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04/04/2001 e e e New Hanover County Health Department Revenue and Expenditure Summaries for February 2001 Cumulative: 66.67% Month 8 of 12 Revenues Current Year Prior Year Budgeted Revenue Balance % Budgeted Revenue Balance % Amount Earned Remalnln -Amount Earned Remalnin $ 1,339.333 630,605 $ 708,728 $1.339,781 849,512 490,269 63.41% $ 523,044 332,739 $ 190,305 $ 516,453 249,769 266,684 48.36% $ 941,900 287,063 $ 854,837 $ 852,884 442,721 410,163 51.91% $ 153,479 153,479 $ 192,301 368,891 (174,590) 190.79% $ 312,900 171,640 $ 312,900 167,n1 145,129 53.62% $ 112,015 97,248 $ 109,515 94,884 14,831 86.46% $ 1,294,423 837,467 $ 824,269 525,336 298,931 63.73% Expenditures Type of Expenditure Budgeted Amount Expended Amount Balance Remaining % Budgeted Expended Balance Amount Amount Remaining % Summary Budgeted Actual % FY 00-01 FY 00-01 Expenditures: Salaries & Fringe $8,201,215 $4,671,660 Operating Expenses $1,823,760 $1,031,061 Capital Outlay $600,535 $240,711 Total Expenditures $10,625,510 $5,943,432 55.94% Revenue: $4,677,094 $2,510,241, 53.67% Net County $$ $5,948,416 $3,433,191 57.72% Revenue and Expenditure Summary For the Month of February 2001 10 NEW HANOVER COUNTY HEALTH DEPARTMENT BOARD OF HEALTH (BOH) APPROVED GRANT APPLICATION STATUS e R~q(i~$t~tl;f!~I'!Q!ijg 12/6/00 $100,000 $4,000 Childhood Asthma Management & Control Interventions- NC Department of Health & Human Services, Division of 11/1/00 Public Health, WCH Section Cape Fear Memorial Foundation-Lice Eradication Program $5,000 $5,000 Healthy Carolinians- Office of Healthy Carolinians, Division of Public Health, North 10/4/00 Carolina Dept of Health & Human Services $10,000 $10,000 March of Dimes- March of Dimes Birth Defects Foundation Eastern Carolina Chapter Enhanced Counseling Program for HIV / 9/6/00 AIDS - Elton John Aids Foundation e Smart Start applying for Cape Fear 8/2/00 Memorial Foundation Grant (MOW) $52,000 $50,000 $2,000 Enhanced Counseling Program- Z. Smith Reynolds Foundation $48,000 $48,000 Teen Aids Prevention- Z. Smith Reynolds Foundation March Toward T8 Elimination- NC Dept 7/12/00 of Health and Human Services (DHHS) $10,000 $7,200 $2,800 Cape Fear Memorial Foundation (TAP Pro ram 2 ear request $55,000 er ear $55,000 $35,000 $20,000 Diabetes Today - DHHS Division of Public Health Servicios Para Ninos-Rahab Therapy 6/7/00 Foundation $50,000 $50,000 Family Planning Outreach Initiative-NC Division of Public Health- WPH Unit (Year One $21,538 and Year Two: $22,615) $21,538 $21 ,538 Healthy Homes Initiative-NC Childhood Lead Poisoning Prevention Program Project Assist-American Legacy e Foundation Grant ($57,500 for each of 3 5/3/00 years) $57,500 As of 3/19/01 . Notification received since last report. 11 NEW HANOVER COUNTY HEALTH DEPARTMENT BOARD OF HEALTH (BOH) APPROVED GRANT APPLICATION STATUS 4/5/00 MOW Services (Infant Mortality)-NC Healthy Start Grant Application (2yr Grant: $85,000 yr 1 and $43,845 yr 2) Skin Cancer Screening- NC Advisory Committee on Cancer Coordination and Control e $128,845 $128,845 $1,500 12/1/99 Child Health Consultant Grant- UNC Dept of Maternal and Child Health- Contract with NC Dept of Health and Human Services, Division of Women and Children's Health $48,210 Healthy Carolinians Task Force- NC Office of Health Carolinians FROZEN) $10,000 Operation Reach Women- Susan G. Komen, Breast Cancer Foundation $19,822 North Carolina Chilhood Asthma Initiative- NC Dept of Health and Human Services, Women and Children's Health Section FROZEN $7,500 $10,000 11/3/99 $19,822 e 9/1/99 School Health Lice Grant- Carolina Power and Light Company Corporate Contributions Fund $4,900 Growing Up Buckled Up- National Highway Traffic Safety Administration Cooperative Agreement $4,900 9/1/99 Model Community Assessment Grant- North Carolia Community Health Initiative- Healthy Carolinians- Center for Disease Control and Prevention Diabetes Today Community Planning Initiative-NC Dept of Health and Human Services - Diabetes Prevention and Control Unit $17,375 $17,375 $10,000 $10,000 7/7/99 Healthy Women First- Community Health Improvement Program Teen Aids Prevention-Cape Fear Foundation Grant $24,692 $24,692 $50,700 $35,000 $15,700 '$9~2;91l2;$~$$t~I!;.$$4i41l!F [$442';$9,41 e As of 3/19/01 . Notification received since last report. 12 e e e NEW HANOVER COUNTY HEALTH DEPARTMENT 2029 SOUTH 17TH STREET WILMINGTON, NC 28401-4946 TELEPHONE (910) 343-6500, FAX (910) 341- 4146 ~~.r.-,w,. DAVID E RICE, M PH, M A Health Director LYNDA F SMITH, M P H Assistant Health Director March 19, 2001 To: New Hanover County Board of Health From: Cynthia W Hewett, Business Officero# Subject: New Medicaid Rates We received an email dated February 28, 200 I, containing an updated list of the new Medicaid rates, from Dennis E. Harrington, MPH, Chief of Local Health Services These rates are retroactively effective January I, 200 I After reviewing this list, there are five of our current fees that need to be increased in order to meet the requirement that our fees should be equal to or greater than Medicaid rates. These five fees are shown below' Code (Description of Service) Current Fee Charged New Medicaid Rate Proposed Fee to Charge 99387 (New Patient Over 65 Year Exanl) $ 143 00 $ 144.38 $ 145.00 54050 (Destruction/Lesion/Condyloma) $ 89 63 $ 120 89 $ 120.89 46900 (Destroy Anal Lesion(s)) $ 132.99 $ 162.26 $ 162.26 W8205 (Parenting Education Classes) $ 73 00 $ 74.59 $ 74.59 GOOOI (Venipuncture) $ 3.99 $ 3.99 "Yo", Healtlr. Ollr Priority" 13 . I Maternity Care Coordination, Child Service Coordination and Parenting _ Classes will be billed to Medicaid. These services are not reimbursable .., through private insurance. For Non-Medicaid patients, these services will be billed to state grants. Orthopedic and Neurology clinic services are available only to Medicaid and indigent patients. All Non-Medicaid visits will be billed to state grants. All Childhood Lead Poisoning Prevention Program services will be billed to state grants. N If an insurance company pays for services rendered and payment is sent directly to the patient; the patient is responsible for payment to the NHCHD In such instances, services may be restricted until said payment is received by the NHCHD, as allowed by law o Reimbursable visits, for patients with insurance coverage, will be billed to the insurance company If there is a balance remaining after the insurance payment is received by NHCHD, the balance will be billed to the patient based on their sliding fee scale rates, except when co-payments have already been applied. P Bad debt write-off policies have been established (Page 27). e Q Fees, based on current cost or purchase of supplies, may be adjusted by the Health Director. R. Tests or vaccines recommended or required as part of the Employee Health Program will be administered at no charge to NHCHD employees or volunteers. For other purchased vaccines the Health Director may establish reduced charges. S. New Hanover County employees may purchase certain in-stock medications, at wholesale prices, for themselves, their spouses, and their dependent children. T All environmental health - laboratory services fees will be collected by the Laboratory or Environmental Health. U The Jail Medical Program shall not charge for services except according to the Inmate Co-Payment Program. v The Health Director, or designee, has the authority to waive or reduce fees for special projects or targeted populations. e 03/19/01 14 . e e e HE.AL T 1-\ NEW HANOVER COUNTY BOARD OF CUMIVJI""IOI~[RS REQUEST FOR BOARD ACTION Meeting Date: 04/~01 Department: Health Presenter: Betty Jo McCorkle, Director Women's Health Care Contact: Betty Jo McCorkle, 343.6660 SUBJECT: Grant Application-Maternity Care Coordination Expansion Grant ($15,000) from North Carolina Department of Health and Human Services, Division of Public Health, Women's & Children's Section BRIEF SUMMARY: We are requesting approval to apply for a grant of $15,000 from North Carolina Department of Health and Human Services, Division of Public Health, Baby Love Program, Maternal Health Unit. These Maternity Care Coordination Expansion Grants are for services to Women Eligible and Ineligible for Medicaid. (See attached memo dated March 19, 200, for further explanation.) New Hanover County is eligible for 2.5 full time equivalent positions based on statistics of our estimated annual number of 253 Medicaid recipients in our county who are not contracted to receive Maternity Care Coordination Services. We are requesting one full.time Maternity Care Coordinator (MCC) position. The $15,000 represents 6 months of start.up funding. This position will be a home visiting position since space at the hospital is an issue. Opportunities for start.up funding do not come along very often. If we are to meet the unmet need and take advantage of funding opportunities, we need to act now Although $15,000 will not meet the total amount needed for salary for 6 months ($21,299 Salary + $5,034 Fringe=$26,333), the combination of this state grant ($15,000) and earned Medicaid Revenue ($12,900 for 1st 6 months) through providing this service will be more than enough ($1,567 more) to meet the salary/fringe requirements of the position for 6 months. After the 6 months, the Medicaid Revenue is projected at $51,600 annually which is only $1,065 less than the annual salary and fringe of $52,665 for the MCC nurse position. This would result in the county providing a small supplement of $1,065 for the annual salary/fringe. In the long term, event hough the county may have some small cost in terms of supplementing the salary, the county would see much more benefit and cost savings due to these services provided to low income pregnant and postpartum women. This will result in better birth outcomes (i.e. healthier babies, shorter hospital stays, and fewer postpartum complications), reduced healthcare costs, and healthier families. RECOMMENDED MOTION AND REQUESTED ACTIONS: Approve grant application for $15,000. FUNDING SOURCE: North Carolina Division of Health and Human Service, Women's & Children's Health Section, Maternity Care Coordination Grant ATTACHMENTS: Yes, 12 pages (Salary/fringe and revenue projection page, 2 page memo and 9 pages grant) IS ... NHCHEAL TH DEPARTMENT SALARY AND FRINGE FY 2001 - 2002 FUNDING FOR MATERNITY CARE COORDINATOR OBTAINED THROUGH START-UP GRANT e Position Employee Grade Salary FICA 7.65% Retirement Insurance Disability TOTAL 4.95% 365.5<{1."2) .23/100 Annual Salary Projection Maternity Care Coordinator-PHNurse Projected Medicaid Earnin9s per year County Appropriation Needed $42,598 $3,259 $2,109 $4,602 $98 $52,665 $51,600 $1,065 $49 $26,333 $15,000 $12,900 -$1,567 First 6 Months Salary Start-up MCC Grant 1st 6 months Projected Medicaid Earnings 1st 6mo County Appropriation Needed 1 st 6mo $21,299 $1,630 $1,055 $2,301 We project, during the 1st 6 months, with the start-up grant of $15,000 & eaming Medicaid Revenue of $12,900, that we will actually have $27,900 total grant and eamed revenue. This is $1,567 more than the the $26,333 needed for the first 6 months salary and fringe for the new MCC position. The extra $1 ,557 eamed during the first 6 month start-up period can be used to offset the shortfall of $1.095 for the 12 month annual salary. In future years, unless we earned additional Medicaid Revenue through this position, the county would need to appropriate the additional $1.065 needed to make up difference between the annual salary/fringe of $52.665 and the earned Medicaid Revenue of $51,600. e e 16 ~ e ~:Jd.IOI e,_ J.)A0~ 'rL(.../... (~~4t'" v=<.) ...~, . ~ ~cj ~ ~ :~~. QC:{~CU-Y ~ i,6--~' J-dID' /::MdW h ~ 1{4 \J, g CCLv-. C>..cCf) ~ VV\..G_",,^0 c: 1\' itA_.n ~..<.---t '';-"::;;.' -k A ~ -lu J,\.ll.. -t North Carolina Department of Health and Human Services ,~F .. . . t... Division of Public Health .Women's & Children's Health Section....wu. f\ .~~ Cj!-,,,,,~. 1929 Mail Semce Center. Raleigh, North Carolina 27699-1929 'L-,'t-~ Tel919-733-7791. Fax 919-715-3410 ill '. Michael F Easley, Governor Carmen Hooker Buell, Secretary March 19,2001 MEMORANDUM FROM: Providers of Maternity Care Coordination Eligible to Receive Grants for FY 2001-2002 Carole M. Barnes, MSW CAS-- Baby Love Program Manager, Maternal Health Unit TO' SUBJECT. Maternity Care Coordination Expansion Grants for Women Eligible and Ineligible for Medicaid We are pleased to announce the availability of grant funds to be used to increase the number of women in your county receiving Maternity Care Coordination (MCC) services. Funding is available through June 30, 2002. All state funds are subject to review for possible reduction for this fiscal year due to the present State budget situation, MCC Expansion Grants are included in this category and funds may be reduced. _Grant for Women Eligible for Medicaid Eligibility is based upon the estimated annual number of Medicaid recipients who are not currently contracted to receive MCC services in your county The number of clients previously contracted to be served is reduced from the estimated number of Medicaid deliveries (excluding estimated emergency Medicaid deliveries) during FY2001 to determine your unmet need for MCC services and the number of positions that may be requested with these grant funds. We are excluding the number of estimated emergency Medicaid deliveries to distinguish between the number of Medicaid recipients who are eligible for MCC services but have not enrolled from those women who were ineligible for MCC services. Agencies may apply for funds sufficient to support as many maternity care coordinators as they have unmet need among Medicaid patients. While there is no maximum amount for which an applicant may apply, the level of funding requested should be commensurate with the additional number of Medicaid recipients to be served. We are estimating that an appropriate case load for a full time (100% FTE) Maternity Care Coordinator is 100 clients served over the course of a year (65-70 women at any given time). Please complete Attachments I ,11 and VlI (Face Sheet). _ Grants For Women Ineligible for Medicaid Funding is targeted to agencies in counties with ~45 deliveries to women who received emergency Medicaid at time of delivery during FYOO Awards will be based upon an annual salary and fringe benefit cost of $33,900 per full-time maternity care coordinator. The level of funding requested should be commensurate with the additional number of persons to be served. The maximum amount that one county may receive is $33,90Q; prorated amounts may be awarded for half-time positions or greater. An appropriate caseload for a full-time (J.O FTE) Maternity Care Coordinator should be 100 clients served over the course of the year. Funding will cover services provided July 0 I, 2001- June 30, 2002. Please complete Attachments V, VI and VII (Face Sheet). @ Location: 1330 St. Mary's Street. Raleigh, N.C. 27605 17 An Equal Opportunity / Affirmative Action Employer . . ! e The application materials are due to the Maternal Health Unit by 5:00 pm April 9, 2001 Notices of grant award will be mailed on or before April 30, 2001 Should you have any questions, please contact either your WCHS Regional Social Work Consultant or Carole M. Barnes at (919) 715-5293. Attachments c: Joseph Holliday Belinda Pettiford WCHS Regional Social Work Consultants WCHS Regional Nurse Consultants Lorie Williams e e 18 ,! e REQUEST FOR APPLICATIONS TO EXPAND MATERNITY CARE COORDINATION SERVICES FOR WOMEN ELIGIBLE OR INELIGIBLE FOR MEDICAID RFA #: A013 Applications, subject to the conditions made a part of hereof, will be received until 5:00pm April 9, 2001, for furnishing services described herein. e Direct all inquires concerning this RFA to: Carole M. Barnes North Carolina Department of Health and Human Services Division of Public Healthl Women's and Children's Health Section 1929 Mail Service Center Raleigh, North Carolina 27699-1929 Phone; (919) 715-5293 Fax: (919) 715-3410 SEND ALL APPLICATIONS DIRECTLY TO THE ADDRESS SHOWN ABOVE. e FUNDING AGENCY NORTH CAROLINA DEPARTMENT OF HEALTH AND HUMAN SERVICES DIVISION OF PUBLIC HEALTH WOMEN'S AND CHILDREN'S HEALTH SECTION WOMEN'S HEALTH BRANCH I MATERNAL HEALTH UNIT March 2001 19 .' BACKGROUND e In Fiscal Year 1990-1991, the North Carolina ~eneral Assembly appropriated $500,000 annually to the Division of Public Health to increase the number of Medicaid recipients receiving maternity care coordination services. For FY98-99, the appropriated amount was reduced to $250,000 The appropriation provides seed funding to local health departments, community, migrant and rural health centers to employ additional full-time or part-time maternity care coordinators. Grant recipients are expected to provide future support for these positions through Medicaid earnings. In Fiscal Year 1989-90, 40 percent of the 28,000 deliveries funded by Medicaid were to women who received care coordination services. With expansion of Baby Love Program benefits to pregnant women up to 150% of poverty in January 1990, pregnant teenagers in April 1990, and pregnant women up to 185% of poverty in October 1990, the Medicaid Program is now covering approximately 35% more deliveries than during 1989-90. In FY 2000, approximately 54% of Medicaid deliveries received maternity care coordination services. It is our goal to provide maternity care coordination to all Medicaid-eligible pregnant women who desire this service. The North Carolina General Assembly first appropriated $125,000 to the Division of Public Health to extend maternity care coordination (MCC) services to low income pregnant and postpartum women who were ineligible for Medicaid in Fiscal Year 1992 (FY92). Appropriations for the next four fiscal years increased to $250,000 annually and then dropped _ to $79,100 in FY97 In subsequent years, funding was restored to $250,000 _ The Women's and Children's Health Section has $450,000 appropriated for FY 2002 to expand Maternity Care Coordination Services to women eligible and ineligible for Medicaid. All state funds are subject to review for possible reduction due to the present state budget situation. Maternity Care Coordination Expansion Grants are included in this category and funds may be reduced. ELIGIBLE AGENCIES Only those local agencies that are currently enrolled with the North Carolina Medicaid Program as a matemity care coordination provider are eligible to apply. Successful applicants must follow the policies and procedures outlined in the Technical Manual For Matemity Care Coordination regardless of the participants' Medicaid eligibility status. e 20 Attachment III TABLE 1- Estimated Unmet need for MCC Services in Counties Previously Receiving MCC Grants , .' ~,I~..I.~.~~~!.. Alamance 878 372 0 0 0 0 0 100 0 0 0 0 406 4.06 Alexander 244 38 0 0 80 20 0 0 0 0 0 0 106 1.06 Beaufort 411 144 0 0 0 0 120 0 0 50 0 0 97 0.97 Brunswick 590 100 75 75 0 39 0 0 0 0 100 0 201 2.01 Buncombe 1,498 270 300 301 38 0 154 0 0 0 100 0 335 3.35 Burke 688 71 150 30 0 77 0 100 0 0 100 0 160 1.60 Cabarrus 792 148 75 0 100 0 0 0 125 125 0 0 219 2.19 Caldwell 657 197 0 0 100 77 154 0 0 0 0 0 129 1.29 I Carteret 381 84 75 75 0 0 0 0 0 0 0 0 147 1.47 Caswell 154 39 0 0 0 32 0 0 0 0 0 0 83 0.83 Cleveland 885 253 136 0 100 154 77 0 0 0 0 0 165 1.65 Columbus 629 344 137 0 0 0 0 55 0 0 0 25 68 0.68 Craven 750 95 150 150 0 0 0 0 0 0 0 0 355 3.55 Cumberland 2,234 523 300 0 0 462 0 300 150 150 0 0 349 3.49 Davidson 1,095 237 150 0 0 231 77 0 0 0 0 0 400 4.00 Durham 1,506 267 300 0 150 0 154 200 0 0 0 0 435 4.35 Irsyth 2,044 317 300 0 0 0 0 0 0 0 0 0 1427 14.27 ville-Vance 844 137 115 135 0 147 0 0 0 0 0 0 310 3.10 uilford 2,550 459 0 0 300 500 308 400 50 50 0 0 483 4.83 Henderson 597 354 0 120 0 0 0 0 0 0 0 0 123 1.23 1redell 850 68 75 150 120 0 0 0 35 75 0 0 327 3.27 Johnston 788 116 150 150 50 77 0 0 0 0 0 0 245 2.45 Jones 102 0 0 0 0 0 0 0 0 0 0 25 77 0.77 Lenoir 562 229 140 0 0 0 0 0 50 0 0 0 143 1.43 Lincoln 380 46 0 0 0 150 0 0 0 0 0 0 184 1.84 Moore 509 123 252 0 0 0 0 0 0 0 0 0 134 1.34 Nash 710 0 0 0 0 0 0 0 0 100 0 0 610 6.10 New Hanover 1,000 127 320 0 300 0 0 0 0 0 0 0 253 2.53 Onslow 1,006 318 129 150 88 0 0 100 0 0 0 0 221 2.21 Pitt 993 278 300 0 0 0 0 0 0 100 0 0 315 3.15 Randolph 1,004 174 150 0 0 150 0 0 0 0 0 100 430 4.30 Richmond 532 156 160 0 0 90 0 0 0 0 0 0 126 1.26 Robeson 1,776 451 310 90 0 80 0 0 50 50 0 0 745 745 Rockingham 720 74 0 0 0 120 0 67 133 0 0 326 3.26 Rowan 900 18 150 0 300 0 77 0 0 0 0 0 355 3.55 R-P-McD 1,071 413 177 0 0 144 37 0 20 20 0 0 260 2.60 Sampson 612 159 150 0 100 77 0 0 0 0 0 0 126 \.26 Stanly 415 111 137 0 0 104 0 0 0 0 0 0 63 0.63 urry 528 148 152 0 0 80 0 0 0 30 0 0 118 1.18 nion 781 171 90 0 0 0 0 0 0 90 0 60 370 3.70 Wayne 983 310 0 0 0 173 0 0 0 200 100 0 200 2.00 Wilkes 597 45 189 0 100 113 0 0 0 0 0 32 118 1.18 21 INSTRUCTIONS FOR APPLICANTS ELIGIBLE TO EXPAND MCC SERVICES FOR WOMEN ELIGIBLE FOR MEDICAID FUNDING Grants will provide approximately six months of salary and fringe benefits for additional matemity care coordination staff. All funds must be utilized by June 30, 2002. Awards will be based upon $15,000 per full-time position. Prorated amounts will be awarded for part-time positions 50% or greater The level of funding requested should be commensurate with the additional number of Medicaid recipients to be served. A full-time (100% FTE) Maternity Care Coordinator should have an annual caseload of 100 clients. This equals a case load of approximately 65-75 women at anyone given time. ASSURANCES The application requires a signed statement from both the agency director and finance officer (Attachment I). The statement provides assurances that (1) grant funds will ~e used to establish new Maternity Care Coordination (MCC) position(s) and/or increase the percentage of time for existing part-time positions and that (2) the revenues generated by care coordination staff will be used to support their salaries in the current and subsequent fiscal years. Agencies that receive funding will be required to submit the date personnel was hired, name of personnel hired and report the number of clients served by the additional matemity care coordinator during the award period. Agencies that fail to comply with these conditions or fail to serve e. additional numbers of Medicaid recipients commensurate with the funding provided will not be I considered for matemity care coordination grants in future fiscal years. . APPLICATION Qualified providers applying for a maternity care coordination grant must provide the following information on DHHS Form T -659 (Attachment II): (1) An estimate of the annual number of pregnant Medicaid recipients in the county who are not contracted to receive maternity care coordination services. (2) An estimate of the additional number of Medicaid recipients who will be served each year by the applicant agency if funding is awarded. (3) The number of full-time and/or part-time maternity care coordinators who will be employed using these grant funds. (4) The amount of funding requested by the applicant agency. (5) Current number of MCC positions in full-time equivalents (FTEs). e District health departments must complete a DHHS T -659 for each county for which funding is being requested. 22 . To help local agencies estimate the number of Medicaid recipients who are not contracted to _ receive MCC services, the Women's and Children's Health Section has enclosed a current .. statistical summary (Attachment III). It provides the following information by county: (1) The estimated number of Medicaid deliveries excluding estimated emergency Medicaid deliveries for FY2000-2001. (2) The number of Medicaid deliveries receiving MCC services prior to the awarding of MCC grants (prior to FY 1991). (3) The additional number of Medicaid recipients who were to receive MCC services from local agencies that received MCC grants during FY 2000-2001. (4) The estimated number of Medicaid recipients not contracted to receive MCC services. This number was obtained by subtracting numbers (2) and (3) above from number (1). (5) Column six indicates the maximum number of MCC positions that each county may apply for based upon 1 DO-maximum clients per each FTE. In determining whether the number of full-time equivalent positions and the amount of funding requested by an applicant agency are in-line with the additional number of persons to be served, Women's and Children's Health Section will use the following formula: e ANNUAL NUMBER OF PERCENTAGE AMOUNT OF ADDITIONAL CLIENTS OF CARE COORDINATOR FUNDING TO BE SERVEDNEAR POSITION REQUIRED REQUIRED 100 100% $15,000.00 80 80% $12,000.00 75 75% $11,250.00 60 60% $9,000.00 50 50% $7,500.00 SUBMISSION DEADLINE The submission deadline for funding requests is April 9, 2001. Applications must be received by that date. Applications should be mailed to: e Carole M. Barnes North Carolina Department of Health and Human Services Division of Public Health Women's and Children's Health Section 1929 Mail Service Center Raleigh, North Carolina 27699-1929 23 Applications may be shipped or expressed delivered, but not mailed to the following address. Carole M. Barnes Division of Public Health 1330 St. Mary's Street Room 516 Raleigh, North Carolina 27605 e REVIEW AND APPROVAL PROCESS Applications will be reviewed by a technical review committee that includes representatives from the Women's and Children's Health Section and the Division of Medical Assistance. The committee will make sure (1) that the application is complete; (2) that the estimated number of Medicaid recipients not receiving maternity care coordination services is accurately documented; (3) that the numbers of additional persons to be served and care coordinators to be hired are commensurate with the level of funding requested; (4) that required assurances are included, and (5) that the submission deadline was met. The technical review committee will determine which applications meet all submission requirements. Priority will be given to applications from providers that did not previously receive MCC grants. The remaining applications will be prioritized by the technical review committee on the basis of each county's number and rate of infant deaths and percent of population unserved. The technical review committee will then forward its recommendations to the Maternal Health Unit for final action. Recommendations may include funding some applications at a level lower than that _ requested. .. Notification of approval/denial will be mailed to applicant agencies by April 30, 2001. Successful applicants will also receive contract and budgetary instructions at that time. CONSULTATION AND TECHNICAL ASSISTANCE Local health departments, community, rural and migrant health centers that need consultation and technical assistance in the preparation of their application may contact their Regional Social Work Consultant. tit 24 , e e e Attachment II DEPARTMENT OF HEALTH AND HUMAN SERVICES WOMEN'S AND CHILDREN'S HEALTH SECTION MATERNITY CARE COORDINATION GRANT APPLICATION FY 2001-2002 APPLICANT AGENCY. New Hanover County Health Department TELEPHONE NUMBER: (910) 343-6500 DIRECTOR: David E. Rice COUNTY: New Hanover A. Estimated annual number of Medicaid recipients in county who are not contracted to receive MCC services. (REFER TO ATTACHMENT III.) 253 B. Estimated annual number of additional Medicaid recipients in the county who will be provided MCC services by the applicant agency if funding is received from the Women's and Children's Health Section. 100 C Additional full-time and/or part-time MCC staff to be employed if funding is received from the Women's and Children's Health Section. Enter number of positions next to the appropriate time percentage(s). (REFER TO ATTACHMENT III FOR MAXIMUM NUMBER OF POSITIONS FOR WHICH AN AGENCY MAY APPLY.) PERCENTAGE TIME 100% 80% 75% 60% 50% 40% 25% 20% #OF POSITIONS 1 AMOUNT REQUESTED $15,000 $ $ $ $ $ $ $ $ COST 15,000 12,000 11,250 9,000 7,500 6,000 3,750 3,000 = x TOTAL D Amount of maternity care coordination funding requested $ 15 ,000 E. Current number of MCC positions in full time equivalents (FTEs). Filled Vacant Total 5 5 DHHS T-659 (11/90) Maternal Health Unit 25 Attachment I MATERNITY CARE COORDINATION GRANT STATEMENT OF ASSURANCE FY 2001-2002 The New H"novpr r.n"n~y ~P"' ~h npp~ .agrees to the following requirements as a condition (Name of Agency) for receiving maternity care coordination grant funds from the Women's and Children's Health Section: (1) To use grant funds to establish a new maternity care coordination position(s) and/or increase the percentage time of an existing part-time care coordination position(s), and (2) To use the revenue generated by the maternity care coordination staff to support their salaries and fringe benefits in the current and subsequent fiscal years as required by the consolidated contract. Signature of Agency Director Date Signature of Agency Finance Officer Date ,. . e e I I I _I 26 I e e e . . Maternity Care Coordination RFA #A013 ATTACHMENT VII APPLICATION FACE SHEET Name of Agency: New Hanover County Health Department Address: 2029 South 17th Street Wilmington. N.C. 2840] Telephone Number: 910 - 343-6~00 Fax Number: 910-341-4146 Email Address: bmccorklelilco. new-hanOVPT nC'. us Agency Status: (x) Public ( ) Private, Non-Profit ( ) Private, For Profit Agency Federal Tax ID Number: 56-6000324 Agency's Financial Reporting Year through tnJ)^ JQ July 1 Name and Title of Contract Administrator: Betty.To McCorkle, Director. Women'" Hpa'~h Care Div. Name of Program (s): MaterniTY r.~rp rnnr~inot-in~ W91R9R'S Healtk G:aY8 Bi"i...16fl SERVICE DELIVERY SITE(S): Hanover Health Npt"wnrlcJ 'R'p::l1rh nop......tm.<JPt... Pr:l?"ate Ilemt.B" Pyi""dl... 8:" 6rrl\,.~c AREA TO BE SERVED' New Hanover County (Vice) President Date 27 e e e HEf1lTi..\ NEW HANOVER COUNTY BOARD OF' cuMMfSSIONERS REQUEST FOR BOARD ACTION Meeting Date: 04/~Ol Department: Hea Ith Presenter: Beth Jones Contact: Beth Jones, Communicable Disease Director (343.6648) SUBJECT: Grant Application.PROPOSAL FOR THE WILMINGTON HOUSING AUTHORITY ROSS GRANT-TEEN AIDS PREVENTION (TAP) PROGRAM AND ALTERNATIVE HIV TEST SITES for 3 year funding of $192,221 BRIEF SUMMARY: We are requesting approval to submit this grant proposal for THE WILMINGTON HOUSING AUTHORITY ROSS GRANT-TEEN AIDS PREVENTION (TAP) PROGRAM AND ALTERNATIVE HIV TEST SITES for 3 year funding in the total amount of $192,221 (Year 1 beginning October 2001 for $ $64,000, year 2 beginning October 2002 for $66,337, and year 3 beginning October 2003 for $68,884 ) The purpose of this grant is to provide continuation funding for the New Hanover County Health Department's (NHCHD) Teen AIDS Prevention program. The purpose of TAP is to provide life skills education and teach risk reduction skills to adolescents to reduce the incidence of the Human Immunodificiency Virus (HIV), which is the virus that causes AIDS, and Sexually Transmitted Disease (STD) infection, and to improve the overall health of New Hanover County adolescents. In addition to TAP's educational programs for youth, NHCHD will provide on-site HIV counseling and testing services for residents of the housing developments. See attached grant application for more explanation and for the budget page for the 3 year funding. (Note: budget page shows an in-kind match which is already in place and is actually indirect costs which will provide administrative, professional and operating expenses to support TAP No county match is required.) RECOMMENDED MOTION AND REOUESTED ACTIONS: Approve grant application for 3 year funding and approve submission of the application to County Commissioners FUNDING SOURCE: WILMINGTON HOUSING AUTHORITY ROSS GRANT ATTACHMENTS: 16 Pages grant proposal, 3 page appendix, and 15 pages attachments 28 ~. 'a ., . e e e PROPOSAL FOR THE WILMINGTON HOllSING AlITHORITY ROSS GRANT MARCH 30. 2001 NEW HANOVER COUNTY HEALTH DEPARTMENT TEEN AIDS PREVENTION (TAP) PROGRAM AND ALTERNATIVE HIV TEST SITES 29 . .. . e Program Proposal New Hanover County Health Department (NHCHD) requests funding for the Teen AIDS Prevention (TAP) program. The purpose ofT AP is to provide life skills education and teach risk reduction skills to adolescents to reduce the incidence of the Human Immunodeficiency Virus (HIV), which is the virus that causes AIDS, and Sexually Transmitted Disease (STD) infection, and to improve the overall health of New Hanover County adolescents. In addition to TAP's educational programs for youth, NHCHD will provide on-site HIV counseling and testing services for residents of the housing developments. Description of Need that the TAP Program and Alternative HIV Test Sites wiD Address The problem that TAP will address is the lack of educational programs for adolescents that effectively change attitudes and behaviors. Nationwide, children between the ages of 10 and 19 acquire an estimated 3 million cases ofSTDs each year. New Hanover County Heahh Department's STD clinic statistics demonstrate that the percentage of people under the age of20 visiting the NHCHD STD Clinic has consistently remained within the range of 15% to 23% since 1995 [Source: NHCHD Clinic Statistics, January 1995- December 31, 2000]. Thus, approximately one-fifth of all NHCHD STD clinic patients are under the age of20. By their presence in the STD clinic, these teenagers are acknowledging that they are engaging in risky behaviors. InNHCHD's STD Quarterly Report from October 1,2000 to December 31, 2000, e 25% of individuals diagnosed with gonorrhea were under the age of20, 19% of individuals receiving the HIV test were under the age of 20, and 45% of chlamydia patients were under the age of20. In addition to the negative repercussions of having an STD, the presence ofSTDs also increases a person's risk ofHIV transmission. According to the Centers for Disease Control and Prevention (CDC), 51 % of new HIV infections in the U.S. are among people under the age of25. For this reason, targeting adolescents with HIV prevention is tantamount to curbing the spread of this virus. Given the incubation period of HIV, 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 HIV transmission, such as alcohol and drug use as well as unsafu sexual practices, were developed as teenagers. The prevalence ofSTDs and HIV have reached an alarming rate in North Carolina and 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 STD infection rate that is more than two times higher than the state average. NHCHD STD Clinic statistics show that there has been a 10% increase in the number of people visiting the STD clinic in Fiscal Year 2001, as compared to FY 2000. There has been an 11 % increase in the number of people receiving HIV tests at NHCHD from FY 2000 to FY 2001. _ There has been an 11% increase in the number of people diagnosed with both chlamydia and - 30 -. of. II \ e e e gonorrhea in New Hanover County in FY 2001, as compared to FY 2000. 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 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. This report describes 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 descn"bed above puts individuals at a greater risk of acquiring HIV or other STDs. For this reason, it is essential to seek new ways to combat the overwhelming pressures many teenagers are unprepared to handle about drug and alcohol use, HIV/STD prevention, relationships, and other critical issues. TAP uses caring and trained peer educators to deliver the lifesaving messages necessary for survival, and helps teenagers develop positive decision-making skills. NHCHD's decision to target the adolescent population was initially determined in 1998 by the Southeastern North Carolina HIV 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 program that specifically targets adolescents with HIV ISTD prevention education. More specifically, it uses the peer education model that has proven to be the most effective strategy to influence change in the adolescent population. According to your 1999 Self-Sufficiency Survey, one-fourth of housing development residents are interested in obtaining health care education services. The results of the survey demonstrate that the majority of residents would like educational programs in their community that specifically target youth, and feel that unsupervised juveniles is a serious problem in the community. TAP offers a comprehensive, structured, enjoyable, after school setting for adolescents to learn skills to prevent teenage pregnancy and AIDs. In addition to HIV prevention educational programs, there are also strong reasons for people at risk ofHIV infection to be tested for HIV and to take charge of their health. Approximately 1/3 ofHIV -infected individuals, or over 200,000 people, are not aware that they are infected, because they have not been tested. Testing for HIV as soon as possible after infection is necessary for individuals to receive medical care and medication to fight the virus. The sooner that HIV- infected individuals begin taking medication to fight the virus, the greater their chances are for living a higher number ofheaIthy years. HIV testing is also the key to stopping the spread ofHIV to others. 31 . .. . ". HIV counseling and testing at locations other than local health departments identify a greater percentage of people with HIV than testing in local health departments: 1.5% of individuals tested at alternative testing sites have HIV positive results, compared to 0.6% of individuals tested at local health departments. People are more likely to take an mv test if it is convenient for them. If they can be tested and receive free condoms by a skilled professional in their own neighborhood, they are more likely to take the test. Because of the response to the question about health care screening services in the community, your 1999 survey results indicate that mv testing and counseling services would be welcome in the housing developments. e TAP's role in connection with the NBCHD and with other community agencies New Hanover County Health Department is a public health facility that provides services to citizens of New Hanover County. Since 1976, NHCHD staffhave looked for opportunities to gain access to Housing Development residents in their neighborhoods. There is a history of working together to provide education on health-related topics, most specifically on STDs and pregnancy prevention. NHCHD has held clinics at many housing development sites in previous years, and wishes to resume this collaboration. This proposal, which offers a combination ofT AP educational programs to youth and HIV counseling and testing services, serves as the perfect channel for resuming services between NHCHD and the WHA. TAP has already begun serving WHA residents; for the past two years, TAP peer educators have been providing ongoing educational workshops to adolescents in Nesbitt Courts and Creekwood South. NHCHD saw the need for collaboration with the WHA, e and encouraged TAP to provide programs to the housing developments. TAP has been accepted and welcomed into the two housing developments where it provides regular programs. There is a high level of participation by youth, especially by adolescent boys, in the weekly TAP presentations. The TAP program works closely with other NHCHD services. The TAP coordinator is responsible for contacting teens seen in the NHCHD STD program to provide individual risk reduction education and referrals to TAP programs. Conversely, referrals for HIV and STD screenings at the health department are made by TAP peer educators when indicated. Other NHCHD staffhave provided tremendous support for TAP through secretarial and administrative oversight, as well as assistance with training activities and transportation of peer educators. Vivian Mears, RN, the HIV Program Nurse at NHCHD, supervises the TAP coordinator. WIth a background in adolescent psychiatric nursing, Ms. Mears has the experience and knowledge to serve as a mentor and advisor to the program coordinator and the peer educators. Ruth Foy, RN, the Immunization Nurse at NHCHD, serves as another mentor and guide for the TAP teens and program coordinator. Ms. Foy attends the weekly TAP meetings and has involved the teens in the development ofa Teen Health Day at the NHCHD in April, 2001. The TAP program coordinator has a Master's in Social Work and a Master's in Public Health from the University of North Carolina at Chapel Hill. She utilizes both her social work skills and e 32 ~ ; e e e her health education skills in working with adolescents. TAP has the support of collaborating organizations. The TAP coordinator is a member of the Cape Fear Teen Health Council, sponsored by Wilmington Health Access for Teens. The TAP coordinator is an active member of two subcommittees of the Cape Fear Teen Health Council: the Teen and Adult Mentoring Project (TAMP) and the Male Responsibility and Involvement subcommittee. TAP collaborates with CARE, a volunteer program that offers services and activities for people infected or affected by HIV. 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. NHCHD also participates in the Southeastern North Carolina lllV Prevention Regional Community Planning GrouJ>- a group of collaborating organizations, agencies, and individuals who meet monthly to identify local needs and improve mv prevention efforts. History of TAP NHCHD began the TAP peer education program in January, 1999 with $32,000 from the lllV/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 fucilitated by the peer educators. After this initial funding, TAP was refunded for a two year period by the Cape Fear Memorial Foundation. This funding expires in October, 2001. As mentioned earlier, TAP has provided programs to two of the housing developments for the past two years. These programs have high levels of participation rates and are well-estabJished. The start-up work is complete; TAP is already a well-attended program in two of the housing developments, as well as in other sites around Wilmington. TAP offers a comprehensive program for adolescents, teaching them how to relate to adults, fumily members, and peers in a positive manner. TAP teaches adolescents how to respect themselves and others; in this way, it promotes fiunily harmony and self-sufficiency. It also helps to prevent adolescents from having children. TAPis not a piecemeal program that focuses exclusively on one or two adolescent issues. Instead, TAPis a holistic, all-inclusive program that teaches teenagers leadership skills, builds their self-esteem, increases their knowledge about how to stay healthy, and gives them something constructive to do during the after school hours. It gives them the opportunity to become role models for their younger peers, and to feel proud ofthernselves. It unifies youth in the community, giving older teenagers the leadership skills and desire to spend time with the younger teens. W~out further funding, however, these programs will disappear in October. It is important to demonstrate to the adolescents living in the housing developments that this program is not another temporary program-- providing hope, a structured environment, and guidance from peer mentors and adults for a short time, and then disappearing, leaving the adolescent residents 33 . , without this positive, structured program in their community. TAP requests continued funding e from your organization so that we can continue to be a consistent force in these adolescents' lives. Objedives ofthe TAP Program 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 the Appendix. The primary goal is to promote an environment in the eight family-oriented housing developments, as well as in other Wtlmington locations, 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 druglalcobol 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 of TAP is to give adolescents the opportunity to send positive messages to their peers to counteract 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. If funded by the WHA. the TAP program will focus its efforts on adolescents in the housing developments; working with these teenagers to create a positive environment where they are free to develop to their potential and have the confidence to resist peer pressure. The TAP program aims to educate teenagers that the risk-taking behaviors that expose them to mv and other SlDs also compromise their potential for healthy and productive adult lives. TAP is a life-skills curriculum that was developed for mv ISlD 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 oflife goals. e 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-two peer educators. The six original peer educators trained a second group of peer educators during a weekend training retreat; this second group then trained the third group of peer educators during another training retreat. The trainings help promote TAP's objective of empowering adolescents to honestly discuss issues and educate one another. Each peer educator is interviewed and carefully selected by the TAP program coordinator, and share three main attn"butes: 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 to make a difference in the community, it is essential for TAP to select peer educators who are the true peers of teenagers at risk of acquiring mv or other SlDs, and may not be teenagers with active leadership roles in their school, star pupils or athletes. These teenagers may seem ordinary, but they are doing extraordinary things. The twenty-two peer educators have been greatly jropacted by the volunteerism and community e 34 " e e e. 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 fucilitates 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 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 offinancially 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 ofmeaning 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. The TAP coordinator utilizes her background as a social worker to serve as a mentor both for TAP peer educators and for program participants. She has developed relationships with program participants that she sees every week at program sites such as the Creekwood South Recreation Center and the Derek Davis Recreation Center. When in trouble or in need of a listening ear, the program participants come to talk with her individually before or after the program. She thus serves as a mentor for the program participants, encouraging them to stay in school, continue coming to the TAP sessions, and teaching them how to resolve conflicts in a non-violent manner. The program coordinator has already established these relationships with youth at some of the housing developments; the mentoring relationships will only grow, as well as increase in number, with continued funding. This past year, the TAP program coordinator encouraged the peer educators to apply for scholarships to attend the Ryan White National Youth Conference in Denver, Colorado. This youth conference, which took place February 17-19,2001, was geared towards adolescent HIV prevention peer educators across the nation. Four TAP peer educators received scholarships to the conference: two received national scholarships sponsored by the conference (please rerer to the newspaper article in the "Attachments" section), one received a scholarship from the Coastal AllEC Health Career Education Department, and one received a scholarship from the local Ryan White chapter. Out of these four teens, only one of them had ever been on an airplane before, and one of them resides in the Creekwood South Housing Development. Their involvement with TAP enabled them to take advantage of opportunities to travel and increase their education. 35 The third goal is to fucilitate 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 every Thursday aftemoon in the fall of2000. The opportunity to discuss issues of concern to them such as violence and relationships was as important as the messages about mv prevention. In particular, the male participants enjoyed listening to an African-American male peer educator talk frankly with them about relationships, drugs, and alcohol. By the end of the semester, 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 in W1lmington 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 of 3 pm and 6 pm because adolescents are bored and lack adult supervision. The July 6, 2000 issue of the Wilmington Morning Star N~s quoted Police Information Officer Linda Rawley as she explained the reason behind the rise injuvenile crime in W1Imington. According to Officer Rawley, the current outbreak of crime among teenagers is caused by the lack of positive outlets and supervision for young people. The TAP program helps to combat this problem by providing adolescents with options to keep them occupied. If funded, TAP will offer the programs on-site at the housing developments so that the programs will be easily accessible to the youth. TAP presentations are composed entirely of interactive activities that challenge program participants to think through problems and express their opinions. TAP peer educators benefit from their hours giving presentations in the connnunity and program participants benefit by being engaged in constructive activities. The TAP program coordinator encourages motivated, active program participants to apply to become peer educators. 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 drugs?" 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 center around dating and relationships. In feedback and evaluations from presentations, we have Jearned that it is extremely helpful for teenagers to learn from their peers that healthy relationships are about self-respect, respect for the partner, and open communication. 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 50010 of the children said that they personally wanted more information about how to protect themselves against mv/AlDS. Too often, adults do not offer teenagers the chance to discuss their concerns about health and e e e 36 , , e e e 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. Strategies to Accomplish this 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 mv 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 peer educators use three methods to reach the target population: a series of small group programs, community outreach events, and one-on-one outreach. Included in the series of programs is basic knowledge ofHIV /STDs and identification of risky behaviors. The most challenging component is in building support for safer behaviors. 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 of program participants. The TAP program coordinator attends each of the peer-led sessions and offers support when needed. TAP prefers to conduct at least six consecutive sessions at each site; however, the quantity of program sessions is t1eXlble in order to adapt to the schedules of collaborating agencies. Whenever possible, the TAP coordinator schedules more than six sessions at a given site. 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. The second method of reaching adolescents is through outreaCh events. TAP has participated in a variety ofthese events, and is always looking for new ways to participate in the conununity. Past outreaCh events include World AIDS Day awareness booths, a Youth summit, and the Hoggard High School Health Fair. These and similar outreach events are described in more detail in the section entitled "TAP's accomplishments and activities". The third method of reaching adolescents is through one-one-one street outreach. TAP peer educators are encouraged to provide one-on-one informal education to their peers, sharing HIV and STD 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. 37 The TAP Peer Educators: Who Are They? e Since the initial group of peer educators was trained, there have been two more training retreats. At each of the retreats, the experienced peer educators train the incoming groups ofpeer educators, with the assistance of the TAP program coordinator. Each peer educator receives a curriculum, designed and compiled by the TAP peer educator. TAP currently consists of twenty- two peer educators. These adolescent educators range in age from 14-22; nine are male and thirteen are female. Fourteen of the peer educators are African-American, five are Caucasian, and three are Latino. One of the peer educators is HIV-infected, and acquired HIV perinata1ly. This diversity within the group teaches the peer educators about people who are different from them, and helps to dispel stereotypes. Discussions at the weekly peer educator meetings often center around cultural diversity and overcoming stereotypes. The hea1th educator selected the initial peer educators from various community sites, including Cure AIDS ofWilrnington, 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. Successive groups of peer educators have been selected from the community organizations and youth groups where TAP gives regular presentations. TAP's philosophy is one ofernpowerment: rather than bring teenagers from the "outside" in to give presentations to youth in a given organization, TAP encourages youth from within the organization to become trained peer educators. In this way, adolescents give presentations to their true peers. For example, when TAP gave presentations to health classes at Hoggard High School, peer educators who were in _ the hea1th classes, as well as other Hoggard High student peer educators, gave the presentations. - One peer educator who gives weekly presentations to youth at the Derek Davis Recreation Center lives five minutes from the center. There is currently a waiting list of eleven adolescents to become peer educators. Out of these eleven teens, two attend TAP's weekly sessions at the Creekwood South Recreation Center, one attends TAP's weekly session at the Derek Davis Recreation Center, one attended TAP's sessions at the Nesbitt Courts Recreation Center, and three participated in the Hoggard High School presentations. The next interview and selection process will take place in April, 2001. TAP's accomplishments and activities Since its inception in January, 1999, TAP peer educators have reached 7,586 individuals through small group presentations, outreach events, and one-on-one outreach activities. In the past five months alone, since October, 2000, TAP peer educators have reached 2,762 adolescents. Since January, 1999, TAP peer educators have given small group presentations alone to 2,811 individuals. These small group presentations have taken place for groups of adolescents at the following collaborating agencies: Cure AIDS ofWilrnington, Girls, Inc., the Juvenile Detention Center, the teen pregnancy division of the Coastal OB/GYN Clinic, the Adolescent Parenting Program ofP1anned Parenthood in both Pender County and New Hanover County, Hope Baptist Church, St. Andrews AME Zion Church, St. Luke AME Zion Church, Soul-Saving Station e Church, Grace United Methodist Church, Duplin County Evergreen Church, the Community Boys 38 , , e e e and Girls Club, the YWCA, the YMCA summer job program, Coastal Horizons, Wilmington Health Access for Teens, Student Action for Farmworkers, Nesbitt Courts Recreation Center, the Creekwood Festival Committee, Wilmington Treatment Center, Crisis Line Open House, Creekwood South Recreation Center, Derek Davis Recreation Center, Hoggard High School, New Hanover High School East Campus, the Domestic Violence Sheher, UNCW Greek Organizations, the gayllesbian youth support group at St. Jude's Metropolitan Community Church, Noble Middle School, Methodist Homes for Children, the Generations Program of Fourth Street, the Wilmington GRASP program, and the Coastal AHEC Health Careers Development Summer Camp. TAP fucilitates several programs on a regular basis. One of these programs bas been held every Wednesday moming during the health class at the Juvenile Detention Center since February, 2000. TAP provides six weekly workshops at the Nesbitt Courts Recreation Center during the full and spring semesters of the school year. TAP peer educators give presentations after school every Thursday to adolescents in the Creekwood South Recreation Center, and every Wednesday to adolescents in the Derek Davis Recreation Center. TAP gives presentations every other Friday to adolescents undergoing substance abuse treatment at the W1lmington Treatment Center. During the small group presentations, peer educators give workshops on a variety of topics that deal with life skills and knowledge. Topics include violence prevention, dating abuse, values clarification, HIV fucts and information, dealing with the consequences of risky behaviors, communication skills, overcoming peer pressure, and making positive decisions. Through interactive games and role plays, peer educators teach participants the skills to combat peer pressure and adopt a bealthy lifestyle. In addition to small group presentations, TAP peer educators have been involved in a diverse range of outreach activities. For example, in December 1999 and December 2000, TAP peer educators participated in several events to raise awareness for World AIDS Day. Peer educators held World AIDS Day booths at UNCW, Hoggard High School, Lakeside High School, New Hanover High School, and Cape Fear Community College. At these booths they distributed AIDS nbbons and conducted activities to raise awareness about HIV in New Hanover County and encourage prevention. Six peer educators attended a World AIDS Day celebration in Raleigh to honor volunteers. TAP also held a booth at the Hoggard High School Heahh Fair in April, 2000. 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 lllV?" In this way, TAP encourages adolescents to actively think about how to have a healthy lifestyle; 500 adolescents played the game during the Hoggard Health Fair. TAP bas also set up the "Wheel of Fortune" two times at Independence Mall, bringing its message ofSTD prevention and healthy lifestyle to the place where teens spend their free time. Wrtb the support of Gloria 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 peer educators-turned-actors. TAP performed 39 the play at two venues: the Adolescent Pregnancy Prevention program, entitled Let's Talk Night, e at Girls, Incorporated; and the Family Fun Day in the Park, which was a community event designed to bring fiunilies and the community together for an afternoon of free live music and family-based entertainment. TAP peer educators have increased their one-on-one street outreach work. Since its inception, peer educators have conducted 278 one-on-one outreach sessions. Since October, 2000, peer educators have facilitated 181 of these sessions, helping their friends in need. In January, 2001, TAP collaborated with Wilmington Health Access for Teens, Crossroads Co- op, Communities that Care, the Community Mediation Center, and the New Hanover Commission for Women, in order to put on a youth sunnnit. TAP peer educators served as fucilitators for small groups at the youth summit, which focused on developmental assets. The TAP program collaborates on a regular basis with Coastal AIDS Resource Efforts (CARE), which is a local volunteer organization that provides services for people infected and affected by mY. In November, 2000, peer educators put together food baskets for fifteen New Hanover County residents living with AIDS. In December, three TAP peer educators volunteered at the CARE children's Christmas party, passing out gifts and serving food to forty children and their fumilies affected by mY. Peer educators have volunteered at CARE's Easter egg hunt for mY- infected children and at Camp CARE, the summer camp for children infected or affected by mY. In January, 2001, CARE presented one TAP peer educator with the Flame of Hope award for his _ outstanding volunteer service and leadership role. ., 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. Last month Professor Sandy Adams, who teaches a public spt'al,ring course at UNCW, spoke to the TAP peer educators about public speaking skills. Three of the peer educators have received additional training as TATU (Teens Against Tobacco Use) peer educators. 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. 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. A Look Into TAP and Alternative Testing Sites if Funded If TAP receives nlnc!ing from your organization, TAP will focus on providing presentations, one- on-one outreach, and community events to the Wtlmington housing developments. TAP will e continue to give its regular presentations at two of the developments, Creekwood South and 40 , e e e Nesbitt Courts. In addition, TAP will continue its regular presentations at the Derek Davis Recreation Center. According to the Derek Davis Recreation Center program director, Ms. Althea Macmillan, a large number of the youtb who participate in center activities live in the housing developments nearby. Iffunded, TAP will increase its presentations at the bousing developments, and provide programs to youtb in the following bousing developments: Hillcrest, Houston Moore, Rankin Terrace, Taylor Homes, Vesta Village, and Willow Pond. Tbe work bas already begun, and collaboration between WHA and NHCHD is already taking place; the collaboration will expand greatly with continued funding. TAP will collaborate with adult staffmembers and mentors at eacb of the housing developments, training them to help participate in the series of workshops. In this way, TAP peer educators, the TAP program director, and adult staff and mentors at the housing developments will collectively build a web to protect teens by strengthening their resolve to develop a beaIthy lifestyle. This presence will demonstrate to the adolescents that people in the community truly value them and are looking out for them. When adolescents misbehave, it is because they are seeking attention. When this attention is wiIIingly given to them, adolescents become free to develop to their potential. In addition to the TAP program coordinator, TAP will also consist of a part-time community outreacb worker. This outreacb worker bas been a TAP peer educator for two years, and bas a great deal of experience working with people and leading presentations. He bas facilitated presentations at the Juvenile Detention Center for the past year, and facilitates numerous other presentations at sites ranging from the W1lmington Treatment Center to the Creekwood South Recreation Center. He bas already taken on leadership roles within TAP: be helps transport peer educators to the meetings, and serves as facilitator at the weekly TAP peer educator meetings. As the oldest of the peer educators, the others look up to him and see him as a mentor. He is the peer educator who received the Flame of Hope award from CARE, and be received a seholarship to attend the National Ryan White Youth Conference. As an African-American male, he serves as a positive role model for minority youth in the community. Wrth the assistance of the community outreacb worker, TAP will be able to provide simuhaneous workshops at two different sites at the same time. In general, the outreacb worker position will enable TAP to reacb a larger number of teenagers at more sites. By offering presentations at sites throughout Wilmington, including the Juvenile Detention Center, the W1lmington Treatment Center, and Hoggard High School, TAP is serving youth who live in all parts of W1lmington, including those who live in the various housing developments. Nevertheless, iffunded by the Housing Authority, TAP will provide presentations to other community groups only when they do not conflict with presentations offered at the housing developments. Because we are a smaIl county geographically, there are adolescents who may not reside in a housing development who interact with those who do. TAP bas the potential to influence many youth in the community. What a positive message it would send to the community to have this effort supported and sponsored by the W1lmington Housing Authority, and implemented in cooperation with NHCHD. TAP currently gives presentations on site, and will continue this practice if funded by the 41 Wilmington Housing Authority. For example, TAP will continue to give presentations in the - Creekwood South Recreation Center, the Nesbitt Courts Recreation Center, and at other sites in .., the community. The weekly peer educator meetings will continue to take place at NHCHD. Transportation is provided for each of the peer educators by NHCHD staffmernbers from school to the meetings, and then back home after the meetings. The TAP program coordinator will continue to utilize her skills as a social worker when working with the adolescents in each of the programs. She will continue to assess when program participants need help, and will continue to talk with them individually, listening to their concerns and sharing resource and refurral information with them. This social work piece is a critical component of the TAP program. Program participants tell the TAP program coordinator about problems with relationships, school, family life, sexual abuse, date rape, and other issues, and the TAP coordinator helps to guide them, or directs them towards services in the community. Iffunded by the Housing Authority, the TAP coordinator will increase the number ofpeer educators from the housing developments during the next selection process. NHCHD will complement TAP's prevention messages with HIV counseling and testing in the housing developments. NHCHD will bring HIV testing services into the housing developments, offering on-site HIV testing services to four housing developments each year. This testing will be available for all residents of the housing developments, and will be free of charge. Time Frame e The TAP program requests funding for three years. During that time, TAP will rotate educational workshops for youth through each of the eight housing developments for families. TAP will provide a six week series of presentations to each of the eight housing developments a minimun1 of two times during the three year period. The housing developments with the highest youth participation rates will receive a greater number of additional sessions. Number of Clients to be Served TAP plans to have approximately 15 youth participate in each series of workshops. Since TAP plans to facilitate sessions for eight housing developments, TAP will serve a minimum of 120 youth a year. However, TAP will also continue its outreach activities and other presentations. TAP has reached 5,718 individuals from February, 2000 to February 2001. Beclln"'" of this history, TAP plans to reach approximately 5,000 youth each year. Evaluation of Program Susan Roberts, Ph.D., an epidemiologist, volunteered to develop an evaluation survey to measure TAP's effectiveness. This survey, which is a modified version of the Prevention Minimum Evaluation Data Set developed by the Sociometrics Corporation, can be viewed in the - "Attachments" section. TAP staff admini>:ter a pre-test of this behavioral questionnaire to all - 42 e program participants before the beginning of each new series of presentations; staff ask participants to fill out the instrument again as a post-test during the last class of each series of workshops. The evaluation tool measures a combination of knowledge and behavioral indicators. 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 participants complete an audience evaluation form after presentations, so that peer educators can learn the skills that need improvement. This evaluation form, as well as some completed evaluation forms, can also be viewed in the "Attachments" section. Program data is collected by peer educators throughout the project using forms to document the number of educational sessions conducted, the type of activity performed, the location of the activity, the number of participants or contacts, and referrals made. The TAP coordinator monitors this data collection. Conclusion e The Wilmington Housing Authority has a unique opportunity to fund a proven successful program that reaches adolescents with messages to preserve, protect, and prepare them for fumily self- sufficiency. If teenagers can be reached early enough, they will feel valued and respected, and learn to respect themselves and others. They will develop more responsible behaviors and will turn negative peer pressure into positive goals that will guide them into becoming healthy, successful young adults. TAP is too important to this population and to this commnnity to lose. The TAP program is already up and running in several of the housing developments; thus, none of the grant money would be spent on start up funds. All of the funding would go towards enhancing an already existing program, ensuring that it reaches a large number of adolescent residents in the housing developments. Ifit does not get refunded, the program will disappear. Collaboration between WHA and NHCHD would increase the access of housing development residents to health department services, since health department staff would be in the developments on a regular basis. This proposal can plant the seeds for a consolidated health education and prevention plan that could be expanded through collaboration with NHCHD, with additional funding. We urge you to give this proposal a chance for survival. e 43 Teen AIDS Prevention Program Budget Project Budget: From Year 1 SalarieslWages $43.014 (1 FfT Health Educator; 1 PfT (15 hrslwk) Community Service Assistant) Fringe Benefits 10,211 Total. . . . . . . . . . . . . . . .. $53,225 Operating Expenses Printing Dept. Supplies Employee Mileage TrainingfTravel Total Operating Exp .... $500 2,875 1,500 5,900 $10,775 TOTAL Grant Request $64,000 NHCHD In-Kind Support Management Support 2 hrslwk x 52 wks x $121hr 1,248 Fringe (25%) 312 Administration 1 hrlwk x 52 wks x $25/hr 1,300 Fringe (25%) 325 Professional Staff Support 3,900 3 hrslwk x 52 wks x $25/hr plus 40 hours initial training Fringe .. 975 Space (36 sq ft x $7/sq ft x 12 mol 3,024 Telephone 200 Utilities 600 Copier Services 300 Employee Mileage .. 165 Dept. Supplies .451 Total NHCHD tn-Kind ... $12,800 Adult Mentor In-Kind Support 32 sessionsiyr x 1.5 hrsisession X $25/hr .. $1,200 Total In-Kind ......,... $14,000 Total Expenses (Including In.ldnd) ...... $78,000 e October 1. 2001 To September 30. 2004 Expenses (by Category) Year 2 $45,165 10,397 . . . . . . . . . . . . . . . . . . . . . . . 55,562 . $500 2,875 1,500 .5,900 . . . . . . . . . . . . . . . . . . . . . . $10,775 . . . . . . . . . . . . . . . . . . $66,337 1,248 312 .1,300 325 3,900 .. 975 .3,024 200 600 300 165 .. 451 . . . . . . . . . . . . . . . . . . . . . . $12,800 $1,200 ...................... $14,000 . . . . , . . . . . . . . . . . . . . . . .. $80,337 Year 3 $47,423 10,686 . . . . . . . . . . . . . . . . . . . . . . . 58,109 $500 2,875 1,500 5,900 . . . . . . . . . . . . . . . . . . . . . . $10,775 .................. $68,8 1,248 312 1,300 325 3,900 975 3,024 200 600 300 165 451 . . . . . . . . . . . . . . . . . . . . . , $12,800 $1,200 . . . . . . . . . . . . . . . . . . . . . . $14,000 ....................... $82' Total Budget: $241.221 44 e APPENDIX e e 45 Goal # 1: Promote an environment in the eight family-oriented housing developments, as well as .- in other Wtlmington locations, 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. Objectives 1. To ensure that 85% ofteens who attend TAP's series of presentations score at least a 30% reduction in intention to engage in risky behaviors on post-test portion ofthe evaluation instrument. 2. To ensure that 80% of program participants report choosing abstinence or safer sexual practices 95% of the time, as measured by the post-test evaluation survey lIdm;n;!ltered to each program participant at the last session of the TAP series of workshops. Activities 1. Give TAP peer-led series of presentations to adolescents in the following Wihnington housing developments: Creekwood South, Hillcrest, Houston Moore, Nesbitt Courts, Rankin Terrace, Taylor Homes, Vesta Village, and Willow Pond. 2. Give TAP peer-led presentations to other community groups. 3. Teach peer educator-led weekly health classes at the Juvenile Detention Center. 4. Participate in health fairs and public events in housing developments and at other sites Outputs 1. :rAP series of six presentations to adolescent residents in each of the eight housing developments _ a minimum of two times during a three year period. ,., 2. Ongoing series of weekly TAP presentations, after the minimum requirement listed in #1, to housing developments with the highest rates of youth participation. 3. TAP peer-educator facilitated presentations to other youth organizations in the community. Outcomes Initial 1. Teenage residents ofWHA developments knowledgeable about lITV & STDs and how to prevent infection. 2. Youth residents of WHA developments made aware of skills in conflict resolution, decision making, communication, assertiveness, and other relevant topics. Intermediate 1. Teenage residents ofWHA developments take active steps to prevent themselves from acquiring lITV I STDs. 2. Teenage residents of WHA developments utilize conflict resolution, decision making, communication, assertiveness, and other skills learned in TAP workshops. Long-term 1. Adolescents of varied racial/ethnic groups in WHA developments encourage peers to practice positive life skills and prevent spread oflITV & STDs. 2. Adolescents who live in other areas ofWtlmington encourage peers to practice positive life e skills and prevent spread oflITV & STDs. 46 , 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 1. To ensure that 95% of peer health educators report practicing abstinence or safer sexual practices, as measured by an evaluation survey Adm;n;!ltered every 3 months. 2. To ensure that 95% ofpeer health educators score 90% or higher on a knowledge test after a 40- hour training period. Activities 1. Hold weekly meetings for peer educators. 2. Provide ongoing training to 22 current peer educators. 3. Train a minimumoflO additional peer educators each year. At least Y. of each new group ofpeer educators will reside in the Wtlmington housing developments. 4. Conduct teen-led brainstorming sessions to decide the most effective strategies and locations to reach other teenagers with prevention messages. Outputs 1. Twenty-two current peer educators increase their number of presentations. 2. Ten additional peer educators are trained each year. At least 5 of these 10 new peer educators will reside in the Wihnington housing developments. Outcomes InitioJ 1. Twenty-two current peer educators increase knowledge and comfort level giving presentations. 2. Ten new peer educators each year learn information to help them give presentations. 3. Peer educators learn drama and public speaking skills. Intermediate 1. Twenty-two current peer educators and the new peer educators increase the quantity and quality of their presentations in the housing developments. 2. Peer educators utilize learned behavioral skills that they teach to program participants. Long-term 1. Peer educators benefit from volunteerism, community service, and leadership that they provide. 2. Peer educators receive message that their community values themand that they canmake 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. 47 Goal #3: Facilitate the exchange of ideas and open communication between TAP-trained teens e 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 ofT AP presentations to teens in eight W1lmington housing developments. 2. Give series ofT AP presentations to teens in church youth groups, after school programs, and other locations. 2. Provide updates to peer educators so that they can learn current filets. 3. Peer educators initiate one-on-one educational sessions with peers. Outputs 1. At least 120 youth who resid~ in WHA developments attend TAP series of presentations each year. 2. TAP peer educators reach approximately 5,000 adolescents a year through presentations, community events, and one-on-one outreach. 2. Approximately 200 youth receive one-on-one educational sessions each year. Outcomes Initial e 1. 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 mmiliar with who the peer educators are in their community. IntermetHate 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 filets and information from one another in a respectful manner about issues of concern to them such as relationships, sexuality, and peer pressure. e 48 I . e ATTACHHENTS · e e 49 e Morning Star, Wednesday.June 21,2000 POSITIV~ PEER PRESSURE Teens get the word out about AIDS prevention By NANCY ROBERT Sw-News CoiTesjKmde1it P' eer.Pressure can bea Powerful influence. . eSpeciJ1ly on adolescents. TAl' (Teen AIDS l'reYention) uses that theory of teen,s influencing teens to educate adolescents about the prevention of AIDS and otherilelp1a\ly transmitted infections. TAP was the.idea ofthreewomen'Whowori< for the New Hanover CoIlnty"Health Department: Vivian . Mean. WV PlOgraM nuISe;1leth]ones. director of the communicable diSeases JlIOIlI'3IIl. and Anne r..wrence. clinic coordinator for the WV pl!lgl'3IIl. '1'he'!ltaiisticiiilthe2()'to 29'-ie8r..,idcategOry for HIV are indicative of those who contract- ed theselnfections as teen- agers, and there were no pl u.,;.u~ out there for teen-age prevention; said-~.Mears. lnfact, according to the Center for Disease,Control. half of the newly diagnosed infe<;- tions nationwide OOcurin people ages 15-24'. Thewomen approached the state department ofhealtil and receiVed a six- month grant forT APiDJariuary 1999.. ]eSSitaNakell; program 'Coordinator. heard a~ut rAP while'finishing hermaster's in social workatNew Hanover ReglonaI'Medicdl.cem.er.. Ms. Nakell was'intereSted because of the auilieJl!:e.thepo'ujs. am hoped to reach and the way the pi-eventioriiniormatiim would be introdu~. "Theresearth shows that the best way to prevent HIV amongUlenS is for otberteells to bethe'roIe models,"1lhesaid. Want to volunteer? For more information about being part ofT AP. orto findout.aboI.ia presentatiOn qy the group. can Jessica Nakell at the New Hanover. County Health Dept; 343$1' For oIher \IOIl.rII8ElI' opportunIIIes see 'Volunteer conneciion : page 3 e e 50 e e After six successful months, Cape Fear Memorial Foundation granted tJie progrnm another year's worth of funding. '''We're so gI'l!teful to the foundation. It's a,local group helping out the community," Ms:N;lkell said. The program started with threevolunteers and now has 20. They range in ages from 13 to 21, and are from diverse ethnic and econQmic backgrounds. Gordon Huggins, the eldest member of the group, joinedaft'er his uncle diedfrom.AIDS. "I know a lot of people that do things that put them at high risk. Maybe I ean help," be said. TAP mem~ meet orice a month'forpianning lind are trained to be familiarwith other local support services, appropriatemethods.ofpresenting informa- tion and how.tocommlmicate in aone-on-one session. T APv.olunteerll have visited schools, churches, youth groups and othei' organizations in the community.. Within the.past few months they have been to the New Hanover Cotmty Juvei1ile Corrections ~cility,Coastal' Horizons, Girls 1oe; and Crisis Line opeI,l house, to name just a few. Besides HIV prevention, they cov.er a wide range of othei' themeS, includi!tg self-esteem and self-respect, howto."say no;" the ef(ectsof drugs and alcohol on decision-making, ,and d-eaIing with peetpreSSure. Just recently , TAP held Family Fun Day in the Park, co-sponsored by the Wi)mingion Police Department, to raise both community aWareness Of AIDS and funding for the group. A three-on-three basketball tournament was part of the event, as well as banda, p~t shows, food, raffle prizes and a PlaY written by veteran TAP' volunteerJalnes Fennell,I7' "HIean getpell\lle to just think, then fve done what! wanted to do and maybe they won't do something they shouldn't,. James said. 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"'!l~81:g!!2~]~:~.gl F e 52 . ittx ~l)~nY Please answer all of the questions below as completely as you can. Your answers are completely confidential. 1'~!t jt BIRTHDA Y@: / / e e Month Day Year Sex: o Femole o Male Which group(s) best describes YOU? (Mark all that apply.) o Hispanic/ Latino/ Mexican o Native American/Alaskan Native o Black! African American o Asian or Pacific Islander o White o Mixed Race (Specify): o Other (Specify): Who do you live with" o One Parent o Two Parents o Grandparents o Other: specify: TeeD $U'D~ 1>f~eDt!oD T:A.1> Is this your first TAP session? DYes ONo If No. how many TAP sessions have you attended before today (not including todoy's session): o One (today makes my 2nd session) o Two o Three or Four o Five or Six o More than six sessions - 1 - Ire you in? (If what grade will you II?) 53 1'ift!\ T '1? e Please circle T for TRUE and F for FALSE. T or F There is a cure for AIDS. T F A person can look healthy but still pass HIV to or their sex partner. e T F The birth control pill will prevent a woman or from getting HIV. T or F Taking an HIV test two weeks after having sex will tell a person if she or he has HIV. T or F Drinking alcohol puts people at a higher risk of getting HIV. T or F You can get HIV through oral sex. e -2- 54 e Imagine thot_.. n' you are at a party and you've been drinking. You meet someone you really like and you go off to be alone together. Things start to happen. You don't have any condoms. You don't want to ask the other person because you think it will ruin the mood. You know that without a condom you might get a disease, but in your head, you just keep hearing, "You don't get a chance like this every day!" e If you were in this situation. how much pressure would you feel to have sex? (check one) No Pressure at All D A Little Bit of Pressure D Some Pressure D A Lot of Pressure D How easy or difficult would it be for you to NOT have sex in this situation? (check one) RillY Ear Sort of Easy D Sort [:~~ru't Rear Diffi\cult Would you end up having sex in this situation? (check one) Yes D No D o 55 ~ '\2/).~ <JOc> t>'V~ 1? ~ft C e Please answer the following questions as honestly as possible: Which of the following best describes your pions or opinions about having sexual intercourse in the future? Check one. o I plan to wait until marriage before having sexual intercourse o I plan to wait until I am engaged before having sexual intercourse o I plan to wait until I find someone I really love before having sexual intercourse o I plan to wait until I am at least 19 before having sexual intercourse o I plan to wait untl1 I am at least 17 before having sexual intercourse o I plan to have sexUtlI intercourse whenever an opportunity comes along e o I plan to have sexUtlI intercourse as soon as possible o Having sexUtlI intercourse isn't something you con plan: it just happens. Have you ever had sexual intercourse? Check one. o Yes: Continue on next paqe (paqe 4).:, o No: Stop here. You are finished with this survey... THANKS! e - 3 - 56 ." .,' '" '-, '- '-, '- '- '- '- '-" '- '- '"' '-"" '- '-, ,. e During the last 3 months. I had sexual intercourse TIMES. During the last 3 months, I had sexual intercourse with _ different PARTNERS. Durina my lifetime, I have had sexual intercourse with _ different PARTNERS. The last time you had sexual intercourse, did you or your partner use a condom? YES NO D D If you or your partner were on Birth Control Pills or Depo-Provera, would you still use a condom? e YES D NO D Could you, now or in the future, tell your boyfriend/girlfriend that you don't want to make out or have sex with him/her? (Check one.) I definitely could D I probably could D I probably could not I definitely could not D D I.i. J ' . < ;- '..' ; ,"." ~ . .,-..'. . -.;. >, ' .. , .; . J .,' .. ....aG... g, ~. e -4- 57 jo-=::-'::o~ =:::=~c~ ---==_:o~ ==-=-o~ ==-- o't ====-o~ .:==::- o~ --=-::-:-o~ ===---oCO =---.::==-o~ =- - G~ ::-===-c.~ -=~ c~ ==~:-Q.CO '--"=:-G~ -::--==:--o~ ----=:-o~ :---==::~o~ --.:=.. 6~ In which of the ways below, if any, have you chanqed your sexual behavior in the last month?(Check all that apply) e 0 Decided to wait to have sexual 0 Stopped having sex with intercourse partners who use needles to 0 Stopped having sexual take drugs intercourse 0 Started to use condoms 0 Don't have sex as often 0 Use condoms more often 0 Stopped having sex with more 0 No changes than one partner 0 Stopped having sex with partners I don't know well e I would insist on using Q condom even if my partner didn't want to. I definitely would insist D I probably would insist D I probably would not insist D I definitely would not insist D lit .: 1 "'; .... ......,:. .......'. . if' ,'.,' ..J ~.: "tit. I'" ; VII. "~'..." eIII.. .:ti! \t.. ': ,. D.: g. " ,".' ,. . ...... ..' , . .-" , -. ~ "....' . e - 5 - 58 e e e \ . PRESENTATIONS BY TAP pEER EDUCATORS \ 1. Name of presenter(s) Yesl Somewhat Not Really 2. Did you learn useful information? 3. Was the presentation interesting? 4. Did they answer your questions? 5. Was presentation well-organized? 6. Was it easy to understand? Excellent Good Needs Work 7. How was the body language of presenters (eye contact, gestures) 8. Overall rating of presentation 9. What do you feel were the best parts about the presentation? 10. What do you feel the speaker needs to work on? 59 . e 1 \ PRESENTATIONS BY TAP PEER EDUCATORS 1. Name of presenter(s)ffir. (;nrdOri 2. Did you learn useful information? 3. Was the presentation interesting? 4. Did they answer your questions? 5. Was presentation well-organized? 6. Was it easy to understand? Yesl ,/ ../ ,/ V ,/ . Excellent . 7. . How was the body language of presenters (eye contact, gestures) 8. Overall rating of presentation .J ..../ Somewhat Not Really Good Needs Work e 9. Wt.at do.... f..l ..... tho b~' ....... the """",atl...? .r ~nl !-v:l1fe a j, ,.,r.. I' t" .W P /"lllJed ~,< ~,,';l'J ~~k: ~,~ ~'n t.P~ "'~~ I 10. What do you feel the speaker needs to work on? ~~:>>',~~ ~;,:~~~;+je~~~,~ ;,~'" e.<(("QI -h:> hl.m. . e 60 . # PRESENTATIONS BY TAP pEER EDUCATORS 1.l'lame of p.........O'(,) ~ \-1, \' tffi ~ Gm ( d..D \'\ Yesl Somewhat Not Really 2. Did you learn useful information? \/ 3. Was the presentation interesting? \/ 4. Did they answer your questions? ,/ 5. Was presentation we\l_organized? V 6. Was it easy to understand? V I Excellent Good Needs Work 7. 'How was the body language of 'v-:: presenters (eye contact, gestures) 8. Overa\l rating of presentation 1,/ = , 61 . . . I PRESENTATIONS BY TAP PEER EDUCATORS 1. Name of presenter(sL~ IA i) ~4/' ) (!d.)/k., 2. Did you learn useful information? 3. Was the presentation interesting? 4. Did they answer your questions? 5. Was presentation well-organized? 6. Was it easy to understand? ~ Somewhat Not Really '\ ..,........" ,/ ~ ,[/ .~ Excellent Good Needs Work 7. How was the body language of presenters (eye contoct. gestures) 8. Overall rating of presentation =tiL~ 9. Whot do you feel were the best ports about the presentation? J:J'ktf~J;~::A.~l":::?~'~ ,::i.j~i-; 10. Wh~~~>>~~/,~rrn2((J( K /.r e l e e 62 ; ~ -- 1 \ PREsENTATIONS BY TAP PEER EDUCATORS Yesl Somewhat Not Really V J ~ ~-) ,I 1. Name of presenter(s) " ,X,\' , ( . '. t'" ,-;: /",-, ! \ (,\ 1\'- (,\ \1 2. Did you learn useful information? 3. Was the presentation interesting? 4. Did they answer your questions? 5. Was presentation well-organized? 6. Was it easy to understand? Excellent I 7. How was the body language of presenters (eye contact. gestures) 8. Overall rating of presentation ~ \;",...\"( \'-"\f_~' '"-........ .~ . ' ~ .... Good Needs Work 9. What do you fee' were the best parts about the presentation? l'. I (J I' (Ie, c.\ Ie '"" W',""\c ''f'"I0 """'(-. ('<0> <rl) '" 10.\ e ( 10. 10. What ~ you fi\~ the speaker needs to work on~~, ^ Qof'\ \'\(~ C" ~ ,C.f..... l?"':.-\;r ",I) N\\. ''\ ~..), e \ l '\,............,\~"z=-.:. - l,;-o..'\.'<-eJ c:JaDU'C \r<:,v.:.:l ~ "oti-'Cf-L. \r--~~o\ ~~ 'N~~~ ~ ~-rL -:e-",\ ~v0d. e . 63 . e I PRESENTATIONS BY TAP PEER EDUCATORS I 1. Name of presenter(s) 6-cOV' ~ tJ (\ 4;-- k'DDra V\ 2. Did you learn useful information? 3. Was the presentation interesting? 4. Did they answer your questions? 5. Was presentation well-organized? 6. Was it easy to understand? \./"" . 7. How was the body language of presenters (eye contact, gestures) 8. Overall rating of presentation Excellent Good Needs Work v ~ e 9. What do you feel were .the best parts about the presentation? 1\.e.. i('\.u~\\l Wf\.+- ~tu. j~I'--r.-+ M7).~~~ 10. What do you feel the speaker needs to work on? ffi \. (\\L a bo..t S- \.:R'R~~J ~~n D~ lrn 0'" ~d:~'\J ~;S 6\c\. ~~AL\.-:2 .~) '''''-- '-. ~\1 - . e 64 e e e NEW HANOVER COUNTY BOARD OF COMMISSIONERS REQUEST FOR BOARD ACTION Meeting Date: 04/16/01 Department: Health Presenter: Betty Jo McCorkle, Women's Health Care Director Contact: Betty Jo McCorkle, Women's Health Care (343-6660) SUBJECT: SAFE KIDS TRAILER GRANT APPLICATION for$8,74O (FROM SAFE KIDS SAFE COMMUNITIES, NORTH CAROLINA GOVERNOR'S HIGHWAY SAFETY) BRiEr SUMMARY: We are requesting approval of the SAFE KIDS TRAILER GRANT APPLICATION for $8,740 for child passenger safety trailer and equipment. New Hanover County Safe Communities/Safe Kids Coalition is requesting this grant for a trailer and equipment to be used by the Coalition member organizations for the following: . Conduct Child Safety Seat Check events . Use to personnel in neighboring counties through the Southeastern Regional Advisory Committee for trauma system coordination SERAC) . Attract media attention to the issue of Child Passenger Safety . Training purposes for Child Passenger Safety (CPS) courses . Traveling resource creating visibility, resources and incentives . Used at events such as fairs, etc. for Visibility See the attachment itemizing the budget summary for the $8,740 for equipment and supplies. RECOMMENDED MOTION AND REQUESTED ACTIONS. Approve grant application for $8,740 for SAFE KIDS TRAILER GRANT APPLICATION and approve submission to the New Hanover County Commissioners FUNDING SOURCE: SAFE KIDS SAFE COMMUNITY ATTACHMENTS: YES, 8 PAGES 65 . , .' . SAFE KIDS TRAILER GRANT APPLICATION aAFEKIDS Coalition N &Al ~ """Nt::" ~ \-! ')4-vf (,;;rv.M, l W' TI r:s /~I(fb kID:) 2. Contact Person: ":J) A:J ,~ ~ ~ kR'D 3. Contact Person Phone Number: q/o 3~3-(,(J(P Fax: tilo 1~ (- t{/~ft, Will this person be responsible for Quarterly Reports for trailer? Yes~No_ If you answered "NO" complete #7,8, and 9 of who will be responsible. 4. E-mail: ~hm.Jo...rJ6hr./\wJ-ho...\l>\lt.r-.l\c.lA$ 5. Mailing Address: ,2..01- q "S. II -l;:b :)t. 6. City, ZIP: Wl~'o-I".,...~,...J INC.I ~4c>1 7. Person responsible for quarterly reports . Address 9. Phone: E-mail: 10. Person(s) to be responsible for trailer: '1) /Irl tq) ~A1~S> 11. Address: '-o2-"l 'S. nth '51t. 10 ;\"""~ I 1-\(., .2t+o I 12. E-mail: ~I"-JKRb@ c.O.M.... -hll'>'I7Vl!A"".o\c........... 13. Insurance for trailer and contents will be provided by: UOA-\oVlW" ~_ .t..J:K ~ 14. Address: J-tJ-.9 "5. qt;1, st. }vJ:I,,^,'1'er. :,.J0 ~4ol 15. Phone: (lilo) 5<-13-"""3(., e 66 . . GRANT PROPOSAl FOR CHllD PASSENGER SAFETY TRAIlER/EQUIPMENT ., e USE OF TRAILER & EOUIPMENT IN COUNlY/AREA: . Trailer will be used by Coalitlon member organizations . Trailer will be used to conduct O1ild Safety Seat 01eck events for a minimum of six (6) events per year . Trailer will be offered for use to personnel in neighboring counties conditional on tt1e personnel having adequate C.P.S. training (specifically, contact will be made with EMS providers and Fire Services providers in neighboring counties via the Southeastern Regional Advisory Committee for trauma system coordination (SERAq) . Trailer will be used to attract media/public attention to tt1e Issue of O1ild Passenger Safety . Trailer will be used for training purposes: a minimum of three (3) two-day (16 HR) c.P.s. courses are uff""ed per calendar year by our coalition . Trailer will be used as a traveling resource for fitting stations around the area: creating visibility, resources, and incentive . Trailer will be used at events such as fairs, etI:. for visibility Coalitlon Membership; those members involved with CPS, bicycle, and pedestrian safety; and list of Instructors, Technidans, 2-day checkers attached Budaet Summarv: 1 covered trailer (approx 10' in length) 2 Tents @ $1,695 each 2 storage socks @ $100 each 16 251b sandbags (for tents &. signs) @ $100 for set of four 1 highway sign (48") & base ("free child car seat check") @ $200 3 V signs (enter, exit, caution children) @ $350 each 16 traffic cones @ $50 for set of four 4 Banners (blue w/ NC SAFE KIDS logo) @ $25 each Insurance, tags, upkeep for three years TOTAL $ 2,200 3,390 200 400 200 1,050 200 100 1,000 e $8,740 e 67 . .~ .y e e e Coalition Membershio: New Hanover Co. Health Dept. American Red Cross 0111d Advocacy Commission Coastal Area Health Education Center Full Potential New Hanover Regional Medical Center- Trauma Services Cooperative Extension Service Parents As Teachers Wilmington Health Ai:a:sS for Teens WWAY lV-3 (abc affiliate) Wilmington BIcyde AdvIsory COUncil Hurricanes B1cyde Racing &. Club Chain Reaction B1cyde Shop City of Wilmington (Parks, Fire, P.O.) Communities That care Jeff Gordon Chevrolet Partnership for O1lldren New Hanover SherIffs Dept. Highway Patrol Two Wheeler Dealer Blcydes Wrightsvlne Beach P.O. State Farm Insurance Coastal Horizons cape Fear Cyclists Coalition Members Involved with CPS. blcvde. nMestrlan safety: New Hanover Co. Health Dept. 0111d Advocacy Commission Coastal Area Health Education Center New Hanover Reg. Med. Center- Trauma Srvcs Parents As Teachers Wilmington Health Ai:a:sS for Teens Jeff Gordon O1evrOIet Hurricanes B1cyde Racing &. Oub State Farm Insurance Ust of National In<:tructors. Technicians. 2-dav checkers: American Red Cross City of Wilmington Full Potential New Hanover SherIffs Dept. Highway Patrol Two Wheeler Dealer Bicycles Chain Reaction Blcyde Shop Wllm Bicycle AdvIsory Council cape Fear Cyclists Wrightsvllle Beach P.O. InStructors - Larry McMahon (retired VA patrolman, per leslie Worthington, She thought he told her he's a nationalinstructorl?) Technicians - DavId Howard 1"9416 (NHC Health Dept.) Renu Daryanl (WIlm Health Ai:a:sS for Teens) Tony Bur1le (Oak Island Police Dept., Brunswick Co.) CpI David MacAlpine (NHC Sheriff's Dept.) 2-day - Elisabeth Constandy DeAnne O1ryst Pamela Heath candace Artis Joanle Michael Alberta Robinson KItty Yeriles MaryAnn Atkins felICia Myott Sylvia Brown Kelly Davis Jon Knoll Teresa Stanley KeIe' Batchelor Andrea carson Mamie Carlos Christy O'Herron Pam Cooke Joyce Hatem Beverly Bass Deborah Goodwin Paula Calvert Tracie Franks carole Merritt Mary Jo Newton Beverly Fussell Andrea Davis Joe Sigman Deborah Biddle 01ad lewis Rhonda Smith Josette Williams D.R. Swan all area Hwy Patrol O1r1st1ne Craft Shannon Smiles Wendy 0ewiS - Cariton Charlotte NoniS W.T. Schllpp 68 , '. / ,......,:~ ~'".~ .' I " . ~ J " . ":{ . ~SAFE ~KIDS ~ i>' ... Insurance Commissioner Jim Long, Chair North Carolina Department of Insurance Office of State Fire Marshal PO Box 26387. Raleigh NC 2761 I e North Carolina Hospital Association. Founding Sponsor MEMORANDUM A J' ir ~.b<- ~'('<"'''''' /~cl b.r ~-') d ~<-c: . 0 . c . c X1lfX'}.ZX17 To: From: Re: Date: NC SAFE KIDS County Coordinators Paul Jones Request for Proposal for Equipment purchase Grant JanullI)' 31, 2001 In December you received information from us announcing the availability of funds for purchasing trailers, tents, and other hardware that can be used in child passenger safety efforts along with bike and pedestrian safety programs. Attached is the infonnation you need to write and submit a proposal to us. This includes information on equipment that is available for purchase to be used in connection with the program. Because of the success many coalitions and CPS advocates have had with the NC SAFE KIDS van and equipment, we believe there are compelling reasons for buying the hardware listed. e If you are the Safe Communities coordinator for your county or your organization is the lead for SafeColDIDunities, please keep in mind that we cannot accept two applications from you, i.e., one from your SAFE KIDS Coalition and one in the name of your Safe Communities Coalition. In order to expedite the procedure, we ask that all applications be sent to: N. C. Department of Insurance Office of State Fire Marshal P.O.Box26387 Raleigh, N. C. 27611 Attn: Angie Gregg Angie is the Department of Insurance CPS coordinator. In the meantime, if you have any questions you can contact me at 1-888-347-3737 or send an email tomeatpjones@ncdoi.net. cc: Angie Gregg, Injury Prevention Specialist & CPS Coordinator, OSFMlNC SAFE KlDS e IIJree: 888/347-3737 · 919/733-3901 · Fax: 919nJ3-917I 69 . . J' ,'t e e e ~-. Ii STA IE OF NORTH CAROLINA DEPARTMENT OF TRANSPORTATION MICHAEL F EASLEY GoVERNOR DAVID MCCOY ACTING SECRETARY MEMORANDUM To: Safe Communities Coalitions From: Frank Hackney ~ Re: Recent Funding Notice for Occupant Safety Efforts Date: January 29, 2001 In December you received information from us announcing the availability of funds for purchasing durable goods for occupant protection programs. This announcement coupled with other program announcements has raised some questions as to the process for applying. Enclosed is a set of the criteria for this grant as well as information on the equipment that will be available. In order to expedite the procedure, we ask that all applications be sent to: N. C. Department oflnsurance Office of State Fire Marshall P. O. Box 26387 Raleigh, N. C. 27611 Attn: Angie Gregg If you have any questions you may contact me at 919-733-3083. MAIUNG ADDRESS: He DePARTUENTOFTAANSPOFlTAllON GovERNOR'S HlGHWAY SAFETY PROGRAM 150S MAIL SERVICE CENTER RALeIGH NC 27699-1508 TEl.EPHONE: 919-733-3083 FAA: 919-733-0604 LOCA'I10N: 215 EAsT lAHE STREET RALEIGH Ne _,DOT.STA TC,NC,USlSERVICESlGHSP/ 70 ....~.. . ,. NC SAFE KIDS / Safe Communities Office of State Fire Marshaland Governor's Highway Safety Program , e Grant for trailers and appropriate equipment (not to exceed $9,000) to be used for child safety seat checking stations, training programs, bike rodeos, health and safety fairs, pedestrian safety training, classes and workshops. Reauirements/Criteria: " . Must be a coalition holding regular meetings and submitting minutes on a timely basis Recipient coalitions of trailers must designate a coordinator or person responsible for trailer. Recipient coalitions will be responsible for insurance, maintenance, repairs, and upkeep of trailer and equipment for three years. -- Coordinator must file a short quarterly report to the grantor agency for three years regarding the pro grams and activities in which the trailer and equipment was used. Trailer must be white with graphics that include NC SAFE KIDS (or Safe Communities, where appropriate), Office of State Fire Marshal (OSFM) logos and "Funding Provided by the Governor's Highway Safety Program." ". Tents (Quick-E TM Vehicle Topper, Model TPU-04 [Vendor Information Attached.]) and appropriate signs necessary for car seat check ups, similar to those used in the NC SAFE KIDS van. \;. Coalition lead organization or coalition members must have vehicle(s) capable of pulling the trailer. _ . Extra weight or consideration will be given to applications that include a commitment to use the equipment. to help adjacent counties with injury prevention activities in a multi-county collaborative effort. Letters from collaborating agencies would be appropriate. ~~.tC ( :- "'. "'. ? . . \,. Trailer will be eauinned with the folIowin2 sunnlies: . 2 tents (Quick-E TM Vehicle Topper, Model TPU-04)* - Product Code 73-A-TU04 . 2 storage socks, Model TPU-04 - Product Code 73-B-KU04 . 8 25 lb. Sandbags for tents - Product Code 34-B-SB25 . 2 Highway signs (48") and bases with message "Free Child Car Seat ChecK' - Product Code 34-S-RK36 Ootional but recommended: . 4 V signs (Enter, Exit, Caution Children, Car Seat Check) 151 Options should be Enter & Exit . 4 Sandbags for signs . 16 Traffic cones (or more ifneeded for large bike rodeo) Applicants can review the attached information from TV! Corporation in Glen Dale, Maryland and decide if you want to order from this vendor or make your own local arrangements for signs announcing your events.èRegardless, the application should include specific information about your plans to sign events in the interest of safety. e 71 ,. '. I'. .. ,. .plicatiOn for Grant , Provide a written summary - not to exceed two pages - with the following information: . How the trailer and equipment will be used to promote injury prevention in your county/area (See criteria). . Attach a list of members of your coalition. . Attach a list of the agencies involved with child passenger safety, pedestrian safety and bike safety in your coalition. . Attach a list of known National Instructors, Technicians, and NC 2-Day-Trained Checkers in your county. . Provide a budget summary. Annlication must be submitted and received bv March 5, 2001. Mail to: Office of State Fire Marshal, Attention: Angie Gregg, PO Box 26387, Raleigh NC 27611 Recipient organizations awarded the grant will be required to submit orirtinal invoices to the NC Department of Insurance (DOl), Office of State Fire Marshal for reimbursement of equipment. Invoices should be submitted asa package, so the DOl Controller will not have to write more than, one check to grantee _anizations. Note' The Quick-E 77J Vehicle Topper, Model TPU-04 are the tents used in the NC SAFE KIDS van. The tents are patented and available only through the manufacturer. The National SAFE KIDS Campaign researched tents and the staff found nothing that can be considered a competitive. e 72 I . .. .. , Tents, Signs, and Related Hardware - {; , . Vendor: m Corporation 7100 Holladay Tyler Road Glenn Dale, MD 20769 Phone: Fax: 301-352-8800 301-352-8818 Price List: (For use only by NC SAFE KIDS and member agencies) Prices subiect to change. based on actual number of tents and hardware ordered 73-A-TU04 Quick-ETM, Vehicle Topper, Model TPU-04 $1,695 34-V-SK48-A Sign, Portable, V-Board, Yellow, Model ASK-48A $350 NC SAFE KIDS logo and Enter 34-V-SK48-B Sign. Portable, V-Board, Yellow, Model ASK-48B $350 NC SAFE KIDS logo and Exit 34-V-SK48-C Sign. Portable, V-Board, Yellow. Model ASK-48C $350 Caution Children and Car Seat Check Up 34-S-CKI8 Cone. Safety, 18" tall, NO logo, Caution Children $50 Set of Four 34-S-RK36 Sign, Stand and Roll-up, 48' $200 e Free Car Seat Check I 34-B-SB25 Sand Weight, 25 lb, Black Bag, Set of Four $100 34-B-WB05 Water Bag, 5 Gallon, Set of Four $100 34-C-0024 Table Cover, 2' by4', Blue $100 Product Components: 73-B-KU04 Storage Sock, Model TPU-04 $100 73-Y-KODl Door, Topper, Blue $200 73- Y -KOB I Banner, Blue, NC SAFE KIDS logo $25 73-Y-KOB2 Banner, Blue, NC SAFE KIDS logo $25 34-Y-V48K-A Poster, Yellow, Model ASK-48A $100 34-Y-V48K-B Poster, Yellow, Model ASK.-48B $100 34-Y-V48K- C Poster, Yellow, Model ASK-48C $100 e 73 - e e NEW HANOVER COUNTY BOARD OF HEALTH AND SHERIFF'S DEPARTMENT RESOLUTION IN SUPPORT OF PROGRAMMING AND ACTIONS TO REDUCE MOTOR VEHICLE CRASHES RELATED TO DRIVER DISTRACTION AND/OR POOR DRIVING BEHAVIOR WHEREAS, According to the North Carolina Department of Transportation 1999 data, New Hanover County ranks first among North Carolina counties In total crash rate, non-fatal Injury crash rate, crash injuries per 1000 people; third In crashes per 1000 registered vehicles; sustains a crash-related Injury every two hours; and has a monetary crash cost per hour of $22,962, and WHEREAS, In North Carolina motor vehicle crashes are the leading cause of injury-related deaths for all ages, and the leading cause of death for persons up to 34 years of age. Motor vehicle crashes are also a leading cause of non-fatal injury to persons up to age 34, and the leading cause of traumatic brain and/or spinal cord injury, both of which can cause life-long disability for the victims with great coat to family, friends, and communities, and WHEREAS, A year 2000 study by the United States National Highway Traffic Safety Administration found higher risk of crashes due to mobile phone use distraction; also concluded many distractions have the potential to cause crashes at similar magnitude, and WHEREAS, The North Carolina Governor's Task Force for Healthy Carolinians lists the reduction of motor vehicle Injuries as one of It's priorities, and WHEREAS, The New Hanover County Board of Health and Sheriff's Department recognize motor vehicle crashes as a major impediment to community health and safety, and WHEREAS, The New Hanover County Board of Health and Sheriff's Department recognize driver distraction, inattention, and poor driving behaviors as significant contributors to crash Injuries and deaths. THEREFORE BE IT RESOLVED, The New Hanover County Board of Health and Sheriff's Department support programming and actions by government, private business, community groups, schools, Individuals, and others to reduce motor vehicle crashes related to driver distraction, Inattention, and/or poor driving behaviors. Adopted the _ day of ,2001. Wilson O'Kelly Jewell, DDS, Chairman New Hanover County Board of Health (Seal) Joseph W. lanier, Sheriff New Hanover County Attest: Secretary to the Board of Health 74 , - Thi' ""'ear-, f7r-eate,t IH()ck.l3u,ter- ()()n~t Mi" It 12ated: T~~~~ f)~L"'" (:()minlf t=eatur-ed AUr-aCU()n, e ""-ad! ~Q~ 'G@CtJt 'Gcrl~ ,..... ~ ~ .Ii! ....af;) Cb-y..O~e6;:'Jl 6 0 ~~ ~~, ~V"'- ~ , e/ ':S ~ ~ 0.... ..:1.,\0 ~.:; I ~ ,~~ ~ .r,71 s.(J ,i'.V ~ ~ ../j, 1~0';1 ~. ,fi , \l. ~~ ~~ -"'~ jf .:' ... ~~ ~~- ,C' ~ ~ ~ .~ ~r~" v ~ .~ k;l ! ~ " $ ~ ()~ OIte 1uek8 ~Jt UlD1 be fiIte 8ftIJlcl ~i8e UliJtJt~ or cl1cclclecl eompllf;ep , '.~ i e e e STRATEGIC PLANNING PRIORITIES March 27, 2001 Update Access to health care (Issues #7,11 & 5) ~ Communities That Care: Janet McCumbee attended this meeting on 3/2/01 The following items were discussed: a Youth Development Conference in late summer/early fall to highlight successful programs; Wilmington Housing announced the availability of grant money from her office to provide services to residents of family self sufficiency program in public housing, section 8, and old Jervey residents; United Way Volunteer Program, 500 volunteers for the week of April 21-27; a project to promote Youth Mental Health and Prevent Youth Violence and Substance Abuse; and SPINNC, a service to the community (http://www.spinnc.orQI. ~ A follow-up meeting with the New Hanover Community Health Center concerning access to dental care issues is scheduled for April 3 and April 1 O. ~ Smart Start: Based on legislation, the Partnership for Children is developing an accountability plan for local Smart Start participants. The new standards are being developed. Concern: local committee has no public health representation. More than 30 grants were submitted locally this year ~ Child Health Division has signed 5 agreements with local physicians to provide Health Check services for the Medicaid children they see in their offices. Under the agreement, the physician remains the child's primary care provider and provides sick care. We see these children for well checkups and immunizations as outlined in the Health Check guidelines. ~ Dave Rice met with Region 8 Health Directors on March 23. Centralized Environmental Health training, placement of Environmental Health at State level (DENR or DHHS), and Coastal Health Alliance's proposal regarding diabetes were discussed. ~ New Hanover Community Action is applying for federal money to start a Headstart program for prenatal and birth to 3 years of age. ~ II. I. Preventive services & lifestyle-related risks (Issues #12 & 15) ~ Flu/Pneumonia Vaccine: Communicable Disease Division visiting sites in March to immunize the high-risk population. ~ School Nurses screening 6th and 8th grade girls and 8th grade boys for scoliosis during March. ~ Breast Pumps: State is purchasing additional electric breast pumps for the Nutrition Division. ~ Sex Crimes Investigation Training: COD will present HIV information for participants - law enforcement, rape crisis, emergency room staff. Contact Beth Jones (6648) for more information. ~ Wild Animals: Board of Health regulations makes the harboring of wild animals illegal to reduce the potential of rabies. A local veterinarian identified an African Servol cat ~ Healthy Carolinians will be working in two groups on action plans ~ for recertification in May The two groups are: 1 Chronic Disease (diabetes to start BUT not limited to this area!); and 2. Community Health (access to health care; health promotion). ~ Commit to Quit: Campaign ended with a celebration on March 15. Thanks to those involved, especially DeAnne Chryst. Congratulation to those quitting smoking! ~ Diabetes Today' Workshop held for providers on March 15. ~ Asthma Task Force: Hosting a health care provider luncheon on April 2. ~ TB Infection Control: Report completed. No employee PPD conversions this year! NHCHD facilitv meets "very low risk" category Contact investigation on new case underway 1 it ~ Animal Control Officers began canvassing designated problem areas in the county to verify rabies vaccination and county license fee status of residents. ~ Wake Forest med students will be working with Community Health Team to develop pamphlets related to common student health problems. These pamphlets will be distributed on an as needed basis. ~ The New Hanover County Dental Program is sponsoring "Guard Your Smile" Mouthguard Program. The goal of the program is to increase awareness and use of mouthguards as an important part of injury prevention for children and young adults in New Hanover County On April 21, 75 young soccer participants will be professionally fitted for mouthguards at no charge. The program will be held at the YMCA on Market Street in Wilmington. Additional sponsors of "Guard Your Smile" include the North Carolina Oral Health Section, the YMCA, and Cape Fear Community College. ~ Wilmington East Rotary Club and Rotary Internation donated $1000 each for an immunization campaign at Nesbett Court. Smith Cline Beecham donated 120 doses of Hepatitis B. ~ III. Communication, education & marketing (promotion) (Issue #1 & 4 in part) ~ ACS Open House on March 17 - 10 am -145 pm. Flyers distributed. ~ ACS went to JC Roe School to do the rabies puppet show for the kindergarten class. Dr Bob Weedon's honors class from UNCW was taught at ACS concerning shelter staff's issues involving wild or feral cats and euthanasia procedures. ~ Adoption animal photos may be viewed on the internet by accessing petharbor.com. This was accomplished by advanced technology through the Chameleon software program. ~ NHC Shelter Animals: Can be found on line at http://www.petharborcom. ~ Women's History Month: Elisabeth requested to teach a class on eating disorders at UNCW. ~ WAAV Radio and Airport Display' Slots available. Contact Elisabeth (6658). ~ Azalea Festival Parade: Health Department will not have an entry this year Notified on March 5 that $175 fee would not be waived. Too late for a staff fundraiser ~ The Environmental Health Division secured copies of "Diagnosis and Management of Foodborne Illness, A Primer for Physicians" from the American Medical Association to distribute in the community The Communicable Disease Division will promote the availability of this information kit through their quarterly newsletter to physicians. ~ Spring Health Fairs: Taylor Homes -April 14, Cape Fear Community College - April 19, Red Cross Safety Day at Lowe's - April 21, Town Hall at the Mall - May 5, Summer Safety Rally at UNCW - May 12, and Hurricane Expo at Trask Coliseum - June 2. ~ Salute to Teens: Activity for teens at NHCHD on April 28. COD fundraising to purchase door prizes: Ladies old shoes - bring in by March 16, Chicken dinner - April 5. ~ Public Health Month: Kickoff on April 2 with John Bennett (UNCW). Dances from different cultures. Theme is "Be Active." Keep an eye out for the calendar next week. ~ Talk Radio: Janet McCumbee discussed the importance of getting kindergarten health assessments on March 27 .. Medical Laboratory Week will be celebrated April 15 - 21 ~ IV. Facility utilization & Information technology (Issues #6 & 4 in part) ~ HealthJT Requests: Address to send information technology (computer) requests. Effective March 12, all requests should go through this address. ~ Software: It is imperative that a license is purchased for each copy of software application(s) loaded on County computers. NHC/NHCHD IT Staff must load applications. We will be inventorying each computer station to ensure compliance. e e e 2 .J e e e + On March 16, the Facilities Task Force will review and finalize listing for bilingual signs, and review the Facility Needs Surveys. + The Facilities Task Force met on March 16, 2001 at 11am. Members decided to have minutes from each meeting to capture action items and/or assignments. The minutes started with this meeting. The listing for Bilingual Signs was distributed, reviewed and revised. Betty Creech is checking with staff on the wording of and location of some of the signs. Betty will submit the information to Lynda for a final revision of the listing prior to submitting to our interpreter for final conversion to Spanish and prior to contracting with a vendor for the signs. Betty has volunteered to coordinate getting the signs made and put up. (Attachment 12) + HSIS User IDs: Users are reminded to update their HSIS passwords once a month. If a user attempts to log on HSIS three times unsuccessfully, you will be revoked from HSIS. Once revoked the State must be contacted by Health_IT to reset user's access + SRVNOTES 1 will be updated this weekend. The following network printers will be inaccessible: ACS, EHS, and Maternal Health. These printers will be available on March 26. + IT Inventory. for computer equipment and software is underway Scheduled to complete inventory on April 20. + An alternate location for the spay/neuter facility was identified by building on the opposite side of the building with an entrance leading out of the current shelter supervisor office. + Meetings with Property Management helped to identify needs involved in securing a generator transfer switch and a generator at the facility + Keys and Locks: Lynda Smith is reviewing requests with Property Management. A locksmith will be contacted. + Personal Computers: Health IT staff are imaging PCs for School Health, TANF, WIC, Laboratory and Women's Health this week. New printers are being installed. + V. Water quality, storm water management & drainage; & Air quality (Issues #3 & 8) + Environmental Health Division obtained an updated map from NHC Engineering Department defining areas presently served and areas proposed to be served in the near future. + VI. Emerging health risks (Issue #13) + Center for Public Health Preparedness: Dr Robin Ryder will meet with the EpiTeam on March 12 + Rabies: A positive case of canine rabies was reported in Mecklenburg County + Hurricane Preparedness: Our EpiTeam review and revise the media releases in preparation for the upcoming hurricane season, starting June 1 Revisions should be completed in April. + Staff participated in a City / County meeting to develop a planned response to rodent complaints. Residents brought this issue to City Council's attention in a recent meeting. Discussion focused on the cause of the rodent problem that is habitat destruction via development and migration to urbanized areas in search of food. Vector Control Program and City Code Enforcement staffs efforts are and will continue to be educating the public concerning rodent control. The opportunity created by the rodent issue is for the City and County to work jointly towards ameliorating the problem. + Scombroid Poisoning: Report of a scombroid (histamine fish) poisoning case was received from a physician on the 24-hour reporting phone line. Environmental Health staff investigated a local restaurant and seafood market as well as reported findings to the North Carolina Department Of Agriculture and US Department Of Health And Human Services Food And Drug Administration. Mahi mahi was the type fish implicated and was believed to have been shipped from an out of state source. Three years ago, tuna burgers and grilled tuna salad were implicated in a series of cases of scombroid poisoning. + Emergency Policy. Updated list of employee names and addresses was distributed to employees for inclusion in their policy manual. 3 -+ Shigella Outbreak: No new cases last week, March 12 - 16. Outbreak may be resolving, although some septra-resistant organisms identified. -+ VII. Population growth & diversity (Issue #2) -+ HOLA (Helping Our Latin Americans) is hosting an educational program featuring Ms. Matty Lazo-Chadderton on April 3'" Ms. Lazo-Chadderton works as a Hispanic/Latino Education Advocate with the NC Education and Law Project at the NC Justice and Community Development Center She will be sharing about her current position and will touch on special needs education and ESL programming. -+ Daytime Spanish radio station (1180 AM WYMT) available soon. -+ VIII. Discontinued services picked up by Health Department (Issue #9) -+ ACS was informed of the absence of an ACO at Wrightsville Beach. Options for that area being covered by New Hanover County were discussed with Lt. Narrimore of WBPD, and he was sent a copy of our fee schedule. -+ IX. Staff Development & continuing education (Issue # 14) -+ UNCW student nurses orienting with school nurses (Spring 2001) as part of child health education -+ UNCW Students: Dr Bob Weedon brought his honors class to the Animal Shelter on March 1 -+ OSHA Training: Susan O'Brien and Beth Jones attended training on March 5. Focused on the Bloodborne Pathogens Standard. Effective Date of Changes, April 17, 2001 As of this date NHCHD must provide Hepatitis B titers to any employee in Category 1 that was vaccinated by New Hanover County after November 1, 1999. NHCHD Staff using equipment must evaluate the use of best equipment available to protect employees from sharps sticks. -+ Public Health Month Activities: Calendar being developed. "Be Active" lunch-and-Iearn activities may include: dance, yoga/stretching, aerobics, walking, health snacks, etc. -+ Several employees attended computer courses to improve their skills. -+ March 26 videoconference, "Betrayal of Trust - The Collapse of Global Public Health," -+ Epi Lunch & Learn programs will be scheduled on the fourth Thursdays. -+ Nutrition Lunch & Learn: Inhome Breastfeeding Support Program will be held on March 27 -+ The second Consolidated Agreement Training will be held by videoconference from 9:00 a.m. - 11 :00 a.m. on March 30, 2001 -+ The NC DHHS Division for Public Health has requested all local health departments to identify a local HIPAA coordinator no later than March 28. -+ Center for Public Health Preparedness: Management Team met with Dr Rachel Stevens, Janet Alexander, and She ilia Pfaender from UNC School of Public Health, Center for Public Health Preparedness on March 20. The three-year grant will have two prongs: 1 Surveillance Model, and 2. Workforce preparedness/training. Four sites across the US were awarded CDC grants. In addition to UNC, Columbia University, University of Washington, and University of Illinois were selected as Centers for Public Health Preparedness. UNC is working with four NC pilot counties: Edgecomb, Cumberland, Wake and New Hanover Dr Robin Ryder met with the EpiTeam on March 12 to start the process for the first prong, the surveillance model focusing on salmonella javiana. Dr Stevens discussed the 2nd prong with the Management Team. The UNC School of Public Health, Center for Public Health Preparedness is developing an assessment tool to survey all NHCHD staff regarding our knowledge, skills and training needs. The assessment tool should be ready by May 2001 Hopefully, several training opportunities will surface from the survey and will be addressed during the next three years. 4 . . e e e , e e e + A representative from HLP, Inc., which is the parent company for our Chameleon software, spent the entire week with ACS staff to do training refresher and update. + as Training: Available to NHCHD staff using as. In-house as users group being developed. + X. Evaluation of services (Issue #16) + Travel and Training Restrictions: Essential travel/training was discussed. The Health Director will be reviewing and approving only essential travel and training for the remainder of FY 2000-01 + Consolidated Agreement: Program guidelines should arrive this week. Training on processing the agreement is scheduled for March 30. + Health Department County Courier Goal is for our courier not to leave before 9am. Ideally, our courier would leave at 9am and return by 10am. + Teen Survey. Evaluation tool developed for TAP with formatting by Susan Roberts, Volunteer Epidemiologist. + AEIOIU Teams: Members for three priority teams have been selected. Minutes from AEIOU Team meeting on March 19 will be sent soon. + Temporary Food Regulations: Environmental Health held a meeting to review and consider updating rules governing temporary food facilities on March 26. 11 vendors participated. + Procedures for handling traps were addressed by ACS staff. + 5 e. e e NEW HANOVER COUNTY HEALTH DEPARTMENT 2029 SOUTH 17TH STREET WILMINGTON, NC 28401-4946 TELEPHONE (910) 343-6500, FAX (910) 341-4146 Everywbcre.Everyday.Everybody- DAVID E. RICE, M.P.H., M.A. Health Director LYNDA F. SMIm, M.P.A. Assistant Health Director March 14, 2001 Representative Daniel F McComas North Carolina House of Representatives 609 Legislative Building Raleigh, NC 27601 Dear Representative McComas: At its regular monthly meeting on March 7, 2001, the New Hanover County Board of Health strongly opposed repealing the motorcycle helmet law. The Board of Health does not support anything less than the present requirement for riders and passengers of motorcycles to wear approved helmets. According the National Centers for Disease Control and Prevention, each year approximately 2,000 motorcyclists are killed, and more than 50,000 are injured in traffic crashes. Many of these injuries and deaths could be prevented if motorcycle riders and their passengers wore helmets Per mile driven, motorcyclists are about 14 times more likely than persons in a car to die in a motor vehicle crash, and they're about 3 times more likely to be injured. While motorcycles make up less than 2 percent of all registered vehicles in the U.S., motorcyclists account for 6 percent of total traffic deaths. Wearing a helmet lowers a motorcycle rider's risk of fatal injury by 29 percent and reduces the risk of traumatic brain injury by 67 percent. Traumatic brain injury is a leading cause of death and disability among children and young adults in the United States. These injuries have both short-term and long-term effects on individuals, their families, and society and their financial cost is enormous. For the people who live with a traumatic brain injury-related disability, the financial cost is only part of the burden. The long-term impairments and disabilities associated with traumatic brain injury are grave and the full human cost is incalculable. These disabilities, arising from cognitive, emotional, sensory, and motor impairments, often permanently alter a person's vocational aspirations and have profound effects on social and family relationships. According to the Insurance Institute for Highway Safety, motorcycles are less stable and less visible than cars, and they have high performance capabilities. For these and other reasons, motorcycles are more likely than cars to be in " ?jour ..JJeaftt" - Our Priorit"" crashes. And when motorcycles crash, their riders lack the protection of an enclosed vehicle, so they're more likely to be injured or killed. Per mile traveled, the number of deaths on motorcycles is about 16 times the number in cars. Because serious head injury is common among injured motorcyclists, helmet use is vital. Please reconsider your position of repealing the motorcycle helmet law. The lack of helmet use translates into high costs for individuals, their families, and society. The use of helmets will protect the public's health. Thank you for your time and consideration. Sincerely, NEW HANOVER COUNTY BOARD OF HEALTH /lWJt~ Michael E. Goins, 00 Robert G. Greer Optometrist County Commissioner ~IJ,Q~ Anne Braswell Rowe Philip P. m h, Sr., MO General Public Member Physician du. ,.,J.~ k;t//~~ William T Steuer, PElRLS Estelle G. Whitted, RN Engineer General Public Member e li~~~u General Public Member e 7#J~L~ Melody a.'Speck, VM Veterinarian e e e e NEW HANOVER COUNTY BOARD OF COMMISSIONERS Ted Davis, Jr., Chairman (Jane). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 313-0755 Home 7111 Creeks Edge Drive E 26409 e-mail: tdavis@co.new-hanover.nc.us 763-6249 Office 762-5175 FAX Robert G. Greer, Vice-Chairman (Lou) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 763-5961 Home 1216 Country Club Road 26403 e-mail: bgreer@co.new-hanover.nc.us 619-7879 Mobile 763-5961 FAX Julia Boseman. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 686-4442 Home 6605 Providence Road 26411 e-mail: jboseman@co.new-hanover.nc.us 251-6975 Office 251-6976 FAX William A. Caster, (Diane). . . .. . .. .... ... . ... .... ... ... . . .. .. . ... 452-1282 Home 310 Brookshire Lane 26409 e-mail: bcaster@co.new-hanover.nc.us 341-7149 Office 452-2875 FAX Nancy Pritchett. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 791-2827 Home 637 Robert E. Lee Drive 26412 e-mail: npritchett@co.new-hanover.nc.us 798-1706 FAX NEW HANOVER COUNTY BOARD OF HEALTH Wilson O'Kelly Jewell, DDS, Chairman (Christie). . . . . . . . . . . .. ....... 216 Pine Grove Drive 26403 e-mail: wojewell@aol.com 791-6113 Home 791-2401 Office 791-2408 FAX Gela N. Hunter, RN, FNP, Vice Chairman (Jim) . . . . . . . . . . . . . . . . . . . . .. 799-0723 Home 126 Quail Ridge Road 26409 e-mail: gelajim@hotmail.com 763-2072 Office 763-1586 FAX Henry V. Estep, RHU (Lisa). . . . . . . . . . . . . . . . . . . .. ................ 792-9584 Home 3213 Strawberry Court 26409 e-mail: hankestep@isaac.net 792-0188 792-0188 FAX Michael E. Goins, 00 (Anne) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 392-3445 Home 5030 Randall Parkway 26403 e-mail: 02seedoC@wilmington.net 392-0270 Office 392-0271 FAX Robert G. Greer (Lou) . . . . . . . . . . . . . . . . . . . . . . . . . .. .............. 763-5961 Home 1216 Country Club Road 26403 e-mail: bgreer@co.new-hanover.nc.us 619-7879 Mobile W. Edwin Link, Jr., RPH (Laurie) ................................. 343-1244 Home 306 Colonial Drive 26403 e-mail:linkrx@aol.com 763-0845 Office 763-0846 FAX Anne Braswell Rowe (Mercer). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 762-2425 Home 2216 Acacia Drive 26403 e-mail:annerowe@bellsouth.net Philip P. Smith, Sr., MD (Nancy)............................ .. . 762-2230 Home 1610 Azalea Drive 26403 e-mail:ppsmithsr.@aol.com Melody C. Speck, DVM ( Matt) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4605 Wrightsville Avenue 26403 452-0542 Home 799-5587 Office 799-8545 FAX 799-2144 Home 395-5585 Office 395-5586 FAX 675-2179 Home William T. Steuer, PElRLS, (Mary). . . . . . . . . . . . . . .. ................ 5710 Oleander Drive, Suite 110 26403 e-mail:wsteuer541@aol.com Estelle G. Whitted, RN (Louis) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1611 Rock Hill Road, Castle Hayne 26429 Frank Reynolds, MD, Med Cons. (Marguerite). . . . . . . . . . . . . . . . . . . . . . . 762-4621 Home 1706 Fairway Drive 26403 David E. Rice, Health Director (Linda). . . . . .. ...................... 791-2092 Home 1006 East Primivera Court 26409 e-mail: drice@co.new-hanover.nc.us 343-6591 Office 888-745-5094 - Pager 341-4146 FAX 612-1684 Cell 03/20/01 . J : .. ~ . . . . . . .. . . '"- The University, of North Carolina at Chapel H'i11 '. , ,',., '"., ' < , ' . LOCAL GOVERNMENT LAW Number 97 February 2001 David M. Lawrence, EdIp,r HEALTH AND SOCIAL SERVICES AGENCIES' LEGAL DUTIES TO CLIENTS wri'u LIMITED ENGLISH PROFICIENCY: NEW FEDERAL GUIDANCE . Jill D. Moore North Carolina is in the midst of a dramatic demographic change. In the past ten years, both the size and the diversity of the state's population increased markedly. Growing percentages of the state's newcomers are originally from countries other than the United States, including substantial numbers of people from Latin American countries and Southeast AsiLI One result of this demographic change is that North Carolina's lOCal health and social services agencies are facing a new and increasing challenge: assessing and meeting the needs of large numbers of residents who qualify for the agencies' services but who may have Irouble accessing those services because they do not speak English proficiently. 2 Communicating with limited-English-proficient (LEP) clients requires health and social services agencies to grapple with a host of complex issues: maintaining confidentiality and good agency-client relationships while working through interpreters, navigating differing cultural expectations, assuring that language barriers do not compromise the availability or quality of services-and doing all this with limited financial and staff resources. Yet the agencies musi tackle these issues and find workable solutions in order to fulfill their core I. James H. Johnson, Karen D. Johason-Webb, and Walter C. Farrell. Jr.. A Profile of Hispanic Newcomers 10 North Carolina, Popular Government 65 (Fall 1999), at 2, 2. Between 1990 and 1997, the state's Hispartic population increased by 94.7 percent, while the AsianlPacific Islander population increased by 76.4 percent. Iii at 4, Table 1. 2. It is not known precisely how many limited-English-proficient persons currently reside in North. Carolina; however, it has been estimated that there,are between 250,000 and 300,000 Spanish speakers alone. Jane Perkins, Overcoming Lan,uage Barriers 10 Health Cart!, Popular Government 65 (Fall 1999), at 38, 38-39. - < Local Government Law Bulletin No. 97 missions of prolecting lhe public's heallh and general welfare and to ensure thatlhey are in compliance with federal civil rights laws. Tille VI of the federal Civil Rights Act of 19643 prohibits health and social services agencies that receive federal financial assistance from discriminating against any individual on the basis of race, color, or nalional origin. Policies and procedures that treat LEP persons and English speakers differently may have an adverse and disparate impact on certain national origin groups. Accordingly, Title VI and its implementing regulations have been interpreted to require agencies and organizations that receive fedefat financial assis- tance to offer free language assistance 10 LEP persons who seek their services or benefits. The laws and regulations that require federally assisted health and social services agencies in North Carolina to provide free language assistance to LEP persons have been on the books for more than thirty years. However, it was not until the demographic changes described above that local government agen- cies in North Carolina began to see large numbers of LEP persons. Many local government officials and agency staff members may be entirely unaware that they have a legal duty to assist LEP persons, and even those who are aware of the duty may not know how to go about fulfilling iL To assist agencies in this maner, the federal Depanment of Health and Human Services (HHS) issued a policy guidance document on August 30, 2000.4 The document, Policy Guidance: Tide VI Prohibition Against National Origin Discrimination As It Affects Persons With Limited English Proficiency, describes the policies and procedures health and social services agencies that receive financial assistance from HHS should have in place in order to ensure that LEP persons have meaningful acCess to their services. This bulletin begins with a brief review of the legal basis for the requirement that health and social services agencies provide language assistance to LEP persons. It then summarizes the HIlS policy guidance document (the HHS Guidance) and describes how HHS's Office for Civil Rights (OCR) will enforce compliance with the language assistance requirements. It concludes with two appendixes offering practical assistance: OCR's model plan for compliance with lhe 3. Civil Rights Act of 1964, Title VI, Section 601 (42 U.S.C. ~ 200ld). 4. Policy Guidance: Title VI Prohibition Against National Origin Discrimination As It Affects Penons With Limited English Proficiency. 65 Fed. Reg. 52,762 (August 30,2000) (hereinafter HHS GuiJance). . , . February 2001 . f, . language assistance requirements. and a list of _ resources for local agency personnel involved in developing and implementing language assistance policies. S Background and Legal Basis for the HHS Guidance Federal Civil Rights Law Section 601 of Title VI of the Civil Rights Act of 1964 states: No person in the United StaleS shall. on the ground of race. color, or national.origin, be excluded from participation in, be denied the benefits of. or be subjected to discrimination under any program or activity receiving Federal financial assistance.6 5. This bulletin d.oes not address a coll8leral matter tbat some local government officials or agency staff may view as a threshold issue: which individuals witltin a LEP population mayor musl be served by the agency. Agency staff and officials may wonder whether LEP persons of a noo-U.S. national origin are legally eligible to receive publicly funded .... benefits and services and niay question whether language WI' assistance is necessary for persons who are not U.S. citizens or who are undocumented immigrants. Federal law sets the parameters for noncitizens' eligibility for publicly funded benefits and services. Some benefits and services-including most public health depanment services and several significant social services ~ available without regard to citizenship or immigration status, even 10 undocumented immigran15. Other benefits and services- including Temporary Assistance to Needy Families, Medicaid, and other financial assistance programs adminislered by social services agencies-are unavailable to many noncitizens, including significant numbers of non- citizens with legal immigration status. For a full discussion of these issues, see Jill D. Moore,lmmigranu' Access /0 Public Benefiu: Who Remains EJigiblefor What?, Popular Government, Vol. 6S (Fall 1999), al22. Even programs thai are required to deny benefits to certain categories of immigrants must be prepared to communicate with LEP persons in accordance with the OCR guidance. At a minimum, the agency will have to derermine whal kind of assistance the LEP person is seeking and whether the person meets eligibility criteria for the assistance. If the person is eligible for benefits or services, language assistance will be required to ensure they are . provided appropriately. 6.42 iJ.S.C. ~ 2001d. 2 . . " . ) . . . . . February 2001 While this law by its terms prohibits only intentional discrimination, the regulations for implementing Title VI make clear that practices or policies that have a - disparate impact based on race, color. or national ori. gin are also prohibited. The regulations forbid entities that receive federal financial assistance from (I) using race, color, or national origin as a basis for denying services, financial aid, or other program benefits; (2) using race, color, or national origin as a basis for pro- viding services, financial aid, or other program benefits to some differently than to others; and (3) using "cri. teria or methods of administration which have the effect of subjecting individuals to discrimination because of their race, color, or national origin, or have the effect of defeating or substantially impairing accomplishment of the ~bjectives of the program" with respect to individuals of a panicular race, color, or national origin.7 Neither Title VI nor its implementing regulations expressly address language assislance. However, the U.S. Supreme Court has held that failure to provide language assistance to LEP persons violated the Tille VI regulations when the failure had a disparate impact on a particular national origin group. In Lau v. Nichols,8 the Court held that a public school system's failure to provide English language instruction to Chinese students who did not speak English discrimi. nated on the basis of national origin, in violation of Title VI. The Court noted that the Chinese-speaking studen... received fewer of the school system's benefits than English-speaking students, "which denies them a meaningful opportunity to participate in the educa. tional program-all earmarks of the discrimination banned by the [Tille VI] regulations.'>9 More recenlly, the Eleventh Circuit Court of Appeals held that giving driver's license tests only in English violates Tille VI's prohibition against national origin discrimination. 10 7 45 C.F.R. ~ 80.3(b). 8. Lou Y. Nichols, 414 U.S. 563 (1974). 9.ft/. at 568. 1beCowt noted that Section 602 of Tille VI authorized the federal agency (then the Department of Health, Education and Welfare) to issue rules, regulations, and orders, and it based its holding in large pan on the agency', clarifying guidelines, which addressed the duly to provide language assistance to LEP students. S.. id. at 567- 68. 10. Sandoval v. Hagan, 197 F.3d 484 (11th Cir. 1999), "Maring denied, 211 F.3d 133 (II th Cir. 2000), cerr. granted. 121 S. CL 28, 147 L Ed. 2d 1051 (September 26, 2000) (No. 99-1908). Certiorati was granted on the single issue of whether Tille VI and its implementing regulations contain an implied private cause of action. Local Government Law Bulletin No. 97 The Supreme Coun and a number of lower federal courts also have acknowledged on many occasions that there is a link between primary language and national origin, and there is a considerable amount of dicta in the case law that suggests that discrimination on the basis of primary language may violate the Constitu- tion's Equal Protection Clause, as well as Tille VI. I I Over the past three decades, OCR has conducted thousands of investigations into allegations of non- compliance with Tille VI that were based on a health or social service provider's failure'to accommodate LEP persons' language needs. Many of these investi- gations have culminated in voluntary compliance agreements setting forth a specific plan for bringing the provider into compliance. 12 Over time, OCR formulated review criteria and compliance expecla- tions from the types of issues uncovered by the inves- tigations and the specific components of the compliance agreements. Those expeclations and crite- ria were reflected in an internal guidance document OCR issued to its staff in January 1998.13 The HHS guidance document discussed in this bulletin is directed to recipients of HHS financial assistance and reflects and refines the principles set forth in the 1998 OCR internal guidance documenL II. S... e.g., Hernandez v. New York, 500 U.S. 352, 371-72, III S. Cl. 1859, 114 L Ed. 2d 395 (1991) (plurality opinion) ("It may well be, for cenain ethnic groups and in some communities, that proficiency in a particular language, like skin color, sbouId be treated as a surrogate for race under an equal protection analysis. i; Sandoval, 197 F.3d at 510 (stating that the Supreme Court, COngress, and federal agencies "have repeatedly instructed state entities for decades that a nexus exists between language and national origin"); Yniguez v. Arizonans for Official Language, 69 F.3d 920, 948 (9th Cir. 1995) ("Since language is a close and meaningful proxy for national origin, restrictions on the use of languages may mask discriminstion against specific national origin groups.''), vacalI!d on orMr grounds, 520 U.S. 43. 117 S. CL lOSS, 137 L Ed. 2d 170 (1997): Odima v. Westin Tucson Hotel Co., 991 F.2d 595, 601 (9th Cir. 1993) ("accent and national origin are obviously inextricably intenwined"); Garcia v. Gloor, 618 F.2d 264, 270 (5th Cir. 1980) ("To a penon who speaks only one tongue or to . person who has difficulty using another language than the one spoken in his home, language might well be an immutable characteristic like skin color, sex, or place of birth.''). 12. HHS GuiJance, 6S Pod. Reg. at 52,764. 13. Office for Civil Rights, Title VI Prohibition Against National Origin Discrimination-Persons With Limited English Proficiency (Jan. 1998) (on file with aulhor). 3 Local Government Law Bulletin No. 97 President's Executive Order and DOl Guidance With the release of its final policy guidance document (the HHS Guidance) on August 30, 2000, HHS became the first federal agency to comply with a presidential executive order that had been issued only days earlier. On August II, 2000, President Clinton signed Executive Order 13,166,14 which directed each federal agency to develop and implement a system by which LEP persons can have meaningful access to services without unduly burdening the fundamental mission of the agency. The order specifically required federal agencies to develop Tide VI guidance for recipients of the agencies' financial assistance and to submit their guidance documents to the U.S. Depan- ment of Justice (D01) for its approval. On August 16, 2000, DOJ published a general guidance document (the DOJ Guidance) intended to assist federal agencies in developing their specific guidance documents. I' The DOJ Guidance directed Iederal agencies to develop policies that require recipients of federal financial assistance to take ''reasonable'' steps to pro- vide LEP persons with meaningful access to informa- tion and services. Whai is reasonable will vary depending upon a number of factors, including: . The number or proportion of LEP persons in the eligible service population. The DOJ Guidance cautions that this is simply a factor in determining whether the steps taken are reasonable; it is not intended to be a threshold for determining whether an agency or organi- zation has a legal duty to LEP persons. Recipients of federal financial assistance that serve Ila few or even one LEP person" are still subject to the requirement to take reasonable steps to provide meaningful access. . The frequency with which LEP individuals come in contact with the program. Entities that provide programs or activities that LEP persons must access regularly have a greater duty than entities whose contact with LEP persons is unpredictable or infrequenl. . The imporuuu:e of the service provided by the program. More affirmative steps will be required from agencies administering pro- grams "where the denial or delay of access 14. Exec. Order No. 13,166, 6S Fed. Reg. 50,119 (August 16, 2(00). 15. Enforcement ofntle VI of the Civil Rights Act of 19M-National Origin Discrimination Against Persons With Umited English Proficiency, 65 Fed. Reg. 50,123 (Augusl 16, 2(00). . . February 2001 .. may have life or death implications" than from less critical programs. For example, a federally assisted hospital will have obliga. tions that are different from those of a feder- ally assisted zoo. The fact that a program or activity is compulsory under state or local laws (e.g., a mandatory immunization pro- gram) will be strong evidence of aprogram's importance. The resources available to the recipient of the federal financilll assistance. Small entities with limited resources may not have to take the same steps as larger entities to provide LEP assistance. The DOJ Guidance cautions that claims of limited resources from large entities will need to be well substantiated. The HHS Guidance incorporated these provisions of the DOJ Guidance and received DOJ approval prior to its publication on August 30, 2000. ~ , - Summary of the IBIS Guidance The HHS Guidance is not a federal regulation, but a practical guide designed to assist recipients of federal HHS financial assistance in meeting their obligations under Tide VI and its implementing regulations. Moreover, the HHS Guidance does not create any new legal requirements or d.uties-rather, it describes and clarifies Tide VI principles and OCR's long-standing approach to ensuring that health and social services providers do not deliberately, or inadvenendy discrimi- n~ against non-U.S. national origin groups through their language practices and policies. The document is intended to provide a "flexible road map" for providers to follow to ensure that LEP persons have meaningful access to their programs and activities. It acknowl- edges that different providers will have different needs and abilities depending upon the LEP populations they serve and reiterates the DOJ Guidance's statement of the factors tlu\t will be considered in determining whether a'particular covered entity is in compliance with Tide VI. The HHS Guidance includes concrete e~arnples of policies and practices that OCR would find to be in violation of Tide VI. It also provides examples of promising language lISsis18nce practices currendy being used or developed by health and social service providers, Finally, the HHS Guidance offers a model plan for compliance (see Appendix A). . . 4 '.. i . . . February 2001 Coverage 16 The HHS Guidance applies to all entities that pro- vide heallh or social services programs or activities and receive federal financial assistance through HHS, This includes state and local government agencies and private organizations that receive such assistance. The financial assistance may be direct (i.e., provided directly to the agency or organization by HHS) or indi- rect (i.e.. provided to the agency or ~rganization by another entity that was the direct recipient of the assistance). Examples of covered entities include, but are not limited to, hospitals, state and local public health agencies, state and local welfare agencies, pri- vate health care providers who accept Medicaid or State Children's Health Insurance Program (N.C. Health Choice) funds. and public and private contrac- tors and subcontractors who receive federal financial assistance. Federal financial assistance includes, but is not limited to. federal grants and loans. donations or grants of federal property, details of federal personnel, and any agreement. arrangement. or contract that has as one of its purposes the provision of assistance. In most cases, all operations of an entity that re- ceives HHS federal financial assistance-not just the programs or activities that use the federal financial assistance-are covered by the requirements of Title VI and thus by the HHS Guidance,11 16. The HHS Guidance uses the tenos "covered entities" and "recipients" interchangeably to refer to the health and social services providers who are covered, Note that the term "recipient" in this context refers only to the agency or organization that receives the HHS financial assistance and provides health or social services. The term does not refer to the clients or beneficiaries of the covered entity's services. For clarity, this bulletin uses the term "covered entities." 17 Title VI prohibits discrimination in "any program or activity" that receives federal financial assistance. 42 U.S,C, f 2oo1d. ''Program or activity" was not defined in the Civil Rights Act of 19M. In 1984, the U.s. Supreme Court held that TItle VI was violated only if the discrimination occurred in the particular program or activity that received federal funds. Congress subsequently passed die Civil Rights Restoration Act of 1997. P.L. 1()()'259 (codified in part as 42 U,S.C. i 2oo1d-4a). Those amendments defined ''program or activity" as "all" of the operations of an entity receiving federal funds. 42 U.S.C. f 2OOld-4a. Local Government Law Bulletin No. 97 Basic Requirement: Meaningful Access To comply with Title VI, agencies and organiza- tions that receive federal financial assistance through HHS must ensure that LEP persons who are eligible for programs or services have "meaningful access" to those programs or services. Covered entities must en- sure that LEP persons are given adequate information. are able to understand the services and benefits avail- able, are able to receive benefits and services for which they are eligible, and can effectively communicate the relevant circumstances of their situations to the service provider. Covered entities must not charge LEP persons for the language assistance they provide. The HHS. Guid- ance states that meaningful access to benefits and services cannol be ensured unless language assistance 'is provided' at no cost to the LEP person, and that the provision of free language assistance is the most important step in meeting the obligations to LEP persons under Title VI., The type of language assistance that must be pr0- vided to ensure meaningful access will vary. In'its investigations and compliance reviews, OCR will de- termine on a case-by-case basis. whether the assistance provided is adequate, considering the following factors: .The size of the entity providing the service The size of the eligible LEP population served by the entity . . The nature of the program or services provided . The objectives of the program or service . The resources available to the entity The frequency with which particular languages are encountered The frequency with which LEP persons come into contact with the program or service OCR's Four Keys to Compliance In the course of its investigations over the years, OCR has identified four elements that are usually pre- sent in language assistance programs that comply with Title VI. The HHS Guidance identifies these elements as the "four keys to compliance," and slateS that OCR will co!'Sider an entity to be in compliance with language assistance requirements when the entity in- corporates and implements all the elements. The ele- ments are: (I) assessment of the language needs of the population to be served, (2) development of a compre- hensive written policy on language access, (3) training of staff, and (4) vigilant monitoring of the language 5 Local Government Law Bulletin No. '17 assistance program to ensure that LEP persons have meaningful access to the entity's benefits and services. OCR will review the totality of the circumstances and will not find a program noncompliant if implementa- tion of the elements would be so financially burden- some as to defeat the legitimate objectives of the entity's program, or if there are equally effective alter- natives for ensuring that LEP persons have meaningful access to the entity's programs and services. Each of the elements is described in more detail below. ASSessment Covered entities should thoroughly assess the language needs of the population they serve. Entities should: . Identify the non-English languages that are likely to be encountered and estimate the number of LEP persons that are eligible for services 18 . Identify the language needs of each LEP client and record this information in the client's file . Identify the points of contact in the entity's programs or activities where language assis- tance is likely to be needed . Identify the resources that will be needed to provide effective language assistance . Identify the location and availability of those resources . Identify the arrangements that must be made to access the resources in a timely fashion Written Policy Covered entities should have a comprehensive written language assistance plan with policies that address all of the following: . The assessment of language needs described above . Responding to the need for oral language assistance . Giving notice to LEP clients-in a language they can understand-of the right to free language assisljUlCe . Providing for the periodic training of staff . Providing for monitoring of the language assistance program 18. The HHS Guidance suggests the following methods for completing this step: reviewing census data. reviewing utilization data from client files, and obtaining information from schools and community agencies and organizations. -. February 2001 .. Providing for the uanslation of written materials in certain circumstances The HHS Guidance provides additional information on oral interpretation, written translation, and notice requirements. Those issues are discussed in more detail below. - Staff Tnzining Covered entities should take steps to ensure that employees understand the language assistance policies and are able to carry them out. They should dissemi- nate language assistance policies to all employees and provide periodic employee training. An effective training program will ensure that all employees are knowledgeable and aware of language assistance poli- cies and procedures and that training in the policies is a part of new employee orientation. 19 It is especially critical to ensure that employees in client contact posi- tions are properly trained. The training program should address working effectively with in-person and tele- phone interpreters and the dynamics of interpretation. Monitoring Covered entities should conduct regular evalua- tions of the language assistance program to ensure that LEP persons are provided with meaningful access to the program. Tbe HHS Guidance recommends seeking the input of clients and advocates in this evaluation process. At least annually, covered entities should: . Assess the current LEP makeup of the service area and the current communication needs of LEP clients . Determine whether existing assistance is meeting needs . Determine whether staff is knowledgeable about language assistance policies and proct- dures and their implementation . Determine whether sources of and arrange- ments for language assistance are still current and viable - Oral Interpretation The HHS Guidance states that an effective lan- guage program will include procedures for obtaining 19. The HHS Guidance recognizes that high turnover is common for some agencies or staff positions and notes thar: entities may find it useful to maintain a training regisUy, with employees' names and the dates of their training. . 6 .. '. " . . . February 2001 and providing trained and competent interpretalion in a timely manner. Covered entilies can provide this interpretalion in a number of ways, depending upon their individual needs and circumstances. . Entities may choose to hire bilingual staff. NOle, however, thaI this option may be insuf- ficienllo meelthe needs in areas where there are a variely of LEP language groups. Also, the HHS Guidance caulions thaI bilingual staff musl be trained and musl demonstrale compelence as interprelers before being used as such. Entities may hire staff interpreters. OCR con- siders this a particularly appropriale option when there is a frequenl or regular need for interpretation in a particular language. . Entities may contracl with an outside inler- preler service. OCR considers this an appro- priate option for entities thai have an infrequenl need for inlerpreting services, have less-common LEP language groups in their service areas, or need 10 supplement their in- house capabilities on an as-needed basis. . V olunleer commonily interpreters may be available. OCR emphasizes the importance of having formal arrangements with voluntary organizations and of ensuring thaI volunteers are competenl and understand their obligation 10 maintain clienl confidentiality. . Entities may also arrange or contracl for the use of a lelephone language interpreter ser- vice. OCR recognizes that this is a useful oplion, either to supplemenl other arrange- ments, or when a covered entity encounters a language il cannol otherwise accommodate. It cautions, however, thaI these services do nol always have readily available interpreters who are familiar with terminology peculiar to health or social services programs. The HHS Guidance notes that this should nol be the only language assistance offered "excepl where other language assistance options are unavailable (e.g., in a rural clinic visited by an LEP patienl who speaks a language thaI is nol usually encountered ia the area)."20 Friends or family members may be used as inter- preters, but only in limited cIrCumstances. First, the entity musl inform the LEP person thaI alternative lan- guage assistance is available al no COSI. If, after being so informed, the LEP person declines the language assistance and asks 10 use the family member or friend 20. HHS Guidane<, 65 Fed. Reg. at 52,767. Local Governmenl Law Bullelin No, '17 instead, Ihe entily may use thaI person, provided that doing so does nol compromise the effectiveness of the service or violate the LEP person's confidentiality Refusals of language assistance should be documented in the client's file. Entities should never encourage or require LEP persons to use friends or family members as interpreters. The HHS Guidance cautions covered entities againsl using minor children as interpreters, bUI il does not prohibil the practice oulrighl. Nevertheless, the use of minor children for interpretation is a risky practice that should be avoided for IWO reasons. Firsl, it may prevenl the agency from obtaining full and accurate information. For example, when children interpret for their parents, Ihe parents may be reluctanllO reveal personal information thaI is relevanllo their health care (e.g., information aboul use of birth control) or 10 their eligibility for services (e.g., financial informa- tion). Second, il is unlikely thaI a minor child will understand the ethics of interpretation-including the duty 10 maintain confidentiality-or the specialized terminology used by -the agency in Ihe provision of its services. Therefore, agencies should avoid the use of minor children as interpreters in all bul extreme or emergency circumstances in which immediate inter- pretation is essential and there are no other options available. The HHS Guidance refers repeatedly 10 "compe- tenl" interpretation and offers some help in assessing interpreter competence. .II notes thaI formal certifica- tion as an interpreter is helpful bUI will nol be required by OCR. However, il also notes that "competency requires more than self-identification as bilingual."21 A competenl interpreter will have demonstraled profi- ciency in both languages, training in the skills and ethics of interpreting, knowledge of specialized terms or concepts in each language, sensitivily 10 the LEP person's culture, and a demonslraled ability to convey information accurately. Agencies that need assistance in locatiqg or evaluating interpreters may wish 10 con- laCl the North Carolina Bilingual Resource Group or the Carolina Association for :rranslalors and Interpret- ers (see Appendix B for contacl information). Written Translation of Documents Written materials thaI are routinely provided in English 10 clients and the public musl also be available in languages other than English thai are regularly 21./d. at 52,769. 7 Local Government Law Bulletin No. 97 encountered by the covered entity 22 It is particularly important that ''vital'' documents be translated. Vital documents include, but are not limited to, applications; consent forms; letters containing important information regarding participation in a program; notices pertaining to the reduction, denial, or termination of services or benefits, or the right to appeal such actions; and notices advising LEP persons of the availability of free language assistance. The extent of a covered entity's duty to provide translated wriucn documents will vary. In its investi- gations and compliance reviews, OCR will assess each situation individually, taking into account the nature and length of the document and the other factors it has identified as relevant to a determination of whether an entity is meeting its duty (see the list in the section entitled Basic Requirement: Meaningful Access, above). The HHS Guidance also includes "safe harbor" provisions for covered entities. OCR will consider a covered entity to be in compliance with the obligation to provide written. materials in non-English languages if all of the following conditions ale met. . The entity provides translated wriucn mate- rials, including vital documents, for each eligible LEP language group that constitutes 10 percent or 3,000 (whichever is less) of the population of persons eligible to be served or liltely to be directly affected by the entity's programs. . The .entity translates vital documents for LEP language groups that do not meet the above threshold but constitute 5 percent or 1,000 (whichever is less) of the population of per- sons eligible to be served or liltely to be 22. Recall thal both slate and local health and social services agencies are coveml entities under the HHS Guidance. Questions may arise about whether the stale or the local agencies should be responsible for pmviding translated documents. The best practice is probably for the agency thal issues the documents to take responsibility for those documents-thal is, to assess the need for translations into other languages and to pmvide written translations for frequently encountered languages. For eXalDple, if a stale agency provides the application form for local agencies to use for a particular service, the stale agency should also provide a version of the application form in any language (such as Spanish) that is frequently encountered by significant numbers of local agencies. Local agencies may still need to translate the forms for LEP groups that are present in significant numbers althe local level but not the state level. February 2001 directly affected by the entity's programs. . Translation of nonvital documents may be provided orally to these groups. . The entity provides competent oral translation of written documents for LEP groups of less than 100 persons. and provides written notice in the primary language of the LEP group of the right to receive such translation.23 The HHS Guidance cautions that the safe harbor provi- sions are not to be viewed as requirements. Depending upon the circumstances, OCR may find a covered en- tity to be in compliance with Title VI even if it fails to fall within the safe harbor provisions. The HHS Guidance states that persons engaged to translate documents must be well qualified. but it does not offer much information about how an entity can evaluate a translator's qualifications. It warns, how- ever, that verbatim translations may not accurately or appropriately convey the substance of wriucn materi- als, and it recommends that community-based organi- zations of LEP persons be engaged to review translated materials to ensure that they are accurate and understandable. 24 Notice to LEP Persons of Right to Free ... Language Assistance WI' Covered entities must give notice to LEP persons of their right to free language assistance. The notice must be given in a language that the LEP person can understand. The HHS Guidance offen the following suggested methods for giving notice: . Distributing "I speak" cards-written cards that allow LEP clients to identify the language they speak . Posting and maintaining signs in regularly en- countered languages that inform LEP clients of their right to free language assistance and 23. The safe harbOr pmvisions dO not address written translation of documents for LEP population groups thal number more than 100 but less than 1.000. At a minimum, groups falling in this range should receive oral interpretation of wrinen documents. . 24. The N.C. Bilingual Resource Group has published a manual for stale and local agencies on translating documents into Spanish. The manual includes a very helpful discussion of how to assess the quality of translalOn and translated documents. Suzanna Aquirre Young, Developing. . TranskJ/ing. and Reviewing Spanish Maleri<JIs, available at httD:J/www dhhs.state.nc.usldDhlfonnsmanuals.htm. 8 . . '. .' . . . February 200 I . invite them to identify themselves as persons in need of such services Translating application forms and instruc- tional or informational materials into other languages, supplelllC!nting this as needed with assistance from an interpreter to explain the contents of the documents Developing uniform procedures for employ- ees to prompdy obtain interpretation assis- tance for telephone contacts Including statements, in appropriate non- English languages,. about the services avail- able and the right to free language assistance in outreach materials and other information that is routinely distributed to the public . Enforcement of Compliance with.Title VI OCR is legally obliged to investigate complaints, reports, or other information alleging or indicating a covered entity's possible noncompliance with Tide VI-including the entity's failure to provide language assistance to LEP persons. In addition, OCR is authorized to conduct compliance reviews of covered entities.2j The HHS Guidance states that OCR will conduct compliance reviews with a focus on language assistance policies. It will target for review principally larger entities such as hospitals, state agencies, and social service organizations that have a significant number of LEP persons likely to be affected by the entity's practices. If OCR finds an entity to be noncompliant, it will send a letter of findings setting out areas of non- compliance and steps that must be taken to correct the 25.45 C.F.R. t 80.7 Local Government Law Bulletin No. 97 noncompliance. Federal regulations require OCR to attempt first to secure voluntary compliance through informal means.26 If voluntary compliance cannot be secured. OCR may secure compliance by terminating rederal financial assistance,27 referring the matter to the U.S. Department of Justice for injunctive relief or other enforcement proceedings, or by any other means authorized by federal or Slate law.28 Conclusion The primary purpose of this bulletin is to make lo- cal government officials and employees aware of their legal duties to the LEP persons they serve and to high- light the critical elements of the policies and proce- dures needed to fulfill those duties. Readers may have funher questions or desire addition;li details about spe- cific practices. The HHS Guidance contains examples of prohibited practices and promising practices, and an appendix to the HHS Guidance includes additional information in question-and-answer format. Those who are involved in developing policies for local govern- ment agencies are strongly encouraged to read the HHS Guidance in its entirety. 29 Current demographic trends make clear that local health and social services agencies can expect to serve increasing numbers of LEP persons. Most local agen- cies have already begun developing slrategies to address language assistance needs. Existing policies and procedures should be reviewed-and new ones developed, if necessary-with careful attention to the HHS Guidance. 26. 4S C.F.R. t SO.7(d). 27 Before rederal financial assiSlance is terminated, the covered entity must be iliven notice of the noncompliance and an opportunity for a hearing. 45 C.F.R. t 80.8(c). 28.45 C.F.R. t SO.8(a). 29. The HHSGuidance is available in the Federal Register, Vol. 65, No. 169, pages 52,762-52.774, or on the Internet at hnD'/lwww.hhs.llov/ocrlleoltruidehunt. 9 Local Government Law Bulletin No. 'J7 February 2001 Appendix A OCR's Model Plan for Compliance [Reprinted from Policy Guidance: Title VI Prohibition Against National Origin Discrimination As It Affects Persons With Limited English Proficiency, 65 Fed. Reg. 52,762 (August 30, 2000).] The following is an example of a model language assistance program that is potentially useful for ail recipient/covered entities, but is panicularly appropriate for entities such as hospitals or social service agencies that serve a significant and diverse LEP population. This model plan incorporates a variety of options and methods for providing meaningful access to LEP beneficiaries: . A formal wrillen language assistance program; . Identification and assessment of the languages that are likely to be encountered and estimating the number of LEP persons that are eligible for services and that are likely to be affected by its program through a review of census and client utilization data and data from school systems and community agencies and organizations; . Posting of signs in lobbies and in other waiting areas, in several languages, informing applicants and clients of their right to free interpreter services and inviting them to identify themselves as persons needing language assistance; . Use of.I speak. cards by intake workers and other patient contact personnel so that patients can identify their primary languages; . Requiring intake workers to note the language of the LEP person in hislber record so that all staff can identify the language assistance needs of the client; . Employment of a sufficient number of staff, bilingual in appropriate languages, in patient and client contact positions such as intake workers, caseworkers. nurses, doctors. These persons must be trained and competent as interpreters; . Contracts with interpreting services that can provide competent interpreters in a wide variety of languages, in a timely manner; . Formal arrangements with community groups for competent and timely interpreter services by community volunteers; . An arrangement with a telephone language interpreter line; . Translation of application forms, instructional, informational and other key documents into appropriate' non-English languages. Provision of oral interpreter assistance with documents, for those persons whose language does not exist in written form; . Procedures for effective telephone communication between staff and LEP persons, including instrUctions for English-speaking employees to obtain assistance from bilingilal staff or interpreters when initiating or receiving calls from LEP persons; . Notice to.and training of all staff, panicularly patient and client contact staff, with respect to the recipient/covered entity's Tide VI obligation to provide language assislance to LEP persons, and on the language assistance policies and the procedures to be followed in securing such assistance in a timely manner; . Insertion of notices, in appropriate languages, about the right of LEP applicants and clients to free interpreters and other language assistance, in brochures, pamphlets, manuals, and other materials disseminated to the public and to staff; . Notice to the public regarding the language assistance policies and procedures, and notice to and consultation with community organizations that represent LEP language groups, regarding problems and solutions, including standards and procedures f!lf using their members as interpreters; . Adoption of a procedure for the resolution of complaints regarding the provision of language assistance, and for notifying clients of their right to and how to file a complaint under Title VI with HHS, . Appointment of a senior level employee to coordinate the language assistance program, and ensure that there is regular monitoring of the program. 10 . . " . - - ", ., ., , February 2001 Local Government Law Bulletin No. fJ7 . Appendix B Resources for Assistance FEDERAL AGENCY United States Department of Health and Human Services Office for Civil Rights Regional Office, Region N (Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, Tennessee) Atlanta Federal Center, Suite 3B70 61 Forsyth Street, S.W. Atlanta, GA 30303-8909 404.562.7886 httD://www.hhs.20v/ocrneol STATE AGENCIES North Carolina Department of Health and Human Services . Office of Minority Health, 919-715-0992 . Bilingual Resource Group, 919-715-3119' . Hispanic Ombudsman, Office of Citizen Services, 1-800-662-7030 or 919-733-4261 . N.C. Migrant Health Program, medical interpreter service for health care providers serving migrant farm workers and their families, 1-800-255-8755 . North Caronna Bilingual Materials Database , Direct requests for specific topics and languages to Suzanna Young, Refugee Health Program, fax: 919- 715-3144, ore-mail: suzanna.voun2@ncmai1.nel. North Caronna AHEC Latino Health Information and Latino Cultural Resonrces Webslte hUD://www.hhcc.arealahec.dst.nc.us1 OTHER REsouRCES Carolina Association for Translators and Interpreters Telephone: 919-577-0840 E-mail: CATJ.@oobox.com AT&T Language Line (demonstration and information about AT&T' s telephone translation service) 1-800-821-0301 . 11 Local Government Law Bulletin No. 97 February 2001 This Bu.llctin is publiahed by the Institute of Government EO addn:ss issues of intaat to local 8Dd state govenuuem employees and officials. Pubtic officials may phoIoc:opy Ihc Bulletin under Ihc foBowing condidOllS: (1) it;' copied in its enlimy; (2) i.;. copi<d solely for diJtribudon to _ pubtic officials, employ<<s' or staff members: and (3) copies .... not sold or used for conunerciaJ pwposcs. Additional copies of this Bulletin may be purchased from the Institute of Govemmc:nt To place an Older or to request a catalog of Institu.. or Govemmen. PUbticatiOllS, please conlacllhc Pubtications Sales Office, Insti.... of Govenunen~ CB113330 Knapp Building. UNC-cH. CIapeI HiD, NC 27599-3330; "lcphone (919) 966-4119: fax (919) 962-2707: ..mail thun..iO)pDllil.iog.unc.edu; or visit the Institute's Web site at http://ncinfo.iog.unc.edu. The Insti.... of Governmenl of The University of Nonh Carotina at Chapel Hill has prinled . total of 909 copies of this pubtic document at a cost of S48t.77 or SO.53 each. These figures include only the direct cosls of reproduction. They do not include preparation. handling, or distribution costs. lQ200t Insti.... of GovemmenL The University of North Carolina at Chapel HiD Prinled in the Uniled Swes of America , This pl~lication is printed on permanent, acid-free paper in compliance with the Nonh Carolina ~ ~ne~Statu~ RECEIVED MAR 0 2 200t 12 N. H. CO. HEALTH DEPT. ~ t '. " .~ - - . National Association of Local Boards of Health \ Published for Members of Local Boards of Health Febl'lUlry 2001 President's Message By Harvey A. Wallace, PhD ~~-- :.."t i~' I ~ I This is my frrst message to you as President of NAL- . BOH. It's 2 days after Christmas and I'm sitting in my office at Northern Michigan University in Marquette looking out the window at a fairly heavy lake-effect snow shower, which is adding to the De- cember total o.f almost 80 inches, about 3 inches shy of the re- cord. Looks hke we'll break it today Sitting on a shelf by this same window is a Christmas cacws in full bloom with branches reaching out almost 2-feet all around. The dark green leaves and Ce hot pink flowers of this succulent offer a sharp contrast to the ,ear whiteout conditions just outside. In a few minutes the sun is likely to come out as we wait for the next cloud to come off Lake Superior. The weatherman said this morning that this pattern should be with us for another four or five days. It could be worse. Twenty-three years ago I lived in Florida where the sum- mers were so hot and humid we had to stay indoors to keep cool. Now, keeping cool all year round is not an issue. During the past year as President-Elect I have had the honor to represent NALBOH at events allover this country Last January at the Surgeon General's conference to introduce Healthy People 2010 (HP20l0), I spoke to a national audience about NALBOH's importance to the development of a public health infrastructure and about our continuing role in the development of a nationally recognized set of performance standards for local boards of health. In the coming months, I shall keep you informed on how your local boards of health will benefit from the National Public Health Performance Standards Program (NPHPSP). Working on this project with NALBOH's Boards of Health Training Institute (BOHTI) has, during the past three years, resulted in several trips to the Centers for Disease Control and Prevention (CDC) in At- lanta meeting and working with our partners on this project: CDC-Public Health Program Practice Office (pHPPO) the Na- tional Association of County and City Health 'Officials (NACCHO), the Association of State and Territorial Health Offi- r '-.... (Conlimted on page 2) Leadership: Your Role as a Board of Health Member By Diane Weber In 1988, the Institute of Medicine (10M) report, The Future of Public Health, defined public health as "what we as a s0- ciety do collectively to asaure the conditions in whi~h people can be healthy." It also stated that "today the need for lead- ers is too great to leave their emergence to chance." This assertion has been supported in numerous subsequent reports and is not ~mited to developing leaders only within public- sector pubhc heahb, but encompasses developing leaders in all sectors which impact the health of communities who can effectively address broad issues to improve health. ' ~gnizing the need to facilitate the diffilsion of leadership sktlls tbroughout health organizations, in 1991 the Centers for Disease Control and Prevention (CDC) b~ to provid- ing technical assistance and seed money for the development of state, regional and national public health leadership insti- wtes throughout the country. Currently, 18 state/regional leadership programs are in development or are currently be- ing implemented and form !be National Public Health Lead- ership Development Network. These instiwtes were founded to improve the health of the residents of their state/region by enhancing the leadership skills of state and local health pro- fessionals and community leaders. Who better can serve as a leader in a community than a local board of heahh member? No one else can have a greater im- pact on local public health policy than board of health mem- ber~ who are committed to improving the health and quality of hfe of members of their communities. "I recommend that board members get involved in their state or regional leader- ship instiwte. You will get to see how public health works in your state and have the opportunity to learn what your role is as a board member," says Ken Hartke, a gnduate of the Mid- America Public Health Leadership Instiwte, President of the Illinois Association of BoaMs of Health and trustee fur NALBOH. According to Ken, "If you understand what the functions of public health are, you will see how you fit in you WIll have a clear sense of your responsibilities. The (Contimud em".ge 3) . -' ~ I February 2001 Preoi_ M_e_ (Conlinutdfrorn pogt 1) cials (ASTHO), the American Public Health Association (APHA) and the Public Health Foundation (PHF). In February 200 I, all the partners are scheduled to meet again in Atlanta and plan the release of the "first edition" of all 3 performance stan- dards documents for state public health systems, local public health systems, and governing bodies (e.g., local boards of health). These will be posted on the CDC-PHPPO web site. Like you, it has taken me a few years to get used to all the acronyms used in this business. Wait until we talk about NEHA (National Environmental Health Association), EHAC (National Environ- mental Health Science and Education Accreditation Council) and HRSA (Health Resources & Services Adntinistration). But before I get to the topic of environmental health, let me just mention some of the other groups I have had the honor to talk with just since July In August, I went to St Paul, MN to be a part of the state-wide meeting to initiate a field test of the state and local performance standards documents. Also in August, I spoke to conferees at the Michigan Association for Local Public Health meeting at the Grand Hotel on Mackinac Island. This is a place you just have to visit. In October, I was off to Columbus, OH to be with our friends at the annual meeting of the Ohio As- sociation of Health Boards. November was interesting. On Sat- urday the eleventh, I was with representatives of PHPPO and NACCHO in Ontario, CA talking to a group of the National As- sociations of Counties (NACo). The next day, I was at the APHA annual conference in Boston. The next week, I partici- pated in the CDC orientation program for local health officers. The next week, I was in Omaha for a meeting with the Nebraska Partnership of Local Health Departments. I was surprised to see an old friend from graduate school days at this meeting. Dave was kind enough to give me tour of Omaha before my flight left. The following week found me back in Atlanta for a NPHPSP workgroup session for the state document. Fortunately, my day job as head of the Department of Health, Physical Education and Recreation provides me with a great deal of flexibility The uni- versity looks at the time I spend with NALBOH as a service to my profession as a health educator. Now back to NEHA. Last June in Denver, I spoke to NEHA about our project with EHAC. With the help and direction of Dr. Gary Silverman, pr0- fessor of environmental health at Bowling Green State Univer- sity, we are preparing an "Environmental Health Primer." The "Primer" will contain several easily understood chapters describ- The NALBOH N<wsBlUfi. published by the National Association of Local Boards of Health 1840 East Gypsy Lane Road Bowling Green, OH 43402 Phone: (419) 353-m4 Fax: (419) 352-6278 E-mail: nalboh@nalboh.org Websile: www.nalboh.org The production and discributioD of Ibi8 pab&atkJo are 8IIppOI1:ed by hmds &om the Centers ,. DbeluIe ContIol .m. Prevention. NALBOHOfli.... -, President-Elact Sccretuy/freuurer PastProsidcnt """,oy WoIla<:e, PbD (MI) Phil Lyons (ill) stcphon PBJ'CllberJ (NJ) Voughn U""",,w, EdD, IXPH (NC) NALBOH Staff Executive Director Marie M. Fallon. BS DireclorofLW900 aDd Edwin 1'cd"Pratt, Jr.. Governmental Relations MfA Projcot Dinlcto<- Tobacoo Robooca Edwonb, MPH Projoot DUocto<- T........ Suah CIwd, MA Dinx:tor ofMcmbcnbip Sylvia Beck. MPA SaM"" Program Coordinator Jamifct O'Brien. MPH AdmlnistndiYc Assistant Grace SenaIo I Page 2 NALBOH Newsbrief I ing the environmental health issues commonly discusaed by local boards of health. We introduced draft chapters of the "Primer" at NALBOH's annual conference in Raleigh for discussion and editing. This document will be the first in- ("\\ stallment in what we see as an ongoing training project for \J) our membership. There is one last trip I'd like to tell you about. During my speech to the Surgeon General's HP20 I 0 conference I de- scribed how my local board of health, the Marquette County I Board of Health, was able to establish what has turned out to be a very successfid dental clinic for uninsured and underin- sured children. In the audience was Alice Horowitz, Ph.D who is on the staff of the NIH-National Institute for Denta1 and Craniofacial Research. She is responsible for oversee- ing the achievement of the HP20 I 0 objectives for oral health. Not an easy task. She, in turn, invited me to partici- I pate on a panel at the Surgeon General's Conference on Children and Oral Health in Washington, D.C. last June. She also invited me to be a member of the HP201O-0ral Health Steering Committee. Fortunately for her, my basic philosophy is to "Just Say Yes." You never know what doors will open and what opportunities will present them- selves to you. As the work of the steering committee devel- ops, I will keep you informed. One sure way to stay in- formed is to attend our annual conference where a session on oral health has been scheduled. If you were able to attend the NALBOH 2000 conference in Raleigh, pethaps you were able to participate in the very successful "Back to Basics" preconference workshop spon- ,~ sored by NALBOH and the American Nonsmokers' Rights V Foundation. This year, our annual conference will be held in Cleveland with another preconference workshop being planned to provide board members with the skills and tools necessary for strategic planning. Honestly, strategic plan- ning is not one of my favorite things to do, however, neces- sary it may be. Any help to make this activity more mean- ingful and less painful is always welcome. I look forward to another exciting year serving NALBOH, the national voice for local boards of health. In Bowling Green, OR and in Washington, D.C., we have a wonderful statfwho work hard to meet the needs of our membership. We also have a Board of Directors who work jnst as hard to represent the 22,000 individuals who serve on the more than 3,000 local boards of health. I wish you all a happy and productive year. 0 NALBOH Trustees Riclwd ~ lD(MA) lohn c. ......ti, MA (NI) I. Ftoderiol: Api (OA) JimR.cu.:hio(OH) 1Con_(IL) DUmc W_w (CO) Connic:T.....(Uf) Ronald Bura<< (GA) _ Vnnd<<flooah (10) North AdaDtic Mid A1lantic Southoast East Gn:ot Lakoo WestGreatLakes Midwest W... StBteAffiIiate StaleAffiIiatll The NALBOH New3Brief Editoo- FIanina Fallon, MD, IXPH ~ (--- NALBOH Newsbrief February 2001 Leadenhlp: You Rol.... (Continued from pogt 1) O leadership institute can help you to develop the skills needed , for you to be a leader and to help your board to move forward." You can take advantage of this opportunity by contacting the leadership institute in your state or region. Information regard- ing each existing/developing institute can be obtained on the National Public Health Leadership Development Network's website at http://www.slu.edulorganizationslnln in the "Programs" section. Many institutes also have their own web- sites which are linked to this section. You may also obtain the contact information by calling Diane Weber, Network Coordi- nator at (314) 977-3219 Please note that not all states or re- gions have an institute available as yet and also, some institutes do not yet admit board of health members. 0 Report from Washington By Edwin "Ted" Pratt, Jr. Di1<dor of LiIlison and Gouemmmtol ReLztimts Things are still quite hectic here after the first week of the new Administration. Latest developments send mixed messages to the public health community There is rising concern that the federal suite against the tobacco companies will not be carried on under likely Attorney General Ashcroft. Undertaken by the Clinton Administration to recover billions of dollars expended by Medicare, Medicaid, the Veterans Administration and other federal agencies as a result of tobacco-related illness, this legal O action does not appear to have the support of either Health and Human Services Secretary Tommy Thompson, nor that of President Bush. There is, however, positive news that the Bush administration has indicated support for the continued increase in funding for CDC and the National Institutes of Health (NIH). This is of great interest to states and local jurisdictions. In re- cent years over 75% of new CDC and NIH money has been passed through to public and private agencies outside of the federalgovemment in the form of grants and cooperative agree- ments. Boards of Health should encourage their health officers to keep track of announcements of grants and other funding op- portunities by regularly checking the DHHS, CDC and NIH websites. It is also reported that Surgeon General David Satcher and CDC Administrator Jeffi'ey Koplan will be asked to stay on. There is action in Congress to re-introduce legislation to estab- lish Federal Drug Administration authority to regulate tobacco products. Representatives Greg Ganske (R-IA) and Henry Waxman (D-CA) are expected to submit their bills of last ses- sion (HR 4207 and HR 4042) - both bills had bi-partisan spon- sorship. There is also significant bi-partisan support to expand federal funding of tobacco use cessation programs in Medicare, Medicaid and other federally supported programs. r Finally, there is the important Frist-KennedylBurr-Stupak bill passed last year, The Public Health Threats and Emergencies Act of 2000, This legislation authorizes up to $540 million in order for the HHS Secretary, in collaboration with state and 10- . - cal health officials, to establish "reasonable capacities" for national, state and local public health systems and the per- sonnel or work forces of such systems. The capacities shall improve, enhance or expand the ability of national, state and local public health agencies to detect and respond effectively to significant public health threats. These may include epidemiological capacity, lab capacity, preventive and therapeutic capacity, the capacity to communicate in- formation rapidly, or capacity to develop and implement policies to prevent the spread of infectious disease or an- timicrobial resistance. This is a potential resource for local health departments. Boards of health should be in contact with both their state health departments and elected offi- cials to ensure adequate awareness of this legislation's po- tential. Authorization is not funding, however, and NALBOH is working with other public health partners to insure that sig- nificant new funding is provided under this authorization in appropriations for FY 2001 and beyond. NALBOH par- ticipates in three important coalitions; the ENACT Coali- tion which focuses on tobacco related issues, the Friends of HRSA (Health Resources and Services Administration) and the CDC Coalition. We all have a busy few months ahead, and will be contacting NALBOH members in the states and districts of Members of Congress when we need some direct support of our efforts. As always, the Washington office is here to serve NAL- BOH's members directly as well as the interests of local boards of health generally If we can be of assistance, please contact us. The office has moved to a new location, after a successful 14 months in the Public Health Founda- tion's (PHF) premises, so please note the new contact in- formation. I would be remiss if I did not thank Mo Mullet, PHF Board Chairman, Ron Bialek, PHF President, and the entire PHF staff for their warm and generous support of NALBOH. 0 Ted Pratt NALBOH Washington Office 160 17 Oursler Road Burtonsville, MD 20866 Phone: (301) 476-8144; Fax: (301) 476-8145 E-mail: <nalbohdc@olg.com> y ~ Request for Articles and Meeting Dates NALBOH would like to receive papers and articles for future issues of the NewsBrief If you bave a topic which would be of interest to other loea1 boards of health, please let us know. We would also be interested in publishing upcoming confer- ence announcements and meeting dates. The next publication deadline is April 10, 200 I. Please mail your items to NALBOH at 1840 East Gypsy Lane Road, Bowling Green, OH 43402, fax to (419) 352-6278, or <>-mail us at <marie@nalboh.org> [--. I Page 3 --' February 2001 NALBOH Newsbrief A Look at the Membership . ;Ox".." ';:"'" New NALBOH Members in 2001 NALBOH extends a very warm welcome to the following new members of NALBOH. We look fOJWard to your involvement and hope to see all of you at the NALBOH Conference in Cleveland July 25-28, 2001. At that time there will be a special welcome session for you provided by the NALBOH Emeritus Committee. A!lI!!!I Alaska State Division of Public Health - Juneau, AK Ark.n.A!Il Arkansas State DePartment of Health - Little Rock, AR Arizona Office of Local & Minority Health - Phoenix, AZ Colorado Pueblo-City/County Board of Health - Pueblo, CO San Juan County Board of Health - Silverton, CO Connecticut City of Bridgeport Board nfHealth - Bridgeport, CT Greenwich Board of Health - Greenwich, CT Geonria Emanuel County Board of Health - Swainsboro, GA Lumpkin County Board of Health - Dahlonega, GA Miller County Board of Health - Colquitt, GA Polk County Board of Health - Cedartown, GA Union County Board of Health - Blairsville, GA Iowa Lee County Board of Health - Fort Madison, lA Mills County Board of Health - Glenwood, IA Ulinois McLean County Board of Health - Bloomington, IL Monroe-Randolph Bi-County Board of Health - Waterloo, IL Shelby County Board of Health - Shelbyville, IL Indiana St. Joseph County Board of Health - South Bend, IN Steuben County Board of Health - Angola, IN Washington County Board of Health - Salem, IN ~ Labene County Board of Health - Oswego, KS Kentuckv Franklin County Board of Health - Richmond, KY MA.sachusetts Barnstable County Board of Health - Barnstable, MA Grafton Board of Health - Grafton, MA Ipswich Board of Health - Ipswich, MA Nahant Board of Health - Nahan!, MA Natick Board of Health - Natick, MA Norwood Board of Health - Norwood, MA Otis Board of Health - Otis, MA Sandisfield Board of Health - Sandisfield, MA Michil!an Jackson County Board of Health - Jackson, M1 Saginaw County Board of Health - Saginaw, M1 Minnesota Fairbault-Martin Community Health Board - Fairmont, MN Minnesota State Department of Health - St. Paul, MN Nobles-Rocke Community Health Board - Worthington, MN Winona County Community Health Board - Winona, MN Missouri Cape Girardeau Board of Health - Cape Girardeau, MO Montana Cascade County Board of Health - Great Falls, Mf Deer Lodge County Board of Health - Anaconda, Mf North Carolina Edgecombe County Board of Health - Tarboro, NC Richmond County Board of Health - Rockingbarn, NC Stokes County Board of Health - Danbury, NC Surry County Board of Health - Dobson, NC North Dakota Custer District Board of Health - Mandan, NO New Hamosbire Durham Board of Health - Durham, NH Meredith Board of Health - Meredith, NH New Jersev Hampton Township Board of Health - Newton, NJ Little Ferry Board of Health - Little Ferry, NJ West Windsor Township Board of Health - Princeton Junction, NJ New Mexico Albuquerque Area Indian Health Board - Albuquerque, NM New York Westchester County Board of Health - New Rochelle, NY Ohio Crawford County Board of Health - Bucyrus, OH Logan County Board of Health - Bellefontaine, OH Meigs County Board of Health - Pomeroy, OH Pennsvlvania Chester Board of Health - Chester, PA Muhlenberg Board of Health - Hyde Park, P A Tennessee Tennessee Department of Health - Nashville, TN Washin2ton Northeast Tri County Health District - Colville, W A Wisc:onsin Dodge County Health & Human Services Board - Janeau, WI Shawano County Board of Health - Shawano, WI Shorewood Board of Health - Shorewood, WI Waupaca County Board of Health - Waupaca, WI West Vinrinia Randolph-Elkins Board of Health - Elkins. WV Q o '\ 'J Page 4 NALBOH Newsbrief Membership Committee Update NALBOH ends year 2000 with 669 memberships. Of these rr'\ 609 were local boards of health representing over 3,000 indi- \V vidual board of health members. During the year, Sylvia Beck joined the NALBOH staff as the Director of Membership. Please fell free to direct membership questions or suggestions to her attention. The 2001 membership campaign was kicked off in November. Already we have received over 400 applications including 64 new members as noted on page 4. Membership certificates are being mailed to all 200 I paid members. Individual wallet size membership cards will be included for each member of a member of board of health. In this packet also look for a short questionnaire which we ask you to complete and return to NALBOH office so we can bet- ter serve your needs and keep our database up to date. As a valued member of N ALBOH we ask you to share your NALBOH experiences with other boards of health. Any cur- rent member ofNALBOH who gets 3 new members to join in 200 I will receive an additional 10"10 discount on registration fees for the 2001 NALBOH Annual Educational Conference in Cleveland, OR, July 25-28. During this coming year the NALBOH membership commit- tee will be studying the NALBOH membership categories and r7\ dues structure. The committee will be looking at NALBOH ~ financial needs, studying dues structures of other national pub- lic health organizations and considering the concerns of the membership. Results of this study will be shared with the membership at the NALBOH's 9th Annual Conference in Cleveland. Your thoughts and suggestions on this important study are always invited. 0 Showcase Your Efforts NALBOH is interested in hearing success stories on how local boards of health have worked as a team with their health officer or commissioner in addressing public health issues. Please e-mail <marie@naIboh.org> or fax a short description of your efforts and contact information to (419) 352-6278. ( Check Out Our New Improved Website!!! www.oaIbob.org If you have not checked out our _te, then now is the time. With the help of Grace Senato & Jennifer O'Brien. our website bas really expanded. We are Dying to meet the needs of all NALBOH menmer.. We welcome suggestions on how to improve our site. Remember our goal is to assist local boards in providing up to date information and training. I February 2001 Has Your Voice Been Heard The new year brings a new opportunity for communicating with your representatives at the national and state level. leg- islators need to know your opinions if they are to serve you and members of your community effectively There are many ways of communicating with your representatives. Personal contact is an effective way to communicate your concerns. In many instances your contact will be an aide. Aides will for- ward your concerns to your representative. Another way of communicating with representatives is by mail or bye-mail. A more effective form of communicating is by testifying before the committee considering a bill that affects you. If you wish to attend a committee hearing, information may be obtained by calling your representative's office or the committee chairman's office. It is not necessary to appear in order to testify Testimony may be presented in writing. This may not be available in all states; check with your state repre- sentative. There may be times when you want to contact a Governor Contact information is available by calling your state capitol or the state's website. At the national level, you will find addresses, telephone num- bers and e-mail addresses through <www.senate.gov> or <www.house.gov> You may also phone the United States Capitol switchboard at (202) 224-3121 and the operator will connect you with the office you request. At the state level, check the web site for your state or call the state capitol for in- formation. Before you make contact with your representative, be prepared to provide the number of the bill in question, designate whether it is a House Bill (HB) or a Senate Bill (SB), state your position and provide a reason for your support or opposi- tion to the bill. 0 Invitation to Former Members of Local Boards of Health Each year some local board of health members complete their term of service. Even after completing their official duties, many of these members remain interested in the public health of their communities, state and nation. A retired membership in NALBOH offers an opportunity for all former local board of heath members to keep in touch with public health activities across the country Membership is only $10 a year For that you receive NALBOH's quarterly NewsBrief and information on other NALBOH publications, are eligible to attend the NALBOH conference at membership rates and serve on NALBOH committees. NALBOH invites all former board of health members to join NALBOH so you can continue to share your experiences and knowledge with others. To join NALBOR, send your com- pleted membership application-(page 15), to the NALBOH office. You may also send the names and address of retirees from your board to NALBOH at 1840 East Gypsy Lane Road, Bowling Green, OH 43402, and we will be in contact with them. 0 Page 5 February 2001 NALBOH Newsbrief Nomination Form ~/ Return by May 15, 2001 for NALBOH Recognition Awards 0 Rev. Everett I. Hageman Award This award, named for one of the founding members of NALBOH, is the most prestigious award given to a current or past board of health member who has demonstrated outstanding leadership to a board of health and commitment to and enthusiasm for local public health. 0 State or Local Health Officer/CommissionerjDirector Award This award is given to a current state or local health official who has: (I) contributed significantly to state or local public health; and (2) contributed to the training, support and strength of a local board of health or state association of local boards of health. 0 Legislator of the Year Award This award is given to a national leader who: (1) is currently serving in the United States Congress; (2) has shown outstanding leadership in promoting public health; and (3) has sponsored or contributed significantly to bills championing public health issues. 0 Regional Trustee Award This award is given at the sole discretion of the Regional Trustee of NALBOH to a current or past local board of health member who has donated significant time and energy in supporting state and/or local public health issues. Nominee's Name: Occupation: Address: Home phone: Work phone: DepartmentlBoard of Health: Offices and Committee Positions: Legislative or Department/Board of Health years of service: Outstanding achievements: Examples of public health enthusiasm: Involvement in other community/state/national activities: Nominator's name and title: Address: Daytime phone: Please attach other pertinent information as necessary (two-page limit). Send nomination form to: NALBOH, 1840 East Gypsy Lane Road Bowling Green, OH 43402 "\ Fax: 419-352-6278 ~.J NALBOH's 9th Annual Conference Update Cleveland, Ohio July 25-28, 2001 Page 6 NALBOH Newsbrief ~o TWO IMPROTANT UPCOMING NALDOH EVENTS () National Association of Local Boards of Health c. IS40 East Gypsy Lane Road Bowing Green. OH .43..02 Phone: (419) 353-7714 Fax: (419)352-6278 E~mail: nalboh@nalboh.org Website: www.nalboh.org February 2001 Available By Satellite To AU Local Boards of Health Ned E. Baker Lecture Series Featuring guest lecturer: Michael Bird, MSW, MPH President, American Public Health Association Public Health Teleconference Friday, April 6, 200 I 7:30 p_m. - 8:30 p.m. Eastern Time Olscamp Hall, Bowling Green State University This lecture will be broadcast by satellite for local boards of health sites throughout the country! Sponsored by the College of Health and Human Services at Bowling Green State University and NALBOH. Satellite: SBS6 Ku-Band Transponder' 3 Frequency' 11774 Horizontal Audio: 6.216.8 Production Trouble: (419) 372-7016; Uplink Trouble: (419) 372-7013 NALBOH's 9th Annual Conference July 25-28, 2001 Sheraton Cleveland City Center Cleveland, Ohio BOARDS OF HEALTH: BUILDING HEALTHY COMMUNITIES THROUGH PARTNERSHIPS AND POLICIES Conference Highlights . Effllcti" Gonrnane8 . Em.rgency Response . Environmental Health . Healthy P.opl. 2010 Initiati... . Injury Prevention . Natianol Publi, Health P"farman" Standard. . Tobacco (ontrol and Prevention through Policy . Training th. Publi, H.alth Workfa", AND MUCH MORE In cooperation with The Ohio Association of Boards of Health Page 7 February 2001 NALBOH Newsbrief Tools and Strategies for Media Interaction Abbrieviated Article By _ I. HC1WID'd Centers for Disease Omfro/""d Preumtion Submitted by I. Frederick Ag<l Increasingly we are faced with the challenge of communicat- ing with a public that may well have little understanding (or considerable misunderstanding) of our work and public health. When the popular media seek answers and information for the public, a communications strategy that uses the concept of message development and delivers timely and accurate infor- mation is very effective. Both reporters and the public have begun to ask probing ques- tions: Why should the United States be concerned about an outbreak of Ebola in Zaire? Why is the risk for &cherichia coli infection higher when eating undercooked hamburger than undercooked steak? Should we lose sleep over West Nile vi- rus infection? It is incumbent on the public health community to provide readily understood answers and address public con- cern. The limited time that the media will devote to this single issue must be used to deliver the most powerful, uniform and effec- tive message. Questions that are the core of translating scien- tific data into useful and direct messages for the public in- clude: 1. What is the key point of this interview? What would you like to see as the lead paragraph in a newspaper story or broadcast news report about this subject? 2. What is the single message your audience needs to take away from this report? 3. What are the three facts or statistics you would like the public to remember after reading or hearing about this story? 4. Who is the main audience or population segment you would like this story to reach? Is there a secondary audience? 5 Who in your department will serve as the primary point of contact with the media and when will this person be available? What are the means of contact? The persons interviewed must decide how deep into the data to go. When the message is delivered to the public, communica- tions must address the public's concerns, not those of a scien- tist's. The challenge in developing a communications strategy to deal with evolving and complex issues of public and media interest is to create a mind-set where the communicator and the institution understand the value of information exchange and can develop single overriding communication objectives for both short-term and long-term communication goals. As an issue evolves, so may the communication objectives. The initial message may be one of a warning or an advisoty alert- ing the public to a threat. Subsequent communications may direct the public about what actions to take regarding preven- tion and control. Communication objectives evolve quickly and require frequent and careful development that tracks the t1'\ progression of the scientific findings. This process has proven \J,tIJ valuable in short term-and long-term communication pro- grams. In the short tenn, it allows focusing on clear useful messages for the public, as was the case during the hantavirus outbreak in the southwestern United States. Residents were given simple, timely health advice: "Avoid contact with ro- dents; don't provide havens for rodents; and report all hanta- like symptoms to your doctor immediately" In the long term, the communication process places disease in proper perspec- tive. Even though human cases of Ebola virus infection have not reached the shores of the United States, a global village message stressed that whether it is Ebola or West Nile virus, what happens in Zaire or the Sudan today may well be a prob- lem in the United States tomorrow "We live in a global vil- lage" and "diseases are only a plane flight away" are messages that everyone can understand. For a complete copy of Robert Howard's article, please con- tact the NALBOH office. 0 CDC Resource on Fall Prevention for Older Adults CDC's National Center for Injury Prevention and Control (NCIPC) recently published u.s. Fall Prevention Programs for Seniors, a compilation of programs to prevent falls and 0 related injuries among America's older adults. This publica- _ tion, the first of its kind, describes in depth 18 comprehensive programs that use a number of fall risk-reduction strategies, including home assessment and home modification. Each program summary provides readers with the name of the organization, a description of the target populations, program goals and procedures, strengths and weaknesses, types of program materials used, funding method, and contact information. The publication also includes sample materials that practitioners can use as models, and contact information for 22 additional programs. To order a free copy of this publi- cation or to downloaded it directly from NCIPC's web site, visit <www.cdc.gov/ncipclpub-res/pubs.htm>. or call toll free (888)252-7751. 0 Training Materials for NALBOH's Videotape Now Availablel Traini~ materials for NALBOH's videotape, Assessment, Policy Development, and Assurance: The Role of the Local Board of Health are now available! There is a note taking sheet to use while viewi~ the film: a worksheet and an- swer guide to test your knowledge about the film: and a discussion guide to help stimulate your board's knowledge of their role. If you would like copies, please notify Jen- '\ nifer via email at <jennifer@nolboh.org> or by phone at J 419-353-nI4. Page 8 NALBOH Newsbrief February 2001 () Biological Agents as Natural Hazards and Bioterrorism as a "New" Natural Disaster Threat - Part I By Eric K. Noji, Biot<rrorism Preparedn... and Response Program, Ccn/eTs for Disease Control and Preumlion Submillcd by Ronald C. BUTg<r Biological weapons represent a unique natural hazard. The pathogens involved are natural in the sense that they are risks that naturally occur in our environment. However they are unnatural in the way in which they are inflicted upon society Despite their current notoriety, biological weapons are not new. One of the earliest reported uses occurred in the 6th century B.C. when the Assyrians poisoned enemy wells with rye ergot, and Solon used the purgative herb hellebore dur- ing the siege of Krissa. In 1346, plague broke out in the Tartar army during its siege of Kaffa in the Crimea. The attackers hurled the corpses of those who died over the city walls. The plague epidemic that followed forced the de- fenders to surrender, and some infected people who left Kaffa may have started the Black Death pandemic that spread throughout Europe, killing one-third of the popula- tion. CLO In 1972, the United States and many other countries signed the Convention on the Prohibition of the Development, Pro- duction and Stockpiling of Bacteriological (Biological) and Toxin Weapons and on Their Destruction, commonly called the Biological Weapons Convention. This treaty prohibits the stockpiling of biological agents for offensive military purposes and fOlbids research into offensive employment of biological agents. The former Soviet Union and the govern- ment of Iraq were both signatories to this accord, but despite this historic agreement, biological warfare research contin- ued in both countries. Since 1972, there have been several cases of suspected or actual use of biological weapons. For example, an incident in Sverdlovsk in the former Soviet Union appeared to be an accidental release of anthrax in aerosol form from a Soviet military compound. Residents living downwind. from this compound developed high fever and difficulty breathing, and a large number died. The final toll was estimated to be 200 to 1,000. In August 1991, the first United Nations inspection ofIraq's biological warfare capabilities was carried out in the after- math of the Gulf War The Iraqi government announced to the leaders of the United Nations Special Commission that they had conducted biological weapons research and it veri- fied many of the concerns of the international community Biological agents were tested by the Iraqis in various deliv- ery systems, including rockets, aerial bombs, and spray tanks. ( Despite the Biological Weapons Convention in 1972, the threat of biological warfare has actually increased in the last two decades, with a number of countries continuing to conduct research on the use of these agents as offensive weapons. The extensive program of the former Soviet Union is now controlled largely by Russia, and the Russian government has slated that they will put an end to further biological research. However, the degree to which the program has been scaled back, if any. is not known. A senior bioweapons program manager who defected from the Soviet Union in 1992 outlined a remarkably robust bio- logical warfare program. There are also concerns that the small- pox virus - eradicated in the late 1970s primarily through the enormous efforts of the U.S. Centers for Disease Control and Prevention (COC) and the World Health Organization and now stored in only two laboratories (the CDC in Atlanta and the Insti. tute of Viral Precautions in Moscow, Russia) - may have been "bargained" away by desperate Russian scientists seeking money An attack with an agent such as smallpox could pose threats to large populations because of the potential for person - to - person transmission, enabling spread to other cities and states. Such disease would quickly become a nationwide emer- gency, with international involvement sure to follow There is currently intense concern about the proliferation or en- hancement of offensive programs in several countries due to pos- sible hiring of expatriate Russian scientists as well as a number of other conditions, including neglected security systems and unpaid and unemployed technical personnel with access to and knowledge of weapons of mass destruction. Reportedly, in Janu- ary 1998, Iraq sent about a dozen scientists in Libya to help that country develop a biological warfare complex disguised as a medical facility in the Tripoli area. In a report issued in Novem- ber 1997, Secretary of Defense William Cohen singled out Libya, Iraq, and Syria as countries "aggressively seeking" nu- clear, biological, and chemical weapons. In addition to biological agents as weapons of war, there is also increasing concern over the possibility of terrorist use of biologi- cal agents to threaten civilian populations. There have already been cases of extremist groups in the U.S. trying to obtain micro- organisms to use as biological weapons. Until recently, attack on civilians with a biological agent was considered very unlikely However. now it seems entirely plausible. Recent events indicate that neither arms control treaties nor the moral repugnance long associated with the use of biological weapons will deter their use as terrorist weapons. Some experts have stated publicly that it is no longer a matter of if but when such an attack will occur. They point to the accessibility of information on how to prepare biological weapons (e.g., on the internet) and to activities by groups such as the Japanese terrorist group Aum Shinriky, which, in addition to releasing nerve gas in Tokyo's subway system, experimented with botulism and anthrax and vigorously sought to obtain the Ebola virus. For a full copy of Eric K Noji's article, please contact the NALBOH office Part n to be continued in the May NewsBrief 0 Page 9 L February 2001 Tech Tips By Jenniftr M. O'Brien, MPH We1come to Tech Tips, a colwnn devoted to discussing is- sues mvolving the Internet and electronic and digital me- dia. The Internet can be such a powerful tool for learning about public health issues, communicallons, and forming partnerships online, that we have deClded to address these issues in this column. Before beginning the topic of this colwnn (Access to Technology), there are three caveats. First, I am not an expert in these matters, but I will either find out the an- swer or find someone who knows the answer. Second, this is a forum for learning about the Internet and technol- ogy. Questions about hardware (e.g. the computer, printer, monitor, etc.) or non-public health related software should be directed to your computer support personnel. Thtrd, this forum is for NALBOH members, so please participate by submitting questions. Information about how to sub- mit questions to Tech Tips is at the end of the article. Now that the business end of the colwnn .s out of the way, let us talk about why using the Internet is so valuable and how to obtain access to it if you do not have a com- puter. To discuss the value of using the Internet, let's as- sume that your board of health has been charged with working on a program to improve community safety (e.g. reduce injury) for children. Using the Internet, you could: read about various kinds of injury and the rate at which they occur; obtain statistics on injury prevalence rates; find injury prevention programs that have worked elsewhere, compare your conununity's data to other conununities, or become a member of an organization working to reduce childhood injuries. 1bis example is true for other topics as well. For example, if your board is working on smoke- free regulations, you can find mfonnation on model statutes, studies con/innmg that going smoke-free does not reduce restaurant or har revenues, resources for grant monies, and discover con- tacts whom you can call to gain first hand knowledge about the challenges of enacting legislation. Regardless of the topic, there is mfonnation available online that may better inform you about public health issues. So, how does one get to this infonnallon? Obtaining ac- cess to both a computer and the Internet is the answer. If you or your board does not have access to a business or personal computer and/or the Internet, you may want to consider some free or fee-based computer services to gain access. Some examples are to: }> Work with your local health department, county or local officials to detennine .f there is some way to gam NALBOH Newsbrief access to department computers and develop an ar- rangement for board members to use them. For ex- ample, during a late night climc, board members could use department computers (not in the clinic) for an hour or two after non-clinic employees have left for the day. OJ }> Check out your local library. Most libraries have computers with Internet access. Typically, there is no charge for using the computer or the Internet, al- though there may be a charge for printing. An addi- tional benefit is the experienced librarians who may help you find the infonnation you are seeking. }> Use a local college or university library. Again, while there mayor may not be charges associated with printing in these libraries, you will have access to the librarians. }> Check with churches, schools, nonprofit organiza- tions, or community partners to see if they can help you. Depending on your board, you could: exchange services (e.g. computer access for reduced costs for immuru.zations); or share costs (e.g. work w.th an- other group to "buy" Internet access or a computer, then negotiate a sharmg schedule). }> See what kind of businesses offer fee-based services A~ (such as Kinko's). While there are fees involved with V.J/ using these kinds of setvlces, you may be able to work out reduced fees or for in-kind services (such as free advertlsing on health literature). Once you have access to a computer and the Internet, you may want to start at NALBOH's website <www. nalbohorg> Using the Web Directory, you can cormect direcrly to online infonnation about various public health topics. You can also request infonnallon about tobacco resources or get a full text copy of our keynote speeches from our past conferences, as well as learn about our 9th Annual Conference in Cleveland! If you have top'c suggestions or questions for Tech Tips, please either email them to me at <jennifer@nalboh.org> or send them to: Jennifer O'Brien, NALBOH Tech Tips, 1840 East Gypsy Lane, Bowling Green, Ohio 43402. '. Next Tech Tips: Using Internet Search Engines! 0 ~) :m Page 10 L_.___.._ ------1 I -.-.-._._._1 NALBOH Newsbrief FebrulU)' 2001 o A TSDR Releases Seven Toxicological Profiles Released lanURr)/ 2, 2001 The Agency for Toxic Substsnce and Disease Reghrtry (ATSDR), announced the availability of seven toxicologIcal profiles for aldrin/dieldrin, beryllium, creosote, DDTIDDDI DOE, di(2-ethylhexyl)phthalate, hexachlorobenzene, and methoxyclor. Each toxicological profile exsmines, summarizes: and. inter- prets available toxicologic information and epIdemIologIc evaluations on a given hazardous substance. The toxicological profiles also contain a public health state- ment that provides, in layperson's terms, a basic overall de- scription of the substance and the health effects associated with the hazardous compound. Additional information has been added to specifically address the effects of toxic sub- stances on the developing immune, nervous, and reproductive systems of children. These sections provide information on how the substance can effect children, how families can re- duce the risk for exposure, the particular ways children are susceptible to the effects of the substsnce, and how children are likely to be exposed. For more information about ATSDR's toxicological profiles, contact the information center toll free at (888) 42-A TSDR (422-8737) or check their website <www.atsdr.cdc.gov> 0 () Michael E. Bird to Deliver the Second Annual Baker Lecture L Fleming FaJlcm, Ir., MD, D,PH I, I , I i Michael E. Bird, the President of the American Public Health Association (APHA) will deliver the second annual Ned E. Bsker Lecture in Public Health. The lecture will be telecast live via satellite to local boards of health throughout the coun- try The hour-long lecture will be presented on the Bowling Green State University campus beginning at 7:30 Eastern t.me on Friday, April 6, 200 I Details on connecting to the satellite are presented in an accompanying article on page 7 of this NewsBrief NALBOH and the eleven state associations of lo- cal health boards are cosponsors of this important event. Community has been an important concept for Michael Bird. It is a theme that has accompanied him through his travels in life. As a social worker, he understands the need for close in- terpersonal cooperation and connections. As a public health professional, Michael has worked with members of dIverse communities, always striving to ensure that all peoples have the same access to quality health care services. During his term as President of the APHA, he will be a forceful spesker for equity and access to public health services throughout the world. (j Community will be the centerpiece of Michael Bird's lecture. He will note the importance of community in governing local public health efforts. Citizen involvement is a primlU)' re- [- quirement for success in community improvement. With a renewed focus on community, public health should become even more of a critical resource in the coming decsdes. Mark your calendars for Friday, April 6, at 7:30 pm Eastern time. Plan on hearing Michael E. Bird's thoughts on commu- nity, leadership and public health. 0 Announcing the National Public Health Brand Identity Initiative (pillturc&oll1di.l PIwHo"-'...."'~af.".N_'..H.l4APHA Americans do not have a clear understanding of the relevance of public health on their lives every day - through the safety of the food and water we consume, the air we breathe, the immunizations that protect us from unnecesSlU)' disease and death, etc. Many times when public health is mentioned, people think about services for the elderly or the poor. In a recent survey conducted by Opinion Research CorporatIon, nearly 800/0 of over 1,000 respondents said they had NEVER been helped by public health! To address these types of gross misconceptions, eight leading non-government public health organizations have joined in a Memorandum of Understsnd- ing to form The Public Health Branding Identity Coalition. NALBOH, in a joint effort with the American Public Health Association, the Association of Maternal and Child Health Programs, the Association of Schools of Public Health, the Association of State and Territorial Health Officials, the Na- tional Association of County and City Health Officials, the National Association of State Lsboratory Directors, and the Public Health Foundation, has committed to work on this ini- tiative. An RFP was issued, and three firms subsequently interviewed in October. We are pleased to announce the unanimous selection of Hill & Knowlton. James Friedman, with 23 years of experience in Public Health Service, will serve as the Senior Managing Director for Hill & Knowlton to create a marketing, business and fundraising plan. At the completion of this project, we will move forward and seek support for the development of a national campaign strategy A public health brand identity refers to the product we intend to create through this effort. It is a visual and verbal summa- tion of what we understand the essence of public health to be, expressed in a logo and thematic material that can be used by all partner organizations. The Executive Directors of each organization will oversee this project and report back to their boards and constituents. We will keep you posted as this pro- ject progresses. 0 Page 11 ! - February 2001 NALBOH Newsbrief ImMtC~1 V ~ Join Other Local Board of Health Members for Tobacco Control Conference Calls Monday, March 12, 2001 Monday, May 14,2001 12 noon -1 p.m. ESf Contact Rebecca Edwards at <rebecca@nalboh.org'> for the toll-free bridge number and conference code. NALBOH will moderate discussions on various tobacco con- trol issues relevant to local boards of health. If you would like Q reminder notice before the calls, please send me your e~ mail address, Gear Up for Kick Butts Day- April 4, 2001 Kids across the country are preparing for a tough fight. Their opponent? Big Tobacco. On April 4, thousands of kids will be participating in the sixth annual Kick Butts Day, holding events and activities from anti-tobacco track meets and soccer games to mock trials and convenience store surveillance. Kick Butts Day is organized and sponsored by the Campaign for Tobacco-Free Kids, and is co-sponsored by 31 other organizations, including the National Association of Local Boards of Health. The CAMPAIGN is the nation's largest non- governmental initiative to protect children from tobacco addiction and exposure to secondhand smoke. The CAMPAIGN and its partners recognize that tobacco products are deadly, and that the tobacco industry spends almost $7 billion a year, over $18 million a day, to market its products, much of it aimed at kids. More than 3,000 kids become regular smokers each day and one-third of them will die prematurely from tobacco- related disease. On Kick Butts Day, kids across America will stand up to Big Tobacco. Kick Butts Day not only serves as a chance to educate kids about the dangers of tobacco, but also acts as an opportunity for kids to take matters into their own hands and achieve real results in the field of tobacco prevention, control and education. Some of the most successful youth advocacy activities include "Rallying the Troops," an event designed to introduce kids to lobbying by holding a student rally on the state capital or town hall. "Lobbying for a Local Ordinance" and "Smoke-Free Dining," encourage kids to take action and influence tobacco regulations in their own community by limiting illegal tobacco sales to minors and petitioning local restaurants to become smoke-free. MODEL ORDINANCES Model Tobacco Control Ordinances are available for inter- ested board of health members by contacting NALBOH. Kick Butts Day encourages activism and leadership among elemenlllIy, middle and high school students, with rallies and events taking place in every state, and several nations, showing that kids are powerful voices in the fight against tobacco. The Kick Butts Day activity guide includes events for all ages, with activities both in the classroom and in the community This year's Kick Butts Day activity guide also includes two new sporting event activities, a soccer event, "Kids Kicking Their Way to Health," and an anti-tobacco track meet. The soccer game encourages participation of kids and parents, as well as local officials and soccer teams. The anti-tobacco track meet includes individual events such as a "Get rid of that cigarette as fast as you can!" relay, "Breathe Easy" races, a "Crush Big Tobacco!" shot put event, and the "How far will you go to stay tobacco free and stop big tobacco?" long jump event. These activities not only highlight the tobacco industry's practices of targeting kids through strategic advertisements, but they also illustrate the dangerous health effects associated with tobacco use and the advantages of staying healthy, active, and tobacco-free. To order your free Kick Butts Day Guide, go to <www kickbuttsday.org>, or call toll free 1-888-839-3869, and to find out more about the Campaign for Tobacco-Free Kids, visit their website at www.tobaccofreekids.org. 0 NCI Monograph Available to Members The National Institutes of Health's, National Cancer Insti- tute has recently published its 11th Monograph on Smoking and Tobacco Control. The title of the August 2000 publica- tion is "State and Local- Legislative Action to Reduce To- bacco Use." NALBOH has several copies for distribution to local board of health members. If you are interested in obtaining a copy, please send NALBOH your contact in- formation and the number requested. 0 If you are e-mail friendly and would like to communicate with other board of health members and health officers on tobacco control and prevention, you should join our new list serve called Smokelesslocals! Contact Rebecca at (419) 353- 7714 or e-mail <rebecca@nalboh.org> for more informa- tion. 0 r Juiu~ I eGlOUPS o Q)) Page 12 to NALBOH Newsbrief February 2001 (i ..,/ ROCKDALE COUNlY, GEORGIA CELEBRATES TIlE 24m ANNUAL GREAT AMERICAN SMOKEOUT (Submitted by Ronald C. Burger, OuIimum, Roclcdale County Board of Health and Roclcdale County Youth Tol>u:co Use Pr....tion Task Fore<, a mnrrber of NALBOH's Tol>u:co Control AdviS<JT)f Committee and a State Affiliafe Trustee) The Rockdale COunty Board of Health in Georgia decided to help cele- brate the American Cancer Society's 24" Annual Great American Smokeout: a day of celebration for people who have never used tobacco, for people who have quit using tobacco, and for people who try to stop using tobacco. In conjunction with the Roekda1e County Youth Tobacco Use Prevention Task Force, the board of health held a press conference on that day at the fIrst restaurant in the county which adopted a voluntsry smoke-free environment. This restaurant, along with 24 other restaurants or about 12 percent of Roekdale's total number ofrestaurants, has chosen to protect both their patrons and employees from the adverse health effects of second-hand tobacco smoke. (0 During the press conference and in a press release it was explained that second-hand smoke, or environmental tobacco smoke, is classifIed by the US EP A as a Group A carcinogen Accordiogly to the US Surgeon General, 53,000 nonsmoking Americans die prematurely each year due to exposure to second-hand smoke, Second-hand smoke has also been related to a host of both fatal and non-fatal conditions such as Sudden Infant Death Syndrome, asthma, inner ear infections, low birth weight, and acute and chronic respiratory conditions. The restaurants also benefit from providing a smoke-free environment Statistics show that their cleaning costs are reduced; their fire insurance premiums are lower~ faster patron turnover since nonsmokers tend not to linger at the table as long as smokers; reservations and seating are simpli- fIed; employee absenteeism is reduced while productivity is increased; most of the time a large portion of the smoking section is occupied by non-smokers who ask for the fIrst available table rather than waiting for a non-smoking table; and only about 5% of patrons would demand a smoking table. A recent statistically valid telephone survey was con- ducted in Roekdale and 86% of the respondents said that they would be more likely or equally likely to eat at a smoke.free restaurant. ,( I, '.. p' After the press conference, members of Rockdale's task force and board of health visited the smoke-free restaurants to present each with a handsomely framed certifIcate of appreciation and a neat window decal depicting "Fresh food deserves fresh air." The task force is looking for ways to help prevent our youth from using tobacco and one way is by the restaurant owners providing smoke free dining. This helps to set positive examples for the youth in Rockdale County Hopefully, other restaurants will catch-on and voluntarily promote smoke-free dinning. o r""\ ...... IS TOBACCO SMOKE REALLY A DANGER TO MY HEALTIl?-A PenonaI View (Rebecca Edwards, MPH, NALBOH Project Director) Is environmental tobacco smoke (ETS), also known as sec. ondhand smoke, really a health issue? The Environmental Prntection Agency, Centers for Disease Control and Pre- vention, the United States Surgeon General, and frankly everyone knows it is by now How can anyone claim that breathing in tailpipe exhaust, nail polish remover, formal- dehyde, arsenic, gas chamber poison and thousands of other chemicals (all of which are in ETS) won't harm you? I( in fact, ETS is harmful to health, why aren't more local boards of health considering tobacco control regulations? The evidence is there. Model regulations are available at NALBOH. Local authority, in most states, is there. Com- munity support is overwhelming Are local boards waiting for the state legislature to do something about it? The evidence is and has been right in their faces and they won't touch it because of the tremen- dous influence the tobacco industry has at the state level. Does this mean that ETS is good for me and I should not be concerned? Or that kids should be allowed to steal packs of cigarettes because vendors are dumb enough to put them next to the candy? No, I believe it means that we need to protect ourselves locally We need to force vendors to put cigarettes behind counters or in areas out of reach. So regulating a legal product is a touchy subject you say' personal rights, economic impact, fear of lawsuits, etc. In every board related activity you engage in, you focus on what is the best for health of the public. Sewage, waste wa- ter, zoning. Why is ETS different? What are your actions based on? Is your board sitting stagnant on regulating ETS because action might involve hurt feelings, concerned busi- ness owners, potential for law suits, comments from your friends and neighbors? By committing to protect your community members from the dangers of tobacco, your board will be make the largest public health contribution possible during your terms as board members. Facing the tobacco issue takes a recipe which includes: a dash of pro-activity, an ounce of leader- ship, a model regulation, a base made of community sup- porters, and some gumption to go the long haul. Does your board have what it takes to get started on this healthy dish? Are you willing to be the ounce of leadership, or the dash of pro-activity? If your board of health has ignored tobacco control and prevention, ask yourself, why? Lack of motivation, time, information, what is it that is holding you back from taking action now, before your authority is taken away? Your community is counting on you to protect them! Start by protecting kids through youth access regulations or other small hurdles and then move on to larger issues such as clean indoor air Gather local support. NALBOH is here to help you! 0 Page 13 'I I ii, , NALBOH Newsbrief I b I FebfUllI)' 2001 I Calendar of Events Tobacco Control Conference Call NALBOH will moderate discussions on various tobacco control issues relevant to local boards of health. Monday, March 12, 2001 and Monday, May 14, 2001 12 noon -1 p.m. Eastern Standard Time Contact Rebecca Edwards at <rebecca@nalboh.org> for the toll-free bridge number and conference codes. National Public Health Week 2001 "Healthy People in Healthy Communities" This national celebration provides an opportunity to recognize public health contributions to the nation's well-being as well as help focus public attention on major health issues in our communities. April 2-8, 2001 For more information visit the website at <www.apha.org> NALBOH's 2nd Annual Ned E. Baker Lecture Series Available via Satellite to all Local Boards of Health Friday, April 6, 2001 7:30 p.m. Eastern Standard Time For more information check our website at <www.nalboh.org> o A Public Health Response to Asthma Thursday, May 17, 2001 1:00 p.m.-3:3O p.m. Eastern Standard Time For more information visit the website at <www.cdc.govfphtnfasthma>. NACCHO Annual Meeting "Confronting Disparities: Addressing the Social Determinants of Health" June 27-30, 2001 Raleigh, North Carolina For more information visit the website at <www.naccho.org> or call (202) 783-5550. NALBOH's 9th Annual Conference Boards of Health: Building Healthy Communities Through Partnerships And Policies July 25-28, 2001 Sheraton Capital Hotel Cleveland, OH For more infol'l1lation, contact NALBOH at (419) 353-7714 or visit <www.nalboh.org> ASTHO Annual Meeting September 18-21, 2001 Orlando, Florida For more information visit the website at <www.astho.org> or call (202) 371-9090. :) Page 14 ~-------------------------------------------------------------------------- APPLICATION FOR MEMBERSHIP Date Membership Year 200 I Board of HealthlOrganization/Name Address City Telephone ContBcl Person Type of Membership State Zip Code Fax E-mail Title . Institntional (Dues $100, or $75 if you belong to a State Associatioo of Local Boards of Health that is an Affiliate Member of NALBOH) local board of health or other governing body that oversees local public health services or programs Affiliate (Dues $250) State association oflocal boards of health Associate (Dues $50) Individual Retired Board of Health Member (Dues $10) Sponsor (Nonprofit $50; For-Profit $250) Organization, agency or corporation . . III (C: : . I I I .--------------------------------------------------------------------------- Mail this form, with payment of dues to: NALBOH, 1840 East Gypsy Lane Road, Bow6ng Green, OH 4J402 , I Page 15 I I: NALBOH's 9th Annual Conference o! Join Us!! NALBOH's 9th Annual Conference July 25-28,2001 Cleveland, Ohio Oeve1and Bridge In cooperation with OHIO AsSOCIATION OF BOARDS OF HEAL'IH Boards of Health: Building Healthy Communities Through Partnerships and Policies . Effective Governance . Emergency Response . Environmental Health . Health People 2010 Initiatives . Injury Prevention Conference Hlahllahts . Local Public Health Strategic Planning 0 . National Public Health Performance Standard Update . Tobacco Control Efforts . Training the Public Health Workforce AND MUm MORE For more information contact the NALBOH office at Phone: (419) 353-m4; Fax: (419) 352-6278 E-mail: <nalboh@nalboh org>; Website: <www.nalboh.org> r;;;:;r;;;;l ~ National Association of Local Boards of Health 1840 East Gypsy Lane Road Bowling Green, OH 43402 NONPROFIT ORG. u.s. Postage PAID Bowling Green, OH .:) r \ NEW HANOVER COUNTY HEALTH DEPARTMENT , ~.o - ~tid ~- '[1 --"'--- fff- HIs the fish fresh?" Also in this issue... c 2 Raw Fish Facts- What to know about sushi, sashimi, and ceviche 2 Crabs & Lobsters- How to find flaws in food with claws 2 Buying Finfish- Be a well.educated consumer , \ 3 Pearls of Wisdom- Tips on inspecting, storing, and preparing oysters 3 Raw Bar Roulette- Who is at risk of getting sick from oysters 4 Fish on the Rocks- Q&A about freezing and thawing fish Copyright 2001 Pike & Fischer, Inc. 1-800-255.8131 Spring 2001 -, C t- ' S f- tyN" t' as Ingra~i-~:~!.~. -', ~f!' Around Seafood 'L; Sushi bars. Crab houses. AII-you-can-eat seafood buffets. With sa many ways to serve up morsels from the ocean, seafood is more popular than evet Most of the time, fish, shrimp and other edibles are perfectly safe to eat. But if they're har- vested, stored or prepared improperl'b they can be downright lethal. Inside you'll find more information on safety issues for various types of fish and shellfish. One of the biggest dangers in seafood is pollution. Certain fish are likely to be contaminated with toxic chemicals-including mercury, polychlorinated biphenyls (PCBs) and various pesticides. People who eat those fish can ingest the chemicals, which can create a variety of health problems. Mercury is especially dangerous, particularly for the developing fetus and nursing infant. Children of women who ingest high levels of mercury during pregnancy may be born with learning disabilities and other disorders. Fish to look out for include shark, swordfish, king mackerel, and tilefish. They are among the fish that can contain high levels of mercury because they feed on smaller fish which already contain high levels of the toxin, plus they live a relatively long time. Fish is a good source of protein, which pregnant women and women of child-bearing age need, but they should select other varieties, such as shellfish, canned fish, smaller ocean fish, or farm- raised fish. Mercury is distributed in a fish's muscles, rather than fat and skin, so cleaning and cooking mercury-laced fish won't make it any safer But there are some ways to protect your customers from other pollutants (see box). ------1 , \ \ , \ \ , '. ! \ , ut down on lodtont ron 01 sea 0 d When Proper prepO~o' suth os peslid eS. 0 lessen 101_sol~ble I~h~~:~: Ihe lollowi~f :=~;e p(8s, pfeponng 'S, f tUS,otn8fS VI' t Ihe risk Ihol YO~milor themitols: hordone and s . t Remove 011 sk.n. I glhe botkbone. . 011101 0 on Ihe bottom. I . (ul away II 101 along eoth side 0 . slite off Ihe ~esh~ped wedge ~dlongl eoth lillel. QVIOY 0 .- 1<' 51 e 0 . (u:mole tish, or Olin ~:~ ~~ elevoled rotk, SO o. bake Ihe IS . 80.1 or dial drips off. Ihol melle . (p(8s build up .n Ihe 101 ollish.) . Discord 011 the 'I drippingS. Don use Ihem lor soutes Of ------------------- graVY. __'- --- .----...-- Food Talk ) : . -" '" ',,,~<'3tJ~:-.~it'Otf~~ ""-~~.-"-"~ Spring 2001 ~~~.;t:~ )?~~';-;.;ii,'.J-.-t:,~:-;.,~~: " ':~ What's So Creepy Abou~ Raw Fish? Plenty, If You Don't Freeze It I Sushi, sashimi and ceviche, once served only at high-end ethnic restau- rants, are everywhere now Yau can even buy packaged sushi at your local supermarket. But many sushi fans may not realize that they could be sucking down a tape- worm or other type of para- site with their seem- ingly healthy meal. Parasitic or worm in- fections are rare, and \ scientists still don't completely under- stand them or the dan- gers they pose. For ex- ample, fish experts don't know how long larvae can live in a human. So how do you make sure the raw delicacies you serve up don't have any- thing creeping inside? Most seafood processors look for worm-infested fish using the candling method: holding a light behind a translucent piece of fish filet to check for tightly coiled, half-inch worms. But candling is only effective 20.25% of the time, according to fed- eral food safety experts. Candling can't detect larvae. One way to minimize the chance of gobbling up a lovely piece of sushi with a nicely imbedded worm is to fol- low federal guidelines and freeze your raw fish. Proper freezing should kill worms. The federal govern- ment recommends freezing fish to minus 40 F center temperature for 24 hours. (A home freezer may take seven days to kill the worms.) Unlike sushi and sashimi, ceviche is fish marinated in a vinegar and lemon mix. This highly acidic marinade kills any bacteria, but not the worms. Raw fish intended for ceviche stills needs to be thoroughly frozen. CRABS & LOBSTERS How to Find Flaws in Food with Claws How can you tell if a <rob or a lobster is alive and kicking, and therefore safe to prepare and eat? Check the legs, which should be moving_ In addition, a lobster will curl its tail underneath when handled. If the crab and lobster have been in the refrigera- tor for awhile, they won't move their legs much. But you'll still see a Iinle movement even when they're chilled aut. After steaming the clawed favorites, remember to place them in a fresh container. If you return them to their original basket, they can pick up harmful bacteria. Never, ever cook 0 dead crab or lobster. When a crustacean goes to the great ocean in the sky, it's earthly remains start growing dangerous bacteria. Keep in Mind: ~ I I I I , , I 1 The older and the bigger the fish, the more likely it will be infested with parasites. 2 More fish and consequently more humans are infected with parasites on the West Coost than on the East Coast. Why? Because the Pacific Ocean is home to seals, porpoises, sea lions and whales that hast tha para. sites. 3 i i I I I , i I i i I , i , I ! i I .~ Yellow fin and blue fin tuna don'tlypically carry para- sites. Roundworms are found in saltwater fish such as halibut, rockfish herring, sea bass and flounder. 5 Tapeworms are found in fresh water fish (e.g. pike and perch), and in fresh saltwater fish such as salmon. 4 BUYING FINFISH Firm, Shiny Flesh Means the Fish Is Fresh When you look at a whole piece of fish, you need . to .take a few basic steps to make sure it's fresh and safe to eat: . look for firm flesh. If you press the fish with your finger, and it leaves a dent, be careful. It may not be safe to eat and should be looked at more closely. . look for shiny flesh because dull flesh means the fish is old. . Make sure the eyes are clear and bulge a linle. Remember that some fish, like the walleye pike, have naturally cloudy eyes. . Make sure there is no darkening around the edges of the fish. And make sure there is no brown or yellow discoloration and that the fish is not mushy. . The final test: rinse the fish and smell it. A fresh piece of fish will not smell .fishy. or like ammonia. If it does, do nat eat it. When in doubt, throw it out. "E1leJEl6!J!E1J 'O~ 'MoI9q"6 'e!J9loeq L 'sno!!!uln^ 'v 'SJQlSAO"€ ')jJe4s ~ :ssoJo't AmOJ9W "S 'sB:Jd '9 'U9Z0J! "S 'UO!lnIlOd "Z '!4sns ~ :UMOa :a6ed JfoeQ uo a/zznd OJ SJ8MSUl1 ~ -) J Spring 200 I Food Talk , Pearls of Wisdom About Oyster Safety Hip-and-happening raw bars now serve pricey delicacies often referred to as boutique oysters. Connoisseurs claim that each oyster at the bar has its own unique taste. But no matter how differently each morsel may delight one's taste buds, none of them are any less prone to carrying dangerous bacteria. However, there are a variety of ways to make sure oysters stay safe and fresh before they're served. (- When You're Inspecting Them: Always read the tag. All government-inspected oysters will be tagged and labeled with the time ot harvest, the location and the grower's name. This is one way to make sure the oysters came from an area that has been inspected and is free of contaminants. To make sure it's a living, healthy oyster' . Top the oyster shell. The oyster is alive if the shell is closed, or if it closes after being tapped. If that doesn't happen, toss the oyster . (heck the shell. Don't accept oysters with damaged shells. . Open the oyster Oyster meat should be plump and smell slightly salty If it is dry or if the oyster smells bad, throw it away . (heck the oyster's color An oyster is usually cream colored, but it can be green or reddish, which is harmless. '- If the oyster meat is pink and smells iffy, yeast is present and the oyster should be thrown away When You're Storing Them: "If oysters are properly handled, they can stay alive and kicking for up to 10 days. Temperature abuse is the single most important thing to try to prevent," says Mike Marshall, an oyster farmer in Portland, Oregon. . Keep' em cold. Refrigerate and store the oysters below 400F to keep bacteria from growing. . Make 'em feel at home. Don't store oysters in fresh water-it kills them. . Save the juice. Store live oysters upside down to keep the juice in the shell. The juice provides oxygen for the oyster When You're Preparing Them: . Remember to wosh your honds. Always wash hands thoroughly with hot soapy water before and atter handling raw seafood. . Scrub the oyster. Use a stiff brush on the oyster just before shucking or cooking to remove surface bacteria. . Keep your surroundings dean. Disinfect utensils, plates, cutting boards and other surfaces touched by raw oysters to prevent cross-contamination. . Don't use 0 dishcloth or sponge. When cleaning up oyster juice, it's better to use something disposable. Raw Bar Rouleffe: Eating Oysters Is a Gamble As many os 20 million Americans love to suck down . Uver disease from excessive alcohol intake, viral row oysters, and most will enjoy these slippery morsels hepatitis or other causes without 0 hint of trouble. But row oysters con be deadly . The iron disorder hemochromatosis for those identified os being in 0 high-risk group. . Diabetes .People with weak livers, especially heavy drinkers, . Stomach problems, including previous stomach shouldn't eat row oysters,. soys TIm Hansen, 0 govern- surgery and low stomach acid (from antacid use, ment seafood specialist. for example) The boderio Vibrio vulnificus and Vibrio porohaem- . (oncer olyticus ore the culprits in 90% of 011 shellfish induced . Immune disorders including HIV infedion illnesses. Even if 0 botch of oysters is contaminated with . La t 51 .d' f th t t t f . .. ng- erm erol use, os or e reo men 0 bodeno, not everyone who eats them will get SIck. th d rth .t. S... dh.ld f h.h d-kb os moon 0 n" emor CItIzens on c I ren ace 0 elg tene ns, ut If h . II h FDA S f d h I h I f h . I .,. you ove more questIons co t e eo 00 even t e more et 0 0 t e two stroms, V. vu n",<us, H I. 1 800 FDA 4010 0 th I t h Id' h h I h I f ot me, - - - . r contact e n erstote s ou n t arm e~ t y peop .e. Howeve~,_ 40 ~er<ent 0 Shellfish Sanitation (onference at (803) 788-7559 those who become mfeded WIth V. vulmf/<us dIe. The t ISS( , h infedion con couse sudden chills, fever, nausea, or 0 www. .org. Iyt. US are t e vomiting, blood poisoning and death within two days. h elllO IC If you would like to post 0 warning notice about d VOlbrio para a dOli esses. eating row shellfish, here is 0 list I Of 0 US an 0 0 duce I n of conditions that make VOlbrio VU nl IC f II shellfish In people more vulnerable: 0 0 900/0 0 a culprits .n FOOD TALK ~ NEW HANOVER COUNTY HEALTH DEPARTMENT ENVIRONMENTAL HEALTH DIVISION 2029 SOUTH 17TH STREET WILMINGTON, NC 28401 David Rice Health Director Health Department Chill Out! Q: What ore the best ways to thow frozen seafood? A: Never thaw seafood at room temperature. Leave it in the refrigerator, either overnight or long enough to thow. Or if you'd like it to thaw more quickly, place it under cold, running water. Whole shellfish, such os shrimp or clams, con be held in 0 colander under cold running water. Dressed seafood like fillets con be placed in 0 tightly closed plastic bog, then in 0 deep pan filled with cold water. Q: If frazen seafood is accidentally thawed in the freezerl is it safe to refreeze it? A: If the food is still cold to the touch, it's usually sofe to refreeze it. If it's rather worm to the touch, enough bacteria may hove grown to couse spoilage or 0 food-borne illness. Q: How should cooked seafood be stored? A: Refrigerate any cooked food within two hours after cooking. Refrigerate or freeze cooked seafood in covered shallow pons, not deep contain- ers, so that 011 of the product will freeze quickly. Always leave some space around (ontain- ers for cold air 10 circulate. Printed on recycled poper I n Terms of Seafood Safety ACROSS , This tish could be contaminated with mercury 3 are a ------- potentially hazardous food when eaten raw 4 The more lethal vibrio strain, _ ~ _ _ _ _ _ _ __ strikes those with liver damage. 7 _ _ _ _ _ _ _ _ in fish can cause illness or even death. 9 Keep oysters _ _ _ _ _ 400F to keep bacteria from growing. The words that fit these clues con be found throughout the issue... 10....................... any cooked food within two hours of cooking. DOWN 1 is bite-sized raw ----- tish. 2. One danger to seafood is in our oceans. 5. Raw tish should be to 40F in the center 6. Polychlorinated biphenyls are also known as 8. A toxic chemical found in swordfish. ...still stumped? The answers are listed at the bOl/om of poge 2. ~ '-_/ . March 2001 New Hanover County Health Department Betsy Summey, FNP, 343-6531 Group A Steptococcal Disease Cluster In Buncombe County, North Carolina, during the six week period from January 1, 2001 to Febru- ary 14, 2001, eight cases of invasive Group A Strepto- coccal disease (GAS) were reported, including five cases of toxic shock syn- drome (TSS). All eight cases were hospitalized; one was fatal. e TSS Cases All cases of TSS were In males ages 20 - 49 years. Two presented with pharyngitis, one with perito- nitis, one with pneumonia, and one with cellulitis. Two were household contacts, but it is unknown if any of the other cases were linked. The other three cases in females presented as cellulitis, but did not meet criteria for TSS. e TSS Symptoms TSS is defined as fever, diffuse rash with late des- quamation, hypotension, and multisystem involve- ment caused by Group A Strep or Staph aureus. It can evolve rapidly or after several days of symptoms with high fever, chills, vom- iting, diarrhea, myalgia, and rash. Many patients have pharyngitis and about half of necrotizing fascitis cases are preceded by TSS. There is no standard pro- tocol for prophylaxis. Vigilance Required New Hanover County Health Department encourages phy- sicians to have a high index of suspicion at this time when patients present with strep pharyngitis or any acute feb- rile illness. Special consid- eration should be given if a patient diagnosed with strep does not Improve rapldty with treatment, worsens rapidly, or re- lapses after treatment for strep pharyngitis. Patients should be alerted to report any of these circumstances promptly to the physician. Remember to report all cases of GAS disease to New Hanover County Health Department, Cam- mie Marti, RN, 343-6532. Rabies Information for the Medical Provider The veterinary public health program of the North Carolina Department of Health and Human Ser- Yices, has developed and produced an educational CD, Rabies Information for the Medical Professional, for physicians and other medi- cal care providers. As well as general informa- tion about rabies (epidemiology, pathology, transmission, clinical pres- entation, and treatment), the CD has an interactive com- ponent to help guide physi- cians through the decision making process when they are faced with a rabies ex- posure and need to decide on a course of action. . . . . . . . . . . . . . . . . . A free copy ofthe CD . . . . may be requested by . . writing: . . . : Veterinary Public Health : . Division of Public Health . . 1912 Mail Service Center . : Raleigh, NC 27699-1912 : . . . . . . . . . . . . . . . . Rubella Immunization Effort Continues In the year 2000, there were 95 cases of rubella confirmed in North Carolina. The Department of Health and Human Services will continue to supply measles/ mumps/rubella vaccine (MMR) to local health de- partments to enable vacci- nation of all susceptible non-pregnant individuals. Suspects Susceptibility is defined as no documented history of MMR vaccine or no docu- mented immunity. Health care providers are encour- aged to be alert to the pos- sibility of susceptibility of individuals they see, di- rectly, or as a family mem- ber of individuals they see. Women of child-bearing age are a partlculariy Im- portant group. (ConJinwd) Disease Control Earty Identification and In- tervention of rubella is the key to controlling this dis- ease. Signs and symptoms are a prodrome of low-grade fever, headache, malaise, coryza, conjunctivitis, lympha- denopathy and arthralgia, fol- lowed by a diffuse maculo- papular rash. If you suspect rubella, Immediately isolate the Individual and refer to Cammie Marti, RN, at the Health Department, 343- 6532. -------------- Communicable disease information especially important for our state and community can be relayed by the Health Department to health care providers via e- mail. Please send your e- mail address to: bjones@co.new-hanover. nc.us If you would like to be Included In these communications. -------------- Diabetic Supplies Transmitted HBV in a Nursing Facility An outbreak of hepatitis B in a skilled nursing facility was apparently transmitted through diabetic supplies, ac- cording to researchers in Cali- fornia and at the CDC. The outbreak came to light in No- vember 1999 when a resident of the facility developed acute hepatitis B. A serosurvey of 158 residents showed that five (3 percent) of the residents had acute hepatitis B infec- tion. Infection All the infected residents were diabetic and resided in the same unit of the facility In- fection was strongty associ- ated with diabetes mellitus, and acutely infected resi- dents had received signifi- cantly more insulin, more insulin doses, and more fin- ger sticks. Recommendations The investigators said ongo- ing hepatitis B virus transmis- sion was probably caused by contamination of diabetic sup- plies. They recommended regular cleaning of glu- cometers, avoiding trans- port of diabetes care sup- plies between patients dur- ing blood glucose monitor- Ing, and separating blood testing procedures from in- sulin administration. Communicable Disease Statistics New Hanover County July 1, 2000 - February 28, 2001 Antimicrobial Resistant Shigella sonnei Emergence .. Since December, the New Hanover County Health Department has been investi- gating a community outbreak of shigellosis. Sixty cases of Shig- ella have been diagnosed, with 47 (78%) in children attending child care centers. One facility accounted for 23 (49%) of the child care center cases. Isolates resistant to both am- picillin and trimethoprim- sulfamethoxazole have been identified In four of the cases. However, the incidence of an- timicrobial resistance is possibly higher The state public health lab does not routinely perform susceptibility testing but agreed to arrange testing on selected isolates after treatment failures were observed. e The AMA, CDC, FDA, and USDA have developed resource materials to assist medical care providers. Diagnosis and Management of Foodbome Illnesses, A Primer for Physicians, is available free upon request. If you would like a copy of this very informative package, contact Betsy Summey, 343-6531. AIDS........................... 15 Campylobacter ........... 6 Chlamydia ............... 274 E. Coli 0157:H7 ...........1 Gonorrhea............... 249 HIV Infection ....................18 Lyme Disease ....................2 Pertussis ............................0 Rky. Mt Spotted Fever......1 Salmonellosis ..................40 Shigellosis .......................90 Strep, Group A Invasive....O Syphilis ..........................184 Tuberculosis ......................7 Hepatitis A.................. 1 Hepatitis B (acute)...... 7 Hepatitis B (carrier).. 12 Hepatitis C (acute)...... 0 -