FY2017-2019 STRATEGIC BUSINESS PLAN, North Carolina
STRATEGIC BUSINESS PLAN OUR To promote and protect the public s health. Public health refers to all organized measures (whether public or private) to prevent disease, promote health, and prolong life among the population as a whole. Its activities aim to provide conditions in which people can be healthy and focus on entire populations, not on individual patients or diseases. Thus, public health is concerned with the total system and not only the eradication of a particular disease. OUR The World Health Association Health Department assures the health and safety of our diverse and changing community today and for future generations. The 10 Essential Services of Public Health
MECKLENBURG COUNTY OUR ENVIRONMENT Overview The Health Department (MCHD) offers a full array of programs and services to meet the community health needs of more than 1,012,539 residents. Over 813 employees work to ensure its mission of providing a safe and healthy environment for Charlotte and the six towns within the County. These services encompass the everyday work of inspecting restaurants and other facilities, following up on suspected communicable disease cases to prevent further infections, providing clinical preventive services, performing health case management, conducting health education in the community and monitoring the population s health through epidemiologic surveillance. Internal Changes MCHD has expanded dramatically in the past three years as the County ended the management contract with Carolinas HealthCare System, restructured Environmental Health and moved programs from the Provided Services Organization. A new Health Director and a reorganized management structure position MCHD to enhance the quality, efficiency and effectiveness of our services. External Focus As diseases, events and community health needs evolve, MCHD is challenged to address new and emerging demands. Improving health will take us beyond our traditional spheres, recognizing that the physical environment and social factors such as poverty and education are significant determinants of health. The work we do and our strategic planning remains informed through community participation in establishing our priority focus areas: Chronic Disease and Disability; Mental Health; Access to Care and the health impact of Violence. In response, MCHD has developed action plans that include increasing opportunities for physical activity, improving access to healthy foods, promotion of mental health services and addressing barriers to care. This is accomplished through innovative partnerships with County agencies such as DSS, Parks and Recreation and the Sheriff s Office, collaboration with the Opportunity Task Force and community organizations, and alignment with the goals of the Mecklenburg Livable Communities Plan. The successful implementation of policies establishing tobacco-free government grounds and parks evidences the added value of this collaborative approach to creating a healthy community. A Context of Change This work will take place in the context of a growing, increasingly diverse population, challenging us to provide culturally competent services. Technological changes will provide opportunities for greater efficiency to meet the needs of a growing population, accompanied by increasing numbers of restaurants and facilities needing inspection to ensure safety. Clinical services will be influenced by the ongoing impact of the Affordable Care Act. There are new opportunities to prevent the spread of HIV through prophylaxis, and for early interventions to mitigate the impact of diseases. Underlying all of this is an ongoing commitment to health equity, addressing racial and ethnic disparities in infant mortality, adolescent pregnancy, diabetes morbidity and mortality, HIV disease and homicide. 3
MECKLENBURG COUNTY OUR GOALS A primary responsibility of Public Health is to prevent and control infectious diseases. To accomplish this we are proposing to increase use of evidence-based strategies to address HIV disease by assuring the availability of new prevention approaches, expanding opportunities for those at risk to know their status, and supporting them remaining in the care that will keep them healthy and prevent spreading infection. With prevention as a priority, MCHD seeks to increase our preparedness capacity and our ability to meet mandated inspections of the increasing number of food service and other facilities opening to meet the growing population. In response to the findings of our Community Health Assessment, we look to make the healthy choice the easy choice for County residents. Collaborating with organizations to support health in all policies and increasing access to healthy food choices will help address chronic diseases. Increased access to Long Acting Reversible Contraception will prevent unintended pregnancies and increase the inter-pregnancy interval. This will support women s health and prevent the health and social consequences of unintended pregnancy, positioning these women to complete their education or secure employment. I am deeply grateful for the energy, passion and commitment of our staff and leadership team, a supportive County Executive Team and Board of County Commissioners and the partnership of health serving community agencies. Collectively our focus and dedication will help create a vibrant, healthy community. Marcus Plescia, MD, MPH Health Director Addressing the challenges of health disparities supports increased capacity for data analysis, the use of data-driven, evidence based interventions and strengthening the School Health program. Expanding the Child Development-Community Policing program to the six towns in the County, training more law enforcement personnel in Crisis Intervention Teams and enhancing Human Service Agency personnel with the capacity to successfully manage professional exposure to trauma will help lessen the impact of mental health challenges. DIRECTOR S MESSAGE This plan will help us build on a legacy of service, guiding us through emerging challenges to continued success. Reflecting identified needs and linking our efforts to partners within County government and in the communities, this plan supports the building of a healthier Mecklenburg for all residents. I am deeply grateful for the energy, passion and commitment of our staff and leadership team, a supportive County Executive Team and Board of County Commissioners and the partnership of health serving community agencies. Collectively our focus and dedication will help create a vibrant, healthy community. 4
GOAL 1: Improve Services to Prevent and Control Infectious Diseases across the Entire Community Objective 1: Reduce the number of new HIV Cases (cont d) Strategy A Secure treatment for, and support retention in care of those who are HIV-positive. Actions 1. FY17: Hire and train 1 patient navigator. 2. FY18: Hire and train additional patient navigator. 3. FY18: Implement new HIV Case Management Electronic Medical Record tool. 4. FY19: Sustain and train navigators. Number individuals referred to treatment. Number of individuals enrolled in treatment. Number of individuals successfully linked to care (i.e. attended second medical appointment with an HIV specialist) Retention in care is critical to reducing HIV infection and controlling healthcare costs. Currently 1 grant funded position (part of research study targeting a specific population) to end September 2016. This would allow for expansion of patient navigation and retention in care to all infected. There are multiple options under evaluation to fulfill the need for a HIV Case Management Electronic Medical Record tool, 2 are currently utilized by other county services. Success will be defined as sustaining the current rate of 80% (36 of 45) HIV-infected clients served by the program receiving appropriate medical care achieving viral suppression, reducing new infections, emergency room, in-patient and associated social support costs. This rate is higher than both national and state percentages. The additional patient navigator will serve an additional 30 HIV-infected clients, as well as linking those who test positive for syphilis and Hepatitis C to care. An HIV Case Management Electronic Medical Record will enhance capacity in linking patients to care, supporting successes listed above. The return on investment for these strategies include reduced emergency and in-patient costs for HIVinfected persons, increased viral suppression helping to prevent transmission, reducing the incidence of new cases of HIV. The average lifetime costs for an HIV patient in North Carolina is $367,073. (CDC) 5
Strategy B Assure the availability of PrEP (Pre-Exposure Prophylaxis) in the community to reduce HIV transmission. Actions 1. FY17: In collaboration with national Infectious Disease experts and local HIV providers and partners, research effective models for making PrEP available to community. 2. FY18: Establish collaborative relationship with community based organizations, hospitals/medical providers for coordination of PrEP program. 3. FY18: Train and educate public health staff, community partners in benefits of PrEP program. 4. FY18: Initiate PrEP education of people engaged in high-risk behaviors to reduce risks of transmission. Number of people securing PrEP Number of people counseled in PrEP Reduction in HIV cases investigated as new. Pre Exposure Prophylaxis is a CDC recommended strategy for reducing risks of HIV transmission. Community education program will be coordinated with Public Information. Success will be defined as community acceptance of PrEP as an effective HIV prevention tool, leading to a reduction in new cases of HIV. There are currently 8 PrEP providers in the County (2015); number of patients on therapy is unknown at this time. Future state will be 15 providers and achieving a targeted number of PrEP patients after establishing baseline. The return on investment for this strategy includes lower transmission rates and reduced medical costs; the average lifetime costs for an HIV patient in North Carolina is $367,073. (CDC) 6
Strategy C Increase the number of non-traditional HIV/STD testing opportunities in the community. Actions 1. FY17: Involve community in researching best practices and direction setting (HIV Council, Black Treatment Advocates Network). 2. FY17: Develop evidenced based social and traditional media campaign to influence behavior in high-risk populations. 3. FY18: Develop implementation plan. 4. FY18 & FY19: Implement identified best practices and strategies. Measure Number of people who know their HIV status. Strategy requires coordination with Public Information in development of media campaign. Success will be defined as an increase in the number of partnerships supporting HIV testing at sites in the community (currently 31) and HIV Awareness Events providing greater access to at-risk populations. Earlier identification of HIV infection and linkage to care reduces viral load, decreasing new infections and their accompanying medical costs. In FY15 this program tested 4,184 individuals, which is 26% of MCHD HIV testing. Additional resources would support a 30% increase in testing (1,250). There are multiple systems in place to notify persons of their HIV-status including return to testing sites, the Televox phone system for all lab results, and Disease Investigative Specialist (DIS) notification. Currently, 97% of HIV-infected clients are informed of their test results. The return on investment for this strategy ranges from $1.46 to $2.01 (per dollar invested) for alternative testing programs. (Journal of AIDS, 1 March 2012). 7
GOAL 1: Improve Services to Prevent and Control Infectious Diseases across the Entire Community (cont d) Objective 2: Increase safety of food, facilities, and water Strategy A Achieve 85% of mandated regulatory inspections. Actions 1. FY17: Hire and train 1 Environmental Health Specialists (EHS) to maintain 85% compliance rate for food and lodging facility inspections. 2. FY18: Implement recommendations from Internal Audit for supervisor/staff ratio. Hire 1 Environmental Health Supervisor to improve staff/supervisor ratios and improve quality assurance checks on field staff. 3. FY18: Identify business requirements for enhanced technology. 4. FY18: Hire and train 2 new EHS to handle new growth in facilities in. 5. FY19: 1 Hire and train 1 new EHS to handle new growth in facilities in. 2.5% of mandated inspections conducted by 1 new full time EHS Due to lengthy State training protocols, year 1, 125 mandated regulatory inspections conducted by 1 new full time EHS. Year 2, 375 mandatory regulatory inspections conducted by the same staff member. Currently meeting 80% of mandated regulatory inspections with 40 positions. Success will be defined by 85% of mandated regulatory inspections completed in accordance with state guidelines. The return on investment is difficult to quantify. The Food and Drug Administration estimates that nationally: Foodborne illnesses are annually costing the economy more than $15.6 billion, or about one-half of the $32 billion the World Health Organization says the Ebola outbreak will cost the world economy. Each year, more than 8.9 million Americans will be sickened by one of the 15 pathogens, with more than 5.4 million of those illnesses due to Norovirus. Foodborne illness sends 53,245 Americans to hospitals annually, which is where the majority are when infections take the lives of 2,377. (Food Safety News, 10/2014). 8
Strategy B Increase visits not related to regulatory inspections for proactive education. Actions 1. FY18: Develop and implement social media strategies. 2. FY18: Research industry models for educating customers to reduce incidences of critical violations (those violations likely to cause food borne illness.) Strategy C Decrease incidences of critical violations (faster completion of regulatory inspections) Number of non-regulatory interactions. Strategy will require partnership with Public Information. Stall will visit facilities to teach, train and encourage customers. Success will be defined as improved satisfaction for both employees and customers, and the establishment of a partnering relationship that will increase facility understanding and compliance with safety and sanitation requirements. The return on investment will be reduced infractions, resulting in faster, more efficient inspections. Restructure capacity to enhance administrative processes. Actions 1. FY18: Redesign and implement improvements in administrative functions and processes 2. FY18: Evaluate and implement Environmental Health Specialists classification leveling. 3. FY18: Evaluate benefit of facilitators for front counter intake. 4. FY18: Evaluate Coordinator for entire Environmental Health Division. 5. FY18: Evaluate need for Environmental Analyst for Pools & Environmental and Ground Water Services program. Improve employee motivation and satisfaction. Improve customer satisfaction. Currently 67% of Environmental Health employees state that their workload is reasonable; goal is to reach score of 89%. Success will be defined as the establishment of a partnering relationship that will increase facility understanding and compliance with safety and sanitation requirements. In FY15 there were 219 reinspections, where the grade dropped below a 90, and 1,761 verification visits, required for follow-up to critical violations that were not corrected on site at the time of the inspection. The return on investment will be reduced critical violations, resulting in faster, more efficient inspections and reduced number of inspections requiring mandated follow-up. 9
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GOAL 1: Improve Services to Prevent and Control Infectious Diseases across the Entire Community (cont d) Objective 3: Enhance public health preparedness Strategy A Maintain and manage a cross-agency Incident Command System (ICS) structure with position descriptions and assignments. Actions 1. Identify ICS positions and assign responsibility to appropriate staff. 2. Train necessary staff in ICS structure and operations. 3. Successfully complete at least one exercise or actual event in each year. 100% successful completion of event in each year At least 80% response within 1 hour of notification of situations where Health Department receives alert to need for public health response to incident within. Success will be defined as 100% of necessary staff trained in ICS structure and operations. This will meet state requirement and position MCHD to maintain state funding. The return on investment is estimated at $5 for every dollar spent on preparedness. (Atlantic CityLab, 8/2013) Strategy B Strengthen collaborative relationships with community partners (mental health agencies, hospitals, first responders) to enhance response to emergency events. Action 1. Conduct ongoing preparedness planning meetings with community partners. Measure Increase in number of preparedness planning meetings. Success will be defined as a community more collaborative, integrated and coordinated in its preparation for disaster. These qualities will be measured through response rates to practice drills, and if necessary, real emergencies. The return on investment is estimated at $5 for every dollar spent on preparedness. (Atlantic CityLab, 8/2013) 11
Strategy C Improve effective medical counter measures program (Strategic National Stockpile) to respond to biological terrorist attacks and/or communicable disease outbreaks. Action 1. Maintain ongoing communication and planning with Charlotte-Mecklenburg Schools and first responders to support training, exercise and coordination of staff. Number of Point of Dispensing (POD) staff trained. 100% successful completion of POD exercises. Coordinate with NC Office of Preparedness in all responses. Salary of current Preparedness Coordinator is grant funded; achieving required level of preparedness necessitates increased support. Success will be defined as a community more collaborative, integrated and coordinated in its preparation for disaster. The enhanced ability for the MCHD-CMS collaborative implementation of the Strategic National Stockpile plan will be measured through audits conducted according to CDC guidelines. The return on investment is estimated at $5 for every dollar spent on preparedness. (Atlantic CityLab, 8/2013) 12
GOAL 1: Improve Services to Prevent and Control Infectious Diseases across the Entire Community (cont d) Objective 4: Enhance department capability to manage required immunizations for health department staff Strategy Utilize technology to more effectively ensure that all health department staff have required immunizations. Action 1. Purchase software that interfaces with MyHR to document staff compliance with job-specific immunization requirements. Enhanced management of immunization requirement compliance by staff. Improved wellness state for all employees. Staff have immunization requirements linked to job classification and duties. Increase to 800+ employees requires more effective means for documenting adherence. Recommended software provides streamlined occupational health operational tools for tracking and analysis of employee information with reports focused on data collected to improve awareness of critical health and safety issues. Will require PeopleSoft interface. Success will be defined as increased staff vaccination rates, enhanced ability of MCHD leadership to document staff compliance and identify those who need additional safety measures. The return on investment for influenza immunization is estimated as $11 to $1; $91 $141 in direct medical costs saved per vaccination. Absenteeism costs range from $40,000 to $130,000. Other costs averted though immunization include: One to six sick days initially. Reduced productivity due to fatigue may persist for another two weeks or more. Drug expenditures for antiviral and antibiotic medications (the latter for secondary infections). 13
GOAL 2: Promote Community Health by Making the Healthy Choice the Easy Choice Objective 1: Improve the quality of the built environment to increase active living Strategy Increase the Health in All Policies approach in decision-making in. Actions 1. Contract with the Urban Institute at UNC-Charlotte to conduct baseline survey and create database of targeted organizations (faith communities, worksites, schools and multi-unit housing complexes) to identify existing tobacco/nutrition/active living policies. 2. In each fiscal year, establish one Health Department partnership with built environment decision makers. 3. Conduct 2 Health Impact Assessment (HIA) annually to identify opportunities to positively impact health in built environment decisions. In each year, 1 established partnership with built environment decision-making body, resulting in adoption of health-influenced plan/policy. Establishment of database with information on existing tobacco/ nutrition/active living policies to guide health department activities; assessment in Years 2 and 3. Completion of 6 Health Impact Assessments by 2019. This strategy supports the Livablemeck strategy: Create a culture of health and wellness. Contract costs with UNC-Charlotte is estimated. Success will be defined as 6 completed HIAs with accepted recommendations influencing healthimpacting policies in partner organizations that utilize best practice principles. The long-term return on investment will be measured in terms of healthcare costs, health status and health disparities, and non-health benefits such as wealth, education, employment, safety, transportation, housing, worksites, food, and recreational spaces. (CDC. A Framework for Assessing the Value of Investments in Nonclinical Prevention. 12/2015) 14
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Objective 2: Increase the number of outlets with access to healthy food choices Strategy A Increase the number of healthy corner store environments. (10% of 200 corner stores at the end of year 3) Actions 1. FY17: Enlist, train and support 6 corner stores in expanding healthy food offerings. 2. FY18: Enlist, train and support 6 corner stores in expanding healthy food offerings. 3. FY19: Enlist, train and support 8 corner stores in expanding healthy food offerings. Measure Strategy B Number of corner stores expanding healthy food offerings. The strategy supports the Livablemeck strategy: Create a culture of health and wellness. Success will be defined as 20 corner stores expanding their offerings of healthy food. Using 2010 Census data and the CDC recommended Alteryx Analytics Gallery the number of residents within a 1-mile radius of the 20 identified stores is 184,215. Increase the number of farmers markets to improve access to fresh fruits and vegetables. Actions 1. Increase number of farmers markets that accept SNAP/EBT payments; (FY18: 15; FY19: 18). 2. FY17: Coordinate with DSS on increasing utilization of SNAP/EBT at farmers markets. 3. FY17: Open famers market located at Health Department facility on Beatties Ford Road. 4. FY18: Coordinate with WIC program on the utilization of WIC vouchers at farmers markets. Number of farmers markets accepting SNAP/EBT benefits Retention rate of vendors at Beatties Ford Road farmers market This strategy supports the Livablemeck strategy: Create a culture of health and wellness. Success will be defined as a collaborative DSS/MCHD effort resulting in more farmers markets accepting SNAP/EBT benefits and the opening of a farmers market on MCHD campus at 2845 Beatties Ford Road. Using 2010 Census data and the CDC recommended Alteryx Analytics Gallery the potential number of residents that can be served by this farmers market is 173,874. 16
Objective 3: Improve the overall health of children ages birth-5 Strategy A Increase availability and promote use of Long Acting Reversible Contraception (LARC) to reduce unintended pregnancies and increase inter-pregnancy interval to recommended >24 months Actions 1. FY17: Research models and best practices for expansion of LARC in community. 2. FY18: Build support through community education campaign. 3. FY18: Increase case management for postpartum women to increase intervals between pregnancies. Number of women case managed to increase intervals between pregnancies; documented intervals >24 months Reduction in number of women with inter-pregnancy interval <24 months. Strategy B Success will be defined as a decrease in infant mortality and unintended pregnancies, and an increase in the inter-pregnancy period >24 months. National (Colorado, New York) and regional (Gaston Youth Initiative) data show increased utilization of LARC result in reductions in unintended pregnancies in all racial and ethnic groups. The return on investment is $5.85 for each dollar spent on these programs (Colorado Dept. of Public Health and Environment). In addition, reduced/delayed pregnancies have a positive impact on infant mortality and economic mobility. Coordinate regional community planning to identify top evidence-based strategies to lower infant mortality rates; improve health outcomes and improve the overall health of children ages birth to 5. Actions 1. FY17: Establish implementation plan based on identification of best practices. 2. Enhance clinical technology capacity to increase patient access to services. Establish partnership with regional providers. Establish service implementation plan. Success for this initiative will be measured according to indicators set by NC Division of Public Health. These include: Infant Mortality; Child Health Insurance enrollment; and Child Poverty. Existing racial and ethnic health disparities will be a focus of this program. The return on investment will be reduced infant mortality and improved health outcomes for children and families served by the program. 17
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GOAL 3: Improve Monitoring and Increase Access to Resources and Care that Address Health Disparities Objective 1: Equip MCHD, faith-based organizations, community groups, small minority businesses and individuals to become effective partners in efforts to reduce risk factors for chronic disease and to improve hypertension control in high risk populations Strategy A Using the existing Village Heart B.E.A.T. (Building Education Accountabilities Together) infrastructure, increase the capacity of faith-based organizations to engage in evidence-based health education/health promotion activities. Actions 1. Formalize health ministry activities through establishing a certification process with the North Carolina Council for Churches Partners in Health and Wholeness (PHW) initiative. 2. Recruit and train community ambassadors from faith-based organizations in a health ministry certificate/program that provides training on congregational health assessment/health promotion. 3. Expand facility joint use agreements to increase access to community-based wellness opportunities. By the end of year 1, 50% of VHB eligible churches will be certified through the PHW program; by year 2, 75% of VHB eligible churches will be certified through the PHW program; by year 3, 100% of VHB eligible churches will be certified through the PHW program By the end of year 1, 50% of VHB eligible churches will have trained community ambassadors; by year 2, 75% of VHB eligible churches will have trained community ambassadors; by year 3, 100% of VHB eligible churches will have trained community ambassadors Village Heart B.E.A.T is a multi-component intervention with an ecological framework, targeting activities at the individual, social network, and community levels that will improve health outcomes for populations with greatest chronic disease (hypertension) burden and risk. Success will be defined as increased participation by churches and congregants as indicated in performance measures. The long-term return on investment will be measured in terms of healthcare costs, health status and health disparities, and non-health benefits such as wealth, education, employment, safety, transportation, housing, worksites, food, and recreational spaces. (CDC. A Framework for Assessing the Value of Investments in Nonclinical Prevention. 12/2015) 19
Strategy B Create a framework and align Village Heart B.E.A.T. with the Million Hearts Initiative Actions 1. Design Million Hearts implementation approach. 2. Identify, engage, and recruit local, faith-based and community-based organizations, and provider groups into the national Million Hearts Initiative. (e.g., symposium, district town-hall meetings, workshops, website, social media etc.). 3. Develop messaging campaign with the county s public information (PI) to disseminate messages about the importance of action steps to hypertension control (e.g., social media, print media, radio). 4. Develop and implement hypertension academy to supplement the Million Hearts initiative. By year 1, 25 churches will be enrolled to participate in the Million Hearts initiative; by year 2, 50 churches will be enrolled in the Million Hearts initiative; by year 3, 75 churches will be enrolled in the Million Hearts initiative Improved health care seeking behaviors Improved lifestyle behaviors (increased fruit and vegetable consumption, increased physical activity, increased medication adherence) Within 1 year, the hypertension academy will be developed, including inclusion criteria for participants, recruitment and enrollment strategies Million Hearts is a national initiative to prevent 1 million heart attacks and strokes by 2017 that brings together community stakeholders to fight heart disease and stroke as part of the better care, smarter spending, healthier people approach to improving health care delivery. Centers for Disease Control and Prevention (CDC) co-leads the Million Hearts Challenge with the Centers for Medicare & Medicaid Services to identify prevention strategies that help individuals achieve blood pressure control. Objective will serve Adults (40-65 years), Older Adults (65+ years), Young Adults (19-39 years) Success will be defined as 75 churches engaged in different aspects of the Million Hearts campaign. The long-term return on investment will be measured in terms of healthcare costs, health status and health disparities, and non-health benefits such as wealth, education, employment, safety, transportation, housing, worksites, food, and recreational spaces. (CDC. A Framework for Assessing the Value of Investments in Nonclinical Prevention. 12/2015) Strategy C Create a structural framework for a Coordinated Health Equity Council (Original Name: Partners in Eliminating Health Disparities) that can be used to sustain Village Heart B.E.A.T. activities and programs and identify new programs to prevent/control chronic disease Actions 1. Create a structural partnership with academic stakeholders. 2. Convene stakeholders to develop county-wide health equity agenda. Within 6 months, the infrastructure for the Coordinated Health Equity Council will be in place, including initial members, rules/terms for membership, organizational structure Within 9 months, the Coordinated Health Equity Council will hold their initial committee meeting By the end of year 1, Coordinated Health Equity Council will have developed an initial health equity agenda Success will be defined as more efficient utilization of resources targeting health disparities. 20
GOAL 3: Improve Monitoring and Increase Access to Resources and Care that Address Health Disparities (cont d) Objective 2: Retain a school nurse workforce for Charlotte-Mecklenburg Schools that allows for daily student access to the services of a school nurse Strategy A Establish float pool of school nurse temporary positions; hire full-time new school nurses for CMS projected opening of two new schools. Actions 1. Investigate funding opportunities for additional staff. 2. Research, design and implement float pool model for School Health. 3. Coordinate with CMS on planned opening of additional schools. Hire 2 full-time School Nurses in FY18 for anticipated new schools. Increased health services provided by school nurses. Reduce school nurse turnover. Success will be defined as having a nurse in every school. The float pool will maintain/increase high job satisfaction rates of school nurses. Return on investment is estimated based on the theory that onboarding a new employee costs a minimum of 20% of the new employee s salary. The turnover rate for FY15 was 9%; resulting in an estimated $224,000 onboarding cost. Strategy B Establish agreement on clearly understood operational expectations by Public Health and CMS Schools. Actions 1. Create a Public Health CMS work group to clarify expectations and duties of school nurses. 2. Design common agreement on expectations of school nurses working with CMS schools. 3. Communicate shared understanding to school nurses, principals, Public Health and CMS leaders, parents and interested parties. Creation of consensus agreement on school nurse expectations and duties of school nurses. Improve school health job satisfaction scores. Reduce school nurse turnover. The differing expectations of the role of the school nurse by CMS staff and School Health personnel has been identified as a concern by the School Health Program Retention Committee and during exit interviews. The consensus agreement is expected to decrease confusion and provide an agreed upon platform for working together to meet the health needs of students. This will also support staff retention. 21
GOAL 3: Improve Monitoring and Increase Access to Resources and Care that Address Health Disparities (cont d) Objective 3: Increase immunization compliance rates for CMS students Strategy A Staff development for School Health Program nurses and CMS registrars on immunization requirements Actions 1. Conduct immunization skills assessment for school nurses. 2. Design and implement immunization training program for School Health Program RNs and LPNs. 3. Work with CMS staff to design and implement training of CMS registrars in understanding immunization requirements and their role in assuring compliance. School nurses show improved knowledge and skills on immunization compliance. Number of CMS registrars trained. Success will be defined as increased school health nurses to properly audit student records for immunization compliance. This will identify students who have not met state requirements prior to the exclusion date, increasing attendance and protecting them from preventable diseases. The return on investment includes improved student attendance. Strategy B Conduct audits of immunization compliance in all CMS schools. Actions 1. Design audit implementation plan. 2. Train school nurses in efficient auditing of student immunization records to identify students who are not adequately immunized. 3. Conduct school audits for 3 years (during summer) to establish baseline and identify students in need of referral for immunizations. 4. FY18: Pilot summer immunization audit program. 5. FY19: Implement full-scaled summer immunization summer audit program. Completions of audits; establishment of baseline data on immunization compliance. Increase in immunization compliance. Success will be defined as each nurse and school administrator knowing the immunization status of all of her/his students; this is important due to more complex immunization requirements. This will support an efficient response to an outbreak (e.g., measles, varicella, mumps) and a reduction in the number of students excluded for non-compliance with state requirements. The return on investment includes improved student attendance and more efficient public health response to outbreaks. 22
Strategy C Establish summer immunization clinics to meet compliance goals, state requirements. Actions 1. Hold 4 summer immunization clinics to improve access for families and provide increased opportunities for students identified as non-compliant in audits. Measure Number of students immunized. Success will be defined as an increase in the number of students fully immunized. In Fall 2015, MCHD immunized 981 students with 2,517 shots. Return on investment includes reduced student exclusion from school. 23
GOAL 3: Improve Monitoring and Increase Access to Resources and Care that Address Health Disparities (cont d) Objective 4: Increase Health Department access to and utilization of local health data on more focused level (census tract; neighborhood) Strategy Action Conduct Behavioral Risk Factor Surveillance Systems survey (BRFSS) and Pregnancy Risk Assessment Monitoring System survey (PRAMS) on annual basis to identify focal points for public health activities. Contract for survey of residents as well as oversample residents in public health priority areas to better determine health indicators. Improve planning and evaluation capacity through access to high quality county-level health indicator data, which is currently unavailable. Improve planning and evaluation capacity through access to high quality health indicator data in public health priority areas; data is currently unavailable. Access to this level of data is critical for grant applications, supporting community partner activities and increasing effectiveness of interventions by focusing on neighborhood-level needs. This data is not available from any other source. 24
GOAL 3: Improve Monitoring and Increase Access to Resources and Care that Address Health Disparities (cont d) Objective 5: Improve law enforcement-mental health collaborative responses to individuals experiencing a mental health crisis Strategy Increase number of law enforcement personnel certified in Crisis Intervention Teams (CIT). Actions 1. Facilitate collaboration among CMPD, Sheriff s Office, town police departments National Alliance on Mental Illness and other partners in implementation of CIT training and programming, to include ongoing assessment of interest, demand for service, resources needed, and contributions from each partner. 2. Provide CIT training 4-6 times annually. 3. Implement usage of database for officers to report data on CIT encounters. Increase in number of CIT trained law enforcement personnel by 120 per year Increase number of pre-booking diversions through CIT trained personnel. Success will be defined as an increase in pre-booking diversions from jail of persons with mental health disorders, thereby reducing harm. Strategy includes partnerships with CMPD, MCSO, town police departments, National Alliance on Mental Illness-Charlotte and others. *MH Licensed Clinician currently funded with police grant to expire in FY17. 25
GOAL 3: Improve Monitoring and Increase Access to Resources and Care that Address Health Disparities (cont d) Objective 6: Complete the expansion of Child Development-Community Policing (CD-CP) services to children and families exposed to violence (CEV) and other trauma to reach all of including the six towns Strategy Increase engagement of town police departments (Cornelius, Davidson, Huntersville, Matthews, Mint Hill, Pineville) to provide CD-CP services to CEV in their communities. Actions 1. Engage town and town-police leadership to implement CD-CP services to CEV and other trauma. 2. Provide CD-CP officer seminars on a quarterly basis. Operationalize the CD-CP program within all CMPD divisions and town police departments Percent of families that receive a Child Trauma Intervention Increase police referrals of children exposed to violence by 200 annually Success will be defined as successful implementation of CD-CP in all of CMPD and the town police departments. This will result in an increase in family referrals from trained officers. The return on investment will be all children experiencing violence and trauma will have access to an immediate, coordinated police-mental health response to address their needs and help them return to a sense of safety and security. This will ultimately represent cost savings in the form of a reduction of usage of more expensive services for more serious, chronic problems that would be likely to develop without this intervention. 26
GOAL 3: Improve Monitoring and Increase Access to Resources and Care that Address Health Disparities (cont d) Objective 7: Create a trauma-informed health and human services workforce equipped to provide trauma-informed care (TIC) to citizens Strategy Increase county employee knowledge of trauma-informed care and professional trauma exposure and implement practices that reflect TIC principles. Actions 1. FY18: Hire health manager to design TIC training program in collaboration with Charlotte AHEC, CMS, Cardinal Innovations and other partners. 2. FY18: Hire coordinator to implement program. 3. FY18: Hire training specialist to implement program. 4. Conduct collaborative planning and implementation across the county. 5. Conduct TIC trainings for human service personnel. 6. Provide training on professional trauma exposure and self-care, recognizing the needs and experiences of staff. Number of staff trained in utilization of TIC resources (FY18 measure) 1 Community-wide conference on Trauma Informed Care (FY18 measure) CDCP Referrals and Children 7000 6000 5000 4151 4379 4939 5799 5730 5456 5533 5763 Count 4000 3000 2000 1000 1662 853 2117 1094 2575 1321 2900 1505 3171 1763 2293 2358 2641 3083 3092 2947 3148 3388 0 2002 2004 2006 2008 2010 2012 2014 2016 Fiscal Year Referals Children 27
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GOAL 4: Maintain Environmental Sustainability of Operations Objective 1: Adhere to environmentally preferable purchasing (EPP) guidelines Strategy Actions Monitor department practices to ensure adherence to environmentally preferable purchasing (EPP) guidelines FY 2017 Identify a department representative to work with the County s Sustainability Manager to track and meet the department s environmental goals. FY 2017 FY 2019 Educate department employees on the importance of adhering to the County s environmentally preferable purchasing (EPP) guidelines. Enforce the department s adherence to the County s EPP guidelines by monitoring purchasing habits. Embrace new and innovative opportunities for improving the environmental-friendliness of the department s purchasing habits. When making purchasing decisions, consider the full cost of the products environmental, social, and economic. Dollars spent on recycled paper / Dollars spent on all paper purchases Dollars spent on environmentally preferable office supplies / Dollars spent on all office supplies Dollars spent on remanufactured printer cartridges / Dollars spent on all printer cartridges 29
GOAL 4: Maintain Environmental Sustainability of Operations (cont d) Objective 2: Provide employees with opportunities to learn about and practice environmentallyfriendly activities (via the County s Work Green program) Strategy Actions Support employee involvement in environmentally-friendly activities (via the County s Work Green program) FY 2017 Identify a department representative to work with the County s Sustainability Manager to track and meet the department s environmental goals. FY 2017 FY 2019 Measure Educate department employees on the importance of participating in the County s Work Green program. Educate department employees on opportunities to participate in the County s Work Green program via educational opportunities (i.e. Lunch & Learns), volunteer opportunities, alternative commuting (i.e. carpooling, mass-transit, walking, or cycling), and other unique employee engagement campaigns. Enforce the department s participation to the County s Work Green program by consistently monitoring performance. Total number of Work Green credits earned by the department s employees 30