Annual Report FY 2009/2010 T ABLE OF C ONTENTS Board Members and Administration 3 The Mission 4 Directorʼs Message 5 Budget Expenditures 6 Budget Revenues 7 The Organization 8 Functional Areas ♦ Chief Medical Officer ♦ Clinical and Outreach Services 10 ♦ Directorʼs Office 12 ♦ Emergency Management and Homeland Security 12 ♦ Health Promotion and Education 13 ♦ Pima Animal Care Center 16 ♦ Public Health Nursing 17 ♦ Public Health Services 19 Page 2 9 BOARD MEMBERS AND ADMINISTRATION Pima County Board of Supervisors Honorable Ann Day District 1 Honorable Ramón Valadez, Chair District 2 Honorable Sharon Bronson District 3 Honorable Ray Carroll District 4 Honorable Richard Elías District 5 County Administration C. H. Huckelberry, County Administrator Dennis Douglas, Deputy County Administrator Medical and Health Services Pima County Board of Health Paul Horwitz, M.D., President Carolyn Trowbridge, R.N. Vice President Lidia Allen Kwang Chun An Bradley Brumm, D.D.S. Richard Elías, Ex-Officio Vincent A. Fulginiti, M.D. Mary Lou Gonzales Hector Morales Chuck Stopani Pima County Health Department Sherry Daniels, MS, MPH, RN, Director Michelle McDonald, M.D., Chief Medical Officer Kim Janes, Manager, Pima Animal Care Center Diane Kerrihard, Manager, Clinical and Outreach Services Isela Luna, Manager, Public Health Nursing Karen Martin, Manager, Health Promotion and Education Brad McKinney, Manager, Public Health Services Page 3 T HE M ISSION Our Vision...to help the residents of Pima County achieve and maintain an optimal level of wellness. Our Mission...to be a leader in protecting health, preventing disease and promoting community well-being. C ULTURAL D IVERSITY Pima County Health Department and its members are committed to embracing and promoting diversity throughout our programs. Our rich diversity of racial and ethnic heritage, gender, sexual orientation and other life experiences enhances our work environment, collaboration with our community partners, care for our clients, and our public health presence throughout Pima County. Page 4 D IRECTOR ʼ S M ESSAGE As Director of the Pima County Health Department, it is my pleasure to present our Annual Report for the fiscal year 2009/2010. The Department encountered interesting and challenging public health issues, such as the response to H₁N₁ Influenza, the relocation of the TB clinic and the completion of the shelter addition for the Animal Care Center. This year our nation, state and local communities diligently worked to understand the emergence of pandemic H₁N₁ Influenza. This event involved a tremendous amount of resources, communication, organization and teamwork. As with all new viruses, information about H₁N₁ Influenza evolved and changed and public communication was crucial. The Health Department activated the Incident Command System and organized a community wide response requiring daily coordination with state and national public health officials. The response lasted 143 days and involved over 23,000 coordinated hours of staff and volunteers. In the fall of 2009, the Pima Animal Care Center completed their shelter addition and system upgrades. The improvements provided an additional 3,600 square feet of new kennel area to include 30 new indooroutdoor kennels. These improvements were made possible through the support of the Pima County Board of Supervisors and the voters of Pima County. In February, we celebrated the relocation of the Tuberculosis Clinic to the same campus as the Department's main offices. This new location was upgraded with a state of the art air handling system able to conduct a higher rate of air exchange and improve the air quality for clients and staff. During this fiscal year, federal, state and local governments experienced significant financial challenges and deficits that were felt across all county departments as budget reduction decisions were implemented. In an effort to meet these financial challenges, the Board of Supervisors and County Administration realigned department staff who provided internal administrative support services. The staff who were centralized includes Human Resources, Information Technology and Finance and Risk Management. It is with great pride that the Department was awarded a grant from the Communities Putting Prevention to Work program. The grant will provide resources to increase physical activity, improve nutrition awareness, and decrease obesity within our community. Looking forward, the Department will add the experiences of this past year to shore up emergency response plans and continue to expend energies for a healthier and more prepared community. Sherry Daniels, MS, MPH, RN Director, Pima County Health Department September 2010 Page 5 B UDGET E XPENDITURES 6% 4% 13% 19% 7% 20% 20% 5% 6% Administrative Services Community Nutrition Programs Consumer Health and Food Safety Disease Prevention Emergency Mgt/Homeland Security Family Planning Pima Animal Care Center Public Health Nursing Tobacco Prevention and Education Total Expenditures 2 6 , 7 1 0 , 8 7 6 Administrative Services 4% Consumer Health and Food Safety 7% Community Nutrition Programs 13% Disease Prevention 20% Emergency Management and Homeland Security 6% Family Planning 5% Pima Animal Care Center 20% Public Health Nursing 19% Tobacco Prevention and Education Page 6 6% B UDGET R EVENUES 5% 9% 4% 34% 10% 4% 4% 6% 8% 16% Administrative Services Community Nutrition Programs Consumer Health and Food Safety Disease Prevention Emergency Mgt/Homeland Security Family Planning Pima Animal Care Center Public Health Nursing Tobacco Prevention and Education Other Revenue Total Revenues $26,710,876 Administrative Services 5% Consumer Health and Food Safety 4% Community Nutrition Programs 9% Disease Prevention 10% Emergency Management and Homeland Security 4% Family Planning 4% Other Revenue Public Health Nursing Pima Animal Care Center Tobacco Prevention and Education 34% 8% 16% 6% Page 7 THE ORGANIZATION Staffing by Functional Area Chief Medical Officer 9.7 FTEs 63.7 FTEs Directorʼs Office 3.0 FTEs Emergency Management and Homeland Security 8.5 FTEs 109.5 FTEs Pima Animal Care Center 78.5 FTEs Public Health Nursing 63.1 FTEs Public Health Services 54.5 FTEs Clinical and Outreach Services Health Promotion and Education Page 8 CHIEF MEDICAL OFFICER Chief Medical Officer (CMO) Is an integral position assuring that all public health functions within the Pima County Health Department are medically reviewed. Programs ♦ ~ Chief Medical Officer ♦ ~ Public Health Clinicians ♦ ~ Laboratory and Compliance ♦ Responsible for assuring compassionate, high quality, public health services to Pima County residents through diligent quality management, training and medical review. Assures that clinicians are providing the most current medical practices that support quality care services to residents who present to our clinics. Responsible for the medical oversight and recommendations for disease and outbreak investigation conducted by the Department. Provides medical oversight of public health response to a disaster. Public Health Clinicians Under the medical direction of the Chief Medical Officer, Health Department clinicians provide quality public health services to Pima County residents who present at the following public health clinics: Family Planning, Immunizations, STD, Tuberculosis, Well Child Care, and Well Woman Healthcheck. Program Accomplishments ♦ ♦ ♦ ♦ ♦ Coordinated investigation and surveillance activity during the fall influenza season. Participated with Incident Command System Section Chiefs in the early planning for the fall response to a potential H1N1 Influenza outbreak within the community. Coordinated re‐allocation of H1N1 Influenza vaccine for distribution to local medical providers. Provided clinical direction for the public health medical staff and the volunteer medical staff who responded to the community threat of H1N1 Influenza. Provided direct clinical services to over 12,000 individuals at Health Department clinics and supported the immunization clinics with standing orders and medical backup. Laboratory and Compliance Assesses and assures compliance within applicable Health Department programs regarding requirements and regulations for federal, state and local laws. Program Accomplishments ♦ Provided more than 14 training sessions for staff that included CLIA, OSHA and HIPAA education. ♦ The Department attained the 8th straight “review with no deficiencies” for the 72,955 laboratory tests performed by the clinical programs. ♦ Provided safety training for all Health Department staff. The depth and scope was expanded to include outpatient clinic licenses and pharmaceutical security. Page 9 CLINICAL AND OUTREACH SERVICES The Family Planning Program Provides individuals with information and the means to exercise personal choice in determining the number and spacing of their children. The program is funded by Pima County tax dollars and Federal Title X funds. All services are provided on a sliding fee basis and no client is refused service based on inability to pay. National data shows that each public dollar spent to provide family planning services saves an average of $3 in Medicaid costs for pregnancy related and newborn care. In Arizona, the average birth is approximately $5,000 and 52 percent of all births are paid for by state Medicaid dollars. A full year of family planning services costs less than $250. Program Accomplishments ♦ Received carry‐over funds from Arizona Family Planning Council to purchase an electronic appointment scheduling system. The system enhanced program performance and clinic efficiency by allowing staff to schedule for multiple sites and monitor no‐show rates and clinic productivity for improved customer service. Programs ♦ ~ Family Planning ~ Well Woman Healthcheck ~ HIV and STD ~ Tuberculosis Clinic ♦ Served 6,648 unduplicated clients and provided 12,713 direct services related to family planning, sexually transmitted diseases, breast and cervical cancer screening and pharmaceutical distribution to clients who are uninsured or underinsured. Welcomed the Kino Teen Center into Family Planning operations this past year. This new addition enhances support services for the health and well‐being of Pima County teens. Project CONTACT Community Outreach Network Teaching Adolescents Contraceptive Techniques (CONTACT) is a community based program designed to help youth, at high risk of pregnancy or sexually transmitted disease infections, obtain needed reproductive health services. Program Accomplishments ♦ Served 518 unduplicated students at three high schools within Sunnyside Unified School District. Based on student surveys, most teens would not seek these services elsewhere, hence the importance of continuing to provide on‐site services for this high risk population. Well Woman Healthcheck Program Provides services to uninsured and underinsured women primarily over the age of 50 within Pima County. The goal is to increase the awareness of female related cancers and reduce the number afflicted by providing breast and cervical screening and education. Women with symptoms of these cancers and who have had a tubal ligation can receive services regardless of age. Services are provided through a network of local providers and Health Department clinicians. Program Accomplishments ♦ Provided breast and cervical cancer screenings to more than 1,870 medically underserved women. ♦ Experienced a decrease in staff and a simultaneous increase in the number of women served. Programmatic performance remained stable due to process improvement and realignment of existing staff. Page 10 CLINICAL AND OUTREACH SERVICES HIV and STD Program Strives to prevent infection and minimize the impact of sexually transmitted diseases (STDs), including HIV, through comprehensive STD infection control, prevention, education, and treatment services for Pima County residents. Programs ~ Family Planning ~ Well Woman Healthcheck ~ HIV and STD ~ Tuberculosis Clinic Program Accomplishments ♦ Provided 6,374 clinic visits including individuals who returned for follow‐up treatment. ♦ Of those screened, 4,114 infections were diagnosed and treated. ♦ Among those diagnosed and treated were: ♦ 346 cases of Chlamydia ♦ 73 cases of Gonorrhea ♦ 64 cases of Herpes ♦ 75 cases of Syphilis The program experienced a reduction in the number of cases of Chlamydia, Gonorrhea and Syphilis. Successful, focused outreach that reduces the incident of infection and promotes earlier testing illustrates the program’s commitment to build community awareness of disease transmission and actions to reduce the spread. Program Accomplishments ♦ ♦ ♦ Staff performed rapid HIV tests for 4,784 individuals. Seven new cases of HIV were identified, a decrease of 16 cases from the previous year. As a result of a streamlined process initiated in 2008/2009, an increased number of people were tested and offered education and prevention information. Of the individuals tested, 21 percent were considered at high risk for HIV infection because of their sexual or drug‐using behaviors. This is a 12 percent decrease from last year when 33 percent were considered at high risk. Tuberculosis (TB) Clinical Program Assures the provision of comprehensive TB prevention and control services to persons with known or suspected TB disease or latent TB infection. Staff ensure practices are current based on the CDC guidelines. TB Cases Treated at TB Clinic According to Country of Origin: 30% US 26% Mexico 8% 8% India Somalia 4% For each of the following Countries: Vietnam, Haiti, Philippines, Bhutan, Nepal, Kenya and Sri Lanka. Program Accomplishments ♦ Provided services to over 4,200 residents of Pima County. ♦ Over 95 percent of cases successfully completed treatment within recommended time. ♦ Moved to a new location with a state of the art facility. ♦ Expanded the clinic hours. ♦ Provided over 500 successful outreach visits quarterly ensuring that clients took the medications correctly. ♦ Approximately 75 percent of refugees identified with latent TB infection successfully completed treatment. ♦ Screened over 1,600 individuals for shelter clearance, 1,400 individuals for work clearance, 117 individuals for rehab clearance, 177 child care employees, and 300 individuals for school clearance. ♦ Conducted services for physician referrals for patient evaluations and screening of persons with contact to individuals with TB. Page 11 DIRECTORʼS OFFICE Director Establishes a leadership role in protecting health, preventing disease, and promoting community well‐being through the adoption of core public health functions and national standards. Develops and fosters an active network of public health and safety professionals and community‐based organizations. Assures Department compliance with all Pima County policies, procedures and codes, and addresses all Board of Supervisor inquiries and requests regarding public health issues. Responsible for 390.5 FTEs and an annual budget of $26,710,876 to include 37 grants that provided $9,667,009 in revenue. Program Accomplishments ♦ Served as Incident Commander for the organized response to the threat of H1N1 Influenza and the distribution of vaccine within the community. ♦ Collaborated with community schools to assist in the planning and preparation for the fall influenza season to mitigate the potential impact to student and staff attendance. ♦ Awarded the Communities Putting Prevention to Work Federal Grant providing resources to increase physical activity, improved nutrition awareness and decrease obesity within our community. EMERGENCY MANAGEMENT AND HOMELAND SECURITY The Office of Emergency Management & Homeland Security (OEMHS) ♦ ♦ Strives to prevent the loss of life and reduce property damage due to man‐made, technological and natural disasters within Pima County in accordance with ARS Title 26 and Pima County Code Title 9. OEMHS acts as a facilitating and coordinating agency for disaster response. OEMHS provides professional emergency management services that include prevention, protection, response and recovery activities. Program Accomplishments ♦ Coordinated multiple activities and trainings designed to protect lives, property, and the environment in the event of a community disaster. ♦ Assisted municipalities and local governments to develop their plans and ensure the highest level of individual and agency preparedness for disaster response and recovery. ♦ Launched a new emergency web‐based software called Web‐EOC. ♦ Conducted community CERT classes for 182 citizens. ♦ Organized and executed six training exercises and participated in 21 additional exercises organized by local jurisdictions and municipalities. ♦ Provided 18 civic presentations to include four specifically targeted for neighborhood organizations. ♦ Assisted five local schools with disaster planning. Prepare ~ Response ~ Recovery ~ Mitigate Page 12 HEALTH PROMOTION AND EDUCATION Consumer Health and Food Safety Program Contributes to the community’s health and the well‐being through inspection, investigation and enforcement of public health laws for regulated facilities. Inspections are conducted to assure proper procedures are in place and establishments meet regulatory compliance. Programs ~ Consumer Health and Food Safety ~ Community Nutrition ~ Tobacco Education and Prevention ~ Physical Activity Program Accomplishments ♦ Continued its membership in the Voluntary National Retail Food Regulatory Program Standards sponsored by the Food and Drug Administration (FDA). Participation in the Program Standards enables the program to strengthen support of the Health Department’s mission of optimal wellness for the community. ♦ In December 2009, hosted a statewide, three‐ day workshop sponsored by the Food and Drug Administration (FDA) that focused on the 2005 FDA Food Code. Inspections Performed ♦ Food Establishments ♦ Public and Semi‐Public Pools and Spas ♦ Complaints ♦ Public School Grounds ♦ Hotel/Motel/Mobile Home or RV Park Total Inspections Performed 8,091 3,838 734 266 194 13,123 Licenses Issued ♦ Food Service Establishments ♦ Public and Semi‐Public Pools and Spas ♦ Temporary Food Vendors ♦ Hotel/Motel/Mobile Home or RV Park ♦ Public School Grounds Total Licenses Issued 4,519 2,521 1,395 591 244 9,270 Inspectors conducted 12,359 compliance inspections for the Smoke‐Free Arizona Act which prohibits smoking inside most enclosed public spaces, places of employment and prohibits smoking within twenty‐feet of public entrances, open windows and ventilation systems. Vector Control ♦ The SWAT Team (Strategic Warriors Against Transmission) which began in 2003, continued to meet monthly beginning in April through October. These meetings enable the various municipalities, school districts, local Davis Monthan Air Force Base, the University of Arizona and other interested groups to share information about mosquito borne diseases and strategies to combat them. ♦ There were no human or equine cases of West Nile virus reported. ♦ Diligent efforts are continuing to perform surveillance and control activities in conjunction with community education and awareness campaigns. Both are necessary to address vector borne illness and disease in Pima County. Page 13 HEALTH PROMOTION AND EDUCATION Community Nutrition Programs Promotes healthy eating habits for pregnant women, new moms, infants, children and seniors. Federally‐funded services are provided to recipients through the Women, Infants and Children (WIC) Program and FOOD Plus. Programs ~ Consumer Health and Food Safety ~ Community Nutrition ~ Tobacco Education and Prevention ~ Physical Activity Women, Infants and Children Program Is a federally‐funded supplemental nutrition program that provides low‐income pregnant women, new mothers, infants and children under five years old with nutrient‐rich food; nutrition and health education; growth monitoring; and referrals to health and social services programs in our community. A significant emphasis of the program is breastfeeding support and education. Breastfeeding provides better nutrition and digestibility for the infant, enhances the baby’s immune system building a solid foundation for good health, improves weight management for mothers, positively affects the bonding between mother and infant, and is less expensive than purchasing formula. Program Accomplishments ♦ Distributed $10.9 million in federally‐funded food and infant formula to certified program recipients. ♦ Provided services to 171,483 clients to include 42,808 breastfeeding and postpartum women; 46,845 infants; and 81,830 children ages five and under. ♦ Provided individual health and nutritional education sessions to 49,808 clients. These educational sessions are offered by Health Educators, Community Nutrition Specialists and Registered Dietitians. ♦ Distributed a year’s supply of multi‐vitamins containing folic acid to prevent neural tube defects, including spinal bifida to 3,011 women. ♦ Provided 514 hospital‐grade and 178 personal breast pumps. FOOD Plus Is the Commodity Supplemental Food Program funded through the United States Department of Agriculture providing eligible families with a food packages rich in protein, calcium, iron and Vitamins A & C. Eligible participants are pregnant women, new moms up to one‐year post partum, children five years old and under who are not on WIC, and qualifying seniors over the age of 60. Program Accomplishments ♦ Provided 53,043 food packages for eligible recipients enabling them to receive monthly assistance to put healthy, nutritious food on their tables. Arizona Farmers’ Market Nutrition Program Is a program designed to increase the fruit and vegetable intake for women and children who participate in the WIC Program and for seniors who participate in FOOD Plus. Eligible recipients receive coupons that allow them to purchase fresh, locally grown fruits and vegetables at farmers’ markets. Program Goals ♦ Improve the nutrition of women, children and seniors by increasing their intake of fruits and vegetables. ♦ To keep food dollars in the local economy and increase local growers’ share of food dollars spent. Program Accomplishments ♦ In May, the program received 2,443 coupon booklets. ♦ By June, had successfully issued 1,485 of the coupon booklets to women, children and seniors. Page 14 HEALTH PROMOTION AND EDUCATION Tobacco Education and Prevention Assures that Pima County residents are encouraged to engage in healthier lifestyles and participate in smoking cessation services to help reduce tobacco use through education and support services. Program Accomplishments ♦ Provided evidence‐based curricula and training to ~ Consumer Health teachers at 165 elementary and and Food Safety middle schools to implement a ~ Community tobacco education and healthy Nutrition lifestyles program for 4th and 8th graders. Students were ~ Tobacco Education taught resiliency awareness and Prevention techniques, addiction risks and ~ Physical Activity refusal skills. Programs ♦ ♦ Established a youth coalition, Students Working Against Tobacco, or SWAT, comprised of 350 students representing 28 local charter schools. Members pledged to promote healthy lifestyles through a variety of community tobacco awareness activities geared towards youth. Established partnerships with 35 businesses to educate employees and Responding to clients about chronic disease prevention and cessation services through the H1N1 Influenza AZ Smokers Helpline, the statewide quit‐line. Tobacco Education and ♦ Provided training for facilitators to conduct cessation classes within their organizations. ♦ Offered materials and training for tobacco users regarding tobacco etiquette. ♦ Conducted proactive referral training to increase referrals to the statewide quit‐line. Smoke‐Free Arizona Staff responded to 632 community complaints of the ARS 36.601.01 Smoke‐Free Arizona Act. Inspections were conducted to verify the complaints and, where indicated, education was provided regarding compliance with this statute. Each confirmed violation received a follow‐up inspection. Prevention staff provided vital support during the H1N1 Influenza outbreak response. Over 300 staff hours were dedicated to the support of the H1N1 immunization clinics. Staff participated as line control, logistics support, community information dissemination, and clerical support. Physical Activity Program Promotes active lifestyles for 4th through 8th graders and their families. Participants are encouraged to make healthy lifestyle choices to reduce the onset of chronic diseases in children. Program Accomplishments ♦ Staff trained teachers to incorporate 15 to 30 minutes of exercise into a daily routine. ♦ Over 2,000 children participated in the Physical Activity Program. ♦ A total of 100 adults from selected neighborhoods participated in classes and the Walk Everyday Live Longer (WELL) Arizona Program that offered education and tips on how to improve their physical abilities through activity. Page 15 PIMA ANIMAL CARE CENTER Pima Animal Care Center (PACC) Protects public health and safety for people and animals by enforcing rabies control, welfare laws and cruelty ordinances. PACC employees and volunteers work diligently to place adoptable animals into safe and loving homes. Center Goals ♦ Reduce the risk of diseases and injuries caused by wild and domestic animals. ♦ Maximize the care of companion animals waiting for adoption or rescue. ♦ Reduce the impact of companion animals on urban lifestyles through spay and neutering. Programs ~ Enforcement ~ Dog Licensing ~ Shelter ~ Clinic ~ Outreach and Education Enforcement Accomplishments ♦ The 28 enforcement officers drove more than 400,000 miles and responded to over 37,000 field service calls within Pima County. Typical calls include bite investigations, animal welfare or cruelty concerns, loose animals, noise and waste complaints. ♦ Issued a total of 5,897 citations. Dog Licensing Accomplishments ♦ Issued 111,970 dog licenses. This is an increase of eight percent over last year. Clinic Accomplishments ♦ Medically treated over 24,500 animals received by PACC. ♦ Spayed and neutered over 7,100 animals. ♦ Provided 104 forensic investigations, involving multiple animals in welfare and cruelty cases. ♦ Provided spay and neuter services at no cost for 2,900 animals through the Board of Supervisor’s support, funding from licensing fee revenue, and private donations for Animal Welfare Alliance of Southern Arizona. Shelter Accomplishments ♦ Received 27,641 animals at the shelter. ♦ Adopted or rescued 10,161 animals. ◊ 5,479 animals were adopted, a 28 percent increase over last year. ◊ 1,959 animals were returned to owners. ◊ 2,723 animals were rescued, a three percent increase over last year. ♦ Completed the shelter expansion project increasing the shelter area to 28,740 square feet adding new indoor‐outdoor kennels. ♦ Upgraded the air conditioning and drainage system for the entire facility. ♦ Successfully implemented a inmate work‐release program employing 36 inmates who care for the animals in the shelter and gain life skills. Outreach and Education Accomplishments ♦ Partnered with PetSmart to host an adoption clinic for adoptable shelter animals. ♦ Coordinated additional off‐site adoption events with Muttropolis at La Encantada Mall. ♦ Participated in over 100 community‐wide health fairs and educational forums and outreached to over 8,700 individuals with educational material and program awareness. ♦ Organized educational volunteer and outreach events involving local school children. ♦ Presented an animal at the ‘Pause for Paws’ program at the Pima County Board of Supervisors meeting. ♦ Partnered with local television news stations to highlight adoptable pets from the shelter. Page 16 No adoptable animal has been euthanized since 2002 PUBLIC HEALTH NURSING Public Health Nursing Program Assists the community to resolve public health concerns and improve the health of Pima County residents. Nurses provide individuals and families with services that promote health and prevent disease. Programs ~ Clinics ~ Child Care Health Consultants ~ Car Seat Safety ~ Teen Pregnancy Prevention ~ Home Visits/Case Management ~PHN/TFD Project ~ Health Start ~ Early Childhood Oral Health ~ Dental Sealant ~ Mobile Dental Program Accomplishments Clinics ♦ Vaccinated over 23,400 clients for a total of 46,731 vaccinations given at community public health nursing clinics. Child Care Health Consultants (CCHC) ♦ Provided training, technical assistance and referrals for child care staff through the Arizona Department of Health Services, First Things First grant funds. ♦ Hired a registered dietician and six public health nurses. ♦ Consulted with child care staff, evaluated 243 child care programs, and identified targeted interventions to improve health and safety. ♦ Provided 523 child care consultation visits. ♦ Conducted 83 child care staff trainings with 952 participants. ♦ During the H1N1 immunization effort 696 doses of H1N1 Influenza vaccine were provided at 36 on‐site child care program clinics. Car Seat Safety Program ♦ 330 families with children five years old and younger received car seats and participated in car seat safety and education classes. ♦ 59 families participated in car seat safety education on the proper use of their existing car seat. Teen Pregnancy Prevention ♦ The Pima County Juvenile Court referred over 50 youth who participated in the Sin Puertas Program and learned life skills and risk‐taking behavior prevention from community professionals. The teens participated in monthly preventive health education workshops taught by Public Health Nurses. Home Visits/Case Management ♦ Conducted 1,052 in‐home visits for Pima County residents needing supportive medical case management enabling them to live independently. Back to School Summer Immunization Clinic In the month of August, the Public Health Nurses organized the annual “Back to School Immunization Clinic” using the incident command structure. The clinic was held at the Abrams Public Health Center over six different days that included evenings and weekends to increase accessibility for parents preparing their children for school. A total of 2,403 children received vaccinations this year. Page 17 PUBLIC HEALTH NURSING Public Health Nursing (PHN) and Tucson Fire Department (TFD) Project Is a collaborative effort between the Health Department and the Tucson Fire Department to reduce the number of non‐emergent 9‐1‐1 calls. Program Accomplishments ♦ Referred 179 of the 9‐1‐1 callers to community agencies. The 179 callers represented 989 of the “9‐1‐1” calls. ♦ The 9‐1‐1 calls dropped as much as 36.2 percent following community health referral. ♦ Increased the collaboration and communication among community health care and behavioral health providers. ♦ Reduced the duplication of services for the referred clients. Health Start Program Is a prenatal outreach program funded by the Arizona Department of Health Services. Program Accomplishments ♦ Enrolled 193 women and families. ♦ Made 970 visits to enrolled families. ♦ Hired one full‐time and two part‐time Public Health Aides. ♦ Expanded services to Ajo, AZ. ♦ Experienced no low‐birth‐weight or premature infants among women enrolled. Programs ~ Clinics ~ Child Care Health Consultants ~ Car Seat Safety ~ Teen Pregnancy Prevention ~ Home Visits/Case Management ~PHN/TFD Project ~ Health Start ~ Early Childhood Oral Health ~ Dental Sealant ~ Mobile Dental Early Childhood Oral Health Program Is a prevention and early intervention program funded by First Things First Southern Pima Regional Partnership Council serving children from birth to five years old and their families. Enrolled children and their families receive oral health screenings, fluoride treatments, and referrals for insurance or to be scheduled for dental care. Program Accomplishments ♦ Conducted over 2,000 early childhood visits in partnership with University of Arizona’s Mobile Health Program, El Rio Community Health Center, and Desert Senita Health Center. ♦ Educated and encouraged medical and dental providers to promote the “First Dental Visit by the First Birthday.” ♦ Parent and child care staff received education regarding the importance of early oral health care. Mobile Dental Program Has a mobile dental unit equipped with two complete dental operatories, sterilization and digital x‐ray equipment. ♦ Non‐profit agencies provided comprehensive dental services to rural area communities using the mobile dental unit. Page 18 H1N1 Influenza Fall Response The role of Public Health Nursing (PHN) during the H1N1 Influenza response included leadership of the operational branch for the incident. The level of PHN staff participation required closing the Public Health Nursing Offices for three weeks in order to dedicate critical medical resources exclusively to the administration of H1N1 vaccines and public education. Initially, the vaccination clinics were held at Public Health Nursing Offices. The community response was tremendous and prompted the decision to establish a single location for large scale immunization. A mass vaccination clinic was organized at Tucson Electric Park Stadium and enabled 26,765 Pima County residents to receive the H1N1 vaccine. The role that Public Health Nursing provided during operations, illustrated opportunities to refine practices for mass community clinics that will be implemented in future epidemic responses. Dental Sealant Program Is an evidence‐based program funded by the Arizona Department of Health Services, Office of Oral Health. The program screens 2nd and 6th grade children attending schools with a 50 percent or greater enrollment in the National School Lunch Program. Program Accomplishments ♦ 52 schools and 1,800 children in the Amphitheater, Flowing Wells, Sunnyside, Marana and Tucson Unified school districts received screening and sealants. PUBLIC HEALTH SERVICES Programs ~ Epidemiology ~ Vaccine Preventable Diseases ~ Public Health Emergency Preparedness ~ Administrative Services ~ Vital Records ♦ Epidemiology Epidemiologists carefully monitor patterns to detect increases in disease and potential epidemics. Through surveillance, investigation, intervention and education, the program strives to reduce illness and death from infectious diseases and public health emergencies. Program Accomplishments ♦ Investigated 3,438 cases of communicable and infectious diseases and 13 disease outbreaks. ♦ Evaluated disease‐specific cases monthly to identify changes or increases in disease patterns. ♦ Participated in disease investigations for cases linked to contaminated food products. ♦ Conducted enhanced surveillance of mumps following outbreaks reported in several states and for pertussis following outbreaks in California. ♦ Monitored for changes in sales of over‐the‐counter medications. ♦ Investigated communicable and infectious diseases that have ties to international travel using the Early Warning Infectious Disease Surveillance ‐ Border Health Program. Hosted three interns from the University of Arizona, College of Public Health. The interns researched the following public health issues: 1) the health status of Arizona border counties, 2) the health status of pregnant teenagers, teenage mothers and their children in Pima County’s African American population, and 3) conducted a study of frequently reported symptoms and co‐morbidities for children with confirmed H1N1 influenza. H₁N₁ Influenza Response The influenza outbreak was a major disease event this year with 2,342 confirmed cases identified in Pima County. The outbreak triggered enhanced surveillance, case investigations, public education, and frequent communiqués and updates for the medical community. With a grant-in-aid from the Tohono O'odham Nation, epidemiologists enlisted additional sentinel surveillance sites within the community to increase reporting capacity. Populations at higher risk for complications and mortality were targeted for enhanced surveillance and prevention education. The higher risk groups included young adults, children, pregnant women, and those with immune-compromised health conditions. Epidemiologists investigated individual cases reported by medical providers, schools, child care facilities and other sources. Vaccine Preventable Diseases Develops and supports ongoing strategies to address immunization issues, promote activities towards immunizing adults and children, and focuses on increasing immunization levels in the birth to two year old population. Collaborates with community agencies and schools providing a variety of immunization services and educational outreach activities for underserved areas. These coordinated efforts improve the use of resources in the private and public sector and support school‐based Vaccine for Children sites. Administers the Perinatal Hepatitis B Program designed to prevent the spread of the hepatitis B virus from mother to newborn. Program Accomplishments ♦ Assessed immunization coverage levels of children within two age groups, 12‐23 months and 24‐35 months of age. ♦ Conducted monthly vaccination reminders to parents or guardians of children under the age of 24 months. ♦ Assessed immunization levels of children attending licensed child care facilities and schools assuring adherence to state immunization requirements. ♦ Conducted immunization trainings for Health Department staff, school nurses, paramedics, and Medical Reserve Corps volunteers. ♦ Assembled and delivered New Mother Packets containing information about hepatitis B birth dose, the importance of vaccinating parents against pertussis (whooping cough) before the baby is born or post partum, and baby safety recommendations. ♦ Distributed hepatitis B and C vaccines for adults with specific high‐risk behaviors. Page 19 PUBLIC HEALTH SERVICES Programs ~ Epidemiology ~ Vaccine Preventable Diseases ~ Public Health Emergency Preparedness ~ Administrative Services Public Health Emergency Preparedness Program Prepares Pima County agencies and first responders to meet the community’s public health needs by employing time‐tested strategies and innovative approaches in the event of a disaster. Program Goals ♦ Improve public health workforce capacity through training and preparedness exercises. ♦ Educate the community through preparedness education materials, presentations, and public announcements. ♦ Provide effective communication and management procedures for all public health response activities by implementing the National Incident Management System and Incident Command System. ♦ Ensure all preparedness and response plans are fully vetted and in compliance with local, state and federal response agencies. ~ Vital Records Program Accomplishments ♦ Plan Development: Designed an All‐Hazards Public Health Emergency Response Plan to comply with all facets of the National Incident Management System (NIMS). Plan components include; 1) planning, 2) training, 3) response, 4) exercises, 5) equipment, 6) evaluation, and 7) corrective actions. The newly revised plan provides a consistent strategy for coordinating the efforts in response to the community’s public health and safety needs in a timely and professional manner. This approved plan is the standard by which staff operates when responding to a public health emergent situation or threat. Project Public Health Ready Actively engaged in attaining Project Public Health Ready status from the National Association of County and City Health Officials (NACCHO). Project Public Health Ready requires a health department to review, revise, and develop response plans demonstrating the capacity to respond to community threats. This review process serves to enhance and shore up existing internal preparedness systems, plans, and activities. Principal goals incorporated in the Project Public Health Ready Plan included: ♦ Preparedness Planning: The All Hazards Emergency Response and Recovery Plan details how the Health Department will respond to an emergency, disaster, or incident where its resources are required to prevent, mitigate, and recover the health of the community. ♦ Workforce Competency: The Workforce and Development Plan applies strategies to strengthen and develop the skills of the Health Department’s employees, contractors, and volunteers. ♦ Exercise Simulation: The Exercise Plan illustrates Health Department participation and leadership in designing, implementing, and evaluating functional exercises in the community. Page 20 PUBLIC HEALTH SERVICES Public Health Emergency Preparedness Program Response to H₁N₁Influenza Outbreak During the 2009 H₁N₁ Influenza Response, the Public Health Emergency Preparedness Program (PHEP) served as one of the lead health department response programs. To assure a successful and well organized response, PHEP activated the Health Department All Hazards Response Plan, Pandemic Influenza Plan, and Strategic National Stockpile (SNS) Plan and assumed responsibility for: ♦ Programs ♦ ~ Epidemiology ~ Vaccine Preventable Diseases ~ Public Health Emergency Preparedness ~ Administrative Services ♦ ♦ ♦ Receiving and distributing anti-viral medication and medical supplies from the SNS to medical providers throughout Pima County; Managing and coordinating the mobilization, operation, and demobilization of Pima County’s mass vaccination site; Assigning County and volunteer staff to fill necessary positions at the mass vaccination site; Administering the grant funding allocated to the response; Ensuring the 2009 H₁N₁ Influenza Response was carried out in accordance with all National Response Framework and National Incident Management System compliance procedures. Pima County Health Department Unified Response to H₁N₁ Influenza Outbreak In July, the Health Department activated the incident command system (ICS) for the community wide response and vaccination for H₁N₁ Influenza. Initially, vaccine was distributed through public health clinics and local medical providers. Later, a centrally located mass clinic was established to accommodate large numbers of people at a single location. ~ Vital Records A total of 288,200 doses of the H₁N₁ Influenza vaccine was allocated to the Health Department and 86 percent, or 246,380 doses, were re‐allocated to community health care providers. The Health Department administered a total of 26,765 doses of the vaccine. On the busiest day, 2,923 vaccinations were administered. This response required a high level of communication with local providers, medical partners and the public. An automated Flu Information Line was initiated to provide basic information about the virus. Simultaneously, the Call Center was activated and staffed with medical personnel to respond to community inquiries. The ICS was active for 143 days, encumbered 13,348 staff hours and 10,000 volunteer hours. The estimated expense for the entire response was $722,284 which was offset by emergency federal funding. Page 21 PUBLIC HEALTH SERVICES Administrative Services To create a more efficient workforce, Pima County Administration consolidated staff from individual County Departments whose primary responsibilities were information technology, personnel, and finance and risk management. As a result of the consolidation, the Health Department reorganized its business and administrative operations to extend greater fiscal responsibility to division staff. Programs ~ Epidemiology ~ Vaccine Preventable Diseases ~ Public Health Emergency Preparedness ~ Administrative Services The Administrative Services Team is comprised of staff designated as the Health Department liaison with the centralized County Departments of Human Resources, Information Technology, and Finance and Risk Management. The Health Department retains responsibility for Central Supply, and the development and management of Health Department budgets and contracts. Program Accomplishments ♦ ♦ ♦ Transitioned the Department to the new Countywide electronic payroll system. Continued to participate in the preparation for the countywide transition to a new electronic finance and human resource system called PimaCore. Responded to projects related to the countywide consolidation. ~ Vital Records Vital Records Is responsible for the issuance of birth and death certificates for residents within Pima County. Serves as the agency to establish paternity affidavits as correction to the official record and when court ordered. Provides same day certificate issuance at the local main office. Provides training for funeral homes, hospitals, nursing homes, medical record staff and hospital birth clerks to the proper procedure for vital records. Enables residents to use an expeditious online certificate request using VitalChek online services. Program Accomplishments ♦ Issued a total 106,737 certificates. ♦ Enhanced services to issue death certificates for deaths that occurred 2008‐present. ♦ Made death certificate registration electronically accessible, meeting the 2003 standard. ♦ Assured that all Pima County funeral homes were completing death certificates electronically for registration. ♦ Decreased window response time to twenty‐minutes or less for client wait time after being called to the window. ♦ Updated lobby signage to include information in both English and Spanish. Page 22 P IMA C OUNTY B OARD OF S UPERVISORS Honorable Ann Day District 1 Honorable Ramón Valadez, Chair District 2 Honorable Sharon Bronson District 3 Honorable Ray Carroll District 4 Honorable Richard Elías District 5 C OUNTY A DMINISTRATION C. H. Huckelberry, County Administrator Dennis Douglas, Deputy County Administrator Medical and Health Services Pima County Health Department Herbert K. Abrams Public Health Center 3950 S. Country Club Road ~ Tucson, Arizona 85714 Prepared by: Health Promotion and Education Program Staff Page