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Home My WebLink About02 February JEFFERSON COUNTY BOARD OF HEALTH MINUTES Monday, February 12,2001 Board Members: Dan TitternesJ, Member - County CommisJioner DÙtrict # 1 Clen Huntingford, Member - County CommÙJioner DiJl1id #2 Richard Wqjt, Member - County CommÙsioner DÙtrict #3 Cer1frry MaJà, Member - Pori Town.rend Ci!y Counàl . pll Buhler, Chairman - Hospital Commissione¡^ DÙtrid #2 Sheila Wl"e,fterman, Vice Chairman - Citizen at I...ßr;ge (City) Roberta Frimll - Cïtizen at Larlf/ (Coun(yj Staff Members: ~anBaUwm,1VHnmgSen;«~fDire(wr Lat'?)' }-<qy, Ent'ironmental Healtb Diredor Thomas Locke, MD, Health qlficer Chairman Buhler called the meeting to order at 2:00 p.m. All Board and Staff members were present with the exception of Commissioner Wojt and Member Masci. APPROVAL OF MINUTES Member Frissell noted that Commissioner Wojt did not attend the last meeting. On page one, paragraph one, the last sentence should be deleted. In paragraph three, "Member Westerman seconded the motion instead of Commissioner Wojt, noting that Commissioner Wojt was not in attendance." Commissioner Huntingford moved to approve the minutes as corrected. Commissioner Titterness seconded the motion, which carried by a unanimous vote. Vice Chair Westerman requested that a discussion of the letter from Goodman Sanitation be added to the agenda. Member Frissell also asked that a food handling class for members of volunteer organizations be discussed. OLD BUSINESS Substance Abuse Treatment in Jails: Jean Baldwin agreed to provide a brief report next month on current treatment in jails and the possibility of a liaison between the Substance Abuse Board and the Board of HeaJth. NEW BUSINESS Community Health Indicators Follow-up: Jean Baldwin reported on the January 25th workshop with Dr. Chris Hale, a summary of which was provided in the agenda packet. The workshop was a success and met staff's goals for generating enthusiasm about the BRFSS Risk Survey and reaching other interested data users. There were also discussions with Clallam County about a regional approach. The partnerships that were developed exceeded expectations. The challenge will be to retain the long-range vision while setting up a strong steering committee and data users group. The data users HEALTH BOARD MINUTES - February 12,2000 Page: 2 group may include the County, WSU, OlyCAP, and OAAA Thc BRFSS information is available on the Jefferson County web site and will be updated regularly. Dr. Hale will return in March and April to work with subcommittees of law and justice and other agencies addressing issues involving seniors, families with young children and youth 15 to 25. In response to a question about how the $50,000 offered by the City would be used, Jean Baldwin said it would buy certain additional elements in the BRFSS study needed to identify behavioral risk issues. A steering committee will decide what information is needed and will also work with the data users group. County Administrator Charles Saddler added that the goal is to use this data to develop policies that would have a beneficial impact on jail populations. Jean Baldwin reported that aside from $5,000 already budgeted for the Jefferson County Environmental Health indicators, the Health Department also submitted a grant application to cover half of the BRFSS costs. Additionally, the assessment data will demonstratc the need for Department of Corrections treatment funding that will become available next year. Vice Chair Westerman stressed the need for calendar coordination with hospital representatives before future workshops are scheduled. Jean Baldwin said it will be important to identify whom in the hospital is interested in looking at the health indicator information and senior and youth issues. Dr. Tom Locke is the hospital liaison. Report on Future of Rural Health Colloauium: A report was provided by Member Prissell on the January 29th colloquium sponsored by the Washington Health Foundation. There were roughly 70 people in attendance representing 10 rural counties. She was particularly impressed with the keynote speaker from the Center for Disease Control (CDC) who spoke on the concept of "social capital" and showed how it is measured. During a discussion of what counties would most like to see within the next 3-5 years, most spoke in terms of crisis and survival. Many attendees voiced support for her comment that she would like to see measurable improvement in the community's health, including improved access to healthcare. At the meeting, the Washington Health Foundation announced that grants of up to $50,000 are available for pilot projects to help communities with alternative healthcare financing systems. She reviewed the grant criteria. Dr. Tom Locke said that Jefferson County, through its joint board process, meets the criteria for involvement in a demonstration project. He commented that while the healthcare situation is bad locally, conditions are worse in other areas of the state. Statewide, trends are expected to continue downward. Noting that modern problems are beyond the resources of any given entity, the CDC representative suggested that the best solutions to complex health delivery problems come when communities work together and pool resources. Modern problems are beyond the resources of any given entity. Best Beeinnines Update: Jean Baldwin reminded the Board that David Olds will be presenting his model for maternal child health in a work session on February 15th in Lacey. HEALTH BOARD MINUTES - February 12,2000 Page: 3 After introducing Maternal Child Health Coordinator Carol Hardy, Jean Baldwin rcferenced the status report, the purpose of which is to show the Board the many pieces connected with maternal child health, to express interest in the Hawaii model, and to announce that funding is being pursued to provide a menu of services. Child Protective Services wants to start a Hawaii Healthy Start program in conjunction with the County's Best Beginnings and Maternity Support programs. Jefferson County is likely to receive an Early Head Start grant which would cover ten families at 100% of the poverty level from pregnancy through school-age and would serve all famiJies including Medicaid families. Charles Saddler provided examples of how the Hawaii model was used in Florida to address issues of domestic violence and the risk factors associated with juvenile delinquency, neglect and abuse. He talked about some of the differences with the Hawaii model versus other models. Jean Baldwin said the desire is to expand services to the whole community as opposed to just those who qualify through maternity support or Medicaid. If the community can come up with funding, then more families can be served. Vice Chair Westerman expressed her support for these long-term programs and, at the same time, acknowledged the difficulty in pursuing policy shifts because the results take so long to see. Charles Saddler said the local community has to be willing to invest in social capital. Once the community understands and prioritizes children's service issues, various models can be implemented. He talked about a variety of funding mechanisms and the development of a coalition of community leaders that helped support the model in Florida. It took a five-year commitment and the cost was approximately $2,700 per year per family. Jean Baldwin provided a brief overview of the components of the Washington First Steps programs that help support home visits and case management. The cost savings are not necessarily reflected in the cost center paying for the initial visits, but are seen in DSHS welfare and disability, schools, and juvenile justice. While the infrastructure is in place to provide services, funding is not there to increase the number served. Lee:islative Uµdate: Dr. Locke reported that a huge budget crisis is looming. Most requests for new spending are not expected to pass because there is not enough money for current programs. As directed by the Board last month, he reviewed the priorities as outlined in a draft letter from the Board to State Legislators: (1) rural health care access improvement, (2) maintain and/or enhance local public health funding, and (3) continued support for Washington State Universal Vaccination Distribution System. Absent from the list is tobacco use. Although the legislature set aside $100 million of the tobacco settlement funds for health-related projects, it has only authorized spending $15 million dollars. Legislative action is needed to authorize further spending. Washington is currently one of the few states spending settlement dollars on health-related issues and there is stiff competition for health and non- health programs. Commissioner Huntingford asked if these funds were stable enough to use as a funding source for Basic Health? HEALTH BOARD MINUTES - February 12,2000 Page: 4 Dr. Locke said a sin tax is never a good funding source for health programs. Vice Chair Westerman said she agrees with thc three priorities. She also agrees with Representative Lynn Kessler who said that, given the growth in the state, legislators need to talk about lifting the 601 lid or thcre will not be enough funds to support thesc programs. Shc proposed that a sentence be added to the letter acknowledging that the legislators need to engage in a discussion about raising that lid. Commissioner Huntingford said he agrees that if you are going to send a letter outlining spending priorities, you need to offer a funding solution. It is also important at the local and state level to prioritize programs and consider areas where cuts can be made. He rarely sees programs being cut. Dr. Locke said many health advocacy groups support lifting the 601 limit specifically for health issues. The rate of increase in the health sector is much higher than the annual percentage allowed by 601 and is driven by factors that do not relate to inefficiency, but technology and the aging of the population. Both demands and options are increasing. The Board approved the letter with an addition to the first sentence in the last paragraph "and that the legislature needs to engage in a discussion about raising the 1-601 limits to address these important health issues." Dr. Locke pointed out that HB 1742, the text of which was included in the agenda packet, is the bill referred to in the letter. Policy on Review of Buildine Permit Applications: Larry Fay reviewed that last month, the Board discussed the policy designed to implement provisions of the new regulations that says when you apply for a building permit, you need to meet current code. The policy has not yet been reworked, but the two situations discussed were: (1) when a septic system is in the ground and an owner is ready to build and (2) when someone has an existing system and they want to remodel. With the second situation, Member Masci suggested staff sit in on City discussions about Smart Code to see whether that approach might help develop a policy for triggering when building upgrades are required. Instead of using a straight formula from the UBC to determine the threshold for compliance with everything, there may be a matrix with gray areas to help make those judgment decisions. Staff still feels that the compliance decision will be linked to the building permit so there is a uniform expectation, but a similar decision matrix may be able to be incorporated. Linda Atkins reported that the City has hired two consultants to review a range of commonly-confronted issues related to remodels, construction and destruction. The City will be addressing certain areas of the building code and evaluating and comparing language of other codes used in situations to come up with a matrix showing thresholds and then offering choices and timelines. Smart Code primarily applies to historical buildings. The compliance threshold was typically an increase of 50 percent of the assessed value or 50 percent of the square footage of the roof. On February 26, the City will look at 12 issues to see how Smart Code would be applied and then look for specific projects where these options could be tested. County staff will bring back information and see if there are applications for septic system compliance. HEALTH BOARD MINUTES - February 12,2000 Page: 5 Charles Saddler added that this would be yet another code that the building official might utilize. If it is a new structure, they would use the building code. If it is a retrofit of an existing structure, then they might decide to use the Smart Code. There is a question of liability, however, if the code allows for interpretive decisions. Commissioner Titterness said it is often necessary for the applicant to read the code and then find the exceptions. Typically, the enforcing official will not provide the exceptions for the applicant. Commissioner Titterness understands the UBC is going to be superceded by a combination code and adopted at the state level. He believes it is worth considering whether DOH can take the risk to adopt less restrictive codes in building or give approval for new technologies and then push the state to move in that direction. Larry Fay said we may not be able to change the building code, but we could generate ideas that help DOH implement the regulations in logical ways and in a way which most people can understand and accept. The goal is to reach an interpretation which is more flexible than one which says that at a certain point an owner must upgrade everything. He reviewed what other jurisdictions are doing in interpretation of the state code. Linda Atkins said knowing the associated risk in particular areas is also a factor, such as high water tables or less populated areas where it is not a public health issue. More aggressive programs exist around the Puget Sound. Commissioner Huntingford said the County Commissioners discussed at length the issue of systems that are in the ground but no longer meet current code. He sees the need for a mandated site inspection to ensure a system is working before a sale takes place, but expressed concern about the need to meet current code even though a system may be working. Larry Fay said some people on the advisory committee believe that if it does not meet code, you replace it. He said we are conducting the sale inspections purely to determine whether the system is functioning -- meeting code is not the issue. If you are applying for a building permit, that is another issue. Upon the suggestion that the Department give owners a warning of problems, Linda Atkins said with every evaluation of existing systems, she or any other staff make a concerted effort to help the owner understand the situation with which they are faced. Food Handline Class: Member Frissell said she has spoken with Susan Porto about a food handling class for volunteer organizations. Ms. Porto suggested notifying volunteer organizations that a class will be available. It would not be the same class as for a food handler's permit but, rather, food safety education information for non-permitted activities. HEALTH BOARD MINUTES - February 12, 2000 Page: 6 AGENDA CALENDAR/ ADJOURN Future Planning Topics: Review of Goodman Sanitation Letter and Discussion of Food Handling Class. Update on Building Permit Applications and the Internal Assessment Report and Recommendations. 2001 AGENDA ITEMS 1. CONTINUED STABLE FUNDING TO REPLACE MVET 2. ACCESS HEALTH CARE 3. PROGRAM MEASURES (Genetic Research and Public Health Implications) 4. METHAMPHETAMINE SUMMIT 5. PERFORMANCE STANDARDS & COMMUNITY ASSESSMENT 6. TOBACCO PREVENTION AND COALITION 7. FLUORIDE 8. TRANSIT AND PUBLIC HOUSING 9. BIOTERRORISM READINESS & PLAN 10. AGING POPULATION 11. WATER 12. MATERNAL CHILD PREVENTION GOALS (0-3) Meeting adjourned at 4:05 p.m. The next meeting will be held on Thursday, March 15,2001 at 2:30 p.m. JEFFERSON COUNTY BOARD OF HEALTH fj¿¡JÔ-- . ).' " :/ I . t..-(.{/I__.. r Buh~er, Chairman Sw ltJ-.. ~te) (~/ v~-'v~ Sheila Westerman, Vic C! irman (Excused Absence) Geoffrey Masci, Member (Excused Absence) Richard Wojt, Member /L?'¡ilti:f1~~(! Roberta Frissell, Member JEFFERSON COUNTY BOARD OF HEALTH Monday, February 12,2001 2:00 - 4:00 PM Main Conference Room Jefferson County Health and Human Services AGENDA I. Approval of Minutes of Meeting of January 18,2001 II. Public Comments III. Old Business IV. New Business 1. Community Health Indicators Follow-up 2. Best Beginnings Update 3. Report on Future of Rural Health Colloquium Jean (30 min) Jean (30 min) TomIRoberta (15 min) Tom (10 min) Linda A (20 min) 4. Legislative Update 5. Policy Relating to Building Permit Applications V. Adjourn Next Meetin2: March 15, 2001 t JEFFERSON COUNTY BOARD OF HEALTH .:1 MINUTES Otl~'t- Thursday,]anuary 18,2001 Board ¡vlembers: Dan Harpole, Member - COJII1!Y CommifJioner District #1 Glen Huntintford, Member - CounD' CommiJ"Jioncr DÙtriti #2 Richard ¡,Fqjt. Member - COlli:!)' Commirjjoner District #3 GeojJ7"0' Ma.rá, Member - Port Townsend City COlll1âl Jill Buhler. J,"ice-Chairman - Hospital CommisJioner Distri.t #2 S hei/a Jr-'Úterman, Citizen at urge (Ci!J) RobeT1a Fri.mll. Cbai17J1an. Citizen at Large (CoNn!)) StafMembers: Jean Baldwin, NHrsillg Sm'kes Director Larry Far, Environmental Health Dimior Thon;as Locke. MD, Health OJficer DRA.Fr Chairman Frissell called the meeting to order at 2:30 p.m. All Board and Staff members were present with the exception of Vice Chairman Buhler. Commissioner Wojt arrived shortly after the meeting began. ELECTION OF 2001 CHAIR AND VICE CHAIR Member Westerman moved to elect Member Buhler as Chairman. Member Masci seconded the motion, which carried by a unanimous vote. Member Masci moved to elect Member Westerman as Vice Chairman. Member Frissell seconded the motion, which carried by a unanimous vote. APPROVAL OF MINUTES Member Frissell noted that at the top of page two, second sentence, cr increasing income tax" should be changed to "establishing an income tax. " Member Masci moved to approve the minutes as corrected. Commissioner Wojt seconded the motion, which carried by a unanimous vote. OLD BUSINESS Internal Assessment Report: Dr. Tom Locke distributed copies of the Health and Human Services Internal Assessment Report, which the County Commissioners received yesterday. He commented that useful information was generated from the assessment and the raw data can be used as a baseline for future assessments. He thanked Chairman Frissell for her assistance with the survey. NEW BUSINESS 2000-2001 Influenza Season Update: Jean Baldwin introduced Public Health Nurse Jane Kurata, who is in charge of immunizations. Ms. Kurata reported that due to production problems the target age for the vaccine was increased to 55. Although there were delays in receiving the vaccination and clinics were rescheduled, the Health Department eventually received 1,300 doses, of which about 40 remain. ~ , HEALTH BOARD MINUTES - January 18,2001 Page: 2 Member Masci asked what number of the population was being targeted as "at-risk?" Jean Baldwin said she would try to provide these figures by the January 25 Workshop. Child Health Profile Implementation in Jefferson County: Communicable Disease and Immunization Program Coordinator Lisa McKenzie explained that the two main components of Child Health Profile are the health promotion materials and the immunization registry. This information is derived from the database of birth certificate information. She reported that King, Pierce and Snohomish Counties have been using the registry for five years, but the Peninsula has yet to participate. The expense of this service is often a deterrent for rural health departments and local physicians. A two-year trial period is being offered in which subscribing providers get access to a statewide immunization registry at no cost. State and local jurisdictions are interested in the registry to ensure children are not over-immunized due to lost records, to quickly identify those not immunized during a disease outbreak, to target under-immunized areas, and measure immunization rates. Jean Baldwin said the Health Department has signed up for the free two-year trial period. Information taken from Medicaid records show that, 31.5% of children under age six are already in Jefferson County's database. The Health Department has budgeted for a clerical support person to assist local physicians by entering four or five years of data into the system. The governor's budget includes an additional $2 million for Child Health Profile. Staff will continue to move forward with this project as a priority. Substance Abuse Treatment in .Jails - Public Health Issues: Dr. Locke said this item was suggested by Commissioner Tittemess to better understand the long-range public health implications of incarcerating people without intervention or treatment. Dr. Locke said this has been a big public health issue for some time. He pointed to the two drugs that have the most widespread adverse effect - tobacco and alcohol. The combination of those two account for 500,000 preventable deaths per year compared with 20,000 for all illegal drugs combined. The issue of treatment for drug addiction in County jails is one that overlaps jurisdictional boundaries (Le., Sheriff's Department, County Commissioners, and Health Departments). The report from the Department of Justice provided in the agenda packet is reflective of the situation in Washington State, where 70% of inmates are either addicted to one or more substances or are incarcerated because of a drug-related offense, or both. Drug addiction is not their only health problem, but is a contributing factor in their incarceration. Despite this fact, very few get treated for their addiction while incarcerated (roughly 10%) and a very high percentage of addicts will return to their primary addiction once released. The report also indicates that drug use while incarcerated is not a rare phenomenon. Member Masci pointed out that the report did not mention the number of staff arrested for providing drugs to inmates. Vice Chairman Westerman mentioned California's recent initiative guaranteeing treatment for first and, in some cases, second-time offenders. With law and justice using an increasing amount of the state and local budgets, she asked if it is time for Health Boards to take action toward treatment? One of the reasons she supported expanding the Board of Health was to provide a forum to address issues that may HEALTH BOARD MINUTES - January 18,2001 Page: 3 be too controversial for elected officials to take on alone. Jean Baldwin said the Health Department does not want to compete with Mental Health for funding in finding a solution to these problems. She suggested the Health Board assist the Substance Abuse Board by setting a vision and standards. That Board, by statute, is required to be configured with a high percentage of people in recovery and is also charged with helping the Commissioners layout a vision for disbursing funds. Member Masci asked if it would be helpful to appoint a Substance Abuse Board liaison with the Board of Health? County Administrator Charles Saddler talked about the County's development of a Health and Human Services Advisory Committee to look at the human condition and perhaps create subcommittees to take on certain tasks or responsibilities such as Substance Abuse. A task force comprised of the Health and Human Services Committee and the Law and Justice Council could address methamphetamine, a problem which is consuming more and more resources outside of health, law and justice. Member Masci suggested that this committee include a representative from the City. Vice Chairman Westerman said she supports the objective of broadening people's vision. She is concerned that current Boards would be disbanded. As a long-time Developmental Disabilities Board Member, she hopes Board members continue to have a place to provide their input and expertise. When asked if the Board of Health has a recommendation to begin addressing the issues in the jails, Dr. Locke responded that the role of Public Health is in keeping track of the statistics and pointing out that addiction is a disease for which there are effective treatments if they are, in fact, utilized. He added that, under state law, the human service component is the responsibility of the Board of County Commissioners, not the Board of Health. Member Masci asked whether there could be mandatory drug testing of inmates entering the jail system, so that there could be a focused effort on drug addiction? Charles Saddler suggested that the Board of Health, as a neutral party, could be the arbitrator of effective treatment methods. While the Sheriff would like to see an in-jail drug treatment program, there is a great deal of resistance from others in law enforcement. Jean Baldwin agreed to ask Dick Gunderson, Substance Abuse Coordinator of DASA whether anybody is doing treatment in jails. Charles Saddler said the County has a stable jail population with recurring offenders. Opportunities for intervention, even late in the game, may prevent re-entering or the next generation from entering the criminaljustice system at all. While it may not be prevention in the truest sense of the word, it has the potential to have a significant preventive element. While the Board did not regard this topic as an action item, there was interest in further discussion about " HEALTH BOARD MINUTES - January 18,2001 Page: 4 possible additional requirements or mandatory testing. Dr. Locke said that a fairly complex body of law already exists that specifies what testing is permissible (such as for TB) and what is sometimes permissible (such as HIV). Legislative Update - Meeting With 24th Legislative District Representatives: As requested by the Board at the last meeting, Dr. Locke said he and Member Buhler inquired about the possibility of a meeting with legislators in February. Jefferson General, the Clallam Board of Health, and several other agencies also expressed interest. However, the legislators are each offering different alternatives to a meeting. Representatives Buck and Hargrove are going to be attending a State Hospital Association meeting. Representative Buck offered to do a telelink with the Olympic Medical Center. Representative Lynn Kessler has agreed to come to Port Angeles and participate in a town hall meeting, Saturday, February 10 or 17, part of which could be devoted to health issues. It is hoped that if a town hall meeting is scheduled that Senators Buck and Hargrove will also attend. \ Dr. Locke asked that the Commissioners provide encouragement for these meetings. He sees a benefit to having a health-related meeting where not only Boards of Health and Hospital Commissioners, but medical providers and healthcare workers can tell their stories. He is convinced that the health care crisis has finally hit Jefferson and Clallam Counties. Member Masci said he believes that a clearly-articulated position needs to first be outlined. Legislators know that each group is going to ask for more money. The Board agreed that a letter be written to legislators listing Jefferson County's priority issues and presenting ideas for what legislators can do to maintain or improve access. Jean Baldwin mentioned that her priorities for the Rural Health Summit would be MVET replacement and additional child health tracking. She will let the Board know whether Representative Kegy was going to ask for the Olds project to be replicated in more Counties or at least continue the funding for the four Counties that are currently participating. Dr. Locke suggested focusing on three key areas: (1) no additional cuts to Medicaid funding, (2) alternatives for health care, and (3) public health funding, which he believes includes the areas Jean Baldwin mentioned. He agreed to work on drafting a letter with assistance from Member Buhler and will circulate an initial draft to the Board. Commissioner Huntingford said he received an emaiI about further cuts in mental health, which will be discussed at the Steering Committee meeting tomorrow. He will try to find out more information and provide an update to Jean Baldwin. Policv on Design Standards For Site-constructed Elevated Fixed Media Filter Vessels: Larry Fay pointed out that the draft policy statement included in the agenda packet has not been modified since the last meeting. Although no written material is available for today's discussion, industry representatives for pressure treated lumber have confirmed there are specifications for different HEALTH BOARD MINUTES - January 18.2001 Page: 5 kinds of exposures. The engineer would be able to specify what kind of materials they are using to construct the vessels. The draft policy was reviewed by an engineering firm. designers. and a statewide committee and indicated that the language is clear. It appears that as a result of the case in Jefferson County, Glendon Technology is working to change their business practices, moving to a modular kit with standardized materials, with which their distributors are required to work. Member Masci moved to approve the Fixed Media Filter Vesse! Policy as submitted. Commissioner Huntingford seconded the motion, which carried by unanimous vote. Policv on Review of Buildim! Permit Applications - Second Draft: Larry Fay noted that the policy statement provided in the agenda packet incorporated changes resulting from the last meeting. He then distributed another version of the policy, which is basically the same, however it reflects staff's recommended changes. The new ordinance has two provisions in different sections that deal with inspections of on-site systems for when a building permit application is submitted. Under Applicability, if the system is currently in the inspection program and up-to-date with inspections, a building permit application inspection would not be needed. A second tier of inspection applies to building permit applications that are either for new construction that involve plumbing or an expansion of use. This policy is written so that it applies to any new construction, remodel or addition. What he is proposing is that this policy apply to any site that has an on·site sewage system in the ground, whether it be a new construction or additions/remodels that are expansions. In an expansion that significantly changes the house so that it affects sewage flows and the potential performance and reliability of that system, it is proposed that the permit be tied to the building code. When the work of remodeling the house is equivalent to some percentage of the assessed value of the property, the whole building will need to be brought up to code. In other words, when the building official requires a complete upgrade of a house the septic system would be included. Member Masci invited Larry Fay to the next City's Smart Code committee meeting January. The City has received a state grant to explore Smart Coding and he believes the County may be able to use the method by showing on a matrix the combination of things that trigger septic compliance. Commissioner Huntingford would like to know more about the threshold in the building code. He asked at what point does that building permit trigger new compliance standards? He is concerned that property owners with septic systems approved by the County under the code of that period, will now be required to upgrade their systems. Some lots may no longer be buildable under the current code. Vice Chairman Westerman said when you buy property, there is a risk that you may be able to build on the property and you may not. You cannot always allow citizens to operate their systems under 20 and 30-year old regulations. Member Frissell said the Board has to be concerned about the health issues associated with these systems. Commissioner Huntingford said he questions the prosecutor's interpretation of what the state law requires. While he does not want to see property owners having problems with their well, for instance, · HEALTH BOARD MINUTES - January 18,2001 Page: 6 there may be other options available to them such as moving their well. He is not aware of health issues with systems approved in the early 1980s. Larry Fay provided a recent example of a property owner that installed two septic systems and had two mobile homes on the property. At some point, they removed one home and then recently applied to add another mobile home using the old system. Because of the density on that particular site, there may not have been an immediate environmental or health problem, but the system is not functioning up to current code since it is discharging septic effluent into that shallow water table. There will be situations where currently unused fields would not perform in accordance with modern standards. The policy stipulates that when the County determines there is the adequate 3 feet of vertical separation, etc., the owner is required to establish a reserve area to proceed with a building permit application. If there is between three feet and one foot of vertical separation, the system can still be used, but instead of being on a 3- or 6-year monitoring schedule, the system is placed on a I-year monitoring schedule. The concern being that with the reduced vertical separation, failure is of a higher consequence. An upgrade would be requested when a system is 12 inches or less from a water table. Even then, the owner can still use the drain field, but a treatment standard will be added in front of the drain field so effluent is treated before leaving the system. Commissioner Huntingford asked about elimination of wording on pg. 3, item 4, "owner may install curtain drain or make other site improvement and keep monitoring. " Larry Fay agreed to follow up on this item. If there is a site that is logical for a curtain drain and there is a place to discharge that does not interfere with anything, it ought to be an option to improve the system's performance. He said it is allowed in the on-site sewage code. Larry Fay said if a septic system was installed sometime after 1987 and the owner submitted the building permit applications consistent with the terms and conditions of that permit, enough information is available and the standards have not changed, that it is likely the permit would be approved. However, between 1983 and 1987, the Board of Health indicated to the public that if a septic system was in the ground you would be able to build. While a reserve area will need to be designated, it will not be a big problem until the lot in question is small enough where there cannot be both a reserve area and a place to build a house. Commissioner Tittemess said in that situation, there has to be a contingency for them to agree to an alternative system of some kind, should their system fail. Larry Fay said situations where there is no reserve area would be candidates for pretreatment to provide high-quality effluent in the drain field and make such failure improbable. In the case of a sand filter or a package treatment plan, it would provide a repairable component if failure did occur. Vice Chairman Westerman commented that this seems to be a reasonable response. Member Masci said because there are always going to be gray areas he would like to see a regulatory structure that included a customer service component. He suggested that a grid of priority mitigation HEALTH BOARD MINUTES - January 18,2001 Page: 7 responses be developed. Larry Fay said the biggest challenge is preserving water quality and balancing real and perceived expectations. Differentiating between a real health problem and a problem with design standards is often a judgment call. Applications submitted before this policy is in place will be dealt with on a case-by-case . basis. If someone had a septic permit and the system was installed and permitted for a 3-bedroom sometime between 1983 forward. it is fairly predictable that they are going to use that system and build a house. However. if there is no reserve area. an alternative system needs to be considered. Commissioner Huntingford suggested the O&M program offers safeguards. Larry Fay said while the O&M program will pick up the kind of failures where there is effluent running across the surface of the ground, it will not uncover the treatment failures in the soil. The concern is where there is not vertical separation and untreated effluent is moving through the shallow water table and showing up 100 or 200 feet away from the drain field in an untested area and feeding into some of the other tributaries. A system may drain for 10 years, but what is happening in the soil is also a concern. Member Masci asked if it is possible to create the policy and then educate the real estate community that septic tank inspection is a contingency of the sale. Charles Saddler said this is occurring, but the County needs to come up with a more comprehensive, more formalized process because of the entire Unified Development Code (UDC). Larry Fay summarized that while he believes the Department can deal with the 1983 permits and small lots and vertical separation, he does not yet have clear direction on a 3-bedroom septic system irrespective of when those applications are made. Commissioner Huntingford asked staff to find out how many old permits are still on the books. Larry Fay responded that is difficult unless someone reviewed the files to see if there was a )uilding permit issued or go through the Assessor's records and see if there is a building on the property. Commissioner Titterness said while he guesses there are not many systems from that period, there needs to be consistency. At the time the owner requests a permit, it is our responsibility to let them know of potential problems for which they will be responsible. He asked if something that accomplishes a perimeter check on those few systems could be added to the annual inspection? Larry Fay said site-specific ground water sampling is challenging at best and would not provide water quality information that could be counted on to determine a failure. The question is what do we do if there is 12 inches or less of vertical separation? Commissioner Titterness said he believes a permit would still be issued. In the annual inspection, if there are signs of failing, you make it clear to the owners that an advanced system was recommended. HEALTH BOARD MINUTES - January 18,2001 Page: 8 AGENDA CALENDAR/ADJOURN FUTURE PLANNING TOPICS: Update on Building Permit Applications and the Internal Assessment Report and Recommendations. 1. CONTINUED STABLE FUNDING TO REPLACE MVET ,., ACCESS HEALTH CARE 3. PROGRAM MEASURES (Genetic Research and Public Health Implications) 4. METHAMPHETAMINE SUMMIT 5. PERFORMANCE STANDARDS & COMMUNITY ASSESSMENT 6. TOBACCO PREVENTION AND COALITION 7. FLUORIDE 8. TRANSIT AND PUBLIC HOUSING 9. BIOTERRORISM READINESS & PlAN 10. AGING POPUlATION 11. WATER 12. MATERNAL CHILD PREVENTION GOALS (0·3) Meeting adjourned at 4:30 p.m. Due to a lack of a quorum the next meeting will be held on MONDAY, FEBRUARY 12,2001 AT 2:00-4:00 P.M. JEFFERSON COUNTY BOARD OF HEALTH (Excused Absence) Jill Buhler, Chairman Geoffrey Masci, Member Sheila Westerman, Vice·Chairman Richard Wojt, Member Glen Huntingford, Member Roberta Frissell, Member Dan Tittemess, Member Board of Health Follow-up Report of January 25th and 26th Jefferson County Health & Human Services Looks At County Health Indicators Dr. Chri" flak. of Hale Associates. joined us on January 25/11 and revÎe\ved health indicators from vital records. other health indicators and demography. Dr. I-laic provided energy and excitement while the community looked at somewhat overwhelming numbers. The numbers became stories as they were revÎc\\ed. ¡'or those of you unable to attend, I have enclosed a copy of the agenda. the data and Behavioral Risk Factor Surveillance Survey (BRFSS) sheet. The current data is available for the cnmlllUI1 i ty atIJJt.¡;¡:.//.W..\ðCt£. co. iefferson. wa. us/Ilea ¡tll/ defa u It. htm The general consensus of the meeting is that participants want rei iable assessment data. · There is great interest in the BRFSS that will happen in Jefferson County throughout 200 I. · There is interest in other data that is not compiled and possibly not easily available · There is also interest in continuing partnership to improve the accuracy of data - Olycap came tÓnvard at the training and said that they would like to partner and gather data · Tlh: city or Port Townsend will provide $50,000 funding over two years to review the social law andj Llsticc issues that result in incarceration or juvenile j usticc system services. Existing data \\iJI he analyzed and new data gathered so that coherent science based policy development and program recommendations can be available. JCHHS will enhance their contract with Dr. Hale tor thi" data analysis. program research and recommendations. Illese partnerships exceeded the expectation or the statf in bcginning this project. As policy makers. ,\PLI. rhL' Bpard or Health. must look at assessment data to determine priorities. Dr. Hale and JCHHS \\ ill h:\ \e d s....ri L'S 0 r quarterly meetings that special ize in topics of substance aouse, law and justice. hirth [(I dge II\e. school age. youth 15 to 24. aging adults and 70 + years and service needs. Short llIanl'rh !11eL'lÎngs \vill run two hOLlrs at WSU. Thc challcngc will be to invite the number ofpeoplc \\110 arl' !11pst likely to be interested. An e-mail list \vill hc established and we will send out reports to l'\....ryP1J<.· 1\ w attcnded. as \vell as those who \vcre invited. Jefferson Count.Y Communít.Y Health Jndícators Meetíng W SU Spruce Koom Januar'y 25,200 I AGENDA Dr. Tom Locke- Assessment shapes good decisions Dr. Chris Hale - Overview · What do we know about data in Jefferson County? · Economic Data · Health Indicators · Birth · Death · Communicable Diseases · Quality of Life · Quality of Life Discussions: Families & Young Children Youth 15 to 25 Adults 25 - 64 Seniors Environmental Health Tobacco I Substance Abuse Defining the gaps I What would we like to know? · What is the Behavior Risk Factor Surveillance Survey? o When is it coming? o What is available? o Who uses it? o Morbidity · Upcoming Census Data Break to review data Where do we gal How do we track 'NtIat is important to Jefferson County citizens? · Build partnerships - County wide I Regional data users groupl web sites · Establish committee that is a clearinghouse of quality i>....· ·.·..··....·...···.··..2001 Behaviora.··..·.···.·..··.··.·..I.·......... R1sk>F.·......·~.a.··.·.. ctÔ.·...·.i·Surveillance . " "",'" ",'" S.$teIÍ1Questionnaire In troducti on ......... .............................. ........................................................................... iii CDC CORE QUES TIONS ............................. .................. ..... ... ..................................1 Section I: Health Status............ .......... ...... ........................................ ...................... ......... 1 Section 2: Health Care Access (& CDC Optional Module).............................................2 Section 3: Exercise..... ............................ .................... ...................................................... 4 Section 4: Hypertension Awareness......................... ....................................................... 4 Section 5: Cholesterol Awareness............. ....................................................................... 4 Section 6: Asthma..................................................... ....................................................... 5 Section 7: Diabetes (& CDC Optional Module) ..............................................................6 Section 8: Arthritis..................................................... ......................................................9 Section 9: Immunization (& Washington State-Added Questions) ...............................10 Section 10: Tobacco Use ................................................................................................11 Section 11; Alcohol Consumption.......................................................................... ........ 12 Section 12: Firearms................................ ...... .............. ................................................... 12 Section 13: Demographics ...... .................. ............... ....................................................... 13 Section 14; Disability....... ......................... ...................................................................... 18 Section 15; Physical Activity (& Washington State-Added Questions)......................... 18 Secti on 16; Prostate Cancer Screening.... ........ ......... ................................................ ...... 21 Secti on 1 7: Colorectal Cancer Screening........................................................................ 23 Sect i on 18: HIV I AIDS.................................................................................................... 24 WASHINGTON STATE-ADDED QUESTIONS .............................................27 Section 19: Health Care Coverage and Use ....................................................................27 Secti on 20: Unmet Health Care Needs........................................................................... 28 Secti on 21: Oral Health............ ......... ......... ..................................................................... 29 Secti on 22: Asthma History............................................................................................ 31 Section 23: Cardiovascular Disease................................................................................ 34 Section 24 : Tobacco Indicators............................... ........................................................ 3 7 Section 25: Other Tobacco Products............................................................................... 39 Section 26; F ami ly Planning........................................................................................... 39 Section 27: Family Violence........................... ..... ........ .... .......... ..... ...... ......... ....... ....... ...43 WA 2001 BRFSS December 15 2000 12.14.2000 State of Washington HOllsc of RepreSentatives January 31,2001 RECEIVED FE B 0 5 2001 Jefferson County Health & Human Services Jean Baldwin 615 Sheridan Port Townsend, W A 98368 Dear Jean, The House Health Care, House Children and Family Services, Senate Health Care, and Senate Human Services and Corrections Committees will be holding a joint work session on home visiting on February 15th. We would like to invite your project, along with the three other projects around the state, to make a brief presentation before committee members. David Olds will present for the first half hour. Then, the legislative committees would like to hear ITom the four pilot programs implementing his model about the families they serve and how the individual programs operate. It would be wonderful if you or a representative of your project could speak for 2-3 minutes. We will also have a brief presentation fÌ'om WCPCAN on community-based home visiting. We will then open the session up for questions and discussion. The work session will take place fÌ'om 12-1pm on February 15th in House Hearing Room A of the John L. O'Brien Building. Please let us know if someone fÌ'om your project will be able to speak for a few minutes. We look forward to hearing ftom you. Sincerely, /z~ ~ Ruth Kagi Co- Vice Chair, House Children & Family Services Committee Shay Schual-Berke, M.D. Co- Vice Chair, House Health Care Committee Memorandum Date: To: From: Cc: RE: February 6. 200 I Board of Health & County Commissioners Jean Baldwin / Carol Hardy Bill NeSmith. Jude McClure, CharJes Saddler Update Jefferson County Report on Maternal Child Health Year 11 History The goal of the Washington State First Steps program, authorized by the Federal Maternity Aecess act of 1989. was to provide "matemity care necessary to ensure healthy birth outcomes for low-moderate income families". The legislation called for removal of unnecessary barriers to receiving prenatal care and provided for increased access to care and expanded Medicaid services for these pregnant women. The First Steps Program includes the following components: · Expanded Medicaid eligibility to 185% of the federal poverty level for pregnant/postpartum women and intànts less than one year old (a íàmily of three. mom, dad and unbom child, can make $2182.00 per month or $26,168.00 per year). · Provided Maternity Support Services (MSS) during pregnancy and two months postpartum by a multidisciplinary team consisting of a Public Health Nurse. Social Worker and Nutritionist. These 10 visits werc to be provided by an approved agency and consisted of home and/or oftice visits. · Maternity Case Management (MC\1) during pregnancy and for one year postpartum for the women in MSS \vho were identiíied as high-risk for poor outcomes (specific high-risk criteria \vas designated by the state. see Attachment A). Increased the number of MSS visits for MCM designated clients to 20 visits for the pregnancy and two months postpartum. Jefferson County Health and Human Services began to otfcr these programs in January of 1990. Referral to this program is made by all of the local OR/GYN family practice doctors. other clinics, nurse practitioners/midwives. DSHS welÜ1re office. tàmily planning, WIC, The Life Center, Jefferson GenerallIospital. the school counselors and \vord of mouth. Over the last eleven years Jefferson County Health and Human Services has worked very hard at building relationships in order to receive the referrals for all pregnant "vomen who qualify for Medicaid. In 1997 Jefferson County had 201 births and 104 were Medicaid reimbursed (see Attachment B). Of the JetTerson County pregnant women Medicaid reimbursed, MSS/MCM program was providing services to 8sr~;), second in the state. The state average is about 65% of the Medicaid reimbursed births (see Attachment C). Jefferson Count)' Health and Human Services Maternal Child Services Maternit)' Support Services (MSS) is offered to any medicaid eligible pregnant woman. Serviœs include 10 visits for assessment. education and consultation provided by an interdisciplinary team of professionals boom each of the three disciplines of Public Health Nursing. Nutrition and Psychosocial Services. It can also be provided by a community health \vorker under supervision. These services also include development. implementation and evaluation of plans of care tar pregnant women and their infants up to t\VO months postpartum. The intent of the program is to provide MSS interventions as early in a pregnancy as possible in an eff'ort to promote positive birth and parenting outcomes. MCM is offered to MSS clients who meet the state high-risk criteria (see Attachment A) who request services: it is also voluntary. The services arc the same as in MSS. however, more intensive and a caseworker is chosen for each woman. The woman is allowed 20 prenatal and two I110nths postpartum visits rather than 10 and can be followed until the iníànt is I year old. Best Beginnings (B8). the Dr. David Olds Project replication project began in Jefferson County in July of 1999 with three nurses attending a weeklong training in Denver, Colorado. This project wi II continue for at least three years along with the other three counties that make up thc Washington State Consortium in collaboration with the University of Washington. University of Washington currently gathers the data tì'om the four consortium sites in Washington that are implementing this program, and sends the data to the University of Colorado where the data is analyzed for types of visit, acuity of maternal and infant mental health, tobacco use, demographics. parenting risks, environmental health and substance use, as well as other risks. The data is also being analyzed in relation to the "íidelity" to the original research protocols. At some point, we arc hoping to provide the same services without the University providing sLlpcrvïslÜn. A major focus of thc BB project is a local attempt to decrease the number of families in the child protective service system. Dr. Olds' research. based on the combination of brain development. attachment theory and object relations theory. has documented decreases in court involvement substance abuse inÜmt and child injuries. Therefore the long-term intervention is striving fÌJr long-term generational changes in self-competency. family dynamics and parenting style. Since the first pregnancy in a woman's life otTers a unique opportunity for change. it is the first time mothers that come tì'om backgrounds at risk or from tàmilies at risk that we are targeting for the BB intensive series of visits. These visits have been proven to be the most effective up to. and including, the child"s second birthday. Visits arc made on an every two weeks schedule with increased visits (weekly) upon initiation of the program and around the birth of the infànt. This frequency· and consistency of visits allo\\s the mother to develop a trusting relationship with the care provider and then tar the mother to develop a trusting relationship with her child. Dr. Olds' longitudinal studies have shown that by the child's fourth year there is a cost reimbursement pay back to communities tar those programs who follow the protocols and when the nurses providing the visits have ongoing administrative support and clinical supervision, as well as a limit on their caseload to 25 tàmilks per 4() hour week. 2 For ./efferson County residents who do not qualitY for ivledicaid. as well as those that do. there are other services otTcred by JCHHS: 1. Childbirth Education Childbirth education is offered at Jefferson County Health & Human Services in collaboration with Jefferson Generall-!ospital. This is 3. 6-\veek series of 2-hour classes tocusing on healthy pregnancy. the birth process. options for pain relief immediate postpartum. breastfeeding. birth control and other resources. Most tirst time families who de!iver either in Jefferson County or out of the county do take childbirth education classes here. This is funded by First Steps for First Steps eligible moms and private fees for others. 2. Newborn Follow Up: Harrison Hospital. Olympic Ì\ilemorial and Jefferson General. às well as Swedish, Cnivcrsity. Mary Bridge and Tacoma General. contact JCHHS upon births of new babies. Phone call follow-up is offered to all ne\v parents just to see if there are problems with breastfeeding. sleeping, jaundice and any for any concerns that they may have. Problem solving and referrals fÒr services are provided if needed. Home visits or clinic visits. breastfeeding consultation and telephone follow-up are offered for those families who \vish them. Some families lHeet the nurse. many are never seen by the nurse but have a series of foJlow-up phone calls. None of these arc billable services. They are paid for in the JCHHS budget by Maternal Child Health (MCH) block grant money and county general funds. 3. Postpartum Breastfeeding Tea Party: The Postpartum Breastfeeding Tea Party meets wcek!y and has averaged tive to twelve mothers a week. usually attending for six to eight months. The attendee profile varies. but very often includes mothers with income and insurance and those on Medicaid. Issues of baby care. feeding, depression. domestic violence. drugs. alcohol. changing relationships, birth control within their family. crisis intervention. discipline. different feelings and parenting styks. appropriate childcare. self care and sibling issues are just some of the topics that comc up universally with each nevv group of women and babies. This is a peer support group. Referral to resources is ongoing. There has been no funding for this at all. Altemative Response System (ARS) and Early Response Program (ERP) are JCHHS programs that are in conjunction vvith the Child Protective Services and are for families designated at risk by Department of ChiJd and Family Services (DCFS) or Child Protective Services (CPS) and referred by DCFS or CPS. The JCHHS Maternal Child Health nurses do see these clients for as ]ong as 90 days. The Child Protective Service caseworker is the case manager rather than the JCl-II-IS nurse.rhese visits are usually around specitìc problems and not relationship based long~term interventions. DCFS or CPS has refened specitic high-risk tàmiiies that need a high intensity short-term intervention. Community Plans Jefferson County will be eligible for Early f-lead Start. JCHHS has met with Olycap and collaborated in their application fÒr Early I-lead Start in this county. Early Head Start will be able to serve ten or fewer tàmilies a year who have income at lOoo/!) of poverty level. The hope is that they will serve those Ülmilies who have another toddler in the home so that both the -, J toddl~r, the mother and the n~\vborn can be served in the same visit. One of the real gifts of this is that families who had a lìrst baby while in MSS could have a different provider for the next child who could be involwd with both children and help with the transition into school for potentially high need families.fhe JCHHS provider focus is health. growth and development. The Early ¡lead Start t'Ócus is education and family systems. The small shift in focus may provide families \vith a deep enrichment and thc plan is that .rCHHS will be the gatekeeper and referral point tor Farly H~ad Start. Kitsap. Tacoma and Snohomish counties have used the Healthy Start (Hawaii) tamily model. There has been discussion of starting it here. In light of the already existing services that are outlined above. it seems that in order to tollow families with children until the age of five utilizing the ¡--Ieahhy Start model there are some important considerations: 1. Funding Funding for any potential new program is needed, as well as tìll~in funding for the second and third year of BB. Maternity Support Services only pays up until the infant is two months old and case management until infant is 1 year. There are no public dollars available to follow a tamily the length of time required by either Best Beginnings or Healthy Start. Currently the 45 t~lmilies being ¡-ollowed by Best Beginnings are using the entire Maternal Child Health contribution of county general fund money, a March of Dimes grant. Medicaid administrative match outreach dollars and the carryover trom the prior year of MSS/MCM. 2. Collaboration .rCHHS could potentially provide the Healthy Start Program (Ha\vaii model) in conjunction with their other services as well as supervise professional peer home visitors working with families up until the ehild's 5th birthday. However. collaboration would be important in order to provide for easy transitions and continuity of care as well as to avoid duplication of services and resources. Working closely with the existing JCHHS programs would be ~ssential to avoid confusing offerings and competition for funding. 3. Assessment JCHHS will be conducting a yearlong Pre Natal Risk Assessment Matrix (PRAM) study in \vhich a series of45 questions is asked of all mothers after the bi11h of their baby. These questions inc1ude tobacco use, domestic violence, support of mother, income, etc. The PRAM study is currently being used in every county in Washington and the survey is being conducted by the Department of Health (DOH). In JdTerson County only 5 to 6 women a year are questioned yearly. Since we have such a small number of births per year and this rate has remained stable for the last 10 plus years, it is reasonable to involve all of the women who deliver in Jefferson County·. thereby giving information that accurately retlects our county rather than the larger counties within the State of Washington. It is a very simple survey to conduct and we can conduct it in a similar tashion to doing the newborn follow-up, in a non-invasive way, with the State DOH's help. 4 4. Plan With Dr. Chris Hale. epidemiologist. the plan is to conduct a PRAM survey on all births in 2001. With this int'Örmation we \-vill have a better profile of how extensive an early intervention/homl>visiting program JetTerson County needs. Best Begirmings is attempting to serve all tirst time high-risk families that qualify for Medicaid (about 44 to 45 first time fàmiJies). MSS/MCM currently serves another 60 to 70 families. That \-vill be our maximum BB/MSS/MCM caseload unless hours change within staff and we were to discover that there are more Medicaid fàmiJies wishing our services. Early Head Start will be able to provide services for ten families. With additional money, the Hawaii model could serve additional families if a need were to be demonstrated. However. the PRAM survey could evaluate the county need for new programs and/or expansion of existing ones. 5 --i I :E S " ~ " --, (', ,,--..., ::r :L. ;:; ::¡ 1: 'J --, 0 r, r;q --L. ::¡ ~ C ::J -; n ,.... I ~ (' ~J 0 .:¡; :¡; ""'" "I " ;::! D I ::¡ = ""'" ("'¡ :L. r ¡J~ :¡;. ::r ? n ("'¡ ::¡ n '~ ~ " ::L n ::.> ::.> r\ ""'" " u\ 7J ;') :J" ""'" :") :L. ""'" c " ,X ."¡ (¡) (t:, c --, \,...[) i ^. n '" c . . Cy. -:¡ -:¡ s ;:;:'\: o ';~ ,.. Cj: ^' '" :¡; (\ :J :J ::¡ ""'" C 7J "¡ n 'i ::J rl' -:;: S (1; ::¡ n :") ,........ " r:; :--n : :, . . ',~ ::¡ C; s: ~ ,.. ., ~ ~ ~ - c· ;; ::1 =--0 :) ~ ,. ~ --, :") "-... ~ ::.> ;+¡ (t , t" (t:, :f o o r (¡) '.-' ~ -'- " " ;::! -- ~ ., (¡) (¡) ::¡ :"> IJ¡ 'J. ::i (S ¡n ~ c) > ,..... ""'" ^' -' c' ::r ::¡ :ì -.!... ::¡ ...,. ^' :: > " > --, ~ V :ft< r--- .:...- (¡) o ').. rf ., .J ,':Y c ~ -; ...::: ::¡ C :L. :;' rJ~ -'- r, -; ^. ... G ..., ::¡ -.- i1 .-L ::¡ (]G' :S, -; '.) :r ::¡ ;::! 7J 0 ~ -, (/) r:- n .., -, rl- () .., -, CD i1 ,.. - " S! ""'" ~ ::¡ 'J> :¡- 0. ~ :r .- 'J> ~ \J ;;, :.; " - ~ ',OJ :.s;; e; -. ,........ I :ì rJI 'J¡ · Attachment B Medicaid Medicaid-paid delivery*, Jefferson County and Washington State, 1992-1999 Jefferson County Year All Births Medicaid 1992 228 113 1993 224 120 1994 204 92 1995 210 113 1996 195 95 1997 201 104 1998 195 103 1999 211 115 Year 1992 1993 1994 1995 1996 1997 1998 1999 Jefferson County 49.6% 53.6% 45.1% 53.8% 48.7% 51.7% 52.8% 54.5% *Based on births for which payment source was known. Washington State 30.9% 34.3% 34.1% 32.2% 33.4% 32.3% 31.3% 32.5% Medicaid-paid Delivery, Jefferson County and Washington State, 1992-1999 100.0-". 90.0-". 80.0-". 70.0.". 60.0% 53.6*/* 50.0-". 40.0e¡. 30.0·/. 20.0·/. 10.0·1. 0.0% 1992 1993 1994 53.8,.. 1995 1996 52.set. S4.5*h 1997 1998 1999 ,- Jefferson County D Washington State I Àttachment C Skamania Jefferson ISland CJwiitz Kjng Pend Oreflle Chelan Douglas Grays Harto Whatcom Garfield San Juan KJttitas C:ailam Pacific Ferri S:':agit KJic!<itat Okanogan Lewis Franklin Snohomish ~STATE TOTAL Yakima Stevens Thurston Adams Grant Cclumbia Benton Waila Walla Whitman Ciark Pierce Mason KJtsap Wahkiakum Spokane Asotin LJncoln Unknown STATE OF WASHINGTON· FIRST STEPS DATABASE 3/3/99ES Maternity Support Services and Maternity Case Management Use by Total Women with Medicaid-paid Births In 1997 "~ , 1 , 1 ; , I I -, . I 1 I I -J r 1 , I ~ I -J ì I " , , I ~ i i I -J , I I " - -, ! ~ i I -I , I I ~ I i -I I I ~ : -I I "i r I -j ~ ltY'ÞäI.n. -i I -I I i i ; I I I ~ I I , , I ~ , i I ... -I , fJUlL!i~"a.iIUI!I~14~_ :íItI - . ; i I ~~ :::=:'::~ . . :W'SP. I -I i , "...17 , ---. , -I I - , i -I ! , i , i I I JI...:..... : :.,J:..._ r-'1'~ i , I i i 0% 30% 50% 80% 90% 100% 60% 70% 10~IO 20% 40% . Both MSS & MCM .MCMQNLY IJ MSS ONLY DSHS Research and Data Analysis Laurie Cawthon, MD, MPH (902-0712) MS: 45204 . . . DRAFT I. Intake to MSS --4- Forums Consent ROI Baseline Assessment 2. Baseline Assessment Includes: a. The client's knowledge of pregnancy, childbirth. and parenting b. Client cultural or religious beliefs/prJetiœs regarding pregnancy and childbearing c. The client's knowledge of major heJlth risks, danger signs of pregnancy, Jnd healthy vs, unhealthy behaviors d. MedieJI fJetors relating to pregnancy risk and health behaviors. This includes HIV risk. availability of counseling and testing, and if appl icable, lIse of AZT to reduce perinatal tr,msmission e. Signs and symptollls of personal drug/alcohol use and/or drug/alcohol use in the client's environment f. Personal tobacco use and/or consistent e'posure to tobacco use g. The client's communication skills, primary language. literacy, ability to communicate feelings. maturity. decision- making ability h. Family structure, support system, physical/sexual/emotional abuse. roles and relationships, coping ability, stress level I. Home and work environment. including housing, safety and security, occupation. transportation and access issues. and tìnancial resources J. Dietary patterns and intake, resources for obtaining and preparing food, and evaluation of nutritional needs k. Pregnancy and postpartum related changes in activities of daily living slIch as activity/exercise, elimination, sel f· concept/body image, sexual ity I. Understanding and utilization of health care resources, including dental and vision services m. Screen for MCM eligibility n. Need rÖr child care o. Intant eligibility and linkages to pediatric primary care, parent-infant relationship, infant care concerns, parenting I·esources. infant safety, immunizations and infant health status p. Knowledge of and understanding of ramily planning services and birth control methods q. Knowledge of breast feeding as an option Team Meeting to: a. Determine Further Assessment b. Develop Interdisciplinary Plan i. Client tÖcused integrating professional assessment and client concerns/needs c. Confer on MCM Potential i. Assign case manager~ ii. or primal")'~tact person _~ ---------.... MSS MCM Up to 10 Visits (otlice ()r home including intake visit) t 3. --4- B8 t Initial review by ALL team members. either face to tltce with client or in team meeting. Documentation t Review by ALL team J., OngoinQ review . Preparation for parenthood recommended for all . CBED Child Care Screen Transp0l1ation t Inwlementation of Plan MSS Team Concerns Referrals WIC ADTSA CSD Prenatal DV ~ Ongoing review Client's Concerns Housing Mental Health Dental Vision Parenting Classes Family Planning CBED · COMA-fUNIIT NETWORK POSITION PAPER Summer, 2000 Are you aware that 50% of Jefferson County's General Funds are spent on Law and Justict: services? These services include the Sheritrs Departmt:nt, the Courts. Juvenile Services, and the Prosecuting Attorney's Office. The activities of these departments mainly are related to handling crime in one fonn or another, be it vandalism, domestic violence and other assault, child abuse, and illegal activity related to substances. In our county, we are spending half of our general funds on responding to and processing criminal activity. In our community and most others, criminal activity and the funds needed to respond to it are continually on the rise. Many communities have responded to the trend by building large law andjustice complexes. These complexes provide state of the art security; single-site locations for agencies, courts, and often incarceration facilities; and convenient access for the public. We are poised to build just such a complex in Jefferson County. It will come about via a bond issue whose time, we agree, has come. Our county courthouse is unsafe by a number of different benchmarks, and obsolete for handling the extent and nature of the crime we face at this time. One unfortunate reality is that the new law and justice complex-needed as it is-will come at a cost to our other 'bond issue' instirutions such as recreational facilities, the hospital, the libraries and our schools. We may indeed be heading for a time in which more of our public funds are spent maintaining our safety than promoting our growth and well-being. The fact that it costs more annually to house a prisoner than to pay for a college education lends some legitimacy to this idea. A second unfortunate reality is that the new ceIlter represents a response to, and not a solution to, damage already done to our community. It is needed because we have somehow failed to adequately safeguard our citizens, or to ensure that our commumty members -whatever their ages-are capable of making healthy, legal choices. Current tn~nds bemg what they are, we will only pay more and more to respond to crime if we do not start investing in solutions. The Community ~etwork poses these questions to our leaders and our citizens~ Are we comfortable as a community spending an enonnous amount of our taxes to - process' social problems, with no safeguards consistently in place to help solve these problems? Couldn't our tax resources be invested more effectively ¡fat least a portion of them were devoted to preventing social problems-such as violence in the home or school and substance abuse-before they do their damage and progress to the legal system? Isn't it time to develop a comr,unity plan for reducing the levels of these problems. as a solution to reversing the ever-expanding industry that the criminal justice system is becoming? Weare talking about making solid investments at the front end in creating healthier community, while we simultaneously maintain the necessary mechanisms for responding to social problems and crime. Research has proven that prevention and early intervention programs can be highly effective. and result in huge savings to communities. As examples: -Home visitation programs that offer intensive support to mothers at risk of abusing their newborns have produced a 75% reduction in cases of child abuse and neglect, thus breaking a violent cycle in which the abused too often grow up to become violent offenders; --Programs that introduce at·risk youth to positive environments can have a significant impact Boys and Girls Clubs in 64 at-risk neighborhoods across the COlmtry have reduced juvenile crime in these areas by 13%; --Strategies that encourage commitment to school and academic success reduce delinquency among high.risk students. For example, promoting reading skiHs helps reduce delinquency. Reading failure as early as the first grade has been found to be a predictor oflater delinquency. Communities across the country are building prevention programs into their local budgets and reaping the rewards. For example, Deschutes County, Oregon has significantly reduced costs of incarceration by designating a portion of its juvenile justice funds for prevention. The money saved by the State has been fed back into the system to create more programs that intervene early with at-risk children. Jefferson County has a number of model programs in place that we know reduce violent behavior, substance abuse, and other social problems. One is the Best Beginnings Nurse Visitation project currently in place with grant funding at the Health Department. Another is the YIPPEE program, founded on the successful Best Self model in Skagit County, which offers low--cost after-school and summer programs to children and youth in the south county. YIPPEE is a good example of a prevention program that began with local commitment from the Law and Justice Council and the Commissioners. and is now supported by a combination of local and state grant funds. Y LPPEE and the Best Beginnings project have the potential for significant positive impact if they are in place over the long·tenn. Their longevity will take a solid commitment from local government and our community. We have proof that these programs work: it is time to make that kind of commitment. The Community Network asks the citizens and leaders of Jefferson County to commit to preventing the sorts of problems that we otherwise will continue to pay for more and more dearly. Tt m;:ans making a local financiaJ commitment that may not yield immediate. tangible results. It means investing in prevention programs that have demonstrated long.term social gains in rural communities such as ours. We believe that it is time for our citizens and government officials to commit to building a safety net of programs in Jefferson County that win help ensure the well-being of our community. We ask this not only to stem the rising costs of the criminaljusticc system; but to help ensure that al1 children, youth, and fami1ies are given the opportunities to thrive and reach their positive potential. Jefferson Coun Health and Human Services JANUARY 2001 NEWS ARTICLES These issues and more are brought to you every month as a collection of news stories regarding Jefferson County Health and Human Services and its program for the public: 1. "They call it puppy love" - Peninsula Daily News, January 12,2001 2. "Saddler: PT not being taxed twice" - Peninsula Daily News, January 14, 2001 3. "Agency adds to hepatitis protections" - Peninsula Daily News, January 19,2001 4. "Jefferson, PT services pact is near" - Peninsula Daily News, January 23,2001 5. "Flu vaccine still available" - P.T. LEADER, January 24,2001 6. "Jefferson's health due for survey" - Peninsula Daily News, January 26, 2001 7. "City, county settle spat over fees" -Peninsula Daily News, January 30, 2001 8. 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'"C .- .... :::J 0..:;;1 . - cd E-< oj bO ~:::JUJ qs ¡¡¡;j ~= -æ oj ..E-< '-' ,-,0 ¡¡:¡@UJ -"000 <1.>c¡¡00 oÆ ~o<;O~c¡¡ ,-,,_0,-, ....'-'E-< ~"'O ......-r:;J_~>, PE:-JINSULA DAlLY NEWS Agency adds to hepatitis protections Peninsula health offices welcome reporting rules By KEN SHORT FOR THE PENINSU/-A DAlLY NEWS Health-care providers in Clallam and Jefferson coun- ties now must report inci- dences of patients diagnosed with two forms of chronic hepatitis to state health authorities. The contagious hepatitis B and hepatitis C conditions have been added to a revised list of 63 notifiable conditions reportable to the state Depart- ment of Health. Hepatitis is a liver-scarring disease that comes in seven forms beginning with type A. The conditions is caused by a parasitic virus that scars the host's liver. Tom Locke, chief health officer for the two counties, said the regulations, revised last December, are intended to unify a previously complex system of reporting. 'Compelling benefits' Locke said he helped craft the new reporting require- ments because of the "com- pelling health benefits" of tracking the contagious dis- ease. Hepatitis was notifiable in the past, but only the initial diagnosis. "The rules were frag- mented, confusing and scat- tered through a myriad of state laws," Locke said. "You had to look up a dozen different laws." . But patients shouldn't worry about breaches of confi. dentiality - the data are used only by the state in part to stop the spread of the disease. "We have a perfect record of main taining confidential i ty," Locke said. "Our goal is not to generate lists of names." Some people are more likely to contract hepatitis C than others. Approximately 4 mil- lion have the disease nation. wide, Locke said. Hepatitis C is spread pri- marily through direct contact with the blood or body fluids of an infected person, Locke said. How it spreads Rabies, anima] bites, anthrax, smallpox, diseases a!;sociated with the human immunodeficency virus, measles and plague are among other previously notifiable conditions. . Prior to Dec. 22 when the new regulations became effec- tive, only four hepatitis C diagnoses were reported between 1995 and 1999 in Clallam County, Locke said. Two cases were reported in Jefferson County during the same time period. Locke said new treatments, interferon and ribavirin, have increased the cure rate to 40 percen t. But in some cases where a patient refuses to be treated for a reportabJe disease the county can take legal action to force treatment. "We have some public health police power," Locke said The regulations give the counties' health department a wide range of protocols includ. ing notifying and tracing part- ners of patients diagnosed with some infectious or sexu- ally transmitted diseases. For example; when a patient diagnosed with tuber- culosis refuses treatment, county health officials on rare occasions can force the patient into quarantine and trigger an investigation of the outbreak, Locke said. {-L9-ol Edition January 23, 2001 Jefferson, PT services pact is near Health coverage sticking point in ongoing talks BY PHILIP L. WATNESS PENINSCLA DAlLY :-lEwS PORT TOWNSEND - Several issues concerning money are still out- standing, but Port Townsend should ::;oon have a regional services contract with Jefferson County. Port Townsend City Manager David Timmons was authorized by the City Council on Monday to sign the agreement, although he will con. tinue - to work out the details regard- Ing the municipality's contribution for health service::;. County Administrator Charles Saddler had proposed that Port Townsend ante up $80,000 for the county Health Department. 2O-minute council meeting He has maintained that Port Townsend used to contribtlte money for health services before the state Legislature enacted a law that had cities contribute a portion of the motor vehicle excise tax to counties to support county health departments. \\!hen Initiative 695 passed in 1999, that funding evaporated. That is one issue that still must be resolved. Timmons said Monday that he will meet with Saddler on Thurs- day to discuss that and the other out- standing issue of jail services billing from previous years. In the shortest meeting of the past three years - a mere 20 minutes _ the six council members at the special meeting Monday unanimously approved three resolutions authoriz. ing Timmons to execute contracts for law and justice services. mcluding District Court, jail services and emer- gency dispatch, health and human services including animal services and substance abuse programs, and computer services. The council previously budgeted $400,000 to pay for the regional ser. vices, which included $17,000 for a joint study concerning the equity of the contract. Jefferson County counted on receiving $495.000 from Port Townsend when the commissioners approved the 2001 budget. However, the county budget included the $80,000 municipal contribution pro. posed for health services. Timmons said the disparity between the amounts will be addressed through a supplemental budget once the contract has been finalized. He said the city budget includes a larger reserve than needed for just ,that reason. Agreement over jail The two governments have also reached agreement on the details of what information the Jefferson County Jail will provide Port Townsend regarding inmates housed there on misdemeanor municipal charges. Past records haven't included such details, leading to a disagreement between Port Townsend and JeITer. son County regarding how much money the former should be billed. ----- ----. A 8 . Wedne5day, January 24, 2001 Flu vaccine still available Jefferson County Health and Human Services still has flu vaccine available. Anyone who wishes to be vaccinated to lessen the chance of ' catching influenza may come to the department's walk-in immu- nization clinics at its office at 615 Sheridan St. in Port Townsend. Regular immunization clinics are 1-3 p.m. Thesdays, Wednesdays and Thursdays throughout January. Immunizations are $8. No insurance other than Medicare will be billed. Those who are on Medicare should bring their cards with them. Influenza vaccine is indi- cated for: · persons age 65 and older. · residents of nursing homes. . adults and children, includ- irg pregnant women, who have chronic heart, lung or kidney disease, diabetes or other serious chronic health prob- lems, including asthma. · persons who are less able to. fight infection because of HIV infection, other immune system disorders, long-term treatments with steroids or can- . cer treatment. . children' and teenagers on long-term treatment with aspirin, who, if they catch influenza, could develop Reye's syndrome. .' women who will be in the second or third trimester· of pregnancy during the fIu season (beyond three and one-half months pregnant). · health care providers and close friends and family of per- sons at high-risk forfIu, to re- duce the possibility of spreading the fIu to these persons. · anyone wanting to de- crease their chance of catch~g influenza. Jefferson's health due for survey Population aging, but by how much? BY PHn.lP 1.. WATNESS PENINSULA DAlLY NEWS Local social service organizations haven't had accurate data about the demographics and health issues of residents of Jefferson County. That will change beginning in March when 600 residents will be asked to provide information on everything from tobacco use to domestic violence. The Jefferson County Health Department has already made'\ignif- icant progress in weeding through mounds of data to provide a snapshot of county residents. Epidemiologist Dr. Chris Hale of the University of Washington and the Bremerton-Kitsap County Health ..."...r."_.7'"""(."'~-!~-~ Dr. Chris Hale Jefferson ~exceedingly old county" District reviewed the information Thursday for about 40 representa- tives from Jefferson health, social ·services, education and govenunent agencies gathered in Port Hadlock. The data will fInally allow local policy makers to make informed deci- sions. Good data, I¡¡etter decisions "Good data drives better decisions and better decisions drive more effec- tive programs," said Dr. Tom Locke, public health officer for Jefferson and Clallam counties. "We have to make decisions in the dark and that impairs the effectiveness." Hale said the data clearly show what many in Jefferson County have divined from subjective experience: The county is aging dramatically with far fewer young families bearing children. Inflating house prices also makes Jefferson County one of the most expensive places to live, especially for the same young families at the low end of the wage scale. "You've become an exceedingly old county,'! Hale said. :~That._doesn't mean there's no young people: Yo4 have two worlds, the young families that are increasingly disadvantaged _ because it's an extraordinarily expen- sive p1ace to live" and an expanding popwation of people 55 and older. Jefferson ages Hale said 20 years ago' Jefferson County had 200 people ages 85 and older, while it now has more than 700. The county with a 7 percent. rate outstripped Washington state's 3.7 percent growth rate. The two reali- ties mean more older people are mov- ing into the area. The median age has steadily grown from 35 years of age in 1980 to 42.4 in 1999. "You are now the classic popwa- tion in which deaths outstrip births," she said. "Only countries in Western Europe is where you see that kind of aging in-migration." TuRN TO SURVEY/A2 v 8 ~ CJJ V .~ ..µ ~ ..µ CJJ o .µ '"D V ..µ u Q) ~ Þ< V C/) '"D ~ Q) ~ .. ~ G) > .. = en -a; g¡ ~R.8E~ ~.:g j.j¡ ~ 5 >: <l)"":' 0')..c:~:;I o-¡¡¡~..c:o 'i~~ :: § ~ ~. ¡ß £ 5.-::" ", ã) ¡¡¡ ::g _~ ~ .::: ._ "=' t>) ,3.. 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But Timmons and Saddler agreed that Port Townsend will identify municipal jobs that could be filled by developmentally disabled persons in exchange for the county forgiving jail fees for 1998 and 1999. Jail Ser- vices Administrator Carla Schuck won't have to do a thorough review the incarceration records to set the amount underbilled. Port Townsend will also chip in 'VDJ (-30-D/ $50,000 over the next two years for a county study to identify methods for alleviating jail overcrowding. That will be in lieu of payments under- billed in the first half of last year. "This is an imperfect solution, but it reflects that they're getting equity and we're getting return for our contribution," Timmons said. The agreement comes after sev- eral months of wrangling over the . jail billing. "We found mutual ways to satisfy both our needs without getting stuck on the contentious issues," Saddler said. Timmons agreed to contribute $40,000 for health services, half of the amount Saddler proposed for the regional services contract between the governments. Other county services Timmons said he is still war¡ of setting a precedent for paying for Health Department services, but the contribution will at least resolve the issue for this year. TimrrlOns and Saddler will also continue discussions about Port Townsend contracting with Jeffer- son County for building inspector and fire marshal services. That would lessen the financial burden of each government in individually providing those services. . ;1 ~ ....... ~ = = ) = ~ ..J - 0 e î 0 U -\ ..... '- ~ J(YÙ ~ J ¡ ~ . ____ I ..- .- OIJ ~ ~ r:IJ. ~ CIj QJ ~ ~ QJ .- ;... Q.. ~ Q.. 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",tJ",,,, ...;.;gï::-o~-o ul! <>-5 c: I.r.t~< tU C=:n-;:¡ b ~ ~-õ:i;;çt~§g¡r;~ <>F-=-=E_>.~ ~ t-.;; ::I :g ¡r; E ¡:¡ 0 .~ ~ s8~~¡:: E¡S § NOTICE OF MEET/NO CHANGg JEFF"'SON COUNTY BOARD OF HEALTH The Jefferson County BOard of Health will be meeting on Mon- day; February 12, 2001 from2:OO p.m. to 4:00 p.m. at the Jefferson County Heálth Department, 615 Sheridan Avenue, Port Town- send, WA 98368. Next month the regularly scheduled meeting date will be resumed which is the third Thurs- . day of each month. 3015m 02f1 - ---- -- - -- Affidavit of Publication STATE OF WASHINGTON) 55 COUNTY OF JEFFERSON) SCOTT WILSON. being sworn, says he is the publisher of the Port Townsend Jefferson County Leader, a weekly newspaper which has been established. published in the English language and circulated continuously as a weekly newspaper in the town of Port Townsend in said County and State, and for general circulation in said county for more than six (6) months prior to the date of the first publication of the Notice hereto attached and that the said Port Townsend Jefferson County Leader was on the 27th day of June 1941 approved as a legal newspaper by the Superior Court of said Jefferson County and that annexed is a true copy of the Meeting Change; Feb. 12, 2001 as it appeared in the regular and entire Issue of said paper itself not in a supplement thereof for a period of one consecutive weeks, beginning on thenh-day of Fl'!hrl1;:!ry ,20..íll....-. & ending on the --1.thday of Fp.hrlll'lry ,20..íll....-. and that said newspaper was regularly distributed to its subscribers during all of this period. That the full amount of $ 21 . 00 has been paid in full. at the rate of $9.50 ($9.00 for legal notices re~ ceived electr tion. Publisher Subscribed and sworn to before me this=.Lday of Fe brl1àry .-"-"-.. ,-- 20a .-.- -,~ :,/) 4Jd~~ () - -No~'~ PUhlicin and for the State f Washington - - -- residing at Port Hadlock