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Jefferson County Public Health – 2009 Report Performance Measures
FAMILY SUPPORT
BUDGET/PROGRAM: Community Health: Family Support Programs
Maternal Child Health (MCH) including newborn follow-up, and Breast Feeding Support, Maternity Support
Services (MSS)/Infant Case Management, Nurse-Family Partnership (NFP), Children with Special Health Care
Needs (CSHCN), Women Infants and Children (WIC), and the Child Protective Services (CPS) Contract
Programs: Early Family Support Services (EFSS formerly ARS), Early Intervention Program (EIP), and
Passport.
MISSION:
The mission of the Family Support Program is to offer health education and support to Jefferson County
pregnant women and families with young children as they build a secure foundation for a lifetime of health,
learning, and community contribution.
The Family Support Team consists of public health nurses, registered dietician, social worker, and support staff.
Our goals are:
-To honor the diversity of Jefferson County families with young children.
-To support and guide families by building on their strengths in order to create a safe, healthy, and hopeful
future for their children.
-To collaborate with community partners in our shared goal of improving health, preventing adverse
childhood experiences and creating a seamless continuum of services.
-To provide high quality services through community assessment, commitment to best practices, professional
continuing education and program evaluation.
GOALS and OBJECTIVES FOR FY2009:
Goal: Improve the quality of caregiving for infants and children through support, education, and intervention
for parents and caregivers.
Objective: JCPH will offer services to all Jefferson County pregnant women, families, and caregivers of young
children through an array of programs designed to fit the diverse and complex needs of a child and family.
JCPH will work with staff and families in the schools, child care facilities, health care settings, and in the
community. Spanish speaking families will receive interpretive services along with forms and educational
materials in Spanish.
Goal: Prevent harm to mothers, infants, and families at risk for or affected by maternal depression.
Objective: Depression screening and education will be offered to all pregnant and parenting women who are
participating in JCPH programs and appropriate referrals will be made for those who have a positive screen.
Data will be collected by staff and become part of program evaluation and community assessment.
Goal: Encourage and support breastfeeding for optimal nutrition and health for infants and mothers.
Objective: Provide education and support to all pregnant women and their families about the benefits of
breastfeeding. Each woman’s decision on how to feed her baby will be supported. Individual office or home
visits will be offered in addition to the group support of the Breastfeeding Tea Party. Ongoing collaboration
with Jefferson Healthcare staff for lactation support will help ensure all families receive the services they need.
Goal: Prevent nutritional related problems for pregnant, post-partum, and breastfeeding women and children
under five in Jefferson County.
Objective: Provide WIC nutrition education and support to all eligible county women and children.
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Goal: Prevent unintended pregnancies.
Objective: Assist parents in making goals and plans around family size and child spacing through education
and referrals for birth control.
Goal: Improve birth outcomes by preventing birth defects, prematurity, and infant mortality. Promote health
and development in children with special health care needs.
Objective: Provide education and support to women who are or are planning to be pregnant about potential
risks, healthy choices and ways to reduce risks to themselves and their fetus/infant. Screening, referrals, risk
reduction, and education will include substance/tobacco use, domestic violence, mental health, and health and
nutrition. Provide developmental and health screening of newborns and children to identify children with
special health and development needs and assist families in getting further evaluation and intervention services.
Staff will collaborate with community providers to ensure quality, comprehensive services for each family.
Monitor state collected data on first trimester access to prenatal care.
Goal: Address child abuse and neglect through outreach, education, collaboration, prevention, and intervention.
Objective: Awareness and assessment of, and prevention and intervention in child abuse/neglect is an integral
component of all Family Support Service Programs. Referrals to CPS/DCFS will be made as appropriate and
services will be provided to families at risk or involved in child abuse/neglect through the EFSS and EIP
contracts. Staff will collaborate closely with other providers to develop a comprehensive plan of care to keep
children safe. Staff will engage in clinical supervision, consultation, and professional education to ensure high
quality care and staff safety.
Goal: Improve quality of services through collecting and analyzing data on health risks and intervention
outcomes. Maintain program fidelity, quality, and caseload capacity of the Family Nurse Partnership Program
as an evidence based best practice.
Objective: Continue research based programs such as Nurse Family Partnership (NFP) and Promoting First
Relationships while developing technology systems to collect and analyze data on promising programs.
Collaborate with state and local agencies in collecting, sharing, analyzing data in program design, delivery, and
client/program outcomes. Support the Nurse-Family Partnership program capacity and program fidelity by
providing opportunities for ongoing support and education to the nurses through weekly clinical supervision,
professional consultation and education and participation in the Washington State Consortium for Nurse-Family
Partnership.
Goal: Increase awareness and support of the Family Support Program mission through community outreach,
involvement, and collaboration.
Objective: JCPH will continue to engage our community partners in exploring the issues of, and finding
solutions to, family and community health issues. We will continue to provide education and information to
community groups, agencies, and providers through our website, local newspapers, and community forums.
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PERFORMANCE INDICATORS: 2006
Actual
2007
Actual
2008
Actual
2009
Planned
2009
Actual
1. Number of depression screenings completed 65 87 85 90 53
2. Number of newborn follow up contacts 145 130 116 120 111
3. Number of Home and Office visits provided by
Family Support Staff in all programs.
1144 1170 1363 1100 1349
4. Families served annually in Family-Nurse Partnership 20 20 25 20 25
5. Total number of women infants and children served
by WIC in Jefferson County (from CIMS report)
829 872 881* 850 868**
6. Number of children with special health care needs
Birth through age 18 referred for Public Health Nurse
Case Management.
81 70 85 40 75
7. Number of families served through CPS/DSHS
contract.
20 30 40 50 57
*From State WIC office Calendar year 2008, Federal Fiscal year 867, ** Local WIC data 2/9/10
Projections for 2009 Budget written July 2008:
Due to Federal cutbacks, JCPH had a 100% elimination of funds in our Children with Special Health Care
Needs (CSHCN) program that targeted prevention services for children birth to three. The annual budget was
$25,000 but was heavily leveraged. (July 2008)
First Steps revenue is down 20% due to reduced reimbursement rates. (July 2008)
We are experiencing a significant increase in the EFSS/EIP (CPS) program caseload and reimbursement. The
contract increase covers approximately a .7 FTE PHN. The record high referral rate and complexity of the cases
has necessitated increased staffing in these programs including more visits requiring 2 PHN’s and a significant
increase in collateral contacts and cross agency collaboration.
NFP has a full caseload and remains without stable and adequate funding. We remain committed to NFP as a
very high priority prevention program.
Our Satellite clinics in Quilcene and Chimacum are being heavily utilized. Currently approximately 35 families
are served at each site. Utilization has increased as families have increasing financial stress.
We continue to work down one PHN position. We have been unable to fund and attract a qualified nurse.
Based on our years of work in the community with a broad spectrum of families we feel quite concerned about
the very high level of stress families are coping with while they also face an astounding lack of real resources.
We have seen an increase in food insecurity as housing and transportation/energy costs increase. We also have
seen a huge increase in incidence and severity of methamphetamine use in women and teens.
Summary/Analysis of 2009 Results - February 2010:
July 2009 Washington State cut funding for Maternity Support Services by 25%. The State made the cut by
increasing the risk criteria for families to qualify for services. JCPH management reduced outside personal
services contract to compensate for anticipated reduction in revenue starting in July. To compensate for
reduction in staffing Family Support programs eliminated offering universal newborn follow-up for all
newborns referred to JCPH. JCPH continues to follow families who qualify for MSS as funding and staffing
allows. As of December 2009 MSS revenue is down 35% due to reduced reimbursement. February 2010 a
Family Support Public Health Nurse resigned and it is unknown if that positions will be filled based on funding.
NFP has a full caseload (22-25). JCPH was able to secure 1 10th of 1% funding in 2010 to maintain NFP
services/staffing with the loss of MSS funding that had supported some of the NFP visits in the past. JCPH
remain committed to NFP as a very high priority prevention program.
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JCPH Satellite clinics providing WIC and Family Planning and MSS in Quilcene and Chimacum are being
heavily utilized. Quilcene clinic enrollment has doubled since we initiated weekly drop in hours; now 50
families. Family Support Programs are now down 2 nursing positions from 5 with no budget to hire.
Childrens Administration programs EIP/EFSS continue with full support in 2009 with many referrals from
Child Protective Services. 2010 funding is secure but 2011 funding is not secure due to a change in how
Childrens Administration will be contracting for services. Foster Care Passport program Contract with
Chidrens Administration ended December 2009. The Public Health Nurse providing that service offered to
reduce her hours to compensate for the reduction in revenue.
JCPH Family Support Programs is proceeding with a new project thanks to a small grant from a local group.
We have created and are using a new screening tool designed for new and interval clients who are pregnant
and/or parenting. This tool uses questions from standardized assessments such as the BRFSS and includes the
CDC short from of the ACE questionnaire. Currently we are using this to help clients understand their own
health risks and develop a care plan. This next year we hope to start looking at this as data to better understand
the needs of families with young children in our county. We have contracted with and MCH epidemiologist for
this process.
WIC continues to have Federal support and Federal funding. WIC numbers continue to stay up. Monthly
caseload numbers are slowly increasing.
February 23, 2010 draft