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07/12/2000 e NEW HANOVER COUNTY BOARD OF HEALTH Dr. Thomas Fanning Wood Memorial Conference Room New Hanover County Health Department AGENDA Date: July 12,2000 Time: 8'00 A.M. Place: Dr. Thomas Fanning Wood Memorial Conference Room New Hanover County Health Department Presiding: ~ Invocation: l -~ Minutes: Mr. William T Steuer, Chairman Ms. Gela N Hunter June 7, 2000 - R~fOP1t';fi~1~ /~4~~ Suner StatlA~ard - Mr William T Steuer Chairman Years of Service 5 Years Deborah Lovett, Clerical Specialist, Environmental Health 10 Years Jean McNeil, Animal Control Services Director, Animal Control Services 20 Years Tom Stich, Environmental Health Supervisor, Environmental Health Personnel New Emnlovees e Vivian Anderson, Public Health Nurse I, Community Health/Jail Lucretia Cox, Medical Laboratory Assistant I, Laboratory Shenita Josey, Public Health Nurse II, Community Health . * ~~v ~ \O~ ~ - - e NHCBH Agenda July 12, 2000 - Page 3 Comments: Board of Health Members Health Director - Mr David E. Rice I National Association of Local Boards of Health 8th Annual Conference- July 26-29,2000 Summer 2000 Hurricane Recovery Corps G~ i ,Iff' t1J) New Hanover County Blood Drive - July II, 2000 ~ r /1(/,(;"""1 ''I 61t7t"'Mo\ F,.y( FJJefj3,rlk" o 3 if. Other Business: Mr William T Steuer e Adjourn: Mr. William T Steuer H/vI~ '- ~~~~Ir - &t'9hf Fp:;A ~~ - ~te$~/1Jke.4~'le - f-q~(' cr!tJ4~~ II-I'I/~ - /3/()o{ aI/It ~ -O~tr~ ~5l..lI,fI-~ ::woo) - ~ ~/01t1J~ S-fe fed tJ~-5 ~- - NHCBH Agenda July 12, 2000 - Page 2 - Student Interns Meredith Bank, University of North Carolina @ Wilmington Ashley Brewster, University of North Carolina@ Chapel Hill Kristen Collins, University of North Carolina@ Wilmington Michael Greenwood, University of North Carolina @ Wilmington Jessica Hulick, University of North Carolina @ Wilmington Karen Miller, University of North Carolina @ Chapel Hill Antonio Montgomery, Elizabeth City State University Tracy Pena, University of North Carolina @ Wilmington Mandy Thurston, University of North Carolina @ Chapel Hill Department Focal: Friends in Deeds --(r~\.~ Ms. Betty Creech CommunityHealth Director New Hanover Health Network Update - Dr. William K. Atkinson President & CEO, New Hanover Health Network e ID -II Monthly Financial Report: May 2000 Ms. Cindy Hewett l3usirKiss Ojficer Committee Reports: Executive Committee (listed under New Business) /')...- / t - Budget Committee - FY 2001 Budget Update Environmental Health Committee (listed under New Business) Personal Health Committee (listed u~er NSiw B~sines~ t-5t''''fIC fl4II1f*, f1~ Unfinished Business: ~ New Business: I)' - ;).. 'f March Toward TB Elimination Grant Application ~~ ;;..Ii' -5'f Cape Fear Memorial Foundation Grant Application Ikf eSt) ....5, Diabetes Today Grant Application k{ (gO - Co J- Proposed Rules Governing Fencing and Operation of Private Swimming Pools Af Co?> -" t~ Strategic Planning Process - Mr. William T. Steuer - Ms. Anne Rowe, Chairman - Mr. W Edwin Link, Chairman [~,>> lstep, Chairman - Mr illiam T Steuer Generators/Hookups at Emergency Shelters - Mr. William T Steuer I I I 151 Mr. William T. Steuer, Chairman, called the regular business meeting of the New Hanover County Board of Health to order at 8:00 a.m. on Wednesday, July 12,2000. Members Present: William T. Steuer, Chairman Wilson O'Kelly Jewell, DDS, Vice-Chairman Henry V. Estep, RHU Michael E. Goins, OD Gela M. Hunter, RN Mr. Robert G. Greer W. Edwin Link, Jr., RPH Philip P. Smith, Sr., MD Melody C. Speck, DVM Estelle G. Whitted, RN Members Absent: Anne Braswell Rowe Others Present: Mr. David E. Rice Frances De Vane, Recording Secretary Invocation: Ms. Gela N. Hunter gave the invocation. Minutes: Mr. Steuer asked for corrections to the minutes of the June 7, 2000 New Hanover County Board of Health meeting. The Board of Health approved the minutes of the June 7, 2000 Board of Health meeting. Recognitions: N. C. Department of Labor Award _10th Consecutive Year Mr. David E. Rice, Health Director, displayed the Safety Award presented to the New Hanover County Health Department for the tenth consecutive year from the N. C. Department of Labor. He commended the staff for their outstanding injury prevention and safety record. Super Staff Award Mr. David E. Rice presented Ms. Ruth Roethlinger, X-ray Technician, and Communicable Disease, recipient of the Semi Annual Super Staff Award. Ms. Roethlinger received the award in recognition of her dedicated service to the Tuberculosis Program. She was nominated by her peers and selected by the Board of Health Executive Committee. Personnel Service Awards Mr. Rice recognized and congratulated the following New Hanover Count Service Award recepients: 1 152 Years of Service 5 Years Deborah Lovett, Clerical Specialist, Environmental Health 10 Years Jean McNeil, Animal Control Services Director, Animal Control Services 20 Years Tom Stich, Environmental Health Supervisor, Environmental Health Mr. Rice introduced the following new Health Department employees: New Emplovees Vivian Anderson, Public Health Nurse I, Community Health/Jail Lucretia Cox, Medical Laboratory, Assistant I Laboratory Shenita Josey, Public Health Nurse II, Community Health Summer 2000 Hurricane Recoverv Corps Mr. Rice introduced the college/university interns from the Hurricane Floyd Recovery Corps placed in the Health Department by the Department of Health and Human Services to perform public health outreach services and to assist with a backlog of work due to the hurricane. They are as follows: Meredith Bank, University of North Carolina @ Wilmington Ashley Brewster, University of North Carolina @ Chapel Hill Kristen Collins, University of North Carolina @ Wilmington Michael Greenwood, University of North Carolina @ Wilmington Jessica Hulick, University of North Carolina @ Wilmington Karen Miller, University of North Carolina @ Chapel Hill Antonio Montgomery, Elizabeth City State University Tracy Pena, University of North Carolina @ Wilmington Mandy Thurston, University of North Carolina @ Chapel Hill Mr. Rice advised the ten interns are adding capacity to our organization and serving our community. He thanked the interns for their assistance. Department Focal: Friends in Deeds Ms. Betty Creech, Community Health Director, presented a department focal entitled Friends in Deeds. She stated that today is a special day to say thanks to and to recognize our professional friends for their volunteer services rendered to health department clients and clinics. She emphasized these people are truly Friends in Deeds who for years have given their time and services to the Wilmington Rotary Orthopedic Clinic, Neurology Clinic, and New Hanover County Schools. 2 I I I I I I 153 On behalf of the New Hanover County Health Department, Mr. Rice presented plaques to the following in appreciation for their outstanding and dedicated volunteer services: James D. Hundley, M. D., Wilmington Rotary Orthopedic Clinic Medical Director, and On Behalf of Students in New Hanover County Schools Thomas Craven,M.D., Wilmington Rotary Orthopedic Clinic & New Hanover County Jail Health David S. Bachman, M.D., Neurology Clinic Medical Director Michael E. Goins, O.D., On Behalf of Students in New Hanover County Schools F. Michael Floyd, C.P.O., Wilmington Rotary Orthopedic Clinic Wilmington Orthopaedic Group, 45 -Years Volunteer Service To The Community Wilmington Health Associates Neurology Division, Volunteer Service To The Community New Hanover Health Network Update Dr. William K. Atkinson, President and CEO, made a presentation on the status of the New Hanover Health Network. He informed the Board New Hanover Health Network like other hospitals nationwide is facing budgetary cuts in reimbursement from federal health insurance programs. The budget reductions are forcing some hospitals into bankruptcy. Many hospitals have laid off employees to cope with cuts in federal reimbursements and managed-care payments. Dr. Atkinson stressed the importance of caring for sick people. He stated health care is involved in every element of things that happen to people and that health services left undone mean an unhealthy population. Dr. Atkinson advised hospital officials are trying to figure out how to keep the essential services. With modern technology, science and population growth our regional hospital demands and costs have increased. New Hanover County is involved in four areas of health care including Public Health, Mental Health, Emergency Medical Services, and hospital services. Dr. Atkinson gave a brief history of the 30-year-old regional hospital. He advised New Hanover County citizens voted to construct the hospital but did not fund for hospital expenses and facility upkeep. Dr. Atkinson emphasized the budget crunch is here with reduced reimbursement from the federal government for existing services. He advised New Hanover Regional Home Health is in serious financial trouble. Beginning October 1, 2000, Home Health will not receive enough federal reimbursement to operate, and it will probably be sold. The Health Department ran the Home Health Program until January 1995 when New Hanover Regional Medical Center acquired the program. Mr. Rice advised it is unlikely that the Health Department will consider taking the program again because the reimbursement rate would be similar the hospitals. Reimbursements for Home Health are based on the number of visits. Dr. Atkinson expressed the hope is the federal government probably eventually will realize that nationwide hospitals are in financial trouble, will probably have to provide resources, and will probably designate available health care services. Both federal resources and permanent solutions are needed to make health services work for citizens. The duplication of agency services will need to be eliminated. Mr. Estep inquired regarding the breakdown of revenue for the hospital. Dr. Atkinson stated funding includes approximately 50% Medicare, 20% Medicaid, and less than 1 % full insurance coverage. The current reimbursement is 35 cents on I-dollar of costs. Dr. Smith asked if there is any likelihood of the Coastal Diabetes Center being reopened. Dr. Atkinson advised the Coastal Diabetes Center would not be revived unless $300,000 funding is provided to operate the Diabetes Center. 3 154 Mr. Rice expressed his appreciation to Mr. Atkinson and the hospital staff for their health care services, I for their open communication, and for working with the Health Department staff in a cooperative manner. Mr. Atkinson expressed the New Hanover Network is regional and works with multi-programs and activities to make a difference in the health of people in our community and region. He stated the hospital is committed to working with the Board of Health and the Health Department in health care Issues. Mr. Steuer thanked Mr. Atkinson for his presentation. Monthly Financial Report: Mav 2000 Monthly Financial Reoort Mr. Steuer reported the Executive Committee reviewed the May Financial Health Department Financial Summary Report Ms. Cindy Hewett, Business Officer, presented the May Health Department Financial Summary Monthly Revenue and Expenditure Report that reflects an earned revenue remaining balance of $517,788 (87.90%), an expenditure remaining balance $1,702,875 (82.45%), and a cumulative percent of 91.67%. Ms. Hewett advised revenue and expenditure balances are basically on schedule and in line compared to last year. She indicated Animal Control budgeted revenue is $516, 453 and revenue earned is $384,709. For the prior year the revenue projected was $493,100 and revenue earned was $340, 062. Committee Reports: I Executive Committee Mr. Steuer reported the Executive Committee met at 6:00 p.m. on Tuesday, June 27, 2000. Items are listed under New Business on the Board of Health Agenda. Budeet Committee - FY 20001 Budeet Update Ms. Lynda Smith, Assistant Health Director, presented the following summary of the Requested and Approved New Hanover County Health Department FY2000-2001 Budget: Requested Aoproved Salary and Fringe Operating Expenses Capital Outlay $7,904,401 $1,731,565 $ 591.334 $7,532,967 $1,553,934 $ 291.851 Total $10,227,300 $9,378,752 Ms. Smith explained the Total FY 2000 Approved Budget was $9,701,833 and is $9,378,752 for FY 2001 which is a decrease of $330,000. She reported the County Commissioners approved a 3.5% market increase for county employees (based on performance) and approved increasing the Health Department Salary Lag to $300,000 (current budgeted amount $225.000). The FY 2001 Budget is effective July 1, 2000. I The New Positions request was for 20 New Positions and (1) increase from a part-time to a full-time position. The Approved FY 2001 Budget includes 3 New Positions: 1 Environmental Health Specialist 4 I I I 155 and 1 ClericallEnvironmental Health funded by Water Sample Revenue, Partnership for Children Clerical PT-FT grant funded, and 1 Jail Health Licensed Practical Nurse. Ms. Smith reported on June 30, 2000, we received information from the State Mosquito Control Program that we will not receive any of the $20,000 State Grant for Mosquito Control which was projected in the FY 2000 revenue projection for Vector Control. She also announced we will not receive approximately $20,000 of the $111,572 revenue projected for FY2000 from the Corps of Engineers. On behalf of the Board of Health and Health Department Staff, Dr. Goins recommended and requested Mr. Rice prepare a letter of appreciation to the New Hanover County Commissioners thanking the Commissioners for their budgetary efforts and for the approved 3.5% market increase for county employees (based on performance). Dr. Goins stated this year the budget process has exceptionally difficult, and the County Commissioners should be commended for their dedicated services to New Hanover County. Environmental Health Committee Mr. Link, Chairman, Environmental Health Committee, reported the Executive Committee met at 6:00 p.m. on June 14, 2000. Items are listed under New Business on the Board of Health Agenda. Personal Health Committee Mr. Estep reported the Personal Health Committee met at 6:00 p.m. on June 20, 2000. Items are listed under New Business on the Board of Health Agenda. Unfinished Business: Generator Hookups at Emereencv Shelters Mr. Rice referred the Board to a memo from Dennis Ihnat, School Retrofit Projects, New Hanover County Emergency Services, containing an Update on Generators and Manual Electrical Transfer Switches for Schools Used as Emergency Shelters. On April 18, 2000, the county signed a contract with Watson Electric Company to install manual switches with a required completion date of July 22. The contract price is $211,851. Mr. Rice reported manual electrical transfer switches are installed at the Central Office Freezer, Dorothy B. Johnson, Eaton, Noble, and Trask Schools. Plans are to install an additional generator switch at Codington School in August 2000. Dr. Speck inquired about the availability of personnel to operate the generators in the evacuation centers. Mr. Rice responded personnel would be available for the operation of electrical service generators, and a New Hanover County Emergency Shelters Standard Operating Guide Manual has been developed by the Emergency Shelter Planning Group. New Business: March Toward Tuberculosis (TB) Elimination Grant Application ($10.000) Mr. Steuer recommended from the Executive Committee for the Board of Health to approve a March Toward Tuberculosis (TB) Elimination Grant Application in the amount of$10,000 from the 5 156 Tuberculosis Control Program, Division of Public Health, North Carolina Department of Health and Human Services (DHHS). I The purpose of the grant is to improve the local Tuberculosis Control Program and to implement demonstration projects for replication in other areas of North Carolina. Funding is requested to purchase a portable sputum induction device and supplies, to implement and computerize surveillance information, to produce a patient testimony video, to provide travel kits for incarcerated individuals upon release from the Jail, to develop a Communicable Disease Web page, to purchase two television video-phones for patient/staff communication and follow-up, and to furnish other educational materials to the public. Motion: Mr. Steuer moved from the Executive Committee for the Board of Health to accept and approve a March Toward Tuberculosis (TB) Elimination Grant Application in the amount of $10,000 from the Tuberculosis Control Program, Division of Public Health, North Carolina Department of Health and Human Services and to submit the grant application to the New Hanover County Commissioners for their consideration. Upon vote, the MOTION CARRIED UNAMIOUSL Y. Cape Fear Memorial Foundation Grant Application ($55.000) Mr. Steuer recommended from the Executive Committee for the Board of Health to approve a grant request to reapply for the Teen AIDS Prevention (TAP) for $110,000 from the Cape Fear Memorial Foundation with funding at $55,000 each year for FY 2001 and 2002. The purpose of the grant is to continue the TAP peer education program. The goals are to promote an environment where personal health, safety, and positive life skills are more desirable than healthy I alternatives IE unsafe sexual practices and drug/alcohol abuse, to empower adolescents to make a difference in their lives through education, and to facilitate open communication between TAP-trained teens and their peers. Motion: Mr. Steuer moved from the Executive Committee for the Board of Health to accept and approve a Grant Reapplication for Teen AIDs Prevention (TAP) for $110,000 (2 year funding at $55,000 FY's 2001 and 2002) from the Cape Fear Memorial Foundation and to submit the grant renewal application to the New Hanover County Commissioners for their consideration. Upon vote, the MOTION CARRIED UNAMIOUSL Y. DIABETES TODAY GRANT APPLICATION ($10.000) Mr. Steuer recommended from the Executive Committee for the Board of Health to accept and approve a DIABETES TODAYIDIABETES COALITON Second Year Grant Application for $10,000 funding from Diabetes Today Community Implementation Funds through the Diabetes Prevention and Control Unit, Division of Public Health, DHHS. The second year grant proposal includes two broad goals to reduce the burden of Diabetes in New Hanover County: Educating Patients and Communicating with Physicians. The budget ($10,000) includes the services of a Coordinator and a Program Assistant @ 160 hours each and operating expenses. Motion: Mr. Steuer moved from the Executive Committee for the Board of Health to accept and approve the Diabetes Today Second Year Grant Application for $10,000 from the Diabetes Prevention and Control Unit, I Division of Public Health, North Carolina Department of Health and Human Services and to submit the grant application to the County Commissioners for their consideration. Upon vote, the MOTION CARRIED UNAMIOUSL Y. 6 I I I 157 Proposed Rules Governin!! Fencin!! and Operation of Private Swimmin!! Pools Mr. Steuer recommended from the Executive Committee for the Board of Health to approve for the Environmental Health Committee and staff to pursue obtaining more information related to the Proposed Rules Governing Fencing and Operation of Private Swimming Pool. Mr. Link, Chairman, Environmental Health Committee, advised the existing swimming pool rules passed in June 1992 do not include above ground pools. A four (4) foot fence is required around four (4) sides of the swimming pool. He referred the Board to the draft of the Proposed Rules Governing Fencing and Operation of Private Swimming Pools. Mr. Link explained the proposed rules include in-ground and above ground swimming pools, wading pools, and spas capable of holding 24-inches of water. Water gardens and water fountains are exempt. These rules state all private swimming pools shall be enclosed by a fence or a permanent barrier designed to minimize the possibility of unauthorized or unwary persons entering the pool area. Private swimming pool enclosures shall be completely installed within thirty (30) day of the pool completion. Private pools must be maintained in a clean and sanitary condition so as not to create a nuisance or a hazard to others and to prevent a breeding site for pests such as mosquitoes. Private swimming pools constructed prior to the effective date of this regulation must be brought into compliance at the earliest possible date, but in no case longer than one (1 ) year of the regulation date. Mr. Link clarified Ms. Dianne Harvell, Environmental Health Director, and Mr. Robert Keenan, Environmental Health Specialist, are working on the proposed pool regulations and are seeking the Board of Health's and more public input. Dr. Goins endorsed the Proposed Rules Governing Fencing and Operation of Private Pools prior to a possible tragic injury or death. Ms. Hunter inquired if Section 1.4 Non-conforming Private Swimming Pools regarding pools constructed prior to the effective date of this regulation is going to be left at one year. Mr. Keenan responded the committee is considering requiring pools must be brought into compliance no longer than six months. Mr. Keenan reported the Environmental Health staff receives many citizen inquires regarding the lack of fence requirements and the neglect and sanitation of swimming pools. Mr. Steuer expressed concern about the proposed pool regulations and fencing requirements being an encroachment of individual liberties. He stressed the importance of education and responsible pool owners. Ms. Dianne Harvell, Environmental Health Director, explained the intent of the proposal is more educational than for regulatory purposes. Ms. Harvell advised before the Board of Health approves the revised swimming pool rules, more information is needed from the public and from swimming pool vendors. Mr. Estep reiterated the regulations are needed to promote safety, to prevent loss of life, and to address pool sanitation problems to prevent nuisances. He stated children have the right to be protected from swimming pool drowning and near-drowning incidents. Fences are now required for private inground pools, and the proposed swimming pool rules would incorporate above ground swimming pools in the regulations. Motion: Mr. Steuer moved from the Executive Committee for the Board of Health to approve for the Environmental Health Committee and staff to pursue obtaining more information related to the Proposed Rules Governing Fencing and Operation of Private Swimming Pool. Upon vote, the MOTION CARRIED UNAMIOUSL Y. 7 158 Strate!!ic Plannin!! Process I Mr. Steuer recommended from the Executive Committee for the Board of Health to accept and approve the Strategic Planning Process with Mr. William T. Herzog, MPH, as facilitator; a two-day Strategic Planning Retreat on October 6 and 7, 2000, (located off the Health Department site); and with the participants composed of the full Board of Health, Assistant County Manager, Health Director, Assistant Health Director, Health Department Division Directors, Budget Officer, and Administrative Assistant. Mr. Estep, Chairman, Personal Health Committee, advised the Personal Health Committee met to discuss and to formulate the development of the Strategic Planning Process for the Health Department. He reported Mr. Rice, Health Director, recommends Mr. William T. Herzog as facilitator for the planning effort. The University of North Carolina School of Public Health, UNC @ Chapel Hill, North Carolina, is to fund the expenses for Mr. Herzog. Mr. Estep referred the Board to Mr. Herzog's professional biography and a proposal for Strategic Planning for New Hanover Health Department. Mr. Estep explained the advance work and information gathering process is to be completed by Health Department staff. The Board of Health is to be involved in the interviewing of key stakeholders. Mr. Rice stated he plans to distribute a Key Community Leaders and StakeHolders List and Strategic Planning Process forms to the Board of Health. The next meeting of Personal Health Committee is on July 19,2000. Motion: Mr. Steuer moved from the Executive Committee for the Board of Health to accept and approve Strategic Planning Process with Mr. William T. Herzog, MPH, as facilitator; a two-day Strategic Planning Retreat on October 6 and 7, 2000, (located off the Health Department site); and with the participants composed of the full Board of Health, Assistant County Manager, Health Director, Assistant I Health Director, Health Department Division Directors, Budget Officer, and Administration's Administrative Assistant III. Upon vote, the MOTION CARRIED UNAMIOUSLY. Comments: Board of Health Members Mr. Steuer asked for comments from the Board of Health. There were no additional issues. Health Director National Association of Local Boards of Health 8th Annual Conference - Julv 26-29.2000 Mr. Rice reminded the Board the 8th Annual Conference of the NALBH is to be held on July 26-29, 2000, at the Sheraton Capitol Center, in Raleigh, North Carolina. Registration is due for the conference. Summer 2000 Hurricane Recovery Corps anterns) Mr. Rice reiterated the Hurricane Recovery Corps interns are providing added outreach, administrative and clerical I capacity to our organization. , 8 I I I 159 New Hanover County Blood Drive - July 11. 2000 Mr. Rice invited Board members to participate in the New Hanover County Blood Drive on July 11, 2000 at the Health Department Blood donors are being accepted at the Red Cross Center two weeks prior to and after the County Blood Drive. Three Letters Ree:ardine: Mercury in Ocean Fish Mr. Rice referred the Board to three letters regarding the collection and frequency of samples for the detection of rnercury in ocean fish. The Division of Marine Fisheries plans to resample 30 to 40-inch mackerel within two years. Mr. Greer, Ms. Hunter, and Mr. Steuer expressed a need for rnore frequent, consistent testing and statistical data on king mackerel. Information for Board of Health Mr. Rice referred the Board to supplementary information in their folders including a letter from Congressman Mike McIntyre, Future of Children Article, a Dangerous Dog Report (April - January 2000), and a Food Talk/Serving Safe Food Class Other Business: There was no other business presented to the Board of Health. Adjournment: Mr. Steuer adjourned the regular meeting ofthe New Hanover County Board of Health at 10:00 a.m. þ~/~ William T. Steuer, PEIRLS, Chairman New Hanover County Board of Health /kA David E. Rice, M.P.H.,M.A., Health Director New Hanover County Health Department Approved: June 7, 2000 9 , e e - Mr. William T Steuer, Chainnan, called the regular business meeting of the New Hanover County Board of Health to order at 8:00 a.m. on Wednesday, June 7, 2000. Members Present: William T. Steuer, Chainnan Wilson O'Kelly Jewell, DDS, Vice-Chainnan Henry V Estep, RHU Michael E. Goins, 00 Melody C. Speck, DVM Gela N. Hunter, RN, Nurse Practitioner W Edwin Link, Jr., RPH Anne Braswell Rowe Philip P Smith, Sr., MD Estelle G. Whitted, RN Members Absent: Others Present: Mr David E. Rice Frances De Vane, Recording Secretary Invocation: Ms. Estelle Whitted gave the invocation. Minutes: Mr Steuer asked for corrections to the minutes of the May 3, 2000 New Hanover County Board of Health meeting. The Board of Health approved the minutes of the May 3, 2000 Board of Health meeting. Recognitions: Mr Rice introduced Health Department new employees. Personnel New Emplovees Kristen E. Keenan, Public Health Nurse I, Child Health India Foy, Health Education Student Intern, Appalachian State University Mr Steuer welcomed Ms. Kenan and Ms. Foy Department Focal: Healthv Homes Prol!ram Ms. Janet McCumbee, Child Health Director, presented a department focal on the Healthy Homes Program. She introduced Ms. Lorna Blackler, Licensed Practical Nurse, who works with the Healthy 1 e e e Homes Program. Ms. Blackler displayed drawings from the Draw A Breathe Asthma Contest sponsored by the Asthma Task Force. Ms. McCumbee gave a powerpoint presentation on the Healthy Homes Program, a health department program to increase public awareness of environmental impacts on a child's health and to provide tangible household products to directly improve child care environment at Family Child Care Homes (FCCHs). She explained the Healthy Homes Initiative Mini-Grant is currently funded (July 1999) by the North Carolina Childhood Lead Poisoning Prevention Program ($16, III). The proposed budget request for $20,000 is to continue the Health Homes Initiative Mini-Grant for FY2000-200 I The purpose of the grant is to address both lead poisoning prevention and asthma control for children. Ms. McCumbee reported from January through May 2000, 42 FCCHs were visited serving 269 children. Accomplishments of the grant included Assessments of Environmental Health Asthma Triggers and Lead Sources, the creation of the New Hanover County Asthma Task Force co-sponsors of World Asthma Day, increased lead testing and follow-up, the installation of 115 mini blinds and 39 air filters, medical and social services referrals, and evaluation of the Healthy Homes Initiative. The School Health nurses encouraged attendance at the American Lung Association Asthma Camp for chi Idren with Asthma. Ms. Blackler introduced Ms. Cheryl Aguilar, owner of Precious Little Angel's Child Care, a participant in the Healthy Homes Environmental Assessment. Lead was identified in her child care home, and the initiative installed mini-blinds. Mr Rice presented to Ms. Aguilar a Certificate of Appreciation for Participation in the Healthy Homes Initiative. On behalf of the Precious Little Angel's Child Care Home and Family Child Care Homes, Ms. Aguilar thanked the Board of Health and Health Department staff for their assistance and for a most successful project. Mr Steuer thanked Ms. McCumbee for her presentation. Monthly Financial Report: April 2000 Monthlv Financial Report Mr Steuer reported the Executive Committee reviewed the April Health Department Financial Summary Report Ms. Cindy Hewett, Business Officer, reported the April Health Department Financial Summary Monthly Revenue and Expenditure Report reflects an earned revenue remaining balance $906,092 (78.82%), an expenditure remaining balance of $3,128,447 (67.56%), and a cumulative percent of 78.82%. She stated the financial report is for 10 of the 12 months and is basically on schedule. Medicaid earnings are $570,504 (71 18%). Animal Control Services fees are $329,474 (63.80%). Ms. Hewett advised Medicaid is being billed and health department reimbursement will follow Dr Speck inquired about the reimbursement for Animal Control services and complaints regarding citations. Mr Rice explained the New Hanover County Infonnation Technology (IT) Department is pleased with the implementation of the Animal Control Services new computer system, the progress of the electronic billing system, and with the improved method for the handling of citation complaints. Committee Reports: Executive Committee Mr Steuer reported the Executive Committee met at 6:00 p.m. on Tuesday, May 30, 2000 Items are listed under New Business on the Board of Health Agenda. 2 e e e Unfinished Business: Generator Hookups at Emel'l!encv Shelters Mr Steuer, Chairman, gave an update on the generator hookups for emergency shelters. He reported manual electrical transfer switches should be installed in the schools used for evacuation shelters at Dorothy B. Johnson - June 22, 2000, Eaton - June 29, and Noble - July 5 Inner lock systems have been ordered for Trask School and are to be installed upon arrival. Mr Steuer clarified the School Retrofit Project including the central school office and the Cape Fear Museum should be completed by mid- hurricane season. New Business: Grant Status Update Mr Rice referred the Board to a Grant Status Report. He summarized from March 3, 1999 through May 3, 2000, the Health Department submitted 21 grant applications ($949, 064) and received II grants ($257,298). One Environmental Health grant proposal ($57,500) is pending. Eleven (II) grant applications ($555,742) were denied. Mr Estep noted the health department receives approximately 50% of the grant requests. Ms. Whitted expressed it appears several infant/children grants were denied. Mr Rice stated there are actually more grants in this category HeaIthv Homes Grant Reapplication Mr Steuer recommended from the Executive Committee for the Board of Health to accept and approve a grant request to reapply for the Healthy Homes Initiative Mini-Grant for $20,000 from the North Carolina Childhood Lead Poisoning Prevention Program. This $20,000 grant request for second year funding includes salary and fringe for a Licensed Practical Nurse @ 20 hours a week and departmental supplies. The purpose of the grant is to address children's environmental health issues including lead poisoning prevention and asthma control. MOTION: Mr Steuer moved from the Executive Committee for the Board of Health to accept and approve second year funding for $20,000 for the Healthy Homes Initiative Mini-Grant from the North Carolina Childhood Lead Poisoning Prevention Program, N. C State Department of Natural Resources, and to submit the grant renewal application to the New Hanover County Commissioners for their consideration. Upon vote, the MOTION CARRIED UNAMIOUSLY. Smart Start "Servicios para Ninos" Grant Application Mr Steuer recommended from the Executive Committee for the Board of Health to approve a request for the Child Service Coordination Program (CSCP) to enter into a contract with Smart Start to provide the services of the Servicios Para Ninos Grant. The New Hanover County Partnership for Children (Smart Start) submitted a Servicios Para Ninos Grant Application for $50,000 to the Rehabilitation Therapy Foundation. The grant is designed to enhance the CSCP of the Health Department by providing a Bilingual Child Service Coordinator, appropriate health care, early intervention, and therapy for the at-risk Hispanic children under age five. The budget includes salary and fringe for a Bilingual Child Service Coordinator, operating expenses. capital outlay for a personal computer, and contracted services. 3 Ie e e Motion: Mr Steuer moved from the Executive Committee for the Board of Health to approve a request for the Health Department Child Service Coordination Program to enter into a contract with the New Hanover County Partnership for Children (Smart Start) to provide the services of the Servicios Para Ninos Grant if funded by the Rehabilitation Therapy Foundation. Upon vote, the MOTION CARRIED UNAMIOUSLY. Childbirth Classes Proposal Mr Steuer recommended from the Executive Committee for the Board of Health to approve the Childbirth Classes Proposal for the Women's Health Care Division to assume the responsibility of conducting the childbirth education classes to Medicaid clients. Ms. Mary Piner, Public Health Nurse, Women's Health Care, explained the proposal is for the Women's Health Care Division to conduct Childbirth Education (Lamaze) Classes. For 20 years the New Hanover Regional Medical Center conducted the childbirth classes. Since November 1999, the Coastal Area Health Education Center (CAHEC) has coordinated this effort; however, CAHEC will discontinue the classes effective May 31, 1999 Dr Goins expressed concern regarding the Health Department accepting this responsibility without additional funding. He stated this could be a continuing trend when programs are discontinued at the regional hospital and possibly referred to the Health Department without funding. Mr Rice stated if the Health Department does not offer these childbirth classes, they probably will not be available to Medicaid clients. Ms. Piner advised two private Ob/Gyn offices employ Childbirth Educators. Ms. Hunter stated these Lamaze classes should be available to all prenatal patients regardless of ability to pay Dr Speck inquired if the additional responsibility of providing the childbirth classes will be revenue producing for the health department. Ms. Piner advised this is a reimbursable service through Medicaid and should pay for the contract staff (instructor) to conduct the classes, educational materials, and incentives. The proposed start date for the classes is July 3, 2000. The proposed budget is $25,056 for conducting the childbirth classes and contracted services. Motion: Mr Steuer moved from the Executive Comm ittee for the Board of Health to approve the Childbirth Classes Proposal for the Women's Health Care Division to assume the responsibility of conducting the childbirth education classes to prenatal Medicaid patients. Upon vote, the MOTION CARRIED UNAMIOUSLY. Grant Application for Familv Planninl! Outreach Initiatives Mr Steuer recommended from the Executive Committee for the Board of Health to accept and approve a Grant Application for Family Planing Outreach Initiatives for $22,180 from the North Carolina Division of Public Health- Women's and Children's Health Section, Department of Health and Human Services. The purpose of the grant is to address the preventive, follow-up care, and needs of Medicaid pregnant women. Outreach efforts will include postpartum hospital visits, phone calls and appointment reminders, home visiting, and outreach through the Women, Infants, and Children (WIC) Program. Motion: Mr Steuer moved from the Executive Committee for the Board of Health to accept and approve the Grant Application for Family Planing Outreach Initiatives for $22,180 from the North Carolina Division of Public Health- Women's and Children's Health Section, Department of Health and Human Services and to submit the grant application to the New Hanover County Commissioners for their consideration. Upon vote, the MOTION CARRIED UNAMIOUSLY. 4 e e e Workforce Preparedness Proposal- UNC Letter of Support Mr Steuer recommended from the Executive Committee for the Board of Health to accept and approve a Workforce Preparedness Proposal in the amount of$12,500 developed by the North Carolina Institute for Public Health, UNC School of Public Health. The proposal is an opportunity for the Health Department to participate in the training and in the design of the Workforce Preparedness Proposal. First year funding is $12,500 to cover the expense for a coordinator for the proposal. Motion: Mr Steuer moved from the Executive Committee for the Board of Health to accept and approve the Workforce Preparedness Proposal in the amount of $12,500 developed by the North Carolina Institute for Public Health, UNC School of Public Health. Upon vote, the MOTION CARRIED UNAMIOUSLY. Discussion on Diabetes Mr Steuer advised the Executive Committee expressed concern and discussed the closing of the Coastal Diabetes Center He reported Mr Bill Caster, Chairman of New Hanover County Commissioners; Mr Rice; and he met to address this issue. It would cost approximately $300,000 to $400,000 to continue this educational program for diabetes patients. Mr Rice reported Dr Bruce Chapman, a Podiatrist, addressed the Executive Committee about the need to reestablish a diabetes education center in our community Dr Coleman presented a request for the Board of Health to consider undertaking the responsibility of the Diabetes Center for the county Mr Rice explained the Health Department received a Diabetes Today Community Planning Initiative Grant from the North Carolina Department of Health and Human Services - Diabetes Prevention and Control Unit for $10,000 to establish a Diabetes Coalition for education. He expressed a need to work with the American Diabetes Society Dr Smith and Mr Estep emphasized the importance of a healthy lifestyle and patient involvement in both Diabetes prevention and treatment. They concurred the Coastal Diabetes Center rendered a valuable service; however, the closing of the center is essentially economical. Dr Goins emphasized it is a tragic loss to the community and an economical matter of who pays and why Ms. Whitted stated Diabetes control is lifestyle; however, the Board must consider the issue, the health of our children, and educate the public Mr Steuer explained the Board of Health does not have revenue to provide funds for this project unless the county would provide funding. Ms. Rowe inquired if Health Promotion could provide the Diabetes patient education. Mr. Rice eXplained the division has the capability but not the capacity He clarified Coastal Diabetes Center had trained certified educators and consultants. Recommended FY2000-2001 Budl!et - Budl!et Hearinl! June 5, 2000 Mr Steuer reported the FY2000-2002 Budget Hearing before the County Commissioners was held at 7'10 p.m. on Monday, June 5, 2000, in the General Assembly Room of the New Hanover County Courthouse. Ms. Cindy Hewett, Business Officer, presented a PowerPoint presentation on the County Manager's Recommended FY2000-2001 Budget. She summarized Total Capital Outlay as follows: Computer Costs Recommended Capital Outlay Excluding Computers $169,628 (Requested $215,350) $122,223 (Requested $454,934) 5 Ie e e Ms. Hewett explained the total recommended computers was 44 PC's (76 requested), I Laptop (10 requested), and 20 Desktop Printers (22 requested). The Total Capital Outlay Requested was $454,934, and the Total Capital Recommended was $\22,223 Recommended Capital Outlay deletions included I mow tractor, 2 mowers, I electronic gate, 2 generators, I 4x4-conversion van, I concrete patio, I partition for auditorium, I fire/smoke alarm, 12 workstation cubicles, I copier, and I audiometer Ms. Hewett stated the New Position request was for 20 New Positions and (I) Increase from PT to FT The Recommended Budget included 3 New Positions: I Environmental Health Specialist and 1 Clerical/Environmental Health funded with Water Sample Revenue and I Partnership for Children Clerical PT-FT Position grant funded. Total New Positions - grant funded equal $77,178. Ms. Hewett presented the following Summary of Projected Expenditures for New Positions and Capital Outlay for FY 2000-2001 Salary and Fringe Capital Outlay' Computer Requests Other Equipment Vehicles Building Improvements $ 77,178 $\19,300 $ 42,723 $ 79,500 o Ms. Hewett reported the Total Requested Expenditures was $10,227,300 and the Total Recommended Expenditures was $9,378,72. The Total Requested Revenue was $4,402,776 and the Total Recommended Revenue was $4,029,551 She stated the Recommended Budget for FY 2000-2001 represents a -I 4% decrease in County Appropriations from FY 1999-2000. It does not include merit or market increases for staff but it does include a 4% increase for implementation of the Pay and Classification. The following budget items were submitted to the County Commissioners for reinstatement in the Approved Health Department Budget for FY 2001 Positions Total Salarv/Frinee Epidemiologist - I Full Time Administration $52,848 Computer Support Specialist - I Full Time Administration $36,654 Licensed Practical Nurse II - I Full Time Jail $29,356 Capital Outlav Total for Re-Consideration 9 Laptop Computers for Environmental Health $ 22,500 Strateeic Plannine $ 12,000 (Board of Health - Contracted Services $10,000) (Board of Health - Departmental Supplies $2,000) Other Expenditnres: 6 e e e Salarv La!! $225,000 (Maintain Salary Lag @ $225,000 instead Recommended $300,000 based upon history of Health Department Salary Lag) Mr Steuer explained the Executive Committee approved the above budget items except for a request for one Licensed Practical Nurse (LPN) position in Jail Health. This nursing position was added to the budget request following the Executive Committee meeting of May 30, 2000 Sheriff Joseph McQueen supported the budget request for the Jail LPN position. Mr Steuer stated the salary lag of $300,000 (based upon staff turnover for one year) is unreasonable. He expressed the importance of planning for the next fiscal year budget. Other Business: Home Health Mr Rice advised the Board New Hanover Network may want to discontinue Home Health services. This issue is being addressed by hospital and county officials. Mr Rice expressed all stake holders need to come together to find a solution to this patient care issue. He advised state legislation requires that Home Health Services shall be provided in all counties. Comments: Board of Health Members Dr Jewell commended Chairman Steuer for his excellent budget presentation at the Budget Hearing. He stated the County Commissioners have many difficult decisions to make during the budgetary process. Dr Goins expressed concern over the trickle down effect of accepting the responsibility for discontinued hospital programs without funding and emphasized the need to address alternate resources to provide more public health services for our citizens. Ms. Rowe thanked Mr Steuer for his budget request presentation to the County Commissioners and thanked those who attended the Budget Hearing. Healtb Director Invocation Schedule Mr. Rice distributed a Board of Health Meeting Invocation Schedule. 7 e e e Letter Re!!ardin!! Mercurv in Ocean Fish Mr Rice reported he has not received a response to his letter to Mr Bill Holman, Secretary of North Carolina Department of Environment and Natural Resources, regarding the collection and frequency of samples for the detection of mercury in ocean fish. Care to Collaborate Au!!ust 17.2000 Mr Rice referred the Board to the Care to Collaborate May 17, 2000 Agenda and to a Southeastern N. C. Regional Health and Human Service Needs Assessment. Medical Records Renovation Update Mr Rice displayed photographs of the Health Department Medical Records Renovation and invited Board members to take a walk-through tour of the construction project. He reported Phase I ofthe project is almost completed, and the total renovation should be completed in approximately one and one-half months. Mana!!ement Academv for Public Healtb - Mav 10-12,2000 Ms. Smith, Ms. Hewett, and Mr Rice attended and graduated from the 1999-2000 UNC Management Academy for Public Health held from May 10-12, 2000. Ms. Dianne Harvell, Environmental Health Director; Ms. Betty Jo McCorkle, Women's Health Care Director; Ms. Nancy Nail, Nutrition Director' and Ms. Elizabeth Constandy, Health Educator; plan to attend the next Management Academy, a training program for public health managers from North Carolina, South Carolina, and Virginia. National Association of Local Boards of Health 8th Annual Conference - Julv 26-29,2000 Mr Rice announced the 8th Annual Conference of the NALBH is to be held on July 26-29, 2000, at the Sheraton Capitol Center, in Raleigh, North Carolina. He referred the Board to a brochure that contains a program of schedule of events and forms for membership, registration, and nomination forms. Customer Appreciation Letter Mr Rice presented a copy of a letter of appreciation from a health department client to the Women's Health Care Division commending the health department staff for their excellent customer service. Nortb Carolina Institute for Public Health Update Mr. Rice reported Ms. Lynda Smith, Assistant Health Director; Deputy Director Rachael Stevens and Dr Bill Hertzog, North Carolina Institute of Public Health, UNC at Chapel Hill; and he met to discuss Strategic Planning for the Health Department. Dr Hertzog is to serve as facilitator for the planing process and for a two-day retreat in September or October 2000. 8 e e - Summer 2000 Hurrican Recovery COrDS College Intern Students from the Hurricane Floyd Recovery Corps will be placed in the Health Department by the Department of Health and Human Services to perform public health outreach services and to assist with a backlog of work due to the hurricane. Information for Board of Health Mr Rice referred the Board to supplementary information in their folders, an EPllnformation Newsletter, and to a Dangerous Dog Report. Adjournment: Mr Steuer adjourned the regular meeting of the New Hanover County Board of Health at 9:50 a.m. William T Steuer, PE/RLS, Chairman New Hanover County Board of Health David E. Rice, M.P.H.,M.A., Health Director New Hanover County Health Department Approved: 9 Ie New Hanover County Health Department FY 99 . 00 MONTHLY REVENUE REPORT As of MAY 31,2000 Sunvnary for the New Hanover County Health Department Cumulative % 91.67% Month Reported Mon 11 of 12 May-OO Current Year Prior Year Type 01 Budgeted Revenue Balance % Budgeted Revenue Balance % Revenue Amount Earned Remaining Amount Earned Remaining Federal & state 1.394,968 1,197,337 197,631 85.83% 1,3n,269 1 ,202,806 174,463 87.33% ACFees 516,453 384,709 131,744 74.49% 493,100 340,062 153,038 68.96% Medicaid 801 ,504 641,932 159,572 80.09% 824,754 600,885 223,869 72.86% Medicaid Max 386,891 386,891 100.00% 401,769 401,788 1 100.00% EHFees 312,900 283,507 90.61% 243,100 267,811 (24,711) 110.16% Health Fees 109,515 117,950 107.70% 98,065 90,578 7,487 92.37% Other n6,172 788,289 98.98% 572,457 515,988 56,_ 90.14% Note: County Appropriation is not calculated above. The County appropriation is the difference between the total amounts on the program expenditure report and the totals on the program revenue report. The budgeted amount for County Appropriation lor FY 99 . 00 is ($9,703,333 - $4,278,403) = $5,424,930. The expended amount for County Appropriation lor this FY (year4o-date) Is ($8,000,458 - $3,760,615) = $4,239,643. e -- Revenue summary For Month of MAY 2000 10 e New Hanover County Health Department FY99.00 MONTHLY EXPENDITURE REPORT As of MAY 31, 2000 sunvnary for the New Hanover County Health Department Cumulative % 91.67% Month Reported Mon 11 of 12: May-OO Current Year Prior Year Type 01 Budgeted Expended Balance % Budgeted Expended Balance % Expenditure Amount Amount Remaining Amount Amount Remaining e e Expenditure Summary For Month of MAY 2000 11 e "C ., '" '" .c ~ '" ., ., '" 0 C. E IV '" - ;; " " Ol 0 "C <.l " ~ al .E t: IV ., '" E "" .... 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N '" N CD CD .,. o o - <OM ~ <0 '" (I) Q) 13 :is :::l U c: o ~ :E1 ~ o ~ III S o ~ 14 e e e HE:RLT+-I NEW HANOVER COUNTY BOARD OF ~SSI(}RtRS REQUEST FOR BOARD ACTION Meeting Date: 07/1 /00 Department: Health Presenter: Beth Jones, Communicable Disease Director Contact: Beth Jones, 343.6648 SUBJECT: Grant Application-March Toward TB Elimination ($10,000)-from the North Carolina Department of Health and Human Services, Division of Public Health, Tuberculosis Control Program, BRiEr SUMMARY: We are applying for a grant of $10,000 through the Tuberculosis Control Program of the North Carolina Department of Health and Human Services, Division of Public Health to strengthen our local tuberculosis (TB) control program and implement demonstration projects for replication in other areas of North Carolina. Funding is requested to work on specific activities to improve TB services and data use to evaluate effectiveness of the TB program in New Hanover County Funds will be spent by June 30, 2001 See attached 5 pages of grant application narrative for specific program objectives, activities, budget information, and timelines, RECOMMENDED MOTION AND REOUESTED ACTIONS: Approve grant application for $10,000 and related budget amendment if grant awarded, FUNDING SOURCE: Grant from the North Carolina Department of Health and Human Services, Division of public Heath, Tuberculosis Control Program. ATTACHMENTS: Yes, 7 pages (Memo about grant availability and 5 page grant application). 15 e e e March Toward TB Elimination Request for Funding New Hanover County Health Department New Hanover County Health Department is requesting $10,000 funding to strengthen the local tuberculosis (TB) control program and implement demonstration projects for replication in other areas of North Carolina. Funding is requested to work on specific activities to improve TB services and data used to evaluate effectiveness of the TB program in New Hanover County Funds would be spent by June 30, 2001 1 $300 is requested to purchase a portable sputum induction device and supplies. There are occasions when individuals are referred to the local hospital for induced sputum collections, some whom receive bronchoscopies. These situations occur when there are questionable x-rays, positive skin tests, or symptomatology suggestive ofTB and the individual does not produce a sputum specimen. The ability to induce the specimen collection by the TB program staff would reduce unnecessary costs and delays and improve the quality of diagnostic specimens submitted to the State Lab. 2. $3,400 is requested to implement CountTB to computerize surveillance information, thereby improving the ability to easily review management of cases and individuals. A laptop computer is requested to be used by clinical staff (physician, nurse practitioner, and nurses). CountTB would be installed on desktop computers and laptop and be accessible to the TB clerk, x-ray technician, and clerical staff. 3. $1,800 is requested to produce a video using actual patients (disguised if they prefer) to tell their stories to others. There are several individuals who can give dramatic testimony about the importance of taking preventive therapy to prevent disease development-stories that include failures and successes. The video will be copied to be used as loaners to all new cases and individuals with L TBI as one component of patient education. By allowing the individuals to watch the video in the privacy of their homes, family members can also participate and hopefully become supportive for completion of therapy. The video would be approximately 20 minutes long and use patients and TB program staff to promote success in completion of therapy. 4 $300 is requested to develop materials for incarcerated individuals to be given upon release from the local jail. There are gaps in continuity of care since jail medical staffmay not be involved at the time of release from the facility. We would like to improve follow-up by having important information placed in travel kits with individual's personal belongings that would be given upon release. This information would include clear instructions on the importance of contacting the local health department in the county of residence so that medications can be continued or initiated when indicated. One of the current cases being treated for MTB was identified in the local jail as L TBI, initiated preventive medications, and upon release after two months, left the area and never followed up until he returned to Wilmington sick and was admitted to the hospital 16 e e e with MTB. Fortunately, he does not have a resistant strain, however, this treatment failure for L TBI is an example of the need to improve the information and follow-up for these high risk individuals. 5. $500 is requested to purchase/print written information in English and Spanish to increase supply of materials available for distribution at health fairs, physician offices, and other locations in the community 6. $1000 is requested to develop a display board to be utilized at health fairs to raise public awareness about TB disease and L TBI. Physicians are provided information using EPI Information, a bimonthly newsletter produced by the Communicable Disease Division. By increasing consumer awareness about TB, we would like to encourage consumers to request appropriate TB screening from their medical providers. During the month ofJune 2000, the New Hanover County Airport displayed TB information. A professionally done display board, reversible, in English and Spanish, could more effectively provide information in a colorful, interesting and creative format. Currently the display being used is approximately 5 years old, was done by TB staff whose ideas were great but skills not adequate to produce a product reflective of the quality of the TB program standards and services provided by the Health Department. 7. $2,000 is requested for Web page development. Money will be used to contract with a professional to develop a communicable disease Web page and train staff to maintain it, making it bilingual (English and Spanish) if feasible. The Web page would be publicized for medical providers, health care facilities, and the general public to provide correct information on local TB incidence, publish monthly statistical report, and provide information frequently requested by others in the community who are developing TB plans in their facilities, ex.: number of cases of drug resistance. It would also provide much of the information that we have in written materials such as the Risk Factor Determination Form and general information about TB skin testing. (Copies of sample documents attached.) It would include information that would assist providers with TB screening by including information about placing and interpreting positive and negative skin tests and recording tests using millimeter reading. The Web page would give instructions on connecting to other Web sites for additional information, including CDC Treatment Guidelines. 8. $700 is requested to purchase two television videophones. There are situations with individuals who are cooperative and not comfortable with directly observed therapy. A recent TB case is a corporate executive who frequently travels, has adequate health insurance, and opted not to receive TB medications from New Hanover County Health Department. An alternative to having a TB program staff member come to his home or have him come to the Health Department two days a week to watch him take medications could have kept us involved with this individual and his family which is in the best interest of the individual and the community. Since neither of those choices was satisfactory with the individual and perhaps not indicated, a less disruptive method to directly observe this individual would have enabled us to be more -2- 17 e e e involved with his case. Though it is not a system that would be effective with those individuals which caused DOT to become the standard, there are cases where this less expensive and creative system of monitoring may be an exciting solution. The cost of the equipment to establish a site in a patient's home would be less expensive than home visits for a six to nine month period. Proper consent and promissory note for the equipment would be obtained initially. The system would be used by a higWy motivated individual who was not a great risk for noncompliance but could benefit from interaction with TB program staff, and would receive medications at less frequent intervals than "by the dose." After a phone call to the patient by TB program staff, or at a prearranged time, the individual would turn on the device at the same time the device is turned on at the Health Department and interaction and observation would occur. Equipment would be removed at the conclusion of treatment. Itemized Reouest bv Obiective Objective 1: Improve quality of diagnostic specimens submitted to State lab. Activity: Purchase and utilize sputum induction device. Budget: Nebulizer Electronic Pump (tubing, mouthpieces [I case] & aerosol masks [I case]) - $300 Timeline: By January 20, 2001 Evaluation: If desired for research purposes, staff is willing to submit specimens obtained before and after nebulizing treatment. If State Lab does not approve comparison study, results of sputums will be compared to specimen results prior to use of nebulizing treatments. Objective 2: Improve methods of surveillance to track patients being followed in TB program. Activity: I. Purchase laptop computer and software for TB nurses, physician extender, and physician to share. Purchase software licenses for Microsoft Access for computers. 2. Install CountTB and provide staff training to implement. Budget: Laptop computer with Microsoft Access and licenses for 2 personal computers - $3,400 Timeline: By February 28, 2001 Evaluation: Improved efficiency for case management allowing more time for contacting individuals. Improve completion rate for preventive therapy. Objective 3: To provide messages to individuals that will have an impact on their commitment to complete TB preventive therapy. -3- 18 e Activity: 1 Produce video using actual patients followed by TB program. 2. Make copies of video. 3. Loan to individuals contemplating preventive therapy Budget: Video production cost, supplies, and honorarium for patients participating - $1,800 Timeline: By April, 2001 Evaluation: Review rates for completion of preventive therapy. Objective 4: Improve follow-up on individuals with L TBI from jail setting. Activity: 1 Develop take-home package to be placed with personal belongings. 2. Make produced video available to view while in jail setting. 3. Jail medical staff report LTBI with identifying and locating information. 4. Enter jail referrals to Count1'8 surveillance system. Budget: Jail packages in travel kits - $300 e Timeline: By May 30, 2001 Evaluation: Conduct folIow-up on data from jail medical staff. Objective 5: Increase public awareness and assertiveness regarding 1'8 screening. Activity. I Purchase brochures. 2. Have information developed by TB staff printed to disseminate. 3 Place written information in various locations in community, including physicians' offices. 4. Publicize services of Health Department TB program including individual patient education and encourage referral to verify skin test interpretations. Budget: Purchase of print brochures - $500 Timeline: By May 30, 2001 Evaluation: I. Report number of brochures distributed, number of locations placed. 2. Monitor number of individuals referred to Health Department for education, preventive therapy, and skin test interpretations. e -4- 19 e Objective 6: Improve quality ofTB information provided at various community settings. Activity: I. Develop display board and have professionally produced. 2. Seek additional opportunities to set up portable display in community Budget: Display board - $1,000 Timeline: By April 30, 2001 Evaluation: Monitor uses ofTB display in community. Objective 7: To increase public's ability to access current information about TB, services ofTB program, TB treatment guidelines, and local data. Activity. 1. Web page development. 2. Publicize availability in newspaper, bimonthly newsletter. Budget: Contract for professional Web page development - $2,000 e Timeline: By June 30, 2001 Evaluation: Review number of visits to Web page. Objective 8: To seek creative ways to enable TB staff to monitor individuals receiving TB therapy that meet the standard of directly observed therapy without expensive, labor intensive home visits. Activity. Purchase and implementation of equipment. Budget: Purchase two television videophones - $700 Timeline: By June 1,2001 to have purchased and installed in one patient's home if agreements made and where staff deems appropriate. Evaluation: Review problems encountered, evaluate success or failure of project using staff and patient reactions. e -5- 20 New Hanover County Health DepartmentTB Control Program Tuberculin Skin Test Results-Risk Factor Determination NAME: ADDRESS: TELEPHONE': (HOME) Date of Birth: EMPLOYMENT: There are risk fadors, that affea the way your tuberculin skin test is handled. In order to provide you the best medical treatment with regard to prevention of TB disease, medical recommendations are based on your personal risk fadors. The following questions will help us decide if you are at risk. Please answer the questions honestly. Your answers are completely confidential. Reason this PPD was clone e I I yes II no I I yes II no I I yes II no II yes II no II yes II no [I yes [I no [] yes [I no e [] yes [J no [J yes [Jno [Jyes [J no [] yes [I no [Jyes [] no [J yes [I no [J yes [J no [] yes [I no [I yes [J no [J yes [] no [Jyes [] no [Jyes [I no [] yes [Ino [] yes []no [I yes [] no [Iyes [I no [J yes [I no [I yes [J no e Date this PPD done C::t2lff c:;.ion::.tlrrlll (WORK) 55. Race: Are you now, or have you ever been, a close contad of a person with infeaious TB? If .yes., when was this person sickl Have you ever been told your chest x-ray showed you had TB which was healed? Have you ever had an HIV test? If "YES", what yearl If tested, was your HIV test positive? Have you ever used IV drugs? Have you ever had any of the following medical conditionsl diabetes silicosis liver disease cancer of the head or neck leukemia or Hodgkin's disease AIDS sarcoidosis kidney failure malabsorption syndromes low body weight drug or alcohol overuse. an illness requiring prolonged steroid treatment cancer, which required chemotherapy intestinal by-pass or part of your stomach removed Were you bom in the U.S.A.l If not, where born How many years have you lived in the USA? less than S More than 5 Have you ever been a resident of, or worker in, a prison, jail, rest home, boarding home, group home, homeless shelter, or migrant farm group? Have you ever been treated for T8 diseasel Are you pregnant now, or do you suspect you might be pregnanll Have you ever taken T8 medicine for prevention of disease or to cure the diseasel Have you been vaccinated against Rubella (German Measlesll When was your last T8 skin test done prior to this onel Where was your last T8 skin test done prior to this onel What was the result of that skin tesll What medicines do you now take? What medicines can you IHIl take due to allergy or side effea? When was your last tetanus sholl Date this PPD Read X-Ray done ( ryes (] no Date 21 OalP GENERAL INFORMATION ON TUBERCULOSIS e Anyone can get tuberculosis (TB) It's a serious disease caused by a type of bacteria that can be spread from person to person through the air TB most often infects the lungs, but may infect other parts ofthe body, such as the kidneys, bones, or the brain. TB can be fatal, but it doesn't have to be. Because TB is on the rise, it's important to know more about it. HOW IS T8 SPREAD? TB can be spread by people sick with TB disease who spray the bacteria into the air from their mouths by coughing, laughing, sneezing, and occasionally by singing or just speaking. TB is most commonly spread to people in confined, poorly ventilated spaces. You cannot get TB by touching drinking glasses, bed linens, or doorknobs. T8 DISEASE OR T8 INFECTION? e T8 Disease Keep in mind that, although many people are infected with TB, very few develop TB disease. TB disease means the tuberculosis bacteria are active and multiplying in your body and can be spread to other people. TB disease almost always causes symptoms that may include any of the following: . a lasting cough . fatigue . coughing up blood . fever . loss of appetite . weight loss . night sweats TB disease can almost always be cured, but it may be fatal if medication is not taken properly T8 Infection If you have TB infection, you've been exposed to TB. You have the bacteria, but the bacteria are inactive. You have no symptoms. TB infection may become disease if your immune system is weakened with other illnesses, certain medications, HIV infection, or unhealthy lifestyles. TB infection (without disease) is not contagious and will not spread to others. The only way to .. know if you have TB infection is to be tested with a TB skin test (PPD). Some people with infection _ are able to take medication to prevent the development of disease. To protect your health, get tested. 22 e e TO: FROM: SUBJECT: North Carolina Department of Health and HumaD Services Division of Public Health 1902 Mail Service Center . Raleigh. North Carolina 27699-1902 225 North McDowell Street. (919) 733-3421.Courier 56-32-21 AnnF. Wolfe, MD., M.P.H., Director May 5, 2000 Local Health Directors ('y) TB Nurses ~r. Raoult Ratard, TB Medical Director March Toward TB Elimination n The Tuberculosis Control Program announces the availability of funds to assist local health departments in strengthening their tuberculosis control programs. Health departments are requested to submit proposals for funding special projects by June 30, 2000. Suggested Problems to be addressed: ~ ~ --- . Rapid identification of newly infectious tuberculosis cases, rapid initiation of an appropriate treatment and monitoring of the infectiousness of each case are the main measures to prevent the transmission of tuberculosis. Laboratory services allowing examination of sputums are provided by the State Laboratory. However sputum collection is found to he lacking among patients unable or unwilling to submit specimens. SP. induction is a cost-effective way of obtaining sputum without having In resort In more expensive techniques like gastric washings or bronchial lavages. This program aims In develop the health departments' capacity to obtain induced sputum with acquiring portable sputum induction devices, sputum induction booths or setting up systems to collect sputums in a safe lD8JD1er. . Ensuring that infectious tuberculosis cases are kept under adequate treatment In prevent transmission of tuberculosis and development of resistant strains. Directly observed therapy (DOT) is the main method used to maintain patient adherence to the therapeutic regimen. DOT is a labor intensive and time consuming activity. Innovative approaches are needed to implement DOT under special circumstances. This program aims at encouraging testing and implementation of innovative approaches In DOT and improvement of patients' adherence. . An ever-increasing proportion of tuberculosis case patients is of foreign origin. Poor communication between health care provider and their client is a main obstacle to patient adherence. This program .. aims at improving communication through language training or workshops that offer cross cultural training aild awareness for staff dealing with tuberculosis patients of foreign origin. . Using computerized registers of cases (such as CounTB), contacts and infected individuals is an important 1001 for the improvement of epidemiological surveillance. This announcement aims at promoting the use of compulerized registers of cases, contacts and L TBI individuals. . Elirninstion of tuberculosis entails preventing the development of disease among those who have latent tuberculosis ~ection (L TBI). Effective interventions include testing of population at high risk of infection and adherence to proper L TBI treatment. Detailed epidemiological knowledge of the distribution of L TBl among the oopulation served is necessary to appropriately determine the targc;ted population group for testing. Objectives: The objectives are as follows: 1. Improve the capacity of local health departments to develop and sustain infrastructures to improve tuberculosis case fmding and diagnosis. 2. Improve patient's adhere. ,.(' '='<!at-o:lent through directly observed therapy and improved communication. 3. Strengthen the epidemiological capacity of health department through enhanced surveillance 4. Foster any innovative approaches leading 10 tuberculosis elimination. Jij EveryWhere. EveryDay. EveryBody. @ An Equal Opportunity / Affirmative Action Employer -1!1t 23 .- ~ e e e Page Two March Toward TB Elimination 11 May 5, 2000 Funds: Monies are available to fund several proposals (20 to 50 depending on the amount awarded) ranging from $500 to $10,000 each. Funding may change based on the availability of funds, scope and quality of applications.received, and appropriateness of the budget justification. Funds will have to be committed by December 31, 2000 and spent by June 2001. This is a one time proposal, and funding cannot be expected to continue in the following years. Therefore, applications requiring continuous funding not sustainable by a local health department will not be considered. Funding will take into consideration the severity of the tuberculosis problem in the area served, the amount requested and the perceived effectiveness of the proposal. Application: The application should include: . Statement of the problem to be lddressed . Objective(s) of the proposal . . . Plan of operation: describe the strategies that will be used and the activities that will be conducted . Timeline: provide a time line that identifies the major implementation steps and assign approximate dates for inception and completion . Program evaluation plan: descnbe the plan for monitoring progress and ensure that stated objectives are met . Budget Applications are expected to be no longer than five pages typewritten single space 12 pitch, with one-inch margins. Provide a budget for each proposed activity. Justify all expenses in relation to stated objectives and planned activities. Not all activities may be approved or funded, so be precise about the program purpose for each budget item and itemize calculations wherever appropriate. Submission and deadline: Submit one original and five copies to the TB Control Program at 1902 Mail Service Center, Raleigh, NC 27612- 1902 ~o later than June 30, 2000. Proposals received after that date will not be considered. Evaluation criteria: Each application will be evaluated individually against the following eriteria by a panel of Tuberculosis Control Program staff and outside consultants. . Quality of the objectives and consistency with the purpose of this announcement . Feasibility of the proposed activities . Demonstrated ability of the applicant to catty out the proposed activity . Quality of the plan of operation Final reports including evaluation will have to be submitted no later than September 1, 2001. If you need additional information call Dr. Raoult Ralard at (919) 218-20r' cc: Dr. Ann Wolfe .. Dr. Steve Cline Dr. Newt MacCormack Mr. Dennis Harrington fl\ I RECEIVED t.lAY tl 9 2000 N II. ell u~.,... .-.... . iI. ~,; 24 ... e Ie e ~H NEW HANOVER COUNTY BOARD OF' SIlJluffS REQUEST FOR BOARD ACTION Meeting Date: 07/lJ./00 Department: Health Presenter: Beth Jones, Communicable Disease Director Contact: Beth Jones, 343.6648 SUBJECT: GRANT APPLICATION-Reapplication for Teen AIDS Prevention (TAP) for $110,000 (2year funding at $55,000 each year for FY's 2001 and 2002) from the CAPE FEAR MEMORIAL FOUNDATION BRIEF SUMMARY: We are reapplying to CAPE FEAR MEMORIAL FOUNDATION for grant funding (for 2 years at $55,000 each year FY2001 and FY2002) to continue our Teen AIDS Prevention Program. We began the TAP peer education program in January, 1999 with $32,000 from the HIV/STD Prevention and Care Section of the North Carolina Department of Health and Human Services, with initial funding for six months to pilot a peer education program for teenagers. A health educator was hired, a curriculum manual developed, recruitment and training of teen peer educators completed, and successful programs were facilitated by the peer educators. TAP was then refunded through a $35,000 (original request from CAPE FEAR MEMORIAL FOUNDATION was for $50,200) grant from the CAPE FEAR MEMORIAL FOUNDATION for FY2000 With continued funding from the foundation, the health educator position and the TAP program can continue to access the hard.to.reach adolescent population. See attached grant narrative for specifics. We have already included and you (the Board of Health) have approved the $55,000 expenditure and revenue projection for TAP in our FY2001 budget request. We are submitting this application narrative for your information. Since this has been included and approved in our FY2001 budget request, it will not need to go back to the County Commissioners (if the second year, FY2002 is awarded, it will be included in the budget request for next FY2002). RECOMMENDED MOTION AND REOUESTED ACTIONS: Application submitted just for the Board's information.already approved during the budget process. FUNDING SOURCE: CAPE FEAR MEMORIAL FOUNDATION ATTACHMENTS: Yes.29 page grant application 25 e e e Revised: 4/30/99 CAPE FEAR MEMORIAL FOUNDATION GRANT APPLICATION I Part 1 : YOUR ORGANIZATION Name: New Hanover County Health Deoartment Street Address: 2029 South 17th Street City, State, & Zip Code Wilminaton. North Carolina 28401 Name of Key Contact Person: Beth Wolfe Jones Title: Communicable Disease Division Director Telephone #. (910) 343-6648 Fax#: (910) 341-4146 Fiscal Year End: June 30 Federal Tax 10 #: 56-6000324 1. Is your organization a nonprofit, tax-exempt organization under IRS Code Section 501 (c) (3) or a governmental unit? If no, you do not qualify for a grant. If your organizations is a 501 (c) (3), please attach a copy of your current IRS tax-exemption letter with this Application. Yes 2. Is your organization a private, nonoperating foundation? If yes, you do not qualify for a grant. No 3. Would a grant from Cape Fear Memorial Foundation in the amount being requested jeopardize your tax-exempt status? No 4 Will any of these funds be used to pay a nationally affiliated organization? If yes, please explain. No 5. Does your organization, now, or does it plan in the future, to engage in any way in the promotion or advancement of political causes? If yes, please explain. Organization is a local public health department. Board of Health appointed by County Commissioners. Department does not engage in political activity. 26 e Revised: 4/30/99 e e CAPE FEAR MEMORIAL FOUNDATION GRANT APPLICATION FORM 6. Sunnnarize your organization's background, goals and current programs. Discuss your assets in personnel, services and programs which could be built upon by the Foundation's help. The New Hanover County Health Department (NHCHD) is a public health facility that provides services to citizens of New Hanover County. Funding comes from state and local government for most programs and services. Some revenues are generated through fees. The NHCHD has II divisions that offer programs for the prevention of disease and the promotion of health. The Communicable Disease Division (CDD) provides medical and educational services to screen, treat, and prevent the spread of communicable diseases. Programs administered by the division include: Tuberculosis Control; Sexually Transmitted Diseases (SID); Human Immunodeficiency Virus (HIV) Counseling, Testing, and Prevention; Surveillance and outbreak control for other infectious diseases; childhood and adult immunizations; medical records; and general registration. The division consists ofa nursing director, 9 staffnurses, I physician extender, I communicable disease investigator, and management support staff. There is also a health educator position for Teen AIDS Prevention (TAP), which is eliminated unless funding is approved. Operating expenses for CDD are approximately $148,000, which are used for employee mileage reimbursements for outreach activities and medical, laboratory, and office supplies, including purchase of some medications and vaccines not provided to NHCHD by the state. NHCHD participates in the Southeastern North Carolina mv Prevention Regional Community Planning Group- a group of collaborating organizations, agencies, and individuals who meet monthly to identify local needs and improve mv prevention efforts. NHCHD is also involved in the newly formed Cape Fear Region Adolescent Health Council, facilitated by Wilmington Health Access for Teens. NHCHD does not receive any funding specifically to provide mv and SID prevention activities, with the exception of the funding from your foundation. Despite this lack of funding, since 1985 NHCHD Communicable Disease Division staffhave promoted mv and STD prevention by offering individual testing on a daily basis. The testing procedure incorporates risk elimination/reduction counseling and education for each patient. In addition, NHCHD staff offer educational and screening activities in community settings and distnbute literature to medical providers' offices. NHCHD's mv focus is to prevent transmission of the disease and provide access for free mv testing to individuals who are at risk. Obiously, testing alone does not prevent transmission. However, identification of infections, referral for care, and education and counseling can reduce secondary transmissions. This will continue to be a focus for CDD staff. 27 e e e Primary prevention is much more compassionate and cost-effective than secondary efforts. Behaviors that for some people begin during adolescence must be changed. TAP addresses those behaviors and decisions that are necessary to protect health by teaching life preservation skills. The longer that risk-taking can be postponed, the more well- equipped an individual will be to make decisions about his or her behavior. The NHCHD began the TAP peer education program in January, 1999 with $32,000 from the HIV/SID Prevention and Care Section of the North Carolina Department of Health and Human Services. The initial funding was for six months to pilot a peer education program for teenagers. Though six months was hardly adequate time to implement and evaluate a new program, the initial start-up work was completed. A health educator was hired, a curriculum manual developed, recruitment and training of teen peer educators completed, and successful programs were facilitated by the peer educators. After this initial funding, TAP was refunded for a one year period by the Cape Fear Memorial Foundation. During this period, the TAP program coordinator and eight peer educators trained twelve new peer educators. Together, the twenty TAP peer educators have written and presented a thirty minute play about peer pressure, stereotypes, and drug/alcohol use; co-sponsored the 51b Annual Family Fun Day in the Park to raise awareness ofHIV and serve as a fundraiser; continued to receive ongoing training; served on panels throughout the community; participated in school health fairs; given numerous presentations to adolescents in the community; and provided one-on-one street outreach to their peers. The TAP program coordinator and peer educators facilitate approximately 3-5 peer-led presentations per week to adolescents in different community groups. There is a waiting list of teens who want to participate as peer educators. Other staffin CDD have provided tremendous support for TAP through secretarial and administrative oversight, as well as assistance with training activities and transportation of peer educators. With the help of the Cape Fear Memorial Foundation, the health educator position and the TAP program can continue to access the hard-to-reach adolescent population. 7. Describe your organization's structure and attach a list of your officers and directors. See attached organizational diagram and Board of Health list. 28 e Revised: 4/30/99 CAPE FEAR MEMORIAL FOUNDATION GRANT APPLICATION FORM PART II: PROJECTIPROGRAM (Please quantify whenever possible.) I. Describe the problem/need that the program/project will address. e The problem that the TAP program will address is the lack of educational programs for adolescents that effectively change attitudes and behaviors. Nationwide, children between the ages of10 and 19 acquire an estimated 3 million cases ofSTDs each year. New Hanover County Health Department's SID clinic statistics demonstrate that the percentage of people under the age of20 visiting the NHCHD STD Clinic has consistently remained within the range of 16% to 23% since 1995 [Source: NHCHD Clinic Statistics, January 1995-March 31,2000]. Thus, one-fifth to one-fourth of all NHCHD STD clinic patients are under the age of20. By their very presence in the SID clinic, these teenagers are acknowledging that they are engaging in risky behaviors. In NHCHD's STD Quarterly Report from January 1, 2000 thru March 31, 2000, 27% of individuals diagnosed with gonorrhea were under the age of20, 20% of individuals receiving the mv test were under the age of 20, and 39% of chlamydia patients were under the age of 20. In addition to the negative repercussions of having an STD, the presence ofSIDs also increases a person's risk ofIllV transmission. According to the Centers for Disease Control and Prevention (CDC), S1% of new mv infections in the U.S. are among people under the age of2S. For this reason, targeting adolescents with mv prevention is tantamount to curbing the spread of this virus. Given the incubation period ofIllV, it can naturally be assumed that many of those who develop AIDS in their twenties and early thirties became infected as teenagers. Many of the behaviors associated with IllV transmission, such as alcohol and drug use as well as unsafe sexual practices, were developed as teenagers. The prevalence ofSIDs and mv have reached an alarming rate in both in North Carolina and in New Hanover County. Teens account for 3% of all reported AIDS cases within North Carolina, which is more than three times greater than the cumulative percentage for the United States. New Hanover County has an SID infection rate that is more than two times higher than the state average. e In April, 1999, the Search Institute published a report on New Hanover County adolescents entitled "Developmental Assets: A Profile of Your Youth." The Institute surveyed students in grades 6 through 12 at the New Hanover County Schools, Cape Fear 29 e Revised: 4/30/99 CAPE FEAR MEMORIAL FOUNDATION GRANT APPLICATION FORM Academy, and Myrtle Grove Christian School. According to the survey, 33% of the students used alcohol once or more in the last 30 days, and 20% of students got drunk once or more in the last two weeks. Twenty-three percent of students used marijuana once or more in the last 12 months, and 10% used other illicit drugs once or more in the last 12 months. Thirty-three percent of students have had sexual intercourse one or more times, and an alarming 22% of students have had sexual intercourse three or more times in their lifetime. e This report descn'bes the risk-taking behavior of youth living in New Hanover County. The TAP program is taking heed of these survey results, offering positive alternatives to teenagers so that they will be less likely to engage in these destructive activities. Each of the factors described above puts individuals at a greater risk of acquiring mv or other SIDs. For this reason, it is essential that peer-led educational sessions about drug and alcohol use, mv /SID prevention, relationships, and similar issues are available to this population so that they can form the foundation for adolescents to develop positive decision-making skills. NHCHD's decision to target the adolescent population was initially detennined in 1998 by the Southeastern North Carolina mv Prevention Regional Community Planning Group as the area population least served by existing HIV prevention education efforts. While Coastal Horizons Center, Inc. and Cure AIDS of Wilmington have programs that target injecting drug users and minority females of childbearing age respectfully, the NHCHD's TAP program has been the only local peer education program that specifically targets adolescents with mv /STD prevention education. 2. Descn'be the objective of the project/program and indicate how individual lives of the recipients will be changed and what benefits are expected to result. e The TAP program espouses three main goals- these goals, as well as the objectives, activities, outputs, and outcomes that arise out of these goals, are found in table format in Appendix A. The primary goal is to promote an environment in Wilmington and the surrounding areas where personal health, safety, and positive life skills are more socially and personally desirable to young people than unhealthy alternatives such as unsafe sexual practices and drug/alcohol abuse. Adolescents are constantly bombarded with peer pressure coaxing them to engage in negative activities: to have sex, to not use protection when they have sex, to try drugs, to drink alcohol, to smoke cigarettes, and so on. The purpose ofT AP is to give adolescents the opportunity to send positive messages to their 30 e Revised: 4/30/99 e e CAPE FEAR MEMORIAL FOUNDATION GRANT APPLICATION FORM peers to counteract all of the negative pressures. By providing information, teaching personal risk reduction strategies, and serving as role models for their peers, TAP peer educators help to foster a social climate where it is comfortable and acceptable for adolescents to avoid risky behavior. The TAP program aims to educate teenagers that the risk-taking behaviors that expose them to mv and other STDs also compromise their potential for healthy and productive adult lives. TAPis a life-skills curriculum that was developed for mv /STD prevention. Once these skills are learned, they apply to behaviors and experiences throughout life. The TAP program offers adolescents the information, skills, and self-esteem building exercises that lead to increased self-confidence, improved health, and attainment of life goals. The second goal is to empower adolescents to make a positive difference in their own and other teenagers' lives through education, leadership and being a role model for other teenagers. The TAP program currently consists of twenty peer educators. The six original peer educators trained fourteen new peer educators during a weekend training retreat. The training helped promote TAP's objective of empowering adolescents to honestly discuss issues and educate one other. The peer educators were interviewed and carefully selected by the TAP program coordinator, and share three main attnbutes: they demonstrate a zeal for helping their peers, they are dedicated to alleviating the problems faced by adolescents, and they come from communities and demographic groups that have been targeted as "at-risk" for mv and other STDs. In order make a difference in the community, it was essential for TAP to select peer educators who are the true peers of teenagers at risk of acquiring mv or other STDs, and not simply teenagers with active leadership roles in the schools. The twenty peer educators have been greatly impacted by the volunteerism and community service that they have provided through TAP. TAP has given these teens a message that their community values them and that they can make a difference in their own and other teenagers' lives. One TAP peer educator, Gordon, who facilitates TAP presentations every Wednesday morning at the Juvenile Detention Center, stated that TAP has shown him the ''power of one," that he alone can make a difference. As an African- American male, Gordon feels that he is making an impact by serving as a positive role model for the African-American males in the detention center. Adolescents in the detention center respect Gordon and his messages of prevention, and openly and honestly discuss the issues that he raises with them. Through continued support, skill-building, and discussions, TAP has encouraged its peer educators to reach beyond themselves and become leaders in their community. At the 31 e Revised: 4/30/99 e e CAPE FEAR MEMORIAL FOUNDATION GRANT APPLICATION FORM same time, TAP staff provide guidance and mentoring to peer educators to encourage them to practice positive life skills and reach their goals. The subgroup of teens targeted for TAP training falls in the category of financially needy and medically underserved. Some of the TAP peer educators come from single parent homes and some lack an adult mentor. The TAP coordinator serves as an adult mentor for them, helping them through crises and periods of doubt in themselves. Some of the peer educators have stated that TAP has given them a sense of meaning in their lives- a positive force to outweigh the negativity that surrounds them in their violence-torn, impoverished neighborhoods. TAP provides an opportunity for teenagers to develop a higher sense of self-esteem. Research shows that teenagers who have a higher self-esteem, as well as a supportive adult mentor, are less likely than other teenagers to engage in behaviors that put them at risk for HIV and other STDs. One peer educator, a college freshman named Megan, asserts that TAP has made her into a stronger person. Through the information, skills, and assertiveness training that she has gained from TAP, Megan has learned to assert herself and express her feelings to her boyfriend, which has enhanced their relationship. The third goal is to facilitate the exchange of ideas and open communication between TAP-trained teens and their peers, and provide opportunities for question and answer sessions. TAP presentations have enabled hundreds of teenagers to discuss issues of concern to them in an environment where they receive both correct information and respect for their opinions. For example, peer educators facilitated TAP workshops for teenage residents of Nesbitt Courts in Wilmington every Thursday afternoon during the school year. Stereotyped as "uneducated," "criminal-looking," and ''unmotivated,'' the program participants nonetheless demonstrated a strong desire for knowledge. The opportunity to discuss issues of concern to them such as violence and relationships was as important as the messages about HIV prevention. In particular, the male participants enjoyed listening to an African-American male peer educator talk frankly with them about relationships, dmgs, and alcohol. By the end of the school year, several program participants were motivated enough to prepare and facilitate parts of the workshops, demonstrating the hypothesis that if teenagers are given the attention and the opportunity to succeed, they will rise to meet expectations. Teenagers around Wilmington often comment that they are bored, and that they get into trouble for lack of anything better to do. The majority of adolescent pregnancies occur between the hours of3 pm and 6 pm, because adolescents are bored and lack adult supervision. The TAP program helps to combat this problem by providing adolescents with options to keep them occupied. TAP peer educators benefit the most from their hours giving presentations in the community; program participants, however, also benefit 32 e Revised: 4/30/99 CAPE FEAR MEMORIAL FOUNDATION GRANT APPLICATION FORM by being engaged in constructive activities. TAP presentations are composed entirely of interactive activities that challenge program participants to think through problems and express their opinions. TAP peer educators often include question and answer sessions in their presentations. Index cards are passed out to program participants and collected to ensure the anonymity of questions. Questions recently asked at a session at the Juvenile Detention Center include "How do you know if you can trust someone?" "How can you stop doing dmgs?" and "Why should you stay a virgin before marriage?" These questions reveal that teenagers welcome the opportunity to talk with and listen to other teenagers. Many of the questions typically center around dating and relationships. In feedback and evaluations from presentations, we have learned that it has been extremely helpful for teenagers to learn from their peers that healthy relationships are about self-respect, respect for the partner, and open communication. e The Advocate, a newsletter sponsored by the Adolescent Pregnancy Prevention Coalition of North Carolina, printed the results ofa survey of parents and kids ages 10-15. The survey, conducted by the Kaiser Family Foundation and Children Now, revealed that 50% of the children said that they personally wanted more information about how to protect themselves against HIY/AIDS. Too often, adults do not offer teenagers the chance to discuss their concerns about health and relationships, or teenagers are uncomfortable being candid with adults. TAP provides teenagers with this opportunity in a safe environment, assisted by a health educator who can provide them with referral and resource information. e 33 e Revised: 4130/99 e e CAPE FEAR MEMORIAL FOUNDATION GRANT APPLICATION FORM 3. Describe the strategies you will develop to accomplish the objective. The Centers for Disease Control (CDC) has conducted research to determine effective strategies to reduce the risky behaviors of adolescents. Based on current data, the most effective prevention strategy to reduce high risk behaviors among adolescents is to train peer leaders to provide prevention messages to at-risk youth. According to the National Campaign to Prevent Teen Pregnancy, peer pressure can be a positive influence to assist adolescents in making smart choices to avoid behaviors that put them at risk for HlV and STDs. One proven strategy is a series of programs for small groups of adolescents, largely conducted by peer leaders. This research-based evidence directed the development of the TAP program. The TAP coordinator has identified and trained twenty adolescents as peer leaders. These adolescent educators range in age from 14-21; six are male and fourteen are female. Twelve of the peer educators are African-American, five are Caucasian and three are Latino. One of the peer educators is H1V-infected, and acquired HIV perinatally. The health educator selected the peer educators from various community sites, including Cure AIDS of Wilmington, Girls, Inc, the YMCA's Black Achiever's Program, the youth group at Union Baptist Church, the Latino youth group at St. Mary's Catholic Church, and the schools. Each peer educator received a curriculum, designed and compiled by the TAP peer educator. The educators use four methods to reach the target population: a series of small group programs, community outreach, a play, and one-on-one outreach. Included in the series of programs is basic knowledge ofHlV/STDs and identification of risky behaviors. The most challenging component is in building support for safer behaviors. The following topics are included in the sessions: determining benefits and barriers to behavior changes, assessing individual personal risk behaviors ( not openly), and identifYing life goals and priorities and how to reach them Skills building is an integral part of the series, assisting adolescents in developing methods of resisting external pressures and exercising internal control over behavior decisions. TAP peer educators are encouraged to follow the curriculum closely so that HIV prevention messages are intertwined with strategies to improve the self-esteem, confidence, and decision-making capabilities ofprograrn 34 e Revised: 4/30/99 CAPE FEAR MEMORIAL FOUNDATION GRANT APPLICATION FORM participants. The TAP program coordinator attends each of the peer-led sessions and offers support when needed. TAP peer educators prefer to conduct at least six consecutive sessions; however, the quantity of program sessions is flexible in order to adapt to the schedules of collaborating agencies. Whenever possible, the TAP coordinator arranges to schedule four or more sessions at organizations requesting presentations. Research has demonstrated that the effectiveness of health-related educational messages is maximized by repeating sessions. Repeat sessions are also necessary in order to involve program participants in the curriculum's interactive games and exercises. e Since its inception in January, 1999, TAP peer educators have given presentations to over 2,000 teenagers. Collaborators who have utilized TAP for programs include: Cure AIDS of Wilmington, Girls, Inc., the Juvenile Detention Center, the teen pregnancy division of the Coastal OB/GYN Clinic, the Adolescent Parenting Program of Planned Parenthood, Hope Baptist Church, St. Andrews AME Zion Church, St. Luke AME Zion Church, Soul-Saving Station Church, Grace United Methodist Church, the Community Boys and Gilrs Club, the YWCA, the YMCA summer job program, Coastal Horizons, Wilmington Health Access for Teens, Student Action for Farmworkers, Cape Fear Academy, Nesbitt Courts Recreation Center, W1lmington Treatment Center, Crisis Line Open House, and the Creekwood Festival Committee. TAP facilitates two programs on a regular basis. One of these programs is held every Wednesday morning during the health class at the Juvenile Detention Center. The other program takes place every Thursday after school, during the school year, at the Nesbitt Courts Recreation Center. Teens presenting at these two sites give workshops on a variety of topics, such as violence prevention, dating abuse, values clarification, mv facts and information, and dealing with the consequences of risky behaviors. TAP travels beyond Wilmington's city limits in order to reach teenagers. For example, on June 25,2000, TAP teens gave a presentation to a church in Duplin County. TAP has also traveled to a camp near Fayetteville to give a series of two presentations to 53 adolescents participating in a Student Action for Farmworkers conference. The participants, all of whom were Latino and the children ofrnigrant farrnworkers, rated the TAP presentation as one of the highlights of the weekend conference. e The second method of reaching adolescents is through outreach activities. On December I, 1999, TAP sponsored an awareness campaign for World AIDS Day. Peer educators 35 e e e Revised: 4/30/99 CAPE FEAR MEMORIAL FOUNDATION GRANT APPLICATION FORM held educational booths at the three local high schools and at University of North Carolina at Wilmington. At these booths, the educators passed out AIDS remembrance ribbons, encouraged peers to stay safe, and asked students to guess the number ofM & M's in a jar, which represented the number of individuals in New Hanover County infected with mv. TAP peer educators spoke to approximately 900 students on World AIDS Day. TAP also held a booth at the Hoggard High School Health Fair. Every student who walked by the booth was encouraged to spin the "Wheel of Fortune" and answer questions such as "How can you prevent yourself from acquiring mv?" TAP peer educators talked with over 500 adolescents during the health fair . TAP has participated in II outreach activities that reached approximately 2500 individuals. If funded, TAP plans to continue to participate in health fairs and other outreach activities in the community. The third method of reaching adolescents is through drama. With the support ofGJoria Crist of the DREAMS program, two TAP peer educators wrote a thirty minute play about peer pressure, stereotypes, sexuality, relationships, and alcohol abuse. Gloria Crist directed rehearsals of the play for the fifteen peer educators-turned-actors. TAP has performed the play at two venues: the Adolescent Pregnancy Prevention program, entitled Let's Talk Night, at Girls, Incorporated; and the Family Fun Day in the Park, which was a community event designed to bring families and the community together for an afternoon offree live music and family-based entertainment. If TAP is refunded, we will continue to perform the play around Wilmington and hope to present the play in the New Hanover County schools. The fourth method of educating adolescents is through one-on-one street outreach. TAP peer educators are encouraged to provide one-on-one infonna1 education to their peers, sharing H1V and SID prevention education with other teenagers. Peer educators are also trained to provide their peers with support and referrals for teen issues such as depression, pregnancy, and substance abuse. At this time, peer educators have talked with 121 of their peers in these one-on-one sessions. With additional funding, TAP aims to provide 200 more one-on-one sessions by October, 2001. In the future, TAP hopes to increase its outreach by collaborating with local media programs in order to encourage the media to insert more safer sex, abstinence, and tobacco prevention messages on their shows. Two peer educators are currently writing a proposal to submit to the producer of Dawson's Creek, inviting him to meet with TAP and listen to teenagers who want more positive, health-related messages on their shows. With future funding, we would like to increase our community awareness campaigns and media interventions through similar strategies. 36 e Revised: 4/30/99 CAPE FEAR MEMORIAL FOUNDATION GRANT APPLICATION FORM The TAP peer educators and staff meet weekly to discuss ideas and practice presentations. Each week, a different teen practices giving a presentation to the group. This strategy introduces the peer educators to different games and activities and provides feedback and constructive criticism to each presenter. The peer educators take advantage of opportunities to expand their knowledge base. They attended Youth Sunnnit 2000, which was sponsored by the Teen Leadership Experience. Three of the peer educators received additional training as T ATU (Teens Against Tobacco Use) peer educators. e TAP has the support of its collaborating organizations. The TAP coordinator is a member of the Cape Fear Region Adolescent Health Council, sponsored by Wilmington Health Access for Teens. In addition, TAP collaborates with CARE (Coastal AIDS Resource Efforts), which is a volunteer program that offers services and activities for people infected or affected by HIY. Ten TAP peer educators volunteered for the CARE Easter Egg Hunt for HIV -infected children. Peer educators also volunteered at a CARE party and at the day camp sponsored by CARE for children infected or affected by my. In addition to providing CARE with volunteer assistance, the partnership has served as an opportunity for peer educators to get to know people living with AIDS. The TAP program works closely with other NHCHD services. The TAP coordinator is responsible for contacting teens seen in the NHCHD SID program to provide individual risk reduction education and referrals to TAP programs. Conversely, referrals for my and SID screenings at the health department are made by TAP peer educators when indicated. With future funding, TAP hopes to train eight new peer educators by October, 2001. This will bring the total number of trained peer educators up to twenty-eight. Since TAP's inception in January, 1999, peer educators have facilitated seventy presentations at 24 collaborating agencies. With future funding, TAP plans to conduct at least 50 more presentations for at least 25 community groups or agencies by October, 2001. With funding, TAP aims to reach at least 1,000 more youth through presentations by October 31,2001. TAP has the support of the staffand teen residents of Nesbitt Courts to facilitate weekly workshops at their recreational center during the next school year. With funding, TAP peer educators will continue to facilitate weekly presentations to youth at the Juvenile Detention Center. e Currently, TAP gives presentations on almost a daily basis; it is not uncommon for TAP to provide two presentations on a given day. TAP receives daily requests for presentations. The majority of these requests come from organizations that have heard about TAP from 37 e Revised: 4/30/99 CAPE FEAR MEMORIAL FOUNDATION GRANT APPLICATION FORM other agencies or professionals who were impressed by the presentations. Recently, two TAP peer educators gave a presentation for an outpatient teen substance abuse support group at Coastal Horizons. We were invited to give only one presentation; nevertheless, the day after the presentation, the program coordinator called TAP requesting a repeat presentation the next week. All of the group participants told her that they enjoyed the participatory nature of TAP activities and wanted another session With future funding, TAP can continue to provide ongoing sessions to community groups and can increase the number of collaborating agencies. 4. State how, when, and who will conduct an evaluation to measure how well your project/program is meeting its objectives. e TAP staffwill administer a standardized pre- and post-test behavioral questionnaire to all program participants. The post test will be administered to all program participants three months after their attendance at a TAP presentation. TAP peer educators will be required to complete the pre-test behavioral questionnaire before they begin their training. They will then complete the post-test every three months afterwards. In addition, pre- and post-test instruments that measure knowledge have been designed for use by peer educators before and after they complete 40 hours of training. Project documentation and pre- and post-test data will be analyzed and compiled in a final project report. Role plays and interactive games are used throughout the series to not only liven the presentations, but also to assess the participants' abilities to apply the information learned. Program participant complete an evaluation form after presentations, so that peer educators can assess skills that need improvement. Program data is collected by peer educators throughout the project using forms to document the number of education sessions conducted, the type of activity performed, the location of the activity, the number of participants or contacts, the characteristics of groups of individuals receiving the information, and referrals made. The TAP Coordinator monitors this data collection. e 38 e e e Revised: 4/30/99 CAPE FEAR MEMORIAL FOUNDATION GRANT APPLICATION FORM IPART III: FINANCIAL INFORMATION I. Amount requested from Cape Fear Memorial Foundation. $55,000 for October 1, 2000 to October 1, 2001 $55,000 for October 1, 2001 to October 1, 2002 2. Develop a complete project/program budget, including income and expenses, for the period you are requesting funds (see attached format). Also, please attacb a copy of your most recent audit or financial statement witb tbis application. See attached budget. 3. List the names of organizations, both public and private, to which you have applied for support for this specific project/program. Also, show the amount requested and the status (pending, approved or disapproved). Orl!anization Elizabeth Taylor AIDS Foundation MetLife Foundation For All Kids Foundation Design Industries Foundation Fighting AIDS Z. Smith Reynolds Foundation Ford Foundation Amount $55,000 $55,000 $55,000 $55,000 $55,000 $55,000 Status Pending Pending Pending Pending Pending Disapproved Other We have sent out letters of inquiry to seven foundations requesting a grant application for the TAP program. At this time, we have received responses from three out of these seven foundations. In addition to your foundation, MetLife Foundation and Z. Smith Reynolds Foundation have invited us to submit proposals. The Ford Foundation said that they were not currently funding projects such as TAP, so they did not invite us to submit a proposal. We will submit full proposals to MetLife Foundation and Z. Smith Reynolds Foundation, and are waiting to receive responses to our letters of inquiry for the Elizabeth Taylor AIDS Foundation, For All Kids Foundation, and Design Industries Foundation Fighting AIDS. In addition to these grant applications, we have written 5 letters of inquiry to request grant applications to fund the transitional counseling program descnbed in question 4 on the 39 e Revised: 4/30/99 CAPE FEAR MEMORIAL FOUNDATION GRANT APPLICATION FORM following page. Z. Smith Reynolds Foundation and the Elton John AIDS Foundation have invited us to submit grant applications; we are waiting to hear responses from the A.J Fletcher Foundation, Until There's A Cure Foundation, and the Public Welfare Foundation. In the unlikely event that funding is obtained from one of these foundations, Cape Fear Memorial Foundation will be notified. Cape Fear Memorial Foundation can direct us to expand TAP and submit additional budget information or recall unexpended funds. The TAP program could be strengthened and expanded by additional funding. There is more to be done than money to do it, and the potential for TAPis such that overfunding will not be a problem. Total e e 40 e e e Revised: 4/30/99 CAPE FEAR MEMORIAL FOUNDATION GRANT APPLICATION FORM 4. Describe how your project/program will become self-sufficient within three years. TAP may never be self-sufficient because it is a program for teens, and there are not likely to be opportunities to receive third party payment or charge for services. Because it is a service program and especially because of the population served, there will always be a need for funding. The presentations are given at sites not likely to be able to be charged if we expect to continue to reach our targeted population. TAP fund-raising activities this year raised $3,166.27, with a $2000 donation from a pharmaceutical company. This money was used along with the Communicable Disease Division budget to support activities, while the Cape Fear Memorial Foundation money was used to pay the TAP coordinator's saIary- the most critical ingredient to TAP's success. There were discussions held with WHAT earlier in the year, and we mutually agreed that TAP should not be integrated into the WHAT peer education program. The groups are very different, the TAP presentations are meant to be done as a series, the TAP curriculum is very focused, and the TAP peer educators want their identity. That evolution mayor may not occur later, but certainly will not occur if the peer educators are not comfortable in the transition. There were too many successes to risk fuilure by trying to move TAP to WHAT. The groups collaborate on some programs and learn from one another, which will continue. TAP is a long term investment in our teenagers. It takes years to change attitudes and behaviors in a society full of negative messages. That does not deter TAP but rather magnifies the necessity for efforts to continue TAP in this community. As descnbed in the evaluation section, we will be using standardized behavioral measurement instruments to measure the success rate ofT AP. Thus, over time we hope that the results of the evaluation will offer scientific evidence of the impact of our program, which will help with funding efforts. We are looking for alternative ways to fund the TAP program, including the possibility that TAP can be partially funded by several organizations. Ideally, TAP needs permanent and stable funding. As TAP continues to perform well in this community, it is our hope that our community collaborators and partners will assist us in supporting our efforts for either county or private funding for the TAP program, so that fund-raising and grantwriting does not take time away from TAP activities. 41 e Revised: 4/30/99 CAPE FEAR MEMORIAL FOUNDATION GRANT APPLICATION FORM We are also applying for funding to create a position to provide enhanced counseling services for newly identified mv positive individuals and for repeat SID clinic users. As TAP peer educators become more accomplished and more are trained, the hope is that the role of TAP coordinator can be less than full-time and be combined with the enhanced counselor position, which would also require less than full-time duties. We are asking for two years of funding from the Cape Fear Memorial Foundation in order to give us the time to secure funding for the enhanced counselor position. Because it requires years to change attitudes and behavior, we request two year funding in order to give our evaluation measurements the opportunity to demonstrate valid program results. We hope that once these results are documented, either county or private funders will be willing to support our continuing efforts. e We welcome suggestions from Cape Fear Memorial Foundation on how to move TAP to a self-sufficient program and commit to pursue other avenues. NHCHD is extremely appreciative of the gift from your foundation and recognize that your generosity allowed us to continue this important work. 5. If the funds are to be used for construction or equipment acquisition, explain the bidding process. N/A e 42 e e e Revised: 4/30/99 CAPE FEAR MEMORIAL FOUNDATION GRANT APPLICATION FORM I PART IV: REPORTING REQUIREMENTS Do you agree to furnish to Cape Fear Memorial Foundation, in a timely manner, periodic progress reports informing the Foundation of the progress made by your _ project/program? If Progress Report forms are enclosed for projects previously funded for which an annual report has not yet been made, please complete the forms and return with this Application. SUBMITTED BY: David E. Rice, Health Director Typed Name of Chief Executive Officer of Requesting Organization Signature of Chief Executive Officer Date Health Director Title William T. Steuer,. Chairman, New Hanover County Board of Health Typed Name of Chairman .of the Board of Directors Signature of Chainman of the Board of Directors Date Signature of Chief Executive Officer and Board Chairman is required for Application to be viewed as complete. Completed Application must be received in the Office of Cape Fear Memorial Foundation by 5:00 p.m. on the cutoff date for each grant cycle. The cutoff dates are January 15 and July 15 annually. 6 43 CAPE FEAR MEMORIAL FOUNDATION GRANT APPLICATION FORM e Part III: Question 2 Attachment, Project/Program Information Develop a complete project/program budget, including income and expenses for the period you a re requesting funds as shown below: Project Budget: From October 1. 2000 To SeDtember 30.2001 Expenses (by Category) Income (by Sources) Salaries/Wages ... .., $30,032 Fringe Benefits . . .,. 8,455 Total . . . . . . . . . . . . . . . . . . . . $38,487 Cape Fear Foundation . $55,000 e Operating Expenses Postage........ . . $300 Printing .... ..... .. 500 Dept. Supplies. .. . 13,685 Employee Mileage . . 878 Training/Travel . . . 3,750 Cellular Expense .,. ., .., 400 Total Operating Expenses .. $16,513 TAP Peer Educator Fundraising Activities ...3,000 Totallncome .............. $58,000 NHCHD In-Kind Support. . . .. $20,974 TOTAL... . . . . .. .... .. . .., $58,000 . NHCHD In-Kind Support Management Support 2 hrslwk x 52 wks x $12/hr Fringe (25%). ..... . . Administration 5 hrslwk x 52 wks x $25/hr Fringe (25%) . .. ... ... Professional Staff Support - 4 hrslwk x 52 wks x $25thr Fringe ......... . . . .. ., 1,300 Space (36 sq ft x $7/sq ft x 12 mo) .. . 3,024 Telephone ............. . .. 200 Utilities .. ...... .. ... ....600 CopierSeNices....... .......300 Employee Mileage .. . .. . ... 165 Dept. Supplies. . . .. ..... 500 Totalln-Kind ............. $20,974 1,248 . 312 .6,500 .1,625 ...5,200 Total Budget: $78.974 e Total Expenses: ........... $78,974 Collaborating agencies will contribute in-kind space and staff for programs. 44 e e e CAPE FEAR MEMORIAL FOUNDATION GRANT APPLICATION FORM Part III: Question 2 Attachment, Project/Program Information Develop a complete project/program budget, including income and expenses for the period you a re requesting funds as shown below: Project Budget: From October 1, 2001 To SeDtember 30. 2002 Expenses (by Category) Income (by Sources) Salaries/Wages . $31,534 Fringe Benefits .... 8,829 Total. .. . .. . . .. . . . . . . . .. . $40,363 Cape Fear Foundation $55,000 Operating Expenses Postage $300 Printing .. .. ... . 500 Dept. Supplies 13,685 Employee Mileage . 878 TraininglTravel ... 3,750 Cellular Expense. . . .. 400 Total Operating Expenses .. $19,513 TAP Peer Educator Fundraising Activities 3,000 Other Funding Sources . 1,876 Total Income .............. $59,876 NHCHD In.Kind Support. . . .. $20,974 TOTAL. . . . . .. . .. . . .. .. ... $59,876 NHCHD In-Kind Support Management Support 2 hrslwk x 52 wks x $121hr 1,248 Fringe (25%) . . . . . . .. ..... 312 Administration 5 hrslwk x 52 wks x $25/hr . Fringe (25%) . . . Professional Staff Support ... 4 hrslwk x 52 wks x $25/hr Fringe . Space (36 sq ft x $7/sq ft x 12 mo) . 3,024 Telephone . . .. . .. ... 200 Utilities .. . ...... 600 Copier SeNices . . . . . . 300 Employee Mileage .. 165 Dept. Supplies 500 Total In-Kind ............. $20,974 6,500 . 1,625 .5,200 ., 1,300 Total Expenses: ........... $80,850 Total Budget: $80.850 Collaborating agencies will contribute in-kind space and staff for programs. 45 , Ie I APPENDIX e e 46 e e e GOALS, OBJECTIVES, ACTIVITIES, ANDOUTCOHESOFTAP PIlOGIlAH 47 e e e Goal # 1: Promote an environment in Wilmington where personal heahh, safety, and positive life skills are more socially and personally desirable to young people than unhealthy alternatives such as unsafe sexual practices and drug/alcohol abuse. Objectives I. To ensure that 85% of adolescents who attend TAP's series of presentations score at least 90% on a standardized behavioral post-test. 2. To ensure that 80% of program participants report choosing abstinence or safer sexual practices 95% of the time, as measured by a follow-up survey administered to each program participant three months after they attended TAP's presentations. Activities I. Give TAP peer-led presentations to at least 25 community groups by October 31, 2001. 2. Teach peer educator-led weekly health classes at the Juvenile Detention Center. 3. Communicate with local media representatives, i.e., Dawson's Creek production staff, to encourage media to insert more safer sex, abstinence, and tobacco prevention messages into shows. 4. Participate in health fairs and public events. Outputs I. TAP presentations to 25+ adolescent service community groups by October 31, 200 I. 2. Approximately 24 weekly TAP peer-educator facilitated presentations to the Juvenile Detention Center. Outcomes Initiol I. Teenagers knowledgeable about my & STDs and how to prevent infection. 2. Youth made aware of skills in conflict resolution, decision making, communication, assertiveness, and other relevant topics. 3. Local media programs learn that teenagers want positive, health-related messages on their shows. 4. Increased awareness of TAP program and TAP's prevention messages in community. Intermediate I. Teenagers take active steps to prevent themselves from acquiring my I STDs. 2. Teenagers utilize conflict resolution, decision making, communication, assertiveness, and other skills learned in TAP workshops. Long-term I. Adolescents of varied racial/ethnic groups and social classes in Wilmington encourage peers to practice positive life skills and prevent spread qfmy & STDs. 2. Local media portrayals & TAP's community awareness campaigns positivelyinfIuence adolescents. 48 e e e Goal #2: Empower adolescents to make a positive difference in their own and other teenagers' lives through education, leadership, and being a role model for other teenagers. Objectives I To ensure that 95% of peer health educators report practicing abstinence or safer sexual practices, as measured by a behavioral questionnaire administered every 3 months. 2. To ensure that 95% of peer heahh educators score 90% or higher on a knowledge test after a 40- hour training period. Activities I.Hold weekly meetings for peer educators. 2. Provide ongoing training to 20 current peer educators. 3. Train 8 more peer educators by October 31, 2001. 4. Collaborate with the DREAMS program to teach drama skills to peer educators. 5. Conduct teen-led brainstorming sessions to decide the most effective strategies and locations to reach other teenagers with prevention messages. Outputs I. Twenty current peer educators increase their number of presentations. 2. Eight additional peer educators are trained. 3. TAP peer educators perform play for other teens that deals with peer pressure and alcohol abuse. Outcomes Initial I. Twenty current peer educators increase knowledge and comfort level giving presentations. 2. Eight new peer educators learn information to help them give presentations. 3. Peer educators learn drama skills. Intermediate I. Twenty current peer educators and eight new peer educators increase the quantity and quality of their presentations, making TAP messages more effective and widespread. 2. Peer educators utilize learned behavioral skills that they teach to program participants. 3. Peer educators perform plays to a variety of adolescent groups throughout Wilmington. Long-term I. Peer educators benefit from volunteerism, community service, and leadership that they provide. 2. Peer educators receive message that their community values them and that they can make a positive impact on community. 3. Peer educators receive guidance and mentoring from staff to encourage them to practice positive life skills and reach their goals. 4. Adolescents throughout community are exposed to positive messages of TAP plays. 49 e e e Goal #3: Facilitate the exchange of ideas and open communication between TAP-trained teens and their peers, and provide opportunities for question and answer sessions. Objectives 1. To ensure that 85% of evaluations of presentations give a score of "excellent" for the category "overall rating of presentation." 2. To receive requests to return for additional presentations from 80% of organizations visited. Activities 1. Give series of TAP presentations to teens in church youth groups, agencies, public housing projects, after school programs, summer job programs, and other locations. 2. Provide updates to peer educators so that they can learn current facts. 3. Peer educators initiate one-on-one educational sessions with peers. Outputs 1. At least 1,000 youth attend a TAP presentation by October 31, 200 I. 2. Approximately 200 youth receive one-on-one educational sessions by October 31, 2001. Outcomes Initial I. Youth learn that they can ask questions about issues relevant to adolescents in a safe environment. 2. Peer educators learn the most current health-related information to inform audiences. 3. Adolescents become familiar with who the peer educators are in their community. Intermediate 1. Adolescents take the active step of reaching out to peer educators and asking them questions of concern to them. 2. Peer educators share the most current information about health-related topics with peers. 3. Peer educators share their knowledge and skills one-on-one with friends and acquaintances. Long-term 1. Young people integrate the information and skills learned in TAP workshops into their daily lives, following prevention messages and behavioral skills. 2. Adolescents comfortably talk with their peers and receive correct facts and information from one another in a respectful manner, about issues of concern to them such as relationships, sexuality, and peer pressure. 50 I Ie ATTACHMENTS e e 51 e e e NEW HANOVER COUNTY HEALTH DEPARTMENT July 1, 1999 Director II (i) , 1 i Assistant I i Director I I (i) I Administration , Community I i Communlcable NutrltionlWlC I I i- (6) I Health ,..' Dlsea.. I- (11) I (27) (27) I . Animal Control I Dental Health Women's (17) -I Health ,.. Promotlonl L- Health Care (i) I (4) (24) Child Health I! Environmental 1-1 Laboratory , (11) "'"I Health I (7) I i (22) I I Employees .. .167 " " 52 e NEW HANOVER COUNTY HEALTH DEPARTMENT - COMMUNICABLE DISEASE DIVISION July 1, 1999 e Public H..1th Nurs. Director II (1) I TUBERCULOSIS I I I Public i Public , PhYllcl.n II Admlnlltratlv. , H.olth I! I Health Nurs. III Hi Hullh NurlO II I E,t.ndor Alllltont III Educ.tor , i (11 I i (Clinic Coordinator) : (1) (1) (1) (1) , , ! ~I Public H.olth ; Public H.olth Nurs. I i Admlnlltrotlv. ! Nurl.1I (1) ! Alllltont II . II , i I (5) , (1) I I ; , , i i LPN II I Communicable (1) ! D...... Control ! i CI.rlcal I spoclollst I 'peelollstl , (1) . (8) , Ii ~ Cl.rlcal ; XoRor I Tochnlclon 'peelollstll ! f-! (1) I (1) I I Ii ; ; . LPN II j CllnlcallCl.r1col , Alllltonl I (1) ~ .... ! i (1) ~ ! Employees" 27 " e " 53 e e e NEW HANOVER COUNTY BOARD OF HEALTH William T. Steuer, PEIRLS, Chair 5710 Oleander Drive, Suite I) 0 Wilmington, N.C. 28403 Wilson O'Kelly Jewell, DDS, Vice Chair 218 Pine Grove Drive Wilmington, N.C. 28403 Henry V. Estep 3500 Melissa Court Wilmington, 28409 Michael E. Goins, OD 5030 Randall Parkway Wilmington, N.C. 28403 Robert G. Greer 1218 Country Club Road Wilmington, N. C. Gela N. Hunter, Nurse Practitioner 126 Quail Ridge Road Wilmmgton, N.C. 28409 W. Edwin Link, Jr. RPH 306 Colonial Drive Wilmington, N.C. 28403 Anne Braswell Rowe 2216 Acacia Drive Wilmington, N.C. 28403 Philip P. Smith, Sr., MD 1810 Azalea Drive Wilmington, NC 28403 Melody C. Speck, DVM 4605 Wrightsville Avenue Wilmington, NC 28403 Estelle G. Whitted, RN 1611 Rock Hill Road Castle Hayne, N.C. 28429 Frank Reynolds, MD 1706 Fairway Drive Wilmington, N.C. 28403 " .' 1/4/99 54 e e e ~-+EALlI-l NEW HANOVER COUNTY BOARD OF' CG.u11l1 :IIINERS REQUEST FOR BOARD ACTION Meeting Date: 0711:11 100 Department: Health Presenter: Lynda Smith, Assistant Health Director Contact: Lynda Smith, 343-6592 SUBJECT: Grant Application for second year funding for DIABETES TODAY IDIABETES COALITION from Diabetes Today Community Implementation Funds through the Diabetes Prevention and Control Unit of the North Carolina Department of Health and Human Services, Division of Public Health ($10,000). BRIEF SUMMARY: In September, 1999 we received a $10,000 grant from the North Carolina Department of Health and Human Services, Division of Health, Diabetes Prevention and Control Unit, to establish a community diabetes coalition_ The purpose of the Coalition was to plan Community-based interventions to increase community awareness regarding the severity and consequences of diabetes by focusing on education, outreach and improving access to care. The Coalition has developed goals and objectives and is seeking second year funding to continue and implement planned interventions. We have just received and are writing the grant application. We are notifying you of our intent to apply for the second year funding of $10,000 and are requesting your approval The completed application including a budget page will be completed and sent in the Board of Health packet for the July 12, 2000, meeting. RECOMMENDED MOTION AND REOUESTED ACTIONS: Approve grant application for $10,000 for second year funding and approve the related budget amendment for $10,000 if grant awarded. FUNDING SOURCE: Diabetes Prevention and Control Unit.North Carolina Department of Health and Human Services, Division of Public Health ATTACHMENTS. Yes.4 pages. memo and 3 page grant application 55 e North Carolina Department of Health and Human Services Division of Public Health 1915 Mail Service Center < Raleigh, North Carolina 27699-1915 1330 Saint Mary's Street < Courier 56-23-01 Ann F. Wolfe, M.D., M.P.H., Director June 14,2000 David E. Rice New Hanover County Health Department 2029 South 17th Street Wilmington, North Carolina 28401 Courier 04 1737 SUBJECT: Diabetes Funds _ Request for Application Due July 14, 2000 Dear Mr. Rice: The Diabetes Prevention and Control Unit (DPe) is requesting applications from local health departments who arc interested in developing and implementing a community based diabetes initiative. Approximately ten awards for up to $10, 000 will be provided for a one-year period with the potential for funding for two additioual years based on performance. All awards will be based on the availability of State llDd federal funding. Enclosed arc a copy of the Request for Application (RF A) and a description of the Diabetes Today pI.nning Initiative. Also provided is a copy of the Diabetes Today Map representing counties previously funded for Diabetes Today, as well as, counties with churches that arc participating through the General Baptist State Convention Partnership. e Participating local health departments have implemented a variety of initiatives, including support groups, training for health professionals, health fairs, diabetes awareness campaigns, nutrition and weight management classes and exercise programs for persons with diabetes and their family members. Churches participating in the Diabetes Today Program have hosted diabetes workshops, presented brief awareneas messages during worship services, distributed educational materials'to membera, spoDSOred health fairs. As you develop your RFA remember to keep objectives clear, precise and realistic. Your efforts will be evaluated and your success will impact future funding opportunities. If you have questions about the Diabetes Today Program or would like additional information on any activities sponsored, please contact the program's coordinator Ann Dixon, Education and 'Community Development Specialist at (919) 715-4544. Sincerely, ~ 9~ :r- Joyce Page, MSPH, MPH Director Diabetes Prevention and Control Unit encl. cc: Nursing Director Leah Dev1in, DDS, MPH Betty Wiser, EdD Dennis Harrington, MPH Joy Reed, EdD, RN e ~ EvetyWhere. EveryDay. EveryBody. x All Equal OpportU1llty / Affirmative ActIoII Employer 56 ~ e Goals and Objectives The New Hanover Diabetes Today Coalition set two broad goals aimed at reducing the burden of diabetes in New Hanover County' Educating Patients and Communicating with Physicians. During the training sessions, the Coalition narrowed its focus to a target audience and two priority complications. The target audience is African Americans aged 45-64. The two priority complications are diabetic eye disease and diabetic foot problems. Using the Diabetes Today model, the Coalition developed intervention objectives. Those objectives have determined the activities for the second year operations. Goal I : Educatinl! Patients Because one third of those with diabetes are not aware that they have diabetes, the Coalition set the following Intervention Objective: Distribute information and care cards to 20% of the target population. There are 7,252 African Americans between the ages of 45 and 64 in New Hanover County. 20% of that group is 1450 people. Goal 2: Communicating with Physicians. e Patients under the care of endocrinologists and diabetes educators are well-informed and their diabetes can be managed well. Most people, however, receive health care services through primary care physicians who do not specialize in treating diabetes or its complications. It is likely that the 6.6% of the target audience with diabetes also receives their primary health care from primary care providers. To assist family medicine practitioners and internists, the coalition set the following Intervention Objective: Reach 100% of primary care physicians with diabetes care information. There are 57 internal medicine and family practice offices in New Hanover County representing approximately 150 primary care physicians. e 57 e Timeline. Two major intervention activities are in the planning stages. November 2000. Take Control Day Taking advantage of election day publicity, citizens will be urged to Take Control of Your Political Needs and Your Physical Health Needs. Nursing students and :liiculty from UNCW School of Nursing and Cape Fear Community College will collaborate with New Hanover County Health Department nurses and the Diabetes Today Coalition to provide community health education. Do you know what your blood pressure is? Have you had your flu and pneumonia vaccine? Do you know what you need to take care of if you have diabetes? Do you know what your feet and eyes have in common (besides you)? Do you know what an Al C test is? e Teams of people will be strategically located throughout the community to reach members of the target audience. Coupons will be issued for blood pressure screenings, diabetes screenings and flu shots telling patients how, when and where they can receive these services. A proclamation by local leaders will encourage everyone to do their civic duty - and pay attention to a heahhy body, too. February 2001. Physician Training. Working in collaboration with the Coastal Area Health Education Center and the Physician Advisory Members of the Diabetes Today Coalition, an inservice training will be presented by a prominent diabetes spokesperson. It is the goal of the coalition to offer CME credits to physicians in attendance. Primary care physicians and physician extenders will be invited. Patterns of Care will be requested from the Diabetes Control Unit and distributed at the training. Additional copies of this manual will be available for those not in attendance and will be personally delivered by members of the Diabetes Today Coalition. Budget e Coordinator (160 hours at $22 per hour) Program Assistant (160 hours at $12 per hour) Printing, copying Food, space rental Advertising Conference Management Fee Postage TOTAL 3520.00 1920.00 2000.00 1500.00 510.00 250.00 300.00 $10,000 58 e Capacity The main source of diabetes education for the region hIlS closed its doors. Newly diagnosed diabetics have no place to go. Doctors have no place to which they can refer their patients for diabetes education. Endocrinologists with diabetes educators on staff have full caseloads. The problem is exacerbated for low income people with poor diets, and lack of access to adequate health care. These stakeholder members of the Diabetes Today Coalition realize how much more important their role now is. Four of the Coalition members are part of a working group to bring diabetes education to patients who need it. The Coalition was invited by a group of concerned physicians to participate. We will be working with this group to secure funding and deliver services. Community Partners e The Diabetes Today coalition is comprised of well-informed, hard working members representing the major institutions in the community - the hospital, Department of Aging, Community Health Center, Dialysis Center, Department of Social Services, University of North Carolina at Wilmington School of Nursing, Coastal AHEC, Cooperative Extension Service, Lions Club, Health Department, Star News Newspaper and diabetes . support groups. Physicians, diabetes educators, nurses, nutritionists, advertising executives, teachers, pharmacists and peer educators are members. These are workers and ~tworkers who can deliver. - 59 . . " e NEW HANOVER COUNTY BOARD OF HEALTH RULES GOVERNING THE FENCING AND e OPERATION OF PRIVATE SWIMMING POOLS IN NEW HANOVER COUNTY NORTH CAROLINA EFFECTIVE e 60 I ' . . " e e e DRAFT June 14, 2000 The Board of Health of New Hanover County, pursuant to North Carolina General Statutes G.S. 130A-39, which authorizes a local board of health to adopt rules necessary to protect and promote the public health, does hereby ordain that the "Rules Governing the Fencing and Operation of Private Swimminl! Pools in New Hanover County" is hereby amended as follows: Section I. I Definitions. "Private Swimming Pool" is any swimming pool operated in conjunction with a single family residential unit, the use of which is limited to occupants of that residence and their guests. ill definition shall include in-ground and above ground swimminl! pools. wading pools and spas that are capable of holding 24 inches of water. Exemptions from these rules include water gardens and water fountains. Section 1.2 Site Lavout All outdoor private swimming pools shall be enclosed by fence or other permanent barrier which discourages climbing and is designed so as to minimize the possibility of unauthorized or unwary persons entering the pool area. (II) All fences must be II minimum of 4 ft in height (from the outside apl'roacht (b) All fences must be constructed so as not to provide hand holds or foot holds for children to climb. Openings in between vertical slats and the bottom of the fence shall not exceed 4 inches to prevent children from squeezing through. Horizontallv slats must be at least 30 inches apart to prevent children from using the fence as a ladder. If chain link fences are used. the mesh size shall not exceed 2 114 inches The top railing of the fence shall be capable of slWporting at least] 50 Ibs in order to prevent the possibility of the fence colla,psing. (c) Larger above ground pools that have an exterior wall height of 4 ft. do not need a fence. however. a 4 ft. high enclosure with a self -closing 1 positive self -latching gate must be constructed around the ladderlel!ress area of the pool. (d) All gates and doors shall be equipped with self-closinl1 and positive self-latching mechanisms and shall be equipped with locking devices. (e) The gate Illtches shall be located 54 inches above the horizontal bottom rail of the access I!ate or the gate latch may be installed on the pool side of the fence. 3 inches below the tQP of the I!ate. If the I!ate latch is installed on the pool side of the gate. an anti-access shield shall be installed to prevent children from reaching through the I!ate o'peninl1s to open the l1ate latch. The anti-access shield be cover at least 18 inches of area around the latch. There shall not be any openings greater than Yo inch within the anti-access shield. (:() Ifthe house is used as one side of the pool fence. all doors and windows from the home must remain secure to prevent children from entering the pool area. It is recommended that an alarm be installed on doors to signal when the door is opened uneJ<;pectedlv and that self-closing and self- latchinl! mechanisms be installed. 61 " 'I I e e e (g) All private swimming pool enclosures shall be completely installed within thirty (30) days of pool completion. A completed pool is any pool capable of holding 24 inches of water. Section 1.3 Operation (a) Private swimming pools must be maintained in a clean and sanitary condition (suitable for swimming) so as not to create a nuisance or a hazard to others and to prevent a breedinl! site for unwanted pests such as mosquitos. If the pool cannot be maintained in this condition. then it shall be drained and covered with a safety cover. Standing water on pool covers shall be kept drained It is recommended that all private swimming pools have a walk or deck area out the entire perimeter of the pool ofa minimum width of three (3) feet of unobstructed clear distance. Section I 4 Non-conforming Private Swimminl1 Pools Private swimming pools constructed prior to the effective date of this regulation must be brought into compliance at the earliest possible date, but in no case longer than one (1) year from the effective date. Section 1.5 Right OfEntrv Pursuant to authority granted by North Carolina General Statute 130A Section 17, the Department shall have the right to enter upon the premises of any property for the purpose of conducting an inspection and determining compliance with these Rules. Section 1.6 Remedies If a person violates any part of these Rules, then helshe shall be guilty of a misdemeanor and shall be subject to sanctions provided in Chapter 130A Section 25 of the North Carolina General Statutes. Section I 7 Severabilitv If any provision of these Rules or the application thereof to any person or circumstance is declared invalid, then the remainder of these Rules or the application of such provision to other persons or circumstances shall not be thereby be affected. Section 1.8 Effective Date Adopted on and after by the New Hanover County Board of Health, these Rules shall be effective Signed Chairman New Hanover County Board of Health Signed Director New Hanover County Health Department 62 e e e WILLIAM T. HERZOG P.O. BOX 9034 CHAPEL HILL, NC 27515 David E, Rice, MPH, MA Health Director New Hanover County Health Department 2029 South 17th Street Wilmington, NC 28401 Dear David. Attached is a proposed approach to a Strategic Planning effort for New Hanover County Health Department based on our May1 0,2000 discussion (plus a broader list of common questions and a brief biography), As far as I am concerned the entire approach is open to discussion and negotiation and, in any case, will require additional thought and refinement. One of the reasons that I hesitated on making a final commitment on serving as the consultant for this process is that I wanted you to see what I believe is involved in an effective strategic planning effort, test the idea with key staff and Board leadership, and assure that are all on the same wave length. In any case, my role will be one of getting the process started and to provide a "neutral third party" in facilitating the retreat sessions. When I look over past efforts in organizational strategic planning, the successful efforts have shared five key characteristics; 1 shared commitment and readiness among key leadership; 2, agreement on goals, expectations, and individual responsibilities; 3 primary focus on questions, issues, and tasks (rather than because it is good to do strategic planning, CQI, reengineering, etc.); 4 assurance of organizational follow-through; and, 5 to paraphrase a real estate saying - "timing, timing, timing." I think that we should both test carefully to make sure these conditions apply here Although I will be glad to serve as "coach and consultant" in the process, most of the advance work will have to be done by you and your staff, There are some special areas where Racheal and the NC Institute of Public Health may be of additional help which, aside from general coordination, is one of the reasons that I am sending this packet through her office enroute to you, If you have the interest and funds could be found, the advance work on "Basic Organizational and Community Data" and "Interview of Key Stakeholders" could be expanded to include more detailed community assessment, community focus groups, etc, She may want to comment on that, Let me know what you think, 8JJall71~S' Bill Herzog, MSPH PHONE 919-942-2314: FAX 919-932-2314 E-Mail Address:bherzog@intrex.net 63 e e e Bill (William T ) Herzog, MSPH Associate Professor Emeritus, Health Policy and Administration Health Organization Consultant BRIEF PROFESSIONAL BIOGRAPHY Education: - 1955, Bachelor of Arts, Knox College, Galesburg, Illinois; 1958 Master of Science in Public Health, University of North Carolina at Chapel Hill; Advanced studies in health care administration and organizational development, UNC Chapel Hill. Program and Project Leadership: 1992-93, planning and development of Public Health Leadership Doctoral Program, UNC School of Public Health; 1983-85. Director, Program in Health Promotion and Disease Prevention, UNC School of Public Health; 1974-83, Director, Non-Residential Master's Degree Program in Health Administration; 1979-80, UNC Senior Public Services Fellow and Initial Project Director, NC Public Manager's Program; 1969-73. Director, Office of Continuing Education in Health Sciences, UNC; 1970-73, Deputy Chair and Director of Operations, University Comprehensive Health Services Program; 1964-69, Assistant Director then Director, Office of Continuing Education Services, UNC School of Public Health; 1961-64, Senior Operations Research Analyst and Project Leader, Operations Research Division, Research Triangle Institute. Graduate and Undergraduate Teaching, 1969 - 1993. Role and Use oflnformation in Public Health Leadership Decisions; Evolution, Organization, and Financing of Health Services; Implementing and Managing Change in Health Organizations; Management of Human Resources in Health Organizations; Fundamentals of Health Financial Management; Introduction to Health Management Methods; Ecology of Human Health; Planning and Evaluation Methods; Concepts of Public Health Administration. Publications: Health Planning, Organizational Assessment, Contract Management, Group Process in Issue Development, Issues and Problems in Continuing Education, Evaluation of Educational Programs, Consumer and Community Participation in Health Planning, and Emergency Care and Health Preparedness in Nuclear Disaster. Bonors and Awards: North Carolina Public Health Association Distinguished Service Award, UNC School of Public Health McGavran Award for Excellence in Teaching, UNC General Administration, Public Health Fellow Award; North Carolina Hean Association Distinguished Service Award. Organizational Consultation: Topics - Project planning and management, strategic plauning, organizational design, planning and implementation of organizational change, design and implementation of educational programs, and meeting facilitation. Clients. National Public Health Leadership Network; Chapel Hill-Durham Family Practice Groups; Triangle Family Practice; UNC Sheps Center on Health Services Research; Association of Schools of Public Health; Northwestern University, Buehler Center on Aging; Davidson County; Mecklenberg County Health Department; Wake County Health Department, Orange County Health Department; Durham County Health Department; Association of Boards of Public Health; NC Department of Environment, Health, and Natural Resources; UNC Department of Family Medicine; Presbyterian Hospital, Charlotte, NC; National Early Childhood Technical Assistance System, Chapel Hill, NC; Western North Carolina Rural Hospital Alliance; J & G Healthcare Consultants; UNC Hospitals - School of Business, North Carolina Memorial Hospital Management Training Institute; Washtenaw County Health Department, Ann Albor, MI; Orange-Chatham Community Health Services, Inc., North Carolina Department of Human Resources, Division of Health Services. World Health Organization, Geneva, Switzerland; WHO European Regional Office, Ankara" Turkey; UNC School of Business, Government Executive Institute; US AID, Turkish Ministry of Health, General Directorate for Health and Family Planning; Veterans Administration Hospitals Durham, Fayetteville, NC 64 e Strategic Planning-New Hanover County Health Department Proposed Approach Expected Outcomes: . basic awareness of community health status and risks . clear understanding of overall organizational goals and priorities . shared knowledge of the most important issues facing the organization . specific strategies for addressing each issue including who is going to do what and when . system for monitoring and assessing progress and success Advance Work Basic Organizational and Community Data (See Attachment A-I) DepartmentalfDivisional Survey (See Attachment A-2) Interview of Key Stakeholders and Community Leaders (See Attachment A-3) Expectations from Planning Process (See Attachment A-4) Summarv Packet (To be distributed at least two weeks before first retreat session.) Executive summaries of material developed in advance work plus any additional data which can aid in the Retreat review, analysis, and decision process. e Retreat Aeenda Initial Review and Fine-Tuning of Approach Division reports and survey review Organizational overview Process review, ground rules, and adjustment Initial task and issue identification Decision Session Issue identification and review Selection and discussion of the most important issues Outline of monitoring and evaluation criteria Responsibility charting BoardlExecutive role (for policy decisions and issues) Divisional responsibilities Special individual or task force assignments Follow Throueh e Report on Executive and Board Decisions on policy issues Work plans for divisional or task force e!Torts including times and milestones Six month and one year progress reports One year reassessment and adjustment 65 e e e ATTACHMENT A-I Basic Oreanizational and Community Data Basic data collected and summarized by Departmental Staff to give retreat participants a general overview of community health status, resources, and risks. This might include: Demographics Population growth rates Racial or ethnic characteristics and significant changes Age distribution and significant changes Educational attainment and significant changes Changes in occupational structure Economic structure, population income, and poverty Population Health Status and Indicators Leading causes of death: trends and significant changes Maternal and infant health: pregnancy, childbirth, early childhood, teenage pregnancy, infant mortality, low birth weight, immunizations Chronic disease and risk factors Communicable and infectious diseases Injuries, homicides, and suicides Dental health Mental health Substance abuse Environmental Health Status and Indicators Industrial growth and impact on the environment Water sources and water quality Air quality monitoring and control Food and restaurant supply, inspection, and safety Radiological sources, monitoring, and control Other biological, chemical, or radiological hazards and control mechanisms Perceived community risk and preparedness for biological, chemical, or radiological terrorism 66 e e e A TT ACHMENT A-2 Deoartmental/Divisional Survey (Example:) The following questions are intended to provide background information for the Departmental Strategic Planning effort. The answers will be reviewed and discussed by participants in a strategic planning retreat to include Division Directors, Board Members, and, possibly, several interested community leaders. You are encouraged to involve your staff in any way you believe appropriate. Please do your best to keep your responses as brief and as free of technical and professional jargon as possible. --------------------------------------------------------------------------------------------------- What do you see as the top two strengths of your division? What do you see as the top two areas for improvement in your division? How can the division and department as a whole best work to improve in these areas? How aware are key market segments of your population (e.g. high risk community groups, teachers, health care professionals, building contractors, restaurant operators, etc.) of the programs, services, and policies of your Division? -- of the Department as a whole? What kind of image would your division most like to present to the public at large, to key target or client groups, and persons or organizations who may contribute to community or environmental hazards? How clear are reporting channels and lines of authority the Health Department? What type of services or products should your work unit or division add in the next three years to better meet the needs of clients or the community as a whole? What type of services or products should the Health Department as a whole add in the next three years to better meet the needs of clients or the community? What significant problems or issues do the existing or projected demographic characteristics of your community present to your Division and its services? What changes or additional issues can be expected to be most important over the next five years? Overall, what do you see as the most plausible (expected or unexpected) health risks to the County over the next five to ten years? What steps do you believe should be taken to better prepare the community to face these risks? 67 e e e ATTACHMENT A-3 Interview of Kev Stakeholders and Community Leaders What do you think are the primary goals and priorities of the New Hanover County Health Department? What two or three things would you most like to see the overall organization achieve within the next two years? One of the primary purposes of a governmental public health agency is to address health risks and provide health services which affect the community as a whole, for example: food, water, and air quality; monitoring of community health status; and, monitoring of mfectious and chronic diseases in the community How important and well-received do you believe these services are to the public at large? Public health agencies are also closely involved in providing direct preventive health services and basic health services to high risk segments of the population? How important and well-received do you believe these services are to the public at large? -- to the specific population groups affected? Overall, how aware do you think the general public is of the community based services and personal health services of the New Hanover County Health Department? How aware are key segments of the population (e.g. high risk community groups, teachers, health care professionals, building contractors, restaurant operators, etc.) of the programs, services, and policies of New Hanover County Health Department? How comfortable, clean, and welcoming are the facilities the Department for clients and visitors? What do you see and the most significant public or personal health problems in New Hanover County? Overall, what do you see as the most plausible (expected or unexpected) health risks to your community over the next five to ten years? What steps do you believe should be taken to better prepare the community to face these risks? 68 e e e A TT ACHMENT A-4 Expectations from Plan nine Process (Suggested advance questionnaire for retreat participants.) What does the concept of "Strategic Planning" mean to you? If nothing else, what one or two things would you like to see achieved during this effort? What are your primary concerns about the effort as you understand it? How successful has the Department been in implementing and following through on ideas from similar planning efforts in the past? What barriers or limitations most impeded successful implementation? What factors contributed most to successful efforts? What changes, if any, do you expect in your own role as a result of this effort? What do you see as the primary forces that will contribute to the success of this effort? What do you see as the primary barriers which must be overcome for this effort to be successful? 69 '. ," e e e Common Questions in Strategic Planning Organizational Factors Mission, Goals, Vision What do you think are the primary goals and priorities of the organization? If asked, what do you think that the receptionist would say are the primary organizational goals and priorities? When asked by a favorite aunt, uncle, or mend, how do you describe the primary mission or purpose of your organization? How understandable or meaningful would the current mission statement be in this context? What two or three things would you most like to see your work unit or division achieve during the next two years? What two or three things would you most like to see the overall organization achieve within the next two years? What specific mandates or formal directives most influence the direction of your organization? What do you see as the major underlying principle or direction of your organization? What do you see as the top two strengths of your organization? What do you see as the top two weaknesses or areas for improvement in your organization? How can the organization best work to improve in these areas? How can your organization best position itself for the changes in population, clientele, and the environment that it can expect over the next three years? What are you top personal, professional goals for the next three years? Climate, Culture, Values What several key words or phrases best describe how it feels to work in your organization? What are some favorite "stories," if any, that illustrate how it was like to be a member of your organization in past years? What stories, if any, illustrate how it is today? What significant events, activities, or decisions do you believe influenced the course and direction of your organization? What kinds of behaviors or activities are most celebrated and rewarded in your organization? What kind of behaviors or activities are considered "taboo" by most employees and administrators alike? W T Henog, Chapel Hill, NC, 5/18/00 70 '. e e e What underlying principles or values are most important to you in gaining satisfaction from your work? Would you recommend your organization as a place to work for a person of your education, background, skills, and career aspirations? If you could make just one change in your organization to make it a better place to work, what would it be? Marketing How valuable and well-received are the direct preventive and health care services to organizational clientele? How valuable and well-received are the community and other population based services to the community at large? How important are patient or client values and satisfaction within your organization? What mechanisms does your organization have in place to client and community knowledge, opinions, and attitudes toward your organization? How does your organization go about exploring and testing new ideas, new procedures, or new programs within your community? What issues does the enforcement role of your organization present in taking necessary action to protect the public health and how are these dealt with? How competitive is your organization is developing and providing services which may be available from other sources within your community? What policy guidance does your organization have in dealing with such competitive situations? How aware is the general public of the personal and public services available from your organization? How aware are key market segments of your population (e.g. high risk community groups, teachers, health care professionals, building contractors, restaurant operators, etc.) of the programs, services, and policies of your organization? What kind of image would your organization most like to present to. the public at large, to key target or client groups, and persons or organizations who may contribute to community or environmental hazards? What image does the average employee have about the role, quality, and importance of organizational services? Structure, Coordination, Systems, and Procedures How well do you believe that most people in your organization understand their primary roles and responsibilities? How clear are reporting channels and lines of authority in your organization? W T Herzog, Chapel Hill, NC, 5/18/00 71 2 e e e What words or phrases best describe the degree of formality and role of structure in your organization? How well does communication work along supervisory and leadership channels in your organization? How well does communication work between units and division in your organization? How well do the systems and procedures in your division or unit work? What are the primary problems that you have experienced? Technology, Task Definition, Productivity What type of services or products should your work unit or division add in the next three years to better meet the needs of clients or the community as a whole? What type of services or products should your organization as a whole add in the next three years to better meet the needs of clients or the community as a whole? How rapidly is the basic technology of your division or work unit changing? To what extent are staff' being provided with the necessary training and continuing education opportunities to stay current with this technology? How well do you think the organization as a whole understands the level of complexity and demands of your particular division or work unit? How well do the members of your division or work unit understand the role, tasks, and issues of other units in the organization and of the organization as a whole? How demanding and stressful is the work within your division or work unit and how do you think this compares to the organization as a whole? Buman Resources How well are the knowledge and skills of employees utilized in your organization, in general? How well is the organization using your own knowledge, skills, and experience? How are single mistakes or major errors handled in your organization? How are repeated mistakes and/or performance errors handled in your organization? How do people in your organization react when things get especially hectic or stressful? To what extent do you think that the organization does its best to recognize and reward excellent performance? What freedom and resources does it have to reward top performance? How capable is the organization to recruit, train, and maintain essential professional, technical, and support staff? How competitive is your organization in the local, state, and national job market? What factors motivate most people in your organization to go the extra mile to do a good job? W T Herzog, Chapel Hill, NC, 5/18/00 3 72 e e e What steps or resources does your organization provide for employee growth and professional development? What else should it be doing? What do you think are the primary barriers to getting and keeping enough qualified staff to do the job in your organization? Finances How stable is the basic financing of your organization? What could you do, if anything, to improve the financial resources available to your organization? What particular programs or services do you believe could be added by more creative fund raising or marketing of services? What are the primary sources of organizational revenue? What trends, threats, or opportunities do you see in future available revenue? What are the major organizational expenditures and trends? Equipment and Facilities What kind of working environment does the organization provide for its employees? How comfortable, clean, and welcoming are the facilities for clients and visitors? How adequate is the available physical space to existing staff' and services and to projected future growth? How current and functional is the information technology, communications equipment, and other office equipment within the organization? How current and functional is the diagnostic and scientific equipment which is required for competent organizational performance? What do you project to be the most critical facility and equipment needs of the organization over the next five years? Community and Environment Demographics Population growth rates Racial or ethnic characteristics and significant changes Age distribution and significant changes Educational attainment and significant changes Changes in occupational structure Economic structure, population income, and poverty W T Herzog, Chapel Hill, NC, 5/]8/00 73 4 . . e What significant problems or issues do the existing or projected demographic characteristics of your community present to your organization and its services? e Population Health Status and Indicators Leading causes of death. trends and significant changes Maternal and infant health: pregnancy, childbirth, early childhood, teenage pregnancy, infant mortality, low birth weight, immunizations Chronic disease and risk factors Communicable and infectious diseases Injuries, homicides, and suicides Dental health Mental health Substance abuse Health attitudes and health behaviors Health utilization statistics: outpatient care, emergency room utilization, hospital care What are the most important health concerns and health issues facing specific population groups and the population as a whole? What are the most important issues facing public health organizations and health care providers? What changes or additional issues can be expected to be most important over the next five years? Overall, what do you see as the most plausible (expected or unexpected) health risks to your community over the next five to ten years? What steps do you believe should be taken to better prepare the community to face these risks? e Environmental Health Status and Indicators Industrial growth and impact on the environment Water sources and water quality Air quality monitoring and control Food and restaurant supply, inspection, and safety Radiological sources, monitoring, and control Other biological, chemical, or radiological hazards and control mechanisms What are the most important existing environmental hazards to community health? What issues, trends, or hazards are likely to be most important to the future? W T Herzog, Chapel Hill, NC, 5/18/00 5 74 e e e Overall, what do you see as the most plausible (expected or unexpected) environmental hazards within your community over the next five to ten years? What steps do you believe should be taken to better prepare the community to face these risks? Expectations from "Strategic Planning" What does the concept of "Strategic Planning" mean to you? If nothing else, what one or two things would you like to see achieved during this effort? What are your primary concerns about the effort as you understand it? How successful has your organization been in implementing and following through on ideas from similar planning efforts in the past? What barriers or limitations most impeded successful implementation? What factors contributed most to successful efforts? What changes, if any, do you expect in your own role as a result of the current effort? What do you see as the primary forces that will contribute to the success of this effort? What do you see as the primary barriers which must be overcome for this effort to be successful? W T Herzog, Chapel Hill, NC, 5/18/00 , ~ 6 75 e - - - e e ,~ Dennis Ihnat ~ 07/07/200005:12 PM /1 ~'* I" c- To: David E Rice/NHC@NHC cc: Lynda Smith/NHC@NHC, Betty Creech/NHC@NHC, Dan Summers/NHC@NHC, Allen O'Neal/NHC@NHC, David Weaver/NHC@NHC, Pat Melvin/NHC@NHC, Brenda Coffey/NHC@NHC, Debbie Reed/NHC@NHC, Wyatt Blanchard/NHC@NHC, Greg Thompson/NHC@NHC, Max Maxwell/NHC@NHC Subject: Re: Update on generators, hook-up, etc for Schools ~ Contract with Watson Electric Co. for Manual Electrical Iransfer .switches (MTS) at 5 school properties (Central Office Freezer. Johnson, Noble, Eaton and Trask) was signed by the county on April 18th. Notice to proceed was given on April 2Oth_, with required completion date of July 22nd. (90 days). Contract price is $211,851 The following Installations are complete. with only labeling. final inspections and site clean-up pending: Central Office Freezer - Installation complete. Security light installed. Because MTS cabinet was installed closer to parking area than specified, Watson has installed protective bollards. Because MTS cabinet was installed closer to the ground than specified, Watson will move the 4" pipe nipples (for generator electrical cable aaccess) from the bottom of the cabinet to the side. Johnson" Installation complete. Eaton - Installation complete. The following sites are in process: Trask. MTS Panel. underground conduit. wire runs complete. Two Kirk Key circuit breakers scheduled to be installed on 7/14, with electrical service intercepts on same day Have replacement circuit breakers for main panel available for use if bad circuit breakers are identified. (During last hurricane season, some breakers failed to open properly) Noble - Largest MTS, longest lead time. Was scheduled to be shipped on 7/2. Watson Electrical has not yet been able to confirm shipping info. Most complex installation (must intercept service in CP&L vault room). Installation scheduled for 7/17-7/20 (3.day shutdown). Expect to meet project's required 7/22 substantial completion date. The following major change order is in process: Codington . Codington would be used as the fifth shelter this season. Based on available funds and estimated design/installation costs, we did not expect to be able to install an MTS this season. Due to actual contract price being lower than initial estimate, and low value of change orders. the School Retrofit Projects Steering Group directed that we proceed with design and request price proposal for installation. WK Dickson prepared design drawing. Watson's price proposal is within available construction budget. A change order to add an MTS for Codington has been accepted by Watson and is in routing to the County Manager for approval. Expect approval 7/10 or 7/11. Required completion date will be 30 Days from approval. Watson projects realistic completion 2 to 3 weeks from approval to proceed. Good news! t ~~,.~}~y'~- :'"1: ..' ". ,.:,:',j 1"/(' . - .-#,t>' --/ I '.'...' t ,,\)!..~~" :.;..,~~,......I.' )~,., :> [ .;; ,i" . ~' I ~!,h I NCQE~R,'.'h i,> . j~_; ~;n;'>9'."':r,, ';';:~"~1 i;'" .~r;:~,:~/' ,y .'.?::L'1 i. ~~" ." ',' " . _ i'!.i...'F''- :~rJ~' 'i"'J- _~ ,I "~, ! l~\-~#~A~?~,~. HUNT.~;:. I }.-:;, ,GoVERNOR I':t:~~r""" ".~"",~)'." - :.;' ,:'(" !'n(!.~" .s .if.i~ <i"j? ~., ';iOa'.L':: H~CMf'!),; ~ ~'" },'~'1~~~~r~';&. . ' ift1'~rf (;).t,;o,~;'~~ ,,,,,Oli,,,~~,, ". '<,' .,. 0 If.. I _I' .' ,,"C.ct.\~,., " ~f?,"' ": ;~o' :1 AI' 0"0 " ~ ~ 9~ ~o-t,~ ~t ~~'.l ) 5{.". ~ Q ., .. 00:: ", Q \ . 'ii~ I~""'-.:r ~t::I,l !'''<;., 'j ~ I' ,- ~'.\ , ~;} _l:"'8l, ',.r'" I "IF;i' ~. ' i I r i?' .' I lJ~~lh~: jl:~"..~Jj [I~ 1 (, 't~ : " . ~ 'I' I' ", ',,-I U ~;';'" ! f '<.,. : L" I, ",', . "5' fr l.ilvlJird"" ,'t1:~.'if.1 ~t d <-i1tl' 'Il" ',...-\ oJ feD '--..;;- ,,\ ._~ ~_ .._ ;_.__--...:.-.....J ! ~j~~~~~~ I'=- . -.. "~~~. ~,.,.;...-" <---~:,~-~." .:) ~''''~~<<.~~, ,. .~,;;-~-!;;2'"'~.-.' [E'-- .,.._,_...~~~ '~~~;:;""""'I' ,~::;r-,~;~-'-' r _._._;j~ ~':,,':..~~:~,~ ~. ];~ ~..._" __ ":).,~ :-''b-.-"" ~2T~~-'~~ [:,'., -'<r"".~~___, C .'- _~,~r ..,,,,'j ~_,--_--..J~";:;~$'\ .~~~~' ,<.:,> \...~ /'--- "- =-~'~' '~' I""'. ~-'. '<. ~ ..".., . ~. <-'. '':bC::::-' ....." I.",. ___-~..y, l- --- .'(2.........~... -.,.....,~.,.." .~.-::::..~~ r.--~'._~ =..0 ~ "::-..0 .<:~~ ~ .~ I?""-~~T----' ;. r::' , _. .~. "~{~~4.~ ~:? ....~..'. '.:; ~<r-~---">Y:'r:.Ji' j ~,'",<''''''''><;Y0'_'' ~' . ~'~~'--""':"''<;::;::;%'i d-... _ .i ;. :T\:f> ! c; c>,--., ' .....-\ ::'0 ~~?...;;: l _ __~__ __=-/ .~l - -------~..----:-, ~ L _ _ _ _ _,__ .~_._~J ~.... ,; ..::, ~~ __._...;:l: NORTH CAROLINA DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES June 12,2000 Mr David Rice, M.P.H., M.A. New Hanover County Health Department 2029 South 17th Street Wilmington, North Carolina 28401-4946 Re: Mercury in Ocean Fish Dear Mr. Rice: Thank you for your letter of May 18, 2000 asking the Division of Marine Fisheries of the Department of Environment and Natural Resources (DENR) to collect the necessl\!)' samples and review the issue of mercury in ocean fish within the next two years. I have referred your letter to Preston Pate, Director of the Division of Marine Fisheries for a more detailed response. DENR appreciates the support and cooperation of the New Hanover County Health Department in advising the public not to consume king mackerel larger than 39-inches and to limit consumption of33 to 39-inch king mackerel in order to protect public health. DENR is concerned about the public health and environmental concerns of unsafe levels of mercury in fish and about the economic impacts of limiting consumption of a prized recreational and commercial species of fish. DENR will continue to work with other states and agencies to monitor mercury contamination in fish. DENR's Division of Air Quality is working with the Secretary's Scientific Advisory Board on toxic air pollutants to better understand emission, transport, and deposition of mercury from coal-fired power plants and other sources. Please let me know if you need more information. Sincerely, ""'''1, cc: The Honorable Charlie Albertson The Honorable David Redwine Jimmy Johnson, Chairman, MFC Sherri Evans-Stanton Dewey Botts Robin Smith Preston Pate Linda Sewall Tommy Stevens Alan Klimek 0.., l/,... I cr: _I ~ ,- ~I::~m~~;>:~... .~~~. ~ -~ IF ~.w f ~ ~ -- - .--.- 1601 MAIL SERVICE CENTER, RALEIGH, NORTH CAROL.INA 27699.1601 PHONE 919.733-4984 FAX 919-715-3060 WWW.ENR.STATE.NC.us/ENR/ AN EOUAL. OPPORTUNITY I AFFIRM...TlVE ACTION EMPLOYER. 50% RECYCl..EO'10% POST-CONSUMER PAPER . . State of North Carolina Department of Environment and Natural Resources e Division of Marine Fisheries James B. Hunt, Jr., Governor Bill Holman, Secretary Preston P. Pate, Jr., Director M'A DEHNA. 26 June, 2000 Mr. David Rice New Hanover County Health Department 2029 South 17th Street Wilmington, North Carolina 28401-4946 Dear Mr. Rice, Secretary Holman has forwarded me your request for the Division of Marine Fisheries to collect ocean fish for mercury testing. For clarification, the DMF sampled king mackerel at the request of the North Carolina Department of Health and Human Services (DHHS) after they learned of an advisory that had been issued for king mackerel in the Gulf of Mexico. While the DMF collected these samples, the Division of Water Quality (DWQ) was responsible for conducting the tissue analysis. Dr. Louis Daniel of my staff has been in close contact with Dr. Luanne Williams of DHHS and Mark Hale with DWQ, is aware of your request, and has notified the appropriate DMF staff that we may resample 30-40 king mackerel for mercury testing in 2002. We have not been made aware that e any other ocean fish would be collected or tested during this time. I am concemed, however, over the possible ramifications of this next round of testing. From my discussions with Dr. Daniel, there is an extremely remote probability that the mercury levels determined for king mackerel will change over such a short period of time, if ever. This proposed round of testing may simply result in another round of public meetings and press releases that tend to elevate fear among the fishing public and consumers. The DMF is working with our Marine Fisheries Commission, South Atlantic Fishery Management Council, and DHHS to educate and inform the public about the potential health risks related to consuming marine finfish and shellfish. Based on the risk assessment conducted by Dr. Williams, this may be the most prudent action that we can take. I would appreciate the opportunity to discuss this issue with you on a conference call with Dr. Daniel and Dr. Williams. We would like to set up this meeting for July 5 or 7,2000. Please let Dr. Daniel (800-682-2632 extension 105) know of a convenient time and we will set this up. Sincerely, L..~ /~,/ Preston P. Pate / Director 00 1-'~ -r~ aAI\ ~.I\' \ cc: e Bill Holman Louis Daniel Jimmy Johnson <:> . , e e ~} . s "-"'" North Carolina Department of Health and Human Services Division of Public Health ' 1912 Mail Service Center. Raleigh, North Carolina 27699-1912 2728 Capital Boulevard. (919) 733-3421 . Courier 56-32-00 Ann F Wolfe, M.D., M.P.H., Director June 26, 2000 Mr Bob Perciasepe US Environmental Protection Agency Office of Air and Radiation Mail Code: 6101A 1200 Pennsylvania Avenue, NW Washington, DC 20460 Dear Mr Perciasepe: The North Carolina Department of Health and Human Services recently issued a fish consumption advisory due to finding high levels of mercury in the large Atlantic king mackerel. The public has been advised not to consume king mackerel larger than 39-inches and to limit consumption of 33 to 39-inch king mackerel. In addition, there are ten freshwater fish consumption advisories in North Carolina due to finding high levels of mercury in largemouth bass, bowfin, and chain pickerel. Other southeastern states have issued similar advisories (see Attachment1). With the increase in number of fish consumption advisories, we are concerned about the release of mercury from coal fired-power plants, a major source of mercury in our state. Economic impact will certainly be felt up and down the coast of North Carolina as well as other southern states, as Atlantic king mackerel is a prized catch to commercial and recreational fishermen. This confirms the loss of a valuable natural resource that may not be restorable and moreover, suggests that other large Atlantic species may also be suspect. Studies conducted in the Faroe Islands confirmed the health risks to children whose mothers ingested high levels of mercury Delayed or limited language and motor development as well as attention deficit problems were documented in this research. At the June 8, 2000, North Carolina Scientific Advisory Board meeting, Dr Robert Stevens with the US EPA discussed some of the latest findings of the atmospheric mercury studies (see Attachment 1). He reported that the majority of the mercury emissions being released from major sources like coal fired power plants, municipal waste incinerators, and medical waste incinerators are in the form of mercuric chloride. According to Dr Stevens and other scientific experts, mercuric chloride has a very short residence time in air and tends to be deposited near the source. Deposition of mercuric chloride from these major sources like coal fired-power plants in water bodies where there is favorable conversion of mercuric chloride to methylmercury could cause elevated methylmercury concentrations to appear in the fish caught close to these major sources. As shown in the enclosed maps, many of the top 50 mercury air emission point sources for 1996 to 1998 are located in areas where the state has issued fish consumption advisories for methylmercury (see Attachment 3). EveryWhere. EveryDay. EveryBody. @ ~ An Equal Opportunity I AffimlOtive Action Employer , I " JLL-10-2000 12:34 FROM STEUER fN) ASSOC MII<E McII11TYRE 7nf~, N'OIlfMCAlQJNA COMMTTTE! ON AGAfCULTURI TO 3414146 P. 02 ,,-- "1Jf~1UILDlNG w~DC_''''''' ............ ""'............ -""""" 21.1'ECI&\Al1UlLlltlCG FAftTn'l'lU.4.Nt~ "'~........ 701N....51RDT l.IIOOIIImlf<.""_ -- _1'OIT0FfCl1Ul.DlNO -...- -..- -- ~~I' ..__ "angr~. at tlJt llnittb IPtatti Jloue of BqJtestntatibtf IiIIaJ1JlRatIn, _ 20515-S307 wvtteOMMlT'T1ln: e ---=::='~- LIYISTOClC.AND~l\IIII'. coMMtTTU ON ARMED SIfMCES e - -.rT..,..~"'T .....-- ......- RUMLH!Ai.ntc:AAliCQALlT1Ol\l Maroh 28,2000 Mr. William Steuer Chairman New Hanover County Board Of Health 2029 South 17th Street Wilmington, North Carolina 28401 Dear Mr. Steuer: ThaDk you for CODIJIding me concerning AmeriCllll-born children ot illegal immigrants. I appreciate the benefit of your views on this ~1bd1l issue. As you know, Amendment XIV to the Constitution, which was ratified on July 9, 1868, gulII'lU1tees citizenship to 8ll persons born or naturaliml in the United States. Pending in Congress is H.R. 73, the Citizensb;p Reform Act of 1999, which would deny automatic citizenship to children born in the United States to parents who lire illegal aliens. This m~ is currently in the U.S. HollSe Su~ttee tllI lnunigratl~and Claims for further review and study. Please be assuredtbat I wili clOsely monitor this bill, Ho~, since enactment of this legislation is highly doubtful.llkelyum:onstitlltional, and would ~Iude an entire clasS of Americans from citizenship, Congress is more likely instead to ensure that our laws are respected by concentrating on a more effective and stronger enforcement of immigration law. Toward this end, lllllpputted and the House passed in 1999 an amendment to tho National Defense Authorization Bill for Fiscal Year 2000, which would authO!Ue the U,S. SecretarY of Defense to assign U.S. troops to assist the Immigration and Naturalization Servic:e and the United States Customs Service In patrolling our borders. This measure passed by a vote of242 to 181 on Julie 10, 1999, Unfortunately, this provision was not included in the final defense authorization bill signed by President Clinton. In addition. on September 30, 1996. President Clinton signed into law the lllegal Immigration Reform and Immigration Responsibility Act. This law instituted several important and much needed changes to discourage aliens from illeg811y entering the United States. altered the admissibility standard for prospective Immigrants, and strengthened the fmancial res~"bility ofpetitllinerS for ~Iy an4 work based imJ.1li8!'8l1ts.S~ifi!'8l1'y, ~ 1,l;8islation driubles the nilmber ofbordcr patrol agents oVer the nei! five years, ~~ the J~c:e Department to install additional physical barriers, and funds the acquisition of additional aircraft, hclicopters, and night vision devices to improve the deterrence of illegal border crossing. Furthermore, it enhances the authority of federal law enforcement officials to investigate alien ....,..Oit fII!ettlI6NPIR TOTA... P. 02 lLL-10-2000 14: 18 FR01 STEUER fN) A5SOC 3414146 P.02 TO smuggling, and those found transporting or harboring illegal aliens can be fined and imprisoned _ for up to ten years. In addition, illegal immigrants and non-citizens an: now ~licitly ineligible _ for a broad set of federal. state, and local benefit programs, including Social ecurity and Medican:. Please n:st assured that I will continue to support these and all measures that deter illegal immigration and enforce the responsibly assumed by U.S. citizens and companies who petition for legal immigrants. Your views an: important, and I appreciate your taking the time to lct me know of your concerns. If I may be of further assistance, please do not hesitate to contact me. Sincen:ly, ~}k..~- Mike McIntyre Member ofCoqress MM:cb TOTI'lL P.02 e - 1/3/ J-oCo . ~ J'R-~ " .~ ~~~~" ~~:~ "'-?"-~ U::~ ;I., 3,-o-'-(:t.~ '"' ''"'' 00' com "'0"" .0"""'0' '('""- L ~~~ ~ e Future ~~ . L"S of Children VOLUME 1 0 . NUMBER 1 - SPRING/SUMMER 2000 e , e UNINTENTIONAL INJURIES IN CHILDHOOD . ~ e e * ANALYSIS Injuries are the leading cause of death among children between ages I and 19 in the United States. In 1996, more than 13,000 children and adolescents in the United States died of un in- tentional ("accidental") injuries, predominantly motor vehicle crashes, drowning, and residential fires. Unintentional injuries are responsible for more child deaths each year than homicide, suicide, congenital anomalies, cancer, heart disease, respiratory illness, and HN combined. Unintentional injuries to children are costly. Unintentional childhood injuries that occurred during 1996 cost society $66 billion in present and future productivity losses due to premature death or long-term disability, $14 billion in lifetime medical spending, and $1 billion in other resource costs. , For every fatal injury, approximately 18 children are hospitalized and 233 are treated in emergency departments for nonfatal injuries. Most unintentional injury deaths to children can be prevented. Simple, proven interventions such as using child car seats and bicycle helmets, con- trolling traffic in residential neighborhoods, and installing smoke detectors in homes could reduce childhood injury deaths by one-third, representing more than 4,000 deaths to children in 1996 alone. The three key approaches to injury prevention are education, environment and prod- uct changes, and legislation or regulation. Education to promote changes in individual behaviors can have a modest effect in reducing the risk of childhood injuries. Education by health care professionals has increased individual safety behaviors including car seat use, smoke detector ownership, and safe tap water temperature, at least for a time. A . ,e - e , '> Community-based education in schools, neighborhoods, and cities, often com- bined with economic incentives, has increased the use of bicycle helmets and car seats among children, but programs should be more widespread. --)f- Environment and product modifications that make children's physical surroundings, toys, and clothing safer can dramatically decrease the incidence of childhood injuries, though many such efforts are not wide- spread. , The use of child-resistant caps for medications and household poisons, and lim- iting the number of pills in medication vials have virtually eliminated poisoning deaths to children under five years old. ,; Traffic calming to reduce or slow the speed of traffic in neighborhoods reduces the risk of pedestrian injuries, pemaps by more than 60%. ? Swimming pool fences with self-latching gates prevent roughly 40% to 70% of swimming pool drowning and near-drowning incidents in young children. * Legi.slatiun and regulation are among the most powerful tools to reduce childhood injuries, and most environment and product design changes require legal action. Many existing laws, however, are not fully enforced or have loopholes that limit their effectiveness, and some effec- tive laws have not been adopted in every state. <> Car seat laws in all 50 states increase the use of car seats, which prevent about 71 % of automobile crash-related deaths to infants and young children, but most states do not require appropriate protection for children between the ages of about four and eight years old. .(> Even though research has shown that bicycle helmets are 85% effective at reduc- ing head injuries, 35 states lack bicycle helmet laws. .(> Regulations requiring flame-retardant children's sleepwear have substantially reduced clothing bums, though current efforts to relax this standard may result in their reappearance. Deficiencies in four areas have stymied injury prevention efforts of the past and continue to be a problem today: .) The absence of reliable data on nonfatal injuries to allow proper targeting of interventions. '> The lack of training to prepare a multidisciplinary group of professionals to enter the field of injury prevention. ,'> Inadequate funding for injury research and prevention given the magnitude and cost of the unintentional injury problem. \> The lack of coordinated prevention efforts by public and private agencies. A . ,e j e 7f Reducing the rate of child injury deaths in the future will require the dedication of individuals to implement what we know works, the deter- mination of communities to create environments where children can grow up safely, and the public and private dollars to support injury pre- vention research and to disseminate effective interventions. RECOMMENDATIONS RECOMMENDATION 1 Pediatricians and other health care providers should incorporate education about safety prac- tices into routine health visits using positive behavioral counseling. To encourage this, private insurers and state Medicaid programs should adequately reimburse for counseling, and the National Committee for Quality Assurance should make counseling for injury prevention a mea- sured indicator of the quality of health plans. RECOMMENDATION 2 Effective community-based injury prevention programs grounded in a health behavior frame- work, such as those shown to increase bicycle helmet and car seat use, should be implemented in every community. New programs based on these models need to be developed and evaluated in communities to target other prevalent child and adolescent injury problems such as pedestri- an injury, drowning, and motor vehicle injury associated with the misuse of car seats and seat belts for small children, ~~. , RECOMMENDATION 3 Passive strategies that make children's environments safer, such as traffic calming measures and fences that enclose swimming pools on all sides, should be implemented in all communities and mandated by law. l?ECOMMENDATlON 4 Uniform legislation should be enacted and enforced in every state to mandate the following safe- ty practices: age-appropriate car seat or booster seat use for children, bicycle helmet use, and res- idential smoke detectors that are hard-wired or use lithium batteries. The National Center for Injury Prevention and Control should catalog model legislation and state activities for these and other injury prevention strategies. RECOMMENDATION 5 Information on the cost effectiveness of strategies to reduce injuries to children must be collect- ed to better inform public debate on the merits of these interventions. RECOMMENDATION 6 The mandatory recording of external cause of injury codes should be required for hospital dis- charge data systems in all 50 states. Medical providers and hospital information system staff e should be trained to use these codes for all admitted instances of nonfatal injuries. A . ,e i - It:....-- e -t. :":I...~~I';"~"--;,i' :.~""'~;:",}.~'.;::{I..:..:*I.i'-''.:;":;.(~.".~j'Z:';..~--.1~-,..!....:."''''.~-'<.' , . "', ,'~ ,'/ c<",,,'~"')!:::~'i-<'l,~'-;-~,~" .~h~";J:~'~~~:'~" r~jj":';-~i~~"p.:;:~'f~~,/~;~y-'}~,Vnlnrenf[onal rnlunes"rliChtldhood.{';.:, 'r -~ ~~-> >', :",:' 1\:f:ir~'1f:",~;~~l!"-,, :ii-? '~'~:'.f.:t1.:ll':<,;:~~~l.-..): :';'~~<,.:>~~~'!~':"fit<'~"'~"i'~f1:!"."'1;..'I~ ~;;::f.~ :,~}.(,sr..,..~p.::;",. ~~ .J~"" .' ';";', ,- ~ .. ' . .-,;- l __...~{ ". ~ - . r _ -. ~li',,~.. \,.;:.:\':>. """;f...:r,.f~ RECOMMENDATION 7 State and local governments, hospitals, and nongovernmental organizations that implement injury prevention programs should require that employees obtain training in the principles of injury control. Funding of these programs should be tied to this training requirement. RECOMMENDATION 8 National training programs and career development awards for injury control investigators should be developed and funded by federal agencies. RECOMMENDATION 9 A comprehensive analysis of federal spending on child and adolescent injury prevention and con- trol should be undertaken. Based on this analysis, the knowledge of the magnitude and costs of injuries, and the effectiveness of prevention efforts, federal funding for injury research should be set at a level commensurate with the problem. RECOMMENDATION 1 0 A national agenda for the prevention of unintentional injuries should be developed and imple- mented through coordination of federal efforts across a variety of agencies under the lead of the National Center for Injury Prevention and Control within the Centers for Disease Control and Prevention. ARTICLE SUMMARIES The History of Injury Control and the Epidemiology of Child and Adolescent Injuries David G. Grossman, M.D., M.P.H. Unintentional injuries claim the lives of more children each year than any other cause of death and account for a sulr stantial proportion of child hospitalizations and emergency depamnent visits. The concepwalization of unintention- al injuries as a public health problem that is preventable, has gained credibility over the past few decades as e!fective solutions to reduce th~ burden of injuries, such as child safety seats, bicycle helmets, and smoke detectors, have been identified. Successful implementation of these strategies, however, requires a clear understanding of the circumstances surrounding injuries, and risk and protective factors. Motor vehicle occupan~ drowning, and pedestrian injuries were the cause of more than half of all child unintentional injury deaths in 1996, although rates varied considerably by age. Overall, unintentional injury rates are the highest among adolescents ages 15 to 19, males, children from impoverished families, and minorities. Environmental and behavioral risks, such as unsafe roads, alcohol intoxication, unfenced swimming pools, and the absence of a smoke detector in the home, can be successfully reduced using the appropri- ate strategies. More widespread diffusion of successful injury prevention strategies among populations at highest risk for injuries is necessary to further reduce the toll on children's lives. Individual-Level Injury Prevention Strategies in the Clinical Setting CarofJnDiGuiseppi, M.D., M.P.H.. and/an G. Roberts, M.B., B.Ch., M.R.G.P.. Ph.D. Health care providers working in physician offices, clinics, emergency deparunents, or hospitals have numerous oppor- tunities to intervene with parents and children, to promote child safety practices that reduce unintentional injuries. This systematic review examined 22 randomized controlled trials that examined the impact of interventions delivered in the clinical setting on child safety practices and unintentional injuries. Counseling and other interventions in the A e e e Evaluating Injury Prevention Programs: The Oklahoma City Smoke Alarm Project S~ Mo.lJmrn, R.N., M.P.H. Evaluation of injury prevention programs can be used to test program strategies, to measure penetration of the program in the target population. and to measure program effects on injury-related morbidity and mortality or the adoption of safety practices. An evaluation of The Oklahoma City Smoke Alarm Project increased the program's success at reducing residential fire-related injuries and deaths by providing data during the program's implementation that allowed for midcourse corrections. The program included the disbibution of free smoke a1arms in targeted neighborhoods. accompanied by written educational pam- phlets and home-based follow-up to test whether a1arms were functioning correctly. During the six years following the project, the residential fire-related injury rate decreased 81 % in the target population, but only 7% in the remainder of Oklahoma City. This dramatic decline in fire-related injuries in the target area is largely attributed to the free smoke a1arm disbibution, as well as educational efforts promoting awareness about residential fires and their prevention. Training Injury Control Practitioners: The Indian Health Service Model Richard] Smithm, M.S., Alan] DeI1apennaJr., M.P.H., andLawrmceR. Jlewr, M.D., M.P.H. Many individuals practicing injury control do not receive specific training for their work because of a scarcity of training opportunities. The Indian Health Service (IHS) created an innovative training pro- gram for federal and bibal employees. This model emphasizes training that is practical and' can be applied immediately to community interventions. Components of the program include the use of experiential instruction, preceptors, and community case studies to train individuals from diverse cultural and educa- tional backgrounds; educational strategies for employed adults; and courses that promote community empowerment, The success of the training model is evident in programs instituted by IHS injury special- ist fellowship graduates, whose projects have ranged from drowning prevention in Alaska to fire safety in South Dakota. The IHS training model could be applied in a variety of other community-based settings. A SELECTED BffiUOGRAPHY r. In' back ((}ver If)}- "/njormatlOl/. about (mien'll,!!: rulrlitiona.l Hxecutivl' 5i'ltNlIJ/flneS If}" i.,'sues 0/ thl> JOltn/.a!. 1711 Future of Childrm (ISSN 1054-8289) l4' 2000 by The David and Lucile Packard Foundation, 300 Second Street, Suite 200. Los Altos, California 94022. all rights reserved. Printed in the United States of America. Cover photo 0 B. Daemmrich/The Image Works. ~ Printed on recycled paper with soy ink. (The electronic edition of tbis issue can be found at http://www.futureofchildren.org on the World Wide Web.) Note: Opinions expressed ill The Future of Children by the editors or the writers are their own and are not to be considered those of The Packard FowtdatiotL A .e clinical setting are effective at increasing the adoption of some safety practices-including motor vehicle restraint use, smoke alarm ownership, and maintenance of a safe hot tap water temperature-but not oth- ers. Clinical interventions were most effective when they combined an array of health education and behavior change strategies, such as counseling, demonstrations, the provision of subsidized safety devices, and reinforcement Community-Based Injury Prevention Interventions Terry P. KI=en, M.D., M.Sc., F.R.G.P.(C),] Morag Mlltkay, M.Sc., David Moher, M.Sc., Annie Walker, M.A., and Alison L]tmLS Community-based injury prevention interventions seek to change social norms about acceptable safety behaviors by focusing on altering behavior, promoting environmental change within the community, or passing and enforcing legislation. This systematic review analyzed 32 studies in schools, municipalities, and cities that evaluated the impact of community-based injury prevention efforts on childhood injuries, safe- ty behaviors, or the adoption of safety devices. Most relied on an educational approach, sometimes in com- bination with legislation or subsidies to reduce the cost of safety devices such as bicycle helmets. Community-based approaches are effective at increasing some safety practices, such as bicycle helmet use and car seat use among children. Common elements of successful community-based approaches that should be replicated in future studies include (I) the use of multiple strategies grounded in a theory of behavior change, (2) approaches that are tailored to meet unique community needs, (3) the inclusion of community stakeholders in the development of interventions, and (4) the use of a randomized con- trolled design to maximize the truStworthiness of reported findings. e Legislative and Regulatory Strategies to Reduce Childhood Unintentional Injuries RicharrJA. Schi.ber, M.D., M.P.H.,]uIU Gikhrist, M.D., and David A. Sleet, Ph.D. Laws and regulations are one of the most effecljve mechanisms to get large segments of the population to adopt safety behaviors. These have been applied at both the state and federal levels for diverse injury issues. In this article, six legislative efforts are described to demonstrate the pros and cons of the legislative approach to ensuring safety. Three such efforts are aimed at preventing injuT}"producing events from occurring-mandating child-resistant packaging for prescription drugs and other hazardous substances, regulating tap water temperature by presetting a safe hot water heater temperature at the factory, and graduated licensure. Three other examples illustrate the v.due and complexities of laws designed to pre- vent an injury once an injuT}"producing event does occur-mandatory bicycle helmet use, sleepwear stan- dards, and child safety seat use. The article concludes with specific recommendations, which include assessing the v.due of laws and regulations, preventing the repeal of laws and regulations known to work, refining existing laws to eliminate gaps in coverage, developing regulations to adapt to changing technol- ogy, exploring new legal means to encourage safe behavior, and increase funding for basic and applied research and community programs. e The Cost of Childhood Unintentional Injuries and the Value of Prevention Ted R. Miller, Ph.D., Eduardn O. Rumarw, Ph.D., and Rthecta S. spim; M.P.H. Cost data are useful in comparing various health problems, assessing risks, setting research priorities, and selecting interventions that most efficiently reduce health burdens. Using analyses of national and state data sets, this article presents data on the frequency, costs, and quality oflife losses associated with unintentional childhood injury in 1996. Unintentional childhood injuries in 1996 resulted in an esti- mated $66 billion in present and future work losses, $14 billion in lifetime medical spending, and $1 biJ. lion in other resource costs. These injuries imposed quality of life losses equiv.dent to 92,400 child deaths. Several proven child safety interventions cost less than the medical and other resource costs it saves. Thus, governments, managed care companies, and third-party payers could save money by encouraging the routine use of selected child safety measures such as child safety seats, bicycle helmets, and smoke detectors. Yet, these and other proven injury prevention interventions are not universally implemented. A The Future of Children Journal and Executive Summary BACK ISSUES IN PRINT 'J u.s. Health Care for Children (Winter 1992 ' Vol. 2, No.2) .J Health Care Reform (Summer/fall 1993 . Vol. 3. No.2) ..J Children and Divorce (Spring 1994 . Vol. 4, No.1) '.J Sexual Abuse of Children (Summer/fall 1994 ' Vol. 4, No.2) .J Critical Health Issues for Children and Youths (Winter 1994 ' VolA No.3) '.J Low Birth Weight (Spring 1995' Vol. 5. No.1) .J CMticallssues for Children and Youths (Summer/fall 1995 . Vol. 5, No.2) ..J Long- Term Outcomes of Early Childhood Programs (Winter 1995 . Vol. 5. No.3) ij Special Education for Students with Disabilifles (Spring 1996 . Vol. 6, No.1)' :.J financing Child Care (Summer/fall 1996 ' Vol. 6. No.2)' .J The Juvenile Court (Winter 1996 . Vol. 6. No.3)' cJ We~are to Work (Spring 1997 . Vol. 7, No. I)' ..J Children and Poverty (Summer/fall 1997 . Vol. 7. No.2)' .J financing Schools (Winter 1997 'Vol. 7, No.3)' .J Protecflng Children from Abuse and Negiect (Spring 1998 ' Vol. 8, No.1)' .! Children and Managed Health Care (Summer/fall 1998 . Vol. 8, No.2)' .J Home Vi~flng: Recent Program Evaiuatlons (Spring/Summer 1999 . Vol. 9, No.1)' ..J When School Is Out (fall 1999 . Vol. 9, No.2)' .J Domesflc Violence and Children (Winter 1999 . Vol. 9, No.3)' CURRENT ISSUE .J Unintentional Injuries in Childhood (Spring/Summer 200l . Vol. 10, No.1)' UPCOMING ISSUES :j Children and Computer Technology (fall/Wlnter 200l . Vol. 10, No.2)' MAILING LIST .J I would like to receive all upcoming issues '.J Remove my name from mailing list . ExecutIve Summaries available' for these Issues only. All issues-including those out of prlnt-avallable online. Name TItle Organization Dept./Floor /Suite/Room Street Address City Phone / Affiliation State E-mail Zip To order free JOURNALS and/or ExECUTIVE SUMMARIES, please send requests to: Circulation Department, The David and Lucile Packard Foundation, 300 Second Street, Suite 200, Los Altos, CA 94022 E-mail circnlation@futnreofchildren.org or FAX (650) 948-6498. Please allow 4-6 weeks for delivery. JOURNAL and ExECUTIVE SUMMARY also available online: http://www.futureofchildren.org Note: We regret that, at this time, only Executive Summaries can be shipped internationally. UIlC500 BENRVE r(! .i:)) Every year, your heart pumps 2,625,000 pints of blood. Could you spare just one? Summer Blood Drive July 11,.2000/ 9:30AM - 3:00PM New Hanover County Health Department Auditorium 2029 S. 17th Street Call Libby Johnson @ 341-7178 Ext. 7311 OR June 26th - July 28th Call the American Red Cross Center @ 762-5540 or 762-2683 for an appointment Free t-shirt if you donate between June 29th & July 9th ... Employees who donate will receive 4 hours Comp Time Donor Form on reverse ~.~"r..."'\. . ~* .,. ~ ~ ....:;r;;. ~""...,.~ 10> BLOOD DRIVE DONOR FORM To receive compensatory leave credit, you must (1) donate at the Red Cross Center between the dates of Monday, June 26th, and Friday July 28th, 2000, or at the Blood Drive on Tuesday, July 11, 2000. (2) Complete this fomn and retum to the Department of Human Resources. INSTRUCTIONS 1 Complete Section 1 2. Have a Red Cross representative authorize the donation or deferral in Section 2. 3. Take this completed form back with you and SUBMIT IT DIRECTLY TO THE HUMAN RESOURCES DEPARTMENT Please DO NOT attach your completed donor form to your time sheet. The Human Resources Department will add four (4) hours of blood time to your blood account. 4. If your classification is other than "employee", leave your completed fomn with a Red Cross representative. It will be forwarded to the Human Resources Department for credit to the department of your choice. 5. When you are ready to USE your leave, record it on your time sheet as BLUDU Name of donor' SSN#' Donation site: SECTION 1 (TO BE COMPLETED BY DONOR) Date of donation: County department to receive credit: o BLOOD DRIVE LOCATION 0 RED CROSS CENTER Work time used to donate: minutes (Note: Everyone will receive 4 hours compensatory time.) Donor status: 0 EMPLOYEE 0 BOARD MEMBER 0 RETIREE/SPOUSE/OTHER SECTION 2 (TO BE COMPLETED BY RED CROSS REPRESENTATIVE) RESULTS: 0 SUCCESSFUL DONOR (donor was assigned collection bag) o DEFERRAL (deferred prior to receiving collection bag) Verified by' , American Red Cross Representative SECTION 3 (TO BE COMPLETED BY HUMAN RESOURCES/FINANCE) o Four (4) hours added to BLUD (blood) account (date). Keyed by' DONATION SITE INFO Red Cross Center 1102 S. 16th Street June 26th - July. 28th, 2000 Call 762-5540 or 762-2683 for appointment Mon. 12-6pm Wed. 12-6pm Fri. 8am-1pm New Hanover County Health Department 2029 S. 17th Street July 11th, 2000 Call Libby Johnson at 341-7178 ext. 7311 for an appointment e e e FROM J:0.lN1'l BOOTH NB'L 2 PH:l'oE t-IJ. 910 458 0233 Jun, Z7 2lil00 13: 58 P2 ",.',\'1'1 tit", tJ;'~.i~.i~'.' fi.~:.0 ~?~,~ 11iJ;-U.". NEW HANOVER COUNTY ANIMAL CONTROL DIVISION 220 DIVISION DRIVE WILMINGTON, NORm CAROLINA 2g401 T~:I.":P1l0NE (910) 341-4197 FAX (9/0) 34/-4349 IlAVIIIIl. Rlell Uo..1I1I 1JI...lor ,IEI\N \', MoNlm. 1\111111111 (:ollt",1 Ulrelo'lnr TO: The New Hanover County Boerd of Health FROM: Dangerous Dog Determination Hearings CONCERNING: The cases heard__Aprl! thru June 2000____ NUMBER OF CASES HEARD 39 DECISIONS: DANGRROUS 2 POTENTIALLY DANGEROUS 31 NOT DANGEROUS 3 (OWNER BITES_new procedured__) PJC no longer used PJC REVISED no longer used_ PJC REVOKED--- 1 EUTHANASIA 2 AGE OF VICTIMS 11 children 21 adults___B anima1a Rf,(/1TTRRD MRIlWAT. ATTRNTTON --.;]1. hl t.... NOT UNDER CONTROL____sll -- NOTES: New Hanover County Emergency Management and Project Impact ere setting precidents in the United Stntoe. Other areas are using what is being done here to gain access and thus help animals in amergencies. Rabies is 331 ahesd of lsst yesr in the stete and i~ still a serious problem that must be attended to. ~OU'l. dfE-aft!: - O\.l'l. P'l.lo'l.lty NEW HANOVER (OUNlY HEALTH OEPARTMENT "The mag wheels come in handy when I'm eluding the health department." Also in this issue... ( 2 Coming (Iean- How to warn consumers about risky foods 2 The Risks We Toke- FDA's advice on which foods should be passed up 3 Donating Safe Food- What you need to know about food donations 3 Outdoor Dining Rules- Tips on making outdoor dining establishments safe 4 Whaddya Know?- Put your food safety knowledge to the test Copyright 2000 Pike & Fischer, Inc. 1.800-255-8131 Summer 2000 Temporary Events Require Permanent Vigilance Summer is herel TIme for outdoor fairs and fesli- vak Unfortunately, with- out adequate care, the food and drink at such events can cause illness, sometimes with tragic results. Last sum- mer, over 700 aOendees at a (ounly fair in New York State became ill due to contami- nated water. Two died, in- cluding 0 three-year-old girl. Not so long ago, "fair food" <onsisted mainly of hamburgers, hol dogs and (oOon candy. T odoy, we see pasta, gyros, and even sushi served in temporary booths on the streets or in the parks at summer festivals across the (ountry. Many cities have festivals dedicated to specific ethnic cuisines. Others take a "Taste of the Town" ap- proach, hosting fairs where local restaurants can show- (ase specially dishes_ Preparing diverse and (omplicated foods in make- shift kitchens, however, re- quires extra precautions. Many health departments hove established HACCP-slyle requirements for temporary food vendors to help iden- tify and (ontrol risks_ Specific requirements vary between iurisdictions, so check with your 10(01 health deport- ment, but here ore somo general recommendations: SIMPLIFICATION: There are often many ways to pre- pare the same dish. Choose the simplest way pos- sible to prepare your chosen menu items. Eliminate cooling and reheating, and substitute commercially prepared foods whenever possible. APPROVED SOURCES: Never store or prepare food anywhere other than in a licensed restaurant. REFRIGERATION: If ice is used for refrigeration, it must completely surround the food. And, you may not use that ice for anything else, especially not for iced drinks. If the event provides electricity and you plan to use a refrigerator, monitor it. Power supplies at temporary events can sometimes be unreliable. MONITORING: Use thermometers to monitor tempera- tures of food, both hot and cold. SEPARATION: Separate raw meats from foods that are "ready to eat" at all times, including in the cooler and on the cutting boards. HANDWASHING: At a minimum you must have warm, running water (many jurisdictions allow a picnic wa- ter jug with a spigot,) soap, paper towels, and a con- tainer to catch the dirty water Or, consider renting a portable handwash station. HANDS OFF: Touch food with your bare hands as little as possible. Use utensils or disposable gloves. Change gloves often, and wash hands in between. WASH, RINSE, AND SANITIZE: You'll need a three- compartment "sink" to wash utensils. Three plastic "bus tubs" or clean five-gallon buckets work fine. Fill one with soapy water, one with clean water, and one with sanitizer solution. Don't forget sanitizer for tables, countertops and other surfaces. KEEP IT UP: Store food and equipment off the ground, out of the dust and mud. COVERING: Because insects frequent outdoor events, keep garbage cans tightly covered and away from food and other equipment. APPLICATION: The earlier you submit your plans to the health department, the more opportunity they have to help you fine-tune them. Food Talk Spring 2000 You've Been Warned... Most food workers know that eating a rare burger increases the chance of coming down with E. coli, or that eating raw oysters could cause a Vibrio infection. But for the benefit of the dining public who may not be aware of those risks. FDA has developed "consumer advisory" language in the Food Code. The FDA Model Food Code is the framework on which state and local food regulations are based. The most recent Model Food Code contains a requirement that any food establishment selling food which contains raw or undercooked meat, poultry, seafood, or eggs must warn consumers about the health risk of eating those foods. It is worth keeping in mind that in the Model Food Code, this item is considered a "critical violation. II That means failure to comply with the consumer advisory provision carries the same weight as violations of refrigeration or hygiene. Several health departments and industry groups asked FDA for further advice on how to comply with the consumer advisory requirement. In March, the FDA provided that clarification and posted it on its web site. Many states have already adopted the Model Food Code to be used as the food regulation in their state, and several others are in the process of adopting it, so this requirement may become a reality in your neighborhood in the near future. If you want more information about the consumer advisory provision, contact your local health department or review the FDA guidance at < vm.cfsan.fda.gov/ -dms/fc99guid.html > '-, ,~ The basic requirements of the consumer odvisory provision: . Any menu item containing raw or undercooked meat, poultry, seafood, or eggs, must be identified os such on the menu or by other written means. This includes foods such os Caesar salad mode with row eggs and soft (heeses like Brie. . Consumers must be warned, using wording specified by the FDA, that eating such foods (on pose 0 health risk, partiwlorly to those with weak immune systems. . The FDA has provided 0 brochure that operators con use to educate customers about the risks of eating the identified foods, or on operator may choose to write their own bro- chure. If operators choose to write their own, the FDA has provided 0 list of "essential criteria" which must be included. -' The Risks We Take As part of its March 22 guidance document on how to comply with the consumer advisory provision of the Food Code (see above), FDA offered the following model chart showing who's most at risk from eating certain foods. Risky Foods la partial listl Who Is at Risk Cause of Illness Row or under<ooked eggs: Caesar salad dressing; soft-cooked eggs; some puddings and custards; mousse; sauces made with raw eggs (e.g., Hollandaisel Everyone, especially older adults, young children, immune-compromised Row dairy products: Raw or unpasturized milk; some soft cheeses like Camembert and Brie Salmonella Enteritidis Everyone, especially pregnant women, older adults, immune- compromised, young children Listeria monocytogenes E. coli 0157:H7, Salmonella Everyone, especially older adults, young children Everyone, especially persons with liver disease or alcoholism, immune- compromised Row or rore meot: Hamburger; carpaccio Row or under<ooked: Molluscan shellfish; raw clams or oysters on the half shell Row fish: Sushi; ceviche; tuna carpaccio E. coli 0157:H7, Salmonella Vibrio vulnificus, Other vibrios Hepatitis A Everyone, especially immune- compromised, older adults Parasites, Vibrio parahaemolyticus Spring 2000 c Pulling Gooil Food 10 Good Use About 96 billion pounds of food, over one-fourth of 011 food produced in the U.S. eo(h year, goes to waste, occording to 0 USDA study. The some study estimated thot if only 5% of thot wasted food could be recovered and donoted, it would be equol to on entire day's worth of food for 4 million people. If you ore interested in helping the hungry in your community by donoting food, follow these new guidelines to do it sofely. . Donated food can include excess commercially packaged food, including canned and frozen goods, or it can be "prepared foods" (foods prepared in your establishment which were never served to customers). . Food must be in good condition and free of spoilage. Commercially packaged foods must be in their intact, original packages. Prepared foods must be wrapped securely in food- Food Talk grade packaging, and separated by food type. (For example, don't throw the extra apples on top of the bowl of pasta salad I) . Prepared foods must have been made with strict attention to employee hygiene, time and temperature control, and good sanitation. . Before entering into an agreement with a food distribution organization, you should meet with their representative to discuss the organization's policies. Tour their facilities to verify that they are clean and that they handle and transport food in a sanitary manner . Except in cases of gross negligence, establishments that donate food for charitable purposes are protected from liability under federal law by the Bill Emerson Good Samaritan Food Donation Act. State laws vary However, they may provide more protection than the federal act, so learn about your state's laws. If you would like more information about donating food. that would otherwise be discarded, you can contact the USDA food recovery hotline {1 BOO-GLEAN-IT} A summary of the new guidance on food recovery, ap- proved at the April 2000 Conference for Food Protection, can be found at the National Restaurant Association web site at <www.restaurant.org/cfpissues> : C Dining? Take it Outside! A summer cookout ranks up there with baseball and apple pie as being a treasured American tradition. Many resorts, theme and recreational parks and even some restaurants operate seasonal or year-round outdoor grilling and dining operations so that guests can enjoy the out.of-doors and a good meal at the same time. Lacking clear guidance in the Food Code on how to regulate these "perma- nent outdoor cooking establishments," inspectors have tended to treat them as temporary establishments, which the code defines as those operating for no more than 14 consecutive days. But recently, a Conference for Food Protection panel developed Food Code- based guidelines inspectors can use to grant permits to establishments that operate outdoor cooking facilities on a more permanent basis. According to the draft guidelines, which will likely be contained in the 2001 Food Code, here are some features to keep in mind: The outdoor site must be operated along with a permanent food service operation that acts as "home base." r The cooking site must be on your property You are not allowed to build your grill in the park next door Walls are not required if only cooking is done at the outdoor site. If food preparation is done outdoors, there must be protection against the elements, such as a tent with sides. While electricity or gas is preferred, sterno, wood, or charcoal may be used as a heat source for cooking and hot holding equipment. Ice or electric or gas-powered equipment is allowed for cold holding of food provided they maintain foods at proper temperatures. Portable tanks may be used to supply water When not in use, no food may be stored at outdoor sites. Food must be covered while being carried to and from the outdoor site. Customers may not have access to outdoor cooking and preparation areas. Open containers of food or condi- ments are not permitted. Handwashing facilities must be available if there will be bare-hand contact with food or any food prep. Oops! As 0 few alert Food Talk readers pointed out, our advice on "Boiling Down Easter Egg Safety TIps" contained in the Spring 2000 issue leh something to be desired. Namely, the word "covered." We advised readers to remove eggs from heat and simmer for 1 5 minutes, but we neglected to mention the pan should be covered to hold in the heat. Our apologies. Food Talk Spring 2000 Whaddya Know? Your estoblishment moy serve up the best food in town, but without knowing the food safety basics, you could also be serving up trouble. Test your knowledge. I. All foods thot ore to be held cold must be held ot or below: a. 410F b. 500F c. 320F d.OOF 2. All foods thot ore to be held hot must be held ot or obove: a. 700F b. 980 F c. 1200F d 1400F 3. Most of the bocterio thot couse foodborne illness grow: a. With or without oxygen at an ideal temperature of 98.60F b. Only without oxygen at an ideal temperature of 1100 F c. Only with oxygen at an ideal temperature of 1100 F d Only without oxygen at an ideal temperature of 98.60F 4. The number one contributing foetor leading to foodborne illness in food estoblishments is: a. Improper cooling of foods. b. Cross contamination. c. Poor personal hygiene. d. Inadequate cooking of foods. 5. The strength of the sonitizer in the third comportment of 0 three-comport- ment sink must be checked frequently because: a. If the chemical is too strong, it may ruin fragile dishware. b. The chemical strength increas~s over time which may leave a toxic residue on equipment and utensils. c. The strength of sanitizers may drop as germs are killed and the sanitizer is diluted with rinse water d. The strength of the chemical in- creases as germs are killed off 6. Which of the following is nolo rule that should be closely followed when purchosing food? a. Foods prepared in a private home may not be used or offered for human consumption in a retail food establish- ment. b. Buyers should only purchase food that is safe, wholesome and from an approved source. c. Avoid the use of commercially raised game animals as meat and poultry items. d. Only buy meat and poultry that has been inspected by USDA or state agency officials. 7. All potentiolly hozordous foods thot hove been cooked ond cooled need to be reheoted to on internol temperature of _ within two hours to be sofe. a.1400F b. 1450F c.1550F d. 1650F 8. Bocterio grow best' within 0 temperoture ronge called the Hdonger zone~'whi(h is between: a. 0 and .220oF b. 0 and 1400F c. 41 and 1400F d. 41 and 2200F 9. Whot fodor hos the greotest influen(e on where people (hoose to eot or shop for food? a. Cost of the food. b, Nutrition of food. c. Quality of service. d. Cleanliness of food and facilities. ~) 8-9 corred: / / / 6-7 (orrect: / / 4-5 (orrect: / Less thon four: Stop servin9 and start studying! Source: 'Essentials of Food Safety and Sanitation," Prentice-Hall, Inc., 2000 (PIS '(018 ')PIL '(019 '(OIS '(elv '(elf; '(Plz '(e) ~ :SJ9MSU"it FOOD TALK ~ NEW HANOVER COUNTY HEALTH DEPARTMENT ENVIRONMENTAL HEALTH DIVISION 2029 SOUTH 17TH STREET WIlMINGTON, NC 28401 Printed on recycled paper David Rice Health Director Health Department - e e - - - Cape Fear Community College Center for Business, Industry and Government 411 North Front Street, Wilmington, NC 28401 Tel. (910) 251-5696 Fax. (910) 251-5947 Serving Safe Food 16 hour Manager's Certification Class (Certificate is valid for 3 years) This class is open to managers or responsible persons who work full time. After successfully completing the course, restaurants are eligible to receive two (2) additional points during inspections. The National Restaurant Association Educational Foundation offers certification to those who successfully complete this course. New Hanover County Environmental Health Specialists will teach the course. Dates: Where: Cost: Special recognition will be awarded to establishments that have five (5) or more employees attend and successfully complete the course. The establishment will be rewarded a framed certificate for display August 8: 10: 15: 17 4:00pm. - 8:00pm. *Note August 8, registration starts at 3:30pm. New Hanover County Health Department Auditorium. 2029 South 17tb Street, Wilmington, NC 28401 $55.00 registration fee. Textbook has been revised by the National Restaurant Association to include more information and graphics. Revised textbook cost - $81.41 (includes tax) Prior to first class participants must purchase the textbook at CFCC bookstore and read chapters 1 - 4. **NOTE -Textbooks may be re-usedfor other employees, but eac;, student must have a book. Restaurants may purchase separately the NRA test for use with these recycled books. This may also be purchased at CFCC book store for $27 15 (includes tax) per test. To reserve a place in this class please call 251-5696 This class is offered by Cape Fear Community College and the New Hanover County Health Department Environmental Health