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Home My WebLink About2011- August File Copy • Jefferson County Board of health Agenda _Minutes t .august 18, 2011 • • JEFFERSON COUNTY BOARD OF HEALTH August 18,2011 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 July 21,2011 Board of Health Meeting III. Public Comments IV. Old Business and Informational Items 1. Changes in Washington State Law Regarding Exemptions to Immunization requirements for School Entry(last month packet) 2. Water Quality Outreach Projects (last month packet) • V. New Business 1. Tdap community need and GIFT program 2. EPA Grant& Onsite Program Updates 3. Standards for Public Health in Washington State: Jefferson County Public Health 2011 Performance Review www.jeffersoncountypublichealth.org/pdf/Standards2011_JCPHreview.pdf 4. Performance measures 5. Budget update VI. Activity Update VII. Agenda Planning Calendar: VIII. Next Scheduled Meeting: September 15, 2011 2:30—4:30 pm Jefferson County Public Health • •• JEFFERSON COUNTY BOARD OF HEALTH MINUTES Thursday, July 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 2:30 PM. A quorum was present. Members Present: Phil Johnson,David Sullivan, John Austin, Roberta Frissell, Kristen Nelson, Sheila Westerman, Jill Buhler Staff Present: Dr. Thomas Locke, Jean Baldwin, Julia Danskin,Veronica Shaw • APPROVAL OF AGENDA Member Buhler moved to approve the agenda; Member Austin seconded. The agenda was approved unanimously. APPROVAL OF MINUTES Member Austin moved to approve the minutes of the June 16,2011 BOH meeting; Member Buhler seconded. The minutes were approved unanimously. PUBLIC COMMENTS None OLD BUSINESS and INFORMATIONAL ITEMS Board Correspondence Member Nelson reported to The Board that correspondence was received from Larry Dennison, owner of Dos Okies Barbeque,which is in connection with changes in temporary food permits and fees, a copy of which was enclosed in the packet. 411 NEW BUSINESS • Public Hearing: Revisions of Environmental Health Fees Regarding Food Service Establishment Member Nelson disclosed to The Board that she is a local business owner could be indirectly affected by the decision that will be made. There was discussion regarding whether she as Chair of the Board should be able to participate in the discussion. Member Austin moved to endorse The Chair participation in the discussion of the afore mentioned items; Member Buhler seconded. The motion was approved unanimously. Member Sullivan moved to allow Member Nelson to lead the discussion; Member Johnson seconded. The motion was approved by a majority vote. Since one person was opposed to the motion to allow Member Nelson to lead the discussion she asked Vice Chair Johnson to lead the discussion. Dr. Locke discussed how the State Food Code is linked with Federal code, which the Department of Health is obligated to enforce in Jefferson County. Earlier this year it came to JCPH attention that the code for fixed location events has been being incorrectly interpreted. The code states that every time the location of the event changes it requires a new permit. He pointed out that the new interpretation of the code is not consistent with the current fee schedule, so reasonable fees to cover administrative costs, were needed to be determined and approved by The Board. • Susan Porto,Environmental Health Specialist,presented a power point presentation showing how the fee structure, current and proposed, would impact the cost to vendors. Ms. Porto outlined WAC. She then compared the current fee structure to the proposed fee structure which would decrease fees charged for permits for a single event, such as a fair or festival from$130 per event to $130 for the first event and$30 for each subsequent event to cover administrative costs. Ms. Porto pointed out that the fee for an event that is not more than 3 days a week at a fixed location,with a fixed menu, in conjunction with an approved, recurring organized event are not changing, however they are charging a fee for each farmers market. All farmers markets are not included under one permit. Ms. Porto gave a comparison of fees for temporary, mobile and full service fees from Island, Clallam and Kitsap Counties to Jefferson County. She ended the presentation with Jefferson Counties proposed Temporary Fees. Member Johnson opened the floor for public comment. Several members of the community attended the BOH meeting and spoke in favor of changing the current fee schedule for single event temporary food permits. Concern was also raised by some community members regarding fees for the farmers market being charged for each market since the vendors stands are not changing from market to market; therefore they feel an inspection should not be required for each market. Jean Baldwin reminded The Board that the fees that are charged should be in connection with the actual cost of issuing a permit. She stated that the proposal was based on a V2 hour of working time,which is an average of how long it will take to issue each permit. • Next the Board Members asked several questions of the staff and discussed why, how and when the fees for temporary food permits should change and also offered solutions and compromises to the issue. Dr. Locke responded to the Boards discussion by recommending that the Board must make a good faith effort to follow federal and state code, by requiring JCPH to issue a separate pennit for each event a vendor participates in and then also to determine what fee should be charged for each permit. Finally there was discussion among Board Members as to what the fee should be. Member Westerman moved to amend the staff recommendation under the limited menu and complex menu portion of the fee schedule from $30 for additional events with the same menu,to $15 until January 1,2012. Member Buhler seconded the motion. The motion was approved unanimously. Member Austin moved to adopt the amended proposed fee schedule with the words "3 days a week at your location" added under Organized Recurring Events on the fee schedule. Member Sullivan seconded the motion. The motion was approved unanimously. Member Westerman moved to charge $15 for the last months fees which had been suspended; Member Frissell seconded the motion. The motion passed unanimously. Member Nelson Declared agenda items 2 through 5 be moved to the August BOH meeting. AGENDA PLANNING CALENDAR The next scheduled BOH meeting will be held Thursday, August 18, 2011 from 2:30-4:30 PM at the Department of Health, 615 Sheridan Street, Port Townsend, WA. ADJOURNMENT Chair Nelson adjourned the BOH meeting at 4:40 p.m. JEFFERSON COUNTY BOARD OF HEALTH Jill Buhler, Member Phil Johnson, Vice-Chair Kristen Nelson, Chair, John Austin, Member Roberta Frissell, Member David Sullivan, Member Sheila Westerman, Member w JEFFERSON COUNTY BOARD OF HEALTH III MINUTES Thursday, July 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 2:30 PM. A quorum was present. Members Present: Phil Johnson, David Sullivan, John Austin, Roberta Frissell, Kristen Nelson, Sheila Westerman, Jill Buhler Staff Present: Dr. Thomas Locke, Jean Baldwin, Julia Danskin, Veronica Shaw • APPROVAL OF AGENDA Member Buhler moved to approve the agenda; Member Austin seconded. The agenda was approved unanimously. APPROVAL OF MINUTES Member Austin moved to approve the minutes of the June 16,2011 BOH meeting; Member Buhler seconded. The minutes were approved unanimously. PUBLIC COMMENTS None OLD BUSINESS and INFORMATIONAL ITEMS Board Correspondence Member Nelson reported to the Board that correspondence was received from Larry Dennison, owner of Dos Okies Barbeque, in connection with changes in temporary food permits and fees, a copy was enclosed in the packet. 111 Board of Health,July 21,2011 1 NEW BUSINESS 0 Public Hearing: Revisions of Environmental Health Fees Regarding Food Service g Establishment Member Nelson disclosed to the Board that she is a local business owner who could be indirectly affected by the decision that will be made. There was discussion regarding whether she as Chair of the Board should be able to participate in the discussion. Member Austin moved to endorse the Chair participation in the discussion of the afore mentioned item; Member Buhler seconded. The motion was approved unanimously. Member Sullivan moved to allow Chair Nelson to lead the discussion; Member Johnson seconded. The motion was approved by a majority vote. Since one person was opposed to the motion to allow Chair Nelson to lead the discussion she asked Vice Chair Johnson to lead the discussion. Dr. Locke discussed how the State Food Code is linked with Federal code, which the Health Department is obligated to enforce in Jefferson County. Earlier this year it came to Health Department staffs attention that the code for fixed location events has been incorrectly interpreted. The code states that every time the location of the event changes it requires a new permit. He pointed out that the new interpretation of the code is not consistent with the current • fee schedule, so reasonable fees to cover administrative costs, were needed to be determined and approved by the Board. Susan Porto, Environmental Health Specialist, presented a power point presentation showing how the fee structure, current and proposed, would impact the cost to vendors. Ms. Porto outlined the WAC. She then compared the current fee structure to the proposed fee structure which would decrease fees charged for permits for a single event, such as a fair or festival from $130 per event to $130 for the first event and $30 for each subsequent event to cover administrative costs. Ms. Porto pointed out that the fee for an event that is not more than 3 days a week at a fixed location, with a fixed menu, in conjunction with an approved, recurring organized event are not changing, however they are charging a fee for each farmers market. All farmers markets are not included under one permit. Ms. Porto gave a comparison of fees for temporary, mobile and full service fees from Island, Clallam and Kitsap Counties to Jefferson County. She ended the presentation with Jefferson Counties proposed Temporary Fees. Member Johnson opened the floor for public comment. Several members of the community attended the BOH meeting and spoke in favor of changing the current fee schedule for single event temporary food permits. Concern was also raised by some community members regarding fees for the farmers market being charged for each market since the vendors stands are not changing from market to market; therefore they feel an inspection should not be required for each market. ID Board of Health,July 21,2011 2 Jean Baldwin reminded the Board that the fees that are charged should be in connection with the IPactual cost of issuing a permit. She stated that the proposal was based on a '/2 hour of working time, which is an average of how long it will take to issue each permit. Board Members asked several questions of the staff and discussed why, how and when the fees for temporary food permits should change and also offered solutions and compromises to the issue. Dr. Locke responded to the Boards discussion by recommending that the Board must make a good faith effort to follow federal and state code, by requiring JCPH to issue a separate permit for each event a vendor participates in and then also to determine what fee should be charged for each permit. Finally there was discussion among board members as to what the fee should be. Member Westerman moved to amend the staff recommendation under the limited menu and complex menu portion of the fee schedule from $30 for additional events with the same menu, to $15 until January 1, 2012. Member Buhler seconded the motion. The motion was approved unanimously. Member Austin moved to adopt the amended proposed fee schedule with the words "3 days a week at your location" added under Organized Recurring Events on the fee schedule. Member Sullivan seconded the motion. The motion was approved unanimously. Member Westerman moved to charge $15 for the last months fees which had been suspended; Member Frissell seconded the motion. The motion passed unanimously. • Chair Nelson declared agenda Items 2 through 5 to be moved to the August BOH meeting. AGENDA PLANNING CALENDAR The next scheduled BOH meeting will be held Thursday, August 18, 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 4:40 p.m. JEFFERSON COU TY/q,ARD OF HEALT ,j_...,,i, YNI\ i n Ielson, Chair P' Jo s:z1"9'"' -Chair .....2../(6,2eL 14 1 1 ill Buhler, Member _1 Jo Au tin, Member Roberta Frisse , Member Da d ull ;I:41-Zr )1,_61.4__. et)tvy ivea t___- • Sheila Westerman, Member Board of Health,July 21,2011 3 Jefferson County Board�of.9Cealth Wow Business & Informational-Items Agenda Item # 17, 1 dap Community Need and • wyg"Program .august 18, 2011 • Saving Lives: , �, Integrating Whooping Cough (pertussis) la` Vaccines for 1. , „ - Adults Into Routine Care What is whooping cough? Whooping cough, also known as pertussis, is a serious infection that causes coughing spells so severe that it can be hard to breathe.The disease can even lead to cracked ribs, pneumonia or hospitalization.Adults and adolescents (parents, grandparents and older siblings) typically have a milder form of pertussis; however,they can easily spread the infection to infants and young children, who are at greatest risk of serious complications including death. Since the 1980s,there has been a dramatic increase in the number of cases of pertussis, especially among teens and ba- bies less than five months of age. In 2005,there were more than 25,000 cases reported in the U.S., which is 25 times higher than the all-time low of just over 1,000 cases in 1976. In 2010, California reported the largest outbreak in over 50 years, with 10 infant deaths in the first 10 months of the year. What are the symptoms of whooping cough? Early symptoms of whooping cough are similar to the common cold or bron- chitis and may include runny nose, sneezing and low-grade fever.The infection Did you know... also causes coughing that lasts for weeks, even months.This violent and rapid cough may create a "whooping" sound as the person inhales air. However, rates of pertussis the "whoop" is not always present, particularly in adults. Pertussis is typically have been increasing in • most severe in infants,who are at high risk of getting the disease if they come in contact with adults who have it. adolescents and adults? Adults and adolescents Which adults should get vaccinated? can give the infection The CDC recommends that adults receive one dose of pertussis vaccine. to infants, who are at a Pertussis vaccine is given in combination with tetanus and diphtheria vac- cines (Tdap).Tdap should replace one of the every-l0-year booster doses of Td greatly increased risk recommended for all adults. In addition,the CDC has issued recommendations of serious complications for specific adult populations: • Adults who have not previously received Tdap and who have or who including death. anticipate having close contact with infants younger than 12 months of age (e.g., parents, grandparents, childcare providers, healthcare workers) • Healthcare personnel in hospitals or ambulatory care settings who have direct patient contact and have not previ- ously received Tdap. Priority is given to vaccination of workers in direct contact with infants younger than 12 months of age. • Tdap is recommended immediately post-partum for pregnant women who had their last Td vaccine at least 2 years but less than 10 years earlier.Women who received their last Td booster 10 or more years earlier should speak with their doctor about receiving either Td or Tdap during or immediately following the pregnancy. Once fully immunized,the Tdap vaccine provides up to 85-percent protection against pertussis. 4110 rill National Foundationecusfor This website is supported b unrestricted educational grants to the National Foundation for Infectious pPo Y " ,Diseases Infectious Diseases from GlaxoSmithKline,Merck&Co.,Inc.,and sanoh pasteur. www.NFID.org November 2010 • Jefferson County Board of aCealth, Netiv Business & Informational items ,agenda Item # 17, 2 ERA Grant and • Onsite Program `Llpclates August 18, 2011 • Onsite Sewage and Operations and Monitoring Program Update —August 2011 July of 2007 - Adoption of JC Onsite Sewage Code revisions and adoption of the local Sewage Management Plan Meeting Local Management Plan Goal ✓ Entering and updating existing paper records to the database ✓ Scanning records entered for access by the public on the website o Scanned all paper monitoring inspections completed between 2000 and June 2010. ✓ June 2010 implemented the use of online service (OnlineRME) for entering monitoring inspections. o These reports are available for the property owner and others to see online. ✓ Identifying previously unknown systems via monitoring inspections as time of sale or application for some building permits and coordination with the Water Quality Programs activities in project areas—Discovery Bay, Chimacum, Mats Mats Bay and Hood Canal. ✓ Database changes to facilitate the creation of maps showing where septic systems are located and the status of monitoring of the onsite sewage systems (OSS). ✓ Meeting twice a year minimum with the Designer Roundtable and the O&M • provider Roundtable to discuss issues that arise and retain consistency in reporting facilitate sharing solutions to challenges in these areas. o March 2011 - Provided a training to over 85 professionals in the onsite sewage field on "Evaluating and Managing Pre-Failure Conditions". ✓ Conducted 19 workshops on "Taking Care of Your Septic System" to 355 homeowners. Coordination with surrounding counties to develop and implement a system to train and allow homeowners to complete some of the monitoring inspections required under the state code. Once a year for any system with a pump and every three years for conventional gravity fed systems. Clallam County has completed their online video for homeowner inspection and has 130 participants signed up for the pilot project. The participants have agreed to: ❑ take the trainings required, ❑ take and pass the online test, ❑ allow a county environmental health specialist to standby and observe while they do the inspection and ❑ file their inspection via the counties online reporting system. ❑ complete a survey of their experience with the training, report completion and • report filing. Clallam Counties project is scheduled to be completed by the end of 2011. They will be doing an evaluation of the process at that time. Our goal is to have the amendment to the Jefferson County Code providing for certification of homeowners to do some monitoring inspections ready for Board review and approval early in 2012. Benefit from the learning experience of Clallam County before we finalize our changes. This fall we will convene an Advisory group to assist us in the revisions to the monitoring program. o Up to 12 members for a limited time to review and develop options around the homeowner monitoring program. o This group will be facilitated and meeting notes will be provided as well as a summary document of the proceedings. o The group will be composed of onsite sewage professionals (such as O&M provider and Designer), building industry reps., real estate/development reps., homeowner association reps., banking/title co. rep., utility operator, and other community members. As we roll out the homeowner inspection program we will also begin the incentives program that provides rebates for installing access risers over the tanks, monitoring ports in the drainfield and completing a first monitoring inspection by a professional. • Providing updates through out the fall with our progress. • Jefferson County Board of.1fealth, New Business & Informational-Items Agenda Item # 17, 3 Standards for Public Wealth in • 1NA State: Jefferson County Public .1Cealth 2011 Performance Review .august 18, 2O11 • J. • Standards for Public Health in Washington State Jefferson County Public Health • 2011 Performance Review Report (Basic Set) The Standards and the 2011 Performance Review Thank you for participating in the performance review of the Standards for Public Health in Washington State.The intent of the Standards is to provide an overarching measurement framework for the many services, programs, legislation, and state and local administrative codes that affect public health. With permission from Public Health Accreditation Board (PHAB), the 2010-2011 Standards for Public Health in Washington are based on the PHAB Standards(Beta Test version) as well as recommendations from the 2008 Washington State site reviews. In late 2010 the Public Health Standards Workgroup,with approval from the Public Health Improvement Partnership, developed a Basic Set of public health performance standards for the 2010-2011 Standards Review cycle.This set of standards contains • approximately 40%of the measures found in the Washington 'required' set of standards.The intent was to reduce the burden on smaller local health agencies and to encourage statewide participation in the standards review. Agencies had a choice about the scope of the 2010-2011 review.Those who wanted to prepare for accreditation in the future could use this cycle to prepare by agreeing to be reviewed on all standards and measures. Local health agencies had three options for their type of review: 1. The full set of PHAB/National Standards as well as several Washington only measures 2. The Washington set of standards and measures (80%overlap with the PHAB Beta set) 3. The Basic set(reduced set by 60%fewer measures than the WA set) This Report The site reviews again demonstrated the incredible commitment, creativity and hard work of the people in the public health system.This report is specific to your local health jurisdiction and is intended to give you feedback about the documentation you provided as a demonstration of how you met each measure. However, before describing the details that are in the report,we want to summarize overall observations regarding your organization's strengths and opportunities for improvement as observed during the standards review. • 2010-2011 Public Health Standards Performance Review Report May 13, 2011 1 Strengths S • Written Policies regarding Confidentiality and HIPPA requirements • Process and protocols to maintain collect data from multiple sources for comprehensive review and analysis of surveillance data • Conducting and disseminating health data focused on population health status and issues facing the community • Investigating health problems and environmental public health hazards to protect the community including the timely investigation and reporting of notifiable diseases,lab test results and investigation results • Maintaining written protocols and implementing a system to receive and provide health alerts and appropriate response on a 24/7 basis • Risk Communication Plan • Development of public health policies and plans • Conducting enforcement activities • Numerous exemplary documents representing multiple strengths in your programs • 01 improvement efforts Areas for Improvement • Implement a Quality Improvement Plan • Establish and implement quantifiable and time-framed measures and outcomes in all program areas and activities The Performance Review Approach The performance review included the 2010 Department of Health review as a PHAB Beta Test site and 34 local health jurisdictions (LHJs)sites. Each site was asked to use the appropriate Guidelines to prepare for the performance review, organizing documentation supporting the review of each measure. During the performance review, an independent consultant from MarMason Consulting, LLC evaluated the documents and scored each measure. For those LHJs that opted to submit documentation for either the full PHAB/National standards or the Washington Standards,an internal DOH reviewer also participated in the scoring. When the reviewer had questions regarding the documentation, an informal interview was conducted with the appropriate manager or staff person from the agency. In addition, potential exemplary practice documentation was collected from each site.The reviews concluded with a closing conference in which general strengths and opportunities for improvement were discussed, and feedback on the standards and assessment process was obtained.All of this information will be compiled into a statewide system report, with recommendations regarding the next steps for the performance improvement of public health practice across the State. Results of the Site Review The attached report is organized into three sections. First there is a summary showing Part A and each ISO of the ten domains and the performance on each measure in each standard.This section is color coded 2010-2011 Public Health Standards Performance Review Report Mav 1 i 2n11 • with green to indicate that the measure was demonstrated,yellow to indicate that the measure was partially demonstrated and red to indicate that the measure was not demonstrated.The measure is blank if it was scored as 'not applicable.'This summary gives the agency immediate information on performance in each of the standards.The second section is a detailed summary for each measure with a list of all the documents used to score the measure and related comments for all measures applicable at the agency level. In this second section, measures that were scored at the program level show the calculated score derived from the program scores and the documentation and comments for all programs.The third section of this report is the program detail with the list of documents and comments for each of the programs reviewed for the LHJ.The scores from each of the programs were aggregated to provide a single score for that measure at the agency level that is reported in section two. Comparability to Previous Results Due to the adoption of the PHAB standards, a major revision from the previous WA Standards, as well as changes in the type of review for many measures, comparison with the three earlier cycles of standards review cannot be made. Scoring and Related Information in the Site Reports For each measure scored by the reviewer: o 2= demonstrates the measure, IP o 1= partially demonstrates the measure, o 0=does not demonstrate the measure, Note that some measures were Not Applicable due to scoring in previous measures or the determination that they are not part of the activities of a specific program and these measures are noted as NA. Comments provide clarification regarding the intent of the measure or the score assigned. Documents lists, in abbreviated form,the documents that were the basis for the score. When multiple documents were provided and some did not demonstrate the measure or there were many more examples than needed,they are not all listed. For each Standard: at the end of each Standard,there is a roll-up of the scores on all applicable measures in the Standard (the percent of measures scored as demonstrates, the percent scored as partially demonstrates,the percent scored as does not demonstrate). Next Steps First,celebrate what you have accomplished. In the period between the 2008 Performance Review and this performance cycle, it was clear to the site reviewers that improvements had been developed and implemented.Again,thank you for all of your hard work every day and especially for your work in • preparing for the standards reviews. 2010-2011 Public Health Standards Performance Review Report May 13,2011 3 Next,select the areas where you want to improve your performance. All of the information provided in • this report is intended to support improvement of your organization's work on behalf of the citizens in your community and Washington State. After you have had a chance to digest this report and share it with staff and your Board of Health, you should review the data again to determine which areas of your work might benefit from a focused improvement process. Develop a brief, but specific and doable work plan—don't try to improve everything at once! In selecting your areas of improvement you will be able to look at your overall strengths and opportunities for improvement(summarized above), or at the scores of specific Standards or measures. You will be assisted in this effort by several initiatives: • Exemplary practices:The Exemplary Practices Compendium provides you with documentation from many of the LHJs in Washington State. Potential exemplary practice documents were gathered from each of the sites and the very best examples for each measure will be organized into an electronic tool kit. This material will be available at www.doh.wa.gov/phip/Standards/BestPractices/StandardsExemplaryPractices.htm. • Statewide initiatives such as the Multistate Learning Collaborative and other efforts like the 5930 Initiative provide opportunities for formal efforts to improve performance. Based on the recommendations in the system wide report, the Public Health Improvement Partnership will adopt additional statewide initiatives related to the measures. Finally, begin preparing now for the next performance review.The Standards Performance process • itself has been conducted using quality improvement principles and methods, including the Plan-Do- Study-Act cycle. At this time,the next cycle is planned for 2013-2014. Strategies for building on your current performance: • Save the documentation you have used in this cycle as a good starting point for continuing to identify documentation for demonstrating performance. • Establish an electronic document library for collecting documentation and to facilitate the continued use of an electronic format for the next cycle. • Adopt or adapt as many exemplary practices as possible to improve your performance against the measures.There is no reason to 're-invent the wheel,'when another LHJ may have an excellent process or documentation method that you can start using with less time and effort. • Identify methods for getting technical assistance from state programs, or from other LHJs that may have targeted the same areas for improvement. Great gains can be made through sharing ideas and resources. Again, we thank you for all your work in preparing for this performance review, and especially for the terrific work you do in protecting and promoting the health of the citizens of Washington State that we • were privileged to review. 2010-2011 Public Health Standards Performance Review Report May 13, 2011 Jefferson County Public Health Summary Site Report Score Key: • 2= Demonstrates 1 = Partially Demonstrates 0 = Does Not Demonstrate NA= Not Applicable Overall Score Totals 94% Demonstrated partially Demonstrated 6% NOT Demonstrated 0% Note: Totals may not equal 100% due to rounding • The entire report can be found on our website at: www.jeffersoncountypublichealth.orq Click on 'About JCPH'. S Page 6 2011 Standards Review Report Jefferson County Board of aCealth Netiv Business & InformationaCltems Agenda item # 17, 4 Performance .Measures • august 18, 2011 Jefferson County Public Health — Planned Performance Measures 2012 COMMUNICABLE DISEASE PROGRAMS: Tuberculosis, Communicable Disease, Immunizations, Travelers Immunizations, Sexually Transmitted Disease, HIV, Syringe Exchange Program. MISSION: The purpose of the Communicable Disease Health program is to protect Jefferson County residents from serious communicable diseases by providing disease surveillance, investigation and reporting, along with education, screening,treatment and immunization services. The program interacts with community members, medical providers,the Washington State Department of Health (DOH),Region 2 Emergency Management partners and other agencies while working toward this purpose. GOALS FOR 2012: 1. Maintain the low rates of active TB in Jefferson County. (TB) 2. Timely investigation of reportable conditions. (CD) 3. Medical providers will be informed about current communicable disease trends and new communicable disease control recommendations. (CD) 4. Support universal access to vaccines for all children. (Imm) 5. Promote more extensive use of all Child Profile Immunization Registry functions by the provider clinics. 6. Assess childhood immunization rates for children served by private health care provider clinics receiving State supplied vaccines. (Imm) • 7. The Family Planning and STD clinics will assist in controlling Chlamydia transmission in Jefferson County. (STD) 8. Maintain access to federally funded HIV testing and counseling for persons at high risk for HIV infection who have no medical insurance. (HIV) 9. Prevent the spread of blood borne communicable diseases among injecting drug users and their partners. (SEP) 10. Annual report to BOH for CD, TB, SEP, Immunization Programs. 11. Maintain and enhance Public Health Emergency Preparedness and Response (PHEPR) capacity. OBJECTIVES (INTERVENTIONS) FOR 2012: 1. Encourage appropriate screening and treatment for latent TB infection. (TB) 2. Develop &update protocols as needed for investigation of notifiable conditions using DOH electronic reporting systems PHIMS, PHIMS-STD, and PHRED. (CD, STD) 3. Provide updates, outreach and training to providers about local, state and national communicable disease outbreaks and disease control recommendations. Provide reminders about reporting notifiable conditions and using the Regional Duty Officer for after hours contact. (CD) 4. Maintain an efficient system for supplying vaccine recommendations, up-dates and information on changes in the State vaccine program to provider clinics in Jefferson County. 5. Continue to provide training and support to provider clinics for ordering vaccines using the Economic Ordering Quantity(EOQ) system to place orders through Child Profile. (Imm) • 6. Provide training and support to provider clinics for use of all Child Profile vaccine related functions to more accurately and efficiently track vaccine supply, administration and client records. (Imm) 1 of 5 7. Perform vaccine quality assurance and childhood immunization rate assessment for 50% of clinics receiving State supplied vaccines, as required by DOH. (Imm) 8. Assess Jefferson County childhood immunization rate using the new Child Profile County View Reports. (Imm) 9. Women seen in Family Planning clinic who are at higher risk for Chlamydia(age 24 and under) • will be screened for Chlamydia annually. (STD) 10. Clients at high risk for HIV and without medical insurance will be tested through the Washington State Public Health Lab, others requesting testing will be tested through the Quest Lab and charged for testing. (HIV) 11. Promote utilization of syringe exchange program services. (SEP) 12. Develop and update regional Public Health Emergency Preparedness and Response Plan, coordinating with Region II partners Clallam and Kitsap Health Departments, local emergency response agencies, Jefferson Healthcare, local health care providers and agencies. (PHEPR) • • 2 of 5 L PERFORMANCE INDICATORS 2010 2011 2012 Actual Planned Planned (TB)Number of clients tested for TB infection with PPD or (244 ) New for New for • QFT test 2012 2012 (TB)Number of positive PPD and QFT TB tests evaluated (+PPD: 8) New for New for (+QFT:2) 2012 2012 (-QFT:4) (TB)Number of clients started on preventive treatment for 2 2 2 latent TB infection (CD)Total number of communicable disease reports 132 110 110 confirmed, interventions applied and processed for reporting to the State (CD)Number of Cryptosporidiosis cases reported to the State 8 8 8 - (CD)Number of Giardiasis cases reported to the State 9 8 8 (CD)Number of STD cases reported to the State 71 65 65 (CD)Number of alerts/updates/newsletters faxed or mailed to 13 10 10 providers about communicable disease outbreaks or other urgent public health information (Imm) Total number of doses of publicly funded vaccine, 5,389 5,200 5,200 administered by private health care providers and Public Health Not clinics, supplied and monitored through Public Heath's including H1N1 _immunization program _ (Imm)Number of doses of publicly funded vaccine(pediatric) 4741 4600 4600 _administered by private health care providers (Imm)Number of doses of publicly funded vaccine (pediatric) 648 600 600 administered by Public Health • (Imm)Number of adult vaccinations administered by Public 1037 1030 1030 Health (Imm)Number of visits to clinics to provide vaccine education, 8 6 8 updates and technical support for clinic staff (Imm)Number of providers using EOQ to place appropriate New for New for 5 vaccine orders through Child Profile 2012 2012 (Imm)Number of providers using Child Profile to track New for New for 5 monthly vaccine inventory 2012 2012 (Imm) Number of providers using Child Profile to track New for New for 5 monthly vaccine doses administered 2012 2012 (Imm)Number of Jefferson County children<6 with 2 or more 87% 86% 88% immunizations in Child Profile system (Imm)Number of clinic site visits,to assess childhood 2 2 2 immunization rates in clinic patients and/or do VFC Program Quality Assessment (Imm)Jefferson County childhood immunization rate, using New for New for Assess Child Profile County View Report 2012 2012 baseline, &report options (STD)Assess total # and%of female FP clinic clients at risk 379 280 350 for Chlamydia(age 24 and under) screened for Chlamydia. 49% 50% 50% (HIV)Number of persons counseled and tested for HIV DOH Lab:38 90 100 Quest Lab:69 • infection , Total: 107 (SEP)Number of visits to SEP 81 60 80 -(SEP)Number of syringes exchanged 9,156 10,000 10,000 (PHEPR)Develop and update Public Health Eeney 1 1 1 Preparedness and Response Plan SUMMARY OF KEY FUNDING/SERVICE ISSUES: Communicable Disease/Immunizations JCPH CD programs address locally identified and defined public health problems. Communicable disease prevention is primarily a locally funded program, county milage was returned from the state to • counties for TB control. Immunization funds from the state are primarily in the form of vaccine,this vaccine is provided to primary care clinics that care for children. County funding provides a professional staff that prevent, identify and respond to disease outbreaks and immunization staff that work with the hospital, health care providers,the schools and local groups sponsoring trips abroad for students. Immunization staff provide routine immunization clinics and international travelers clinics. Substantial staff time is spent on responding to public requests for information about communicable diseases and screening for reportable illnesses in the process. The CD team continues to work on strengthening the notifiable conditions reporting system through outreach to the Jefferson Healthcare lab, ER, Infection Control Committee and local health care providers. Increased funding was received for 2008-2009, from the Washington State Department of Health (DOH), specifically for Communicable Disease surveillance and improving immunization uptake in children. This funding was reduced by 20%for 2010-2011 and has been reduced by another 30% for 2012. A report on these performance measures is sent to DOH. The Jefferson County rates for Cryptosporidiosis and Giardiasis, both waterborne diseases, are frequently above the State average. We have been following these, looking for any trends, and have added these to our PM indicator table this year. The number of doses of publicly funded vaccine administered to children in Jefferson County has increased each year, from 3,748 doses in 2005 to 6,100 doses in 2009 and then decreased in 2010 by 711 doses to 5,389. The increases have been primarily due to new vaccines being added to the immunization schedule and new school immunization requirements. A catch-up period for new • vaccines can spill over into the following year, as was seen in 2008-2009. A new meningococcal vaccine for infants may be added to the schedule in the upcoming year. The number of infants seen in the JCPH immunization clinic has been decreasing over the past several years as more infants are seen for immunizations by their primary care providers in their medical homes. The number of adults seen in the JCPH clinic has been increasing. The Immunization team will continue to monitor vaccine usage across the County. The new ability to run the new County View reports in Child Profile will provide more information on county wide immunization rates. The new Washington State law requiring most parents seeking exemption from school vaccine requirements to have a discussion with their health care provider about the benefits and risks of immunizations and with-holding immunizations may have an effect on our vaccine dose numbers. This law is especially designed to reduce "convenience exemptions". The Immunization team consults with the school secretaries to assist them in using Child Profile to get immunization records for those students who do not have a complete Certificate of Immunization Status on file. The immunization team participates in the annual school secretary orientation discussing updates in school immunization requirements. The JCPH Immunization Program staff provide technical assistance to the clinics, immunization updates, vaccine refrigeration incident follow-up,training of new vaccine coordinators in the clinics, and clinic immunization program quality assessment. The visit numbers do not reflect the daily work with the clinics. Many contacts are by phone and information is faxed or mailed to clinics. All clinics receiving State supplied vaccines participate in the statewide Child Profile Immunization • Registry.New Child Profile functions allow direct electronic vaccine ordering, receiving and inventory 4 of 5 tracking, and monthly doses administered reporting. These functions will more accurately and efficiently track vaccine supply, administration and client records. • D TheSTFamily Planning and STD clinics follow the Center for Disease Control's STD testing recommendations for the high risk age groups. The Family Planning and CD program staff will continue to monitor and explore ways to assure appropriate testing and testing data collection. HIV Prevention HIV services are funded by the state and federal government. HIV case management services are provided by Clallam County Health Department. The new CDC guidelines focus on funding HIV Prevention Programs for high risk populations based on HIV prevalence in the local area. Jefferson County is classified as a low prevalence county. In May 2011 JCPH submitted a successful RFP for continued funding of the Syringe Exchange Program (SEP), receiving $10,000 for 12 months, similar to the 2011 funding. The 2011 HIV prevention funding, $9,766, was a 50%reduction from the 2009 funding level of$19,702. The 2012 HIV prevention funding does not include any funding for HIV testing in low risk counties. The State Public Health Lab will continue to do a limited number of free tests for high risk clients but there is no funding for staff time for counseling and testing services. JCPH staff will however continue to provide free HIV testing services for low income high risk clients with no medical coverage. Others requesting testing will be tested through the Quest lab and the cost of the testing will be billed to the client. The syringe exchange program success is not easily measured in disease prevention numbers but the number of clients seen and syringes exchanged reflects the disease transmission prevention capacity of this program. The number of client visits to the Syringe Exchange Program increased to 81 in 2010 after remaining stable over the past three years, while the number of syringes exchanged decreased in • 2010. A1 mid-year projection for 2011 shows an expected increase in the number of syringes exchanged in 2011. The number of new SEP clients increased in 2009 and 2010. This trend appears to be continuing in 2011, with more clients coming to SEP rather than solely relying on other exchangers to supply them with clean syringes through secondary exchange. This allows SEP staff to offer other disease prevention services and referrals to more individual SEP clients. The number of visits in which clients reported exchanging for other people as well as themselves (secondary exchange) decreased in 2009 and increased in 2010. This increase appears to be continuing in 2011. Public Health Emergency Preparedness and Response (PHEPR) Federal funding originally for developing bioterrorism response capacity now includes all hazards emergency response. Response capacity is developed in coordination with Region 2 PHEPR partners Kitsap and Clallam Counties, local emergency response agencies, Jefferson Healthcare and other health care providers. Public Health staff have been trained in and use National Incident Management System protocols during communicable disease outbreaks. The roles, responsibilities and training have been invaluable for managing communicable disease outbreaks. JCPH participates in the Regional Duty Officer 24/7 contact system for Public Health with Kitsap and Clallam Counties' staff, responding to after hours calls and triaging them to the appropriate Public Health professional if necessary. This allows JCPH to share call time and standardizes regional response to Public Health issues. Federal funding for emergency preparedness activities increased in 2010 due to funding for HIN1 influenza response. As of August 2011 PHEPR funds will be reduced by at least 15% for the 2011-2012 Federal funding cycle. • Decreased funding for any program would result in scaling back on services. The Board of Health would be involved in deciding which services would be impacted. 8/11/11 5of5 Jefferson County Public Health — Planned Performance Measures 2012 TARGETED CLINICAL HEALTH SERVICES • PROGRAMS: Family Planning, School Based Health Clinics, Breast and Cervical Health, and Foot Care MISSION statement for Targeted Community Health Service: to provide targeted health services, health screenings and prevention services to specific populations with limited access to improve the health of the community. Mission Statement for Family Planning Program: To provide accessible, high quality confidential reproductive health services in a safe, respectful environment. GOALS FOR FY 2012: 1. Assure low cost Family Planning Services are provided and accessible for all women 2. Maintain the low teen pregnancy rate in Jefferson County 3. Improve access to health care for the high school student population in Jefferson County. 4. Insure access to breast and cervical health exams to women age 40 to 65 years old 5. Support seniors' independence by maintaining their walking mobility OBJECTIVES FOR FY 2012: 1. Track Family Planning usage patterns 2. Emergency contraception to be provided, 5 days per week, and expand community outreach and clinical services 3. 40% of enrolled students at Port Townsend and Chimacum High Schools will be serviced by School Based Clinics. 4. Maintain breast and cervical health screening program in Jefferson County 5. Maintain the current level of community foot care io PERFORMANCE INDICATORS: 2010 2011 2012 Actual Planned Planned Number of unduplicated clients served in Family Planning 1253 1300 1300 Number of adolescents under 19 served in Family Planning 447 350 440 Number of Chimacum and Port Townsend High School Clinic 253* 255** 300 Unduplicated Clients Number of FP clients aged 30-39 180 160 185 Number of FP clients aged 18-29 593 620 630 Number of Breast& Cervical screening exams 99 100 90 Number of foot care contacts (Senior Center and Home visits) 2786 2400 2400 SUMMARY OF KEY FUNDING/SERVICE ISSUES: The goal of the Family Planning program is to provide support for families and individuals to control the timing of pregnancy and prevent unintended pregnancies. Jefferson County Public Health(JCPH)provides the only family planning program in east Jefferson County. Clinical fee revenue in the first half of 2011 has decreased by up to 20%. The Teen Pregnancy rate of Jefferson County in 1992-94 was 16.6 per 1,000; from 2007-09 it was 5.2 representing a drop of 69%. WA State had rates decrease from 20 to 10.9 in the same years. JCPH continues to partner with Jefferson Healthcare to provide two school clinics: one at the Port Townsend . High School, and one at the Chimacum High School. Clinics provide primary care and address other student health issues. Approximately 60%of the visits are family planning related. 1 of 2 The Breast and Cervical Health Program (BCHP) provides cancer screenings to decrease deaths from breast and cervical cancer in Jefferson county women. State and federal funding for BCHP was reduced in 2011. Outreach and Education was cut to a minimum. The 2012 allocation is unknown(at this time)but it is anticipated JCPH will continue Clinical Women's health exams with less revenue. Jefferson County's senior population has grown rapidly in the last few decades. The number of seniors over 85 years increased 99%from 1990 to 2000. Since 2000 the growth rate has slowed to 38%. The JCPH Foot Care Program helps this population maintain independence and mobility by providing foot maintenance at community centers and in homes. Services include filing calluses, cutting nails, and tending to sores resulting from diabetes. August 10, 2011 Jefferson County Public Health — Planned Performance Measurers 2012 • POPULATION & PREVENTION PROGRAMS: Drug and Alcohol prevention, School Health and Tobacco prevention MISSION: The purpose of the Population & Prevention Programs is to provide health education and public health interventions to county residents in order to promote a healthier community. GOALS FOR FY 2012: 1. Improve identified social and health indicators for school-age youth. 2. Reduce favorable attitudes toward problem behavior within the youth and adult communities. 3. Enhance the overall health & safety of Jefferson County children. 4. Improve overall health of Jefferson County residents. OBJECTIVES FOR FY 2012: 1. Convene Prevention Coalition with Jefferson County Community Network to identify interventions to address drug and alcohol prevention in community. 2. Increase the perception of risk for youth regarding alcohol and marijuana use, especially for 6th 8th and 10th grade students. (source Healthy Youth Survey) 3. Maintain delivery of school in-service/trainings, student health screenings, student health consults, student health care referrals by the School Nurse. 4. Provide education and enforcement of the Clean-indoor Act preventing tobacco smoke exposure in • workplaces PERFORMANCE INDICATORS: 2010 2011 2012 Actual Actual/ Planned planned Prevention Coalition—Completion of Strategic Plan Fall 2012 * Number of classroom presentation/interventions (Drug and Alcohol 116 120 112 preventions) School year** Number of students served in the class room presentations (Project 382 350 398 Alert and TATU)** Number of student health screenings** 1034 1400 1200 Number of school Care Plans for students with health needs. ** 120 120 Number of human growth and development classes ** 243 240 225 Number of students served in the school health classes** 1,102 1105 1000 Smoking in Public Places awareness education to Businesses 17 15 5 *Strategic Plan from Communities That Care process ** data based on school year Sept. 2011 —June 2012 SUMMARY OF KEY FUNDING/SERVICE ISSUES: Jefferson County Public Health (JCPH) delivers programs that promote healthier communities and individuals. The above programs provide universal prevention for all youth in the community. Nationally preventing substance abuse and tobacco use have proven to be cost effective. The results of the 2010 1 of 2 Washington State Healthy Youth Survey were released in the spring of 2011 and are being used to determine community needs and prioritize services based on funds available. • Drug and Alcohol Prevention program continues to provide integrated prevention services that promote healthy behaviors,prevent harm and support youth and family in the community and in the schools. Starting July 1, 2011 the Division of Behavioral Health and Recovery (DBHR) changed the contract for alcohol/drug prevention. DBHR funds are now to be used for a part-time staff to assist the Jeff. Co. Comm. Network (JCCN) in prevention policy development, environmental changes, capacity building and direct service delivery of prevention programs in the school (if funds are available for direct services).Tasks to be accomplished by June, 2012 are JCCN completion of: 1) Communities that Cares training; 2) community assessment; 3) development of community strategic prevention plan; 4) implementation of the plan; 5) evaluation and reporting of implementation of the plan. Tasks#2 through#5 are on-going. At this time funding is available to complete Project Alert(Drug and Alcohol Prevention Classes)through the 2011-2012 School Year. Local funding through the City of Port Townsend supporting JCPH Drug and Alcohol Activities is anticipated to end in 2012. State DBHR funds will be focused on community coalition building. Drug and Alcohol Prevention classes for the 2012-2013 school year will be cut as funding is reduced. School Health funding is based on State School Nurse Corp through the Educational Service District and contracts with school districts. The School Nurse Corp funds pay to provide a School Nurse to insure Student Health Plans are in place for students with health problems. School Nurse Corp Nurse also trains school staff to support students with health problems,monitor student immunization and provide information on healthy school environments. State funding has been limited but School Districts have been willing to contribute funding to maintain the same level of services as last year. JCPH contracts separately with the school districts to provide required Health Education Classes and Health Screening. Those contracts remain the same in 2012. State Tobacco Prevention funding ended in 2011. JCPH is still responsible to enforce Washington State's Clean Indoor Air Act. JCPH will continue to provide education and enforcement so businesses comply with the state law. State funding for Oral Health outreach and education ended December 2010. For the first 6 months of 2011 JCPH continued providing Oral Health services through WIC and the School Based clinics anticipating Medical Assistance fee for service revenue to cover cost. Assessment in July 2011 shows Medical Assistance revenue was not covering cost and Oral Health services will end October 2011. August 10, 2011 • 2 of 2 Jefferson County Public Health — Planned Performance Measures 2012 FAMILY HEALTH SERVICES . PROGRAMS: Family Health/Maternal Child Health(MCH)including Breast Feeding Support, Maternity Support Services/Infant Case Management,Nurse-Family Partnership (NFP), Children with Special Health Care Needs (CSHCN), Women Infants and Children(WIC), and the Child Protective Services (CPS) Contract Programs: Early Family Support Services (EFSS), Early Intervention Program (EIP). MISSION: The mission of the Family Health Services is to offer health education and support to all Jefferson County pregnant women and families with young children as they build a secure foundation for a lifetime of health, learning, and community contribution. GOALS FOR 2012: 1. Improve pregnancy and birth outcomes by helping women improve prenatal health. 2. Improve children's health, safety, and development by helping parent's provide competent and sensitive caregiving. 3. Assure community health needs are served by monitoring health data and targeting services to respond to these needs. OBJECTIVES FOR 2012: 1. Provide comprehensive education, risk reduction strategies, and referrals to community services to pregnant women and families about the health risks of: substance use including tobacco, alcohol, prescription narcotics, and illegal substances; domestic violence; mental illness; and adverse childhood experiences. 2. Increase access to prenatal care in the first trimester by referring and facilitating pregnant women's . enrollment in Medicaid and by collaborating with local health care providers to reduce barriers to care for Medicaid eligible pregnant women. 3. Educate pregnant women and families about the benefits of breastfeeding, of increasing fruits and vegetables, daily exercise, and healthy weight strategies. 4. Screening, education,referrals, and risk reduction strategies will be offered to pregnant and parenting families to prevent shaken baby syndrome/abusive head trauma, sudden infant death syndrome, falls, burns, and other injuries. 5. Educate parents on how to support their infant/child's health, development and learning. Promote and refer to well child care, immunizations, and dental care. Screen for developmental progress using standardized measures and refer to community providers for specialized services. 6. Clinical services will use science based programs and interventions when possible. Nurse Family Partnership will be prioritized as the highest quality evidence based, two generation,prevention program. 7. Maintain contract with Nurse Family Partnership (NFP)National Office for data analysis of program fidelity, quality assurance, and client outcomes. Maintain contract with Kitsap Health District for other program data analysis. Family Health Services data will be available to Board of Health and community through web site and reports. • 1 of 2 PERFORMANCE INDICATORS: 2010 2011 2012 Actual Planned Planned Number of home/office visits provided in Family Health 863 900 750** Programs not including WIC • Number of home visits provided in NFP 229 * 200 Number of referrals from NFP to community resources 143 * 140 Number of individuals served in WIC 837 880 825 _Individual visits for WIC nutrition assessment and education 3,914 * 3,700 Breastfeeding initiation rate in WIC mothers 94.1% * 90% _Breastfeeding at 6 months rate in WIC mothers 58% * 55% *not part of 2011 plan ** anticipate redesign and/or loss of CPS contracts and MSS/ICM SUMMARY OF KEY FUNDING/SERVICE ISSUES for 2012: JCPH Family Health programs address local, state, and federal public health goals. The table below shows selected health indicators we monitor that provide both direction and feedback for our program goals and objectives. WIC and NFP have data collection and analysis systems that produce high quality health data on individuals enrolled in these programs. Jefferson County's small numbers in certain population groups leads to the need to aggregate data for both accuracy and confidentiality, SIDS data are an example. Caution is needed in interpreting this data. The healthy People 2020 goals represent the general population of the United States. The WIC and NFP data represent Jefferson County residents who are eligible for these programs because of their low income and within this group a significant number will have multiple, serious health risks. Given that we are engaging this higher risk sub-population, we expect that some of our Jefferson County data would compare less favorably to the national data. Family Health programs provide both intervention and prevention. Many outcomes will only be realized in • 15-20 years. Measuring what did not happen or what you hope will happen in 15 years can be difficult, for example- in NFP we anticipate that the infants now served will be less likely to be incarcerated and more likely to graduate from high school. In NFP we collect extensive quality assurance data to measure our fidelity to the research model. This data shows we are maintaining fidelity so we can expect similar positive outcomes in the future. Healthy People 2020 national health goals' Jefferson County data Children 2-5 years old obesity rate-less than 9.6% WIC children 2-5years old- 5.5% Iron deficiency in children 1-2 years old-less than WIC children 1-5 years old-10.4%2 14.3%, 3-4 years old-less than 4.3% Breastfeeding initiation- 81.9% WIC breastfeeding initiation- 94.1% _Breastfeeding at 6 months- 60.6% WIC breastfeeding at 6 months- 58% Prenatal care starting in first trimester- 77.9% 2007-09 Medicaid—66% Private insurance- 88% 3 Pregnant women smoking- less than 2% Jefferson County pregnant women smoking- 25% _ WIC pregnant women smoking- 23% Preterm birth rate less than 7.8% Jefferson County preterm birth rate- 9.7% Low birth weight rate less than 11.4% Jefferson County low birth weight rate- 9.5% WIC low birth weight rate- 11.5% July 2011 • ' http://www.healthypeople.gov/2020/default.aspx 2 Note aggregate age group reported-WIC data not divided by same age groups as HP 2020 3 The Health of Jefferson County,2010-11 Update:http://www.jeffersoncountypublichealth.org/index.php?health-of-jefferson- county S Jefferson County Public Health - Planned Performance Measures 2012 Solid and Hazardous Waste PROGRAMS: Solid Waste Enforcement, Solid Waste Education& Outreach, Site Hazard Assessment, Business Pollution Prevention(Local Source Control,EnviroStars Certification, Green Business Certification). MISSION: The mission of the Solid Waste Code Compliance and Education Program is to enforce Washington State and Jefferson County solid and hazardous waste code, educate the community about ways to reduce solid and hazardous waste, and to promote the goals and objectives for solid waste reduction and recycling outlined in the Jefferson County Comprehensive Solid Waste Management Plan. GOALS FOR FY 2012: • Investigate solid and hazardous waste complaints in a timely manner. • Resolve solid and hazardous waste violations through voluntary compliance or citations and legal action when necessary. • Investigate all Initial Investigations as referred by Ecology. . • Resolve backlog of Site Hazard Assessments awaiting ranking. • Reduce the incidence of illegal dumping. • Assure all permitted facilities (past&present) and exempt facilities meet current regulation standards. • Increase public awareness of household hazardous waste (HHW) disposal requirements and options. • Promote "rethink, reduce, re-use, and recycle"to facilitate the County goal for 50%waste reduction, recycling, composting, and waste diversion. • Provide on-site technical assistance site visits to businesses to encourage environmentally sustainable business practices. OBJECTIVES FOR FY 2012: • Coordinate with other agencies to resolve complex solid waste violations. • Work with the County's Prosecuting Attorney to pursue legal remedy for enforcement cases when warranted. • Respond via phone, letter or site visit to all solid waste complaints. • Respond to all initial investigations within 3 business days. • Conduct Initial Investigations and Site Hazard Assessments as referred by Ecology. • Educate consumers on choosing non-toxic alternatives to HHW. • Educate public on proper disposal of HHW. • • Promote consuming less and re using more. Recycling is not enough. • Conduct LSC site visits to identify and actively work with high priority SQG's to ensure use of best management practices and prevent toxic and hazardous wastes • from entering surface waters. • Promote Green Business and EnviroStar certification programs. PERFORMANCE INDICATORS: 2008 2009 2010 2011 2012 Actual Actual Actual To Date Projected Total number of solid waste complaints received 114 60 65 32 75 Total number of solid waste violations resolved 117 90 68 51 75 Number of illegal dumps complaints received 12 14 11 9 12 Number of illegal dumps complaints resolved 11 19 10 8 12 Number of illegal burning complaints received 4 5 7 1 6 Number of illegal burning complaints resolved 7 1 6 Number of citations/tickets issued 28 24 5 6 5 Number of court hearings attended 19 2 6 2 Tons/cubic yards of solid waste removed/recycled >450 cu 55+tons 38 tons 50 through compliance efforts (not including junk yards _vehicles) Total number of solid waste violations awaiting 2 1 2 5 3 _legal action/abatement Number of warrants of abatement 1 0 0 1 1-2 obtained/completed Number of Jeff. Co. permitted facilities meeting 8 of 9 8 of 9 8 of 8 8 of 8 8 of 8 • current regulation standards (8) Number of Jeff. Co. exempt facilities inspected/ 4 of 4 4 of 4 4 of 4 4 of 4 4 of 4 meeting current regulation standards(4) Total number of active EnviroStars businesses 10 14 18 20 23 Number of new EnviroStar businesses 1 3 5 2 3 _Number of active Green Businesses 21 26 27 33 Number of new Green Businesses - 6 6 6 6 _Number of Junk Cars removed/recycled 279 139 141 2113 150 Number of"Amnesty Day" events 1 0 1 0 0 Tons/yards of solid waste recycled/disposed of 2500 0 3000 0 0 during"Amnesty Day". tires Tires Plus 601 South tons(2) County(2 ) Number of LSC site visits - 4 28 4 72 Number Initial Investigations Completed 3 13 7 3 10 Number Site Hazard Assessments Completed 4 4 0 3 7 Number Site Hazard Assessments pending 14 10 10 7 0 Notes: (I)At the end of 2008 JCPH broke out several facilities that had previously been lumped together.(Jefferson County Transfer Station,Recycling Center,and closed Municipal Landfill.)This enabled clarification for the purposes of monitoring and permitting.In 2010,Ecology took over permitting of the Olympic Corrections Bio-solids composting facility;this reduced the#of sites to 8. • SUMMARY OF KEY FUNDING/SERVICE ISSUES: JCPH solid waste program strives to ensure solid waste is managed in such a way that ensures protection of both public health and the environment through enforcement of solid waste regulations, education and outreach regarding "green living" choices, and pollution source identification and mitigation through the Local Source Control program, and promotion of environmentally sustainable businesses that achieve EnviroStars or Green Business certification. State grants and contracts continue to be the primary source of funding for these programs; and are expected to remain consistent in 2012 with the exception of additional funding contracted through Department of Ecology Local Source Control contract. Solid Waste Enforcement includes solid waste complaints and violations, and solid waste facility permitting and compliance inspections. Solid waste complaints, including illegal dumps,have continually declined since 2007. Of the remaining outstanding complaints, there are a higher percent of difficult, chronic cases (usually involving mental health issues)which require a greater amount of time and resources to resolve (e.g.: multiple citations, court hearings, and warrants of abatement). For example, in 2011 a warrant of abatement case totaled more than 75 staff hours. A backlog of these time-intensive cases exists and staff will work diligently during 2012 to resolve them. The number of illegal dump complaints seems to be stabilizing at 11-14 per year; the goal is to have none. Illegal dumping and burning of garbage is expected to remain consistent until/unless there are structural changes such as mandatory garbage collection service (at least for rental units). JCPH continues to assist • citizens with junk vehicle affidavit requests, freeing up Sheriff's Deputies' time. Since 2007 JCPH has assisted with the removal of over 2113 junk vehicles from Jefferson County. Jefferson County's eight permitted facilities are all fully compliant with state and local requirements. JCPH staff will inspect four exempt facilities in 2012 to ensure compliance with current state and local codes. JCPH staff will continue to investigate hazardous waste complaints and perform initial investigations and site hazard assessments (SHA's) for Ecology. The solid waste team will respond to all new referrals from Ecology and expects to resolve the backlog of SHA cases during 2012. Staff will respond to new referrals for Initial Investigation within 3 business days. Solid Waste Education and Outreach includes the EnviroStars Certification program, Green Business program,public education and outreach, and Local Source Control program. In 2011, JCPH was awarded a first-time biennial contract from Department of Ecology for Local Source Control (LSC)to identify and mitigate potential sources of pollution into surface waters from businesses which generate or utilize hazardous waste in their operations. Guidance and education are offered regarding the proper management and disposal hazardous waste and best management practices to prevent pollution into waterbodies. The Local Source Control Specialist(LSCS)provides no-cost technical assistance to Jefferson County businesses, including marina and boatyard activities, auto businesses, equipment rental companies,mobile cleaning businesses, etc. For businesses operating with sustainable business practices, the LSC program serves as a gateway into EnviroStars and Green Business certification programs. These programs provide free advertisement and other promotional materials to reward good business practices. Sites found to be in gross violation • of the law and/or apparently contaminated are referred for SHA and mitigated or ranked on the state database. Both the reduction in hours of the Jefferson County HHW facility and economic factors are expected to affect businesses proper hazardous waste disposal. It is less convenient and more expensive to properly dispose of wastes. Increased education and outreach to businesses through Local Source Control site visits may reduce the occurrences of improper management and disposal. Solid waste public education continues to focus on pollution prevention through education and outreach on proper disposal of pharmaceutical waste, and toxic alternatives for household cleaners and yard care products. In 2011, JCPH minimized food waste by starting a worm bin for food waste from lunch scraps. In 2012, we will continue to lead by example choosing environmentally sustainable business practices continuing to encourage other city and county departments to adopt and environmentally-preferable procurement policy. Jefferson County Household Hazardous Waste (HHW) facility reduced its operational hours and eliminated community outreach collection events during 2011,thus there will be a need for greater education and outreach,particularly to rural communities,to educate on proper disposal methods and sites. The reduction in funding and staffing of all county departments means we must carefully and honestly evaluate priorities and division of labor. Increased inter-departmental cooperation will enable us to accomplish the most with limited funds. Inter-agency cooperation between JC Sheriff's Office, City of Port Townsend,Animal Services, • Washington State University (WSU) extension office, Climate Action Committee (CAC), Department of Community Development, Department of Ecology, Puget Soundkeeper Alliance and Child Protective Services was essential in 2011 and will continue in 2012. This allows for resolution of difficult and complex cases, shortening of resolution time on cases, and over-all cost savings to JCPH. Citizens need to be informed about the necessary reduction in and speed of services (i.e. JV affidavits are not as high a priority as a hazardous waste complaint). Jefferson County Sheriff Department has had a decrease in staff hours due to budget constraints therefore are available less often to the Solid Waste team for site visits. In response to this reduction, Solid Waste staff schedules an officer once per month and hold all cases that require sheriff escort for those days. Updated 08/02/11 • i Jefferson County Board of Health Media Report r .august 18, 2011 • • Jefferson County Public Health July/August 2011 NEWS ARTICLES 1. "Food vendors stirred over fee proposal," Port Townsend Leader, July 20th, 2011. 2. "A break for food vendors," Peninsula Daily News, July 21st, 2011. 3. "Anderson Lake toxin levels remain lethal," Peninsula Daily News, July 25th, 2011. 4. "Picnic set Aug. 3 to celebrate World Breastfeeding Week," Port Townsend Leader, July 27th, 2011. 5. "Too many chefs," Port Townsend Leader, July 27th, 2011. 6. "Gibbs Lake status now `warning'." Peninsula Daily News, August 1st, 2011. 7. "Athletes need physicals," Port Townsend Leader, August 3rd, 2011. 8. "County prepares for flat budget in 2012," Port Townsend Leader, August 3`d, 2011. 9. "New fees for food vendors lower than first proposed," Port Townsend Leader, August 3rd, 2011. 10. "Nutrition for Women, Infants and Children," Port Ludlow Voice, August 2011. • • Hearingon ThursdayPermits: BContinued from page 1 • is no longer sure what the s vendors effect of a second fee propos- z ,y al might be on him and other food vendors throughout the Y" . ' county. „*,,.. lA stirredBut he's worried — as '- is Lela Hilton, who runs - ' ? the Cape Cleare salmon . • I VII- sandwich cart at the Port II tk” *lifer fee Townsend Farmers Market • and other special events. '' - ��r Both plan to attend the , t :`` ®r °sal Jefferson County Board of ; a ` ` rl• Health meeting Thursday, *ate; -, !.' `�" ` July 21 to pepper health , , County board commissioners on why s ' 1. �.i�'. ;,t ' p as kV t says the proposed fees are needed. Leta Hilton,who runs the Cape Cleare salmon sandwich cart at the Port If the board adopts the Townsend Farmers Market,is concerned about the possible impact new rules comply new fees, they would take effect July 21, according to fees may have on vendors.Photo by Allison Arthur _ with state law the proposal.The board meets A narrative of the need at 2:30 p.m. at the health a proposal for amending the fee sched- By Allison Arthur of the Leader department at 615 Sheridan Apr details of the propos- St. says,"The state food code St. in Port Townsend and a r.,,o ;check• ,out the county's requires that changes in the Larry Dennison figured his public hearing on revisions Ibstte atjeffersoncoun_ location or menu of a food annuald,,'-,, permits for bringing his to fees for food service estab- * ublictiealth.org/pdf/ service event require a new famous pulled pork sandwiches to lishments is the first "new fBOH fee_ord_2011.pdf. temporary service permit." major events in Jefferson County business"item. It also says the fees would could go from$130 a year to$2,200 cover the cost of printing a year if the county's Board of COMPLYING WITH STATE "If you are additional permits, office Health had approved a first draft Susan Porto, environ- review and limited oversight of new fees, mental health specialist going to make of the vendor at successive The owner of Dos Okies with Jefferson County Public changes, tell the events. Barbeque Restaurant and Catering Health, said July 19 that Dennison said he came • See PERMITS,Page 13V the purpose of the first pro- stakeholders. "unbuttoned" when he dis- posal—that would have cost What happened covered the health depart- Dennison$2,200 a year—is ment wanted to charge him to comply with state codes, is no one found $130 to inspect his sand- which the county hasn't out until we went wich cart at various sum- been doing, according to the mer events. He prepares his health department. to get our food food in his already approved "That's what we are try- permits." kitchen and for years that to rectify," Porto said. $130 annual fee seemed rea- ingShe said state law requires sonable. Larry Dennison "Now they're saying you the county to permit every vendor at ever-event. owner have to buy a y Dos Okies Barbecue permit every The county learned it time you change menus or was not complying with that Restaurant and Catering venues,"Dennison said of his state law only recently when understanding of the first new staff came on board, The new proposal has proposed fee. Porto said. Both Stuart different fees for different That proposal has Whitford, environmental menus and kinds of events changed and now Dennison health services director,and and would appear to require says no one seems to know Alison Petty, environmental Dennison to pay a $30 fee what to charge him — and health specialist, are new for every event as long as won't until the hearing to the department.Dennison it's the same menu. If he Thursday. said Petty told him she was were to add a different sand- "I put my application in responsible for the propos- with, for example, he would for Music on the Green and al. Petty was unavailable have to pay$98.the proposal a concert in August and no for comment Monday and appears to suggest. Tuesday. one"knows what to charge," Porto also said it's her Dennison said. "I don't think anyone understanding that other Asked Tuesday how much understood the extent it counties have already made Dennison would be charged would impact the commu- changes to their permit for serving his food at the nity,"Porto said of the initial schedules to meet the law Wooden Boat Festival, for proposal. and Jefferson County is example,Porto said."Larry's right. We're having a hard behind in that regard. time telling him what we'll el charge because it's up to the b,ard of health." 1749/eaa j 7/a1%r Hilton, who teaches The proposed new tem- TALK TO STAKEHOLDERS English composition at porary food service per- One of the problems Edmonds Community Dennison has with the pro- e, mit application will state College and also runs a posal is the sudden discos- "A temporary permit , s Clemente Course education valid for a specific event. ery of the proposal–in the program, says the ,salmon- This event may be either a • middle of his busiest season. sandwich cart is her sum- "I make more in four dayssingle event lasting up to mer job. 21 days or for an approved, of Wooden Boat than I make She's concerned the new recurring, organized event the entire month of October," fee proposal could impact he said of how important that occurs three or fewer most temporary food yen- times per week. Changes summer events are to his dors in the location or the menu year-round business. "To have to get a differ- "If you are going to make of a temporary food service ent permit in each differ- activityrequires a new tem- changes, tell the stakehold- ent venue, especially with q fou What happened is no one porary food service permit." the same menu, seems Judi- The proposed new fee found out until we went to get crows:'she said. our food permits," Dennison schedule has 12 fee changes "If you've got a permit under the temporary per- said. He questions why the and it says what you're doing county hasn't reached out mit category, adding 10 new is meeting the guidelines, categories of fees, including more to the peopletwhose why do you have to keep • livelihoods are at stake. fees for organized recurring - - getting a permit?I just don't — -- events with both limited and After he started asking understand the need for it questions, Dennison said he if all the conditions are complex menus. the Dennison says it's all got- Pao ram to ube doo blthe Food same,"Hilton said. ten confusing and compli- Program Roundtable, but "We are all really con- cated. the group no doesn't take min- cerned about public health. "It's really confusing how utes and he's not clear on its We all want to do the right purpose. thing and cooperate with the it's going to work.'Dennison "The sense I get is this county but it seems there are said. "I can't speak authori- wholething has been hall these arbitrary decisions tiavely because I don't in a back room somewhere with no rational reason for understand it. We're in the and when the ground around them. That's what gets us middle of the season and them caught fire, it's like concerned. None of us are we have this huge snarl.It's 'Now what do we do?" renegades. Our margins are got everyone tied in knots. If there are problems to be so tiny,"Hilton said. solved, let's sit down and "I don't solve them,but let's not cre- think anyone PAST PRACTICES, ate them. REVISED RULES What happened is no one • understood the A narrative of the need pp for the rule in the health found out until we went to extent it would board's packet for the July get our food permits.There's impact the 21 meeting says that in the never been a catering permit community:" past, temporary permits before. But I got a bill for were valid for a year and $350 for my business and could be used for an unlim- ited number of events, pro- vided the events weren't Ion- I went to get my temporary Jefferson County ger than three days. permit and Alison (Petty) Under the state food code, said you have to pay $130 "The issue for me isn't a temporary food service for every event. If you do • that,then instead of costing being inspected.If they want event could be defined as a fine. single event or celebration me $130 it's going to cost to inspect every day, g , But don't run me out of busi- lasting for 21 days or less $2,200Thursdav's meeting. ness by charging me for a or an "approved, recurring. At redundancy for an inspec- organized event such as a Dennison and Hilton want tion I've already passed," farmers market.", In both to question health board Dennison said. types of events, the tempo- members. "If I don't do these things rary food service must be "Have you read it and do in the summer,I won't make operating at a fixed location you understand it,and if so, it in the winter. The last and have a fixed menu. what does it mean?" is the few years have been dismal. So those old county rules question Dennison plans to People are scared. What I allowing Dennison. for ask. find in my business is that example, to conduct multi- my regular customers are ple events under one $130 coming in a third as often.If permit umbrella, therefore, I had to rely on just over-the- were in conflict with that counter, I'd be gone a long state law. time ago,'said Dennison. . • r r . ,,,i �' i * ... { „'. t"' , ✓ mow, z P r -4•1:,i';',: �r Larry .: , � t I + x""' d, . ,--:.�d� Dennison, 1 --- ... g'' CIIAELIE BEEMANTIPENINStL4 DAILY I�ER'S standing, i,s d'i & „„�, _ -.. speaks out 4 Lela Hilton is one of the food against a • vendors who spoke out Thursday at ermit a Board of Health meeting. increase 1 , for food ! •r ; }'" vendors at i V 1i'k f, , t e us a Jefferson ! '` -- ' A break person Board of ^`_-- � Health s r." „,,k,"-„;.7,.; r 11 for food meeting l'.=4 s Thursday. ; ,,, t�`+� vendors : �� r ,FR Iwz. i ..-..-:,-, Permit fee increasefr.,,,-..>44.0.,4,441,,,,,.,... E CILIRGIF.Btivtnv�/Pesis�n.:�D.�n.r\e�c� will be incremental Food: Raise affects livelihoodsBY CHARLIE BERMANT PENINSULA DAILY NEWS CONTINUED FROM Al not change the safety of the eventual action,though he motion passed unani- PORT TOWNSEND — The Jefferson food operation because we had lobbied for no addi- mously. County Health Board approved a compro- The compromise our safety se Thursday between a staff reeommen- bring with us.” tional charges after the mi- Jefferson County Publicatlon for temporaryWefood service permit approved Thursday cuts the tial permits were granted. Health Director Jean Bald- �fees and what vendors felt was ance afford- 2$30 fee in half to y$15 for Dennison proposal Board member Sheila win said the$30 fee amount able amount, and vendors m et to develop Dos Okies owner Larry to forgive��an made a motion Nwas agfor 30 minutes of the sought to restructure the permitting pro- Y per son Count commissioner, mits and smove toward health inspectors time, mit structure. Y cess,saying it was necessary to come into said the new system was estab the ndco a commit- avers e' duration of an About 20 people came to Y tee b g compliance with state law, and recom- unreasonable because it Y the end of the year, inspection. mended a separate permit and inspection the meeting Thursday added inefficient and "hich was seconded by Using this formula, the fee for each event rather thanissuing a afternoon, the crowd spill- redu ddan to Y board member Jill Buhler, single permit for the whole season. mg out into the atrium of cY the current who is also chairwoman of fee increases would cover the Health Department's Process. the Jefferson Healthcare only the administrative This would have increased the cost of Sheridan Street head uar- "I propose we stopthis costs to meet state health the permits so they would exceed the profit q commission. mar n for a articular event and discour- gym' major reinvention of our Jefferson County Com- requirements,she said. age vendors from amici atin in an event, Several vendors. spoke process on the fly which has missioner John Austin,also These administrative g P P g out against increased fees, thrown businesses that a)ward member,s oke out costs will not be covered said Joy Baisch,who manages the annual saying the costs would depend on these events into a P by Brinson ShrimpFest. gainst the motion,saying the $15 fee,but it will not The staff proposal recommended a$130 threaten their livelihoods. relative chaos right in the to forgive the permit fees cause a serious impact to charge for each permit and an additional Lela Hilton, who runs middle of our very busiest would be to indicate the the department,she said. $30 for each additional event throughout the Cape Cleare Salmon and most critical season," permits would have no the season. Cart—a fixture at the Port Dennison said. value. Townsend Farmers Market "I propose'that we con- Westerman amended Jefferson County Reporter Cnar- TURN TO FooDIA7 —said vendors have concis- vene a group of stakehold- her motion to include a$10 he Berman(can be reached at 360 tent habits that they use at ers and staff to address fee, again seconded by 385-2335 or at chadiebermant every location. real, definable problems Buhler,at which time board penrnsuladaitynews.com. For this reason, requir- with the current system member Kris Nelson,who is ing.a separate permit for and develop a strategy of also a Port Townsend City each event is nota good problem-solving that works Council member,suggested idea,she said. for the county and the busi- $15 because it represented "We all bring our own nesses that depend on tern- the midpoint between $30 hand-washing and our own porary permits" and zero. power,"she said. Dennison's idea provided Westerman amended, "Changing the sites does the basis for the board's Buhler seconded, and the 0 ?y0/1/y 7/02 Anderson Lake toxin , ., remain lethallevels • By LEAH LEACH begin producing toxins at Highway 104 remains clear, PENINSULA DAILY NEWS any tune,Thomasonwarned, Thomason said. and testing is always a week Anyone who observes an The level of toxin in behind the fact,since sam- algae bloom at a Jefferson Anderson Lake has fallen, ples are taken Mondays and County lake is urged to, but the water is still lethal. results are received from phone 360-385-9444 and The lake, which was King County Environmen- inform the public health closed to all water recre- tal labs Fridays. department, which posts ation June 10 this season "It could be putting out information about lake because of algae-created toxins as we speak,"Thom- quality at http://tinyurl. toxins, remains deadly, ason said. com/6z64o/y. according to the latest test Caution signs remain at No toxic blue-green algae results, said Greg Thorne- Gibbs Lake south of Port has been reported in Clal- son,Jefferson County envi- Tlownsend and Silent Lake lam Counts where health r rial health specialist, on the Toandos Peninsula. officers do not test for toxins. Friday.riTay. The toxin level in Gibbs, Instead,they visually moni- The closure doesn't affect sampled last week,was the for lakes for algae blooms. the 410-acre state park sur- same as that in Leland, Algae blooms in Clallam rounding the 70 acre lake. Thomason said. County lakes should be The park, which is Silent Lake probably reported to the county between Chimacum andwill be tested this week,he Department of Health and Port Hadlock,remains open added. Human Services' environ- for hiking,horseback riding, It's safe to eat properly mental health division at biking g—all recreation not cleaned fish from Leland, 360-417-2258. related to the lake. Gibbs and Silent lakes,but Test results found 21 no one should swim in the Managing Editor/News Leah micrograms of anatoxin-a,a lakes or drink the water. Leach can be reached at 360-417- neurotoxin, and quick-attune Sandy Shore Lake south 3531 or leah.leach@peninsula neurrtoxin,per liter of lake of Port Ludlow near state dailynews.com water. 21 times safe level That's way down from the 725 micrograms of anatoxin- a per liter discovered the week before,but it's still 21 • times the safe level of 1 gram per liter,Thomason said. 'It's still dangerous in the lake,"he said. Toxins are created by blue-green algae species. times,it is benign,but at other times,it can produce poisons in the lake water. Researchers don't know why algae sometimes pro- duces toxins. Levels of toxins can vary drastically as algae blooms die off. Although a long-term scum on a lake may appear to be the same bloom,actu- ally it is a series of.algae blooms,Thomason said. Individual blooms die off every seven to 10 days. When a blooms withers, toxins decrease. A new bloom can immediately send the level skyrocketing. Other lakes open All other fishing holes in East Jefferson County are open. A warning sign remains posted at Lake Leland, north of Quilcene,because of a heavy bloom of algae known to sometimes pro- duce toxins. The algae are benign, according to last week's test, which found no anatoxin-a 0 and a miniscule amount of microcystin,which can poi- son the liver over a period of ingestion of lake water. /�l,J, i,' However,the algae could Picnic set Aug. 3 to celebrate World Breastfeeding Week Jefferson County Public ensure successful breast- Health supports the annual feeding. global celebration of World A weekly breastfeed- Breastfeeding Week, Aug. ing tea is scheduled each 1-7, with a 1 p.m. picnic Wednesday at 1:30 p.m. at on Wednesday, Aug. 3 at Jefferson County Public Chetzemoka Park in Port Health. All moms, babies Townsend. and children are welcome. Current and former Ninety-four percent of breastfeeding moms, babies, women on Jefferson County families and friends are WIC give their children a invited to bring their own good start by breastfeed- picnic lunch and celebrate ing, exceeding the national healthy children and a corn- breastfeeding initiation rate munity that supports breast- of 75 percent, according to feeding. information provided by the Jeff&rson Healthcare, health department. medical providers, Jefferson Breastfeeding's impacts County Public Health and on health include the reduc- the WIC program all pro- tion of many long-term vide education and sup- chronic illnesses such as port to local pregnant and diabetes, asthma and obe- breastfeeding women to help sity. • • . • OpinionFOrufli • editorial Too many chefs There are too many chefs trying to cook up new and pricier regu- lations inside Jefferson County Public Health. For some reason,regulators within the department have proposed an exponential increase in the permit fees that must be paid by food vendors who cater food for events through mobile means.Dos Okies,for example,would have seen its annual fees rise from$130 to $2,200. The shocking increase seems to come from some new staff people within the health department who had a different interpretation of state codes.It's not that the standards have changed;it's certainly not because our local food vendors suddenly deserve additional layers of oversight and expensive new fees.Instead,it would appear that someone has too much time on their hands inside the local bureau- cracy and devoted it to coming up with new fees. At a July 21 meeting,the county Board of Health—citizen appoin- tees and elected officials—took up the question with some 20 affect- ed vendors in the room.They split the baby down the middle,impos- ing a new per-event fee of$15 rather than the$30 initially proposed. That applies if the vendor is offering the same menu for which they previously paid a full permit fee of about$100. for the The extra fees,according to the agency,are used to pay extra inspections and administration needed to regulate the food • vendors.But as Lela Hilton of the Cape Cleare salmon sandwich cart noted,the mobile vendors bring their facilities with them from event to event.Their food infrastructure does not change."We bring our safety with us,"she said. Joy Baisch, a key volunteer with the Brinnon ShrimpFest,noted that the originally proposed fees would cost vendors more than they can make at some events. The Board of Health's temporary solution will last through the end of this year,getting our mobile food businesses through the busy months ahead and into the winter,when cooler weather—and heads —should have time to prevail towards a better solution. — Scott wGL • ?idea oeee, V/1.2 2/// Gibbs Lake • status now `warnin ' . Recreational use still prohibited in Anderson BY LEAH LEACH PENINSULA DAILY NEWS A thick algae bloom was found infesting Gibbs Only Anderson Lake closed Lake last week,prompting a public health down- Thick blooms of blue-green algae infest three grade in its status from"caution"to"warning." Jefferson County lakes,but only one—Anderson Although tests Lake—is so poisoned with algae toxins that it is show that both ana- nderson Lake closed to all water recreation,including fishing. toxin-a and microcys- Atoxi' readings The level of toxins in Anderson Lake,which was Ieatin,a liver toxin,areng closed June 10,is decreasing,but it's still too dan- below safe levels inhave been gerous to go in the water,according to Friday's test Gibbs Lake,the algae decreasing since a results of samples taken last Monday from the that is reproducing lakes. in the lake is known June 24 test result Those test results showed the lake contained to be of a type thatshowed 1,112 2.3 micrograms of anatoxin-a,a powerful neuro- can suddenly begin rams icro per liter toxin,per liter of water.The safe level is 1 milli- creating toxins. micrograms gram per liter. They aren't pro- of anatoxin-a, theAnderson continues to come down,"said Greg ducing a dangerous highest level since level of toxins now g Thomason,Jefferson County environmental health but could begin doing 2008, when the lake specialist,Friday."It's still double the safe level." so at any time,said set a world record— Tum TO LAKE/A6 Greg Thomason,Jef- still unbroken—of ferson County envi- • ronmental health 172,640 micrograms specialist,Friday. per liter. Testing is always a week behind the fact, since samples are taken Mondays and results are received from King County Environmental labs Fridays. "There's a really thick bloom of algae there," Thomason said. "It looks worse than Anderson Lake." Lake: Gibbs only one of five with routine microcystin tests CONTINUED FROM Al of a heavy algae bloom. ing since a June 24 test inform the public health No toxins were found in result showed 1,112 micro- department, which posts The closure doesn't affect Silent Lake on the Toandos grams per liter of anatoxin- information about lake the 410-acre state park sur- Peninsula,which is posted a, the highest level since quality at http:I/tinyurl. rounding the 70-acre lake. with a caution sign because 2008,when the lake set a corn!6z64-(6. The park, which is of a light-to-medium bloom world record—still unbro- No toxic blue-green algae between Chimacum and of toxin-producing algae. ken — of 172,640 micro- has been reported in Clal- Port Hadlock,remains open Sandy Shore Lake,which grams per liter. lam County, where health for hiking,horseback riding, is south of Port Ludlow near Before state parks officers do not test for toxins. biking—all recreation not state Highway 104,remains authorities would consider Instead,they visually moni- related to the lake. clear. reopening the lake, tests tor lakes for algae blooms. Gibbs is the only lake of results would have to be Algae blooms in Clallam Other lakes the five that the county below the threshold for County lakes should be health department rou- safety for at least two con- reported to the county A warning sign remains tinely tests that shows any secutive weeks. Department of Health and posted at Lake Leland. microcystin at all,Thome- It's safe to eat properly Human Services' environ- north of Quilcene,because son said. cleaned fish from Leland, mental health division at "In fact. microcystins Gibbs and Silent lakes.but 360-417-2258. el levels came up this week, no one should swim in the although they are still lakes or drink the water. below safe levels," he said Anyone who observes an Managing Editor/News Leah Friday algae bloom at a Jefferson Leach can be reached at 360-417- Anderson Lake toxin County lake is urged to 3531 or leah.leachepeninsula readings have been decreas- phone 360-385-9444 and dailynews.com. pip N Athletes needphysicals Summer is over earlier for about the upcoming 2011 fall sports physicals from 9 a.m. those high school student ath- season: to 3 p.m.on Tuesday,Aug. 16, letes turning out for a fall Friday, Aug. 19 and Tuesday, sport: volleyball, girls' soccer, PORT TOWNSEND Aug. 23. Athletes should football, girls' swimming and All incoming freshmen call Jefferson County Public cross-country. need a current physical,noth- Health,385-9400,to schedule Here is what the Port ing earlier than April 2011, an appointment.Walk-ins are Townsend High School and before participating in an ath- also welcome. Chimacum High School ath- letic team's practice. Here are some other PTHS letic directors want athletes, The school-based health dates: and their parents, to know clinic at PTHS is open for Tuesday, Aug. 16: Fall Sports parent meeting,6 p.m. in the PTHS library. Meet coaches, talk about policies, rules,etc. Wednesday, Aug. 17: The PTHS Associated Student Body (ASB) office opens for Fall Sports paperwork on this day, 9 a.m. to 2 p.m. This is also the first day of football practice. CHIMACUM Chimacum High School student athletes must submit all required forms to their coach or the school district office to be eligible to prac- tice.Forms can be obtained in the district office during the summer(limited hours)or on the Chimacum School District • website. All freshmen must have a new physical. Physicals are good for two years.Junior students or stu- dents playing for the first time should also plan to get a new physical. Students can get a physi- cal through their own physi- cian or at the school-based health clinic in the CHS com- mons from 9 a.m.to 3 p.m.on Monday,Aug. 15,Wednesday, Aug. 17, Monday, Aug. 22 or Wednesday,Aug. 24.Athletes should call Jefferson County • Public Health, 385-9400, to schedule an appointment, although walk-ins are also welcome. Here are dates specific to Chimacum High School: Tuesday, Aug. 16: Fall Sports parent meeting starts at 6 p.m. in the high school commons.Students interested in playing volleyball, football, girls' soccer or boys' tennis should attend to meet coaches, talk about policies,rules,etc. Tuesday, Aug. 17: Football practice begins. // 1)/i i O 1.. O' by...w ��0 CN1 5 ai :ioO U j d TiMil w O• 0.4.,-,.-. C aa> G , .a O.U..L .N >-. y 0 r a> q s>. s. o o ca ^c7 C U cco as.s cc coal ..•w A ur-''a w°= C y y 3 ci U .. o a) O Q. Lo A yam. .., a o m. ca C a a•o o a 0me O- aC (a'J WmN .C ao h0 a s C , 7:„, 1 0 ,.. 0 0 � aa� 3c�.4N o. g m 7 t,c-4a .y a]-o Oe-o al q a> , A 7,3 >, 6 !.,40•o m Z-,. ;52 U _ : . o n w'' +' 'O d C C > W q ).O .0 a> A w • m a. . 4 U. O U'b O'CS U y .7'3' a' P. O. 00., C C w a; ;r, C J ra E' .a dcs, d 0• is 0 `a o m ci O b w J • .' 00w oU O F cI a. aa '- U _ � a J 0 LnMEM ' ' � w tC▪ i. .-. wwO O. OCO 0 .� .: C0N '" 6ao - ha al 't ^� ' . d a> a. 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C...0 e 0 y 7' V Uy' Y CCN"O ODa ,4.,NM ^ 3 _ "a 26II 0.0 oo � em' aat ^ 'a `-'y �' 3 coW ' y a .'a E. � 74 - . ai ' Ed co N bA x a c C m . v• G b ' :. co m• d o>2 caw N .' 3 U Q > .. . . . ___ _ New fees for food vendors • lower thaniirstproposed By Gina Cole of the Leader makes there,said Joy Baisch, other vendors' sentiment that .who is involved with Brinnon one permit should cover a ven- The Jefferson County ShrimpFest. dor for the whole year. Board of Health voted unani- Several vendors suggested He also took issue with the mously July 21 to temporar- that one fee should cover an proposal's timing. ily reduce permit fees for food establishment for the entire "We're finding this out in vendors who serve at more season and multiple permits the middle of our busiest,most than one event. are unnecessary. difficult season,"he said,add- Instead of$30,as outlined ' But state law requires mul- ing that he only learned of in a draft proposed ordinance, tiple permits,and the proposed the changes when he applied the fee for additional events is fee for secondary permits was for his permit this year. (The $15 until Jan. 1,2012. meant to cover administrative Leader made the news widely The action was a way for and inspection costs for issu- public in the July 20 edition). the board to comply with state ing those permits. As Dennison suggested, law until the busy summer Vendors' practices do not the board intends to gather season had passed, and it change from place to place, stakeholders sometime before could work with vendors to said Lela Hilton,who runs the the Jan. 1, 2012 expiration find a more agreeable solution, Cape Cleare salmon sandwich of the approved change, said • , board members said.It was a cart at the Port Townsend board chair Kris Nelson,who compromise between the pro- Farmers Market and other is also on the Port Townsend posed$30 fee and the food ser- special events. City Council and is a down- vice establishments' requests "Changing sites isn't town restaurant and pub for no secondary fee at all. changing the safety of our owner. The $15 fee is in addition operations because we bring Board members hope to . to a fee for a vendor's initial our safety with us," Hilton find a permanent solution that application — $98 for a lim- said. complies with the law, covers ited menu and$130 for a com- The mobile Cape Cleare the costs of doing so and does 0 plex menu — that covers the cart has its own wastewater not put too heavy a burden on first event the vendor serves storage, hot water and power food-service establishments, 'at. The $15 covers any other generator. she said. events as long as the vendor "The permit fees are the The board approved the serves the same food.A differ- same whether the site has ordinance changing the fee ent menu requires a new $98 these amenities or not,"Hilton schedule for food-service or$130 permit. said, adding that it doesn't establishments that get per- The board's meeting room seem equitable. "We're the mits to sell food at events.An was packed with about 20 infrastructure." earlier proposal to increase people. Larry Dennison, owner the fees was not adopted. In some cases under the of Dos Okies Barbeque All other agenda items proposed plan, the permit to Restaurant and Catering,said from the Board of Health's .participate in an event would the proposal was too expensive July 21 meeting were forward- cost more than a vendor and too complex. He echoed ed to the Aug. 18 meeting. • p7"ofQc) Nutrition for Women, Infants and Children by Karen Obermeyer,Jefferson County Public Health Openings exist in the Women, Infants and Children(WIC) program which provides nutrition information to help pregnant women,new mothers and young children eat well, learn about nutrition and stay healthy.This special supplemental nutrition program offers many benefits for participants immediately and into the future.It is well known that children do better when they are nurtured and receive a proper diet early. WIC provides: • Health screening. • Nutrition and health education. • Breastfeeding promotion and support. • Help getting other services. • Checks for nutritious foods. Call 385-9400 for information and to learn how to sign up.Information is also available at wwwjeffersoncounty- publichealth.org. • • Connect with other• mothers 4 ;,„ K y ' _, { 44 41*. r • a .y r it JOIN US AT THE r BREASTFEEDING TEA • Visit with other mothers • EVERY WEDNESDAY 1 :30 PM • Discuss your concerns • AT THE HEALTH DEPARTMENT with Public Health Nurses • ALL BREASTFEEDING & • Relax & have some tea PREGNANT WOMEN WELCOME Babies & children are welcome. PUBLIC HEALTH QUESTIONS: 385 9400 " ALWAYS WORKING FOR A SAFER AND �' HEALTHIER JEFFERSON ADA(American with Disabilities Act) accommodations will be provided upon request. Please call 385-9400 for assistance. No person because of race,color,national origin,creed,religion,sex,age or handicap shall be discriminated against in any aspect of the activities and services of Jefferson County Public Health Jefferson County Public Health WIC Program provides breastfeeding support to local families & health care staff ashington State WI• Nutrition Pro_ram t Jefferson County Public Health WIC program: Working with you to support breastfeeding WIC mothers in Jefferson County • 0 WIC Staff is trained in Breastfeeding The BreastfeedingTea: a weekly support and social time for all pregnant and breastfeeding mothers. (See back for details) LUEducational material for families & health care providers LUBreastfeeding mothers enrolled in WIC can receive: 1.1.1. • Additional WIC foods including fish Emm. • Breast pumps that suit their needs: Medela electric double breast pumps for working WIC moms, Medela hospital grade pumps Ci) O available to WIC moms with breastfeeding difficulties, or hand breast pumps • Breastfeeding review and appropriate education & materials W Q Jefferson County Public Health 615 Sheridan Port Townsend,WA 98368 a:i cn 38594O011,27-r-i) PUBLIC HEALTH www.jeffersoncountypublichealth.org ALWAYS WORKING FOR A SAFER AND HEALTHIER JEFFERSON _JOIN US FOR THE BREASTFEEDING TEA • A FRES e�et1C :: a .kf A FREE event Every Wednesday 1:30 pm at Public Health • Visit with other mothers • • Ask a Public Health Nurse questions Does your food budget need a boost? • Relax &have some tea Good News -WIC has openings for: Pregnant/breastfeeding women and children under 5 • All breastfeeding and pregnant women, wic is the Nutrition Program for Women,Infants and Children' children and babies welcome Did you know working families and those on unemployment can get WIC?If you get DSHS Medical,TANF or Basic Food Questions call: 385-9400 you are also eligible forWlC.WIC gives you: • Monthly checks to buy up to$100 worth of healthy foods when two in your family are PUBLIC HEALTH enrolled.Each person on WIC gets checks co buy up to$50 worth of healthy foods. ALWAYS��■WORKING FOR A SAFER AND Washington,Scare\v1 HEALTHIER JEFFERSON Tsps to help your family eat well and stay healthy. Nutrition Program • Breastfeeding support. It's easy to apply.No paperwork,no hassle. /!•► Monthly WIC Income Guidelines •Family of 2'earning up to$2,268 per month •Family of 4'earning up to$3,446 per month •Family of 6'earning up to$4,624 per month •Include each unborn child in femilysize. 4 s t { t Call us today Iy�Reach 1.800.32 Hem I tI Getting WIC does not affect your rmniigratrin.stotus.WIC is on equal apportunrty pro-worn. AiO L'!T.}}j