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Steuben County Public Health Annual Report 2015
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Table of Contents
Table of Contents .................................................................................................................................1 Message from the Director…………………………………………….………………………………………………………….……..2 Mission, Vision, and Core Values..........................................................................................................3 Organization Chart ........................................................................................... …………………………….……4 Health Department Staff ......................................................................................................................5 Essential Service 1: Monitor Health Status ...........................................................................................6 Essential Service 2: Diagnose and Investigate Health Problems and Health Hazards ......................... 7 Essential Service 3: Inform, Educate and Empower People about Health Issues ...............................15 Essential Service 4: Mobilize Community Partnerships to Identify and Solve Health Problems ........17 Essential Service 5: Develop Policies and Plans that Support Community Health Efforts ................. 18 Essential Service 6: Enforce Laws and Regulations That Protect Health and Safety .........................21 Essential Service 7: Link People to Health Services ........................................................................... 23 Essential Service 8: Assure a Competent Public and Personal Health Care Workforce .....................3 0 Essential Service 9: Evaluate Effectiveness, Accessibility & Quality of Personal and Population Based Health Services ..................................................................................................................................31 Essential Service 10: Research for Innovative Solutions to Health Problems .................................. 32 Financial Statement .......................................................................................................................... 35
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A MESSAGE FROM THE DIRECTOR
I am pleased to present the Steuben County Public Health Department’s 2015 Annual Report. This report reflects another year of hard work and dedication of the entire public health team and describes the programs and services provided throughout the past year supporting and facilitating better health for all: healthy people, strong families, and vibrant communities. As a Licensed Home Care Services Agency, the department is able to conduct operations and programs which require home visitation such as nursing visits to new mothers and infants, to families of children identified with elevated lead levels, and to individuals diagnosed with Tuberculosis Infection or Disease. The Department also operates as a Diagnostic and Treatment Center permitting clinic activities for immunizations, HIV Testing and Tuberculin Skin Testing. Both licenses are necessary to complete the core work of a local health department as required by Public Health Law. Throughout 2015, the department continued our commitment to working with community partners and stakeholders to implement the Community Health Improvement Plan (CHIP) as identified in the Community Health Assessment (CHA) from 2013. The Steuben County Health Priorities Team, rebranded as Smart Steuben, has worked tirelessly towards improving the health of our residents by focusing on Chronic Disease prevalence of heart disease, hypertension and obesity. It is exciting to see the outcomes of the work of the collaborative as we continue to focus on the CHIP initiatives in 2016. In 2016 we will continue to implement evidence based strategies in collaborative and community focused initiatives and evaluate the population health of Steuben County. Staff will continue to strengthen existing partnerships and develop new opportunities to share resources via participation in various community meetings and coalitions. Another major undertaking will be to continue with the preparation for national public health accreditation in partnership with the S2AY Rural Health Network members. A statement of Intent (SOI) was accepted by the Public Health Accreditation Board on July 2, 2015 and we anticipate being ready to submit our joint application in June 2016. In November we were able to put into use the Finger Lakes Public Health Alliance Mutual Aid Agreements as we responded to assist Seneca County in staffing Points of Dispensing clinics (PODS). These PODS were held to provide prophylaxis to over 2,000 individuals exposed to Hepatitis A through two employees at fast food establishments. This activity allowed us an opportunity to not only assist another small local health department, but to also test our readiness to respond locally should the need arise and to make any necessary revisions or additions to our Emergency Preparedness plans. We are excited to have hired a new Director, Darlene Smith, near the end of 2015 who looks forward to serving Steuben County residents through prevention, promotion and protecting our communities along with the rest of our experienced, talented and loyal public health staff. Respectfully, Victoria Fuerst, RN, MPH Former Director of Public Health
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Mission, Vision and Core Values
Mission Statement Steuben County Public Health will:
Conduct a periodic comprehensive assessment of the health needs of our county
Act as a resource through collaboration, education and service
Promote health
Prevent injury and disease
Enhance and protect the quality of life within our community
Vision Statement To support and facilitate better health for all: healthy people, strong families, and vibrant communities.
Values
Quality Collaboration
Empowerment Responsiveness
Effectiveness Service
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Organizational Chart
Steuben County Public Health Organizational Chart
November 2015
Human Services, Health and Education
Committee
Corporate Compliance
Officer
Medical Director
S2AY Health Services Advisory Board
Professional Advisory
Committee
County Legislature
County Manager
Director Public Health
Assistant Director Public Health
Director of Patient Services
Quality Improvement Committee
Quality Improvement Coordinator
Public Health/Prevent Services Disease
Control/Family Health LHCSA/D&TC
1 PH Coordinator
Public Health Education
1 PH
Education Coordinator
Finance/Clerical Support
1-Chief Fiscal
Officer
Special Children’s Services
1 Administrative
Officer/EIO
Local Early Intervention
Coordinating Council
Regional Early Intervention
Coordinating Council
5 RNS 1-Principal
Clerk 4 Acct Clerk /
Typists 1 Key Entry Operator
1-Senior Clerk
Physically Handicapped
Children’s Program
Children With Special Health Care
Needs
Early Intervention
2 Service Coordinators
(RNs shared with PH)
Preschool Services
Contract Providers
PH Emergency Planning
1 PHE
Coordinator
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Public Health Department Staff PERSONNEL
Administration
Darlene Smith Director of Public Health (began 11/15) Victoria Fuerst Director of Patient Services, Assistant Director of Public Health Dennis O’Connor, M.D. Medical Director
Support Staff
Christine Congdon Chief Fiscal Officer Terry Moss Principal Clerk
Staff
Diane Amidon Account Clerk Typist Shirley Davis Senior Clerk Kim Gotshall Account Clerk Typist Virginia Hargraves Account Clerk Typist Linda Griffin Account Clerk Typist (Retired)
Public Health Staff Gail Wechsler Public Health Coordinator Deb Matthews Dog Control Officer Nurses
Mary Fitzpatrick RN (Resigned) Kathy Ingham RN Contract Nurse Dawn Lindsey RN Jo-Anne Taylor RN Brenda Pruden-Hutches RN (Resigned)
Public Health Education Coordinator
Lorelei Wagner, MPH, CHES
Emergency Preparedness Coordinator
Karen Travis RN Special Children’s Services
Diane L. Kiff Administrative Officer Anne Roser RN Service Coordinator Regina Rice RN Service Coordinator (Resigned) Karen Dgien RN Service Coordinator
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Essential Service 1: Monitor Health Status to Identify and Solve Community Health Problems
Introduction: Essential Service 1 activities include assessing the health status of the community through formal and informal needs assessments and data analysis. Steuben County Public Health collaborates with a diverse group of community partners to address community health problems. In this section, the agency’s community health assessment, community health improvement planning and leading health indicators are featured.
Steuben County Public Health completes a Community Health Assessment (CHA) in conjunction with area hospitals routinely as directed by New York State guidelines. The last CHA was completed in 2013 and resulted in the current Community Health Improvement Plan (CHIP). The CHIP collaborative team includes representatives from Steuben County Public Health, Arnot Health, Guthrie Corning Hospital, St. James Mercy Hospital, the S2AY Rural Health Network, the Steuben Rural Health Network, Southern Tier Tobacco Awareness Coalition (STTAC), the Center for Tobacco Free Finger Lakes, the Finger Lakes Health Systems Agency (FLHSA), Cornell Cooperative Extension, Finger Lakes Community Health (FLCH), Corning Community College, Steuben County Legislature, and WIC. The goals of the 2014-2016 CHIP are to:
1. Reduce obesity in children and adults 2. Reduce heart disease and hypertension
The complete CHA can be viewed on the Public Health website at http://steubencony.org/Files/Documents/publichealth/steuben_cha_2013.pdf
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Essential Service 2: Diagnose and Investigate Health Problems and Health Hazards in the Community
Introduction: Essential Service 2 includes provision of epidemiological identification of emerging health threats and active investigation of infectious disease. The following programs/activities are highlighted in this section: seasonal influenza, communicable disease control, immunization program, rabies and lead poisoning prevention.
Immunization Clinics Clinics are staffed by the Primary and Prevent Team nurses along with volunteers. These clinics are held twice a month in Bath, one during the day and a second clinic being held in the evening. Clinics in Hornell and Corning were discontinued in 2015 as they were underutilized. In October of 2015, the agency starting vaccinating adults who are either uninsured or underinsured, and are now eligible to receive vaccines from the NYSDOH Vaccines For Adults program. During the months of September and October 2015, Public Health offered seasonal flu clinics for Corning City Fire and Police personnel, State Health Department employees, SCPH employees, and Steuben County employees. All children less than 19 years of age are enrolled in the New York State Immunization Information System (NYSIIS), which is part of the HCS, and all adults are encouraged to consent to be enrolled in NYSIIS.
Total Number of Clinics 2015
Bath, Corning, and Hornell 32
Special Clinics 4
Influenza Clinics 2
Jail Clinics 24
Total Clinics 62
Immunizations Administered at Clinics 2015
Diptheria, Tetanus & Acellular (DTaP) 10
DTaP-Hep B-IPV (Pediarix) 9
DTaP-Hib-IPV (Pentacel) 1
DTaP-IPV (Kinrix) 8
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Haemophilus Influenza Type B (HIB) 13
Hepatitis A 27
Hepatitis B 6
Human Papillomavirus (HPV) 20
Inactivated Polio Vaccine (IPV) 12
Influenza 23
Meningococcal Conjugate 16
MMR 26
Pneumococcal Conjugate 15
Rotavirus 6
Tetanus, Diphtheria (Td) 3
Tetanus,Diphtheria,Acellular Pertussis (Tdap) 26
Varicella 44
Adult Hepatitis A 34
Adult Hepatitis A/B 98
Adult Hepatitis B 89
Adult Human Papillomavirus (HPV) 5
Adult Influenza 280
Adult Meningococcal 5
Adult MMR 19
Adult Pneumococcal Polysaccharide 0
Adult Td 1
Adult Tdap 82
Zoster 0
Total Immunizations 878
Total People Receiving Immunizations 577
TST (TB Tests) Administered at Clinics 2015
Total TSTs 106
Total People Served at Clinics 2015
Total 683
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Lead Poisoning Prevention Program Two children were newly identified for lead levels over 15µg/dl, and two were newly identified for lead levels over 20µg/dl during 2015. Home visits were made to 5 households, both by Public Health and by NYSDOH staff from the Hornell Office.
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Communicable Disease Services Communicable disease activities involve surveillance to confirm reports of cases and follow-up to prevent the spread of communicable diseases. When necessary, staff from the Hornell District Office of the New York State Department of Health and staff from this agency cooperate in the investigation. There were no outbreaks of communicable diseases in the county in 2015.
*= cases/ investigations
Disease 2015
Amebiasis 0
Campylobacteriosis 29
Cryptosporidios 8
E. Coli 0157 1
E. Coli Non-0157 0
Encephalitis, Viral 0/1*
Giardiasis 6
Haemophilus influenza 0
Hepatitis A 1
Hepatitis B, Acute 0
Hepatitis B, Chronic 9
Hepatitis C, Acute 4
Hepatitis C, Chronic 65/81*
Legionellosis 8
Listeriosis 0
Lyme Disease 38/120*
Malaria 0
Measles 0
Meningitis 2
Mumps 1
Pertussis 5/5*
Salmonellosis 16
Shigellosis 0
Strep, Group A-Invasive 0
Strep, Group B-Invasive 8
Strep. Pneumoniae 5
Yersiniosis 0
Total 206/305*
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Tuberculosis Services Medical care is provided to patients and their contacts by Pasquale Picco M.D. and the Arnot Pulmonary Group under a contractual arrangement with the county. Nursing staff provided health guidance, and service coordination for one new tuberculosis case and 14 patient contacts.
HIV Clinics
Clinics are held biweekly in Bath, if there are appointments scheduled. The monthly clinics in Corning, and Hornell were discontinued as they were under-utilized. Fourteen individuals were tested and none were positive for HIV.
Sexually Transmitted Disease Lab Reporting Public Health nurses assess and evaluate reported positive gonorrhea, chlamydia and syphilis lab reports, and establish whether the patient is infected and has been treated. County residents seeking STD testing are referred to either Family Planning in Bath, or Planned Parenthood in Corning and Hornell; the total number of referrals for the year was 15.
Positive Cases Reported By MD’s 2015
Gonorrhea: Female 28
Male 7
Syphilis: Female 2
Male 3
Chlamydia: Female 219
Male 115
About 1 in 6 people
with HIV in the United
States do not know
they are infected.
--CDC
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Rabies Program
This past year the rabies program facilitated post exposure treatment for 44 persons exposed to rabies, a 33% decrease from 2014. All captured animals that were potentially rabid and that were in contact with humans or domestic animals were tested. There were 63 animals submitted for testing to the NYSDOH lab; of these 5 were positive for rabies.
Reported Animal Bites to Humans
2015
Animals testing positive for rabies by the NYSDOH Laboratory
2015
Dog 250
Raccoon 1
Cat 111
Bats 1
Cattle 4
Skunk 1
Other Domestic 1 Fox 0
Skunk 3 Cow 0
Fox 4 Dogs 0
Bat 47 Cats 2
Raccoon 8 Total 5
Small Rodents 1
Other Wild 0
Unknown 0
Total 433
Rabies in humans is 100% preventable through prompt
appropriate medical care.
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Public Health provided free rabies clinics in Bath, Corning and Hornell with the cooperation of veterinarians, animal handlers, nursing staff, and volunteers. Free vaccine and supplies were made available to local townships to hold additional clinics. The following clinics were conducted by the County and the townships: 2015 Clinic Sites
Other Animals
# Dogs
# Cats
Total
Addison 2 99 26 127
Avoca 1 158 65 224
Bath - Town 0 86 32 118
Bath–Public Health 1 99 32 132
Bradford 0 82 35 117
Cameron 0 114 18 132
Campbell 0 170 30 200
Canisteo 1 289 65 355
Caton 1 192 70 263
Cohocton 0 170 56 226
Corning–Public Health 0 196 88 284
Corning Town 0 0 0 0
Erwin 0 52 20 72
Finger Lakes Humane 0 1 304 305
Fremont
0 100 31 131
Greenwood 0 102 40 142
Hartsville 0 65 23 88
Hornby 0 134 40 174
Hornell–Public Health 1 137 52 190
Howard 0 143 49 192
Jasper 0 97 24 121
Lindley 0 70 18 88
Prattsburgh 0 0 0 0
Pulteney 0 56 21 77
Rathbone 0 69 20 89
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Savona 0 108 25 133
Thurston 1 151 29 181
Troupsburg 0 65 38 103
Tuscarora 0 137 28 165
Urbana
0 126 49 175
Wayland 0 139 53 192
Wayne 0 19 14 33
West Union (Rexville) 0 66 20 86
Wheeler 0 111 26 137
Woodhull 0 41 19 60
Clinic Sites Other Animals # Dogs # Cats Total
TOTALS-2015 8 Animals 3644 1460 5112
TOTALS - 2014 14 Animals 3670 1531 5215
Total Rabies Clinics
2012 2013 2014 2015
51 50 49 50
Avoca, Bath PH, Canisteo, Caton, Hornell PH, Corning PH, Hartsville, Hornby, Thurston, and Urbana each held two clinics and Finger Lakes Humane Society held 8 regular clinics
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Essential Service 3: Inform, Educate and Empower People about Health Issues Introduction: Essential Service 3 includes social marketing, targeted media public communication and providing accessible health information resources to reinforce health promotion messages and programs. The following activities are highlighted in this section: general health education and the Steuben County Public Health managed website. The Public Health Education Coordinator provided education to target groups and the public through a variety of methods in 2015.
Activity Topic Target Audience
# Reached Location # Completed in 2015
Presentation Car Seat Education
Expectant parents
178 Corning Hospital
4
Car Seat Check Event
Car Seat Education
Parents / Guardians
72 Addison, Bath 2 (More were completed by Sheriff’s Office)
Strong Kids Safe Kids and Family Fling
Helmet distribution and general PH info
Parents and children
539 (132 helmets distributed)
Avoca, Bath 2
Health Fair HPV Vaccine and tobacco cessation
High School Students
200 Corning 1
Baby Café Grand Opening
Breastfeeding Coalition, Car Seat Education, Tdap Vaccine, Baby Café info
Parents 120 Bath 1
Steuben County Fair
All PH Programs
Steuben County residents
410 Bath 1
Presentation Lead Poisoning Prevention
WIC Staff 12 Bath 1
Table Display National Influenza Vaccination Week
Steuben County residents and visitors
n/a Bath 1
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Health information was also provided to Steuben County healthcare providers through blast faxes. A variety of topics were covered including seasonal flu, STD’s, communicable disease, Baby Café, rabies and Hepatitis A. Steuben County Public Health Facebook page (www.facebook.com/SCNYPublicHealth) posts:
each week on topics that range from those that are time sensitive to those that are valuable throughout the lifespan.
553 followers (likes), up 81 from the previous year
271 posts were made
reaching over 17,000 viewers Public Health’s main page of the website (www.steubencony.org/publichealth) was visited over 5850 times throughout 2015, averaging nearly 500 new visitors per month. Pages on the Public Health website are updated as needed and include information on all our programs, pertinent community and health information, and links to other resources on timely information. In 2015, we added a Zika virus page and a Permits, Licenses and Certifications page for accreditation purposes. Two programs were offered to Steuben County employees and the public in 2015 in an effort to increase health: the National Diabetes Prevention Program (NDPP) and Freedom From Smoking (FFS). The goal of NDPP is to prevent type 2 diabetes from developing in those with prediabetes or who are at risk for developing type 2 diabetes through moderate weight loss and regular physical activity. This year-long CDC program meets weekly for 16 weeks and then we met nearly every other week for the rest of the year. The first NDPP class started in February with 14 county employees participating in Bath. Thirteen of the employees completed the first 16 weeks (1 had resigned during this time) with an average weight loss of 15.7 pounds. All but two of the participants met their goal weight (loss of 7%) during the program. The second NDPP class started in October in Hornell with 11 community participants. By the end of the year, the group had met nine times with an average weight loss of 6.6 pounds.
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Essential Service 4: Mobilize Community Partnerships and Action to Identify and Solve Health Problems
Introduction: Essential Service 4 involves convening and facilitating community groups in undertaking defined preventive and population focused activities in order to capture the full range of potential resources to solve community health problems. Highlighted in this section are: Southern Tier Diabetes Coalition, Dental Steering Committee, Breastfeeding Coalition and Southern Tier Tobacco Awareness Coalition.
2015 outcomes: The Public Health Education Coordinator serves as the chair for the Southern Tier Diabetes Coalition, which includes representatives from Public Health in Chemung and Schuyler, Arnot Health, Guthrie, the Bath VA, Novo Nordisk, Cornell Cooperative Extension, the S2AY Rural Health Network, the Steuben Rural Health Network, American Diabetes Association, and Diabetes on Target. The coalition participated in Diabetes Alert Day with representatives tabling at Corning Hospital, Guthrie Centerway, Ira Davenport, Arnot, Steuben County Office Building, and the Bath VA. More than 75 people were educated about diabetes and individual risk that day. The coalition hosted the annual Diabetes Fair at the Arnot Mall. Approximately 35 vendors tabled at the fair, ranging from local organizations to national organizations. Arnot Health offered blood glucose screenings, and 58 participants were screened. Guthrie provided foot assessments. ServSTEUBEN MRC volunteers were trained in the best practice for taking blood pressures and were utilized at the fair along with medical students affiliated with Arnot Health. Eighty people had their blood pressures taken at the fair. Estimated attendance was over 200 people. The coalition also presented posters at the DASH-NY conference in Albany and the Institute for Human Services conference in Corning. The Dental Steering Committee includes members from the S2AY Rural Health Network along with representatives from the health departments in their 8-county region. Committee members completed a train the trainer program to be able to train healthcare providers in applying fluoride varnish to the teeth of toddlers through children up to age 5. The committee members were also supplied with dental donations to give to area food pantries. The Steuben County Breastfeeding Coalition was formed with members of Steuben County Public Health, Guthrie MOMS, Guthrie Labor and Delivery, WIC, the S2AY Rural Health Network, ProAction, Southern Tier Pediatrics, the Bath VA, Pregnancy Resource Center of the Valleys, TASA, Arnot Health, Healthy Families, and local International Board Certified Lactation Counselors (IBCLC) and childcare providers. The coalition started meeting monthly and by July,
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the county’s first Baby Café was opened at the Dormann Library. The Bath Baby Café is a nationally recognized drop in support program for pregnant women, new moms, moms who have breastfed in the past, supporters, and their families. The Café is open every Friday through a collaboration of WIC, Public Health, Healthy Families, the S2AY Rural Health Network, and IBCLCs at the library. Bath Baby Café staff members are all trained in lactation and are a combination of Certified Lactation Counselors (CLCs), Peer Counselors, and IBCLCs. As a member of the Southern Tier Tobacco Awareness Coalition (STTAC), we support and encourage businesses, municipalities, housing complexes, and media outlets to consider smoke-free or tobacco-free policies for their grounds or other aspects of their business. In 2015, STTAC gained two new tobacco free policies in Steuben for the grounds of Twin Tiers Eye Care Associates and the Village of North Hornell.
Essential Service 5: Develop Policies and Plans that Support Individual and Community Health Efforts
Introduction: Essential Service 5 involves providing leadership for systematic community and state level planning for health improvement; development and tracking of measureable health objectives as a part of continuous quality improvement strategies and development of codes, regulations and legislation to guide the practice of public health. Highlighted in this section are the agency’s strategic plan, Community Health Improvement Plan and Emergency Preparedness. The Strategic Plan was set in place beginning in 2014, outlining goals for the department to achieve for optimum performance and function. The chart found at http://steubencony.org/Files/Documents/publichealth/steuben_county_public_health_sp_2015_progress.pdf details the goals of the Strategic Plan along with the progress made in 2015. Some of the items were completed in 2014 and that is identified in the status column. The Community Health Improvement Plan (CHIP) chart that details goals set forth beginning in 2013 for Steuben County Public Health, area hospitals, and community partners to complete and the progress towards meeting the overall goals defined by New York State Department of Health in their Prevention Agenda can be found at http://steubencony.org/Files/Documents/publichealth/steuben_county_chip_chart_and_progress_for_2015.pdf. The priorities chosen were to reduce obesity in children and adults and to reduce hypertension and heart disease. For more information on the New York State Prevention Agenda, please visit http://www.health.ny.gov/prevention/prevention_agenda/2013-2017/.
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PUBLIC HEALTH EMERGENCY RESPONSE PLANNING Steuben County Public Health continues to review and plan for potential All Hazard events including those of a biological, chemical, radiological, nuclear or explosive nature. These may be naturally occurring, large-scale communicable disease outbreaks or natural disasters. The Public Health Emergency Preparedness and Response Plan, also known as the PHEPR Plan, is the preparedness and response guide for these events. It is updated regularly and reviewed annually. The Licensed Home Care Service Agency (LHCSA) Plan, Continuity of Operations (COOP) and Risk Communication Plan are appendices to the PHEPR Plan and were updated this year as well. Public Health utilizes the Incident Command Structure to manage drills, exercises and events and to interact with partner agencies. Public Health staff is structured into these four response teams: Public Health Emergency Preparedness and Response Team, Clinic Team, Public Information Team and Clerical Team. Our partners:
County Emergency Planning Assessment (CEPA
Western Region Health Emergency Planning Coalition (WR HEPC)
Southern Subregional (SSR) and Finger Lakes Area Planning (FLAP)
Finger Lakes Public Health Alliance (FLPHA)
Human Needs Task Force (HNT)
Local Emergency Preparedness Council (LEPC
Corning-Painted Post (C-PP) Partners Meeting
Southern Tier/Finger Lakes Voluntary Organizations Active in Disasters (ST/FL VOAD)
Finger Lakes Chapter of the American Red Cross
MRC Wellcheck
Region II MRC All Hands Conference Calls 2015 Outcomes:
Maintained Steuben County Public Health staff and volunteer awareness of personal and community emergency preparedness through drills, exercises, formal education and newsletters.
Held the 2nd Annual Emergency Preparedness Equipment training for ALL Public Health Staff. The focus was on County and Public Health Incident Command awareness, review of equipment needed to operate during a Public Health event and knowledge/practice with NYSDOH programs necessary to collect data for a mass event associated with the emergency preparedness program.
NYSDOH Notification Drills
Assisted as evaluators at both the Ontario and Chemung County Mass Antibiotic Dispensing (MAD) exercises.
Public Health participated in the national Great NorthEast ShakeOut Earthquake drill in October.
Western Region Emergency Communication Knowledge and Information Test (WRECKIT) – this was the first year of a 3 yr. NYSDOH planned exercise, focusing on our ability to
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receive information and communicate it to partners before, during and after a catastrophic winter storm event.
Steuben County Emergency Operations Drill (EOC) – participated with other partners in training and then an actual exercise (as part of WRECKIT) to simulate activation and operation of a county-wide EOC for a winter storm event
Ebola Viral Disease (EVD) Drills and Personal Protective Equipment (PPE) training.
Steuben County Public Health conducted a Mass Antibiotic Dispensing (MAD) Medical Countermeasure exercise this year for the first time.
Participated in the activation of the Intermunicipal Agreement in Seneca for Hep A outbreak. Over 2500 persons were vaccinated that weekend.
Primary/Prevent staff has been trained and continues to monitor the ED surveillance data uploaded to the Health Commerce System (HCS).
ServSTEUBEN MRC:
ServSTEUBEN MRC (Medical Reserve Corps) is our local county volunteer management system consisting of both medical and nonmedical volunteers. It is housed under Steuben County Public Health. This database assists with registering, credentialing, deploying and maintaining records/contact information of both medical and non-medical volunteers in Steuben County. Currently, we have 318 registered medical and
non-medical volunteers in this database.
Protect yourself and your loved ones by making an
emergency plan. You should make a plan for:
How you will contact one another, and
What special steps you will take in different types of
emergency situations.
-CDC
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Essential Service 6: Enforce Laws and Regulations that Protect Health and Safety
Introduction: Essential Service 6 involves full enforcement of sanitary codes, especially in the food industry; full protection of drinking water supplies; enforcement of clean air standards and timely follow-up of hazards. Highlighted in this section are: the areas of responsibility that our District Office in Hornell oversees as Steuben County Public Health is a partial service health department.
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Essential Service 7: Link People to Needed Personal Health Services
Introduction: Essential Service 7 involves assuring effective entry for disadvantaged people into a coordinated system of clinical care; linkage to services for special population groups; ongoing care coordination; targeted health information to high risk population groups and technical assistance for effective worksite health promotion/disease prevention programs. Highlighted in this section are the agency’s Early Intervention program, Special Children’s Services, Jail Health, Maternal Child Health, Certified Lactation Consultants, and Worksite Wellness.
Maternal & Child Health The agency welcomes and encourages prenatal, postpartum, and pediatric referrals for the purpose of providing health guidance and teaching in the home. Services include prenatal health education, preparation for parenting, and postpartum health education. Women and children with needs beyond education are referred to the appropriate agencies.
2014 2015
Patients Visits Patients Visits Antepartum/Postpartum Infant
50 52 61 62
Asthma prevalence (the percentage of people who have ever been diagnosed with asthma and still have asthma) increased in the U.S.
from 7.3% in 2001 to 8.4% in 2010. --CDC
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Jail Health
This department continued to collaborate with the Sheriff’s department in 2015. The nursing staff provided HIV counseling and testing and testing for other sexually transmitted diseases to inmates who request it. Hepatitis A/B vaccinations are also available for these clients. Starting in October, jail clients also received other adult vaccines through the VFA program.
Jail HIV/ STD Clinic Attendance 2014 2015
Clinic Attendance by Unduplicated Count: Male 61 57
Female 7 14
Total 68 71
HIV - Screening tests 68 70
Cases/Epidemiologiv Treatment 0/0 0/0 Gonorrhea - Screening tests 59 71
Cases/Epidemiologic Treatment 2/0 1/0
Syphilis - screening tests 36 63
Cases/Epidemiologic Treatment 0/0 0/0
Trichomoniasis - screening tests 5 0
Cases/Epidemiologic Treatment 2/0 0/0
Chlamydia - screening tests 59 71
Cases/Epidemiologic Treatment 10/0 8/0
Licensed Home Care Services Agency In 2013, we received approval to become a Licensed Home Care Services Agency (LHCSA). This license allows us to provide visits in the home for our Lead and Maternal Child Health Programs. We also continue to provide a nurse who works with DSS to complete assessments for DSS home care programs, these visits are paid for by Medicaid, Insurance or Medicaid Managed Care. Most DSS programs now use the Uniform Assessment System (UAS). In 2015, our nurse completed 377 UAS and 15 other assessments.
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Dental Van Project The primary focus of the dental program is to provide quality, affordable, and accessible dental services to children in schools, during school hours. This program is designed to benefit children who are underinsured, who do not have transportation or who otherwise have difficulty accessing dental care. The program targets areas that are underserved by dental providers and are in areas that do not have fluoridated water sources. Each child that participates in the dental program is offered a dental screening/referral, prophylaxis (cleaning), a fluoride treatment, home care instructions and a toothbrush/floss. 710 children were seen in 2015.
SPECIAL CHILDREN’S SERVICES (SCS)
CHILDREN WITH SPECIAL HEALTH CARE NEEDS PROGRAM (CSHCN)
The CSHCN Program is a public health program that provides information and referral services for health and related areas for families of CSHCN. There is no cost to families.
Autism is about 4.5 times more common among
boys (1 in 42) than among girls (1 in 189).
--CDC
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PHYSICALLY HANDICAPPED CHILDREN’S PROGRAM (PHCP) PHCP provides financial assistance and referrals for medical care for children (newborn-21 years old) who have or are suspected of having a disabling condition or serious chronic illness. Parent payments are based on income guidelines. Providers bill Medicaid and private insurance companies for services. New York State reimburses the county for 50% of the remaining balance.
PHCP 2014 2015 New Referrals: 6 3 Reapplications 42 11 Medical Consultations 0 0 Dental Consultations 0* 0*
PHCP Authorizations 2014 2015
PHCP Authorizations 68 78
Unduplicated child count 20 15
PHCP Expenditures 2014* 2015*
Medical Payments $34,147.91 $9,353.79 *(50% State Reimbursable)
PHCP Revenue 2014 2015 Parent Payments $3,921.40 $917.20
State $13,090.17 $4,303.78
Refund Prior Years $352.73 $204.00
Total Revenue $17,364.30 $5,424.98
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PRESCHOOL SPECIAL EDUCATION
Children 3 – 5 yrs. old having or suspected of having a disability are eligible for referral to school districts’ Committee on Preschool special Education. Evaluations are arranged with approved special education evaluators. An individual education plan is developed recommending either center-based programming with related services or community-based related services. Services may include Special Education, Speech Therapy, Physical Therapy, Psychology, Social Work or Occupational Therapy. Transportation is provided to center-based programs. There is no cost to families.
Preschool Program Children Receiving Services (School Year)
2013-2014 2014-2015
341 374
Preschool Program Expenditures
2014 2015
Tuition $3,092,657 $3,214,666.49
Transportation $654,777 $790,457.81
CPSE Admin $187,842 $190,000.00
School Age Summer $115,000 $125,000.00
Total
$4,050,276 $4,320,124.30
Preschool Revenue 2014 2015 Medicaid $657,685 $624,533.77 Refund Prior Years $18,896 $29,467.04 State $1,780,604 $1,997,161.02 School CPSE Admin $119,407 $114,343.65 Totals $2,576,591 $2,765,505.48
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EARLY INTERVENTION (EI)
Early Intervention is a free, statewide program for providing early identification, screening, evaluation, special services, and service coordination for infants, toddlers and their families at risk for developmental delays. Children birth to 3 years old with suspected developmental delays, a diagnosed disability, or condition affecting development are eligible for EI. Eligibility Criteria includes premature infants, low birth weight infants, growth deficiency/nutritional problems, parental substance abuse, suspected developmental delay, at risk factors or parental concern. Service Coordinators work with families in their homes to meet the special needs of each child and family and refers families to other community services such as Medicaid, SSI, or medical insurance. Services provided may include Special Instruction, Speech Therapy, Physical Therapy, Psychological Services, Social Work, Occupational Therapy or Nutritional Services.
EI 2014 2015 New Referrals 202 175 Children Receiving Services 303 388 Closed 186 136
EI Expenditures 2014 2015
Program Supplies $293 $165.03
Services $298,064 $260,316.83
Service Coordination $6,188 $3,976.00
Respite $624 $1,081.60
Total $305,169 $265,539.46
EI Revenue 2014 2015
Medicaid $19,215 $23,534.00
State $162,866 $127,636.11
Refund Prior Year Expense -$600.00
Escrow Payment $9,774 $12,698.00
Respite $312 $415.80
Total $192,167 $163,683.91
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Worksite Wellness Representatives from Public Health departments in the S2AY region, along with other partners, met monthly in 2015 to strategize worksite wellness efforts. Performance measures and goals were established for the group to meet in 2016.
Performance Measure Target Responsible Group
# Worksite wellness assessments completed. Assessments can be any type of worksite evaluation or survey.
25-30 Total across all participating S2AY counties
# Worksite wellness resources or information distributed to businesses. Can be any type of resource – sample policies, full toolkits, brochures, etc.
5 Steuben
# Chamber, business, or community events attended for the purpose of promoting worksite wellness / sharing resources.
1 Steuben
# of affiliations and/or relationships made with local Chambers, businesses, or organizations.
5 Total across all participating S2AY counties
# Worksites to adopt a health promotion policy (i.e. Lactation Policy, Healthy Vending Policy, Healthy Meeting Guidelines, Paid Leave and/or Flex Time for Cancer Screenings, Tobacco Free Policies).
1 Steuben
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Essential Service 8: Assure a Competent Public Health Care Workforce Introduction: Essential Service 8 involves educating and training personnel to meet the needs for public and personal health service; adoption of continuous quality improvement and life-long learning and active partnership with academic institutions. In order to provide the highest quality public health service, the Steuben County Public Health department strives to ensure that all our staff possesses the knowledge, skills, and abilities necessary to perform their jobs effectively and efficiently. Highlighted in this section is Workforce Development.
In 2015, staff members were trained collectively on the following topics throughout the year:
Performance Measurement
Community Dimensions of Public Health Practice
Cross-Cultural Communication
Health Literacy and Public Health
Quality Improvement Team Development and Performance Management
Health Equity
Collaboration: The Key to Public Health System Improvement
HIPAA Compliance Individual staff members completed training specific to their respective program areas as well.
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Essential Service 9: Evaluate Effectiveness, Accessibility & Quality of Personal and Population Based Health Services
Introduction: Essential Service 9 calls for ongoing evaluation of health programs to assess program effectiveness and to provide information necessary for allocating resources and shaping programs. Measures for assessing this essential service indicate a need for strengthening Steuben County Public Health activities in this domain. Highlighted in this section are our activities related to pursuit of accreditation with the Public Health Accreditation Board (PHAB, and the professional advisory committee meetings. Steuben County Public Health, along with five other local county health departments – Ontario, Schuyler, Seneca, Wayne, and Yates – worked collaboratively to set the foundation for a multijurisdictional accreditation application to the Public Health Accreditation Board (PHAB) to become nationally recognized. Throughout the year, the counties met to identify documents or examples of joint efforts that met the measures spanning 12 domains of Public Health work:
Domain 1: Conduct and disseminate assessments focused on population health status and public health issues facing the community
Domain 2: Investigate health problems and environmental public health hazards to protect the community
Domain 3: Inform and educate about public health issues and functions
Domain 4: Engage with the community to identify and address health problems
Domain 5: Develop public health policies and plans
Domain 6: Enforce public health laws
Domain 7: Promote strategies to improve access to health care
Domain 8: Maintain a competent public health workforce
Domain 9: Evaluate and continuously improve processes, programs, and interventions
Domain 10: Contribute to and apply the evidence base of public health]
Domain 11: Maintain administrative and management capacity
Domain 12: Maintain capacity to engage the public health governing entity A statement of intent for the counties to apply for accreditation jointly was submitted to PHAB in June 2015. The accreditation process is a multi-year project and all documentation is due to be submitted to PHAB by June 2017. For more information on accreditation or PHAB visit www.phaboard.org.
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Essential Service 10: Research for New Insights & Innovative Solutions to Health Problems
Introduction: Essential Service 10 includes continuous linkage with appropriate institutions of higher learning and research. Highlighted in this section is Steuben County Public Health’s participation with the S2AY Network and Finger Lakes Health System. S2AY RURAL HEALTH NETWORK: The S2AY Rural Health Network is a unique horizontal network comprised of the Public Health Departments of eight contiguous rural counties (Steuben, Schuyler, Seneca, Ontario, Wayne, Yates, Chemung and Livingston), along with a legislator, consumer and provider from each county. This network has been in existence since 1997 and began with three founding counties (Steuben, Allegany and Yates). The area served covers 4,668 sq. miles of rural upstate New York and 528,493 people. Our objectives:
Developing comprehensive cost-effective health care systems, including dental care, that increase access to care and fill gaps in service delivery.
Increasing and strengthening cooperation through affiliation, coalitions or partnerships that enhance and coordinate the array of needed health care services.
Improving the financial viability of rural health care providers and in the existing health care economy.
Increasing community involvement and locally-generated, innovative solutions to health care system issues.
Increasing the number of health care personnel trained and practicing in rural communities.
Strengthening the accountability of local providers for improvements in key public health and/or health care outcomes in the communities they serve.
The S2AY Rural Health Network includes Early Childhood Services, the regional emergency public health planning and the in-school mobile dental program, as well as the following major activities:
A wide variety of Public Health Quality Improvement and Assurance initiatives, including Corporate Compliance, In-service Training, over 200 joint policies and procedures, and staff committees on Public Health, Home Care and Finance. Since 2007 a Quality Coordinator has been employed by the S2AY Network and shared among
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counties to assist member counties with Quality and In-Service Training. Additionally, the Network is assisting public health departments prepare for the accreditation by conducting assessments and helping with the development of necessary materials and documentation for the process.
Steuben County Public Health partnered with the Network, NYSDOH and six hospitals and five senior meal providers to implement an initiative focusing on reducing sodium in hospital and senior meals in five counties. Cardiovascular disease is the leading cause of death in Steuben County. High blood pressure is a leading contributor to heart disease and reducing sodium consumption is an evidence-based approach to prevent and treat it. The recipes for all senior and hospital meals are analyzed to determine sodium content. Environmental scans were done at all hospitals (Ira Davenport, Arnot Ogden and St. Joseph’s (all Arnot Health System), Schuyler, Soldiers and Sailors and Guthrie Corning Hospitals. In the first year, the initiative reduced sodium in targeted meals by almost 12%, and in the second year sodium in targeted meals was reduced by over 20%. The third and final year started in late 2015.
Navigators enrolled over 7000 people in health insurance in 2015 in an eight county region, and took a total of over 8700 applications. Almost 2,250 of those enrolled came from Steuben County. The Network also provides a Community Health Advocate for Steuben County. Advocates help people with all types of health related problems, including problems with access, prescriptions, co-pays and understanding health insurance coverage and needs. Almost 600 people and small businesses were served through this program in 2015.
Participation and leadership on various groups, such as NYSARH, R-AHEC, the Finger Lakes Perinatal Network, the New York State Oral Health Coalition, The Finger Lakes Performing Provider System (FLPPS) and the Care Compass Network, and the FLHSA Partnership on the Uninsured. The Network pulled together various partners including Finger Lakes Community Health (FLCH), Regional Primary Care Network (RPCN), Finger Lakes Addiction and Counseling Referral Agency (FLACRA), and Tri County Family Medical to develop a Network Plan for a Community-Based Regional Independent Provider Association (IPA). Regular meetings continue with these partners and FLHSA to ensure our rural region is represented as the changes due to the Affordable Care Act, Triple Aim and Medicaid Waiver (Delivery System Reform Incentive Payment (DSRIP)) occur.
The Network continues support of a campaign focusing on reduction of alcohol-related injuries among young people. The Network staff co-chairs the Steuben County Task Force on Underage Drinking.
The implementation of Community Health Improvement Plans and coordinated efforts to address common needs identified through this process were led by the Network as required by the New York State Department of Health. The Network worked with
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Steuben County Public Health, county hospitals, and other community partners in this process. In Steuben County the priorities focused on reducing obesity in children and adults and reducing heart disease and hypertension. Additionally, a focus was on the disparity of promoting tobacco cessation among low SES populations and those with mental health illness.
Joint regional efforts focused on worksite wellness, farm to cafeteria, breastfeeding and hypertension. In the fall of 2015, Network staff geared up for a new Community Health Assessment process for the eight county region to be conducted in 2016.
The Network secured funds from the Komen Foundation to assist Steuben County residents with breast cancer related expenses.
Contact: Andrea Haradon or Betsy Hull: 607-962-8459. [email protected] or [email protected]
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Budget Summary 2015
Expenditures 2014 2015
PHN Salaries & Administration $1,186,196 $1,012,534 STD $4,647 $4053 Immunization $24,738 $14,501
Lead $2,133 $2,433
Tobacco $515 $3,984
Injury Prevention $85
PH Emergency Preparedness $94,953 $77,446
Sodium Reduction Grant $112,477 $116,649
Diabetes Coalition $2,491 $2,724
Communicable Disease $737
Rabies $68,000 $46,051
TB $1,330 $1,537
Comp. Health Study $1,000 $1,000
PHCP $34,148 $9,354
Preschool $4,050,276 $4,320,124
Early Intervention $305,169 $265,540
SCS Administration $549,118 $473,314
Totals: $6,438,013 $6,351,244
Revenue 2014 2015
Patient Fees & Third Party Payors
$740,091 $686,992
State Aid $562,133 $664,237
Other NYS Aid $2,200,825 $2,284,903
Grants $379,584 $374,143
Other $100,056 $122,623
Total $3,982,689 $4,132,898
