Grand Forks Public Health Department


Thursday, July 19, 2012

I. Call Meeting to Order

The meeting was called to order at 12:10 p.m. by Don Shields.

Members present at the meeting: Dave Molmen, Kristi Mishler, Lee Lipp, Corey Mock, Brenda Severson, Kate Kenna, John Packett, Pat Berger, Tara Dupper, Gretchen Graf, Col. Jane Denton, Dr. James Hargreaves, Jody Thompson, Ed Christ, and Don Shields. Other individuals attending the meeting were: Lt. Col. Marie Colasanti (319th Medical Group, GFAFB), Zach Downs (intern with Altru); also Haley Thorson, Mara Jiran, and Keith Westerfield (all from Public Health).

II. Old Business

A. Review and Approval of Minutes of meeting on April 19, 2012: The April meeting minutes were motioned and approved with no changes.

B. Grand Forks “Detox” Community Facility Initiative Update: Kate Kenna gave an update.

· Don S. and Kate K. had the opportunity to be interviewed by local news station WDAZ, to talk about the community effort to have a social detox program, which continues to be a community effort. One agency is putting a budget together for the detox committee, with the idea of providing social detox. There are several agencies involved with the social detox program that have committed money towards the program.

· The committee expects one to two, or more people a night would benefit from the social detox program. Altru Hospital is currently providing medical detox, which has a higher cost. Glenmore Center in Minnesota has been used occasionally, but Minnesota has only one level of detox that includes both medical and social detox. North Dakota has different levels of detox, and people need to meet different criteria. With social detox, people would need to be screened to ensure they do not need medical detox.

· Other major cities in North Dakota have a social detox program, but not Grand Forks. The committee will continue to meet and identify the model that best meets the needs of the individuals, and the Grand Forks community as a whole.

III. New Business

A. Comprehensive Smoke-Free Ordinance Community Impact Study: Haley T. gave a briefing on the study, and handed out a booklet that gave a brief overview and highlights of the study (see attachment).

· Haley also thanked the Mayor’s Cabinet for showing their support in 2010 by signing a resolution and helping propel the initiative forward. The Grand Forks Smoke-Free Ordinance was adopted in April 2010, and went into effect in August 2010. It has been almost two years since the ordinance was implemented. There has been great feedback in our community. This study is a more scientific way to show that the community was, and still is, behind the smoke-free ordinance.

· The data for the study was collected in January through March of 2011, a little more than a year after the ordinance went into effect. The study tells us how aware people were of the ordinance, how they were reacting to the ordinance, what their perceived risks were of second-hand smoke, and what their attitudes were toward public smoking. The study also shows what, if any, impact it had on the citizens in our community; such as their patronage and behavior, after the ordinance went into effect.

· The study showed that a large majority of the respondents support the ordinance, with 84 percent; 71 percent strongly support, and 13 percent somewhat support. The UND Social Science Research Institute conducted the survey and pointed out how uncommon it is to have a large majority in the 80 to 90 percent range.

· The study found that the number of those who perceive second-hand smoke as a health risk is only continuing to go up. The science and research out there is hard to refute these days. Nine out of ten adults feel that second-hand smoke is harmful to their health, and that even a majority of smokers admit that second-hand smoke is harmful to people’s health.

· When comparing the pre-ordinance study to the current study, it shows that the social norms are changing in our community. Those that felt that is was “very important” or “somewhat important” to have a smoke-free environment in the workplace, especially for the workers, increased since the ordinance went into effect. This coincides with a North Dakota Department of Health’s state-wide Second-hand Smoke Study that shows support continues to grow. Results also show that a majority of respondents are going out just as often or more often, and their experience is more favorable.

· A study has been commissioned to further study the economic impact of the ordinance in Grand Forks, and these results should be released sometime early next year.

· A copy of the full study can be obtained on the Grand Forks Tobacco-Free Coalition website at, or by emailing Haley at:

· There are currently eight communities in North Dakota that have smoke-free workplace ordinances, and there is also currently a state-wide effort to place a comprehensive smoke-free law on the ballot in November. After only four weeks, advocates across the state have surpassed gathering the required signatures needed for a state-wide smoke-free workplace initiative.

· Public Health is trying to venture out more to the rural communities of Grand Forks County to assist with tobacco related policy initiatives such as ordinances and school policies, as well as continued promotion of the North Dakota Tobacco Quitline now called ND Quits (information can be obtained by calling 1-800-QUIT-NOW, or going to their website:

B. Alliance for Healthcare Access (AHA) Update: Mara Jiran gave the latest update on the Community Health Center (CHC), and gave out a flyer on AHA (see attachment).

· The Alliance for Healthcare Access grew from a group of individuals who helped develop the dental clinic in downtown Grand Forks. This dental clinic was created to serve people who are without insurance, or who have a low income. Too many times though the patient’s health was not stable enough to undergo the dental procedure, but there was no good place to refer them for primary health care. Altru does a wonderful job of taking in some of these patients, spending quite a bit of money on community care. However, this is often reactive care which is provided in the emergency room, not primary care.

· What first started as an informal conversation, has now grown to more than 30 people, representing over 20 organizations who are meeting formally to figure out what they could do to have better access to health care. The Alliance began to investigate whether a Community Health Center (CHC) would be a good fit in Grand Forks.

· The newly formed Alliance wrote a grant request for assistance from the Health Resources and Administration (HRSA) to bring a person in to help plan their efforts. Grand Forks was one of 127 cities nationally to be awarded a planning grant. That planning grant funded a one-time coordinator position, contracting Mara for eight months until August 2012. Mara holds the only paid position on the Alliance. The United Way awarded the Alliance with funds for the year 2012 to support planning efforts. This United Way contribution allows Mara to continue to work until December 2012.

· A CHC is a model of care, but is not a free clinic. Services are provided on a sliding fee scale if the client qualifies at 200 percent poverty level or below. Medicaid, Medicare, and private insurance will also be taken at the CHC. The CHC needs all three of these revenue sources to be sustainable. A grant of $650,000 a year will help with uncompensated care, and the rest would come from a sound business model, so the CHC would not be searching for funding every year. The CHC would concentrate on the idea of the “whole self.” Mental health along with oral health is very important. A CHC is required by the federal government to show that the CHC is serving their patients with medical, mental, and oral health care.

· A solid working budget was developed for the CHC that demonstrates sustainability. The current projection for the CHC calls for three middle-level providers, one or two physicians, and additional administrative staff. When the Alliance first started, they were looking at who could be the agent to manage the operation. Valley Community Health Centers (VCHC) runs CHCs in Northwood and Larimore, as well as the community dental clinic in downtown Grand Forks, with good results. If the CHC initiative takes hold in Grand Forks, VCH would be the operating agency. The Alliance is looking at ways to help support approximately 10,000 additional patients to the VCHC’s business with a CHC in Grand Forks.

· The process of developing a CHC is a competitive one. The Alliance has been working for the past few months to highlight the need for a CHC. It is shocking how much of a need there is in Grand Forks. There are pockets of poverty that in the past ten years have grown from one downtown neighborhood to three with over 30 percent poverty. The Alliance wants to highlight what works, where the struggles are but also the strengths, and put that into the application process to submit to HRSA.

· The CHC concept is not new. In fact, they have been around for more than 40 years with bi-partison support. In the past, CHCs have not been a political issue, but right now things are a little tenuous in Washington, especially with the election coming up and debate of the passage of the federal budget. The passage of Affordable Health Care Act supports expansion of CHC model. The Alliance is waiting to see if the application process is opened up for year 2012, for which they plan to apply. It is uncertain how many sites will be awarded, perhaps up to 25. With hundreds of applicants, it will definitely be a competitive process. The Alliance currently has a budget in place, and a grant writer to give them a solid application. The application process is expected to possibly open up in August or September of this year. If the Alliance is awarded a grant, they then have 120 days to open the doors of the CHC to patients. It would be a scramble, but it has been this way since the program started. Because of the 120-day timeframe, the Alliance is working now to have everything it can do in place, so they will have a good head start when awarded and the clock starts.

· The Alliance has been looking at locations for the CHC. One of the requirements is that the CHC needs to be located where there is the greatest need, so the Alliance is looking at the downtown district area. The dental clinic that VCHC operates downtown is located in the old Deaconess Hospital building. The Alliance has been working with an in-kind architect from Altru to develop the space.

· In order to move forward with the development of the CHC, it is imperative that VCHC is awarded new access site funding from HRSA. If there is no new access site funding, the CHC will not be sustainable. All development decisions moving forward are contingent on the being awarded this grant.

· Altru has stated they will donate equipment that they are no longer using after their remodeling project. The Alliance is looking at ways to support a pharmacy associated with the CHC. The CHC can qualify for a program called “340B” so people could get inexpensive medicine, but they have to be a patient of the CHC. This is a high priority for the Alliance, and hopes the CHC could be a dispensing source.

· The next step the Alliance is planning is an event in the fall to educate the community on the CHC model. The Alliance plans to bring in a national representative to do a general presentation to inform the community members of the CHC model, help with CHC board development, and educate policy makers on CHCs.

· There are over 8,000 CHCs in the country, but North Dakota only has a few. CHCs are not right for every community, but the Alliance believes Grand Forks would be a wonderful place for one.

C. Member Update:

· Pat B. – United Way is excited about a new program that Altru and the school district is doing through the Foundation of Education. They have brought Dolly Parton’s Imagination Library Program to Grand Forks. This is an important reading program that delivers a book monthly to every registered child from birth to their fifth birthday. The books are mailed directly to the child’s home, in their name. The cost is only $25 a year. United Way held a read-off event on May 3, 2012, and were overwhelmed with the response to the program. They anticipated 500-540 kids to sign up for the program, but currently have 579 registered! It was more successful beyond their imagination.

· Corey M. – Third Street Clinic is ten percent above the previous annual high number of patients. Last year 1,459 patients visited the clinic. As of June, the Third Street Clinic has had 803 patient visits, on track for 1,600 for the year.

Corey thanked Altru on behalf of the Alzheimer Board for being one of the sponsors of the Alzheimer Association Memory Walk on September 8, 2012.

· Jody T. – Mark your calendars, Grand Forks schools start Wednesday, August 22, 2012! A new elementary school is in the preliminary planning stage, to open in the fall of 2014.

· Kate K. – Northeast Human Service Center (NEHSC) is starting a new practice called Integrated Dual Diagnosis Treatment (IDDT) for people who are seriously mentally ill and seriously addicted, and tend to be high-end users of NE systems. NEHSC is in the process of training staff, and they will start with only ten consumers. Hopefully, it will prevent hospitalization in Grand Forks and Jamestown. Fargo has been doing this practice with great success.

· Col. Jane D. – The 319th Medical Group’s Health Services Inspection is next month, and things are very busy in the clinic preparing for this visit.

· Tara D. – The New American Services (NAS) office had received more refugees than anticipated. They were expecting to have received 90 new arrivals by the end of the fiscal year in September, but will have received 99 by end of this month. Jacqueline Wieland left a few weeks ago to teach English in the Philippines. Reggie Tarr, a social worker intern who came to North Dakota eight years ago as a refugee, took her position.

· Dave M. – Some fun community health, wellness, and fitness announcements from Altru coming in August.

IV. Other: None

V. Adjournment – The meeting was adjourned at 1:15 p.m.

VI. Next Meeting: Thursday, October 18, 2012, at 12:00 noon,
Altru Hospital (Lower level, Multi-media room) Conference Room
(Lunch will be provided by Altru Health System).

1. Comprehensive Smoke-Free Ordinance Community Impact Study Highlights Booklet, May 2012
2. Alliance for Healthcare Access Flyer