Florence County Health Department

Florence County Health Department Florence County Health Department 2017 Annual Report Connecting You to a Better Life! 1

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Executive Summary The Florence County Health Department (FCHD) met statutory requirements for a level III health department services. The staff provides services with compassion, commitment and collaboration meeting the strategic goals of our department. Our mission is to connect you to a better life! 2017 highlights FCHD Community Health Improvement Plan (CHIP) developed to improve the health of Florence County residents. Focus areas for the 2015-2020 plan are: Priority One: Alcohol and other Drug Abuse Priority Two: Mental health awareness and suicide prevention Priority Three: Chronic Disease Prevention Became an agent for the state through the Department of Trade and Consumer Protection (DATCP) and began providing inspections to permitted facilities including lodging, restaurants and retail establishments. Received Prevention for Success grant for $25,000 to reduce prescription drug misuse in Florence County including distribution of home lock boxes in collaboration with the ADRC, Sheriff s Office, HSD and local clinic and pharmacy. Participated in two drug take-back days in April and October. Amber Kolberg was hired for the role of Emergency Preparedness Coordinator/Community Health Specialist in October 2017. Coordinated Chronic Disease Prevention programs such as Walk with Ease and Strong Bodies meeting our third health priority on the CHIP. Site visit for National Public Health Accreditation in April 2017. Complete two Quality Improvement (QI) projects improving services to increase Tdap rates among adults and in creating sustainable Public Health Funding. Looking forward to 2018 In 2017, FCHD submitted documentation to become a Level III Health Department through the Wisconsin department of Health Services 140 Review. The department was awarded the Level III designation recognizing the highest level of public health services. Florence County Health Department will be a certified water laboratory through DATCP and enter into the Transient Non-community (TN) grant with the DNR to provide onsite water bacteria testing to permitted facilities and the public. Standardization grant to assess environmental inspections based on national standards through the Food and Drug Administration. 3

Our Staff OUR VISION Florence County Health Department will be a proactive, knowledgeable and professional resource leading the way to a healthy, safe and vibrant community. OUR MISSION Connecting You to a Better Life! OUR CORE VALUES Commitment Compassion Collaboration ANNETTE SEIBOLD ANN PRICE Director, Health Officer Annette has been with the health department for 7 years and provides leadership and oversight for all programs. Public Health Nurse Ann is an RN/RS and has been with FCHD for 4 years. She provides services in the Women, Infants and Children (WIC) program, communicable disease follow-up, immunizations, lead screening, fluoride supplements and facility inspections. She is also the Accreditation Coordinator. Administrative Assistant Our Administrative Assistant joined our team in November 2016. Cinde is the receptionist, WIC clerk and provides support and financial management for all programs. BOARD OF HEALTH MEMBERS Holly Wahlstrom- Stratton chair Susan Theer-vice chair Sherry Johnson Yvonne VanPembrook Cindy Kmecheck Carolyn Lemanski Jason Neuens/Mark Wenzel Cynthia Nichols AMBER KOLBERG NANCY OSTERBERG Emergency Preparedness Coordinator/ Community Health Specialist Amber joined the health department in October of 2017. She is the lead in public health emergency preparedness and AODA prevention. She has a BS in nutrition and provides facility inspection support. WIC Dietitian Nancy has worked with the Florence WIC program for 9 years. She provides respectful and motivating nutrition counseling and guidance for our WIC clients. 4

Programs ESSENTIAL PUBLIC HEALTH SERVICES Monitor health status. Diagnose and investigate health problems. Inform, educate, and empower people about health issues. Mobilize community partnerships. Develop policies and plans. Enforce laws and regulations. Link people to personal health services. Assure competent workforce. Evaluate populationbased health services. Research new solutions to health problems. Maternal Child Health Public Health Nurse coordinates the Child Death Review Team which meets biannually to discuss safety and prevention in the community. We will continue to address issues of safety and prevention for youth in Florence County. Annual bike safety class to the Florence Elementary 3rd graders with the Sheriff s Office. Question, Persuade, Refer (QPR) coordinated with Florence School District School Psychologist for middle/ high school students. Facilitated evidence based abstinence program, Choosing the Best, to 7th grade students. Chronic Disease Prevention Provided 19 blood pressure screenings and consultation by a RN in 2017. Facilitated evidence-based, chronic disease prevention programs including Walk with Ease, Strong Bodies, and Eat Smart, Live Strong in collaboration with ADRC and UW Extension. Community Human Health Hazards Investigated one Human Health Hazard in Florence County as required by State Statute. Investigations may include collaborative effort with Zoning, ADRC, and Human Services Department. Lead Public Health Nurses documented 43 blood lead tests for children in 2017. FCHD provides onsite testing for early detection of childhood blood lead poisoning. Radon Provided 38 radon kits for residents to test radon levels in their homes and follow-up consultation for results above recommended level per EPA. Rabies Annual Rabies publication to local newspapers. Conducted investigations of four animal bite reports in coordination with Florence County Sheriff s Office as required per State Statue. School Health FCHD provides contracted services as a school nurse consultant to the Florence County Schools. Completed school immunization review to assure compliance with state immunization laws. Florence Elementary and High/Jr High School had 99% compliance rates. 5

Environmental Health Inspections Month Lodging Retail Campgrounds Restaurants Temporary/ Mobile Restaurants Pools July 3 0 0 1 0 0 4 Aug 4 2 1 2 2 1 12 Sept 2 0 0 0 0 0 2 Oct 0 2 0 2 0 0 4 Nov 1 1 0 1 3 0 6 Total As of July 1, 2017 Florence County Health Department began inspecting facilities regulated by the Department of Trade and Consumer Protection in accordance with state statues and the Federal Retail Program Standards. The chart provides an updated report on facilities inspected in Florence County. Dec 0 0 0 1 0 0 0 2017 Totals 10 5 1 7 5 1 28 *Florence County Health Department as an agent of the state of Wisconsin under Wis Stat 97.30 and Subchs.III and IV of ch 97, and Wisconsin Administrative Code ch ATCP 74 issues licenses to, inspect, and regulate retail food establishments including restaurants, campgrounds, recreational and educational camps, public swimming pools and water attractions, hotels, motels, tourist rooming houses and bed and breakfast establishments enforcing all applicable provisions of the Wisconsin statutes and Administrative Code and associated State Department policies. Water Quality Assisted 38 private well owners to test their well water coordinating with the Wisconsin State Lab of Hygiene for testing including Bacteria, Nitrates, Fluoride, and metals. Municipal water systems provide safe drinking water to the Town of Florence and parts of Commonwealth and test their water regularly to ensure it is safe, but it is up to private well owner to test their well water annually. Florence County Health Department initiated a water lab for bacterial testing of private wells. Through a contract with the Wisconsin Department of Natural Resources, 39 transient non-community water supply systems will be tested to ensure that safe and dependable water is available to the public. Wells of businesses that serve the public are also inspected for structural soundness and routes of potential contamination. 6

Women, Infants & Children (WIC) WIC is a Federal supplemental nutrition program that focuses on breastfeeding support and healthy eating for pregnant women and families with children under 5. 2017 highlights ewic debit card system for WIC clients continues to provide a more pleasant and efficient shopping experience for our WIC families. The amount of benefits redeemed in the year 2017 at local vendors was $32,450.81. FCHD averaged 73 families with a total of 108 WIC participants overall. WIC BePC Principles Being Person-Centered communication skills Respect Individualize Motivate Empathize Listen to Understand WIC Director provided training and required reviews for Farmers Market and WIC grocery vendors. Farmers markets are coordinated locally in a continued effort to provide increased access to fresh vegetables. In 2017, 45% of the WIC families participated in the Farmer s Market Nutrition Program and spent a total of $216.00 at local Farmer s Markets. WIC Moms Who Have Initiated Breastfeeding State Florence County 92.3% 78.3% 87.5% 83.0% WIC participants that have ever initiated breastfeeding 66.8% 51.5% 68.3% 61.1% 70.5% 71.5% 72.1% 72.6% 66.7% 71.4% 72.5% 72.3% 72.8% 73.0% their infants has remained above the State of Wisconsin s rate since 2013. 2009 2010 2011 2012 2013 2014 2015 2016 2017 *It is noted that data may have limited interpretive value due to the small numbers. 7

Disease Prevention and Control Wis. Stats. 252.05: Any health care provider who knows or has reason to believe a person treated or visited by him or her has a communicable disease is required to report. Per Administrative Rule DHS 145.04 (1), this includes reporting of a case or suspected case. Certain diseases must be reported to local health departments by law. FCHD staff regularly receive and investigate these communicable diseases through WEDSS (Wisconsin Electronic Disease Surveillance System). 2017 Top Communicable Diseases investigated in Florence Lyme Disease most commonly reported in 2017 45 40 35 30 25 20 15 10 5 0 2016 2017 Reporting and follow up guidelines for Lyme disease changed and although many positive blood tests for Lyme disease were reported, only cases with a reported erythema migrans (bull s eye rash) were counted as a case. * It is noted that annual data may have limited interpretive data due to the small numbers. Top Communicable Diseases Florence County 1. Lyme Disease 2. Chlamydia 3. Hepatitis C 4. Campylobacter 8

2017 TB (tuberculosis) tests administered Definitions 19 Tdap (Tetanus, Diphtheria, and Acellular Pertussis) protects against Pertussis (whooping cough) Tetanus and Diphtheria. Pertussis is highly contagious. HPV (Human papillomavirus) - protects against the types of HPV that most commonly cause cervical cancer and genital warts. HPV is most common in people in their teens and early 20s. Meningococcal (Meningitis) - protects against Meningococcal Meningitis, a very serious infection of the lining around the brain and spinal cord that can cause death. Immunizations Many serious diseases can be prevented by vaccines. The Florence County Health Department provides a wide range of childhood and adult immunizations at regularly scheduled immunization clinics and community satellite clinics to reduce barriers to care. 2017 highlights Received HPV grant to increase awareness and education through movie Someone You Love. Utilized Wisconsin department of Health Services immunization grant for Mass Clinics to offer free adolescent vaccine at school based clinics including Tdap, Meningitis and Flu (and Medicaid eligible for HPV). Implemented Quality Improvement projects to improve Adult Tdap coverage and public health funding. Added a satellite clinic in the town of Tipler. Florence County Health Department is a member of the Northwoods Immunization Coalition, which includes public/private providers from Vilas, Oneida and Forest Counties. Due to implementing school based immunization clinics, FCHD has been able to continue to increase immunization rates by increasing access to care for underinsured and uninsured adolescents. 2017 Adolescent Immunization Rates Florence County rates continue to trend upward Tdap Meningitis HPV Series FCHD remains on an upward trend for adolescent immunization rates surpassing state rates in 2016-17. 2016 Wisconsin state rates for: Tdap 78%; Meningitis-38%; and HPV Series- 29% (Wisconsin Immunization Program, March 2017). 9

Immunizations Children Up to Date on Immunizations at 24 Months Fact: The injectable vaccine does not contain any live bacteria so it is impossible to get influenza from it. There may be some side effects, such as mild soreness, redness or swelling at the injection site, headache or a low-grade fever. 2016-17 Vaccines for Children (VFC) Doses Administered Student receives a vaccine at a school-based clinic providing increased access to healthcare in our community. Hepatitis B HPV Gardisil 9 Meningococcal Influenza Quadrivalent 6m-35m Influenza Quadrivalent 3y - 18y Tdap Hib Pneumoccocal Varicella MMR Polio Dtap 0 10 20 30 40 50 60 70 80 90 2016 2017 10

FLUORIDE SUPPLEMENT PROGRAM Florence County Health Department provided fluoride supplements (tablets or drops) to 17 children in 2017 Research shows that multi-component interventions that include merchant and community education, regular inspections, and penalties for vendors who sell to minors have been shown to reduce illegal tobacco sales, which in turn decreases youth smoking. Northwoods Dental Project Northwoods Dental Project, a partnership between Oneida, Vilas, Florence and Forest counties, has been working to prevent tooth decay and create awareness of oral health. According to research, school-based sealant and fluoride varnish programs have been associated with reducing the incidence of tooth decay by 70 percent. Healthy Smiles Fluoride Varnish Program Highlights School Year 2013-14 2014-15 2015-16 2016-17 2017-18 Students participating 32 23 41 39 22 Students referred for untreated 5 6 13 9 3 dental decay % of students on Medicaid 55.9% 42.1% 39% 57.1% 45.4% Seal-a-Smile Dental Sealant Program Highlights School Year 2013-14 2014-15 2015-16 2016-17 2017-18 Students receiving education 50 54 57 56 57 Students receiving oral 30 26 40 36 35 health exams & dental supplies Students receiving sealants 23 21 26 24 17 Students referred for untreated dental decay Tobacco Prevention 2017 WI WINS Compliance checks 11 4 18 8 10 % of students on Medicaid 39% 55% 35% 47.2% 45.7% Florence had a 8% sales rate with 1 sale to minor by a clerk 11

Emergency Preparedness Federal funding for emergency preparedness is provided at all levels of government, and working with community partners to prepare for disaster continues to be a high priority for our agency. 2017 Highlights Exercises Organized Mass Clinic Exercise at Florence High School and Elementary in October to dispense influenza and adolescent vaccines through a state grant Participated in Regional Healthcare Emergency Response Coalition (HERC) Ebola exercise in May and submitted After Action Report to the state with regional partners. Participated in Regional HERC Hazard Vulnerability Assessment (HVA). Preparedness Activities CDC annual Review of Strategic National Stockpile plans through Point of Distribution (POD). Quarterly Local Emergency Planning Committee (LEPC) Meetings. Respirator Fit Testing for FCHD nursing staff. Reviewed Florence County Mass Clinic Plan. Reviewed Public Health Emergency Preparedness Plan. Emergency Preparedness booth at Florence County Library and Florence County Courthouse to educate awareness. Facilitated Wisconsin-Michigan Border Coordination Group meetings in April and September. The group includes 8 health departments, Emergency Management, American Red Cross, Michigan Healthcare Region 8, Wisconsin Healthcare Regions 2 & 3, Wisconsin Northern Region DPH, and Florence County Sherriff s Office. Updated Risk Communications Plan. Revised 24/7 Contact Call Down to assure public health staff availability and exercised three different times in 2017. Trainings Radio training with Sherriff s Office in September. Received training grant supporting Wisconsin Public Health Association Infectious Disease and Emergency Preparedness. 2018 Planned Activities County-wide Emergency Operations Center (EOC) exercise on February 17th. Mass Clinic After Action Report. School-based mass clinics. Revising Public Health Emergency Preparedness (PHEP) and Mass Clinic Plans. 12

Financial Revenue Sources for 2017 2017 Total Revenue $332,958 Federal, State, Fee for Service Revenue $168,474 County Levy $164,484 *Florence County Health Department utilized less tax levy than anticipated due to the revenue from grants and programs in 2017. 13

Client Feedback Excellent program! Keep it going! - Keeping It Real Adult Participant The speakers were an amazing inspiration!- Keeping It Real Student Participant It gave me a different point of view on sex, drugs and alcohol. It is very helpful so you can know how to say NO. Choosing the Best Path, 7th Grade Student We appreciate the consistency of inspections in our county. - Establishment Owner I appreciate the communication and information on communicable disease and when I should take my child in. - Florence County Parent Excellent service! My kids and I were in great hands, very helpful. - WIC Participant 14