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Home My WebLink About2011-March File Copy • Jefferson County Board of 3leaCth .agenda BVI inutes • rlarch 17, 2011 JEFFERSON COUNTY BOARD OF HEALTH March 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 February 17, 2011 Board of Health Meeting III. Public Comments IV. Old Business and Informational Items 1. Prevention Team Report 2. Letter to Washington State Federal Delegation • V. New Business 1. 2010 Public Health Performance Measures Report 2. 2011 Public Health Heroes Award Nominations 3. Influenza Update and Notifiable Conditions Reports 4. Mandatory Healthcare Worker Immunization 5. Legislative Update ADD VI. Activity Update VII. Agenda Planning Calendar: VIII. Next Scheduled Meeting: April 21, 2011 2:30—4:30 pm Jefferson County Public Health LetzutfL,Letsc -J -- the, e c o-, C�e r G5-w. C-Dyr,rim ��- JEFFERSON COUNTY BOARD OF HEALTH MINUTES Thursday, February 17, 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) Jill Buhler,Hospital Commissioner,District#2 Chair Kris Nelson called the meeting of the Jefferson County Board of Health to order at 2:34 pm. A quorum was present. Members Present: David Sullivan, John Austin, Roberta Frissell, Kristen Nelson, Sheila Westerman Members Excused: Phil Johnson and Jill Buhler Staff Present: Dr. Thomas Locke, Jean Baldwin, Julia Danskin APPROVAL OF AGENDA It was moved and seconded for approval of the agenda. The agenda was approved unanimously. APPROVAL OF MINUTES Member Austin moved to approve the minutes of the January 20,2011, Board of Health meeting. Member Russell seconded the motion,which carried unanimously. PUBLIC COMMENTS Mr. Thomas Brotherton, a resident of Quilcene, asked if it was cost-effective to keep the Quilcene clinic open or would it be more efficient to have those medical services provided by other medical clinics? He proposed changing to a voucher system for Quilcene residents to receive needed medical care. • Page I of 6 BOH Minutes February 17,2011 OLD BUSINESS and INFORMATIONAL ITEMS 111/ Letter to the Editor: American Journal of Public Health Ms. Baldwin reported that Dunia Faulx, who is working with Jefferson County Public Health (JCPH) as an AmeriCorp student, co-wrote a letter with four staff to the American Journal of Public Health regarding Adverse Childhood Events (ACES). The letter has been accepted for publication. Issue Brief: Responding to Vaccine-Hesitant Parents Dr. Locke updated the Board on a provider briefing prepared by the Seattle & King County Public Health on the issue of"vaccine-hesitant parents". The letter reviewed the history of Andrew Wakefield's 1996 article linking the MMR vaccine and autism and its subsequent determination to be fraudulent. The issue brief offers excellent advice to practitioners on how to counsel vaccine hesitant parents and to inform them that the alleged links between MMR and autism have been conclusively disproved. This letter was sent out to all providers in Jefferson County last week. Dr. Locke is hopeful that a bill currently before the Washington State legislature will make it mandatory for vaccine-hesitant parents to receive risk-benefit counseling by a licensed health care provider before they can exempt their children from school entry vaccination requirements. Letters to Legislative Delegation: Medication Take Back and Vaccine Exemption • Letters to legislators expressing the Jefferson County Board of Health's support for the medication take-back program and the vaccine exemption were provided in the packet. NEW BUSINESS Community Health Services in South County Quen Zorrah presented a report of Community Health Services in South County focusing on public health priorities and the data supporting those priorities. The services in South County are targeted services based on the needs of two different populations: Giving children a healthy start in life through Women, Infants, and Children (WIC) and Maternity Support Services and reducing the cost burden of health care in our community by decreasing the number of unintended pregnancies through consistent family planning services. Ms. Zorrah reported that the data collected has shown improvements in areas such as reduced child abuse referrals, lower teen birth rates, and decreased smoking during pregnancy. There are also areas which need continued work such as first trimester prenatal care. Ms. Zorrah listed the goals to support these priorities and the target population for these services. There was discussion on the importance of WIC services in South County because JCPH is the only provider of WIC in Jefferson County. Not only does WIC provide food vouchers but also provides medical screening, developmental screening, screening of pregnant women, education • Page 2 of 6 BOH Minutes February 17,2011 for pregnant women and parenting families and referrals to other community services. Weekly drop in hours in South County have improved the enrollment in WIC. Margie Boyd, Jefferson County Public Health Nurse, commented on the community health services in South County. Ms. Boyd expressed her concern that the Jefferson County Public Health Clinic in South County is providing services such as WIC that are not and cannot be provided by other clinics. They are seeing high risk patients who do not have the means to travel to another city for services or prescriptions, so without this clinic they simply would not be receiving the care they need. Ms. Boyd maintains that this clinic is serving a different population with different needs than other medical clinics in the south county area. Ms. Baldwin pointed out that all other services that have been provided in South County by other agencies are no longer there. JCPH and Jefferson Health Care are last of the original five service providers that remain in South County. Member Nelson raised the question whether signage would increase the amount of people using the clinic. Ms. Zorrah responded that they have relied on word of mouth, community referrals, an ad in the Leader and posting fliers. This is a clinic targeted at people needing family planning, pregnant women, and children under age 5. Board of Health Guidelines for Adoption of Policies, Procedures, and Protocols Dr. Locke stated that Jefferson County Public Health has been going through a standards review • process over the past several months. Part of this has involved the review and updating of current policies. In addition to BOH policies, there are also administrative policies and various procedures and protocols. Dr. Locke clarified that the only policies that the Board has to formally review and approve are those that have to do with the Boards authorities and responsibilities. The role the Board wants to take in the development of other types of policies, procedures, and protocols is open for discussion. Member Westerman asked for an explanation of the difference between policy and a protocol. Dr. Locke defined policy as a governing board's statement of intent on how to carry out its specific powers and duties. Dr. Locke defined a protocol as a standardized sequence of actions that are performed to achieve a particular outcome. He stated that protocols typically based on current science and seek to improve quality be assuring best practices are followed in performing specific activities. Finally, he defined a guideline as an educational document that explains and clarifies specific issues. Member Nelson requested a clarification of the title of the document being Policies, Procedures and Protocols, because the explanation was on Policies, Protocols and Guidelines. Dr. Locke agreed and suggested that a better title for this document would be Guideline for Adoption of Policies, Protocols and Guidelines. Member Frissell moved to adopt Guideline for Adoption of Policies, Protocols and Guidelines. Member Westerman seconded the motion. The motion was approved • unanimously. Page 3 of 6 BOH Minutes February 17,2011 JCPH Strategic Planning and Quality Improvements: Past, Present and Future Ms. Baldwin presented the materials and graphs that were included in the packet on the Past, Present and Future of the Jefferson County Public Health Strategic Planning and Quality Improvement. Ms. Baldwin reviewed the JCPH Planning History Graph,which shows the who, what,when and where of different trainings and models used in the past. Ms. Baldwin described how the staff has been reorganized into teams, with a lead staff for each team. Teams are based on shared work, performance based budgeting and the end of the year performance measures. There are trainings for the leads so that they can become technical experts in their areas of responsibility. Ms. Baldwin addressed the Mission Statement. She pointed out that in 2004 and 2006 priorities of JCPH were recommended by BOH to be based on the State Standards Review. Those standards are; Assessment of local needs and health indicators, Communicable Disease Prevention and Control, Environmental Health and Safety, Public Policy Development. Ms. Baldwin in 2008 looking at the JCPH personnel roster, found a large percentage of the staff that would retire within the next 10 years. Team leaders and staff met to discuss strategies for JCPH to mentor internal leadership, develop regional partnerships, and provide services by using the concept maps. The goals teams identified as most important were brought back to the Board. In 2009 the C-mapping JCPH strategic goals were discussed, and the list of the steps that are being taken to achieve these goals. A copy of the JCPH Strategic Goals graph was provided in the packet for reference. Next Ms. Baldwin addressed what is being done presently to achieve these goals in the time of a continuing recession. She explained the process teams use to build performance measures and quality review into the County budget process. Teams also must use a Quality Assurance approach while they respond to emergencies, identified problems or performance measures deficiencies are addressed with a Plan-Do-Study-Act model. The JCPH Plan-Do-Study-Act model describes how a problem is approached and how JCPH will evaluate the effectiveness of this approach. A copy of a sample Plan-Do-Study-Act project was provided in the packet to show how a Chlamydia outbreak problem is reviewed by two technical nursing teams, what will be done in the future to resolve the issue and review the outcomes. Finally Dr. Locke addressed the future of JCPH continuing 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. He stressed the importance of a Community Health Improvement Plan (CHIP)by doing strategic planning with hospitals and medical providers to identify the gaps in the community's needs, and develop a plan to address the gaps. Dr. Locke stated an option is to do strategic planning in the context of a broader community partnership. Ms. Baldwin stated the unknowns of legislative action will change state and federal funding make long term planning difficult. The BOH must monitor the level of expertise and funding needed to have the Health Department and their different programs maintain quality. Ms. Baldwin recommended not doing a new strategic plan in this uncertain environment. She does • Page 4 of 6 BOH Minutes February 17,2011 r feel that it is important to prioritize the services, and maintain a level of expertise while engaging 40 other community partners when looking at these priorities. WA State 2010-11 Supplemental Budget Update Dr. Locke stated that Legislative passage of the supplemental budget for the current fiscal year has not yet occurred. Ms. Baldwin stated that there are many programs whose funding levels are still uncertain. Legislative action is expected in the near future. Legislative Update Dr. Locke reported that a bill that expands the powers and duties of the local Boards of Health to allow Boards to assess fees to fund operation and maintenance programs for onsite sewage systems has been introduced. Mr. Whitford addressed other Environmental Health bills. The first being a septic utility which would take the place of existing funding fees, which he explained is a more stable funding source. The second bill addressed is that onsite inspectors must be certified through Department of Licensing to inspect septic systems, there are several health jurisdictions that are not in favor of this program so there is a compromise bill that reduces fees, reduces continuing education requirements, but keeps the program in place. Another bill allows members of the restaurant association to do their own food card testing. Environmental Health Directors are against this bill. Dr. Locke stated that the Board has already taken a stand on the two important bills; the medication take-back bill and the vaccine exemption bill. • Influenza Update Dr. Locke reported that influenza activity has been slowly increasing in Washington State for the past several weeks. Jefferson Healthcare and Olympic Medical Center now have policies in place that require unvaccinated health care workers to wear masks when influenza is circulating in the community. One of the responsibilities of the local health officer under this new policy is to advise the respective hospitals when influenza activity reaches the point where masks should be worn and when those masks are no longer necessary. That point has not yet been reached but is likely in the next week or two. ACTIVITY UPDATE Data Steering Committee, February 24,2011: Health Care Access Ms. Baldwin announced that the Data Steering Committee will be meeting next Thursday February 24, 2011. She has released the health care access data to all of the committees early so that they can be sued for program changes. Next module is death and birth numbers and birth outcome. 1111 Page 5 of 6 BOH Minutes February 17,2011 AGENDA PLANNING CALENDAR Board of Health Meeting Calendar for 2011 The next scheduled BOH meeting will be held Thursday, March 17, 2011 from 2:30-4:30 pm at the Health Department, 615 Sheridan Street, Port Townsend, WA. Ms. Baldwin stated they need to work on performance measures for the next meeting. ADJOURNMENT Chair Nelson adjourned the meeting at 4:30 pm. JEFFERSON COUNTY BOARD OF HEALTH Excused Kristen Nelson, Chair Phil Johnson, Vice-Chair John Austin, Member David Sullivan, Member S Excused Roberta Frissell, Member Jill Buhler, Member Sheila Westerman, Member • Page 6 of 6 BOH Minutes February 17,2011 JEFFERSON COUNTY BOARD OF HEALTH • MINUTES Thursday, February 17, 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) Jill Buhler,Hospital Commissioner,District#2 Chair Kris Nelson called the meeting of the Jefferson County Board of Health to order at 2:34 pm. A quorum was present. Members Present: David Sullivan, John Austin, Roberta Frissell, Kristen Nelson, Sheila Westerman Members Excused: Phil Johnson and Jill Buhler • Staff Present: Dr. Thomas Locke, Jean Baldwin, Julia Danskin APPROVAL OF AGENDA It was moved and seconded for approval of the agenda. The agenda was approved unanimously. APPROVAL OF MINUTES Member Austin moved to approve the minutes of the January 20, 2011, Board of Health meeting. Member Russell seconded the motion,which carried unanimously. PUBLIC COMMENTS Mr. Thomas Brotherton, a resident of Quilcene, asked if it was cost-effective to keep the Quilcene clinic open or would it be more efficient to have those medical services provided by other medical clinics? He proposed changing to a voucher system for Quilcene residents to receive needed medical care. S Page 1 of 6 BOH Minutes February 17,2011 OLD BUSINESS and INFORMATIONAL ITEMS Letter to the Editor: American Journal of Public Health Ms. Baldwin reported that Dunia Faulx,who is working with Jefferson County Public Health (JCPH) as an AmeriCorp student, co-wrote a letter with four staff to the American Journal of Public Health regarding Adverse Childhood Events (ACES). The letter has been accepted for publication. Issue Brief: Responding to Vaccine-Hesitant Parents Dr. Locke updated the Board on a provider briefing prepared by the Seattle & King County Public Health on the issue of"vaccine-hesitant parents". The letter reviewed the history of Andrew Wakefield's 1996 article linking the MMR vaccine and autism and its subsequent determination to be fraudulent. The issue brief offers excellent advice to practitioners on how to counsel vaccine hesitant parents and to inform them that the alleged links between MMR and autism have been conclusively disproved. This letter was sent out to all providers in Jefferson County last week. Dr. Locke is hopeful that a bill currently before the Washington State legislature will make it mandatory for vaccine-hesitant parents to receive risk-benefit counseling by a licensed health care provider before they can exempt their children from school entry vaccination requirements. Letters to Legislative Delegation: Medication Take Back and Vaccine Exemption • Letters to legislators expressing the Jefferson County Board of Health's support for the medication take-back program and the vaccine exemption were provided in the packet. NEW BUSINESS Community Health Services in South County Quen Zorrah presented a report of Community Health Services in South County focusing on public health priorities and the data supporting those priorities. The services in South County are targeted services based on the needs of two different populations: Giving children a healthy start in life through Women, Infants, and Children (WIC) and Maternity Support Services and reducing the cost burden of health care in our community by decreasing the number of unintended pregnancies through consistent family planning services. Ms. Zorrah reported that the data collected has shown improvements in areas such as reduced child abuse referrals, lower teen birth rates, and decreased smoking during pregnancy. There are also areas which need continued work such as first trimester prenatal care. Ms. Zorrah listed the goals to support these priorities and the target population for these services. There was discussion on the importance of WIC services in South County because JCPH is the only provider of WIC in Jefferson County. Not only does WIC provide food vouchers but also provides medical screening, developmental screening, screening of pregnant women, education Page 2 of 6 BOH Minutes February 17,2011 for pregnant women and parenting families and referrals to other community services. Weekly • drop in hours in South County have improved the enrollment in WIC. Margie Boyd, Jefferson County Public Health Nurse, commented on the community health services in South County. Ms. Boyd expressed her concern that the Jefferson County Public Health Clinic in South County is providing services such as WIC that are not and cannot be provided by other clinics. They are seeing high risk patients who do not have the means to travel to another city for services or prescriptions, so without this clinic they simply would not be receiving the care they need. Ms. Boyd maintains that this clinic is serving a different population with different needs than other medical clinics in the south county area. Ms. Baldwin pointed out that all other services that have been provided in South County by other agencies are no longer there. JCPH and Jefferson Health Care are last of the original five service providers that remain in South County. Member Nelson raised the question whether signage would increase the amount of people using the clinic. Ms. Zorrah responded that they have relied on word of mouth, community referrals, an ad in the Leader and posting fliers. This is a clinic targeted at people needing family planning, pregnant women, and children under age 5. Board of Health Guidelines for Adoption of Policies, Procedures, and Protocols Dr. Locke stated that Jefferson County Public Health has been going through a standards review • process over the past several months. Part of this has involved the review and updating of current policies. In addition to BOH policies, there are also administrative policies and various procedures and protocols. Dr. Locke clarified that the only policies that the Board has to formally review and approve are those that have to do with the Boards authorities and responsibilities. The role the Board wants to take in the development of other types of policies, procedures, and protocols is open for discussion. Member Westerman asked for an explanation of the difference between policy and a protocol. Dr. Locke defined policy as a governing board's statement of intent on how to carry out its specific powers and duties. Dr. Locke defined a protocol as a standardized sequence of actions that are performed to achieve a particular outcome. He stated that protocols typically based on current science and seek to improve quality be assuring best practices are followed in performing specific activities. Finally, he defined a guideline as an educational document that explains and clarifies specific issues. Member Nelson requested a clarification of the title of the document being Policies, Procedures and Protocols, because the explanation was on Policies, Protocols and Guidelines. Dr. Locke agreed and suggested that a better title for this document would be Guideline for Adoption of Policies, Protocols and Guidelines. Member Frissell moved to adopt Guideline for Adoption of Policies, Protocols and Guidelines. Member Westerman seconded the motion. The motion was approved unanimously. Page 3 of 6 BOH Minutes February 17,201 I • JCPH Strategic Planning and Quality Improvements: Past, Present and Future • Ms. Baldwin presented the materials and graphs that were included in the packet on the Past, Present and Future of the Jefferson County Public Health Strategic Planning and Quality Improvement. Ms. Baldwin reviewed the JCPH Planning History Graph, which shows the who, what, when and where of different trainings and models used in the past. Ms. Baldwin described how the staff has been reorganized into teams, with a lead staff for each team. Teams are based on shared work, performance based budgeting and the end of the year performance measures. There are trainings for the leads so that they can become technical experts in their areas of responsibility. Ms. Baldwin addressed the Mission Statement. She pointed out that in 2004 and 2006 priorities of JCPH were recommended by BOH to be based on the State Standards Review. Those standards are; Assessment of local needs and health indicators, Communicable Disease Prevention and Control, Environmental Health and Safety, Public Policy Development. Ms. Baldwin in 2008 looking at the JCPH personnel roster, found a large percentage of the staff that would retire within the next 10 years. Team leaders and staff met to discuss strategies for JCPH to mentor internal leadership, develop regional partnerships, and provide services by using the concept maps. The goals teams identified as most important were brought back to the Board. In 2009 the C-mapping JCPH strategic goals were discussed, and the list of the steps that are being taken to achieve these goals. A copy of the JCPH Strategic Goals graph was provided in the packet for reference. • Next Ms. Baldwin addressed what is being done presently to achieve these goals in the time of a continuing recession. She explained the process teams use to build performance measures and quality review into the County budget process. Teams also must use a Quality Assurance approach while they respond to emergencies, identified problems or performance measures deficiencies are addressed with a Plan-Do-Study-Act model. The JCPH Plan-Do-Study-Act model describes how a problem is approached and how JCPH will evaluate the effectiveness of this approach. A copy of a sample Plan-Do-Study-Act project was provided in the packet to show how a Chlamydia outbreak problem is reviewed by two technical nursing teams, what will be done in the future to resolve the issue and review the outcomes. Finally Dr. Locke addressed the future of JCPH continuing 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. He stressed the importance of a Community Health Improvement Plan (CHIP) by doing strategic planning with hospitals and medical providers to identify the gaps in the community's needs, and develop a plan to address the gaps. Dr. Locke stated an option is to do strategic planning in the context of a broader community partnership. Ms. Baldwin stated the unknowns of legislative action will change state and federal funding make long term planning difficult. The BOH must monitor the level of expertise and funding needed to have the Health Department and their different programs maintain quality. Ms. Baldwin recommended not doing a new strategic plan in this uncertain environment. She does • Page 4 of 6 BOH Minutes February 17,2011 feel that it is important to prioritize the services, and maintain a level of expertise while engaging • other community partners when looking at these priorities. WA State 2010-11 Supplemental Budget Update Dr. Locke stated that Legislative passage of the supplemental budget for the current fiscal year has not yet occurred. Ms. Baldwin stated that there are many programs whose funding levels are still uncertain. Legislative action is expected in the near future. Legislative Update Dr. Locke reported that a bill that expands the powers and duties of the local Boards of Health to allow Boards to assess fees to fund operation and maintenance programs for onsite sewage systems has been introduced. Mr. Whitford addressed other Environmental Health bills. The first being a septic utility which would take the place of existing funding fees, which he explained is a more stable funding source. The second bill addressed is that onsite inspectors must be certified through Department of Licensing to inspect septic systems, there are several health jurisdictions that are not in favor of this program so there is a compromise bill that reduces fees, reduces continuing education requirements, but keeps the program in place. Another bill allows members of the restaurant association to do their own food card testing. Environmental Health Directors are against this bill. Dr. Locke stated that the Board has already taken a stand on the two important bills; the medication take-back bill and the vaccine exemption bill. • Influenza Update Dr. Locke reported that influenza activity has been slowly increasing in Washington State for the past several weeks. Jefferson Healthcare and Olympic Medical Center now have policies in place that require unvaccinated health care workers to wear masks when influenza is circulating in the community. One of the responsibilities of the local health officer under this new policy is to advise the respective hospitals when influenza activity reaches the point where masks should be worn and when those masks are no longer necessary. That point has not yet been reached but is likely in the next week or two. ACTIVITY UPDATE Data Steering Committee, February 24, 2011: Health Care Access Ms. Baldwin announced that the Data Steering Committee will be meeting next Thursday February 24, 2011. She has released the health care access data to all of the committees early so that they can be sued for program changes. Next module is death and birth numbers and birth outcome. • Page 5 of 6 BOH Minutes February 17,201 1 AGENDA PLANNING CALENDAR III Board of Health Meeting Calendar for 2011 The next scheduled BOH meeting will be held Thursday, March 17, 2011 from 2:30-4:30 pm at the Health Department, 615 Sheridan Street, Port Townsend, WA. Ms. Baldwin stated they need to work on performance measures for the next meeting. ADJOURNMENT Chair Nelson adjourned the meeting at 4:30 pm. JEFFE ' ON COUNTY B 1 A' I OF HEALTH YExcused Kristen Nelson, Chair Phil Johnson, Vice-Chair it et„� ,v,. Jo. n Austin, Member David Sul ivan, Member • ()/4„/,,,,,,g ..,ael Excused Roberta Frissell, Member Jill Buhler, Member (,,,A Li__ w il4e,t/i.\,t ,____._ Sheila Westerman, Member • . • Page 6 of 6 BOH Minutes February 17,2011 • Board of.9 Leath 0C Business & Informational Items Agenda Item # 117, i. � Prevention beam Report Xlarc( 17, 2011 Jefferson County Board of Health — Prevention Team Report March 17, 2010 • April is National Child Abuse Prevention and Sexual Assault Awareness Month. Jefferson County Public Health and the Jefferson County Community Network are partnering to present the 4th annual "Our Kids: Our Business," a social awareness and prevention campaign. Many community partners are collaborating to highlight the things we can do as individuals, Our organizations, agencies, and businesses to prevent child abuse Kids: and sexual assault. It is our community's commitment to protect and nurture our children. Our Business No one person can do everything, But everyone can do something, and Together we can create change for the better. Also Sponsored by: City of Port Townsend —All Departments, Jefferson County —All Departments, the Board of Health, Dove House Advocacy Services, Jefferson County Historic Society, Jefferson County METH Action Team, Jefferson County 4-H, Jefferson County YMCA, Developmental Disabilities Advisory Board, the Boiler Room, Safe Harbor Recovery Center, Substance Abuse Advisory Board, Jefferson Teen Center, Department of Children and Family Services/Children's Administration, Jumping Mouse Children's Center, Jefferson Mental Health Services, Jefferson Community School, Jefferson NAMI, makewaves!, Sunfield Farm, OLYCAP, Brinnon School District, Chimacum School District, Port Townsend School District, Quilcene School District, • DBHR, DSHS, PT Kiwanis, The Rose Theatre, the Elks Lodge and the Port Townsend & Jefferson County Leader and many, many more businesses, agencies and service clubs. Activities will be listed http://ieffcocommunitynetwork.orq/okob and in the newspaper Kelly Matlock, Prevention Specialist, 379-4476 THE PORT TOWNSEND PUBLIC LIBRARY TEEN COMMUNITY READ The Port Townsend Public Library was awarded a two year Paul Allen Family Foundation Grant for a Teen Community Read. For the spring of 2011 the Teen Community Read book will be 13 Reasons Why by Jay Asher. While the book deals with the issue of teen suicide, it has a positive and hopeful message. The book has resonated with thousands of teens and the author's website site boasts over 13,000 comments from young people around the world. Many community activities, ranging from book discussions, visual art workshops, a theatre forum, and poetry workshops, have been planned for Port Townsend High School and for the larger community. Each Port Townsend High School student will receive a copy of the book with a list of the activities related to the book, a copy of the youth HELP CARD, and a list of community counselors who are willing to talk to teens about the book, suicide or other related issues. The Prevention Team with Jefferson County Public Health assisted the Port Townsend Public Library with research and data for the grant application, arranged for presentations and trainings for the PTHS staff and students and for community members by the Youth Suicide Prevention Program, and is assisting with the facilitation of many of the community activities. • The Teen Community Read and its activities will be a part of the "Our Kids: Our Business" 2011 campaign. For more information about the Teen Community Read contact the Port Townsend Public Library at ptpubliclibrary.org or call 360-385-3181. March 10, 2011 • Board of Cealth Odd Business & Informational ltems .agenda Item # rV., 2 • Letter to /Washington State Federal Delegation N(arch 17, 2011 i • s �I'I • STATE O WASHINGTON February 23,2011 Dear Members of the Washington State Federal Delegation: Over the weekend, the U.S. House of Representatives passed H.R. 1, a continuing resolution that would fund the federal government through the remainder of the federal fiscal year. H.R. 1 would have drastic adverse impacts on state and local government programs and services. We are acutely aware of the need to address the federal debt and deficit. As our state and local governments have struggled with reductions in our budgets over the last few years,we have made the difficult choices you face. Such choices involve careful balancing of current needs against anticipated revenue,but these choices must also be tempered by the impact of reductions on our communities, citizens,and businesses. As you know, approximately one-third of the spending cuts in H.R. 1 reduce funding for state and local governments. For the state of Washington, the spending cuts enacted by the House of Representatives would result in more than one billion dollars of reductions in funding in areas such as education, health care and in transportation infrastructure. We certainly understand the shared sacrifice that is required to overcome our current obstacles, but reductions on this scale make already • difficult state and local budget problems that much more challenging. Multiplied across the states -at least 48 of which face shortfalls this year these reductions will have a devastating impact on the economic recovery of the nation. While states stand ready to help with the challenges you face, the cuts imposed by H.R. 1 have to be implemented by September 30 of this year. To cut these amounts in such a short time would result in a tremendous reduction in essential state and local programs and services and the loss of thousands of jobs in both the public and private sector. Again, we are acutely aware of the pressure you are under to reduce the nation's debt and deficit. As you undertake that effort,we urge you to be mindful of the impacts of the reductions you make on state and local governments. We welcome the opportunity to work together to identify how all levels of government can better manage programs on behalf of the shared constituencies we serve. Sincerely, f';'V f Christine O. Gregoire Governor kcttkyl Kathy Turner Paul Pearce • President,Association of Washington Cities Vice President, Washington State Association of Board of Directors, and Mayor of Puyallup Counties, and Skamania County Commissioner • Board of 3Cealth Netiv Business Agenda Item # 17., 1 2010 Public Wealth • Performance .Measures Report iVLarch 17, 2011 • ``! JEFFERSON COUNTY PUBLIC HEALTH 615 Sheridan Street • Port Townsend •Washington • 98368 " '" www.jeffersoncountypublichealth.org 2010 Public Health Performance Measures Reports Board of Health March 17, 2010 Reviewing Performance Measures annually is part of Jefferson County Public Health Quality Improvement process. The Annual Reports provided to the Board of Health are a Local Public Health Standard in Washington State. The 2010 Performance Measures were originally written for the 2010 Budget Planning in the summer 2009. Each Report in the packet for the March 17, 2011 Board of Health Meeting has an additional section called Study/Analysis. This section has been written by program staff as they reviewed the Actual 2010 Performance Indicators. The Public Health Performance Measures are divided into groups Community Health Communicable Disease Prevention and Control including Tuberculosis treatment and prevention Immunizations: Children/Adult/Travelers Sexually Transmitted Disease Public Health Emergency Response and Preparedness HIV and Syringe Exchange Program Family Health Maternal Child Health Federal Block Grant Maternity Support Services and Infant Case Management S Nurse Family Partnership WIC—Women, Infant, Children Federal Nutrition Program Children with Special Health Care Needs Child Protective Services Contracts Targeted Clinical Health Services Family Planning Clinic School Based Health Clinic Breast and Cervical Health Program Foot Care Population and Prevention Services Drug and Alcohol Prevention Program Tobacco Prevention Program School Health Services Oral Health Childcare Health and Safety Environmental Health On Site Sewage (OSS) and Operation and Monitoring (O&M) Food Safety Solid and Hazardous Waste Water Quality Drinking Water Administration March 10, 2010 • COMMUNITY HEALTH ( ENVIRONMENTAL HEALTH DEVELOPMENTAL DISABILITIES PUBLICt. WATER QUALITY MAIN: (360) 385-9400 ALWAYS WORIONG FOR A SAFER AND MAIN: (360) 385-9444 FAX: (360) 385-9401 HEALTHIER COMMUNITY FAX: (360) 379-4487 Jefferson County Public Health — Performance Measures 2010 - Report • COMMUNICABLE DISEASE PROGRAMS: Tuberculosis, Communicable Disease, Immunizations, Travelers Immunizations, Sexually Transmitted Disease, HIV, Syringe Exchange Program. MISSION: The purpose of the Communicable Disease Health program is to protect Jefferson County residents from serious communicable diseases by providing disease surveillance, investigation and reporting, along with education, screening, treatment and immunization services. The program interacts with community members, medical providers, the Washington State Department of Health, Region 2 Emergency Management partners and other agencies while working toward this purpose. GOALS FOR 2010: 1. Maintain the low rates of active TB in Jefferson County. (TB) 2. Timely investigation of reportable conditions. (CD) 3. Medical providers will be informed about current communicable disease trends and new communicable disease control recommendations. (CD) 4. Support universal access to vaccines for all children. (Imm) 5. Continue to support immunization registry in Jefferson County, promoting use by all immunization providers. (Imm) 6. Assess childhood immunization rates for children served by Primary Care Clinics receiving State supplied vaccines. (Imm) 7. The Family Planning and STD clinics will assist in controlling Chlamydia transmission in Jefferson County. (STD) • 8. Federally funded HIV testing and counseling clinic resources are focused on persons at risk for HIV infection. (HIV) 9. Prevent the spread of blood borne communicable diseases among injecting drug users and their partners. (SEP) 10. Annual report to BOH for CD, TB, Immunization Programs. (CD, TB, STD, Imm) 11. Maintain and enhance Public Health Emergency Preparedness and Response (PHEPR) capacity. OBJECTIVES (INTERVENTIONS) FOR 2010: 1. Encourage appropriate screening and treatment for latent TB infection. (TB) 2. Develop & update protocols as needed for investigation of notifiable conditions using electronic reporting systems, Public Health Issue Management System (PHIMS), PHIMS-STD, and Public Health Reporting of Electronic Data(PHRED). (CD, STD) 3. Provide updates, outreach and training to providers about local, state and national communicable disease outbreaks and disease control recommendations. Provide reminders about reporting notifiable conditions and using the Regional Duty Officer for after hours contact. (CD) 4. Maintain an efficient system for supplying vaccine recommendations and up-dates to private Health Care Providers in Jefferson County, including training for ordering vaccines through the Vaccine Ordering Module (VOM) in the Child Profile system. (Imm) 5. Continue to provide private Health Care Providers support and education on the Child Profile Immunization Registry. (Imm) 6. Perform an assessment of childhood immunization rates for 25% of clinics receiving State supplied vaccines and Vaccines for Childern Program QA assessments in clinics, as required by DOH. (Imm) IP7. Women seen in Family Planning clinic who are at higher risk for Chlamydia(age 24 and under) will be screened for Chlamydia annually. (STD) 1 of 5 I 8. 80%of clients who receive HIV testing through the Washington State Public Health Lab will be high 1' risk. (HIV) 9. Promote utilization of syringe exchange program services. (SEP) 10. Develop and update regional Public Health Emergency Preparedness and Response Plan, coordinating• with Region II partners Clallam and Kitsap Health Departments, local emergency response agencies, Jefferson Healthcare, local health care providers and agencies. (PHEPR) PERFORMANCE INDICATORS 2008 2009 2010 2010 Actual Actual Planned Actual (TB)Number of clients started on preventive therapy for 3 1 3 2 latent TB infection (CD)Number of communicable disease reports confirmed, 164 123 90 132 interventions applied and processed for reporting to the State (CD)Number of alerts/updates/newsletters faxed or mailed 13 24 10 13 to providers about communicable disease outbreaks or other urgent public health information _ _ (Imm)Number of doses of publicly funded vaccine, 5,167 6,100 4,000 5,389 administered by private health care providers and Public Not Not Health clinics, supplied and monitored through Public including including H1N1 H1N1 Heath's immunization program (Imm)Number of visits to clinics to provide vaccine 6 13 6 8 education, updates and technical support for clinic staff (Imm)Number of providers trained in VOM, vaccine New for Module 4 Module ordering and receiving module through Child Profile 2009 remains in remains indevelopment development", (Imm)Number of providers participating in the statewide 6 5 6 5 Child Profile Immunization Registry (Imm)Number of Jefferson County children <6 with 1 or 88% 90% 88% 91% more immunizations in Child Profile system (Imm)Number of Jefferson County children <6 with 2 or 82% 86% 82% 87% more immunizations in Child Profile system _ (Imm)Number of clinic site visits,to assess childhood 1 1 2 2 immunization rates in clinic patients and/or do VFC Program Quality Assessment (STD) Assess total# and % of female FP clinic clients at New for New for Assess 379 baseline. . risk for Chlamydia(age 24 and under) screened for 2010. 49.9% Chlamydia, includes exam visits and non-exam visits. (HIV)Number of persons counseled and tested for HIV DOH Lab:73 DOH Lab:31 90 DOH Lab:38 Quest Lab:52 Quest Lab:64 Quest Lab:69 infection Total: 125 _ Total:95 Total: 107 (HIV) Percent of persons tested for HIV infection through 90% 95% 80% 95% the Public Health Lab that were in high-risk category (SEP)Number of visits to SEP 70 65 50 81 (SEP)Number of syringes exchanged 21,330 14,044 15,000 9,156 (PHEPR)Develop and update Public Health Emergency 1 1 1 1 Preparedness and Response Plan IP 2 of 5 f SUMMARY OF KEY FUNDING/SERVICE ISSUES (from Plan written 7/2009 for 2010 budget): JCPH CD programs address locally identified and defined local public health problems. Communicable disease prevention is a locally funded program, county milage was returned from the state to counties for TB • control. Immunization funds from the state have been primarily in the form of vaccine, this vaccine is provided to primary care clinics that care for children. County funding provides a professional staff that prevent, identify and respond to disease outbreaks and immunization staff that work with the hospital, health care providers, the schools and local groups sponsoring trips abroad for students. Immunization staff provides routine immunization clinics and international travelers clinics. Substantial staff time is spent on responding to public requests for information about communicable diseases and screening for reportable illnesses in the process. The CD team continues to work on strengthening the notifiable conditions reporting system through outreach to the Jefferson Healthcare lab, ER and local health care providers. Increased funding was received in 2008 and 2009 from the Washington State Department of Health (DOH), specifically for Communicable Disease surveillance and improving immunization uptake in children. Future funding will depend on State Legislative decisions. (See 2010 analysis). In May 2010 the Washington State Universal Vaccines for Children (VFC) Distribution system will change to one in which children with private insurance will not qualify for State supplied vaccine. This will require clinics to stock a privately purchased supply of all pediatric vaccines, and screening each child to determine which vaccine type is appropriate for them. This will affect JCPH, Jefferson Healthcare and the five clinics currently administering State supplied vaccines. JCPH Immunization Program staff will continue the training that began in 2009 on screening every child for VFC eligibility and ordering and tracking separate inventories of VFC vaccine and privately purchased vaccine and reporting doses of VFC vaccine administered. (See 2010 analysis). The Family Planning and STD clinics follow the Center for Disease Control's STD screening • recommendations for the high risk age groups. The Family Planning and CD program staff will continue to explore ways to assure appropriate screening and screening data collection. HIV services are funded from the state and federal government to provide basic communicable disease prevention, HIV testing and counseling of high-risk community members, partner notification and focused high-risk interventions. The syringe exchange program success is not easily measured in disease numbers but the number of clients seen and syringes exchanged reflects the disease transmission prevention capacity of this program. The world wide spread of the novel H 1 N 1 Influenza strain will require increased influenza season response capacity during the 2009/2010 flu season. This is predicted to involve immunization clinics for target groups (not yet specified)to deliver two doses of the vaccine that is currently being developed. This will require coordination with our community partners including Jefferson Healthcare, clinics and the schools. The influenza season will likely require outbreak control using community mitigation strategies discussed in our Pandemic Influenza Plan. This will include increased community education efforts with many stake holder groups. The Notifiable Conditions reporting work load will be increased through out the flu season. We expect a small amount of funding to assist with this work, but not enough to cover the cost of staff time required for this response. We may need to reassign staff from other JCPH programs to assist with outbreak response, in which case the services for which they would normally be able to bill will be suspended and these funds will not be coming in. Federal funding originally for developing capacity to respond to bioterrorism threats is now for all hazards ipemergency response. Response capacity is developed in coordination with Region 2 PHEPR partners Kitsap and Clallam Counties, our local emergency response agencies, Jefferson Healthcare and other health care providers. For 2010 projects involve participating in drills to test and update the appendices and procedures 3 of 5 • that go with the local Public Health Emergency Preparedness and Response Plan, including the Strategic National Stockpile plan and the Pandemic Flu plan. Public Health staff have been trained in and use National Incident Management System protocols during communicable disease outbreaks. The roles, responsibilities and training have been invaluable for managing communicable disease outbreaks. JCPH participates in the Regional Duty Officer 24/7 contact system for Public Health with Kitsap and Clallam Counties' staff, responding to after hours calls and triaging them to the appropriate Public Health professional if necessary. This allows JCPH to share call time and standardizes regional response to Public Health issues. Federal funding for emergency preparedness activities decreased in 2009 and is expected to decrease more in 2010. Decreased funding for any program would result in scaling back on services. The Board of Health would be involved in deciding which services would be impacted. 2010 STUDY/ANALYSIS OF RESULTS: Communicable Disease The Communicable Disease team shares health alerts and important updates with Jefferson Healthcare and the medical providers by fax and email. A new fax system for collecting notifiable conditions reporting information from providers was initiated in the fall of 2009 to assist in timely reporting from the providers. This system worked well in 2010, decreasing the time required for CD team nurses in obtaining information needed for investigation of reportable diseases. Increased funding was received in 2008 and 2009 from the Washington State Department of Health (DOH), specifically for Communicable Disease surveillance and improving immunization uptake in children. This funding was decreasing by $20,000 in 2010. A report on these performance measures is sent to DOH. • Immunizations The expected May 2010 change in the Washington State Universal Vaccines for Children (VFC) Distribution system to one in which children covered by private insurance do not qualify for State supplied vaccine was averted by the development of a new system by a coalition of health care providers, health insurance providers and the Washington State Department of Health. The Washington Vaccine Association (VAC) was created allow the State supplied vaccine program to continue while having the insurance companies pay the State back for vaccines administered to their members. The transition to the WVA documentation and billing requirements was a challenge. All Jefferson County pediatric vaccine providers have a billing program that does not allow the generation of the WVA required Dosage Based Assessment form, so additional paperwork has been necessary. However, the fact that the clinics do not need to order and stock private supply vaccine in addition to State supplied vaccine has ensured that vaccines continue to be available for all children. The number of doses of publicly funded vaccine administered to children in Jefferson County has increased each year, from 3,748 doses in 2005 to 6,100 doses in 2009. Doses administered in 2010 decreased by 711 doses to 5,389. In the past this increase was primarily due to new vaccines being added to the schedule and new school immunization requirements. There were no new vaccines added to the schedule or school requirements in 2009 or 2010 and the number of babies born each year in Jefferson County has been stable for many years. 2008 and 2009 were years in which young children and adolescents were catching up with previous new vaccine recommendations, especially Rotateq (rotavirus) for the infants, Varicella for Kindergarten, HPV and MCV4 (meningococcal) for the adolescents, and Hepatitis A for all ages. Seasonal influenza vaccine doses administered in 2009 were up by 306 doses over 2008. Immunizing children against H1N1 influenza gave providers an increased opportunity to administer seasonal influenza vaccine. By 2010 • many children had received the new vaccines available for their age cohort so the number of doses administered in 2010 decreased. This does not fully apply to influenza vaccine though, which is 4 of 5 7 recommended every year. In 2010, 115 fewer doses of influenza vaccine were administered. However, for those under age 9,two doses are needed in the first year, so there may have been a catch-up related surge if more young children were getting the influenza vaccine for the first time in 2009. • While the Human Papillomavirus Vaccine (HPV) is available to all adolescents age 11-18 through the State supplied vaccine program,this vaccine is also recommended for women through age 26. The private supply HPV vaccine an expensive vaccine,the JCPH fee is $139/dose and three doses are needed. Many of the young adult women in Jefferson County are in the low income bracket and are not covered by health care insurance. In the last half of 2009 JCPH immunization clinic staff worked with the Merck vaccine company's Patient Assistance Program to set up procedures to be able to obtain free HPV vaccine for low income uninsured women. Individual applications are required for each woman. Twenty three doses were administered through this program in the last half of 2009, 62 doses were administered in 2010. The JCPH Immunization Program staff provides technical assistance to the clinics, immunization updates, vaccine refrigeration incident follow-up, training of new vaccine coordinators in the clinics, assessment of immunization rates for clinic patients and vaccine program quality assurance assessment. The visit numbers do not reflect the daily work with the clinics. Many contacts are by phone and information is faxed or mailed to clinics. Family Planning The Family Planning and STD clinics follow the Center for Disease Control's STD screening recommendations for the high risk age groups. In 2010 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. This process included exploring ways to assure appropriate screening and screening data collection. The report for this project was included in the BOH meeting packet in February 2011. • HIV Prevention Clients tested for HIV are screened for risk factors and the State Public Health Lab is used for those in the high risk category. This allows high risk clients with no medical coverage and low income to be tested. Others are tested through the Quest lab and the cost of the testing is billed to the client. The number of client visits to the Syringe Exchange Program increased to 81 in 2010 after remaining fairly stable, between 65 and 70 over the previous three years. The number of syringes exchanged decreased from 14,044 in 2009 to 9,156 in 2010. Thirteen new clients visited the SEP in 2010. There were 12 new clients in 2009, 6 in 2008 and 9 in 2007. The 13 new clients seen in 2010 have tended to exchange fewer syringes, even though some report syringe reuse and secondary exchange. New clients often fear being found with larger supplies of syringes. Continued education in safer practices during each SEP visit is important for continuing the disease transmission prevention mission of this program. The number of visits in which clients reported exchanging for other people as well as themselves (secondary exchange) increased in 2010 after decreasing in 2009. A separate annual SEP report is sent to DOH. JCPH will be submitting a competitive application to DOH, in the spring of 2011, for continuing funding for the SEP Program after July 2011. SEP program funding from the State for the first 6 months of 2011 was decreased by 27%. Influenza The H1N1 influenza outbreak in the spring of 2009 and returning in the fall and continuing through early 2010 required the implementation of our Pandemic Flu Plan for community education, and coordination and communication with our partners. A detailed discussion of these activities was included in the 2009 Performances Measures Report. These activities continued during the first quarter of 2010. A separate report on PHEPR activities is submitted to DOH. An After Action Report on the H1N1 response was completed in • April2010. 3/10/11 5 of 5 Jefferson County Public Health —Performance Measures 2010 - Report FAMILY HEALTH ItUDGETIPROGRAM: Community Health: Family Support Programs Maternal Child Health (MCH) including Maternity Support Services (MSS)/Infant Case Management,Nurse- Family Partnership (NFP), Children with Special Health Care Needs (CSHCN), Women Infants and Children (WIC), and the Child Protective Services (CPS) Contract Programs: Early Family Support Services, Early Intervention Program (EIP), and Passport. MISSION: The mission of the Family Support Program is to offer health education and support to all Jefferson County pregnant women and families with young children as they build a secure foundation for a lifetime of health, learning, and community contribution. The Family Support Team consists of public health nurses, registered dietician, and support staff. Our goals are: -To support and guide families by building on their strengths to create a safe, healthy, and hopeful future for their children. -To collaborate with community partners in our shared goal of improving health, preventing adverse childhood experiences and creating a seamless continuum of services. -To provide high quality services that have expected outcomes after a community assessment, commitment to best practices, professional continuing education and program evaluation. GOALS and OBJECTIVES FOR FY2010: Moak Improve the quality of caregiving for infants and children through support, education, and intervention Wor parents and caregivers. Objective: Jefferson County Public Health(JCPH) will offer services to all Jefferson County pregnant women, families, and caregivers of young children through an array of programs designed to fit the diverse and complex needs and risks of each child and family. JCPH will work with other agency staff and families in the schools, child care facilities, health care settings, and in the community. Spanish speaking families will receive interpretive services along with forms and educational materials in Spanish. Goal: Prevent harm to mothers, infants, and families at risk for or affected by maternal depression. Objective: Depression screening and education will be offered to all pregnant and parenting women who are participating in JCPH programs and appropriate referrals will be made for those who have a positive screen. Data will be collected by staff and become part of program evaluation and community assessment. Goal: Encourage and support breastfeeding for optimal nutrition and health for infants and mothers. Objective: Provide education and support to all pregnant women and their families about the benefits of breastfeeding through WIC and weekly Breastfeeding Tea. Collaboration with Jefferson Healthcare staff for lactation support ensures all families receive the services they need. Goal: Prevent nutritional related problems for pregnant, post-partum, and breastfeeding women and children under five in Jefferson County. Objective: Provide WIC nutrition education and support to all eligible county women and children. *oak Prevent unintended pregnancies. bjective: Assist parents in making goals and plans around family size and child spacing through education and referrals for birth control. 1 of 4 Goal: Improve birth outcomes by preventing birth defects, prematurity, and infant mortality. Promote health and development in children with special health care needs. Objective: Provide education and support to women who are or are planning to be pregnant about potential risks,healthy choices and ways to reduce risks to themselves and their fetus/infant. Screening, referrals, risk reduction, and education will include substance/tobacco use, domestic violence, mental health, and health and nutrition. Provide developmental and health screening of newborns and children to identify children with special health and development needs and assist families to have evaluation and intervention services. Staff will collaborate with community providers to ensure quality, comprehensive services for each family. Monitor state collected data on first trimester access to prenatal care. Goal: Decrease child abuse and neglect through outreach, education, collaboration, prevention, and intervention. Objective: Awareness, assessment, prevention and intervention of the child abuse/neglect cycle is an integral component of all Family Support Service Programs. Referrals are made and received from Child Protective Services (CPS)/Division of Children and Family Services (DCFS) and services will be provided to families at risk or involved in child abuse/neglect through local contracts with CPS. Staff will collaborate closely with other providers to develop a comprehensive plan of care to keep children safe. Staff will engage in clinical supervision, consultation, and professional education to ensure high quality care and staff safety. Goal: Maintain program fidelity, quality, and caseload capacity of the Family Nurse Partnership Program as an evidence based best practice. Objective: Support the Nurse-Family Partnership program capacity and program fidelity by providing opportunities for ongoing support and education to the nurses through weekly clinical supervision, professional consultation and education and participation in the Washington State Consortium for Nurse-Family Partnership. Program and client data will be collected and analyzed by the national NFP office. Quarterly reports resulting from this analysis will guide JCPH staff in program quality control. • Goal: Improve quality of services through collecting and analyzing data on health risks and intervention outcomes. Objective: Maintain fidelity of the research based programs such as Nurse Family Partnership (NFP) and Promoting First Relationships while developing technology systems to collect and analyze data on promising programs. Design local system and collaborate with state in collecting, sharing, analyzing data in program design, delivery, and client/program outcomes. Goal: Increase awareness and support of the Family Support Program mission through community outreach, involvement, and collaboration. Objective: JCPH will continue to engage our community partners in exploring the issues of, and finding solutions to, family and community health issues. We will continue to collaborate with and provide information to community groups, agencies, and providers through our website, local newspapers, and community forums. 2 of 4 PERFORMANCE INDICATORS: 2006 2007 2008 2009 2010 2010 Actual Actual Actual Actual planned Actual 1. Number of depression screenings completed 65 87 85 53 90 56 2. Number of Home and Office visits provided 1144 1170 1363 1349 900 863* by Family Support Staff in all programs. _ 3. Families served annually in Family-Nurse 20 20 25 25 25 25 Partnership 4. Total number of women infants and children 829 872 881 868 880 872 served by WIC in Jefferson County(from CIMS Enrolled annual report) 5. Number of children with special health care 81 70 85 75 60 66 needs Birth through age 18 referred for Public Health Nurse Case Management. 6. Number of families served through 20 30 40 57 50 35 CPS/DSHS contract. *722 home & office visit MSS/MCH/CSHCN, 141 home & office visits CPS Programs (EFSS and EIP) SUMMARY OF 2010 KEY FUNDING/SERVICE ISSUES: Family Support Program's goal in 2010, with fiscal constraints and uncertainties in revenues, is to clarify our priorities and be deliberate in protecting our prevention priorities and community services. Our current level of services were modified in July 2010 when MSS funds were decreased at the state and in 2011 they were reduced further. In 2009 JCPH had to eliminate universal newborn follow up and some breast feeding support and ended all contracts for on-call staff JCPH is collaborating with our community partners to minimize the impact of these changes on local families. gii010 JCPH had reductions in Maternity Support (MSS) visits to pregnant women based on State reductions in nding and changes in the State criteria for who qualifies for MSS. NFP received in 2010 funding from the 1/10 of I% Mental health and Chemical dependency treatment tax, and in 2011 successful Prop 1 vote supports one community family nurse. 2010 one year grant JCPH developed a new assessment tool for parents of young children. We will be collecting data such as the Center for Disease Control short form Adverse Childhood Experiences questionnaire and some Behavioral Risk Factor Surveillance System questions to better understand our clients and our community. Study/Analysis: In 2010 Family Health programs continued to implement the reductions and changes in Maternity Support Services/Infant Case Management(MSS/ICM)programs started in the 2009 cuts. Our home and office visits decrease in numbers from 2009 to 2010 reflect that JCPH is not funded to do as many visits to women and infants as previously. We have maintained fidelity to the Nurse Family Partnership model and so those women have been served even with the MSS/ICM budget cuts. Jefferson County low income families have been affected by budget cuts at every agency and service provider. DSHS has also changed Medicaid eligibility procedures for all clients but pregnant women and infants are being seriously impacted. Infants are being dropped from coverage and are subsequently not accessing medical care and pregnant women delay seeing a prenatal care provider while awaiting Medicaid. The most recent DOH data on access to prenatal care indicates we have a persistent challenge in access to prenatal care. This data shows Ape percentage 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 period. Particularly concerning is the income disparity effect: access to 1st trimester prenatal care 3 of 4 is lower among all Jefferson Co women with Medicaid-paid births 64% compared to non-Medicaid 86%. We will continue to support access to care by outreach and education to pregnant women and referrals to DSHS and prenatal care. Our goals in Family Health programs are best achieved by an active collaboration with community partners who S share these health goals. For 2 years we have met almost every month with the local OB and family practice physicians for care conferencing and discussion and collaborations around access to care and health concerns. These meetings have led to better client services through increased phone contacts from the physicians for collaboration and increased referrals to and from the medical providers for a variety of health and social concerns. The number of depression screens is less than previous years because of 2 factors: fewer women are eligible for our services due to changes in state First Steps guidelines and more women are already being treated for depression by their physician. 2011 Children's Administration is on track with the legislative mandate to privatize services for families involved with CPS. Our contracts for home visits to CPS involved families have been reduced and we have had less referrals as CPS has changed their procedures making fewer families eligible for services. For example; a mother who's newborn tests positive for methamphetamine is now offered a voluntary service plan and the infant goes home. If the family chooses not to accept any services the case is closed. Previously the level of involvement would have been intense and often the infant placed in foster care. These changes place a high level of responsibility on all Family Health programs including WIC as we strive to provide a safety net for these very vulnerable infants and families. March 7, 2011 • • 4 of 4 Jefferson County Public Health —Performance Measures 2010 - Report TARGETED CLINICAL HEALTH SERVICES • PROGRAMS: Family Planning, Breast and Cervical Health, and Foot Care MISSION statement for Targeted Community Health Service: to provide outreach, access, health education, support treatment to specific populations in Jefferson County in order to improve the health of the community. Mission Statement for Family Planning Program: To provide accessible,high quality confidential reproductive health services in a safe, respectful environment. GOALS FOR FY 2010: 1. Assure Family Planning Services are provided in community and accessible 2. Decrease unintended pregnancy rates in Jefferson County(measure) 3. Insure access to breast and cervical health exams to women age 40 to 65 years old 4. Support seniors' independence by maintaining their mobility OBJECTIVES FOR FY 2010: 1. Track Family Planning usage patterns and produce annual report 2. Emergency contraception to be provided under standing orders, 5 days per week, and expand community education and clinical services 3. Maintain breast and cervical health program in Jefferson County 4. Maintain the current level of community foot care and continue expanding into home care PERFORMANCE INDICATORS: 2007 2008 2009 2010 2010 Actual Actual Actual Planned Actual Number of unduplicated clients served in Family Planning _ 1195 1128 1202 1200 1253 Number of adolescents 19 and under served 312 300 345 300 447 Number of Chimacum School Clinic Unduplicated Family66 91 Planning Clients Number of Port Townsend School Clinic Unduplicated86 87 Family Planning Clients Number of Breast& Cervical screening exams 111 110 84 100 99 Number of foot care contacts 2946** 3131** 3065** 2400 2786** ** Foot Care Senior Center and Home Visits SUMMARY OF KEY FUNDING/SERVICE ISSUES: Preventing unintended pregnancies is a local, state, and national Public Health Goal. Jefferson County Public Health (JCPH)provides the only Family Planning program in east Jefferson County. Family Planning is considered a Critical Health Service by the State Board of Health. Washington State Dept. of Health slightly decreased Family Planning funding in 2009 due to State budget shortfalls. Client numbers are staying level or slightly decreasing. JCPH identified the need for Medical/Family Planning services at Port Townsend and Chimacum High Schools through a planning grant from the State Department of Health in late 2008. With the collaboration of the School Districts and Jefferson Health Care, School Based Clinics were started in 2009. JCPH hopes to continue this program in 2010 as the clinics have been well utilized by students and supported by families and the School Districts. The Breast and Cervical Health Program provide Cancer screening and early treatment to decrease deaths from breast and cervical cancer in Jefferson County. With continued community support and level funding from Washington State in 2010 JCPH will continue Breast and Cervical Health exams at the same level. 1 of 2 Jefferson County has a high percent of over age 85 citizens. JCPH Foot Care Program helps this population maintain independence to stay in their homes. The Foot Care program continues to provide needed services to the senior population in Jefferson County. • Study/Analysis 2010: School Based Health Clinic (SBHC)continues at both Port Townsend High School and Chimacum High School in collaboration with Jefferson Healthcare. School Based Health Centers 2009-2010 Participation Report and current school year data shows an increase in students accessing a variety of services. The complete report is available on www.jeffersoncountypublichealth.org under Data and Publications. The number of clients 19 or younger has increased by over 100. This represents increased outreach and access to JCPH Targeted population through the SBHC to prevent unintended pregnancies and increase access to health care services. The teen pregnancy rate continues to decrease to lower WOMEN UNDER AGE 18 (aged 10 to 17): In 2007-09 there were 20 pregnancies among Jefferson County teens under age 18. In 1995-97 and 2004-09, the Jefferson County teen pregnancy rate was significantly lower (better)than the WA rate; rates in both places have been statistically decreasing (improving) since 1992-94. During the 6 months review of 2010 the Communicable Disease Performance Measures Goals the Chlamydia screening percentage for clients under 25 years old was less than the goal. With careful evaluation of process, the Family Planning and Communicable Disease teams discovered tests were being done but not always marked on appropriate forms. Also during the evaluation process it was identified that the satellite clinic needed updated information on annual screenings of all clients for CT under age 25. Data will be reviewed every 6 months. Breast and Cervical Health(BCHP)maintained expected number of clients for 2010. JCPH continues to • receive donations through Port Townsend Main Street"Girls Night Out"to support services. State and Federal funding has been reduced. JCPH hopes to maintain the same numbers through 2011. Foot Care visit numbers continue to remain high. No other agency in the community is currently providing this service. March 7, 2011 • 2 of 2 Jefferson County Public Health —Performance Measures 2010 - Report POPULATION & PREVENTION OPROGRAMS: Tobacco (TP/C), School Health (S/H), Childcare Health and Safety (CC), Oral Health(OH), and Drug and Alcohol prevention (DA) MISSION: The purpose of the Population & Prevention Programs is to provide health education and public health interventions to county residents in order to promote a healthier community, prevent disease and unintentional injury, improve the quality of life and reduce disparities in health. GOALS FOR FY 2010: 1. Improve identified social and health indicators for school-age youth (S/H) 2. Improve overall health of Jefferson County residents.(TP/C) 3. Enhance the quality of child care provided in Jefferson County (CC) 4. Enhance the overall health & safety of Jefferson County children (PI) and (OH) 5. Reduce favorable attitudes toward problem behavior within the youth and adult communities. (DA) 6. Delay age of initiation of problem behavior. (DA) 7. Reduce adverse childhood experience as measures by reduced CPS referrals (DA) OBJECTIVES FOR FY 2010: 1. Maintain delivery of school in-service/trainings, student health screenings, student health consults, student health care referrals (S/H) 2. Provide tobacco specific education and resources to employers to support employee cessation (TP/C) 3. Maintain child care provider consultation re: health, immunizations, safety and child development (CC) 4. Health education classes will be provided to elementary, middle &high school students; and increase • Oral Health prevention interventions through outreach in WIC and School Based Clinics. (S/H) (OH) 5. Increase the perception of risk for youth regarding alcohol and marijuana use, especially for 6th, 8th, and 10th grade students.(DA) 6. Increase access to adults with healthy beliefs and clear standards for 4th through 6th grade students in Jefferson county.(DA) 7. Provide Early Intervention services to at risk families to prevent adverse childhood experiences. (DA) See Felitti study showing how adults who had reported greater than 2 Adverse Childhood Experiences had increased health problems including tobacco, drug and alcohol use. See Family Support services program performance measures. PERFORMANCE INDICATORS: 2007 2008 2009 2010 2010 Actual Actual Actual Planned Actual Number of student health screenings 1135 1124 1034 1400 1040 Number of employers receiving tobacco specific 3 4 17 15 15 technical assistance (TP/C) _Number of school health classes 200 218 233.5 225 243 Number of students served in the school health 1,084 1,145 1,102 classes Number of phone calls to WA State Tobacco 63 93 170 75 143 Quit line from Jefferson Co. Number of classroom presentation/interventions 144 134 116 120 117 (Drug and Alcohol preventions) Number of students served in the class room 475 404 382 350 493 • presentations(Project Alert+TATU) 1 of 3 SUMMARY OF KEY FUNDING/SERVICE ISSUES written July 2009: Jefferson County Public Health (JCPH) delivers programs that promote healthier communities and individuals. Focusing public funds on prevention programs have proven to be cost effective. JCPH hopes to continue in 2010 to continue to collect Assessment data to assist in determining community needs and prioritize services (access to health care, substance abuse, domestic violence and child abuse and neglect). The above programs provide universal prevention programs available to all in the community. State prevention health services monies come with extensive evaluation components. Tobacco funding has community specific goals and measures that must be met to maintain funding. Local Tobacco Prevention and Control funding from Washington State Department of Health has been reduced by approximately 20%for Fiscal Year 2009-2011. Staffing will for this program will be reduced and as a consequence of reduced funding. Deliverables for the grant will also be reduced. School nursing services are funded by contracts with ESD 114 State School Nurse Corps and school districts. Public Health Nurse priorities for this funding include to: 1) facilitate health care and emergency response plans for students with chronic health conditions with staff training as needed for student health and safety; 2) provide training and distance supervision for school staff to safely administer needed medication to students; 3) facilitate annual hearing and vision screening as mandated; 4) provide nursing consultation for students and their families upon referral from school staff; 5)provide consultation on immunizations and communicable disease. Drug and Alcohol prevention program continues to work with Community Health programs providing integrated prevention services. In 2007 the Drug and Alcohol Prevention program wrote a 6 year strategic plan to address the identified prevention needs in the community. In 2009 the Substance Abuse Advisory • Board is working with the community and agencies assessing the progress of the plan and set priorities. State and local funds are utilized primarily through the school based Best Practice education Programs. These funds allow Health Educators to provide prevention education classes to middle school students in the community. The ongoing delivery of these classes for the 2009—2010 School Year will depend on the state funding, which is still being determined as of July 2009. In addition JCPH staff is working with community partners to identify other resources to increase capacity of prevention programs for example; Jefferson County Sheriffs Departments is using"Protecting You Protecting Me" a best practice instead of"Dare" curriculum in the 5th grade classes and Port Townsend Police are planning to provide the "Protecting You/ Protecting Me"curriculum with 5th graders in the city of Port Townsend. Other community members are being trained in this curriculum with the intention of providing this prevention program to 1St through 4th graders. In the past the Peer-In educational program has been funded by various grants. Those grants are no longer available. The Peer-In health education presentations for the 2009—2010 School Year will also depend upon the development of funding to train and oversee the Peer Educators In April 2009 JCPH Prevention Staff continued for the second year a community wide social awareness and prevention program called"Our Kids Our Business". There were at least 70 Business, Services Clubs and government departments as well as 220 individuals involved in the campaign. Our goal for 2010 is to increase community partnerships and collaborations. 2 of 3 .. r •tudy/Analysis 2010 results: Adult smoking rates in Jefferson County are approximately 14.1% and the annual trend from 2003 to 2009 is unchanged. The highest rates are in 18-34 year old and are higher among adults with low income/low education level. Providing technical assistance to employers about cessation benefits and accessing state/local cessation resources for employees has been well received. Calls to the WA state Tobacco Quit Line have shown a steady increase from 0 in 1999 to 143 in 2009, due in part to local outreach and promotion in Jefferson County. Teen tobacco use is being addressed through many avenues including: Peer education program, "Teens Against Tobacco Use, youth access prevention and tobacco retailer education. Report on Tobacco Prevention program was presented at the December 2010 Board of Health Meeting. Jefferson County School enrollment continues to slightly decrease reflecting a decreasing the number of 2010 HearingNision screenings. Of the 1040 initial hearing and vision screenings, 281 students were rescreened and 130 students were referred for further evaluation, 90 for hearing and 40 for vision. The number of health care and emergency response plans in place for students with chronic health conditions that may affect their health and safety at school was 106, total, for Port Townsend and Chimacum School Districts. The number of Human Growth and Development classes increased due to providing special curriculum classes for Special Education students at Chimacum and Port Townsend high schools. Initial training and staffing for these classes was provided by Developmental Disabilities program. Due to a loss of funding, the Peer-in health education program was eliminated in 2010. Public Health Nurse (PHN) Child Care Consultation funding ended December 2010. Continued services for Child Care Providers in 2011 will depend on local funding and staff availability. State and Federal funds are being reallocated through regional contractors. It is unknown at the moment how state and federal funds will be distributed to local agencies. State Oral Health funds ended December 2010. In 2010 JCPH Oral Health Coordinator/Registered Hygienist Cyndi Newman set up monthly Oral Health clinics at the School Based Health Clinics. She also arranged for the Washington Dental Foundations Smile Mobile to come to Chimacum High School/Middle school in Nov. 2010. She continues to provide Oral Health Screenings and preventive oral health services monthly in WIC clinic. Oral Health Services will decrease in 2011. JCPH is hoping to continue some Oral Health services with Medical Assistance fees. In 2010 Drug and Alcohol Prevention staff provided the Best Practice Project Alert, a drug and alcohol prevention curriculum, in Jefferson County Middle Schools. The City of Port Townsend Funds for 2011 for drug and alcohol prevention programs are unsure. Jefferson County Sheriff's Department continued to facilitate the Best Practice "Protecting You/Protecting Me"classes for the 5th grade at Chimacum and the Port Townsend Police facilitated these classes in Port Townsend for the 5th grade. Port Townsend School District staff facilitated the"Protecting You/Protecting Me" classes for the 1st, 2nd and 3`d grades. Again, in April 2010 JPCH worked along with community partners on the "Our Kids: Our Business" Social Awareness Campaign. •March 1, 2011 3 of 3 Jefferson County Public Health - Performance Measures 2010 - Report ON SITE SEWAGE (OSS) and OPERATION AND MONITORING (O&M) PROGRAMS MISSION: The mission of the Onsite Sewage Program is to protect public health from adverse effects of improperly treated sewage by ensuring the proper design, installation,and maintenance of onsite sewage systems(OSS). The mission of the Operation and Monitoring Program is to protect public health by monitoring onsite sewage systems and identifying deficiencies that may lead to costly premature failures of OSS that contaminate surface and ground waters. GOALS FOR FY 2010: 1. Educate homeowners,builders,real estate personnel,banks, installers,designers and onsite system maintenance personnel in the proper operation and maintenance of onsite sewage systems. 2. Assure a high quality-onsite sewage system monitoring program. 3. Implement and enforce state and local rules and regulations governing the installation and use of onsite sewage systems. 4. Investigate action requests and complaints in a timely manner to reduce the threat of human contact with untreated wastewater. 5. Complete all State funded grant activities on-time and on-budget. 6. Assure high quality customer service. 7. Establish a Homeowner Inspection Program for the Operation and Monitoring Program. OBJECTIVES FOR FY 2010: 1. Develop written informational materials for public distribution and conduct workshops for community groups addressing onsite sewage system operation and maintenance. 2. Provide training to community groups to increase awareness of regulatory requirements for onsite sewage systems. 3. Review monitoring and inspection reports and provide timely follow up 4. Utilize existing data systems to track action requests and complaints. 5. Develop and implement a system for routinely surveying customer service. • 6. Assure communication with applicants regarding the status of onsite sewage permit applications. PERFORMANCE INDICATORS: 2008 2009 2010 2010 Actual Actual Projected Actual Number of systems repaired/upgraded 32 32 30 37 Percent of system failures less than 5 years in use 0 0 0 0 Number of complaints received 42 43 50 52 Number of complaints closed 24 19 30 33 Number of septic permit applications submitted ' 231 169 175 158 Number of evaluations of existing system(EES) 295 255 325 463 Percent of existing systems receiving regular 3rd party 2.2% 1.8% 2% 3.4% monitoring.2 #of previously unknown systems having a monitoring 15 9 10 10+595 inspection3 Percent of monitoring inspections resulting in some 29% 28% 30% 56%4 maintenance needed. Percent of monitoring inspections resulting in required 12.5% 16% 15% 18.7% significant maintenance or repair. Percent of failures/major maintenance <2% <2% <2% <2% Number of educational workshops 6 5 17 19 Number of workshop participants 239 102 214 355 Number of applications does not equal approved permits • 2 Based on estimated 13,500 systems in the county(from the Local Sewage Management Plan) 3 Represents cases created only as a result of a monitoring inspection consistent with past years. Additional systems were identified through sanitary surveys but do not get a full inspection and were not counted in this category. 4 Includes inspections where the only maintenance item identified was that the tank needed to be pumped. Previous years did not include this maintenance item. March,2011 1 of 2 510 systems were identified and observed via regular monitoring inspections,59 systems were identified(and had some level of observation)via sanitary surveys and sites where no previous records exist. A regular monitoring inspection will not be required unless problems are identified,the property sells or application is made for a building permit. SUMMARY OF KEY FUNDING/SERVICE ISSUES: Tracking was done with existing data systems and an online program implemented in June 2010(OnlineRME)to evaluateeffectiveness of monitoring programs. Differences in the reporting between the two systems resulted in some inconsistencies reported in past years. Efforts to provide comparable numbers will continue in the coming year. Ongoing O&M activities are funded through permit and inspection fees,report filing and processing fees, WS DOH grant for implementing our Sewage Management Plan,Clean Water Grant,and the Clean Water District. Implementation focuses on coordination with the private contractors to set up systems for scheduling and tracking inspection activities. 2010 STUDY/ANALYSIS OF RESULTS ❑ Met regularly with providers to maintain consistency in reporting Monitoring Inspections and conducted community outreach to increase awareness of the requirements. ❑ Emphasis early in 2010 was providing a class specific to food service establishments around understanding septic system operation and managing their food service operations to safeguard their onsite sewage system. ❑ The onsite sewage records that have been scanned are used extensively by Designers as well as O&M Specialists to access record drawings(asbuilts).This improves the quality of the work submitted. ❑ Monitoring Inspection Reports are reviewed and follow-up letters sent where problems/deficiencies are noted that indicate either imminent failure or identify a violation of the permit. ❑ This year saw a slight increase in the percentage of systems receiving a monitoring inspection. This may be due to the requirement for food service establishments to obtain an inspection prior to renewal of their food service permit. The requirement for annual monitoring of septic systems serving food service establishments has existed since 2000 in the WAC,but JC did not connect it to the food service permit until this year. Several problems were identified during the inspections and corrections will occur during 2011. Deficiencies identified include components installed without permits, baffles missing,ponding in the drainfield,pump not operating on automatic,tanks needing to be pumped/serviced. . ❑ A Manual of Onsite Sewage Program Standards of Practice was developed and in the final stages of review by years' end. The document will provide guidance on processing violations of the Onsite Sewage Code and the procedures followed in the PIC(Pollutions Identification and Correction)process. ❑ Classes to provide information on taking care of your septic system continue to be provided and are very well received in the community. They also provide an opportunity to inform homeowners about funds that are available to repair or upgrade a substandard or failing system. Additionally we share information about efforts to identify water quality problems and correct them. Work is coordinated with the Water Quality Team and the work they do on sanitary surveys in communities. ❑ As part of implementing our Sewage Management Plan,staff continued to identify previously unknown onsite sewage systems. Unknown systems are also being identified through the sanitary surveys which are completed as part of several grants.Current projects include portions of Discovery Bay,the Hood Canal,Chimacum Creek and Mats Mats Bay. The systems identified in this report are consistent with previous years as they are systems that were identified via a regular monitoring inspection that includes an inspection of the septic tank. Sanitary Surveys help us to identify that a system is on a property but do not generally include a detailed inspection of the system.These systems will be tracked separately. ❑ A grant was obtained late in 2010 to support Clean Water District activities. The grant includes coordination with Clallam County to model the homeowner inspection program that is currently under development in Clallam County. We anticipate beginning that program late in 2011 or early 2012. ❑ Onsite sewage permitting and staffing has declined due to the economic downturn of the past several years. The team continues to strive to maintain effective communication with our clients and partners(other State and local departments)to effectively manage workload and requests for information while diligently reviewing and enforcing County Code and policies. e March,2011 2 of 2 Jefferson County Public Health —Performance Measures 2010 - Report FOOD SAFETY PROGRAM OIISSION: The mission of the Food Safety Program is to minimize the risk of the spread of disease from improperly prepared, stored or served foods handled in commercial retail settings and community events. GOALS FOR FY 2010: 1. Provide classroom food safety instruction for all food service workers. 2. Assure minimum sanitary standards are observed in all food service establishments and establishments operate in compliance with codes. 3. Provide basic food safety information to the general public. OBJECTIVES FOR FY 2010: 1. Offer food safety training at a frequency and in locations convenient to food service workers. 2. Review all new food service establishments for compliance with state and county requirements. 3. Inspect all food service establishments at a frequency adequate to assure compliance with state and local regulatory requirements. 4. Offer educational materials and technical assistance to non-regulated community groups and organizations where requested. 5. Prevent septic system failures at food establishments by assisting with enforcement of operations and monitoring requirements. 6. Provide additional education to food workers through food/tobacco newsletters and other methods. • PERFORMANCE INDICATORS: 2006 2007 2008 2009 2010 2010 Projected Actual Number of food workers 1,100 1,205 1314 1,137 1250 1269 trained _ Number of food worker 52 52 52 61 52 82 classes at Health Department, special here _ Number of food worker 25 35 31 21 30 10 classes at other locations, Tri-Area, special away Number of food 270 270 237 228 240 235 establishment permits Number of required 352 350 217 299 292 249 inspections completed, routine, pre-open, re- inspections %of required inspections -- -- 0 83% 85% 85% completed • 1 of 2 PERFORMANCE 2006 2007 2008 2009 2010 2010 INDICATORS: Projected Actual • Number of inspected 70 45 N/A 34 40 6 establishments that required repeat inspections due to critical violations. Number of establishments 43 40 89 38 35 0 receiving Outstanding Achievement Awards Number of temporary 80 85 17 74 80 82 food service permits Number of plan reviews 16 that opened SUMMARY OF KEY FUNDING/SERVICE ISSUES: Food Safety Program activities are funded solely through permit and technical assistance fees. We utilize the hourly technical assistance fee to recoup costs. STUDY/ANALYSIS: • Staffing changes included a new person starting in Nov 2010 and a team approach to covering the program. After reviewing the 2010 service year structural changes were made to the program: Percent of required inspections completed was at 85%, which is consistent with the previous two years. A plan is now in place that should ensure 100% completion in 2011. In summary, Susan Porto has taken over as Lead of the Food Program, a backup EHS will be assisting with plans review and temporary events. In addition, JCPH will be contracting with the Tacoma-Pierce County Health Department to bring online food worker training to Jefferson County. These changes will allow staff to focus on field inspections. Plan review was added to the evaluation standards because of the significant amount of staff time. Information for prospective business operators will have intake time and allow other staff time to focus on inspections. In 2010 the permit renewal requirements including annual operations and maintenance of septics for food service establishments. Classes were held through the county for the business. An email list of establishments was created and used for notification of changes and newsletter mailings occurred twice in conjunction with tobacco enforcement news. The email list will help with any emergency notification system for food service managers. Awards were not completed due other program priorities. March 7, 2011 • 2 of 2 Jefferson County Public Health —Performance Measures 2010 - Report SOLID & HAZARDOUS WASTE MISSION: The mission of the Solid Waste Code Compliance and Education Program is to enforce Washington State and Jefferson County solid and hazardous waste code, educate the community about ways to reduce solid and hazardous waste, and to promote the goals and objectives for solid waste reduction and recycling outlined in the Jefferson County Comprehensive Solid Waste Management Plan. GOALS FY 2010: 1. Investigate all solid and hazardous waste complaints. 2. Resolve solid and hazardous waste violations through voluntary compliance or citations and legal action when necessary. 3. Reduce the incidence of illegal dumping. 4. Assure all permitted facilities (past&present) meet current regulation standards. 5. Increase public awareness of small quantity generator and household hazardous waste (HHW) disposal requirements and options through education and outreach efforts. 6. Promote reduction, re-use, and recycling of resources to facilitate the County goal for 50%waste reduction, recycling, composting and waste diversion. 7. Provide on-site technical assistance, through Local Source Control (LSC) program,to small businesses whose operations are considered small-quantity generators of dangerous waste to protect surface and groundwater. Objectives: 1. Coordinate with other agencies to resolve more difficult solid waste violations. 2. Work with the County's Prosecuting Attorney to pursue legal remedy for the most difficult enforcement cases. 3. Continue to work with citizens to investigate and clean-up sites quickly, and identify and prosecute offenders. 4. Educate consumers at point of purchase about proper disposal of HHW and non- toxic alternatives. 5. Work with Jefferson County Public Works to promote HHW collection days and educate participants about non-toxic alternatives. 6. Promote consuming less and re-using more. Recycling is not enough. 7. Identify and actively work with high priority SQG's to ensure use of best management practices and prevent toxic and hazardous wastes from entering the storm- and/or groundwater. I of 4 a PERFORMANCE INDICATORS: 2007 2008 2009 2010 Actual Actual Actual Actual Total number of solid waste complaints received 184 y 114 60 65 Total number of solid waste violations resolved 135 117 90 68 III Number of illegal dumps complaints received _ 27 12 14 11 Number of illegal dumps complaints resolved 23 11 19 10 Number of illegal burning complaints received 4 5 7 Number of illegal burning complaints resolved 7 Number of citations/tickets issued 49 28 24 5 Number of court hearings attended 19 2 Tons/cubic yards of solid waste removed/recycled 50+tons >450 cu 55+tons through compliance efforts (not including junk yards vehicles) Total number of solid waste violations awaiting 2 2 1 2 legal action/abatement Number of warrants of abatement 1 1 0 0 obtained/completed Number of Jeff. Co. permitted facilities meeting 6 of 8 8 of 9 8 of 9 8 of 8 current regulation standards (out of 8) (1) Total number of active EnviroStars businesses 10 10 14 18 (Out of 100 eligible in Jefferson County) Number of new EnviroStar businesses 2 1 3 5 Number of active Green Businesses 21 26 Number of new Green Businesses - 6 6 Number of Junk Cars removed/recycled 701 279 139 141 • Number of"Amnesty Day" events 0 1 0 1 Tons/yards of solid waste recycled/disposed of Over 300 2500 0 3000 Tires during "Amnesty Day". tons of tires South tires(2) Plus 601 County(2) tons(2) Number of LSC site visits - 4 28 Notes: (1)At the end of 2008 JCPH broke out several facilities that had previously been lumped together. (Jefferson County Transfer Station,Recycling Center,and closed Municipal Landfill.)This enabled clarification for the purposes of monitoring and permitting. In 2010,Ecology took over permitting of the Olympic Corrections Bio- solids composting facility;this reduced the#of sites to 8. (2)Tire recycling events were paid for through a grant from Ecology. 0 2 of 4 Analysis: • The number of solid waste complaints reported and resolved, including illegal dumps, has fallen since its peak in 2007. The complaints that remain open continue to include a higher percent of difficult, chronic cases (usually involving mental health issues)that require a greater amount of time and resources to resolve (e.g.: multiple citations, court hearings, and warrants of abatement). There were no properties cleaned-up through warrants of abatement this year. One abatement request is scheduled for court in February 2011. It is anticipated that during 2011, the overall number of solid waste cases will decrease, with a relatively high percentage of time-intensive cases. This should stabilize in time as the backlog of these cases is resolved. The number of illegal dump complaints seems to be stabilizing at 11-14 per year. The goal is to have none. There will probably be a certain amount of illegal dumping and burning of garbage until/unless there are structural changes such as mandatory garbage collection service (at least for rental units). The number of junk vehicles (JVs) removed/recycled decreased from its peak in 2007. Scrap metal prices remain high enough that hauling by local businesses has been free. The downside is that illegal wrecking yards are proliferating as people seek quick money from scrapping vehicles, with resulting environmental pollution from improperly handled/disposed vehicle fluids and components. JCPH is working with State Patrol to close these sites. JCPH continues to assist citizens with junk vehicle affidavit requests, freeing up Sheriffs Deputies' time. Since 2007 JCPH has assisted with the removal of over 1000 junk vehicles from Jefferson County. • In 2010, all of Jefferson County's permitted facilities became fully compliant with State and local requirements,the first time in twenty years. 2010 saw continued inter-agency cooperation between JC Sheriffs Office, Public Health, Animal Services, Washington State University (WSU) extension office, Climate Action Committee (CAC), Department of Community Development, and Child Protective Services. This allowed for resolution of some very difficult cases, shortening of resolution time on other cases, and cost savings. In 2010 the solid waste team, through its Local Source Control Program (LSC), focused its education component on pollution prevention measures for Puget Sound. LSC is an Ecology funded program, started in 2008, where JCPH proactively visits businesses that utilize or produce toxics and hazardous materials. Guidance and education are offered regarding the proper disposal of these materials. The Local Source Control specialist provided technical assistance to businesses which have high storm-water pollution potential, including marina and boatyard activities, auto businesses, equipment rental companies, etc. JCPH's Local Source Control staff person provided on-site technical assistance visits assisting with Best Management Practices and code compliance issues. Eligible businesses were referred to Envirostars and/or Green Business programs to promote sustainable business practices. Sites found to be in gross violation of the law and/or apparently contaminated are referred for site hazard assessment and clean-up. JCPH continues to investigate hazardous waste complaints • and perform Site Hazard Assessments (SHA's) for Ecology. The Solid Waste team expects to 3 of 4 have a shift towards more hazardous waste casework due to referrals from the Local Source Control (LSC) during 2011. Solid waste public education also focused on pollution prevention through education and outreach on proper disposal of pharmaceutical waste, and toxic alternatives for household cleaners and yard care products. We also expanded our in-house waste reduction efforts. In • 2010, JCPH adopted a Waste Reduction and Recycled Product Procurement Policy, and became Green Business certified. The department made great strides to reduce, reuse and recycle. In 2011, we will continue environmentally sustainable business practices and we will reduce waste by starting a compost bin for food waste from our employees. JCPH staff will continue to encourage other City and County departments to adopt an environmentally friendly procurement policy. SUMMARY OF KEY FUNDING/SERVICE ISSUES: The reduction in funding and staffing of all County departments means we must carefully and honestly evaluate priorities and division of labor. Increased inter-departmental cooperation will enable us to accomplish the most with limited funds. Citizens need to be informed about the necessary reduction in and speed of services (i.e. JV affidavits are not as high a priority as a hazardous waste complaint). Our departments can also stretch the funding by utilizing volunteer/citizen groups where possible. March, 2011 • • 4of4 Jefferson County Public Health --Performance Measures 2010 — Report WATER QUALITY PROGRAM • MISSION: The mission of the Water Quality Department is to protect public health by monitoring and responding to threats to water quality for protection of human health and fish habitat by using available local, State, and Federal funding effectively and efficiently. GOALS FOR FY 2010 1. Continue to implement a lake monitoring program to protect the public from the threats of toxic blue-green algae. 2. Complete a limnological study of local lakes to determine causative factors of toxic blue-green algae blooms and suggest a solution. 3. Ensure healthy beach water quality at heavily used public saltwater beaches. 4. Institute actions under a Clean Water District that monitor, protect and enhance water quality. 5. In cooperation with Environmental Health and the Conservation District use awarded State funds to improve water quality in Chimacum Creek, Discovery Bay, Mats Mats Bay and Hood Canal. 6. Use funds awarded by the Centennial Clean Water Fund to initiate pollution identification and correction actions that prevent a downgrade of the commercial shellfish growing area in Mats Mats Bay. 7. Continue to support a volunteer network of shellfish samplers to monitor for shellfish biotoxins in a timely and cost effective manner. JCWQ will work with Washington Department of Health to communicate risks from the recreational harvest of shellfish to the public. 8. Continue to insure that the stream gauging network is maintained to accurately measure streamflow and water quality in critical streams such as Chimacum Creek, Salmon Creek and Snow Creek. 9. Continue public education on the importance of clean water in Jefferson County focusing on actions citizens can take to keep our water clean and productive. 10. Report to the Commissioners and public through a written report on the state of water quality in Jefferson County. OBJECTIVES FOR FY 2010 1. Continue to implement a lake monitoring program and use State funding to determine the causative factors involved in local blue-green algae blooms. Secure State funding for remedial actions to stop toxic blue-green algae blooms as appropriate. 2. Monitor water quality at public swimming beaches on a weekly basis during the swimming season to protect public health. 3. In partnership with the Jefferson County Conservation District complete the tasks outlined in the scopes of work of the Chimacum Creek, Discovery Bay, Mats Mats Bay and Hood Canal Centennial Clean Water Fund funded programs. • 1 of 2 PERFORMANCE INDICATORS: 2006 2007 2008 2009 2010 2010 Actual Actual Actual Actual Planned Actual Lakes monitored for cyanobacteria 9 9 9 4 3 3 Water quality stations monitored:Chimacum Creek 0 40 40 28 28 28 Water quality stations monitored: Salmon&Snow Creeks 0 17 0 19 19 19 Water quality stations monitored: Hood Canal watershed 0 0 0 0 0 0 Miles of shoreline surveyed for pollution N/A 5 49 76 77 77 Marine water quality stations monitored N/A 7 7 7 17 17 Sanitary surveys completed N/A N/A N/A 259 400 241 Beaches monitored for shellfish safety 7 7 7 7 7 7 Swimming beaches monitored 0 2 3 4 3 3 Stream gauges maintained 8 8 9 8 8 8 SUMMARY OF KEY FUNDING/SERVICE ISSUES: This program is funded by grants from the Washington State Department of Ecology, Washington State Department of Health, with matching funds provided by the Jefferson County Clean Water District. • Current revenue sources are adequate for 2011 staffing levels. In 2010 we applied for two additional grants totaling approximately $340,000. STUDY/ANALYSIS The water quality department reorganized in 2010 with the departure of the Program Manager, the arrival of a new Environmental Health Director and movement of staff into and out of the department. All sampling and monitoring goals were met. The number of sanitary surveys completed was less than planned. Several measures have been undertaken to address this shortfall. A new organizational staff structure was put into place. Additional EH staff have been trained to perform sanitary surveys and have been assigned neighborhoods to complete. More than 2,400 sanitary survey records were researched, printed and organized for staff to take into the field. Efficiency has improved and the rate of sanitary surveys completed is now higher than it has been for over a year. In addition, many more septic failures have been identified and corrected as new procedures have been put into action to deal with complaints and enforcement more effectively. Also, Water Quality Program staff are now lead on onsite sewage complaint response. March, 2011 • 2 of 2 Jefferson County Public Health —Performance Measures 2010 - Report DRINKING WATER PROGRAM MISSION: The mission of the Drinking Water Program is to protect public health by assuring that residents and visitors to Jefferson County have access to a safe and reliable supply of quality drinking water. The Drinking Water Program assists in achieving compliance with regulations for private and public water supplies by owners, purveyors and the drilling community in coordination with the Washington Department of Ecology and Department of Health, thereby minimizing the threat of waterborne disease. GOALS FOR FY 2010: 1. Assure that all new wells are constructed in accordance with requirements established by the Washington Department of Ecology. 2. Provide technical assistance when requested so that individual water supplies are safe. 3. Where regulatory authority exists, such as the Food Safety Program or water adequacy review for building permit approval, we work to limit public exposure to water systems with known deficiencies. 4. Integrate water adequacy review information with the Jefferson County GIS mapping program to maintain the Seawater Intrusion Protection Zone information. OBJECTIVES FOR FY 2010: 1. Inspect at least 50%of all new wells constructed (25% of these with the well driller present) and properly decommission 90%of abandoned wells identified during the year. 2. Maintain high rates of compliance with State well drilling regulations. • 3. Review all building permits and project applications to assure that potable water supplies meet basic public health standards as well comply with State statutory and regulatory requirements. 4. Provide technical guidance to any residents requesting assistance with their individual or small water systems to deliver safe drinking water. 5. Establish appropriate policies for alternative water supply systems. 6. Continue contracting with Washington Department of Health for public water supply projects, as long as adequate funding is provided. PERFORMANCE INDICATORS: 2007 2008 2009 2010 2010 Actual Actual Actual Projected Actual Number of well applications received & 127 76 83 80 62 reviewed Number of new wells start notification 108 79 77 75 63 (drilled)(includes some well applications from previous years) Number of wells decommissioned 16 17 8 12 13 Number of new wells inspected (start 67 48 53 31 40 notification received) Percent of new wells(starts) inspected 62% 63% 68% 55% 64% Percent of new wells(starts) inspected with 62% driller on site Number of decommissioned(abandoned) 16 17 8 12 13 wells inspected • Percent decommissioned (abandoned)well 100% 100% 100% 100% 100% inspected I of 2 SUMMARY OF KEY FUNDING/SERVICE ISSUES: Increased tracking will be done within existing databases such as permit plan and the food service database. Coordination between the Solid Waste team Site Hazard Assessment work and the Drinking Water program(both internally and at the State level) is improving. This coordination enables better protection of the groundwater and improved communication with those involved. Where funding is available,we need to update our database to include the following: (1)new requirements associated with the Water Management Rule for WRIA 17, (2) more effective reporting of drinking water quality issues, and(3) make information readily available for the public and define effort for future focus. This year,two projects highlighted the apparent lack of regulatory authority to enforce standard setback requirements from individual wells where municipal sewer lines are proposed. The two projects were: Eco Village project in Port Townsend and the Dosewallips State Park sewer system. In regards to the Eco Village project,the sewer line was designed, approved and installed less than 50' to an irrigation well. The proposed sewer lines for the Dosewallips State Park(that run through Brinnon) were designed without regard to locations of existing single family residential wells and group B water systems. To eliminate this confusing inconsistency, it may be prudent to establish a policy or ordinance to authorize this department regulatory authority over these situations. 2010 STUDY/ANALYSIS OF RESULTS • Applications for well inspections continue to be down substantially after several years of an increase in well drilling activities. The number of wells drilled in the county this year is approximately 58%of 2007. Drilling activities have generally been declining since 2008, basically mirroring the local and state economy. • The increase in well decommissioning would likely be attributed to expansions/repairs and upgrades of septic systems on properties where public water is available and setback requirements cannot be met, without decommissioning the well. We are also tracking a decommissioning that occurs as a result of an initial attempt to drill,where the result is either dry or untreatable water(mostly chlorides),and the well is decommissioned prior to the driller leaving the site. We started tracking this in 2007. • The economic downturn has impacted all applications for development in the county. As a result, staffing S has been decreased, hours reduced and programs reassigned. There is no longer a staff member dedicated exclusively to working in the drinking water program. • A funding source should be evaluated to consistently provide adequate staffing to focus on water issues in Jefferson County. Water quality and quantity is a topic expected to be at the forefront of future economic and environmental sustainability. Lacking appropriate energy directed to the issue, staff will be at a severe disadvantage to appropriately respond to the public regarding concerns. March 1, 2011 • 2 of 2 Jefferson County Public Health —Performance Measures 2010 - Report ADMINISTRATION • GOALS FOR FY 2010: 1. Assure accurate and timely fiscal reports. 2. Assure technical support in assessing the basic health needs of Jefferson County communities. 3. Assure administrative,technical and financial support for all Jefferson County Public Health (JCPH) contractual agreements. 4. Provide administrative,technical and financial support to interlocal agencies that contract for fiscal services with JCPH. 5. Assure accurate and timely technical and clerical support to each division within JCPH serving the residents of Jefferson County. 6. Provide certified birth and death certificates to the community within the guidelines required by the Center for Health Statistics of Washington State. OBJECTIVES FOR FY 2010: 1. Continue the valuable partnership with Kitsap County to update and maintain the priorities identified through the community assessments. 2. Provide administrative and financial support to meet required reporting, invoicing, and tracking of contractual agreements with federal and state agencies, interlocal/departmental agreements and MOU's held by JCPH. 3. As fiscal agent, provide administrative and financial support to meet quarterly reports and contractual agreements as required by federal and state agencies for all agreements held by agencies that contract with JCPH. 4. Provide supervision, training, assistance and evaluation of the systems that provide the business service support to the various public health services provided to the residents of Jefferson County. . 5. Enhance and improve tracking procedures for grant deliverables, reporting requirements, and encumbered and unencumbered balances within active grants. Refine the relationship between fiscal staff and technical staff, combining efforts in tracking and preparing required documentation for each award or task. 6. Participate in statewide conference calls and available training to maintain knowledge of law and guidelines. PERFORMANCE INDICATORS: 2009 2010 2010 Actual Projected Actual Health of Jefferson County will update priorities and Update& Update&maintain Update&maintain indicators of Jefferson County citizens maintain priorities priorities priorities Number of federal,state, intergovernmental,and 72 61 78 interdepartmental grants currently active Number of professional service contracts,MOUs and 104 79 87 other agreements currently active Number of public records requests fulfilled 414 450 394 Average number of invoices processed per month 136 115 125 Number of birth and death certificates issued by JCPH Births-414 Births 402 Deaths-236 Deaths -295 SUMMARY OF KEY FUNDING/SERVICE ISSUES: The Administration Division benefited from an ARRA grant which was awarded in the middle of 2010. However, due to this revenue a reduction in revenue from Interfund Charges for Services occurred, preventing an impact to the Administration budget. JCPH will continue to seek funding sources that assist with administrative expenses. March 7,2011 1 of 1 • Board of Cealth NetivBusiness .agenda Item # 2 • 2011 Public CeaCth Ceroes Award Nominations .March 17, 2 01 JCPH rage 1 of 2 Always working for a healthier Jefferson. Jefferson County Public Health Home About JCPH Community Health Environmental Health/Water Quality Information Public Health News&Events Public Health News and Events. N- fli.., 4 Welcome>>Public Health News&Events JEFFERSON COUNTY PUBLIC HEALTH IS CELEBRATING 2011 NATIONAL PUBLIC HEALTH WEEK BEGINNING APRIL 4TH Port Townsend, February 28, 2011 -Jefferson County Public Health (JCPH) is celebrating National Public Health Week April 4-10. This year the National Public Health Week theme is Safety is NO Accident. JCPH asks you to join the Board of Health in nominating local Public Health Heroes who make our community safer. We want to hear your story. It only takes a moment for an injury to happen - a fall on a stair, a moment's glance away from the road,a biking or sports-related injury, a medication mix-up. But it also takes just a moment to protect against injuries and make communities safer. The potential for injury is all around us. Each year, nearly 150,000 people die from injuries, and almost 30 million people are injured seriously enough to go to the emergency room. Injuries are not"accidents", and we can prevent them from happening.Taking actions such as wearing a seatbelt, properly installing and using child safety seats, wearing a helmet and storing cleaning supplies in locked cabinets are important ways to proactively promote safety and prevent injuries. Together, we can help Americans live injury-free in all areas of life: at work, at home, at play, in your community and anywhere people re on the move. We all need to do our part to prevent injuries and violence in our communities. JCPH began honoring Public Health Heroes as a way to locally celebrate National Public Health Week. The annual public health awards honor people who live or work in Jefferson County and promote Public Health in their daily lives. Nominations are open to the public through Wednesday March 16. Please submit a nomination for an individual, agency or group you feel is making a difference in the health of Jefferson County. What is Public Health?: Public Health helps communities to be healthy places to live, work and play. Public Health provides reliable information you can use to make healthy choices and protects our communities from hazards in the environment. Public health works to prevent health problems before they occur.The focus is on improving an entire community's health through achieving healthier lifestyles. What is a Public Health Hero?A Public Health Hero is a person or organization that promotes public health in their daily lives. Public Health Hero awards could represent the following categories but are open to others: •The Community Health Promotion award honors individuals or groups whose efforts increase the quality of life in the county. •The Public Health Leadership award honors those in our community who have provided leadership in creating policy solutions that assure, promote, and protect the community health. •The Business Merit award recognizes a companies for environmentally sound practices but many make healthy choices in what they sell, how they support employees, and how they promote community health. •The Community Based Organization award recognizes those who provide infrastructure and services that promote public health in a variety of ways. •The Special Recognition for the Public Health Hero honors individuals or organizations who help identify a problem and then help the community work towards its resolution, e.g. planting trees, building trails, promoting physical exercise or health diets, or fitting children's car seats. I know someone in my community who is a Public Health Hero. How do I nominate them? • Nomination forms may be picked up at the JCPH office, 615 Sheridan St., Port Townsend, or • Download form online, or •• Request that an application be mailed to you by calling (360) 385-9400 How do I return the completed nomination form? • Drop off or mail completed forms to: Public Health Heroes c/o JCPH, 615 Sheridan Street, Port Townsend, WA 98368, or httn://www.ieffersoncountypublichealth.org/index.php?natl_ph_week 3/10/2011 JCPH rage 2 of 2 • • Fax completed form to (360) 385-9401 Can I nominate more than one person or group?You can nominate as many deserving people or groups as you like. The deadline for submitting nominations is Wednesday March 16. Winners will be announced at the April 21 Jefferson County Board of Health meeting at 615 Sheridan 2:30. Learn more about National Public Health week and"Building the foundation for a health America"at www.nphw.orq. For further information contact Julia Danskin,jdanskin@co.jefferson.wa.us, (360) 385-9420. ### Always Working for a Safer&Healthier Jefferson County Jefferson County Public Health 615 Sheridan Street-Port Townsend,WA 98368 Community Health:360.385.9400 I Environmental Health:360.385.9444 '•" . info@jeffersoncountypublichealth.org Website by:Lineangle i • httrr//www_ieffersoncountvaublichealth.org/index.php?natl ph_week 3/10/2011 .., ,,,ON C ,0 , A , ,, Public Health Hero Award .6„ ., 2011 ss'1 i Nc;i(' Deadline: Wednesday, March 16, 2011 Submit to: Jefferson County Public Health, 615 Sheridan St., Port Townsend, WA 98368 or email to publichealthhero(ajeffersoncountypublichealth.org Please complete all fields below so that we can contact the appropriate person/s. Your Name: Address: City, State, Zip: Phone: Email: rson or group you are inating: How can we contact this nominee? Please fill in all fields ** Nominee's address**: City, State, 4.ip**: Phone**: Email: Category for which you are nominating this person/group (one category per nomination please) Community Health Promotion Public Health Leadership Business Community based Organization •eciat Recognition Award Other (specify) The following criteria will be used to select Public Health Heroes: ➢ Public health efforts make a significant difference in the lives of the people served. ➢ Public health efforts build on individual and community strengths and assets. ➢ Public health efforts mobilize individuals and community groups to work in collaboration and cooperation. ➢ Public health efforts are unique, innovative, or fill an identified gap in a specific community. ➢ Public health efforts are characterized by social justice and a celebration of diversity. Please describe how this person or group promotes health and wellness in our community: • Please describe why you feel this person or group should get Public Health Heroes Award. • • Board of aCealth Netiv Business Agenda Item //17., 3 • InfCuenza `i,lpdate and Notifiable Conditions Report March 17, 2011 JEFFERSON COUNTY PUBLIC HEALTH y 615 Sheridan Street • Port Townsend •Washington • 98368 'S'F7;..o\C` • www.jeffersoncountypublichealth.org Notifiable Conditions Reported to Washington State Department of Health* Jefferson County 2010 Jan-Mar Apr-Jun Jul-Sep Oct-Dec 2010 Condition 2010** 2010** 2010** 2010** Total** Campylobacteriosis 5 0 1 1 7 Cryptosporidiosis 1 2 2 3 8 E. coli enterohemorrhagic 1 1 Giardiasis 3 1 2 3 9 Pertussis 0 0 1 0 1 Salmonellosis 0 0 3 0 3 Rare Diseases of Public Health Significance: Creutzfeldt-Jacob disease, III sporadic 1 1 Cryptococcal diseas; C. gattii 1 1 Hepatitis B, chronic 1 1 Hepatitis C, chronic 6 8 8 7 29 Chlamydia _ 15 4 23 16 58 Gonorrhea 1 1 2 Herpes, initial infection 1 2 1 6 10 Syphilis 1 0 0 0 1 Grand Total 33 18 44 37 132 *Cases are those that have been counted as"confirmed and probable" by WA State Department of Health, some have disease onset dates in 2009. **Counts are preliminary, counts may increase as reports are received and finalized. 2-18-2011 • COMMUNITY HEALTH PUBLIC * ENVIRONMENTAL HEALTH DEVELOPMENTAL DISABILITIES A WATER QUALITY MAIN: (360)385-9400 _ S 0 C: a hi N= ?C ., r b,,-aN�s MAIN: (360)385-9444 FAX: (360)385-9401 HEALTHIER COMMUNITY FAX: (360) 379-4487 Communicable Disease Surveillance Report: Kitsap, Clallam, and Jefferson Counties February 14, 2010 to February 26, 2011 • WASHINGTON STATE-LEVEL DATA: Washington State's Weekly Influenza Update: "Influenza activity was elevated" (1) World Health Organization/National Respiratory& - 50% 2 60 Enteric Virus Surveillance System, Washington*(1) 50 'reporting labs:WA State Public Health Labs,Seattle&King T40% County Public Health Lab,and UW/Children's Hospital Lab I Y _ 40 Type B 30% �' t" 0 Type A not subtyped ._ 0 s 30 � v ., Type A(H1 or H3) + 20% Nin o - 20 TType A(2009H1N1) •• c a m -- %positive 10 d 10 • 0 a • 0 0 ' -W-.T.,• - • - -• • - ..• +- -., i 0% o NN9oNWDO.J+NiN(N(L <+N LO- NAN A °N' O WO7A4VL'W'1N'. N<-O' o° TTKK11DDe0w7KKcLC- - LcDDmn(nfn °000000S «- ;-1P ending:week +0 2 0 0_0 0 0 0 0 0++0 0 0 0 0 0 0 0 0 0+++0+0+.0- + 0 0 0 0 0 0 0 0 000 000 0 0 0 0 0.0 0 00. + ++ ioo Positive Respiratory Viral Specimens, University of Washington Virology Laboratory at Seattle Children's Hospital(2) _a> 80 - N.o Influenza A Influenza B®RSV Other resp viruses' c °- 60 - d 2 'includes parainfluenza,adenovirus, 40 rhinovirus,and metapneumovirus ar 0 0 20 ��411 N N O) + N W 8 N +W + N N (n + W + N W 1 + N N ? + N(;° N m ? N L.Ou + N N+ + o - W o O V A (T N CO L �0 O) L O A A 00 +N O O (J Z W O V 'v+Oo(P V� N (0 T fD week Q Q- w w -'7 7 11 w w w w m- 3 > ? — c c c m m m- j— 0 0 0 0 0 0 9 2 0 0 L . =$0-.m ending: L. o cfl aa-o < + + , ? ? ? Qvv 88° 88808880 0 0 0 0 0 888 0 0 0 0 0 0 0 0'8880 ° 888 ° 888000 . COUNTY-LEVEL DATA: Harrison Medical Center Emergency Department(ED)Visits*for Influenza-like-Illness(ILI)**(3) 1.0% 5 Iiiillim number of ILI visits %visits for ILI 0.8% I 4 g 0.6% / 3 0.4% - 2 s 0.2% 1 r.)1 + N N W+ N +OD + N N (T + N W+ + N W .74 N A + + N N fD+ N W O -- N N A + W N N N + N 9'W O V D O v A - Vi N m L N tD O) L O '4 A 'D A W 4" +00 f/C OC W O (4 O V :-.' 4818 L L N fD N Z8 week a m m nF) m a'ova m w w I c c c c c eS c c c v 0 0 0—`Q) 7.0 0 0 2 0 0 0 0 0 o o? ? w m`w o m m m endin z , + + .c 7 -0- _'. _.0 +9 9 co O-- 7 7 8 +g I E. + < < < + p 9 = f, f, ? + q Q v 0 0 80888 0 0 0 0 0 0 0 0 0 0 0 c,0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 c' 888 0 0 0 0 + - + - - - - includes Emergency Depts at:Harrison Medical Center Bremerton and Harrison Medical Center Silverdale.Jefferson Health Care and Olympic Medical Center data not available. "Influenza-like-Illness is derived from the patient chief complaint not provider diagnosis and is defined as"influenza"OR fever with cough or sore throat.Data do not represent 100%of ED visit records as not all records contain chief complaint text. Percentage of Kitsap,Clallam and Jefferson County Public Schools Rep.rting Over 10%Absenteeism on at Least One Day of the School Week(4,5,6) Kitsap Jefferson 't. #reporting schools: 41 ,12 18 b , 9/7/10.10/1/10 0% 0% 0% 0% 10/3/10-10/29/10 0% 0% 0% 0% 11/1/10-11/24/10 0% 0% 0% 0% 1111 11/29/10-12/24/11 0% 0% 0% 0% 1/3/11-1/31/11 0% 0% 0% 0% 2/1/11-2/28/11 1% 0% 1% 0% 'includes one school serving grades 6-12 and four schools serving grades K-12 Note:All data are preliminary and might change as additional reports are received. Produced by:Kitsap County Health District report date:3/4/2011 Communicable Disease Surveillance Report: Kitsap, Clallam, and Jefferson Counties February 14, 2010 to February 26, 2011 Kitsap,Clallam,&Jefferson County Hospitalizations and Deaths with Confirmed Influenza(A or B)(4,5,6) 411111 Hospitalizations: Month/Year # Deaths: Month/Year # Feb 2010 1 0 Kitsap, Clallam and Jefferson County Deaths*with Pneumonia or Influenza Listed as Immediate, Underlying or Contributing Cause of Death(4,5,6) =• 25 - Jefferson • l Clallam aa) 20 II G 15 - co o 41) 0 1111 11111 II IIINM II III ___Mil___ O. 2/28-3/27 4/3-5/1 5/8-5/29 6/5-7/3 7/10-7/31 8/7-8/28 8/29-10/2 10/9-10/30 10/31-11/27 12/5-12/26 1/2-1/30 2/6-2/27 # 2010 2011 Percent of total Kitsap,Clallam and Jefferson deaths due to influenza and pneumonia 10% - 8% - r ■pneumonia 6% IIiIIsIIuIl . t luenza 2% 0% , 2/28-3/27 4/3-5/1 5/8-5/29 6/5-7/3 7/10-7/31 8/7-8/28 8/29-10/2 10/9-10/30 10/31-11/27 12/5-12/26 1/2-1/30 2/6-2/27 2010 2011 `includes all deaths occurring in Kitsap,Clallam or Jefferson County regardless of county of residence;data obtained from death certificates received,not based on date of death. Note:Influenza takes precedence over all other causes incl.pneumonia(i.e.,if death certificate has both pneumonia and influenza as underlying causes,death is counted as influenza) Note:Haemophilus influenzae and parainfluenza virus are not included as influenza;aspiration pneumonia,pneumonitis,and pneumococcal meningitis are not included as pneumonia Kitsap,Clallam and Jefferson County Selected Reportable Conditions by 2010 Quarter(4,5,6,7) • Kitsap efferson, Jan-Mar Apr-June July-Sept Oct-Dec Jan-Mar Apr-June July-Sept Oct-Dec Jan-Mar Apr-June July-Sept Oct-Dec C.Gattii 0 0 0 0 0 0 0 0 0 1 0 0 Campylobacteria 4 12 7 5 1 4 5 1 5 0 1 1 E.coli 0157:H7 2 0 1 0 0 1 0 0 0 0 1 0 Giardia 3 3 3 6 0 1 0 5 3 1 2 3 Hepatits A 0 0 1 1 0 1 0 0 0 0 0 0 Pertussis 0 6 19 4 0 0 0 1 0 0 1 0 Salmonella 5 10 10 4 1 0 2 0 0 0 3 0 Tuberculosis 0 0 0 0 0 0 0 0 0 0 0 0 Chlamydia 195 191 198 205 42 50 32 39 15 4 23 16 . Gonorrhea 12 13 9 13 4 6 5 6 0 i 0 i 1 1 Sources: 1)WA State Dept.of Health Weekly Influenza Update 4)Kitsap County Health District 2)http://depts.washington.edu/rspvirus/respiratory.htm 5)Clallam County Health&Human Services 3)Essence-Syndromic Surveillance 6)Jefferson County Public Health 7)Public Health Info Mgmt System(PHIMS) • Note:All data are preliminary and might change as additional reports are received. Produced by:Kitsap County Health District report date:3/4/2011 Board of Cealth Netiv Business .agenda Item /IV., 4 Nlandatory .7Cealthcare Worker Immunization 3vlarcGt 17, 2 01 1275 K Street, NW, Suite 1000 Washington, DC 20005-4006 r4lp Phone: 202/789-1890 Fax: 202/789-1899 4111 ' apicinfo@apic.org www.apic.org Linda R.Greene,RN.MPS,CIC,Lead Author,APIC Board of Directors Tracy Cox,RN,CIC.Co-Lead Author,APIC Public Policy Committee Susan Dolan,RN,MS,CIC,Chair,APIC Public Policy Committee Patricia Gray,RN,CIC,Vice Chair APIC Public Policy Committee Raed Khoury,MA,MPH,MT(ASCP),CIC,ARM,CHSP,CPHQ,APIC Public Policy Committee Patricia Kulich,RN,CIC,APIC Public Policy Committee Frank E.Myers.III,MA,CIC.APIC Public Policy Committee Charlene Ludlow,RN,MHA,C1C,APIC Public Policy Committee Stephen Streed,MS,CIC,APIC Board of Directors and Board Liaison to the Public Policy Committee APIC Position Paper: Influenza Vaccination Should Be a Condition of Employment for Healthcare Personnel,Unless Medically Contraindicated Influenza is a serious disease that is associated with high rates of morbidity and mortality. In the United States, an estimated 5%to 15% of the population is affected by the virus each year.' Influenza infections result in approximately 150,000 hospital admissions and 24,000 deaths annually.2 A recent study estimated that annual influenza epidemics account for 610,660 life-years lost, 3.1 million days of hospitalization and 31.4 million outpatient visits.; The most efficient method of preventing annual influenza epidemics and their associated morbidity and mortality, is through pre-exposure vaccination.4 In addition to their risk for exposure to influenza from • community sources,healthcare personnel (HCP)are at an increased risk for acquiring influenza due to their exposure to ill patients. Conversely,those patients who are at greatest risk of developing severe complications of influenza are themselves more likely to be exposed to potentially infectious HCP. Therefore, one of the most important strategies to decrease influenza transmission to or from high risk persons is to immunize healthcare personnel.5 Despite long standing recommendations by the Association for Professionals in Infection Control and Epidemiology(APIC),the Centers for Disease Control and Prevention (CDC)and other national healthcare organizations,the response to voluntary programs has failed to increase immunization rates to acceptable levels required to substantially reduce healthcare-acquired influenza.6'' Annual influenza vaccination for HCP has been recommended by the CDC since 1981; however national survey data from 2010 demonstrated only marginal increases in HCP seasonal influenza vaccination coverage levels (61.9 %)8 As a profession dedicated to the prevention of infection,we have an ethical responsibility to protect those individuals entrusted to our care. We must do a better job of immunizing HCP every year to ensure patient safety and protect those individuals at high risk of developing complications of influenza. Recommendation: Therefore, APIC recommends that acute care hospitals, long term care, and other facilities that employ healthcare personnel* require annual influenza immunization as a condition of employment unless there are compelling medical contraindications. This requirement should be part of a comprehensive strategy which incorporates all of the recommendations for influenza vaccination of HCP of the Healthcare Infection Control Practices Advisory Committee(HICPAC)and the Advisory Committee on 1111 Immunization Practices(ACIP)for influenza vaccination of HCP.9 An essential part of this comprehensive strategy includes strict attention to important infection prevention practices such as hand Spreading knowledge. Prevent nig in ection. hygiene and respiratory etiquette. Individuals exempted from annual vaccination due to medical411 contraindications must be educated on the importance of careful adherence to all of the non-vaccine related HTCPAC prevention strategies, including hand hygiene and cough etiquette. Further,they may be required to wear a surgical mask when contact with patients or susceptible employees is likely. Additionally, strong leadership commitment that takes into account and collaboratively addresses concerns by employees and the organizations representing them is essential to providing the necessary support and resources to implement such a comprehensive program. Rationale: D Multifaceted mandatory vaccination programs have been tried and tested and have been found to be the single most effective strategy to increase HCP vaccination rates,with multiple facilities and systems achieving vaccination coverage of more than 95%10 D The vaccine is most effective in younger, healthier individuals. Patients at highest risk including the elderly and the immunocompromised are least likely to develop an adequate response to the vaccine.' Several studies now demonstrate that HCP influenza vaccination reduces patient mortality.'2 Therefore vaccination of those individuals who come in contact with our vulnerable population is the most effective strategy for prevention. D The virus can be transmitted to patients by both symptomatic and asymptomatic HCP. Multiple studies show that 70%or more of HCP continue to work despite being ill with influenza,thus exposing patients to the virus.13 D Institutions that have implemented a mandatory policy have dramatically reduced employee • absenteeism as well as healthcare associated influenza,thereby improving patient safety and reducing healthcare costs.14 ➢ Influenza vaccine is safe. The most common side effects of the injectable(inactivated) influenza vaccine include soreness,redness,or swelling at the site of the injection. These reactions are temporary and occur in 15%-20%of recipients.15 ➢ Immunization requirements are effective in increasing vaccination rates. HCP policies requiring demonstrable vaccination for measles, mumps and rubella have been successful in achieving near universal compliance. Requiring influenza vaccine should similarly be highly effective.16 Positions on mandatory vaccination have been endorsed by the Infectious Diseases Society of America(IDSA),the American Academy of Pediatrics(AAP), and the Society for Healthcare Epidemiology of America(SHEA). Conclusion: Seasonal influenza vaccination of HCP offers an important method for preventing transmission of influenza to high-risk patients. Evidence supports the fact that influenza vaccine is effective,cost efficient and successful in reducing morbidity and mortality. Evidence also demonstrates that the current policy of voluntary vaccination has not been effective in achieving acceptable vaccination rates. As healthcare providers,we have an obligation to ensure that all HCP are vaccinated against influenza. As a profession that relies on evidence to guide our decisions and actions,we can no longer afford to ignore the compelling evidence that supports requiring influenza vaccine for HCP.This is not only a patient safety • imperative, but is a moral and ethical obligation to those who place their trust in our care. Spreading knowledge, Preventing infection:' r RP I S "[TJhe term HCP includes: all paid and unpaid persons working in health-care settings who have the potential for exposure to patients with influenza,infectious materials, including body substances,contaminated medical supplies and equipment, contaminated environmental surfaces or contaminated air.HCP might include(but are not limited to)physicians,nurses,nursing assistants,therapists,technicians,emergency medical service personnel,dental personnel,pharmacists,laboratory personnel, autopsy personnel,students and trainees,contractual staff not employed by the health-care facility,and persons(e.g.,clerical, dietary,housekeeping,maintenance,and volunteers)not directly involved in patient care but potentially exposed to infectious agents that can be transmitted to and from HCP.The recommendations in this report apply to HCP in acute care hospitals, nursing homes,skilled nursing facilities,physician's offices,urgent care centers,and outpatient clinics,and to persons who provide home health care and emergency medical services."[Source MMWR August 28,2009) • I Spreading knowledge. Preventing infection r r' 4 -TO Rp: C • World Health Organization. Influenza(Seasonal). Available from: http://www.who.int/mediacentre/factsheets/fs211/en/. Accessed December 10, 2010. 2 Estimates of Deaths Associated with Seasonal influenza—United States, 1976-2007.JAMA 2010;304(16):1778- 1780. 3 Molinari NA,Ortega-Sanchez IR,Messonnier ML,Thompson WW,Wortley PM,Weintraub E,et al.The annual impact of seasonal influenza in the US: Measuring disease burden and cost.Vaccine 2007;25:5086-5096. 4 Poland,GA,Tosh P,Jacobson RM.Requiring influenza vaccination for health care workers: seven truths we must accept.Vaccine 2005;23:2251-2255. 5 Ibid. 6 Talbot TR,Dellit TH,Hebden J,Sama D,Cuny J. Factors associated with increased healthcare worker influenza vaccination rates: results from a national survey of university hospitals and medical centers. Infect Control Hosp Epidemiol 2010;31(5):456-462. 'Bernstein HH,Starke JR.Policy Statement of the American Acedemy of Pediatrics: Recommendation for Mandatory Influenza Immunizatino of All Health Care Personnel. Pediatrics 2010;126:809-815. S Interim Results: Influenza A(H IN I)2009 Monovalent and Seasonal Influenza Vaccination Coverage Among Health-Care Personnel--United States,August 2009--January 2010. MMWR 2010;59(12):357-362. 9 Pearson ML,Bridges CB,Harper, SA. Influenza vaccination of health-care personnel,recommendations of the Healthcare Infection Control Practices Advisory Committee(HICPAC)and the Advisory Committee on Immunization Practices(ACIP).MMWR Recomm Rep 2006;55(RR-2):1-16. • 1° Talbot TR,Dellit TH,Hebden J,Sama D,Cuny J.Factors associated with increased healthcare worker influenza vaccination rates: results from a national survey of university hospitals and medical centers.Infect Control Hosp Epidemiol 2010;31(5):456-462. I1 Wilde JA,McMillan JA, Serwint J,Butta J,O'Riordan MA, Steinhoff MC, et al. Effectiveness of influenza vaccine in healthcare professionals.JAMA 1999;281(10):908-913. 12 Talbot TR,Dellit TH,Hebden J, Sama D,Cuny J. Factors associated with increased healthcare worker influenza vaccination rates:results from a national survey of university hospitals and medical centers. Infect Control Hosp Epidemiol 2010;31(5):456-462. 13 Babcock H,Gemeinhart N,Jones M,Dunagan WC,Woeltje KF.Mandatory Influenza Vaccination of Health Care Workers:Translating Policy to Practice.Clin Infect Dis 2010;50:459-464. 14 Poland,GA.Mandating influenza vaccination for health care workers:Putting patients and professional ethics over personal preference.Vaccine 2010;28:5757-5759. 15 Belshe RB,Nichol KL,Black SB, Shinefield H,Cordova J,Walker J, et al. Safety,efficacy,and effectiveness of live,attenuated,cold-adapted influenza vaccine in an indicated population aged 5-49 Years.Clin Infect Dis 2004;39:920-927. 16 Poland,GA,Tosh P,Jacobson RM. Requiring influenza vaccination for health care workers: seven truths we must accept.Vaccine 2005;23:2251-2255. • January 27,2011 Spreading knowledge. Preventing infection,`" • Board of CeaCtG► NLedia Report • ivlarc(1 17, 2011 Jefferson County Public Health • February/March 2011 NEWS ARTICLES & INFORMATIONAL ITEMS 1. "Is it the flu? Maybe, maybe not", Peninsula Daily News, March 2, 2011 2. "Nominate your `health hero' ", Port Townsend Leader, March 9, 2011 3. "Does the county favor health?", Port Townsend Leader, March 9, 2011 4. "Hospital boards head to Olympia to lobby", Port Townsend Leader, March 9, 2011 5. "Should we move from syringe exchange to distribution?", American Journal of Public Health, March 2011 6. "Jefferson County Budget Committee", Jefferson County, February 16, 2011 7. "Doonesbury", Peninsula Daily News, March 2011 • • 7, H c'. vi r . Q3 .n co m rti awoaCroc m•_m o ?`o� a, . 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Qw , o Ct aO. >, 0 N o av01 bA.a,8 oa, a,.0 bD ah "yd2-0 om + (./ aoo.bo GF' v/ OC1) viy � 1 •G o p . 5 >c) can) 0m3a 0el C o ° m 0 0 o o,5 l',.; ovw a' 8 [ C' " b• 0- '� 8 '.- 3 o 0 o . , py , Q) •.--r o a� a.U � � bo4D � � > a� cu � � .., ., > 0O p a ao03-d ^) p (1) (IA t., u� �.' 5 4 A ^. bn a, 'C a, ai. 0,0 0 ai 'C c6 F.) q0 `b O cid'8 ',j '41. 3 2 ° 2.X MC A p,..0 o a, cn 0 G' p O o a v_ y o t. a, p v �• { m oao0w >cd� oQ�H 0—DeCjI x.4 c, w L1—i o C ai bn N X• c, o ioo! oa, y ido En-4., o� m = 0'O.0 s. a, v liliZ 10..62 a t 0 C1 • • ,�"�ybD c'��. yO,-�� CB. �"'�i'U Q 5 $., _y�' Lpi�j El (0) ct VD •4 A 8 ,..,4-4 g erj..-0 0 wo...,. :72 E = (L-.), ] ..q .. 0.- . „,.. c, Z. am ,E . > 0x000 x > 0) .5 • 1.� ala/1,1 Nominate your health hero, • As part of National health promotion, public Townsend, WA 98368; or Public Health Week, April health leadership, busi- fax the form to 385-9401. 4-10, Jefferson County ness merit and community- Winners will be Public Health (JCPH) is based organization. announced at the April 21 seeking nominations for Submit a nomination for Jefferson County Board of Public Health Heroes. an individual, agency or Health meeting. JCPH began honor- group. Nomination forms For further infor- ing Public Health Heroes may be picked up at the mation, contact Julia as a way to locally cel- JCPH office, 615 Sheridan Danskin, 385-9400 or ebrate National Public St., or downloaded from jdanskin@co.jefferson. Health Week. The annual jeffeiso ncountypubli- wa.us. awards honor people who chealth.org; or request that live or work in Jefferson an application be mailed to County and promote pub- you by calling 385-9400. lie health in their daily Drop off or mail com- lives. Nominations are pleted forms to: JCPH, open to the public through Public Health Heroes, Wednesday, March 16. 615 Sheridan St., Port Recognition includes awards for community • • • • • 1110 .Does the county favor health? Recessions are hard on many people. County revenues are down and going lower. The county has Health, have made difficult cut- reduced expenditures. But why so backs to reduce costs. Local tax- unevenly? payer funds for Public Health were Comparing the 2011 and 2010 $833,000 in 2008 and are$683,000 budgets, the county (mostly) in 2011, an'18 percent decrease. reduced department expenditures, Public Health staff participated in some significantly: commissioners, furloughs and hour reductions for • 1 percent;sheriff,2 percent;parks, the past two years, and agreed to a 2 percent; county roads, 5 percent; wage freeze for 2011. Only 20 per- courts, 9 percent; prosecutor, 10 cent.of Public Health costs are paid percent; solid waste, 13 percent from the General Fund; 80 per- and public health, plus 5 percent. cent is funded by state and federal That's right, the public health bud- service contracts, health insurance get for 2011 was 5 percent more billings and fees. than 2010. Despite cuts elsewhere in Public Jefferson County Public Health's Health, in 2011 we received large fees for services we request are EPA and American Reinvestment quite large, so, presumably, all of and Recovery Act federal stimulus our tax money is going to serve our grants to fund specific work,result- most needy citizens. That's a valu- ing in a net 4.1 percent increase able service, but it only serves a compared to the original 2010 bud- few people. However, it is clear the get. In recent years, actual Public commissioners value public health Health expenditures decreased 2.3 above all other departments. percent front 2008 to 2009, and • Do the commissioners really • cut another 6.4 percent from think it is so much more important 2009 to 2010. than protecting everyone's safety? A few other figures in the let- Or is public health just their favor- ter comparing 2011 to the original ite?Or is it something else? 2010 county budget merit correc- The people should ask them. lion:Sheriff up 1.7 percent,District TOM BROTHERTON Court up 1/2 percent, Superior Quilcene Court down.2.4 percent. • Jefferson County Administrator Philip Morley responds: County departments, including Public • • • • .. • • . • • . ,. /n /. . Wednesday,March 9,2011•A 3 t.:..1.-V ''''. v. 011 -5 1 t °' c -. .." -.1r .*. t. -A` . S S ,. 1.%,.„,, :111111/ 1 i 1 0 4 I y_ ; !*1a lobby 1 By Allison Arthur of the Leader 1 "If someone is ill, _xlxg�� Jefferson Healthcare corn + \ it's not just them, missioners and CEO Mike ':i.'.. :.._ it's their family Glenn join officials from y Olympic Medical Center and friends. on Thursday in Olympia to ,F voice concerns about cuts * i. ' = It has a ripple to health care that impact effect throughout individuals as well as rural �'v - r ' the whole hospitals. 'Any cut is going to hurt, ' community." but it's a whole lot better to cut than to do away with - .I Jill Buhler it completely,"said Jefferson Jill Buhler Jefferson Healthcare Commission chair Jill Buhler of talk about cut- the state, Glenn has noted. commissioner Y backs in Basic Health Care. By comparison, Harrison Gov. Christine Gregoire Memorial in Bremerton pro- in the past. had recommended ending vided 6 percent of its adjusted "Commercial people on Basic Health Care insurance revenue in charity care, and average can go elsewhere for on March 1, which would Olympic Memorial Hospital care, while those on charity have impacted about 510 in Port Angeles gave 3 per- care,many of them are ham- working people in Jefferson cent in charity care, accord- pered by lack of transporta- County. Hundreds more ing to state figures. ' tion, so we have a dispro- were on a waiting list for the In 2011, Jefferson portionate share of them," I low-cost health insurance. Healthcare expects to pro- she said. • Legislators aren't talking vide as much as $4.4 million Buhler connects charity about cutting the program in charity care. That could care and access to care with • completely, Buhler said, but grow depending on the out- preventive care, which in there still is concern that come of legislationand the the long run saves everyone drastic cuts could push more state budget. money, she said. people to seek charity care at "We're getting a double "If they don't come in rural hospitals throughout whammy," Buhler said of originally when they have a Washington. possible cuts in state-fund- small complaint and we can Hospital officials have ed programs as well as an manage them, then they'll set a time to meet with increase in charity care. come in to the emergency Rep. Kevin Van De Wege, Because of the threats of department, and it's much D-Sequim, and Rep. Steve health-care cuts, Glenn has harder,"she said. Tharinger,D-Sequim. revisited the 2011 budget As for access to health and has "right-sized" some care for all, Buhler said the CHARITY CARE RATES departments,Buhler said. board is ready to do bat- Jefferson Healthcare has "Health care is the foun- tle on the issue and his- one of the highest rates of dation of everything,"Buhler torically, has gone back to charity care in the state. said. "If someone is ill, it's Washington, D.C., each year In 2008, the latest year not just them,it's their fami- as well as to Olympia. available for statewide sta- ly and friends.It has a ripple "I think what I feel in my tistics, Jefferson Healthcare effect throughout the whole heart of hearts is we've got provided 10 percent of its community." a board that is dedicated to adjusted revenue to charity Buhler notes that corn- making sure that Jefferson care and bad debt. mercial and private pay County has the best possible , That's the highest of insurance programs have hearth care for every single any hospital in the Puget helped subsidize charity care person,"she said. Sound.region outside of King County and the fifth highest of any acute care hospital in 13' ,, Kelly Barlow LMP . ,� 3, .w massage & Facials -_i--'— 1 `-r1;----77k,,,,-;z: . > 360-385-0393 _3-1- Y-j-k Irl 1 " t l III LETTERS i { l SHOULD WE MOVE FROM SYRINGE • • EXCHANGE TO DISTRIBUTION? • i Kerr et alrecently reported findings indicating • that syringe exchange programs(SEPs)can ..,, maximize their impact by removing restrictive C,policies.We would like to call attention to our '` t ---- - , ''. 1 study,which provides additional evidence link- ':1 'f ink p : ting SEP policy to increased syringe access and • ri-0 ww" � 3 other positive outcomes.As part of a National Institute on Drug Abuse—funded study in Portland,Oregon,we pilot tested a program K ' 4,..,..47,-=':),14::;.,''''''.34:-;;i),, that trained secondary exchangers—metham " \:,1 .t ;� phetamine injectors who frequent our SEP �,�' tt �" " * " ,,,,..-4.4,1.......7f; `" i and regularly provide syringes to others—to to= � ll O ,:4 . z� deliver HIV risk reduction and other health promotion messages along with clean syringes. y I V As part of this programwe also relaxed ouram.VtS� • V ` "1, 47 established 1-for-1 exchange policy for this small ,' 0 group of peer educators,with favorable results. Port-Au-Prince, Haiti,2010:An American aid worker after a failed attempt to deliver desperately Seventeen individuals were trained as peer needed food to 700 Haitians.Photographer:Peter van Agtmael.Printed with permission of Magnum 1 educators during 3 training sessions;peers Photos. received an additional box of 200 syringes on 1 top of usual SEP services at each training j session.For 2 months after the training,those At follow-up interviews,15 of 16 peer unlimited distribution program models.4 Trans- peer educators delivered health messages and educators(94%)reported participation in SEP forming more US syringe exchange programs dean syringes to methamphetamine injectors services at a training session.Of those,13 to such models will require changes in political in the community.Sixteen peer educators (87%)said they received and distributed more acceptance,program design,and staffing,and (94%)completed baseline and 3-month follow- syringes than they exchanged during the pre- may remain financially unrealistic for small up evaluation interviews. vious 2 months,including 7 who said they jurisdictions,despite the recent removal of the expanded their distribution networks. ban on federal funding for SEPs.5 Meanwhile, Comparisons of baseline and follow-up data providing extra syringes to SEP participants who Letters to the editor referring to a recent showed significant increases in the number of reportexchanging syringes within a social net- Journal article are encouraged up to 3 months syringes peers reported distributing in the pre- work appears to be an effective and inexpensive after the article's appearance.Bysubmittinga vious 2 months,from a median of 712.5(range: means of increasing access to clean syringes.i 1. letter to the editor,the author gives permission 50-4800)at baseline to a median of 1500(range: for its publication in the Journal.Letters 200-9000)after the intervention(P=.03,Wil- Linda Drach,MPH should not duplicate material being published Jessica Guernsey,MPH or submitted elsewhere.The editors reserve the toxon signed rank test).For very little cost(about Julie E.Maher PhD right to edit and abridge letters and to publish $19 per 200 needles),peer educators approxi- r onses. mately doubled the volume of syringes they Maureen Rumptz,PhD Mike Stark,PhD Text is limited to 400 words and 10 refer- distributed to other injectors,without necessitat- ences.Submit online at www.editorialmanager. ing the extra costs of staff,vans,or building rental. Kathryn Pranian,BA com/ajph for immediate Web posting or at Our study supplements growing evidence Carol Casciato,BA ajph.edmgrcom for later print publication. from larger jurisdictions suggesting that less Online responses are automatically consid- restrictive 4syringe dispensation policies are as- About the Authors ered for print publication.Queries should be Linda Drach and Julie Li Maher are with Program sociated with increased access to clean syringes Igr Design addressed to the Editor-in-Chief Mary E. and Evaluation Services,Multnomah County Health iNorthridge,PhD,MPH,at men6@nyu.edu. and safer injection practices.1-3 Currently,fewer Department and Oregon Public Health Division,Portland, than 1 in 10 SEPs in the United States report OR.Jessica Guernsey,Kathryn Pranian,and Carol Casciato I March 2011,Vol 101, No.3 I American Journal of Public Health Letters I 389 LETTERS • are with the STD,HIV,and Hepatitis C Programs, Fairly early on in the HIV epidemic,studies Hospital and the Department of Medicine,Facul Multnomah County Health Department,Portland.At the from Europe and the United States demon- Medicine,University of British Columbia, Vance time of the study,Maureen Rumptz and Mike Stark wereCanada. also with Program Design and Evaluation Services, strated that involving drug users in the delivery Correspondence should be sent to:Thomas Kerr,1 Multnomah County Health Department and Oregon Public of HIV prevention efforts,including syringe for Excellence in HIV/AIDS,608-1081 Burrard. Health Division,Portland. exchange programs(SEPs),could helpextend Vancouver,BC V6Z I Y6 Canada(e-mail:uteri-tk( Correspondence should be sent to:Linda Drach,Programubc.ca).Reprints can be ordered at http.://www.ajph Design and Evaluation Services,Multnomah County Health the reach,coverage,and effectiveness of these clicking thr:Reprints/Eprints"link. Department and Oregon Public Health Division,827 NE programs 1-3 These findings were likely,in part, This letter was accepted November 2,2010. Oregon Street,Suite 250,Portland,Oregon 97232 dotx10.2105/AJPH2O10.300065 a reflection of the fact that too manyinjection (e-mail:linda.drach@state.or.us).Reprints can be ordered I athttp://www.ajph.orgby clicking the"Reprints/Eprints"link drug users remained marginalised and did not This letter was accepted October 14,2010. have access to conventional public health pro- Contributors doi:10.2105/AJPH2010.300048 This letter was drafted by T.Kerr and edited b grams.The peer-to-peer model of using drug Wood.Both authors approved the final version. users as peer educators appears to address this Contributors ' All authors collaborated on the pilot study and provided barrier by providing a service that is more References feedback on this letter.L.Drach took the lead on writing acceptable to drug users than professional led 1. Grund JP,Blanken P,Adr aans NF,Kapla ss the letter and conducted the analyses. programs.4 In our recent study,5 an important Barendregt C,Meeuwsen M.Reaching the unre targeting hidden IDU populations with clean nee -- aspect of the change in syringe distribution known user groups.J Psychoactive Drugs.1992;2 Acknowledgments$m policy that led to large declines in syringe 41-47. This study was supported by the National Institute on Drug Abuse(grant no.5R21DA023399-02). borrowing and lending was the creation of 2. Latkin CA.Outreach in natural settings:the peer-driven SEPs. peer leaders for HIV prevention among injecting users'networks.Public Health Rep.1998;113(Su Human Participant Protection Recently,we have evaluated both the mo 151-159. i The study protocols and procedures were approved by the bile and fixed syringe distribution activities of 3. Broadhead RS,Heckathorn DD,Weakliem institutional review board of the Oregon Public Health a local drug user organization—the Vancouver et al.Harnessing peer networks as an instrument Division and the Multnomah County Heath Department Area Network of Drug Users(VANDU).An AIDS prevention:results from a peer-driven intern Y' Public Health Rep.1998;113(Suppl 1):42-57. examination of the fixed exchange showed References 4. Kerr T,Small W,Peeace W,Douglas D that the druguser—led program was attracting 1. Kerr T,Small W,Buchner C,et al.Syringe sharing P Wood E.Harm reduction by a"user-run"o and HIV incidence among injection drug users and a population of injectors who possessed sen a case study of the Vancouver Area Network Via: increased access to sterile syringes.Am JPublic Health eral markers of heightened vulnerability to Users(VANDU).Int JDrugPolicy.2006;17(2):61 2010;100(8):1449-1453. HIV infection.°Surprisingly,despite SurP g 1 5. Kerr T,Small W,Buchner C,et al.Syringe s P being : 2. Bluthenthal RN,Ridgeway G,Schell T,Anderson and HIV incidence among injection drug users an fre R,Flynn NM,Kral AH.Examination of the association quent injectors,the population using the creased access to sterile syringes.Am JPublic Hea between syringe exchange program(SEP)dispensation VANDU fixed exchange was also less likely to 2010;100(8):1449-1453. policy and SEP client-level syringe coverage among report unsafe syringe disposal.More recently, 6. Wood E,Kerr T,Spittal PM,et al.An extet `- injection drug users.Addiction.2007;102(4):638-646. evaluation of apeer-run"unsanctioned"syringe e: we evaluated the VANDU outreach-based 3. Bluthenthal RN,Anderson R,Flynn NM,Kral AH. syringe distribution program and found Simi change program.J Urban Health.2003;80(3):455 Higher syringe coverage is associated with lower odds of 7. Hayashi K,Wood E,Wiebe L,Qi J,Kerr ' HIV risk and does not increase unsafe syringe disposal lar results. This program was reaching high- external evaluation of a peer-run outreach-based s: among syringe exchange program clients.Drug Alcohol risk injectors while helping to reduce syringe exchange in Vancouver,Canada Int J Drug Policy: ..- Depend.2007;89(2-3):214-222. reuse. Sep;21(5):418-421.M 4. Des Jarlais DC,McKnight C,Goldblatt C,Purchase Drach et al.are correct in pointing out that Ueharm reduction better: exchange 6 United States.Addiction.2009;104(9):1441-1446. transformingUS syringe exchan e programs DISTINGUISHING BETWEEN HEAL • 5. Sharon S.Ban lifted on federal funding for needle will require changes in political acceptance. EDUCATION AND HEALTH t exchange.National Public Radio.December 18,2009. Given the evidence concerning the impor- INFORMATION DISSEMINATION Available at:http://www.npr.org/templates/story/story. tant role that drug users can play in en- = php?storyld=121511681.Accessed December 15,2010. hancing SEP delivery,a part of this political Wong and Higgins'article illustrates innc 4 `rt> change must be growing acceptance that tive ways nontraditional public health prt ;R' KERR AND WOOD RESPOND this population can and will work effectively viders such as park rangers are connectin - to support prevention efforts if given the with consumers on health issues.r Similar; .. We thank Drach et al.for their interest in our opportunity. the Centers for Disease Control and Previ study and for sharing evidence from their tion's Action Communities for Health,Irmo intervention study focused on secondary sy- Thomas Kerr,PhD tion,and EnVironmental ChangE(ACHIM, y' ringe exchange.Consistent with the findings of Evan Wood,MD,PhD program works with the National Recreat their study is a large and growing body of and Park Association and other group • evidence pointing to the important role injec- About the Authors promote physical activity and reduce lion drug users can play in enhancing HIV Thomas Kerr and Evan Wood are with the British disease risks.2 Such collaborations are Ion prevention efforts among their peers. Columbia Centre for Excellence in HIV/AIDS,St.Paul's overdue,given that the Institute of Media 390 I Letters American Journal of Public Health I March 2011,Vol 101, N. JEFFERSON COUNTY BUDGET COMMITTEE (Bolded name indicates attendance at the 02/16/11 meeting) • Assessor County Administrator Jeff Com Sheriff's Office Jack Westerman Philip Morley Janet Silvus Tony Hernandez Auditor's Office Anne Sears Kathy Young Steve Richmond Karen Bednarski Community Development Juvenile Services Susan Zoya Donna Eldridge Roseann Carroll Barbara Carr Superior Court Central Services Al Scalf Carol Palmer Michelle Moore Terry Logue District Court Prosecuting Attorney Crad Verser Clerk's Office Erin Kennedy Jan Chadbourne Treasurer Ruth Gordon Jill Landes Scott Rosekrans Janet Holbrook Commissioners'Office Tracie Wilburn Public Works Judi Morris John Austin Health Department Monte Reinders WSU Extension Lorna Delaney Jean Baldwin Frank Gifford Pamela Roberts Phil Johnson Julia Danskin Cathy Taylor Laurie Meyer David Sullivan Veronica Shaw Matt Tyler Jack Reid Meeting Minutes February 16, 2011 Judi called the meeting to order at 8:30 a.m. APPROVAL OF MINUTES: Minutes from January 19, 2011 were approved. • Old Business: Status of 2015 Visioning Process New Business: None REQUEST FOR AGENDA ITEMS: Update on Fund Balances: General Fund Cash Balance - $2,548,924, unreserved $985,319. Is where we expected to be since we used reserves to balance budget. General Sales Tax Receipts — $137,774, better than 2010. Expectation is higher due to Prop#1 and is spread over the year but won't kick in until June. Prop #1 doesn't apply to used car sales. REET Receipts— $56,823, two big sales, Land Trust and Hadlock Marina. Without the sale, would have been approximately $32,000 which exceeds last year. Hotel/Motel Lodging Tax— $11,507, better than last January. Reflects what actually happened in November since revenues are two months behind. Revenue Report: • General Fund at 4% overall. Juvenile & Prosecuting Attorney higher than expected. Will monitor as we go forward. • Expense Report: • General Fund, 2010 came in at 3.1% under budget. 10 Old Business Status of 2015 Visioning Process: Philip stated that since 2008 expenditures have been flat lining. With Proposition #1 expenditures and revenues are close. Future years show a gap that is going to continue to widen. The visioning process is about what do we want to look like. Planning on where to go, getting suggestions from staff, with opportunities for growing the next generation of leadership. Looking at what are the different options on how to allocate resources. With limited resources deciding what is right through collaboration. Working together to decide how best to divide up the General Fund pie. Looking at prevention dollars to reduce number of jail inmates; aligning ourselves with economic development. When society is wealthier they become more functional, demand for services should fall. Look at off loading to another organization. Tony is working on Animal Services. Other areas to look at are Family Planning; look for a non-profit such as Planned Parenthood to take over and getting out of the vaccine business. Parks — hand off to a subsidiary organization or Metropolitan Parks District. Simplicity of regulations. Planning different use for Information Services; looking at ways to reduce staff time on public records requests, more automation, common database; be more effective through phone and computer technology. Looking for more effective ways to do what we do. Volunteer force multiplier— look for more ways to tap citizens to help us do what we do. Citizens want to be asked. It may be time for a Parks District. This is an extremely generous county. • Philip is researching different processes, looking for ideas or suggestions; will meet with department heads and should start the 2015 visioning process in April. Other Business • Judi and Philip presented a press release: Jefferson County was awarded AA- bond rating for good fiscal management and having a good reserve policy and dedicated funding sources for bonds. Many counties are rated below us. • Philip reported on contract negotiations with the City. There are four service agreements: Jail, District Court, Animal Services and Drug & Alcohol Prevention P.T. School District. The City feels we charge too much for District Court. Looking at model from Clallam County and charging actual costs. Possibly negotiating for multiyear contract in the future. Waiting to see what written proposal is. • PIFF Board is scheduled to meet March 11th City received $360,000 for Water St. $180,000 grant and $180,000 loan. The City believes it should be 100% grant. Nothing supports that this was agreed to. The contract states it's a loan. Extensions have been given on projects such as the Quilcene waterline and there have been discussions on whether the 50/50 loan is working. PIFF is funded through 9/10ths sales tax returned to the county to spend on infrastructure in consultation with the Port and City. By ordinance 50% goes to the Tri Area Sewer fund. The PIFF Board only meets when project funding needs to be discussed. • Capital Funds: Road Fund adjusts TIP to meet revenue stream. Seeing more constraints in coming years. Capital Improvement Fund is funded by REET. Bond payments are M $710,000 per year. The $251,000 Solid Waste Equipment Reserve contributed in 2010 and 2011 won't be continuing. The shortfall is a burden of the General Fund. Capital Page 2 of 3 Facilities budget was funded with excess REET. Loring has been doing a wonderful job conserving the balance and deferring maintenance. By 2013 the fund will be on empty. Will be focus of long range planning over the next year. • • Ann will put together committee to track Proposition #1. Collect revenues at the end of June. • Tony stated that he's working on a five year strategic plan; that independent elected officials should work with the BOCC and work with the community at large that they represent. He is looking at service demand, staffing requirements, technology. BOCC has budget authority. Work in a spirit of cooperation and communications within elected officials and BOCC. • Will lose 70 years experience. Need to be looking toward the future, what is going to happen in the next four years and who's going to fill your position. • Prosecutors Office is scrambling to cover staffing. The grant for the drug case prosecutor runs out at the end of the year. They're working with Sheriff Dept. on pre-charging diversion which will cut case load significantly. Deputies won't need to testify, fewer cases filed in District Court. In the process of automating it. • Judi publicized notice of meeting. Reports will be on the web site starting next month. Meeting Adjourned: The meeting was adjourned at 9:30 a.m. The next meeting will be March 16, 2011 at 8:30 a.m. Respectfully submitted, Cathy Taylor, Recorder • • Page 3 of 3 • E ts: -_,,,,..t... ,,, ,,,„„di ,___i_, �,�_, �, f l- . nici-3.- ,c.„--c., 00 .... _:. . ,:3 „,c, ,,4,1..v.,0,9 , N --- ._: ..-a. — „z; -„il .s.:;',--_:,. -,4, ,---:, `',11--- p'„;:,._ '''.-'1 4,‘,,,,......--_,,,,- -71 ki-\---1c3 -I Z ....,,,---...,.., ii. c)c---*.-4.1 , f..' v.-- .e.,-,'-;„4 -,--s)-'--.4 ,,,, , to et V// C Opp ,g , ``c4OA CI- - 7 I O! mulm mCQC a % x v+_ G C �-o r;� � > _J f y -.� ` ®� rlm- IIrI` ��ll . �=edie*,,,x-- - plicil , 1 fi iii, ...., ,, ,J.,....._ rry,,,,,J, „ix,,,...7i,,,.._•._:;_i_i:_,Li..,?;..,,,t.t,:,/ .. ,_, ,;,....... ..„.„,/..,,. .,....,,,..,..,. .._ ......v.,.., ,,. ,,.. . .,-,, dfp (7_ 7-- A-' -13FT,i-f,;,,.-.4zo...,,i,,..14:-.4.: - � -r$ s Q v q a `� '-:, m • ' ' \, .,'..' ,1 c,z m 1, `\1\ti :' '` c,Z m aA 1 ` � mvz y 1i i , `\ - 1' ,emsX•r ` Aom 1 c: ..r -.Zb Iv1 '''.::**.t.:'-',';!.E1'":‘,fi.,.':':,,, Sri\ '. li: I; i:' ''nZili 4 X11 tri.. vr,'-'''''--,4-1-azy, .'5.-i-'/. '`',j ' - \\ W*--'41- ' - ---- - J1'yvy s- f - z e° K . \\ ',„,,..-.-!'il ,- "" - -----tr:-',--*-c----trs,.'4°-,ii-,, . ,.)4 'tib` n oma , .. m�mwbmI. z � ..c). vis-- . a r c�-r ", �6 Ramo r Z h O li. .��10., 1 /. ' 'm �, Our Kids : Our Business • My Call to Acton Our Kids: Our Business Pledge: My Call to Action: I believe our children are owed a safe community; a nurturing environment where all kids can become connected to the resources they need to live healthy and fulfilling lives as caring and competent citizens. In furtherance of my commitment to this mission, I support the "Our Kids: Our Business" campaign and agree in the coming year to take specific action in support of the Five Promises. Five Promises to our Children 1. Caring Adult 2. Safe Places and Constructive Activities 3. A Healthy Start and Future 4. Effective Education for Marketable Skills 5. Opportunities to Serve Actions can be big or small and can address any one of the above promises, such as: * Be a caring adult who asks a neighbor about their school activities. * Serve an organization that supports healthy youth and families. * Donate time or money to a cause that supports healthy youth and families. *Allow youth opportunities to serve in your organization. flior details, go to www.jeffcocommunitvnetwork.orq or www.jeffersoncountvpublichealth.orq. To take the Pledge, please fill in the section below and follow delivery instructions. The names of all those signing this Call to Action will be printed in the Port Townsend Leader in the month of May. Name: City: Email: Signature: OPTIONAL: If you wish to have your contact info forwarded to a local group or agency, please fill out the contact section below. This information will not be printed in the newspaper. Agency/organization to notify of your interest Address Ohone Number E-mail Mail or deliver this form to: Our Kids: Our Business Or fax to: JCPH 360-385-9401 615 Sheridan Street Port Townsend, WA 98368 April is National Child Abuse Prevention and Sexual Assault Awareness Month. The Jefferson County's 4th annual "Our Kids:Our Business" is a social awareness and prevention campaign. Many 1110 community partners are collaborating to highlight the things we can do as individuals, organizations, agencies, and businesses to prevent child abuse and sexual assault. It is our community's commitment to Our protect and nurture our children. Kids: No one person can do everything, Our Business But everyone can do something, and Together we can create change for the better. 2011 "Our Kids: Our Business" activities and events planned for April (stay tuned; more is developing each day. This update 3-16-11): • A "Call to Action" for the residents of Jefferson County inviting citizens to pledge an action that will make Jefferson County a more nurturing and safe environment for children. (The pledge is asking for action, not money.) • The City of Port Townsend and Jefferson County Commissioners are proclaiming April to be National Child Abuse Prevention Month. • Jefferson County Historical Society is sponsoring a History Game for children of all ages on Saturday, April 2nd from 11:00 to 3:30 pm. The game will be family friendly. There will be fun prizes. Admission is free for Jefferson County residences. For information call 360 385-1003 or Phyllis(c�jchswa.org. • Port Townsend Public Library was awarded a two year Paul Allen Family Foundation Grant for a Teen Community Read. For the spring of 2011 the Teen Community Read book will be 13 Reasons Why by Jay Asher. Many community activities, ranging from book • discussions, visual art workshops, a theatre forum, and poetry workshops, have been planned for Port Townsend High School and for the larger community. Specifics about these events are still developing. • The Food Co-Op and Sound Experience will host "Our Co-Op Kids," an Earth Day festival celebrating boats, planes, worms and fish on Sunday April 17th from 1:00 to 4:00 pm in the Food Co-Op parking lot. Other participants are Northwest Maritime Center/Wooden Boat Foundation, P.T. Sea Scouts, Northwest School of Wooden Boatbuilding, P.T. Marine Science Center, Schooner Martha, Community Boat Project, P.T. Aero Museum, Tri-Area RC Club and theTri-Area School Garden/Compost Program. • Crime Victims Service Center will host a free Family Fun Fest on Saturday, April 23rd from 10 to 3 pm at Mountain View Gym. Children and families will be able to learn about health and safety and community resources in a fun and interactive environment. Free child ID Kits will be available. • PTHS Student Task Force will sponsor a media campaign called Let's Draw the Line, which will ask adults to make a commitment by "drawing a line" between youth and tobacco, alcohol and drugs. Event, date and time still be scheduled. • Dove House Advocacy Services will sponsor a "Walk a Mile In Her Shoes" event on Wednesday, April 27th to bring awareness to the issues of sexual assault and rape. This event is part of a national men's movement to bring an end to sexual violence. (Specifics about the Port Townsend walk will be given in future Events List updates.) For more information go to www.walkamileinhershoes.org. • MakeWaves! is sponsoring a free pool party for families and children on Saturday, May 21st from 3:00 to 5:00 pm (right after the Rhody Run). Refreshments and a fun time will be provided. • (Contact information will be added in future Event List updates) • The Developmental Disability Advisory Board, Jefferson County Tobacco Prevention and Control and other community partners are sponsoring a county-wide Posters & Coasters Campaign to Prevent Fetal Alcohol Spectrum Disorders" to educate the public about the risk of birth defects caused by drinking and smoking at any time during pregnancy. Look for the thoughtful posters and coasters in the community. OVER • Jefferson County 4-H News will cover the OKOB campaign through video on their Youtube channel and blog, 4-H Network News. • An ad will run at The Rose for the month of April • • Presented by: Jefferson County Community Network and Jefferson County Public Health Also Sponsored by: City of Port Townsend —All Departments, Jefferson County—All Departments, Board of Health, Dove House Advocacy Services, Jefferson County Historic Society, Jefferson County METH Action Team, Jefferson County 4-H, Jefferson County YMCA, Developmental Disabilities Advisory Board, the Boiler Room, Safe Harbor Recovery Center, Substance Abuse Advisory Board, Jefferson Teen Center, Department of Children and Family Services/Children's Administration, Jumping Mouse Children's Center,Jefferson Mental Health Services, Jefferson Community School, Jefferson NAMI, makewaves!, Sunfield Farm, OLYCAP, Brinnon School District, Chimacum School District, Port Townsend School District, Quilcene School District, DBHR, DSHS, PT Kiwanis, The Rose Theatre, the Elks Lodge and the Port Townsend & Jefferson County Leader and many, many more businesses, agencies and service clubs. • • PORT TONM Erm, PVBLIK LIORfR ' .o.k,M„ ` SESiSSLL6R 1 �S :4I ..,�.^."' .,r�.�„_�-4. .—,-,� — ,-7,;—._ , TH IR T7.: ` R3A SONS S �• . OMMVMITY REFID QQ _ 1 .._ JAY ASHER The Teen Community Read & I--Jow It Works - 4 .x Thirteen Reasons Why,by Jay Asher,is the book selected for the inaugural Teen Community A� '" � i: Read. The novel tells the story of a teenage girl slowly losing hope.After reading the book, teens are invited to discuss the issues it raises and express these issues through art,writing and theater.Students will create works of art that can take the form of stories,plays,poems,songs,short films,drawings,cartoons, paintings,zines,collages or other mediums of expression. 4 ALL EVENTS ARE FREE!!! 'ART ®RKSN®IPS WRITINIx WORKStiOPS Local artists Counsel Langley,Jesse Watson,Kathleen Burgett IP and Margie MacDonald will work with teens at PTHS and Anna Quinn,owner of The Writers'Workshoppe, Jefferson Community School to create artwork based on personal will work with teens in PTHS and Jefferson Corn- interpretations of the story.Not taking an art class?Four art workshops munity School English classes to craft personal for teens are conducted in two locations during the month of April: responses to 13 Reasons Why.Not Wednesday,April 13 at PTHS art portable(behind the gym),2:30-4 pm taking an English class in a school? Wednesday,April 20 at PTHS art portable(behind the gym),2:30-4 pm • You can also bring your writing to the PT Public Library or post it online at Saturday,April 23 at Jefferson Community School,280 Quincy, 11 am-3 pm Saturday,April 30 at Jefferson Community School,280 Quincy, 11 am-3 pm http://ptlibraryteens.blogspot.com. Teens can also create a piece of art at home and bring it to the library by All of the writings will be compiled Friday,April 29. into a zine that will be distributed May 6 at the four-minute readings at the PT Library All work will bejuried and hung in four locations during May: Undertown and May 7 during Gallery Walk at Undertown,The Coffee,The Boiler Room,Jefferson Community School and PT Public Library. Boiler Room,and Jefferson Community School. Twenty teens will be chosen by lottery to present141/000 four-minute readings of their work May 6 at the PT Public Library,from 7 to 9 pm. FORUki 1NEATRE " 4"Alit Raven McMillen and Kai Addae,with Marc Weinblatt,will BOOK DIStUSSYNS.; work with a group of teens to explore the issues that are stimulated by the book,culminating in an interactive public performance and community dialogue. Just want to talk about 13 Reasons Why? Join the discussions at the Charles Pink House The Masonic Hall, 1338 Jefferson St.(by the post office) (next to the Library). Saturday,April 9 7-9 pm Saturday,April 16 7-9 pm Tuesday,April 12 Teens only,3-4:30 pm Tuesday,April 19—All ages,3-4:30 pm M MIN Or join the online discussion at , http://ptlibraryteens.blogspot.com. ;.* E>E LIE AU1T R ;44-0-0 . - Jay Asher gives two community presentations • GALLERY %/AEI( at the high school on May 6. He also gives ,w a--- a presentation at PT Public Library,Saturday, ryi '` Teen artwork inspired by 13 Reasons Why joins Gallery Walk May 7,2-3 pm. To learn more about the book :.,,. on May 7 with exhibits at The Boiler Room,Undertown and to follow Asher's blog,visit - , Coffee,Jefferson Community School and PT Public Library. http://www.thirteenreasonswhy.com/index.php. The artwork is displayed throughout the month. , Alig.V4g44 - 44. • .‘,',11-4,;104%r41;:i5.:,:0-4,1!•*; p w focal Counselors Crisis Resources Amy Elizabeth Gordon,MA,LMHC,CDP free phone consultations to teens 24-hour Crisis Lines during normal business hours 385-0321 360-821-1422 1-800-suicide www.hopeline.com Mark Saran, LMHC 385-7744 Jefferson Mental Health 385-0321 Sherry Nesmith,RN, LMHC,NBCC 379-9107 PTHS Health Clinic 385-9400 or 379-4609 Sponsors Port Townsend Public Library Port Townsend High School ,;; • Jefferson Community School Jefferson County Community Network Jefferson County Health Department Our Kids: Our Business Special thanks to Counsel Langley,Jesse Watson, Kathleen Burgett, Kelly Matlock, Margie MacDonald,Anna Quinn, ;, Anna Nasset, Marc Weinblatt, Kai Addai, Raven McMillen, Jennifer Barron, Undertown Coffee, and The Boiler Room. This project funded by a grant from The Paul G. Allen Family Foundation. THE PAUL G. ALLEN FAMILY foundation oat -rownSFry Q 4 • For more information: 360-385-3181 www.ptpubliclibrary.org •�'' �� ERINa Fay. `` JEFFERSON COUNTY PUBLIC HEALTH 615 Sheridan Street • Port Townsend •Washington • 98368 www.jeffersoncountypublichealth.org For Immediate Release: March 16, 2011 Contact person: Thomas Locke, MD, MPH Jefferson County Health Officer Health Department Provides Assessment of Radiation Exposure Risk and Health Recommendations Regarding the Nuclear Reactor Emergency in Japan Port Townsend We have all been touched by the magnitude of damage and human suffering caused by the catastrophic earthquake and tsunami that struck Northeastern Japan last week. It is especially sobering when we realized that the Olympic Peninsula is an area of the world at risk for similar earthquakes and whose coastal communities are vulnerable to devastating tsunamis. We can imagine losing family members and friends, and we can picture being isolated for days, without power, food or water. Public health agencies at a local, state, and national level are closely monitoring the situation at Japan's Fukushima Daiichi Nuclear Station. Japan is facing a very serious emergency as they struggle to cool several heavily damaged nuclear reactor cores and prevent additional releases of radioactive material in the immediate vicinity of the plants. There is widespread agreement by U.S. public health experts that there is no S current or potential radiation hazard to the mainland United States, including the Olympic Peninsula, even in the event of a catastrophic meltdown of the Japanese reactors. Comparisons have been made with the 1986 Chernobyl accident which spread radiation over a wide area. These comparisons are inaccurate and misleading. The Chernobyl accident involved a runaway reactor that exploded and burned, sending massive amounts of radioactive materials into the upper atmosphere. The radiation that has been released in Japan is of a much smaller amount and was not at a high enough altitude to travel in the jet stream to the U.S. That said, there are a number of agencies continuously assessing the situation as it evolves, regularly measuring atmospheric conditions, and monitoring for dispersal of radioactive materials. Disasters often surprise us with their impacts, and it pays to stay alert and prepared, even when the potential impact seems minimal. As Health Officer for Jefferson County, I want to reassure you that the best available information indicates that there is currently no risk of harmful radiation exposure to residents of the continental U.S. as a result of the damaged Japanese nuclear reactors. Unless there are entirely new and unforeseeable developments in Japan, no future human health risk is anticipated. You may be hearing about taking potassium iodide or Prussian blue to protect you from possible radiation sickness. The Washington State Department of Health (DOH) and • Centers for Disease Control (CDC) strongly recommend against this. COMMUNITY HEALTH ENVIRONMENTAL HEALTH DEVELOPMENTAL DISABILITIES PUBLIC WATER QUALITY MAIN: (360)385-9400 ALWAYS WORKING FOR A SAFER AND MAIN: (360) 385-9444 FAX: (360)385-9401 HEALTHIER COMMUNITY FAX: (360) 379-4487 • Potassium iodide is available as an over-the-counter drug. It has the potential for411 significant side effects, and can be harmful for people with certain medical conditions. Its benefits do not outweigh its risks unless you have acute exposure to significant amounts of radioactive iodine in a situation where evacuation is not possible. • Prussian blue is available by prescription only. You SHOULD NOT consume Prussian blue artist's dye or paint pigments. This type of Prussian blue is not designed to treat radioactive contamination. If a radiation risk were to occur, local health departments would have access to both substances from the Strategic National Stockpile and would use our emergency procedures to make it available to our community. Washington's DOH serves as the state's expert agency in matters of radiation affecting public health. DOH is partnering with Federal agencies, the International Atomic Commission, other western state DOH's and Canadian agencies to monitor the situation in Japan. They are collecting air, crop and other samples 24/7 throughout the West Coast to ensure an early warning should the situation change. As part of our job to protect your health in the event of any natural disaster or man-made emergency, we have plans in place to handle many different types of emergencies. We partner with other local and state agencies so that together, we can prevent harm where possible, and when harm is unavoidable, to contain it and limit its damage to you and your family. As part of this work, we are part of a 24/7 public health communication system that will inform us promptly if there are any increased risks from the events in Japan. We will then activate our own emergency communication processes to promptly 1111 inform the public in Jefferson County. We are fortunate that the tsunami risk from last week's earthquake has passed and there is no significant risk of radiation reaching the continental U.S. We are in no way immune from a similar disaster occurring in Washington State. Accordingly, we strongly recommend that every family have a personal disaster plan in place. An excellent guide can be found at http://seattletimes.nwsource.com/news/local/links/disaster/prepare.pdf. This handy check list was published by the Seattle Times and will guide you through all the things you need to do to be as safe and healthy as possible after a disaster, until help arrives. Share it with your neighbors — and collaborate on how you could support one another. A safe community is a resilient community. For additional information, we recommend that you visit the DOH website at the link below. They are our most valuable and credible information source on this situation, and they update their website information around the clock. They have a helpful Frequently Asked Questions (FAQ) link that can answer many of your questions. Washington State Department of Health: http://www.doh.wa.gov/Topics/japan2011.htm/ COMMUNITY HEALTH PUBLIC HEALTH ENVIRONMENTAL HEALTH DEVELOPMENTAL DISABILITIES , y �t�i ��,w � �n WATER QUALITY • MAIN: 66385-94400 HEALTHIER COMMUNITY MFAX: 3603779-4487 FAX: 360385-9401 JEFFERSON COUNTY BOARD OF HEALTH Guidelines for adoption of Policies, Protocols and Guidelines (Repeals and Replaces Jefferson County Health Department Environmental Health Service Policy Statement Number 2-88 (adopted June 22, 1988) Purpose: The development and adoption of policies, procedures, and protocols is an essential part assuring quality, accountability, and consistency in the provision of public health services. The following guidelines establish criteria for determining when a policy, procedure, protocol, or guideline should be developed. Definitions: Generally defined, a policy is a plan or course of action intended to influence and determine decisions, actions, and other matters. Policy:Two major types of policy statements are utilized by Jefferson County Public Health: Board of Health policy: a statement of intent by the local Board of Health involving its statutory authority as outlined in RCW 70.05. These areas of authority include, but are not limited to, enforcement of the rules and regulations of the State Board of Health, interpretation and enforcement of ordinances and codes adopted by the Local Board of Health, and the enumerated powers and duties of a local board of health (RCW 70.05.060). Board of Health policies may also contain specific procedures for carrying out the policy intent of the Board. Administrative policy: a plan, standardized practice, code of conduct, or course of action established by Jefferson County Public Health administrators to promote the quality, efficiency, and consistency of program services. Administrative policies may also contain specific procedures(i.e. a series of steps to accomplish a defined goal). Protocol: A step-wise plan,generally based on evidence-based standards and expert opinion that specifies actions taken to respond to an incident, carry out a medical procedure, or otherwise perform a series of actions in a highly consistent fashion. Guideline: An education document produced to explain existing policies, regulations, or other health- related codes. A guideline does not create new policies, procedures, or protocols but merely explains them in a manner designed to assist community members in understanding the purpose and requirements of specific health regulations. (e.g. Guideline on Disposal of Household Hazardous Waste) Adoption of Policies: • Board of Health policies are adopted at the direction of the Board or in response to a specific need to clarify existing public health authority. Board of Health policies may be adopted, amended, or repealed at any regular public meeting of the Board of Health. Board of Health policies should be signed by the Chair of the Board of Health and the Health Officer. Board Members Kristen Nelson,Chair,Port Townsend City Council, Phil Johnson, Vice-Chair,County Commissioner District#1, David Sullivan,Comite Commissioner,District#2, John Austin,County Commissioner, Jill Buhler,Hospital Commissioner, Sheila Westerman,Chair,Citizen at large(Cit)y, Roberta Frissel!Citizen at large(County) 615 Sheridan • Castle Hill Center• Port Townsend • WA • 98368 (360)385-9400 • Administrative policies are developed and adopted by the Health Director or Environmental • Director, with the concurrence of the Health Officer, when appropriate. At a minimum, administrative policies sufficient to fully meet the "Standards for Public Health Practice" as promulgated by the Washington State Department of Health should be adopted and regularly reviewed by Jefferson County Public Health directors. • Protocols and Guidelines are developed by program staff, reviewed and approved by appropriate managers, and distributed to e ' ployees or the general public as appropriate. Protocols and guidelines are scheduled for eriodic review for updates. \\\L' 1 1 l Chair,Jefferson County Board of Health Date [ l t I Jefferson County Health Officer Date • 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, Jill Buhler,Hospital Commissioner, Sheila Westerman,Chair,Citizen at large(Cit)y, Roberta Frissell,Citizen at large(County) 11110 615 Sheridan • Castle Hill Center• Port Townsend • WA • 98368 (360) 385-9400