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Home My WebLink About2024_12_19_BOH_PacketPublic H Board of Health Meeting December -19, 2024 Jefferson County Board of Health Agenda Minutes 17 V. Public Healt December 19, 2024 �c0N rCJ �SHrnc•zo Regular Meeting Agenda Jefferson County Board of Health Thursday, December 19, 2024 @ 2:30 PM Jefferson County Courthouse — Commissioners' Chambers 1820 Jefferson Street, Port Townsend, WA This is a hybrid meeting: Virtual and In -Person Attendance You can join this meeting by using these methods: Zoom Meeting: https://zoom.us/i/97862703889 This option will allow you to join the meeting live. You will need to enter an email address. If you wish to provide public comment, click on the hand icon at the bottom of the screen to "raise your hand." Participation will be up to the Chair and/or Clerk of the meeting. ■ Audio -only: Dial: 1-253-215-8782 and use Webinar ID: 97862703889# This option will allow you to listen to the meeting live. If you wish to provide public comment, press *9 to "raise your hand." Participation will be up to the Chair and/or Clerk of the meeting. ■ In -Person: You are welcome to join the meeting in -person. In the event of technical difficulties, at least one of the methods above will be accessible to the public. Please try all methods first before calling 360-385-9100 to report any issues. Public comment will be accepted and can be emailed to: BOH@co.i fferson.wa.us until 5:00 PM the evening prior to the start of the meeting. AGENDA CALL TO ORDER — Chair Dean I. Public Comment (15 mins.) Public Comment Periods are dedicated to listening to ttu, public. Each person may address the Board onetime during these periods. To ensure equal opportunin>,for the public to comment, all comments shall be limited to 2 or 3 minutes per person, depending on the volume ofpublic in attendance. II. Approval of Agenda III. Approval of Minutes of November 21, 2024 Board of Health Meeting IV. Old Business and Information Reports 1. Jefferson County Public Health (JCPH) Report (Apple Martine) (10 mins.) AT A REGULAR MEETING, THE MEMBERS MAY ADD AGENDA ITEMS AND TAKE ACTION ON OTHER ITEMS NOT LISTED ON THIS AGENDA. Americans with Disabilities Act (ADA) Accommodations Provided Upon Request 2. Jefferson Healthcare Report (Dr. Kees Kolff) (5 mins.) 3. Infectious Diseases Update (Dr. Allison Berry) (10 mins.) V. New Business 1. [POTENTIAL ACTION] Election of Board of Health Chair and Vice -Chair for 2025 (5 mins.) 2. [POTENTIAL ACTION] Appointment of New Representative and Alternate to the Behavioral Health Advisory Committee (5 mins.) 3. - Discussion of Board of Health Membership (10 mins.) 4. [POTENTIAL ACTION] BoH Adoption of the Code Compliance Rules of Procedure (Pinky Mingo, Ariel Speser) (20 mins.) 5. Briefing on the BoH Subcommittee, formed in March 2024, to examine development solutions on small lots. (Pinky Mingo) (10 mins.) 6. Foundational Public Health Services Update (Apple Martine) (20 mins.) VI. Future Potential Agenda Topics: Selection of Consumer of Health Position on the Board of Health (January) Winter Storm Preparation and Response (January) Homelessness Public Health Impacts resulting from Federal Initiatives Rural Reproductive Health Emergency Fund for Public Health Strategic planning for the county The Child Development Center The Community Care Hub Sewer projects / wastewater VII. Announcements ADJOURNMENT BY: 4:30 p.m. Next Scheduled Meeting: January 16, 2025 2:30 — 4:30 PM Jefferson County Public Health Hybrid Meeting AT A REGULAR MEETING, THE MEMBERS MAY ADD AGENDA ITEMS AND TAKE ACTION ON OTHER ITEMS NOT LISTED ON THIS AGENDA. Americans with Disabilities Act (ADA) Accommodations Provided Upon Request REGULAR MEETING MINUTES Jefferson County Board of Health Thursday, November 21, 2024 @ 2:30 p.m. Jefferson County Courthouse — Commissioners' Chambers 1820 Jefferson Street, Port Townsend, WA Hybrid Meeting Board Members Greg Brotherton, County Commissioner, District #3 Kate Dean, Chair, County Commissioner District #1 Heidi Eisenhour, County Commissioner, District #2 Amanda Grace, Vice -Chair, Community Stakeholder Dr. Kees Kolff, Public Hospital District #2 Commissioner Monica MickHager, Port Townsend City Council [Vacant], Consumer of Public Health Staff Members Denise Banker, Community Health Director Dr. Allison Berry, Health Officer Michael Dawson, Water Quality Manager Alisa Hasbrouck, Environmental Health Manager Barb Jones, CHIP Program Manager Apple Martine, Public Health Director Pinky Mingo, Environmental Public Health Director Veronica Shaw, Public Health Deputy Director Chair Dean called the November 21, 2024 meeting of the Jefferson County Board of Health to order at 2:31 p.m. Due to the large number present, Chair Dean suggested that those attending introduce themselves. Members Present: Chair Kate Dean, Vice -Chair Amanda Grace, Members Greg Brotherton, Heidi Eisenhour, Dr. Kees Kolff and Monica MickHager. Staff Present: Staff Members Denise Banker, Dr. Allison Berry, Michael Dawson, Alisa Hasbrouck, Apple Martine, Pinky Mingo and Veronica Shaw. PUBLIC COMMENT Chair Dean called for public comment. Commenter wished to alert the Board to the potential decimation of healthcare due to Project 2025. Member Kolff thanked commenter for their work supporting healthcare in the community. APPROVAL OF AGENDA Chair Dean called for a motion to accept the agenda for November 21, 2024. MOTION: Member Grace moved to approve the agenda. Member Eisenhour seconded the motion, which carried by a unanimous vote. Respectfully submitted Page 1 of 4 G. Gilbert APPROVAL OF MINUTES Chair Dean requested a motion to approve the minutes of the October 17, 2024 meeting. MOTION: Member Brotherton moved to approve the minutes. Member Grace seconded the motion, which carried by a unanimous vote. OLD BUSINESS AND INFORMATIONAL ITEMS 1. Jefferson County Public Health (JCPH) Report Staff Member Martine brought to attention the redesign of the county website, and recognized the Jefferson Healthcare Rural Health Convening. They also spoke about current JCPH programs and activities. 2. Jefferson Healthcare Report Member Kolff reported that the hospital replacement and expansion project is, amazingly, on time, on target and on budget. The hospital has recruited new specialty providers to populate the new hospital space. Progress is being made in finalizing a new mobile health unit to serve south county and other areas. Also, efforts are ratcheting up to advocate for priorities at the state and federal level. 3. State Board of Health Report Chair Dean spoke about a panel discussion of PFAS "forever chemicals." Of local concern, testing of commercially available fish has not indicated high levels of PFAS. The state has denied a petition to disallowed fluoridation of public water systems, and decided to adopt newborn screenings, relying on the federal panel that decides on newborn screening. In response to a question, discussion ensued concerning the risks of PFAS in eggs, the state investigating water supply, and contaminated feed and soil. 4. Infectious Diseases Update Dr. Berry reported respiratory illness rates continue to be relatively low, with low rates of transmission documented in wastewater sampling as well as low rates of emergency visits and hospitalizations. The few hospitalizations tend to be older individuals who are not up-to-date on vaccinations. Influenza is just starting to pick up. All individuals over 6 months of age are encouraged to get this year's COVID and flu vaccines. Those who are at high risk are encouraged to get the RSV vaccine if they did not get it last year. This includes individuals over the age of 70, those over 65 with underlying conditions, and pregnant people who will deliver this winter, as well as children under 8 months of age going into their first RSV season. There is a significant rise in pertussis cases in Washington. No cases have yet been documented this fall in Jefferson County, but we only catch about 10% of cases so it is possible that pertussis is already here but not yet detected. All people, especially those with young children and pregnant people in their lives are encouraged to stay up to date on their pertussis vaccines to reduce their risk of getting and transmitting the bacteria. In response to the public commenter, earlier, Dr. Berry represented that Jefferson County Public Health is an agency independent of state or federal departments of health, making its own decisions based on the best available information and not obligated to follow messaging from the federal government. Discussion ensued. Currently, there are no local cases associated with recent national outbreaks of E. coli related to organic carrots. Respectfully submitted Page 2 of 4 G. Gilbert NEW BUSINESS 1. [POTENTIAL ACTION] Discussion of Board of Health Membership Staff member Martine discussed measures taken to expand efforts to recruit new members for the Board, particularly in regards to the "Consumer of Public Health" member. A resolution was presented which authorized a stipend to non -elected members of the Board. Also, there was discussion of progress being made in regards to a tribal representative to the Board. MOTION: Member Eisenhour moved that we pass the resolution in the matter of stipends for community members of the Board of Health of Jefferson County. Member MickHager seconded the motion, which carried by a unanimous vote. 2. Update on the On -Site Septic Code JCPH staff member Carter Erickson, assisted by staff member Pinky Mingo, described the series of public meetings, and consultations with the state DOH, at which the proposed revised septic code was presented and evaluated. They also enumerated steps yet to be taken prior to adoption. Members of the board and staff expressed appreciation for the work reflected in the code, and the thoughtful process of gathering public feedback; recommendation was made for an additional meeting reaching out to south county. 3. [POTENTIAL ACTION/PuBLIC COMMENT] Changes to Environmental Health Fee Schedule Staff member Mingo presented a resolution to update the environmental health fee schedule, and highlighted an additional change to the schedule not included in the advance copy provided to Board members. An additional change was requested for clarification, and discussion ensued. MOTION: Member Eisenhour happily moved to make a resolution adopting a 2025 updated fee schedule for Jefferson County Environmental Public Health with changes of the addition of the fee for scanning and technology and the changes to the references to soil analysis in the document. Member Kolff seconded the motion, which passed unanimously. 4. [POTENTIAL ACTION] Food Safety Enforcement Policy Staff members Alisa Hasbrouck and Hal -Wayne Woodward presented the new policy, based on FDA program standards and recommendations. The policy provides a clear reference to ensure that food service establishment permitting is consistent, and also that staff members treat food establishments equitably, therefore minimizing legal risk. Several errata in the provided policy were pointed out and corrections proposed. MOTION: Member Grace moved to pass the resolution of the Jefferson County Board of Health for Food Safety Enforcement Policy with the amendment of page 3's renumbering and replacing "cannot" with "can" (in new paragraph 2, page 3.) Members Kolff and Brotherton seconded the motion, which passed unanimously. 5. WSALPHO Training for Local Health Jurisdictions, a wrap-up Members Dean and Kolff spoke concerning the benefits of attending the training, sharing ideas and information with representatives from other health jurisdictions. Also of particular interest were the presentations by tribal member Vicki Lowe and by the Network for Public Health Law (which also provided attendees with a "Micro-Toolkit: Equity Assessment Framework for Public Health Law and Policy.") Discussion ensued concerning possible uses of the Micro-Toolkit. FUTURE POTENTIAL AGENDA TOPICS Staff member Mingo announced the need to bring Code of Compliance Rules and Procedure to the Board. Staff members Martine and Berry mentioned that "DEIA" (diversity, equity, inclusion and accessibility) was removed from the list of future topics, as it should inform everything the Board does but does not need to be a singular topic. Respectfully submitted Page 3 of 4 G. Gilbert Member Kolff enquired about the Child Development Center, questioning whether it need remain on the agenda list, as it has been funded and will soon break ground. Chair Dean stated that the scope of the project has grown, and recommended having a speaker address intended services. Member Grace suggested a discussion of homeless displacement and how it's handled in this community. Discussion ensued concerning a wider discourse on homelessness issues. Member Kolff suggested a placeholder for a time to review public health impacts resulting from federal initiatives, changes made by executive order or by changes in governmental agencies, that may impact this community. ANNOUNCEMENTS There was a discussion concerning the difficulty in finding written public comment via the county website. AGENDA PLANNING CALENDAR The Agenda Planning Meeting for the next regular meeting of the Board will be held on December 12, 2024 at 10:30 a.m. The next regular Board of Health meeting will be held as a hybrid meeting on Thursday, December 19, 2024 from 2:30 p.m. — 4:30 p.m. ADJOURNMENT Chair Dean adjourned the November 21, 2024 Jefferson County Board of Health meeting at 4:12 p.m. until the next Regular Meeting or Special Meeting as properly noticed. JEFFERSON COUNTY BOARD OF HEALTH Kate Dean, Chair Glenn Gilbert, Public Health Assistant Respectfully submitted Page 4 of 4 G. Gilbert Jefferson County Board of Health IV. Old Business and Information Reports Item 1 Jefferson County Public Health Report [No hand-out] Public Hea I� t�i December 19, 2024 Jefferson County Board of Health IV. Old Business and Information Reports Item 2 Jefferson Healthcare Report rhin hand-aut] Public Healt December 19, 2024 Jefferson County Board of Health IV. Old Business and Information .Reports Item 3 Infectious Diseases Update [No hand-out] 4(.11e,&son Public H December 19, 2024 Jefferson County Board of Health V. New Business Item 1 Election of Board of Health Chair and Vice -Chair for 2025 [No hand-out] �ef fP,�s�n c Public H December 19, 2024 Jefferson County Board of Health V. New Business Item 2 Appointment of New Representative and Alternate to the Behavioral Health Advisory Committee [No hand-out] -,,, elfQi7SC Public H December 19, 2024 Jefferson County Board of Health V. New Business Item 3 Discussion of Board of Health Membership [.No hand -Out] Publ*ic Healtth December 19, 2024 Jefferson County Board of Health V. New Business Item 4 BoH Adoption of the Code Compliance Rules of Procedure .�kwffoson Public H December 19, 2024 STATE OF WASHINGTON COUNTY OF JEFFERSON In the Matter of Repealing Resolution No. 42- 03 and Adding a Resolution Adopting Code Compliance Rules of Procedure Pursuant to RESOLUTION NO.61-1112-24R Chapter 19.05.0200) JCC WHEREAS, Article XI, section 11 of the Washington Constitution, confers upon county legislative authorities a direct and extensive delegation of the police power to adopt such local police, sanitary and other regulations as are not in conflict with general laws; and, WHEREAS, RCW 36.32.120(7) provides that the county legislative authorities shall make and enforce, by appropriate resolutions or ordinances, all such police and sanitary regulations as are not in conflict with state law; and, WHEREAS, RCW 36.32.120(10) provides the county legislative bodies have the power to declare by ordinance what shall be deemed a nuisance within the county; to abate a nuisance at the expense of the parties creating, causing, or committing the nuisance; and to levy a special assessment on the land or remises on which the nuisance is situated to defray the cost, or to reimburse the county for the cost of abating it; and, WHEREAS, police power is that inherent and plenary power which enables prohibition of all things hurtful to the comfort, safety and welfare of society; and, WHEREAS, the scope of police power is broad, encompassing all those measures which bear a reasonable and substantial relation to promotion of the general welfare of the people; and, WHEREAS, developing code compliance policy and procedure for enforcement has been a long-term goal of Jefferson County, as reflected in Resolution 29-03 In the Matter of establishing a Policy on the Complaint Review and Enforcement adopted June 23, 2003, and Resolution 42-03 In the Matter of re-establishing the County Policy on the Complaint Review and Enforcement adopted July 28, 2003; and, WHEREAS, on December 10.2020, Jefferson County Board of Health and Jefferson County Board of Commissioners adopted Ordinance No 09-1210-20 on Code Compliance in Unincorporated Areas of Jefferson County, codified in Title 19—Code Compliance; and, WHEREAS, Jefferson County departments are tasked with implementing Title 19 of the Jefferson County Code ("JCC"); and, WHEREAS, it is efficient for Jefferson County to have Code Compliance Rules of Procedure for all departments that is consistent, reasonable, and legally sound; and, WHEREAS, Chapter 19.05.0200) JCC authorizes Code Compliance Rules of Procedure; and, WHEREAS, Chapter 19.05.020(2) JCC authorizes amendments to Code Compliance Rules of Procedure through a motion by the Board of Commissioners and Board of Health; and, WHEREAS, Department of Community Development and Environmental Public Health have worked together, with assistance from the Prosecuting Attorney's Office, to develop Code Compliance Rules of Procedure in compliance with Title 19 JCC to further implement the intended goal of compassionate and effective code enforcement (Attachment A); and, WHEREAS, throughout Title 19 JCC, and particularly in Chapter 19.10.05 JCC, voluntary compliance is emphasized; and WHEREAS, Chapter 19.30.025 JCC authorizes department directors and their designees to enter into settlement agreements, including but not limited to: deferring penalty payments for up to three years and cancelling a portion of the penalty debt based on sustained and prolonged compliance when appropriate; and, WHEREAS, Chapter 19.30.030 JCC authorizes an Enforcement Fund (Fund 126, HHS Site Abatement Fund) for cost associated with abatements and code compliance enforcement; and, WHEREAS, Jefferson County recognizes that barriers to code compliance enforcement exist, and when those barriers are small and removing them is beneficial to the public, the departments are authorized to use enforcement funds (Fund 126, HHS, Site Abatement Fund) for vouchers; and, NOW THEREFORE, BE IT RESOLVED BY THE BOARD OF COUNTY COMMISSIONERS AND BOARD OF HEALTH OF JEFFERSON COUNTY, STATE OF WASHINGTON: Section 1. Findings of Fact. The Jefferson County Board of Commissioners hereby adopts the above "Whereas" clauses as Findings of Fact. Section 2. Purpose. The purpose of this Resolution is to repeal Resolution No. 42-03 and Add a Resolution Adopting Code Compliance Rules of Procedure Pursuant to Chapter 19.05.020(1) JCC to further implement Title 19 JCC as reflected in Attachment A. Section 3. Repealing Resolution No. 42-03. The Board of Commissioners repeals Resolution No. 42-03 and adds Resolution 61-1112-24R, adopting Code Compliance Rules of Procedure pursuant to Chapter 19.05.0200) JCC. Section 4: Adoption of Resolution 52-1112-24R Code Compliance Rules of Procured. The Code Compliance Rules of Procedure pursuant to Chapter 19.05.0200) JCC, attached as Attachment A, are hereby adopted. Section 5: Effective Date. This resolution shall take effect immediately upon adoption. Section 6: Severability, If any one or more section, subsections, or sentences of this resolution are held to be unconstitutional or invalid, such decision shall not ai%ct the validity of the remaining portion of this resolution and the same shall remain in full force and effect. Section 7: SEPA Compliance. This resolution is categorically exempt from the threshold determination and Environmental Impact Statement requirements of the State Environmental Policy Act under WAC 197-11-500(19). (SIGNATURES APPEAR ON THE NEXT PAGE) APPROVED and ADOPTED this SEAL: =�ariss;p��wA s�pfi ••. .-�p�,4 WA OP. H►NG ATTEST: Carolyn Oiallaway. Date Clerk of the Board Approved as to form only: day of AkWMde,-, 2024. JEFFERSON COUNTY BOARD OF COMMISSIONERS Heidi Eisenhour, Member Philip C. Hunsucker, Date /ill ?lzq Chief Civil Deputy Prosecuting Attorney " 4 APPROVED and ADOPTED this day of , 2024. JEFFERSON COUNTY BOARD OF HEALTH Kate Dean, Chair Greg Brotherton, Member Heidi Eisenhour, Member ATTEST: Glenn Gilbert, Date Clerk of the Board Amanda Grace, Vice Chair Monica MickHager, Member Kees Kolff, Member APPROVED AS TO FORM Philip C. Hunsucker, Date Chief Civil Deputy Prosecuting Attorney ATTACHMENT A JEFFERSON COUNTY CODE COMPLIANCE RULES OF PROCEDURE C- �,o N C r r Public Developed October 2024 Jefferson County Code Compliance Rules of Procedure 2 of 9 TABLE OF CONTENTS PURPOSE........................................................................................................................................3 AUTHORITY..................................................................................................................................3 SEVERABILI'TY.............................................................................................................................3 RULE1 - COMPLAINCE...................... .........................................................................................3 RULE 2 - ROLE OF DEPARTMENT DIRECTORS AND STAFF..............................................4 RULE3 - COMPLAINTS...............................................................................................................4 RULE4 - ENFORCEMENT...........................................................................................................5 RULE 5 - SETTLEMENTS.............................................................................................................6 RULE 6 - ENFORCEMENT FUND...............................................................................................7 RULE 7 - VOUCHERS ......... ....................... -.................. .......................................................... 8 RULE 8 -, LIMITATIONS...............................................................................................................8 RULE 9 - AMENDMENTS AND CORRECTIONS......................................................................9 Jefferson County Code Compliance Rules of Procedure Page 3 of 9 PURPOSE The purpose of these Code Compliance Rules of Procedure (Rules) is to further implement title 19 JCC by providing additional guidance for compassionate and efficient code enforcement to promote and protect the general public health, safety, and environment of Jefferson County residents. Title 19 JCC provides uniform and efficient regulation for civil code violations and public nuisances. Uniform and efficient procedures, and consistent application, is in Jefferson County's best interest to improve the delivery and cost effectiveness of code compliance services to the public. AUTHORITY JCC 19.05.020 authorizes these Rules and sets the scope and limitations on enforceability. Title 19 JCC outlines certain acts to be civil violations and establishes civil enforcement procedures and penalties, and also declares certain acts to be misdemeanors, punishable by a fine of not more than $1,000 or imprisonment in a county jail for not more than 90 days. JCC 19.10.020. These Rules hereby reference and incorporate the enforcement process authorized in title 19 JCC. These Rules confirm and authorize the enforcement discretion of directors to use written policies for staff to uniformly and efficiently process code compliance complaints that do not rise to the level of a rule, including the use,of template documents. SEVERABILITY If any section, subsection, paragraph, sentence, clause, or phrase of these Rules is declared unconstitutional or invalid for any reason, such decision shall not affect the validity of the remaining parts of these Rules. RULE 1 - COMPLAINCE Achieving code compliance is one of the primary ways Jefferson County works to promote and protect the public safety, health, and environment of Jefferson County residents. (a) Voluntary compliance whenever possible It is the intent of Jefferson County to seek voluntary compliance from the person responsible whenever possible as outlined in chapter 19.10 JCC — Voluntary Compliance. (i) As reflected in chapter 19.15 JCC — Voluntary Compliance, it is Jefferson County's directive to encourage compliance using education, prevention, and voluntary compliance as a first step. �l Jefferson County Code Compliance Rules of Procedure Page 4 of 9 (ii) Staff must be sensitive to the possibility that the person responsible may not be aware of regulations and give warnings prior to enforcement, unless there is potential of immediate adverse impact on the people or environment. Staff shall document warnings in writing whenever possible. (b) Non -Compliance. If voluntary compliance is not achieved, then staff shall move forward with enforcement escalation protocols to gain compliance pursuant to chapter ,19.20 JCC —Notice and Orders. RULE 2 - ROLE OF DEPARTMENT DIRECTORS AND STAFF (a) Department Directors and Staff (i) As used in these rules, the term "director" has the same meaning as defined JCC 19.1 OM 5(1), and includes a director's designee. (ii) As used in these rules, the term "staff' means county employees engaged in code compliance under title 19 JCC and includes Code Compliance Coordinators, Code Compliance Officers, Environmental Public Health Officer Designees. (b) Code Compliance Officers and Health Officer Designees (i) Staff shall make every effort to project a professional demeanor, even under difficult situations, and consider the intent of regulations when seeking compliance with the regulations. (ii) Staff should be fair, equitable, vigilant, and guard against the abuse of power. (iii) Department directors have the responsibility of providing on -going training to ensure staff have the knowledge and skills needed efficiently and effectively carry out compassionate code, compliance enforcement pursuant to title JCC following best practices and procedural steps consistent with these Rules. (iv) Staff should engage in early intervention when responding to code compliance issues. (v) Staff should create a visible and credible presence of the interests and responsibility of government in the eyes of the public. County presence may deter some individuals from further violating code requirements. (c) The role of directors and staff is to administer the will of the people as expressed through legislation and initiatives, and codified in state and local laws, including title JCC. RULE 3 - COMPLAINTS (a) Citizen Complaints VJefferson County Code Compliance Rules of Procedure Page 5 of 9 (i) Jefferson County does not accept anonymous complaints. (ii) The Citizen Concern/Code Compliance Form can be found on the Jefferson County website: hu s:8w%-w.co.'efferson.wa.us/formcenteridcd-I l icom p Iaint- form-70 (b) Processing Complaints (i) All complaints shall be timely entered into an approved database for tracking purposes. (ii) Staff shall determine if the complaints are founded or unfounded. RULE 4 - ENFORCEMENT JCC 19.05.020(3) provides the legal authority for these Rules to use the enforcement mechanisms listed in JCC 19.10.025, which says: Jefferson County seeks to gain voluntary compliance and may... consider using one or more of the following code compliance tools, when appropriate, and depending on the severity of a specific violation: education, voluntary compliance, notice of violation, order of abatement, one-time penalty, daily penalties, stop work order, notice to vacate, and property liens. (a) Escalation (i) When a civil code violation has been established according to the provisions of JCC 19.20.010, and voluntary compliance efforts are unsuccessful, JCC 19.10.45 gives discretion to the director to escalate enforcement. (ii) This may include assessing per -day penalties, and putting a lien on the property for unpaid fines and recovery of county costs (staff time, attorney time, etc.). (iii) At each step in the escalation process, the director and staff shall provide opportunities for voluntary compliance. (iv) Directors maintain enforcement discretion. Nothing in these Rules prevents the director from enforcing the violation. JCC 19.10.045. (b) Liens on Liens on Properties Requirements for imposing liens on properties can be found in JCC 19.10.025(3) — Enforcement authority and administration and JCC 19.30.020 JCC — Recovery of costs. (i) All penalties and costs shall constitute a lien against the subject property. A lien for penalties imposed shall be recorded if the monetary penalties remain unpaid for 90 days. Jefferson County Code Compliance Rules of Procedure Page 6 of 9 (ii) The County shall place a lien for any unpaid monetary penalties imposed, the cost of any proceedings, any abatement work perfonned, and all other related costs against the real property on which the monetary penalty was imposed. (iii) Liens shall run with the land but shall be subordinate to all previously existing special assessment liens imposed on the same property and shall be superior to all other liens, except for state and county taxes, with which it shall be on a parity. JCC 19.30.020(3)-(a). RULE 5 - SETTLEMENTS Settling a case helps provide the incentive to deter future violations and sends a message to the community that Jefferson County's goal is compliance, not the collection of penalties. (a) Settlement Authority (i) Directors and staff shall work cooperatively with property owners to settle penalties whenever appropriate. (ii) The director or designee is authorized to settle claims for monetary penalties incurred from the actions and processes related to code violations or nuisances when such settlement is in the best interest of the County. See examples in JCC 19.15.010 — Voluntary compliance agreements and JCC 19.30.025 — Settlement of monetary penalties and costs. (iii) In addition, the director shall consider the following factors: (A) Whether the person responsible responded to notices and cooperated to correct the code violation or nuisance: (B) Whether the person responsible failed to appear at the hearing; (C) Whether the code violation or nuisance was a repeat violation; (D) Whether the person responsible showed due diligence or substantial progress in correcting the code violation or nuisance; and (E) Any other relevant factors. JCC 19.30.025(1)(a)-(e). (iv) The director is authorized to settle claims for monetary penalties incurred under JCC 19.30.010 and costs incurred under JCC 19.30.020 when such settlement is in the best interest of the county. JCC 19.30.025(l). (v) In assessing violations for settlement, directors and staff shall consider the factors outlined in JCC 19.30.025(l) JCC. In settling penalties, directors shall have broad discretion to defer payment of a portion of the penalty for up to three years, unless a shorter time -frame is warranted. Jefferson County Code Compliance Rules of Procedure Page 7 of 9 (vi) All Voluntary Compliance Agreements shall fully comply with the necessary terms and conditions for Settlement Agreements as outlined in JCC 19.15.015. (vii) When a Settlement Agreement is entered into, staff and directors shall determine a reasonable and flexible compliance timeline. JCC 19.15.015. (viii) The director shall make an annual report to the Jefferson County Board of Commissioners regarding all settlements under title 19 JCC. JCC 19.30.025(2). (b) Costs that cannot be settled (i) The director shall not waive any assessed costs of code compliance or actual abatement costs incurred by the County, including associated interest thereon. (ii) Actual abatement costs are funds spent by the County to achieve physical abatement of the code violation or nuisance. JCC 19.30.025. RULE 6 - ENFORCEMENT FUND Title 19 JCC authorizes an Enforcement Fund. (a) Enforcement Fund Authorized Uses (i) Assessed penalties collected in relation to code enforcement efforts shall be deposited into the Enforcement Fund. (ii) All monies collected from the assessment of civil penalties, abatement costs, or other costs recovered for the work relating to civil code or nuisance enforcement shall be allocated to support expenditures for enforcement and abatement and shall be accounted for through the creation of an account in the fund for civil code enforcement and abatement costs or other appropriate accounting mechanisms. JCC 19.30.030.. (iii) The Enforcement Fund is administered by Jefferson County Environmental Public Health with a specific accounting for each department that contributes to the Enforcement Fund. (iv) Monies form the Enforcement Fund shall be used to support code compliance enforcement and abatement, including but not limited to, staff training, abatements, supplies, education and outreach, community clean up events, vouchers for fees and inspections, and recording fees related to code compliance enforcement. (v) Use of the Enforcement Fund must be approved by a director. (vi) Any disagreement between departments about the use of Enforcement Fund monies shall be resolved by a meeting between the respective department directors. c h� Jefferson County Code Compliance Rules of Procedure Page 8 of 9 9 (vii) If the directors cannot reach an agreement, the impasse shall be brought to the County Administrator. (viii) After hearing from all respective departments involved, the County Administrator shall make the final decision regarding how the specific Enforcement Fund monies in dispute should be dispersed. RULE 7 - VOUCHERS Vouchers may be authorized in certain circumstances when it is believed in good faith to be the quickest and most expedient way to gain compliance. (a) Authority for vouchers Vouchers shall only be issued after consultation with the department's director or designee. (a) When vouchers are appropriate Vouchers may be appropriate when working with properties where the owners lack financial resources, the property is a victim of illegal dumping, the problem is relatively small and contained, the property is in probate, or other extenuating circumstances that warrant reducing the barrier to compliance. (b) Limitations on vouchers: (i) Vouchers are limited to one household every three years; (ii) Annual voucher expenditures shall not exceed $5,000; (iii) Vouchers have a limit of $250.00; and, (iv) Vouchers are not guaranteed and subject to budget constraints. RULE 8 - LIMITATIONS (a) No Additional Legal Rights These Rules do not create legal rights beyond those obligations and rights created by statute or other laws binding on Jefferson County. (b) Legal Requirements and Best Practices (i) The provisions of state law and title JCC control, if there is any conflict with these Rules. (ii) These Rules include both statutory requirements and best practices. (c) No Additional Duty That is Not Already Imposed by Law V Jefferson County Code Compliance Rules of Procedure Pa e 9 of 9 No provision nor any term used in 'these Rules is intended to impose any duty whatsoever upon Jefferson County or any of its officers or employees, not already imposed by law. (d) No Basis for Liability These Rules are not intended to and shall not be construed to create or form the basis of any liability on the part of Jefferson County, or its officers, staff, or agents, for any injury or damage resulting from any action or inaction on the part of Jefferson County related in any manner to the enforcement of these Rules by its elected officials, officers, staff, or agents. RULE 9 - AMENDMENTS AND CORRECTIONS (a) Amendments and corrections to these Rules shall be made in accordance with JCC 19.05.020(2). (b) The Clerk of the Board of County Commissioners is authorized to make necessary technical, non -substantive corrections to these Rules including, but not limited to, the correction of scrivener's or clerical errors, references, numbering, section/subsection numbers and any references to them. 11'4;2024 "WI. By Department of Community Development & Environmental Public Health November 2024 y Jefferson County Jk.i� • Title 19 JCC • Code Compliance Rules of Procedure • Code Enforcement Voluntary Compliance Enforcement Options • Alternative Enforcement Program • Social Services Support 0 Jefferson County Code Compliance Implemented by staff Code Compliance Rules of Procedure Title i9 JCC TITLE:Lg JEFFERSON COUNTY CODE Voluntary Code Compliance Enforcement Notice of Education LPena.Ities Violation —� Voluntary Compliance Stop ..Ac reement Work/Vacate Settlement Agreement Property Liens Jefferson County 4 VOLUNTARY COMPLIANCE AGREEMENTS & SETTLEMENT AGREEMENTS Positive Outcomes • Hearing Examiner • Behavior Changes Jeffe,rson county • Treat people with respect and dignity • Treat people fairly and equitably • To be reasonable, professional, and courteous • To guard against the abuse of power and authority • To respect legal rights • Education • Voluntary Compliance • Lean Principals GJefferson County •Enforcement Fund •Vouchers �y f -T - ` r Jefferson County aiJgrzo:a "�' Before ,�. '•Jr,'f fit+: /'..�i. Jefferson County :Slyl3�lae, Before Jefferson Co , unty Afte r r7i lu C,,f AV r" LA Jefferson County Afte r 1.1 Befor �� S.. - �� 11�' _- ,-�' `..: -ail •�' �,�' .�. ' r rl - � . v1,�'�� ;ter;-' • a, . - }.: -�- x 1�i a �c'. - :►�• ,.: f At' L T N4 Jefferson County After Jefferson County • Resolved "Hip Camp" near Kala Point RV Park Marrowstone Island • Flagler Road filing a lien $146,500. I'll 44V A 10 • Discovery Ridge building without permits stop work order • Pre -Application 4L; 1 L,14/ 2 C, 2 4 EV. ,1)D ,O]LAWMAIM NOUN[* Legal Authority • Title ig JCC Code Compliance Rules of Procedure — Requires BOCC & BOH Approval People -Focused • Alternative Enforcement Program Includes Social Service Professional Referrals Encourages Voluntary Compliance Compassionate Code Enforcement • Responsible Stewardship of Resources • Enforcement Fund • Effecti,,/ely Removing Barriers through Vouchers Jefferson Corinty Questions? Jefferson 11/a/20Z4 16 ATTACHMENT A JEFFERSON COUNTY CODE COMPLIANCE RULES OF PROCEDURE Public Developed October 2024 T Healt r� Jefferson County Code Compliance Rules of Procedure Page 2 of 9 TABLE OF CONTENTS PURPOSE......................................................................................................:.................................3 AUTHORITY..................................................................................................................................3 SEVERABILITY.............................................................................................................................3 RULE1 - COMPLAINCE....................... .........................................................................................3 RULE 2 - ROLE OF DEPARTMENT DIRECTORS AND STAFF..............................................4 RULE 3 - COMPLAINTS...............................................................................................................4 RULE 4 - ENFORCEMENT..........................................................................................................5 RULE5 - SETTLEMENTS.............................................................................................................6 RULE6 ENFORCEMENT FUND...............................................................................................7 RULE7 - VOUCHERS...................................................................................................................8 RULE 8 - LIMITATIONS...............................................................................................................8 RULE 9 - AMENDMENTS AND CORRECTIONS......................................................................9 Jefferson County Code Compliance Rules of Procedure Page 3 of 9 PURPOSE The purpose of these Code Compliance Rules of Procedure (Rules) is to further implement title 19 JCC by providing additional guidance for compassionate and efficient code enforcement to promote and protect the general public health, safety, and environment of Jefferson County residents. Title 19 JCC provides uniform and efficient regulation for civil code violations and public nuisances. Uniform and efficient procedures, and consistent application, is in Jefferson County's best interest to improve the delivery and cost effectiveness of code compliance services to the public. AUTHORITY JCC 19.05.020 authorizes these Rules and sets the scope and limitations on enforceability. Title 19 JCC outlines certain acts to be civil violations and establishes civil enforcement procedures and penalties, and also declares certain acts to be misdemeanors, punishable by a fine of not more than $1,000 or imprisonment in a county jail for not more than 90 days. JCC 19.10.020. These Rules hereby reference and incorporate the enforcement process authorized in title 19 JCC. These Rules confirm and authorize the enforcement discretion of directors to use written policies for staff to uniformly and efficiently process code compliance complaints that do not rise to the level of a rule, including the use of template documents. SEVERABILITY If any section, subsection, paragraph, sentence, clause, or phrase of these Rules is declared unconstitutional or invalid for any reason, such decision shall not affect the validity of the remaining parts of these Rules. RULE 1 - COMPLAINCE Achieving code compliance is one of the primary ways Jefferson County works to promote and protect the public safety, health, and environment of Jefferson County residents. (a) Voluntary compliance whenever possible It is the intent of Jefferson County to seek voluntary compliance from the person responsible whenever possible as outlined in chapter 19.10 JCC — Voluntary Compliance. (i) As reflected in chapter 19.15 JCC — Voluntary Compliance, it is Jefferson County's directive to encourage compliance using education, prevention, and voluntary compliance as a first step. Jefferson County Code Compliance Rules of Procedure Page 4 of 9 (ii) Staff must be sensitive to the possibility that the person responsible may not be aware of regulations and give warnings prior to enforcement, unless there is potential of immediate adverse impact on the people or environment. Staff shall document warnings in writing whenever possible. (b) Non -Compliance. If voluntary compliance is not achieved, then staff shall move forward with enforcement escalation protocols to gain compliance pursuant to chapter 19.20 JCC — Notice and Orders. RULE 2 - ROLE OF DEPARTMENT DIRECTORS AND STAFF (a) Department Directors and Staff (i) As used in these rules, the term "director" has the same meaning as defined JCC 19.10.0150), and includes a director's designee. (ii) As used in these rules, the term "staff' means county employees engaged in code compliance under title 19 JCC and includes Code Compliance Coordinators, Code Compliance Officers, Environmental Public Health Officer Designees. (b) Code Compliance Officers and Health Officer Designees (i) Staff shall make every effort to project a professional demeanor, even under difficult situations, and consider the intent of regulations when seeking compliance with the regulations. (ii) Staff should be fair, equitable, vigilant, and guard against the abuse of power. (iii) Department directors have the responsibility of providing on -going training to ensure staff have the knowledge and skills needed efficiently and effectively carry out compassionate code compliance enforcement pursuant to title 19 JCC following best practices and procedural steps consistent with these Rules. (iv) Staff should engage in early intervention when responding to code compliance issues. (v) Staff should create a visible and credible presence of the interests and responsibility of government in the eyes of the public. County presence may deter some individuals from further violating code requirements. (c) The role of directors and staff is to administer the will of the people as expressed through legislation and initiatives, and codified in state and local laws, including title 19 JCC. RULE 3 - COMPLAINTS (a) Citizen Complaints Jefferson County Code Compliance Rules of Procedure Page 5 of 9 (i) Jefferson County does not accept anonymous complaints. (ii) The Citizen Concern/Code Compliance Form can be found on the Jefferson County website: htt s:/fwww.co.iefferson.wa.us/forneenterldcd-I I/com laint- form-70 (b) Processing Complaints (i) All complaints shall be timely entered into an approved database for tracking purposes. (ii) Staff shall determine if the complaints are founded or unfounded. RULE 4 - ENFORCEMENT JCC 19.05.020(3) provides the legal authority for these Rules to use the enforcement mechanisms listed in JCC 19.10.025, which says: Jefferson County seeks to gain voluntary compliance and may... consider using one or more of the following code compliance tools, when appropriate, and depending on the severity of a specific violation: education, voluntary compliance, notice of violation, order of abatement, one-time penalty, daily penalties, stop work order, notice to vacate, and property liens. (a) Escalation (i) When a civil code violation has been established according to the provisions of JCC 19.20.010, and voluntary compliance efforts are unsuccessful, JCC 19.10,45 gives discretion to the director to escalate enforcement. (ii) This may include assessing per -day penalties, and putting a lien on the property for unpaid fines and recovery ofc"unty costs (staff time, attorney time, etc.). (iii) At each step in the escalation process, the director and staff shall provide opportunities for voluntary compliance. (iv) Directors maintain enforcement discretion..- Nothing in these Rules prevents the director from enforcing the violation. JCC 19.10.045. (b) Liens on Liens on Properties Requirements for imposing liens on properties can be found in JCC 19.10.025(3) — Enforcement authority and administration and JCC 19.30.01-0 JCC — Recovery of costs. (i) All penalties and costs shall constitute a lien against the subject property. A lien for penalties imposed shall be recorded if the monetary penalties remain unpaid for 90 days. Jefferson County Code Compliance Rules of Procedure Page 6 of 9 (ii) The County shall place a lien for any unpaid monetary penalties imposed, the ee4t e#cost o['any proceedings, any abatement work performed, and all other related costs against the real property on which the monetary penalty was imposed. (iii) Liens shall run with the land but shall be subordinate to all previously existing special assessment liens imposed on the same property and shall be superior to all other liens, except for state and county taxes, with which it shall be on a parity. JCC 19.30.020(3)-(a). RULE 5 - SETTLEMENTS Settling a case helps provide the incentive to deter future violations and sends a message to the community that Jefferson County's goal is compliance, not the collection of penalties. (a) Settlement Authority (i) Directors and staff shall work cooperatively with property owners to settle penalties whenever appropriate. (ii) The director or designee is authorized to settle claims for monetary penalties incurred from the actions and processes related to code violations or nuisances when such settlement is in the best interest of the County. See examples in JCC 19.15.010 — Voluntary compliance agreements and JCC 19.30.025 — Settlement of monetary penalties and costs. (iii) In addition, the director shall consider the following factors: (A) Whether the person responsible responded to notices and cooperated to correct the code violation or nuisance; (B) Whether the person responsible failed to appear at the hearing; (C) Whether the code violation or nuisance was a repeat violation; (D) Whether the person responsible showed due diligence or substantial progress in correcting the code violation or nuisance; and (E) Any other relevant factors. JCC 19.30.025(l)(a)-(e). (iv) The director is authorized to settle claims for monetary penalties incurred under JCC 19.30,010 and costs incurred under JCC 19.30.020 when such settlement is in the best interest of the county. JCC 19.30.025(1). (v) In assessing violations for settlement, directors and staff shall consider the factors outlined in JCC 19.30.025(l) JCC. In settling penalties, directors shall have broad discretion to defer payment of a portion of the penalty for up to three years, unless a shorter time -frame is warranted. '��rcu�� a t. Jefferson Countti Code Compliance Rules of Procedure Page 7 of 9 x ti. (vi) All Voluntary Compliance Agreements shall fully comply with the necessary terms and conditions for Settlement Agreements as outlined in JCC 19.15.015.: (vii) When a Settlement Agreement is entered into, staff and directors shall determine a reasonable and flexible compliance timeline. JCC 19.15.015.: (viii) The director shall make an annual report to the Jefferson County Board of Commissioners regarding all settlements under title 19 JCC. JCC 19.30.025(2). (b) Costs that cannot be settled (i) The director shall not waive any assessed costs of code compliance or actual abatement costs incurred by the County, including associated interest thereon. (ii) Actual abatement costs are funds spent by the County to achieve physical abatement of the code violation or nuisance. JCC 19.30.0254E--(-. RULE 6 - ENFORCEMENT FUND Title 19 JCC authorizes an Enforcement Fund. (a) Enforcement Fund Authorized Uses Assessed penalties collected in relation to code enforcement efforts shall be deposited into the Enforcement Fund. (ii) All monies collected from the assessment of civil penalties, abatement costs, or other costs recovered for the work relating to civil code or nuisance enforcement shall be allocated to support expenditures for enforcement and abatement and shall be accounted for through the creation of an account in the fund for civil code enforcement and abatement costs or other appropriate accounting mechanisms. JCC 19.30.030.. (iii) The Enforcement Fund is administered by Jefferson County Environmental Public Health with a specific accounting for each department that contributes to the Enforcement Fund. (iv) Monies fonn the Enforcement Fund shall be used to support code compliance enforcement and abatement, including but not limited to, staff training, abatements, supplies, education and outreach, community clean up events, vouchers for fees and inspections, and recording fees related to code compliance enforcement. (v) Use of the Enforcement Fund must be approved by a director. (vi) Any disagreement between departments about the use of Enforcement Fund monies shall be resolved by a meeting between the respective department directors. Jefferson County Code Compliance Rules of Procedure Page 8 of (vii) If the directors cannot reach an agreement, the impasse shall be brought to the County Administrator. (viii) After hearing from all respective departments involved, the County Administrator shall make the final decision regarding how the specific Enforcement Fund monies in dispute should be dispersed. RULE 7 - VOUCHERS Vouchers may be authorized in certain circumstances when it is believed in good faith to be the quickest and most expedient way to gain compliance. (a) Authority for vouchers Vouchers shall only be issued after consultation with the department's director or designee. (a) When vouchers are appropriate Vouchers may be appropriate when working with properties where the owners lack financial resources, the property is a victim of illegal dumping, the problem is relatively small and contained, the property is in probate, or other extenuating circumstances that warrant reducing the barrier to compliance. (b) Limitations on vouchers: (i) Vouchers are limited to one household every three years; (ii) Annual voucher expenditures shall not exceed $5,000; (iii) Vouchers have a limit of $250.00; and, (iv) Vouchers are not guaranteed and subject to budget constraints. RULE 8 - LIMITATIONS (a) No Additional Legal Rights These Rules do not create legal rights beyond those obligations and rights created by statute or other laws binding on Jefferson County. (b) Legal Requirements and Best Practices (i) The provisions of state law and title 19 JCC control, if there is any conflict with these Rules. (ii) These Rules include both statutory requirements and best practices. (c) No Additional Duty That is Not Already Imposed by Law C Jefferson County Code Compliance Rules of Procedure Page 9 of 9 No provision nor any term used in these Rules is intended to impose any duty whatsoever upon Jefferson County or any of its officers or employees, not already imposed by law. (d) No Basis for Liability These Rules are not intended to and shall not be construed to create or form the basis of any liability on the part of Jefferson County, or its officers, staff, or agents, for any injury or damage resulting from any action or inaction on the part of Jefferson County related in any manner to the enforcement of these Rules by its elected officials, officers, staff, or agents. RULE 9 - AMENDMENTS AND CORRECTIONS (a) Amendments and corrections to these Rules shall be made in accordance with JCC (2). (b) The Clerk of the Board of County Commissioners is authorized to make necessary technical, non -substantive corrections to these Rules including, but not limited to, the correction of scrivener's or clerical errors, references, numbering, section/subsection numbers and any references to them. A s - .� Wit. ,,,.•.�.�� '� Code Compliance Rules of Procedure November 12, 2024 Pinky Mingo, Environmental Public Health and Water Quality Manager Nicki Akins, Code Compliance Coordinator for DCD Ariel 5peser, Civil DPA 90CC Pmsymlatizin 3 Agenda Historical Context of Code --! Compliance Legislation Comparison: July 2003 Resolution to Current Proposal Why Code Compliance Rules of Procedure? Who Benefits? it r: Everyone!) �Spo e y ) Historical Context of Code Compliance Legislation N Ordinance 09-1210-20 (Title 19 JCC Code Compliance) Ordinance No. 07-0624-19 (Ch. 8.90 Public Nuisance) Historical Context of Code Resolution 42-03 (Re -Establishing Policy on i Complaint Review & Enforcement) Compliance Legislation ,� . Proposed Code Compliance Rules of Procedure W L Process for Future Amendments to Proposed 41 �- Code Compliance Rules of Procedure Ordinance No. 09-1210-20 (December 2020): Adds an Entire Title to JCC on Comprehensive Code Compliance Wffl�REAS, Jefferson County is exercising its constitutional and statutory authority to declare what shall be deemed a nuisance in unirworporated Jefferson County and is establishing a system for addressing nuisances in the county that is consistent with state law; and, WHEREAS, the BOH and the BoCC each have held a hearing and has received public comment on the draft ordinance proposed by staff; and, WHEREAS, in response to the public comment and testimony, additional improvements to the draft ordinance have been made, and, NOW, THEREFORE, be it ordained by the BOH and the BoCC as follows: Section 1 Adding Tile l+i JCC. The BoCC and the BOH have concurrent legislative authority regarding the adoption of Title 19 JCC and for the changes in the other Titles for which they have legislative authority as stated below. The BoCC and the BOH jointly adopt Title 19, as set forth in Appendix A. iance Ordin Chapters: 19.05 Introductory Provisions 19.10 General Provisions 19.15 Voluntary Compliance 19.20 Notice and Orders 19.25 Vehicle and Public Right -of -Way Nuisances 19.30 Penalties, Costs, and Settlements 19.35 Administrative and Hearing Examiner Appeals for Civil Code Violations 19.40 Hearing Examiner Appeals for Nuisances Ordinance No. 09-1210-20 (December 2020) Below Are Some of the Sections Adopts Title 19 JCC: nos.,o ti1o.1. M OS.015 lW.rr c.rntrvCd. 1a Oi0A Ed. C.gVIIa..a M R.I. R.1- hxm. autlerlEad is 0s 025 S—.b.ky 1919aa Ipklb q men 11.^Mhwl IS N a30 Oecl/rtlon N P,&k M.-n[a mNOYlr.nm I91. 00 EnitRw.wrt-0-"Xr.BMn�N..wn n la ae c.N..9.k. ,Vista aur.xm.[.p.Wftr.y..r.b pwkNlNrN.wn 1. 1.— •1...•p"P"._.i .11.na 191.aa ENarNry w0E9M wMll.n9 la ta.N9 fm+odM111t.9N.Nlnlrytwlyll..t. rNIk.lNmMwrga.nn. Mkn Nrlsl.11.n,..svn.Yr..�l rE�vid.w[I.[w.d.•.d H[f[�e+wr artlrtn-N Islam ROOM 0.r.ry Islam sg1..t..rMnsE.lt9mry, nt.m cN.o—'I -ram 1910.an 4M11.tlw�N1*1011 V I.l..a15 0w+dN9r.nb it IBM S01pa11Y.11 Mtwo[rW101 pN.a1 Islam hx.e to utM 191! O10 Ills. N.NUMYy [onN[nn la [a,015 VruvrV [..w.M..m�+Ml k9 N+rX+ t91a 9:! .l.nl •WIrM 19]a0ia L.y[ 'd' Ordinance No. 07w0624-19 (June 2019): Adds an Entire Chapter for Public Nuisance Enforcement - - • - - COUynOF11rhlw+ )% STATE OF WAM"G"". vat Ord tnaan -n I's1,1, ',n• ,,,.. I ORDINANCE VO, 474624-19 in Unincorporated Ares of Joff race County I WHRREA7, ArtMe Xf. seethe I I of the W confers upon county Iepalaive mahonbes the pohm power to adtp such kcal polrQ, sahivy and other rerylstitm as we not in camfbct vsmh gewmal law+, and. WHEREAS. Article XI, scum I I of the a ■ dwm didepidne of de policeower pto cities and aoustkt and the ptrwer delrped is in c%wouve withu Thar spheres dot poasesar' by the kpslturr: and WMRKA& RCV 76 32 12ot 7 ( psvtdns *m the count) kpriadve tedwities shay sake and enforce. by rtlokdwm"onkaaoce. all Rich police and samrvy mralliftons s we nit in catlllet with war kw; weal. WFl[R[AB, poiim powet is Iha1 imherettl and ptarc. pawner .Rich enables psahihitian of all things hurtful to the cmtfra. safety ad welfae of snctcuy. and. Wift RLU, dw wain of palicc lower is bnmid, etwootpeawng all thou eueuunes which hew a remorWQ and w1 w inbal relation w pnmwwtau of the general weftae of the people: and. WHEREAS. 1tc'R' 1F 7Z.1P0 f 10j provides that cowniki have the power to dectre by xdinow %hat +Mil br dtamed a tamsaoce within the county: to alsent r MANOee a. the � of the priks aeadm& cwjm& or eermninmp the ntasnee, end to kvy a specW amenmem m the laid or prewaw ran winch the a tlawa, a sunward to drhay tie cost, or to reimburse the county for the can of abating it, aid. WHEREAS, the Renard of Counity Conwhainai s (WC I n eaerciang its coowiomiaYl and swtuiory aahvity to dame what shall be deemed a teamace a unincorporated )effnsra County and a coas lishing a system for addraning masatas in the comity the is conoserd Rid aide Inr, and. WHEREAS. an June 17. 2019. the BoCC held a baring an and received public comment no the draft nrdiruin— nrnnowd by etaR- attd. WHEREAS, in response to the public comment and testimony, additional improvements w the draft ordinance have been made, *IOW. THEREFORE, be it ordained by the RoCC as folkras: hspret M 90 XC shall be aided m set lordh to (December 2020) ( from 11/19/2020 BoCC & BOH Presentation) Ordinance No. 09-1210-20 (December 2020): Adds an Entire Title to JCC on Comprehensive Code Compliance WHl�REAS, Jefferson County is exercising its constitutional and statutory authority to declare what shall be Beamed a nuisance in unincorporated Jefferson County and is establishing a system for addressing nuisances in the county that is consistent with state law; and, WHEREAS, the BOII and the BoCC each have held a hearing and has received public comment on the draft ordinance proposed by staff; and, WHEREAS, in response to the public comment and testimony, additional improvements to the draft ordinance have been made, and, NOW, THEREFORE, be it ordained by the BOH and the BoCC as follows: 5ciuon 1. Adding Tidc 11) JCC. The BoCC and the BOH have concurrent legislative authority regarding the adoption of Title 19 JCC and for the changes in the other Titles for which they have legislative authority as stated below. The BoCC and the BOH jointly adopt Title 19. as set forth in Appendix A. f� Resolution No. 42-03 (July 2003) In the Matter of rca[ablahing the County Policy on the Complaint Review 1[F-01.1' I'V IN Nt l 42-03 and Fnfoorcenent WBEREAS, Jefferson County enacted a Complaint Re\•iew and Cnlixcenent Policy by passage of Rt- lurion No ,!pesos nit hme 2.4, !otrS to enlirrce locally adopted codes and ordinances in order to at hir•ee comphancr with the public li licy. and. WHEREAS, this policy was enacted because the County realizes that in the course of enlorrrment and cornpliant a esngations, rrnployrrw may encounter circumstances that require the rmplovrr to make decisions on how to pua7eed that could hacr the lsnential to impinge on property owner pi isac'•y and 'or prolxl ty rights and this polity is to proN ide employees with specific instructions mI wlurt i, rslicted or rheIII iu the perlbrmance of their duties and luow to conduct themselrre wlie n approaching a pwtentral .iodation, conducting an incestigatiun or resp ending to a citizen Complaint; and, WHEREAS. u wus found that Attachment A which was part of Resolotion No 29-M was not ulslared to incorporate changes made by the lksard ofConini6sioners to address citizen enncerne w nh the nngulal docunent and those changes are necessary A'Olt; 7'/16-KF.FURF,. 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TABLE OF CONTENTS PURPOSE............................................................._............._.............................._....,.....3 AUTHORITY...................................................................................................................................3 SEVERABILITY .......................................................................................................... ..............3 RULE1 - COMPLAINCE............................................ ............ --- .............................................. 3 RULE ?. - ROLE OF DEPARTMENT DIRECTORS AND STAFF . .......................................... ...4 RULE3 - COMPLAINTS................................._............................................................................4 RULE4 - ENFORCEMENT ........................... -................._..._..__...............-....I............................5 RULE5 - SETTLEMENTS.............................................................................................................6 RULE 6 - ENFORCEMENT FUND...............................................................................................7 RULE7 - VOUCHERS ........................... ................................... ........................ ........................... .8 RULE8 - LIMITATIONS ................... .-....................................................... ................ ............. 8 RULE 9 - AMENDMENTS AND C'ORRECTIONS......................................................................9 July 2003 — Six Page Complaint and Enforcement Policy with: 1. Enforcement Officer Defined 2. Complaints 3. Site Inspection 4. Administrative Enforcement 5. Legal Enforcement 2024 — Entire JCC Title for Comprehensive Code Compliance with Proposal to Fill in Gaps with Rules of Procedure that Proposes: 1. Role of Directors & Staff • Increased capacity & expertise 2. Complaints - Updated process & technology 3. Enforcement Options • More tools and resources to maximize effectiveness 4. Settlements Encouraged • Saves money! 5. Enforcement Fund • Financial stewardship 6. Vouchers • Creative solutions to barriers g 1. Authorized by chapter 19.05.020(1) Why Rules? _ 4% 2. Clear Expectations Recap of Last Discussion N 3. Better Communication 4. Mutual Understanding & Fair Process Regular Agenda r� 615 Sheridan Street Port Townsend, WA 98368 �„•� _;� www.JeffersonCountyPublicHealth.org Public Healili JEFFERSON COUNTY BOARD OF COUNTY COMMISSIONERS AGENDA REQUEST TO: Board of County Commissioners Mark McCauley, County Administrator FROM: Pinky Mingo, Director of Environmental Public Health Josh Peters, Director of Dept. of Community Development Ariel Speser, Philip Hunsucker, Prosecuting Attorney's Office DATE: Novembert3�2024 SUBJECT: In the Matter of Repealing Resolution No. 42-03 and Adding a Resolution Adopting Code Compliance Rules of Procedure Pursuant to Chapter 19.05.020(1) JCC STATEMENT OF ISSUE: In a joint effort to best serve Jefferson County's code compliance and enforcement needs, Environmental Health, Department of Community Development, and the Prosecuting Attorney's Office have collaborated on developing Code Compliance Rules of Procedure to further assist county departments in implementing Title 19 JCC. On July 28, 2003, the Board of County Commissioners adopted Resolution 42-03—In the Matter of re-establishing the County Policy on Complaint Review and Enforcement, which guided the County's compliance and enforcement. With the adoption of Title 19 JCC—Compliance Code on December 10, 2020, Resolution 42-03 was impliedly repealed. To avoid lingering concerns by county employees about whether Resolution 42-03 remains in effect, Resolution 42-03 should be expressly repealed. ANALYSIS: Developing and implementing a consistent approach to code compliance and enforcement is desired by the public, the Board of Commissioners, Public Health, DCD and other Jefferson County Departments working code compliance cases. Comrnunily H,�, dlli Er virr%nrnental Public Health Developmunl it Dirt. ilili,-- Water Qualify 360-385 Q,irlfl 360-335 9444 360-385-�-1C ,r Always working for a safer and healthier community (f) 360-aI, 9-4487 Staff respectfully request that the Board of Commissioners/Board of Health Repeal Resolution 42-03 and adopt a Resolution Adopting Code Compliance Rules of Procedure Pursuant to Chapter 19.05.0200) JCC. Fiscal Impacts No fiscal impacts at this time. REVIEWED BY: Community Health Environmental Public Health Developmentol Disaklilities Water Quality 360-385-9400 360-385-9444 :360-385-94o1 (f) Always working for a safer and healthier community (f) 360-379-4487 Jefferson County Board of Health 0 New Business Item 5 Briefing on the BoH Subcommittee, formed in March 2024, to examine development solutions on small lots find -out] C.� Public Health December 19, 2024 Jefferson County Board of Health V. New Business J Item 6 Foundational Public Health Services (FPHS): Origin, Traction, and Planning 2023-2025 i Public Health December 19, 2024 FOUNDATIONAL PUBLIC HEALTH SERVICES Providing public health services is a shared state and local responsibility. Some public health services are so critical that they must be provided to every resident. Other public health needs maybe unique to certain regions of our state, so each community determines and implements local priorities. The Foundational Public Health Services (FPHS) model ensures all residents can depend on a core set of services that only governmental public health can provide. Support Foundational Public Health Services funding for local health jurisdictions to ensure that the system can respond to public health threats. THE PROBLEM GOVERNMENTAL PUBLIC HEALTH SYSTEM After a century of effectively preventing illness and premature death and increasing the length and quality of life in Washington communities, the public health system has become woefully inadequate and is now unable to meet its basic responsibilities to protect the health and safety of people in Washington State. Providing public health services is a shared state and local responsibility. Some public health services are so critical that they must be provided to every resident. Other public health needs may be unique to certain regions of our state, so each community determines and implements these local priorities. The Foundation Public Health Services (FPHS) model ensures all residents can depend on a core set of services that only the governmental public health system can provide, THE SOLUTION To rebuild, modernize and fund a 21st century public health system in Washington these are needed: • A statewide set of core public health services, called Foundational Public Health Services (FPHS), that government is responsible for providing. • Core public health services are funded through dedicated revenues that are predictable, reliable and sustainable, and responsive to changes in demand and cost overtime. • Governmental public health services are delivered in ways that maximize the efficiency and effectiveness of the overall systern. • Governmental public health activities arc tracked and performance is evaluated using evidence -based measures. • Local revenue generating options are provided to address locally driven prioritiesthat are targeted to specific community problems. ') PROGRAMS C CAPABILITIES MEETING LOCAL NEEDS Public Health Transformation Foundational Public Health Services Healthy. Vital. Everyone. Everywhere. FPHS GOAL Full funding and implementation of Foundational Public Health Services (FPHS), statewide. • Funding that is adequate, dedicated, stable funding that keeps pace with inflation and demand for services • Implementation that includes system transformation and modernization to deliver services in the most effective, efficient, and equitable manner possible for the funds available. For questions, contact us: carolyn.cartwright@doh.wa.gov FPHS Core Documents • Foundational Public Health Services Law — RCW 43.70.512 & 43.70.515 • FPHS Overview • FPHS Definitions 1.4, March 2019 • FPHS Committee & Workgroup Charter FPHS Reports (Recent) • 2023 FPHS Investment Report — SFY23 • 2023 FPHS 19-21 Investment Report — SFY22 (corrected 12/2023) • 2022 FPHS 19-21 Investment Report — SFY21 (corrected 12/2023) • 2021 FPHS 19-21 Investment Report - SFY20 (corrected 12/2023) • 2020 FPHS Report to the Legislature • 2020 FPHS 17-19 Investment Report - SFY19 • 2020 A Chronology of Funding for the Governmental Public Health SFY19) • 2019 FPHS Evaluation of Shared Services Demonstration Projects • 2018 FPHS Report to the Legislature • 2018 FPHS Baseline Assessment Report • 2018 FPHS Assessment Data Visualizations m in Washington State (Appendix A of 2020 FPHS 17-19 Investment Report — FPHS System Funding Proposal Process — check this space frequently for updates as this pilot process is further developed • FPHS System Funding Proposal Process Overview www.doh.wa.gov/fphs FPHS Web Links — Updated 12/22/2023, Page 1 of 4 FPHS Funding — Budget Requests, Legislative Appropriations, Investments and Accountability 2017 - 2019 2019 - 2021 2021- 2023 2023 - 2025 Budget Request Requested $60 million / Requested $296 million / Requested $285 million / Requested $100 million / biennium biennium biennium biennium 2017-2019 FPHS Decision 2019-2021 FPHS Decision 2021-2023 FPHS Decision Packages Package Summary Package Summary 2019-2021 FPHS Decision 2021-2023 FPHS Decision 2023-2025 FPHS Decision Package Packages Package Legislative $12 million / biennium $28 million / biennium $175 million / biennium $324 million / biennium Appropriation Steering Communicable Disease 19-21 Summary of Investment 21-23 Summary of Investments 23-25 Summary of • Funds to Each Agency (OFM) Committee Investments Foundational Capabilities Investments • Funds to Each Agency • Funds to Each LHJ & SOW Accountability 2018 — FPHS Report to the 2020 — FPHS Report to the Overview — FPHS FPHS Investment Report — Legislature SFY23 Legislature Accountability 21-23 2019 - FPHS Evaluation of FPHS Investment Report - SFY20 FPHS Investment Report — SFY22 Shared Services Demonstration Projects FPHS What Are We Buying 19- 21? FPHS Investment Report - SFY19 FPHS Investment Report - SFY21 Overview - FPHS Accountability 19-21 www.doh.wa.gov/fphs FPHS Web Links — Updated 12/22/2023, Page 2 of 4 Tribal FPHS • Tribal Foundational Public Health Services — AIHC (aihc-wa.com) • Presentation, January 2021— Slide Deck // Recording FPHS Reports (Archive) • 2017 FPHS Report to the Legislature • 2016 FPHS Report to the Legislature • 2015 FPHS Policy Workgroup Report • 2015 FPHS Final Technical Report • 2013 FPHS Preliminary Cost Estimation Model Other Publications • Innovation Webinar Series o Transformation Public Health through the Foundational Public Health Services, January 21, 2023 • Public Health Forward: Implementation Guidance from State and Local Health Department, de Beaumont Foundation o Building Accountabilitv for Public Health Investments • July/August 2022 — Volume 23 —Transformation and Innovation I Public Health Supplement 4. Journal of Public Health management & Practice, Supplement to July/August 2023, Volume 28 — Number 4 o Building a Strong Foundation for Public Health Transformation o Resetting the Course for Foundational Public Health Services (FPHS) During COVID-19 • PHNCI FPHS 215t Century Leaning Community Case Study: Washington, June 2018 o Executive Summary o Case Study RELATED EFFORTS Related Publications • Seize the Opportunity to Reimagine Public Health • Building a Strong Foundation for Public Health Transformation • Resetting the Course for Foundational Public Health Services (FPHS) During COVID-19 • Journal of Public Health Management & Practice — Transformation and Innovation in Public Health Supplement 4 www.doh.wa.gov/fphs FPHS Web Links — Updated 12/22/2023, Page 3 of 4 In Washington • Public Health Advisory Board (PHAB) — The PHAB, established during the 2021 legislative session (RCW 43.70.675), began meeting on March 1, 2022. The law prescribes the representation on this Governor appointed board and directs the PHAB to focus on seven tasks but does not mandate any reports, products or timelines. One of the seven tasks is to evaluate the use of foundational public health services funding by the governmental public health system. More information is available on the PHAB portal — here. Other States • Oregon — Public Health Modernization • Oregon — Public Health Advisory Board (PHAB) • Ohio - Public Health Partnership - FPHS National / Federal • Public Health Forward: Modernizing the U.S. Public Health Svstem • Public Health National Center for Innovation — FPHS o FPHS Video o Ohio — Case Study I Executive Summary o Oregon — Case Study I Executive Summary o Washington —Case Study I Executive Summary • The Imaact of Chronic Underfunding on America's Public Health S, m: Trends. Risks. and Recommendations. 2021. Trust for America's Health • Ready or Not: U.S. Public Health Infrastructure — Congressional Hearing, House Appropriations Committee, 2/24/21. Link to the recording. • Public Health Infrastructure Saves Lives Act — Bill S. 4740 introduced in the 116th Congress (2019-2020) • Developing a Financing System to Support Public Health Infrastructure • Public Health Executive Leadership Forum / RESOLV • For the Public's Health: Investing in a Healthier Future. IOM (2012) OTHER RELATED INFORMATION • Seven Ways Businesses Can Align with Public Health for Bold Action and Innovation, John Hopkins University & de Beaumont Foundation • Staffing Up, Public Health National Center for Innovations & de Beaumont Foundation • Public Health 3.0: A Blueprint for the Future of Public Health • 10 Essential Public Health Services • For the Public's Health: Revitalizing Law and Dolicv to Meet New Challenges. IOM (2011) • For the Public's Health: The role of Measurement in Action and Accountability, IOM (2010) DOH publication number 810-018 To request this document in another format, call 1-800-525-0127. Deaf or hard of hearing customers, please call 711 (Washington Relay) or email doh.information@doh.wa.gov. www.doh.wa.gov/fphs FPHS Web Links — Updated 12/22/2023, Page 4 of 4 Exhibit A Statement of Work Contract Term: 2022-2024 DOH Program Name or Title: Foundational Public Health Services (FPHS) - Effective July 1, 2024 Page 14 of o5 Local Health Jurisdiction Name: Jefferson County Public Health Contract Number: CLH31013 SOW Type: Revision Revision # (for this SOW) I Funding Source Federal Compliance Type of Payment ❑ Federal <Select Ones (check if applicable) EReimbursement Period of Performance: July 1. 2024 through December 31, 2024 ® State ❑ FFATA (Transparency Act) ® Periodic Distribution ❑ Other ❑ Research & Development Statement of Work Purpose: Per RCW 43.70.512, Foundational Public Health Services (FPHS) funds are for the governmental public health system: local health jurisdictions, Department of Health, state Board of Health, sovereign tribal nations and Indian health programs. These funds are to build the system's capacity and increase the availability of FPHS services statewide. Revision Purpose: The purpose of this revision is to add the entire SFY25 allocation. DOH Chart of Accounts Master Index Title ~Master Index Code Assistance Listing Number BARS Revenue Code LHJ Funding Period Start Date End Date Current Allocation Allocation Change g Increase (+) Total Allocation SFY25 FPHS-LHJ FUNDS-GFS 99210850 N/A 336.04.25 07/01/24 12/31/24 1,166,500 1,166,500 2,333,000 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0' _ TOTALS 1,166,500 1,166,500 2,333,000 Payment Task # Activity Deliverables/Outcomes Due Date/Time Frame Information and/or See below in Program Specific Amount FPHS funds to each LHJ — See below in Program Specific See below in Program Specific 1 Requirements — Activity Special Instructions for details Requirements - Deliverables Requirements - Deliverables $520, 000 Assessment Reinforcing Capacity — See below in Program Specific See below in Program Specific See below in Pro r@ am Specific $30,000 2 Requirements — Activity Special Instructions for details Requirements - Deliverables Requirements - Deliverables $60, 000 Assessment — CHA/CHIP — See below in Program Specific See below in Program Specific See below in Program Specific $15,000 3 Reequimments —Activity Special Instructions for details Requirements - Deliverables Requirements - Deliverables $30, 000 Lifecourse - NEW SFY 24 Full Lifecourse Workforce Capacity — See See below in Program Specific See below in Program Specific 300 4 below in Program SRecific Requirements — Activity Special Instructions Requirements - Deliverables Requirements - Deliverables $353, 000 for details Exhibit A, Statement of Work Page 1 of 7 Contract Number CLH31013-Amendment 21 Pans 15 of ob Task Payment itActivity Deliverables/Outcomes Due Date/Time Frame Information and/or CD - NEW SFY 24 Immunization Outreach, Education & Response See below in Program Specific See below in Program Specific Amount $37,500 5 —See below in Program Specific Requirements —Activity Special Requirements - Deliverables Requirements - Deliverables $75, 000 Instructions for details EPH - NEW SFY 24 Fully fund Environmental Public Health Policy See below in Program Specific See below in Program Specific $75,000 6 & Leadership Capacity — See below in Program Specific Requirements Requirements - Deliverables Requirements - Deliverables $150, 000 — Activitv S ecial Instructions for details FC - NEW SFY 24 Strengthening Local Finance Capacity — See See below in Program Specific See below in Program Specific 7 below in Program Specific Requirements — Activity_ Special Instr_uc_tio_ns Requirements -Deliverables Requirements -Deliverables �n `. u0u for details FC - NEW SFY 24 Public Health Communications — See below in See below in Program Specific See below in Program Specific M00,000 8 Program Specific Requirements — Activity Special Instructions for details Requirements - Deliverables Requirements - Deliverables $200, 000 Lifecourse - NEW SFY 24 Illicit Substance Use and Overdose See below in Program Specific See below in Program Specific $75,000 9 Response — See below in Program Specific Requirements — Activity Requirements - Deliverables Requirements - Deliverables $150, 000 Special Instructions for details See below in Program Specific EPR - NEW SFY 24 Emergency Preparedness & Response — See below in Program Specific $89;900 10 Capacity and Capability — See below in Program Specific Requirements - Deliverables Requirements - Deliverables $178, 000 Re uirements — Activity S ecial Instructions for details Assessment — Shared Regional Epidemiology — General See below in Program Specific See below in Program Specific $75,000 11 (Assessment/Surveillance, CHA/CHIP) — See below in Program Requirements - Deliverables Requirements - Deliverables $150, 000 S13ecific Requirements — Activity Special Instructions for details EPH - NEW SFY 24 Social Work Support — See below in Prog am See below in Program Specific See below in Program Specific $42,500 12 Specific Requirements — Activity Special Instructions for details Requirements - Deliverables Requirements - Deliverables $85, 000 EPH Core Team — Safe and Healthy Communities — See below in See below in Program Specific See below in Program Specific $23300 13 Program Specific Requirements — ActiviV Special Instructions for details Requirements - Deliverables Requirements - Deliverables $47, 000 EPH Core Team — Climate Change Response — See below in Program See below in Program Specific See below in Program Specific $49,000 14 Specific Requirements — Activity Spccial Instructions for details Requirements - Deliverables See below in Program Specific Requirements - Deliverables $80, 000 EPH Core Team — Water System Capacity — See below in Program See below in Program Specific .,t0 15 Specific Requirements — Activity Special Instructions for details Requirements - Deliverables Requirements - Deliverables .13.IN1) EPH Core Team — System -Wide Data Management Improvement.— See below in Program Specific See below in Program Specific $3I,500 16 See below in Pro rg am Specific Requirements — Activity Special Requirements - Deliverables Requirements - Deliverables $63, 000 Instructions for details EPH Core Team — Homelessness Response — Sec below in Pr_og See below in Program Specific See below in Program Specific $27,300 17 Specific Requirements — Activity Special Instructions for details Requirements - Deliverables Requirements - Deliverables 555,000 DOH Program and Fiscal Contact Information for all ConCon SOWS can be found on the finance -related inquiry, may be sent to financeCadoh.wa.gov. site. Questions related to this SOW, or any other FPHS staff from DOH and the Washington State Association of Local Public Health Officials (WSALPHO) will coordinate and communicate together to build and assure common systemwide approaches per FPHS Steering Committee direction and the FPHS framework intent. Exhibit A, Statement of Work Page 2 of 7 Contract Number CLH31013-Amendment 21 Page 16 of no • For LHJ questions about the use of funds: o Chris Goodwin, FPHS Policy Advisor, W SALPHO — cgoodwin a.wsac.org, 564-200-3166 o Brianna Steere, FPHS Policy Advisor, WSALPHO — bsteerer?wsac.org, 564-200-3171 The intent of FPHS funding is outlined in RCW 43.70.512. Foundational Public Health Services Definitions and related information can be found here: -,vww.doli.wa._aov/fphs. Stable funding and an iterative decision -making process — The FPHS Steering Committee's roles and responsibilities are outlined in the FPHS Committee & Work r� oup The Steering Committee is the decision making body for FPHS and operates under a consensus -based decision making model, outlined hcre. The Steering Committee use an iterative approach to decision making meaning additional tasks and/or funds may be added to a local health jurisdiction's (LHJ) FPHS Statement of Work (SOW) as funding decisions are made. Spending of FPHS funds — FPHS funds do not require pre -approval or pre -authorization to spend. FPHS funds are to assure FPHS services are available in each jurisdiction based on the FPHS Definitions (link) and as reflected in the SOW. Assurance includes providing FPHS as part of your jurisdiction's program operations, contracting with another governmental public health system partner to provide the service, or receiving the service through a new service delivery model such as cross jurisdictional sharing or regional staff. FPHS funds are eligible starting at the beginning of each state fiscal year (July 1) regardless of when funds are received by the LHJ, even if the expenditure occurred before the LHJ's contract was signed. These funds are not intended for fee -based services such as select environmental public health services. As state funding for FPHS increases, other funds sources (local revenue, grants, federal block grants) should be directed to the implementation of additional important services and local/state priorities as determined by each agency/jurisdiction. Annual Allocations — The legislature appropriates FPHS funding on an annual basis and the FPHS Steering Committee allocates funds annually through the FPHS Concurrence Process for the State Fiscal Year (SFY): July - June. The Legislature appropriates FPHS funding amounts for each fiscal year of the biennium. This means that funds must be spent within that fiscal year and cannot be carried forward. Any funds not spent by June 301h each year must be returned to the State Treasury. Funding allocations reset and begin again at the start of the next fiscal year (July 1). This Statement of Work is for the period of July 1, 2024-December 31, 2024 and may be included in multiple Consolidated Contracts (ConCons) which are based on the calendar year and renewed every three years. Disbursement of FPHS funds to LHJs — Unlike other ConCon grants, FPHS bill -back to DOH is NOT required. Half of the annual FPHS funds allocated by the Steering Committee to each LHJ are disbursed each July and January. The July payments to LHJs and access to FPHS allocation for all other parts of the governmental public health system occur upon completion of the FPHS Annual Assessment. Deliverables — FPHS funds are to be used to assure FPHS services statewide. The FPHS accountability process measures how funds are spent, along with changes in system capacity through the FPHS Annual Assessment, system performance indicators, and other data. DOH, SBOH and local health jurisdictions have agreed to complete: 1. Reporting of spending and spending projections. Process timelines and reporting template are provided by the FPHS Steering Committee via FPHS Support Staff. 2. FPHS Annual Assessment is due each July to report on the previous state fiscal year. Process and reporting template are provided by the FPHS Steering Committee via FPHS Support Staff. System results are published in the annual FPHS Investment Report available at www.doli.wa.gov/fQhs. BARS Revenue Code: 336.04.25 Exhibit A, Statement of Work Page 3 of 7 Contract Number CLH31013-Amendment 21 Page 17 of oo BARS E penditure Coding - provided for vmu reference 562= BARS Expenditure Codes for FPHS aelivMq: see below 10 FPHS E j emiology & Surveillance 11 FPHS Community Health Assessment 12 FPHS Emergency Preparedness & Response 13 FPHS Communication 14 FPHS Policy Development 15 FPHS Community Partnership Development 16 FPHS Business Competencies 17 FPHS Technology 20 FPHS CD Data & Planning 21 FPHS Promote Immunizations 23 FPHS Disease Investigation -Tuberculosis (TB) 24 FPHS Disease Investigation - Hepatitis C 25 FPHS Disease Investigation - Syphilis, Gonorrhea & HIV 26 FPHS Disease Investi ation - STD (other) 27 FPHS Disease lnvesti ation- VPD 28 FPHS Disease Investigation - Entcric 29 FPHS Disease Investi adon - General CD 40 FPHS EPH Data& Planning 41 FPHS Food 42 FPHS Recreational Water 43 FPHS Drinking Water Quality 44 FPHS On -site Wastewater 45 FPHS Solid & Hazardous Waste 46 FPHS Schools 47 FPHS T o Worker Housing 48 FPHS Transient Accommodations 49 FPHS Smoking in Public Places 50 FPHS Other EPH Outbreak Investigations 51 FPHS Zoonotics (includes vectors 52 FPHS Radiation 53 FPHS Land Use Planning 60 FPHS MCH Data & Plaradng 70 FPHS Chronic Disease, Injuty & Violence Prevention Data & Plannin 80 FPHS Access/Linkage with Medical, Oral and Behavioral Health Care Services Data & Planning 90 FPHS Vital Records 91 FPKS Laborata - Centralized (PHSKC Only) 92 FPHS Laboratory Special References (i.e., RCWs, WACs, etc.): FIIHS Intent - RCW 43.70.51 FPHS Fundinl; - RCW 43.70.515 f^f'HS Catninittee & Workgrunp C hartcr FI'lIS Swi!rin - Coinnniuce Consensus Decision Making Model Exhibit A, Statement of Work Page 4 of 7 Contract Number CLH31013-Amendment 21 Page 18 of ao Activity Special Instructions: Investments to Each LHJ: 1. FPHS Funds to Each LHJ These funds are allocated to be used to provide any programs and services within all of the FPHS Definitions. Each LHJ is empowered to prioritize where and how to use these funds to maximize equitable, effective and efficient delivery of FPHS to every community in Washington. Use BARS expenditure codes from the list above that most closely align with expenditure made. Tareeted Investments to Each LHJ: 2. Assessment Reinforcing Capacity (FPHS definition G.2) Support LHJ assessment capacity with flexible funds to meet locally identified needs. BARS expenditure codes: 562.10 or l l 3. Assessment — CHA/CHIP (FPHS definitions G.3) Support any CHA/CHIP activity or service (e.g., data analysis, focus groups, report writing, process facilitation) and may be used to contract with other agencies for staff time or services. Use BARS expenditure codes: 562.11 4. Lifecourse - NEW SFY 24 Full Lifecourse Workforce Capacity (FPHS definitions D, E, F) Infrastructure and workforce investments to each LHJ to meet fundamental needs in three areas: Maternal/Child/Family Health; Access/Linkage with Medical, Oral and Behavioral Health Services; and Chronic Disease, Injury and Violence Prevention. Use BARS expenditure codes: 562.60, 562.70, and/or 562.80 5. CD - NEW SFY 24 Immunization Outreach, Education & Response (FPHS definition C.3) Promote immunization education and use of the statewide immunization registry through evidence -based strategies. Funding can also be used to support vaccine - preventable disease response. BARS expenditure codes: 562.21 and/or 562.27 6. EPH - NEW SFY 24 Fully fund Environmental Public Health Policy & Leadership Capacity (FPHS definitions B.2, A.C, J.1-3, ICI-2, L.1) These funds are to be used for staffing casts for environmental health responsibilities and functions (that are not directly fee -based) within leadership, policy development, foundational public health services implementation, evaluation, or administration, including (but not limited to) Environmental Health Directors. Examples of funded roles include work relating to general policy, statewide and/or system wide, and/or cross jurisdictional work, legislation, and ntiemaking, SBOH engagement, leadership support and/or development, workforce development, leadership within health equity, climate, and environmental justice. Use BARS expenditure codes: 562.14, 562.40 — 562.53 7. FC - NEW SFY 24 Strengthening Local Finance Capacity (FPHS definitions L.2-4, L.6, L.8) Capacity and infrastructure to assure fiscal management and contract and procurement policies and procedures are effectively implemented to support programs and services. Use BARS expenditure codes: 562.16 8. FC - NEW SFY 24 Public Health Communications (FPHS definitions I.1-2) Capacity to enhance the frequency, accuracy, and accessibility of public health communications to diverse populations via various media to support programs and services. Use BARS expenditure codes: 562.13 9. Lifecourse - NEW SFY 24 Illicit Substance Use and Overdose Response (FPHS definitions D.1-2, DA, F.1 3, G.1-3,1.1-2, J.1-13, K.1-2) Capacity and infrastructure related to addressing overdose crisis. This includes but is not limited to: Overdose response trainings, convening stakeholders or coordination groups, data analysis, and community education. Use BARS expenditure codes: 562.13, 562.14, 562.15, 562.60, 562.70, 562.80 Exhibit A, Statement of Work Page 5 of 7 Contract Number CLH31013-Amendment 21 Page 19 of oo 10. EPR - NEW SFY 24 Emergency Preparedness & Response — Capacity and Capability (FPHS definitions H.1-4) Capacity and infrastructure to support and enhance the local delivery of FPHS Emergency Preparedness and Response services and activities across critical subject matter areas. Use BARS expenditure codes: 562.12 Targeted Investments to Select LHJs — Assurine FPIIS Available farrin Multi ile Jurisdictions: 11. Assessment — Shared Regional Epidemiology — General (Assessment/Surveillance, CHA/CHIP) (FPHS definitions G.1,2) Increase assessment and epidemiology capacity via regional/shared epidemiologist model to meet locally identified needs. Use BARS expenditure codes: 562.10 or 11 Targeted Investments to Select LHJs — Assuring FPI S Available in Own Jurisdiction 12. EPH - NEW SFY 24 Social Work Support (FPHS definitions B.1-3, B.6-7, D.1, D.2, DA. E.2, EA, F.2-3, J.1-2, K.1-2, L.3, L.5) This investment is intended to support non-traditional responses to environmental health complaints and challenges in the context of social work support and care coordination with social service providers. Activities include: assessment of complaints and challenges; identifying cases and circumstances for engaging in social work support and care coordination; and engagement with social service providers. Funds may be used to support these activities, as well as related staffing and training expenses. Use BARS expenditure codes: 562.14, 562.15, 562.40, 562.47, 562.48 EPH -- Core Teams (Applies to all EPH Core Team FPHS Investments) (FPHS definition B.1-7) Each EPH Core Team investment is for LHJ staff to participate in a cross jurisdictional topic -specific Core Team. The Core Teams are each tasked with developing one or more model program(s), intended to offer guidance for scalable environmental public health responses relating to their specific sub -topic area(s). Where it makes sense to do so, the Core Teams may also work on implementation of these model programs. The content and output of these model programs will vary depending on the needs and approaches specific to each sub -topic area. Recipients of these Core Team FPHS funds are required to participate in the associated Core Team for each investment. Recipients may spend these funds towards staffing time necessary to participate and on FPHS-qualifying activities for the specific sub -topic areas) attached to its associated investment. Each Core Team FPHS investment is distinctive from all other Core Team FPHS investments. Core Teams exist outside the FPHS structure, in partnership between LHJs and WA DOH, with one co -lead from each. Model programs developed through Core Team work will be made available to all Washington public health agencies. There are currently six EPH Core Teams. They are listed below, with their sub -topic area(s), as applicable. System -Wide Data Management Improvement Climate -Change Response • Lead Exposure o Water System Capacity Homelessness Response e Safe & Healthy Communities Jefferson is receiving funds to participate in these EPH Core Teams: EPH -- Core Teams (Applies to all EPH Core Team FPHS Investments) (FPHS definition B.1-7) Each EPH Core Team investment is for LHJ staff to participate in a cross jurisdictional topic -specific Core Team. The Core Teams are each tasked with developing one or more model program(s), intended to offer guidance for scalable environmental public health responses relating to their specific sub -topic area(s). Where it makes sense to Exhibit A, Statement of Work Page 6 of 7 Contract Number CLH31013-Amendment 21 Page 20 of oo do so, the Core Teams may also work on implementation of these model programs. The content and output of these model programs will vary depending on the needs and approaches specific to each sub -topic area. Recipients of these Core Team FPHS funds are required to participate in the associated Core Team for each investment. Recipients may spend these funds towards staffing time necessary to participate and on FPHS-qualifying activities for the specific sub -topic area(s) attached to its associated investment. Each Core Team FPHS investment is distinctive from all other Core Team FPHS investments. Core Teams exist outside the FPHS structure, in partnership between LHJs and WA DOH, with one co -lead from each. Model programs developed through Core Team work will be made available to all Washington public health agencies. There are currently six EPH Core Teams. They are listed below, with their sub -topic area(s), as applicable. System -Wide Data Management Improvement • Climate -Change Response • Lead Exposure Water System Capacity • Homelessness Response Safe & Healthy Communities Jefferson is receiving funds to participate in these EPH Core Teams: 13. EPH Core Team — Safe & Healthy Communities This Core Team develops system capacity to advance EPH perspectives into planning processes such as State Environmental Policy Act (SEPA) work, Health Impact Assessments, Comprehensive Plans, and related environmental review opportunities. The Core Team will develop one or more model program(s) to provide scalable approaches to healthy community planning, which may include wastewater planning and treatment, seawater intrusion in drinking water, ventilation in public buildings, PFAS contamination, climate change challenges, and other emerging topics identified by the Core Team. • Use BARS expenditure code: 562.40 14. EPA Core Team — Climate -Change Response This Core Team will address environmental health concerns related to climate and the effects of climate change. • Model program development will start with Wildfire Smoke and Harmful Algal Blooms, and may include other priorities and topics. 15. EPH Core Team — Water System Ca acit The goal of this Core Team is to increase LHJ capacity for water resource management and planning. • Use BARS expenditure code: 562.43 or 53. 16. EPH Core Team — System -Wide Data Management Improvement This Core Team will identify and employ a strategy for data sharing, storage and consistency across the state. Y Use BARS expenditure code: 562.40. 17. EPH Core Team — Homelessness Response This Core Team will develop one or more model programs) for a scalable response to homelessness -related public health concerns. • Use BARS expenditure code:,562.40 Exhibit A, Statement of Work Page 7 of 7 Contract Number CLH31013-Amendment 21 »redegroup DOH-810-017 JAN UARY 2024 S - Y23 4v FOUNDATIONAL PUBLIC HEALTH SERVICES IN WASHINGTON STATE State Fiscal Year 2023 INVESTMENT REPORT ;`�'_- wSALPHO WBSHIOCTOO STATE FISSOCIBTIOO OF LOOK PUBLIC HEALTH OFFICIALS Washington State Department of HEALTH DOH-810-017 JANUARY 2024 WAS HINGTON STATE Is BOARDOFHEALTH FOUNDATIONAL PUBLIC HEALTH SERVICES IN WASHINGTON STATE State Fiscal Year 2023 Investment Report To request this document in another format, call 1-800-525-0127. Deaf or hard of hearing customers, please call 771 (Washington Relay) or email: doh.infora).o.tton@doti.wa.go�,. ACKNOWLEDGEMENTS - 2 Acknowledgments This report was produced in January 2024 by the Rede Group for the Foundational Public Health Services Steering Committee and the governmental public health system in Washington state. Rede Group project team: Beck Wright Erin Charpentier Special thanks to DOH and WSALPHO partners: Amanda Gefroh Brianna Steere Carolyn Cartwright Chris Goodwin Jaime Bodden Jeff Ketchel Samantha Fuller »re�� rou�` ACKNOWLEDGMENTS 3 Contents Acronyms Executive Summary Background Baseline Assessment Service Delivery Models Funding Cross -Jurisdictional Sharinq Service Delivery Innovation Health Equity Changes in Capacity Communicable Disease Annual Report Highlight: Hepatitis C Environmental Public Health Annual Report Highlight: Environmental Public Health 6 8 13 15 16 18 23 29 31 33 35 37 39 41 CONTENTS 4 Lifecourse Annual Report Highlight: Child Death Review Vital Records Foundational Capabilities Annual Report Highlight: Foundational Capabilities Annual Report Highlight: Assessment Annual Report Highlight: Emergency Preparedness and Response 43 45 47 54 56 Annual Report Highlight: Health Impact Reviews (Policy Development) 58 Centralized Services 61 Outcomes 63 Gonorrhea & Syphilis Case Investigation 65 Hepatitis C -Case Investigation 66 Completed Immunization Series 69 Appendix 70 CONTENTS - 5 Acronyms AIHC CBO CD CDIVP CHA/CHIP COVID-19 American Indian Health Commission Community -Based Organization Communicable Disease Chronic Disease, Injury, and Violence Prevention Comm -unity Health Assessment and Improvement Plan Coronavirus Disease 2019/Severe Acute Respiratory Syndrome Coronavirus 2 DIS Disease Intervention Specialist DOH Washington State Department of Health ELR Electronic Laboratory Reporting EPH Environmental Public Health FPHS Foundational Public Health Services FTE Full-time Equivalent GIS Geographic Information System HCV Hepatitis C Virus ACRONYMS - 6 HIR Health Impact Review LHJ Local Health Jurisdiction MCH Maternal, Child, and Family Health NSDM New Service Delivery Model PHIMS-STD SBOH Public Health Issue Management System - Sexually Transmitted Disease State Board of Health SFY State Fiscal Year TB Tuberculosis WAPC Washington Poison Center WDRS Washington Disease Reporting System WSALPHO Washington State Association of Local Public Health Officials ACRONYMS - 7 Executive Summary Land Acknowledgment Washington state resides on the traditional homes of many Indigenous Peoples, including the current home of 29 Sovereign tribal nations who are our partners in public health. We honor the original peoples as the first, unbroken caretakers of the land and waters in their rooted territories. Public health's origins trace back to these ancestral stewards who lived the values of physical, emotional, and social wellbeing in both the person and community. The governmental public health system supports tribal sovereignty, self-determination, and upholding government -to -government relationships. We commit to working with Tribes to shape a future that supports the health of all people and all communities in Washington. This report shares information about the progress local public health, the State Board of Health, and the Washington State Department of Health have made in Foundational Public Health Services delivery. Beginning in Fiscal Year 2024, tribal FPHS will be included in this report to reflect the complete governmental public health system in Washington state. EXECUTIVE SUMMARY 8 Background Washington state has made funding public health a priority through public health modernization and the foundational public health services (FPHS). There has been consistent and increasing funding appropriated to improve the governmental public health system since the 2018-2020 biennium, after the 2018 baseline report identified a gap of $225 million annually that is needed to implement FPHS completely. In State Fiscal Year 2023 (SFY23), 50% of the gap, or $112 million, was appropriated to provide FPHS across the state to support the health of all people in Washington, regardless of where they live. The FPHS Steering Committee, made up of State Board of Health (SBOH), Washington State Department of Health (DOH), local health jurisdictions (LHJ), and tribal representation, is the decision -making body for the allocation of FPHS funding appropriations. System Capacity As investments have been made in FPHS, the availability of these foundational services has increased. Investments have been made in the FPHS areas of communicable disease and foundational capabilities (assessment, emergency preparedness, communications, policy development, community partnerships, and business competencies) since SFY19, adding investments in environmental public health in SFY20. As of SFY23, investments have been made in all FPHS program and capability areas, although at 50% of the total funding need identified in 2018. Figure 1 displays the change in the percent of agencies with significant and full availability of FPHS from baseline to SFY23 at the Foundational Program and Capability level. There has been progress made in all areas, with more progress made the longer an area has been invested in. EXECUTIVE SUMMARY 9 Figure 1: FPHS availability at area/capability level, baseline to SFY23 Communicable Disease Environmental Public Health Lifecourse Assessment Emergency Preparedness Communications Policy Development Community Partnerships Business Competencies Baseline 0 SFY23 0% 20% 40% 60% 80% 100% Percent of Agencies with Significant or Full Availability EXECUTIVE SUMMARY 10 Key Takeaways Sustained, regular investment in FPHS has led to an overall increase in the availability of FPHS across the Washington State governmental public health system over the six years it has received funds. As investments have been made in FPHS, there has been an increase in capacity across the governmental system. Some investment has now been made in all of the FPHS programs and capabilities resulting in incremental availability increases as shown. This state-wide investment provides the infrastructure needed to continue existing services for many public health agencies, especially those that have faced staffing and/or funding shortages. FPHS funding has provided the flexibility for agencies to innovate and be nimble in order to provide the types of services most needed in their communities as well as be adaptable to new and emerging threats. There has been an increase overtime in the number of shared FPHS services, and there is willingness across the system for more sharing of services where appropriate. Many efforts are being made within the public health system to improve equity, including assessing where inequities are in collaboration with community; authentic partnership building; and developing culturally and linguistically appropriate communication materials. EXECUTIVE SUMMARY - 11 The impact of the COVID-19 pandemic on the ability for public health agencies to engage in foundational work greatly reduced the ability for agency staff to work on anything else as they faced the pandemic response for nearly three years. It is a testament to the dedication of public health staff and the importance of foundational funding that any progress was made in increasing the availability of FPHS across the system during one of the biggest public health emergencies that has faced the governmental public health system. 4 ❑! EXECUTIVE SUMMARY -12 Background "Protecting the public's health across the state is a fundamental responsibility of the state and is accomplished through the governmental public health system:"' Washington state has been providing some level of public health services since the mid-1900s, and has been engaged in a concerted effort over the past 10-plus years to modernize the governmental public health system. 1. RCW 43.70.512 2. Foundational The framework for Foundational Public Health Services (FPHS)2 in Public Health_ Services are Washington state includes Foundational Programs and Foundational population - Capabilities, as listed in Figure 2. The intent of public health aced, prevention - people g modernization is that FPHS are available to all in Washington oriented services that primarily state, regardless of where they live. Stable, consistent funding for the government FPHS is critical for the governmental public health system to be provides everywhere, in able to pivot to address new public health emergencies such as the orderfrthe system to function system to COVID-19 pandemic, measles outbreaks, and the opioid epidemic. anywhere. BACKGROUND — 13 Figure 2: The FPHS framework: A limited, defined set of core services provided by the governmental public health system vital EPH CD MCH Access Chronic E c Records Disease Additional Important ` & Injury Services oPrevention Provided by: Many d organizations 0 (gov't & non-gov't) 0 c Funded by: Federal, state, & local gov't, 'o foundations, CBOs, healthcare, etc. N Foundational Capabilities: Foundational Public c Health Services c Provided by: V Gov't Public Health Funded by: State 0 and local fees, state a gov't, and some federal grants 0 BACKGROUND -14 Baseline Assessment The 2018 Washington State Public Health Transformation Assessment Report for State and Local Public Agencies (Baseline Report) provided a baseline assessment (using 2016 calendar year data) of current spending on FPHS, the gap in resources for full availability of FPHS, level of sharing of FPHS between agencies, and the level of availability in FPHS across the system. The baseline assessment only included three of the four parts of the governmental public health system - DOH, SBOH, and LHJs. At the time of the baseline assessment Washington Tribes were providing public health services as they could but were not connected to the statewide FPHS efforts. The main takeaways of the baseline assessment were as follows: Although the governmental public health system was providing much of FPHS, no foundational program or capability was fully or significantly available across the statewide system LHJs reported significant cross -jurisdictional sharing There was wide variability in where the gaps in FPHS availability were across agencies and across the statewide system Baseline expenditures for FPHS were estimated at $368 million in a year, which was approximately two-thirds of the cost of full FPHS implementation The estimated additional funds needed from the state government to ensure FPHS availability to all communities in Washington was $225 million annually (in 2018 dollars) BACKGROUND 15 Service Delivery Models 17Lf � According to RCW 43.70.515, "service delivery model" is the systematic sharing of resources and function across the governmental public health system to increase capacity and improve efficiency and effectiveness. Substitute House Bill 1496 (Chapter 14, Laws of 2019) required that any FPHS funding allocations must be jointly certified by specific public health system partners in consultation with federally recognized Tribes, which led to the creation of the FPHS Steering Committee (Figure 3). A portion of the funds appropriated by the legislature each biennium are invested in testing and evaluating new service delivery models. Example projects include building tuberculosis (TB) expertise and surge capacity within Public Health - Seattle & King County to provide support to all LHJs to address TB in their communities, and Tacoma -Pierce County Health Department developing and maintaining communicable disease websites for health care providers in multiple LHJs. FPHS SERVICE DELIVERY MODELS 16 Figure 3: FPHS committ FPHS SUPPORT STAFF LHJs are represented by WSALPHO and American Indian Health Commission (AIHC) participates on behalf of sovereign tribal nations and Indian health programs. CD Communicable disease FPHS SUBJECT MATTER EXPERT (SME) WORKGROUPS EPH Environmental public health ASSESSMENT Epidemiology + surveillance EPR Emergency preparedness + response LIFECOURSE Communicable disease and injury prevention, maternal + child health, access + linkage to care FPHS PROJECT MANAGEMENT TEAM (PMT) + CO-CHAIRS FOUNDATIONAL CAPABILITIES Communications, policy development, community partnerships, and business competencies FPHS SERVICE DELIVERY MODELS — 17 Funding FPHS Appropriations The 2018 Baseline Report estimated a FPHS funding gap of $225 million annually to fully implement public health services across the state. Figure 4 displays legislative appropriations for FPHS through the 2023-2025 biennium. Figure 4: FPHS investment and gap, in millions ui Legislative appropriation a Additional funds needed JUJ IYl .aUJ IYl $113 M $162 M $225 M $219 M $216 M $211 M $211 M $162 M $162 M 72% of need 72% of need $112 M 50% of need $63 M j1- 28% of need $6 M $9 M _ $14 M S 14-M 3% of need 4% of need 6% of need 6% of need BASELINE SFY18 SFY19 SFY20 SFY21 SFY22 SFY23 SFY24 SFY25 FPHS SERVICE DELIVERY MODELS 18 SFY23 Allocations The FPHS Steering Committee determined how SFY23 appropriations would be allocated across the governmental public health system. Per law, tribal consultation and joint certification among all parts of the system that they were in agreement on the distribution and use of state FPHS funds across the public health system was required before funds were released to DOH for distribution. The legislature appropriated $112 million for FPHS for SFY23; Figure 5 displays how those funds were allocated by the FPHS Steering Committee. Among the categories, the most funds were allocated to "any definition," which means the allocated amount could be spent by agencies in any FPHS area. Communicable disease had the highest allocation of any specific FPH-S Program or Capability. Figure 5: SFY23 allocations by FPHS area Any Definition Communicable Disease Lifecourse Assessment Environmental Public Health Foundational Capabilities $19,295,000 $18,075,000 $12,750,000 $10,335,000 $3,677,250 Emergency Preparedness $862,500 $44,597,500 0 Ln N N O, Lq O� 0 a 0 FPHS SERVICE DELIVERY MODELS — 19 When reviewing allocations by type of system partners, the vast majority of FPHS funds were allocated to LHJs, whereas the lowest amount was allocated to SBOH. Figure 6: SFY23 allocations by system partner O uO LHJs/WSALPHO $81,927,250 N N 01 O� O �T DOH $22,850,000 O Tribes/TribalOrgs. $4,230,000 SBOH $585,000 FPHS SERVICE DELIVERY MODELS — 20 SFY23 Spending LHJs, SBOH, and DOH reported how they spent the FPHS funds allocated to their agency by FPHS activities. Of the funds allocated to FPHS, $106,873,850 was spent by the governmental public health system across all FPHS Capabilities and Programs. Over one-third ($36 million) was spent in the communicable disease program area, with the majority ($27 million) spent on disease investigation. The lowest amount of FPHS funding was spent on vital records ($0.5 million). Spending data includes LHJs, DOH, SBOH, Tribes/tribal organizations, -and WSALPHO. For further details on spending by LHJs, DOH, and SBOH, see Appendix A.* Figure 7: SFY23 spending Communicable Disease Foundational Capabilities Environmental Public Health Lifecourse Assessment Any Definition $35,679,636 $22,408,558 $20,876,498 $10,801,494 $10,450,844 $3,975,143 Emergency Preparedness $2,206,103 Vital Records $475,573 *Spending data reflect information reported in June 2023, with some corrected spending in January 2024. See Appendix A for full details. 0 LO OQ ri Oq 10 0 a } 0 FPHS SERVICE DELIVERY MODELS — 21 SFY23 spending FPHS Area Capability Amount Spent % of total Environmental Environmental Public Health Data & $7,361,012 7% Public Health Planning, Radiation, Land Use Environmental Public Health Inspections $13,515,486 13% Foundational Emergency Preparedness $2,206,103 2% Capabilities Communications, Policy Development, and $7,205,809 7% Community Partnership Development Assessment (Epi & Surveillance, CHA, CHIP) $10,450,844 10% Communicable Disease Business Competencies and $15,202,749 14% Information Technology Promote Immunization $924,457 1% Public Health Lab $3,181,195 3% Communicable Disease Data & Planning $4,374,316 4% Communicable Disease Investigation $27,199,667 25% Lifecourse Maternal Child Health $3,935,691 4% Access/Linkages to Care $3,442,964 3% Chronic Disease, Injury, Violence Prevention $3,422,839 3% Vital Records Vital Records System and Birth $475,573 0.4% and Death Certificates Any Definition Any Definition Total $3,975,143 3.7% $106,873,850 100% FPHS SERVICE DELIVERY MODELS - 22 Cross -Jurisdictional Sharing LHJs, SBOH, and DOH reported on SFY23 sharing (defined as the reporting agency receiving services from another agency), as well as on their willingness to receive and willingness to provide services in the future. One important question when reviewing the data is where the gaps are between agencies that are currently receiving shared services and agencies that are willing to receive shared services. Figures 8-13 display the percent of agencies that were significantly or completely receiving shared services in SFY23 and those who reported that they were willing to significantly or completely receive shared services in the future. See Appendix E for methodology. Communicable Disease Figure 8 displays the percent of LHJs who reported receiving communicable disease (CD) foundational public health shared services in SFY23 in comparison to the percent of LHJs who reported a willingness to receive CD shared services in the future, showing areas of currently shared services and opportunities for increased sharing of services. Tuberculosis (TB) disease investigation had the highest percent of agencies receiving shared services from another agency in SFY23 (22%), and also the most willingness in significantly or completely receiving shared services in the future (47%). No agencies reported significantly or completely receiving general disease investigation services from another agency, although almost a third of agencies reported willingness to receive shared services in the future (28%). The lowest percent of agencies reported willingness to receive CD data and planning shared services in the future (22%). FPHS SERVICE DELIVERY MODELS 23 Figure 8: Communicable disease sharing gap Currently receiving Willing to receive TB Disease Investigation 22% Hep C Disease Investigation STI Disease Investigation Immunization s% 33% 33% ki_c ;- 3 28% General Disease Investigation -W% 28% CD Data &,Planning 6% 22% "FPHS funds have allowed us to act as a resource for any interested LHJ 47% across the state for active TB case management and consultations, longitudinal complex case management and consultations, contact investigation consultation and support, congregate setting investigations consultation and support, Class B immigrant and refugee support, and civil surgeon reporting support." Public Health -Seattle & King County FPHS SERVICE DELIVERY MODELS — 24 Environmental Public Health There was a lower percent of agencies currently receiving and willing to receive shared services for environmental public health (EPH) than for communicable disease. About one -tenth of agencies reported currently receiving shared services for zoonotic, airborne, and other related EPH investigation shared services (11%) compared to almost one-third willing to receive shared services in the future (28%). Figure 9: Environmental public health sharing gap Currently receiving Willing to receive EPH Insp. - Zoonotic, air -borne, 11% etc 28% EPH Data & Planning 8% 25% Land Use Planning 8% 17% EPH Insp. - Food, water, etc 11% 11% FPHS SERVICE DELIVERY MODELS — 25 Lifecourse The percent of agencies that reported currently receiving and future willingness to receive lifecourse shared services are similar to EPH services. There were very few agencies who received lifecourse shared services in SFY23, and about a quarter of agencies reported willingness to receive lifecourse shared services in the future. Vital Records Providing birth and death certificates was the only area where a higher percent of agencies (28%) reported significantly or completely receiving shared services than reported a willingness to receive shared services in the future (19%). Figure-10: Lifecourse sharing gap Currently receiving Willing to receive Figure 11: Vital records sharing gap 3°� CDIVP Data & Planning 28% Vital Records System MCH Data & Planning 8% 25% Birth & Death Certificates Access/Linkage Data & 11% Planning 25% ® Currently receiving Willing to receive 2 8`l6 19% FPHS SERVICE DELIVERY MODELS 26 50% Foundational Capabilities There were more agencies that reported significantly or completely receiving foundational capabilities from other agencies than most FPHS areas (described above). Agencies reported the most current sharing in the foundational capability areas of community health assessments/improvement plans (19%), emergency preparedness (16%), and assessment (16%). About a third of agencies reported willingness to significantly or completely receive these three shared services, as well as policy development, in the future. Figure 12: Foundational capabilities sharing gap ■ Currently receiving Willing to receive Emergency Preparedness 16% Assessment (Epi & 16% Surveillance) 35% Policy Development 11% -- 32% CHA/CHIP 19% 32% Information Technology 6 24% Communications Business Competencies Community Partnership 11% FPHS SERVICE DELIVERY MODELS — 27 41% Centralized Services There are a set of services that are centralized, or provided by one main agency (primarily DOH). For centralized services, there are much smaller gaps in the percent of LHJs who are currently receiving these services and who are willing to receive these services in the future. Ideally all LHJs would report receiving centralized services, and the fact that they aren't all reporting completely receiving shared services from another agency may be more a reflection of issues with the reporting question than a lack of shared services being provided at the local level; for example, if an LHJ did not need public health lab service in SFY23, they may have reported no sharing or minimal sharing, but the service is available from DOH when needed. Figure 13: Centralized services sharing gap Currently receiving Willing to receive PH Lab Prevent Radiation 53% Health Care Licensing 58% - 50% Newborn Screening Spending 56% - 50% Vital Records System 56% - - 50% 75% 78% 67% FPHS SERVICE DELIVERY MODELS — 28 Service Delivery Innovation Agencies were asked to share examples of how FPHS funds have supported innovation and transformation within the agency, as well as with external partners. Some agencies reported developing tools as examples of innovation. Types of tools/resources mentioned included a model lead prevention program, a resource guide, protocols and data systems to focus on chronic untreated hepatitis C infections, a checklist and resources for pool operators to support compliance, technical resources and response guidance for climate -related events, GIS capabilities, and a "model program" for climate and health activities across the public health system. A few agencies mentioned innovative practices related to assessment/analysis. Examples included a county - level assessment of unhoused people, completing a gaps analysis, and conducting community listening sessions. A few agencies also mentioned training in response to this question, noting that FPHS funds allowed for better training for staff and partners. And finally, many agencies reported the use of technology as innovative practices. Examples included building out or creating new web pages, electronic medical record system improvements, online environmental "One great example of innovation was sending staff, community members, and local board of health members through some training that will help us reach the most vulnerable populations in our county. At the same time, it helps bolster our relationships with some of our colleagues and others who may not have had positive public health interactions in the recent past. It also informs our board of health of some of our communities' issues and problems:' Asotin County Health District FPHS SERVICE DELIVERY MODELS 29 health application and information systems, the development of data dashboards, and transitioning to technology to increase internal team communications. Externally, many agencies reported innovative practices in working with partners. Types of partners mentioned included daycares, K-12 schools, universities, health systems, community -specific navigators, community based organizations (CBOs), community members and fire departments. Other partnerships built on government - to -government relationships such as working with Tribes, other local health jurisdictions, or government agencies. Some ways that community partners were engaged included providing training, convening meetings, developing plans together, conducting assessments together, building relationships, increased access to care, increased communication mechanisms, and developing community -based messaging. Some agencies also reported expanded programming as service delivery innovation. Examples included expansion of services to more community members, broader implementation of low -barrier treatment with buprenorphine, providing disaster preparedness workshops, providing services to houseless communities, "Mobile public health van received in March 2023— allowing us to take public health services to the community where they live, work, and play:' San Juan County Public Health EPHS SERVICE DELIVERY MODELS 30 expanding rapid syphilis testing, providing chronic disease self -management classes, providing mental health first aid classes, and building out an air quality program. A few agencies also specifically mentioned communications efforts, on topics such as vaccines, food safety, suicide prevention, and opioid abuse prevention. Health Equity Agencies shared several examples of how FPHS funds helped them address health disparities or inequities in their community. Over half of agencies named programs they built, expanded, or continued that addressed specific communities experiencing inequities. For example, agencies mentioned an outreach program for African immigrants, an outreach program for Pacific Islanders related to tuberculosis, data analysis on the disparate impacts of Mpox for men who have sex with men, and provision of naloxone to high -risk populations. About one-fourth of agencies explicitly mentioned partnering with other organizations to better reach communities who experienced inequities. Another way that agencies addressed health disparities and inequities in their_communities was by working to "Funding allowed for an expanded approach to communications, allowing for effective information sharing and coordination among community partners. This enhanced collaboration facilitated the exchange of ideas, best practices, and lessons learned, leading to more impactful interventions:' Island County Public Health FPHS SERVICE DELIVERY MODELS 31 improve communications; creating outreach materials that would resonate with the community, improving outreach to hard -to -reach populations, and trying new communication channels. About half of agencies also discussed improved ability to provide materials or services in other languages. Many agencies began their work to address inequities by collecting data on what inequities exist in their communities and their progress in addressing them. Community Health Assessments were specifically identified as a method agencies used to help identify the inequities they needed to address. They also increased surveillance activities, allowing agencies to identify communities experiencing disparate rates of disease and target outreach. Apart from carrying out full -on programs, some agencies also worked to improve access to resources for communities experiencing inequities, like COVID-19 tests, air cleaner kits, and immunizations. Mobile resource or service delivery was mentioned to be important for serving communities experiencing inequities. Finally, some agencies mentioned helping staff develop - their knowledge and skills related to addressing inequities through conversation and training opportunities. "Through assessment of health disparities in the community and ongoing outreach to populations with chronic disease and injury risks, we hope to continue - to see improvements in health outcomes for marginalized and vulnerable populations in our county." Skamania County Public Health FPHS SERVICE DELIVERY MODELS - 32 Changes in Capacity In the baseline assessment and each annual report, agencies were asked to self - assess their capacity and expertise for Foundational Programs and Capabilities. SFY23 is the first reporting year that assessed all FPHS Capabilities and Programs since the baseline assessment. Using a five -point scale, LHJs, SBOH, and DOH rated their capacity and expertise for seven areas related to the prevention and control of communicable disease and other notifiable conditions, five areas related to environmental public health, five areas related to lifecourse (which includes maternal child health, chronic disease and injury prevention, and access and linkages to clinical care), two areas related to vital records, and eight foundational capabilities. Capacity and expertise scores were combined to create an estimate of the availability of FPHS in each jurisdiction. Availability was then categorized and color coded. For some figures in this report, significant and full availability were combined to visualize differences from baseline. Comparison of levels of availability includes data from LHJs, DOH, and SBOH. CHANGES IN CAPACITY - 33 Figure 14: How availability of FPHS is interpreted See Appendix E for methodology. CAPACITY E JUMSE 1 increasing Agencies rate the availability of FPHS in their jurisdiction on a five -point scale in terms of capacity and expertise (separately). W N UJ W a CAPACITY These measures are combined during analysis. Availability of FPH Services ■ Full availability Significant availability Partial availability Limited availability No availability The combined measure interprets availability of FPHS on a five -point scale ranging from 'No availability', to 'Full Availability'. CHANGES IN CAPACITY — 34 Jefferson County Board of Health M Agenda Planning 10 Ot Publ*ic Healtf December, 19, 2024 Jefferson County Board of Health Announcements Publ'i*c Healtf December 19, 2024 W I - A)lIflj,M Public H