefferson County Website along with previous years. SBOH Notifiable Conditions Rule Takes Effect February 4, 2011 Dr. Locke reported that a comprehensive revision of Washington State's Notifiable Conditions rule has been enacted and takes effect soon. One of the most contentious issues in the new rule is the reporting of animal bites. In the past all animal bites had been reported to local health departments, leading to many unnecessary reports. Reporting requirements have been amended so that only animal bites that are being treated for rabies are being reported. NEW BUSINESS Election of New BOH Officers for 2011 Member Russell called for nominations to elect new Board of Health Officers. Member Russell • nominated Kristen Nelson to serve as Chair. With no other nominations made, Member Russell moved to elect Kristen Nelson as Chair. Member Austin seconded the motion. The vote passed unanimously. Member Austin nominated Member Johnson as Vice Chair. With no other nominations made, Member Austin moved to elect Member Johnson as Vice Chair. Member Frissell seconded the motion. The vote passed unanimously. Member Russell announced he will be leaving the Board and his position will be filled by Jill Buhler, a fellow hospital commissioner and former Board of Health member.. Adoption of Policies and BOH Role Dr. Locke reviewed a draft of the updated Guidelines for Adoption of Policies, Procedures and Protocols which was included in the packet. A similar policy was adopted in 1988, but does not adequately address the broad range of policy,protocol, and guideline documents the JCPH is required to produce. The Board is required to adopt policies that have to do with their statutory powers and duties, including the enforcement of state and local public health codes. Administrative policies, clinical protocols and guideline documents may be of interest to the Board but generally do not require formal Board adoption. The draft policy attempts to categorize the different types of policies and standardizes their review and adoption process. • Page 3 of 7 BOH Minutes January 20,2011 Member's requested a copy of the 1988 Policy and example policies to review. Public Records Requests 2010 Volume and Time • Veronica Shaw reviewed the 2010 public records request tracking sheet that was provided in the packet. She reported that in 2010 there was a total of 366 hours spent on fulfilling public record requests at a cost of about $11,000 in staff time. She stated that simple document requests provided by Environmental Health are not accounted for in this total. The tracking sheet also provides the number of documents gathered compared to the number of documents copied by request. Research time was not tracked previously, but will be tracked starting in 2011. Member Westerman raised the question, whether it would be beneficial to also track whether anything resulted from the information that was provided. A brief discussion followed. 2011 WSALPHO Legislative Agenda Dr. Locke reminded the Board that WSALPHO is the Washington State Association of Local Public Health Officials, a division of the Washington State Association of Counties. Dr. Lutz of the Spokane Regional Board of Health sent an e-mail to Boards of Health around the state requesting that they review the WSALPHO 2011 Legislative Agenda. Dr. Lutz noted that there is an on-going effort to facilitate communication between Boards of Health across the State. Dr. Locke responded that he sees this as a positive step toward improvement in communication between local Boards of Health. • Dr. Locke reviewed the 2011 WSALPHO Legislative Agenda with the main focus on public health funding. The top priority is to retain non categorical funding. The specific non- categorical funding source being looked at is the Back Fill Funding, which was used to make up the city's share of public health funding that was lost when the Motor Vehicle Excise Tax was repealed in 1999. Continuation of this funding is in the Governor's budget, but is reduced by approximately 14%. Ms. Baldwin mentioned the HB5930 and Blue Ribbon funding, which pays for communicable disease services, has seen a cut of 22% in the past 4 years and will now see a further 15% cut in the Governors budget.. Member Austin noted that he did not see support of legislation for reduction of teen tobacco use on the agenda. Ms. Baldwin responded that this is a newer item and the issue is still alive. Ms. Joswick reported that on January 17th, Jefferson County established two drug take-back sites; one at the Jefferson County Sherriff's Office and the other at the Port Townsend Police Station. It is the Substance Abuse Advisory Board's goal to increase from two sites to four. She informed the Board that there are two Bills; HB 1370 and SB5234 that would require the pharmaceutical companies to pay for the installation and maintenance of drug take-back sites. Ms. Joswick requested that the BOH write a letter in support of these two Bills. • Page 4 of 7 BOH Minutes January 20,2011 Member Austin moved to direct the Health Department to draft a letter to be signed by the IDChair on both issues. Member Johnson seconded the motion. The motion was approved unanimously. Member Frissell expressed interest in showing support on the issue of an on-going effort to facilitate communication between Boards of Health across the state. Dr. Locke suggested contacting Dr. Lutz and he offered to make that contact and inquire about efforts that are underway. Ms. Baldwin announced she received a survey from the National Board of Health for the Chair to complete. Ms. Baldwin offered herself and Dr. Locke to do a first draft of the survey for the Chair's review. Environmental Health Policy Revisions: Food Safety Program Mr. Whitford presented four Environmental Health policies to be brought before the Board for approval: Mobile Food Service Establishments, Waiver from a Temporary Food Establishment Permit, Food Establishment Inspection Frequency and Destruction of Hazardous Foods. Susan Porto, Environmental Health Specialist, presented a summary of each policy. She referred to the four policies, provided in the packet. The Mobile Food Service Establishment policy reiterates that the establishment must be readily moveable within a matter of hours, it must retain its wheels, and has defined menu items. The Waiver from a Temporary Food Establishment • Permit states that a temporary food permit expires at the end of the calendar year. The Food Establishment Inspection Frequency policy will allow for a reduced number of inspections on food establishments, when a risk assessment justified this reduced inspection frequency. The Destruction of Potentially Hazardous Foods policy establishes a process for the destruction of hazardous foods that are found during an inspection. She reiterated that all the policies are designed to promote consistency in the performance of staff duties. A brief question and answer period followed Ms. Porto's presentation. Member Austin made a motion for the Chair to approve all four documents. Member Westerman seconded the motion. The motion was approved unanimously. ACTIVITY UPDATE Region 2 Public Health Emergency Preparedness and Response Statewide Exercise: January 25-27,2011 Ms. Danskin reported that there will be an emergency preparedness exercise taking place January 25-27, 2011 at Jefferson County Public Health, which will trigger the communicable disease team to go in to an investigation. Also participating in the drill is Jefferson Health Care, their lab and Jefferson County Department of Emergency Management (DEM), Kitsap County Health District and Clallam County Health Department and both counties DEMs. 4111 Page 5 of 7 BOH Minutes January 20,2011 AGENDA PLANNING CALENDAR . Board of Health Meeting Calendar for 2011 The Next scheduled BOH meeting will be held Thursday, February 17, 2011 from 2:30-4:30 PM at the Department of Public Health, 615 Sheridan Street, Port Townsend, WA. Ms. Baldwin stated that she will include 3 examples of the Policies, Administrative Codes and Procedures, along with a copy of the 1988 Policy in February's packet. It was requested that there be further information at next month's meeting on the Quilcene Clinic. Ms. Baldwin said she would bring the statistics on the Quilcene Clinic. Member Westerman moved to have a letter written in support of the legislation addressing the vaccine exemption problem. The motion was seconded and passed unanimously. Dr. Locke stated he will be meeting with our legislative delegation on January 24th and he will notify them that the Board voted in favor of supporting the vaccine exemption and The Drug Take Back programs and will follow up with written letters. Ms. Baldwin agreed to follow up on the press releases regarding the Wakefield MMR Vaccine fraud. Ms. Baldwin announced that February 24, 2011 is a Data Steering Committee meeting. More • information from the Data Steering Committee can be found on the Jefferson County Website, www.jeffersoncountypublichealth.org ADJOURNMENT Chair Nelson adjourned the BOH meeting at 4:17 PM. • Page 6 of 7 BOH Minutes January 20,2011 i JEFFE' :ON COUN BOARD OF HEALTH 1/ Chuc 'ussell Phil Johnson, Vice-Chair 71.1 1121y1 :11v1j4: Kristen Nelson, Chair, John, ustin, Member ---/2e-A424e,e6 b/2 - Roberta Frissell, Member David Sullivan, Member Sheila Westerman, Member • Page 7 of 7 BOH Minutes January 20 2011 • Board of 3feaCth Old-Business & Informational Items Agenda Item # I�V, 1. • Letter to the Editor: American . Tournal of Public Health February 17, 2011 • 0 • At' Editorial Manager(tm)for American Journal of Public Health Manuscript Draft Manuscript Number: Title:ADVERSE CHILDHOOD EVENTS(ACES)AS A PART OF THE MENTAL HEALTH DISCUSSION Article Type: Letter to the Editor Section/Category: Letter or Response Keywords:Adverse Childhood Events(ACEs); mental health; nurse family partnerships Corresponding Author: Dunia Faulx,BA Corresponding Author's Institution:Jefferson County Department of Public Health First Author: Dunia Faulx,BA • Order of Authors: Dunia Faulx,BA;Jean Baldwin,MSN,ARNP;Quen Zorrah, MSN;Denis Langlois, MSN, ARNP;Lisa McKenzie,BSN, MPH • • Manuscript Glick here to download Manuscript: Letter to AJPH_Final.doc • ADVERSE CHILDHOOD EVENTS(ACES)AS A PART OF THE MENTAL HEALTH DISCUSSION We would like to thank the AJPH for highlighting mental health as a chronic disease in the December 2010 issue' . We urge public health researchers and clinicians to extend the dialogue by reviewing the Adverse Childhood Events(ACEs) work that has been done by the CDC and Kaiser-Permanente'. In the December 17, 2010 Morbidity and Mortality Weekly Report3 an analysis of the ACE module implemented by five states in the Behavioral Risk Factor Surveillance System (BRFSS) stated that that "ACEs have been linked to a range of adverse health outcomes in adulthood, including substance abuse, depression,cardiovascular disease,diabetes,cancer,and premature mortality". Perry et al.'s AJPH editorial states4 that promoting mental health should be part of chronic disease prevention "... by addressing the emotional,social and psychological well-being of the populationi4, however neither the editorial nor the Keyes et al. articles mentioned ACEs contribution to mental illness and other chronic diseases. The cumulative and enduring impacts of ACEs are not emerging science but have been statistically validated and well documented in published research over the last decade'.This growing body of research supports what many public health practitioners have observed:the experience of ACEs contributes to a lifetime of risk. The use of the ACEs score as a health screening tool is a direct way to get scientific measurements into daily clinical practice. With public health funding increasingly limited, using a population based approach such as educating new parents on the lifelong impact of ACEs has the potential to be both clinically and economically effective. Preventing a lifetime of mental illness and • chronic disease starts in pregnancy with the clinician supporting the parent's innate motivation to create a better life for the child. Information about the risks of tobacco use is offered to all pregnant women;to fail to educate parents about the consequences of ACEs is an unacceptable over sight. Twenty five years of research on Nurse Family Partnership demonstrates6 an evidence based process to prevent the generational transfer of ACEs. The Journal has started the discussion of integrating mental health into overall public health practice; it is now the public health community's responsibility to continue to look at ACEs as a tool for prevention of not only mental illness but also of chronic disease. This letter is a call for action. Dunia Faulx, MPHc Jean Baldwin, MSN,ARNP Quen Zorrah, MSN Denis Langlois, MSN,ARNP Lisa McKenzie, BSN, MPH About the authors: At the time of the writing of the letter all authors were with Jefferson County Public Health, Port Townsend, Washington. Correspondence should be sent to Jean Baldwin, MSN,ARNP, Director,Jefferson County Public Health, . 615 Sheridan St. Port Townsend, Washington 98368(e-mail:jbaldwin@co.jefferson.wa.us) • References: 1. Am J Public Health. 2010; 100(12). 2. Felitti Vi,Anda RF, Nordenberg D,et al. Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults:The Adverse Childhood Experiences (ACE)Study. Am J Prey Med. May 1998; 14(4): 245-258. 3. Adverse Childhood experiences Reported by Adults—Five States, 2009. MMWR Morb Mortal Wkly Rep. 2010 Dec 17; 59(49): 1609—1613. 4. Perry GS, Presley-Cantrell LR, Dhingra S. Addressing Mental Health Promotion in Chronic Disease Prevention and Health Promotion. Am J Public Health.2010; 100(12):2337-2339. 5. Keyes CLM, Dhingra SS,Simoes EJ. Change in Level of Positive Mental Health as a Predictor of Future Risk of Mental Illness: Mental Health Promotion and Protection.Am J Public Health. 2010;100(12):2366- 2371 6. Olds DL, Henderson CR Jr,Tatelbaum R,Chamberlin R. Improving the Delivery of Prenatal Care and Outcomes of Pregnancy:A Randomized Trial of Nurse Home Visitation. Pediatrics. 1986;77:16-28. • • • Board of Health Old Business & Informationalltems .agenda Item # �V., 2 Issues Brief Responding to Taccine-3fesitant Parents February 17, 2011 • Communicable Disease Epidemiology Public Health and Immunization Section . 401 Fifth Avenue South,Suite 900 Seattle & King County Seattle,WA 98104-1818 206-296-4774 Fax 206-296-4803 TTY'Relay: 711 1 February, 2011 www.kingcounty.gov/health Issue Brief: MMR, Autism, and Wakefield—Responding to Vaccine-Hesitant Parents When Andrew Wakefield's 1998 article' purporting a link between autism and MMR vaccine was retracted from the Lancet in February 2010 for Wakefield's ethical violations and undeclared financial conflicts of interest, it represented a milestone for public health and medical communities, vaccine advocacy groups and concerned parents. Now, after an extensive investigation,the British Medical Journal has further determined that Wakefield's work was fraud24. Despite the Lancet's actions and the broadly publicized BMJ series, some vaccine-hesitant parents may still be concerned that MMR or other vaccines are linked to autism. • A 2009 survey of 1,552 parents published in Pediatrics, found that 25% of respondents agreed with the statement, "Some vaccines cause autism in healthy children"5. • Similarly, an online survey of 2,026 adults in the US in January, 2011 found that"nearly one in five respondents believe there is a link between vaccines and autism"6. More than half(53%) were unaware that the Wakefield paper had been retracted and that a published account declares the research to be fraudulent 6. Parents' decisions to delay or decline immunizations for their children have led to a decrease in vaccine coverage and an increased risk for disease outbreaks8. • In 2008, there were more cases of measles reported in the US than in any other year since • 1997, with >90% of cases occurring in unvaccinated individuals or in those whose vaccination status was unknown'. The current pertussis epidemic in California is the largest since 19559. Key points regarding the Wakefield "study" and BMJ's findings24: • None of Wakefield's claims regarding MMR and autism has been accurate. o Wakefield altered information from all the patient's medical records in his publication to support his argument that MMR vaccine caused autism. o The Wakefield study claimed that all 12 children were "normal" prior to being vaccinated with MMR, however five had shown developmental problems before receiving MMR vaccine and three never had autism. o The Wakefield study reported that patients experienced their first behavioral symptoms within days of MMR vaccination, but their medical records documented these as starting some months after vaccination. • No studies have been able to replicate the results reported by Wakefield and Wakefield himself was unable to reproduce his results in subsequent studies. • Wakefield's medical license was revoked last May after the British General Medical Council concluded that he committed 30 ethics violations and had displayed a 'callous disregard' for the suffering of his test subjects. • Wakefield failed to disclose serious financial conflicts of interest. He received nearly $674,000 from lawyers trying to build a case against vaccine manufacturers and he attempted to profit by patenting future tests for"vaccine-induced diseases" and his own "safe" vaccines that he predicted would generate millions of dollars. Most of his co-authors abandoned the study in 2004 when payments from the attorneys were revealed. Responding to parents' concerns regarding vaccines and autism10: • 1. Be patient and empathetic— Reassure parents that you understand their child's health is their top priority and it is also your top priority. 2. Convey your knowledge that the onset of(regressive) autism symptoms often coincides with the timing of vaccination but is not caused by vaccination. 3. Inform parents that all reputable studies have found no link between MMR and autism. Multiple studies have been conducted since 1998 in several countries using a variety of sound epidemiological methods and all come to the same conclusion—no association between MMR (or thimerosal, or other vaccines) and autism. 4. Remind parents that vaccine-preventable diseases, which may cause serious complications and even death, remain a threat. 5. Express your personal and professional opinion that vaccination is very safe. 6. Provide a strong recommendation to parents to vaccinate their child(ren). 7. Show your willingness to continue the dialogue at future appointments if the parent chooses not to vaccinate. Resources for Parents: • American Academy of Pediatrics: "What parents should know about MMR and autism," http://www.aap.orq/immunization/families/autismfacts.html and "Vaccine Studies: Examine the Evidence," http://www.aap.orq/immunization/ • Autism Science Foundation: www.autismsciencefoundation.orq • Children's Hospital of Philadelphia's Vaccine Education Center: "Vaccines and autism," http://www.chop.edu/service/vaccine-education-center/order-educational-materials/ • Immunization Action Coalition: "MMR and Autism," http://www.immunize.orq/concerns/mmr.asp . • National Network for Immunization Information: "Evaluating Information About Vaccines on the Internet,", July 12, 2010 www.immunizationinfo.org/issues/general/evaluating-information- about-vaccines-internet • US Centers for Disease Control & Prevention: "Understanding MMR Vaccine Safety,", http://www.cdc.gov/vaccines/spec-g rps/hcp/conv-materials.htm#uvss References 1. Wakefield AJ, Murch SH, Linnell AA, et al. Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children. Lancet, 1998; 351:637. Retracted on Feb. 6, 2010. 2. Deer, Brian. Secrets of the MMR Scare: how the case against the MMR vaccine was fixed. British Medical Journal 2011;342:c5347 3. Deer, Brian. Secrets of the MMR scare: how the vaccine crisis was meant to make money. British Medical Journal 2011;342:c5258 4. Deer, Brian. Secrets of the MMR scare: the Lancet's two days to bury bad news. British Medical Journal 2011;342:c7001 5. Freed GL, Clark SJ, Butchart AT, et al. Parental vaccine safety concerns in 2009. Pediatrics; 2010:125(4):654-9. 6.Harris Interactive. Vaccine-autism link: sound science or fraud? January 20, 2011. http://www.harrisinteractive.com/NewsRoom/PressReleases/tabid/446/mid/1506/articleld/674/ctl/ReadCusto m%20Default/Default.aspx 7. CDC. Diseases and the vaccines that prevent them: measles. 2009 http://www.cdc.govivaccines/spec- g rps/hcp/conv-materia ls.htm#d isvp 8. Feikin D, et al., "Individual and community risks of measles and pertussis associated with personal exemptions to immunization,"JAMA 2000;284:3145-50 9. California Department of Public Health: http://www.cdph.ca.gov/healthinfo/discond/pages/pertussis.aspx 10. CDC. Talking with parents about vaccines for infants. 2009 http://www.cdc.gov/vaccines/spec- grps/hcp/conv-materials.htm#disvp • 2 Board of lealth Odd Business & Informational Items Agenda Item // IT., 3 • Letters to LegisCative Delegation: _Medication make-Back and 'Vaccine Exemption February 17, 2011 JIHTF FRSON COUNTY BOARD OF H IH,ALTH 11111 January 28,2011 The Honorable Steve Tharinger 205 Modular Bldg.E PO Box 40600 Olympia,WA 98504-0600 Dear Representative Tharinger: On behalf of the Jefferson County Board of Health I am writing to express our support for SB 5234 and HB 1370, legislation that has been introduced to create a program to properly dispose of unwanted medicines from households in Washington State. We are concerned that there is no secure and environmentally sound method for disposing of the significant amount of prescription and over-the-counter medicines that go unused or expire. A secure and convenient drug take-back program would help reduce accidental poisonings,drug abuse,water pollution,and harm to our environment. Storing left-over and expired medicines in home medicine cabinets increases the risk of accidental poisonings and illicit use that can lead to drug addiction. Drug overdoses,most involving prescription opiates,now surpass car accidents as the leading cause of accidental death in our state. Accidental poisonings are up 395%from 1990-2006, with 85%of poisoning deaths involving medications. National statistics show teens are using prescription drugs to get high second only to marijuana,most obtain them from a friend or relative. Twelve percent of twelfth graders in our state abused prescription pain relievers;three out of five get them from their own home or someone else's home without permission. Commonly used methods for disposal of unwanted medicines—flushing down the toilet or disposal in the trash—are not acceptable due to their risks to people and the environment. Medicines that are flushed down the drain are not • effectively removed by septic systems or wastewater treatment plants. Instead,most are either directly discharged to surface waters or fall out in the biosolids that are often applied to land. Pharmaceuticals have been detected in many streams and groundwater and can harm aquatic organisms. Trash disposal is also problematic and makes it easier for controlled substances,like narcotics,to be recovered and used illegally. To help counter these serious problems,some police and sheriffs offices in Washington are offering drug take-back programs that collect unwanted medicines,including legally prescribed controlled substances like OxyContin. Unfortunately,this diverts funding needed by law enforcement and only serves a small percentage of the state population. We need financing for an ongoing,safe,convenient,and efficient program across the State. We support legislation requiring pharmaceutical manufacturers to provide and pay for a medicine take-back program for residents of every county. The same pharmaceutical companies that sell medicines in Washington already fund and operate medicine return programs in several other countries. Local governments and law enforcement agencies are facing lean budget times and do not have the resources to carry the burden of financing,collecting and properly disposing of unwanted medicines. We hope you will do all you can to ensure passage of SB 5234 and HB 1370 in order to require the manufacturers of medicines sold in Washington to create . • nd a convenient and safe return program for unwanted medicines from residential sources. Sincerely, f\(1 - elson,C iair Jefferson County Board of Health Board Members • Kristen Nelson,Chair,Port Townsend City Council Phil Johnson, Vice-Chair, County Commissioner District#1, David Sullivan,County Commissioner,District#2, John Austin,County Commissioner,District#3, Sheila Westerman,Citizen at large(City),Roberta Frissell,Citizen at large(County), Jill Buhler,Hospital Commissioner,District#2 615 Sheridan • Castle Hill Center• Port Townsend • WA• 98368 (360)385-9400 JIHTTFIRSON COUNTY BOARD OF HEALTH III January 28,2011 The Honorable Jim Hargrove 411 Legislative Bldg. PO Box 40424 Olympia,WA 98504-0424 Dear Senator Hargrove: On behalf of the Jefferson County Board of Health,I am writing to express our strong support for HB 1015 and SB 5005,legislation that addresses the growing problem of immunization exemptions in Washington State. Immunization mandates for school aged children are in effect in all 50 states. These mandates play a crucial role in preventing outbreaks of vaccine-preventable diseases in preschool and school settings. Washington state law allows parents to seek exemption to these requirements for medical,religious,or personal/philosophical reasons. Medical and religious exemptions to vaccination are very rare. Personal/philosophical exemptions have become alarmingly common. In Jefferson County exemption rates for students in the K-12 system are among the highest in the State. During the 2009-10 school year,the rate stood at 14.4%. Five years ago the rate was 9.4%. This problem is not unique to Jefferson County. Statewide,vaccine exemption rates have steadily risen from 4.2%in 2004-05 to 5.9%in 2009-10. Our concerns about these worsening immunization rates are twofold—un-immunized children are at increased risk of serious,preventable illnesses and the growing number of un-immunized children in our schools increases the risk of outbreaks of measles,mumps,pertussis and other vaccine preventable diseases. When such outbreaks occur,they quickly spread beyond the schools,threatening infants,elders,pregnant women,and the community at large. • Studies of this problem in Washington State indicates that a significant portion of immunization exemptions fall into a category that has been called "convenience exemptions",i.e.parents who find it easier to sign an exemption form than arrange for health care provider appointments necessary to assure their children are fully immunized. We are also concerned that the increasing number of Internet sites that offer fear-based misinformation about immunization (e.g.the fraudulent assertion of a now disgraced British researcher that Mumps-Measles-Rubella vaccination was linked to childhood autism). HB 1015/SB 5005 addresses this problem with the simple requirement that parents who wish to exempt their children from the State's immunization mandate obtain a certificate assuring they have been counseled by a licensed health care practitioner about the risks and benefits of vaccination. This requirement seeks to assure that parents carefully consider accurate,science-based information before they make an important health care decision on behalf of their children. Legislation alone will not solve this growing public health problem. Ultimately a solution will only come when parents sit down with a trusted health care advisor and make a well informed choice on behalf of their children. Health care providers in Washington State are •mmitted to fulfilling this important responsibility. Passage of HB 1015/SB 5005 will assure they have the •••ortunity to educate their patients about the substantial benefits and minimal risks of childhood immunization. Sincerely, 13 _ Kristen Nelson Chair,Jefferson County Board of Health Board Members Kristen Nelson,Chair,Port Townsend City Council, Phil Johnson, Vice-Chair, County Commissioner District#1,David Sullivan,County Commissioner,District#2, • John Austin,County Commissioner,District#3, Sheila Westerman,Citizen at large(City), Roberta Frissell,Citizen at large(County), Jill Buhler,Hospital Commissioner,District#2 615 Sheridan • Castle Hill Center• Port Townsend • WA •98368 (360)385-9400 • Board of ifeaCth NeiwBusiness .agenda Item # 17., 1 • Community Wealth Services in South County February 17, 2011 • • Report to BOH Jefferson County Public Health Community Health Services in South County February 2011 Community health services in South County are planned and delivered in response to these Public Health priorities: • Giving children a good start in life by strengthening support to families with children through prenatal and postpartum maternity services and the Women, Infant and Children(WIC)nutrition program. • Reducing the cost burden of health care in our community by decreasing unintended pregnancy rates through consistent access to family planning services. Data supporting priorities: •ACCEPTED CHILD ABUSE AND NEGLECT REFERRALS: The rate of accepted referrals in Quilcene/Brinnon decreased from 5.2 per 100 to 2.1 per 100 children from 2000-02 to 2006-08; rest of Jefferson County 5.1 per 100 to 4.5 per 100 children over same period'. • KINDERGARTEN CHILDREN WITH COMPLETE IMMUNIZATIONS: In the 2008-09 school year 63% of Quilcene/Brinnon kindergarten students had complete immunizations, 61%in the rest of Jefferson County2. • STUDENTS IN SPECIAL EDUCATION: Proportion of enrolled public school students in Special Education, ay 2010: Brinnon 16.1%, Chimacum 13.4%, Port Townsend 15.9% and Quilcene-12.8%3. • FIRST TRIMESTER PRENATAL CARE: Percent of pregnant women starting prenatal care in the 1st trimester in Quilcene/Brinnon statistically worse from 84%in 1992-94 to 60%in 2007-09; rest of Jefferson County statistically worse from 85%to 74%over the same period4. Jefferson County access to 1st trimester prenatal care lower among Medicaid-paid births 64% compared to non-Medicaid 86%5. • SMOKING DURING PREGNANCY: Percent of pregnant women smoking during pregnancy in Quilcene/Brinnon statistically unchanged but moving in the right direction from 31% in 1992-94 to 20%in 2007-09; rest of Jefferson County also moving in the right direction from 26%to 21% over the same period4. Jefferson County smoking during pregnancy in 2007-09 significantly higher among Medicaid-paid births 30% compared to non-Medicaid 8%5. • TEEN BIRTHS: Percent of all births to teens under age 20 in Quilcene/Brinnon significantly improved from 19% in 1992-94 to 9% in 2007-09 while rest of Jefferson County statistically unchanged from 11%to 9%over the same period4. Department of Social and Health Services,Risk and Protective Profile for Substance Abuse Prevention,July 2010. 2 Washington State Department of Health,Immunization Program 403 Washington State Office of the Superintendent of Public Instruction,Washington State Report Card 4 Washington State Department of Health,Center for Health Statistics,Birth Statistics Database,Accessed in:Community Health Assessment Tool 5 First Steps Database,Characteristics of Jefferson County Women Who Gave Birth,DSHS Research and Data Analysis, 10/13/2010 JCPH Services in South County Report to BOH:February 2011 Page 1 • LOW BIRTH WEIGHT: Percent of babies weighing less than 2500 grams at birth 3-5% since early 1990's in Quilcene/Brinnon; 3-4%in rest of Jefferson County over the same period'. In 2005-09, Jefferson County low birth weight 4%among Medicaid-paid births, 3%among non-Medicaid5. Specific goals in support of these priorities: • Monitor the rate and continue efforts to reduce the incidence of low birth weight infants. • Prevent and reduce prenatal exposure to substances. • Prevent injuries to infants and young children. • Prevent child neglect through education and support to parents. • Promote early learning and healthy development in infants and young children. • Educate parents about the impact of adverse childhood experiences. • Promote healthy nutrition choices for pregnant,post-partum,and breast-feeding women, and children under 5. • Assess childhood immunization rates for children served by Primary Care Clinics receiving State supplied vaccines. • Assure Family Planning Services are provided in community and accessible Target Populations for services: • South County low income families with children under age 5 • South County low income pregnant women • South County teens and low income women in need of family planning • Strategies to serve these targeted populations: Family Planning clinic: • located close to Quilcene High School so students can come in on pass and lunch break • offer Take Charge &Medicaid enrollment and clinical services for low income adults and for teens to access care with confidentiality • consistent weekly hours,drop in to improve access for teens and per community requests • contact and collaboration with school staff, counselor and nurse to improve access • outreach to community providers,churches and services such as the food bank and the school to increase awareness of Family Planning clinic • Scheduling Breast and Cervical cancer screenings and other family planning services WIC/Maternity Support Services clinic: • weekly hours, drop in to improve access for families with limited transportation • informal, open atmosphere with play area, clothing and book exchange to promote social connections and parenting support,to reduce isolation and parenting stress • collaboration with and referrals to other community services such as South County medical clinic,food bank,ECEAP preschool,mental health services, Dove House • developmental screening and referrals to Concerned Citizens, school district, and medical care • assistance with applications for Medicaid pregnancy coverage and children's medical • screening of pregnant women for health risks such as depression,tobacco use, substance use, • dental health and referrals to Jefferson Health Care for prenatal care, Safe Harbor, • JCPH Services in South County Report to BOH:February 2011 Page 2 Jefferson Mental Health, OlyCap dental clinic and other community providers 10 • education and screening of immunization adequacy of children under age 5 with referrals and facilitation to South County medical,Jefferson Health Care • education and referrals to pregnant and parenting families on infant/child safety issues such as Shaken Baby Syndrome prevention, SIDS prevention, second hand smoke exposure prevention, car seat safety • outreach to community providers and services such as the food bank and the school Discussion of goals and strategies: JCPH has offered targeted clinical services to low income families and women in need of family planning for many years. Strategies respond to community need and other provider/agency ability to adequately meet public health priorities. Example-JCPH has traditionally offered WIC and Maternity Support Services by appointment one day per month in both Quilcene and Brinnon. We had enthusiastic but inconsistent attendance of appointments. Mothers were interviewed about the barriers to making appointments and the responses were lack of transportation followed by lack of phone service. We instituted a one day a week drop-in clinic in Quilcene and our WIC enrollment increased by 40%. Families from Brinnon started preferring the Quilcene drop-in clinic so we stopped our monthly clinic in Brinnon. Example-JCPH used to be the sole provider of children's immunizations in South County. When Jefferson Health Care(JHC) started South County Medical Clinic we stopped direct administration and • supplied the clinic with vaccine. JCPH monitors vaccine rates of children in all of Jefferson County; South County Medical Clinic was immunizing few children: in 2005, 5 doses of children's vaccine were given. JHC decided to hire a part time LPN to focus on children's vaccine outreach and administration at South County Medical Clinic. Our role has been to supply vaccine, screen for immunization need, and refer families to South County Medical Clinic. This strategy of inter-agency collaboration has been highly successful with 390 doses delivered to children in 2010. JCPH clinic details Staffing: Wednesdays 10 AM to 2 PM, approximately 48 clinic days a year, 2 RNs or 1 RN and 1 Registered Dietitian Facility: provided rent free by Jefferson Health Care Utilities: paid for by Windermere Real Estate Clinic has no internet or janitorial services • JCPH Services in South County Report to BOH:February 2011 Page 3 .2010 Clinic Data WIC Clients: • 91 total clients 7,0 Infants under age 1, 25 Children age 1-5,40 0 91 WIC Services: • 453 total contacts (251 WIC visits were recorded for check pick-ups) ro o ` . 0 C N N a:.. ,.�.. ., • Uri J O Q Ol 0 202 Family Planning Services: • 50 total clients: 25 under age 20; 30 age 20 or older History of State supplied childhood vaccine in JHC South County clinic: • Good news! Increase in immunizations in JHC South county clinic with addition of LPN 1/2 day week in late 2008 400 300 a) 0 200 v 100 1111 - 0 000 00'\ e\ (Pc Oy0 L L „:,c) 00O(' 00LPN added to staff JCPH Services in South County Report to BOH: February 2011 Page 4 Board of aCealth Netiv Business .agenda Item t/T., 2 • Board of.1CeaCth çuIcfeCines TOT .adoption of Policies, Procedures, and Protocols February 17, 2011 • JEFFERSON COUNTY HEALTH DEPARTMENT 110 ENVIRONMENTAL HEALTH SERVICE POLICY STATEMENT NUMBER 2 - 88 Program - Administrative Subject - Procedure for adopting administrative policies . The purpose of the following is to clarify the process for initiating, drafting and approving policy statements necessary to implement the various Environmental Health functions not covered by State and local regulations , codes and ordinances . 1) Need for policy statements may be initiated by anyone functioning within the environmental health program area. Policy statements may be initiated for any perceived reason. The • subject of policy statements should concern areas not covered in State and local codes , procedures for implementing program goals , methods , division position statements or any other areas of concern where ambiguity or lack of definition exists . 2) The statement should be prepared in the following format: • a. Policy statement number (given when adopted) b. Program area c. Subject of policy statement d. Policy statement or procedure to be proposed . Statement should be brief and clearly worded. e . An optional reference section may be included to. outlin& any applicable code or regulation which may be involved in formulating the policy statement . f . Signature of adoption by Health officer and chair of the Board of Health and date. 3) The adoption process shall consist of the following : a. Initial draft shall be submitted to the Director of Environmental Health . b. Environmental Health Director will review draft statements and prepare for submission to Health Officer and Board of Health. c . Comments and recommendations shall be received and policy will be redrafted as required. d . Obtain adoptive signatures of Health Officer and chair of Board of Health. e . Implementation by staff. 4) Appeal Process . 411 a. Appeal to policy decisions must be made in writing to the Health Officer or Board of Health . Justification or cause shall be clearly explained by the appellant. b. Amending or repealing of policies shall proceed in the same manner or outlined for policy adoption. 5) All adopted policy statements shall be kept on file in the Environmental Health Division. Policy statements shall be open to public inspection. 6) All policy statements , once adopted, shall be binding and subsequently may not be altered by the division or Health Officer. 7) Policy statements shall be consistent with the spirit • and intent of State and County health codes and regulations . This policy shall remain in effect until amended or repealed by action of the Jefferson County Board of Health . illikater/Laid _ June 22, 1988 !II Heal Of ' icer Effective Date 4 June 15, 1988 Chairperson , Board of Health Date of Review • Policies •• `ssor: c JEFFERSON COUNTY LIQ HEALTH N'tHtii.` • Department: Division: Section of Procedure Manual: Jefferson County Public Health Community Health Clinic/Medical Records Title: Infection Control Policy (ICP) Subject: To reduce risks of occupational infectious disease transmission among JCPH employees Et clients Effective (date): Replaces (date): Renewal due (date): Page: 1 of: 7 01/09 10/07 01/11 01/10 (reviewed) Originated by: Approved by: Jean Baldwin Dr. Tom Locke Lisa McKenzie Infection Control Policy (ICP) Jefferson County Public Health Purpose: The Infection Control Program (ICP) has been designed and implemented to reduce the risk of occupational infectious disease transmission among Jefferson County Public Health (JCPH) employees and the clients they serve. ICP policies are designed to be in full compliance with federal Occupational Health and Safety Administration (OSHA) and Washington Industrial and Safety Health Act(WISHA)standards. Section 1: Blood borne Pathogens • Blood borne pathogens are all viral, bacterial, and microbial organisms that can be spread through contact with blood and other potentially infectious body fluids (seminal fluid, vaginal secretions, or blood- contaminated urine, saliva, or fecal material). Control Methods: The following methods have been scientifically proven to be effective in eliminating or substantially reducing the risk of blood borne communicable disease transmission. JCPH employees have a responsibility to protect themselves and their clients by carefully following these methods. 1) Universal Precautions: All blood and potentially infectious body fluids are to be regarded as potentially infectious. Appropriate barrier precautions will be routinely used to prevent skin and mucous membrane exposure to blood and body fluids in all patient contacts where the potential for exposure exists. 2) Hepatitis B Vaccination: All JCPH personnel whose jobs require contact with blood, seminal/vaginal fluids, or blood-tinged body fluids are strongly encouraged to undergo a 3 dose Hepatitis B vaccination series followed by a Hepatitis B surface antibody titer 1-2 months later to confirm immunity. Vaccinees who fail to demonstrate protective levels of Hepatitis B surface antibody are candidates for an additional three dose series of Hepatitis B vaccine up to a total of 6 doses. Antibody titers should be repeated after the second Hepatitis B vaccine series. Hepatitis B vaccination is offered free of charge to full-time and regular part-time JCPH employees who are at risk of exposure to Hepatitis B during the performance of their job duties. 3) Hepatitis B Immune Globulin (HBIG): All JCPH personnel who have not completed an initial series of Hepatitis B vaccine followed by a confirmatory Hepatitis B surface antibody titer and experience a percutaneous or mucous membrane exposure to known Hepatitis B surface antigen positive material are candidates for IM HBIG administration at a dose of 0.06 cc/kg up to a 5 cc total dose. Vaccination should follow this prophylactic use of HBIG. Individuals who fail to develop detectable antibody titers after a second vaccine series are regarded to be vaccine non-responders and should 1 also receive Hepatitis B Immune Globulin following an exposure but should not be given additional vaccine. See# 9. 4) HIV Post-exposure Prophylaxis (PEP): Occupational and animal research indicates that health workers exposed to high doses of Human Immunodeficiency Virus (HIV) benefit from a post-exposure treatment consisting of 2-3 antiretroviral drugs. This treatment should be initiated as soon after • exposure as possible and continued for 4 weeks. See#9. 5) Disposable Linen and Equipment: When feasible, all materials that come in direct contact with potentially infectious blood or body fluids will be made of disposable materials and handled in accordance the infectious waste disposal policy. 6) Reusable Equipment: All reusable instruments, devices, or other items contaminated with blood or body fluids will undergo sterilization and disinfection according to current CDC's Guidelines for Hospital Environmental Control: Disinfection and Sterilization of Hospital Equipment. 7) Baqqinq of Articles: All objects contaminated with potentially infectious materials shall be placed in an impervious bag. Disposal will be in accordance with policies outlined elsewhere in the Infection Control Policy. 8) Hand Washing: After removing gloves, the hands and any other exposed skin surfaces should be immediately and thoroughly washed after contact with body fluids. Additionally, hand washing should be performed following contact with enteric materials, after use of restroom facilities, before and after direct contact with patients, and prior to ingestion of food. 9) Follow-up Procedures After Possible Exposure of Blood borne Pathogens: In the event that an employee experiences a percutaneous exposure (needle stick or cut in the skin), mucous membrane exposure (splash to the eye, nasal mucosa, or mouth), or non-intact skin exposure to blood or bodily fluids the following steps will be taken: a) The individual who is the source of the blood exposure will be asked to voluntarily undergo testing for Hepatitis B, Hepatitis C, and HIV. The results of these tests will be made available, with the • source case's consent, to the exposed employee. b) JCPH employees should receive a prompt medical evaluation at the Jefferson Healthcare emergency room or by a licensed health care provider of the employee's choice. This evaluation should include determination of the type of exposure, Hepatitis B immune status of the employee, a full discussion of infectious disease transmission risks, appropriate baseline blood tests, and discussion of available post-exposure treatment options. c) If the source individual refuses to consent to voluntary testing, the exposure source should be regarded as positive for Hepatitis B and appropriate PEP recommended. Legal methods are available to compel source individuals to undergo involuntary testing for HIV infection. This type of testing is initiated by a petition to the county health officer for an involuntary testing order. Enforcement of such orders, when necessary, is through the Superior Court. d) JCPH employees who experience a substantial exposure to potentially infectious body fluids should be advised of the following recommended evaluation and treatment protocols: i) Hepatitis B: • Vaccinated employees who have ever had a confirmed test of Hepatitis B immunity need no post exposure treatment. • Previously vaccinated employees who have had a 3 dose primary Hepatitis B vaccine series and who are Hepatitis B surface antibody negative, should be administered HBIG and have their Hepatitis B vaccination series repeated. • Employees who have had two Hepatitis B vaccine series and who have negative antibody titers should receive 2 doses of HBIG one month apart after an at-risk exposure. • Vaccinated employees whose Hepatitis B immune status is unknown should be tested for Hepatitis B surface antibody before HBIG administration if diagnostic tests will be available within 72 hours. ii) Hepatitis C: Employees who are exposed to a Hepatitis C positive source case (or an untested individual at high risk for Hepatitis C infection) should have a baseline anti-HCV • and ALT (alanine amino transferase) test, repeated at 4-6 months post exposure. For 2 high risk exposures, HCV RNA testing may be done at 4-6 weeks to determine if infection has occurred. No post-exposure treatment is available for Hepatitis C exposure although treatment is available for the infection itself. iii) HIV: Employees experiencing exposures to HIV-infected body fluids (or fluids thought to • carry substantial risk of exposure to HIV) should undergo an HIV PEP evaluation. Specific recommendations concerning choice of HIV PEP treatment should be made following consultation with the National Clinicians' Post-Exposure Prophylaxis Hotline ("PEP line") by calling 1-888-448-4911. HIV antibody testing should be performed at baseline, 6 weeks, 3 months, and 6 months post-exposure. Employees who elect to take antiretroviral medication will need additional blood tests and evaluations to monitor for medication side effects. e) Employees are free to decline the post-exposure procedures outlined above and will experience no adverse job action as a result of their refusal. Employees who decline post-exposure evaluation or treatment should sign a form documenting this decision. 10) Training and Education of JCPH Employees: All new employees will receive specific infection control training appropriate to their job description. Those employees whose jobs involve potential exposure to body fluids to which universal precautions apply shall undergo an education program that covers precautionary measures, epidemiology, modes of transmission and prevention of HIV/HBV, and risks to the fetus from HIV/HBV infection. Additionally, employees shall receive training regarding the location and proper use of personal protective equipment, infectious waste disposal methods, and procedures to use in the event of exposure to body fluids. Successful completion of this training will be documented in the employee's personnel record. Protective Equipment 1) Gloves: Single use disposable latex, vinyl, or nitrile gloves are strongly recommended in the following circumstances: a) If the employee has cuts, abraded skin, chapped hands, or dermatitis involving exposed skin • surfaces and contact with potentially infectious body fluids is anticipated b) When examining abraded or non-intact skin c) When active bleeding is present d) Cleaning of body fluid contaminated areas or equipment or handling of contaminated instruments Use of latex or nitrile gloves is Mandatory when performing phlebotomy or handling body fluid specimens and: a) The phlebotomist has cuts, scratches, or other breaks in their skin b) Hand contamination with blood may occur(e.g. when drawing blood from an uncooperative patient) c) Finger and/or heel sticks are performed on infants and children d) Training of phlebotomists is occurring Gloves will be made readily available to all employees required to use universal precautions. These gloves will meet all applicable quality standards and be immediately available in the clinic areas where exposures may occur. 2) Other Protective Equipment: Gowns, masks, and eye protectors are appropriate in situations where splashes or aerosolization of body fluids is likely to occur(e.g. dental and surgical procedures). Protective equipment appropriate to the particular dental/surgical procedure being performed will be provided to employees and should be worn during the course of the procedure. 3) Needlestick Prevention Program: All procedures performed at JCPH that utilize needles (e.g. vaccine administration, venipuncture, local anesthesia) will be reviewed on an annual basis to determine whether the type of needles being used offer the greatest level of employee protection • while maintaining patient safety and the quality of services being provided. As improved needle technologies become available, they will be incorporated into JCPH clinical practices. 3 Housekeeping 1) Room Cleaning: General cleaning and facility maintenance will be carried out on a routine basis. When environmental surfaces of rooms have been contaminated with potentially infectious secretions, initial cleaning and disinfection will be carried out by JCPH employees followed by general . cleaning by maintenance staff. Should contaminated areas require additional disinfection or special cleaning precautions, maintenance personnel will be notified by JCPH personnel. 2) Disinfectants: Following initial cleanup of body fluids with disposable cleaning materials, contaminated surfaces will be disinfected by one of the following: a) Commercial products approved for use as hospital disinfectants. These products should be viricidal, bacteriocidal, and tuberculocidal when used at recommended dilutions and exposure times or: b) A solution of 5.25% sodium hypochlorite (household bleach) diluted between 1:100 and 1:10 concentration with water(i.e. 10-100 ml. of bleach per liter of water) Infectious Waste Disposal 1) Needles, scalpel blades, lancets, and glass containers: Contaminated metal or glass items capable of causing a percutaneous exposure to blood or body fluids ( sharps") will be stored in puncture resistant containers specifically designed for this purpose. All such items will be placed in the disposal container immediately after use. Needles, blades, and lancets are to remain uncapped and unsheathed in accordance with current universal precaution methods. Recapping of injection or venipuncture needles after use is specifically prohibited. Appropriate puncture resistant containers are required in all areas where the use of sharps is anticipated, including during home visits by public health nurses. Filled containers will be disposed of by a commercial infectious waste processor. 2) Laboratory Specimens and Biological Vaccines: Laboratory specimens not transported to reference labs (e.g. used Vacutainer tubes) or biologically active vaccines will be placed in the "sharps" containers and disposed of by a commercial infectious waste processor. Urine specimens not sent to • the reference lab may be disposed of in a sanitary sewer system (toilet or sink). 3) Contaminated drapes, dressing, or solid waste: All disposable materials contaminated with blood or body fluids will be placed in solid, leak free containers lined with an impervious bag. Sealed bags shall be disposed of in accordance with current solid waste laws. Section II: Respiratory Protection Program The vast majority of communicable diseases are spread by direct contact with infectious materials and can be prevented by scrupulous attention to Universal Precautions. A small number of diseases are capable of airborne spread. These include Measles, Varicella (chickenpox), and Tuberculosis. Health care workers can be protected against the dangers of Measles and Varicella by assurance of adequate personal immunity, either following natural infection or induced by vaccination (Section III). Tuberculosis (TB) control in occupational settings requires careful attention to a variety of factors. TB is caused by the bacterium Mycobacterium tuberculosis (MTB) that is expelled from the lungs or upper respiratory tract of a person who is actively infected with this microorganism. MTB is carried through the air in infectious"droplet nuclei" that are small enough to remain suspended in the air for prolonged periods and to be inhaled deeply into the lungs. Inhalation of infectious particles by a health care worker can result in an asymptomatic form of TB infection that is detectable only by means of a positive TB skin test reaction (PPD test) or, if available, a newer blood-based test known at Quantiferon (QFT). TB infected individuals have a 10% lifetime risk of developing active TB, with half of that risk (5%) occurring in the first two years post infection. Risk of active disease in TB infected health care workers can be reduced through preventive therapy with anti-TB medications. • 4 • TB control strategies rest on early detection and respiratory isolation of infectious cases, effective treatment, evaluation of contacts, and appropriate use of preventive therapy. In addition to these public health strategies, health care facilities must focus special attention on respiratory protection programs to minimize risk of TB for health care workers involved in initial evaluation or treatment of active TB cases. . 1) Facility Risk Assessment: Risk assessment as outlined in the Centers for Disease Control's "Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings, 2005" (MMWR, December 30, 2005/ 54(RR17);1-141) will be conducted on an annual basis for all JCPH programs. The frequency with which employee PPD testing is performed will be based on this annual risk assessment. Typically JCPH health programs fall in the "low risk" category. 2) Employee PPD Skin Testing: All employees should have a "two-step" PPD skin test evaluation performed when they first join the JCPH staff. This testing is done with an initial 0.1 cc of PPD injected intradermally followed by a second dose one—three weeks later if the first test is negative. New employees who have had PPD tests within the past year, need only have a single baseline PPD test which represents the second stage of the two-step testing. 3) Early Recognition of Active TB Cases: Health care and dental practitioners, nursing staff, medical assistants, and other JCPH staff should be aware of the signs and symptoms of active TB and initiate prompt isolation, respiratory protection, evaluation, and, when necessary, initiation of directly observed therapy. A diagnosis of TB may be considered for any patient who has a persistent cough (i.e., a cough lasting for more than 3 weeks) or other signs or symptoms compatible with active TB (e.g., bloody sputum, night sweats, weight loss, anorexia, or fever). 4) Engineering Controls: The facilities of the JCPH lack appropriate engineering controls to allow for negative pressure treatment areas. Patients with known or suspected active TB should be transferred to facilities that are appropriately equipped for full respiratory isolation. Initial assessment of individuals suspected of having active TB should be performed outside the clinic facility, either at home or, weather permitting, in an open air space. 5) Personal Respiratory Protection: Health care workers who provide services to patients with active TB (i.e. during the initial stages of treatment), should utilize a NIOSH-certified air purifying respirator (42 CFR 84, Types N100, N97, or N95) while sharing an enclosed airspace with the patient. Health care • workers providing transportation in regular or emergency vehicles should likewise use a protective filter mask. Active TB cases should be instructed to wear a regular surgical mask while in transit and that disposable tissue paper should be used to cover the mouth during coughing. 6) Health Care Worker Post-exposure Evaluation: All JCPH PPD-negative staff who experience an potential exposure to an active case of TB should be evaluated with a PPD skin test 3 months following the exposure. Employees who do not have a PPD on record within the past year should have a baseline PPD test followed by an additional test 3 months post exposure. A health care worker who develops a positive PPD reaction after TB exposure (a "recent converter") is a candidate for preventive therapy with an anti-TB medication. 7) Employee Training: New employees will be initially trained in the early recognition of potential TB cases and methods for assuring respiratory protection of health care workers. These guidelines will be reviewed at the annual infectious disease training. Section III: Employee Immunization Requirements Immunity to certain highly contagious viral and bacterial diseases is important to health care workers both to protect their personal health and to prevent the transmission of serious infectious diseases to the patients they care for. Seven vaccine-preventable diseases are of particular concern to health care workers: • Hepatitis B • Influenza • Measles (Rubeola) • Rubella ("German Measles") • • Mumps • Varicella-Zoster (Chickenpox) • Pertussis 5 Immunity to these infections can arise from natural infection or be produced by disease-specific vaccination. Health care workers born before 1957 have a 90% chance of being immune to Measles. Likewise most people contracted mumps and rubella prior to development of effective vaccines in 1967. In the past, over 95% of adults demonstrated naturally acquired immunity to Varicella-Zoster. As • Varicella vaccination becomes more common and wild type varicella infection less prevalent, the probability of acquiring natural immunity is decreasing. Young adults who have not been vaccinated with Varicella cannot be presumed to be immune unless they have a confirmed clinical history of chickenpox. Naturally occurring immunity to Hepatitis B varies among different risk groups. Naturally acquired or vaccine-induced immunity to influenza is of unpredictable duration and seldom has a prolonged protective effect due to the constant"antigenic drift" of the Influenza virus. Pertussis has been increasingly recognized as a cause of respiratory infection and persistent cough in adolescents and adults. Acellular pertussis vaccines are now licensed for adolescents and adults up to age 65 and are strongly recommended for health care workers. The health risks of these seven vaccine preventable diseases vary according to age and health status. The very young, the very old, and those suffering from serious chronic diseases are most likely to experience life-threatening infections. Since it is the professional duty of health care workers to care for these most vulnerable populations, it is imperative that immunity to all seven forms of infection be assured to protect both health care workers and their vulnerable patients. JCPH Immunization Guidelines: 1) Hepatitis B: All JCPH personnel at risk of exposure to blood and body fluids should be vaccinated with 3 doses of recombinant vaccine followed by Hepatitis B surface antibody titers 1-2 months following completion of the vaccine series. Additional vaccination may be indicated in certain circumstances. 2) Influenza: All JCPH personnel should undergo a yearly influenza vaccination, either with an inactivated injectable vaccine or the live attenuated virus vaccine. 3) Measles: All JCPH personnel working in the clinic, medical records and clinic reception areas should have documented immunity to measles. Acceptable evidence of immunity includes: . For staff born before 1957 — 1 dose of MMR vaccine, a history of physician-diagnosed measles or laboratory evidence of immunity; For staff born since 1957—2 doses of MMR vaccine or laboratory evidence of immunity. If MMR history is unknown, the employee will be offered the MMR vaccine or lab titers. 4) Mumps: same as for measles. 5) Rubella: same as for measles. 6) Pertussis: Pertussis vaccination is available in combination with tetanus and diphtheria antigens. Health care workers and the parents/caretakers of infants are strongly encouraged to be vaccinated with Tetanus Diphtheria acellular Pertussis (Tdap) if it has been more than 2 years since their last Td booster immunization. 7) Varicella: All JCPH personnel working in the clinic, medical records and clinic reception areas should have documented immunity to varicella. Acceptable evidence of immunity includes: 2 doses of varicella vaccine or Laboratory evidence of immunity or Diagnosis or verification of history of varicella disease or herpes zoster by a health care provider. For staff born before 1980 a history of childhood chickenpox provided by parents may be substituted for diagnosis by a health care provider. Infection Control Program (ICP) Implementation 1) New Employees: The ICP will be reviewed with all new employees as part of their initial orientation and training. This review will include an assessment of the potential work activities of each employee and the job specific training necessary to assure full compliance with the ICP. Successful completion of training will be documented in the employees personnel file. 2) Compliance with Policy: Employee supervisors are responsible for monitoring compliance with • mandatory sections of the ICP. Employees failing to follow voluntary recommendations will be 6 reminded of the recommendations and their medical basis. Disciplinary actions may be taken against employees failing to comply with mandatory infection control provisions of this policy. 3) Quality Improvement Program: Annual review of the ICP in conjunction with all incident reports involving employee exposure to potential infectious materials will be part of the JCPH Quality • Improvement Program. An annual training for JCPH staff will be conducted to review current infection control protocols. 4) Resolution of Disagreement: Infection Control policies reflect the consensus of medical experts based on current scientific knowledge. Changes in recommended methodologies are to be expected and the potential for uncertainty or disagreement in specific areas of infection control is to be anticipated. The County Health Officer will serve as the final local arbiter of ICP interpretation. The state and local health officers, the state epidemiologist, and private medical practitioners with infectious disease expertise are also available to offer expert opinion regarding communicable disease standards and practices. 01/15/09, 01/07/10 Thomas Locke, MD, MPH Date Jefferson County Health Officer 01/15/09, 01/07/10 Jean Baldwin, RN, ARNP Date Jefferson County Public Health Director • • 7 JEFFERSON COUNTY PUBLiCHEALTH 4 • Department: Division: Section of Procedure Manual: Jefferson County Public Health Entire Department HIPAA Title: JCPH Limiting Access to Documents or Communications Containing Protected Health Information (PHI) Subject: Confidentiality of Protected Health Information (PHI) Effective (date): Replaces (date): Renewal due (date): Page: 1 of: 4 03/09 11/15/06 03/11 Originated by: Approved by: Jean Baldwin Julia Danskin Jefferson County Public Health (JCPH) Limiting Access to Documents or Communications Containing Protected Health Information (PHI) Purpose: This policy reinforces the Jefferson County Public Health's(JCPH)commitment to effective security for Protected Health Information(PHI)collected, documented, reproduced,stored, used, or disclosed in the course of work for JCPH. It applies to all staff in every aspect of their work in the Department. It is intended to clarify the controls in place to ensure that PHI is secure,and that access to PHI is limited to the minimum necessary for staff to perform their job assignments. • Policy: Jefferson County Public Health staff shall comply with Federal Laws for securing(limiting access to)and safeguarding documents or communications containing Protected Health Information under the guidelines of the Health Insurance Portability and Accountability Act(HIPAA)of 1996. JCPH staff shall also comply with the privacy policies and procedures mandated by specific State and Federal programs. Procedures: A) Hard-Copy Medical Records Are Securely Stored in Assigned Areas Hard-copy medical records shall be secured in designated locked Chart Room and accessible by staff who have appropriate authorization and when access is necessary for job function. Medical records shall not be left unattended in non-secure areas. When it is necessary to remove medical records from the building, staff shall take only the minimally necessary records and insure the security of those records and sign-out chart. Staff shall assure that areas containing PHI are secured and locked when not in use or when visitors are escorted in areas where PHI is stored or accessible. Staff shall authenticate the identity of any individual requesting disclosure of their own PHI. Staff shall keep building keys securely stored. Privacy considerations shall be included in the planning for off-site clinics and provisions are made to safeguard PHI in these settings. B)Electronic Data Is Securely Stored Staff shall follow county computer security guidelines including password protection in order to maintain security • of electronic PHI. Staff shall access only electronic PHI they are authorized to use, and only as necessary to complete their job function. Staff shall not leave client health information on computer screens or openly accessible in a workplace where it can be viewed by others. Staff will log off computers before leaving them. Only authorized staff shall create, change or delete computer records. Staff shall not add or remove hardware or software on computers without authorization. Staff shall not send or forward e-mail or text messages containing ' PHI. C)Reproduced Documents In order to ensure security of reproduced documents containing PHI, staff shall avoid leaving documents • containing PHI unattended on printers, copiers, or fax machines. Staff who discovers documents containing PHI on printers, copiers, or fax machines shall avoid reading and place in confidential distribution bin in the front office. D)Access to Facility Areas Containing PHI Is Limited by Job Class and Assignment Access to Department areas containing PHI is restricted to staff needing access for performance of their job assignments. Facility areas containing PHI and those authorized to enter the area are listed below: Facility Area Authorization for Access Job Assignments/ Reason for access Chart Room JCPH staff trained in the confidentiality Performing work for which the room is policies of the Department with a signed intended confidentiality statement on file at Level 1 and 2. Jefferson County Maintenance Personnel or Scheduled maintenance contractors who have signed the confidentiality statement All Office Areas except JCPH staff trained in the confidentiality Not restricted by specific job assignment Clinic and Chart room policies of the Department with a signed confidentiality statement on file • Jefferson County Maintenance Personnel or Case consultation or Private contractors who have signed the collaboration confidentiality statement. Non-staff guests and visitors to the premises Scheduled maintenance will not enter the area unless accompanied by a Department Staff member meeting the qualifications outlined above. Clinic Clinical services staff Clinical services Administrative or administrative support staff Administration or administrative support for clinical services Clients/staff accompanied by authorized staff Appointment/Receiving treatment Jefferson County Maintenance Personnel or Scheduled maintenance contractors who have signed the confidentiality statement Old Records Jefferson County Information Services trained Job-related research/purging in the confidentiality policies of the County with a signed confidentiality statement in personnel files may remove confidential files and store securely. • E) Levels of Access to Medical Records Job Description HIPAA Ratings Job Description When Authorized to Access Protected Health Overall Rating • Information (PHI)-any form,i.e. electronic or hard copy Health Officer ■ patients currently being treated I Highest Director • patients having been seen in the past Deputy Director ■ patients that are scheduled to be seen in the Public Health Supervisor future Nurse Practitioners • whenever consulting with another authorized All Public Health Nurses staff member, professional health care worker, All Community Health Nurses agency or contractor Medical Assistants ■ complete program specific tasks as assigned JCPH MH Specialists by the Nursing Supervisor, Director, or Health Case Managers Officer Transcribers • program development and assessment as assigned by Nursing Supervisor, Director or Health Officer Admin& Fiscal Manager ■ maintaining and updating PHI as directed by 2 All Medical Records Clerks Level I staff member WIC Clerk • pulling charts for all authorized professional Receptionist Medical Records health care staff • scheduling and canceling appointments; appropriate note charting • pulling files and sending PHI after consent is received • all administrative tasks related to on-going • patient care, program development, assessment, billing, etc. Board of Health • no direct access to PHI, however,job 3 DD Board/Substance Abuse performance can require limited access to Board PHI. This access to be reviewed and assigned Environmental Health Staff by a Level I staff member. Financial Support Staff Information Technologies Staff Custodial Staff Volunteers • not unless authorization is obtained from the 4 Contractors Director or Health Officer Students F)Access to Components of Medical Records Is Limited by Assignment and Secured by JCPH Staff Staff who use PHI as part of their job duties shall limit other staff's access to this information as appropriate. Staff shall not read,review or use any medical record or part of a medical record if it is not necessary to complete their work. G)Unintentional Disclosures of PHI Are Avoided Unintentionally divulging PHI shall be avoided through careful handling of documents, oral communications, or electronic devices: PHI Contained In Method To Protect From Unintentional Disclosure • Documents on Printers Documents containing PHI found on printers shall be given to the staff person who sent the document to the printer. Staff shall retrieve these documents in a timely manner. Documents found on the printer that cannot be identified shall be placed in the confidential distribution bin in the front office. Documents On Copy Machines Any person copying documents containing PHI shall remain at the copier to complete the copying and remove the documents in a timely manner. Documents found on the copy machine that cannot be identified shall be placed in the confidential distribution bin in the front office. Faxed Documents Faxing may be used if: a cover sheet marked"confidential"accompanies the document, only necessary identifiable information is included. Faxed documents containing PHI shall be given to or picked up by the staff person receiving the document in a timely manner. If the owner of the document cannot be identified,the document shall be placed in the confidential distribution bin in the front office. Discarding Documents Shredder bins area shall be used for disposal of documents containing PHI and shall be shredded periodically. Staff shall also have access to a shredder. Portable Computers Staff shall not download, maintain, or transmit PHI on a portable computer without protecting the device from theft. . Telephone Messages Any PHI shared by telephone shall be made directly with the intended recipient of the information. Staff shall not leave messages on answering machines or with household members to confirm clients' appointments,to relate test results or for other purposes unless documented client authorization is included in the client file. Oral Discussions Staff shall avoid discussing client PHI within earshot of another client who does not need to know the information. H)Privacy and Security Breaches Are Reported And Sanctioned Staff shall report any breach of security—whether accidental or intentional--to their supervisor or the Jefferson County Public Health Privacy Officer. JCPH Supervisor and/or Privacy Officer will respond to any alleged breach of security in a timely way. If immediate action is needed JCPH Supervisor will assess the alleged breach and respond verbally to staff to insure they understand if it is a breach and make changes to correct the situation. Willful disregard of this policy will result in disciplinary action, and can result in termination of employment. Violations of a severe nature may result in notification to regulatory, accreditation, and/or licensure organizations. Documentation of any disciplinary action as a result of a breach of confidentiality will be retained in personnel files according to Jefferson County Personnel Policies. • All staff of JCPH is held to this policy and sign Jefferson County Public Health Employee Confidentiality and accountability agreement. • JEFFERSON COUNTY LIC HEALTH Department: Division: Section of Procedure Manual: County Public Health Community Health Clinic/Medical Records Title: Disclosing Protected Health Information (PHI) Subject: Policy &t procedures for appropriate disclosure of protected health information (PHI) Effective(date): Replaces(date): Renewal due(date): Page: 1 of: 5 05/09 09/07 05/11 Originated by: Approved by: Jean Baldwin Veronica Shaw DISCLOSING PROTECTED HEALTH INFORMATION This policy defines the appropriate means to disclose protected health information (PHI). "Disclosure" refers to the release,transfer or provision of access to PHI collected within the Department to individuals or institutions outside the Department. This policy protects the privacy of individuals' PHI and allows for disclosures permitted or required by law. ROUTINE: • A)Disclosures Follow the Minimum Necessary Rule Staff disclosing PHI ensure that the minimum amount of information needed to accomplish the purpose of the disclosure is provided. A client's entire medical record is copied and disclosed only rarely. Such disclosures require a signature from a Public Health provider supervisor or manager who has reviewed the request and determined that the entire medical record is needed for a use as described by the requestor, and that such use falls within limitations for disclosure described below. The minimum necessary standard covers uses of PHI within the Department as well as disclosures of PHI outside the Department except for disclosures to a health care provider for treatment; disclosures to a client about themselves; or disclosures made according to an authorization. B)Routine Disclosures Require the Client's Informed Consent Before PHI is used for routine purposes in a client's health care(uses such as medical treatment or billing insurance companies for services),the client is informed of our privacy practices and gives consent to use his or her PHI in this way. Parents or legal guardians provide this informed consent on behalf of minors and are given access to the minor's PHI' (see Attachment A"Routine Request of Protected Health Information"). Disclosures to family members or other persons involved in the client's care or payment for care may be made with the client's verbal permission. When the client invites another individual to participate in the clinic visit, such permission may be inferred. Minors over the age of consent must grant permission for access to their records, Age of consent is 13 • for mental health,drug and alcohol services; 14 for STD,or HIV/AIDS services; any age for birth control or abortion; 18 for other health care or confidential records. • NON-ROUTINE: C)Non-Routine Disclosures Require the Client's Authorization Clients may specifically authorize disclosure of their medical records for purposes other than the routine uses of the Department or the Department may request authorization from a client to disclose PHI for research or other purposes. These non-routine disclosures are not made without completion of the authorization to disclose PHI form (see Attachment B"Documentation of Non-Routine Disclosure"). D)Legally Mandated Disclosures Can Be Made Without Client's Consent or Authorization State and federal law permits or requires disclosure of personal health information without client authorization for purposes of protecting public health and safety, or for other limited legal purposes as outlined below: DISCLOSED TO: FOR PURPOSE OF: DISCLOSED BY: Public health authority Preventing or controlling disease or serious Member of communicable (local,state or federal) harm to people disease team or designee Persons who may have Preventing or controlling communicable Member of communicable been exposed to certain disease disease team or designee communicable diseases Law enforcement Preventing or controlling communicable • Health Officer authority disease • Member of Management • Team • Prosecuting Attorney Child Protective Preventing child abuse or neglect Any staff member Services Adult Protective Preventing abuse or neglect of vulnerable Any staff member Services adults County Human P rocessing worker accident or injury reports Any supervisory/ Resources and/or Workers'Compensation claims management staff representatives Legal authority Responding to an order of a court,or in Prosecuting Attorney response to a subpoena,discovery request,or other lawful process Coroners,medical About decedents for investigation of deaths Vital Records Registrar or examiners and funeral any Deputy Registrar directors Law enforcement 1. Preventing abuse or serious harm to the • Health Officer authority individual or other potential victim,when an • Member of Management immediate enforcement activity depends Team upon disclosure and would be adversely • Prosecuting Attorney affected by waiting until the individual is able to agree to the disclosure 2. Reporting crimes Other law enforcement purposes including identification and location of people, identification of a crime victim,or about decedents for investigation of deaths • • Legally mandated disclosures are logged on the"Documentation of Disclosure"form in the client's chart (see Attachment).. E)Verification of Identity Prior to Disclosure Department staff takes reasonable precautions to verify the identity of recipients before PHI is disclosed. Appropriate verification of identity depends on the situation: In some cases, clients or business representatives are known to Department staff. In of her cases, clients' identity may be verified through signature comparisons or photo identification. Businesses may be verified by using business letterhead for requests or business photo identifications for employees. When requests for unauthorized disclosures come from organizations such as corrections or CPS, Department staff may call the requestor back through the organization's publicly listed number to verify the authenticity of the request. In most cases,when the identity and legal authority of an individual or entity requesting PHI cannot be verified, staff refrains from disclosing the requested information and refers the case to the Jefferson County HIPAA Officer. F)Privacy and Security Breaches Are Reported And Sanctioned Staff report any breach of security—whether accidental or intentional --to their supervisor or the Jefferson County HIPAA Officer.2 The County"whistle-blower" policy protects anyone who reports a breach in client privacy and security from being punished for such reporting. • Any staff member who does not adhere to this policy is subject to disciplinary action up to and including termination, notification of law enforcement, and notification of licensure agencies. The severity of the sanction depends on the severity of the violation,_whether or not it was intentional,or whether the violation indicates a pattern or practice of improper access, use or disclosure. G) Processing Records Requests 1. Requests for records should be processed as soon as possible; the same day is preferable,however we reserve the right to take up to 3 business days. 2. Review Record Request to determine the nature of the information being requested. 3. Note any special protection information re:STD/HIV,mental health, substance abuse,etc. before releasing any information. This information must be excluded before releasing any information. 4. Do not send records from an outdated authorization. A current authorization must be obtained before sending records. 5. Ascertain the date(s) requested from client record. 6. If you are unable to determine what information to send, ask the medical records/family planning supervisor or the practitioner last seen by the client. 7. A cover letter must be sent with all records requests verifying the record information being sent. File letter in client chart under correspondence. 8. Place a detailed note in the client's chart describing the records that were sent and to which clinic they were sent. ATTACHMENT A-(SEE SEPARATE FORM) ROUTINE REQUEST FOR RELEASE OF PROTECTED HEALTH INFORMATION (PHI) • • ATTACHMENT B • DOCUMENTATION OF NON-ROUTINE DISCLOSURE CLIENT NAME D.O.B. FOR PURPOSES OF: (check those that apply) Preventing or controlling disease or serious harm to people Preventing or controlling communicable disease Preventing child abuse or neglect Preventing abuse or neglect of vulnerable adults Processing worker accident or injury reports and/or Workers' Compensation claims Responding to an order of a court,or in response to a subpoena,discovery request,or other lawful process About decedents for investigation of deaths 3. Preventing abuse or serious harm to the individual or other potential victim,when an immediate enforcement activity depends upon disclosure and would be adversely affected by waiting until the individual is able to agree to the disclosure • 4. Reporting crimes 5. Other law enforcement purposes including identification and location of people, identification of a crime victim,or about decedents for investigation of deaths Special notes: SENT TO DATE SENT: Staff Name: AGENCY NAME: (please print) CONTACT NAME: Signature: ADDRESS: Date signed: / / CONTACT#: (FORM UPDATE 5-17-07) i JEFFERSON TY PUBLIC HEALTH Department: Division: Section of Procedure Manual: . Jefferson County Public Health Admin Communications/PIO Title: Public Information Officer (P10)/regarding Press Releases Subject: PIO In-house protocols and job description for press releases Effective (date): Replaces (date): Renewal due (date): Page: 1 of: 2 01/11 01/10 01/12 Originated by: Jean Baldwin Approved by: Jean Baldwin U v Public Information Officer(PIO) Regarding Press Releases For Press Releases: 1. Submit your press release to supervisor for review. Supervisor will review the document and ask these questions: What is the story you are trying to tell?What do you want the public to know? Why should the public care?Who does"it" impact?When will/has "it" occurred? Who should I contact for more information? Additionally, the content should be written at a 6th grade reading level. DO NOT USE JARGON OR ACRONYMS!!! This is critical in a time when clear, concise messages are needed to explain public health issues. 2. Once your supervisor has reviewed and approved the content of the press release, it shall then be formatted as shown in Figure 1 (attached). 3. At least three people will officially clear a document before it is released, including: • Subject-matter expert • Health Officer • JCPH Director(or Deputy Director in their absence) • Incident Commander(if Emergency Command Center is open) • PIO Others may be asked to review and comment on the product, but they cannot delay its release. Wherever possible, we will ensure that response partners know which new information we're planning to release. We will work to have a mechanism in place to give a courtesy check to those response agencies with a stake in our release such as: • Hospitals • Doctor offices • schools • CDC • Public Works • BOCC All information in a release will be cleared simultaneously in person or by phone, whenever possible. We will make three copies; take one to each person and stand there while they review and approve the document. We will point out any part of the document we believe needs their careful consideration. We will ask if they would be comfortable seeing this as the headline of the next day's local paper. We will work to ensure that as much information is prepared and pre-cleared as is possible. However, we will • make sure that pre-developed information is sensitive to a crisis situation. 4. Once you have placed your text in the approved format, submit the press release to the RIO with the date you wish to have it submitted to the media, and a list of the outlets you wish to have it sent to. This can be • both internal and external contacts. The PIO will review the press release and will either accept it as-is, or will ask you for edits, if needed. 5. The RIO will then post the press release to the media and other county departments for immediate release. The PIO will also post the press release via the email system to all JCPH staff, and post on web. A script will be available from receptionist and general staff if needed. 6. The PIO will then work with staff to evaluate whether the press release reached the targeted audience with standardized assessment methodologies. • • ON C. JEFFERSON OU TY PUBLIC HEALTH • Department: Division: Section of Procedure Manual: Jefferson County Public Health Admin Communications/PIO Title: Public Information Officer (P10)/Regarding Printed Materials a Presentations Subject: PIO In-house protocols for content of printed materials Et presentations Effective (date): Replaces (date): Renewal due (date): Page: 1 of: 1 01/11 01/10 01/12 Originated by: Jean Baldwin Approved by: Jean Baldwin Public Information Officer(PIO) Regarding Printed Materials and Presentations For Printed Materials and Presentations: 1. Submit printed material (brochures, pamphlets, leaflets, handouts, informational boards, lesson plans, etc.) to supervisor for review. The supervisor will review the documents and ask these questions: • What is the story you are trying to tell? • What do you want the public to know? • • Why should the public care?Who does "it" impact? • Who should I contact for more information? Additionally, the content should be written at a 6th grade reading level. Do not use jargon or acronyms. 2. Since printed material needs can differ significantly from program to program, you should have a clear objective when you are developing any printed material. It should meet (at least) one the strategic goals of the program, be visually captivating, informative, succinct, and timely. All printed material must clearly identify JCPH, address, phone number and correct format of JCPH logo Always Working for a Healthier Community. 3. All lesson plans or staff presentations are scientifically based and clearly presented and cleared by Supervisor. 4. Once your supervisor has reviewed and approved the content, submit printed materials to the PIO for review of the presentations. 5. The PIO will review the content and will either accept it as-is, or will ask you for edits if needed. 6. The PIO will then work with staff to assure the printed material reaches the intended audience, and will work with staff to evaluate the effectiveness of the messages with standardized assessment methodologies. • JEFFERSON COUNTY PUBLIC HEALTH Department: Division: Section of Procedure Manual: Jefferson County Public Health Admin Communications/PIO Title: Public Information Officer (P10)/Regarding Website Subject: PIO In-house protocols for JCPH Web content Effective (date): Replaces (date): Renewal due (date): Page: 1 of: 1 01/11 01/10 01/12 Originated by: Jean Baldwin Approved by: Jean Baldwin Public Information Officer(PIO) Regarding JCPH Web Content For Web Content: 1. Submit your web content updates to your supervisor to review. Your supervisor will review the content and ask these questions: • Is this something I would want to look at on the Web? • What would the "surfer" get from this content? • Why should they care about it? • • Is it timely? • Are there additional links needed? • Who should they contact for more information? Again, the web content needs to be written at a 6th grade level, very visually alluring, and written in a story- telling fashion. Do not use jargon or acronyms. 2. Once,your supervisor has reviewed and approved the content, submit it electronically to the Web clerk for review. 3. The Web clerk will review the layout and will either accept it as-is, or will ask you for edits if needed. 4. The PIO will then post the web content to current JCPH guidelines. The PIO will notify JCPH staff, other County departments, and the media of the changes. JCPH staff will be encouraged to view the material via an email from the PIO. 5. The PIO will then work with staff to evaluate whether the messages have reached the targeted audience with standardized assessment methodologies. • 1 i SOh CGC JEFFERSON UNTO PUBLIC HEALTH Department: Division: Section of Procedure Manual: Jefferson County Public Health Admin Communications/PIO Title: Public Information Officer (PIO) Subject: PIO In-house protocols and job description Effective (date): Replaces (date): Renewal due (date): Page: 1 of: 4 01/11 01/10 01/12 Originated by: Jean Baldwin Approved by: Jean Baldwin Public Information Officer (PIO) Protocol/Policies OBJECTIVE In order to release concise and timely messages to the media about Public Health in general, and Jefferson County Public Health (JCPH) in particular, it is necessary to standardize external and internal messages. Therefore, the JCPH management team has determined the best way to deliver messages and disseminate information is to utilize a Public Information Officer (PIO). The PIO is actually a team of JCPH staff dedicated to delivering superb public health messages and information, and reporting to the JCPH Director during regular business. • GOAL Dissemination of succinct, science-driven, powerful and easily understood messages to be delivered with every media request. DUTIES AND RESPONSIBILITIES The primary duty of the PIO is to assure succinct, science-based, powerful and easily understood messages about public health topics that are disseminated in an orderly way to all media outlets within Jefferson County. The PIO and team will determine timeframes and priorities to release to the public. The PIO will be the focal point for all external media releases, which include local and regional newspapers, radio and television outlets. In order to maintain powerful, cohesive and easily- understood public health messages, the following protocol should be followed by all Jefferson County Public Health staff. This policy and procedure should be considered a "living" document that can be modified as necessary as extraordinary circumstances dictate. POLICY As stated above, the PIO will be the focal point for all media relations. Therefore, the PIO, with final approval from the Department Director, will be the contact person for all media requests and press releases. This does not mean that the PIO will be fielding and answering questions in areas outside his/her areas of expertise. It does mean that all media requests for information should be submitted to the PIO for review, and the PIO will work with the appropriate staff person/expert on the request to assure the appropriate messages are forwarded to the media. This arrangement will allow for staff to continue to serve as the experts in their field, but will also allow for continuity in public health • messages to be released each and every time to the media, the public, and in written materials. I PROCEDURES • Identify additional staff to support the emergency Public Information activation. • • Establish and coordinate emergency public information prior to, during and after an emergency. • Prepare and distribute public information releases regarding disaster preparedness, response and recovery. • If necessary, coordinate with the County Public Information Coordinator to review and coordinate releases of information from other County offices and departments through the EOC. • Respond to media inquiries. • Provide information to the Board of Health, other jurisdictional elected officials, other agencies, and to employees as necessary. • Monitor news media coverage of the incident. • Establish rumor control capability. • Obtain approval for all information releases from the Incident Commander. • Coordinate the release of public information, or establish a Joint Information Center, with other jurisdictions, as appropriate. • Provide emergency public information support to the County EOC or FEMA Disaster Field Office upon request. • • Region 2 Public Health Emergency Response Plan December 2010 5-S-1 Sample Initial Statement Tab 5S: Sample "Initial Statement" [Insert Letterhead Here] Contact: Public Information Officer (Phone number) (Email address) (Website) At press conference or incident site: Date: Time: Approved by: "This is an evolving situation, and I know that just like we do, you want as much information as possible right now. While we work to get your questions answered as quickly as possible, (want to tell you what we can confirm right now: At approximately, (time), a brief description of what happened or is happening At this point, we do not know the number of (persons ill, persons exposed, persons hospitalized, injuries, deaths, etc.) We have procedures in place for an emergency like this are we are working closely with • (police, fire, EOC, State DOH, etc.) as part of the plan. The situation is (under, not yet under) control and we are working with (local, state, federal) authorities to (contain the situation, determine how this happened, determine what actions are needed to prevent this from happening/continuing/spreading). We will continue to gather information and release it to you as soon as possible. I will be back to you within (xx hours) to give you an update. As soon as we have more confirmed information, it will be provided. We ask for your patience as we respond to this (emergency, crisis, urgent situation). • Region 2 Public Health Emergency Response Plan December 2010 5-T-1 Sample Media Statement Tab 5T: Sample "Media Statement" [Insert Letterhead Here] Contact: Public Information Officer (Phone number) (Email address) (Website) Month, Day, 20XX Statement provided by Dr. Tom Locke, MD, MPH, Director: "Today, we learned of several more cases of HINT virus that have been confirmed in the county. Our top priority is to ensure that we take all necessary and precautionary steps to prevent the spread of the virus. (New information. Facts up front. Compassion.) We ask that parents prepare for possible school closures if we continue to see an increase in confirmed cases over the next two to three days. (Asking for a clear action to be taken by your audience.) We are working closely with our school district and county officials to monitor the situation and will provide updated information as frequently as we receive it. At this point, schools in the Jefferson and Clallam County school districts remain open. We acknowledge the burden school closures place on parents and guardians, and we • ask families to understand that safety and health must remain a priority. We will not call for a school closure if we believe the virus is not spreading at a rate that is potentially harmful to our students and other residents of the county. (Expression of compassion, understanding.) I would like to remind you that getting an HINI vaccination is an effective, prevention measure, and vaccinations are available through health care providers and many pharmacies. I urge residents in the county to seek out the vaccination. Other preventive measures we can all engage in are frequent hand washing, covering our mouths when we cough and staying home from work and school if we are sick. (Provide context — other actions.) For the latest updates, I ask that you go to our website, or call (360) 385-9400. • • Protocols • ,, ,.,ON C. �VA , JEFFERSON OU TY PUBLIC HEALTH Department: Division: Section of Procedure Manual: • Jefferson County Public Health All Staff Legal Title: Mandatory Reporting Subject: Reporting procedures on child abuse and neglect Effective (date): Replaces (date): Renewal due (date): Page: 1 of: 2 08/09 12/07 08/14 Originated by: Approved by: Jean Baldwin Quen Zorrah Css. - -.1e,,c - MANDATORY REPORTING POLICY: Jefferson County Public Health (JCPH) strives to protect the health of all citizens, and to this end, follows Washington State law with regard to reporting suspected child abuse and/or neglect. JCPH professional staff is required to report suspected child abuse and/or neglect to Child Protective services (CPS). JCPH professional staff are responsible for knowing and adhering to current reporting policies and procedures as specified by Washington State Law RCW 26.44.030. PROCEDURE: Clients will be informed through a statement included in JCPH program consent forms that all professional staff are mandated to report suspected child physical abuse, sexual abuse and/or III neglect. If staff are unclear whether a report is mandated then staff need to consult with the Nurse Lead. Professional staff will exercise clinical judgment in determining whether to inform the client that a report must be made and whether to include the client in the reporting process. Report will be made by telephone to CPS intake as soon as possible but no later than 48 hours after becoming aware of a child at risk. Washington State Law states that those required by law to report must do so; those who knowingly fail to make a report shall be guilty of a gross misdemeanor. Giving your name will provide proof of your report and offers protection to you. For reports made as an employee of Jefferson County you cannot report anonymously. Document in each client's file the name of the CPS staff member that you speak with including the date, time and reason for the report. Information to be reported includes: 1. Your name, title, agency address, phone number 2. Name, age, birth date of child and alleged perpetrator 3. Address and phone number of family 4. Specific allegations about the abuse, including how the abuse is affecting the health, safety, and development of the child 5. Risk factors - other details about child's behavior, history, caretaker, environment, etc. When a report is made to CPS, notify the Public Health Nurse Lead as soon as possible. You should be prepared to direct questions regarding our CPS reporting procedure to the Department Director or Nurse Lead in the event that a parent, guardian or alleged perpetrator tries to question you regarding a report made to CPS. II Washington Laws Pertaining to the Sexual Abuse of a Minor This summary is meant to be used as a reference and in no way takes precedence over the full RCW or court cases. In Washington, the age of majority is 18. Anyone under 18 is considered a minor. Laws pertaining to • sexual abuse of a minor do not apply if the minor is married to the perpetrator. Rape of a Child: • First Degree: The victim is under 12, and the perpetrator is at least 24 months older. (RCW9A.44.073) • Second Degree: The victim is 12 or 13, and the perpetrator is at least 36 months older. (RCW9A.44.076) • Third Degree: The victim is 14 or 15, and the perpetrator is at least 48 months older. (RCW 9A.44.079) Child Molestation: • First Degree: The victim is under 12, and the perpetrator is at least 36 months older. The perpetrator has sexual contact with the victim, or"knowingly causes" another minor to have sexual contact with the victim. ((A.44.083) • Second Degree: The victim is 12 or 13, and the perpetrator is at least 36 months older. The perpetrator has sexual contact with the victim, or "Knowingly causes" another minor to have sexual contact with the victim. (9A.44.086) • Third Degree: The victim is 14 or 15, and the perpetrator is at least 48 months older. The perpetrator has sexual contact with the victim, or"Knowingly causes" a minor to have sexual contact with the victim. (9A.44.089) Sexual Misconduct: • • First Degree: The victim is under 16 or 17 and the perpetrator is at least 60 months older and has authority over the victim. The perpetrator has sexual intercourse with the victim or "knowingly causes" another minor to have sexual intercourse with the victim. (9A.44.093) • Second Degree: The victim is 16 or 17 and the perpetrator is at least 60 months older and has authority over the victim. The perpetrator has sexual contact with the victim or"Knowingly causes" another minor to have sexual contact with the victim. (9A.44.0-96) • (There is no Third Degree, Sexual Misconduct.) By signing this form I agree that I have read and understand this policy and acknowledge my legal duty to follow RCW 26.44.030. Print Name Signature Date .��SCyN flip • • COUNTY .I HEALTH • Department: Division: Section of Procedure Manual: Jefferson County Public Health Community Health Nursing Title: Expedited Partner Therapy (EPT) for Chlamydia and Gonorrhea - RN Standing Orders Subject: Communicable Diseases - RN Standing Orders - Expedited Partner Therapy (EPT) Effective (date): Replaces (date): Renewal due (date): Page: 1 of: 3 01/11 06/09 01/13 Originated by: Approved by: Thomas Locke, M.D. Carol Burwell, PHN I Expedited Partner Therapy (EPT) for Chlamydia and Gonorrhea RN Standing Orders Expedited Partner Therapy is an alternative to traditional partner therapy for chlamydia and gonorrhea. EPT refers to the practice of treating the sex partners of persons with sexually transmitted infections (STIs) without requiring that they first see a medical provider. In practice, EPT usually involves patient-delivered partner therapy (PDPT); that is, giving an index patient medication to give to their sex partners. Alternately, sex partners of index patients, who have been notified by the index patient, JCPH staff or a community health care provider, may come into JCPH to receive treatment. Effectiveness It is estimated that EPT has increased partner treatment from 39% to 61%. The efficacy of EPT has significantly reduced re-infection and increased the number • of partners treated. Indication EPT is indicated for all sex partners of any confirmed case of chlamydia and/or gonorrhea during the last sixty (60) days. Treatment Medications are provided to JCPH by Washington State Expedited Partner Therapy Program. There is no cost to partners of index patients. Community health care providers for index patients can fax prescriptions for partners to JCPH. Chlamydia Medication • Partner Pack #1 (provided to contacts of chlamydia) Azithromycin 1 gm orally in a single dose Contraindications • History of allergic reaction to any of these medicines: azithromycin (Zithromax), erythromycin, clarithromycin (Biaxin). • If a partner has a serious, long-term illness like kidney, liver or heart disease, colitis or stomach problems, he/she should be referred to his/her health care provider before taking this medication. • • Pregnancy and breastfeeding are not contraindications to treatment. Refer for prenatal care and test of cure. Gonorrhea • Medication • Partner Pack#2 (provided to contacts of gonorrhea) or cefixime (Suprax) 400mg orally in a single dose and azithromycin 1 gm orally in a single dose Contraindications • History of allergic reaction to any of these medicines: azithromycin (Zithromax), erythromycin, clarithromycin (Biaxin), cefixime (Suprax), penicillin or any cephalosporin. • If a partner has a serious, long-term illness like kidney, liver or heart disease, colitis or stomach problems, he/she should be referred to his/her health care provider before taking this medication. Pregnancy and breastfeeding are not contraindications to treatment. Refer for prenatal care and test of cure. JCPH ensures treatment for partners • Verbally confirm exposure. • Review history. If partner has symptoms, refer to a health care provider. • Note any contraindications medical allergies. • Complete appropriate record. See Chlamydia/Gonorrhea EPT form. • Give appropriate medication Partner Pack as indicated by infection (for partners only). Instruct partner to take medication in clinic. If partner chooses to take the medication outside of JCPH, advise her/him that medication is not in a childproof safety package and complete Rx label on pack. • Advise partner to abstain from sexual activity for one week after taking medication to prevent infecting/reinfecting partner(s). • • Advise partner not to share these medications or give them to anyone else. • Advise partner to tell everyone he/she had sex with in the last sixty (60) days that they need to see a health care provider for testing. Index patient ensures treatment for partners • Advise index patient of all instructions for partner(s) listed above. • Advise index patient to give partner(s) verbal instructions and entire Partner Pack, including pack inserts for partner(s) to read before taking medication. Stress screening for allergies. • Up to three (3) partner packs may be given to index patient. If more than three (3) partner packs are needed, fax a prescription to Safeway Pharmacy. There is no limit on the number of faxed prescriptions for each index patient. Fax: 385-0573 Counseling Provide client centered risk reduction counseling. Resources recommended, but not limited to, are: • Patient educational materials provided by the Washington State Expedited Partner Therapy Program. See EPT binder in clinic lab. • Reproductive Health Clinical Practice Guidelines by Vivian Hanson, section 600. See binder in Family Planning. • • American Social Health Association, www.ashastd.orq. • Hepatitis Education Project, www.hepeducation.orq. Jefferson County Public Health Chlamydia/Gonorrhea Expedited Partner Therapy (EPT) • Partner Name: DOB: / / (Intended Recipient) Address: Phone Number: ❑ Partner Questioned or ❑ Information reported by index patient ❑ No symptoms present ❑ Yes symptoms —* STOP Et Refer to MD (no burning, discharge, abdominal pain, nausea,fever) ❑ No known contraindications or ❑ Yes contraindications or adverse drug reactions adverse drug reactions —* STOP&Refer to MD (see EPT Standing Orders) ❑ Male ❑ Female no or unknown pregnancy U Female known pregnancy EPT OK EPT OK with Referral to MD ❑ Chlamydia Only Public Health Pack 1: azithromycin (Zithromax) 1 gram orally • ❑ Gonorrhea Only or Gonorrhea and Chlamydia Public Health Pack 2: azithromycin (Zithromax) 1 gram and cefixime (Suprax) 400 mg orally ❑ Patient information given: ❑ Pack 1 ❑ Pack 2 ❑ Additional information ❑ Medication taken on site U Medication taken out of JCPH ❑ Verbal instructions on how to take medication provided ❑ Advised that medication is not in child-proof safety package ❑ Rx label on pack completed ❑ Advised not to share medication or give to anyone else ❑ Advised to abstain from sexual activity for one full week after taking medications ❑ Advised to tell all sex partners in past 60 days that they need to be tested Print name(circle one: partner or index patient) Date of birth(of index patient, if taking medication to partner) Signature(partner or index patient) Date EPT delivered • Signature(RN) Date of review Signature(ARNP/ MD- review and sign) 01/06/11 dm i-17 A 0 33 0D a o M C) n m 0a 3 o r s m N o) SU .: • 1 —I ill 0 0 1 to N 0 5; r cn ov o -o 10 v o -o cFP o -ocDCo CD < 0. 3 Q3 n3(D N 12., N a cn 1 r+ _h 3 N 3 07 3 N CD 5 CO 0 ,.„„. o ^ l) 7,,,*,11,2„•:1:7;:::,,,,11 (Du)cr° Qoa---<. ,,., o N p' •- m-i -P_ Vie. s -0 73 tl O D CD CD o -1 m o Cl) O O C) v O coo o r O m D � 0 ( r�r 0. co o7 m `� —i CD 3 o -.4 CD III) ,' m O o = 0- 0 O O . oE o :Lo .. 1- ...< CDm m v atea ..< ,-. v o VyMm o C NVl :5 N N Q D co?NQ N Q N N N N 1"h N 77 CD 17 CD"iCD 17 CD CD Cn cn M 0 m m m m < c z 73 vo co 0 CD^.on oxStk O N Q N cm N N N lD4 7O - r CD-'s"a o '. M < D(D _ W uO s; 3 . ,crI no f . BO t 0 zm * o a: Fm o § < c5o ;Uo S I 0.Q 3 a v Iv v Fmw ez cn y C) Q O N cc, O d s O 0 m n 'Or' 00 I- 0 Guidelines ,5(3h coe ' ". JEFFERSON COUNTY PUBLIC HEALTH 't ,,,,,..,,,,,, Department: Division: Section of Procedure 40 Jefferson County Community Health Manual: Public Health Immunizations Title: Guidelines for Vaccine Ordering, Receipt &t Storage Subject: Vaccines: Ordering, Receipting, Storing, Paperwork Effective (date): Replaces (date): Renewal due (date): Page: 1 of: 2 9/10 09/08 9/11 Originated by: Jane Kurata Approved by: Jean Baldwin riginated by: Jc)e, for Vaccine Ordering, Receipt and Storage Ordering Vaccines. Only Immunization Program staff will order vaccines. State-supplied vaccines will be ordered by the VFC Coordinator according to amounts determined by past use. Whenever possible, vaccines will be ordered every other month via the Child Profile Vaccine Ordering Module and fax to the State Immunization Program. In the VFC Coordinator's absence, the Travel Vaccine Coordinator will order pediatric vaccines. The Travel Vaccine Coordinator will order private supply vaccines (adult and travel vaccines) through the purchasing department after approval of the Clinical Supervisor. II In the Travel Vaccine Coordinator's absence, the VFC Coordinator will order adult and travel vaccines. Receipt of Vaccine Orders. When a vaccine order is delivered, the receptionist will notify a nurse in the Immunization Program promptly. If the nurse does not check in and store the vaccine within 1 hour, the receptionist should again remind the nurse of the arrival of new vaccines. To protect valuable and fragile vaccines, they should not be left at the front desk for long periods of time, but should be transferred to the refrigerator as soon as possible. If none of the Immunization Program nurses are available, a Communicable Disease or Family Planning nurse should be asked to put new vaccines into the refrigerator or freezer (see storage section below). In this instance, all vaccine paperwork should be placed in the Immunization Program coordinator's mailbox for completion when she returns. Storage. All vaccines except varicella and MMRV should be stored in the refrigerator, with newer vaccines placed behind older vaccines so the older vaccines will be used first. Varicella and MMRV should be stored in the freezer with newer vaccine placed behind older vaccines. Refrigerator and freezer temperatures are to be checked and recorded twice daily. • The temperature recording charts in the Tempscribes are to be changed, or data downloaded from digital temperature loggers every Tuesday. State-supplied vaccine will have a "S" or "VFC" sticker placed on every box to identify the source of the vaccine. Privately purchased vaccines will have a "P" sticker on every box when the same vaccine is also available from the State-supplied program. Free adult vaccines obtained through special programs will have an "0" sticker for $0.00 cost vaccine. When appropriate, stickers will be put on vaccine boxes stating the proper age of clients for whom the vaccine is indicated. State-Supplied, privately purchased and free vaccines each have separate storage trays in separate areas of the refrigerator. Paperwork. When checking in vaccines, the vaccine type, lot number, expiration date, and number of doses received should be verified and listed on the packing list. After checking in the vaccine and properly storing it in the refrigerator, the original packing list should be given to Vaccine Purchasing, and copies should be given to the appropriate Immunization Program manager. Vaccine Purchasing will enter the doses, lot numbers, and expiration dates into KIPHS. Transfer of Vaccines Between Facilities. When it is necessary to transfer vaccines to or from other provider facilities or School- based Clinics, a transfer form should be completed. Copies of the transfer form should be given to the VFC Coordinator and Vaccine Purchasing. A third copy should accompany the vaccine or go to the other immunization facility involved. Vaccine will be transported in a cooler with an ice pack covered with an insulating material. Incorrect Temperature Incidents. If the refrigerator temperature is found to be out of the correct range, the VFC Coordinator should be notified immediately. If the VFC Coordinator is not available, • the Travel Vaccine Coordinator should be notified. Time and temperature information will be documented. Vaccine manufacturers will be called with the details of the incident to determine the viability of the vaccine. Do not assume that the vaccine is spoiled. Do not use the vaccine until the viability has been determined. Expired or Wasted Vaccine. In the event vaccines are spoiled due to temperatures out of correct range or expire before the vaccine is used, the non-viable vaccine should be placed in a plastic bag with a label clearly stating the date of non-viability and a message to not use the vaccine. A Vaccine Return Form should be completed stating vaccine type, lot number, number of spoiled doses, and reason for wastage. Copies of the Return Form should be given to the appropriate Vaccine Coordinator, Vaccine Purchasing, and another copy returned to the manufacturer with the spoiled vaccines. • A" S-,,,, Co `-1 JEFFERSON LIQ HEALTH •S0(^ ,r • Department: Division: Section of Procedure Manual: Jefferson County Public Health Community Health Nursing Title: Guidelines for Notifiable Conditions Investigations and Reporting Subject: Protocol for Notifiable Conditions Investigations and Reporting Effective (date): Replaces (date): Renewal due (date): Page: 1 of: 3 11/10 04/08 11/11 Originated by: Approved by: Jean Baldwin Lisa McKenzie e) t x.,,,.A,_.. GUIDELINES FOR NOTIFIABLE CONDITIONS INVESTIGATIONS AND REPORTING To be used in conjunction with the Region 2 Public Health Emergency Response Plan algorithm and checklist for Epi/Surveillance. A member of the Jefferson County Public Health (JCPH) Public Health Nursing staff will evaluate all reports of suspected or confirmed notifiable conditions. Jefferson County's response to and management of the specific condition will be directed by the Jefferson County Health Officer, Thomas Locke MD, MPH or his assigned representative. I. Reports of confirmed or suspected notifiable conditions are reported to the public health Ill department via telephone calls, Public Health Reporting of Electronic Data (PHRED), confidential fax, or through the mail. A. Telephone Referrals 1. All telephone calls coming into the main public health number, (360) 385-9400, are forwarded to the public health nurse assigned to communicable disease (CD) coverage for the day. 2. The primary staff member responsible for CD coverage will be noted on the monthly nursing staff coverage schedule. 3. Telephone referrals coming directly to a public health nurse's direct line will be managed by that nurse or referred to the CD coverage nurse. 4. The CD coverage nurse will review and return all telephone messages before the end of the workday in which they were received. B. Confidential Fax Line and Mailed Reports 1. Laboratory and provider faxed or mailed reports of notifiable conditions are to be placed in the secure CD nurse mail slot in the medical records room. 2. The CD coverage nurse is responsible for checking the CD mail slot for reports. II. All reports of suspected or confirmed notifiable conditions will be investigated in accordance with established epidemiological investigational procedures and reported to the Washington State Department of Health (DOH)within the stipulated timeframes. A. Data Collection 1. Obtain laboratory documentation for all reported conditions and determine status of suspected cases by interpreting the lab report. This may require contacting the laboratory or the health care provider who collected the specimen or made the report. 2. Determine if the condition is reportable by referencing the notifiable conditions list. 3. Refer to and follow the Washington State Guidelines for Notifiable Condition Reporting and Surveillance binder or the online disease specific Guidelines at http://www.doh.wa.gov/notify/forms/for disease specific reporting timeframes, case • definitions, investigation and infection control guidelines. 4. Notify DOH CD/EPI Program if reporting timeframe is "Immediately"for the condition, for suspected and confirmed cases. (877) 539-4344 (24 hr). Notify Health Officer and JCPH Director. 5. Print the appropriate DOH reporting form, from the web site noted in #3, to be used for data collection and reporting. 6. Contact the healthcare provider first (before calling the case) to obtain the medical history, known exposure, locating information and notification status for the case. 7. Interview the case or the guardian of the case. 8. Follow the principles of field epidemiology in collecting person, place and time data. B. Evaluation of Collected Data 1. Determine that the collected data meets the case definition for the notifiable condition. 2. Establish a Preliminary Action Plan which delineates recommendations for the management of the individual case, all case contacts and the community at large using an accredited communicable disease resource guide. a. Washington State Guidelines for Notifiable Condition Reporting and Surveillance b. Control of Communicable Diseases Manual, David L. Heymann, MD, Editor,l9th edition, 2008. c. Red Book 2009, American Academy of Pediatrics. d. Centers for Disease Control Guidelines. e. Infectious Disease Control Guide for School Staff, Washington State DOH and Washington State Office of Superintendent of Public Instruction, 2004. 3. Enter case report into PHIMS once enough information is collected to determine that it meets the case definition. Send preliminary report to DOH with lab result and the clinical information • collected from the provider. Final report will be sent later, after completing the investigation. C. Finalize Action Plan 1. Consult with Health Officer, or his assigned representative, and CD Program Manager to review the data and Preliminary Action Plan as appropriate for the specific condition and for outbreaks. 2. Finalize Action Plan. 3. Notify JCPH Director of investigation and Action Plan. D. Initiate Action Plan as Appropriate for the Specific Condition and for Outbreaks 1. Notify and/or assemble additional JCPH staff if indicated. a. Notify Environmental Health Food Safety Program Manager if investigating a possible food borne illness, coordinate investigation if restaurants may be involved. b. Notify Environmental Health Director if animal, shellfish, bird, mosquito or water borne disease transmission is suspected. 2. Notify external departments, agencies, or facilities, including BOH, other LHJs, regional staff, as appropriate. 3. Management of index case, including instructions to prevent transmission to others and referral for care if not already in care. 4. Contact identification, notification and management. 5. Initiate any indicated community public health response. 6. Conduct active surveillance for additional cases if indicated. E. Complete Documentation, Reporting, and Response Evaluation1111 1. Submit completed case report to DOH in PHIMS 2. File hard copy of case report and investigation notes in CD reports files in medical records office, retain for six years. 3. Review, evaluate and critique the response and management of the case/outbreak. 4. Address any identified deficiencies and modify response policies to reflect the recommended • changes. Ill. Information, Risk Communication and Practice Guidelines regarding Notifiable Conditions will be clearly and accurately communicated to the appropriate professional groups, general public and media in a timely manner. A. Media Response 1. One person will be identified as the Public Information Officer (PIO) by the Incident Commander or the JCPH Director 2. All media requests for information will be directed to the designated PIO. 3. All media releases will be approved by the Health Office, the Director of JCPH or their appointed representative. 4. The Jefferson County Public Health Emergency Response Plan, Appendix VI Risk Communications, contains guidelines for the PIO and for coordinating public information with other agencies through the use of a Joint Information Center. B. Response to and Education of the General Public 1. Fact sheets will be provided to administrative and professional staff who will be responding to questions from the general public. 2. Communicable Disease Fact Sheet Resources: http://www.cdc.gov/az/a.html http://www.doh.wa.qov/a-z topics/a.htm http://www.Kingcounty.gov/healthservices/health/communicable/diseases.aspx 3. Public inquiries requiring more than basic information will be referred to professional staff. 4. Situation specific education materials or guidelines will be produced and distributed if • indicated. 5. JCPH's public information line will be utilized for a recorded message if needed. C. Directives and Guidelines for Health Care Providers and Other Professionals 1. All inquiries from professionals will be directed to JCPH CD Program staff. 2. Written guidelines and directives will be approved by the Health Officer or his assigned representative. 3. Communications will be transmitted in a timely manner. 4. Information about contacting the Regional Duty Officer for after hours contact with Public Health will be distributed to all professionals annually. • tit�et, rot. t�. JEFFERSON TY PB • Department: Division: Section of Procedure Manual: Jefferson County Public Health Community Health Immunizations Title: Program Guidelines for Vaccines by Source Subject: Bars 320-State Supply Vaccines, Bars 321-Private Supply Vaccines Effective (date): Replaces (date): Renewal due (date): Page: 1 of: 1 09/10 09/08 09/12 Originated by: Approved by: Jean Baldwin Jane Kurata1; Program Guidelines for Vaccines by Source September 2010 Program 320 is all State-Supply vaccines. In general these vaccines are used for children and adolescents under age 19. However, there are a couple of exceptions: Hepatitis B can be used until age 20; MMR can be used for college students born after 1957. Program 321 is all Private supply vaccines. This includes travel vaccines as well as adult vaccines and any new children's vaccines that are not yet part of the State-Supply program. Bars 320—State Supply Vaccines Bars 321 —Private Supply Vaccines DTaP = Diphtheria + Tetanus + Pertussis DT= Diphtheria + Tetanus Pediarix = DtaP + IPV + Hepatitis B Pentacel = DtaP + IPV + Hib • Hepatitis A Hepatitis A Hepatitis B Hepatitis B Twinrix = Hepatitis A+ B Hib = Haemophilus B Conjugate HPV = Human Papillomavirus HPV= Human Papillomavirus IPV = Inactivated Polio IPV= Inactivated Polio MCV4 = Menactra Meningococcal MCV4 = Menactra Meningococcal Menomune = Meningococcal MMR = Measles + Mumps + Rubella MMR = Measles + Mumps + Rubella MMRV= MMR + Varicella PCV = Pneumococcal Conjugate Pneumonia Polysaccharide Pneumonia Polysaccharide Rotavirus Td =Tetanus + Diphtheria Td = Tetanus + Diphtheria Tdap = Tetanus + Diphtheria/+ Pertussis Tdap= Tetanus + Diphtheria + Pertussis Varicella Varicella Influenza -for over age 3 Influenza FluMist-age 2 thru 18 FluMist-age 19 thru 49 Influenza - preservative free under age 3 Influenza - preservative free age 3 thru 18 Japanese Encephalitis = Ixiaro or JE-VAX Rabies = RabAvert or Imovax Typhoid - Oral or Injectable Yellow Fever Immune Globulin • BARS 325 BARS 395 Free Adult HPV Program Free Twinrix Program Board of aCealt( Netiv Business .agenda Item #17., 3 .ICPaCStrategic Planning and Quality Improvement: Past, Present & Future February 17, 2011 • s • Jefferson County Public Health Strategic Planning and Quality Improvement: Past, • Present, and Future JCPH Planning History: Dynamic process Strategic Plan Who When C-Mapping(Concept Mapping) Lead Staff/Management 2008-2009 to now Workforce Board of Health(BOH) development& Strategic plan Lean training(Lean Sigma HO/JHC 2009 to now Teams QI as well as Application) Management team measuring performance Reorganize staff into specialty Family Support,Clinical, 2003 to now Lead staff&technical Team s—CH Communicable Disease, expertise monitor Community Prevention Performance Measures and quality systems Reorganize-Team- EH Water Quality, Onsite, Food 2008 to now Lead staff assigned R.W.Johnson—Turning Point All lead staff, managers 2008 Collaborative Team Leadership training leadership Modules— 6 sessions Performance based budgeting All staff, lead staff form goals 2003-4 to now 4 CH sections of programs,goals and and measurements deliverables,6 EH measurements BOH sets, 2 admin sets Strategic Plan for JCPH based BOH 2004-6 JCPH to improve on State standards and Standards and improving performance of maintain local JCPH assessment. Definitions: CH =Community Health EH= Environmental Health WQ-=Water Quality Ql= Quality Improvement Lean=Lean 6 Sigma, Quality Functions CM=Concept Mapping Mission: The mission of Jefferson County Public Health is to protect the health of Jefferson County Residents by promoting healthy communities and environments. JCPH Priorities in 2004-2006 based on State Standards • Assessment of local needs and health indicators • Communicable Disease Prevention and Control • Environmental Health and Safety including water • Public Policy development • Several programs received BOH universal support—with recommendation for County funding. These included Nurse Family Partnership program, shellfish protection • programs, and continue efforts to decrease tobacco use. January,2011 In 2008, JCPH began to experience retirements of staff and faced the reality that more than 50% of the staff would retire in 10 years. Working with the concept mapping charts, the Sound • Knowledge Strategies group, staff teams and the BOH, strategies were discussed for JCPH to mentor internal leadership, develop regional partnerships, and only provide services JCPH is uniquely able to provide and to set priority goals that have the greatest community impact. C-mapping JCPH strategic goals 2008-2010: • Reducing cost burden of healthcare in our community • Supporting economic health in our community • Building capacity for sustainable community health • Giving children a good start in life • Provide data that informs BOH in decisions on Community Health • Providing responsible stewardship of public funds • Protect community from PH threats Please refer to attachment A to see the JCPH programs refer to these goals. Culture of Quality Improvement in JCPH: Teams build performance measures and quality review into the Jefferson county budget process. Teams also must respond to emergencies, identified problems or performance measures deficiencies with a Plan- Do- Study-Act approach. Quality improvement is an ongoing process rather than a time-limited project. • 2011-2013 The next steps: Budgetary Constraints Worsen As State and local contributions continue to decrease and demand for services increases, the BOH must set standards of prioritization. The c-mapping was started to review the essential knowledge and capacities needed for JCPH to protect and improve community health during upcoming retirements of experienced staff. The challenge that lies ahead is to determine how JCPH continues to fulfill its core mission while dealing with budgetary constraints, the retirement of a highly skilled workforce, and the political uncertainties of health care system reform. One promising opportunity is the Community Health Improvement Plan (CHIP) process that is being developed in conjunction with State and National Health Care Reform efforts. The CHIP process requires a close working relationship between hospitals, health care providers, local health jurisdictions, and other community partners to identify opportunities for community health improvement and implement needed system changes. Board of Health guidance is being sought on how best to approach Strategic Planning and Community Health Improvement Planning in the very challenging times that lie ahead. • January,2011 JCPH Strategic Goals 2008-2010 appendix A • 1. Reduce the cost burden of health care in the community by • Preventing disease outbreaks (Immunization Programs and Communicable Disease prevention programs) • Safe and clean water • Reduce tobacco use, especially preventing initiation of tobacco use in school age population • Reduce underage alcohol and drug use • Improve and/or support healthy nutrition, especially in pregnant women and children • Reduce premature births • Reducing or eliminating child abuse and neglect 2. Give Children a good start in life • All families with newborns are contacted by a Nurse • Nurse Family Partnership home visits • Family planning visits to decrease unplanned pregnancies • Family Support includes a weekly breast feeding tea for all Moms • 3. Economic health of the community through workforce and supporting business. • Safe restaurants • Safe shellfish industry • Workforce able to leave children in safe, healthy childcare facility • Decreasing unintended pregnancies • School Based Clinics to decrease the dropout rate • WIC program allows pregnant women and families with young children to buy healthy food from local stores and farmers market • Community emergency preparedness 4. Build community infrastructure and increasing relationship systems • Work with hospital,JHC clinics, DSHS, schools, families and community leaders • Jefferson County Department of Emergency Management • Olycap, Olympic Area Agency on Aging, Drug and Alcohol treatment programs , Jefferson Mental Health,Jefferson County Domestic Violence, Jefferson County Citizens Committee on Health Care Access • DD groups • K t 5. Guide good community prioritizations; become a catalyst to discussion • Community Health and demographic Assessment work will have current,thorough • community data identifying needs & assets for policy makers and citizens • Guide to Prevention in Jefferson County • Quality Assurance part of all department programs 6. Responsible stewardship of public funds and clear outcomes for service dollars • Performance based budgeting • Manage complex multi year plans • Program budgets monitored and tracked • e al 0 E —iP Q 1— /la g j „, i ,---Th Liu 0 a) / ", c, 13) U \rt$ 01 O. ., . I � 13 OMI '4.) / 4.1is R X .L3 J = O C I U l �W � 'a hit in to LfaJ 4- = + Q?/' \> \\ t fY ryi ii)1a 4.) O 0 a 0 V in L 'Q X ++ w m fa ar Q a , o a. co c \ 3 0 us tri co 1•► O46 (7) .c \ 4., ,.... o J L M r E fU 0 ,4ivi C 1 Z C u 1 44 4 'ro i } L. tn >00 1 �' I U PI N co rn 0 n MI �, 75 ., coO N ti u -4, II 13ry 0 t.01 ai MP 3u V 'a a un u. U n r -,ft ! L.) 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O. 0. t7 / 8E o c > � � v a. c• to 0 D // W 3 7 v c', ccr V- (..) t• i) i * p ° O.3 ,L." v -0v IiiQ .= v, 0a o wLC@ 3►n a °�' CC o 1 " = v n Z o \, 'v 4.. = Fri , \ u �t t N 1 0, to o \ cr o U) u1 r \ o r r \ S 5 fLno 0 _ LL r 1- O C +un w cu c -a co , 5 +, _ tn0 t70 U =, y �.�' a v 'i CL v .V to c = 0 u dl •.I a) 1 I a N V U t VV L Chlamydia Screening Improvement Process 2010 Jefferson County Public Health 2/2/2011 Plan In response to CDC and Washington State DOH Infertility Prevention Project (IPP) Chlamydia (CT) screening guidelines, JCPH decided to assess the CT screening rate for women age 24 and under in our Family Planning (FP) Clinic and improve the rate if needed. This is being done as part of our Performance Measures Planning and Reporting. The Washington State IPP guidelines state that sexually active women age 24 and under should be screened for CT at least annually. The JCPH Performance Measures Plan for 2010 includes the following objective: "Women seen in Family Planning Clinic who are at higher risk for CT (age 24 and under) will be screened for CT annually." For 2010 we are assessing our baseline. The Performance Indicator we are using for this objective is: "Assess total # and %of female FP clinic clients at risk for CT(age 24 and under) screened for CT, includes exam visits and non-exam visits." The plan is to assess our 2010 baseline rate of CT screening for females age 24 and under, with the long term goal of improving our screening rate. Accurate data collection and baseline measurement are needed in order to assess long term improvement. The plan includes a 6 month data collection and baseline review. Do • For the first 6 months of 2010 the established system for recording CT tests was used to collect data. FP providers routinely recorded CT tests on the AHLERS form and the KIPHS encounter form (internal billing system). A clinic medical assistant entered the data from the AHLERS forms into the electronic AHLERS reporting system. The KIPHS encounter forms were entered into the KIPHS system by the billing clerk. The FP providers were aware of the recommendation for screening all those in the high risk group. Study In July 2010 the FP Clinic providers and staff were provided data showing the CT screening rate for the first 6 months of 2010, see page 2. An email discussion followed, including feedback from the providers that the AHLERS data was quite different from the providers' subjective impression of their screening rate. Several possible problems with the data were discussed. AHLERS data was compared to KHIPS data for CT screening in the first six months of 2010. The number of CT tests entered into KHIPS was twenty percent greater than the number entered into AHLERS. Act On 10/14/10 the FP Clinic providers, staff and the Communicable Disease Program Coordinator met to discuss the possible causes for AHLERS data issues, ways to improve data collection, and ways to increase CT screening of the high risk population. Various ways to improve the system for filling out the AHLERS CVR form were discussed. Paper flow within the School Based Clinics and from the SBC back to JCPH was discussed. Yearly CT screening recommendations for high risk groups were discussed. • A decision was made to have the MAs record the CT tests on both the AHLERS and KIPHS forms. Previously only the providers filled out the AHLERS form. Providers and staff will try to have all clients coming in for other than an exam (OC refills, pregnancy tests, etc) give a urine sample (if previous void>lhour ago)with the intention of screening for CT. The decision to test will be made by the provider based on the client's risk factors and when the client was last tested. At the Medical Records Staff meeting on 12/16/2010 the reconciliation of labs in the Family Planning clinic was discussed. The MA is to do this at the end of each clinic day, making sure that all labs are recorded in the lab log book, on the encounter form and on the AHLERS form. The Communicable Disease Program Coordinator will evaluate the CT screening data from both the AHLERS and KHIPS systems for the last 6 months of 2010 and the full year as part of the 2010 Performance Measures Report. Feedback will be provided to the FP providers and staff and the next round of planning for increasing our CT screening rate will begin. JCPH 2010 Chlamydia Testing, Family Planning Clients Age 24 and Under from AHLERS Report: Clients, CT Tests and Percent Tested—2010 First 6 Months: • 2010 Females Family Planning clients age 24 and under, total 486 Number of CT tests age 24 and under 167 Number of pelvic exams 121 Number of tests done without pelvic exam 46 Percent of clients tested 34% 2010 Performance Measures Plan: 2010 Planned (STD) Assess total # and % of female FP clinic clients at risk for Assess Chlamydia (age 24 and under) screened for Chlamydia, includes baseline. exam visits and non-exam visits. S Board of aCeaCt( Nledia Report • February 17, 2011 • • Jefferson County Public Health January/February 2011 NEWS ARTICLES 1. "Biomass clear of EP rules, Peninsula Daily News, January 18th, 2011. 2. "County health officials prepare for flu season," Peninsula Daily News, January 19th, 2011. 3. "Second biomass appeal," Peninsula Daily News, January 20th, 2011. 4. "Study: Plenty of wood for biomass," Peninsula Daily News, January 20th, 2011. 5. "Drug drop-off program is launched," Port Townsend Leader, January 26th, 2011. • • t , • Biomass • clear n _,. il,.. , PA rules Rules: PT mill . Agency defers action CONTINUED FROM Al only a delay. "It doesn't exempt the for 3 years for analysisThe state Department of businesses from meeting Ecology granted the Port the standards.It just defers Townsend mill Oct. 25 a enforcement for three "notice of construction"per- years,"she said. BY Tom CALLI3 the list of facilities that must com- mit for its$55 million prof- "It doesn't let them off ect, which would generate the hook for meeting the PENINSULA DAILY News ply with the new regulations—at. newgreenhousegas re a least for the next three years. up to 24 megawatts of elec. g� Wood-burning facilities will Both burn wood waste now tncal power, tions." not be regulated under the The EPA's new green- Port Townsend Air- and expect to have upgraded facil- gasesWatchers is one of five envi- Environmental Protection house rules are ities online sometime this year. ronmental groups appeal- Agency's new greenhouse gas Nippon plans a new boiler,while intended to improve fuel in thepermitP for ort regulations that went into effect efficiency among large emit- g earlier this month,the federal the Port Townsend mill intends to ters of Earth-warming gases Townsend paper's biomass agency announced last week. install a new steam generator. and are aimed at facilities energy project to the state EPA said it will defer further Nippon administrators said that emit more than 100,000 Pollution Control Hearings action on the matter for threer they expected their $71 million tons of greenhouse gases Board. years while it analyzes whether biomass energy project would per year. It is also one of seven comply. groups thatplan to appeal the burning of wood waste to P Ppe 1 Still,said Harold Norlund,mill theNippon roect to the 410produce electricity,among manager, the decision is good Biomass opponents llu P uses, can really be considered state pollution control board "green." news. Opponents of the two in the spring. The move came after propo- Peninsula projects were not The other groups are nems of biomass energy,includ- Pleased with announcement pleased with the change. Olympic Forest Coalition, ing Washington state officials "We are very pleased with the Diana Somerville,a Port Olympic Environmental and some members of Congress, EPA announcement,"he said. Angeles resident and Council,No•Biomass Burn protested the inclusion of bio- "Certainly,we believe that it is spokeswoman for environ- of Seattle, the Center for mass projects under the new common sense. This is exactly mental groups opposed to Environmental Law and regulations. both projects,said the deci- Policy of Spokane,the World what we've been saying and what They said that wood-burning we're doing here." sion is another example of Temperate Rainforest Net- facilities should not be treated Nippon's new boiler would pro- the United States"backing work and the Cascade -the same as those that burn fol- duce steam to make telephone away from important con- Chapter of the Sierra Club. sil fuels,because by burning book paper and newsprint, and trols to climate change." The Center for Environ- wood waste they are"carbon- generate up to 20 megawatts of "I think that industry mental Law and Policy of neutral"and add no additional electrical power. The company pressure got to them,"she Spokane and the Cascade carbon to the atmosphere. said. Chapter of the Sierra Club The EPA move means the. then could sell credits for the elec- "I think they're not did not join the appeal of trical power. North Olympic Peninsula's two standing up for the health the Port Townsend milI's A call requesting comment biomass energy projects at the of the public." facility. Nippon Paper Industries USA's from Port Townsend paper mill Gretchen Brewer, a No other facilities on the officials was not returned. Port Angeles mill and Port member of Port Townsend North Olympic Peninsula Townsend Paper Corp. are off TURN TO RULES/A6 AirWatchers, also spoke of fell under the EPA's new industry pressure. greenhouse gas regulations, "I think it's a partial according to data from the capitulation to pressure state Department of Ecol- from businesses,"she said. ogy and Olympic Region "We're all unhappy to see Clean Air Agency. that. • "Our atmosphere can't Reporter Tom Calsis can be handle more carbon dioxide reached at 360-417-3532 or at • being poured into it." tom.caliis®peninsuladailynews. 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" o a p2 'E-4.4 - xa) " 7o7cl b°G " ` ' m y4 oc '''l41v • .0bA 'D'-. .z1 .c . P.- -, Et-'1 C2 00z � E ” " O 0 N4- 0 o .0 5 wC - EZ ++ m a +,f=+ .r.—, 0. „poy2 �? mO0Aa "It' o � C M G1 C omE a)>,� A a)-0 , 0, co • • 1 1 a R. • CO k g PI appe4 4 � Environmentalists' ,, ; ` ,sa 2 0 megawatts challenge in PA CONTINUED FROM Al "The physical electrons never leave the site: like move in PT "We look at it as an over- HAROLD NORLUND all mill site,"she said,"and Nippon mill manager By Tore CALL'S the production of power PENINSULA DAILY NEWS enables the mill to func- The Shoreline Hearings City Council. The council tion." Board has 180 days to make upheld the The second round of appeals for a bio- Harold NorIund, mill a decision after an appeal is month. permit last mass energy project in Port Angeles has manager,said Nippon would filed. Environmentalp begun,while opponents await a separate use the electricity it pro- state grou s hearing on an appeal filed in Novem- said by burning woody Online in August 2012 aid they plan to file an g her against a biomass project proposed in biomass. appeal of the environmental Port Townsend. "The physical electrons Norlund said the mill is assessment for the Nippon Six of the seven envi- ALSO... never leave the site," he still ordering equipment,and project with the state Pollu- ronmental groups that may study said- expects to have the facility hon Control Hearings Board PI lost an appeal of the But the mill also would August2012. in the spring. shoreline substantial I shows good online in develo mentpermit that I supplies of sell 20 megawatts worth of The groups appealing the Appealing the Port P biomass in renewable energy credits, Nippon permit are No Bio- Townsend Paper Corp.'s pro- the city of Port Angeles forests/A4 since it would be using that mass Burn,Port Townsend Posed biomass cogeneration gave Nippon Paper Indus- much less from the grid, AirWatchers,World Temper- Project are Port Townsend tries USA are taking their Norlund said. ate Rainforest Network, AirWatchers, No Biomass • case to the state Shoreline Hearings Board. Port Angeles resident Olympic Environmental Burn, World Temperate An appeal was filed Friday. Diana Somerville,a spokes- Council, Olympic Forest Rainforest Network, Olym- Five of those environmental groups filed woman for the groups,said Coalition and the state chap- plc Environmental Council an appeal with the state Pollution Control the mill should still have to ter of the Sierra Club. and Olympic Forest Coali- Hearings Board in November against a YmP proposed $55 million upgrade of the Port get the conditional-use per- The Center for Environ- tion. Townsend biomass facility, which is mit even if the electricity mental Policy,which is not expected to generate up to 24 megawatts of itself is not leaving the part of this appeal,joined power,which the facility could sell. null. the other groups to appeal reached rte 360-at7 3532aor at That appeal is scheduled to be heard "That's just a paperwork the shoreline substantial reachellis®peninsulad32 orwat June 2 and 3. shuffle,"she said. development permit to the com. The pollution hearings board has 90 days after the last hearing to make a deci- sion. Ecology permit for PT mill The action challenges a permit granted in October by the state Department of Ecology for the Port Townsend mill to con- struct the upgrade. The groups appealing the. Nippon pro- posal said the city erred by not requiring the mill to receive a conditional-use permit for its proposed $71 million cogeneration project. 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W> ao o asx � F� CC Ce ao� - • Report to BOH Jefferson County Public Health Community Health Services in South County February 2011 Community health services in South County are planned and delivered in response to these Public Health priorities: • Giving children a good start in life by strengthening support to families with children through prenatal and postpartum maternity services and the Women, Infant and Children (WIC) nutrition program. • Reducing the cost burden of health care in our community by decreasing unintended pregnancy rates through consistent access to family planning services. Data supporting priorities: • ACCEPTED CHILD ABUSE AND NEGLECT REFERRALS: The rate of accepted referrals in Quilcene/Brinnon decreased from 5.2 per 100 to 2.1 per 100 children from 2000-02 to 2006-08; rest of Jefferson County 5.1 per 100 to 4.5 per 100 children over same period'. • KINDERGARTEN CHILDREN WITH COMPLETE IMMUNIZATIONS: In the 2008-09 school year 63% of Quilcene/Brinnon kindergarten students had complete immunizations, 61% in the rest of Jefferson County2. • STUDENTS IN SPECIAL EDUCATION: Proportion of enrolled public school students in Special Education, Say 2010: Brinnon 16.1%, Chimacum 13.4%, Port Townsend 15.9% and Quilcene-12.8%3. • FIRST TRIMESTER PRENATAL CARE: Percent of pregnant women starting prenatal care in the 1st trimester in Quilcene/Brinnon statistically worse from 84% in 1992-94 to 60% in 2007-09; rest of Jefferson County statistically worse from 85% to 74% over the same period4. Jefferson County access to 1St trimester prenatal care lower among Medicaid-paid births 64% compared to non-Medicaid 86%5. • SMOKING DURING PREGNANCY: Percent of pregnant women smoking during pregnancy in Quilcene/Brinnon statistically unchanged but moving in the right direction from 31% in 1992-94 to 20% in 2007-09; rest of Jefferson County also moving in the right direction from 26% to 21% over the same period4. Jefferson County smoking during pregnancy in 2007-09 significantly higher among Medicaid-paid births 30% compared to non-Medicaid 8%5. • TEEN BIRTHS: Percent of all births to teens under age 20 in Quilcene/Brinnon significantly improved from 19% in 1992-94 to 9% in 2007-09 while rest of Jefferson County statistically unchanged from 11% to 9% over the same period4. Department of Social and Health Services,Risk and Protective Profile for Substance Abuse Prevention,July 2010. 2 Washington State Department of Health, Immunization Program ashington State Office of the Superintendent of Public Instruction, Washington State Report Card fiv ashington State Department of Health,Center for Health Statistics,Birth Statistics Database,Accessed in:Community Health Assessment Tool rst Steps Database,Characteristics of Jefferson County Women Who Gave Birth,DSHS Research and Data Analysis, 10/13/2010 JCPH Services in South County Report to BOH: February 2011 Page 1 LOW BIRTH WEIGHT: Percent of babies weighing less than 2500 grams at birth 3-5% since early 1990's in ilcene/Brinnon; 3-4% in rest of Jefferson County over the same period. In 2005-09, Jefferson County low birth weight 4% among Medicaid-paid births, 3% among non-Medicaid5. Specific goals in support of these priorities: • Monitor the rate and continue efforts to reduce the incidence of low birth weight infants. • Prevent and reduce prenatal exposure to substances. • Prevent injuries to infants and young children. • Prevent child neglect through education and support to parents. • Promote early learning and healthy development in infants and young children. • Educate parents about the impact of adverse childhood experiences. • Promote healthy nutrition choices for pregnant, post-partum, and breast-feeding women, and children under 5. • Assess childhood immunization rates for children served by Primary Care Clinics receiving State supplied vaccines. • Assure Family Planning Services are provided in community and accessible Target Populations for services: • South County low income families with children under age 5 • South County low income pregnant women • South County teens and low income women in need of family planning • Strategies to serve these targeted populations: Family Planning clinic: • located close to Quilcene High School so students can come in on pass and lunch break • offer Take Charge & Medicaid enrollment and clinical services for low income adults and for teens to access care with confidentiality • consistent weekly hours, drop in to improve access for teens and per community requests • contact and collaboration with school staff, counselor and nurse to improve access • outreach to community providers, churches and services such as the food bank and the school to increase awareness of Family Planning clinic • Scheduling Breast and Cervical cancer screenings and other family planning services WIC/Maternity Support Services clinic: • weekly hours, drop in to improve access for families with limited transportation • informal, open atmosphere with play area, clothing and book exchange to promote social connections and parenting support, to reduce isolation and parenting stress • collaboration with and referrals to other community services such as South County medical clinic, food bank, ECEAP preschool, mental health services, Dove House • developmental screening and referrals to Concerned Citizens, school district, and medical care • assistance with applications for Medicaid pregnancy coverage and children's medical • • screening of pregnant women for health risks such as depression, tobacco use, substance use, • dental health and referrals to Jefferson Health Care for prenatal care, Safe Harbor, JCPH Services in South County Report to BOH: February 2011 Page 2 Jefferson Mental Health, OlyCap dental clinic and other community providers • • education and screening of immunization adequacy of children under age 5 with referrals and facilitation to South County medical, Jefferson Health Care • education and referrals to pregnant and parenting families on infant/child safety issues such as Shaken Baby Syndrome prevention, SIDS prevention, second hand smoke exposure prevention, car seat safety • outreach to community providers and services such as the food bank and the school Discussion of goals and strategies: JCPH has offered targeted clinical services to low income families and women in need of family planning for many years. Strategies respond to community need and other provider/agency ability to adequately meet public health priorities. Example- JCPH has traditionally offered WIC and Maternity Support Services by appointment one day per month in both Quilcene and Brinnon. We had enthusiastic but inconsistent attendance of appointments. Mothers were interviewed about the barriers to making appointments and the responses were lack of transportation followed by lack of phone service. We instituted a one day a week drop-in clinic in Quilcene and our WIC enrollment increased by 40%. Families from Brinnon started preferring the Quilcene drop-in clinic so we stopped our monthly clinic in Brinnon. Example- JCPH used to be the sole provider of children's immunizations in South County. When Jefferson Health Care (JHC) started South County Medical Clinic we stopped direct administration and • supplied the clinic with vaccine. JCPH monitors vaccine rates of children in all of Jefferson County; South County Medical Clinic was immunizing few children: in 2005, 5 doses of children's vaccine were given. JHC decided to hire a part time LPN to focus on children's vaccine outreach and administration at South County Medical Clinic. Our role has been to supply vaccine, screen for immunization need, and refer families to South County Medical Clinic. This strategy of inter-agency collaboration has been highly successful with 390 doses delivered to children in 2010. JCPH clinic details Staffing: Wednesdays 10 AM to 2 PM, approximately 48 clinic days a year, 2 RNs or 1 RN and 1 Registered Dietitian Facility: provided rent free by Jefferson Health Care Utilities: paid for by Windermere Real Estate Clinic has no internet or janitorial services s JCPH Services in South County Report to BOH: February 2011 Page 3 010 Clinic Data Il IC Clients: • 91 total clients 1, b rw Infants under age 1, \wb�Vvim 5 Children age 1-5,40 '�hnai+ r { 1i 0 91 WIC Services: • 453 total contacts (251 WIC visits were recorded for check pick-ups) —..l -�� ". .,. _ .. . CD lD 1 xng s €t vim+ -3, rn o 202 Family Planning Services: • 50 total clients: 25 under age 20; 30 age 20 or older History of State supplied childhood vaccine in JHC South County clinic: • Good news! Increase in immunizations in JHC South county clinic with addition of LPN 1/2 day week in late 2008 400 .. ._ .. 300 —_ _ v o 200 -- --- tt 100 0 , - V LO0(0 LoP\ O¢P LOC) '• LOBO 'lOO- LPN added to staff JCPH Services in South County Report to BOH: February 2011 Page 4