Grand Forks Public Health Department


Thursday, May 10, 2012

I. Call Meeting to Order

The Grand Forks Board of Health met at 4:22 p.m. on Thursday, May 10, 2012, at the Public Health Department conference room. This meeting was rescheduled from April 12, 2012, due to not enough members were available to have a quorum. Members that were present for this meeting: Cynthia Pic, Don Shields, Dr. Sally Pyle, Dr. James Hargreaves, and Dr. James O’Connell. Others present: Debbie Swanson, Marlene Johnson, Javin Bedard, Theresa Knox, Mara Jiran, and Keith Westerfield (all from Public Health).

II. Approval of Minutes of Regular Meeting on October 6, 2011.

Approval of the October 6, 2011 minutes, was deferred until the May 2012 meeting, because there were not enough members for a quorum in January 2012. A motion was made and seconded to approve the October 2011 minutes as submitted. All approved and the motion passed.

III. Old Business

A. Alliance for Healthcare Access (AHA) Update: Debbie S. introduced Mara J., Project Coordinator for the AHA, to give the update. Mara J. handed out a flyer on the AHA and gave a PowerPoint presentation (see attachments):

· The Community Health Center (CHC) process was started by a group of people who were looking at development of a community dental clinic. When the group went through the process to get the dental clinic up and running, they realized that there were a high number of people who were medically unstable to have the dental procedure done. That started a conversation on how this was happening and what they could do about it. Also, what was working or not working, and looking at ways they could improve the system. From that grew the Alliance for Healthcare Access (AHA).

· The AHA is composed of 30 volunteers, representing 20 different agencies in Grand Forks and Polk Counties. They have been working together since September 2010, meeting once a month. One of the goals of the AHA is improving accessibility to healthcare. They are also looking at ways to better collaborate on what is happening now within the city of Grand Forks.

· The 2010 U.S. Census shows a 21 percent poverty level in Grand Forks, and 15 percent in East Grand Forks, Minnesota. The national poverty level is 14 percent, at $23,000 for a family of four. There are families working that do not have health insurance through their employers, but earning too much to qualify for state-assistance programs. A recent Kids Count study showed a jump from one neighborhood in access of a 30 percent poverty rate to three neighborhoods, with one of those neighborhoods close to a 50 percent poverty rate.
· The Northland Rescue Mission had an average of 30 people looking to use their services in 1999, but the past few years they have been having up to 130 staying each night. Grand Forks is one of three cities in North Dakota that has refugee resettlements, and are on track to receive 95 refugees this fiscal year.

· It became apparent that a CHC would be a good fit in Grand Forks. In order for a CHC to be sustainable and variable, there has to be community collaboration for it to work. The AHA decided that Grand Forks fit the qualifications, and submitted a planning grant. There were

127 cities awarded, with Grand Forks as one of them. One of the main reasons Grand Forks was chosen was due to the high amount of collaboration happening here that is not seen in many places, and that made an impression at the federal level.

· Mara J. showed a video that described what a CHC is and what it does for the community. This video can be viewed at: CHC’s have been around since the mid-1940s.

· Most services done at the CHC will be on a sliding fee scale, it will not be a free clinic. It will be taken into account that there are people who can only pay a little bit, some people who can pay a little bit more, and some who cannot pay at all. The AHA is looking at what nominal fee the CHC would be asking for. The fee will be requested so there is a contribution to the community that the client needs to respect and be a part of.

· This will be a state-of-the-art clinic. The AHA will be bringing in providers; both physicians and nurse practitioners, as well as administrative staff. One of the AHA partners is Altru Health System. Altru realizes that they are spending a lot of money in their emergency room (ER) on care that is not necessarily anything but reactive care. Those dollars being spent on the ER could be used for more specialty care and used in better ways. There are other agencies in Grand Forks that realize this may affect them one way or another, but are on-board because they think this is a vital solution.

· The AHA will be going through the development process this summer. A working budget is being made that they can adjust as the summer goes along. The AHA has been looking at spaces for the CHC. One of the places is above the community dental clinic downtown. It would have the space required of about 6,000 square feet, and is available. Dental care is as important as your medical care, and this would provide access to both in the same building. The AHA is currently looking into what it would cost for renovation there.

· The AHA is broken down into subdivisions looking into different aspects of the CHC: Workforce, Finance, Facility, and Services. These groups are looking at answering questions, such as how they will create this medical home, or how they are going to provide labs and x-rays. The AHA is working with Altru so those expectations and the relationship is already built up before the CHC opens the doors, and there will be a strong sense of communication from day one.

· The next phase of the application process will be in late summer. The AHA is looking at generating funds to hire an experienced grant writer so when they submit their application for federal funding, they have a better chance of getting funded. The funding is very competitive and the AHA wants to make sure they get the federal grant to ensure $650,000 coming in every year to make the CHC sustainable. Once approved, the AHA has 120 days for the CHC to open the doors and start seeing patients. The goal of the AHA is to get everything done that can be this summer, so when the grant is awarded they are ready to go. The AHA has a lot of people working on many different projects this summer to get the CHC to this point. The grant is funded by Health Resources and Services Administration (HRSA).

· Don S. requested the Board of Health support the AHA’s efforts for full application for a CHC grant. The request was motioned and approved unanimously.

· For more details, please access the AHA website:

B. Environmental Health Data Management System Update: Javin B. briefed on the update:

· Javin B. made requests for changes with the Data Management System regarding the nuisance investigation data tracking, and is waiting to hear back from the company. That data involves enforcing city ordinances on environmental complaints from the public: junk, cleaning up after pets, not mowing lawns, etc. Environmental Health tracks when they received the complaint, how long to get there to investigate, and how long to resolve the complaint.

· Environmental Health is currently training and practicing with the new system, and plans on going live on July 1, 2012. They will be using new Samsung Galaxy tablets for field use and food establishment inspections.

· Don S. commented that Environmental Health Supervisor, Timothy Haak’s last day was on April 30, 2012.

C. Grand Forks Food Code Update: Javin B. gave an update on the new city code:

· The new Food Code has been implemented since January 1, 2012. One requirement was for certified food managers. Many managers are using other sources for training besides the SafeServ classes offered twice a year by Environmental Health.

· The goal is 100 percent of required food managers to be trained. The new Data Management System will be used to track training.

D. CHAMP Software Update: Debbie S. provided the following update:

· Grand Forks Public Health Department (GFPHD) started their CHAMP journey in January 2012, with training every two weeks. It has been more of a journey than anticipated. Public health departments do all different programs with different processes, so there is no way to take a software program and make it work for all of them.

· The software program needed to be highly customized. A significant amount of time has been spent on practice sessions, and customizing the software and the pathways in the software to document client care.

· GFPHD initiated a North Dakota user group to share information with other public health departments. There are other public health departments that are ahead of GFPHD, and many that are behind in this process.

· Specific programs will be implemented by GFPHD as they are ready, which will eliminate some of the forms currently in use. There is more work to do, but the staff at GFPHD is up to the task.

IV. New Business

A. Public Health Accreditation Update: Don S. briefed on Accreditation (see Issue Listing attachment):

· In the fall of 2011, accreditation standards were published for public health departments. This is the first time there has been an accreditation program for public health departments. There are 300 standards to meet for accreditation. No public health department in the nation has been accredited yet, but there should be some soon. The goal for GFPHD is to be an accredited public health department.

· A Community Health Needs Assessment will need to be accomplished. GFPHD is working with Altru on this, who has a group forming. Afterwards, a Community Health Improvement Plan needs to be done, and then form a plan to address issues identified. Also needed is a Strategic Plan, which GFPHD already has had in place for a number of years. Completing these three items will allow GFPHD to apply for accreditation.

· This process should take GFPHD about a year and a half to complete, to ensure compliance with the three items required. GFPHD is expected to apply for accreditation in late 2013 or early 2014.

· The cost for accreditation is $21,000, but can be paid over five years.

· Don S. requested the Board of Health support GFPHD efforts at accreditation. The request was motioned and approved unanimously.

B. Comprehensive Smoke-Free Ordinance Community Impact Study: Theresa K. handed out copies of the 2011 study (see attachment), and gave a summary of the study results:

· It is typical to do this kind of study after an ordinance goes into place. The study finds out what are the attitudes, perceptions, and awareness about the ordinance and hazards of second-hand smoke. Theresa pointed out a few items of interest in the Executive Summary.

· Most people are aware of the smoke-free law, and most people favor the law. Most people believe that second-hand smoke is a health hazard. The majority of smokers, former smokers, and non-smokers consider second-hand smoke a health risk. Most people feel it is important to have a smoke-free environment inside all workplaces.

· Theresa K. wanted to share how the percentages of this study compared to a study done in 2010 on the importance of having a smoke-free environment. In bars, 88 percent of people felt it was very important, compared to 57 percent in 2010; in casinos, 80 percent now compared to 57 percent then; and in truck stops, 82 percent now compared to 63 percent in the 2010 study.

· The ordinance impact on patronage showed that most bar patrons indicated they go out more often now, and 79 percent believe it to be more enjoyable. Twenty-one percent of casino patrons said the ordinance impacted how often they visit, but 59 percent now go to casinos more often. One-third (29%) of truck stop patrons indicated the ordinance impacted their patronage, but 72 percent now visit truck stops more often. Two-thirds said their experience was more enjoyable.

· Results were similar in other communities that had these studies. The more you change the social norm, the less tolerant people become of exposure to second-hand smoke. People feel that it is more normal not be exposed to it.

· Eight ND communities now have smoke-free ordinances for bars, with Cavalier being the latest.

C. Resolution to Support Local Control by Avoiding Preemption in State Legislature: Theresa K. briefed on the resolution (see Issue Listing attachment):

· Theresa K. handed out copies of the resolution (see attachment). Support of the Board of
Health was requested for avoiding preemption in state laws so local laws can be enacted and enforced. There was a brief discussion on the wording of the resolution, and the board voted unanimously to support this resolution.

· The Grand Forks Tobacco-Free Coalition supports avoiding preemption in all state
legislation that impact tobacco regulation. The coalition is asking other
Boards of Health state-wide to sign-on and show support for this resolution.

V. Next Regular Scheduled Meetings – 4:15 p.m., Thursday, July 12, and October 11, 2012, at the Public Health conference room.

VI. Other: Don S. thanked Marlene J., GFPHD Administration Supervisor, on behalf of the Board of Health for her 11 years of service to public health. Marlene J. is moving to Washington D.C.

VII. Adjournment: The meeting ended at 5:20 p.m.

1. Issue Listing
2. Alliance for Healthcare Access handout
3. Comprehensive Smoke-Free Community Impact Study
4. Resolution to Support Local Control By Avoiding Preemption in State Legislation

Respectfully submitted,

James Hargreaves, MD, Secretary
by: Keith Westerfield
Office Specialist, Senior
Public Health Department