HomeMy WebLinkAboutBoard of Health October 2 20121
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WHATCOM COUNTY COUNCIL
Board of Health
October 2, 2012
CALL TO ORDER
Council Chair Kathy Kershner called the meeting to order at 10:30 a.m. in the
Council Chambers, 311 Grand Avenue, Bellingham, Washington.
ROLL CALL
(10:30:29 AM)
Present: Barbara Brenner, Ken Mann, Sam Crawford, Carl Weimer, Bill Knutzen,
Kathy Kershner and Pete Kremen
Absent: None
1. PUBLIC SESSION
No one spoke.
2. SUPPORTING HEALTHY CHILDREN & FAMILIES
Crawford asked if today's purpose is for the Health Department to get feedback that
the Council will fund the Women, Infant, and Children (WIC) program for the next two
years.
Regina Delahunt, Health Department Director, stated that's part of the reason. They
also want to have time to frame what they believe is a good approach for children and
families in the community.
She brought proposed Community Health Improvement Plan documents forward to
the Board at a past meeting. Children and families are one aspect of the plan. The Board
provided feedback that the community needs to focus on children. She will talk about the
vision for the future of children and families in the community.
They don't have a cohesive system for connecting and accessing the many programs
and services available in the community. The homeless housing situation was similar to the
children and family situation. Over the last several years, they've developed the system so
people know where to go to access the housing services system. She envisions the same
type of system for children and families.
The system is necessary because people in a program must know where to go and
get one -on -one case management support. The staff have evaluated the current programs
in the past year and thought about how to strengthen the programs. They want to realign
activities and programs to better meet the needs of children and families.
Astrid Newell, Health Department, read from the presentation in the Board packet
(on file).
Board of Health, 10/2/2012, Page 1
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Brenner stated she supports the WIC program. Make sure they assist people who
need it, and not just increase the number of participants. Many of the things people want
can wait. People aren't owed. People need to realize that they aren't supposed to have
everything they want just because they want it.
The assessment should talk about young single mothers, rather than anyone who
decides to have a baby and then decides to take advantage of a program. Being a single
mother isn't a reason for bad child rearing. Plenty of single mothers do an excellent job.
The younger single mothers may need more assistance, especially if they don't have a
support network. Delahunt stated she agrees. The nurse - family partnership will focus on
first time, low income, pregnant mothers.
Brenner stated she is surprised that they don't understand the reason for the
percentage of WIC eligible people who don't enroll.
Knutzen asked if they are monitoring the women who are having kids born with fetal
alcohol addiction, and if there efforts to work with them. The same people are doing the
same behavior over and over again. Newell stated the purpose of maternity support
services is to make a difference in those circumstances. Link prenatal services with services
to help people with substance abuse, mental health, and other issues.
Delahunt stated the nurse - family partnership program enrollees have more time
between pregnancies and there are fewer pregnancies. That program helps.
Knutzen asked if there is an effort to promote traditional families. It seems young
couples don't get married because they would qualify for more benefits if they don't marry.
He asked if there are efforts to provide marital counseling. One problem in society is that
the traditional family is lost. Find a way to create programs to encourage fathers to take
responsibility and reward good behavior. Delahunt stated those efforts may exist in the
community or need to be developed. That is good feedback when developing the system.
Those services should be available.
Mann asked if there is an actual incentive to not be married. He asked if there are
more benefits for a single mother than if she were married. Newell stated eligibility is based
on combined income.
Crawford stated that a married couple with no income may be eligible for more
benefits.
Mann stated there is an incentive to remain single.
Crawford stated there is an incentive to remain low- income.
Mann stated that if the father has income, eligibility is reduced when married.
Kremen stated that's true, if there is income.
(11: 02:35 AM)
Brenner stated Councilmember Knutzen has more experience than anyone. He and
his family have provided foster respite and foster care for years. There will be a problem if
the federal government doesn't get its act together. People used to be punished for being
married, and will be punished again if things aren't fixed by the end of the year. She asked
Board of Health, 10/2/2012, Page 2
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if the WIC program or another program will teach young, single mothers why it's important
to not keep having babies and to get an education. Newell stated there is a support model
where nurses care for mothers and children through a child's second birthday. Included is
information on parenting and healthy outcomes and behaviors. The nurse - family
partnership program outcome is that women are employed and finish high school. The
program supports the mothers and the families with the social and economic factors.
Kershner asked how these programs coordinate with the State Community Services
office (CSO) and Work First Office.
Judy Ziels, Health Department, stated a coalition of service providers, including the
CSO, meet quarterly to do intake and screening of families eligible for services. They have
been a strong supporter of the nurse - family partnership. The CSO is part of the overall
system. The County works with them to develop the program.
Kershner stated she doesn't want anyone to duplicate services. She's glad to hear
about their coordination. Delahunt stated a County role is to make sure they don't duplicate
services.
Ziels stated it's also important to not duplicate services between the WIC program
and nursing services within the Health Department. They can streamline the intake process
to reduce duplication and free up nursing capacity.
Crawford stated the Council has not yet received the Executive's proposed budget for
2013 -2014. He asked if the WIC program is in the proposed budget. Delahunt stated it is.
They are close to breaking even on the direct costs, and are working to reduce overhead by
moving to a County facility.
Crawford asked the difference between direct and indirect costs, and where the staff
are moving. Delahunt stated examples of an indirect cost are rent and telephone,
information technology and human resources services. All the direct services will move to
Girard Street. Health Department administration and Human Services would probably move
to the Civic Center. The staff will move by the end of 2013. The Executive supports the
plan to move. Dr. Goldfogel has been notified that the County will terminate the lease at
State Street. There are about 30 employees at State Street. Staff on State Street will
move to Girard Street, and staff without public interaction will move to the Civic Center.
The plan isn't totally set yet, but that's the most recent update.
Newell stated the space issue was impetus for talking about collocating services with
community partners. The long term effort is to have services for children and family
services located closer to community health and social services.
Delahunt stated they will do better collocation in one to two years.
Knutzen asked if Seamar is interested in providing the WIC program. Newell stated
Seamar has a program that serves about 1,700. They may be interested in absorbing the
WIC program, which serves about 2,000, but it's a big caseload to absorb.
Delahunt stated Seamar said in the past they would take on a portion of the County
caseload if someone else took on the rest of the caseload.
Knutzen asked if the Opportunity Council is providing the service at the Kendall
Resource Center. Newell stated they've considered outreach in a county location. The
Board of Health, 10/2/2012, Page 3
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challenge in the east county is that there aren't many people who aren't already being
served. It wouldn't be efficient to have a site in the east county. A remote location would
be more appropriate in north county, such as in Blaine or Birch Bay. Seamar was not
involved in the Resource Center.
Brenner asked the caseload at Nooksack and Lummi. Newell stated it is much lower
than the County and Seamar. Lummi caseload is 220, and Nooksack caseload is 200.
Mann asked if there is not a large population being served in the east county or if the
population doesn't need to be served. Newell stated there is not a large population that
isn't already engaged in services. The State WIC office provides information by zip code
and where there are eligible families not enrolled.
Kershner asked the total number of people served, about 4,300 participants, is the
number used to figure out the percentage of people not using services. Newell stated it is
not. The number of eligible people not being served is determined by looking at the
Medicaid data. They look at women and children who are eligible for Medicaid and match
that data with the WIC roster. The County caseload number is an average number. The 38
percent is an approximate. It is a number that comes from Medicaid.
Knutzen asked if there are quite a few people in the Kendall area that are on WIC.
He asked why the Nooksack number is only 200. Newell stated the Nooksack number is
associated with the Tribe. Others can go to the Nooksack facility, but they can choose to
come in to Bellingham for the service.
Kelly Molaski, Health Department, stated clients can access services at either facility
in Whatcom County. Many clients who live in the County make trips into Bellingham
regularly, and will receive services in town. It's not from a lack of cooperation on the part
of the Nooksack Tribe.
Kershner asked the administrative rate on the contract with the State for the WIC
program. It sounds like they are trying to increase the program to capture more money.
Newell explained the funding system. They use the Health Department rate of 24.9
percent.
Delahunt stated the County doesn't get an indirect rate on the program. The County
receives an amount per caseload, used to cover the cost of the direct service. The County
doesn't really get funding for it's indirect costs.
Kershner asked how expandsion and outreach would help the County. Delahunt
stated the County would get more revenue, but wouldn't expand the program.
Brenner asked if there is cooperation with the State or federal government. She
asked why the County can't work with the Medicaid program. Newell stated the State sent
a letter to those who are eligible who aren't participating. The County can do a better job
with outreach.
Brenner stated it would be more personal to verbally contact those eligible.
Delahunt stated they've talked about working with partners to compare client lists, but
there are confidentiality issues to work through.
Board of Health, 10/2/2012, Page 4
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Kershner asked if the Medicaid clients are getting services from other places. Newell
stated she hopes they are using prenatal or well child care. It's likely there are families who
are eligible for services but choose not to receive services for a variety of reasons.
Mann asked what kind of results they are getting, and if they are getting improved
outcomes. Newell stated they are, in some areas. There are certain areas where they can
do better. It's important to focus on measurement and data. The Health Department
embarked on a performance management system for each program, which will have
outcome measures that will be tracked. They need to make sure they're making a
difference.
Weimer stated he appreciates the community work that focuses on the child. The
parents may not do the best, but that's not the fault of the child. Find any way possible to
help those children. He thanked staff for figuring out the system. In the future, bring data
on the big picture, without focusing on people who are trying to abuse the system.
Delahunt stated the recent domestic violence vigil focused on the children.
Kremen stated that even if the children aren't directly abused by domestic violence,
they are profoundly affected. Those children are many times emotionally harmed and
abused. It's a very important issue.
ADJOURN
The meeting adjourned at 11:30 a.m.
The Council approved these minutes on October 23, 2012.
ATTEST:
WHATCOM COUNTY COUNCIL
WHATCOM COUNTY, WASHINGTON
Please contact the Council Office to obtain an
official, signed copy:
360- 676 -6690 or council(g-.o.w hatcom .wa.us
Board of Health, 10/2/2012, Page 5