Apache County Public Health Services District Annual Report 2010-2011 February 2, 2012 Prepared by Chris G. Sexton, Health Director 1 Table of Contents Introduction ____________________________________________ 3 Organizational Chart 4 Listing of District Employees 5 District Activities and Services: Public Health Administration 6 Division of Public Health Clinical Services 9 Division of Public Health Education 12 Division of Public Health Prevention 17 Division of Public Health Emergency Preparedness 25 Division of Environmental Health 33 Financial Analysis __________________________________35 Revenue and Expenses Chart _________________________36 Goals 37 2 Introduction The annual report as required by A.R.S. § 36-186(7), is an opportunity for the Director to formally report the progress and challenges of the past year, as well as to make recommendations for the future. It is my hope that this report will provide some insight into the valuable services provided by the Apache County Public Health Services District employees as well as outline how the ACPHSD has enhanced public health services in the 2010-2011 fiscal year. I would like to extend my gratitude to the Apache County Board of Supervisors and County Manager for their support in promoting public health throughout the county. Chris G. Sexton, Health Director 3 4 Public Health District Employees as of July 01, 2011 Title/Position Health Director Assistant Health Director Executive Assistant FT Administrative Assistant - Vital Records Contract Medical Examiner Contract Medical Consultant PT Custodian FT Secretary Receptionist Employee Name Chris Sexton Keli Sine-Shields Kimberly Penrod Michael Johnson Dr. James Sielski Dr. Catherine O'Rourke Taylor Stuart Wilkins Theresa Jumper 7 8 9 10 Division Manager - Public Health Clinical Services Program Coordinator II Program Coordinator I Public Health Nurse RN Public Health Nurse LPN Shonde Burgess, R.N. Carla Walker April Blair Shonde Burgess Catherine Chustz 11 12 13 14 15 16 Division Manager - Public Health Emergency Preparedness Epidemiology Coordinator Administrative Coordinator CERT Coordinator Administrative Coordinator Secretary Kellie Monterrosa Bill Worsnop Gaylene Kirkhorn Jean Wilson Kerry Pena Misty Anderson-Bond 17 18 19 20 21 22 23 24 Division Manager - Public Health Prevention Program Coordinator II Program Coordinator I FT Health Educator FT Health Educator FT Health Educator FT Health Educator FT Health Educator Debbie Padilla Octavia Thompson Tomasa Lozoya Malena Bazurto-Jaramillo Tina LeSueur Unfilled Michael Schacht Laura Salazar 25 26 27 28 29 30 31 32 Division Manager - Public Health Education Program Coordinator II Program Coordinator I FT Health Educator FT Health Educator FT Health Educator II (WIC) Dietician Health Educator Robin Aguero Lee Castillo Mary Romero Desirae Erhart Suzanne Trezise Irene Sanchez Unfilled Jody Goodsell 33 34 Division Manager - Environmental Health Environmental Health Coordinator Administrative Assistant Chris Sexton Jonathan Catlin Liz Castillo 1 2 3 4 5 6 5 District Activities and Services: Public Health Administration Coalition to Advance Health Resources and Essential Services (CAHRES): As mentioned in previous Apache County Public Health Services District (ACPHSD) annual reports, a goal was set to undertake a community-wide strategic planning process called Mobilizing for Action through Planning and Partnership (MAPP). This year progress was made in collecting information about health needs in the County. Health status and vital statistical data are very difficult to obtain for Southern Apache County. The difficulty in obtaining this information is slowing the process down. Assistant Health Director Report: Staff Development: In the fiscal year 2010/2011, the staff development and training program continued the priority of addressing the eighth Public Health Essential Service; ENSURE A SKILLED, COMPETENT PUBLIC HEALTH WORKFORCE and to ensure National Incident Management System (NIMS) training compliance for all staff. The ACPHSD leaders believe that quality services can only be delivered by well trained, knowledgeable staff. New employees are introduced to public health practice by taking online courses that include an introduction to public health and an orientation to the Incident Command System (ICS 100 & 700). While learning their job duties, new employees build a foundation in public health upon which they will add layers of knowledge as they continue their careers. Annual mandatory training for all staff is a core component of the staff development and training plan. The mandatory number of training hours required are outlined in the ACPHSD training policy and the classes offered for the year are outlined in Public Health Training Calendar accessible to all staff. Employees are required to attend a minimum number of training hours depending on their length of employment and whether they are a full or parttime employee. Additionally certain classes are mandated while others are elective in nature. In the 2011 training year (January 1, 2011 - December 30, 2011) blood-borne pathogens, confidentiality and HIPAA training were required for staff. Public Health staff is also required to maintain current CPR certification. The majority of the 2011 trainings have been facilitated by current public health staff and other local experts in an effort to keep training costs down and to utilize local talent. 2011classes include: Blood-borne Pathogens Mandatory Reporter Food-borne Illness Confidentiality Major Vector-borne and Zoonotic Diseases of the Southwest 6 STD and HIV Awareness First Aid and CPR/IAD Mental Health First Aid Vital Records & Medical Examiner: Deaths: The office of Vital Records registers deaths and issues certified death certificates for all deaths occurring in Apache County. The Vital Records office is supervised by the Assistant Director, Keli Sine-Shields. Michael Johnson is a full-time employee who provides the majority of the death registration work including: receiving requests for disposition transit permits and generating permit numbers, death certificate reviews, processing corrections and amendments, and answering public inquiries. This year the funeral homes and Medical Examiners (MEs) began entering their data directly into the electronic system. The electronic data is forwarded to Apache County for review and registration. Dr. James Sielski is currently serving as Alternate Medical Examiner in Apache County. The AME is primarily responsible for the certifying of deaths occurring outside of a medical facility, authorizing cremations and ordering autopsies for deaths occurring in southern Apache County. Ten autopsies were ordered by the AME in the 2010-2011 fiscal year. Births: The office of Vital Records began processing birth certificates in August 2010. The Vital Records office processes corrections and amendments and prints certain birth certificates. Vital Records & Medical Examiner Measures Fiscal Year % Increase / MEASURE Decrease 2009-2010 2010-2011 26% increase from (2009/2010) # of certified copies of death 1223 1642 certificates issued # of autopsies completed # of certified copies of birth certificates issued 10 10 0% change 0 818 100% change 7 Apache County Child Fatality Review Team: The Apache County Public Health Services District continues to be an active participant in the Apache County Child Fatality Review process. Public Health contributes to the review process by collecting the information necessary to complete a detailed review of the circumstances surrounding each child death that occurs in Apache County. During each review the team completes a standardized data form and develops recommendations for reducing preventable childhood deaths. A local multidisciplinary team meets throughout the year to complete the reviews. The local team consists of representatives from the Apache County Attorney’s Office, physicians, law enforcement, Child Protective Services, Little Colorado Behavioral Health Center, New Hope Ranch, CASA, Navajo Nation Division of Social Services and the St. Johns School District. During 2010/11 sixteen (16) child deaths were reviewed. These deaths took place in 2010. 8 DIVISION OF PUBLIC HEALTH CLINICAL SERVICES (PHCS) The Clinical Services Division implements several grant funded programs to the community. There has been change in the department with the closure of the Home Health Program, the addition of a Child Care Health Consultant and the acquisition of Title X funds for the family planning program. Not only were there changing in programs but in staff as well, Jennifer Foote, RN stepped down as Division Manager, and Shonde Burgess, RN was promoted into the position. PHCS currently provides the following programs, Immunization Services, Tuberculosis Control Program, HIV Services, Family Planning, Well Women Health Check, and Child Care Health Consultant. Blood pressure checks were also offered at the Round Valley Senior Center on Tuesday afternoons and the St John’s Senior Center on Wednesday afternoons. Clinical Services also participates in Health Fairs throughout Apache County offering free TB screening and information for vaccinations, family planning, and the Well Women Program. Immunization Services: Free immunizations are offered to all children up to the age of 19 years of age through the Vaccinations for Children Program (VFC), a federally funded entitlement program. Immunizations for adults are also offered through the Vaccination for Adults (VFA) program, the 317 program which provides hepatitis vaccines to uninsured adults at high risk of contracting hepatitis, and through privately purchased vaccines that are offered for cash paying adults. Weekly immunization clinics are held in Springerville on Tuesdays and St. Johns on Wednesday. The second Tuesday of the month the clinic in Springerville is extended until 7:00 pm to accommodate those who would not be able to make our regular scheduled clinics. During busy seasons such as back to school and flu, the clinics are extended to daily clinics MondayThursday. During flu season many community clinics were scheduled to include Alpine, Round Valley, Concho, and St. John’s schools, Sanders, Ganado, Assisted Living Homes, Dentist’s offices, Dr. office’s, and many of the county offices. A flu campaign with the PHEP Division allowed Clinical Services staff to go to the Apache County Schools and offer the seasonal and H1N1 vaccinations to all school aged children throughout Apache County. Immunization Services also serves as case managers for the Perinatal Hepatitis B Prevention, a program for pregnant mothers infected with hepatitis B virus (HBV). Case management educates the mother on the risks of hepatitis B to herself and her newborn, ascertains the vaccination history of all household contacts and vaccinates those as needed, contact with the birthing facility regarding the administration of immune globulin and the first hepatitis B vaccination within 12 hours of birth, and assures the completion of the hepatitis B vaccination series and the post vaccination testing. Since the implementation of this program in 1990, the transmission of HBV has been significantly reduced in the US. 9 Immunization Services records historical and current immunization data into the AZ State Immunization Information System (ASIIS), a HIPPA approved immunization registry. ASIIS provides access to immunization records for authorized physicians, school health personnel, and state programs assessing the Healthy AZ 2010 initiative. Immunization Services promotes immunization completion by age two (2) through education at community health fairs and reliable vaccine information resources, reminder cards to parents that their child is due for immunizations and phone calls to parents whose child is past due on their vaccinations. ASIIS provides a monthly county-wide missing DtaP (diphtheria, tetanus, acellular pertussis) list which we use to notify the administering clinics and a card to the parents to make an appointment with their provider. Immunization Services has also began to contract with insurance providers. This allows Clinical Services to bill an administration fee for vaccinations given to children and offering insurance billing to private paying adults. This supplements the District financial support and grants support already given to the program. Tuberculosis Control Program: The Tuberculosis Control Program provides Tuberculosis Skin Tests, test results, referral for diagnostic testing, investigation, management of latent tuberculosis infection, and Direct Observation Therapy (DOT) for tuberculosis disease. TB skin testing is offered during Immunization Clinic hours in Springerville and St. Johns for $10 to non-contact, non-suspect cases. Contact and suspect cases are tested at no charge. During the 2009-2010 year one (1) TB skin test read positive, a Quanterfuron Gold test was performed; the results were negative, clearing the suspect case. Apache County contracts with Northern Arizona Council of Governments (NACOG) to provide TB skin tests to Head Start students and staff. In 2008 NACOG revised their criteria for testing to high risk individuals only. None from this high risk group had positive skin tests. Tuberculosis information is available to the public through our office, and at health and resource fairs. Tuberculosis Control Measures MEASURE Fiscal Year 2008-2009 # of PPD Tests Placed 199 % Increase / Decrease 2009-2010 148 -25.62% 10 Head Start students/staff 17 1 -94.11% 182 147 -19.23% # of Chest x-rays ordered 1 1 n/a # of Positive results 1 0 n/a Community HIV Prevention Services Program: HIV Prevention Services provides confidential HIV counseling, rapid testing and referral services, targeting populations at highest behavioral risk for HIV, and those infected with TB. Additionally, the program offered a simple urine test for Chlamydia and Gonorrhea, treatment of disease for patient and partner(s), and makes condoms and educational material available through the confidential “brown bag” program. HIV rapid tests are offered by appointment only. The cost of an HIV rapid test is based on a sliding fee scale from $0-$25 for individuals who are not at high-risk or infected with TB. Highrisk individuals or those infected with TB are tested at no charge. STD testing and treatment services are offered free of charge. Appointments are encouraged. STD services will be provided under a new contract which began in May 2009. The new contract will allow the financial means to provide blood tests for other sexually transmitted diseases, courier and laboratory fees, and education and out-reach. HIV Program Measures MEASURE Fiscal Year 2008-2009 % Increase / Decrease 2009-2010 # Pre-test evals completed 9 12 33.33% # HIV Rapid tests completed 9 12 33.33% # HIV blood tests completed 0 0 # of partner notifications 0 0 30 50 66.66% 350 502 43.42% # of Urine STD Tests # of brown bags 11 DIVISION OF PUBLIC HEALTH EDUCATION (PHE) The Division of Public Health Education is overseen by Robin Aguero, Division Manager of Public Health Education. This division administers the Tobacco Use Prevention Program, WIC (Women, Infants, & Children), AZ Nutrition Netword Program and the educational component of the Smoke-Free AZ Act. Additionally, members of PHE are taking the lead in the Coalition to Advance Health Resources and Essential Services (CAHRES), attend community-based coalition meetings and are available to hear, and then address, public health concerns from local agencies and community members. PHE is active in the Apache County Drug-Free Alliance utilizing their skills and resources to promote alcohol, tobacco and drug awareness and reduce substance abuse in our communities. Bureau of Tobacco and Chronic Disease (BTCD): Executive Summary of Activities For the Fiscal Year 10/11, we were met with the challenge of implementing our new scope of work, however those challenges were complimented by the many successes we encountered. We began the year with various summer programs which included many Health Fairs; LDS Preparedness Fair, White Mountain Regional Medical Center Fair, Window Rock Tribal Health Fair, Apache County Fair, and Round Valley School District Information Fair. We performed Business compliance checks with the Attorney General’s office, distributed new signs to businesses and provided education for them. Our youth were involved in numerous trainings, including: CADCA, Partnership for Drug-Free America, and Rachel’s Challenge- peer mentoring training. They participated in various community programs including Library Story Hour (providing presentations for younger children), The Recovery Walk, Friends of Rachel’s Club, Characters in Motion, as well as provided promotional activities during all home games during half time. The youth gave out information pamphlets, educated other youth on the history of Red Ribbon Week, designed a Homecoming float, spoke with parents on the importance of promoting a healthy life style, educated the public on the dangers of Tobacco, Alcohol and Drugs, and importance of making positive choices. Our BTCD Staff participated throughout the year in many programs including: Back to School Activity Day, Fun Focus Day, Safe Routes to School, Healthy Heart, Eglin/Project AlertTobacco Prevention programs for youth and parents, Teen Maze events for Teens, Childbirth education classes, provided Tobacco Education programs for community groups, and were involved in numerous events with our partner groups in Apache County, which include: Apache County Drug Free Alliance, Apache County Youth Council, PLAY group, Kids in Woods, CASA, White Mtn. Regional Medical Center, Summit Health Care, Navajo Nation, T.O.P.S. , Health Start, WIC, and Head Start. BTCD Staff also participated in several trainings during the year which included: CADCA Youth Trainings, Smoke Free Arizona, County Trainings, Chronic Disease Self Management Leaders Training, and Master Trainer Training, Diabetes Trainings, and Brain and Addictions-6 part series webinar. 12 We have completed one CDSMP workshop here in Apache County, with the next series in the planning stage. We have promoted this through distribution of materials to local libraries, health care providers, the wellness center, Senior centers and other key gathering sites. We recently began a new partnership with the Boys and Girls club which opened this summer, to promote our programs at their center and to retain and train new youth mentors. One very large unexpected challenge for our community this summer was the shock and strain of the Wallow Fire, which tested Apache County, as a whole, and the Health Department in particular, as staff helped man the JIC Call Center phone lines. Professionalism and compassion were key elements displayed daily, during the month of June, as evacuees depended on those working the phones to keep them in touch with their homes and communities. Despite being contained for almost a month, the effects of this fire will continue to be felt for months, even years, to come. Status of Strategic Plan Goals Strategic Plan Goal 1: Reduce Initiation of Tobacco Use among Youth/Youth Coalitions We addressed this goal by allowing youth to take an active role in community/school related programs, such as Rachel’s Challenge. This program allowed youth to address the dangers of addictions to tobacco, drugs, and alcohol and the importance of making healthy choices. The presentation of this program was first introduced to the public in both communities of St John’s and Round Valley as well as neighboring communities through a day and evening assembly. Parents were encouraged to attend as this presentation and challenged to address family issues as well. This activity addressed middle schools students in one session, high school students at a second session and the community at large including parents in the evening session. Friends of Rachel’s Club, was formed following these presentations, where youth organize activities which focus on being mentors for their peers and community. This program is going into its 2nd year and is currently active in our schools, youth groups, and community. It will be introduced in the Boys and Girls Club this upcoming Fall. Cherish the Youth Health Fair, in Window Rock was an amazing event which allowed our staff to provide information to residents of the Navajo Nation. We used this opportunity to present information on Tobacco dangers and especially focused on the use of CHEW and its myths and the real dangers its presents. Due to the common use of CHEW on the reservation, we gave out pamphlets and other pertinent information on this topic which we found the youth and parents very receptive to. Our community partnerships include groups such as the TOHC youth group, Apache County Drug Free Alliance, Teen Outreach Program (T.O.P.S.), and the Teen Maze. We partner with these groups, whose main focus is peer-mentoring, promotion of healthy choices among youth through participation in various community and school events. We all partner to provide training for youth, to provide peer mentoring programs, one example is a training from CADCA and other area trainings as well as those provided through local Youth leaders. The Recovery Walk was an activity organized by the youth for the community. Each person who joined the walk did so in memory of a family member lost to addiction to Tobacco, drugs or alcohol-living or deceased. The youth directed this activity, including the set up and presentation and 13 informational speeches at the end of the walk. Dinner for participants was provided by a local restaurant. The goals in these various events was to help identify needed policy changes related to Tobacco, Drugs and Alcohol and to provide information to the community and schools on these topics. Some of the topics included: establishing healthy environments, promoting healthy life styles through education on dangers of Tobacco and drugs, and making positive choices and taking personal responsibility for their choices. Strategic Plan Goal 3: Promote Smoking Cessation / Build Cessation Networks. These activities are on-going. We meet regularly with other departments within the Health District to promote Ashline as well as encourage referrals. We present Tobacco information in the Health District’s Childbirth classes, and accept referrals from Health Start and WIC. We also provide one-on-one cessations as requested for clients from our other departments, and meet with any walk-in inquiries. We continue to provide cessation information in the Apache County Juvenile Detention program at the Apache County Juvenile Facility, on Tuesdays and Thursdays each week. We address the topics of Tobacco, drugs, alcohol as well as give them materials to take with them when they get released. Strategic Plan Goal 4: Identify and Eliminate Tobacco Related Disparities in Specific Population Groups. The Coalition to Advance Health Resources and Essential Services, (CAHRES) have completed surveys, and work specifically with focus groups to collect information to help identify areas of need. CAHRES meetings are held at specific community locations (i.e. Round Valley. St John’s, Vernon) to help identify specific population and groups needs. One activity that is aiding in addressing disparities is our Chronic Disease Self Management Program. We have completed one workshop in Apache County and are currently planning our second. Strategic Plan Goal 5: Assist in the Prevention and Early Detection of the Four Leading TobaccoRelated Causes of Death in Arizona. Suzanne & Mary trained to become Lay Leaders in the Chronic Disease Self Management Program (CDSMP) in December 2010 and Suzanne trained as Master Trainer March/April 2011. They held 1 very successful workshop, with 100% completing the workshop. The Wallow Fire postponed scheduling of their second workshop however they recently began a partnership with the Diabetes educators at Summit Healthcare and began the next workshop. Staff also partnered with one of our nutrition staff members and assisted in presentations she provided to the schools addressing areas of good nutrition and exercise, as well healthy lifestyles, free from tobacco, drugs, and alcohol. The key being that youth will see healthy choices as a means of prevention. These were done through in-class activities, the Boys Girls Club activities, and Health Fairs. 14 Staff also provided a presentation on the Healthy Heart Program to Head Start staff and parents which also addressed the above areas, during a parent night. Staff have also addressed the four leading Tobacco related causes of death by teaming up with the Apache County PLAY Group, where they participate in the Safe Routes to School walks each month. On average more than 100 students participate in each walk, including school staff and administration, staff from the White Mountain Medical Center, City council members, and parents. Characters in Motion is another program used to address prevention. This is a peer mentoring program where the trained youth leaders go into school classes, youth groups and other youth gatherings (i.e. Teen Maze and Friends of Rachel Club) and do presentations on dangers of Tobacco, drugs, and alcohol. This is done through activities such as Recovery Walk, dramatic presentations, information booths at Health fairs and home game half time activities. MEASURE BTCD Program Measures 2009-2010 # of youth served in school-based intensive interventions (6-7th grade) # of youth served in school-based intensive interventions (4-5th grade) # of youth served in school-based booster lessons (7-8th grade) # of community events # of referrals to Ashline 2010-2011 292 379 364 457 375 433 18 events FY2009-2010 65 35 events FY2010-2011 75 Women, Infants, and Children (WIC)/Folic Acid Program: Apache County WIC is a Federally-funded nutrition program serving pregnant, breastfeeding and post partum women; and infants and children up to five years of age who meet eligibility requirements. WIC provides families in the community with nutrition education, food instruments for the purchase of nutritious foods, health screenings, and referrals to other programs and medical providers as needed. In October, the WIC food package changed to include more nutritious foods including fresh fruits and vegetables, jarred infant foods, whole grain products, soy products, and canned salmon. Additionally, extra foods are now provided to mothers and infants who are exclusively breastfeeding. We were fortunate to have a full-time Registered Dietitian to perform high risk nutrition counseling, formula approvals, and nutrition trainings for staff; for almost two years. Unfortunately she accepted a position in Chicago and resigned her position with us in July. We continue to have a full-time bilingual Community Nutrition Educator on our staff to better serve 15 our Spanish-speaking population. Because WIC recognizes breast milk as the ideal food for infants, we offer breastfeeding support and education by a Certified Lactation Counselor. Additionally, all WIC employees recently attended a 40 hour breastfeeding course in the hopes of improving our breastfeeding knowledge and counseling skills in order to encourage breastfeeding in the community. WIC staff attended six meetings and various trainings with ADHS during the reporting period. Additionally one of our staff took the International Board Certified Lactation Consultant (IBCLC) exam and passed with flying colors! Lee Castillo is now an official IBCLC, which serves as a great credential for our WIC program. In Fiscal Year 2010, WIC clinics throughout Arizona saw a significant decrease in the number of clients served from the previous year. However, as the current Fiscal Year comes to a close, Apache County WIC is experiencing an increase in our monthly caseload due to additional outreach efforts. Our Folic Acid program for FY 10/11 was discontinued. However, we still had Folic Acid vitamins still available to distribute, so those have been given out as needed. If a woman has enough folic acid in her body before and during pregnancy, it can help prevent major birth defects of an infant’s brain and spine called neural tube defects. Through the Folic Acid Program, Apache County WIC staff offer women in of childbearing age a full year of supplemental vitamins to aid in the prevention of neural tube birth defects. Folic acid supplementation during childbearing years has been proven to decrease the occurrence of these birth defects infants by 50-70%. This year, we were able to provide vitamins to 48 women. MEASURE # of WIC clients served # of folic acid vitamins Fiscal Year 2009-2010 2010-2011 6,384 6926 160 48 % Increase /Decrease 9.2% (+) 60% (-) 16 DIVISION OF PUBLIC HEALTH – HEALTH PROMOTION (PHP) The Division of Public Health – Health Promotions is overseen by Debbie Padilla, Division Manager. This division administers the Community Health Injury Prevention Program, Governor’s Office of Highway Safety Injury Prevention Program, Health Start Prenatal Outreach Program, Teen Outreach/Teen Maze Program, Physical Activity and Nutrition Program, and Dental Sealant Programs. Community Health Program: The fiscal year for the community health grant runs from January to December. From July 2010 to December 2010, the first half of the county’s fiscal year, priority areas for the program included: reduce the rate of injuries, both intentional and unintentional, reduce infant mortality among children, improve the mother’s overall health status prior to and during a pregnancy and reduce obesity among women and children. For the second half of the grant’s fiscal year, and directed by Arizona Department of Health Services, Bureau of Women’s of Children’s Health priority areas were changed that included: Improve the health of women prior to pregnancy and reduce the rate of injuries, both intentional and unintentional. Health Promotion staff actively collaborated with multiple agencies within southern Apache County and the Navajo Nation in meeting the objectives for both time frames within the fiscal year by providing certification classes for child passenger safety technicians, distribution of car seats and bike helmets, providing students K-12 and families with educational classes regarding seat belt safety and injury prevention. The program also distributed conceptual health materials, provided nutritious foods to create healthy snacks for youth during classes with the Promoting Lifetime Activity for Youth (PLAY) program, as well as provide a walking program for women. Injury Prevention - National Highway Traffic Safety Administration (NHTSA) statistics state that 80% of caregivers who transport children in car seats do so incorrectly. All staff of the program has become certified child passenger safety technicians through Safe Kids Worldwide; a nationally recognized advocate and leader of child passenger safety. Technicians provide families with car seats and seat belt safety educational classes through one-on-one instruction. Caregivers learn how to properly fit their child in their car seat provided; learn the proper techniques for installing car seats in their vehicle through correct seat belt use. Families must meet eligibility guidelines to receive car seats; for all others education is provided. The program also furnished car seats and educational materials to agencies located in the Navajo Nation who promote child passenger safety through their injury prevention programs. Distribution of educational materials occurred during car seat classes, car seat check and outreach events and during child passenger safety technician trainings. Fort Defiance, Chinle, and Gallup service areas (Sanders) were assisted with staffing for car seat check events and technician trainings as well as materials to aid their injury prevention programs. Collaborative efforts between Apache County and the Navajo Nation have allowed for services to be provided since 2003. 17 In addition, kindergarten and Head Start children were provided injury prevention classes through the booster seat campaign during “National Child Passenger Safety Week” in September 2010. NHTSA recommends children under 4’ 9”, and who weigh less than 80 pounds be transported in a booster seat. Children viewed a I’m Safe video, were weighed and measured to determine what type of car or booster seat they needed, and sent home information for parents/caregivers on how their child could receive a free booster seat. Further, Seat Belt Safety and Crash Dynamic educational classes were provided to students 4th12th grades through interactive presentations during science classes. High school students also received education before major events such as homecoming and prom. Department of Public Safety personnel assisted program staff when the presentation was provided at the high school. Conceptual health materials were provided to women enrolled in the prenatal program and during outreach events. Trimester specific materials were given to women enrolled in the prenatal program as well as those who attended bi-monthly childbirth classes. Newborn and infant health materials were provided to women following birth of their child through the prenatal program. The Community Health fiscal year runs January through December; therefore the data reported is through December of 2010. CHIPP Measures MEASURE th th # of 4 and 6 grade students receiving education # K-8 students provided activity/nutrition program # of women enrolled in walking program Bike Helmet education # women receiving preconception educational material # of individuals attending carseat classes # of car-seat classes provided to Native American families # of child passenger safety technicians certified # of preschool children served by booster-seat campaign # of booster-seat classes # high-school students who received education Calendar Year 2009 450 2010 421 333 368 0 31 0 116 % Increase /Decrease 6.44 (-) 10.51 (+) 38 235 102.58 (+) 286 202 29.37 (-) 140 83 4.07 (-) 10 20 100 (+) 455 354 22.19 (-) 28 789 12 825 57.1 4.56 (-) (+ 18 Objectives Form Safe Kids Chapter Calendar Year Jan to Balance June 2011 0 1 Provide 100 car seats in AC 54 46 Provide a 6 CEU workshop 1 0 Provide CPS Tech Training 1 0 Provide 3 safety educational classes 3 0 Provide 1 ATV safety class 1 0 Provide 1 Suicide or Mental Health First Aid Training Provide medical providers with conceptual health materials 1 0 1 0 25 women will complete reproductive life plan 25 0 Process/Outcome Evaluation Results Safe Kids chapter will be created once child passenger safety technician training is provided to law enforcement personnel 2011 On-going distribution occurring for families in both southern and northern Apache County CEU class provided at Pinetop Fire Department in collaboration with Navajo County Public Health Services District Certification class provided at Pinetop Fire Department in collaboration with Navajo County Public Health Services District Classes will be provided to Head Start, Little Colorado Behavioral Center and Child Protective Services staff Work in progress with Apache-Sitgreaves Forest Service personnel Training scheduled for December 2011 Kits are being designed for medical providers to distribute during doctor visits Reproductive life plans will be distributed to women during childbirth classes, prenatal program and medical visits 19 15 Native American youth will complete a reproductive life plan 15 0 Provide “Get up and Move” walking program 1 0 Provide 3 outreach events in AC 3 0 Work in progress with nurse and counselor at Valley High School in Sanders Program will be implemented Winter of 2011 Outreach provided to families during Head Start Resource Fair in Springerville and St. Johns and Bike Rodeo at Ramsey park in Eagar. Car seat check event is scheduled for Sanders in September. Strengthening individual knowledge and skills; promoting community education; educating providers; fostering coalitions and networks; changing organizational practices and influencing policy and legislation are all levels of prevention that the Arizona Department of Health Services would like us to promote through the program for fiscal year 2012. In January 2012, ADHS instructed our program that direct services for the program would be less funded and the program priorities would lean towards increasing policy and legislation changes with agencies we work with in our communities. Health Start Prenatal Outreach Program Since August of 2000, Apache County Public Health Services District has administered the Health Start Prenatal Outreach Program to women and their families in the communities of southern Apache County. Primary service care areas of southern Apache County include: Round Valley (Alpine, Eagar, Greer, Nutrioso, Springerville and Vernon), and St Johns (St. Johns, Sanders, and Concho). Health Start is a neighborhood outreach program that helps high-risk pregnant women obtain early and consistent prenatal care, and for their children, timely immunizations. Health Educators of the program who reflect the ethnic, cultural and socioeconomic makeup of the neighborhoods they serve connect pregnant/postpartum women with community resources that provide prenatal and related infant/child services. The families are followed for two years after the birth of the child to assist with identification of a “medical home” for each family member and to encourage immunizations for all children in the family. All women in the community are invited to attend bi-monthly childbirth classes hosted by the prenatal program. 20 Health Start Measures MEASURE Fiscal Year 2009-2010 2010-2011 % Increase /Decrease # of families served 95 81 14.73 (-) # of prenatal visits 314 263 16.24 (-) # of family follow-up visits 327 779 138.22 (+) Teen Pregnancy Prevention Program (TPPP): The Teen Pregnancy Prevention Program (TPPP) provides services to southern Apache County communities by utilizing comprehensive sexual health evidence-based curricula. Curricula selected are approved by the Arizona Department of Education to be used in school-settings. Program staff currently is comprised of three full-time facilitators whom are certified to deliver two comprehensive sexual health programs: Wyman Teen Outreach Program and Making a Difference. Wyman Teen Outreach Program (TOP) TOP was provided at four sites during September 2010 – May 2011. Sites included: Round Valley High School, St. Johns High School, St. Johns Learning Center, and Apache County Juvenile Detention Center. Round Valley High School and St. Johns Learning Center delivered the program with fidelity by providing classes during the entire school year with classes held twice a week for at least an hour in duration. These students received elective credit from their school for successful completion of the program. Sites at St. Johns High School and the Juvenile Detention Center were provided with Wyman Teen Outreach Program classes but did not follow the school year. Classes were held twice a week and 80% of the curriculum was completed. Participated in all programs that were on probation did receive community work service credit as an agreement was made between Apache County Juvenile Probation and Apache County Teen Pregnancy Prevention Program to offer service hours to those who attended regularly and actively participated. Making a Difference All program staff became certified to deliver the Making a Difference program to middle-school youth by June 2011. Concho Elementary School was our pilot program. Making a Difference was provided to Concho Elementary youth during April – May 2011 as an elective class. Program was delivered for eight weeks with fidelity. 21 Measure # of students that completed Wyman Teen Outreach Program # of students that completed the Making a Difference program # of youth served at the Juvenile Detention Center # of outreach life skills classes provided to Middle and High Schools # of parents/guardians who attended a parent session # of community outreach events Community Served St. Johns Round Valley Fiscal Year 2008-2009 2009-2010 - 6 12 15 % Increase/ Decrease 25(+) - - - 17 N/A - 31 37 35 0.05(-) - 27 30 41 37(+) - - - 15 N/A - - - 7 N/A 2007-2008 2010-2011 Site Frequency of classes / event Duration # of classes Apache County Juvenile Detention Center Weekly 60 minutes 40 St. Johns Learning Center Biweekly 60 minutes 59 St. Johns High School As Scheduled 50 minutes 36 St. Johns Middle School As Scheduled 60 min. 5 Round Valley High School Biweekly 60 minutes 48 As Scheduled 60 minutes 9 (after-school Wyman program) Concho Concho Elementary School 22 Teen Maze Program: The goal of the teen maze projects are to increase the knowledge of youth as to the risks and consequences of certain behaviors so they will make healthy choices and decisions that will enable them to achieve their aspirations for the future. Apache County works with the local Youth Council, high schools, and other organizations within the community to implement this project. The purpose of the maze is to provide primary and secondary prevention and health promotion education to youth on topics including but not limited to: teen pregnancy, responsible sexual behavior while stressing abstinence, date rape, substance abuse, school and domestic violence, suicide prevention, diversity, physical activity, nutrition, higher education, and vocational/career options. A Teen Maze event was planned for April 2011 at Sanders Valley High School but due to the teen suicide of one of their students, the event was cancelled. On May 9, 2011, an assembly that was initially part of the Teen Maze event was provided instead to the entire student body. Mr. Ernest Tsosie III, well-known Native American Actor and Comedian, delivered a speech about the consequences of alcohol and tobacco use while incorporating humor. All student received drawstring bags with the message, “Positive Choices, Positive Consequences” printed on them as this was our Teen Maze theme. A number of agencies from southern Apache County and the Navajo Nation contributed to the items that were given in the bags. Fiscal Year Measure # of students served by the Teen Maze events 20072008 407 20082009 669 20092010 815 20102011 360 % Increase/Decrease 55.82 (-) Physical Activity Program: Over the past 12 months, the Apache County Physical Activity Program (PA) has been involved in events in and out of the public school setting. Beginning in September of 2010, the PA Program began working with Apache County Schools for the 2010-2011 school year. The PLAY curriculum was used in Alpine, Sanders, Round Valley, Saint Johns, and Vernon, and Ganado School Districts. More than 800 students completed the curriculum and over 200 students earned the Presidential Active Lifestyle Award. Several events were planned in the community over the same time frame. These included Walk to School Days in Round Valley and Saint Johns, St. Johns Literacy Fair, Round Valley Middle School Field Day, Kids in the Woods Nature Hikes. The Physical Activity Program is a partner with organizations such as Big Brothers Big Sisters, USDA Forest Service’s Kids in the Woods Program, Girls on the Run of Northern Arizona, Apache County Wellness Coalition, White Mountain Communities Wellness Coalition, North Country Health Care, Apache County Youth Coalition, and Arizona Youth Partnership. Meetings are held with partners on a monthly basis, mostly at mixed coalition venues. Community events and volunteer opportunities are designed through these partnerships. 23 The Physical Activity program also strives to educate and promote health for the adult community. In the past 12 months months the PA Program has presented information workshops at the Round Valley Senior Center. In conjunction with North Country Health Care and Dr. James Sielski, the PA program co-facilitates a program that teaches nutrition and physical activity. The same types of activities are planned for the next twelve months. The application for Safe Routes to School funding was submitted and awarded for the St. Johns School District. The Physical Activity Program will implement the Girls on the Run after school program during the 2011-2012 school year. The Physical Activity Program will turn its attention to Worksite Wellness initiatives with North Country healthcare staff and teachers at St. Johns Middle School. The PLAY curriculum will be utilized in Apache County Schools and hopes to reach 801 students by March 30, 2012. It is the goal of the PA program, that 280 students earn PALA’s by May 2012. Physical Activity Program Measures MEASURE Fiscal Year % Increase /Decrease 2008-2009 2010-2011 # of participating students 1139 858 # of PALA awards 329 415 # of teachers participating 53 30 43.39 (-) Total # of schools participating 10 6 40 (-) # of Navajo Nation schools participating 3 2 33.33 (-) # of community events 18 12 33.33 (-) # of WELL participants 106 100 5.66 (-) 24 (-) 26 (+) Dental Sealant Program: Dr. Stephen Palmer, Eagar dentist, obtained the credential of “affiliated practice” needed to allow ACPHSD to implement its dental sealant program for southern Apache County students. Contracts have been put in place for an affiliated hygienist, and two dental assistants to administer the program through a mobile dental office. This year, dental sealants and exams were provided at the end of the school year at both Concho and Vernon School. Students will continue to be provided before the end of March 2012 at other area schools in the district. Contractors attended training with Arizona Department of Health Services (ADHS), Office of Oral Health to implement the program. ADHS contacts and invite schools to participate in the program. 24 Division of Public Health Emergency Preparedness (PHEP) The Division of Public Health Emergency Preparedness facilitates preparedness efforts relating to public health and pandemic influenza under the direction of Kellie Monterrosa, PHEP Division Manager. Additionally, the Division handles the receipt and investigation of all disease reports for Apache County. To that end response plans are created and maintained, trainings are attended, partnerships are cultivated, exercises are developed, organized and executed, education is provided to the community, relationships with medical providers are maintained, and investigations are conducted. The Division is fully funded through the Bioterrorism Preparedness and Response Program contract from the Center for Disease Control (CDC) through ADHS. Because ADHS contracts separately with the Navajo Nation and Apache County, PHEP works with the tribal preparedness group but focuses its efforts on southern Apache County. Further, PHEP collects information pertaining to, and facilitates a public health response for the entirety of the county. Additionally, PHEP conducted the following activities during the reporting period per their grant deliverables: Project Public Health Ready (PPHR) Recognition In 2009 PHEP hired an outside consultant to rewrite the Emergency preparedness plan for Apache County Health Department; this plan has been written in conjunction with Apache County Emergency Management. This plan has been completed and approved By the Board of Supervisors in June of 2010 Attendance of all PPHR meetings as mandated by ADHS, including Northern Regions committee meeting and State exercise meeting. PPHR submission has been fully completed and ACPHSD was recognized by PPHR for our rediness. The PHEP department wants to thank Kerry Pena in particular for her outstanding work and contribution to this overall project. Federal guidelines have required local health departments to develop and employ emergency response plans for their health departments. Federal grants are issued to aid Counties in this cause. The guidelines they have set forth have required timelines and County compliance dictates future funding. PHEP has worked hard to develop a Public health workforce training plan; again Kerry Pena was in charge of this project and has done a stellar job in completing the project. The workforce development plan was attached to the PPHR submission. Currently PHEP is in the process of interviews with staff and is developing an individual training plan for each public health worker. Staff has completed a series of two interviews that helped them identify where in the ICS command structure or response they want to be. Staff will be trained first to the emergency plan and then to the role they have chosen in the ICS command structure or the response staffing. PHEP has also responded to the Wallow Fire and flood mitigation, by operating the 593 information center during both county emergencies. In January 2010 the County suffered a winter storm emergency. PHEP employees set up and manned an emergency shelter at the Round Valley Middle School for five days. This was an 25 excellent training tool to utilize lessons learned for future training exercises. In June 2010 a small plane crashed into the local high school. PHEP set up a shelter at the Round Valley Middle School which was manned for five hours. Two H1N1 clinics were run by PHEP and the County Health Departments in 2009 Wallow Fire Response PHEP team operated the 593 call center for the Wallow fire and flood response. The PHEP team along with community and public health volunteers operated the center from June 3, 2011 through mid-July. The initial operation was 7 am until 10 pm daily. After the fire the flood call line was operated as requested by ACEM Liaison with ADEQ for air quality issues, PHEP staff worked with ADEQ to provide air quality information. Dave Kirk assisted the department in fit testing for P95 when appropriate Special needs subcommittee assisted in facilitating the evacuation of elderly and those without transportation. Special thanks to Springerville Senior Center staff for the assistance and coordination of this event. Red Cross operated the emergency evacuation center; ACPHEP kept in contact with them and offered to run a special needs shelter of needed. The Red Cross indicated to us that they would not need our assistance with this matter. Public Health PIO’s Gaylene Kirkhorn and Kellie Monterrosa worked closely with the 593 manager and USFS PIO staff to provide local information to them and conduct media interviews when needed. Gaylene was seen on national news, and heard on radio stations locally and internationally. Special needs Populations Special needs subcommittee was formed through the Local Emergency Planning Committee (LEPC). The subcommittee meets quarterly and is creating a list of goals for the committee in order to address our special needs population. Current Chairperson is Toni Preder from NACOG and CO-Chair person is Shonde Burgess PH RN. The goals of this committee over the next year are being currently assessed. activities have been limited due to the real world events in Apache County Coordination of Disease date and reporting Trained additional users on the disease reporting database from the state, we now have 2 users, Bill Worsnop and Kellie Monterrosa. Currently White Mountain Regional Medical Center is intersteted in training lab personnel and infectious disease personnel. . In addition we have one user from the Chinle Service unit; her name is Kris McConaha, RN. 26 Hired a new Epidemiologist Bill Worsnop that is in charge or surveillance and investigations of all reportable diseases Participated in various committees at the state level for epidemiology, these committees deal with the various disciplines within epidemiology and are instrumental in creating better community within the state for epidemiology practice ACPHEP Participates in 4 quarterly drills from the state to gauge the response time and action taken at the county level for 24 hour reportable diseases. Each drill was passed with a variety of lesson learned throughout the year that have helped us make changes to specific areas within the reportable disease process At the end of the Fiscal year, Epidemiological duties have been split between PHEP, Clinical Services and the Directors office. Budget cuts prevent PHEP from employing a full time epidemiologist. Exercising and Training to current plan Training Activity October 2010 ESAR VHP volunteer coordination training CISM (Critical Incident Stress Management) Workshop @RV Annex November 2010 PPHR (Project Public Health Ready) final submission December 2010 Planning meetings for Public Health Workforce Development Plan January-May Worked daily with Nomad consulting to develop Public Health’s Workforce and Development Plan Working with Nomad Consulting we developed a comprehensive Training and Workforce Development plan for Public Health staff. The plan was written for staff to be able to train and respond to Type III incidents. A step by step approach to training for Public Health staff to respond to events utilizing the Incident Command structure has been completed and being implemented as of October 2011. Nomad Consulting is working with Public Health Emergency Preparedness on a volunteer basis to develop the training modules for staff response specific to the Apache County Emergency Response Plan. 27 We are currently wrapping up the TB outbreak response and have been utilizing the Command Structure following the plan developed with Nomad. This process has worked very well for our staff and will be a great asset to future response. February 2011 Attended the Public Health Preparedness Summit in Atlanta, GA Worked with ADHS Training division during the Palo Verde exercise March 2011 Attended the State Preparedness Conference April 2011 Simulation Exercise with Public Health staff for the State exercise, held at the RV Annex Attended the RSS (Resource Strategic Stockpile) training in Tucson, AZ May 2011 Attended multiple planning meetings with the Navajo Nation for their Table Top Exercise Received recognition for the PPHR project that we are accredited through NACCHO June 2011 Wallow Fire Response I worked directly with multiple agencies at the call center. I was responsible for volunteer scheduling and training on the phone systems and call center functions. During the fire and flood response we were able to test our response capabilities and incorporate the lessons learned to the training plan. One of the best outcomes from the fire and flood response to me was the relationships built with outside agencies and County employees. June-August 2011 Wallow Fire and Flood response September 2011 Held employee interviews for Public Health ICS roles October 2011 28 TB Outbreak response I assigned responsibilities for Public Health staff in the ICS system for the TB response. I acted as coach as far as the roles and responsibilities for the command structure. Increase Volunteer Capacity ESAR-VHP State database that registers volunteers and checks credentials of medical personnel, state maintained and managed. Apache County Medical Reserve Corps has 44 volunteers; 16 volunteers have registered on AZ ESAR-VHP. Citizen Corps CERT – Citizens Emergency Response Team As of July 2010 through June 2011, we had a TOTAL of 216 Volunteers; 79 are trained CERT members and 41 MRC members. Education has been offered to the members of this team, to increase readiness for response: August 5-7, 2010 we conducted a CERT Training in Nutrioso CISM Training (employees and volunteers) on October 19-21, 2010 Presentation at the El Camino Restaurant in St. Johns to the San Juan Women’s Club on Preparedness NARBHA Training on Mental Health First Aid, April 25-26, 2010 CERT team members have been utilized in the following ways this year: July 31, 2010 we had a preparedness booth at the White Mountain Regional Medical Center August 7, 2010 the volunteers helped with Eagar Daze August 28, 2010 Health and Wellness Fair at WMRMC Apache County Fair Sept. 7-10, 2010 Flu Shot Clinic at the RV Dome on October 16, 2010 June 2-24, 2011 Wallow Fire, Joint Information Center MRC – Medical Reserve Corps We have 41 volunteers on file and 15 have registered on AZ ESAR-VHP 29 Communications Exercises and real world events December 27,2010 Utilized 593info.org webpage, hotline, twitter and Facebook to send out information to residents regarding a possible strong winter storm. Sent a notification alert message to all public health staff to remain on standby in case a shelter needed to be established. March 17,2011 Utilized the Joint Information System with Arizona Emergency Management and Arizona Health Services to receive information regarding radiation levels in Arizona due to the earthquake in Japan. April 12, 2011 A notification alert was sent out to Apache County Public Health Staff for the Surge Exercise at 0853 hrs. Messages went to Cell phone, if no answer calls were sent to Office phone and work email. May 6, 2011 A notification alert was sent out to Apache county Public Health Staff on tier 2 level for a standby call on the Locust fire located in White river for possible shelter needs at 1441 hrs. 60% of staff responded within 15 minutes. All other staff did not respond. June 6, 2011 A notification alert was sent out to all Apache County Public Health Staff for a standby call on the Wallow Fire located in the White Mountain area for possible shelter needs at 1208 hrs. Wallow Fire Utilized the Joint Information System and call center to assist with volunteers answering phones for resident calls. Also used as a source for media press briefings and interviews. Updated the 593info.org webpage and hotline with current information regarding the fire, air quality and evacuations to keep the residents informed. In the process of scheduling time to train on the use of the public health handheld radios for key staff that would use the radios during exercises and real world events. Notification System (Communicator, NTX ● Continually test the notification alert system for public health staff in order to strengthen response level during an emergency. ● Recently changed notification system from the Communicator through the Arizona Division of Emergency Management to AzHAN provided by the Arizona Department of Health Services. In the process of getting all public health staff signed up to the new system. 30 Developing more ways of reaching all populations of Apache County. ● Assisted in creating an APCON level (Apache County Condition level) alert system that has been placed on the Apache County Website. ● Twitter and Facebook is being used through the Public Information Officer in the PHEP department in order to reach a larger percentage of the county population and closer interaction with the media. ● JIC/JIS 593.info continues to expand in order to reach those interested in information for Apache County. In 2011-2012 we intend to continue to look for innovative ways to reach all sections of the population in Apache County. ● Further develop the pages on social media websites to include more departments within the health district and fully utilize the free services that are available through these sites. Create Community Partnerships Navajo County ● Worked with partners in Navajo county to increase 593. Info capabilities by training staff in that jurisdiction to make updates to the 593 web site and all related joint information systems (JIS/JIC) in Apache County Community Trainings ● Created and offered resources to office and business for COOP planning o Community based training on the Apache County Emergency Management Plan is currently under development. Worked with I.H.S and Navajo nation ● In conjunction with ADH and Navajo nation Health preparedness Apache County has participated in plans for the creation of a new SNS site that will service the Navajo nation. ● HHP grant drills were participated in as secondary contacts for all I.H.S facilities several times during the year. WMRMC ● HHP grant drills were participated in as secondary contacts for WMRMC several times during the year. o Particiapted in the State Vigilant Guard exercise with WMRMC and H.I.S. hospitals. 2010-2011 Goals Completed additional training for Staff and Community of the ACEMP Redesign the Citizen Corp recruitment plan Recruit and Train DORT teams 31 Work with the Red Cross to create a local chapter Work on the following items as per PHEP contract with state o Surge management o Information management o Countermeasure and Mitigation o Biosurvelliance activities Complete COOP plans for each division Complete a ACPHSD Hazard and Risk Assessment Secure additional funding or alternative revenue streams. Disease Surveillance/Reporting: The Apache County Public Health Emergency Preparedness (PHEP) Epidemiology Coordinator serves as the contact person for disease reporting in the county. All medical offices and White Mountain Regional Medical Center have been supplied with the Arizona Department of Health Services (ADHS) “Reportable” disease list as well as “communicable disease report” (CDR) forms. Each office has been provided with a training and a binder supplied by PHEP which includes instructions on reporting as well as a 24 hour number for “urgent” disease reports. The goal is to get all providers on the ADHS web-based electronic reporting system Medical Electronic Disease Surveillance Intelligence System (MEDSIS). Some laboratories will begin implementation of Electronic Laboratory Reporting (ELR) this year. Currently we still rely on reporting by mail, phone and fax. On the Navajo Nation the disease surveillance and investigation is handled by Indian Health Services, but good communications and working relationships have been the key to good disease reporting and medical needs assistance. With this in mind PHEP personnel have begun in-person visits to IHS medical facilities to establish more personal contact and share ideas about individual needs that our county personnel may be of help with. 32 Division of Environmental Health Environmental Health – DEQ: During the reporting period the Apache County Public Health Services District Environmental Health Division was overseen by Chris Sexton, Health Director. The Arizona Department of Environmental Quality delegates authority to ACPHSD to review onsite wastewater system plans, site inspection and issue permits for conventional and alternative onsite wastewater systems. The primary concern is the retention of qualified personnel. Only a Registered Sanitarian certified by the State of Arizona or an Engineer may carry out the duties of the delegation agreement. Jonathan Catlin is a Registered Sanitarian and has been the primary onsite wastewater system inspector for the last four years. Having the position consistently filled has greatly improved the program and the service available to the residents. Jonathan has been a great asset to the program; he is conscientious and intelligent. Through remarkable self-motivation he has learned a great deal about the rules and statutes governing onsite wastewater system facilities. In the 2011 fiscal year the submission of septic tank applications (fell approximately 16.8%) as compared to a decline from the 2010 fiscal year (43%). At the current fees this program is not paying for itself. Fees would need to increase from $300.00 to almost $700.00 per system for this program to be self supporting. ACPHSD – DEQ Measures MEASURE Fiscal Year 2009-2010 2010-2011 % Increase /Decrease Septic Applications Processed 101 84 (-) 16.8 Well Applications Processed 37 14 (-) 62 Environmental Health –DHS: The Division of Environmental Health Services inspects and licenses food service establishments, grocery stores, temporary food service booths, provides food worker classes, issues food-worker cards, inspects hotels and motels, children’s camps, swimming pools and schools grounds. Also this section responds to a variety of citizen complaints. These functions are overseen by a Registered Sanitarian (RS) certified by the State of Arizona and in accordance with Apache County’s delegation agreements with the Arizona Department of Health Services (ADHS). These services are administered from the Public Health Services District. The food establishment inspection program has lacked consistency for several years do to turn over in staff. Inspection of licensed establishments is not current as a result of staffing difficulties. 33 Fixed Establishment Program Measures MEASURE Fiscal Year 2009-2010 2010-2011 % Increase /Decrease 164 95 42 (-) 107 90 17.7 (-) # of pre-operational inspections 15 6 60 (-) # of licensed public accommodations 29 18 37.9 (-) # of public accommodation inspections 29 0 0 (+) # of public school inspections 24 10 58.3 (-) # of food worker tests administered 239 300 25.5 (+) # of food worker cards issued 202 266 31.7(+) # of licensed food establishments # of routine food inspections 34 Financial Analysis Due to the Board of Supervisors decision to form the Apache County Public Health Services District July 1, 2007, a property tax continues to supplement the revenue of the District. In 2007-2008 the percentage of grants, service fees, and local revenue was approximately 74% of the Public Health Services District budget with the other 26% coming from a secondary property tax levy. In the 2008-2009 fiscal year 67% of the Public Health Services District funding came from grants, fees, and other local sources and 33% of the revenue resulted from a secondary property tax levy. For the 2009-2010 fiscal year 68% of the Public Health Services District funding came from grants, fees, and other local sources and 32% of the revenue was from a secondary property tax. The secondary tax rate for FY 11 was .1580 a slight reduction from FY 10. In FY 11 secondary property tax ($854,550.00) was 32% of the budget and grant revenue ($1,278,120.00) accounted for 48% of the budget. The remaining 20% of the budget was fee revenue, SRP and opening balance. In FY 11 there was a reduction in the Public Health Emergency Preparedness grant, Smoke Free Arizona grant, physical activity grant and car seat grant. In the coming years I expect to see grant funding reduced resulting in loss of programs and personnel. 35 APACHE COUNTY PUBLIC HEALTH SERVICES DISTRICT REVENUE Estimated 2011 Actual 2011 Estimated 2012 Secondary Tax $854,550 854,550 764,191 Grant Revenue 1,278,120 1,316,692 1,776,966 Fee Revenue 117,716 71,416 153,353 1,124 5,117 2,500 145,450 145,450 235,809 2,396,960 2,393,225 2,932,819 Interest SRP Total Revenue EXPENSES Adopted 2011 2,567,291 Actual 2011 Budgeted 2012 2,386,598 2,537,246 36 Goals for 2010-2011 Fiscal Year Consistent with County Manager direction, locate downtown buildings in Round Valley and Saint Johns suitable for the needs of the Health District Personnel and for remodeling to enhance downtown areas and begin purchase negotiations. o The economic condition of the County has reduced my efforts to aggressively look for buildings. I keep looking for deals that will benefit both the Health District and the County. However, until the financial position of the County improves not much will happen with this goal. Search for new grant money to sustain the public health emergency management division. o Funding of grant money for emergency management continues to dry up. This division will most likely loose personnel in FY 12. Continue to explore service needs and ways to fund those needs. o As usual needs outstrip resources. I will continue to seek partnerships to fulfill needs. Conclude the first phase of the CAHRES project. o The first phase was completed. Hire a Registered Sanitarian for inspections of Arizona Department of Health Services delegated facilities. o Bill Worsnop was hired to inspect the Arizona Department of Health Services delegated facilities. Goal for 2011-2012 Fiscal Year Align number of grant funded employees with grant funding. Reduction in grant funding equates to reduction in employees or hours employees work. As requested by the County Manager, participate in budget reduction. Solidify mission critical activities and identify mission critical personnel. 37