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Z Y �. •� • 7:-.;E,,'.,....,:-::,,,,,...:,..,-;-.:-:,;,.:::::0:,-7,..,,,,,7 + n wd w csii) 0 `� 7.r'yn A�, ir : g .„.....„,..,,,,,,,,., ,,,.;..„,*,-,r,z.-,..- „:„..„,:-..,,,,. .,,,4, ;ift : •NN x § Y"1� f3?A{ :4 : , O ,"t1;,,ilir..,::;;;i:-.,.." :rill v l yY , i t i1.s , __ co 23 03 co corcil) INC ..._,.,,, . , c Eco m - co o o y U T., E w C .4?-- O U z3 m W E aQi o • Board of 3-CeaCth New Business Agenda Item # T., 1 • Food Service Awards June 16, 2011 • ,,,,, 1pC ,,A i. .,- JEFFERSON COUNTY PUBLIC HEALTH 4615 Sheridan Street • Port Townsend •Washington • 98368 '16Itai°-\`'• www.jeffersoncountypublichealth.org • Jefferson County Public Health — Food Safety Program Outstanding Achievement Awards for 2010 The Belmont Restaurant Cuisine Med Catering Rick Unrue Darcia Morrisonbuck 925 Water Street 640 Blackbear Road Port Townsend, WA 98368 Port Townsend, WA 98368 Blue Moose Cafe Dos Okies Barbeque Tana Kettle Larry Dennison 311B Haines Place 2310 Washington St. Port Townsend, WA 98368 Port Townsend, WA 98368 The Boiler Room Dream City Market& Café Cara Leckenby Joann Saul 711 Water Street 23 Kala Square Place Port Townsend, WA 98368 Port Townsend, WA 98368 Brinnon School District#46 El Sarape Olycap— Kathy Crowley Ricardo Vega, Cesar Garcia 46 School House Road 628 Water Street Brinnon, WA 98320 Port Townsend, WA 98368 • Brinnon Senior Nutrition Fat Smitty's OLYCAP, Sandra Pederson / Carl & Mayo Schmidt Jennifer Loring 282624 Hwy 101 306144 Hwy 101 Port Townsend, WA 98368 Brinnon, WA 98320 Fiesta Mexican Restaurant Chimacum Café Tabatha Kibler Debbie Lynes, Brian Horner 1232 Sims Way 9253 Rhody Drive Port Townsend, WA 98368 Chimacum Elementary School Food Co-op Deli Heidi Holmes, Chimacum School District Briar Kolp, Shila Zimmerman 91 West Valley Rd. 414 Kearney St. Chimacum, WA 98325 Port Townsend, WA 98368 Chimacum High School Fountain Café Linda Boyd, Chimacum School District Nick Yates 91 West Valley Rd. 920 Washington Street Chimacum, WA 98325 Port Townsend, WA 98368 • COMMUNITY HEALTH ENVIRONMENTAL HEALTH DEVELOPMENTAL DISABILITIES HEALTH WATER QUALITY MAIN: (360) 385-9400 ALWAYS WORKING FOR SAFER AND MAIN: (360) 385-9444 FAX: (360) 385-9401 HEALTHIER COMMUNITY FAX: (360) 379-4487 Galatea Café & Papas Bar Market Place at Aldrich's Lora Wood Renee Fukuda • 842 Washington St. 940 Lawrence Street Port Townsend, WA 98368 Port Townsend, WA 98368 The Galley McClane's Diane Coleman R. J. Keds Ent./ Gail McClane 308913 Hwy 101 2123 West Sims Way Brinnon, WA 98320 Port Townsend, WA 98368 Half-Way House Restaurant Olympic Timberhouse Yvonne Peterson Carin Rutledge 41 Brinnon Lane PO Box 386 Brinnon, WA 98320 Quilcene, WA 98376 In-Season Catering Pizza Factory Beth Johnson Francis &Valorie Danielek PO Box 1695 PO Box 201 Port Townsend, WA 98368 Port Townsend, WA 98368 Jefferson County Jail Plaza Soda Fountain Russ Longorier Don & Donna Hogland 81 Elkins Road 1151 Water Street Port Townsend, WA 98368 Port Townsend, WA 98368 Khu Larb Thai Restaurant Point Hudson Café Rosie Itti Palico Inc. /Jackie Pallister • 225 Adams St. 130 Hudson Street Port Townsend, WA 98368 Port Townsend, WA 98368 La Isla Mexican Restaurant PTHS, BHMS, Grant St. Schools Ignacio Rangel Mark Sperrazza 1145 Water Dr. 450 Fir Street Port Townsend, WA 98368 Port Townsend, WA 98368 Lanza's QFC # 870 Deli — Port Hadlock Lori & Steve Kraght Dan Diederichs, Carmen Farias 1020 Lawrence St. 1890 Irondale Rd. Port Townsend, WA 98368 Port Hadlock, WA 98339 Logger's Landing Queets Clearwater Elementary School Jack Helgens Queets Clearwater School District PO Box 491 146000 Hwy 101 S. Quilcene, WA 98376 Forks, WA 98331 C OM's UNI l Y HEAL FII FNIRONMKN AFHEAL I H DrVhLO MENrA1,DISABILrr1-S PUBLIC HEALTH WATER QUALITY MAIN: 30` - A! YS WORKING FOR A SAFER � • FAX:3ca3859401 HEALTHIER COMMUNITY �X 360-379-4487 f > Spruce Goose Cafe • Chris Cray & Andrea Raymor 310 Airport Road Port Townsend, WA 98368 Tri-Area Community Center Sarah Miskimins, OLYCAP 10 West Valley Road Chimacum, WA 98325 T's Restaurant Nancy Tocatlian 141 Hudson Street Port Townsend, WA 98368 Twana Roadhouse Melody Bacchus 294793 Hwy 101 Quilcene, WA 98376 Upstage Restaurant Last Stage Co / Mark Cole 923 Washington Street Port Townsend, WA 98368 • Uptown Pub & Grill Laura Millet 923 Washington Street Port Townsend, WA 98368 (OMMIJNIJYIIE AI IH • D1V H OPME NIADISABILITIES MAIN.3630° PUBLIC HEALTH ALWAYS WORKING FOR A S FRR AND ENVIRONMENTAL HEA rI NIVATCK QUALITY FAX: 360.385-940I HEALTHIER COMMUNITY nAIv: 360-385-9I41 FAX: 360-379-4487 I • Board of 3-fealth Netiv Business ,agenda Item #T., 2 • Env ironmentaC 3-fealth Food Permit Tee Discussion & Recommended Call for Public 3-fearing June 16, 2011 • Environmental Health Food Safety Program FOOD SAFETY PROGRAM: CORRECT MISTAKE IN 2011 FEE SCHEDULE A mistake was discovered in the 2011 Environmental Health Fee Schedule, Ordinance 10-1216-10. The fees for Grocery Stores (1-3 check outs) and Espresso Stands were reversed, Correct fee for Grocery Stores (1-3 check outs) is$174. Correct fee for Espresso Stands is$136. Fee billings were done correctly. Environmental Health staff requests that the Board of Health hold a Public Hearing to change the Environmental Health Fee Schedule at their July meeting. FOOD SAFETY PROGRAM: TEMPORARY PERMIT ISSUES and PROPOSED FEE CHANGE As a preface: The fees associated with a Temporary Event in Jefferson County since 2010 have been: • $98 for a low risk limited operation or • $130 for a complex menu with potentially hazardous foods. Per WAC 246-215 the following definition: (26) "Temporary food establishment"means a food establishment: • (a) Operating at a fixed location, with a fixed menu, for not more than twenty-one consecutive days in conjunction with a single event or celebration, such as a fair or festival; or (b) Operating not more than three days a week at a fixed location, with a fixed menu, in conjunction with an approved, recurring, organized event, such as a farmers market. Past Practice: An event was defined on the permit application as: A temporary permit is valid until the end of the current calendar year and can be used for an unlimited number of events, provided that the events are not more than 3 days a week, with an organized recurrent event or not more than 21 days in a row with an organized event. Events may be changed or added if notification is given to the Environmental Health Department a minimum of 10 working days prior to the proposed change. Please proved address for each event(Attach additional sheets, if necessary) In practice, this meant that regardless of the above definitions, we permitted vendors to participate in multiple events at multiple locations associated with any kind of food service that was not an annual permit application, for one fee. This included some vendors who were not associated with an organized event, such as requesting to set temporary food service in front of the co-op or other establishment, for a day or so. Current Practice: An event is defined on the application as: A Temporary permit is valid until the end of the current calendar year. Multiple events may be approved for food operations meeting the temporary food establishment definition with a fixed menu and at a fixed location. • In practice, we have interpreted an event strictly by what is stated in the code: associated with an "organized event". June 16,2011 We understand that according to the definitions, if the vendor is not specifically participating in a farmers market, allowing multiple events with a single license and a single fee is problematic. • In (b) above which allows recurring events, we have been charging one fee per vendor, allowing ALL of the farmers market vendors to pay that single fee, no matter how many of the 4 markets they intend to participate in. When a temporary event application seems to lean toward an annual permit, we have met with the applicant and convinced them to change their application to allow for a cost savings, but also a more appropriate, safe, consistent food service procedure. (examples: fairground kitchen permit and concession permit for 4H and Celestial Rebeeka food service) Issues for this year's process: • Fees for a temporary permit are the same as last year, but we are charging separate fees for events that do not qualify for a multiple event category, according to the language in code. • Multiple vendors have complained about changes in interpretation and associated cost. • This "reset" of the permitting process, has taken significantly more staff time in discussion with vendors to ensure consistency. Solution to THIS SUMMER TEMPORARY EVENT SEASON: We propose that: • The first event application be assessed the full permit fee in accordance with the fee schedule as existing. • Any vendor who then chooses to sell at other festivals or fairs, within the same calendar year, and has the same menu as the initial application can pay a reduced fee for each following event. • This fee should be sufficient to cover the cost of printing additional permits and abbreviated in 41111 office review with limited oversight of the vendor at successive events. • Environmental health staff requests that the Board of Health hold s public hearing to change Environmental Health Fee Schedule pertaining to temporary food establishments at their July meeting. i June 16,2011 Washington State Retail Food Code • 1-201.10 Statement of Application and Listing of Terms. (A)The following definitions apply in the interpretation and application of this Code. (B)Terms Defined. (36) Food Establishment. (a) "Food establishment"means an operation that stores, prepares, packages, serves,vends,or otherwise provides FOOD for human consumption: (i) Such as a restaurant; satellite or catered feeding location;catering operation if the operation provides FOOD directly to a CONSUMER or to a conveyance used to transport people; market; vending location; conveyance used to transport people; institution; or FOOD bank; and (ii)That relinquishes possession of FOOD to a CONSUMER directly, or indirectly through a delivery service such as home delivery of grocery orders or restaurant takeout orders, or delivery service that is provided by common carriers. (b) "Food establishment"includes: (i)An element of the operation such as a transportation vehicle or a central preparation facility that supplies a vending location or satellite feeding location unless the vending or feeding location is PERMITTED by the REGULATORYAUTHORITY; and (ii)An operation that is conducted in a mobile, stationary,temporary, or permanent facility or location;where consumption is on or off the PREMISES; and regardless of whether there is a charge for the FOOD. 8-401.10 Establishing Inspection Interval. (A) Except as specified in¶11(B)and (C)of this section,the REGULATORY AUTHORITY shall inspect a FOOD ESTABLISHMENT at least once every 6 months. (B) The REGULATORY AUTHORITY may increase the interval between inspections beyond 6 months if (1)The FOOD ESTABLISHMENT is fully operating under an APPROVED and validated HACCP PLAN as specified under§ 8-201.14 and¶¶8-103.12(A)and (B); (2) The FOOD ESTABLISHMENT is assigned a less frequent inspection frequency based on a written • RISK-based inspection schedule developed by the REGULATORY AUTHORITY, or set by state or federal LAW, and uniformly applied throughout the jurisdiction; or[Amended by WAC 246-215- 181(2)] (3) The establishment's operation involves only coffee service and other unPACKAGED or prePACKAGED FOOD that is not POTENTIALLY HAZARDOUS such as carbonated BEVERAGES and snack FOOD such as chips, nuts,popcorn, and pretzels. (C)The REGULATORY AUTHORITY shall inspect a TEMPORARY FOOD ESTABLISHMENT during its PERMIT period,unless the REGULATORY AUTHORITY develops a written RISK-based plan for exempting certain categories of TEMPORARY FOOD ESTABLISHMENTS from inspection that is uniformly applied throughout the jurisdiction. [Amended by WAC 246-215-181(3)] 8-401.20 Performance-and Risk-Based. Within the parameters specified in§8-401.10,the REGULATORY AUTHORITY shall prioritize, and conduct more frequent inspections based upon its assessment of a FOOD ESTABLISHMENT'S history of compliance with this Code and the establishment's potential as a vector of foodborne illness by evaluating: (A) Past performance,for nonconformance with Code or HACCP PLAN requirements; [Amended by WAC 246-215-181(4)] (B) Past performance,for numerous or repeat violations of Code or HACCP PLAN requirements; [Amended by WAC 246-215-181(5)] (C) Past performance,for complaints investigated and found to be valid; (D)The HAZARDS associated with the particular FOODS that are prepared, stored, or served; (E)The type of operation including the methods and extent of FOOD storage, preparation, and service; (F)The number of people served; (G)Whether the population served is a HIGHLY SUSCEPTIBLE POPULATION; and (H) Whether the establishment is properly implementing an APPROVED self-inspection program. [Amended by WAC 246-215-181(6)] • Board of 3-CeaCth Netiv Business .agenda Item #17., 3 • 3-CeaCth of Jefferson County Data Summary June 16, 2011 • JEFFERSON COUNTY BOARD OF HEALTH • Health of Jefferson County Data Steering Committee Meeting April 28, 2011 —Jefferson Healthcare Notes and Action Items Data presented from June 2010— March 2011 were reviewed. Everyone was reminded that data from this update process are available in three different formats: Power Point for simplistic overview, detailed topic-specific sheets which include the margin of error and other analyses, and overview sheets from today's meeting. The overview sheets are highlights to really look at Jefferson County "then" and "now." "Then" is a historical year, usually used around the year 2000 (the exact year is noted in the bottom right hand corner of each square) and "now" is the most recent year available. This particular approach helps us see changes in a broad overview format that can be further investigated using the detailed topic-specific sheets. There were action discussions around who should see this information, what is the next step of action, is it necessary to have a fact sheet that can be used by anyone? The Health Department has agreed to be a data repository and to update these data occasionally. The data will always have a baseline of comparison that is good for policy makers and grant writers. The Health Department will systematically update the Census and OFM information and keep the webpage current. The Health Department cannot do the awareness building and community development work alone, and that is where partnerships and other systems must step in and collaborate. Are these data a call to action? Is this a community improvement planning process? Many agencies can do little during a recession, yet there is action for prevention on some things. What can we do locally and really have an impact?As we reviewed many of these questions we realized that there continues to be frustration with how complicated the data are. We talked about doing some work groups where we talk about what is valuable to all —what can we actually do as a community and how can we use social marketing and other media and messaging to bring people to action. At this point we will move forward with presentations on a couple of narrowed topics with targeted audiences. The first will focus on youth. June 9, 2011 update May 18, 2011 JCPH Prevention Team and Siri Kushner did a community presentation on 2010 Healthy Youth Survey results. Over 20 community members attended the presentation. Areas highlighted were alcohol, tobacco and other drug use, bullying, feeling sad, binge drinking, suicide ideation, physical fighting, physical activity and academic success. The JCPH Prevention Team will schedule follow-up meeting when school starts in the fall. Community partners include the Community Network (Prevention Coalition) and the School Based Health Clinic Advisory Committee. • The Health of Jefferson County: 2010-11 Updates • Jefferson County Public Health Part I: Demographics Part II: Mental Health, Alcohol and Drug Use Part III: Health Care Access Part IV: Births, Quality of Life, Deaths HIGHLIGHTS SUMMARY Presented April 28, 2011 The Health of Jefferson County 2010-11 Highlight sheets summarize information presented in four Data Steering Committee meetings from June 2010 to March 2011. The Highlight sheets are designed as a first glance and broad overview of the health of Jefferson County. Please use the data workbooks and presentations available online at www.jeffersoncountypublichealth.org for detailed and additional information and analysis. The data used in this process were the most currently available at the time of preparation, updates will be done when possible. Guide to using the Highlights sheets: There are four 2 to 3 page sheets to cover each of the four updates. The format is consistent for Parts I - IV of the 2010-11 Updates. For each topic (row) two points in time are presented "THEN" and "NOW" and the percentage change between the two is described by a word "up/same/down" or"better/same/worse" and the percentage value. The percentage change is "now" minus "then" divided by"then" multiplied by 100. Depending on the indicator, positive change can be good or bad; negative change can also be good or bad. "THEN" is either the earliest time period available or the best historical data for comparison; "NOW" is the most recently available data at the time of calculation. The notes column can include the Washington State rate and/or details about the Jefferson rate. Below the values for"THEN" and "NOW" the data year is presented. The data source is noted in an endnote in the last column. THEN CHANGE NOW NOTES SOURCE Total population 25953 up 15% 29872 1 2000 2010 Note: Change over time presented in the Highlights may differ from that reported in the detailed data for Parts I - IV of the 2010-11 Updates. The calculation methods differ- highlights use percentage change between 2 points in time; detailed data use statistical trend over time. Prepared by:Jefferson County Public Health For more information and data sources:www.jeffersoncountypublichealth.org Introduction,page 1 HIGHLIGHTS: The Health of Jefferson County: 2010-11 Updates Part I: Demographics POPULATION S The 2010 Jefferson County population is nearly 30,000. Population growth has slowed to about 1% per year and • results from people moving into the County. Since 2000, population growth is highest among adults; the number of children under 18 has decreased. Median age is 50, up from 39 in 1980. Since 2000, Non-White, Non-Hispanic and Hispanic population has increased, especially among school-aged children and persons with disabilities have increased slightly. THEN %CHANGE NOW NOTES SOURCE Total population 25953 up 15% 29872 1 2000 2010 New 2010 Census population Population growth 2.7% down -56% 1.2% 2 1990-99 2000-09 Estimated in-migration (new residents not births-deaths) 197 up 75% 345 2,3 2000 2009 Children under age 18 5159 down -3% 4994 increase among age 0-4 2 2000 2010 Adults age 18-34 3456 up 6% 3652 2 2000 2010 Adults age 35-64 12203 up 17% 14269 decrease among age 35-49 2 2000 2010 Older Adults age 65+ 5481 up 16% 6384 2 2000 2010 Median Age 35.0 up 43% 50.2 WA 2009:36.9;up 5 years from 2 1980 2009 1980 White, Non-Hispanic 91.5% down -2% 89.7% WA down:79%to 75% 2 2000 2010 est Non-White, Non-Hispanic and Hispanic 8.5% up 22% 10.4% WA up:21%to 25% 2 2000 2010 est Public school students White, Non-Hispanic 90.1% down -17% 74.4% WA down:74%to 64% 4 2000 2010 est Public school students Non-White, Non-Hispanic, and 9.9% up 59% 15.7% WA up:26%to 36% 4 Hispanic 2000 2010 est Age 16+with a disability 21% up 5% 22% WA down:21%to 18% 1,5 2000 2005-07 Age 16-64 with a disability 16% up 13% 18% WA down: 17%to 14% 1,5 2000 2005-07 • Jefferson County Public Health,April 2011 --BOH Presentation June 2011 More information available at:www.jeffersoncountypublichealth.org demographics,page 2 HIGHLIGHTS: The Health of Jefferson County: 2010-11 Updates Part I: Demographics EDUCATION Since 2000, Jef ersori County adults have higher levels of education. Since 2002-03, graduation rates are improved in Chimacum and Port Townsend,worse in Quilcene.The County drop out rate is worse compared to 2000--01. Public school enrollment has decreased more than 1,000 students since 1999-00. THEN %CHANGE NOW NOTES SOURCE Adults 25+high school or less education 36% down -3% 35% WA down:38%to 36% 1,5 2000 2006-08 Adults 25+some post high school education 36% down -8% 33% WA unchanged:34% 1,5 2000 2006-08 Adults 25+ bachelor's degree 18% same 0% 18% WA up: 18%to 20% 1,5 2000 2006-08 Adults 25+graduate or professional degree 9% up 56% 14% WA unchanged: 11% 1,5 2000 2006-08 High School ontime graduation rate (in 4 years) 71% better 13% 80% WA better:66%to 74% 4 2002-03 2008-09 Port Townsend ontime grad rate 79% same 0% 79% 4 2002-03 2008-09 female rate better than male Chimacum ontime grad rate 60% better 38% 83% 4 2002-03 2008-09 female rate better than male Quilcene ontime grad rate 96% worse -18% 79% 4 2002-03 2008-09 female rate better than male *Drop out rate 2% worse 50% 3% WA better:6%to 5% 4 2000-01 2008-09 Chimacum(2%);PT/Quilcene(4%) Public school enrollment 3785 down -25% 2846 4 1999-00 2009-10 Private school enrollment 62 up 35% 84 4 1999-00 2009-10 The annual unemployment rate was nearly 10%in 2010, up dramatically compared to 2000. In March 2011, the rate as 11.1%. THEN %CHANGE NOW NOTES SOURCE Unemployment rate-annual 5.4% worse 80% 9.7% WA worse:5%to 9.6% 6 2000 2010 Mar-2011: Jeff 11.1%;WA 9.7% Jefferson County Public Health,April 2011 --BOH Presentation June 2011 More information available at:www.jeffersoncountypublichealth.org demographics,page 3 HIGHLIGHTS: The Health of Jefferson County: 2010-11 Updates Part I: Demographics INCOME/POVERTY • income were divided equally among county residents, annual income for each resident would be about$43,000. • However, half of all households have a combined total annual income below$48,000 and average earnings per job are less than$30,000 per year. Jefferson rates of poverty are up and higher than Washington for most age • groups. Nearly 1 in 2 Jefferson public school students has free or reduced meals; 2 in 3 Jefferson babies is born to a mother living in poverty. THEN %CHANGE NOW NOTES SOURCE Per Capita Income $28,731 up 50% $43,105 Jefferson#3 among WA 7 2000 2008 counties Median household income $39,129 up 22% $47,660 WA up:$48,499 to$52,413 2 2000 2009 Average earnings per job (adjusted to 2005 dollars) $29,749 down -8% $27,492 WA average earnings up 45% 8 1969 2008 Population living below 100%federal poverty level (FPL) 11% up 16% 12% family of 4$22,050;single$10,830 9 2000 2009 WA up:9.6%to 11.3% Children in families in poverty 17% down -6% 16% 1999 2006-08 Jefferson rates statistically Adults age 18-64 in poverty 11% up 36% 15% higher than WA for age groups: 1,5 1999 2006-08 12-17; 18-24;25-34;45-54;55-64; 75+ Adults age 65+in poverty 6% up 50% 9% 1999 2006-08 Female single parent households 37% up 5% 39% WA up:31%to 34% 1,5 • 1999 2006-08 Population living below 185%poverty 26% up 22% 32% family of 4$40,793 1,5 • 1999 2006-08 WA up:24%to 25% Public school students with free or reduced meals (185% 33% up 42% 47% WA up:31%to 42% 4 FPL eligibility) 2000 2009 Pt Townsend students with free or reduced meals 36% up 28% 46% pmary 58%;elem 42%;mid/high 43% 4 2000 2009 Chimacum students with free or reduced meals 26% up 77% 46% elem 59%;middle 48%;high 36% 4 2000 2009 Quilcene students with free or reduced meals 40% up 20% 48% 4 2000 2009 Medicaid-paid births (185%FPL eligibility) 65% up 2% 66% WA up:43%to 49% 10 • 2000 2009 • Jefferson County Public Health,April 2011 --BOH Presentation June 2011 More information available at:www.jeffersoncountypublichealth.org demographics,page 4 HIGHLIGHTS: The Health of Jefferson County: 2010-11 Updates Part I: Demographics •HOUSEHOLD COMPOSITION & MARITAL STATUS Over half of Jefferson County households are married couples; since 2000, single parent households are down slightly. Adults never married have increased since 2000. Four in 10 babies are born to unmarried mothers, up since the early 1990's. THEN %CHANGE NOW NOTES SOURCE Married couple household, no children 38% down -3% 37% WA unchanged:28% 1,5 2000 2006-08 Married couple household,with children 16% up 6% 17% WA down:24%to 21% 1,5 2000 2006-08 Single parent household 8% down -25% 6% WA unchanged:9% 1,5 2000 2006-08 More than 1 person, non-tamily household 6% up 17% 7% WA down:8%to 7% 1,5 2000 2006-08 Adults married 61% down -3% 59% WA down:57%to 53% 1,5 2000 2006-08 Adult never married 16% up 31% 21% WA up:26%to 29% 1,5 2000 2006-08 Same-sex partner households 0.23% up 96% 0.45% WA up slightly:0.3%to 0.31% 1,5 2000 2006-08 Divorce rate per 1,000 adults 6.1 down -30% 4.3 WA down:6.0 to 4.9 11 2000 2008 Births to unmarried women 34% up 21% 41% WA up:26%to 33% 3 1991-93 2006-08 HOUSING .' The median price for a Jefferson County house was$281,000 in early 2010, up 60%over prices in 2000. Only 1 in 4 Jefferson households is able to purchase an average priced Jefferson home, fewer than in 2000. More than 1 in 4 Jefferson households spend more than 35%of monthly income on owned housing costs; nearly 1 in 2 on rented housing -both percentages up since 1999. The number of persons receiving Basic Food support from the government is up 206%compared to 2005. THEN %CHANGE NOW NOTES SOURCE Median house prices (sales of existing homes) $176,400 up 59% $281,000 WA up:$176,900 to$246,800 12 2000 2010 Qtr2 36% down -31% 25% WA down:46%to 37% 1,5 Households able to purchase an average priced home 2000 2006-08 Households spending at least 35%of income on owned 19% up 42% 27% WA up: 18%to 25% 1,5 housing 1999 2006-08 Households spending at least 35%of income on rented 37% up 30% 48% WA up:33%to 38% 1,5 housing 1999 2006-08 Number of DSHS Basic Food clients reporting being 98 up 206% 300 13,14 homeless PIT Homeless Count 2010: 179 2005 2010 • Jefferson County Public Health,April 2011 --BOH Presentation June 2011 More information available at:www.jeffersoncountypublichealth.org demographics,page 5 HIGHLIGHTS: The Health of Jefferson County: 2010-11 Updates Part II: Mental Health and Alcohol and Drug Use MENTAL HEALTH • verao-'G ;"e"-41.*tilts self-reportei '4..4- =Q.° --4.- 'unchange. - X 001 ho ,ad ortinental distress (14+ poor mental health days) increased. Over 2 in 3 youth visits to the School Based Health Clinics in Jefferson County were related to mental health. Youth self-reporting poor mental health up slightly since 2002, nearly 1 in 5 8th graders reported seriously considering suicide in the past year. Suicide-related hospitalizations down slightly while suicide death rate is up slightly. h THEN %CHANGE NOW NOTES SOURCE Adults reporting poor mental health days in past month 35% down -6% 33% WA down:40%to 36% 15 2001 2007-09 higher:females,younger&less educated Average number poor mental health days in past month 2.9 same 0% 2.9 WA same:3.3 15 2001 2007-09 higher:female,younger,less edu,binge Adults reporting 14+ past month poor mental health days 8% up 25% 10% WA up:9%to 10% 15 2001 2007-09 higher:females,younger&less educated SBHC visits related to psych/mental health/emotional I 68% relationships,family,school 16 SBHC=School Based Health Clinic at Pt Townsend and Chimacum High Schools 2009-10 performance,depression Youth report sad/hopeless everyday for at least 2 weeks 30% up 3% 31% WA down:27%to 25% 17 8th graders 2002 2010 higher:female,use/binge alc,marijuana Youth report seriously considering suicide in past year 17% up 12% 19% WA down: 15%to 14% 17 8th graders 2002 2010 higher:females Suicide-related hospitalizations 78.6 down -35% 50.7 WA up:50.0 to 54.8 3 2000-02 2006-08 higher:females,adults age 18+ Suicide death rate (age-adjusted) 11.2 up 19% 13.3 WA same: 12.5 to 12.7 3 2000-02 2006-08 higher:males,adults age 50+ Adverse Childhood Experiences Index-average # 1.8 WA: 1.7;JCPH clients:3 110 2009 0 Jefferson County Public Health,April 2011 --BOH Presentation June 2011 More information available at:www.jeffersoncountypublichealth.org mental health,alc&drug use,page 6 HIGHLIGHTS: The Health of Jefferson County: 2010-11 Updates Part II: Mental Health and Alcohol and Drug Use „ALCOHOL USE Adults having at least one alcoholic drink in the past month unchanged since 2001 however, adults reporting binge drinking (5+ drinks on an occasion) up slightly. Youth self-reported alcohol use is down. Alcohol-related hospitalizations and deaths are up. Alcohol treatment admissions are down. Alcohol-related arrests are up for adults, down among youth. THEN %CHANGE NOW NOTES SOURCE Adults report having at least one drink in past 30 days 68% same 0% 68% WA down:62%to 59% 15 2001 2007-09 higher:males,younger,more educated Adults report having 5 or more drinks on an occasion in 12% up 17% 14% WA unchanged: 15% 15 past 30 days (binge drinking) 2001 2007-09 higher:males,younger Youth report ever having more than a sip or alcohol 59% down -27% 43% WA down:44%to 39% 17 8th graders 2002 2008 Youth report drinking alcohol in past 30 days 28% down -29% 20% WA down: 18%to 16% 17 8th graders 2002 2008 Youth binge drinking (5+drinks in a row in past 2 weeks) 17% down -24% 13% WA down: 10%to 9% 17 8th graders 2002 2008 higher among 8th females;12th males Youth drunk/high at school in past 12 months 12% down -17% 10% WA unchanged:8% 17 8th graders 2002 2008 higher among 8th/12th males;10th females Alcohol-related hospitalization rate (age adjusted) 164.2 up 11% 181.8 WA up: 127.9 to 173.9 3 1992-94 2007-09 av 41/year;higher among males,age 65+ Adult alcohol arrests 6.9 up 52% 10.5 WA down: 12.0 to 10.3 11 1994-96 2006-08 average 53/year •Adult state funded alcohol treatment admissions 5.5 down -36% 3.5 WA down:3.8 to 3.6 18 1997-99 2004-06 average 81/year Youth age 10-14 alcohol or drug arrests 14.7 down -66% 5.0 WA down:3.4 to 2.6 11 1994-96 2006-08 average 8/year Youth state funded alcohol treatment admissions 31.0 down -45% 17.2 WA down:7.8 to 7.3 18 1994-96 2006-08 average 45/year Alcohol-related death rate (age adjusted) 3.7 up 295% 14.6 WA up: 8.8 to 10.3 3 1990-94 2005-09 average 6/year;higher males;age 65+ Alcohol-related traffic fatalities of all traffic fatalities 55% down -39% 33% WA down:48%to 41% 11 1994-96 2006-08 • Jefferson County Public Health,April 2011 --BOH Presentation June 2011 More information available at:www.jeffersoncountypublichealth.org mental health,alc&drug use, page 7 HIGHLIGHTS: The Health of Jefferson County: 2010-11 Updates Part II: Mental Health and Alcohol and Drug Use DRUG USE o"64"awviolations are up substantially ..as..w ; • jail inmates reported past month meth use; 1 in 14 8th graders reported ever using meth, unchanged since 2004. Eighth grade youth reporting using pain killers and marijuana are down. Adul treatment admissions are up Drug- related hospitalizations and deaths are up dramatically. THEN %CHANGE NOW NOTES SOURCE Adult drug law violations 2.2 up 159% 5.7 WA up:4.9 to 5.9 11 1994-96 2006-08 Youth (age 10-17) drug law violations 7.1 down -7% 6.6 WA up slightly:4.4 to 4.5 1 1 1994-96 2006-08 Jefferson Co. Jail inmates report meth use in past 30 days 27% up 15% ( 31% inmates completing nurse assessment 19 2009 Jan-June 2010 Adult state funded meth treatment admissions 1.3 up 138% 3.1 WA up:0.8 to 2.0 18 1997-99 2006-08 average 73/year Youth report ever using meth 7% same 0% 7% WA down 4%to 3% 17 8th graders 2004 2008 Youth state funded meth treatment admissions 1.4 up 36% 1.9 WA up:0.8 to 1.0 18 2000-02 2006-08 average 5/year Youth report using a pain killer to get high in past 30 days 6.0% down -33% 4.0% WA unchanged:4% 17 8th graders 2006 2010 Youth report ever smoking marijuana 26% down -38% 16% WA down: 16%to 12% 17 8th graders 2000 2010 higher among males Youth report smoking marijuana in past 30 days 16% down -31% 11% WA down: 10%to 8% 1 41/ 8th graders 2000 2010 higher among males Youth state funded marijuana treatment admissions 11.1 down -3% 10.8 WA unchanged:5.6 18 1997-99 2004-06 average 10/year Adult state funded marijuana treatment admissions 1.2 up 17% 1.4 WA up:0.7 to 1.1 18 1997-99 2004-06 average 32/year Adult state funded cocaine treatment admissions 2.3 up 87% 4.3 WA up:7.7 to 8.9 18 2000-02 2004-06 average 10/year Adult state funded heroin treatment admissions 1.3 up 108% 2.7 WA down:7.2 to 6.8 18 2000-02 2004-06 average 6/year Number of syringes exchanged at JCPH 506 up 2675% 14044 peak year 2007:24,585 syringes 20 2000 2009 Drug related hospitalization rate (age adjusted) 112.1 up 30% 146.1 WA up:99.1 to 171.7 3 1992-94 2007-09 av 43/year;higher:females,age 65+ Drug related death rate (age adjusted) 8.8 up 142% 21.3 WA up: 10.8 to 14.3 3 2000-04 2005-09 av 6/year;higher:males,age 35-64 • Jefferson County Public Health,April 2011 --BOH Presentation June 2011 More information available at:www.jeffersoncountypublichealth.org mental health,alc&drug use, page 8 • HIGHLIGHTS: The Health of Jefferson County: 2010-11 Updates Part III: Health Care Access HEALTH CARE COVERAGE adequatet , ,n Si �.."�F .'Over a quarter of Jeff n resid' s use DSHS services; 2 in 3 Jefferson births are covered by Medicaid. Fewer than half of Jefferson adults have dental insurance compared to more than two thirds in Washirt,ton State. Jefferson Health Care has one of the highest rates_of charity careitte THEN %CHANGE NOW NOTES SOURCE Adults (age 18-64) reporting having health insurance 90% down -10% 81% WA down:90%to 83% 15 2001 2007-09 higher:females,older&more educated Adults adequately insured 85% down -11% 76% WA down:86%to 79% 15 (not uninsured or unable to pay for needed care) 2001 2007-09 higher:females,older&more educated Children age 0-17 with health insurance 88% WA:95% 15 parent self-report,aae adiusted rate 2008-09 DSHS service utilization 25% up 14% 28% WA up slightly:32%to 33% 21 2000-01 2006-07 Medicaid paid births 65% up 2% 66% WA up:42%to 49% 10 1999 2009 Basic Health subsidized coverage-# enrolled 727 down -24% 555 WA down: 15%to 14% 22 Jul-07 Jul-10 higher:females Adults reporting having dental insurance 53% down -11% 47% WA unchanged:68% 15 2001 2007-09 higher:males,age 35-64,more edu Jefferson Health Care Charity Care%of adjusted revenue 6.2% up 61% 10.0% $2.8 million in 2008:Sth highest of all WA 3 2005 2008 hospitals;1st highest of rural hospitals HEALTH CARE ACCESS Jefferson County has just under 2 physicians for every 1,000 residents, slightly below Washington State. Eight in 10 adults have a regular health care provider, slightly down since 2001. 15%of adults report being unable to get needed medical care due to cost, up since 2001. Just under 3 in 4 adults had a routine annual check-up; half of 8th graders report a routine annual check-up, down since 2002. In 2010, School Based Health Clinics in Chimacum, Port Townsend and Quilcene had on average 49, 33 and 31 medical visits per month and 31, 24, and 18 mental health visits per month respectively. About 7 in 10 adults and 8th graders report an annual dental check-up, down since 2001 and 2002 respectively. Pregnant women initiating prenatal care in the 1st trimesteriss .wn and drarnaticoll up for inititating in the 3rd trimester or not at all. THEN %CHANGE NOW NOTES `" SOURCE Physician rate per 1,000 population 1.4 up 21% 1.7 WA up:2.0 to 2.4 23 1996 2008 Adults report a regular health care provider 85% down -4% 82% WA down slightly:79%to 78% 15 2001 2007-09 higher:females,older,more education Adults not getting needed medical care due to cost 9% up 67% 15% WA up:8%to 13% 15 2001 2008 higher:females,younger,less education Adults report routine medical check-up in past year 74% down -1% 73% WA down:68%to 61% 15 2002 2008 higher:females,older,more education Youth report past year medical visit(not for injury/illness) 61% down -18% 50% WA unchanged:60% 17 8th graders 2002 2008 SBHC Chimacum-average medical visits per month 35 up 40% 49 16 SBHC=School Based Health Clinic 2009 2010 .BHC Pt Townsend-av medical visits per month 31 up 6% 33 16 2009 2010 Jefferson County Public Health,April 2011 --BOH Presentation June 2011 More information available at:www.jeffersoncountypublichealth.org health care access,page 9 HIGHLIGHTS: The Health of Jefferson County: 2010-11 Updates . Part III: Health Care Access SBHC Chimacum-av mental hlth visits per month 25 up 24% 31 410 2009 2010 SBHC Pt Townsend-av mental hlth visits per month 19 up 26% 24 24 2009 2010 SBHC Quilcene-av mental hlth visits per month 19 down -5% 18 24 2009 2010 Adults report dental visit in past year 72% down -3% 70% WA up slightly:70%to 71% 15 2001 2008 higher:males,age 35-64,more education Adults report dental cleaning in past year 71% down -7% 66% WA up:68%to 70% 15 2001 2008 higher:males,age 65+,more education Youth report dental visit in past year 77% down -12% 68% WA up:70%to 74% 17 8th graders 2002 2008 higher:younger,females Pregnant women initiate prenatal care in 1st trimester 85% down -12% 75% WA down:80%to 77% 3 1991-93 2006-08 higher:age 30-39;non-medicaid Pregnant women initiate prenatal care in 3rd trimester or 1% up 293% 6% WA up:4%to 5.5% 3 not at all 1991-93 2006-08 higher:age 20-29;medicaid ROUTINE PREVENTIVE HEALTH CARE Similar to Washington State, about 4 in 10 Jefferson adults get an annual flu shot and 7 in'..,, 44 `‘--40:41® ` ever had a pneumonia vaccine. Fewer than 6 in 10 children have complete immunizations when they s... compared to 9 in 10 in Washington; children exempted from immunizations has increased dramaticaI,, 8 in 10 adult women had routine mammogra *:.. ;, 6,, ®.0,.,® ; . sigmoid/colonoscopy. , THEN %CHANGE NOW NOTES SOUR Adults get annual flu shot 36% up 6% 38% WA up:26%to 40% 15 2003-05 2007-09 higher:female,older,more education Adults age 65+ report ever getting pneumonia vaccine 75% down -5% 71% WA up:67%to 71% 15 2003-05 2007-09 higher:female,older,some college Children with complete immunizations at school entry 60% down -3% 58% WA up:81%to 90% 25 1997-00 2006-09 Children exempted for immunizations at school entry 9% up 79% 16% WA up:3%to 4% 25 1997-00 2006-09 Women age 50+ had mammogram in past 2 years 73% up 15% 84% WA up:78%to 83% 15 2004 2008 higher:age 50-64,more edu,higher income Women age 18+ had Pap smear test in past 3 years 78% up 3% 80% WA down:84%to 81% 15 2004 2008 higher:younger;JC less edu;WA more edu Adults age 50+ had a sigmoid/colonoscopy in past 5 yrs 79% down -1% 78% WA down:78%to 66% 15 2001 2008 higher:JC female,65+/WA male,age 50-64 • Jefferson County Public Health,April 2011 --BOH Presentation June 2011 More information available at:www.jeffersoncountypublichealth.org health care access,page 10 • HIGHLIGHTS: The Health of Jefferson County: 2010-11 Updates Part IV. Births, Quality of Life, Deaths BIRTHS =so "p"re: . • HQUALITYIGHLIGHTS:OFLIFE The Health of Jefferson County: 2010-11 Updates Part IV. Births, Quality of Life, Deaths 110 In general, Jefferson adults are expected to enjoy 55 additional years of healthy life after age 20. Adults reporting having fair/poor general health is down slightly while adults reporting 3 or more days of health-related activity limitations was up dramatically. Hospitalizations for injury or accidents among children are down but up among adult females. CPS referrals are down but still above Washington rates. Adult and youth smoking rates are down but still above Washington rates. Eighth graders reporting using chewing tobacco up dramatically since 2002. Eighth graders reporting being bullied in the past month up while students reporting feeling safe at school is unchanged. The total crime rate for the County is down. THEN %CHANGE NOW NOTES SOURCE Years of healthy life expected at age 20 51 up 8% 55 WA unchanged:51 26 1996 2008 Jefferson 3rd highest county in WA Adults report general health fair/poor 16% down -25% 12% WA unchanged: 13% 15 2001 2007-09 " °^A,. 4imak' Adults report 3+days of health-related activity limits 15% up 107% 31% WA up:24%to 29% 1.5 2001 2007-09 Child injury and accident related hospitalizations 7% down -14% 6% WA up:3.7%to 4% 11 1998-00 2007-09 average 18 per year Child abuse and neglect accepted referrals 5.2 down -17% 4.3 WA down:3.9 to 3.3 11 rate per 100 children 0-17 2000-02 2006-08 average 217 per year Adult female injury and accident hospitalizations 14% up 28% 18% WA up: 10.8%to 14.3% 11 1998-00 2006-08 Adult current smokers 21% down -10% 19% WA down:23%to 15% 15 2001 2007-09 higher:males,younger,less education Adult smokers reporting a quit attempt in past year 72% down -22% 56% WA down:64%to 56% 1 2001 2007-09 Youth report cigarette smoking in past 30 days 13% down -38% 8% WA down:7%to 6% 17 8th graders 2002 2010 10th grade:down 22%to 14% Youth report using chewing tobacco in past 30 days 2% up 200% 6% WA unchanged:3% 17 8th graders 2002 2010 10th grade:up 4%to 5% Youth report being bullied in past 30 days 29% up 31% 38% WA unchanged:30% 17 8th graders 2002 2010 6th:36 to 32%;10th 26%to 22% Youth report feeling safe at school 84% same 0% 84% WA up:80%to 83% 17 8th graders 2002 2010 6th:86%to 87%;10th:77%to 87% Total Crime index 34.3 down -29% 24.5 WA down:71 to 40 27 2000 2009 ill Jefferson County Public Health,April 2011 --BOH presentation Jun e 2011 More information available at:www.jeffersoncountypublichealth.org births,qual of life,deaths, page 12 HIGHLIGHTS: The Health of Jefferson County: 2010-11 Updates Part IV. Births, Quality of Life, Deaths DEATHS THEN %CHANGE NOW NOTES SOURCE Death rate (age adjusted) 7.9 down -9% 7.2 WA down:8.6 to 7.2 3 1992-94 2007-09 Male death rate (age adjusted) 9.9 down -19% 8.0 WA down: 10.7 to 8.5 3 1992-94 2007-09 Female death rate (age adjusted) 6.5 down -3% 6.3 WA down:7.0 to 6.1 3 1992-94 2007-09 Infant mortality rate (age<1 year) 12.5 down -53% 5.9 WA down:6.7 to 5.2 3 1990-94 2005-09 average 1 death per year Death rate age 15-24 0.9 up 11% 1.0 WA down:0.9 to 0.6 3 1990-94 2005-09 Death rate age 25-44 1.7 same 0% 1.7 WA down: 1.5 to 1.2 3 1990-94 2005-09 Death rate age 45-64 5.6 up 4% 5.8 WA down:6.3 to 5.3 3 1990-94 2005-09 •Death rate age 65+ 38.1 up 5% 40.0 WA down:47.8 to 46.4 3 1990-94 2005-09 Accidental poisoning deaths (age adjusted rate) 0.7 up 186% 2.0 WA up:0.5 to 1.2 3 1995-97 2005-09 av 3 per year;higher 25-64,male Motor vehicle injury deaths (age adjusted rate) 2.1 down -43% 1.2 WA down: 1.3 to 0.9 3 1990-94, 2005-09 average 3 per year Accidental fall deaths (age adjusted rate) 0.5 up 40% 0.7 WA up:0.7 to 1.1 3 1990-94 2005-09 av 3 per year;higher 65+;female Alcohol and drug related deaths (%of all deaths) 7% up 103% 14% WA up:9%to 12% 11 1998-00 2007-09 av 45 per year;Jeff#3 of WA Counties Premature death rate (death before age 65) 35.8 up 13% 40.6 WA down:43.6 to 35.6 3 2001-03 2007-09 Male premature death rate (before age 65) 49.9 up 5% 52.6 WA down:46.8 to 44.2 3 2001-03 2007-09 Female premature death rate (before age 65) 21.8 up 31% 28.6 WA down:27.9 to 26.8 3 2001-03 2007-09 Life expectancy at birth 77.8 up 2% 79.4 WA up:77.3 to 79.8 3 1992-94 2007-09 Male life expectancy at birth 75.4 up 3% 77.4 WA up:74.2 to 77.5 3 1992-94 2007-09 Female life expectancy at birth 80.5 up 1% 81.7 WA up:80.2 to 82.0 3 • 1992-94 2007-09 Jefferson County Public Health,April 2011 --BOH presentation Jun e 2011 More information available at:www.jeffersoncountypublichealth.org births,qual of life,deaths, page 13 0 o I L\?<./c / \ \(c/ o\ i0cy < c \ \ \ 0 43 o - 0 ) £ 2 % / } \ t / o / 0 \ o o ƒ 'al < e } rz \ 0 0 0 \ o _ m £ 2 0) § \ 0 E c ° / -0 \ \ » \ \ r ID 2 5 c ^ o a 2 / \ 0 \ 0 § \ \ / E \ » - @ e 6 \ o 0 6 = 0 0 \ \ . 0 0 ƒ \ 7 q 2 7 6 e ƒ « = o = g * � = \ E [ E / W ll a j \ \ 5 = o o " 0 — § — z U U ( $ ° 0 % _ {_ \ / E / uin § U) a E § / j \ E E / ƒ ƒ \ / i / / E j \ ) ) \ 5 § o / 0 k / / \ \ / ° % @ ° e m e E — / \ - ƒ \ ; > = 0 — 6 9 5 \ » 3 a 7 / 2 ƒ + ƒ ® ° / 0 / £ - » / 5 © _ — m o ° ° 2 § > \o < C e = ® C 0 / \ / U 4Lii £ 0 § o - E 0 . \ •4 0 0 ® ® > » 0 ® e % 2 & 2 2 m z • / f t • \ /- E z o — = E z t 2 C = £ e a c = 0 0 a / / o o - E o g 0 o = 0 = o g o m _ 0 < 2 / / / ._ \ \ = \ \ / » / >, -U = / 7 / 0 / \ •© •9 § o 2 — 0 - > e o 2 2 c = 0 7 e 0 \ / / E_ \ 0 0 / \ { / 0 o 2 § o \ \ ± 0 c $ k / \ $ \ = p o o E c = ° c o - - _ c — 0 -0 - w ƒ F / j ) E � 5 « E § \ } \ \ \ / j \ G / \ a. / / \ O O e t ± o c U o E \ § / m — U \ co, 0 0 0 - 9 ± / ± g o o@ c » m p < q- c 5 o f 5 0 f e o 0 0 p 2 _ * O ° ; 0 4 0 — o = c x E o b o g o = a < _ & o • > o = _ -6_• e • 0 7 2 \ o U Lu } % 7 G \ \ 7 7 y / = G k t / / § ƒ \ / > 0 / o 2 U r < e < E o = e E < @ ® ® Q o o m m o « o E g < o o x � 4 O « < 4 � = m = = 4 c = = m = e e e o < m « 4 4 U .A - N n « m w = > o .- N CO < ,o _ 0- o — Nr V' < < w m m N m m N N N 40 x f • Board of a fearth New Business .agenda Item #17., 6 • 'Washington State Budget I.Lpdate June 16, 2011 • Julia Danskin rom: Flake, Marie D (DOH) [Marie.Flake@DOH.WA.GOV] ent: Monday, June 06, 2011 10:28 PM To: DOH DL OS LHJ Leadership; DOH DL OS Tribal Health Directors; DOH DL OS Tribal Clinic Directors; DOH DL OS Tribal Emergency Contacts Subject: DOH Budget -Overview of 2011-13 Budget Impacts Dear LHJ and Tribal Health Leaders: As you all know, the 2011 legislative session came to an end on May 25,2011 and with it came the adoption of Washington's new biennial budget. The governor is expected to sign the final budget between now and June 16; meanwhile, we've developed and posted online a high level summary of the maior impacts we see for the Department of Health (http://www.doh.wa.gov/NewsRoom/documents/2011-13-OverviewOfDOHBudgetlmpacts.pdf). Many people in our agency are continuing to review the new budget and to more clearly identify the affect it will have on the work of our programs. As we develop a more clear vision of our future we will share that information with you. For now, please review the link provided above for the high level summary. marie Marie Flake, MPH, BSN, Local Health Liaison Office of Public Health Systems Planning and Development Washington State Department of Health 101 Israel Road,Tumwater,WA 98501 //PO Box 47890, Olympia,WA 98504 Phone 360-236-4063 // Mobile 360-951-7566 // Fax 360-586-7424 // marie.flakea,doh.wa.gov Public Health-Always working for a safer and healthier Washington • • 1 SDepartment of Health Overview o impacts of 2011-13 Biennial Budget This is an overview of some of the significant impacts to Department of Health funding in the 2011-13 budget. None of these decisions are final until the legislative budget is signed by Governor Chris Gregoire. Environmental Health: Local health onsite management grants: Reduces grant funding used by the 12 Puget Sound counties to identify and address onsite sewage system problems in sensitive marine areas. ($504,000) Redirect Model Toxics Control Account (MTCA) funding to Pesticide Illness Investigations: A portion of the agency's MTCA funding is redirected to the Pesticide Illness Surveillance program. This will result in reduced epidemiology and outreach effort in program areas such as indoor and outdoor air quality and childhood lead poisoning, as well as reduced drinking water quality evaluation activities. ($716,000) Office of Environmental Health, Safety, and Toxicology reductions: Reduces the capacity to support environmental public health protection effort in a number of program areas within this office. This includes reductions in education and prevention activities for zoonotic diseases, water recreation, chemical and pesticide hazards, school environmental health, and food safety. • ($400,500) Office of Drinking Water reductions: Reduces the capacity within this office to conduct compliance oversight activities of public water systems, and reduces the outreach and technical assistance to public water systems in areas such as cross connection control. ($670,000) Epidemiology,Health Statistics, and Public Health Laboratories: Health Care Declarations Registry: This reduction eliminates the Health Care Declaration Registry—a statewide electronic system known as the Living Will Registry—that Washington residents can use to store their health care directive documents. New registrations will be discontinued as of June 20, 2011. ($104,000) Community Health Assessment: This reduction eliminates training and reduces agency capacity to provide consultation and technical assistance for local health assessment coordinators. This will affect local public health's ability to monitor and analyze indicators needed for community health assessments that are used to guide public health work. ($170,000) External Health Professional Training: The public health labs' training program will be reduced, including professional training in public health microbiology and other laboratory related topics to individual health professionals and local health partners. Health professionals will lose professional training opportunities, resulting in reduced knowledge of laboratory-related topics. ($150,000) I Updated: 06-06-2011 Healthcare Acquired Infections: A portion of the state funding in this program is switched to • federal funding that will run out after one year. This will reduce assistance to hospital infection control professionals, validation of the accuracy of infection reporting, and improvements to our Healthcare Acquired Infections website. The result may be increased infection rates or loss of progress toward improving infection control programs. ($244,000) Health Systems Quality Assurance: Funding for adverse event reporting from health care facilities is eliminated. As a result we will no longer provide health care facilities with technical and clinical support for reporting adverse events and developing root cause analyses for reportable events. ($254,000) Health System Resource Grant Program: This program is eliminated. These were grants were used to support health care projects and recruitment in rural areas of the state. ($234,000) Washington Poison Center: Funding to the poison center is reduced by 10 percent. This will result in the center reducing its capacity to take calls from the public and health care providers when a poisoning or harmful drug interaction is suspected. ($202,000) Youth Suicide Prevention: Funding for our contracted partner for youth suicide prevention programs is reduced. The budget requires the agency to continue funding this program,but reduced from previous funding levels. ($170,000) EMS and Trauma: Funding for rural health and EMS and Trauma program activities is reduced, . resulting in significant cut backs in these programs. The specific impact of these cuts is yet to be determined. ($490,000) Community and Family Health: Maternity Support Services program oversight: The Department of Social and Health Services (DSHS) contracts with the Department of Health to provide program oversight for the Maternity Support Services, Infant Case Management, and Childbirth Education components of the First Steps Medicaid program. DSHS is reducing funds for the program to 30 percent of current levels, and will take over the program oversight role. ($600,000) Family Planning Grants: Reduced funding that supports family planning services throughout the state. ($2.25 million) Maternal and Child Health Program: Funding for the program has been reduced; however, the amount of reduction is different than expected and the impact of this cut is still being analyzed. ($1.8 million) Sexually Transmitted Disease Program: Funding reduced by five percent. The impacts of this reduction are unknown and are still being analyzed. ($54,000) S 2 Updated: 06-06-2011 t Women, Infant, and Childrens Program (WIC): All state funding ($800,000) is eliminated for general WIC services. This program will continue entirely with federal funds. A small amount of funding remains for the WIC Farmers Market Nutrition Program. It will be reduced over the next two years—$100,000 reduction in the first year and $320,000 cut in the second. Oral Health Program: Funding is transferred to Medicaid Purchasing Administration for the Access to Baby and Child Dentistry (ABCD) Program. As a result, funding for oral health activities will be reduced. ($800,000) Tobacco Prevention and Control Program: There's not enough funding in the Tobacco Prevention and Control Account to support tobacco prevention work. All remaining state funding is eliminated for the quit line, local community support, public awareness, and other tobacco prevention activities. ($43 million) Overall Dept of Health/Other: Local health funding: Blue Ribbon Commission funding (5930)was reduced by 50 percent. This will result in less discretionary funding passed through the Department of Health to support the local public health system. ($10,000,000). Central Administration: Specific reductions that have yet to be determined will be made to the central administrative support functions within the agency. ($1,160,000) Management efficiencies: Yet to be determined reductions will be made as the result of expected management and administrative reforms. ($836,000) Overall employee salary reduction: All agency staff will have a three percent salary reduction (or equivalent). ($1,332,000) general funds; ($6,445,000)total funds. • 3 Updated: 06-06-2011 Board of aCealtFi Nledia Report 1 June 16, 2011 • File Copy • Jefferson County Board of 3CeaCth .Agenda .Minutes • June 16, 2011 • • JEFFERSON COUNTY BOARD OF HEALTH June 16, 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 April 21, 2011 Board of Health Meeting III. Public Comments IV. Old Business and Informational Items 1. Adverse Childhood Events May 2011 Article - American Journal of Public Health 2. Jefferson County Public Health—WIC Facts 2010 • 3. Green Business /EnviroStars Awards V. New Business 1. Food Service Awards—Presentation 2. Environmental Health Food Permit Fee Discussion and Recommended Call for Public Hearing 3. Health of Jefferson County Data Summary 4. Community Report—Port Townsend /Chimacum Food Bank Report 5. Substance Abuse Advisory Board Nomination 6. Washington State Budget Update VI. Activity Update VII. Agenda Planning Calendar: VIII. Next Scheduled Meeting: July 21, 2011 2:30—4:30 pm Jefferson County Public Health • 406C Y` JEFFERSON COUNTY BOARD OF HEALTH g4pi. MINUTES Thursday, April 21 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 Kristen Nelson called the meeting of the Jefferson County Board of Health to order at 2:34PM. A quorum was present. Members Present: David Sullivan, John Austin, Roberta Frissell, Kristen Nelson, Jill Buhler, Phil Johnson Members Excused: Sheila Westerman Staff Present: Jean Baldwin, Julia Danskin, Stuart Whitford, Veronica Shaw • APPROVAL OF AGENDA Member Nelson recommended that the Public Health Hero Awards be moved to Item 1 of the agenda. Member Sullivan moved to approve the agenda as amended and Member Johnson seconded for approval. The agenda was approved unanimously as amended. 2011 Public Health Heroes Awards Member Austin moved that the Board endorse the nominations of the Public Health Heroes. Member Johnson seconded the motion. The motion passed unanimously. Member Nelson presented the 2011 Public Health Heroes awards to the following individuals for their contribution to the community: The Special Recognition Award and was presented to Jeanette and Bruce Travis and Tom Brannigan on behalf of the Ecumenical Christian Helping Hands Organization (ECCHO). The Community Based Organization Category was presented to Carl Hanson for the Community Outreach Association Shelter Team (COAST) for their work in the homeless shelter. • Page 1 of 5 BOH Minutes April 21,2011 '* The Public Health Leadership Category was presented to Shirley Moss from the Port Townsend Food Bank and Connie Johnson from the Tri Area Food Bank on behalf of the four Food Banks • in Jefferson County. The Business Category was presented to Chancey and Dash Tudhope-Locklear who run the Recyclery, a business that promotes safety through the use of bike helmets and by providing recycled bikes and parts. The Community Health Promotion Category Award was presented to Linda Pfafman,from the Jefferson County Sheriff's Office, for her work with child safety seat training and instruction. APPROVAL OF MINUTES Member Buhler moved for approval of the March 17,2011 minutes; Member Frissell seconded. The minutes were approved unanimously. PUBLIC COMMENTS None OLD BUSINESS and INFORMATIONAL ITEMS Press Release Re: Japanese Nuclear Power Plant Disaster Ms. Baldwin reviewed the press release from March 16, 2011 regarding the nuclear reactor • emergency in Japan, a copy was provided in the packet. She stated that there have been additional RAD monitoring stations added in Washington. Many of the risks still remain unknown. Member Austin handed out copies of slides from the State Board of Health, which outlines facts and concerns from the Japanese Nuclear Reactor accident. Jefferson County Adult Tobacco Use Ms. Baldwin reviewed the Comparison and Explanation of Available Rates, included in the packet. Ms. Baldwin said she asked Siri Kirschner, Epidemiologist from the Kitsap Health District,to review the graph on Adult Tobacco Use. Siri Kirschner's summary stated that since the small sample size results in the potential for wide variation in rates year-to-year, it's best to look at the trend over time. Ms. Baldwin stated that this graph is used by the State for a year-to- year State comparison. Our Kids: Our Business—April Update Ms. Danskin highlighted some of the upcoming events that are planned for the remainder of the month in honor of National Child Abuse Prevention and Sexual Assault Awareness Month. On April 27th the Olympic Educational Service District(OESD) is sponsoring a training by Dennis • Page 2 of 5 BOH Minutes April 21,2011 Embry, President of the Paxis Institute in Tucson, AZ, at the Port Townsend High School. This • event is open to the public. Family Fun Fest will be held April 23rd at Mountain View. Member Sullivan talked about the Drug Take Back event on April 30th at the Port Townsend Police Department. He stated that the Jefferson County Sheriff's Office will take back unwanted medications and supplements. As a result of differing interpretation of the DEA restrictions, the Port Townsend Police Department will only take items in their original containers but the Sheriff's office will take back unidentified drugs as well. Member Buhler asked what the best way to dispose of unidentified medications would be. Ms. Baldwin stated they should be broken and placed in wet kitty litter or coffee grounds,put in a coffee can and thrown in the garbage. They should not be flushed down the toilet. ACES (Adverse Childhood Experiences) article—"The Poverty Clinic" Ms. Baldwin stated the article on"The Poverty Clinic"was a good article on the ACES issue. Ms. Baldwin said that staff had drafted a letter to the editor of the Journal of American Public Health Association thanking them for publishing the article and stressing the importance of integrating mental health into overall public health practice. Member Frissell passed around a book by Paul Offit called"Deadly Choices, How the Anti- Vaccine Movement Threatens Us All". NEW BUSINESS • Washington State Budget—Local Health Department Impacts Ms. Baldwin reported that at this time there wasn't any new information to share. She will continue to update the Board as she learns more. County Health Ranking Report Ms. Baldwin stated that the County Health Rankings Report is a report that only 17% of Health Departments use in Washington State. The rankings do not give a clear picture of the health status in Jefferson County in comparison to other counties in Washington State because the numbers are based on a small population and the report does not look at the data over time, which is necessary when looking at numbers for a small population. Ms. Baldwin did note that this report is a good way to look at the nation and at the state, but it does not do much at a county level. A brief discussion was held on the different rankings in the report and possible reasons for the way Jefferson County was ranked in comparison to other counties. Board Discussion: Jefferson County Food Safety Code Revisions Mr. Whitford informed the Board that there is a type written error on the fee schedule. The fees for `espresso stand' and `grocery stores checkout 1-3' were reversed. He will bring the corrected fee revision to the next BOH meeting for discussion. • Page 3 of 5 BOH Minutes April 21,2011 I Mr. Whitford talked about forming an advisory group to discuss and strategize ways to resolve issues around food service. The first issue that needs to be addressed is temporary events. • Temporary events present a significant risk for foodborne illness transmission and are strictly regulated according to state and local food code. This means that separate permits are required for events with different locations and/or menu items. However,the fee schedule and temporary guidelines did not adequately anticipate this change in approach. So,proposed changes to both our guidelines and the fee schedule are being developed for the Board of Health's review.. Other Legislative Updates Mr. Whitford reported on a bill which includes changes in licensing for designers and limiting continuing education requirements. In regards to Environmental Health, a bill related to licensing of onsite wastewater system designers/engineers/inspectors passed. This bill will have positive impacts on fees and continuing education requirements. Most bills that were of concern to Environmental Health Directors did not become law. A bill that would have authorized local boards of health to work with County Assessor's Offices to charge an annual onsite sewage management fee did not pass. That bill could have led to a stable and consistent funding source for implementing onsite sewage system local management plans. ACTIVITY UPDATE Ms. Baldwin announced that both she and Dr. Locke will be absent for the May BOH meeting. Ms. Baldwin stated she can provide reports and have staff members review the reports, unless the Board prefers to cancel the meeting in May. • Ms. Baldwin suggested having community members come to the BOH meetings and talk about their organization and the services they provide. Member Nelson pointed out that she would like to make sure enough time will be allowed for community members to speak to the Board about their programs and how they are affecting our community. Member Johnson moved to cancel the May BOH meeting; Member Austin seconded. The motion was approved unanimously AGENDA PLANNING CALENDAR The next scheduled BOH meeting will be held Thursday, June 16, 2011 from 2:30-4:30 PM at the Health Department, 615 Sheridan Street, Port Townsend, WA. ADJOURNMENT Chair Nelson adjourned the BOH meeting at 3:53 p.m. • Page 4 of 5 BOH Minutes April 21,2011 • JEFFERSON COUNTY BOARD OF HEALTH Kristen Nelson, Chair Phil Johnson, Vice-Chair Jill Buhler, Member John Austin, Member Roberta Frissell, Member David Sullivan, Member Excused Sheila Westerman, Member • • Page 5 of 5 BOH Minutes April 21,2011 JEFFERSON COUNTY BOARD OF HEALTH MINUTES Thursday, April 21, 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 Kristen Nelson called the meeting of the Jefferson County Board of Health to order at 2:34PM. A quorum was present. Members Present: David Sullivan, John Austin, Roberta Frissell, Kristen Nelson, Jill Buhler, Phil Johnson Members Excused: Sheila Westerman • Staff Present: Jean Baldwin, Julia Danskin, Stuart Whitford, Veronica Shaw APPROVAL OF AGENDA Member Nelson recommended that the Public Health Hero Awards be moved to Item 1 of the agenda. Member Sullivan moved to approve the agenda as amended and Member Johnson seconded for approval. The agenda was approved unanimously as amended. 2011 Public Health Heroes Awards Member Austin moved that the Board endorse the nominations of the Public Health Heroes. Member Johnson seconded the motion. The motion passed unanimously. Member Nelson presented the 2011 Public Health Heroes awards to the following individuals for their contribution to the community: The Special Recognition Award and was presented to Jeanette and Bruce Travis and Tom Brannigan on behalf of the Ecumenical Christian Helping Hands Organization (ECCHO). The Community Based Organization Category was presented to Carl Hanson for the Community Outreach Association Shelter Team (COAST) for their work in the homeless shelter. • Page 1 of 5 BOH Minutes April 21,2011 The Public Health Leadership Category was presented to Shirley Moss from the Port Townsend Food Bank and Connie Johnson from the Tri Area Food Bank on behalf of the four Food Banks in Jefferson County. The Business Category was presented to Chancey and Dash Tudhope-Locklear who run the Recyclery, a business that promotes safety through the use of bike helmets and by providing recycled bikes and parts. The Community Health Promotion Category Award was presented to Linda Pfafinan,from the Jefferson County Sheriff's Office, for her work with child safety seat training and instruction. APPROVAL OF MINUTES Member Buhler moved for approval of the March 17, 2011 minutes; Member Frissell seconded. The minutes were approved unanimously. PUBLIC COMMENTS None OLD BUSINESS and INFORMATIONAL ITEMS Press Release Re: Japanese Nuclear Power Plant Disaster Ms. Baldwin reviewed the press release from March 16, 2011 regarding the nuclear reactor • emergency in Japan, a copy was provided in the packet. She stated that there have been additional RAD monitoring stations added in Washington. Many of the risks still remain unknown. Member Austin handed out copies of slides from the State Board of Health, which outlines facts and concerns from the Japanese Nuclear Reactor accident. Jefferson County Adult Tobacco Use Ms. Baldwin reviewed the Comparison and Explanation of Available Rates, included in the packet. Ms. Baldwin said she asked Siri Kirschner, Epidemiologist from the Kitsap Health District,to review the graph on Adult Tobacco Use. Siri Kirschner's summary stated that since the small sample size results in the potential for wide variation in rates year-to-year, it's best to look at the trend over time. Ms. Baldwin stated that this graph is used by the State for a year-to- year State comparison. Our Kids: Our Business—April Update Ms. Danskin highlighted some of the upcoming events that are planned for the remainder of the month in honor of National Child Abuse Prevention and Sexual Assault Awareness Month. On April 27th the Olympic Educational Service District (OESD) is sponsoring training by Dennis • Page 2 of 5 BOH Minutes April 21,2011 Embry, President of the Paxis Institute in Tucson, AZ, at the Port Townsend High School. This • event is open to the public. Family Fun Fest will be held April 23rd at Mountain View. Member Sullivan talked about the Drug Take Back event on April 30th at the Port Townsend Police Department. He stated that the Jefferson County Sheriff's Office will take back unwanted medications and supplements. As a result of differing interpretation of the DEA restrictions,the Port Townsend Police Department will only take items in their original containers but the Sheriff's office will take back unidentified drugs as well. Member Buhler asked what the best way to dispose of unidentified medications would be. Ms. Baldwin stated they should be broken and placed in wet kitty litter or coffee grounds, put in a coffee can and thrown in the garbage. They should not be flushed down the toilet. ACES (Adverse Childhood Experiences) article—"The Poverty Clinic" Ms. Baldwin stated the article on"The Poverty Clinic"was a good article on the ACES issue. Ms. Baldwin said that staff had drafted a letter to the editor of the Journal of American Public Health Association thanking them for publishing the article and stressing the importance of integrating mental health into overall public health practice. Member Frissell passed around a book by Paul Offit called "Deadly Choices, How the Anti- Vaccine Movement Threatens Us All". NEW BUSINESS • Washington State Budget—Local Health Department Impacts Ms. Baldwin reported that at this time there wasn't any new information to share. She will continue to update the Board as she learns more. County Health Ranking Report Ms. Baldwin stated that the County Health Rankings Report is a report that only 17% of Health Departments use in Washington State. The rankings do not give a clear picture of the health status in Jefferson County in comparison to other counties in Washington State because the numbers are based on a small population and the report does not look at the data over time, which is necessary when looking at numbers for a small population. Ms. Baldwin did note that this report is a good way to look at the nation and at the state,but it does not do much at a county level. A brief discussion was held on the different rankings in the report and possible reasons for the way Jefferson County was ranked in comparison to other counties. Board Discussion: Jefferson County Food Safety Code Revisions Mr. Whitford informed the Board that there is a type written error on the fee schedule. The fees for `espresso stand' and `grocery stores checkout 1-3' were reversed. He will bring the corrected fee revision to the next BOH meeting for discussion. S Page 3 of 5 BOB Minutes April 21,2011 Mr. Whitford talked about forming an advisory group to discuss and strategize ways to resolve issues around food service. The first issue that needs to be addressed is temporary events. , Temporary events present a significant risk for foodborne illness transmission and are strictly regulated according to state and local food code. This means that separate permits are required for events with different locations and/or menu items. However,the fee schedule and temporary guidelines did not adequately anticipate this change in approach. So, proposed changes to both our guidelines and the fee schedule are being developed for the Board of Health's review.. Other Legislative Updates Mr. Whitford reported on a bill which includes changes in licensing for designers and limiting continuing education requirements. In regards to Environmental Health, a bill related to licensing of onsite wastewater system designers/engineers/inspectors passed. This bill will have positive impacts on fees and continuing education requirements. Most bills that were of concern to Environmental Health Directors did not become law. A bill that would have authorized local boards of health to work with County Assessor's Offices to charge an annual onsite sewage management fee did not pass. That bill could have led to a stable and consistent funding source for implementing onsite sewage system local management plans. ACTIVITY UPDATE Ms. Baldwin announced that both she and Dr. Locke will be absent for the May BOH meeting. Ms. Baldwin stated she can provide reports and have staff members review the reports, unless . the Board prefers to cancel the meeting in May. Ms. Baldwin suggested having community members come to the BOH meetings and talk about their organization and the services they provide. Member Nelson pointed out that she would like to make sure enough time will be allowed for community members to speak to the Board about their programs and how they are affecting our community. Member Johnson moved to cancel the May BOH meeting; Member Austin seconded. The motion was approved unanimously AGENDA PLANNING CALENDAR The next scheduled BOH meeting will be held Thursday, June 16, 2011 from 2:30-4:30 PM at the Health Department, 615 Sheridan Street,Port Townsend, WA. ADJOURNMENT Chair Nelson adjourned the BOH meeting at 3:53 p.m. i Page 4 of 5 BOH Minutes April 21,2011 O JEFFERSON COUNTY B 6 RD OF HEALTH ! ' , 3&,\6() Kristen Nelson, Chair Phil Johnson, Vi e-Chair ad4-- Ji Buhler, Member Jo rig Austin, Member yt�2(��eiW Roberta Frissell, Member David Sullivan, Member Excused Sheila Westerman, Member s i Page 5 of 5 BOH Minutes April 2I,2011 • Board of 3feaCth Old Business & Informationalltems .agenda Item # IV, 1. • .Adverse Childhood-Events .flay 2011 .Article - American Tournal of Public Health June 16, 2011 • Published Ahead of Print on May 12, 2011, as 10.2105/AJPH.2011.300207 The latest version is at http://ajph.aphapublications.org/cgi/doi/10.2105/AJPH.2011.300207 III LETTERS ADVERSE CHILDHOOD EVENTS IN published research during the last decade.1 Contributors THE MENTAL HEALTH DISCUSSION This growing body of research supports what All authors contributed equally to the writing of this many public health practitioners have ob- letter. We would like to thank the Journal for high- served:the experience of ACEs contributes to lighting mental health as a chronic disease in a lifetime of risk.The use of the ACEs score as References g g 1. Felitti VJ,Anda RF,Nordenberg D,et al.Re- the December 2010 issue.We urge public • a health screening tool is a direct way to get lationship of childhood abuse and household dysfunction health researchers and clinicians to extend scientific measurements into daily clinical to many of the leading causes of death in adults:the Withpublic health funding mcreas Adverse Childhood Experiences(ACE)Study.Am J Prey the dialogue by reviewing the Adverse Child- practice. g Med 1998;14(4)245-258. hood Events(ACEs)work that has been done ingly limited,using a population-based ap 2. Centers for Disease Control and Prevention.Ad- by the Centers for Disease Control and Pre- proach such as educating new parents on the verse childhood experiences reported by adults-five vention and Kaiser-Permanente.1 In the De- lifelong impact of ACEs has the potential to be states,2009.M1l4YVR Morb Mortal Wkly Rep.2010; 59(49)1609-1613. cember 17,2010,Morbidity and Mortality clinically and economically effective.Prevent Weekly Report,2 an analysis of the ACE module ing a lifetime of mental illness or chronic 3. Perry GS,Presley-Cantrell LR,Dhingra S. Addressing mental health promotion in chronic disease disease starts in pregnancy,with the clinician prevention and health promotion.Am J Public Health implemented by 5 states in the Behavioral Risk Factor Surveillance System(BRFSS)stated supporting the parents'innate motivation to 2010;100(12):2337-2339. that"ACEs have been linked to a range of create a better life for their child.Information 4. Keyes CLIVI,Dhingra SS,Simoes EJ.Change in level adverse health outcomes in adulthood,includ- about the risks of tobacco use is offered to allof positive mental health as a predictor of future risk of mental illness.Am J Public Health.2010;100(12):2366– ing substance abuse,depression,cardiovascu- pregnant women;by the same token,to fail to 2371. lar disease,diabetes,cancer,and premature educate parents about the consequences of 5. Olds DL,Henderson CR Jr,Tatelbaum R, mortality."In their editorial,Perry et al.state ACEs is an unacceptable oversight.One suc- Chamberlin R.Improving the delivery of prenatal care • that promoting mental health should be part of cessful evidence based program that educates and outcomesisitation.of prediatgnancy:a randomized trial of nurse home vPerics.1986;77(1):16-28. chronic disease prevention"...by addressing parents and prevents the generational transfer the emotional,social,and psychological well- of ACEs is Nurse-Family Partnership(NFP). being of the population"3;however,neither The efficacy of NFP has been demonstrated Perry et al.nor Keyes et al.4 mentioned the through 25 years of research.5 contribution of ACEs to mental illness and The Journal has started the discussion of other chronic diseases. integrating mental health into overall public The cumulative and enduring impacts of health practice;it is now the public health ACEs are not emerging science but have been community's responsibility to continue to look statistically validated and well documented in at ACEs as a tool for prevention of not only mental illness but also of chronic disease.■ Letters to the editor referring to a recent Dunia Fault BA Journal article are encouraged up to 3 months Jean Baldwin,MSN ARNP after the article's appearance.By submitting a Quen Zorrah,MSN letter to the editor,the author gives permission Denis Langlois,MSN ARNP for its publication in the Journal.Letters Lisa McKenzie,BSN,MPH should not duplicate material being published or submitted elsewhere.The editors reserve the right to edit and abridge letters and to publish responses. Text is limited to 400 words and 10 refer- About the Authors ences.Submit online at www.editorialmanager. At the time of the letter's writing all authors were with com/ajph for immediate Web posting or at Jefferson County Public Health,Port Townsend, WA. ajph.edmgr.com for later print publication. Correspondence should be sent to Jean Baldwin,MSN, Online responses are automatically consid ARNP Director,Jefferson County Public Health,615 eyed for print publication.Queries should be Sheridan St.,Port Townsend WA 98368(email:jbaldwin@ col'effersonwa.us).Reprints can be ordered at http.//www. • addressed to the Editor-in-Chief,Mary E. ajphorg by clicking the'Reprints/Eprints"link. Northridge,PhD,MPH,at men6@nyu.edu. This letter was accepted February 9,2011. _ — doi:10.2105/AJPH.2011.300207 Published online ahead of print May 12,2011 I American Journal of Public Health Letters I el. Copyright 2011 by the American Public Health Association Board of Health Old-Business & InformationaCltems .agenda Item # XV., 2 • .Tefferson County Public Health WIC Facts Zoio June 16, 2011 • e erson CountyJ Public woorea ,,. Health 4111 WIC Facts: 2010 Special Supplemental Nutrition Program for Women , Infants and Children ( WIC ) Infants Born in County WIC Families Served by WIC Working families 62% Jefferson 54% Families living in poverty 67% Statewide 50% Even though they are working,the majority of WIC families are living in poverty. In 2010,the monthly income for a family of four living in poverty was $1,838 or less. Women, Infants and WIC Nutrition Education Children Served Promotes Healthy Choices Total: 850 Total nutrition education sessions 2,402 Infants and WIC nutrition education: 411 children under 5 593 • Emphasizes healthy habits so families can eat better and stay active to prevent obesity and other chronic diseases. Pregnant, breastfeeding and • Promotes breastfeeding for at least the first year of life. postpartum women257 And,helps working mothers breastfeed longer by providing breast pumps. WIC and the Farmers • Helps prevent early childhood caries by giving parents ideas for healthy snacks and stressing dental care by Market Nutrition age one. Programs Benefit the Local Economy WIC Attracts Families to Prenatal Care/MSSPreventive Health Services Dollars to grocery stores Immunizations $284,503 Family Planning WIC referrals 4,084 Dental Care WIC helps families get the services they need. Dollars to farmers Quit Smoking $1,876 • *Maternity Support Services Washington WIC "...improving the lifelong health and nutrition of women,infants and young children" Jefferson County Public Health WIC Sites Statewide WIC Facts 2010' Chimacum 316,133 pregnant and breastfeeding women and children under age 5 benefit from WIC Port Townsend • 65%are from working families. Quilcene • 15,388 are from military families,including women serving in the armed forces. • Families receive healthy foods,education and counseling on nutrition and physical activity,referrals,and breastfeeding support. $120 million in grocery store sales • Each client receives checks to purchase an average of$52 a month in healthy foods. • Families buy healthy food with their WIC checks at more than 739 grocery stores statewide. $743,722 in purchases from local farmers • With WIC Farmers Market Nutrition Program checks,families can eat more fresh fruits and vegetables from local farmers. 85%of WIC mothers give their child a healthy start by breastfeeding,far exceeding the national rate of 68%.2 • Children who are not breastfed are more likely to have asthma, diabetes,and childhood obesity.3 • Mothers who breastfeed lose pregnancy weight gain more quickly. • Mothers who do not breastfeed have higher rates of breast cancer and osteoporosis.3 In the past 30 years,Washington WIC has contributed more than $1 billion in grocery sales and saved an estimated $700 million in health care costs.4 1 Federal Fiscal Year 2010. 2 CDC.Provisional Breastfeeding Rates by Socio-demographic Factors,Among Children born in 2007,Breastfeeding Among U.S.Children Born 1999-2007,CDC National Immunization Survey. 3 U.S.Dept.of Health and Human Services.HHS Blueprint for Action on Breastfeeding,Wash.D.C.,DHHS,Office of Women's Health,2000. 4 Mathematica Policy Research:The savings in Medicaid costs for newborns and their mothers from prenatal participation in the WIC program.Prepared for U.S.Department of Agriculture,Food and Nutrition Service,October 1990. wagtonsm�llero/ Contact Us Visit www.doh.wa.gov/cfh/wic to find more information about Washington WIC,a copy of our Annual Report, r�' artmen�Health and county-specific fact sheets.You can also call 1.800.841.1410 and press 0,or write PO Box 47886,Olympia WA DOH 960-144 April 2011 98504-7886.For persons with disabilities,this document is available on request in other formats.To submit a request,please call 1-800-841-1410(TDD/TTY 1-800-833-6388).This institution is an equal opportunity provider. 0 Board of 3Cealth Old Business & Informational Items Agenda Item # IV., 3 0 Green Business & EnviroStars Awards June i6, 2011 • w45or JEFFERSON COUNTY PUBLIC HEALTH k0 615 Sheridan Street • Port Townsend •Washington • 98368 www.jeffersoncountypublichealth.org • June 16,2011 Jefferson County Board of Health PO Box 1220 Port Townsend, WA 98368 Dear Board of Health Members: �� I am proud to announce that The Car Wash, located at 515 Howard Street, Port Townsend, WA 98368, has been awarded Green Business certification! This business is going the extra mile to conserve water, energy and other resources in its business operations. Additionally, Port Hadlock Marina has been awarded the 5-Star rating for EnviroStar certification, and has also been certified as a Clean Marina. This marina is a leader in sustainable environmental business practices in our community. 410 R After signing these awards, please return it to: Er�vloaTARs CERTIFIED Jefferson County Public Health Attn: Lori Clark 615 Sheridan Street Port Townsend, WA 98368 Thank you for your continued support of the EnviroStars and Green Business certification programs! Sincerely, (�/i\J.Jj{,(-(j�J(�/j/; l/ V`✓ Lori Clark, MS, RS/REHS Environmental Health Specialist Jefferson County Public Health • COMMUNITY HEALTH ENVIRONMENTAL HEALTH DEVELOPMENTAL DISABILITIES PUBLIC HEALTHWATER QUALITY MAIN: (360)385-9400 ALWAYS WORKING FOR A SAFER AND MAIN: (360) 385-9444 FAX: (360)385-9401 HEALTHIER CoUIUTY FAX: (360) 379-4487 • Jefferson County Public Health April/June 2011 NEWS ARTICLES 1. "County honors public health heroes," Port Townsend Leader, April 20th, 2011. 2. "'Fun fest' teaches health, safety," Port Townsend Leader, April 20th, 2011. 3. "Fishing in Anderson Lake's Future?", Peninsula Daily News, April 22nd, 2011. 4. "Test results clear Anderson Lake," Peninsula Daily News, April 24th, 2011. 5. "Law &Justice — Drug take-back Saturday" Port Townsend Leader, April 27th, 2011 6. " `Health heroes' honored for work" Port Townsend Leader, April 27th, 2011 7. "Quit-nicotine program while supplies last," Peninsula Daily News, May 6th, 2011. 8. "So far, so good at lakes," Peninsula Daily News, May 8th, 2011. 9. "New mom says `thanks' to locals," Port Townsend Leader, May 11th, 2011. 10. "Parent to Parent," Peninsula Daily News, May 15th, 2011. 11. "New law promotes kids' vaccinations," Peninsula Daily News, May 15th, 2011 12. "New warning to be added at Jefferson lakes," Peninsula Daily News, May 16th, 2011. 13. "Three lakes' quality good —for now," Peninsula Daily News, May 22nd, 2011. 14. "Let's hear some health department facts," Port Townsend Leader, June 1st, 2011. 15. "Does your food budget need a boost?", City of Port Townsend Newsletter, June 2011. 16. "County acts to avoid shellfish beach closure," Peninsula Daily News, June 5th, 2011. 17. "Toxin level increases in Anderson Lake," Peninsula Daily News, June 5th, 2011. • 18. "Tobacco sales to youths slowing," Port Townsend Leader, June 8th, 2010. • County honors public health heroes In honor of National the board will recognize the Public Health Week, the efforts of the 400 volunteers Jefferson County Board of the Community Outreach of Health plans to recog- Association Shelter Team nize individuals who have (COAST),who staff two shifts worked to make the comma- a night in the homeless shelter nity safer—and healthier. and provide meals. The board is scheduled In the public health leader- to present awards at 2:30 ship category are the 60 volun- p.m. on Thursday,April 21, teers who work in the four food at the health department banks in Jefferson County. offices at 615 Sheridan St. In the business category, in Port Townsend. the board plans to honor the This year, the theme Recyclery,run by Chancey and for National Public Health Dash Tudhope-Locklear. The Week is "Safety is no acci- Recyclery's bike maintenance dent." classes are offered at Grant The Ecumenical Street School,the Boiler Room Christian Helping Hands and the Food Co-op. Organization (ECCHO) is In the community health slated to receive special roc- promotion category, the board ognition. will recognize Linda Pfafman In the community-based of the Jefferson County organization category, Sheriff's Office. • • • /0, o/i 'Fun fest' teaclqes • health, safety y Jefferson County contin- to learn about health, safety ues to celebrate "Our Kids: and community resources in Our Business" — a social a fun and interactive envi- awareness and prevention ronment. Free child ID kits campaign — this month and are available. next. Other "Our Kids: Our A free-"Family Fun Fest" Business" events include the is from 10 a.m. to 3 p.m. Teen Community Read with on Saturday. April 23 at the Port Townsend Public Mountain View Commons. Library,weekly happenings at 1919 Blaine St. The Crime the Boiler Room,and"Walk a Victim Service Center offers Mile in Her Shoes"and"Dine children and families a chance Out for Kids"on April 27. • 411 'r /ate/ 72 v may• '..1 ...e q.tyo + yy— y.,., y Wim® or) on ma �m ° F'[ oo °.nyFo ao.y> .5-0 '� wog ' m1-Gm 4'og' o• . 6.4-5 " C �II Oec> ^ 'A .•ryJ a U t. + o > . m^ m ! Ak. odE.23 ci,!-'-_ Cem. •CQ T�i � C UUfE' "O 2 y O 5. A c>k a° uA"C . ° o O m o%V./ • N O C _G m O 7v e N CA'7Qat F. - mmdo 6m� ° o� wec3a> o ' 5 yogcy to t� 1 = '� yc n\ CJj v. mG -io o 0. C'C mUw o ° C E <-1 U a 0 - ~ y�:'° tit,�iia "ma °)_`O �yyOc° -'" • L-3 woo.. 0y o NO 0..-� ' UC1d .19 . ..., •..,_., •••. — • -C �•V5O 'di.; ay o �"-� . 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M a. as ,,s1.___,.., vI Xs • Test results clear Anderson Lake III Word expected Tuesday fishing hole between CM- dangerous for both people if fishing season to open macum and Port Hadlock, and animals,have plagued may be because of cloudy the popular trout-fishing . conditions. He said he has lake since May 2006,when BY JEFF CHEW been monitoring the lake two dogs died after drink- PENINSULA DAILY NEWS since April 4. ing water,and the lake was CHIMACUM — Water closed. quality test results show Status could change In April 2010,Anderson Anderson Lake is low in' But that could change Lake was opened for fishing deadlytoxin Concentra- for the first time since 2008 with a few sunny,windless but was closed three weeks tions, Jefferson County's days, he said, because environmental specialist later when toxin levels shot warmer, sunny days tend said Friday,and he expects upas the weather warmed to aid in the incubation of and encouraged the algae word from state parks offs algael blooms that carry growth. cials no.later than Tuesday toxins including mycrosys- about whether the lake tin and anatoxin-a. Can damage liver will reopen for the fishing Ultimately, he said, season Saturday. Anderson Lake State High concentrations of "No blue-green algae park's manager,Mike Zim- toxins from blue-green showed up in the samples," merman,will make the call algae can damage the liver Greg Thomason, Jefferson on whether the lake will or the neurological system. County environmental open for fishing season. Jefferson County Public health specialist, said Fri- "If we see a bloom as Health has been collecting day afternoon after receiv late as Friday,we will have and submitting water ing results of water sam to recommend closing it" quality and algae samples pies taken Monday at the just prior to fishing season from Lake Leland, Ander- lake. opening,Thomason said. son Lake and Gibbs Lake ill `Clearest I've seen' "We're going to watch it since 2006. every day next week, and Typically, if a bloom is "This is the clearest I've each day we will be updat- observed, a sample will be seen it this late." ing" lake conditions, he taken and submitted to That means an said. King County Environmen- announcement could be The history of Anderson tal labs for testing,officials forthcoming that the lake Lake shows that an early, said. will open for fishing sea- mid- and late summer son. bloom is likely, public Sequim-Dungeness Valley Edi- Thomason said the lack health officials said. for Jeff Chew can be reached at of algae bloom in Anderson Toxins created by blue- 360-681.2391 or at jefl.chew@ Lake, a popular 70-acre green algae, which are peninsuladailynews.com. S P,0N 3 14•Wednesday,Ape 27,2011 i71 ' S • „.„ x Mme : -N e- _.. weF. �'.ro nl'"1-4.7 6r-fs' ''''' ke-'- - -rt.' 'a,..E -ii9 r -7e7t-7: ....,, Area residents can dispose inside the lobbies of the admin- unwanted medications to the of their unused. expired or istrative offices. The sheriffs first take-back event. unwanted prescription drugs office drop box is located at 79 According to the 2010 from 10 a.m. to 2 p.m. on Elkins Road in Port Hadlock. Washington State Healthy Saturday,April 30 at the Port The sheriffs office lobby is Youth Survey, 8 percent of Townsend Police Department. open from 8 a.m.to 4 p.m. students in grades 10 and The office is located at "Every day is drug take- 12 used a prescription pain Mountain View Commons, back day for the Jefferson medication to get high in 1925 Blaine St. County Sheriff's Office,” said the past 30 days. Called the Drug Take- Sheriff Tony Hernandez. In addition,state and local Back Program, the service is Since January.the sheriffs health and environmental offi- free and anonymous,and part office and police department cials have expressed concerns of an ongoing effort among have collected nearly 100 about the impact of medica- local law enforcement agen- pounds of prescription drugs. tions on the water supply and • cies to keep prescription drugs Last September, natural aquatic habitats. The off the streets and out of the Americans turned in 242,000 have said medications should environment. pounds of prescription drugs at not be flushed down the toilet The April 30 "take-back” nearly 4,100 sites operated by or thrown away in the trash. event is offered in addition the Drug Enforcement Agency The following items should to the ongoing take-back pro- and more than 3,000 state not be brought for disposal at grams started by the Port and local law enforcement the April 30 event: IV solu- • Town$end.Police Department partners, including the Port tions,syringes,medical waste, and Jefferson County Sheriffs Townsend Police Department. syringes with liquid in them. Office in January 2011. Both In Jefferson County, more old crutches, air casts and agencies have drop boxes than 50 people brought their splints. 40 Port Townsend&Jefferson County Leader r�� d©`I 7 Health 4 • raa "a; '`t� k�" W'g'�"i c P+s t, ,„w3M 'm i,�+,.., �.- iPIT- 4 k '- ' `i m, fivil',1—'- 1,, , :go vi*- v:70 , 410 (44) _ F -,;°,, a1 /'3' 0.' -- .+. 4" .fie+ s ' ' ' ' -tt7::. li ' r \ {, .0-' 11 4 -V-e;-i i i -;51 t, >r j `I,Allfir.-ty.• j `,., S trimto. ,, •:. feed f f 0,0° . ,ft a rzy x`ra �;, Bks •—z,-.4...1... ,..ho'.ns'?*r° y" "is Aiii --'1!1-51:171:7;:f;?1' m , ti Representatives of organizations as well as individuals were recognized April 21 for their contributions to the health of the community as Jefferson County Health Heroes,including(from left to right)Connie Johnson of the Tri-Area. Food Bank,Jeanette and Bruce Travis of ECCHO,Shirley Moss of the Port Townsend Food Bank,Chauncey Tudhope Locklear of the ReCyclery,Lnda Pfafman of Jefferson County Sheriff's Office,Dash Tudhope- •Loctklear of the ReCyclery and Carl Hanson of COAST.Photo by Allison Arthur `Health heroes' honored for work Hundreds of volun Travis, co-founders of teers of COAST staff two 26,500 hours of service teers help keep Jefferson Ecumenical Christian shifts a night in the Port helped alleviate hun- County healthy. Helping Hands Townsend homeless shel- ger in Jefferson County. A handful of repre- Organization (ECCHO), ter and provide meals. Volunteers also provided sentatives from several received a special recogni- The group of 15 faith- 77,000 home visits in 2010 organizations, as well as tion.ECCHO is made up of based and service orga- and drove 7,000 miles to several individuals, were 75 volunteers, who drove nizations, 14 businesses, acquire some of the food. recognized April 21 at the 40,511 miles last year and countless individuals Young entrepreneurs Jefferson County Board of transporting elderly, dis all give time, money and Chauncey and Dash Health meeting for being abled or low-income resi- goods to keep the shelter Tudhope-Locklear of the "health heroes:' dents of Jefferson County open for 15 to 17 people ReCyclery, which offers Port Townsend coun- to medical appointments, per night during the win- bike maintenance classes cit member. Kris Nelson errands or.appointments. ter. at Grant Street School, the handed out awards to In 2010, the group's Shirley• Moss, the Boiler Room and the Food ' eight representatives of volunteers served 849 new manager of the Port Co op, received praise in organizations. residents from Brinnon to Townsend Food Bank, and the business category. Jeanette and Bruce Port Townsend. Connie Johnson of the Tri- •Linda Pfafman of the •Carl Hanson, Area Food Bank accepted Jefferson County Sheriff's Community Outreach the public health leader- Office was recognized for Tp (Tu �l Association Shelter Team ship award on behalf' of her work on child safety- Outreach �UTH ( (COAST),accepted honors 60 volunteers who work seat training and instruc FLEXIBILITY in the community-based in the four food banks in tion in the community organization category. Jefferson County. health promotion catego- II� �� More than 400 volun- In 2010, their ry. i • PENINSULA DAILY NEWS Briefly . . . Quit-nicotine program while supplies last OLYMPIA—For a short time,the Washington State Tobacco Quitline has patches and nicotine gum available for free while supplies last. State residents ages 18 or older need to call the Quitline before June 30 for the free Nicotine Replace- ment Therapy. • No health insurance is required. The program includes counseling and a free course of nicotine treat- ment—nicotine gum or • patches. The Washington State Tobacco Quitline has already helped 160,000 people access tobacco ces- sation services. For more information, phone 800-Quit-Now or 877-2N0-FUME,or visit www.quitline.com. • j)4)1V ., So far, _ • so good at lakes No algae blooms Lakes: Past found toxins but bad signs seen • can cause liver failure BY LEAH LEACH PENINSULA DAILY NEWS CONTINUED FROM Al tion,Thomason said. ity and algae samples from Toxin levels remained low in Lake Caution signs say toxic Lake Leland, Anderson Anderson and other East Jefferson County "As we get sunnier, algae may be present and Lake and Gibbs Lake since lakes in samples taken last week. warmer weather, it will advise lake users to refrain 2006. Lake Anderson,Lake Leland and Gibbs probably change,"he said. from drinking lake water For more information, Lake all remain open to fishing. Toxins found in Jeffer- and to clean fish well, dis- visit the environmental But yellow caution signs sprouted on son County lakes in the carding the guts. health website. Phone the shores of those lakes last week. past have been the neuro- Caution notations for direct questions cora- "The only reason we have the caution toxin anatoxin and micro- Anderson, Leland and ments to the de aror ot at signs up is that for the first time this sea- cystin, which can cause Gibbs lakes went up on the p son,we're seeing some toxic algae species liver failure. environmental health web- 360-385-9444. showing up"in water samples,said Gary Test results of samples site at http:I/tinyurl. No toxic blue-green Thomason,Jefferson County environmen- taken Monday found no com/6z64ofy last week. algae has been reported in tal health specialist, by cellphone as he detectable level of anatoxin Sandy • Shores Lake Clallam County, where planted the signs at the lakes Friday. in Gibbs Lake.It was pres- remained clear of algae. health officers visually "None of the three lakes have any ent but barely measurable The site is updated monitor lakes for signs of [algae] blooms, which is great," he said. in Anderson and Leland weekly after samples col- algae bloom. "The water is clear. lakes,Thomason said. • lected each Monday are Algae blooms in Clallam "Go for it,"he told fishermen. , Ivlycrgcytip was.belaw .. 1 ed at County {�vi- County lakes'•�slonld' be deteetable levels,.he said.- ronniental fabs. re o d to the"Clallam Lake Anderson history Mtliough_the • presence of .'Testing .will.•'continue p- - the algae doesn't mean the throughout the summer. County 'Department of Toxins created by blue-green algae have water is poisoned, the fact Jefferson County Public Health and Human Ser- especially plagued Lake Anderson,a popu- that it wasn't detected until Health has been collecting vices'environmental health lar 70-acre trout fishing hole between Chi- last week is cause for cau- and submitting water qua]- division at 360-417-2258. macum and Port Hadlock,since May 2006, when two dogs died after drinking water tainted with anatoxin,a quick-acting neu- rotoxin,and the lake was closed. In April 2010, Anderson Lake was opened for fishing for the first time since 2008 but was closed three weeks later when toxin levels shot up as the weather warmed and encouraged the algae growth. In 2008,lake samples had the largest concentration of toxins measured in West- ern Washington when samples tested at a level of 170 micrograms of toxins per liter in June 2008 reading. A dangerous level of toxin is one micro- gram per liter,environmental health offi- cials have said. Anderson Lake opened April 30. "At this time last year, we had'a big bloom in Anderson,"Thomason said,attrib- uting the slow growth of algae in the lake to cool,rainy weather. TURN TO LAKES/A5 • . P,dN •5-/A/, New mom says `thanks' to locals • I wanted to give a special thanks to several businesses, organizations, and people in Jefferson County, Being a Jefferson County resident now for about three years,I am just delighted by all the wonderful help and support this county has to offer. It really is quite amazing. I found out in July that I was expecting. I was very excited. A few months passed,and the father decid- ed that he didn't want to be involved with me or the baby.I was left scared and alone—or so I thought. I started exploring local services and organizations that could,in any way,be of help to me.After spending some time, and of course, the effort, I was completely astounded by the amount of help Jefferson County has to offer. First, I want to give special thanks to all of the ladies at the health department,such as Mary Jo. You are such a special part of my life. Thank you for lending a listening ear and an open heart. And to all the lovely ladies at WIC:Jen and Mayra, • thank you! The fantastic and extra helpful staff at Olympic Primary Care—Dr. Harris, Dr. Hong and Dr. Parker, and all the nurses(especially Laurie, for your help and advice through my toughest times), Karen and all the other staff—have been so helpful. Also, an extra-special thanks to O1yCAP. What a fantastic contribu- tor to our county.And another thank- you goes to the staff at the local DSHS. This support has inspired me to reach out to others, so thank you for opening up my heart, like you all do so well to those of us in need. Thank you,Jefferson County. C. HAAPALA Port Hadlock • Parent to Parent The event is free,and PORT TOWNSEND— dinner is provided. To RSVP and find out • The Arc of Kitsap&Jeffer location infoi enation,phone son Counties is hosting a. Jennell DeMatteo at 360- Parent to Parent meeting 379 8934 or email at the Girl Scout House, 379-89 4 or epen.com. 838 Tyler St.,from Peninsula Daily News 5:30 p.m.to 7 p.m.Wednes- day,May 25. Jefferson County Devel- opmental Disabilities Pro- gram Coordinator Anna McEnery and state Depart- ment of Health and Human Services Disabili- ties Case Manager Tobias Clawson will be updating families on services and opportunities for people with developmental dis- abilities. 111111 • • New law promotes • kids' vaccinations THE ASSOCIATED PRESS which had historically OLYMPIA — A new lagged behind most other states. state law is making it more difficult for parents to send Some parents oppose vaccines on religiouss their children to school grounds. without first getting immu- Others continue to nized against diseases. believe that vaccines are The bill,signed into law harmful despite a multi- by Gov. Chris Gregoire last tude of studies supporting week, requires parents to the safety of vaccines for receive a written certificate children. of exemption by a licensed Selecky noted that per- health-care provider to tussis — commonly called enroll their children in pub- whooping cough — along lic schools without the rec- with measles are two dis- ommended battery of vacci- eases that have spread nations designed to protect among populations of chil- children. dren who have not been "For too long Washington vaccinated. has had an easy way for Health officials are parents to opt out," said counting on medical profes- Secretary of Health Mary sionals, including physi- Selecky. "All it took was a cians, physician assistants, simple check on a form." osteopaths, naturopaths S This extra requirement and advanced registered for parents opposed to vac- nurse practitioners, to cines for their children is stress the importance of expected to bolster the immunizing children state's vaccination rates, against many diseases. S �,rd }+ --,�''o N 0'O\ �O+' N (.O Nr v0j :,.dgm� zo2. o0, F'oo5C' J '" New warning /� •0 fes„ c'" A.d i.. ,CC? a8'i o c'�0 3 .,6 l i J cU o00 �'O N L+"---4E t-a N .p Z co o " ov va ,. oA `a3�,. „ g wdt • to be added at �/) ft ! hllU! � "8mm s CON—cry NO a3 Y O Y-•�U)+-, + .-.- -.4. J co'O ! :I!Jfl1 +"' o of lit Hi Jeersn lakes (f, -0 y'' `Algae toxins may be present •,---Cf) �▪ , .• ��+{ o_p,Nw ��g� ��b, .y . a� will read ca .9 in fish tissue,' signs ro 4q °°, y - 0 g •BY LEAH LEACH Anderson and Leland in East `./ ° cva g'� o'c..0 3.� 4-2 c• a 0.2.0 C...);-0 -g p co a,4v Co-,.., w a c2 m-O w of a s �>e PENINSULA DAILY NEWS Jefferson County. N o 5 ' 4''0 *' c°.W C G The study,which is supported `a G si 0 w ens �, 3 as o o >w;� y o PORT TOWNSEND—Anew by research elsewhere, found •� N v 0 o•� m o o a> a> N a>v warning will be added this week that the toxin microcystin,which 0 a o as, 0 C, 0 F o en-8 5 o as to the yellow caution signs at can cause liver failure, accumu- o N o o o 0 , C as^ o b. . o 8 up Anderson, Leland and Gibbs later in muscle tissue—the part a) H 0.5 a o a, " 5 2 '.5 O.ti P.G lakes. of the fish that is eaten. • c w o U�r y y Just underneath the sugges- That's a change from earlier 0 o v 5 5.o 0 0 uo 6 o.�o•f tion that all fish be cleaned and research indicating that the O +° s~ d a p ti �� 'o b the guts discarded will be the toxin accumulated only in the Z 3 h i~ d a, a a, ii O 1.-' .E" o following wording: viscera, which is usually dis- o o XI-0 p,co y co -0 a w 'Warning—algae toxins may carded. w . be present in fish tissue. For a; . pp.0 '0 o y a -, m more information, please call No link to effect on health o G j 3 b r. w o 3 0 , m 360-385-9444" — the phone ` ° ° 8 o 0 0 0 number for Jefferson County No studies, including Ecolo- o 4` w 0 ca 4 a C o Public Health. gy's last year, have linked con- O o >--0 o •` „ •ti C.75 III 0 CO The change in the signs, sumption of fish from lakes with K o o,, l ..,o'8 which are supplied by the state toxic algae to an effect on human o=� 5.4 al m.yi ca ';. Department of Health, was not health,said Dr.Tom Locke,pub- s o o a•�n m N g a� '49 �a o o 0 prompted by any change in the lic health officer for Jefferson u� o-, v o o aCS lakes'algae content. and Clallam counties. ti`o o ' y N o o None of the three lakes posted "We now have pretty clear • 5 o 5.n o o 4.. o • a 0 s y a with the caution signs has visi- information that one of the tox- ble blooms.No large amounts of ins produced by blue-green algae o y y o •� N w toxin have been found in the does get into the tissue of the x o w :~ a y d`a� °O1 'ti'ti r„.1 o}, water. Fishing is permitted in fish,"he said. 3 ° " b En �' tn a the lakes. "Since we know that the toxin o °� ao o Wt0 0 " tu is in the fish,we felt we needed •� m a o o a R to advisepeople of that. o' o o >m°'w G m.a y :,,..3 y Fish study T'ti fA e Ti o s. o 'b N c''ti 3 c"o ''' "' "People need to factor that in b o as a> a, a, .ti • > a - E R a) Caution signs went up early when considering how much of n N o ,4,,,,,:i N a q a°, this month because minuscule the fish to eat." - amounts of toxin producing p 1 y .N-a '-" a- o w u a' 0 b U.P •' Anderson Lake,in articular, o °a, sn a y ,.ti 2 as o-,g3y„a,c 5. ri algae were found in water sam- is one of the Peninsula's most LI ® '4 �-, o d y a o • w, cu 0 a, o 0 pies. popular trout fishing holes. .� -C7 U.. ,. o >,� o -' .' d "" 0 • The change in wording was Health authorities can't say tt r, w .� o y N o prompted by a March 2010 study how much fish is safe to eat. as-n °; N c v•o +-,.,, a by the state Department of Ecol- TURN TO Waararre/A6 o a-C a o• 0 0 G~ ogy of fish in six lakes,includingC". m N o p i~Cr).� p a� P 'iu y s°'. oge) m",., oca—v~wow ]kV z n+6 oq �v o 0 o y o o 0 I U• 0 o o 0 °aro as 0 a).->ill is a,:p' 0 a� q+,' fir.`-,-0„� ca.~ . p o q y+�.,., o o.-. '511-2, o c,= a p. t•C a,a> a) >,o a.a)” 4&b, • Three lakes' good probably change,"he noted quality earlier thimonth.Thee situation ation now is that the algae species known to produce toxins have been me_ for now foundsamples from the threehreelakes. Although the presence of i ---_. the algae doesn't mean the 'Anything can happen' water is poisoned, it is of Warmer ater samples enough concern to erect the taken from Anything can happen yellow caution signsat the after three or four days of weather may W Anderson, sunny weather." lakes. Caution signs say toxic Researchers have change that Leland and Gibbs lakes last week noticed that warmer,sunny algae may be present and advise lake users to refrain days tend to aid in the into- from drinking lake water showed no change, bation of algae blooms that BY LEAH LEACH carry toxins microcystin, and to clean fish well,dis- PENINSULA DAILY NEWS ' said Greg Thomason which damagesthe liver, carding the guts.Jefferson County and anatoxin-a,a powerful Last week,caution signs The toxins are low,and neurotoxin. were changed to add a the fishing is good for now, environmental health They.aren't sure exactly warning that"algae toxins but public health officials specialist, on Friday. how weather affects algae may be present in fish tis- are wary of the warming All three lakes are growth. sue." weather's future effect on "Is it sunlight,tempera- blue-green algae growth in posted with yellow ture or a mix of the two?" Fish tissue East Jefferson County caution signs because Thomason said. The warning stems from lakes. "It's really hard to pre- "There are no changes" of minute amounts of dict" research showing that seen in the water samples algae species that microcystin accumulates in Toxins created by blue- taken from Anderson, roduce toxins green algae were first mea- fish tissue—the part that Leland and Gibbs lakes last p sured in East Jefferson is eaten = as well as in week,said Greg Thomason, showing up in water County in Lake Anderson,a viscera. 4110 Jefferson County environ- samples popular 70-acre trout fish- The signs direct those mental health specialist,on mg hole between Chima- who want more information Friday. cum and Port Hadlock after to phone 360-385-9444 — "The toxins are still very two dogs died after drink- the phone number for Jef- low —about the same asing water tainted with ana- ferson County Public last week — and there'stoxin-a in May 2006. Health. still no visible bloom," heThat discovery prompted Anyone who observes an said. the first closure of Lake algae bloom at a lake also is All three lakes areAnderson because of algae urged to call that phone posted with yellow cautiontoxins. number. signs because of minuteIn April 2010,Anderson "We're counting on the amounts of algae speciesLake was opened for fishing public to call us if they see that produce toxins show- for the first time since 2008 any visible blooms"at any Mg up in water samples. lake in the count but was dosed three weeks y,Thoma- It's still good to go,good later when toxin levels shot son said. to fish,"Thomason said. up as the weather warmed "If we get a call saying Samples will be taken and encouraged algae they have seen a bloom, from all three lakes Mon- growth. - we'll be out there checking day and sent to King In 2008, lake samples it right away." County Environmental labs had the largest concentra- For more information for testing as they are every tion of toxins measured in about lake quality in Jef- week during the summer. Western Washington when ferson County, visit the But also, given the samples tested at a level of environmental health web- onslaught of pleasant 170 micrograms of toxins site at http://tinyurl. weather,Thomason will be per liter in June 2008. com/6z64ofy. alert for algae blooms. A dangerous level of No toxic blue-green "If it stays warm and toxin is one microgram per algae has been reported in sunny, I will be out there liter, environmental health Clallam County, where checking all three lakes, officials have said. health officers visually probably on Thursday, to This year, Anderson monitor lakes for signs of see if there are any visible Lake opened April 30 for algae bloom. blooms,"he said Friday. the fishing season and has Algae blooms in Clallam since stayed open largely, County lakes should be Thomason thinks, because reported to the Clallam of the unseasonable cool, County Department of rainy weather. Health and Human Ser- As we get sunnier, vices'environmental health warmer weather, it will division at 360-417-2258. S Managing Editor/News Leah Leach can be reached at 360-417- 3531 or leah.leach®peninsula dailynews.com. Pl)' °fr • Let's hear some health department facts Of late I have been critical of what I perceive as the county health department's terrible per- formance, and Dr. Tom .Locke responded to my criticism with a gloriously vague "arm waving" lic health policy? There are none defense. He espoused the bene on their recently and expensively fits of prevention and illogically claimed they wouldn't save much redesigned Web page. I have been to seven health money if they reduced expenses. board meetings and they never dis- What the county needs to see cuss such things with the public. from him and his bureaucratic Why the secrecy? Are they afraid cronies is an explanation of their it might become"political"?We are extravagant expenses using some paying for all of their actions and actual facts. yet it seems they don't care for our Here is such a fact from the opinions and don't want us to know state auditor for them to explain: theirs. Where is open government Jefferson County's public health in Jefferson County? expenses per capita exceed every We deserve better performance county in the state, save King from our county health depart- County. •That's right, we spend went. i feel cheated when I pay for 410 more than 37 other counties. Of a Mercedes and get a Yugo. course,King County is in a rather different situation than us, since QuiTOM BROTHERTON TON ene they have a lot of well-paying jobs. Here's a fact.from the state health department county score- card they need to explain:Jefferson County performs below average in 12 of 31 health categories and we are"dead last"in tobacco Another fact they need to explain is their policy. Are they spending all of our money on pre- vention and ignoring those fac- tors that actually kill us?Has any person not on the health board ever seen an explanation of pub- Pr,ear 6/r/i/ Does your food budget need a boost? • Good News -WIC has openings for: ' • • Pregnant or breastfeeding women • Children under 5 years old Did you know that working families and those on unemployment can get WIC? Income guideline include many working families: • Family of 2 earning up to $2,268 per month • Family of 4 earning up to $3,446 per month See more about how to apply: www.doh.wa.gov/cfh/WIC/apply.htm Each eligible person can receive $50 worth of healthy foods per month. Fruits, vegetables, whole grains, ce- real, peanut butter, milk, cheese, and more. It's easy and no hassle. Call Jefferson County Public Health today at 385-9400. • • • Good Teen Read worthy of praise Four hundred copies of Thirteen PTHS,gavean evening program'at Reasons Why by Jay Asher were the Port Townsend Public Library distributed to teens in Port that was open to the public and Townsend during April. also led a discussion with 18 stu- And,despite some people think- dent leaders at the high school. _. ing teens don't read anymore,they Carrie 'Ehrhardt, principal ;of not only read the book, but they PTHS, and Paulette Lack, direc- created art based on the book, tor of Jefferson Community School, participated in or watched a play were supportive of this project from the beginning. A special thanks based on teen issues, wrote amaz also goes to Kelly Matlock of ing. poetry related to the book, Jefferson County Public Health. and talked and argued about the The teen writings have been col- book. Then they got to meet Jay lected into a zine that is available Asher, who gave a moving;inspir- at the library,Writers'Workshoppe ing and very funny presentation about becoming a writer. and Boiler Room. A video of Jay Besides Jay, I'd like to thank Asher's presentation is also avail- some wonderful people who helped able for checkout at the library. maksthis program a succiess.The The Teen Community Read artists who worked with teens were was generously funded by a grant Jesse Watson, Margie McDonald, from the Paul G. Allen Family Counsel Langley and Kathleen Foundation, which supports non- Burgett. Anna Nasset, owner of profit organizations focused on Artisans on Taylor, happily sched- making positive and measurable • uled the teen art show at the change in the Pacific Northwest. Undertown Coffee and Wine Bar The foundation's vision for trans- during May. Anna Quinn of the forming lives and building healthy Writers' Workshoppe visited every communities guides its funding English class at Port Townsend areas,which include nurturing the High and Jefferson Community arts, engaging children in learn- schools, working with students to ing, addressing the needs of vul- create poetry. nerable populations, advancing Marc Weinblatt, Kai Addae, scientific and technological discov- Raven McMillen, Josie 'Juntara, eries,and providing economic relief Molly Brown, Shawn Kellogg and amid the downturn. Colin Cabe created an interac- For more information, go to tive play that was.performed six pgafamilyfoundation.org. - times during the month. Jennifer .,Thanks, again, PT teens for a Barron, deputy director of the great Teen Community Read! Youth Suicide Prevention Program JODY GLAUBMAN in Seattle, presented an in-service youth services program for all the teachers at Port Townsend Public Library • ^ 3 o mvo a .4.)'g 5,3 odd i ; c- ,g .2° -.0-o o-§.....0 `�c `'m rnm� m.. iwx f t � m• . .+ aanma .t ++ o�,IIflhiI Uy zC Cm dqV 0iU.d 2a b . m E= -' '� ` ' te9'�,�x + ix o 0 -hl • ... , 'p.. g ■ dq'•9' a G ai` 1Josd 101i$I!!ilWij aam ` t i. a 5 e -4 r. '• 1- 8p-�O ,� `}0. 1t,4./Z:,o a� ,., o F Z a one U C t „,,,.„-„--,,,q,,-„,, S r� O O IA .5 O a co a” E", C••c M r ` ' --; re l ego, ,,..n-gc ., °,4°„ ..' -R 2az'a d C 2 m c �° 4 • t "' Or+ O ar 3■ dit7•.A a) ,-,=) 037,3:4 (1aC ■ > - y� '� y s,-,t,-..-,,,,,',.''1`,.P:-. ...i..,)',,,y t :A.,„,•,.' -:k4 ; d D.�W 2 //1 49 A ^88 14 2 a5 E:,s,0 -, I -0.a>-0 .y °, � tri. 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"`: � ' r ., 44, i Jefferson County youths are this year,in accordance with xt kx declining,according to the state law.Only one retailer .' 4" ' 2010 Healthy Youth Survey. in Jefferson County was g,, "' , Eighty-six percent of 10th- cited for selling tobacco to a � r,? ,1 \`° ' graders report that they do minor. Is„,„. 5'1'3'''''''''''5.:t'''"44' 1 1 ' , t r. not smoke cigarettes;this "We have been working ;e�^ , „ � is an improvement from with retailers and are happy qr„ 2004,when only 77 percent to see that" the rate of tobac �a ," a '"' .„.. of 10th-graders reported co sales to kids is dropping," 4 .' ,, .,4 `,.�,,# ,F --'" they were tobacco free. said Karen Obermeyer of ,,,�,, -,, • - • `� Current Jefferson County Jefferson County Publicyouth tobacco-use rates Health."However, any sale .1::-.47:47V:01•:: are statistically similar to of tobacco to someone under Washington state. 18 is not onlyillegal,it's �,F' .4, There is an increasing g ; unacceptable in our commu ''" 1.','1„.--..,,,,,,,,„. y vfiC l<� trend in the use of chew- nitv."Both the clerk and the ;$4,7,,,,,,,,n-,:,:,,,,,,,,-;- , .. r ing tobacco products by business receive fines when �� Washington youths,from they fail a compliance check ' 'i,-, T b 4.6 percent to 6.2 percent of Clerks who sell tobacco tory Y�� ;;' 10th graders;9.5 percent of minors are not doing teens ;',`,' ¢ „lit4 n, . ,: " "`" 10th-grade boys use"chew," any favors,Obermeyer said. 3 ups 5 Y 4 . _ �y ,,, - , _ r and the rate of use among They are aiding what often N^ ' § girls more than doubled to turns into a lifelong,expen ,,,fit r 3.2 percent. sive addiction that can result d " f 2 _ The Healthy Youth ,,° 1, X .. in illness and premature '"' Survey While the rate of cigarette smoking among Jefferson County youths is is taken anonymous death. ly by more than 212,000 • Fostering a healthy corn- declining,chewing tobacco use is on the rise. students in 235 districts munity requires efforts and 1,049 schools statewide. such as compliance checks our kids. So when we draw children and a healthier It tracks health behaviors to ensure that clerks check a line between our kids and community,"said Anne and attitudes among sixth-, for ID."We want to create things like tobacco and alco- Dean,Jefferson County eighth-, 10th-and 12th- a healthy environment for hol,we will have healthier Community Network pro- graders. • To: Jefferson County Health Board From: Larry Dennison, owner • Dos Okies Barbeque Re: 2011 Changes in Food Service fees/permit requirements June 12, 2011 Dear members of the Jefferson County Board of Health: I am writing you as a concerned local restaurant owner and member of an ad hoc Environmental Health committee— the Food Program Roundtable. I have specific concerns about a fairly radical change in the rules and fees that are being applied to local food service establishments for 2011. I intend to be present at the June 16 Health Board meeting to receive an Outstanding Achievement Award for my restaurant, Dos Okies Barbeque, and discuss my concerns over the changes in fees and permit requirements for 2011. In short, As a result of these changes Dos Okies will experience a minimum 217% increase in total permit fees, including a potential 600% increase in temporary food service permit fees for 2011 for virtually the same activities as last year. Last year I paid $440 in • permit fees for my restaurant, catering, and special event concessions. With the new permit requirements and fee structure, I would be paying $1395—more than tripling my 2010 fees for essentially the same activities. This additional burden is not sustainable for my business, and after a thorough study of WAC 246- 215-131 I can find no justification for these onerous changes. The WAC simply states that there must be a permit. The purpose of a permit it to provide the governing body with the necessary information upon which it can make decisions about inspection and any additional requirements that may be required of an applicant. The previous policy of allowing a single over-arching permit clearly meets the intent of WAC 246-215-131 by providing all the same information that multiple permits would, while making the process much more streamlined and affordable for permit holders. The original goal annual permits, rather than individual permits, was to create efficiencies in permitting and in administration of the permit process. That is still a valid reason for continuing that process. Thank you very much. • Larry Dennison Dos Okies Barbeque 360 301-0120 Cost Increase of Permits for Dos Okies Barbeque 2010—$310 for Restaurant (catering included in permit) $130 for Annual Temporary Food Service Permit 2010 Total County food service permit fees = $440 2011—$310 for Restaurant $175 for Catering (new fee) $910 for seven individual Temporary Permits 2011 Total Permit Fees = $1395 or 217% increase 2011 Temporary Permit Fees alone = 6000/0 increase Temporary Food Service Permits for Jefferson County • Previous years, allowed single annual permit which required detailed information on each event as per [WAC 246-215-131 (1-3) ] 9-201.11 (A)] • Required applicant to notify Environmental Health at least 14 days before any new event is added to annual permit. [WAC 246-215-131 (1-3) ] 9-201,11 (C) (1)] WAC 246-215-131 DOES require a permit for defined Temporary Food Service Establishments. • WAC 246-215-131 DOES NOT require a permit for each event The current requirement for a separate permit for each event creates an unnecessary and potentially fatal burden on food service establishments without increasing safety. We already are permitted and inspected numerous times through our existing restaurant and catering permits. Alternative Solution: Increase basic permit fees by some resonable amount while keeping the previous permit structure in place. • Advantage: increases revenue without need for complex new rules and more staff for redundant new inspections.. ki r1 Pertinent code references: WAC 246-215-011: (26)"Temporary food establishment"means a food establishment: S (a)Operating at a fixed location,with a fixed menu, for not more than twenty-one consecutive days in conjunction with a single event or celebration, such as a fair or festival; or (b)Operating not more than three days a week at a fixed location,with a fixed menu, in conjunction with an approved, recurring, organized event,such as a farmers market. WAC 246-215-131: (3)The owner of a temporary food establishment must: (a)Apply to the regulatory authority for a permit to operate the temporary food establishment at least fourteen calendar days before intending to provide food service, or as otherwise required by the regulatory authority; FURTHERMORE: The FDA 2001 food code defines: I. (36)Food Establishment. 1. (a)"Food establishment"means an operation that stores,prepares,packages,serves,vends,or otherwise provides food for human consumption: 1. (i)Such as a restaurant;satellite or catered feeding location;catering operation if the operation provides food directly to a consumer or to a conveyance used to transport people;market; vending location;conveyance used to transport people;institution;or food bank;and 2. (ii)That relinquishes possession offood to a consumer directly,or indirectly through a delivery service such as home delivery of grocery orders or restaurant takeout orders,or • delivery service that is provided by common carriers. 2. (b)"Food establishment"includes: 1. (i)An element of the operation such as a transportation vehicle or a central preparation facility that supplies a vending location or satellite feeding location unless the vending or feeding location is permitted by the regulatory authority;and 2. (ii)An operation that is conducted in a mobile,stationary,temporary,or permanent facility or location;where consumption is on or off the premises;and regardless of whether there is a charge for the food. WAC 246-215-200 A food establishment is required to have a valid permit: 2. (1)Any person operating a food establishment without a valid permit issued by the regulatory authority may be guilty of a misdemeanor under RCW 70.05.120 and local regulations. WAC 246-215-181 (6)and 8.401.10 Washington State Retail Food Code Working Document (Establishment inspection interval (C) The regulatory authority shall inspect a temporary food establishment during its Permit period, unless the regulatory authority develops a written risk-based plan for exempting certain categories of temporary food establishments from inspections that is uniformly applied throughout the jurisdiction. 8-304.11 Responsibilities of the Permit Holder. Upon acceptance of the PERMIT issued by the REGULATORY AUTHORITY,the PERMIT HOLDER in order to • retain the PERMIT shall: (A) Post the PERMIT in a location in the FOOD ESTABLISHMENT that is conspicuous to CONSUMERS; PROPOSED REVISION OF 2011 TEMPORARY FOOD SERVICE FEES The Food Team (and temporary vendors) recognize that the current fee structure for Temporary Food Service permit applications are not adequately flexible and are too costly for vendors who want to participate in multiple fairs or festivals in the community with the same menu. This is an urgent request for a revision of the classification and the fees for the remainder of 2011. We will continue to analyze the cost and risks to determine appropriate fees and propose future changes for your review. Please find below the proposed revision,all examples apply to same vendor: TEMPORARY FOOD SERVICE FEES AND CLASSIFICATION Classification Current Fee Proposed Fee Comments Single event $ 98.00 $ 98.00 Same menu, same Limited menu location, not more than WAC 246-215-011 (26) (a) 21 days in a row Single event $130.00 $130.00 Same menu, same Complex menu location, not more than WAC 246-215-011 (26) (a) 21 days in a row Successive/Recurring event $98.00 Administrative fee Same menu,different following above initial ($30.00)to allow permit location of event- not application. Limited menu issue and minimal more than 21 days in a WAC 246-215-011 (26) (a) oversight (conversation row with vendor may only be necessary) Successive/Recurring event $130.00 Administrative fee Same menu, different following above initial ($30.00)to allow permit location of event- not application. Complex menu issue and minimal more than 21 days in a WAC 246-215-011 (26) (a) oversight(conversation row with vendor may only be necessary) Successive/Recurring event $98.00 $98.00 Different menu and following above initial different location- not application. Limited menu more than 21 days in a WAC 246-215-011 (26) (a) row Successive/Recurring event $130.00 $130.00 Different menu and following above initial different location- not application. 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