Board of Health. Dan Martindale, M.P.A. Public Health Director. Date: June 22, 2016 (reflects May 2016) Director s Report

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1 To: From: Board of Health Dan Martindale, M.P.A. Public Health Director Date: June 22, 2016 (reflects May 2016) Office of the Director Re: Director s Report Acronyms EPCPH El Paso County Public Health CDPHE Colorado Department of Public Health and Environment Office of Communication (OOC): Television News Media Media value dollar figures reflect equivalent costs for 30-second spot advertising during the respective newscasts and times. There are other stories, as well as coverage and video on local news media outlets websites that are not included in this news media value report. Topic Date Media Outlet Number of viewers Estimated Value Fox Friend in the Business: 5/4/16 KXRM (Fox) 7,241 $ Tobacco Targets Youth Marijuana use while pregnant 5/9/16 KXRM (Fox) 1,760 $ Zika in Colorado 5/12/16 KXRM (Fox) 2,487 $ Youth Suicide 5/19/16 KOAA (NBC) TBD TBD West Nile Virus 5/31/16 KOAA (NBC) 3,877 $1, TOTAL 15,365 $3, Print/Online Colorado Springs Independent, Be aware of nasty microbes that might lurk in the water, by Pam Zubeck. Tara Olson, REHS, Environmental Health Specialist, discussed how recreational water facilities are inspected Fox 21 News Online: Interview provided by Dr. Chris Nevin-Woods, Medical Director The Gazette, Wells tested in Widefield, Security and Fountain areas exceed EPA advisory limits for damaging chemicals, by Jakob Rodgers. Tom Gonzales, Deputy Director, and Aaron Doussett, Environmental Health Program Manager discussed the new EPA advisory levels set for human-made chemicals KOAA Online, Teen suicides up in El Paso County, by Andy Koen. El Paso County Public Health provided data from the Child Fatality Review Team. 1

2 The Gazette, "More Colorado Springs Area Homes May Be Using Contaminated Water," by Jakob Rodgers. Tom Gonzales, Deputy Director, and Aaron Doussett, Environmental Health Program Manager discussed the new EPA advisory levels set for human-made chemicals. Radio iheart Radio. Dr. Chris Nevin-Woods discusses Zika virus prevention and risks with radio personality Captain Dan. Segment airs across all iheart radio stations in Colorado Springs. News Release Joint Press Release with The Colorado Department of Health & Environment and El Paso County Public Health, EPA issues new perfluorinated compounds health advisory Public Health urges residents to fight the bite against mosquitoes to prevent West Nile Virus. Communication Support Maintained current information on an Emerging Infectious Diseases page, FAQs, infographic and key messages to provide updated public health information about the Zika virus. In response to updated EPA health advisories for PFCs, updated EPCPH s PFC fact sheet, letter to private well owners, website, and coordinated with CDPHE and EPA to develop joint news release. Completed the 2015 El Paso County Public Health Annual Report Partnered with Peak Vista to develop communication materials for new Dental Hygienist program at EPCPH. Partnered with the American Diabetes Association to create Spanish-language flyer promoting WIC, Immunization Clinic, and Clinical Services programs. Social Media Created and posted social media content on Mental Health Month, National Women s Health Week, Air Quality Awareness Week, communicable disease prevention tips, and Tobacco Targets Youth educational information. 945 Facebook page followers with an average of 9,687 unique users reached daily 2,098 Twitter followers with 89,900 tweet impressions. 128 Instagram followers Website statistics 7,342 new visitors to the site with 22,138 page views Development and Strategic Initiatives: Convened more than 30 agencies as part of the Healthy Community Collaborative for second round of data presentations to inform the 2017 Community Health Assessment. Data presented included Mental Health and Substance Abuse, Oral Health, Safe Food, and Infection Prevention. Staff participated in Community Health Assessment Planning System training conducted by Colorado Department of Public Health and Environment. Received $12,000 grant from The Colorado Trust to present Health Equity Learning Series and include health equity in the 2017 Community Health Assessment. Public Health Planner attended Practical Playbook National Meeting in Baltimore as part of our partnership with LiveWell Colorado Springs and Penrose-St. Francis Health Services to improve health in

3 Public Health Planner had two poster presentations accepted to the American Public Health Association s annual conference, to be held in Denver in November. The posters are titled: Impact of a hospital cafeteria price incentive program on healthy eating and the bottom line and "Food Preparation Policies Result in Healthier Lunch Sides in Public Elementary School Cafeterias." Communicable Disease (CD): Disease May Totals 2016 (Jan - May) 2015 (Jan - May) 2015 Totals Botulism, Infant Campylobacter Carbapenem Nonsusceptible Enterobacteriaceae Cholera Creutzfeldt-Jakob Disease Cryptosporidiosis Dengue Fever Giardia Haemophilus Influenzae Hemolytic Uremic Syndrome Hepatitis A Hepatitis B (Acute) Hepatitis B (Chronic) Hepatitis C (Acute) Hepatitis C (Chronic) Influenza (Hospitalized)* Legionellosis Listeriosis Malaria Measles Meningococcal Disease Mumps Pertussis Q Fever (Acute) Q Fever (Chronic) Relapsing Fever Rocky Mountain Spotted Fever Rubella Salmonella Shigellosis Shiga Toxin Producing E. coli

4 Invasive Strep Pneumo Tularemia Typhoid Fever Varicella (Chickenpox) Vibriosis West Nile Virus Total Table 1 Notifiable diseases reported to El Paso County Public Health *The influenza season began October 4, 2015 and ran until May 28, In it ran from September 28, 2014 until May 23, Outbreak Setting Type Etiology Env. Health Referral? Total Number Ill Long Term Care Facility Person-to-Person Influenza B No 5 El Paso County Jail Person-to-Person Influenza B No 6 Retail Food Establishment Point Source Unknown Toxin Related to Fiddlehead Ferns Yes 64 Retail Food Establishment Point Source Clostridium Perfringens Yes 11 Retail Food Establishment Point Source Unknown Toxin Yes 2 Total 88 Table 2 Outbreaks reported to El Paso County Public Health, May 2016 Possible Foodborne Illness Complaints # Referred to Env. Health 15 6 Table 3 Foodborne illness complaints received at El Paso County Public Health, May 2016 Responded to 27 calls regarding human or pet exposures to potentially rabid animals, or other rabiesrelated concerns. From those inquiries four animals were tested for rabies (one cat, one fox, one raccoon, and one bat) all tested negative. Persons recommended for rabies post-exposure prophylaxis (PEP): 2 Total rabid animals for 2016: 0 Presentations Facilitated by CD/TB Staff: o Presentation to School District 20 nurses providing general information about the CD/TB programs at EPCPH, including mandatory disease reporting o Two presentations to El Paso County Criminal Justice Center medical staff about infection control and prevention, including healthcare versus community acquired infections, and general information about mandatory disease reporting to EPCPH CD/TB programs o Forensic epidemiology workshop including multiple presentations about forensic epidemiology and coordination of investigations related to intentional biological or chemical outbreaks with the FBI o Colorado Epidemiology Conference facilitated by EPCPH staff, including presentation about how to use excel for organizing and presenting outbreak data o Presentation about social determinants of health and health indicators of El Paso County for board members of the Colorado Health Trust Tuberculosis (TB) activities for May: New active TB cases investigated: 2 4

5 New suspect TB cases investigated: 4 Cases on Direct Observed Therapy (DOT): 1 Cases on Directly Observed Preventive Therapy (DOPT): 3 Total DOT/DOPT visits: 41 General TB skin tests done: TB - 18, IZ 24 TB blood tests (Quantiferon) done related to contact investigations: 7 TB skin tests done related to contact investigations: 0 Contact investigations ongoing: 3 Contacts evaluated/tested: 7 Refugee and/or class B immigrant TB evaluations: 7 Other community referred evaluations: 9 Latent TB infection (LTBI) cases under treatment: 14 LTBI cases completing treatment this month: 3 Environmental Health (EH): Drinking Water and Onsite Wastewater Treatment Systems (OWTS) Co-presented a private well water and OWTS maintenance workshop with CSU Extension at the Black Forest Community Center. There were over 70 residents in attendance. El Paso County Public Health, in conjunction with the Colorado Department of Public Health and Environment and the U.S. Environmental Protection Agency, are continuing work with residents in the Security-Widefield-Fountain area who are on private water wells to sample water for Perfluorinated Compounds (PFCs). To date there have been 21 private wells tested, with 16 lab analysis results received. EHS Individual Staff Plan Developed a new EHS individual staff plan to enhance efficiency. This itemized plan identifies each program, each programmatic activity, each time commitment per activity, and then distributes workloads equitably among all staff members. This plan empowers staff to schedule their unique workloads (inspections and plan reviews) in concert with other duties to achieve successful work-based outcomes. Laboratory Performed 593 bacteriological well water tests, 349 public water systems and 244 private wells. There were 53 test performed for inorganic anions (nitrates and nitrites). The Laboratory performed 911 hemoglobin tests for the Women, Infant and Child (WIC) program. Land-Use and Planning There were five El Paso County Development Services Division projects submitted for review and comment. One proposed project being considered is a new 283 single family residential development with 114 acres of open space and a 199-acre golf course. All of these lots will utilize individual wells and OWTS. School Safety The Supplemental Environmental Projects (SEP) grant program received six applications from local high schools. EPCPH awarded $1, to each school to address inspection deficiencies and improve student safety. These monies will go towards new eye wash safety stations, goggle sanitizing equipment, and acid cabinets. 5

6 Environment Health Activity May Total 2015 Total Air Quality Construction Permits Air Quality Open Burn Permits Air Quality Complaints Body Art Inspections Body Art Follow-up Inspections Body Art Complaints Child Care Regular Inspections Child Care Follow-up Inspections Child Care Complaints Land-Use Planning Review OWTS Final Inspections OWTS Soil And Site Evaluations OWTS New Permit Applications OWTS Repair Permit Applications OWTS Application Design Reviews OWTS Acceptance Doc for Title Transfer OWTS Pumper Truck Inspections OWTS Complaints Recreational Water Safety Inspections Recreational Water Follow-up Inspections Recreational Water Complaints RFE Regular Inspections RFE Follow-up Inspections RFE Complaint Investigations RFE Plan Reviews School Safety Regular Inspections School Safety Follow-up Inspections Waste Tires Facilities Regular Inspections Waste Tires Follow-up Inspections *First year of program Emergency Preparedness and Response (EPR) Emergency Preparedness and Response Team attended Catastrophic Incident Annex Training at the Colorado Springs Emergency Operations Center. This training enabled our team to meet with local partners and familiarize ourselves with the Colorado Springs Office of Emergency Management s execution matrix for hazardous events. Program manager presented at Grand Rounds for Penrose Hospital. The topic was Integration of Medical Reserve Corps volunteers in the Waldo Canyon Fire response. Coordinator conducted a South Central Healthcare Coalition Communications drill with 41 partnering agencies. The communications drill tested partnering agencies ability to receive and respond to vital healthcare communications utilizing pre-identified emergency and backup systems. 6

7 Coordinated the annual Sky Sox Preparedness Day. During this event, community members were provided educational materials in order to promote public health preparedness for a real world emergency. Attended a Colorado Springs Airport tabletop exercise to discuss and identify gaps in local preparedness plans, policies and procedures in response to an aviation related incident or accident. Epidemiologist developed, coordinated, and hosted the first epidemiology conference for the state of Colorado. One hundred participants from across the state attended this daylong event at the Olympic Training Center. Staff also developed a table top exercise for participants, providing an opportunity to apply knowledge and lessons learned to a scenario involving a case of a highly pathogenic emerging infectious disease. Attended a two-day spiritual and emotional care in disasters workshop. This workshop enabled our team to build relationships with spiritual and emotional care providers who serve as primary resources for post-disaster support. All Public Health staff attended active shooter hands-on-training hosted by El Paso County Sheriff s Office. Attended a joint criminal epidemiological investigations course. This course provided an opportunity to improve our ability to work together with law enforcement in response to a potential bioterrorism event. Toured the Fountain Creek Recovery project with Colorado Springs Utilities. This tour enabled our team to visually conceptualize the process for activating Fountain Creek Recovery when downstream water is at risk of contamination. Hosted the Leadership in Times of Crisis training for the South Central Healthcare Coalition in Teller county and for the management team at the health department. Health Services May Total 2016 Total 2015 Total Health Care Program for Children with Special Needs (HCP) caseload HCP referrals Information only HCP clients Nurse Family Partnership (NFP) clients served NFP completed and attempted visits WIC client caseload 12,943 64, ,658** QuitLine referrals EPCPH and DHS Child immunization visits Adult immunization visits Travel client visits Total number of vaccines given Strong and Healthy Families (SHF) Clinical Services (total) 260 1,050 * Completed visits. **Cumulative monthly totals for 12-month period in Monthly average during 2014 was 14,773. Clinical Services Outreach Activities: Clinical Services manager presented to the women in the Strong and Healthy Families Program educational information about a variety of available services. Clinical Services manager provided 7

8 reproductive educational information and materials to women at ComCore. They were provided Clinic fliers for services available for women and men. The presentation was interactive with questions from the audience. Cancer Outreach Coordinator Activities: The Outreach Coordinators participated in presentations and community events to provide educational information, and resources for community events, agencies and medical providers. They meet with staff at 10 medical offices and had direct contact with 149 community members. They provided information and brochures for breast, cervical and colorectal cancer screening, information about Clinical Services and Immunization services. Providers reported a range of barriers to care for Medicaid eligible patients to include transportation, awareness of preventive screenings, fear of test results and out-of-pocket costs. Maternal Child Health (MCH) Child Health/Early Childhood Obesity Prevention (ECOP): Through partnership with Beth-El College of Nursing at UCCS, four nursing students completed their public health clinical under the direction of our Community Health Educator (CHE). This collaboration resulted in more than 400 hours of student nurse time devoted to the delivery of health education activities and messages to support to our ECOP activities in the community. Our Community Health Educator (CHE) and Public Health Information Officer were invited by CDPHE to participate in the development of a video entitled This is MCH which will highlight Maternal Child Health Program efforts in Colorado. Specifically EPCPH staff were invited to share their experiences related to the development and dissemination of consistent messages for the Early Child Obesity Prevention (ECOP) priority. Community Health Educators (CHEs) facilitated the following trainings in May: Healthy Eating Active Living (HEAL) for Early Learning providers. Immunization/Travel Program (IZ) During IZ clinic s second full month of providing vaccines for privately-insured clients through VaxCare, we served 35 insured clients giving 56 vaccines. Nursing staff completed two Vaccines for Children (VFC) provider site visits. IZ clinic served 42 adult refugees and 41 walk-in clients in May. Tobacco Education and Prevention Partnership (TEPP) Youth Initiatives Assisted with Students Working Against Tobacco (SWAT) meetings in five schools (Palmer High School, North Middle School, Harrison High School, Panorama Middle School, and Sand Creek High School). Students participated in lessons about tobacco use and tobacco policies, and they prepared and presented information about tobacco-free policies to school administration. Presented tobacco prevention materials to youth at Urban Peak and Boys and Girls Club. Policy Efforts TEPP staff met with a Colorado Springs City Council representative regarding future plans for the ongoing Non-Cigarette Tobacco Retailer License initiative. TEPP plans to continue exploring opportunities to partner with Colorado Springs city officials to advance overall tobacco prevention efforts. In May, the City of Fountain Police Department conducted tobacco retailer inspections at 17 establishments with assistance from the Colorado Springs Vice, Narcotics, and Intelligence unit. Three 8

9 stores were found in violation of selling a tobacco product to a minor and appropriate citations were issued. Since implementing its non-cigarette tobacco retailer license requirement in 2011, the city has seen violation rates decline from nearly 50 percent to 17.6 percent. The City of Fountain sergeant who oversees all enforcement activities related to its non-cigarette tobacco retailer license was selected to speak with about 20 state-wide tobacco prevention grantees. Via conference call, the sergeant discussed the agency s efforts to help prevent underage tobacco sales. Tobacco Education, Cessation and Prevention TEPP staff partnered with the Strong and Healthy Families program to present and discuss a variety of tobacco education and cessation topics to 12 women enrolled in the program. Tobacco Education and Prevention Partnership Media efforts For May 2016 (Tobacco Targets Youth paid campaign began on 3/14/16) TobaccoTargetsYouth.org: 4,649 Pageviews 88.45% of clicks come from Social Media (99.97% from Facebook and.03% from Instagram) 5.79% of clicks come from typing in the link directly 4.37% of clicks come from referral sites (KKTV, Fox, KOAA, etc ) 1.39% clicks come from an organic search Instagram has 373 followers, (up from 363 in April) with an increased engagement of 2.76% Campaign Reach to date: Facebook/ Instagram reach: 164,941 individuals 22,738 Post engagements (likes/ reactions/ comments) 5,450 Clicks on our website from social media Google reach: 28,373 views, 100 Website clicks YouTube reach: 240,079 Impressions, 18,253 PSA views Tobacco Targets Youth PSAs on: KRDO, KKTV, KXRM, KOAA, Cumulus stations (KVOR, KKPK) iheartmedia stations (KKLI, KVUU) and KRDO News Radio Average net reach: 279,458 individuals Attended the Chief s Youth Advisory Council (CYAC) final meeting of the year. The council chose suicide awareness as the campaign they wanted to focus on, and EPCPH provided assistance to them in developing a survey on youth suicide that was distributed to the high schools that participate in CYAC. Youth Suicide Prevention (New Program in Development) Attended the Behavioral Health Opportunities in Education (BeHOpE) work group meeting. This group is comprised of representatives from the Colorado Springs Fire Department, UCCS, Peak View Behavioral Health, Aspen Pointe, and Pikes Peak Suicide Prevention. Members of this work group will be developing a standard of care and appropriate response protocols that address behavioral health concerns among teens. Met with Executive Director of Learning Services for Academy School District 20, and SAFE Counselor for Rampart High School, to discuss teen suicide prevention efforts in District 20 and ways in which the district can partner with EPCPH moving forward. District 20 was encouraged to provide representation to the El Paso County Child Fatality Review Team and to be involved in the youth suicide prevention coalition we will be convening. Attended the El Paso County Child Fatality Review Team meeting to provide an update on teen suicide prevention activities to date. Participated in case reviews in an attempt to identify opportunities for prevention/intervention in the future. 9

10 Met with Associate Dean for the Colorado Springs Branch of the University of Colorado School of Medicine, to discuss suicides and firearm-related suicides. Associate Dean has offered to assist in getting the word out to primary care providers in our community regarding our youth suicide prevention coalition. Co-presented a Social Determinants of Health presentation for the Colorado Trust Board. Provided data on the issue of youth and adult suicide in El Paso County. Met with Executive Director of Safe2Tell, to discuss youth prevention efforts and issues as it relates to youth suicide, youth substance use/abuse, and school safety. As a result, we planned an Issues Facing Youth Discussion meeting with key stakeholders. Met with Senior Vice President of Community Impact at Pikes Peak United Way (PPUW), to discuss the recent teen suicides in our community, and the support that PPUW can provide for teen suicide prevention moving forward. 10