2015 Annual Report

150 E. Second St. Chillicothe, OH 45601

740.779.9652

Mission: The Mission of the Ross County Board of Health and the Ross County Health District is to protect the physical and environmental health and wellness of the citizens of Chillicothe and Ross County; and to promote healthy behaviors and practices through education, partnerships, outreach, and services.

Agency Leadership Health Commissioner/Chief Executive Officer Dr. Timothy Angel, PhD, REHS/RS, CPM

Dear Residents of Ross County,

I think it’s safe to say that 2015 was a year of highs and lows in public health, both in our county and in our nation.

As we look forward to 2016, two activities will take up much of our time at the Ross County Health District: First, we’re teaming up with our local partners in an effort to create a comprehensive Community Health Assessment (CHA). The CHA will give us a glimpse of the condition of health and public health in our county. Two documents will follow the CHA: a Community Health Improvement Plan (CHIP) that identifies the most pressing community health issues, which all agencies will have input on; and a Strategic Plan that will be agency specific, guiding each agency’s efforts in addressing the identified health issues.

Second, the state has mandated that all local public health districts seek accreditation from the Public Health Accreditation Board. Like it or not, we will be required to take on the challenge of accreditation, so much of our time will be spent trying to meet the standards and measures accreditation requires.

As always, we want to thank you, the citizens of Chillicothe and Ross County, for your support of public health in our community!

Sincerely, Dr. Tim Angel

Division Directors

Kathy Wakefield, RN, WHNP-BC, Director of Public Health Nursing/Community Health

Ben Avery, RS/REHS, Director of Environmental Health

Wanda Whetsel, RN, Director of Home Health

Adam Dyer, Chief Fiscal Officer

Rami Yoakum, Director of Communications

Ross County Board of Health 2015

Board of Health member appointments: Four are appointed by the Ross County District Advisory Council

(DAC); three are appointed by the City of Chillicothe; and one is a member of, and appointed by, the Ross

County Licensing Council. One board member must be a

physician. Board members serve alternating four year terms.

Standing L-R: Ceil Corcoran (DAC appointee); Mike Holdren

(DAC); Ben Daughters (City); Dianna Gray (DAC)

Seated L-R: Thom Hamman (DAC); Chuck Halm, Board

President (City); Dr. David McKell (City); Gary Prater, Vice

President (Licensing Council)

What Is Public Health

P UBLIC HEALTH is about people! As defined by the CDC Foundation: Public health is the science of protecting and improving the health of families and communities through promotion of healthy lifestyles, research for disease and injury prevention and detection and control of infectious diseases.

Overall, public health is concerned with protecting the health of entire populations. These populations can be as small as a local neighborhood, or as big as an entire country or region of the world.

While the Ross County Health District is the public health agency in Ross County, our public health “system” includes many others - both public and private entities - that contribute to the delivery of essential public health services in our community. In one way or another, our local public health system includes or can include: local and state public health agencies; healthcare providers (hospitals/physicians); public safety agencies; human services and charitable agencies; education and youth development organizations; recreation and arts organizations; economic and environmental agencies.

Finally, there are Ten Essential Public Health Services that those agencies involved in our public health system should be practicing and ensuring here in Ross County.

1. MONITOR health status to identify and solve community health problems.

2. DIAGNOSE AND INVESTIGATE health problems and health hazards in the community.

3. INFORM, EDUCATE, AND EMPOWER people about health issues.

4. MOBILIZE community partnerships and action to identify and solve health problems.

5. DEVELOP policies and plans that support individual and community health efforts.

6. ENFORCE laws and regulations that protect health and en-sure safety.

7. LINK people to needed personal health services and assure the provision of health care when otherwise unavailable.

8. ASSURE competent public and personal health care work-force.

9. EVALUATE effectiveness, accessibility, and quality of personal and population-based health services.

10. RESEARCH for new insights and innovate solutions to health problems.

ROLE: Protect & improve the health of all citizens in Chillicothe & Ross County.

VALUE: Programs & services are provided at a minimal cost to all residents.

Environmental Health ROLE: Educate the public, industry, and policy makers concerning Environmental Health (EH) risk identification and prevention; implement and enforce EH laws, regulations, and policy; collect and evaluate data on EH issues; respond to public health emergencies.

VALUE: Empower public, industry and policy makers to make informed decisions and take action to improve EH conditions in the community. Identify emerging EH threats and provide low cost EH services thus reducing the risk of sickness and disease due to environmental factors.

MANDATED PROGRAMS & ASSOCIATED CODES: Private water systems, water wells (ORC 3701.344 OAC 3701-28);

camps, RV parks, manufactured homes (ORC 3729 & 3733, OAC 3701-25, 26, 27, & 4781); food service operations/

restaurants (OAC 3701-21); retail food establishments (OAC901:3-4); farm markets (OAC 901:3-6); food safety code

(ORC 3717, OAC 3717-1); home sewage/septic (ORC 3718 & 3709.091, OAC 3701-29); nuisances (ORC 3707.01 & .02,

3709.21); order violations/penalties (ORC 3707.48 & .99); schools (ORC 3707.03 & 3707.26); tattoos & body piercing

(ORC 3730, OAC 3701-9); smoking enforcement (ORC 3794, OAC 3701-52); Pools (OAC 3701.31); Rabies (ORC 955.26);

Commercial plumbing (OAC 104.2.3).

EH Director Ben Avery explains the new 2015 Ohio sewage

laws, which saw a significant overhaul, to a group of area real-

tors last year at the health district. The new laws were also

explained to the District Advisory Council and others.

For the last few years the Ross

County Health District and our

Environmental Health Division

have teamed up with the North

Fork Animal Clinic and Dr. Blake

Lloyd to offer low cost rabies vac-

cinations to area residents who

own dogs and cats. Our main

vector for rabies in Ross County is

bats, and vaccinating our house-

hold pets not only gives us piece

of mind, but also protects our

beloved pets from the risk of the

deadly rabies virus.

EH Staff 2015: Seated L-R: Lisa Forcum, office manager;

Ben Avery, director; Tara Jones, clerk.

Standing L-R: Tyler Cooper, S.I.T.; Kyle Bianco, RS; Lo-

gan Calhoun, RS; Josh Shelley, S.I.T.; Daniel Caudill, S.I.T.

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Public Health Nursing PROGRAMS & ASSOCIATED CODES: Public health nursing carries out programs/services that are mandated by either the Ohio Revised Code (ORC) or the Ohio Administrative Code (OAC). They include: Infectious disease surveillance and reporting (OAC 3701.3.02); Communicable disease control (ORC 3701.36.05); Maternity Unit Inspection (ORC 3711.10); Vaccinations/immunizations (ORC 3707.27); Tuberculosis control (3701.15 - mandated to county commissioners); Sudden Infant Death Syndrome (ORC 313.121); Newborn screenings for children born at home (ORC 3701.55); Lead case management (ORC 3742.15 - mandated to state, contracted to locals); Bureau of Children with Medical Handicaps (ORC 3701.023); Promoting and protecting health of the community (ORC 3701.36.04); Provide health education (ORC 3701.36.03); Provide at least one injury prevention (ORC 3701.36.074). Additionally, the state mandates to local health districts the staffing of Red Cross Shelters during emergencies, and in Ross County our Public Health Nursing Program offers a Family Planning Clinic.

Class A Communicable Disease

Number Reported

Hepatitis C 281

Hepatitis B 67

Campylobacter 6

Meningitis 6

Pertussis (whooping cough) 6

Invasive Streptococcal 6

Salmonellosis 4

Mycobacteria 3

Hepatitis A 2

E. Coli 2

Lyme Disease 2

Giardiasis 1

Rocky Mt. Spotted Fever 1

Total Number Investigated

(Class A, B, and STDs)

673

Class B Communicable Disease

Number Reported

Influenza 46

Chicken Pox 5

Sexually Transmitted Disease

Number Reported

Chlamydia 183

Gonorrhea 43

Syphilis 9

HIV 0

Service Number

Mantoux Tests Given (Read) 553 (501)

Pregnancy Tests Given 84

Immunizations 2,212

Influenza Vaccinations 1,598

ROLE: The role of public health nursing in public health is both broad and subtle. They focus on protec-tion and prevention through population based programs, services, interventions, and education, and leverage community partnerships as often as possible.

VALUE: The value of public health nursing in overall public health is considerable. Since its prevention efforts and education services are aimed at the entire commu-nity, not an individual, and there is often no direct cost for the services, public health nursing is a great value.

OTHER: Public health nurses had a total of 5,413 client en-counters, through the follow-ing clinics: Nurse-of-the-Day; Family Planning; STD; Physicals (school, work, and volunteer firemen); Vivitrol and Project DAWN; Health Assessments for Seniors; Tuberculosis Man-agement; Home Visits; and Community Outreach.

Administrative Services Financial Report

Program Revenue

Home Health 2,648,572.22

Levy 1,027,991.60

Environmental Health fees 259,354.22

State rollbacks, Property tax replacement 236,398.70

Vital Statistics Fees 169,399.97

Community Health Fees 163,449.65

Vivtrol Fees 86,987.62

State Subsidy 14,620.76

Donations/Misc. 5,254.68

Total Revenue 4,612,029.42

Grant Funds 2015 Amount

Women, Infants and Children 544,880.74

Southern Ohio Women’s Cancer

Project

145,988.85

Home Visiting 116,881.00

MIECHV 97,500.00

Public Health Emergency

Preparedness

90,635.73

Help Me Grow 90,554.39

MAC 50,129.14

Central Coordination 37,229.23

CFHS 36,059.73

Komen 32,074.00

Public Safety 25,598.21

Project D.A.W.N. 15,480.00

Implementation 13,007.73

Ebola Planning 6,788.44

Epidemiology 4,193.14

Total Grant Funds Received 1,307,000.33

3,293,052.76, 76%

1,050,765.69, 24%

Salaries

Insurance/Pers/Medicare/Workers Comp

Expenses Expense Amount

Contract Service 816,466.98

Fuel/Mileage 216,038.65

Rent 165,298.60

State Fee Remittance 101,755.26

Educational Materials/Advertising/Public Awareness 38,088.06

Communications (Internet and Phone) 26,971.46

Auditor/Treasurer Fees 26,565.06

Utilities 23,196.00

Copier/Printing 17,647.05

Liability Insurance 15,538.00

Dues/Licenses, Subscriptions 11,712.73

Building Renovations 11,408.29

Other 11,040.57

Registration/Training 10,275.79

Audit 10,249.50

Postage 9,650.90

Board Meetings 6,640.00

Supplies Amount

Medical Supplies/Pharmaceuticals 213,834.72

Office Supplies 51,443.43

Janitorial Supplies 4,566.69

Building Supplies 3,683.13

Expense Amount

Computer Software/Maintenance/Vehicles 37,521.45

Home Health

Administrative Services Vital Statistics

The recording and keeping of birth and death records for Ross County by the Ross County Health District is mandated by the Ohio Revised Code, Chapter 3705. Certified copies of all births and deaths that occur in Ross County (including the City of Chillicothe) are available in our Vital Statistics Office (740.779.9630). ORC 307.621 and 307.622 require the local health districts to convene a Child Fatality Review Board each year. In 2015 the board reviewed 11 deaths for children younger than 18 years.

Total Births 1,067

Boys 513

Girls 554

Home Births 3

Bainbridge Birthing Center

25 (included in

total above)

Total Deaths 862

Male 464

Female 398

White 829

Black 33

Leading Causes

Heart Disease 243

Failure to Thrive 123

Cancer (Lung) 109 (40)

Respiratory Failure 96

Drug Overdose 40

Tobacco Contribute? Yes No Probably

148 367 294

A program of the Ross County Health District since 1966, Ross County Home Health was the first home health

agency in Ross County. Accredited by the Joint Commission on Accreditation of Healthcare Organizations,

Ross County Home Health offers skilled nursing and home health aide services, as well as physical,

occupational, and speech therapy. Their services are available to all age groups. All new employees receive

competency testing, as do all direct care staff (annually). Ross County Home Health is rated highly as a “Three

Star” agency on Medicare’s consumer compare website (www.medicare.gov/homehealthcompare).

Ross County Home Health can be reached at 740.775.1114.

Medicaid 26,213 PASSPORT 6,300

Medicare 5,799 Private Ins. 2,994

Veterans 2,894 Private Pay 4

Workers Comp 3 Total Visits 44,207

Number of Agency Visits 2015

Top 5 Diagnosis

Diabetes

Heart Disease

Wounds/Ulcers

Lung Diseases

Cancer

Birth - 29 = 16 60-69 = 131

30-39 = 31 70-79 = 203

40-49 = 41 80-89 = 207

50-59 = 103 90-102 = 131

Range of death in decades/years

Grant Programs Women, Infants, and Children (WIC) WIC is the Special Supplemental Nutrition Program for Women, Infants, and Children. WIC helps income eligible pregnant and breastfeeding women, women who recently had a baby, infants, and children up to five years of age who are at health risk due to inadequate nutrition. The program improves pregnancy outcomes by providing or referring to support services necessary for full-term pregnancies; reduces infant mortality by reducing the incidence of low birth weight (infants under 5 ½ pounds are at greater risk of breathing problems, brain injuries and physical abnormalities), and provides infants and children with a healthy start in life by improving poor or inadequate diets. In 2015 WIC averaged a monthly case load of 3,044 clients served (Ross/Pickaway combined).

Help Me Grow Help Me Grow provides two main services: The Home Visiting program provides expectant or new parents with the information, support and encouragement they need through a voluntary, high-quality home visiting service. It aims to educate at-risk parents with the resources to understand and capitalize on the optimal early years of a child’s life. Second, Ohio’s Part C/Early Intervention system aims to identify and serve children under the age of three with developmental delays and disabilities, as provided for under the federal Individuals with Disabilities Education Act (IDEA). The Help Me Grow program communicates with parents, doctors, hospitals, child care providers and other community agencies to identify children with existing developmental delays, or those with medical diagnoses with a high probability of delay. In 2015 HMG car seat technicians checked 33 already installed car seats and found a misuse rate of 64%. Also, 69 car seats were distributed/installed for WIC eligible clients through the Ohio Buckles Buckeyes program.

Southern Ohio Women’s Cancer Project Assisting uninsured and income eligible women ages 40-60 in finding access to mammography services and to pap testing. Serving Ross, Pike, Jackson, Vinton, Highland, Gallia, Scioto, Lawrence, Adams, and Brown counties.

Together We Can Assisting uninsured and underinsured women who are income eligible and aged 40-64 in accessing screening and diagnostic services. Women aged 20-39 who are at a high risk or who are experiencing breast problems may also be eligible. In 2015 the program served 137 area women, enabling 126 of them to gain access to a free mammogram.

Project D.A.W.N./Vivitrol Project D.A.W.N. (Deaths Avoided With Naloxone) is an injury prevention program that offers education and support to those who fear the opioid overdose of a loved one. Staff also educates local first responders on the use of naloxone. Vivitrol is used to help persons who are addicted to opioids fight their addiction.

Baby and Me, Tobacco Free Baby and Me, Tobacco Free is a smoking cessation program created to reduce the burden of tobacco use on the pregnant and post-partum population, due to the fact that women who quit smoking are less likely to have premature and low-birth weight babies. Likewise, the program also strives to reduce the damaging effects of secondhand smoke on these children.

Public Health Emergency Preparedness (PHEP) PHEP grant supports the following health district tasks: emergency response planning; community prepared-ness activities and outreach; and local partnerships with agencies in Chillicothe, Ross County, and Southern Ohio. The PHEP grant also supports public information activities, to include traditional and social media.

Ross County Demographics

R oss County is a rural county, located in South Central Ohio, in the Appalachian Region

of Ohio and has a 2015 population estimate of 77,159. The City of Chillicothe is the

county seat and has a population of 21,738. Villages include Adelphi, Bainbridge, Clarksburg,

Frankfort, Kingston, and South Salem. There are 16 townships: Buckskin, Colerain, Concord,

Deerfield, Franklin, Green, Harrison, Huntington, Jefferson, Liberty, Paint, Paxton, Scioto,

Springfield, Twin, and Union. There are seven public school districts: Adena Local; Chillicothe City; Hunting-

ton Local; Paint Valley Local; Southeastern Local; Unioto Local; and Zane Trace Local. There is one regional

hospital, Adena Regional Medical Center; Veterans Affairs Medical Center, a large federal facility that serves

the entire region; and Hopewell Health, a rural health center. The Scioto Paint Valley Mental Health Center

provides mental health services and drug addiction treatment.

Race Percentage

White 90.8%

Black 6.1%

Two or more races 2.3%

Hispanic or Latino 1.1%

Asian .5%

American Indian/

Alaskan Native

.3%

Foreign born 2009-2013

.7%

Male 52.5%

Female 47.5%

Age under 5 years 5.4%

Age under 18 years 21.7%

Age over 65 years 15.2%

Veterans 2009-2013 7,168

Language Spoken Percent

English 96.9%

Other spoken at home 2009-2013

3.1%

Quick Facts 2015

Housing units 2014 31,793

Homeownership 72.5%

Persons per Household 2009-2013

2.53

Education/Income

High school graduation rate

84.1%

Bachelor’s degree or higher

13.7%

Per capita income $21,310

Families below poverty rate

2,796 or

14.6%

Children living in poverty

28%

Unemployed 8.5%

Adult tobacco use 33-35%

Adult obesity 36%

Physical inactivity 29%

Excessive drinking 15%

Teen births 5

Infant mortality rate 7.3 (2005-14)

Overdose deaths 35

Uninsured 13%

Length of Life Years

Male 72.33

Female 71.74

All cancers 2008-2012 Percent

Lung/bronchus 18.5%

Breast (female) 12.5%

Colon/rectum 10.2%

Prostate 10%

(US Census 2010-2014)

(County Health Rankings 2015) (ODH Cancer Report 2015)

(US Census 2010-2014)

(US Census 2010-2014)

(US Census 2010-2014)

(US Census 2010-2014)

(Ross County Vital Statistics 2015)

Staff Ross County Health District Staff: Administration - Dr. Timothy Angel, Health Commissioner; Donna Atchison, Personnel; Dr. Don-ald Berling, Medical Director; Adam Dyer, CFO; Lori Hice, Community Development Officer; Debbie Miner, Registrar; Vonda Kern, Accountant; Rami Yoakum, Communications. Environmental Health - Ben Avery, Director; Kyle Bianco, Sanitarian; Logan Calhoun, Sanitarian; Tyler Cooper, Sanitarian-in-Training; Lisa Forcum, Office Manager; Tara Jones, Account Clerk; Josh Shelley, Sanitarian-in-Training. Help Me Grow - Amie Unger, Program Coordinator; Kasey Frey, Family Support Specialist; Toni Glandon, Home Visitor; Kelley Minney, Office Manager; Nikki Priest, Home Visitor; Melissa Ross, Home Visitor; Terri Woods, Home Visitor. Home Health - Wanda Whetsel, Director; Sabrina Baker, R.N.; Pam Bethel, Billing Manager; Cynthia Bevan, L.P.N.; Waldeana Brown, Aide; Terry Butterbaugh, Aide; Suzanne Calhoun, Aide; Althea Caplinger, Aide; Khrissa Carroll, Aide; Robert Corey, R.N.; Martha Davis, Aide; Sandie Davis, Aide; Rachel Dennewitz, Aide; Sherry Ehrenberg, Aide; Rose Freeman, Aide; Kristi Fyffe, L.P.N.; Tina Harris, Aide; Sher-ri Heigley, L.P.N.; Donna Higgins, Assistant Director; Nicole Hoffman, R.N.; Caleigh Ingram, Aide; Jody Jones, R.N.; Stephanie Lanzer, R.N.; Karla Latham, Aide; Kimberly Lee, R.N.; Kim Lowe, Aide; Gina McBee, R.N.; Amy McGuire, Case Manager; Kendra Mowery, R.N.; Melanie Olderham, Aide; Mona Pennington, Aide; Linda Pinney, Aide; Courtney Posey, Aide Scheduler; Brittany Pummill, Aide Coordinator; Robin Robinson, Aide; David Skaggs, Office Manager; Debbie Tennant, Aide; Laura Tennant, R.N.; Susan Thompson, Aide; Kelsey Weinrich, Aide. Public Health Nursing - Kathy Wakefield, Director; Amber Beavers, Case Manager; Sara Cutright, Account Clerk; Lisa Grossnickle, Office Manager; Michelle Long, R.N.; Connie Malone, R.N.; Melonie Oiler, R.N.; Vicky Parker, Nurse Practitioner; Helen Ricketts, R.N.; Anurag Sharma, Epidemiologist; Denise Spaeth, Data Processor; Pauline Vaughan, R.N.; Mallory Wagoner, R.N.; Jillian Woods, R.N. Southern Ohio Women’s Cancer Project - Rhonda Brown, Account Clerk. Together We Can - Nicole Wax, Program Administrative Assistant. Women, Infants, and Children - Sharon Rickey, Program Coordinator; Cathy Bentley, Clerk Specialist; Joy Colopy, Clerk Specialist; Karen Dudley, Nutritionist; Elizabeth Fowler, Nutritionist; Sandy Goodman, Office Man-ager; Donna Lambert, Nutritionist; Marla Shanks, Peer Helper; Mary Wilson, Nutritionist; Jennifer Zimmerman, Nutritionist.