Harold Cox Associate Dean, Public Health Practice, Boston University School of Public Health

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1 PUBLIC HEALTH REGIONALIZATION IN MASSACHUSETTS: STATEWIDE TELECONFERENCE/WEBINAR MAY 10, :30P.M. PRESENTED BY THE PUBLIC HEALTH REGIONALIZATION WORKING GROUP Facilitator: Harold Cox Associate Dean, Public Health Practice, Boston University School of Public Health 2 1

John Auerbach, Commissioner Massachusetts Department of Public Health 3 AGENDA Regionalization Working Group Progress and Ongoing Work Report on Subcommittee Work - Phoebe Walker, Director of

2 John Auerbach, Commissioner Massachusetts Department of Public Health 3 AGENDA Regionalization Working Group Progress and Ongoing Work Report on Subcommittee Work - Phoebe Walker, Director of Community Services, Franklin Regional Council of Governments Workforce Credentialing - Donna Moultrup, Belmont Health Director The Practice Based Research Network - Justeen Hyde, PhD, Institute for Community Health Addressing Common Concerns about Regionalization Geoff Wilkinson, Senior Policy Advisor, MDPH Moving Forward with Regionalization Getting Started at the Local Level - Jack Vondras, Director of Public Health, Gloucester Health Department and Sandra Martin, Health Agent, Town of Egremont and Emergency Planner, Berkshire County Boards of Health Association Objectives - Cheryl Sbarra, J.D., MAHB Staff Attorney Question and Answer Session 4 2

3 THE WORKING GROUP Local Public Health Officials Professionals and Advocacy Organizations: (CLPH, MHOA, MEHA, MAHB, MPHA, MAPHN) Legislators (Senator Fargo and Representative Sanchez) Academics (BUSPH) State Agencies (EOHHS, MDPH, MDEP) 5 THE WORKING GROUP 6 3

CHALLENGES TO LOCAL PUBLIC HEALTH NACCHO reports 23,000 local public health jobs lost nationwide between 1/08 and 12/09. 49% of MA Boards of Health received cuts in 2009; 36% lost staff.

Of the 105 towns with fewer than 5,000 residents, most have no full-time public health staff, health inspector, or public health nurse.

4 CHALLENGES TO LOCAL PUBLIC HEALTH NACCHO reports 23,000 local public health jobs lost nationwide between 1/08 and 12/09. 49% of MA Boards of Health received cuts in 2009; 36% lost staff. 70% of MA towns reported inadequate staffing to meet basic legal responsibilities (2006 survey). Of the 105 towns with fewer than 5,000 residents, most have no full-time public health staff, health inspector, or public health nurse. Major cuts to DPH result in reduced technical assistance to local public health. 7 CHALLENGES TO LOCAL PUBLIC HEALTH Local Public Health often lacks resources for: Reporting on infectious disease cases Enforcing environmental health regulations Meeting food inspection requirements Balancing emergency preparedness planning and pandemic response with other work Preventing chronic and infectious disease Addressing health disparities Continued 8 4

WORKING GROUP GOAL To strengthen the Massachusetts public

equitable delivery of local public health services across the

Two or more local health boards or departments collaborating

5 WORKING GROUP GOAL To strengthen the Massachusetts public health system by creating a sustainable, regional system for equitable delivery of local public health services across the Commonwealth. 9 WHAT IS REGIONALIZATION OF LOCAL PUBLIC HEALTH? Two or more local health boards or departments collaborating under a formal agreement to provide a specific set of services. 10 5

BENEFITS Consistency and equity in services provided. Access to a broader range of services and expertise than available in each individual health department.

6 BENEFITS Consistency and equity in services provided. Access to a broader range of services and expertise than available in each individual health department. Economies of scale maximum impact with limited resources. Improved opportunities for grants and other resources. 11 ESSENTIAL ELEMENTS Equity Impact Respect Flexibility Sustainability 12 6

Report on Working Group Subcommittee Work Phoebe Walker Director of Community Services Franklin Regional Council of Governments 13 WORKING

7 Report on Working Group Subcommittee Work Phoebe Walker Director of Community Services Franklin Regional Council of Governments 13 WORKING GROUP SUBCOMMITTEES 2009 ACTIVITIES Developed case statement for regionalization Proposed professional credentials for regional health staff 14 7

8 WORKING GROUP SUBCOMMITTEES 2009 ACTIVITIES Continued Developed a model governance agreement template Created case studies of established regional health districts

10 19 WORKING GROUP SUBCOMMITTEES 2009 ACTIVITIES Continued Conducted legal review of matching requirements Recommended minimum size for regional health district Population of 50,000 OR 155 square miles of land 20 10

11 WORKING GROUP SUBCOMMITTEES 2009 ACTIVITIES Continued Proposed a formula for state regionalization incentive Basic per capita payment. Adjusted based on degree of regionalization, poverty and population density. Practice Based Research Network 21 Public Health Workforce Credentialing Donna Moultrup Belmont Health Director 22 11

12 GOALS OF CREDENTIALS Provide qualified individuals, especially at the district level Salaries usually rise when credentials are required Career ladders are more clear Offer guidance to academic institutions preparing public health practitioners 23 ASSUMPTIONS OR CAVEATS TO RECOMMENDED CREDENTIALS No intention of demoting current staff Credentials intended to upgrade the field; not to eliminate current staff Understand credentials do not guarantee individual abilities Positions will not be left vacant; employers will always have the option of choosing the best available candidate 24 12

13 RECOMMENDED CREDENTIALS Head of a Regional District Advanced degree in public health or related field, 5 years of experience & leadership certification (MA CHO) Head of a Local Health Agency BA/BS with science concentration & 5 years experience and RS/REHS 25 RECOMMENDED CREDENTIALS Continued Environmental Health Professional BA/BS with science concentration & RS/REHS or Associate s or BA/BS with a REHT credential Governing Body Training such as MAHB Orientation course or Foundations course 26 13

14 RECOMMENDED CREDENTIALS Public Health Nurse BS in Nursing required; current MA license and 3 to 5 years public health or community health experience. Continued 27 The Working Group s Practice Based Research Network Committee Justeen Hyde, PhD, Institute for Community Health 28 14

15 WHAT IS A PRACTICE-BASED RESEARCH NETWORK FOR PUBLIC HEALTH? Collaborations between public health practitioners and researchers Identify, design, implement, evaluate, and disseminate solutions to realworld problems in public health practice. Increase the production and translation of research to improve the quality of health care and health outcomes. 29 PRACTICE-BASED RESEARCH NETWORKS FOR PUBLIC HEALTH Robert Wood Johnson Foundation funding in 2008 to be 1 of 5 PBRN sites in U.S. 7 additional sites funded in

16 FIRST INITIATIVE OF THE MA PRACTICE BASED RESEARCH NETWORK Call for proposals in October groups of pilot communities selected Pilot communities are expected to: Demonstrate interest in exploring the feasibility of regionalization Participate in evaluation of the process Develop recommendations and guidelines 31 PILOT SITES FOR REGIONAL PLANNING FOR PUBLIC HEALTH 3 groups 20 municipalities 32 16

17 Addressing Common Concerns about Regionalization Geoff Wilkinson, Senior Policy Advisor Massachusetts Department of Public Health 33 CONCERN 1 What works in one part of the state or for one set of communities won t work for all communities

18 THE REALITY One size does not fit all; different models allow communities to cluster in ways that meet their needs. Few communities face unique public health needs. Concentrate on sameness not differences. Regional needs may vary; neighboring communities best positioned to solve problems together. 35 POSSIBLE MODELS Comprehensive Services District: Formal agreement that all local public health services for two or more municipalities are carried out by one set of employees

19 POSSIBLE MODELS Continued Shared Services District: Formal agreement among two or more municipal boards of health to share some staff (e.g., public health nurse, animal control personnel, epidemiologist, health or environmental inspector) and/or services (e.g., mosquito control, immunizations, tobacco control, emergency preparedness, inspections, investigations). 37 CONCERN 2 When multiple communities share public health services, my town will lose control over public health decision-making and/or resources

20 THE REALITY General law allows for shared services across communities. It is possible to plan for shared services while maintaining local BOHs it s happening now. Regardless of the model, governance and legal policy making authority may be retained by municipal Boards of Health. Option to delegate authority to a District Board 39 CONCERN 3 My community will be forced to regionalize

21 THE REALITY Regionalization Working Group has always promoted core principle that communities need incentives not mandates to participate. The Lt. Governor s Regionalization Advisory Committee (RAC) recommends voluntary regionalization of municipal services. All RAC subcommittees are recommending incentives for regionalization. 41 THE REALITY Continued The Lt. Governor s Regionalization Advisory Committee endorsed an the Working Group s incentive formula to promote public health regionalization

CONCERN 4 Regionalization is being driven by economic factors to cut costs without regard for quality of services. 43 THE REALITY Financial pressures may drive planning.

22 CONCERN 4 Regionalization is being driven by economic factors to cut costs without regard for quality of services. 43 THE REALITY Financial pressures may drive planning. State funding needed for optimal progress; positive results possible using existing resources. We are being forced into the future regionalization is becoming necessary across a range of municipal services. Inclusive planning requires good working relationships in advance between municipal leaders and local public health officials

Engage municipal leaders, health directors and Board of Health members in planning from the beginning.

23 WORKING GROUP RECOMMENDATIONS FOR EFFECTIVE REGIONAL PLANNING Capitalize on retirements and staff vacancies. Ensure that municipal leaders view local public health as a core part of government. Engage municipal leaders, health directors and Board of Health members in planning from the beginning. 45 Recommended Steps to Regional Coordination & Technical Assistance Sandra Martin, Health Agent, Town of Egremont and Emergency Planner, Berkshire County Boards of Health Association Jack Vondras, Director of Public Health, Gloucester Health Department 46 23

REMINDER: WHY ARE WE EXPLORING REGIONALIZATION?

24 REMINDER: WHY ARE WE EXPLORING REGIONALIZATION? Improve our delivery of mandated/needed services Ensure better health outcomes Leverage our resources 47 ESSENTIALS FOR REGIONAL COORDINATION 1. Legal Agreement with enough towns 2. Regional Oversight/Governing Council 3. Fiscal Agent 48 24

BRING TO THE TABLE LBOH members Health Department/LBOH Staff/Agents Town/City Administrators Chief Elected Officials/Managers Fiscal Agent Technical Assistance as needed 49 RECOMMENDED STEPS TO

25 BRING TO THE TABLE LBOH members Health Department/LBOH Staff/Agents Town/City Administrators Chief Elected Officials/Managers Fiscal Agent Technical Assistance as needed 49 RECOMMENDED STEPS TO REGIONAL COORDINATION 1. Assessment - Wants and needs - Resources, including taxes, fees, and seed money 2. Policy - Priorities - Strategies - Fiscal - Legal Structure - Agreements 3. Assurance - Education and buy-in with community - Implementation and quality assurance 50 25

26 ASSESSMENT HOMEWORK What would your town/city like to achieve? Access to grants Better disease reporting and follow up Better health outcomes Shared inspectors Coordinated fees and standards Access to shared services like bacteria lab for beach/pool testing, rabies/animal control, hoarding response, tobacco control 51 POLICY HOMEWORK What model do you think would work for your town? Shared Grants Wellness, Drug Prevention, Tobacco, others. Shared services - Public Health Nurse, Solid Waste Management, Animal Control, others. Shared staff Pool inspector, temporary food inspector, housing inspector, body art inspector, tanning salon inspector, camp inspector, others. Shared Health Department 52 26

27 ASSURANCE HOMEWORK What are your questions/concerns? Will it cost my town/city money? Will my LBOH lose authority? Will we lose capacity/services/jobs? Will it be too hard to implement? Who will do all this work? Will there be grant money? What happens when we lose the grants? How do we start? 53 FINAL STEPS Legal Structure: Chapter 40 Inter-Municipal service agreements by Selectmen/Mayors/Managers Chapter 111 Authorization by Town Meeting/City Council and Board of Health Partnerships with other agencies/organizations Budgets Seed money Grants Partnerships to leverage resources Implementation 54 27

28 TECHNICAL ASSISTANCE Two working meetings for communities exploring regionalization Westfield May 27 5:30-8:00pm Waltham June 2, 5:30-8:00pm Registration required: 55 Next Steps for 2010/2011 Cheryl Sbarra, J.D., Staff Attorney Massachusetts Association of Health Boards 56 28

29 NEXT STEPS FOR 2010/2011 Office of Local Public Health Credentialing Tracking of public health regionalization Address follow-up survey results 57 Questions & Answers 58 29

30 Thank you for joining us. For more information on the Public Health Regionalization Working Group and for the subcommittee reports, visit: Please complete our brief on-line survey. The link will be forwarded to you via

Less than 10 miles miles miles miles. 5. More than 100 miles. 1. Boston. 2. Central MA. 5. Southeast MA. 6.

Less than 10 miles miles miles miles. 5. More than 100 miles. 1. Boston. 2. Central MA. 5. Southeast MA. 6. Massachusetts Public Health Regionalization Project: A Statewide Conversation Sponsors and supporters: February 29, 2008 Coalition for Local Public Health MA Association of Health Boards MA Environmental