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05/02/2007 • New Hanover County Health Department Revenue and Expenditure Summaries for March FY 2006 - 2007 Cumulative: 75.00% Month 9 of 12 Revenues Current Year Prior Year Type of Budgeted Revenue Balance % Budgeted Revenue Balance % Revenue Amount Earned Remaining Amount Earned Remaining Federal& State $ 1,948,525 $ 1,646,145 $ 302,380 84.48% $ 1,846,138 $ 1,247,363 $ 598,775 67.57% AC Fees $ 611,161 $ 516,605 $ 94,556 84.53% $ 659,496 $ 432,170 $ 227,326 65.53°h Medicaid $ 1,580,867 $ 718,979 t ---W-,888 45.48% $ 1,500,300 $ 516,120 $ 984,180 34.40% Medicaid Max $ 310,000 $ - $ 310,000 0.00% $ - $ - $ EH Fees $ 310,000 $ 198,784 $ 111,216 64.12% $ 300,212 $ 131,298 $ 168,914 43.73% Health Fees $ 334,200 $ 314,677 $ 19,523 94.16% 3 128,000 $ 151,971 $ (23,971) 118.73% Health Choice $ 35,125 $ 11,351 $ 23,774 32.32% $ - $ - $ Other $ 2,599,988 $ 1,972,586 $ 627,402 75.87% $ 3,235,186 $ 1,901,078 $ 1,334,108 58.76% Totals $ 7,729,866 $ 5,379,127 $ 2,350,739 69.59% $ 7,669,332 $ 4,379,999 $ 3,289,333 57.11% Expenditures Current Year Prior Year • Type of Budgeted Expended Balance % Budgeted Expended Balance % Expenditure Amount Amount Remaining Amount Amount Remaining Salary 8 Fringe $ 12,101,765 $ 7,791,949 $ 4,309,816 64.39% $ 11,276,483 $ 6,641,743 $ 4,634,740 58.90% Operating $ 2,257,023 $ 1,119,847 $ 1,137,176 49.62% $ 2,064,395 $ 953,981 $ 1,110,414 46.21% Capital Outlay $ 94,894 $ 68,223 $ 26,671 71.89% $ 714,275 $ 203,750 $ 510,525 28.53% Totals $ 14,453,682 $ 8,980,019 $ 5,473,663 62.13% $ 14,055,153 $ 7,799,474 $ 6,255,679 55.49% Summary Budgeted Actual % FY 06.07 FY 06.07 Expenditures: Salaries & Fringe $ 12,101,765 $ 7,791,949 Operating $ 2,257,023 $ 1,119,847 Capital Outlay $ 94,894 $ 68,223 Total Expenditures $ 14,453,682 $ 8,980,019 62.13% Revenue: $ 7,729,866 $ 5,379,127 69.59% Net County $ 6,723,816 $ 3,600,892 53.55% • Revenue and Expenditure Summary For the Month of March 2007 9 NHCHD BOARD OF HEALTH APPROVED GRANT APPLICATION STATUS FY 06.07 Date (BOH Grant Requested Pending Received Denied 4/512007 Colposcopy Funding - Request for $12,000 • start-up funds from Ministering Circle for purchase of Colposcopy equipment. Also plan to request additional funds from other grant sources such as Cape Fear Memorial Foundation for expansion of program to include a second colposcopy unit and additional training, supplies and contract services. $12,000 $12,000 317/2007 Closing The Gap- Request for $225.000 ($75,000 per year for 3 years) from North Carolina Office of Minority Health and Health Disparities for a Health Educator to focus on prevention of HIV and other sexually transmitted disease in the Latino and Afro- American populations. $225,000 $225,000 2/7/2007 CA -MRSA: Funding from UNC-Chapel Hill School of Medicine to assist with research related to the prevalence of community . associated methicillin resistant staphylococus aureus $12,600 $12,600 1/3/2007 Smart Start - New Hanover County Partnership for Children - Child Care Nursing Program $178,500 $170,000 $8,500 1 2/612 0 0 6 Duke Endowment Funds, NHRMC - Dental Unit - Personal Health Services. $25,000 for • indigent dental care and $15,000 for sedation equipment $40,000 $40,000 111112006 No Activity for November 2006 10/4/2006 March of Dimes - Maternity Care Coordination expenditures for Baby Love Program Baby Boutique and Learning Center $3,000 $3,000 91612006 No Activity for September 2006 81212006 No Activi for Au ust 2006 7/5/2006 I ervic6 oor matron Family Counseling Program (Cape Fear Memorial Foundation) - Funding for Licensed Clinical Social Worker for3 years $260,000 $75,000 $185,000 Eat mart ove More -Community Grant (NC Dept of Public Health Physical Activi and Nutrition Branch) 1 $16,495 $12,416 $4,079 Totals $747,595 $265,000 $285,016 $197,579 35.45% 38.12% 26.43% Pending Grants 2 25% Funded Total Request 3 38% Partial/ Funded 3 38% Denied Total Request 0 0% Numbers of Grants Applied For 8 1000/to • 10 As of 4110/2007 NEW HANOVER COUNTY BOARD OF COMMISSIONERS Request for Board Action Agenda: Consent Meeting Date: Agenda: ® BOB: 05/02/07 CC Consent Agenda: 05/07/07 Department: Health Presenter: Kim Roane, Business Manager Contact: Kim Roane 798-6522 Subject: Cape Fear Memorial Foundation Living Well Grant Funds - $12,000 Brief Summary: Cape Fear Memorial Foundation has notified the New Hanover County Health Department (NHCHD) of continuation grant funding of $12,000 to fund four issues of the "Living Well" publication during 2007. This award was made as a result of the Foundation's request for NHCHD to coordinate the publication, and did not involve an application process. This is a grant funded project which will end when grant funding ends. Recommended Motion and Requested Actions: To ratify the award of $12,000 and approve acceptance of the Cape Fear Memorial Foundation grant funds for the Living • Well program. Funding Source: Cape Fear Memorial Foundation grant funding. No County match required. Will above action result in: ?New Position Number of Position(s) ?Position(s) Modification or change ®No Change in Position(s) Ex lanation: Attachments: Grant award letter from CFMF • 11 APR/17/2007/TUE 03:35 PM CAPE FEAR MEMORIAL FAX No,910 452 5879 P.002 ~G e Fear MEMORIAL FOUNDATION 0 2508 INDEPENDENCE BLVD, STe 200 (910) 452-0611 PHONE WRAUNGTON, NC 28412 (910) 4525879 FAX www.cfmfdn.org April 17, 2007 Mr: David E. Rice, MPH, MA - Health DirectoC New Hanover County Health Department 6oARD or Dwt oks: 2029 South 17th Street Wilmington, NC 28401-4946 Amur R. eeua Dear David: WNlM1 H. CAMU~ At its meeting on February 14, 2007, the Board of Directors of Cape Fear J. Rcx Cme n. M.o., F.A.C.R. Memorial Foundation approved a grant of $12,000.00 for your organization to fund 4 issues of the "Living Well" publication during J,wa b. NuwOler. MD.. F.A.C.O.S. 2007. W. CAuu mt a 1. NJ R.T. Smc , A., M.13., C ua With your acceptance of this grant, you agree to use these funds only for Rcro &mwR the purpose stated and to provide progress reports as requested by us. Misappropriation of grant funds or failure to timely submit progress Roew P. W.wwick, CPA reports may result in our demand for repayment of monies to the R~ L. woo° Foundation. Your grant identification number is #925. Please reference this number in GARn Gmm, Pemmea all correspondence relating to this award. The Directors of Cape Fear Memorial Foundation are pleased to continue to support this publication. l Sincerely, Garry~(3aYtis President DEDICATED TO ADVANCING GOD'S DESIRE FOR OUR HEALING AND HEALTH 12 NEW HANOVER COUNTY BOARD OF COMMISSIONERS • Request for Board Action Agenda: Consent Meeting Date: BOH: Agenda: ® 05/02/07 CC: 05/07/07 Department: Health Presenter: Janet McCumbee, Personal Health Services Manager Contact: Janet McCumbee 798-6559 Subject: Contract with New Hanover County Board of Education for Mental Health (MH) services in schools - $1,021,047 FY 07-08 Brief Summary: New Hanover County Schools (NHCS) has requested that New Hanover County Health Department (NHCHD) enter into a contract that would transfer current Mental Health services in the schools from Southeastern Center (SEC) to the NHCHD, beginning July 2007. SEC must divest of this clinical service and the school system wants the service to continue in targeted schools. The contract includes funding for twelve (12) mental health therapists, a supervisor, and clerical support. The therapists provide outpatient psychiatric treatment for emotionally disturbed and behaviorally disordered children, including screenings, assessments, and counseling (individual, group, and family therapy). They also consult with school personnel and • provide education regarding mental health issues. This program would be similar to the long standing arrangement with NHCS to administer the School Health Program Recommended Motion and Requested Actions: To accept and approve the contract with NHCS for $1,021,047 for FY 07-08, to administer the mental health program in the schools and to submit to the New Hanover County Commissioner's for their consideration. Funding Source: New Hanover County Schools (based on revenue from billing for Mental Health services). Positions will be only maintained as long as funded by New Hanover County Schools. Removal of funding will result in removal of positions. No matching funds are required. Will above action result in: ®New Position 14 Number of Position(s) ?Position(s) Modification or change ?No Change in Position(s Explanation: The positions would include 12 mental health therapists outposted at schools, a supervisor, and a clerical position for support and billing. The program will be self sufficient through revenue, and as guaranteed by NHCS. Existing office space in the schools is available for the therapists. Space for the supervisior and clerk will be shared • with other health department staff. 13 Attachments: letter, contract, budget sheet •J O 14 Southeastern Center For Mental Health, Developmental Disabilities, & Substance Abuse Services Serving Brunswick, New Hanover, & Pender Counties 2023 South 17" Street, Post Office Box 4147, Wilmington, NC 28406 (910) 251-6440, Fax (910) 251-6557, 1-800-293-6440 Arthur F. Costantini, Ph.D. Area Director April 17, 2007 Mental Health Workers In The Schools Mental Health Workers in the Schools has been a cooperative program between the New Hanover County Schools for approximately five (5) years. The Program has been very successful in providing mental health services to students during the school day at the school site. The program has been successful because it eliminates the • "no-show" problem, it allows for early intervention and prevention services, and it provides services to children that need these services regardless of the family's insurance coverage and/or ability to pay. State Mental Health Reform prohibits SEC from being the service provider and this causes SEC to divest the services to another public or private agency. SEC is convinced of the positive outcomes achieved by this program and is very interested in seeing this program continue and expand to most if not all of the schools. SEC is offering to work with and to provide assistance and guidance to both the school system and the selected provider in the continuation of this program. If you have any questions about the Mental Health Workers in the schools, please do not hesitate to contact me direct. Sincerely, Arthur F. Costantini Area Director, Southeastern Center 2541 S. 17th Street Wilmington, NC 28401 (910) 796-3130 costant@secmh.org • AFC/jep 15 9090105 New Hanover County Schools Contract for Professional Services 1. AGREEMENT, between New Hanover County Schools, hereinafter referred to as NHCS, and the New Hanover County Health Department, hereinafter referred to as HD, to provide services specified in paragraph 3. 2. HD shall provide services by qualified individuals in accordance with all applicable federal and state laws and implementing regulations, and in accordance with Newover County School Board Policy and Procedures. 3. SERVICES: A. Special Education & Related Services I. HD will provide twelve (12) full time q~ ltfied mental health pr .gs 'onals to provide mental health services in de t6nated schobhThe mental h professionals will work on the school sy}~ fem dailychedule and twel 61 month calendar. II. HD will provide clinical orientation, trainingortwuties, and administrative and clinical supervision to the mental health counselb placed at a school. III. HD will provide the follow ng array-of services on slue and~at the discretion of the counselor: clinical assessmen}l ndividual-therapy, grol~p Therapy, family therapy, • consultation and education, an~'mterdi'tpliiiaty to staffing. / IV. HD will facilitate-referrals to ofj it .services tludmg, but not limited to: psychiatry ss'es me , medication manageme X24-hour emergency services and special'ed psychol )gical evaIuations, o 4. COMPENSATION: The maximum allowed charges-against this+dontract shall be: e: 44 a. For services re~ndere__para aph 3A., not to exceed $446,953.00 of school revenue and $574,0 ?00 from Ike'inssurance collections reserve. Total service hill not Xceed $1,021,047. 5. BILLING: „ . a. For services endee per paragraph 3A., in accordance with New Hanover County School fiscal procedures, HD will submit monthly invoices for $3,103.84 per filled position perr>ionth from school revenue referencing the purchase. HD will assess $3,986.43 per filled position per month from the insurance collections reserve. These invoices shall be prorated as necessary based on the start date of new employees. b. Any insurance revenue collected by HD during the term of this agreement, minus an administrative fee, not to exceed 5%, will be held by HD and will be used to expand school based mental health services in the following contract year. • Southeastern Center 0708 1 16 9090105 6. TERMS: July 1, 2007 through June 30, 2008. NHCS is under no obligation beyond the ending date of this agreement and this agreement can be terminated earlier by either the Superintendent or the New Hanover County Board of Education at their discretion. • 7. This contract for services is contingent upon the availability of adequate revenue. 8. HD assumes all responsibility for reporting Contractor employee income to the state and federal authorities. 9. To the extent permitted bylaw, HD assumes all liability for damages non-performance, malfeasance, negligence, or injury resulting from its negligencZaa-NHCS assumes all liability for damages, malfeasance, or injury resulting from its negligence. -f 10. HD agrees to maintain program and fiscal docume a t n k-services ren& ed. Such documentation shall be maintained in accordance with applicable federal anta•e laws and implementing regulations and New Hanover Cpl iy Board A *Education Policy aanWrocedures. All program and fiscal documentation is subject to audit HD sumes fiscal resrstbility for preparation of program and fiscal documentation, sup ies \d materials. ovide: confidential office space, 11. At the school sites providing these servicesNHCS agrees to`pr counseling space appropriate for indivi~idal ltd group therapy, rovade access to the above / referenced space 40 hours per week for 1~2 oiiths'peryear on a sc}i'edule agreed upon between the principal and HD, office furniture app \~riate~_su °ortqua~ity mental health services and support technology (telephone comp uter, a& etwork access). NHCS will cooperate with the • mental health coun~~ r'ih-ma,xitnizing the counselor's acoess to students and parents for the delivery of mentaI4- alth servtQes. NHCS willvomply with any applicable state and federal laws and regula~o s; ertainmgyto the mental he ilth,§ystem including maintaining the confidentiality of info ion Mdrvidual clieen,bs records in accordance with federal and North Carolina law and re latrons as-cited-,i6NCGS 122 C-52 and 42 CFR Part 2. 12. Tlu contract cannof4~e amendedyy~~mod~fied or altered except by agreement, in writing, by duly ~thortzed officials for ath parties.' ~ tther parry may terminate this contract after giving a thirty-'di notice in w it' 9, of mteCtt to do so. SIGNATURES'affxed below i ndicate agreement to the terms and conditions stated herein: y. Superintendent Date New Hanover County Schools Contractor Authorized Official Date New Hanover County Health Department Attn: Address: Southeastern Center 0708 2 17 9090105 City /State/Zip: Phone: Federal Tax ID#: Finance Officer Signature indicates. the budget contains adequate resources to fulfill this agreement. This instrument has been preaudited in the manner required by the School Budget and Fiscal Control Act. Finance Officer Date New Hanover County Schools Budget Code 2-5840-069-311-000-903 $286,3)f4,0 2-5840-895-311-000-903 $ 3Q-,200-00 3-5840-044-311 $ 86 949.00 2-5840-032-311 X, 30.00 NU "F/ • ,il } _ t.. fi-m> Southeastern Center 0708 3 18 Mental Health Program Budget FY07-08 J Salary/Fringe $952,247 ' • Contract Services 1,800 Printing 3,500 Supplies 36,500 Mileage 18,000 Professional Liability Insurance 4,500 Travel/Training 4,500 Total Budget $1,021,047 • • 19 NEW HANOVER COUNTY BOARD OF COMMISSIONERS • Request for Board Action Agenda:® Consent Meeting Date: Agenda: ® BOH: 05/02/07 CC: 05/07/07 Department: Health Presenter: Jean P. McNeil, Animal Control Services Manager Contact: Jean P. McNeil 798-7505 Subject: Animal Control Services Advisory Committee - Appointment Brief Summary: Appointment of new committee member to fill the vacant Member-at-Large slot with Ms. Joyce Bradley. Ms. Bradley has served on the Animal Control Services Advisory Committee in the past, including the position of Chair. She has also served for many years as a member of the Dangerous Dog Appellate Board for the division. She brings with her many years of knowledgeable animal expertise in a variety of areas. She will be a welcome addition to the committee. • Recommended Motion and Requested Actions: To accept and approve the request to fill the vacant Member-at-Large position of the Animal Control Services Advisory Committee with Ms. Joyce Bradley. Funding Source: N/A Will above action result in: ?New Position Number of Position(s) ?Position(s) Modification or change ®No Change in Position(s Ex lanation: See above. Attachments: Application for A t. NHC ACS Advisory Committee • 20 O 1n ly ~O NEW HANOVER COUNTY T HEALTH DEPARTMENT F 0 Animal Control Services Q4 Z 180 Division Drive NEW XPNOVFA COUNTY HEA Wilmington, NC 28401 TELEPHONE (910) 798-7500 FAX (910) 341-4349 Application for Appointment New Hanover County Animal Control Services ---Advisory-Committee (Please print legibly) Category Interest: Member at Large Name: Joyce Bradley Address: 1062 Winding Trail Drive City: Leland, NC Zip: 28451 Phone (Home) 910-383-0339 (Cell) 910-620-8327 Why do you wish to serve on the Animal Control Services Advisory Committee? I have been a past member and am fully committed to the care and welfare of the Animals of New Hanover County. What areas of concern would you like to see the Committee address? Prohibiting transporting of dogs in the back of pickups /or other types of vehicles unsecured by means of a crate/carrier. Date: April 17, 2007 Signature: JWB 21 "Healthy People, Healthy Environment, Healthy Community" NEW HANOVER COUNTY BOARD OF COMMISSIONERS • Request for Board Action Agenda: ? Consent Meeting Date: May 2, Agenda: ? 2007 -Department: Health Department Presenter: David E. Rice Contact:David E. Rice Subject: Strategic Planning Retreat Brief Summary: Participant packets were created and distributed on April 16, 2007. Included in the packets were: An agenda, SWOT questionnaire (Strengths, Weaknesses, Opportunities, and Threats), and highlights of recent health and demographic statistics. Our vision and mission reviewed in light of the information and complete the SWOT. Our Mission and Vision: The mission of the New Hanover County Health Department is to assure a safe and healthy community. The vision of the New Hanover County Health Department is: Healthy People, Healthy Environment, Healthy Community. The Agenda for the April 21 retreat was: 8:00 - 8:15 Review mission & vision • 8:15 - 9:00 Discussion of external public health priorities and funding: Emergence of infectious diseases Threat of natural disasters, especially hurricanes Rapid spread of chronic illnesses Access to clinical and dental healthcare Availability of/competition for funding 9:00 - 10:00 Identify and prioritize relationships with key community stakeholders 10:00 - 10:15 Break 10:15 - 11:15 Identify key opportunities and threats 11:15 - 11:30 Break for lunch preparation 11:30 - 12:30 Working Lunch: Discuss internal strengths and weaknesses vis-a-vis identified opportunities and threats 12:30 - 1:30 Identify and prioritize key strategic issues Dr. John Graham and Mr. Bill Browder (from the UNC Institute for Public Health) • facilitated the retreat. Attached to this Board Action Form are the following: Stakeholder Grid 22 Extemal public health priorities and funding - Key strategic issues • Recommended Motion and Requested Actions: Discussion only Funding Source: Will above action result in: ?New Position Number of Position(s) ?Position(s) Modification or change ?No Change in Position(s) Explanation: Attachments: - Stakeholder Grid - External public health priorities and funding - Key strategic issues 23 N Ly OWU ~O~ oA NV N 6:b N O O C 4. U L4 Q N O on•= U x~« Uv Y ~r a O O •y Ci ~ Q a1 U U A N c w i o 0 v~ U U x N• O d Q c aLn [1] U ld y • k~zAmw 0 u b T QO C d U ~ -C o U Y c A C U E. U N ~4'j W Gtl ry. o ~O N ~o 0o a ~ 24 • Availability / Competition for funding: Limits on NHC funding Use of grant - start up? Sustainability? Public desire for service (in "keep taxes low" environment) Prevention message Educated public and providers Partnerships can help get message out - esp. colleges and universities Use local govt TV Not enough for PH and private providers for facility to expand growth of clinical svcs Access to clinical and dental funding Mobile dental unit - 25 K children in 2 counties Lack of dental care for adult uninsured Changes in reimbursement Through Medicare - not enough Drs for adults Access to primary care • Adult and children Equality in care Enhance safety net Assurance - role of NHCHD if we are not providing the svc NHCHD - infrastructure not in place to provide primary care Emergence of infectious diseases TB cycle Concern for Salmonella and campylobacter Education Comm. Info Homeless pop Hep C Syphilis / HIV / AIDS / pertussis on rise MRSA - community acquired HPV - new vaccine, 25% of Paps abnormal Cultural issues New terrorist threats Tracking / statewide surveillance? 25 Threat of natural disasters Pop growth - latino pop growth "practice makes good' if not perfect we are nat'l leader MOUs with other counties - need state help Comm. College partnerships Hospital evac Buses Co-location shelter for companion animals IC3 in place Wild fires - poor air quality Sewage spills Informing public Regular storm flooding Well contamination Isolation of employees Mold mildew Diseases from flooding Loss of housing Review response plan every year Rapid spread of chronic illness • Enhance coalitions - look at resources - Hhh promo staff Childhood asthma New diseases coming in from other countries (TB, etc) Dependence on community partners for svcs - what happens when they stop Ex diabetes illness related to homeless or mentally ill Veteran's health 26 April 21: priorities/ commonalities: Threats of natural disasters - educating the public • Media - develop programming • Support Emergency Mgmt to promote education messages • County departments will be called upon soon to create unified media message with new county studio • Speak with one voice on preparedness and response messages • Educate - not scare tactics • Collaborative opportunity for PHRST, state Emergency mgmt, other state agencies Access to healthcare - safety net • What is NHCHD assurance role? Offer / not offer primary care svcs? • Do we establish a non-profit foundation to provide indigent care? Seek funding for this foundation from agencies who stand to save as a result of this effort (like hospital network, etc) • Current grant from KBR to local Healthy Carolinians for safety net coordinator - currently housed out of Access III of Lower Cape Fear. Need to find new "home" for this safety-net coordinator - possibly medical society a good fit? Better agency fit for fundraising? • Encourage local philanthropic agencies (churches?) to raise funds to support • medical costs - some local churches raise funds for similar care and even get referrals from county agencies for identifying those in need. • NHCHD has draft articles of incorporation for local Public Health Foundation to act as a 5016 - original thoughts for this are to increase preventive services... could this serve as arm for raising funds for treatment? Donors tend to respond to immediate need as opposed to prevention? • What is NHCHD role for assuring that other safety net agencies are providing accountable care and service? Are there good channels for communicating this care between the agencies? Some services being duplicated / some not being addressed. • Need mechanism to fund indigent services Communicating importance and value of prevention Who are the audiences that can prioritize these topics and can communicate this value? o Elected officials o Board of Ed o Policy makers o Media o Stakeholders o The people who can focus on prevention (ie: not the people in immediate need of care.)...the financially stable, the healthy o Can we create a message of value for businesses for prevention? 27 Funding for facility expansion • We need to promote ourselves and our services • People don't know what we do , • Educate the commissioners - invite them here for work meeting or staff meeting • Host an open house - for stakeholders / media Controlling infectious diseases: tracking and response • Emphasize surveillance • Keep staff informed on epi-info, HAN network • Encourage info technology • Toot our horn - the reason why people don't know about health threats is because we do a fantastic job of keeping community healthy and responding to outbreaks • Encourage media to toot our successes - we need to improve and sustain positive relationships with media - what is good must be even better • "State of the Health of NHC" Strengthening partnerships to promote assurance • What partners do we need to keep in mind? • We have limited capacity to go out to agencies or businesses to provide worksite wellness programs or direct services (flu shots etc) - but we need more staff capacity to accomplish this. • Can we leverage our assurance role to try and promote worksite programs across the county? Attach this to value of prevention - capitalize on topics that will keep employees healthy and at work. We do a great job with flu, etc-spread it to other topics. • Look at county government and work to "sell prevention" with the hopes of being able to replicate this to other agencies? Worksite wellness for NHC / promoting what is available through insurer-based program already. • How did Brunswick fund fitness coordinator? • CEO roundtable What capacity do we have to address: Facility expansion and/or Foundation to raise funds? • Possibly a topic for next MAPH team? • Need BOH, mgmt, and even community support to further this cause • NHCHD must convey this need - must toot our horn • Do we have capacity to market this need? Do we contract with a consultant? Promoting county wellness program with overall goal of being community resource to replicate to outside agencies? • Research what is available currently though established programs. • Work with HR to seek opportunities to do this 28 • 5. Client is an elementary school male who has been bounced around to four different schools within two- and-a-half years with an astronomical amount of absences (one school he was absent 63 days out of 95 enrolled), both excused and unexcused, not to mention tardier. He had a reputation at his previous school for bullying and getting into physical altercations at recess. On the first day at this school, he had a physical altercation with a peer and was suspended. The therapist saw him and his mother immediately and was able to get him in to see the SEC psychiatrist quickly also. It turned out that the client had also been homeless on more than one occasion. Part of the treatment of the client and family consisted of getting the client correctly diagnosed and on medication that could help him focus and limit aggression, addressing their homeless needs, facilitating to keep the child in one school despite frequent moves from hotel to hotel, addressing his lack of skills to express his anger appropriately, and to form an alliance with the parent. He is now doing much better academically and behaviorally. He has had fewer absences and no physical altercations. He has had no suspensions. He is not claiming that he feels sick a lot and wanting to go home as he did previously. He is happier now and is participating and completing school work. He is able to stay in his seat and is not sitting at a desk away from his peers anymore. He plays with others at recess and is able to maintain peer relationships. He says he likes school and doesn't want to ever leave it. 6. Client is a 12-year-old male middle school student. He is one of four siblings who is being raised in a single parent home. He exhibited intermittent suicidal ideation, engaged in delusional thought processes, and was frequently involved in peer conflicts at school. In addition, he was constantly seeking out the school nurse for a variety of somatic complaints. His teachers reported him as having a great deal of anger and aggression. After evaluating the client and interviewing several of his teachers and his parent, it became known he was being teased regularly at school, and had no coping strategies in place to deal with his anger and emotions. He regularly harbored feelings of embarrassment, and being singled out. His reality testing was very poor (e.g., at times he believed he could predict the future); he received no sense of validation from others, and when stress levels arose, he complained of physical ailments. After immediately addressing his suicidal thoughts, the therapy was aimed at giving him coping strategies for his stress and anger, as well as educating him on proactive techniques he could utilize during times of conflict. Therapy • also enabled the client to contract for his suicidality and also address his inappropriate externalization of anger. Now, during times of stress, he no longer has thoughts of killing himself, and has developed a healthy perception of reality. As his problem solving skills develop, his self-esteem continues to rise, and he no longer complains of physical ailments. He has also improved his relations with peers as he now has several good friends both inside and outside of school. In addition, his grades have improved dramatically. Ile now feels he is in control of his life, his emotions, and has a direct role in the level of happiness in experiences. 7. Client is a 7-year-old female who was referred for services due to problems with anger management. This affected her relationships with her mother and her stepfather. She was also having difficulties with sibling rivalry issues with her younger brother which resulted in both of them becoming verbally aggressive toward one another. In addition, the parent had poor parenting skills, specifically setting limits/boundaries, and being consistent with discipline. The parent was seen monthly for parenting sessions to address the importance of being consistent with discipline, the importance of setting limits and boundaries, having house rules, and having expectations for both children. The client was seen weekly to work on anger management issues by learning what anger was, how we experience it, how it effects other people, how to calm down, and how to re-direct it constructively. Her sibling was also brought in one time a week for joint sessions to address and resolve the sibling rivalry. Issues addressed were anger, aggressive behaviors, positive communication, respecting people, and manners. Today, the client no longer has problems with her anger, as she implements all the skills she learned during therapy. She reported that she learned how much her yelling and "mean words" hurt her little brother. She and her brother reportedly get along very well and have become friends as well as siblings. The younger brother reportedly has dramatically reduced the number of crying spells (it was learned that these were the results of how the family dealt with anger). The children and parent reported the therapy brought great insight in realizing that the emotion of anger can really tear a family apart. Presently, the family reports they can work out things without becoming verbally aggressive toward one another. • i i Success Stories • Client was a 5's grade female who had been exhibiting severe behavior problems since she was in kindergarten. She had a history of hour-long tantrums, physical aggression, stealing, destruction of property, and acting out sexually. She had been treated with stimulant medications sporadically since 2"d grade. Her mother had a long-standing distrust of institutions like DSS, the police, and Mental Health. However, because the therapist was housed at the school where her older children had attended years before and she trusted the faculty and their recotmnendation, she agreed for that therapist to provide treatment. After a short time of working with the child, the therapist realized that her symptoms she was exhibiting was more characteristic of a mood disorder instead of ADHD. In fact, after careful examination of her history, it appeared the stimulant medication being used to treat her previously diagnosed ADHD may have been exacerbating the symptoms of the mood disorder. She was referred to the SEC staff psychiatrist who made her own assessment and decided to change the medication. The symptoms became much more manageable and, for the first time since she started elementary school, she won an award at the closing ceremony just before her graduation. Presently, her mother will call the therapist on occasion and give brief updates which are generally positive, as the child is doing much better. 2. Client is a 17-year-old female who was first seen by the school therapist when she was 13 years old. At that time, the client was diagnosed with Bi-Polar Disorder, Alcohol Abuse, and had failing grades. The client was skipping school and getting involved in deviant behaviors. At the star( of treatment, she was actively suicidal and had begun practicing self-mutilation. Also, her alcohol consumption had led to multiple dangerous situations and black-outs. Over the course of doing individual and family therapy in the office at school and in the family's home, she is now 17 years old and on track to graduate from high school as an A/B student. The therapist continues to meet with her for "check-up" sessions after school and has discovered that the client wants to attend college and continues to successfully manage her symptoms. According to the client and her family, the school mental health services were effective because of the following reasons: believing they had an ally/partner in the therapist; having therapy at the school to de- escalate crises involving the client; the flexibility of meeting the family at their home as late as 7:30pm; and helping the family find their strengths, gain empowerment, and learn to work together to unite against the mental health issues invading their family. By practicing in this middle school, the therapist was able to meet with the student as often as needed, which helped to prevent her from being hospitalized and missing school. Also, the therapist was able to help her teachers develop strategies and support networks to aide this client in her recovery. 3. Client was a 6ih grade male who was referred by the middle school last year because of such severe separation anxiety that he was unable to make it through the school day. He would yell and scream on the floor until the school called his mom to come get him. Through intensive individual and family therapy and coordination of services with his teachers, this client was provided with a system of constant positive reinforcement for acting appropriately in school. Over time, while learning coping skills to deal with his anxiety and communication skills to better deal with his peers, lie was able to consistently make it through the school day without any problems. 4. Client was a male kindergartener who was having a lot of trouble with attention, sitting still, talking, staying in his seat, and finishing tasks. His parents preferred him not to be put on ADHD medicine. Both of his parents were willing to participate in his therapy and do behavior charts at home. His teacher was willing to do charts in the classroom. His behaviors were observed by the school-based therapist in the classroom setting to better delineate his difficulties there. This child was eager to please. He worked hard to make his chart goals. He was awarded the "Can Do Kid" award. He was promoted to the first grade. He had some trouble in first grade without the charts. The charts had set clear expectations for him. Once the charts were instituted again, the client was successful in minimizing his ADHD symptoms. Charts were eliminated at home several months ago and his is continuing to do well. Charts were eliminated about two months ago at school and he only falters about once per month to an "N" conduct grade (needs improvement). Typically, he is getting "S's" and "Ws". O David E Rice/NHC 'To spradleyins@bellsouth.net, donblake@aol.com, 04/27/2007 01:48 PM eweaver@ec.rr.com, rweedon@bellsouth.net, hickmonj@bellsouth.net, jtunstall@nkteng.com, cc David E Rice/NHC@NHC, Dianne Harvell/NHC@NHC, Janet McCumbee/NHC@NHC, Jean McNeil/NHC@NHC, Kim • Roane/NHC@NHC, Marilyn Roberts/NHC@NHC, Scott bcc Subject Public Health Foundation of New Hanover County NHCBH Members, The Public Health Foundation of New Hanover County is incorporated in North Carolina and will be processing an application to become a private non-profit 501 (c) (3) organization. This Foundation was created to fill the gaps among growing public health problems and shrinking resources. Six of nine members of the Foundation will be selected by the New Hanover County Board of Health. The remaining three (3) members will be: Chair of the Board of Health, Vice Chair of the Board of Health, and the Health Director. Please submit to Dr. Edward Weaver, Jr. three (3) names of individuals who you think would be willing to serve on this new organization's Board of Directors. Nominees should exhibit integrity and influence in our community and should only be persons who you know personally. Please submit your names to Dr. Weaver by Friday, May 4, 2007. His email address is: eweaver@ec.rr.com The Board of Health's Executive Committee will select names from those submitted by the Board of Health and Management Team. f • David E. Rice, MPH, MA Health Director New Hanover County Health Department 2029 South 17th Street Wilmington, NC 28401 910-798-6591 phone/910-341-4146 fax drice@nhcgov.com www.nhchd.org • NEW HANOVER COUNTY BOARD OF COMMISSIONERS REQUEST FOR BOARD ACTION • Meeting Date: 08/20/01 Regular Item 15 Estimated Time: Page Number: Department: Health Presenter: David E. Rice, Health Director Contact: David E. Rice, Health Director 343-6591 SUBJECT: Public Health Foundation BRIEF SUMMARY: The Public Health Foundation of New Hanover County will be a local, non-profit organization dedicated to achieving a healthy New Hanover County. It will be incorporated as a 501(C)(3) organization. It will be governed by a nine-member Board of Directors and may appoint honorary directors. The mission of the Public Health Foundation of New Hanover County will be to insure the accessibility of healthcare services, to promote good health practices, to develop public health knowledge and methods, and to provide supportive management and professional resources. This foundation will address the Strategic Planning Priorities of the New Hanover County Board of Health and the New Hanover County Health Department, established in October 2000. The New Hanover County Board of Health Executive Committee recommended the Public Health • Foundation to the Board of Health on June 28, 2001. The Board of Health approved its submission to the New Hanover County Board of Commissioners for consideration on July 11. RECOMMENDED MOTION AND REQUESTED ACTIONS: Approve formation of Public Health Foundation of New Hanover County FUNDING SOURCE: n/a ATTACHMENTS: Attachment is Public Health Foundation By-laws Kym PublicHealthBylaws7-12-01 REVIEWED BY LEGAL: N/A FINANCE: N/A BUDGET: N/A HUMAN RESOURCES: N/A COUNTY MANAGER'S COMMENTS AND RECOMMENDATIONS: Recommend approval with the stipulation that county money cannot be used to fund the Foundation. cr) FIONERS COMMISSIONERS' ACTIONS/COMMENTS: k { p f Dhic J.~w~w e6_; M Article II Membership Section 1: The corporation will not have members. ^ ~x Article III Directors Section Composition of the Board. The Board of Directors shall consist of nine (9) members six (6) ofFwhich,.shall be appointed by the New Hanover County Board of Health x The following Board members shall serve by virtue of their position as e One (1) Chairman of the Board of Health One (1) Vice Chairman of the Board ofiHealtht' ~r One (1) New Hanover County Health Department Director Y .t3' m.it F Section 2: Honorary Directors. In recogniti?on °ofs~sigmficarptatservtce tooth„e Foundation or contributions of other nature, the Board of Directors may, k ,also appoint Fonorary orsemeritus directors Such, irectors'<5ha11rFbe , -t 'w = considered ex officio membersFof the Board butyshall"nofihave the power f F~~ to vote at Board meetings-~~r,„~ ~si~-~° ra ~.,N .XY f1 Sectwn3 Elections;°Tenns`andVacancies:a-`-°Except'm th`e'"case ofthe'mitial directors terms of all directors will be for three (3) years and will y.{{ co.,m~e'mence at a~time correspond ng with~Q*-,calendaprjgear( utilized for „.~~ly yy„{TR' v A ..3 ' C&~'.+'+Y 3?..'Y Y. Yts u yr s r,Board of Health Officer appointments and expire of k"~ t"-` December of the last year of their terms, unless serving by virtue~of~~their position, in which case the Board term shall fully correspond~vvith~and , ass }x7 terminate ~uponl ~he~ end of ~ he rBoard of Health or County~,Healtl _ .T:~-DepartmentG.~appointment.._;Directors"~,mays,serve.,.a}..maximum~xof:.two consecutive terms (six years); they will again be eligible for appointment to the Board after one year off the Board. 2 1 . disability of the President, be assigned by the Board to perform any or all of the duties of the President. C. Secretary. The Secretary shall preserve in the books of the foundation true records and minutes of all meetings of the Foundation, its Board of Directors, and its Committees. D. Treasurer. Subject to the policies of the Foundation, custody and management of the assets of the Foundation shall be ,undertaken by the Treasurer: All financial transactions §Kbll tie overseen and approved by the Treasurer of the Foundation and the Secretary. °y,Ln The Foundation shall operate under an annual budget as recommended by the Director and the Treasurer and as amended and adopted by tM"I~Bodrd. The Treasurer shall review and authorize disbursementof funds according to the budget and F transfer of fundsgamong~'rbank and investment accounts, shall ',t N tea-?{ ni.V F } J :periodically si,review the status aof, then b dget; ntenm fnancial statements,° end the fransactwns'and books of the Foundation; shall monitor investment accounts and ;performance and~Tshail recommend changes, shallrevievr the annual,,independent`audit s and recommend and m nitor correciwe action, and shall render to r M " tFietBoard accounts of all fiscalansactions and of the financial f , Y4 ~=.,.condition~,Whe Founq~dation win::,.y 4a+~.+.vTnM` 5, t'}1'la°HVt"-YPf JI4r`~ t°1T J4'y9kG'hx~ .„pe .~iJ.3b: ~F I+E'.i avk." ry a ~f k°a ~qY~~. '+;r l1<r., r Article Vg>= ~ 'ac ..r L r < s f ~,,r L w ~~k { 'Pt t wt . x F,Section ,1 Committees The Board ofrDirectors may by resolution, provide for any ~'y`"~~p~' ~yy and, all;~committees nece~s~ary~f the proper conduct of the affa~rs~ofthe L Y ~ y Af ) L„ t FoundaUon. 'Committees may also be established`bytlie"President as Fie or she, with the approvall of the,Board, deems desirable. The duties and responsibilitiesof each' comm~ttee;= notconsistent with theyBy laws, shall ,s bye fined by the Board of Directors. The President shall`tie,xmemtiers ex A :E'a 7 4s ka 3. ~u1~ ;Frye " officio of each committee and shall have the power to vote m committee meetings. All other members shall be appointed for certain terms by the ~ ~ ~ ~ _ Board of Directors acting for the Board Vacancies shall be filled by 5~4~,` ~`.',"appointmentof'theaPr sderit.for>unexp~edrterms~x`Y±°ry=,,.~h~x-~ „z~,.;~'S:~.=s' 4 e Approved by the Board of Directors of Public Health Foundation of New Hanover County, Inc. on , 2001. Approved by the New Hanover County Board of Commissioners on _ 2001. '3*r r ^c. ry.,n L ~+*.~`N' ° 311E v a QF ay i'..p ~ ~ 1 ~~f t ,2i'al~ (3 '`x r S F'3 ~ ~~Y p~n+ t v7K ,r- °`w t. S'! ~ a.a... t0~)' 3.a%- 3 t~ v ~ r. aJ~ ,•'v H'l ~~u.iclf"#U.~gtRl,w ,ul~.k r 3"fir.. Es ~1+:+ 9+, y.i.a:6 ~z. m. ; b } Ei a.,.. . ' x dv} iT'MV .px c~ °in M t~~ T..2'~ ;#r 'I7 ~J'vF YES}s_ ~ G ~l ~.f.F'G k>.d.:+~~y-~mq{ ~{`~,e td ~~UCy~-5 7 !x ~4 1 s, h'r 4 d.'+,x6.id 'L .Trv 1 x : xr h y!„ ~E9~.s>,.t'~~ ;n 5r,-t?x ~fq+. M d~ ally E~TZ ce... §g fti4 < -i. i ~;Sa ~x~~\~v ra..0. sJ r~l y~rf ~yx ~jC ~+FJ. ° i4~+ny fk ~d. u;:'~ ~ 2.~..,.art,•~z.,r.H..~c„A.x~4'„~~'a..,~„~,_,.133~.~s,8'I, ti"~,. .~'1~_f,'°...c _r... .w.1a.-`'~''n. ,.xx.u, :.7'%': "L+.v.kl yM4 SYyndJy. Y 'i5 . 4 RY IZ F1k ~~/'yp. p } }4 K 1" en W s~~lL`- ~xr ti x A 9 - vK , ~~.cr Nb+,ii n(Gd l'R~~~ ~y~_ ~ r n P kx>t~' 1-.w y{x4 y, ~F Y~ 'T'~'4e i 1 f ~ o ` 4._ ~yq ~ , f~>yty ''ors n i..! +r{'H O 6 ' % NORTH CAROLINA Department of The Secretary of State To all whom these presents shall come, Greetings: I, ELAINE F. MARSHALL, Secretary of State of the State of North Carolina, do hereby certify the following and hereto attached to be a true copy of ARTICLES OF INCORPORATION OF PUBLIC HEALTH FOUNDATION OF NEW HANOVER COUNTY, INC. • the original of which was filed in this office on the 20th day of September, 2001. p>;vnRrM~ ?t M~ a IN WITNESS WHEREOF, I have hereunto e set my hand and affixed my official seal at the City of Raleigh, this 20th day of September, 2001 - Q Secretary of State Document Id: 212615051 .sMo l CORPORATE INCOME & FRANCHISE TAX North Carolina Department of Revenue Michael F. Easley E. Norris Tolson Governor Secretary March 4, 2002 PUBLIC HEALTH FOUNDATION OF NEW HANOVER COUNTY INC 2029 SOUTH 17TH STREET WILMINGTON NC 28401 Ladies & Gentlemen: Thank you for furnishing information concerning the subject corporation's tax status. This Department has assigned the corporation an exempt status for franchise and income tax purposes under Sections 105-125 and 105-130.11(a)(3), respectively, of the General Statutes of North Carolina. This determination applies only to the organization's status under the corporate income and franchise tax laws. If it becomes subject to the tax on unrelated business income as provided in G. S. 105-130.11(b), it will be required to complete the income tax.schedules of North Carolina Corporation Franchise And Income Tax Return (Form CD-405) and file the return on or before the 15th day of the fifth month after the close of the income year, subject to any extension of time which may be granted. This exemption is contingent upon the corporation's operating within the scope of the applicable provisions of the Internal Revenue Code. This exempt status becomes invalid at the same time as, and upon a determination by the Internal Revenue Service that the organization does not qualify for a tax exempt status under the Internal Revenue Code of 1986 or corresponding provisions of any subsequent Federal Tax Laws. In the event the Internal Revenue Service-denies a current exemption request or revokes a previous exemption this Department should be notified promptly. In the event of changes to either the Articles of Incorporation or to the nature of the functions for which exemption has been granted, this Department should also be notified promptly. Charles R. Craven Administrative Officer Examination Division (919) 715-4468 CRC/jas O P.O. Box 25000, Raleigh, North Carolina 27640 State Courier 51-71-00 An Equal Opportunity Employer • Steps in Establishing a Foundation • Bylaws (Decision Points: Mission Statement, Membership, Officers, Method of Election, Committees, Meetings of the Foundation, Amendments to bylaws) • Articles of Incorporation (Nonprofit Corporation) to NC Secretary of State • Application for Employer Identification Number • User Fee for Exempt Organization - Determination Letter Request ($500) • Application for Recognition of Exemption (Under Section 501 (c) (3) of the Internal Revenue Code) • Consent Fixing Period of Limitation Upon Assessment of Tax Under Section 4940 of the Internal Revenue Code • H/,prgAppalth/drice/NHCBH/Foundation a" v >e 0 c o~ Uw L E r O G ~ p 'O p } U ~ C O ° E (n in L •C C C en ~ C c G r C R O O - r Q O ~ C p .S O ~ Q L R N N O ai O O 'D « ~ O p v+ [0 ~ 'n R E ON .R N N e0 .V R C N 'y y N .a C M C t r N 'O U p N 0. E O O- O O U R °p T R L L O C N C y R. 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L" w > in F w U a u 7 17 :2 E N N M 7 Vl ~O 1~ N \O W 00 w C, 00 W M • C~ C~ C, OGi OCi OCi C, O O O O O O M 7 m m m m m m m m m m m m m m m m m co m C/) Ll~ V) V) V) (A LI) En (A V) N h U1 Ll~ m 0 a 0 ~0. o n. 0 4 0 , ~o c o N Q N O E N O ~ o U o 0 ci F o Uv~m c o m 3 U ' z r x 0 0 a V V ~ 1 L V x • N m Co)N,Y H° New Hanover County ° n Health Department z i o 2029 South 17'" Street _ 3,, 2 Wilmington, NC 28401-4946 • Z Phone 910/798-6500 FAX 9101341-4146 NEW H.eoVea COUNTI HERON 1i5H1~ New Hanover County Child Fatality Team 2006 Summary The New Hanover County Child Fatality Prevention Team (NHC CFPT) is a group comprised of community representatives from diverse agencies and disciplines. Our team welcomed two new members this year. Currently membership is 19 members. Members are either appointed by . their agency board, per the state addendum, or are appointed by New Hanover County Board of Commissioners. Our team currently has one opening. The mission of the NHC CFPT is to promote the development of a community wide approach to understanding the causes of childhood fatalities, identify the deficiencies in public agencies to deliver services to children and families, and to make and carry out recommendations for change in system delivery to prevent future childhood deaths. The NHC CFPT meets on a quarterly basis with meetings in February, May, August and November. The regular NHC CFPT met only twice during 2006 due to few deaths to be reviewed. Several team members also attended two state fatality reviews in 2006. A state review is conducted when the family is involved with DSS within the year preceding the time of death. The state reviews are arranged by DSS in conjunction with the Community Child Protection Team. The attendance this year has averaged 9 community members and two Health Department staff members per meeting. The team Review Coordinator, DSS director and DSS Board Member attended Child Fatality Prevention Team Training in Fayetteville. Brenda Edwards, the State Coordinator for Child Fatality teams visited on May 19, 2006 to observe the team in action. She also • invited the NHC CFPT to participate in a pilot of the revised online reporting form. The CFPT reviews deaths that occurred in the previous year. During 2006, the regular team reviewed the deaths of 8 children. Of these deaths 4 were due to extreme prematurity and complications associated with this. Three deaths were due to congenital abnormalities present at birth. One death was due to accidental overdose. All but one of these deaths reviewed this year were due to extreme prematurity and/or conditions present at birth. However, last year the team reviewed 17 and 11 deaths were due to prematurity and/or conditions present at birth. This is the only identified trend seen in our county for 2006. There were overall fewer deaths in 2006. There were several conversations in regard to maternal drug use during pregnancy, the inability to prosecute these women for child abuse, and the role of the hospital and DSS to identify these babies at birth. The NHC CFPT receives funds annually from DHHS via the Child Health Contract Addendum. This year funds were used to purchase Child Abuse Awareness pins and wrist bands which were distributed to members of the community during a community event. Outlet cover protectors were also purchased and distributed to families being served in the Child Service Coordination Program at the New Hanover County Health Department. The NHC CFPT continues to work to improve participation of its members and invite persons related to investigations of child deaths to be a part of the review process. Attendance has been steady and members share agency information with the coordinator prior to the reviews when they are unable to attend. The goals for next year are to improve identification of system problems in the community and become more involved in the duty to affect change. Respectfuly Su Uned, Jo F.Vem,Csw CFPT Review Coordinator David E Rice/NHC To Kim Roane/NHC@NHC 04/12/2007 08:03 AM cc bcc Subject Re: F.A.C.T. Meeting Recommendations[ Approved. David E. Rice, MPH, MA Health Director New Hanover County Health Department 2029 South 17th Street Wilmington, NC 28401 910-798-6591 phone/910-341-4146 fax drice@nhcgov.com www.nhchd.org Kim Roane/NHC Kim Roane/NHC 04/12/2007 07:46 AM To David E Rice/NHC@NHC cc Subject F.A.C.T. Meeting Recommendations Dave, The NHCHD Fee and Coding Team (F.A. C.T.) met yesterday and have one recommendation: . • We request that the Limited Physical for Kindergarten Health be deleted from the NHCHD Fee Policy, and the fee for this service be removed. The reason for this is changes in the level of physical examination required to complete a kindergarten health assessment form. Clinical staff must perform a full physical on children being screened for kindergarten, as opposed to the limited physical our fees were based upon. Additionally, we're unable to complete an assessment if a child has serious physical issues.... the patient must then be referred to their primary care physician for completion of the physical, resulting in additional cost to the patient. For those reasons, we propose that we only conduct the full child health physicals on children for kindergarten health assessments, which we do still offer. These physicals are still covered under Medicaid and Health Choice, and the sliding fee scale is utilized for private pay patients. Revenues for the limited physicals have been $4,200 for the current fiscal year. This falls within your approval guidelines. I recommend approval. Thanks, Kim Kim Roane Business Manager New Hanover County Health Department (910) 798-6522 fax(910)341-4146