Harnett County Board of Health Minutes of Regular Meeting November 15, 2018  The Harnett County Board of Health met in regular session on Thursday, November 15, 2018 in the Health Department Board Room, Harnett County Governmental Complex, 307 W. Cornelius Harnett Blvd., Lillington, North Carolina. Members present: Ms. Patricia Chalmers, Chairwoman, Ms. Judy Herrin, RPH, Vice- Chairwoman, Ms. Amy Allen, RN, Ms. Emily Barefoot, Ms. Gayle Adams, Dr. Catherine Others present: Mary Jane Sauls, Debra Harris-Hawkins, Donna Surles, Oliver Tolksdorf, Gail Hobbs, Sherrie Byrd, Kyle Hyduke and Natasha Johnson.  Evans, and Mr. John Rouse, Jr., Health Director.  Chairwoman Chalmers called meeting to order at 7:00 p.m.  Annoucements Mr. Rouse welcomed Ms. Sherrie Byrd and Mr. Kyle Hyduke, they will be presenting an update on the Good Hope Hospital Advisory Board. Consent Agenda - Minutes - Motion made by Ms. Emily Barefoot for the October 2, 2018 agenda and minutes to be approved as presented and seconded by Dr. Consider additions and deletions to the published agenda - None made. Public Comment - Period of up to 30 minutes for informal comments allowing 3 minutes for each presentation - Chairwoman Chalmers opened the floor for informal comments by the public, allowing 3 minutes for each presentation up to 30 minutes. Seeing no one, Chairwoman Chalmers closed the informal comments. Nomination Committee Report - Chairwoman Chalmers asked Ms. Emily Barefoot to give Nomination Report. Ms. Emily Barefoot submitted on behalf of the nominating committee Ms. Patricia Chalmers remain as Chairwoman and Ms. July Herrin remain as Vice-Chairwoman. The nominating committee submitted no other nominations to the board. Chairwoman Chalmers opened the floor for any other nominations. No other nominations were received. Dr. Catherine Evans, asked that nominations be closed and accept the slate of officers as presented, Meeting Schedule for 2019 - Mr. Rouse provided a copy of the Board of Health meeting schedule for 2019, and reminded the Board the March meeting is the second Thursday of the month and all other meetings are scheduled for the third Thursday.  Catherine Evans. Motion Carried.  seconded by Ms. Gayle Adams. Motion carried.    Page 2 Board ofHealth November 15, 2018  Harnett County Health Department Board Room  Good Hope Hospital Update - Ms. Sherrie Byrd who is the liaison for the Board of Health on the Good Hope Advisory Board and Mr. Kyle Hyduke, Executive Director presented a 2018 overview of the Good Hope Behavioral Health Services. Currently this year the facility has had 363 admissions with 367 admissions from 2017. The facility accommodates: sixteen adult beds for patients 18 or older who have met the guidelines. Most admittance days average 7-10 days for a patient, however it depends on the situation. After 7-10 days of admittance, most patients are sent to other locations to stay, such as group homes, shelters, assisted living facilities and to stay with family. Some patients do require long care treatment. The facility accepts the following types of payments: self-pay, Private Insurance, Medicare, Medicaid and 3- way contract with LME (Local Management Entity). The Sandhills Local Management Entity (LME) serves the central to the east coast counties of North Carolina. Dr. Ash Mikhail, Psychiatrist from Coastal Carolina Neuropsychiatric Center in Jacksonville, NC serves as the Medical Director. The facility is in the process of expanding by adding 16 more beds, this is due to funds through the North Carolina Legislature, Gold Leaf 2018 Infant Mortality Report - Debra Harris-Hawkins presented a report through a power-point presentation which included 2017 data. Harnett County data was presented with the total live births, which was 1,886; this was a slight increase in comparison from the 2016 data. By race, the number of births included White/Non- Hispanic 1155, African American-361, Hispanic 317, Am. Indian 14, and Other 39. The number ofinfant deaths totaled (16), which was a slight decrease from the previous year which included a total of eleven (11) deaths. Harnett's infant mortality rate was 8.5 per 1,000 live births. In comparison with the North Carolina rate of7.1 per 1,000 live births. A review of the previous year's infant mortality rate were provided. A review of the underlying causes of death included perinatal conditions, birth defects, areas of concern, included women who do not receive. prenatal care, undetermined. We will continue to monitor and work with outreach efforts educate on importance ofe early and continuous prenatal care including promoting the maternal Child Fatality Prevention - Debra Harris-Hawkins provided an overview of the county's Child Fatality Prevention Team (CFPT). The Child Fatality Prevention Team unites local agencies and individuals such as the Health Department, the Department of Social Services, the District Attorney's office, and the Guardian Ad Litem program, Harnett County Schools, and others child advocacy organizations. The CFPT meets quarterly at the Health Department. Members confidentially review medical examiner reports, death certificates and other records of deceased residents under age 18. We discuss outcomes of services and circumstances surrounding the child's death. The purpose of this report is to give a summary of the causes of death, the number of cases reviewed, recommendations for prevention, that have been made and to share local team activities and accomplishments. The CFPT, reviews child fatalities and  Grant and Sandhills LME.  health programs and services offered at the Health Department.    Page 3 Board of Health November 15, 2018  Harnett County Health Department Board Room  looks for strategies to prevent future child deaths. The number of child deaths in 2017 for Harnett County was a total of 29 deaths, which was an increase in comparison to previous year with 24 deaths, occurring. The largest number of the deaths occurring in the under 1 age group. The leading cause of death was listed as Birth Defects/Perinatal and Sudden Infant Death Syndrome (SIDS). CFPT recommendations based on the reviews are: Continue to educate on the importance of ongoing prenatal care. Educate on the importance of car seats including anyone transporting children extended family members. Educate on safe sleep environments, review "Life Jacket Loaner" program-drowning deaths. Raise awareness about protecting kids in and around vehicles, Spot the Tot program. Educate and promote suicide prevention. Individual reports are completed on child deaths reviewed by the team and were forwarded to the State Coordinator. We have a dedicated Team that works well together, and we appreciate their ongoing support, as we. continue to review child fatalities, make recommendations, and take actions to prevent future child  deaths.  Health Director's Report and Program Reports - Mr. John Rouse  Medicaid Transtormation - Mr. Rouse reviewed the North Carolina Medicaid Transformation Section 1115 Demonstration Waiver. The federal government has given approval for North Carolina to begin implementing the Medicaid Transformation. Medicaid will be managed through Medicaid managed care plans through large insurance companies. The health plans will be placing bids and the state will decide on 3-4 vendors for all of North Carolina. The vendors for North Carolina will be decided by February 2019. The key Medicaid Managed Care Waiver features for North Carolina are Behavioral Health Integration/Talored Plans, Opioid Strategy, and Healthy Opportunities Pilots. Patients will be assigned Case Managers and they will work closely with the patients' healthcare needs, such as making sure patients keep their doctor appointments. The Case Management portion of the transformation will be implemented in 2019. The timeline for the complete Medicaid Transformation is 2019-2023. Any changes with North Carolina Medicaid will have to be approved Financial Reports - Mr. Rouse provided a handout of the first quarter finance report July 2018 through September 2018. Mr. Rouse explained the expenditure and revenue summary reviewing the top half of the revenue summaries is our State and Federal money that comes in by programs. Fees collected is currently low due to the issue of getting recertified with Medicare, the recertification is now complete and the approval letter has been received. Revenues in the next quarter will increase due to flu vaccines are now being  by the federal government.    Page 4 Board of Health November 15, 2018  Harnett County Health Department Board Room  billed to Medicare and payments are coming in. The new county finance system Munis was implemented on October 1, 2018, and the Finance Department and the Health Department has been working on learning the new system. Mr. Rouse reported the Employee Clinic saved the county $56,401.00 in the first quarter and remains to be an active clinic among county employees.  Clinical Report - Donna Surles  Child Health (CH) visits have increased as cold and flu season begins with a 67% increase in sick visits from August to October. Well Child Clinic visits are Home Visiting Programs for the Welcome Baby and Postpartum continue to do well. The home visits were down in August 2018 and September 2018 due to the program coordinator being out on medical leave and because of Hurricane Florence affected the visits due to families relocating and road closures affecting travel to some areas. In October, those visits had increased to 23 visits and in November, we. have already seen 17 visits. The home visiting program was a quality improvement (QI) project that has shown sustained improvement. We have informed the community through local newspaper ads, electronic sign advertisements, and updated the county webpage to include information about the home visiting program. As an additional QI initiative to our home visiting program, we would like to offer prenatal home visits. Two prenatal home visits are billable each month and are in addition to the prenatal clinic visits. These visits require an order from the Obstetrician (OB) Provider and can be made anytime during the pregnancy for reasons such as 17P injections, blood Family Planning (FP), Prenatal (PNC), Sexually Transmitted Disease (STD) services have increased from September 2018 to October 2018. The adult health and women's clinic tend to vary slightly throughout the year in visits. We continue with efforts to decrease the infant mortality rate and improve birth outcomes through smoking cessation counseling for our pregnant clients and by encouraging pregnant women to start prenatal care in the first trimester. Although we no longer have the state dental hygienist stationed here in the PNC clinic, we do continue to work with the state dental program and encourage our Employee Clinic visits have increased in October 2018 and usually remain constant throughout cold and flu season. The employee health fair was cancelled due to Hurricane Florence sO the health department staff were able to go to individual county departments to provide flu shots to county employees.  consistent for this time of the year at 104 in October.  pressure rechecks, and smoking cessation.  prenatal patients to seek dental care as needed.    Page 5 Board of Health November 15, 2018  Harnett County Health Department Board Room  Immunization numbers have increased significantly in September 2018 and October 2018 due to our community flu clinics and back to school immunization requirements. Recently adult health has ran out of flu vaccine, and have reordered and now only have a small amount remaining. We have given around 1,600 flu shots this season, that amount does not include infant and children's flu vaccine or adult flu vaccine that has been given in the clinic. We have given 436 flu shots to children in the clinic since September 1, 2018. The CH staff held an afterhours immunization clinic on September 25, 2018 and provided vaccines to 45 children during the three hour event. CH still has children flu vaccine remaining. Off-site clinics, which included senior sites, Harnett County School employees, assisted living facilities and county offices where 1,313 flu vaccines were administered. Hepatitis B vaccine was also provided for school staff and high-risk county employees. We will soon be offering the Shingrix Shingles vaccine for ages 50-64 and we will bill private insurance. This vaccine is a two shot series and is currently on back order. Flu Report is received each year beginning September 30th, we receive a weekly flu surveillance report from the North Carolina Department of Public Health and Center for Disease Control. This report provides statewide influenza surveillance updates that have been reported through the state lab and the seven largest hospital networks across North Carolina. Donna presented a power point to show the graph showing the influenza trend for the current and past 2 years flu seasons. In 2017-2018, the flu peaked in late January and February, and for previous years 2016-2017 it peaked in February. We have not had any positive cases here at the health department this season. We will continue to monitor these reports and keep you informed as to how this season progresses. Ages 6 months and older are encouraged to get the flu vaccine. Preparedness is currently working with the North Carolina Public Health Preparedness & Response Central Region on a contaminating incident exercise. The next site visit is scheduled for February 2019. We continue to have quarterly call down drills for our staff, and we had a 100% response to the call Environmental Health = Oliver Tolksdorf explained the Engineered Option Permit (EOP) for septic systems. The permitting option was created by the General Statue in 2016 G5130A-336.1, but was implemented as a rule in 2017 (15A NCAC 18A.1971). The option allows the owner of a lot to get a septic  down event during Hurricane Florence.  permit from an engineer instead of from the county.    Page 6 Board of] Health November 15, 2018  Harnett County Health Department Board Room  This process began due to major backlog of permits applications in some counties; the EOP is now being used statewide. The state tracks the permits and the current database is up to around 1,000 permits issued. Harnett County Since September, onsite wastewater has not been busy with soil evaluations Aging & Case Management - Mary Jane Sauls reported the Harnett County Family Caregiver Support Program will host the 7th Annual Holiday Craft Fair on Friday, November 30, 2018 from 10:00 am = 4:00 pm at the Governmental Complex, Commons area. A hotdog lunch will be available for $5.00, and proceeds assist with the Christmas Cheer program for the elderly. The Division on Aging continues to provide Medicare counseling through December 7, 2018. The Health Department Care Management staff has started using a new health data system, Virtual Health. The system went online on October 29, 2018. Staff attended intensive trainings sponsored by the Division of Public Health and Community Care of North Carolina. The goal of the system is to offer an improved, customized, and efficient health data system that delivers better The Harnett County Division on Aging is accepting nominations for the 2019 Governor's Volunteer Service Award. Nomination forms are available at all Harnett County Libraries and online. The awards program created by the Office oft the Governor in 1979 recognizes North Carolina's most dedicated volunteers. Through the years, the award has been bestowed on thousands of North Carolinians who have shown concern and compassion for their neighbors by volunteering in their local community. Each county selects up to ten individuals to be recognized for their outstanding contributions to their communities. One of the nominees will be nominated for the Governor's Medallion Award for Volunteer Service, which is awarded to top 20 volunteers in the state. A local Marketing/Communty Outreach = Debra Harris-Hawkins provided an update for the Prevent Type 2 Diabetes program, this program is designed for people with prediabetes and people who are at high risk for type 2 diabetes and want to lower their risk. The program began October 16, 2018, with thirteen (13) persons, sessions are held at 12:00 noon and 5:30pm each Tuesday. Outcome report, as of November 6, 2018 (third week of the program): Participants have lost a combined total of 37 pounds, six (6) of the 13 persons are reporting at least 150 minutes of physical activity. This program is part of the regional  has recently received the first EOP applications in October.  due to the wetness in soil.  services to clients, providers, and partners.  committee evaluates the nominations.  collaborative regarding Diabetes.    Page 7 Board of Health November 15, 2018  Harnett County Health Department Board Room  Upcoming community outreach educational sessions include "Avoid Holiday Weight Gain with the Holiday Challenge starts" on November 14-January 2, 2019. Rather than focusing on trying to lose weight, this free six week program provides participants with education on nutrition and fitness tips, and ideas to help maintain your weight throughout the holiday season. This is a free program for the community, sessions will be held from :30pm-6:30pm here at the Health Department. The Health Department, Cooperative Extension and the Harnett County Employee Wellness Committee, will be providing the program Throughout the month of October, for Breast Cancer Awareness we have provided numerous outreach and educational programs for breast cancer awareness month reaching over 300 persons. We continuously work to educate about screening and promote the mammography screening program that we provide in partnership with Rex Mobile Mammography. Included in the packet is a copy of an article for the annual "Pink Ribbon Breakfast" featured October  for county employees as well.  31, 2018 in the Daily Record newspaper. Closed Session - There was no need for closed session.  New Business - Chairman Williams opened the floor for New Business. Being none Chairwoman Chalmers closed New Business. Chairwoman Chalmers adjourned the meeting.  Respectfully submitted, gMl John Rouse, Jr. Health Director  helhnn Ms. Patricia Chalmers, Chairwoman