Local Health Department Staffing and Services Summary Fiscal Year 2017 North Carolina Department of Health and Human Services November 2017
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Local Health Department Staffing and Services Summary Fiscal Year 2016 2017 1908 Mail Service Center Raleigh, North Carolina 27699-1900 (919) 733-4728 www.schs.state.nc.us
State of North Carolina Roy Cooper, Governor www.ncgov.com Department of Health and Human Services Mandy K. Cohen, MD, MPH, Secretary www.ncdhhs.gov Elizabeth Cuervo Tilson, MD, MPH State Health Director Daniel Staley, Division Director www.publichealth.nc.gov Eleanor Howell, MS, Director www.schs.state.nc.us Authors Kathleen Jones-Vessey Farnaz Chowdhury April Duval November 2017 The Department of Health and Human Services does not discriminate on the basis of race, color, national origin, sex, religion, age or disability in employment or the provision of services.
Table of Contents Introduction...................................................................... 1 Changes to the Survey Instrument...1 Staffing (Section A)................................................................ 3 Local Health Department Occupations and FTEs...3 Total FTEs...3 Recruiting Difficulties............................................................ 4 Trends in FTEs for Specific Occupational Groups...................................... 4 Occupational Composition of LHDs...5 Trends in FTEs by County...5 Public Health Services (Section B)...7 Health Support Services...7 Environmental Health............................................................ 7 Personal Health...12 Bilingual Health Initiatives (Section C)...15 Non-English Information and Education Material in LHDs.............................. 15 Bilingual Staffing and Services...15 Other Topics (Section D)...17 Cultural Diversity...17 Internet Access...17 Governing Body...17 iii
Introduction This survey is the latest in a series of surveys of North Carolina health departments which, since 1984, have provided a count of health department employees by occupational groups, a summary of essential public health services, and assessments of other topics, such as bilingual health initiatives and the use of information technology in health departments. All surveys have been oriented to the state s fiscal year: beginning July 1 and ending June 30 of the subsequent year. The current survey was administered in the spring of 2017, and covers the 2016 2017 fiscal year (FY2017). All of North Carolina s 100 counties are represented in this survey. A total of 85 surveys were returned, consisting of 79 single-county health department respondents and six multi-county district health department respondents. The district health departments included are: (1) Alleghany, Ashe and Watauga counties (Appalachian District); (2) Granville and Vance counties; (3) Martin, Tyrrell and Washington counties; (4) Rutherford, Polk and McDowell counties; (5) Avery, Mitchell and Yancey counties (Toe River Health District); and (6) Albemarle Regional Health District (consisting of Bertie, Camden, Chowan, Currituck, Gates, Pasquotank and Perquimans counties). In this report, we summarize the data from the FY2017 survey, and we present comparisons with prior years of the survey where possible. For the section of the survey on staffing, we use the same definitions that have been used in the past to calculate the number of full time equivalent (FTE) employees in order to ensure consistency across reports. Throughout this report, health department respondents are referred to as health departments, health departments/health districts or LHDs (Local Health Departments). Changes to the Survey Instrument The Information Technology (IT) section of the survey was eliminated for FY2017. Minor additions to the survey were made to reflect current health services categories and occupational categories. 1
Table 1. Health Department Staffing for FY2017: Full-time Positions, Part-time Hours, Annual Contract Hours and FTEs by Occupational Category Occupational Category: Total Funded Full-time Positions Total Weekly Hours Worked by Part-time Staff Annual Contract Staff Hours Worked Total FTE (Not Total FTE Including (Including Contract) Contract) % LHDs with Difficulty Recruiting Health Director 82 78 4,598 84 86 10.6% Administrative/Management Support Staff 1,867 2,092 39,325 1,919 1,939 4.7% LAN/PC Support 45 30 5,439 46 48 1.2% Physician 28 668 32,911 45 61 17.6% Physician Assistant 56 776 2,655 75 77 12.9% Dentist 42 90 12,537 44 51 16.5% Dental Assistant 95 129 4,544 98 100 8.2% Dental Hygienist 47 445 0 58 58 9.4% RN (Clinical) 1,334 4,723 10,217 1,452 1,457 35.3% RN (Enhanced Role) 284 310 1,950 292 293 24.7% RN (Home Health) 152 230 3,342 158 159 15.3% LPN (Clinical) 80 84 800 82 83 4.7% LPN (Home Health) 8 0 1,942 8 9 1.2% Occupational Health Nurse 2 0 0 2 2 1.2% Nurse Practitioner 116 484 19,848 128 138 42.4% Certified Nurse Midwife 16 107 4,069 19 21 4.7% Pharmacist 18 108 10,653 21 26 3.5% Nutritionist 390 734 5,613 408 411 25.9% Therapist 68 0 5,001 68 71 3.5% Social Worker 422 584 12,426 437 443 8.2% Environmental Health Specialist 715 726 6,185 733 736 34.1% Environmental Health Technician 11 0 15 11 11 2.4% Public Health Investigator 10 0 0 10 10 2.4% Lab Technician 180 122 6,003 183 186 9.4% X-Ray Technician 3 0 0 3 3 1.2% Health Educator 283 300 22,773 291 302 11.8% Interpreter, Spoken Language 207 315 22,349 215 226 4.7% Aides (all types) 159 232 34 165 165 1.2% Landfill Operators/Workers 32 954 29 56 56 1.2% Animal Control Officers 79 1,007 0 104 104 4.7% Epidemiologist/Statistician 11 0 587 11 11 2.4% Community Health/Outreach Worker 78 132 2,639 81 83 4.7% Preparedness Staff 46 100 4,571 49 51 7.1% Public Information Officer 21 8 0 21 21 4.7% Other 894 1,523 17,186 932 941 3.5% TOTAL 7,881 17,091 260,241 8,308 8,438 * Note: Part-time hours per week were converted to FTEs by dividing by 40; annual contract staff hours were converted to FTEs by dividing by 2000. Full time and FTE figures are rounded to the nearest whole number. 2
Staffing (Section A) Local Health Department Occupations and FTEs Table 1 presents data regarding Health Department staffing for FY2017. Data are presented for each occupational group, and include the total number of full-time positions, the total hours worked by part-time staff per average week, the annual number of contract staff hours worked, as well as the total FTEs both including and excluding contract staff. FTEs excluding contract were calculated as the number of full-time funded positions, plus the number of part-time hours divided by 40 (one work week). FTEs including contract were calculated as the number of FTEs (as calculated above) plus the number of annual contract hours reported divided by 2000. Total FTEs In FY2017, there were 8,308 full-time equivalent employees in county health departments (not including contract personnel), which is below the FY2013 FTE total by 353 employees (Figure 1). The number of FTEs employed in North Carolina health departments has decreased 14 percent since reaching a peak in FY2007. 12,000 Figure 1 Full-time Equivalent Employees, FY1989 FY2017 (Not Including Contract Personnel) 10,000 8,000 6,000 5,839 6,336 7,026 8,179 8,236 8,595 9,480 8,705 9,676 9,567 8,769 8,661 8,308 4,000 2,000 0 1989 1990 1993 1995 1997 1999 2003 2005 2007 2009 2011 2013 2017 * Note: 2003, 2007, 2009, 2011, 2013 and 2017 were the only years with a 100 percent survey response rate. Survey was not administered in 2015. 3
Recruiting Difficulties The FY2017 survey also asked if health departments/districts had experienced difficulties recruiting for specific occupational groups, as presented in Table 1. The occupational groups that health departments reported having the most difficulties recruiting for included Nurse Practitioners (42%), Clinical RNs (35%), Environmental Health positions (34%), Enhanced Role RNs (25%) and Nutritionists (26%). Trends in FTEs for Specific Occupational Groups In Figure 2, trends from FY1989 FY2017 are shown for three of the largest professional groups working in North Carolina health departments: nurses (LPNs and RNs), management support staff and environmental health specialists. Within the nursing profession, the total number of FTE nurses increased by 10 percent from FY1989 to FY2017 (194 FTEs). The number of environmental health specialist positions increased by 20 percent (120 FTEs) during this time period. In addition, administration/management support staff positions also increased by a total of 245 positions (15%) from FY1989 to FY2017. From FY2013 to FY2017, nursing and administrative staff both decreased, while the number of environmental health specialist FTEs increased slightly (3%). 3,000 Figure 2 Trends in Staffing for Specific Occupational Categories, FY1989-FY2017 (Not Including Contract Personnel) FTE Employees 2,750 2,500 2,250 2,000 1,750 1,500 1,250 1,000 750 500 250 0 1989 1990 1993 1995 1997 1999 2003 2005 2007 2009 2011 2013 2017 Fiscal Year Total Nursing Administration/Management Support Staff Environmental Health Specialist 4
Occupational Composition of LHDs Figure 3 shows the distribution of all public health occupations in North Carolina health departments for FY2017. The nursing profession made up the largest percentage of personnel with 28 percent, followed closely by administrative and management support staff with 26 percent. The remaining specified occupations aides, environmental health specialists, social workers, nutritionists and health educators accounted for approximately 26 percent of all health department personnel. Other occupational categories comprised an additional 20 percent of health department staff. The FY2017 occupational distribution is similar to the results reported in the FY2013 health department survey, with nurses representing 28 percent and support staff representing 26 percent of the health department personnel. Trends in FTEs by County Table 2 shows the change in the number of FTEs and percentage change from FY2013 to FY2017. Overall, 56 of 85 health departments/health districts (66%) reported that they lost FTE positions since the last survey was conducted. Another 28 percent (n=24) health departments reported that they gained FTE positions during this time period. Between FY2013 and FY2017, there was no change in the reported number of FTEs for five health departments (they lost or gained one or fewer positions during this time period). Figure 3 FTE Employees by Occupation, FY2017 ( Not Including Contract Employees ) Other 20.2% Nurses 27.8% Health Educators 3.4% Nutritionists 5.2% Social Workers 5.1% E.H. Specialists/Techs 8.4% Aides 4.1% Admin/Mgmt Support 25.8% 5
Table 2. Health Department Staffing: Change in Number of FTEs FY2013 FY2017, Number and Percent Change by Health Department 2013 FTEs 2017 FTEs Percent Change 2013 FTEs 2017 FTEs Percent Change Alamance 100 92-8.0% Jackson* 50 57 14.0% Albermarle District 351 210-40.2% Johnston 135 146 8.1% Alexander* 34 29-14.7% Jones 21 19-9.5% Anson 19 19 0.0% Lee 38 42 10.5% Appalachian District 91 79-13.2% Lenoir 60 50-16.7% Beaufort 43 43 0.0% Lincoln 75 67-10.7% Bladen 67 56-16.4% Macon 61 64 4.9% Brunswick 79 60-24.1% Madison 31 38 22.6% Buncombe 136 110-19.1% Martin/Tyrrell/Washington 94 74-21.3% Burke 50 45-10.0% Mecklenburg 611 825 35.0% Cabarrus 178 205 15.2% Montgomery 28 30 7.1% Caldwell 81 78-3.7% Moore 50 46-8.0% Carteret 61 61 0.0% Nash 115 113-1.7% Caswell 39 42 7.7% New Hanover 177 160-9.6% Catawba 157 99-36.9% Northampton 58 48-17.2% Chatham 79 72-8.9% Onslow 112 108-3.6% Cherokee 32 29-9.4% Orange 113 102-9.7% Clay 25 29 16.0% Pamlico 16 15-6.3% Cleveland 210 229 9.0% Pender 55 65 18.2% Columbus 55 50-9.1% Person 52 48-7.7% Craven* 143 150 4.9% Pitt 122 133 9.0% Cumberland 244 279 14.3% Randolph 78 80 2.6% Dare 95 87-8.4% Richmond* 69 59-14.5% Davidson 102 98-3.9% Robeson 144 138-4.2% Davie 49 56 14.3% Rockingham 76 73-3.9% Duplin 55 41-25.5% Rowan 77 69-10.4% Durham 207 224 8.2% Rutherford/ Polk/McDowell 99 67-32.3% Edgecombe* 103 76-26.2% Sampson 41 46 12.2% Forsyth 281 236-16.0% Scotland 40 35-12.5% Franklin 56 47-16.1% Stanly 62 65 4.8% Gaston 201 190-5.5% Stokes 42 32-23.8% Graham 24 21-12.5% Surry 132 115-12.9% Granville/Vance 73 74 1.4% Swain 53 29-45.3% Greene 27 26-3.7% Toe River District 156 60-61.5% Guilford 409 385-5.9% Transylvania 27 28 3.7% Halifax 92 80-13.0% Union 121 87-28.1% Harnett 87 68-21.8% Wake* 648 614-5.2% Haywood 64 52-18.8% Warren 41 44 7.3% Henderson 89 95 6.7% Wayne 136 123-9.6% Hertford 50 40-20.0% Wilkes 63 63 0.0% Hoke 36 26-27.8% Wilson 123 110-10.6% Hyde 20 14-30.0% Yadkin 18 18 0.0% Iredell 110 106-3.6% Note: FTE figures do not include contract staff. Sum of health department FTEs may not add up to total statewide FTEs due to rounding. * Where large discrepancies existed between reported figures for FY2013 and FY2017 exist, reported FTEs from FY2011 were used for comparisons. 6
Public Health Services (Section B) According to North Carolina laws: The Public Health Laws of North Carolina establish categories of essential public health services that are to be made available and accessible to all citizens of the State [G.S. 130A-1.1(b)]. Table 3 presents essential services established by this law as well as other services deemed to be essential to the public health of North Carolina citizens. For each service, counties were asked to indicate if the service was provided in their health department or health district. This table also presents a comparison of results from the FY2013 and FY2017 health department surveys, to provide a picture of how things have changed during this time period. Health Support Services The majority of health departments/health districts in North Carolina reported that they provide registration of vital events (89%). Vital records and statistics are maintained in 91 percent of all health departments (n=77). Nearly all health departments indicated that they conduct communicable disease surveillance (98%), offer laboratory services (98%) and perform health assessments for reportable diseases (97%). In addition, most health departments reported that they are engaged in community health education (95%), emergency preparedness response planning (94%) and perform comprehensive community health assessment (89%). However, significantly fewer reported that their health department/district engaged in chronic disease surveillance (61%), health planning (66%), or health code development and enforcement (59%). While 72 percent (n=61) health departments reported offering public health nurse pharmacy dispensing, less than half (35%) reported offering other pharmacy services. Nearly half of health departments indicated that they provided school nursing services (47%). The health support service provided least frequently was pesticide poisoning investigation, with only 14 percent of health departments reporting that they offered this service. The health support services with the largest declines from FY2013 to FY2017 were in pesticide poisoning (-25%) and behavioral risk assessment (-22%). Additionally, there were declines in health departments reporting that they offered other pharmacy services (-17%). The health support service categories with substantial increases were health education (+36%), prenatal care (+34%), child health (+24%) and public health nurse pharmacy dispensing (+11%). Environmental Health Nearly all county health departments report offering water sanitation and safety for public swimming pools (98%) and private water supply (95%). Most health departments also offer restaurant and lodging inspections (97%) and on-site sewage and wastewater disposal services (94%). Lead abatement services are provided by 72 percent (n=61) of the health districts surveyed. Regarding pest management, 25 health departments (29%) report that they provide mosquito control and nine health departments (11%) provide rodent control. Tick control is provided by 6 percent of all health departments (n=5) and bedding control is offered in 14 health departments (17%). text continued on page 12 7
Table 3. Public Health Services Provided by Health Departments/Districts, FY2017 (100 Percent of Health Departments/Districts Reporting) Services Offered Number of Health Departments FY2017 Percent of Health Departments Offering Service Percentage Change from FY2013 to FY2017 HEALTH SUPPORT Registration of Vital Events 76 89.4% -6.2% Assessment of Health Status, Health Needs and Environmental Risks to Health Epidemic Investigations Risk Assessment 60 70.6% -6.3% Pesticide Poisoning 12 14.1% -25.0% Health Assessment Comprehensive Community Health Assessment 76 89.4% -2.6% Behavioral Risk Assessment 28 32.9% -22.2% Reportable Disease 82 96.5% 1.2% Vital Records and Statistics 77 90.6% -3.8% Chronic Disease Surveillance 52 61.2% -8.8% Communicable Disease Surveillance 83 97.6% 1.2% Emergency Preparedness Response Planning & Assessment 80 94.1% -3.6% Policy Development Functions/Services Health Code Development and Enforcement 50 58.8% -5.7% Health Planning 56 65.9% -8.2% Health Assurance Health Education 68 80.0% 36.0% Child Health 68 80.0% 23.6% Prenatal Care 71 83.5% 34.0% Community Health Education 81 95.3% 6.6% Laboratory Services 83 97.6% 0.0% Public Health Nurse Pharmacy Dispensing 61 71.8% 10.9% Other Pharmacy Services 30 35.3% -16.7% School Nursing Services 40 47.1% -4.8% ENVIRONMENTAL HEALTH Restaurant/Lodging/Institutions Sanitation and Inspections 82 96.5% -3.5% On-Site Sewage and Wastewater Disposal 80 94.1% -4.8% Water Sanitation and Safety Private Water Supply 81 95.3% 0.0% Milk Sanitation 4 4.7% -20.0% Shellfish Sanitation 8 9.4% 0.0% Public Swimming Pool 83 97.6% 0.0% Bedding Control 14 16.5% -26.3% Pest Management Mosquito 25 29.4% -3.8% Rodent 9 10.6% -55.0% Ticks 5 5.9% -54.5% Lead Abatement 61 71.8% -3.2% 8
Table 3. Public Health Services Provided by Health Departments/Districts, FY2017 (100 Percent of Health Departments/Districts Reporting) Services Offered Number of Health Departments FY2017 Percent of Health Departments Offering Service Percentage Change from FY2013 to FY2017 PERSONAL HEALTH Primary Care Adult 38 44.7% 0.0% Pediatric 41 48.2% -6.8% Maternal Health Prenatal and Postpartum Care 67 78.8% -2.9% Pregnancy Medical Home 59 69.4% 5.4% Pregnancy Care Management 82 96.5% 2.5% Postnatal Home Visits 58 68.2% -13.4% SIDS Counseling 75 88.2% 0.0% WIC Services Mother 85 100.0% 7.6% Family Planning Preconceptional Counseling 83 97.6% 3.8% Contraceptive Care 84 98.8% -1.2% Fertility Services 41 48.2% 28.1% Pregnancy Prevention Adolescent 81 95.3% 0.0% Child Health Immunizations 85 100.0% 0.0% Care Coordination for Children (CC4C) 82 96.5% 1.2% WIC Services Children 85 100.0% 4.9% Lead Poisoning Services 72 84.7% -10.0% Well-Child Services 69 81.2% -1.4% Adolescent Health Services 61 71.8% 3.4% Newborn Home Visiting Services 56 65.9% -17.6% School Health Services 36 42.4% -18.2% Services to Developmentally Disabled Children 27 31.8% 22.7% Children with Special Health Care Needs Services 24 28.2% -14.3% Genetic Services 14 16.5% -12.5% Chronic Disease Control Early Detection and Referral Kidney Disease 24 28.2% 9.1% Hypertension 55 64.7% -9.8% Cancer 56 65.9% -15.2% Diabetes 63 74.1% -4.5% Cholesterol 43 50.6% -20.4% Arthritis 17 20.0% -15.0% Patient Education Kidney Disease 35 41.2% 25.0% Hypertension 65 76.5% -9.7% Cancer 63 74.1% -6.0% Diabetes 71 83.5% -4.1% Cholesterol 55 64.7% -17.9% Arthritis 28 32.9% 0.0% 9
Table 3. Public Health Services Provided by Health Departments/Districts, FY2017 (100 Percent of Health Departments/Districts Reporting) Services Offered Number of Health Departments FY2017 Percent of Health Departments Offering Service Percentage Change from FY2013 to FY2017 PERSONAL HEALTH (continued) Chronic Disease Monitoring & Treatment 30 35.3% -18.9% Home Health Services 17 20.0% -39.3% Behavioral Health Services Child Behavioral Services 14 16.5% -6.7% Adult Behavioral Services 12 14.1% 500.0% Health Behavior Intervention 12 14.1% n/a Health Promotion and Risk Reduction Nutrition Counseling 73 85.9% 0.0% Injury Control 41 48.2% 2.5% Tobacco Cessation 75 88.2% 2.7% Communicable Disease Control 24/7 day Communicable Disease Response 83 97.6% -1.2% CD Reporting Information for Health Care Providers 83 97.6% 1.2% Acute Communicable Disease Control Surveillance 84 98.8% 0.0% Case investigation 85 100.0% 2.4% Post-exposure prophylaxis 81 95.3% 0.0% Implementation of control measures 82 96.5% -1.2% Outbreak investigations 85 100.0% 1.2% Tuberculosis Control Surveillance 85 100.0% 0.0% Case and contact investigation 85 100.0% 0.0% Directly and observed therapy 84 98.8% -1.2% Treatment of contacts 85 100.0% 0.0% Isolation and other control measures 84 98.8% -1.2% STD Community Level Surveillance, Investigation, Prevention and Control Examination and testing of at risk individuals for STDs within one workday of request 84 98.8% 5.0% Examination, Testing, Treatment, Counseling and Referral 85 100.0% 0.0% Partner notification 81 95.3% 9.5% Investigation of Disease Control Measure Violations 80 94.1% -1.2% Counseling/education community outreach 79 92.9% 5.3% Counseling/education individual 85 100.0% 0.0% AIDS/HIV Community Level Surveillance, Investigation, Prevention and Control HIV/Syphilis Partner Notification Services 51 60.0% 6.3% Case Management 26 30.6% 8.3% Investigation of Disease Control Measure Violations 63 74.1% -8.7% Opt-Out Testing in clinics 52 61.2% -18.8% Community-based testing in partnership with CBOs 36 42.4% 20.0% HIV seropositive counseling, follow-up and referral 55 64.7% -11.3% Hepatitis A and B Immunizations 82 96.5% 0.0% 10
Table 3. Public Health Services Provided by Health Departments/Districts, FY2017 (100 Percent of Health Departments/Districts Reporting) Services Offered Number of Health Departments FY2017 Percent of Health Departments Offering Service Percentage Change from FY2013 to FY2017 PERSONAL HEALTH (continued) Rabies Control: Provide a full range of services when people are bitten by dogs or cats Identify and confine the biting animal for observation or submitting 49 57.6% -7.5% animal for rabies testing Receive reports from physicians of persons bitten by animals capable of transmitting rabies 81 95.3% 3.8% Provide rabies exposure risk assessments 76 89.4% 5.6% Coordinate administration of rabies post exposure prophylaxis if 76 89.4% 2.7% necessary Rabies Control: Provide services when people are exposed to rabies vector species (bats, terrestrial carnivores) Identify (if possible) the biting animal and submit for rabies testing 48 56.5% -11.1% Receive reports from physicians of persons bitten by animals capable of transmitting rabies 78 91.8% 2.6% Provide rabies exposure risk assessments 77 90.6% 10.0% Coordinate administration of rabies post exposure prophylaxis if 74 87.1% 2.8% necessary Rabies Control: Provide services for domestic animals that are reasonably suspected of being exposed to rabies Identify (if possible) the biting animal and submit for rabies testing 47 55.3% -14.5% Order rabies booster, quarantine or euthanasia of the exposed 55 64.7% -9.8% animal Coordinate at least one annual rabies vaccination clinic in the county for 46 54.1% -8.0% dogs, cats and ferrets Canvas the county to search for unvaccinated dogs/cats/ferrets and 23 27.1% 9.5% appropriately administer all animal sheltering functions Administer the voluntary Certified Rabies Vaccinator Program in the 38 44.7% 35.7% county if one exists Dental Health Dental Health Education 54 63.5% -5.3% Topical Fluoride Application 51 60.0% -5.6% Sealant Application 47 55.3% -2.1% Dental Screening and Referral 54 63.5% -6.9% Dental Treatment 39 45.9% -9.3% Community Fluoridation 11 12.9% -45.0% Into the Mouths of Babes Dental Preventative Services 27 31.8% 0.0% Mobile Dental Health Services 17 20.0% Other Personal Health Migrant Health 11 12.9% -38.9% Refugee Health 22 25.9% -8.3% Hospice 3 3.5% n/a 11
From FY2013 to FY2017, North Carolina health departments report that no environmental health service categories increased. The largest declines in environmental health services were in rodent control (-55%) and tick control (-55%). Bedding control and milk sanitation services also declined by more than 20 percent during this time period. Personal Health Personal health services comprise the largest category of services provided at local health departments. Nearly half of all health departments (48%) reported offering pediatric primary care and adult primary care services (45%). While the number of health departments offering adult primary care services remained the same from FY2013 to FY2017, the number offering pediatric services declined slightly (-7%) during this time period. Under the sub-category of Maternal Health services, over 90 percent of all health departments reported offering pregnancy care management (97%) and 100 percent offer maternal WIC services. SIDS counseling was offered by 75 health departments (88%) and 79 percent of health departments reported that they provided prenatal and postpartum care (n=67). Approximately two-thirds of health departments (69%) reported that they provide pregnancy medical home services and 58 health departments reported offering postnatal home visits (68%). None of the maternal health categories experienced substantial increases in reported services from FY2013 to FY2017. Postnatal home visits declined 13 percent during this time period. Within Family Planning services, nearly all health departments reported offering contraceptive care (99%) and preconception counseling services (98%). In addition, the majority of health departments also provide adolescent pregnancy prevention (95%). Fertility services were less likely to be offered, with fewer than half of health departments (48%) reporting that they offered this service. However, within family planning services, the fertility services category experienced the largest increase from FY2013 to FY2017 (+28%). Examining Child Health services, immunizations and child WIC services were provided by all health departments (100%). Most health departments also reported offering care coordination for children (97%). Well child services and lead poisoning services were provided by at least 80 percent of health departments. Adolescent health services (n=61) and newborn home visiting services (n=56) were provided by more than half of all health departments. Child health services which were offered less frequently included school health services (42%), services to developmentally disabled children (32%), services for children with special health care needs (28%) and genetic services (17%). From FY2013 to FY2017, the categories of service with large declines included school health services (-18%) and newborn home health services (-18%). Services to Developmentally Disabled Children was the only child health category of service with a noteworthy percentage increase during this time period (+23%). For services related to Chronic Disease Control, early detection and referral services were most frequently provided for diabetes (74%), cancer (66%), hypertension (65%) and cholesterol (51%). Less than 30 percent of health departments offered early detection and referral for kidney disease (28%) and arthritis (20%). From FY2013 to FY2017, most chronic disease early detection and referral 12
categories experienced decreases. Kidney disease was the only category with a reported increase in services (+9.1%). The number of health departments reporting that they offered early detection and referral for cancer, arthritis and cholesterol all decreased by more than 10 percent. For every disease category, the provision of Patient Education services for these same chronic diseases was higher than that of early detection and referral. Fewer than half (35%) of health departments reported that they offer chronic disease monitoring and treatment services in FY2017 this is lower than figures reported in FY2013 (-19%). Provision of Behavioral Health services was not commonly reported by health departments in FY2017. Only 14 health departments reported offering behavioral health services for children (17%) and 12 health departments offered behavioral health services to adults (14.1%). Health behavior intervention was reported by 14 percent of health departments (n=12). From FY2013 to FY2017, child behavioral health services decreased slightly (-7%). In contrast, adult behavioral health services increased substantially from two health departments offering this service in FY2013 to 12 health departments in FY2017. Regarding Health Promotion efforts, the majority of health departments reported that they provide tobacco cessation counseling (88%) and nutrition counseling (86%). However, slightly less than half (48%) reported health promotion efforts aimed at injury control. There was virtually no change in any of the health promotion and risk reduction service categories from FY2013 to FY2017. Under services for Communicable Disease, nearly all health departments (98%) report that they offer 24/7 communicable disease response and communicable disease reporting information for health care providers. All health departments reported offering case investigation and outbreak investigation services (100%). Nearly all health departments reported that they offer acute communicable disease control surveillance (99%), implementation of control measures (97%) and post-exposure prophylaxis (95%). All of the FY2017 acute communicable disease control categories are comparable to figures reported in the FY2013 survey. With regard to Tuberculosis Control, all health departments (100%) report offering surveillance, case and contact investigation, and treatment of contacts. Nearly all also report offering direct and observed therapy and isolation and other control measures (99%). There were no substantive changes in tuberculosis control services reporting from FY2013 to FY2017. Under the STD section, all health departments (100%) report offering examination, testing, treatment, counseling, and referral as well as individual counseling. Nearly all health departments report providing examination and testing of at risk individuals for STDs within one workday of request (99%). Most health departments also report that they provide partner notification (95%), investigate disease control measure violations (94%) and conduct community outreach counseling/education (93%). Increases were reported for three categories, including partner notification (+10%), community outreach (+5.3%) and examination and testing of at risk individuals (+5%). With regard to AIDS/HIV, most health departments report offering investigation of disease control measure violations (74%). Over half also report providing HIV seropositive counseling, follow-up and referral (65%), opt-out testing in clinics (61%) and HIV/syphilis partner notification services 13
(60%). Less than half of health departments report providing community-based testing in partnership with Community Based Organizations (42%) and 31 percent reported providing case management. In FY2017, six additional health departments reported offering community-based testing in partnership with Community Based Organizations, which represented a 20 percent increase from the number reported in FY2013. The number of health departments reporting that they provide opt-out testing declined by 19 percent from FY2013 to FY2017. Nearly all health departments (97%) reported offering Hepatitis A and B immunizations in FY2017 which was comparable to FY2013 figures. Under Rabies Control services, most health departments indicate that they received reports from physicians of persons bitten by or exposed to animals capable of transmitting rabies (95%). Most health departments also report that they coordinate administration of rabies post-exposure prophylaxis if necessary for those bitten (89%) or exposed (87%). Over half of health departments reported that they identify the biting animal and submit it for rabies testing and coordinate at least one annual rabies clinic in the county for dogs, cats and ferrets. However, only 23 health departments report that they canvas the county to search for unvaccinated dogs, cats or ferrets, and appropriately administer all animal sheltering functions (27%), and only 38 reported that they administer the voluntary Certified Rabies Vaccinator Program (45%). From FY2013 to FY2017, the number of health departments reporting that they administer the Certified Rabies Vaccinator Program increased by 36 percent. Under Dental Health services, more than 60 percent of health departments reported offering dental health education (64%), dental screening and referral (64%), topical fluoride application (60%) and sealant application (55%). However, slightly less than half (46%) of all health departments indicate that they offer dental treatment. Nearly one in three (32%) of health departments reported that they participate in the Into the Mouths of Babes dental preventative services program. Only 17 health departments (20%) indicated that they offer mobile dental health services and only 13 percent provide community fluoridation. The number of health departments reporting community fluoridation has declined 45 percent from FY2013 to FY2017. With regard to Other Personal Health services, 11 health departments (13%) reported that they offer migrant health services and 22 health departments (26%) indicated that they provide refugee health services. Both of these categories decreased from FY2013 to FY2017. Only three health departments report that they offered hospice services in FY2017. 14
Bilingual Health Initiatives (Section C) Non-English Information and Education Material in LHDs All health departments reported that they provide educational and informational materials in other languages, with all reporting that they offer materials in Spanish (n=85). In addition to Spanish, a small number of health departments also report that they provide educational material in other languages such as Arabic, Hmong and Mandarin. Table 4 presents the number and percentage of health departments that report needing non-english material by health department service area. Over half of health departments report using and not needing any additional non-english material for Family Planning (64%), Maternal Health (58%), Communicable Disease (55%) and Child Health (53%) services. In addition, nearly half of health departments state that they use non-english material for Patient Education (49%) and Health Promotion (47%). Slightly more than a third of health departments report that they use and do not need materials for Chronic Disease Control (39%) and Dental Health (37%). Examining the need for non-english education/information across all service types, 32 to 42 percent of all health departments indicated that they use and need or have a need for bilingual materials. Bilingual Staffing and Services Seventy-six health departments (89%) reported having bilingual staff and nine health departments (11%) reported that they did not have bilingual staff. Spanish was the most frequent language provided by bilingual staff; with a few health departments also reporting staff speaking Hmong, Mandarin, Arabic and other languages. Nearly half of health departments (48%) report their service population is becoming more non-english speaking. Half of health departments (50%) reported that their department has specific outreach efforts targeting non-english speaking populations. 15
Table 4. FY2017 Health Department Use of Non-English Educational/ Informational Material Service Use and Does Not Need Additional Use and Needs Additional Materials Need Do Not Need Not Applicable Missing / Unknown # % # % # % # % # % # % Maternal Health 49 57.6 26 30.6 2 2.4 2 2.4 4 4.7 2 2.4 Family Planning 54 63.5 28 32.9 1 1.2 2 2.4 0 0.0 0 0.0 Child Health 45 52.9 27 31.8 4 4.7 3 3.5 3 3.5 3 3.5 Chronic Disease Control 33 38.8 24 28.2 5 5.9 5 5.9 9 10.6 9 10.6 Patient Education 42 49.4 30 35.3 3 3.5 4 4.7 1 1.2 5 5.9 Health Promotion and Risk Reduction 40 47.1 31 36.5 4 4.7 3 3.5 0 0.0 7 8.2 Communicable Disease Control 47 55.3 31 36.5 5 5.9 1 1.2 0 0.0 1 1.2 Dental Health 31 36.5 20 23.5 7 8.2 4 4.7 11 12.9 12 14.1 16
Other Topics (Section D) Cultural Diversity All 85 health departments report that their staff has undergone cultural diversity training. Nearly half of health departments (47%) indicate that their department utilizes the National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care (CLAS Standards); with 58 percent of health departments noting that they would like to know more about CLAS Standards. Internet Access All but one health department reported that their staff has internet access at work (99%). Governing Body As shown in Figure 4, nearly three-quarters of health departments (72%) report that a Board of Health is the governing body over their health department. Consolidated Human Services Board (12%) or a Board of Commissioners (12%) were indicated for almost a quarter of health departments (n=20). A small number of health departments reported multiple governing bodies (n=3). Figure 4: Governing Body Over Health Department, SFY2017 Local Health Department Survey Multiple Governing Bodies Reported 3% Missing/Not Reported 1% Consolidated Human Services Board 12% Board of County Commissioners 12% Health Board 72% 17
Graham Cherokee Clay Swain Macon Haywood Jackson North Carolina Local Health Departments Appalachian District Madison Buncombe Henderson Toe River District Rutherford Polk McDowell District Caldwell Burke Wilkes Surry Stokes Rockingham Caswell Person Yadkin Forsyth Guilford Orange Granville Vance District Warren Halifax Northampton Hertford Albemarle District Martin-Tyrrell-Washington District Beaufort Pamlico Hyde Dare Durham Alamance Wake Franklin Alexander Catawba Lincoln Cleveland Gaston Iredell Davie Rowan Cabarrus Davidson Stanly Craven Mecklenburg Transylvania Union Anson Randolph Chatham Moore Lee Harnett Johnston Nash Wilson Wayne Duplin Pender Edgecombe Greene Lenoir Pitt Montgomery Hoke Cumberland Bladen Sampson Jones Onslow Carteret Richmond Scotland Robeson Columbus New Hanover Brunswick