Report to the Board of Health – November/December 2015 · Board of Health Report_November/December 2015 - Page 2 of 24 The EPA strongly recommends that homeowners install radon

Report to the Board of Health – November/December 2015 Winnebago County Health Department Leadership Team

• Kyle Auman – Health Equity Coordinator • Sue Fuller – Public Information Officer • Lisa Gonzalez, MPH – Center Director, Family Health Services • Theresa James – Emergency Response Coordinator • Todd Kisner, MPH – Interim Center Director

Health Protection and Promotion • Todd Marshall, LEHP – Center Director, Environmental Health Improvement • Patrick Madigan – Finance Director • Karalyn Nimmo, MPH – Data and Quality Coordinator

• Domain I – Monitor Health Environmental Health Improvement (EHI) continues to monitor for critical violations for all EH programs to identify areas where more education is needed for food operators, contractors, and landlords. Over the holidays, Environmental Health published several educational press releases through social media reminding the public the importance of food safety and handwashing. Indoor Air Monitoring

# of

Units CO2 Temp Humidity CO

Month Average 13 748 71.5 37.7 0.6 Month Max 13 1106 83.7 46.8 1.5 YTD Overall Avg 47 827 ppm 71.3 43.9 0.8 ppm YTD Overall Max 47 2195 ppm 94.2 F 81% 16 ppm CO2 CO YTD-CO2 YTD-CO

IDPH Guideline (ppm) > 1,000 > 9.0 > 1,000 > 9.0 Homes with at least one reading exceeding guideline 1 0 19 1

% of Homes Monitored 20% 0.0% 40.4% 2.1% Homes whose overall average exceeds guideline 0 0 12 0

% of Homes Monitored 0.0% 0.0% 25.5% 0.0%

Radon

Phone Calls

Number of Units

Radon Screenings

Average (pCi/L)

Max (pCi/L)

Number of Mitigation

Month 2 0 0 N/A N/A 0 FY16 to Date 2 0 N/A N/A N/A 0 Program total 41 23 23 4.9 14.0 7

Board of Health Report_November/December 2015 - Page 2 of 24

The EPA strongly recommends that homeowners install radon mitigation in homes at or above 4.0 pCi/L, and that homeowners should consider mitigation at levels between 2.0 and 4.0 pCi/L.

Environmental Health’s last correspondence with the Illinois Emergency Management Agency (IEMA) regarding the opportunity to receive some free “certified” radon test kits were put on hold due to internal approves at the State. In the meantime, WCHD is promoting January as “Radon Awareness Month” which a press release was written to promote our radon “screening” program. WCHD has received such a great response that a waiting list was implemented to accommodate an influx of participants.

West Nile Virus Surveillance

Our 2015 West Nile Virus Surveillance report was submitted to the Quality Committee for review/filing.

Total Sexually Transmitted Infections (STI) diagnosed through WCHD clinical services in YR2015 in comparison to the total in YR2014. Overall, STIs diagnosed in clinical services were down in YR2015 compared to YR2014. Syphilis infections though, saw an 80% increase in the number of infections in YR2015 compared to YR2014.

STI YTD 2015 YTD 2014

Syphilis 9 5

Gonorrhea 75 117

HPV 44 111

Chlamydia 197 339

HIV 2 0


• Domain 2 – Diagnose and Investigate CLSR (Creating Lead Safe Rockford) 2013 Objectives Note

Outreach Strategy. CLSR has been working to incorporate more community outreach into its schedule. With the loss of our partnership with La Voz Latina, the program has had to find new avenues to provide education and other services to the Hispanic Community. CLSR staff reached out to several organizations who have established English as a Second Language classes or other meetings for inclusion of lead education and provide referrals into the CLSR program. Organizations contacted for partnership include Rock Valley College, Rockford Catholic Charities, Elizabeth Center, and the YWCA. CLSR is also working with the WIC program to present at WIC Spanish-speaking nutrition education classes. CLSR has also provided WIC with educational slides for the WIC waiting rooms in English and Spanish.

CLSR has also reached out to the Swedish American Foundation, which is sponsoring a revitalization project for homeowners in the community surrounding their main hospital campus on the West side of Rockford. CLSR aims to form a partnership with this foundation to provide collaboration as well as referrals to one another. Commonwealth Edison (ComEd) has also been contacted with the goal of including program information inserts in monthly utility bills and communication to customers in high risk zip codes.

Food Complaints

Month FY 2016 FY 2015 # of Foodborne Illness Complaints 6 10 10 # of Foodborne Illness Investigations 6 10 10 # of Non-foodborne Illness Complaints 22 30 37

Housing Complaints

The Neighborhood Code Enforcement program has sent a proposal to the States Attorney to review amendments to the Winnebago County Code, addressing Chapter 18, Articles IV and IX which apply to Housing Codes. These amendments serve to formally adopt the 2015 International Property Maintenance Code, amend this code where needed to suit local needs, and remove duplications elsewhere in the code. Winnebago County will be joining other area Counties and Municipalities by

Goal Actual Percent Units Enrolled 300 146 48.7 % Inspections 250 128 51.2 % Mitigated Units 225 90 40.0 %

Month FY 2016 FY 2015 # of Housing Complaints 101 159 174 # of Nuisance Complaints 18 29 41 # of Survey Complaints 75 123 163 # of Received Complaints 225 317 404 # of Re-check on Complaints 655 1046 1170


adopting the most recent versions of this and other codes, which will help streamline and standardize enforcement throughout neighboring jurisdictions. The Neighborhood Code Enforcement program has also begun researching ways to expand garbage pickup services to needed areas in the community. WCHD hopes to coordinate discussions with all parties (including waste disposal companies, residents, and local officials) to determine what resources and commitments would need to be made to expand these services. Well and Septic Complaints

Original complaints

Recheck complaints

FY16 Original complaints

FY16 Recheck complaints

FY15 Original complaints

FY15 Recheck complaints

Wells 4 6 6 7 3 4 Septic 3 5 8 5 3 5

Communicable Diseases

Vaccine Preventable Diseases (Reporting timeframe)

November & December Combined

2015 Confirmed

Cases

2015 YTD Investigated &

Determined "Not a Case"

2015 YTD Total Confirmed

Cases

2014 Year Total

Confirmed Cases

Chickenpox (Varicella) (24h) 0 6 2 3 Diphtheria (immediate) 0 0 0 0 Haemophilus influenzae, invasive (24h) 1 2 5 7 Hepatitis A (24h) 0 5 0 1 Hepatitis B-Acute Infection (7d) 0 0 1 2 Hepatitis B-Chronic (7d) 3 4 28 28 Hepatitis C-Acute (7d) 0 4 1 0 Hepatitis C-Chronic (7d) 34 14 237 235 Hepatitis D (7d) 0 1 0 1 Influenza deaths in < 18 yrs old (7d) 0 0 0 0 Influenza A, variant (immediate) 0 0 0 0 Influenza, ICU admissions (24h) 1 6 6 15 Measles (rubeola) (24h) 0 4 0 0 Mumps (24h) 0 1 0 0 Neisseria meningitidis, invasive (24h) 0 0 0 0 Pertussis (whooping cough) (24h) 0 6 8 16 Polomyelitis (immediate) 0 0 0 0 Rubella (24h) 0 0 0 0 Streptococcus pneumoniae, invasive disease, in those < 5 yrs old (7d) 1 0 3 2 Tetanus (7d) 0 0 0 0 Sexually Transmitted Infections AIDS (7d) 0 0 0 0 Chancroid (7d) 0 0 0 0




2015 Confirmed

Cases




Cases

2014 Year Total

Confirmed Cases

Chlamydia (7d) 289 30 1742 1702 Gonorrhea (7d) 107 8 432 443 HIV infection (7d) 0 0 0 0 Syphilis (7d) 0 0 0 0 Other Communicable Diseases Anaplasmosis (7d) 0 2 0 0 Any suspected bioterrorist threat (immediate) 0 0 0 0 Any unusual case or cluster of cases that may indicate a public health hazard (immediate) 0 0 0 0 Anthrax (immediate) 0 0 0 0 Arboviruses (including WNV) (7d) 0 3 0 0 Babesiosis (7d) 0 0 0 0 Botulism, foodborne (immediate) 0 0 0 1 Botulism, infant, wound, other (24h) 0 1 0 0 Brucellosis (24h unless bioterrorism suspected, then immediate) 0 0 0 0 Chikungunya Non-neuroinvasive Disease 0 1 0 0 Cholera (24h) 0 0 0 0 Creutzfeldt-Jakob Disease (7d) 0 0 0 0 Cryptosporidiosis (7d) 2 3 5 4 Cyclosporiasis (7d) 0 0 0 0 Drug-resistant organism, extensively (7d) 0 0 0 0 Ehrlichiosis (7d) 0 3 0 0 Enteric E. coli infections (STEC,O157:H7, ETEC, EPEC, EIEC) (24h) 0 0 6 5 Foodborne or waterborne outbreaks (24h) 0 0 0 0 Hantavirus pulmonary syndrome (24h) 0 0 0 0 Hemolytic uremic syndrome, post diarrheal (24h) 0 0 0 0 Histoplasmosis (7day) 0 7 0 0 Legionellosis (7d) 2 0 8 3 Leprosy (7d) 0 0 0 0 Leptospirosis (7d) 0 0 0 0 Listeriosis (7d) 0 0 0 0 Lyme disease (7d) 0 18 7 8 Malaria (7d) 0 0 1 0 Ophthalmia neonatorum (gonococcal) (7d) 0 0 0 0 Outbreaks of public health significance (24h) 0 0 0 0




2015 Confirmed

Cases




Cases

2014 Year Total

Confirmed Cases

Plague (immediate) 0 0 0 0 Psittacosis (7d) 0 0 0 0 Q fever (2 4h unless bioterrorism suspected then immediate) 0 0 0 0 Rabies, human and potential human exposure and animal (24h) 0 1 16 1 Reye syndrome (7d) 0 0 0 0 Salmonellosis, other than typhoid (7d) 13 2 57 40 Severe Acute Respiratory Syndrome (SARS) (immediate) 0 0 0 0 Shigellosis (7d) 101 1 112 21 Smallpox (immediate) 0 0 0 0 Smallpox vaccination, complications of (24h) 0 0 0 0 Spotted fever rickettsioses (7d) 0 0 0 0 S. aureus, Methicillin resistant (MRSA) clusters (two or more lab confirmed cases) in a community setting (24h) 0 0 0 0 S. aureus, Methicillin resistant (MRSA) in infants <61 days (24h) 1 1 9 11 S. aureus infections with intermediate or high level resistance to vancomycin (24h) 0 0 0 0 Streptococcal infections, Group A, invasive including STSS and necrotizing fascitis (24h) 3 1 11 6 Toxic shock syndrome due to S. aureus (7d) 0 0 0 0 Trichinosis (7d) 0 0 0 0 Tuberculosis (7d) 0 0 0 6 Tularemia (24h unless bioterrorism suspected then immediate) 0 0 0 0 Typhoid fever (24h) 0 0 0 0 Typhus (24h) 0 0 0 0 Vibriosis (non cholera) (7d) 0 0 2 1 Yersiniosis (7d) 0 0 0 0 West Nile Fever 0 2 0 0

* The above table represents only those reportable diseases that have been received this month and year to date in comparison to the 2014 Year totals. *”Investigated & Determined Not a Case” Column indicates an investigation was completed on a “probable” case of the disease noted. As the final diagnosis was not the specified disease, then the investigation work falls in this reporting category.


Communicable Disease Activities

1. Unknown Irritant Investigation in Elementary School On Thursday, December 10, 2015 at 11:30 AM the Winnebago County Health Department (WCHD) was notified of a cluster of children from a single 2nd grade classroom reporting to the school nurse with an urticarial (itchy) rash not accompanied by any other symptoms including fever, difficulty breathing, nausea, vomiting, headache, and/or diarrhea that developed rapidly over the morning. Response: In consultation with WCHD, the school had sent the children home to obtain primary medical care for the symptoms. WCHD staff along with the Principal, School Nurse, Teacher and Maintenance Director conducted a visual inspection of the classroom. The Interim Director contacted each student’s parents in the evening to follow-up on the health of the child. Methodology: The classroom was assessed for possible irritants. Questions were asked of the morning routine of the students. The students spent approximately ½ hour on the carpet in the classroom prior to recess. Upon returning from recess, the students spent an additional ½ hour on the carpet. Shortly thereafter, the index student showed symptoms of the rash. Five (5) students did not sit on the carpet and did not experience symptoms. The carpet, floors, and desk were visually inspected for gross signs of dirt, dust, residue, and or signs of rodents. The vent duct was inspected and the vacuum cleaner bag used in the classroom was taken to assess the contents. The ventilation path reflects the severity of the rash by where the children were sitting. Questions regarding any new additions to the classroom, new cleaners, recent cleaning and pest control were asked of the School Principal and Staff. Cleaning products used by the school were reviewed for potential sources of irritants. WCHD staff followed up the student’s parents to assess child’s health that evening. Action Items: The carpet is to be cleaned over the weekend (December 11 – December 13) when the children are not present. Instruction for cleaning was provided via facsimile to the School Principal on Thursday evening (December 10) – Attachment A. School staff reported sixteen (16) of the seventeen (17) exhibiting symptoms returned to school on Friday, December 11, 2015. The remaining student was called off by parents indicating that the student still exhibited some rash. School staff will report any recurrence of rash associated with uritcaria (itch) in the identified classroom or any other classrooms in the school. The cause remains unknown at this time.

2. Shigella Outbreak WCHD was in active incident command from 11/20/2015 through 01/04/2016 due to multiple Outbreaks of Shigella. Activation of Incident Command was established once the Communicable Disease (CD) staff had determined they needed to reach out across departments for assistance with the cases.


During this period, the Planning Section, conducted daily investigations on a line list of list of confirmed, probable and suspicious cases. Charts and graphs were generated from the line list of cases to identify specific zip codes, age groups, gender, etc.; in an effort to try to locate the source of the outbreak and contain it. The Planning Section mainly consisted of CD staff and Quality. Various members of the CD staff, whom typically are focused on STD’s, were cross trained to investigate general communicable diseases. The Operations Section conducted inspections of suspected daycares, schools, after care facilities and food distribution locations. They also provided hands-on education to multiple daycares and schools utilizing hand washing education tools called glow germs. A revised health alert and handwashing education materials were also sent out to various establishments that serve children and to faith based organizations. The Operations Section mainly consisted of our Health Equity Officer, Environmental Health staff and our Daycare Nursing Consultant. A Social media campaign on proper Handwashing was conducted and press releases were also sent. The Outbreak can be described in the following graphical presentation and statistical data:


Shigella Outbreak 2015 Statistical Data:

Case Type Count % Race Count of

Confirmed % Confirmed 98 79% Asian 1 1% Probable 26 21% Black 56 57% Suspected 0 0% White 39 40% Grand Total 124 100% Unknown 2 2%

Grand Total 98 100% Treatment Count %

Antibiotic 62 63% None 27 28% Unknown 9 9% Grand Total 98 100%

Age Range Count of

Confirmed % Ethnicity Count of Confirmed %

0-4 26 27% Hispanic 8 8% 5-10 35 36% NH 88 90% 11-13 2 2% Unknown 2 2% 14-17 3 3% Grand Total 98 100% 18-24 9 9%

25-34 12 12% Zip Code Count of

Confirmed % 35-44 4 4% 61080 1 1% 45-54 1 1% 61072 1 1% 55-64 4 4% 61088 1 1% 65-74 2 2% 61101 26 27% Grand Total 98 100% 61102 8 8% 61103 20 20%

Gender Count of

Confirmed % 61104 8 8% Female 64 65% 61107 8 8% Male 34 35% 61108 6 6% Unknown 0 0% 61109 11 11% Grand Total 98 100% 61114 1 1%

61115 3 3% Unknown 4 4% Grand Total 98 100%


• Domain 3 – Inform, Educate, and Empower

On November 13, 2015, Dr. Martell presented to the Governmental Affairs Council of the Rockford Chamber of Commerce. The presentation focused on the Core Functions/Essential Services of Public Health, Public Health Accreditation, and the funding of public health in Winnebago County.

Electronic and Social Media Contacts for November and December 2015

November 2015

WCHD Website Page 10,747 Page Views 4,000 Sessions 3,072 Users Facebook 700 Avg. Weekly Reach 46 Avg. Weekly Engagements 590 Total Likes Twitter 3.1K Impressions Per Day 7 New “Likes” 642 Followers

Intranet Page 3,519 Page Views 1,188 Sessions 874 Users

December 2015

WCHD Website Page 9,153 Page Views 3,252 Sessions 2,526 Users Facebook 623 Avg. Weekly Reach 53 Avg. Weekly Engagements 559 Total Likes Twitter 1.4K Impressions Per Day 9 New “Likes” 651 Followers

Intranet Page 3,277 Page Views 994 Sessions 597 Users

During the months of November and December while in Incident Command, WCHD issued the following five press releases to address the Shigella outbreaks and provide prevention information:

1. Winnebago County Health Department reports an increase in the number of confirmed Shigellosis infection cases in Winnebago County

2. Winnebago County Health Department continues to see numbers rise in Shigellosis cases in school aged children

3. Winnebago County Health Department continues to see numbers rise of confirmed Shigellosis cases in school aged population and remind parents about the importance of handwashing during the holiday season

4. Give the gift of handwashing this holiday season 5. Give the gift of health not illness this holiday season

From the releases, media interviews were conducted and news stories were reported to the community through print, radio, and television. The story was also posted on WCHD and partner social media sites. In total WCHD posted 25 times.

mailto:[email protected]

http://twitter.com/WinnCoHealth

http://www.facebook.com/pages/Winnebago-County-Health-Department-Rockford-IL/222539346139

http://www.youtube.com/user/WinCoHealthDept?feature=mhee

http://www.wchd.org/


A large portion of the WCHD homepage was given to this event, where daily / weekly updates, health alerts, flyers, factsheets, videos were posted. This was done to educate the community on the infection and how to prevent it through proper handwashing techniques. In early December, a press release Get a flu shot during Vaccinate Illinois Week was issued which reminded residents it was not too late to get a flu shot before the holiday season. In late December, a press release Winnebago County behavioral health survey project shift to next phase was issued explaining the next steps of the survey process.

• Domain 4 – Mobilize Community Partnerships

Dr. Martell continued to represent the Winnebago County Health Department on the Transform Rockford (TR) Healthy Lifestyles Spoke workgroup. The team continued its work to identify and refine strategies. The following timeline and milestones have been drafted by the workgroup.

• Mobilization and Planning Phase (1 year) – mobilize community stakeholders, assess current circumstances, opportunities, and barriers around healthy eating, active lifestyles, social and emotional well-being and stress management and create a multiyear strategic plan laying out the intended outcomes and interventions with which to move forward

• Early Implementation Phase (3 years) – Begin initial delivery of interventions and setting of some conditions capable of creating access and demand for healthy eating and active living (HEAL) behavior related outcomes. Creating sustainable behavior changes requires focus and interventions in 2 areas. In one area, interventions should encourage and promote the HEAL process. In the other area, interventions should be created that drive public awareness and desire to engage in HEAL behaviors.

o Strategy 1 – Rockfordians will become more educated on the benefits of proper

nutrition through intervention (medical visits), educational (PSA’s) and outreach programs (i.e. community gardens, healthy foods to food desert, healthy cooking at grocery stores) as a way to address chronic disease and adverse health issues relative to our critical success factors.

o o Strategy 2 – Through a united effort, we are a community encouraging sedentary

and insufficiently active people to become physically active and learning how to overcome barriers and developing plans for incorporating physical activity into our daily lives.


• Implementation Phase (3 years) – Translate interventions into everyday conditions that create access to and demand for specific HEAL behavior related outcomes and to accomplish demonstrable behavior changes among the local population as measured by the Illinois County Health Rankings.

o Strategy 1 – Continue to drive the demand and thirst for knowledge on healthy

foods and nutrition through the elimination of food deserts by continuing to utilize greenspace (community gardens), and having sustainable ways to consistently deliver healthy foods (establishment of grocery stores, conversion of vacated manufacturing space) and making the healthy choice the easy choice (engaging restaurants to alter menus).

o Strategy 2 – Through united neighborhoods and increased interconnectedness, physical activity and engage becomes routine through interconnectedness and availability of programs (increased sporting events through park district, yoga in the park, local events with an activity based theme) uniting the community through solidarity

• Advanced Implementation (2 years) – Focus on one or two specific strategies that provide

policymakers, visitors, and the residents of Rockford the sustainable programs, policies, and environmental enhancements to support HEAL and reduce the impact of chronic diseases and poor health.

o Strategy 1 – Engaged citizens are engaged and united with city planners in the development and repurposing of land and access through development of bike paths, interconnected neighborhoods, conversion of abandoned railroads as bike and pedestrian paths.

As a stakeholder identified in the TR as well as participant in the workgroup, the Winnebago County Health Department was asked to respond to five questions.

• Winnebago County Health Department Responses 1. Does our TR Healthy Lifestyle 5 strategies fit in with your strategies?

Response: Not all of the strategies can be aligned with programmatic strategies of the Winnebago County Health Department at the present time; however, the overarching goals of the strategies are aligned. The strategies represent the following overarching goals:

• Increasing knowledge in the community of the behaviors and conditions that support a “healthy” lifestyle.

• Implementation of evidence-based strategies to support healthy lifestyles. • Advocacy for policy that supports healthy lifestyles.

Each organization must determine appropriate strategies that support the overarching goals in the context of their mission, funding, and expertise. The following strategic initiatives are currently being implemented through the health department but are not outlined in the strategies of TR but address one of the three overarching goals: tobacco control activities; breastfeeding; walking-school bus; policy re: sugar sweetened-beverages (SSBs); Ever-thrive campaign around healthy behaviors during pregnancy; and obesity reduction.


2. What other strategies do you have that support the healthy lifestyles effort? Is there anything else you are doing that you can share? Response: See examples provided for question #1.

3. Would you support our strategies and do you have any input for us on our strategies?

Response: As a member of the TR Healthy Lifestyle team, I fully support the overarching goals. The overarching goals should be adopted by every institution/organization in Winnebago County and strategies should be selected by the individual institution/organization based on their mission, funding, and expertise.

4. Can you see yourself getting more involved with Transform Rockford and Healthy Lifestyles?

Response: I am currently involved and represent the Winnebago County Health Department and will continue participation to further the goals.

5. What does a healthy community look like to you?

Response: A healthy community is one in which members can achieve their maximum potential both individually and collectively without health inequities and supported by societal conditions.

WCHD continues to participate in the BusinessFirst initiative. Program Managers from each agency will reconvene on January 15th to finalize proceduralchanges that would enhance effectiveness and efficiency from both the client/customer and agency perspective.

Internal statistics have determined that BusinessFirst has had no impact on the volume of calls and consultations WCHD Environmental Health Improvement routinely receives. However, this initiative has improved working relationships and communication with other agencies involved in regulation of businesses and has provided the public with more consistent information and enforcement of codes. It is anticipated that the procedural changes will reduce staff time and be more meaningful for the client. The workgroup convened to address the address the Department of Justice (DOJ) Rockford Diagnostic Analysis “Next Steps” to prioritize issues and identify evidence-based strategies and community partners has not met since the retirement of Chief Epperson. The group is anticipated to reconvene in January 2016.


• Domain 5 – Policies and Plans The IPLAN Steering Committee comprised of representative staff from all centers and positions within the health department has been meeting bi-weekly since December 3rd of 2015. The group is developing community engagement strategies to complete the four MAPP assessments. The figure to the left lists the 4 assessments. The first assessment to be completed is the Community Health Status Assessment. This assessment looks at local level data to identify demographics, key risk factors, and current community health status. The Community Health Status Assessment will establish baseline data and house relevant assessment information in a centralized location. The data will be presented to community members with an opportunity for community feedback.

After feedback is garnered and the data is gathered, the findings will be complied and disseminated.

There are 6 steps of this assessment: 1. Prepare for the Community Health Status Assessment. 2. Collect Data and core Indicators on CHSA Indicator List. 3. Identify Locally-appropriate Indicators and Collect the data 4. Organize and analyze the Data; Develop a Compilation of the Findings; and Disseminate the

Information. 5. Establish a System to Monitor the Indicators Over Time. 6. Identify Challenges and Opportunities Related to Health Status.

• Domain 6 – Enforce Laws EHI Code Enforcement Stats

Monthly Inspection

FY 2016 Inspections

FY 2015 Inspections

Foods 613 828 960 Wells 15 30 10 Septic 15 31 42 Loan Inspection 66 115 142

Administrative Hearing Month

In- House Hearing Month

Administrative Hearing (FY16)

In-House Hearing (FY16)

FY 2015 Administrative Hearings

FY 2015 In-House Hearing

Housing 17 59 29 88 36 104 Foods 0 8 0 9 0 4 Well/Septic 0 5 1 5 0 1

In follow up to October 30th discussion with the Rockford Park District regarding the safety of their Splash Blaster water roller coaster ride, the Park District contacted the Illinois Department of Labor


(IDOL) and it was determined their involvement would only be associated with the conveyor belt system. IDOL has agreed to send out an inspector for further evaluation of the ride. The Park District has hired aquatic engineers to do renovations to address the “steepness” of the first drop that was associated with the reported injuries. CoCo Keys still remains closed. There has been no communication that the facility has addressed any of the reported health and safety violations. Continued spot checks have been performed to ensure compliance with the closure order. Illinois Tobacco Free Communities Grant/Smoke-Free Illinois Act Total compliance checks provided for November/ December 2015: 9. The Tobacco Coordinator has partnered with 3 county high schools to begin developing a social norms marketing campaign for high school students. The Tobacco Coordinator will be working with county and local officials to review local ordinances concerning outdoor open spaces, retail licensure laws, and multi-unit housing enforcement. Compliance Check Update on Murphy’s Pub: Ivn Noember 2015, the Tobacco Coordinator visited Murphy’s Pub and Grill, located at 510 S. Perryville Road, Rockford to review violations being reported by an anonymous community member regarding smoking inside the restaurant. The Tobacco Coordinator presented himself to the manager and began to discuss the requirements for the Smoke Free Illinois Act and compliant received. After touring the business the Tobacco Coordinator noted several violations which included not posting the universal sign for “ no smoking” at entrances and exits, smoking within 15 feet of the door way, smoking in a public place, particularly in the “outdoor seating area” which is enclosed with brick walls, plexus glass and doors, and smoking in place of employment. After several attempts to discuss and recheck for changes made with the manager on duty, and no changes completed, the Tobacco Coordinator issued a citation and sent the citation to the owners. In December, 2015 the owner contacted the Winnebago County Chairman to discuss “harassment by the WCHD” in their enforcement activities. A meeting was set up and attended by Dr. Martell, the Health Promotion Supervisor, and the Tobacco Coordinator, the owner, and manager. Violations were reviewed and recommended options to correct violations were reiterated. The citation fee was waived in recognition of the owner’s commitment to implement accepted options to address the violations. A recheck for compliance is scheduled for January 14, 2016. Grant Deliverables Smoke Free Illinois Act Compliance Checks: SFIA Compliance Online Update completed on 5 sites from previous months. The Tobacco Control Compliance Officer mailed 2000 “No Smoking Signs” to restaurants/bars which were included in Environmental Health Department Restaurant Registration Packet, to continue to raise awareness regarding SFIA requirements in restaurants. Coordinator has


developed the SFIA Enforcement Policy and Procedures for WCHD, currently being reviewed for final approval. Social Norms Marketing (SNM) Campaign: The Tobacco Coordinator has met with 3 High Schools Administrators, Jefferson, Auburn and Harlem High School. Tobacco Coordinator will begin working with selected students in each high school beginning January 2016. Development and implementation of a social norms campaign for each of the high schools will take place from January to April, 2016. SNM weekly student curriculum currently being developed is to be used with students in creating tools to discourage tobacco use for their school. Outdoor Open Space Policy: An educational packet for Northwest Community Center and Rockford Boys & Girls Club Executive Directors regarding Tobacco Control strategies in communities including open spaces was developed. Tobacco Coordinator is working with Directors to enhance current policies and implement policies by summer 2016. Multi-Unit Housing Policy Development: The Tobacco Free Communities Grant will be amended to change deliverables from a large Media Campaign to addressing Policy in Multi Unit housing through work with the Winnebago County Housing Authority to strengthen the current Smoke Free Policy including e-cigarette. Tobacco Retail Licensing Policy Development – An assessment packet for The obacco Retail Licensing for Key Stakeholders and identified key stakeholders was developed to support creation of a Smoke Free Winnebago Coalition. Illinois Liquor Control Commission Grant The Alcohol Tobacco and Other Drugs (ATOD) Prevention Specialist completed the first of 3 rounds of Tobacco Compliance Checks with the Winnebago County Sheriff’s Office. The Sherriff’s Office helped to complete the first round of Tobacco Compliance Checks at the beginning of December with the help of their Explorer Kids program and the students who were recruited last grant season. Teams of Sherriff’s Department Officers and students visited 176 tobacco vendors and with 6 tobacco retailers cited for selling tobacco to underage youth. Substance Abuse Prevention Program (SAPP) The ATOD Prevention Specialist has provided 6 Youth Prevention Education (YPE) with a select group of twenty 7th grade boys and girls at Lincoln Middle School. She will be starting 5 other All Star groups of 6th and 7th graders in January at Lincoln, West, and Flinn Middle Schools. Each group will consist of 14 sessions. The program is estimated to reach approximately 70-75 students this school year to build idealism and belief in the future, establish positive norms, and increase students’ personal commitment to avoid risky behaviors. ATOD Prevention Specialist has been in contact with the all the Winnebago County Middle and High Schools to recruit for the Illinois Youth Survey. The surveys are to be done by all 8th, 10, and 12th graders between January and June of 2016. Interested schools will meet with ATOD Prevention Specialist to discuss the importance of IYS and to assist to help get them started.


All Stars Youth Prevention Education is being provided in 3 Middle Schools in Rockford a total of six (6th and 7th) grade classes and approximately 75-80 students. After taking a 2 month break over the holidays, the Winnebago County Substance Abuse Prevention Coalition will resume monthly meetings. We are still in the assessment phase of the Strategic Prevention Framework (SPF). Data is being collected, focus groups are being formed, several key informant interviews of local leaders/politicians were conducted, as well as a survey being formed and added to Power 106.3 website for those between the ages of 13-18. The Coalition is hoping to begin the planning phase of the SPF by August of this year. The Coalition has about 10 consistent members of different sectors such as School, Media, Law Enforcement, Religious, Business, Youth Services, and Public Health.

• Domain 7 – Link to/Provide Care

iGrow

iGrow – Coordinated Intake for Home Visiting

December 2015 FY16

November 2015 FY16

Total YTD FY16

Total FY15

# CIAT Completed (Coordinated Intake Assessment Tool)

102 113 248 660

# Referred to Partner Home Visiting Programs

12 11 56 443

The Health Department received preliminary notification in November that the Community Systems Development portion of the MIECHV funding would be discontinued at the end of March 2016. The discontinuation of the funding is due to the new federal grant funding that places less emphasis on systems building and more emphasis on direct services for at-risk families. The Department submitted a preliminary budget for the upcoming federal grant application which would provide support for WCHD to continue to serve as the coordinated intake site for local evidence based home visiting services. IPC – Affordable Care Act With the notification of the In Person Counselor grant award, the Health Department recalled the Project Manager and 4 In Person Counselors (IPCs) in early November. Recalled ACA staff spent the last few weeks in November completing the 2016 Federal and State training updates before they could help consumers. The ACA Enrollment Center re-opened at the end of November to assist consumers with 2016 open enrollment. In December, the Department hired two (2) new full-time IPCs and three (3) new part-time IPCs. The required licenses for the five (5) new employees are expected to be issued in early January 2016. Consumer demand was high in December for assistance with Marketplace plan changes and help with Medicaid redeterminations and plan selections. The December 15 deadline was extended until December 17 due to the extremely high consumer demand.


The next enrollment deadline is January 15th for February 1st coverage. CMS is again expecting a very high consumer demand. The December deadline saw consumer demand 3 times what it was in the prior year. The tax penalty for not having coverage in 2016 rises to $695 per consumer or 2% of household income, whichever is higher. It is unknown at this point if there will be an extension by CMS on the open enrollment period which ends on January 31. The current hours for the ACA Enrollment Center are Monday- Friday from 8 a.m. to 9 p.m. and Saturday from 8 a.m. – 2 p.m. Dr. Martell and Lisa Gonzalez met with Winnebago County Probations Department to explore a partnership to identify and refer for insurance enrollment. The Probations Department will share client data with the Health Department and the Health Department will query the MEDI system in order to identify those probation clients that have active Medicaid or Medicare coverage. The Probation Department will utilize the information to better refer probation clients for enrollment assistance. The pilot project will begin in early January.

Audio/Visual Program Hearing and Vision screenings took place at a number of private preschool and K-8 programs. Priority for services remains for Preschool age children with a number of preschools scheduled for screenings for January-May. Audio/Vision Program Services for November and December 2015

Hearing Services Totals YTD Total Vision Services Totals YTD Total

Screenings 739 1396 Screenings 515 1156

Re-screenings 27 122 Re-screenings 62 152

Referrals 0 0 Referrals 28 28 Women’s Health Services WCHD continues to provide services which are vital to ensuring access to contraceptive services. This service fills this necessary safety net in the community.

Family Planning December2013

December 2014

December 2015

2015 Year to Date

Number of Clients Seen 402 315 115 2742

New Clients 95 62 17 453

Continuing Clients 307 253 98 2298

Pregnancy Tests 223 179 49 1441


Illinois Breast and Cervical Cancer Program (IBCCP)

On Sunday November 15th, 2015 IBCCP staff attended the “Women’s Health and Resource Fair” presented by Senator Steve Stadelman. The event featured healthcare vendors from the Rockford area such as Silver Lining, Mercy Rockford Health System and several others. The free event provided women in the Winnebago County access to vital local resources in one area.

Health Promotion Clinic Activities Total Clients seen by Health Promotion Clinic at 555 N. Court: 113 patients (66 females and 47 males) with 110 visits (66 visits with females and 44 visits with males). Average visit per day is 5.13.

80%

85%

90%

95%

100%

105%

Breast CancerScreening Cervical Cancer

Screening

90%88%

10%

0%

0%

13%

Abnormal Screening Follow up Completed YTD Target = 60 Days

>90Day

5%

7%

25%

13%

% IBCCP YTD Enrollment By Age n=417

Under 35

35-39

40-49

over 50

State Assigned IBCCP Caseload = 417 YTD Enrolled = 206 (49%)

IBCCP/CDC Program Goal = completion of screening and diagnostic follow-up within 60 days of enrollment


Integrated Clinic Services by Visit Type

Visit Type November December Clinician Visit

Annual 47 40 Initial 19 20 Problem Visit 31 20 Refugee Physical 28 30 Refugee Screening 1 0 STI Clinic-Exam 103 101 STI Clinic-Laboratory 0 1 STI Clinic-Treatment 6 3 TB chart review 0 3 TB Intake 1 1 TB Lab 2 0 TB Physician Visit 8 10 Treatment for STI 0 1

Lab Visit Laboratory Work 1 29 28 PEDS LEADS 0 1 Refugee Screening 39 22 Tuberculosis Test 0 1

Nurse Visit Emergency Contraceptive 3 3 Initial 1 0 Nurse Visit 4 8 PEDS NEW IMMS 41 21 PEDS RETURN IMMS 45 38 Pregnancy Test 18 20 Refills 43 45 Refugee Immunization 60 85 STI Clinic-Immunization 1 1 STI Clinic-Laboratory 0 1 STI Clinic-Treatment 7 4 TB Intake 1 3 TB Lab 0 1 Travel Immunization 1 6 9 Travel Immunization 2 0 1 Treatment for STI 1 1 Tuberculosis Test 9 11 Vaccination 1 36 29 Total Visits 590 563


Dental Sealant Two Dental Providers had seen a combined 1386 children the month of November with a total of 59 children receiving 99 sealants from the Dental Sealant Grant in November 2015. December 2015 numbers are currently being reported by the providers. Influenza Vaccinations

• A total of 2,324 vaccinations were provided by WCHD in community and employer flu clinics from September through November. (Distribution of vaccinations based on payer source: 1127 Medicare, 164 Medicaid, and 1033 personal or employer)

• Flu Shot Billing has been completed on 85% of community flu clinic participants which included primarily Medicare recipients, Medicaid, State of Illinois employees, and several small businesses within Winnebago County.

• Planning will begin this next month to determine action steps for 2016 Influenza season with a focus on vulnerable populations who do not routinely vaccinate against flu.

The Winnebago County Health Department’s complete flu clinic schedule can be found at www.wchd.org. Tuberculosis Care Center Activities November and December 2015:

Clients Seen New Clients

51 Returning Clients 15

Professional Services Physician Contacts 24

Medication DOT (direct observed therapy) Visits 10 Diagnostic Servicies Total Active Case(s) in Winnebago County (YTD) 1

Total Actives Case(s) Being Medically Managed Outside of Winnebago County (Ogle & Boone Counties) (YTD) 0

Monitoring of Active Case(s) Diagnosed in YR2014 for Winnebago County 0

Monitoring of Active Case(s) Being Medically Managed Outside of Winnebago County (Ogle & Boone Counties Diagnosed in YR2014)

0

http://www.wchd.org/


• Domain 8 – Assure Competent Workforce

Total Employees

Full Time Employees

Part-Time and Seasonal

Employees

Employees Utilizing

FMLA

New Hires

Separated Employees

109 90 19 9 5 14

The Holiday All Staff Meeting on December 17, 2015 focused on accreditation and the documents that were provided to support PHAB accreditation by Winnebago County Health Department. Staff had an opportunity to socialize with colleagues and learn something new about their fellow staff and PHAB accreditation. This meeting was a joint effort between Leadership and the Employee Committee. Thanks to the planning committee for a fun and informative meeting.

• Domain 9 – Quality Improvement PHAB UPDATE:

1. Pre-application 100% Complete

2. Application 100% Complete 3. Document Selection and Submission

(detailed sub-steps below) 65% In Progress

Documents Submitted 100% Complete

Completeness Review Provided 100% Complete

Response to Completeness Review 100% Complete Pre-Site Visit Questions & Request for Additional Documentation 25% Pending

Response to Pre-Site Visit Questions and Requests 0% Pending

4. Site Visit 0% Not Started

5. Accreditation Decision 0% Not Started

6. Reports 0% Not Started

7. Reaccreditation 0% Not Started

As part of the IPLAN Process, the Quality Committee of the Board of Health has been meeting regularly in November and December to revise and refresh the Winnebago County Health Department Strategic Plan. The first step of the IPLAN is the review and adoption of an agency’s refreshed strategic plan.


• Domain 10 – Evidence-based Practices The American Public Health Association (APHA) Association Meeting was hosted in Chicago from October 31 through November 4, 2015. The theme for the meeting was Health in All Policies. Sessions

attended focused on address health equity in policy, community assessment strategies, community engagement, and improving maternal and child health outcomes from a population perspective. The work is in process to begin the credentialing process through UICOMR to include participation by the Winnebago County Health Department on the community-wide IRB. Dr. Martell participated in the University of Illinois - College of Medicine National Rural Health Day. The focus was on the “power of rural” to transform the health of the community. This was an opportunity to learn the evidence-based practices to address the health issues of the rural population of Winnebago County including a demonstrations on the current best practices on a grain bin entrapment.

• Domain 11 – Administration and Management WIC /FCM/BBO December

2015 FY16

November 2015 FY16

Total FY16

December 2014 FY15

Total FY15

WIC Total Caseload Assigned – SFY15 = 8,359, SFY16 = 7,523

6525 87%

6681 89%

1933

6450 77%

8,039

FCM Total Caseload Assigned – SFY15 = 2558, SFY16 = 2011

2560 127%

2683 133%

3204

2728 107%

2,776

Better Birth Outcomes (BBO) Total Caseload Assigned - SFY15 = 120, SFY16 = 90

71 79%

71 79%

136

84 70%

545

Dean Alex Stegnaro-Green, MD prepares

to be rescued from the grain bin

http://www.apha.org/


The state of Illinois budget impasse continues to impact reimbursement for expenses covered by state of Illinois grants. Advocacy continues through the Northern Illinois Public Health Consortium, Illinois Public Health Association, and Illinois Association of Public Health Administrators but all programs funded through the state of Illinois are experiencing the same issues. The Family Case Management Program ended as planned on November 30, 2015. Case management services continue for the highest risk clients through the APORS (Adverse Pregnancy Outcome Reporting System); DCFS Medical Case Management Program for wards of the state; and the Better Birth Outcomes (BBO) Programs. Targeted home visiting continues through the MIECHV partners. For the months of November and December 2015, $445,974 was received from the state of Illinois based upon the legislation releasing federal dollars for programs. The Federal Single Audit for the WIC, Ryan White, and Lead Programs was completed by the Winnebago County auditors Sikich LLP in December 2015.

• Domain 12 – Governance

Failure to pass a budget for the State of Illinois continues to impact programs funded solely with general revenue funds (GRF). New Board of Health member, Rob Wilhelmi received an official orientation, overview, and introduction to the Winnebago County Health Department on December 11, 2015. Jaymie Nelson is scheduled for her introduction on

Respectfully submitted on behalf of the Leadership Team by, Sandra Martell, RN, DNP Public Health Administrator Please note that our offices will be closed on Monday, January 16, 2016 in observance of the Reverend Martin Luther King, Jr Holiday.

Wishing all a happy, healthy, and prosperous 2016.

From the Winnebago County Health Department.