MASON COUNTY BOARD OF HEAL TH PROCEEDINGS July 26, 2016

Attendance: Randy Neatherlin, County Commissioner; Tim Sheldon, County Commissioner; Terri Jeffreys, County Commissioner; Eileen Branscome was absent, Hospital District #1; Peggy VanBuskirk, Hospital District #2; Kathy McDowell, City of Shelton Commissioner. Others in attendance: Dave Windom, Dr Diana Yu, Debbie Riley, Jeanne Rehwaldt, Brianna Loper and Ben Johnson.

Cmmr. Neatherlin arrived at 3:49 p.m.

I. The Chairperson called the meeting to order at 3:38 p.m. Everyone in the room introduced themselves.

2. McDowell/Jeffreys moved and seconded to adopt the agenda as published. Motion carried unanimously.

3. Jeffreys/Neatherlin moved and seconded to adopt the regular meeting minutes of May 24, 2016 as presented. Motion carried unanimously.

4. Dave Windom spoke about Vaping in Mason County. (Ben Johnson showed a PowerPoint presentation on vaping)

4.1 Washington Law 4.2 Federal Regulation

Dr. Yu said she is concerned about accidental overdose and the lack of knowledge of what is in the vaping liquid.

Cmmr. Neatherlin mentioned vaping lounges.

5. Mason Matters Update - Jeanne Rehwaldt spoke about Mason Matters. She spoke about an RFP for a mobile crisis team in Mason County. They are going to start a campaign this fall in order to move Mason forward. She said she is enjoying her new position. She is open to input as to where Mason Matters should be heading.

Cmmr. Jeffreys encourages the community to provide input to Mason Matters as to what they would like to see happen.

6. Health Officer Report

Dr. Yu said they are working on a Community Forum to take place on September 21 at Shelton High School from 4-7 p.m. This forum will be regarding opiates and the State Opiate Response plan. This plan will deal specifically with opiates. Dr. Yu explained the process and the goals they will strive to meet.

The group discussed Narcan usage in Shelton.

Mason County BOH is being asked to support this community forum.

Jeffreys/McDowell moved and seconded to approve the Mason County Board of Health to sponsor to the September 21, 2016 Community Forum on opiates. Motion carried unanimously.

Commissioner Jeffreys recommends the BOH take the information regarding Narcan to the County Commissioners for possibly possible policy changes. Cmmr. Jeffreys asked Dr. Yu to bring additional information and details to the next BOH meeting so they will have additional details on how this has been implemented in other counties.

BOARD OF HEALTH PROCEEDINGS July 26, 2016 - PAGE 2

Dr. Yu said it's important because they will end up saving lives which may lead to the next step towards recovery.

7. Foundational Public Health /The Latest and Greatest. - Dave Windom spoke about foundational public health issues.

8. Funding Updates

9. Replacement of Frank Phillips on the Board of Health The group had a discussion about this item. This item will be tabled until next Board of Health to provide more time to refer to requirements.

10. Other Business and Board Discussion. Crnmr. Jeffreys said the Behavioral Health Organization (BHO) will be seeking funds for Psych beds in Mason County. She also said there is a triage unit opening in Thurston County. It will add 20 beds and opens September 1, 2016.

Debbie Riley said enforcement work ties in with all the mental health/substance abuse in the County.

11. Next Meeting will be September 27, 2016

12. Adjourn - The meeting adjourned at 5:59 p.m.

ATTEST MASON COUNTY, WASHINGTON

BOARD OF HEALTH PROCEEDINGS July 26, 2016 - PAGE 3

Clerk of the Board

BOARD OF HEALTH MASON COUNTY, WASHINGTON

Kathy McDowell, City Commissioner

Tim Sheldon, Commissioner

Randy Neatherlin, Commissioner

David Windom, Community Services Director

Peggy Van Buskirk, Hospital District #2

Vacant

Terri Jeffreys, Commissioner

Eileen Branscome, Hospital District # 1

September 2016

Staffing Challenges

2016 has been a challenging year for staffing in our division and for coverage for these vacant positions.

Our division has 7 full-time FTE's plus the manager and 3 positons are needing coverage. The remaining

staff have full plates and have stepped up to assist as much as possible while still having to fulfill their

grant program deliverables.

We have one nurse that has been on medical leave since March and is expected to return in November.

This position monitors the four Maternal Child Health programs and also does home visiting for the

Nurse Family Partnership Program. In June she began to do some program reports, as she was able, to

assist with the work load.

Another nurse retired at the end of July. She planned to retire in May but stayed on two extra months

knowing our staffing levels were strained, in hopes we could find her replacement before she left. The

position covers our Communicable Disease, Immunization and Oral Health Programs and is a

foundational public health position. The communicable disease program must be available for 24/7

response. As the manager, I am the one available after hours and on weekends. I have done most of the

coverage of this position with other nurses filling in some of the days. We were finally able to

temporarily hire back a retired nurse until we fill the position. She has greatly relieved the work load for

myself and other nurses the past three weeks. We have currently interviewed for this position and hope

to have it filled in October or early November.

Finally, our Housing/Mental Health Coordinator resigned in July. With all of the other programs to

cover, I have not been able to prioritize much time to these two programs other than reviewing reports,

contracts and facilitating coalition meetings. We have advertised and will begin interviewing next week.

On a positive note, as manager it sometimes helps to return to be a "boots on the ground" staff to be

able to assess processes that may need improving and doing some overall procedure and policy changes

at the programmatic level. Although the pressure with so much to accomplish daily has been intense at

times, I feel that overall delving deeper into each of the 11 programs covered by these three positions

helped me gain a greater understanding of changes that have occurred over the years and will give

greater opportunity to improve program processes to become even more efficient and effective.

Finally, I have even greater admiration and appreciation for all our Community Health and Human

Service Division staff, those that have moved on and those that continue to carry the torch. They all

really give way more than 100% and are passionate about Public Health in Mason County that is

continually demonstrated through their support and dedication to their work.

Emergency Preparedness

Public Health has a number of roles in community safety and working in emergency preparedness is one

of these areas. As part of this work, I am part of the Region 3 (Mason, Thurston, Grays Harbor, Lewis

and Pacific Counties and Tribes) Health Care Coalition, and also am currently on the Executive Board.

September held one of our quarterly meetings. In attendance are members from public health, hospitals

and community health centers. We work on plans for increasing collaboration, communication and

support of the medical and health side in an emergency.

Locally, I attend the monthly Mason County Department of Emergency Management Planning meetings

where we plan and collaborate on emergency preparedness in Mason County. We have begun a sub­

committee on improving communications between agencies in the event normal communications have

gone down. We are in phase one ofthis plan, the partners are DEM, MACECOM, Pubic Health, Mason

General Hospital, PUD and Mission Creek Correctional Facility. Public Health applied for and received a

grant to purchase two digital radios. We ran our first test during Cascadia Rising in June and are now set

to run monthly tests, doing a situational report with these agencies. The goal is to have this monthly

check in become routine and have this communication capability well practiced in the event of an

emergency. There are plans for 2 more phases over the next year bringing other community agencies.

Housing

On September 16, 2016 there was an open house to view the two new Veterans properties that are now

being rehabbed to be a Veteran permanent housing and a Veteran shelter. We are very excited about

this new partnership with Homes First in Mason County. Many thanks to all who worked tirelessly to

make this a reality in Mason County. We look forward to the opening of these facilities soon!

Community Health Improvement

By the time you read this, our Community Opioid Forum will have taken place on Wednesday,

September 21, 2016. This is part of our public health work in "Moving Mason Forward", our Community

Health Improvement Plan. We look forward to sharing the community planning and action that will

result following this event.

As part of the Washington State Association of Local Public Health Officials (WSALPHO) organization, I

attended a two day training this month of the Art of Participatory Leadership sponsored by our

WSALPHO Community Health Leader Committee (CHLC). Our trainers were excellent and gave us tools

to better engage our community in public health improvement. I look forward to sharing these tools

with staff and in our community coalitions.

Foundational Public Health Services: Attachment 1 Stabilizing the Local Public Health System and Implementing Service Delivery Pilots

Agency:

Decision Package CodefTitle:

Budget Period:

Budget Level:

303 Department of Health

FPHS - Stabilizing the Local Public Health System and Implementing Service Delivery Pilots

2017-19

PL - Performance Level

Agency Recommendation Summary Text: This portion of the Foundational Public Health Services (FPHS) funding request provides funding to local health jurisdictions to fill the most critical gaps in core public health services and to develop and test two innovative delivery models for core public health services across the state.

Fiscal Summary: Decision package total dollar and FTE cost/ savings by year, by fund, for 4 years. Additional fiscal details are required below.

0 erating Ex enditures FY 2018 FY 2019 FY2020 FY 2021 FundAAA-X Xxx yyy uz aaa Fund 888-Y Xxx yyy uz aaa

Total Cost 0 0 0 0

Staffing FY 2018 FY 2019 FY 2020 r FY 2021

FTEs x.y x.y x.y x.y

Revenue FY 2018 FY 2019 FY 2020 FY 2021

Fund AAA-X x.y l x.y x.y .2..-Y Fund 888-X x.y x.y x.y x.y

Object of Expenditure FY 2018 FY 2019 FY 2020 FY 2021

A - Salaries and Wages t Xxx yyy

1 uz aaa

8 -Employee~ nefits I Xxx yyy uz aaa

C -Personal Service Contracts I Xxx yyy uz aaa

E -Goods and Services

~ Xxx yyy I uz aaa

G -Travel Xxx yyy r uz aaa

J -Capital Outlays Xxx yyy I uz aaa

N - Grants, Benefits & Client Svc I Xxx yyy

1 uz aaa

T- Intra-Agency Reimbursements [ Xxx yyy uz aaa

Package Description

** This decision package is one of two components of the Foundational Public Health Services (FPHS) initiative to rebuild and modernize the Governmental Public Health system. **

History & Context

The governmental public health system (public health system) in Washington has a critical role that is focused on protecting and improving the health of families and communities through monitoring and control of communicable diseases, promotion of healthy lifestyles, ensuring safe water and food,

preventing injuries and ensuring safe and quality health care. 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 county or state.

Public Health is essential. Investing in disease prevention is an effective way to improve health -keeping thousands of Washingtonians from developing preventable diseases and reducing health care

costs. The public health system works to prevent problems from happening- in contrast to the medical care system, which focuses primarily on treating individuals after they become sick or injured. Public

health also works to give everyone a chance to live a healthy life.

After a century of effectively preventing death and illness and increasing the quality of life in Washington communities, the public health system now faces the dual challenge of a severe funding crisis and a change

in the nature of preventable disease and illness in our state. The cumulative effect of new and more

complex disease threats, smoking, costly and preventable chronic diseases and injuries, increasing need to

ensure that all children have a healthy start in life and several other factors threaten to produce lower life expectancies among today's children than among their parents - something that has never before

happened in US history.

One example of new demands on the public health system was the work needed to prepare for possible Ebola cases in our state. Local health staff had to stop their routine communicable disease work to

monitor travelers from Ebola impacted countries. As a state, we physically monitored over 359 people every day for 21 days to ensure they were not sick; state and local health officers developed guidance for

the health care system so they would be prepared - which sometimes changed daily; and the state public health laboratory had to ramp up for a new test for a biological agent that is considered extremely

dangerous; This was unprecedented work for the public health system and resulted in hundreds of thousands of dollars in unexpected costs.

Monitoring and responding to Zika illnesses presents similar challenges. The unanticipated global

outbreak of Zika virus infection is the most current but certainly not the last emerging infectious disease

challenge to confront the US public health system. Despite a number of such threats in recent years,

significant gaps remain in core areas of the public health system. Responding to these new diseases means

much work is being left undone in other areas, which exposes our residents to unacceptable levels of risk.

Containing the growing health burden and economic impact of preventable diseases in Washington

requires a public health approach. We need to reduce statewide and community rates of chronic disease

through prevention programs, promoting positive changes in behavior and giving everyone a chance to

live a healthy life.

In response to these problems, state and local public health officials and local leaders have defined a set of

core services that government is responsible for in all communities in our state. These core services are a

2

subset of the essential work of the public health system and are called Foundational Public Health Services (FPHS) because they provide the foundation to support the work of the broader public health system and community partners.

To ensure that these core services are available statewide and to maximize return on investment, the Department of Health (DOH) and local health jurisdictions (LHJ) are working to modernize the public health system by looking at how services are currently provided and developing new models for how to deliver them.

The planning for this initiative has been occurring over the past several years and a comprehensive multi­year strategy to modernize and reliably fund the public health system to provide the FPHS will be presented in the December 2016 Foundational Public Heald1 Services legislative report.

The Problem

Due to a cascade of funding changes over the past 16 years, the local public health system is now unable to meet its basic responsibility to provide core public health services to all communities in our state. ·

• When the motor vehicle excise tax (l'vfVET) was repealed in 2000, local public health lost one of its main revenue sources that was anticipated to be adequate and sustainable, and to grow with increases in population. To partially mitigate this loss, the Legislature appropriated an amount from the state general fund equal to about 90% of lost J:vfVET revenues at the time. While this funding continues today, the appropriation has not increased with inflation or population, reducing its purchasing power over time.

• Limited Potential for Additional Revenue. Since 2001 , property tax revenues have been limited to growth of 1 % per year, plus the value of new construction. Effectively, this prohibits a primary governmental revenue source from keeping pace with changes in inflation and population. Over time, purchasing power per capita has been greatly reduced.

• Impact of Large Categorical Funding Changes. Funding from the federal government has become significantly categorical and limited to very specific programs.

• Competition with Other Priorities. Every budget cycle, public health has to compete with other priorities for a smaller and smaller pool of county and city general resources.

As a consequence of the funding challenges described above, many LHJs are not able to meet their basic responsibility to provide core public health services to keep their community safe. When one part of tl1e public health system is unable to provide the core communicable disease services, it leaves all communities vulnerable to disease outbreaks such as measles, pertussis, and foodborne illness that could have been contained if the whole system was functioning as designed.

!According to a 2014 capacity survey, only 44% ofLHJs were able to respond to elevated levels greater than 5 mcg/dL (recommended action level). Over 12% ofLH.Js don't respond to~ elevated blood lead results in cbildrenj This is a :pecific exam2le of inadeguate__public health SJStem c:paciry that affects how __ -LHJs respond to reports of high blood lead levels in children.

[Funding constraints have also led to mininlal public health activities to prevent chronic diseases that result in premature deaths and ever rising health care costs.

• In 2014, 16% (+1%) of Washington adults reported fair or poor health. It is as high as 30-36% for some groups (American Indian/ Alaska Natives and Hispanics, respectively).

3

Comment [Al]: Patty Hayes suggests changing this for something on teen suicide or opiolds

because Lead will be the focus of a separate budget

request.

• Suicide is the second leading cause of death for youth (those between the ages of 10 and 24) in Washington State. Research shows that the majority of suicides are preventable. I_ ___ _________ -

These things don't have to continue. There are evidence based strategies to address the leading causes of preventable death in all communities in Washington but many LHJs aren't able to engage in this essential work due to a chronic lack of funding.

As part of Public Health Modernization, it is imperative to use existing resources more effectively and efficiently, add capacity to the current system, and find innovative ways to provide FPHS to all communities. However, building full capacity at each LHJ, no matter the size, would be cost-prohibitive and a different solution is needed.

What It Will Buy

This budget request includes funding to fill the most critical LHJ gaps in core public health services and to test two innovative delivery models for core public health services across the state.

LHJ Funding - $25 million per year

This request is for an immediate investment in local public health to begin stabilizing the crumbling system and to fill the most critical gaps that threaten the health of our communities. The requested funding will restore key functions that have already been lost, and improve local public health's ability to respond to the threat of communicable and chronic diseases. These are core public health services that need to be available to every community in the state.

The funding will be used specifically for two FPHS programs and the supporting services that provide the greatest threat to the health of Washingtonians: (1) Communicable Disease prevention, and; (2) Chronic Disease prevention. While each LHJ has different gaps, this funding will help raise the bar across the state in these areas but will still fall short of fully funding the FPHS that only government can provide. However, this funding will increase the overall capacity of the local public health system to provide the core public health services detailed below:

• Communicable Disease Monitoring and Prevention - Manage the threat of disease through monitoring, outbreak investigation; identification of causes; and preventing more cases.

• Chronic Disease and Injury Prevention: Containing the growing health burden and economic impact of preventable diseases in Washington requires a public health approach. We need to reduce statewide and community rates of chronic disease through prevention programs, promoting positive changes in behavior and giving everyone a chance to live a healthy life.

The funding is intended to be an interim solution until the comprehensive plan to modernize the Governmental Public Health System and secure reliable funding is fully implemented.

Service Delivery Pilots - $2 million per year

This budget request is to develop and implement two pilot projects specifically designed to test different service delivery elements to see which are most successful and could be implemented at a larger scale.

The pilots will use a new framework that will allow multiple jurisdictions to share staff and services without the need for someone to be physically present in every LHJ to provide the FPHS. The pilots will

4

Comment [A2]: Looking for feedback on whether this is better than the lead capacity issue.

be targeted towards providing capacity for LHJs that don't have adequate resources to do this critical work now.

The pilots will test different structures/elements to support this work including: number ofLHJs in each collaborative; types of shared services; policy development; funding method; management structure; location of staff; expertise of staff; resource allocation; levels of support needed to meet the demands; contracting strategies; and communication methods.

The findings of the service delivery pilots will be incorporated into the Public Health Modernization framework and allocations for FPHS will be based on shared delivery models where practical. This is expected to result in increased efficiency and effectiveness in the delivery of services in the public health system.

The pilots will be focused on two critical parts of the public health sys tem:

• Communicable disease monitoring and control- many LHJs are not able to provide these core services to their community because they lack money or are not able to hire skilled staff. This impacts prevention and response activities and leaves communities vulnerable to disease outbreaks such as measles, pertussis, and foodborne illness that could have been contained if adequate services were available.

• Assessment/Epidemiology- many LHJs do not have access to specialized expertise to analyze community health data to identify which health problems in the community present the most significant impact to residents. Knowing the health status of the community helps focus investments from many sectors (government, hospitals, and community organizations) on the most critical problems. Activities in this area also include the ability to evaluate the frequency of diseases such as lead poisoning, anencephaly, and cancer clusters with the goal of identifying interventions to prevent additional cases. High quality health assessment ensures that the real problems get identified so that decision makers and communities can focus resources in the best places to most effectively address issues.

This is Phase I of the implementation plan. The December 2016 Foundational Public Health Services legislative report will outline the multi-year strategy to modernize and reliably fund the public health system.

Operations Manager/ Subject Matter Expert Contacts:

Ryan Black DOH Budget Manager Ryan.Black@doh.wa.gov (360) 236-4530

Jennifer Tebaldi Agency Subject Matter Expert Jennifer. tebaldi@doh.wa.gov (360) 236-4051

5

Base Budget: If the proposal is an expansion or alteration of a current program or service, provide information on the resources now devoted to the program or service. Please include annual expenditures and FfEs by fund

and activity (or provide working models or backup materials containing this information).

N / A - new project

Decision Package expenditure, FTE and revenue assumptions, calculations and details: Agencies must clearly articulate the workload or policy assumptions used in calculating expenditure and revenue changes proposed.

Local health Jurisdictions will receive $25M per fiscal year. The funding received will be allocated to LHJ s using a methodology that provides a meaningful level of funding for each LHJ to address the most critical FPHS gaps in communicable and chronic disease programs. The December 2016 report will contain the detailed allocation plan.

There will be $2M/year for developing and implementing the 2 service delivery pilots for 2 years. The funding for this work will be coordinated through DOH.

Decision Package Justification and Impacts

What specific performance outcomes does the agency expect? Describe and quantify the specific performance outcomes the agency expects as a result of this funding change. (results washington link)

Goal 1: Access & Success - Providing every Washingtonian a world-class education that prepares him or her for a healthy and productive life. including success in a iob or career. in the community and as a lifelong learner.

Children need to be healthy in order to learn. Preventing diseases through immunization and safe food practices are two examples of the impact of the public health system in ensuring that children are ready to learn. Regular physical activity among students at school, a measure related to maintaining healthy weight, is known to improve academic performance -this is a key public health strategy.

Goal 2: Business Vitality- Washington is a great place to grow your business The public health system monitors and responds to communicable disease outbreaks and works to

prevent chronic disease. The health of employees directly impacts the place where they work - employees that call in sick due to preventable illnesses impact the productivity of the business. Keeping employees

healthy helps reduces health care expenditures for both the employee and business. Caring for sick children also impacts the productivity of the business when parents need to take time off to care for them.

Goal 3: Sustainable energy & a clean environment - Keep our land. water and air clean The public health system is responsible for ensuring water is safe to drink and regulates all public drinking water systems in the state to ensure that people don't get sick.

Goal 4: Healthy & Safe Communities - Safe People - Help keep people safe in their homes. on their iobs and in their communities

The public health system is responsible for monitoring and responding to communicable disease

outbreaks. The ability to achieve this goal is dependent on LHJ s capacity to respond to illness reports and take appropriate actions to control the spread of disease. Preventing chronic diseases is increasingly a critical priority with tobacco use and unhealthy weight as significant causes of disability and premature

death in Washington. 6

The Assessment Pilotwill provide the capacity for all communities in the pilot to measure their success in achieving the performance measures in this goal. It would not be possible to measure many of the performance indicators in this goal if the public health system didn't collect the data needed to measure the progress. For example: 1.1 - Decrease the infant mortality rate for children; 1.2.Y.a - Increase percentage of 1 Od' graders with healthy weight; and 1.2.Y.d.1: D ecrease percentage of 10th graders who report smoking cigarettes in the past 30 days.

O ne outcome of this pilot will be the ability of all communities to get information on the results of these measures for their own community so they can target interventions in the areas needed to gain the desired health improvements identified in the Results lf/ashington goals. Without this information, we could see disparities in health status because data to inform decisions wouldn't be specific enough to guide locally driven interventions.

The Communicable Disease Pilotwill provide the capacity to communities who lack this ability to measure the success of this goal. 2.2: Decrease incidents of food-borne illnesses by 5% from the 2012 baseline by 2020. The ability to achieve this goal is dependent on LH.Js capacity to respond to illness reports and take appropriate actions to control the spread of disease.

Goa/ 5: Efficient. effective and accountability government - Transparency and Accountability - I know how my money is being spent.

The goal of the service delivery pilots is to increase the efficiency and effectiveness of the governmental public health system by ensuring that all communities have access to the core public health services that they deserve. The service delivery pilots will have performance measures developed and will be evaluated periodically throughout the project period.

Performance Measure detail:

LHTFunding The requested funding is to fill the most critical gaps, restore key functions that have already been lost, and improve our ability to respond to the tlueat of communicable and chronic diseases. These are core public health services provided by LH.Js that need to be available in every community in the state. The funding is to be used specifically for Communicable Disease and Chronic Disease FPHS. Because the critical needs are different at each LHJ, the performance measures are intended to reflect individual performance that can be summarized at a sys tems level.

Note: Notifiable Conditions are diseases that the health care system is required to report to public health. The ability of public health to respond effectively is directly linked to the timeliness of the report. Using timeliness as a proxy for the desired outcome of preventing disease (things that don't actually happen) is a critical system performance measure.

Communicable Disease - will be focused on measuring the ability of the system to respond to communicable diseases within the timelines established by state and national guidelines.

1. Percentage of Lfij s with a detailed investment plan for the funding received. 2. Percent of notifiable conditions cases reported to the LI-lJ where investigation was initiated

within the specified time frame . 3. Percent of notifiable condition cases reported to the LHJ with a completed investigation by

public health. 7

Chronic Disease' (for LHJs using funding for this purpose) 1. Percentage ofLHJs with a detailed FPHS investment plan for the funding received.

2. Percentage ofLHJs with community level data to inform priorities.

3. Percentage ofFPHS investment plan activities completed.

Service Delivery Pilots

Performance measures will be identified as part of the pilot project development.

One of the performance measures for the Assessment Pilotwill be the availability of a health assessment

for every community.

One of the performance measures for the Communicable Disease Pilot will be to measure the ability of

the system to respond to communicable diseases within the timelines established by state and national

guidelines.

Fully describe and quantify expected impacts on state residents and specific populations served:

Note: The impact to state residents is dependent on the level of funding received. This request does not

fully fund the estimated costs of providing FPHS in every community in Washington so the full benefit of

these services will not be realized until the public health system is fully funded for this work.

All Washington residents will have increased confidence in the public health system's ability to respond to

outbreaks of communicable disease. Reports of outbreaks and severe communicable diseases will be

followed up on by skilled staff to contain the spread of disease such as foodbome illness, measles, and

pertussis. The public will be protected during public health emergencies such as Zika Ebola, floods or

earthquakes.

When fully funded, LHJ s will have the capacity to address the leading risk factors of chronic disease

across the state, not just in places where resources are available. Chronic diseases are leading causes of

death and illness; they are costly; and contribute to rising health care costs. Preventing chronic diseases

will reduce premature deaths save money and increase the economic health of our communities.

Service Delivery Pilots

Residents in all communities served by the Communicable Disease Pilotwill have confidence in the

public health system's ability to respond to outbreaks of communicable disease. Reports of outbreaks and

severe communicable diseases will be followed up on by skilled staff who will work across political

boundaries to contain the spread of disease such as foodbome illness, measles, and pertussis. Staff will

work with the public, healthcare and community organizations on the day to day activities in disease

prevention, promoting immunizations, and infection control. The staff in the pilot will also work together

to respond to public health emergencies such as Zika, Ebola, floods or earthquakes to ensure that

appropriate monitoring and interventions are in place. Communities will be better prepared and able to

manage an outbreak as a result of participating in the pilot.

8

Residents in all communities served by the Assessment Pilotwill benefit from increased access to specialized skills that are needed to identify community health status and inform community priorities. This information will be used by all groups and organizations focused on improving the health of the public such as hospitals, regional coalitions, and community organizations. They will also benefit from the availability of skilled epidemiologists to monitor and respond to non-communicable diseases that threaten the health of the public, such as lead poisoning.

The organizational structure that is established for providing these services will ensure that FPHS are available no matter where you live. The structure will be developed to take advantage of economies of scale and is expected to result in increased effectiveness across the state. This increased efficiency and effectiveness will stre tch every dollar, allowing the public health system to use scarce resources wisely.

Having a uniform, consistent set of FPHS across the state will ensure that all Washingtonians have an equal opportunity for good health no matter where they live.

What are other important connections or impacts related to this proposal? Please complete the following table and provide detailed explanations or information below:

Regional/County impacts?

Other local gov't impacts?

Tribal gov't impacts?

Other state agency impacts?

----Responds to specific task force, report, mandate or exec order? Does request contain a coml)ensation change? Does request require a change to a collective bargaining agreement? Facility/workplace needs or !!!)!)acts? _ Capital Budget Impacts?

Is change required to existing statutes, rules or contracts? Is the request related to or a result of litigation? Is the request related to Puget Sound recov~ryl_ _ Identify other important

Yes

Yes

Yes

Yes

No

No

No

Yes

No

No

No

No

ldenti This proposal will provide capacity to address critical public health problems in communities with inadequate resources. This proposal supports the Healthier Washington initiative and brings public health resources and knowledge to the !Jlanning/coordination groups._

I This proposal will provide capacity to address critical public health problems in communities with inadequate resources.

I This proposal will provide capacity to address critical _ RUblic health Rroblems in tribal communities.

This proposal supports the work of DEL and OSPI to ensure children are healthy and ready to learn. It also supports the work of DSHS in behavioral and mental health planning and program imRlementation. Identify:

Identify:

Identify:

----Potential to increase space needs for staff for service deliveruilots. Identify:

Identify:

Identify lawsuit (please consult with Attorney General's Office): If yes, see budget instructions Section 14.4 for additional instructions

9

!~D.!l~~Cl_ll~ _ __ . __ -_____ J_ .. _ · ___ J ______ _ - __ - ·__ _. ___ -____ -~---.

Please provide a detailed discussion of connections/impacts identified above.

The FPHS provided by public health are the foundation for many other activities/services provided by government and the private sector. The data collected and analyzed by public health provides the information needed to focus resources in the right places. Collaboration with public health allows the integration of prevention principles and public health knowledge to shape successful interventions to improve the health of all Washingtonians.

Residents in all communities will benefit from increased resources for communicable disease prevention activities. This means LHJs will be better prepared and able to manage outbreaks in their communities.

Increases in chronic disease prevention activities means they will also benefit from increased access to specialized skills that are needed to identify community health status and inform community priorities. This information will be used by all groups and organizations focused on improving the health of the public such as hospitals, regional coalitions and community organizations. They will also benefit from the availability of skilled epidemiologists to monitor and respond to non-communicable diseases that threaten the health of the public, such as lead poisoning.

Residents in all communities served by the Communicable Disease Pilotwill have reports of outbreaks and severe communicable diseases followed up on by skilled staff who will work across political boundaries to contain the spread of disease such as foodbome illness, measles, and pertussis. Communities will be better prepared and able to manage an outbreak as a result of participating in the pilot.

Residents in all communities served by the Assessment Pilotwill benefit from increased access to specialized skills that are needed to identify community health status and inform community priorities. This information will be used by all groups and organizations focused on improving the health of the public such as hospitals, regional coalitions, and community organizations. They will also benefit from the availability of skilled epidemiologists to monitor and respond to non-communicable diseases that threaten the health of the public, such as lead poisoning.

What alternatives were explored by the agency and why was this option chosen?

N/A

What are the consequences of not funding this request?

LHJFunding If new funding is not provided to begin stabilizing LHJ s, they will be unable to meet their basic responsibilities to protect the health of the public from communicable disease and preventable causes of death. This will result in inequities across the state because of unequal distribution of resource~ as well as increased risk of negative public health impacts (outbreak control and mitigation).

The ability of public health to respond effectively to communicable disease is directly linked to the timeliness of response. If one part of the state system is compromised, it impacts everyone.

Service Delivery Pilots

10

Implementing these pilots and testing different frameworks will provide information to effectively implement the concept of Foundational Public Health Services statewide as framed in the December 2016 FPHS Report to the Legislature. Ensuring that FPHS are available no matter where you live is a critical piece of Public Health Modernization. Without testing innovative concepts, it could result in lost opportunities to gain efficiencies in the public health system and provide the accountability for good stewardship of resources that the public expects from government.

The ability to innovate and ensure access to core public health services in areas currently without these se1vices will not happen.

How has or can the agency address the issue or need in its current appropriation level?

N/A

Other supporting materials: Please attach or reference any other supporting materials or information that will help analysts and policymakers understand and prioritize your request.

Information technology: Does this D ecision Package include funding for any IT-related costs, including hardware, software, services (including cloud-based services), contracts or IT staff?

181 No a ,. D Yes _ ue to IT Addendum below and follow the directions on the bottom of the addendum to meet requirements for OCIO review.)

11

From the Director's Desk

September 2016

Welcome to Fall!

Fall is definitely in the air and the colors are starting to change. We've had a number of personnel

changes in the past two months which I'll let the managers discuss in detail.

I attended the Cascade Pacific Action Alliance for the first time this month . There were many familiar

faces that I've worked with on the east side such as the folks from Health Care Authority, DSHS and

DOH. There seems to be a lot of energy in the organization though funding still lags well behind

enthusiasm. The people from the Health Care Authority insist that the 1115 Medicaid Waiver is still in

the works that would provide funding for programs outside of typical Medicaid Treatment.

By the time the Board of Health meets this month I will have attended the first of the meetings for the

Governor's Action Alliance on Suicide Prevention. This first meeting will lay out recent data and address

possible courses of action as the alliance moves forward . I feel that the BOH should discuss this issue in

light of the AG's proposal on gun control as a public health issue. In meeting with Secretary Wiesman,

the AG came out with this position without consulting Department of Health.

For the past six months the Overall Allocation Funding workgroup has been meeting to determine a way

to more clearly, appropriately and with great transparency allocate funding from DOH to LHJ's for work.

I suggested the following formula:

Principles

• Fairness - the formula must be fair in the way in which it allocates funds to all

counties

• Focus on infrastructure - the formula should ensure that there is adequate

public health infrastructure to meet needs especially in underserved

communities

• Simplicity- the formula should be simple to use, understand and explain

• Flexibility - the formula and its use should be flexible enough under review for

improvements or changes over time.

Recommendations

Of the funds allocated by the state, each county {LHJ) should receive a portion based on

population size and level of poverty. Specifically, the following formula weights and measures

should serve as the primary method of allocating these funds to LHJs:

• Population share (20%}

• Poverty share (20%}

• Poverty rate (20%)

• Health Status {20%}

• Burden of disease (10%}

• Base (10%}

Considerthe population of each local publichealthjurisdiction, burden of diseases, total overall health

status (use years of life lost from County Health Rankings) and the ability of each local public health

authorityto utilize these funds. These factors would be placed into an algorithm that would then

be multiplied against the fund total to produce a result for each county.

The committee will take all the recommendat ions and should be making a recommendation to

DOH by the end of this month.

Flu season is just around the corner and the Centers for Disease Control have a new web page

to address the questions for the 2016-2017 flu season. Flu vaccination can reduce flu illnesses,

doctors' visits, and missed work and school due to flu, as well as prevent flu-related

hospitalizations. One of the most notable is the recommendation that nasal flu vaccine not be

used and that only injectable vaccines be used. http ://www.cdc.gov/flu/about/season/flu­

season-2016-2017.htm

Our FTEs stand at 21.2

From the Environmental Health Manager's Desk

September 2016

After 18 years with Mason County Public Health, Stephanie Kenny left to go to work for

Thurston County Public Health and Social Services. We did an internal shifting of duties and

adjusted some work plans to get through until we have a new person on board. The job posting

for an EHS I, II or Ill closes on Friday, September 23 with interviews starting as soon as possible.

Everyone is stepping up to help where they can. Three of our seven EHS have been with us for

right at a year and we will be adding another new person with this posting. The two senior EHS

are eligible for retirement and one will likely leave in 2017. Our institutional knowledge is

walking out the door. We are suffering the consequences of the layoffs during the economic

downturn when we lost all of our newer staff at that time.

Our onsite sewage system permits are up from this time last year. We are seeing more new

construction than we did last year when much of our work was repairs. With new construction

on the rise, well site inspections and well construction site visits are up. The onsite sewage

system and water quality program staff continue to work on identifying and repairing failing

onsite sewage systems to protect and/or improve water quality for public health and shellfish

growing and harvest. Numerous general and targeted mailings have gone out to educate OSS

owners and remind them that all septic systems require maintenance. Our O&M program

continues to be a leader in the Puget Sound. We will have a booth at Oysterfest in October.

With the end of summer we are wrapping up swimming pool inspections and temporary food

events. There were no swimming closures at any of the four Mason County beaches sampled by

the state for the BEACH program this year. Those beaches are Walker County Park, Twanoh

State Park, Potlatch State Park and Allyn Waterfront Park. All in all it was a very good summer.

1

Staff from the on site program and the solid waste program are working with planning and

building program staff on joint complaints. There are some complaints that are bigger or more

complex than one program or even one division of the department can deal with. We are

discovering that many of the complaints we are working on now have poverty, drug use and/or

mental health aspects that we do not have the expertise to handle. We are seeing numerous

illegal RV parks in residential neighborhoods. They are not zoned for anything more than a

single family residence; they do not have an adequately sized onsite sewage system for the load

that is being put on them and the neighbors are angry that they are present in the

neighborhood. Some enterprising property owners saw a need in the community for these

people to have a place to live and these "camps" are popping up all over the county. There is

currently no other place for these folks to go. When we take enforcement and require the

property owner to make them leave, we are "making them homeless" as one of the landlords

put it. We are definitely chasing the problem down the road to another property. This is more

than a solid waste issue or an onsite sewage system issue or even an environmental health

issue ... It is a community issue.

At the September Oakland Bay Clean Water District Advisory Committee meeting former

County Commissioner Steve Bloomfield shared the work he is doing toward implementing an

aquatic sciences academy at the high school. I reminded him that our environmental health

staff would be available for job shadowing opportunities for the students. Over the years we

found that the staff get as much out of the experience as the students do.

2