HomeMy WebLinkAboutBoard of Health June 6 20001
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WHATCOM COUNTY COUNCIL
Board of Health
June 6, 2000
The meeting was called to order at 12:35 p.m. by Council Chair Marlene
Dawson in the Council Chambers, 311 Grand Avenue, Bellingham, Washington.
Also Present: Absent:
Sam Crawford None
Barbara Brenner
L. Ward Nelson
Dan McShane
Connie Hoag
Robert Imhof
1. INTRODUCTION
Chuck Benjamin, Health and Human Services Director, thanked everyone for
attending. Several staff members would be available for questions. He introduced
John Worland, Public Health Advisory Board Chair.
2. PUBLIC SESSION
No one spoke.
3. COMMUNITY HEALTH AND WELLNESS STRATEGIC PLANNING
Kay Guirl, Community Health and Wellness Division Manager, stated she
wanted to talk about the strategic planning process they've been going through for
the past three years. The department requests approval from the Board of Health
to write the community health and wellness component of the three -year plan in a
different format. The three -year plan as written has goals, objectives, indicators,
and activities, and has been well received by the councilmembers. They would like
to do it differently to convey a public health message with priorities for services.
Core public health functions include assessment, policy development,
prevention, access and quality, and administration. In the public health
improvement plan, they identify prevention as the focal point for all public health
services. Prevention includes promotion and protection, reducing susceptibility or
exposure to health threats, and early detection, treatment and containment of
disease.
Ten essential public health services include monitoring health services;
investigating disease; mobilizing communities to address public health problems;
Board of Health, 6/6/2000, Page 1
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developing and supporting policy development that encourages and supports
services and programs to address priority issues; enforcement of laws and
regulations; educating the public to empower them to be more responsible for their
own health care; linking individuals to resources in community and providing those
resources that are not otherwise available in the community; workforce
development; evaluation of programs; participation in some practice -based
research.
They started the strategic planning processes three years ago. Phase one
was a review of the current status. They developed the four -step process used to
identify and transition three services to the community. They will continue to use
that process to assess services for transition. Also in phase one, Community Health
and Wellness worked on outcome measures for its programs. The outcome
measures they developed were those they could be held directly responsible for. In
the past, the three -year plan as written had broad goals, with objectives related to
outcomes or things they would like to see happen but cannot be held solely and
directly responsible for. They wanted to develop outcome measures that the
department can communicate to everyone, including funding sources, the
community, and the County Council. They will provide reports, documentation, and
measures to show they have accomplishments.
Phase two is the phase in which they are looking at the role of community
health and wellness (CHW) in providing public health services. They developed the
CHW mission statement. Also in phase two, they identified what it would take as a
community to address the ten essential public health services. In the packet, there
is a copy of the document that identifies the ten essential services. They also
looked at the specific activities that the division would provide.
Phase three identifies the structure. They are in the middle of phase three
now. They expect to have a recommended structure for the division and a
recommendation on the implementation process by the end of June. In looking at
their structure, they want to ensure that services are provided. The new
component would be community -based teams that are interdisciplinary teams
located in a geographic area or community. The teams work with resources in the
community. They had discussions with senior services to provide population -based
classes. They want to have a good balance of population -based services and
individual services. They also want to support a community response to priority
issues. They envision that the interdisciplinary teams would conduct a needs
assessment for the community or geographic area they are assigned to, and work
with the community on doing the assessment and also prioritize some issues or
concerns of the area. Those would help guide the population -based and other
services that the team would provide. They also want the structure to be non -
categorical, which means not organizing staff according to cost center. The staff
would operate as generalists. They would be cross - trained in all the programs and
services that would be provided. It would provide back up services for those on
leave. People could step in and do other tasks. Now, the staff is specialized.
Board of Health, 6/6/2000, Page 2
1 Phase four is implementation. The strategic plan will include training, team
2 building, and the transition process. It will take a minimum of six months to get
3 through that phase of preparation to move into the geographic teams. They have
4 to address the fiscal year (FY) 2001 budget and three -year plan. They would like to
5 propose that the Community Health and Wellness component of the three -year plan
6 be as demonstrated in the example for Community Health and Wellness: Violence
7 and Injury Prevention, on packet page eight. The three -year plan will be non -
8 categorical and not related to a cost center. This would give the overall view of
9 what each program would do in response to priority issues. Under each issue will
10 be the ten essential services and what all the programs will do in response to that
11 goal, in the specific programs. In order to maintain accountability for the cost
12 centers, they will pull out of the overall plan for each cost center the specific work
13 plan and specific issues. It will be put together so, at the end of the component,
14 they can put together the budget indicating all costs, revenues, and the budget for
15 that cost center for 2001.
16
17 Nelson questioned how the lead is taken as they work together in a
18 collaborative effort. They have to have a product and benchmarks. He questioned
19 how they would make sure the units are doing their share. Guirl stated the
20 supervisors will supervise the community -based teams.
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22 Brenner asked the reason that the violence and injury aspects were put
23 together. They are different. Injury is an innocent thing, such as carelessness, and
24 violence is intentional. Guirl stated the same responses will impact those areas.
25 They can also name them intentional and unintentional injury.
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27 Brenner questioned whether they expect the same tools will be used. Guirl
28 stated the same interventions with families would be used. When working with
29 families, they want to strengthen the family unit and reduce access to guns by
30 working with the families to ensure the guns are locked up.
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32 Hoag stated she liked the format. She questioned who determined the
33 priorities. Guirl stated they have not yet decided the priorities. For instance,
34 instead of saying they are going to reduce unintended pregnancy as a priority, they
35 would like to pick out specific targeted areas of concern when working with families.
36 The targeted areas of concern would demonstrate the public health concern, but
37 doesn't get communicated effectively now. Violence and injury, in their statistics, is
38 an area of concern. She saw that as becoming a priority. Other options, such as
39 promoting health behaviors, can be a priority.
40
41 Hoag questioned the process for putting together the priorities. Guirl stated
42 it would come from the division when developing the three -year plan. They will
43 have to take the overall public health issue priority areas, based on the data
44 collected countywide. That will probably change once the teams are out there and
45 conducting their own small community assessments.
46
Board of Health, 6/6/2000, Page 3
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Benjamin stated they are looking for whether or not the Council supports the
new format. A lot of time and resources will be spent in putting the three -year plan
in this new format.
Hoag asked what the old format was based on. Benjamin stated it is from
the Public Health Improvement Plan, the ten essential services, and the new
proposed public health standards.
Hoag asked if they will take that information and organize it into the new
format. Guirl stated that is correct.
Benjamin stated they have always run the three -year plan through the Public
Health Advisory Board and the Board of Health, who would still have review of the
priorities.
Nelson moved approval of the new concept in health management for the
Community Health and Wellness Division. It is a good idea because they utilize
sources available within the community.
Dawson asked about page three, item seven. She asked how they would
provide health care when other services are unavailable. Guirl stated the
tuberculoses (TB) clinic is an example. Treatment is not available in the
community, and is a public health service that the department would provide.
Dawson asked if they propose to expand beyond that. Guirl stated no. They
are trying to move away from doing the services that are otherwise available in the
community, such as the sexually- transmitted disease (STD) and international travel
clinic.
Motion carried unanimously.
Guirl provided information requested at the April Board of Health meeting (on
file).
4. CHARGING FEES FOR CONSUMER SERVICES POLICY
Benjamin read the Health and Human Services (HHS) mission. The Revised
Code of Washington (RCW) statutes that govern the Board of Health allow
establishment of policy, fees, and funding and sets the direction for public health
programs.
This is a policy on what program they would or would not charge for, as a
public health entity. The Board is approving the policy. He presented the entire
policy, but will concentrate on only two sections. Subsection 13, on packet page
14, says that they are prohibited from charging fees for certain services because
they have a contract to provide those services, or a grant that says the department
must accept those monies as full payment. Those services are the Women, Infant,
Board of Health, 6/6/2000, Page 4
1 and Children (WIC) program, maternity support services, maternity case
2 management, child protective services, and other state programs that prohibit
3 collection of fees.
4
5 The department also does not charge frees for services related to children
6 with special health care needs, including home and office visits; consultations by
7 phone; communicable disease investigations; HIV counseling and testing for
8 targeted risk groups; and tuberculosis skin tests for selected populations. The
9 reason they don't charge a fee for the last two items is because they are the high -
10 risk populations. HHS needs to reach out to them. Fees should not be a barrier to
11 protecting the community's health. Regarding the communicable disease
12 investigation, it would be difficult. The question is whom they charge and for what
13 services. It would be counterproductive to do an epidemiological investigation.
14 They are trying to get the real facts so they can get to the basis of the outbreak
15 and prevent other people from getting sick. A fee in that situation would be a
16 barrier. Regarding consultation by phone, people call for many reasons. They
17 don't charge a fee for that. It would be impossible to administer. They feel
18 strongly that a program for children with special health care needs be at no charge
19 because the families are already responsible for other medical bills. The County
20 should not burden those families any more than they already are.
21
22 There are certain educational components they don't charge fees for,
23 including educational sessions outlined in the three -year plan or in program
24 policies. An example is the bloodborne diseases policy, goal one, objective one,
25 activity one, to provide four educational programs to at lease six drug and alcohol
26 mental health treatment programs. Another example would be outreach and
27 education to high -risk populations. When they are trying to reach out to those
28 components of public health, it would be a barrier to HHS to provide the service for
29 a charge. An example of where they charge is a presentation to an association or
30 professional organization.
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32 Based on the County strategic plan, the HHS services mission, the
33 establishment that some fees would be barriers to protecting public health, and the
34 fact that some fees are prohibited due to arrangements by the payers, the HHS is
35 asking the Board of Health to approve the charging of fees for consumer services.
36
37 Imhof moved to approve as proposed.
38
39 Hoag questioned whether they are less likely to have people come forward if
40 they charge a fee for HIV counseling and testing. They are excluding particular risk
41 groups, but will charge a fee to other people. Guirl stated HIV counseling and
42 testing is a community collaborative effort. HHS is targeting the high -risk
43 population. Other service groups also provide counseling and testing. Other clinics
44 use a sliding fee scale.
45
46 Hoag stated it is difficult to get a person in the door to get that done in the
47 first place. They should not have to pay for it. It is an obstacle to someone doing
48 it.
Board of Health, 6/6/2000, Page 5
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Benjamin stated they could monitor that area, but HHS is currently only
doing the high -risk monitoring. If it is an issue in the community with the other
providers, HHS would address it.
Dawson asked how they would identify high -risk people. Benjamin stated
HHS identifies the behavioral lifestyle.
Guirl stated HHS collects information on individuals, not including names,
such as the risk factors. A lot of people will go into Planned Parenthood and other
areas with a concern of one instance in which something happened, and are not
considered a high -risk person. Also, HHS gets about $15,000 in the consolidated
contract for HIV testing. That money is spent quickly.
Hoag asked how they would know if people are not getting tested. Guirl
stated they would have to let people know there is a sliding fee scale.
Hoag stated they don't use a sliding fee scale for a TB skin test. That is in the
County's best interest to keep an eye on. Guirl stated that contrary to HIV, TB is
required by an employer. They would bill the employer.
Hoag stated that if they are using a sliding fee schedule, the employer would
still pay for it. Guirl stated the test costs $5, which is a minimum charge. They
also have policies the clinic staff can use to decide whether or not to waive a fee for
instances such as a homeless individual or someone who has symptoms and the
HHS wants to conduct the test.
Hoag asked the benefit of not having a sliding fee. Many people are in the
position of not having $5 to spare for a test. Also, she questioned whether an
employer would still be billed if there is a sliding scale. Guirl stated HHS could bill
the employers if there is a sliding fee scale. If one came in the clinic with
symptoms, the staff is authorized to institute a sliding fee scale.
Hoag asked the benefit of having a sliding scale. Business would pay
anyway. Guirl stated the majority is coming in for employment, educational, or
other requirements. They are not a high -risk population.
Hoag stated she didn't support that policy. She moved to remove TB skin
tests from page 13, item four, "...NOTE:... Immunizations, TQ Te
Environmental..."
Dawson stated Councilmember Hoag is asking staff to do additional
paperwork to find out if the patients are qualified. They have already addressed
the instances where they can make exceptions. She didn't want to see a sliding fee
scale on a $5 fee, due to the extra staff time that would be required.
Brenner asked how many TB tests are requested each year. Benjamin stated
they do many.
Board of Health, 6/6/2000, Page 6
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Guirl stated she estimated 1,000 TB tests are done per year. They conduct a
screening clinic three or four days per week.
Hoag asked if it would add a considerable amount of paperwork. Guirl stated
it would. They would have to identify all family members, their gross monthly
income, and go through the calculations.
Hoag asked if the people attending the clinic would already have that
information on file. Guirl stated most of them would not.
Hoag withdrew her motion.
Nelson asked about the unified fee schedule. Benjamin stated that has
already been approved for this year.
Motion carried unanimously.
(Clerk's Note: Imhof left the meeting at 1 :10 p.m.)
S. TOBACCO USE PREVENTION ACTIVITIES
Hoag stated she found a tobacco promotion insert in Popular Mechanics,
magazine that children read.
Benjamin stated Christine Gregoire, Washington State Attorney General,
already filed a suit that the tobacco companies violated the settlement order in
advertising in children's magazines. There was a decision by some tobacco
companies that they will withdraw advertising from the magazines that Gregoire
named in her lawsuit. The good news for Washington State is that it has Gregoire,
who makes this a top priority, as its attorney general.
list.
Hoag asked Benjamin to see if Popular Mechanics is included on Gregoire's
Benjamin stated Popular Mechanics is generally not considered a children's
magazine.
Hoag stated teenagers and young boys generally read it.
Crawford stated he had to leave the meeting, but he supported any use of
tobacco funds being put toward any tobacco prevention programs.
(Clerk's Note: Crawford left the meeting at 1 :15 p. m.)
Joe Fuller, Substance Abuse Prevention Coordinator, stated tobacco is
responsible for over 430,000 deaths in the U.S. Proportionately, the amount of
people who die from cigarette smoking and tobacco use is overwhelming compared
Board of Health, 6/6/2000, Page 7
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to everything else. Tobacco is the only commercial product that, when used as
intended, results in death. It is a legal drug. There is an idea that tobacco is less
harmful.
Carol Wetherill, Tobacco Prevention Coordinator, provided a brief overview
on prevention and control efforts in Whatcom County, services provided by HHS
and other agencies, and the tobacco settlement.
Key components are activities provided by the tobacco prevention program,
maternity support services, WIC, and child health. Key components of the program
are monitoring and assessment, community education and prevention, and policy
development. Monitoring and assessment involves retail compliance checks with
the Liquor Control Board and fire department.
(Clerk's Note: End of tape one, side A.)
Wetherill stated they also collect data for the state.
Hoag stated a large group of kids at her son's school wrote in a wrong birth
date on their application, so the photographer automatically used the year supplied,
which made the kids look like they were over 18. The kids used the student
identification cards as identification to get cigarettes. The principle got wind of it
and punched holes through the year on the ID cards so it couldn't be seen. She
suggested alerting the schools and the stores to not accept student identifications.
Wetherill stated they do retailer education to inform the stores about valid ID and
what a valid ID looks like. Student identification cards are not valid.
Wetherill continued to state that they do community education at health and
safety fairs. They also act as an information resource center. They have many
videos, pamphlets and visual aids that are available to people to check out. They
coordinate anti - tobacco events in the schools and the community, such as the
Great American Smoke Out and Kick Butts Day. They also participate in counter -
advertising through media such as billboards, newspapers, and radio. They do
retailer education to let stores know to check for valid ID and post signs saying
they don't sell tobacco products to minors. They also just produced the first
smoke -free restaurant guide, which includes coupons.
Brenner asked if the restaurants are 100 percent smoke free. Wetherill
stated they are. They are planning to do an updated guide.
Wetherill stated the most active event is Teens Against Tobacco Use (TATU)
program which is peer education to middle school children.
Nelson asked if all school districts participate. Wetherill stated all but
Nooksack and Meridian School Districts. This is the first year for TATU. They asked
10 to 12 kids from each high school to do training and work with people in their
own schools. Those two schools did not make it to the two dates for training. They
will notify the schools earlier this year.
Board of Health, 6/6/2000, Page 8
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Hoag asked about Lynden Christian. Wetherill stated they are also
interested.
Wetherill continued to state that media literacy is a component of community
education. Kids from Whatcom County go to state activities, such as the
Washington State Tobacco Prevention Youth Summit. Smoking cessation
counseling and referral for pregnant women is offered, as is counseling on the
impact of smoke in the environment on young children and children with special
health care needs.
Policy development includes policy advocacy. Other services include activities
sponsored by various agencies, such as the American Cancer Society, who sponsors
the Cancer Relay and is conducting a needs assessment in which they will have
developed into a county profile by late next fall. In addition, they helped fund
counter - advertising. COMMIT focus is outreach to pregnant women, health
professional education, smoke free workplaces, and lobbying. Life Quest at St.
Joseph's Hospital implements and conducts an adolescent cessation class. The
Lummi Tribal Health Center has community outreach, training and presentations,
information fairs, and stop- smoking support groups. The public schools participate
in TATU and youth cessation days and other anti - tobacco days. Treatment agencies
participate in prevention and control efforts through their education and cessation
work. The Washington State Liquor and Tobacco Control Board works closely with
the County in doing the retailer compliance checks and education. Western
Washington University also provides cessation and medication to their students, as
well as education and outreach. Currently, HHS will conduct a needs assessment
and provider survey to determine other local prevention and control efforts. They
want to see if there are gaps in services or if there are duplications of effort.
Other collaborative agencies include GlaxoWellcome, the Northwest
Washington Medical Bureau, the Washington State Medical Association, and the
Whatcom County Medical Society.
Regarding the tobacco settlement update, Washington State Department of
Health received $15 million. They have not decided how to disperse the funding to
the counties. They decided that every component of the state plan would be
implemented. A request for application will be available by June 15. Counties will
need to follow best practices. A community forum scheduled tonight is to educate
people about what is going on in the community and the state. They will ask for
input on community needs.
The northwest region is below the state average for sixth graders who have
tried tobacco. Usage triples between sixth and eighth grades. For those who use
tobacco during their entire lifetime, their first use also triples between sixth and
eight grades. In 1997, about 23 percent of the adults in Whatcom County smoked.
Fifteen percent of the stores in Whatcom County sold tobacco products to minors,
which is above the state average.
Board of Health, 6/6/2000, Page 9
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Nelson moved to approve Whatcom County as the lead agency to apply for
funding.
Hoag asked if there is any information for teenagers who are smoking and
want to quit. Wetherill stated St. Joseph Hospital has youth cessation classes.
They have a contract with the Bellingham School District, not with the county
schools, to send kids to the program when they are caught smoking on campus.
Anyone can take the classes at the hospital. Group Health and Northwest Medical
Bureau cover the cost of the classes. The schools would love to implement
cessation programs, but there is no time. Blaine High School has a cessation
program. It is difficult when kids are being expelled from school when caught.
Brenner questioned whether this is constitutional when they weren't able to
do the tobacco legislation. Benjamin stated it is. The statewide Tobacco Council
looked at tobacco prevention programs nationwide. States have successful
programs. The Tobacco Council developed a Washington State plan and adopted
the best practices where the other states recognized successful outcomes.
Brenner stated that when the Board of Health adopted the tobacco
legislation, it was told it was legal. Before going down that road, she asked to run
it by the attorneys.
Hoag asked what road Brenner is talking about.
Benjamin stated he is referring to the ordinance they already did. The
Tobacco Council priced the plan at $26 million. The Center for Disease Control
(CDC) suggested it would cost $39 million. They only have $15 million. They can
still go ahead with the community plan. He didn't know if the state will extend
funding to all counties or target specific counties to accomplish the plan. That is
unknown. The good news is they are working closely with all providers in the
community. They have the public health matters meeting. They will meet on June
15 with COMMIT to put together the community plan. Dr. Covert - Bowlds approved
the County being the lead agency. Whatcom County will have a community plan
based on services currently available, that will locate gaps, and that can address
those gaps.
Brenner stated she was surprised there is not an outrage about the state
holding on to the rest of the money. Benjamin stated legislators are being
educated about that. He doesn't support the legislature's decision on the budget.
He wished there were money to do the entire plan.
Brenner stated the County needs to lobby the legislature.
McShane stated the adult use in the County has risen. He questioned why.
Wetherill stated they don't have that information.
Benjamin stated there is now a statewide plan that identifies best practices.
They have to develop a Whatcom County plan based on best practices. He hoped
Board of Health, 6/6/2000, Page 10
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that by implementing the best practices, they would have an impact on smoking
rates. They won't see results over night.
Wetherill stated 90 percent of current smokers started when they were under
the age of 18. Washington State now has $15 million, part of which will go into
evaluations.
Brenner asked if the charts on youth tobacco use mean that these kids are
regular smokers, or have only tried it. It seems like part of being a kid is
experimenting. She questioned how they know this means the kids are regular
smokers, rather than the kids who have experimented. Wetherill stated it takes 10
to 12 cigarettes to be addicted.
Brenner stated she wanted to see data on which kids are regular smokers.
She can't imagine a kid not experimenting. Wetherill stated they don't have all the
data because some schools decline to participate in the surveys.
Hoag asked how they measure the adult use. Wetherill stated the hospital is
going smoke free. Every physician asks the hospital patient if he or she smokes.
Benjamin stated HHS is on a committee called Community Health
Improvement Consortium (CHIC), comprised of hospital representatives, local
physicians, and HHS. There is an electronic connection between the three groups.
They are developing a community health record that includes physician practices
and hospitalizations. They have agreed to ask behavioral lifestyle questions of
patients. All information will be on the information system so there will be more
accurate and reliable community information in the long term.
Hoag asked the source of the numbers that are being used now. Wetherill
stated the state, which does a survey, provides the numbers.
Hoag stated part of the ordinance banning signs was declared
unconstitutional. She asked if any of it was salvageable. Benjamin stated that is a
question to ask the Prosecuting Attorney.
Wetherill stated they can't use anything related to health in banning tobacco
advertising.
Hoag asked Benjamin to run the question past legal counsel.
Motion carried unanimously.
OTHER BUSINESS
Brenner asked for HHS's opinion about the needle exchange program not
working, as referenced in an article in Reader's Digest. She asked that HHS look
into it.
Board of Health, 6/6/2000, Page 11
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(Clerks' Note: McShane left the meeting at 1 :47 p.m.)
Benjamin stated he would give an update on this issue. He cautioned anyone
from making a decision based on the article. There were always studies going on.
Brenner stated someone who was supportive of the program did this study.
ADJOURN
The meeting adjourned at 1:50 p.m.
Jill Nixon, Minutes Transcription
These minutes were approved by Council on , 2000.
ATTEST:
Dana Brown - Davis, Council Clerk
WHATCOM COUNTY COUNCIL
WHATCOM COUNTY, WASHINGTON
Marlene Dawson, Council Chair
Board of Health, 6/6/2000, Page 12