Annual Report

Over 135 years of public health N EW HANOVER COUNTY H EALTH DEPARTMENT 2013-2014 Annual Report 2029 South 17th Street Wilmington, NC 28401 910-798-6500 phone 910-341-4146 fax health.nhcgov.com www.facebook.com/nhchealth www.twitter.com/nhchealth On behalf of the New Hanover County Board of Health and the staff of the New Hanover County Health Department, we are pleased to present our Annual Report for fiscal year 2013-2014. Our Annual Report represents the provision of public health programs and services for people in New Hanover County. Caption New Hanover County Board of Health M embers Robert E. Lewis Public Mem ber Chair Melod y Speck Evans, DVM Veterinarian Mem ber Vic e-chair Beth Dawson Count y Comm issioner Brian Ens ign, PE Engineer Mem ber Mic hael E. G oins, OD Optom etrist Mem ber Kim Thrasher Horne, Pharm D Pharm acist Mem ber Zachery S. Mitchem Public Mem ber Mark W. Morgan, MD Ph ys ician Mem ber Linda (Cand y) Robbins Public Mem ber Robert J. Schiffel, DDS Dentist Mem ber Stephanie D. Sm ith, PhD, RN Nurse Mem ber All of us at New Hanover County Health Department believe that we can make a difference as we strive to become the healthiest county in North Carolina. Our mission is to promote a safe and healthy community. This mission is accomplished through assessing the health needs of the community and establishing health objectives to maintain essential personal, family, animal, community and environmental health services. During fiscal year 2013-2014, the Health Department experienced many challenges and opportunities. A great deal of important work was done during the year, and is described throughout this report. Among the most notable highlights were: New Hanover County Health and Human Services Functional Collaboration Action Plan Public Health Clinic Renovation Project South Eastern North Carolina Regional Health Collaborative FDA Standardized Food Regulatory Program Our annual report focuses on many programs, services and activities. For a more detailed account of our Health Department, please visit our website at: health.nhcgov.com. We are proud of our history of serving our community for the last 135 years. From the Northeast River to Federal Point, and from the Cape Fear to the Sea City, Suburb, Village and Farm we are one people striving for healthful and useful living. David E. Rice, MPH, MA Health Director

Over 135 years of public health N EW HANOVER COUNTY H EALTH DEPARTMENT 2013-2014 Annual Report Healthy people living in a safe environment to sustain a strong community focused on prevention and wellness Mission To promote a safe and healthy community Quick Facts Established in 1879, New Hanover County is home to the oldest health department in North Carolina VISION NHCHD is the first health department to become accredited in Southeastern NC We expanded our current location, adding more than 16,000 square feet of space to better serve New Hanover County citizens. Over 135 years of public health ser vice S OCIAL MEDIA In April 2011, the New Hanover County Health Department developed a Social Media Committee with the intent of establishing our presence on Twitter and Facebook. The goal of this group is to increase marketing and community education for the Health Department. This committee is made up of representatives from Personal Health Services, Support Services, Health Programs Administration and Environmental Health and meets on a regular basis. In just over three years, we have made the following progress: Twitter 2,459 Tweets, 361Followers Facebook 409 Likes 2

ANNUAL REPORT 2013-2014 H E ALT H AND HUMAN SERV IC ES FUNCTIONA L C OLLABORATION ACTION PLAN On November 4, 2013 the New Hanover County Board of Commissioners voted unanimously to approve County Manager Chris Coudriet s recommendation for the county, along with the Board of Health, DSS Board and Senior Services, to develop an action plan for combined services. The Board of Commissioners emphasized that this decision was not a policy decision for consolidation. From December 2013 to April 2014 members from the Study Group (Board of Health, DSS Board, Senior Services, Health Director, DSS Director and County Administrative staff) met to discuss moving forward. Members worked together to develop an action plan that addressed seven areas of concern: reduce bureaucracy and administrative costs; eliminate duplications; improve responsiveness and customer service; improve communication and coordination; provide integrated service; improve overall outcomes; and the plan must be sustainable. This action plan must be created and presented to the commissioners on May 5, 2014. The Board of Commissioners accepted the recommendation of the Study Group which included the following: Ongoing Action Steps: Evaluation of positions / staffing within agencies Provide Lean process improvement / program evaluation support to project teams & management Identify and support IT solutions (funding, staff, training) Assess & address staff engagement, satisfaction, turnover and burn out Near-Term Action Steps: Explore feasibility of shared services model Facilitate referrals of WIC eligible clients from DSS to WIC program manager Coordinate scheduling through a common entity BOH, DSS Board and Administration Planning Develop common mission, vision, strategic plan, set annual priorities, review programs and service delivery Bi-annual joint board meetings Cross-sharing board minutes and reports Staff / Management Collaboration Regular DSS, SRC, and Health management/managers meetings Encourage cross-departmental staff-level interaction Establish unified vision and approach to solving issues in a multidiscipline team 3

ANNUAL REPORT 2013-2014 R E N OVA T ION PROJECT September 2012 the Health Department began conducting a Space Study Analysis with local architect, LS3P, to determine current and future space needs. Key partners included the following New Hanover County Departments: County Manager s Office, Engineering, Finance and Property Management. The analysis included an examination of our current location and a possible expansion into the area which housed the Coastal Care Mental Health offices. Through an intensive process, floor plans were approved and finalized with contractors pre-qualified to bid on the project which is estimated to cost $3.5 million. Monteith Construction was officially awarded the contract on January 27, 2014 and the renovation process started in February. The 16,000 square foot facility will house clinic, pharmacy, lab, billing and customer care services. In addition, there will be three offices designated for county government agencies to use and foster greater collaboration between the Health Department and other departments. The expected completion of this project is October 2014. Progress: April 25, 2014 Progress: June 18, 2014 S OUTHEASTERN NORT H CAROLINA REGIONA L H E ALT H COLLABOR ATIVE (SENCRHC) Brunswick, Columbus, New Hanover, Onslow and Pender County Health Departments have joined with the South East Area Health Education Center and the University of North Carolina Wilmington, College of Health and Human Services, to form a regional health collaborative. SENCRHC s focus is to create "collective impact" on issues to enhance the health and quality of life and wellbeing of individuals and in communities in Southeastern North Carolina. 4

HEALTH PROGRAMS ADMINISTRATION I N J URY PREVENTION OUTREACH Safe Kids Cape Fear is dedicated to protecting kids from unintentional injuries including child passenger safety. This past year, Safe Kids Cape Fear hosted classes to certify over 40 new Child Passenger Safety Technicians. As a result, the coalition has added two new permanent checking stations to the list, giving the community a total of 16 locations to receive hands on instruction from technicians. Each year, unintentional poisoning is the cause of death for approximately 100 children ages 14 years and under. To help get expired and unwanted medications out of the home and out of the reach of children, Safe Kids Cape Fear along with New Hanover Regional Medical Center, Coastal Horizons, New Hanover Sheriff s Department and Kure Beach hosted three Medication Drops. In October 2013 and March 2014 over 1400 community members contributed to a total of 1710lbs of medications, including 32,634 dosage units of controlled substances. HIV/STD O U TREACH The HIV Integrated Targeted Testing Site program tested 331 people from February to June in 2014. One individual was treated for a positive syphilis case and another individual has been linked to care for HIV after being tested through our outreach program. In June of 2014 the program held its first annual AIDS Walk Wilmington. Over 60 people gathered to walk for a cause and gain education about HIV and the latest HIV treatment methods. During the walk 17 individuals were tested for HIV & Syphilis. T OBACCO PREVENTION OUTREACH During the 2013-2014 year, the Project ASSIST coalition launched a multi-media campaign to promote cessation options throughout the county. Media included billboards, bus ads, radio ads, community newspaper ads, and television/cable interviews. The coalition also launched a Facebook page for community members to share their quit stories. Multi-unit housing remains a priority, with collaborations taking pace with Wilmington Housing Authority through the Choice Neighborhoods program. The coordinator also made outreach to managers and developers, to assist them in efforts to adopt tobacco free policies, a priority. During the most recent fiscal year, the coalition reached out to principals at all middle and high schools to educate them on policies related to electronic cigarette products. Kick Butts Day and World No Tobacco Day were opportunities to be on campuses throughout the county to discuss tobacco with staff and students. 5

ENVIRONMENTAL HEALTH SERVICES V E C TOR CONTRO L New larvicide products were implemented into the program during the start of the 2014 year and are still currently being evaluated for efficacy. New Hanover County Vector Control started off the 2014 year by participating in the Earth Day Event at Hugh McRae Park in April. This was a first time ever and was a great experience. Many educational brochures were passed out along with a kid friendly booth to view mosquito larvae under a microscope. UNCW interns were also hired to help with mosquito identification which turned out to be very successful. As mosquito season started off slow and dry in May of 2014, the mosquito light trap numbers were abundant at 8979 total mosquitos. With the very wet and cold winter, 2014 is looking to be a very busy larvicide season. During the 2013-2014 fiscal year, complaints totaled 170, light traps were at 40,144 total mosquitoes, 168.32 acres were larvicided, and staff spent 421.25 hours adulticiding the 29 zones in the county. It appears that we are out of the drought situation from previous years since low areas in the county that were normally dry in the past, are now holding water and are positive for mosquito larvae. Rain produced in July (12 inches), August (8.79 inches) and now September 2014 without a hurricane event, may lead to a busy mosquito fall season and possibly a busy spring for the 2014-2015 fiscal year. F OOD REGULATORY New Hanover County Health Department s food safety program has completed our first step towards meeting the Voluntary National Retail Food Regulatory Program Standard #2 which is to have FDA trained Regulatory Staff. Mr. Mark Kenion, REHS has completed all of the training and criteria to become our first FDA Standardized Retail Food Certified Training Officer. Mr. Kenion will be working to standardize our retail food staff. Our food program was also the recipient of an FDA/AFDO grant of $2,000 which was used to send four Environmental Health Specialists to FDA Special Process at Retail training in Virginia Beach. 6

PERSONAL HEALTH SERVICES G E N ERAL CLINIC SERV IC ES The Immunization Clinic had an increase in the number of clients receiving the shingles vaccine and gave 301 doses in the most recent fiscal year. Also, due to recommendations that included the community need for receiving the Tetanus, Diphtheria, Pertussis (Tdap) vaccine, there were a total of 2275 vaccinations provided at the clinic and another 418 Tdap vaccinations given to the county s rising 6th graders during 2013-2014. Routine Immunizations are accepted on a walk in basis. International Travel Immunizations are available by appointment only. Clinic walk-ins are welcome until 4:30pm on Monday through Friday (6:30pm Tuesday). W OMEN S PREVENTIVE HEALTH Women s Preventive Health/Family Planning Services are provided in the NHCHD Clinic under the guidelines of the Federal Title X Project Gran and the Office of Population Affairs. We provide preventive health screening services for both men and women; sexually transmitted infection screening, testing, and treatment; contraceptive services; Level I infertility services; and patient education and counseling on risk reduction and healthy lifestyles. We also provide counseling and education regarding reproductive life planning for men and women with a strong focus on preventing unintended pregnancies. We are continuing to offer long acting contraceptive methods like Paragard and Mirena intrauterine devices and also, through a contract with Dr. Henry Temple, we offer colposcopy and biopsy services for our clients who have abnormal Pap test results. In the 2013-2014 Fiscal Year, WPH/FP Services were provided to 1500 patients with the most utilized methods of birth control being injections and pills. Our services can be billed to insurance companies or can be paid for individually by the clients on a Sliding Fee Scale basis. B R E AST AND CERV IC AL CANCER The NHCHD Breast and Cervical Cancer Control Program (BCCCP) saw 131 patients in the 2013-2014 Fiscal Year which exceeded our target of 111. The priority age range for these patients is age 50-64. These women receive clinical breast exams, mammograms, and Pap tests paid for by the BCCCP Grant. If abnormal findings are obtained with any of these screening exams, the BCCCP funds can continue to pay for any additional diagnostic work-ups to determine if the patient has a diagnosis of breast or cervical cancer. Once a cancer diagnosis is made, the patient may then apply for BCCCP Medicaid in order to obtain insurance coverage for active cancer treatments such as surgery, chemotherapy, and radiation. This year we identified five breast cancer cases and one case of cervical cancer.

PERSONAL HEALTH SERVICES C A R E COORDINATION Pregnancy Care Management (PCM): Pregnancy Care Management is provided by a partnership between NC Division of Public Health, NC Division of Medical Assistance, and Community Care of NC. The purpose of the program is to improve birth outcomes with the following goals: providing case management to only the high risk pregnant women, to ensure that pregnant woman have one medical provider for prenatal/postpartum care; and decrease the number of non-urgent emergency room visits. Through these unique partnerships, the PCM team was able to serve 1134 pregnant women during the 2013-2014 fiscal year. We currently have four case managers, one of which is bilingual. The staff works closely with New Hanover Regional Medical Center, Coastal Family Medicine, Wilmington Maternal Fetal Medicine and Med North to meet the needs of these women. The Care Management Team works closely with Wilmington Kiwanis Club to offer pack-n-play cribs to needy families. Maternal Health: The Maternal Health program consists of two Public Health nurses. These nurses are responsible for completing new Obstetrician interviews at New Hanover Regional Medical Center- Obstetrics (OB) clinic, completing post-partum newborn home visits, making high-risk home visits to pregnant women, and diabetes instruction. The program also provides diabetic supplies to pregnant women who are not eligible for Medicaid. During the 2013-2014 fiscal year, the maternal health team made 192 Postpartum / Newborn Home Visits, 123 Behavioral Health contacts with Licensed Clinical Social Workers, and 52 Diabetic teaching contacts. Care Coordination for Children (CC4C):The program is provided in cooperation with NC Division of Public Health, NC Division of Medical Assistance, and Community Care of North Carolina. The goal of the program is to improve health outcomes of children birth to five years by improving access to quality care and supporting family self-sufficiency, while reducing costs to Medicaid. Staff work closely with other community agencies in New Hanover County serving young children such as local pediatricians, schools, Department of Social Services, Wilmington Children s Developmental Services Agency, and private providers of services. The program served over 1259 children this last year. Family Counseling: The CC4C team includes a Licensed Clinical Social Worker (LCSW) who provides mental health services to young children in their homes. The clinical benefits of providing in-home counseling, in a family s natural environment cannot be overstated. Working in the homes allows for accurate assessments and appropriate interventions where life and conflict happens. The LCSW is also providing evidenced based Parent Child Interaction Therapy (PCIT) in the Health Department. These programs are supported by the Cape Fear Memorial Foundation and Medicaid, and served 221 contacts during the 2013-2014 fiscal year. Child Health: The Child Fatality Prevention Team reviews the fatalities of all children under the age of eighteen years old that reside in New Hanover County, in order to identify any ways to prevent future deaths. The team consists of state mandated representatives for community agencies. Team members also participate in community forums offered to professionals and community members on topics related to child abuse prevention. The team purchased Infant Car Seats to distribute to low income families. 8

PERSONAL HEALTH SERVICES N U TRITION AND WIC PROGRAM The New Hanover WIC Program was one of the first programs in the state to rollover to the new state wide computer system Crossroads. Staff completed a lot of training from January through May to prepare for the transition. Training was accomplished via webinars conducted by the state WIC staff; review of task specific on-line videos, and a 4 day intensive training in Raleigh. The WIC program is now almost paperless with Crossroads. As staff has become more familiar with Crossroads, processing clients through WIC is becoming faster. Three WIC nutritionists and the WIC breastfeeding peer counselor completed mandatory WIC on-line modules for issuing breastfeeding supplies. This included meeting with the regional breastfeeding coordinator for hands-on demonstration to prove competency. All staff nutritionists completed 4-8 of 11 modules for on-line training Pediatric Nutrition Course Module 2 to strengthen their skills in specific areas. During the 2013-2014 year, the WIC nutritionists completed 10,068 nutrition assessments, 29 WIC vendor monitoring visits were completed at WIC vendors. RD completed 197 community MD referrals for medical nutrition therapy and WIC vouchers redeemed at NHC WIC vendors totaled $2,775,334. Five dietetic interns from 4 different academic programs, working on requirements to become registered dieticians (RD s), completed their community nutrition rotation requirements with NHCHD RD s. Time spent at NHCHD ranged from 1 week to 2 months, depending on the requirement for each program. The Region V WIC Breastfeeding Coordinator traveled to California for a one week intensive Train the Trainer Teaching Baby Behavior. This project was developed by UC-Davis to teach WIC staff how to teach parents baby s cues in an effort to avoid overfeeding and as a measure to help prevent childhood obesity. All nutrition staff has now completed NHC Consultant Level 2 Customer Service certification. NHCHD and the WIC program received a Breastfeeding Friendly Business Award from the Port City Breastfeeding Project. L ABOR A TORY The New Hanover County Health Department Laboratory is classified as a moderately complex lab by COLA, a national accrediting organization and is certified by the State Lab of Public Health to test drinking water from wells of private homes and businesses. It is staffed by three Medical Assistants, a Medical Technologist and a supervisor. The laboratory performs and refers tests for all of the Health Departments clinics, WIC and outreach programs. The lab also accepts self-pay clients who have a doctor s order for its test menu. During the fiscal year 2013-2014, the lab performed a total of 15,235 tests in-house, referred 9,426 to referenced labs and performed analysis on 287 well water samples for area businesses and community residents. 9

PERSONAL HEALTH SERVICES C OMMUNITY HEALTH By investigating communicable disease cases, we can more effectively reduce health risks in our communities and respond to outbreaks of disease. During fiscal year 2013-2014, multiple outbreaks of shigellosis, respiratory illness, and gastrointestinal illness required public health assistance. In fiscal year 2013-2014, the CD team investigated 219 reportable diseases and 488 non-reportable cases as well as 138 possible rabies exposures. Due to the threat of the introduction of new diseases in our state, Chikungunya and Middle East Respiratory Syndrome Coronavirus were made immediately reportable in North Carolina under the Temporary Order of the State Health Director effective June 23, 2014 and was extended in August. Two suspect cases of Chikungunya have been investigated in our county. The CD Team received Ebola guidance from the Centers for Disease Control and Prevention for management of high and low risk exposures to evaluate and manage returning travelers that arrive in New Hanover County from outbreak affected areas. In addition, packets of information on tick-borne diseases were distributed to local urgent care centers and other facilities in order to increase awareness of physicians to report tick-borne diseases. F LU C L I N I C In our continued efforts to promote the health and wellness of the citizens of New Hanover County, the New Hanover County Health Department administered 5218 flu vaccinations during the 2013-2014 flu season. S TD/ H IV PROGRAM The STD program provides screenings for sexually transmitted diseases for men and women. The program currently has two Nurse Practitioners and one Enhanced Role Nurse that can examine patients for STD services. In 2013-2014, the personal health services team provided service to 2,857 STD patients and had six confirmed HIV cases. T U B E R C U L O S I S CONTO R L During fiscal year 2013-2014, the TB team investigated 6 cases of active TB and 74 clients were placed on treatment for Latent TB Infection. In addition there were 1,030 home visits that included nurses providing directly observed medication therapy to patients. In addition, there were a total of 150 TB medication refills. H OMELESS MEDIC A L For the fiscal year 2013-2014, the Good Shepherd Medical Clinic provided 871 total patient visits with 227 unduplicated patients. In addition, there were 398 prescriptions filled and 68 lab and diagnostic testing performed. In order to promote preventive health and to help reduce emergency room visits, the health department in collaboration with the UNC-W nursing students provide education sessions to the residents of the shelter. During this fiscal year, 27 education classes were conducted with a total of 333 participants. The UNC-W nursing students continue to participate in this clinic rotation in order to learn about the medical needs of this population. 10

PERSONAL HEALTH SERVICES S C H OOL HEALT H School Nurses eliminate or minimize health problems which impair learning. School Nurses reduce health related absenteeism by managing acute and chronic illness and by promoting student and family participation in management of their disease. They advocate for students and assist families in securing medical services when needed. School Nurses are a vital part of the collaborative team in schools whose goal is to increase academic success by ensuring physical, emotional and social wellness. In New Hanover County, the School Nurses serve over 25,000 students from ages Pre-K through 12th grade. Here are some totals for Fiscal year 2013-2014, for School Health: 116,000 visits by students and staff to health rooms 57,000 student medications dispensed or medical procedures performed 3,203 Emergency Action Plans developed 7,711 students screened for vision M OBILE DENTA L UNIT S C H O OL MENTAL HEALT H The School Mental Health program provided individual and family psychotherapy services to children and families of the New Hanover County School System. In 2013-2014, the program was able to provide these services to 647 students in five middle schools and 13 elementary schools. Therapists collaborated with school staff and many community professionals to assure their clients had access to appropriate supportive services. This program provides comprehensive dental care to children 3 18 years old in New Hanover and Brunswick counties. During this fiscal year, we added 2 new school sites for a total of 8 schools in New Hanover County and 8 schools in Brunswick County. Dental care was provided to 1035 unduplicated children with 1363 patient visits. This is the highest number of unduplicated children seen since the mobile dental unit s inception in 2006 and this represents a 5.1% increase over last fiscal year. 11

FINANCIAL MANAGEMENT REVENUES AND EXPENDITURES The revenues and expenditures for the New Hanover County Health Department were approximately $13.5 million for the year ended June 30, 2014. Below is a comparison of revenues and expenditures over the last five years: Looking forward to the fiscal year ending June 30, 2015, the New Hanover County Health Department has a budget of approximately $13.4 million. 12