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07/03/2002 e e e New Hanover County Health Department Revenue and Expenditure Summaries for May 2002 Cumulative: 91.67% Month 11 of 12 Revenues Current Year Budgeted Revenue Balance Amount Earned Remainin $~6~1;f.P $ I ~1t~~ $ 541,686 $ (8,642) $ 878,299 $ 134,635 $ 208,177 $ 269,141 $ 152,344 $ 1 388 561 Prior Year Revenue Balance Earned Remainin % illl B::::~td % ~L~jbi;:ii $1,337,583 101.62%:;(# $ 523,044 .,~.;.:. 86.71%\11 $ 941,900 ,':'}.< 100.00 ~ $ 153,479 86.02 .... $ 312,900 121.05 "" $ 112,015 90.68 $1 319585 $ 290,881 $ 38,460 $ 326,486 e'&~\) Expenditures Budgeted Amount Expended Amount Balance Remainin % $: ::;:. l Budgeted Amount Expended Balance Amount Remainin % $ 7,672,719 $ 1,296,113 705,196 8,205,489 $1,112,665 $496,474 Summary Budgeted Actual % FY 01-02 FY 01-02 Expend~ures: Salaries & Fringe $8,968,832 $7,672,719 Operating Expenses $2,127,288 $1,422,092 Capital Outlay $207,583 $113,026 Total Expend~ures $11,303,703 $9,207,837 8146% Revenue: $5,303,674 $4,374,345 82.48% Net County $$ $6,000,029 $4,833,492 on ."DL "1;rJ ,'tLf' /0 Revenue and EXllcnditure Summary For the Month of May 2002 10 e e e NEW HANOVER COUNTY HEALTH DEPARTMENT BOARD OF HEALTH (BOH) APPROVED GRANT APPLICATION STATUS FY 02-03 Date (BOHl Grant Reouested Pending Received Denied Prenatal Health Education and InformatlonlReferral Services- March of Dimes 6/512002 Community Grant Program $49,975 $49,975 5/1/2002 No activity to reporl for May 2002. 4/3/2002 No activity to reporl for April 2002. 3/6/2002 No activity to reporl for March 2002. 2/6/2002 No activity to reporl for February 2002. 1/2/2002 No activity to reporl for January 2002. Diabetes Education, Management and 12/5/2001 Prevention - CFMF $60,000 $30,000 $30,000 Youth Tohacco Prevention ProJect- Roberl 11/7/2001 Woods Johnson Youth Center $11,800 $11,800 Teens Against Tobacco Use (TATU)-Health AclIon Counell of NC $350 $350 Healthv Carollnlans- NC DHHS $10,000 $10,000 Family Assessment Coordlnatlon- March 9/5/2001 of Dimes $16,500 $16,500 Folic Acid Proiect- March of Dimes $16,618 $3,000 $13,318 Safe Kids Coalltlon- State Farm"Good Neiahbor" $500 $500 TB Elimination and Prevention - CDC, 8/1/2001 NCDHHD, DPH, TB Control Prooram $10,000 $ 9,200 $800 Teen Aids Prevention (TAPl- CFMF $45,500 $25,000 $20,500 Diabetes Today. Diabetes Prevention & Control 7/11/2001 Unit, NCDHHS $10,000 $10,000 Lose Weight Wilmington - Cape Fear Memorial Foundation $75,000 $75,000 Totels $306,243 $49,975 $99,850 $156,118 16.32% 32.60% Pending Grants 1 8% Funded Total Request 5 42% Partially Funded 4 33% Denied Total Request 2 17% Number of Grants Applied For 12 100% As of 6/1912002 . ....nT-t:. ....., dift.~".n rAr.AIwwt tUnal last reoort. 50.98% 11 << . e .:AzaCea 1)og Training C{ub .:A Not-J'or-profit Service Organization Since 1971 TO: New Hanover County Health Department DATE: May 27, 2002 FROM: Nancy Parrott, President Azalea Dog Training Club RE: New Hanover COunty Animal COntrol Advisory Board Recommendation Azalea Dog Training Oub (ADTC) is sad that we have loss member Cheri Fiste with her move to Florida. Ms. Fiste was also a member of the Advisory Board. We would like to recommend member, Patrice Kaizar, to fill Ms. Fiste seat on the New Hanover COunty Animal control Advisory Board. e Mrs. Kaizar has been active in dogs all her life. Mrs. Kaizar hails from New Jersey where her family is still active in breeding Doberman Pinschers for the conformation and obedience rings. Mrs. Kai~r is active herself in the conformation ring with Dobes and Great Danes. Patrice is also available to handle for others in various breeds. She is active in the obedience ring with Dobermans, and in the past with Great Danes and labradOr Retrievers. Mrs. Kalzar is one of our instructors for the Conformation classes and she is one of our advance obedience instructors. When we have a "problem" dog, Patrice is the one we call to help this student/dog team one on one. Not only does she help during class time, she keeps In touch with the team as needed. Mrs. Kaizar gives her time to students In a three (3) county area with her participation in our School Safety Programs with her Certified Therapy Dogs (Doberman Pinschers). Not only does she give her time to the youngsters of the area, she also goes into area rest homes and nursing homes as her work schedule allows. Not only does Mrs. Kaizar spend time helping others, she also is an active member of ADTC's Board of Directors. e 12 . . i e e e We at ADTC are very fortunate to have someone such as Mrs. Kaizar as a member and feel she can certainly be an asset to the New Hanover COunty Animal COntrol Advisory Board. Thank you. ~/~ Na~arrott, President Azalea Pog Training Club 8026 Sidbury Rd. Wilmington, NC 28411 910-686-4298 ende@wilmington.net adtc.Wilmington.org Patrice Kaizar 3805 Providence Court Wilmington, NC 28412 910-791-0240 DobeROM@aol.com 13 NEW HANOVER COUNTY HEALTH DEPARTMENT 2029 SOUTH 1.,rn STREElI' WILMINGTON, NC 28401-4946 TELEPHONE (910) 343-6500, FAX (910) 341-4146 Evaywbae. Everyday. E~J. DAVID E. RICE, M.P.H., M.A. Health Director LYNDA F. SMITH, M.P.A. Assistant Health Director June 6, 2002 Carol Dukes Hamilton, MD Duke University Medical Center PO Box 3306 Durham, NC 27710 Dear Dr. Hamilton: This letter is to confirm our interest and enthusiasm in participating in the TB-related clinical research trials, funded by the Centers for Disease Control. We understand that the study we will be working on most immediately will be Study 26, and will be recruiting from our pool of clients who have documented new tuberculin skin test conversioIl; especially those in the setting ofTB contact investigation. e If the position is funded, subject to Board of Health and County Commissioner approval, we will work with you and Ann Mosher, NP, MPH to make sure our staff assigned to the project receive appropriate training in the conduct of human subject research. f. The cost for a half-time (50%) licensed practical nurse salary with fringe benefits and including operating costs is projected at $22,000. . Salary and Fringe ..............................$20,200 Uniform Allowance .................................250 Mileage .................................................1 ,000 Medical and Office Supplies....................550 Total.................................................$22,OOO avid E. Rice, MPH, MA Health Director c6at .?J;1tW ) ~ Beth Jones, RN Communicable Disease Division Director e 14 " 1jour .JJealth - Our Priorit'!" " ... Ii'---~~ . ~,~~ ~~~ ....~~.. ::J I I' I .#: e North Carolina Department of Health and Human Services Division of Public Health. Health Promotion and Disease Prevention Section Cancer Prevention and Control Branch, Breast and Cervical Cancer Control Program 1915 Mail Service Center. Raleigh, North Carolina 27699-1915 Tel 919-715-0111. Fax 919-715-3153 Michael F Easley, Governor Carmen Hooker adorn, Secretary March 20, 2002 Betty Jo McCorkle Nurse Supervisor New Hanover County Health Department 2029 South 171h Street Wilmington, NC 28401 Dear Betty Jo, Thank you for your call today regarding funding for the North Carolina WiseWoman Project. Fund allocation is based on a potential for service to 70% of the contracted number of Breast and Cervical Cancer Control Program (BCCCP) patients screened through your health department. Currently your agency has contracted to screen 161 BCCCP patients. ,!J.'1 ~lj.1p I' 3 Project funds in the amount of ~ are available for your agency to serve approximately -HTwomen for the fiscal year 2002-2003 beginning July 1,2002 and concluding June 30, 2003. The NC WiseWoman Project funded by The Centers For Disease Control expects to continue through the 2003-2004 fiscal year The Project will provide on- site education and training for your agency personnel providing service in the WiseWoman Project. Project funds may be used for WiseWoman participant Jab services, clinical support, patient education, transportation, one referral visit to a medical provider during a 12-month screening cycle, and professional education. Int data is used to document to CDC the Project activities such as patient characteristics, clinical values, educational interventions, and re errals for evaluation. Patient data is submitted in hard copy to the WiseWoman Project in Raleigh where data entry is conducted. Thank you for considering participation in the NC WiseWoman Project. We look forward to hearing from you. Please call me at 919-715- 2122 for any questions. Sincerely, ~/?~ Carolyn R. Townsend, RN, BSN, MPH Acting Coordinator North Carolina WiseWoman Project Cc: David E. Rice, Health Director Pat Cannon Larry Jenkins e @ Location: 1330 Sl Mary's Street. Raleigh, N.C. 27605 _ An Equal Opportunity I Affirmative Action Employer 15 e e e . f ~ Draft Budget NC WiseWoman Available Budget 70010 ofBCCCP Caseload - 161x70% = 113 $242 per patient (xl 13) = $27,346 1050 Tenworarv Salaries RN 16 hours/week@ $25 OO/hr = $20,800 3700 Contracted Services PA 40 patient referrals @ $35/hr = $1,400 Lab (Referring P A) 40 patient referrals (lipid panels)@ $18.51 each = $740 TOTAL Contracted Services = $2,140 4210 Deoartmental Supplies Lab (Health Department) Total Cholesterol, HDL for 200 patients = $1,700 Miscellaneous Supplies/Educational Materials = $2,706 TOTAL Departmental Supplies = $4,406 GRAND TOTAL = $27,346 16 ,- , . ~~ e e e d Draft - June 20, 2002 "Public Health Functional Partnerships" A Proposal to Strengthen State s.. Local Public Health Services To Achieve Improved Health Outcomes VISION: A system change that creates new, innovative partnerships between the Division of Public Health (DPH) and local health departments (LHDs), as well as, between local health departments in order to strengthen state and local public health services to effect improved health outcomes with an emphasis on health disparities. CRITICAL ENVIRONMENTAL DRIVERS: Health Outcome 1. worsening health outcomes due to changing demographics of North Carolina (aging, increasing diversity, urbanization, population growth) 2. worsening health status of North Carolina relative to the nation 3. worsening or persistent health disparities Financial 4. decreasing state appropriations 5. increasing uncompensated care 6. increasing constraints of the Medicaid program (currently at risk: rates and increasing local contributions) 7. long term nature of the current financial crisis in the state and nation (projected to go into 2006) System Changes 8. more visible (and accountable) public health role in community after 9-11-01 9. increasing complexity and inter-relatedness of public health issues due to changing families and communities 10. increasing recognition that public health issues are not bounded by county or state lines 11. increasing need for systems innovations to improve public health outcomes 17 ., , Draft . June 19, 2002 PRINOPLES TO GUIDE THE CHANGE: -- 1. Separate consultation and technical assistance from accountability/monitoring 2. Increase focus on "loose/tight": loosen the process --tighten the outcomes 3. Move decision-making and resources distribution closer to the communities to enhance community partnerships. 4. Increase opportunities and options for collaborations between counties 5. Foster innovations in service delivery 6. Maximize resources for direct service delivery 7. Focus DPH activity on maintaining and developing content expertise, resource development and accountability 8. Accredit Public Health Departments through an outside, independent accrediting body 9. Maintain or enhance consultative services every county receives 10. Ensure continued Division of Public Health knowledge, awareness, and support of public e health issues in every county 11. Ensure environments where citizens can achieve optimal health 12. Require 100% participation of the counties in each Cluster 13. Provide incentives to support "innovations" and disincentives for "staying the same" without documentation of positive outcomes 14. Ensure increased cost effectiveness and efficiencies within the PH system 15.Accommodate state employees affected by redeployment from this system change (If the current state employee wants to remain a state employee, DPH will make every effort to ensure this accommodation is achieved) 16. Retrain and cross train affected public health employees, as needed 17. Preserve leaders and advocates for public health in every county by maintaining local Boards of Health and Local Health Directors e 2 18 . ~ . , e e e Draft . June 19,2002 \ I. DESIGNATION OF CLUSTERS DPH Adopts the 10 "Regions" as identified by the NC Association of Local Health Directors as the official Public Health Clusters (PHC) of North Carolina - Fewer than 10 clusters would be allowable (based on local decision process). Any LHD would have the right to appeal to the State Health Director if it desires to move from the original cluster to another cluster II. RFP TO IDENTIFY/CHOOSE CLUSTER TEAM LEADER DPH will issue an RFP initially in the fall of 2002 and will re-issue a RFP ever 5 years that solicits a local health director within each of the 10 clusters to be the PH Cluster Team Leader for that respective Cluster. The RFP format and content will be developed collaboratively with representation of the NCALHD. The Cluster Team Leaders (aL) must be approved by the State Health Director. 1. The proposed Cluster Team Leader (CTL) must commit to the following responsibilities (but not limited to): (a) Development of a business plan for the cluster, (b) Documentation of strong support of the Board of Health and County Administration of his/her county (ies), (c) Documentation of support from a majority of the health directors in the Cluster, and (d) Documentation of the collaborative approach to working within the region to assure participation by all health directors 2. DPH will review all RFPs submitted meeting the above criteria. This review process will be lead by the State Health Director and conducted by the DPH Management Team. The 10 Cluster Team Leaders will be approved based on parameters such as prior administrative success, overall stability and effectiveness within their health departments, their effectiveness in working with community based organizations, the documented commitment and support of their Boards and local administration, and the strength of the RFP submitted 19 3 , " . Draft- JUDe 19,2001 3. Within the 5-year grant period, a change in the Cluster Team Leader may be made bye the State Health Director for the following reasons: vacancy or turnover of health director inadequate performance as determined by the State Health Director, or at the request of the majority of Cluster members to the State Health Director III. CREATION OF A CLUSTER BUSINESS PLAN - JOINT PLANNING Each Cluster Team Leader must submit an initial "Five Year (5) Business Plan (2003-2008)" that will be updated annually for their Cluster. These plans and updates will be developed collaboratively with the other Local Health Directors in the Cluster. The Business Plan must be approved by a majority of the Cluster's local health directors prior to submission to the State Health Director for review. The Business Plan must be developed in consultation with the Division of Public Health Staff e A member of the DPH Management Team will be assigned to each Cluster to actively participate with the group on the development of the Business Plan Final Business Plans submitted by Cluster must be reviewed and approved by the State Health Director Details of the Business Plan must indude, but not be limited to, the following: 1. How technical assistance/consultative staff with specific emphasis on health disparities (dedicated by DPH to that cluster) will be deployed across the Cluster's counties in the following areas: HEALTH OUTCOMES A. WOMEN'S HEALTH 1 FTE e 20 4 . . . . e Draft. June 19, 2001 B SCHOOL HEALTH/CHILD HEALTH C. EPIDEMIOLOGY 1 FTE 1 FTE (for non-BT Cluster) The seven (7) BT Regions will be represented by the 4 BT Team already in Existence. D. HEALTH PROMOTION 1 FTE Tobacco, Nutrition, Physical Activity BUSINESS INTEGRITY E. ADMINISTRATIVE CONSULTANTS 1 FTE 2. How state and federal funding is allocated across the cluster counties. e Any savings from system changes will be allocated within the Cluster Counties to improve public health outcomes with an emphasis on health disparities. All counties would be held at their current Aid to County funding levels for SFY 03-04 with Business Plan innovations effective in SFY 04-05. This process does not address the allocation of Local Appropriations. 3. How Cluster will function, including the creation of a Cluster Steering Committee for planning and decision-making. Development and implementation of the Business Plan (inclusive of all affected local health departments) must be detailed with specific timelines. 4. How each county in the Cluster will fully participate in the Business Plan in order to receive continued State and Federal public health funds 5. How the Clusters will fully participate with Carolina Access, where it exists, to work collaboratively on their shared goals and objectives for improved health of the citizens e 21 5 . . Draft. JUDe 19, 1002 , \ IV. INCENTIVES TO DRIVE THE SYSTEM Incentives for Leadership The use of resources for the Cluster's administration and specific technical support will be supported by DPH as follows: 1. "Cluster Team Leader" - Administrative Support a) Funding to support and enable the Cluster's Business Plan Development and Implementation: . Deputy Human Services Administrator (1 FTE) . Administrative Assistant for cluster activity (1 FTE) b) Incentive Funding for the Cluster Team Leader . State pays the equivalent of 20% of Cluster Team Leader's Salary plus 7.5% salary increase earmarked for the Cluster Team Leader (beyond any current salary) c) Travel, rent & other expenses - Operating Expenses as defined and specified will be provided to the Cluster - Team Leader's department and in designated Health Outcome Leader's Department 2. "Health Outcome Leaders" may be chosen from the Cluster's other Local Health Directors to provide expertise and focus on designated Health Outcome areas. Each Cluster Team Leader may designate up to 2 (two) other local health directors in the Cluster as Health Outcome Leaders. a) Incentive Funding for up to two (2) Health Outcome Leaders could be paid by the state equivalent to 10% of Health Outcome Leader's salary plus 5% salary increase (beyond any current salary) b) Travel, rent & other expenses - Operating Expenses as defined and specified wi! I be provided to the Designated Health Outcome Leader's departments e 6 22 , , ! . . e e e Draft. June 19, 2002 V. Accountability for use of funds and dissemination of best practices 1. DPH will assure a system of accountability tied to outcomes 2. Accountability for use of State and Federal Funds within the Cluster will be assured through the Consolidated Agreement. The Agreement Addenda process administered by the Division of Public Health 3. DPH will be responsible for the creation of an accreditation system, in collaboration with the NCALHDs, and an accountability Team at the state level by January 1, 2003 4. DPH will devise a statewide oversight committee composed, at a minimum, of the Cluster Team Leaders and DPH Management Team Leaders VI. Timeframe Targets - Proposed for Discussion RFP Issued: August 15, 2002 October 15, 2002 RFP's Due: Cluster Team Leaders Identified: November 15, 2002 Accreditation System created and functioning: January 1, 2003 Cluster Business Plans Due: March 1, 2003 Implementation of Plan: July 1, 03 - June 08 Transition Year 1 2003 - 2004 Annual Update Years 2 - 4 2004 - 2008 7 23 .. REPORT TO THE NC ASSOCIATION OF LOCAL HEALTH DIRECTORS FROM THE TASK W' FORCE ON LOCAL PUBLIC HEALTH STANDARDS AND EFFICIENCIES June 20, 2002 Background In March 2002, Wayne Raynor created a Public Health Task Force consisting of the following local health directors: Gibbie Harris, John Morrow, Jerry Parks, David Stone, Tim Green, Barry Bass, Anne Thomas, Chris Swazgiel, Mike Hanes, and Dorothy Cilent~ Chair. Representatives from the state Division of Public Health to the task force were Dennis Harrington, Joy Reed, Kevin Ryan and Bruce Parsons. The charge to the task force was to examine local public health infrastructure and service provision in North Carolina, and to reconunend improvements for the future. The task force held its initial meeting on March 27,2002, met five additional times in April, May and June, and now presents this report for consideration by the Executive Conunittee of the NCALHD. Task Force Focus Prior to the initial meeting of the task force, members were asked to define the purpose of the task force and what outcomes would make participation on the task force worthwhile. In general, members felt the task force needed to define what local public health is to accomplish, standardize processes and outcomes, improve business practices within the local and state public health system, identify administrative efficiencies and economies of scale, and strengthen core public health infrastructure. The group expressed _ the need to identify practical strategies, and not duplicate planning efforts from previous years. The focus of _ the task force was refined at the initial meeting to address public health standards and efficiencies. SUmmary of Activities The task force invited several local health directors and health administrators to its meetings to describe the various public health models currently in place at the local level. John Shaw met with the task force following his presentation to the NCALHD to discuss how his collaborative efforts with Linda Atarian and Fletcher Hartsell might interface with ~d complement the work of the task force. Stephen Keener (Mecklenburg County), Cappie Stanley (Cabarrus County), and Gibbie Harris (Wake County) described the benefits and challenges ofthe public health organizations within their counties. Jerry Parks provided an overview of the Albemarle Regional Health District, citing drawbacks and advantages of a multi-county model. Changes to the Carolina Access program were presented by Tork Wade. e Following these presentations, task force members continued to explore opportunities that might exist from the current fiscal crisis. Consideration was given to whether diminishing resources might present an opportunity to reallocate state and federal public health dollars in a manner different from the current approach. Some ideas that were discussed included creating a hybrid entity ofpartnering health departments with centralized administration and "pollination" of best practices and quality services across counties in this hybrid entity. The task force emphasized the need for performance expectations and standards, with possible monitoring and accountability performed through self-assessment or an outside entity, such as the Alliance for Public Health, state Division of Public Health, or other association. The importance of accreditation was discussed, along with a mechanism for holding public health departments accountable for conununity health outcomes. The task force learned of the Conununity Health Assessment Program (CHAP) standards through a presentation delivered by Joy Reed. The four standards address public health structure and function, quality 24 of services, adequacy of human, fmancial and physical resources, and long-term viability. The standards were developed by the nursing affiliate of ASTHO, but have not yet been released for use by the general public. The task force decided to move ahead with a public health services/functions inventory to be completed by all local health directors as a means to assess these four standard areas and provide some _ useful data regarding how to increase effectiveness and efficiencies, and provide high quality programming and services consistently across counties. An analysis of these inventories was done, and copies of inventories were distributed to regional liaisons for discussion at future health director regional meetings. The task force agreed that such inventories would assist counties within the regions in future public health planning to improve standards, quality of services, and efficiencies throughout the regions. The task force then heard from Dennis Harrington that a state Division of Public Health team had been meeting several times as well to identify system changes that could create new, innovative partnerships between the Division of Public Health and local health departments. He suggested that the task force meet with Leah Devlin to hear more about the proposal under development. In early June 2002, Leah Devlin met with the task force to provide an overview of a draft proposal to strengthen state and local public health through system changes for improved health outcomes. She stated that the Division of Public Health was eager to support an environment for change and innovation without necessarily addressing local public health structure and governance issues. Task force members offered a number of considerations in response to Dr. Devlin's proposa~ which were incorporated into the proposal. The proposal was reviewed again with task force members on June 18, 2002. Recommendations from the Task Force At this time, the task force on local public health standards and efficiencies reconunends: I) That the Executive Conunittee of the NCALHD hear a presentation on the Proposal to Strengthen State and Local Public Health Service "System Changes for Improved Health Outcomes", 2) That the Executive Conunittee of the NCALHD promote participation of all local health directors in regional forums scheduled for early July 2002 to discuss the proposal directly with Division of Public Health leadership, 3) That local health directors forward support, concerns, questions to members of the task force prior to the full association meeting in July 2002 so that additional modifications can be made to the proposal, 4) That a motion to support the proposal as is or support the proposal in a modified form be presented to the full association for a vote at the July 2002 meeting, and 5) That following support for the proposal from local health directors, members of the task force and other local health directors as appointed by the President ofNCALHD work with the state public health leadership team in implementation of the proposal and development of a public health accreditation system for North Carolina. e e 25 .. .. Management Academy for Public Health Business Plan e Purple Cohort - NC1 Janet Nelson, Alicia Pickett, Pat Melvin, Janet McCumbee, Kim Roane April 2002 HAND IN HAND FOR HEALTHIER CHILDREN tilt. Janet McCumbee New Hanover County Health Depl. 2029 5. 17tl1 51. Wilmington, NC 28401 (910) 343-6559 Fax: (910) 341-4146 imceumbee@nhcaov.com Contact Information: Ms. Kim Roane New Hanover County Health Depl. 20295. 17tl1 51. Wilmington, NC 28401 (910) 343-6522 Fax: (910) 341-4146 kroane@nhcaov.com Ms. Alicia Pickett New Hanover County Health Depl. 2029 5. 17tl1 51. Wilmington, NC 28401 (910) 343-6579 Fax: (910) n2-7810 aoickett@nhcaov.com Ms. Janet Nelson New Hanover Partnership for Children 3001-8 Wrightsville Avenue Wilmington, NC 28403 (910) 815-3731 Fax: (910) 815-3733 ianel.nelson@newhanoverkids.ora Ms. Pat Melvin New Hanover County Manager's Office 320 Chestnut 51. Wilmington, NC 28401 (910) 815-7003 Fax: (910) 341-4027 omelvin @nheaov.eom e e e e " NEW HANOVER COUNTY HAND IN HAND FOR HEALTHIER CHILDREN EXECUTIVE SUMMARY New Hanover County is the second-smallest county in the state, covering 199 square miles. Situated along the southeast coast of North Carolina, New Hanover County is one of the fastest growing counties in the United States. Despite its prosperous history, few steps have been taken to proactively address a communicable disease that occurs annually among area children, adversely impacting the health and economic well being of the entire community. That disease is commonly known as Shigellosis, and primarily affects children, providers, and families of children in childcare establishments. New Hanover County reported 119 cases during the 2000-2001 fiscal year. New Hanover County ranks in the top 10 percent in the State, in the number of reported cases of Shigella. The effects of Shigella outbreaks are unimaginable, often resulting in a minimum of $1000 in loss of income per case per family In addition, issues concerning a family's ability to maintain employment and self-sufficiency are adversely impacted. While studies show that preventive healthcare accounts for 50-70 percent of what it takes to create a healthy society, only 3 percent of the nation's healthcare dollars are spent on prevention. Preventive healthcare includes living healthy lifestyles and maintaining a healthy environment. Hand washing is first on the list of ways to prevent the occurrence of Shigellosis, however, there has been no strategic attempt to enhance awareness or ensure and monitor implementation of such techniques on a widespread basis. Based upon all factors considered, that one of the most effective means of reducing the incidences of Shigellosis in New Hapover County will be seen in the arena of health care prevention. The primary mission of the Hand-In-Hand Project is to partnership with the entire community, to enhance the quality of life of area residents via better control of communicable disease in childcare settings. This is a new venture, borne out of a desire to focus on prevention rather than intervention. The primary target market is children, service providers, and families of children in childcare facilities. "Hand in Hand for Healthier Children" will provide public education on handwashing and prevention of communicable disease, with one on one training, monitoring, and evaluation to be conducted in New Hanover County childcare facilities. The New Hanover County Health Department's Childcare Nursing program, in partnership with New Hanover County Partnership for Children, will be the service provider. Implementing this program into an existing program with a proven track record will allow for the establishment of a service with available resources and an established support base. The project can be started at a cost less than $18,000, and will operate at full capacity for under $35,000. The project team will solicit startup funds via the Public Health Foundation, upon obtaining approval to implement from the Board of Health and Board of Commissioners. Subsequent funding will be provided via partnerships with area vendors, healthcare providers, and the Partnership for Children, in addition to grants. An exit strategy from grant funding is key to the success of this plan. Program implementation will be the fall of 2002. 2 '1 e I Revenue Amounts Gl -" N V) ~ C11 .., II) 0 0 0 0 0 ~ .... 0 0 0 0 0 CJl ::I: QO 0 0 0 0 0 'U 0 0 0 0 0 0 D) c: G) ~ !2: C. o' .. :J: D) - CD ~ II) -" \ ~ ;::;: .... ::I: :::T UJ "TI D) 0 < c: ~ ~ \ UJ a. C. II) I . ... ..... c5" N J S>> 0 ~ - "TI -f - .. c: O::I: ~ a. ....CD CJl ~ JD) e CD _ (") CD V) .. .... 0 AI .. J 3 ~ CD -. -0 < CD 0 CD .. CJl ~ ~ (') 0 c :r - ~ )> CD -. - 0 fn C. .... I CiJ :::T CD .., ~ ::0 CD ! < C11 CD ~ c: CD CJl e " REVENUE SOURCES REVENUES e Fast Food Residual $750 $2,500 $3,500 $5,500 $7,700 Donations Toy/Learning Store $500 $2,200 $3,300 $4,500 $6,800 Residual Donations Cleaning Supply Exclusive $500 $1,700 $3,000 $4,500 $5,800 Agreements Puppet Sales Royalties $0 $500 $1,000 $1,250 $1,600 Employer Contributions & $650 $2,500 $3,500 $4,000 $4,500 Corp. Sponsorships Pharmacy Exclusive $0 $0 $2,500 $5,000 $7,800 Agreements Public Health Foundation $2,000 $2,000 $0 $0 $0 Grant Funding $13,000 $15,000 $10,000 $5,000 $0 Fees, Training Services $500 $3,850 $5,250 $5,250 $5,250 TOTAL REVENUES $17,900 $30,250 $32,050 $35,000 $39,450 ADVERTISING e Advertising: The majority of program advertising will be provided as donated in-kind contributions from our community partners.. The value of these services is calculated using actual cost of television, newspaper and billboard advertising. The newspaper does contribute advertising via Community Connections, comparable to a V. page advertisement.. thus, a V. page ad price ($1007.88) was used for calculation of in-kind value. Television advertisement spots are valued at $75.00/30 second spot for early morning local news time slots and $200.00/30 second spot for 6 pm local news time slots. A combination of these will be used throughout the life of the program. Another advertising vision is a partnership with the waste hauling company to result in truck wrappers (installed by the Waste Company as a community donation) on the exterior of a few of the waste hauling trucks, promoting the Hand-in-Hand program throughout the community Billboard advertising rates of $800/month were used as comparables. e Cost Year 1 Year 2 Year 3 Year 4 Year 5 Television - $200/spot $1,400 $2,400 $2,400 $2,400 $2,400 6pm news Television - $75/spot $2,100 $3,900 $3,900 $3,900 $3,900 a.m. news Newspaper $1007/ad $2,014 $4,028 $4,028 $4,028 $4,028 Total Media $5,514 $10,328 $10,328 $10,328 $10,328 Advertising Truck $800/month $5,600 $9,600 (1 $19,200 (2 $28,800 (3 $28,800 (3 Wrappers (1 truck x 7) truck x 12) trucks x 12) trucks x 12) trucks x 12) Restaurant Avoids $6,000 $8,800 $11,750 $14,706 $17,700 $0.34/letter/patron Church Avoids $500 $500 $500 $500 $500 Bulletin $0.34/letter/ family Child Care Avoids $1,000 $1,000 $1,000 $1,000 $1 ,000 Centers $2.00/poster TOTAL $18,614 $30,228 $42,778 $55,334 $58,328 'Advertising . , ., " e e e STRATEGIC PLANNING PRIORITIES June 25, 2002 Update I. Access to health care (Issues #7,11 & 5) -+ During May 2002, Donna Forsythe, Public Health Dental Hygienist, conducted follow-up assessrnents at Mary Washington Howe and J. C. Roe At Risk Pre-kindergarten Centers of children initially referred due to the need for restorative dental services. 68 children at these two centers were initially referred with 25 of these children receiving needed restorative dental care. -+ Due to reduction in staff, reductions in hours to provide services for immunizations, Sexually Transmitted Diseases, Tuberculosis, HIV Counseling and Testing, and outreach activities. Weekly evening hours eliminated. CDD not in compliance with Agreement Addenda from state. -+ Schedules for ACS officers have been altered to accommodate staff reduction. Fewer weekend and evening hours will be available for routine citizen complaint response. -+ ACS was forced to close its doors on Saturdays after six continuous years of serving the public for weekend hours. This is a direct result of staff reduction forced by county budgetary cuts. -+ On May 17'h, David Rice and Janet McCumbee attended a meeting on Carolina Access 11/111. Dr D. Gottovi is chairing this group, which has been tasked with bringing Carolina Access II/III to New Hanover, Brunswick, and Pender Carolina Access 111111 is part of the Medicaid system that provides case management services to Medicaid clients. The state wants to expand CA statewide, presently in 10 counties. CA 111111 monitors ER usage, recommends treatment regimens, and provides patient education on chronic diseases to reduce overall Medicaid costs. The committee is to continue meeting regularly. -+ Animal Control Services: The ACS Shelter will be closed on Saturdays, effective June 1, 2002. -+ II. Preventive services & lifestyle-related risks (Issues #12 & 15) -+ The Laboratory is working with the Women=s Health Care Division to start the A Wise Women Project@ in the BCCCP program in the Health Department. The Wise Women Project is a program to promote heart-healthy lifestyles for women by reducing their risk of heart disease. Offering blood pressure and cholesterol testing, referral to a physician if necessary and having educational programs to reduce the chances of gelling heart disease do this. The project is totally funded by the State. -+ Teen Aids Prevention(TAP) will be terminated June 30,2002, due to loss of funding. TAP has been a highly successful teen peer education program, mostly funded by Cape Fear Memorial Foundation with support from CDD. -+ Members of ACS staff met with Dan Summers of Emergency Management and Donna Batson from the 911 Center to discuss standardization of radio communications. After Dan sets specific guidelines with the 911 Center and other law enforcement agencies, appropriate changes will be made to the system. -+ On May 22, Janet McCumbee participated in a Community Child Fatality review. The state office of Social Services initiated this review of a child death in our county. This is standard procedure, to determine whether there was any system breakdown in family services for the child, which may have contributed to the death. This was the second review since March and both involved other counties, with findings leading to the problems of working between counties when families move back and forth avoiding service providers. -+ Prostitution: NHCHD collaborating on committee initiated by Wilmington Police Chief Cease to develop strategies to offer alternatives for individuals engaging in prostitution, many of whom have multiole oroblems includino crack addiction, historv of victimization for sexual 1 . ., ,. . abuse/assault, and public health law violators. Committee includes representatives from NHCHD, law enforcement, District attorney's office, Coastal Horizons, and SECMH. -+ BRFSS: The 2001 Behavioral Risk Factor Surveillance System summary reports for NHC and NC were forwarded to the Management Team. 405 interviews were completed in NHC. -+ Sixth grade Hepatitis B Immunization Initiative: Sixth grade Hepatitis B Immunization Initiative for school year 2001-02 indicates increases from last year in eligible students participating (from 66% to 76%) and completing series (from 86% to 91 %) thanks to cooperative effort from nurses, schools, and volunteers. Special thanks to Cammie Marti and Kay Lunceford for their leadership. -+ Hepatitis A Post-Exposure Prophylaxis: Provided post-exposure prophylaxis for Hepatitis A to a resident who had eaten in Reidsville where a case of Hepatitis A was reported in a food handler working at Taco Bell. -+ III. Communication, education & marketing (promotion> (Issue #1 & 4 in part) -+ News release issued to inform public of reduced hours of service. -+ ACS hosted the June 5 meeting of the Board of Health at the shelter on Division Drive. The MAPH business plan from the ACS group served as the department focal. The Board approved a request to pursue building an on-site spay/neuter facility with adoption play area. A resolution in opposition to breed specific legislation was also passed. -+ ACS participated in the Hurricane Expo at its new location in the Schwartz Center at Cape Fear Community College on June 8, 2002. It was estimated that as many as 5,000 people visited the event. -+ WIC staff delivered WIC outreach materials to 24 family practice, pediatrician, and obstetrician medical offices to encourage the medical community to refer their patients for WIC services. Surveys to assess the need for breastfeeding education were left for office staff to complete. WIC staff are working with the Best Beginnings for Breastfeeding community group, Coastal AHEC, and the NC Cooperative Extension In-Home Breastfeeding Support Program to develop a training about breastfeeding support for medical professionals to be offered in September, 2002 -+ A video promoting nursing as a profession. It was developed by the NC Center for Nursing and was sent to NHCHD It may be good filler for NHC TV, especially for kids out of school who have not decided on a career -+ NHC Website: NHC's Second Generation Website project is underway. The rollout date is July 1, 2002. Dave Rice will be converting the Health Department site to the Second Generation format. The Management Team was requested to again review our webpages for content. Any suggestions for updates must be received by June 18. Dave Rice gave a demonstration of the new site. -+ Annual Report: The Management Team made two decisions regarding future reports: Based on timeliness and cost, the Annual Report will be processed in electronic form only and will be posted on the NHCHD website. The electronic format will also be used for quarterly reports and will also be posted on the NHCHD website. This will replace the monthly Health Director's report, effective July 1, 2002 -+ Board of County Commissioners: Gela Hunter, Chairman of NHCBH, presented the Board of Health appeal to the NHC Board of Commissioners last evening. Copies of her presentation were given to the Management Team. Thanks to Gela for a job well done! -+ NHCBH approved Resolution in Opposition to Breed Specific Regulation, -+ Stand For Children: A community committee of service agencies, chaired by Clancy Thompson at Child Advocacy Commission, held a Stand For Children event last Friday This year's emphasis was on early childhood education and care, especially for children with special needs. Some local politicians toured the United Cerebral Palsy Center and then meet with service providers at the Child Development Center An informal discussion was held regarding the imoortance of earlv intervention services. e e e 2 ~ . e + Nursing Career Promotion: Mark Boyer is airing a video on NHC TV that promotes nursing as a career option. Prepared by NC Center for Nursing and permission granted to air on community service stations. + Public Service Announcement byT AP' TAP peer educators wrote a PSA for teen-oriented radio stations to promote National HIV testing day on June 27 Information includes STD Prevention message. + Press Conference Announces Settlement Funding Awarded to Local Agencies: On June 14, 2002, a press conference at the Community Health Center announced a $9 million settlement which was granted June 13, 2002, as a result of the NC Consumer Protection Agency's work to uncover price fixing by the manufacturers of multi-vitamins. + IV. e Facility utilization & Information technology Issues #6 & 4 in art + Barcoding for Medical Records in test phase to identify problems and make adjustments prior to implementation. + Jean McNeil met with county engineer, Max Maxwell, regarding the spay/neuter facility addition. Amy Akins in county finance was also contacted to determine procedures to follow in building the facility, if the county commissioners agree to the project. + Daisy Brown and Jean McNeil met with staff from Orange County Animal Control to share tips and information on usage of Chameleon software. + NHCBH approved Building an Onsite Spay Neuter Facility and Adoption Play Area, + Carpet: Carpet in the Pat Johnson and Child Care Nursing area was installed last night. Move back will be done when coordinated with our IT folks and Property Management. Additional carpet will be installed by tomorrow in Child Health and Women's Health office areas. + Security Team: Has been established to address security issues of Health Department Facilities. Property Management will be asked to participate. Members of the Security Team are: Nancy Nail, Elisabeth Constandy, Sharon Neuschafer or Dianne Harvell, Frances DeVane, and Lynda Smith or Dave Rice. + Operable Movable Partitions: Confirmed for installation to begin June 17, 2002 with estimated installation completion of 3 weeks. + Furniture for Public Health Bioterrorism Program: Delivery and set up date June 17 and June 18, 2002. + GIS Software: To be installed at CDD workstation on Tuesday, May 28. NHCHD Staff attended GIS training last week. + V. Water quality, storm water management & drainage; & Air ualit Issues #3 & 8 e + VI. Emerging health risks Issue #13 + Meningococcal Meningitis: reported in a 65 year old male hospitalized @ NHRMC who is a resident of Columbus County. Most close contacts were family members in NHC and post- exposure prophylaxis given through CDD. No identified link to case in three year old reported last week. + Meeting with NHHN, SEMH, and Emergency Management was held on June 3. The Onslow Exercise on May 31-June 1 was discussed. Communications was an area identified for improvement. Marsha Nelson was an observer of the Exercise. + NC DHHS/DPH continues the weekly teleconferences. Naming the regional teams was discussed. Public Health Regional Surveillance Team (PHRST) was recommended. + Meningococcal meningitis: Meningococcal meningitis reported in 3 year old resident of NH Count who attended a small child care facilit in Pender Count . Post-ex osure screenin and 3 .. prophylaxis was administered to 24 close contacts and 3 individuals were referred for medical follow-up by CDD staff on Friday afternoon. Child is improving, still hospitalized at NHRMC. -+ Pertussis Case: Pertussis case reported in 2 year old transferred to Chapel Hill who was not given immunization for pertussis by pediatrician based on Mother's preference, and in absence of medical or religious exemption. A 4 year old sibling (close household contact with likely same exposures) was adequately immunized and did not become ill. Mother is pregnant...will this experience convince her to adequately immunize her baby? -+ VII. Population growth & diversity (Issue #2) -+ Hispanic immunization emphasis during May, using volunteers from Jr Sorosis. -+ We are fortunate to have a new volunteer who is bilingual (Spanish/English). She has committed to being in the building for 10 hours a week to assist our contract interpreter and staff with meeting the needs of the non-English speaking Hispanics. -+ VIII. Discontinued services picked up by Health Department (Issue #9) -+ IX. Staff Development & continuing education (Issue # 14) -+ Community Health nurses provided training in crisis and children's grief management and updated their first aid certification. -+ Staff are learning new assignments and job decriptions changing to reflect new duties required as result of loss of two nursing positions in CDD. -+ City of Wilmington to conduct their annual emergency simulation exercise on June 26-27 Health Department will participate. -+ Volunteers: Are providing valuable assistance at a time when we would have to reduce services further were it not for their help. Two new volunteers on board this week to assist with provision of direct patient services. Great timing!! Thanks to staff who welcome them, orient them to their assignments, and keep them happy so they'll want to continue! -+ Brunswick Nuclear Plant Exercise: There will be a 50 mile radius Brunswick Nuclear Plant exercise this fall. Opening of the EOC. May open shelters or do a table top exercise with the Federals. -+ X. Evaluation of services (Issue #16) -+ Evaluation of priorities to provide mandated services and comply with funding requirements. CDD cannot comply with State Agreement Addenda, but is making adjustments to cover as much as possible. State funds not adequate to support funding requirements. -+ An inter-local agreement between NHC and Wrightsville Beach added a new section to the Animals and Fowl section of the county ordinance. It prohibits dogs at Mason Inlet from April 1 to September 30 each year, and dogs are not allowed running-at-Iarge any time during the year. The Wrightsville Beach ACO will do enforcement, and NHC will handle administrative duties. -+ NHCBH approved Wrightsville Beach Animal Control Services Fee Schedule Revision, -+ NHCBH approved Recommended Fiscal Year 2002-03 Budget, and -+ NHCBH approved Organizational Assessment and Strategic Planning Process Proposal. -+ Strategic Planning: NHCBH has scheduled Saturday, October 26 for the next strategic planning retreat. Division Directors were encouraged to submit monthly updates on the second Tuesdays. -+ Organizational Assessment: Penny Whiteside and Bill Herzog, from the North Carolina Institute for Public Health, met with the Manaaement Team to discuss the oraanizational e e e 4 . " e e e assessment process. .. HIPAA Update: Cindy Hewett attended a Privacy Officer Training Session sponsored by the Institute of Government on Tuesday May 28th and Wednesday May 29th. Several topics were covered in this session. We must be compliant with the HIPAA Privacy Rule as of April 14, 2003. The final rule has been approved but there are proposed changes awaiting approval. We will be filing an extension for the Electronic Data Transmission compliance date of October 16, 2002. HSIS(DIRM) has filed an extension and expects to be compliant with the Electronic Data Transmission in April 2003. We will file for this same type of extension, but before we file for our extension we must coordinate with the County Administration Office. .. Employee Certifications/Licenses: Human Resources is beginning work on the modules in their current Human Resources Information System which maintain information about employee certifications/licenses. To start, Human Resources needs to find out how the employees' certifications, licenses and special training works in all departments. .. Organization Assessment: NHCBH will consider the budget amendment for the Medicaid Cost Settlement funds on Junc 5. Plans are in process for an Organization Assessment and Strategic Planning Process for the New Hanover County Health Department. Discussions have taken place with the NHCBH Personal Health Committee and the North Carolina Institute for Public Health (NCIPH). NCIPH has submitted a proposal for the project. The draft of this proposal is attached for your information. .. Information on Service Reductions: Information on necessary service reduction due to lost positions and funding has been compiled from each Health Department Division and sent to the Budget Director per request .. TAP Program: Mayor Harper Peterson requested meeting to discuss TAP Jessica Nakell and Beth Jones will meet with him on Wednesday, May 29. Perhaps City of Wilmington will find a department that can continue the program, which would work well since most of the sessions have been inside city limits. .. New Hanover County Fiscal Year 2003 Budget: The Board of County Commissioners approved the Fiscal Year 2003 New Hanover County Budget at their June 17, 2002 board meeting. .. 5 II f 'j e. NEW HANOVER COUNTY BOARD OF HEALTH 2029 SOUTH 17TH STREET WILMINGTON, NC 28401-4946 TELEPHONE (910) 343-6500, FAX (910) 341-4146 l' Everywhere. Everyday. Everybody, Gela N. HUDter, RN, FNP, Chainnan W. Edwin Unk, Jr., RPh, Vice-Chairman Henry V. Estep, RHU Marvin E. .~reeman. Sr. Commissioner Robert G. Greer Wilson O'Kelly Jewell, DDS Anne Braswell Rowe Philip P. Smilh, Sr., MD Melody C. Speck, DVM William T. Steuer, PE/PLS FAward Weaver, Jr., OD David E. Rice, MPH, MA Heallh Director June 26, 2002 Lynda F. Smith, MPA Assistant Health Director Representative Thomas E. Wright N. C. House of Representatives 635 Legislative Office Building Raleigh, N. C. 27601 Dear Representative Wright: e We, the New Hanover County Board of Health, are writing to you concerning the State Budget proposal as recently approved by the Senate and now being considered by the House. We realize that there is a massive budget shortfall this year and you have to make tough decisions. We feel that Dental Programs are taking an unfair burden of the proposed cuts. The proposed cuts affecting Dental Health are: . Restructure the North Carolina Oral Health Section (State Public Health Dentistry Program) to place it in the Women and Children's Health Section. This includes cutting 7 Public Health Dentist positions. If this happens, we no longer will have a State Department of Public Health Dentistry. . Reduce dental services for adults under Medicaid by $5 million. This will result in the elimination of some desperately needed adult dental services. . Reduce NC Health Choice dental reimbursement to Medicaid levels. - The proposed cuts to the Oral Health Section with the elimination of a State Department of Public Health Dentistry would be a tragedy. The North Carolina Public Health Dentistry Program is the oldest and one of the most effective programs in the United States. It addresses dental issues such as access to care, prevention, and education. Although there has been a lot of success in disease reduction, there remains much dental disease across our state. The North Carolina Public Health Dentistry Program is a leader in addressing dental disease among our citizens and must not suffer cuts in order to be effective. It is also extremely important that the North Carolina Public Health Dentistry Program remains as a separate section and is not combined with Women and Children's Health. "Your Health - Our Priority" ,. . .~ ' .. e - Representative Wright June 26, 2002 Page 2 The reduction of funding for the Medicaid and Health Choice programs is also a serious mistake. With the reduction of $5 million for dental services under Medicaid, many adults will needlessly suffer. Reducing the dental reimbursement in the Health Choice Program will result in many children not receiving the care they need. Therefore, we ask that you vote to block all of the proposed cuts to Dental Health in North Carolina. We appreciate your time and efforts. Would you please contact us to let us know how you plan to proceed concerning these important Dental Health issues? Si1::elYi~Ji~ ~~'~;~;;:~hairman New Hanover County Board of Health ',;; National Association of Local Boards of Health . r \..... Published for Members of Local Boards of Health President's Message Phil Lyons In my last newsletter, I promised a report on how the Olympics went. As I sit here in my office looking out the window, I can see the cross country venue at Soldier Hollow. The snow is almost gone and the Olympics are over We felt that the Olympics were very successful and as much as we dreaded its coming, we'd do it all over again in a heartbeat. It was a wonderful opportunity to host the world. All the public health professionals played a big part in its success as did all of the wonderful volunteers who gave of their time without any payor C lmpensation - and isn't that what life is all about? If any of you watched the competition, you could see that often the winner was decided in hundredths of seconds. In public health, having food inspectors on site was necessary to prevent any food-bourne illnesses. Efforts were made daily to use tihe Health Alert Network (HAN) to communicate between tihe six health districts that contained the Olympic venues. Information was able to be transmitted very quickly and effectively using HAN. I've just returned from Bowling Green, Ohio where NALBOH's Board of Directors met on April S~ and 6~ We had some very productive meetings. We were able to bring in several state local board of health association leaders and spent considerable time on ways we could help move forward the for- mation of additional state association of boards of health. We have formed an Ad-Hoc Committee that will look into this task. Ron Burger and Barbie VanderBoegh, your State Affiliate Trust- ees, will co-chair that committee. We expect to meet regularly and push state local board of health associations to a higher level. Also at our meeting, we were privileged to attend the Ned E. Baker Lecture Series in Public Health for the third consecutive year. This year the speaker was Dr. Susan Scrimshaw from Chicago, Illinois. Her entire career has been spent in public health. She talked about the importance of boards of health r d their policy decisions. I was very impressed as she talked '- ,out the time she spent in a Central American country. She went there as a nursing director, thinking that she would be able to interact with the people and be able to implement Coobnued on Page 2 1Jnitea 'WI'!' Stand" .... .. May 2002 Opportunities for Attendees at 10th Annual Conference Ken Hartke, President-Elect NALBOH's 10~ annual meeting will be held July 10-13, in New Orleans this year. This is an opportunity for board of health members to once again meet, network, and attend educational meetings. This year is especially exciting because NACCHO is also holding its annual meeting in New Orleans at the same time. The meeting includes many educational events as well as excellent training sessions for board of health members. Special pre-conference workshops dealing with publiC health informatics as well as tobacco are being offered. Of special note is the closing workshop addressing the issue of effective governance. Our primary role in public health is governance and I know that we can all use more information about being more effective. Please consider attending these work- shops. An added feature is that we have a number of joint meetings with the NACCHO members. In New Orleans, we will have both the leaders of local health departments and the leaders of the local boards of healtih. This provides us with a unique opportunity to meet and network witih leaders oftihe health departments throughout the country. Also note that a discount is being offered if both a board member and the administrator of the same local health department attend the conference. This is a great time to meet other board members as well as administrators of local health departments. Please take this opportunity and join us this year. I will see you there. 0 REGISTER NOW! Early Bird Registration Deadline: June 19, 2002. 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" a. o ... m n iil a- ~ n ;lC III n ~~ ....1/1. ~ fir: Ill- ::tg m :J ~l:'~;r -::I ::t "" IlIlDllItD ::I ... := :J Q'ClllQ.n ~ '5;tD G\lDlllo 3~t':J ~ ~:II! 'tII! iii'S 5' 6- .. -' ::r _I! III n' ",:c '\ttD III ~;:;: := ::r. .. I:: 1;' ~ :sl ,-.-, I ~' ,r- ,tI:l I~ I ~, ~ ~ ~ ;;:: " '< N o o N [NALBOH'S 10th AnnuC1~ Conference] o The Foundation of Local Public Health: Boards of Health, Health Departments, and Health Officers July 10-13, 2002 The Astor Crowne Plaza Hotel New Orleans, Louisiana Co-located with the National Association of County and City Health Officials For more information contact the NALBOH office at phone: (419) 353-7714, fax: (419) 352-6278, e-mail: <nalboh@nalboh.org>, or visit our website at <www.nalboh.org> National Association of Local Boards of Health 1840 East Gypsy Lane Road Bowling Green, OH 43402 E-mail: <nalboh@nalboh,org> Website: <www.nalboh.org> NON PROFIT ORG, U.S. Postage PAID Bowling Green, OH Permit NO.4 7 o ~ '----'