WEBVTT 00:00:00.000 --> 00:00:08.000 Thank you for having me. I'm really excited to be back here. This building of course wasn't here when I was a student and it's beautiful. 00:00:08.000 --> 00:00:17.000 Like Megan said I graduated from Western Oregon University in 2010 with a bachelors degree in community health education. 00:00:17.000 --> 00:00:28.000 And I spent five years in my undergraduate because I was having a great time and still kind of figuring out exactly what I wanted to do. 00:00:28.000 --> 00:00:36.000 And then I discovered the master of public health program at Oregon State University 00:00:36.000 --> 00:00:43.000 and they had a track focused on health management and policy 00:00:43.000 --> 00:00:49.000 and at the time I was really intrigued with health care reform 00:00:49.000 --> 00:00:57.000 you know the patient protection and affordable care act was signed back in, when I was in school, I think 2010 00:00:57.000 --> 00:00:67.000 and so policy is what really got me interested in public health and why I pursued a masters degree. 00:01:07.000 --> 00:01:12.000 Throughout my masters program I started taking all of these classes and 00:01:12.000 --> 00:01:18.000 reimbursement mechanisms and health insurance and I was just like what did I sign myself up for. 00:01:18.000 --> 00:01:22.000 I thought I was gonna like, we were going to talk policy 00:01:22.000 --> 00:01:30.000 and actually I quite gravitated towards these reimbursement mechanisms and learning about 00:01:30.000 --> 00:01:42.000 Medicaid and Medicare and private health insurance and really getting a good understanding of how health is funded and delivered in the United States 00:01:42.000 --> 00:01:50.000 and went on to work at WVP heath authority which is a company with several lines of business. 00:01:50.000 --> 00:01:57.000 They operate primary care clinics they were the third party administrator for our Medicaid health plan 00:01:57.000 --> 00:01:66.000 and I also got to help write our application to become a coordinated care organization. 00:02:06.000 --> 00:02:13.000 So how many of you are familiar with coordinated care organizations or Oregon health plan? 00:02:13.000 --> 00:02:24.000 Okay, great. So back in 2012 is when the first coordinated care organizations began 00:02:24.000 --> 00:02:30.000 and I helped with the Willamette valley community health application 00:02:30.000 --> 00:02:36.000 and that was really exciting for me it sounds kind of boring but I had a great time and I really learned a lot. 00:02:36.000 --> 00:02:45.000 And I wasn't really working in you know traditional public health. I was working for a health insurance company essentially. 00:02:45.000 --> 00:02:53.000 And there was a requirement in the legislation to engage public health partners. 00:02:53.000 --> 00:02:59.000 And I had a really great time working with the Marion County public health department. 00:02:59.000 --> 00:02:65.000 And I had a really hard time woking with the Polk County health department and I just couldn't really figure it out. 00:03:05.000 --> 00:03:15.000 And so it was you know after working in Polk County for the past four years I realized we are 00:03:15.000 --> 00:03:24.000 so resource constrained that participation in anything extra that isn't funded is really difficult. 00:03:24.000 --> 00:03:32.000 So while it's nice that this legislation mandates we work with publc health, getting them to the table is essential, 00:03:32.000 --> 00:03:39.000 but you also really need to be mindful of how limited capacity we have. 00:03:39.000 --> 00:03:46.000 So I just wanted to give you all a little background of how I found myself at Polk County public health. 00:03:46.000 --> 00:03:55.000 The vision and mission for our health department was created by our staff which is really important to me. 00:03:55.000 --> 00:03:63.000 We're a small group of people and you really need your staff to buy into your vision and mission. 00:04:03.000 --> 00:04:15.000 And allowing them to set the tone was critical to me being a new leader and getting some momentum on a transition. 00:04:15.000 --> 00:04:18.000 And I'll talk about that transition a little bit later. 00:04:18.000 --> 00:04:29.000 So the vision of out health department is that all people in Polk County live, work, play and learn in a community focused on healthy lifestyles and behaviors. 00:04:29.000 --> 00:04:38.000 And then our mission is to promote, preserve, and improve the health of the community through population-based care and services. 00:04:38.000 --> 00:04:45.000 So you might have heard those buzz words promote, preserve, and typically you hear protect 00:04:45.000 --> 00:04:55.000 but being in a smaller more conservative rural county we did not want to say that the governmental public health was going to protect you. 00:04:55.000 --> 00:04:64.000 So that's the job for law enforcement thats kind of the philosophy in Polk County so we decided to intentionally change the word protect to improve. 00:05:04.000 --> 00:05:12.000 And then these are our five values. And these were also largely driven by our staff. 00:05:12.000 --> 00:05:20.000 And when you hear our staff talk about the vision and mission often times they will start out by saying 00:05:20.000 --> 00:05:25.000 you know I got to be part of the process and thats really important to me, something I'm pretty proud of. 00:05:25.000 --> 00:05:36.000 So I wont go through each one of them but I will just mention that you know it's great for an orginization to have values but you really need to be intentional 00:05:36.000 --> 00:05:41.000 on how you keep those values at the forefront of the work you are doing every day. 00:05:41.000 --> 00:05:52.000 So how we do that is through each month we have a staff meeting and we choose a value, staff choose the value they want to talk about that month 00:05:52.000 --> 00:05:64.000 and we do a little exercise, we either ask a question or we just to know one another a little bit better. How we can improve our health department. 00:06:04.000 --> 00:06:16.000 The past couple of months we've been working on health equity and what that looks like is one of our staff members, she's in a program called delta 00:06:16.000 --> 00:06:27.000 and this delta program trains leaders throughout the state on how to incorporate principals of heath equity into your orginization. 00:06:27.000 --> 00:06:32.000 And thats really where you need to start is with your internal orginization. 00:06:32.000 --> 00:06:40.000 And I'll be the first to admit I'm not an expert in health equity and this is a pretty significant knowledge gap for me and my staff. 00:06:40.000 --> 00:06:46.000 So our, Rebecca is her name. She's our outreach specialist. 00:06:46.000 --> 00:06:54.000 And0 she has been working on a self assessment that was developed by San Fransisco public health department 00:06:54.000 --> 00:06:69.000 And the first component of our self assessment was to ask our staff how do you think that we're doing because you know their perception is reality for me. 00:07:09.000 --> 00:07:16.000 We're in the middle of this health equity assessment and the next component is a community partner survey. 00:07:16.000 --> 00:07:25.000 So we're anticipating its completion in the summer time and at that time were going to convene and implementation team 00:07:25.000 --> 00:07:36.000 to identify where the gaps are in our health department and identify some training and some strategies we can 00:07:36.000 --> 00:07:43.000 implement to make some headway on our policies and how we present ourself to our community 00:07:43.000 --> 00:07:52.000 So a little bit about Polk County. This population estimate is from 2016 with roughly 81 thousand people. 00:07:52.000 --> 00:07:64.000 Our largest city is Salem the 97304 zip code west Salem is around 23, 24 thousand people. 00:08:04.000 --> 00:08:14.000 And it's worth mentioning because we share the city of Salem with our partner Marion County and that's really important for our relationship. 00:08:14.000 --> 00:08:22.000 We are a bit younger county than Oregon and the United States if you look at the graph on the top right. 00:08:22.000 --> 00:08:30.000 And then our race and ethnicity breakdown is on the bottom and you'll see that 00:08:30.000 --> 00:08:37.000 predominantly white however we do have some other racial and ethnic groups present in our community. 00:08:37.000 --> 00:08:44.000 I put this graph up here intentionally because you'll see in our community health assessment thats online 00:08:44.000 --> 00:08:52.000 not so much our status report I'll talk about this in a little bit, but the health disparities in Polk County we know that they exist 00:08:52.000 --> 00:08:64.000 but there really hard to quantify because we have such small numbers of these populations so we're working on another round of health assessment currently. 00:09:04.000 --> 00:09:16.000 And trying to identify ways that we can engage diverse populations and really learn from them, what are their assets and where do their health disparities lie. 00:09:16.000 --> 00:09:24.000 And then heres the structure of Polk County public health. We has roughly twenty staff which 00:09:24.000 --> 00:09:31.000 equals about 16 FTE so that means there's about 16 full time equivalent positions. 00:09:41.000 --> 00:09:49.000 00:09:49.000 --> 00:09:58.000 We have four contractors, our heath officer, our health officer is Dr. Humphrey from Flaming Medical Center in Dallas 00:09:58.000 --> 00:09:70.000 and every health department in Oregon is required to have a health officer to sign off on standing orders and protocols this allows us to get for nurses to 00:10:10.000 --> 00:10:19.000 dispense birth control and to give immunizations and STI medications. 00:10:19.000 --> 00:10:27.000 We are not currently in a credited health department and we're not actively pursuing public health accreditation. 00:10:27.000 --> 00:10:35.000 I encourage you all to look that up. It's a nation framework that several health departments in Oregon have achieved. 00:10:35.000 --> 00:10:41.000 Marion County was the first accredited health department in Oregon. 00:10:41.000 --> 00:10:52.000 And the reason why we are not actively pursuing public health accreditation is because ther'e is a significant cost associated with the application. 00:10:52.000 --> 00:10:62.000 We also need a staff person to gather our policies and procedures, you have to submit a current health assessment and improvement plan 00:11:02.000 --> 00:11:06.000 and we just don't have that capability in our health department right now. 00:11:06.000 --> 00:11:11.000 And it's not a priority for out county commissioners either. 00:11:11.000 --> 00:11:18.000 And then the last paragraph right there, local public health authority, is our three commissioners. 00:11:18.000 --> 00:11:27.000 So if you look in the Oregon revised statutes you'll see that theres a certain set of responsibilities associated with the local public health authority. 00:11:27.000 --> 00:11:36.000 I can give you a couple examples of what that authority entails. For example we enforce the indoor clean air act. 00:11:36.000 --> 00:11:44.000 We follow up on reportable communicable diseases like gonorrhea, syphilis, HIV. 00:11:44.000 --> 00:11:50.000 Flue outbreaks and long term care facilities in schools and day care settings. 00:11:50.000 --> 00:11:58.000 And we also have the ability to issue isolation and quarantine orders which we've never had to do before. 00:11:58.000 --> 00:11:68.000 But this was really relevant when we were monitoring people who were coming back from West Africa during the ebola outbreak. 00:12:08.000 --> 00:12:15.000 We didn't have to isolate or quarantine anyone but we do have that authority. 00:12:15.000 --> 00:12:21.000 We also have a health advisory board which are appointed by the county commissioners. 00:12:21.000 --> 00:12:32.000 That health advisory board meets quarterly, it is open to the public and we talk about behavioral heath and public health at the same meeting. 00:12:32.000 --> 00:12:44.000 And the members of the health advisory board give us strategic direction on financial issues and where do they think we should be spending our resources. 00:12:44.000 --> 00:12:50.000 So I have an ORG chart which is probably hard to see but I think the presentation is on moodle. 00:12:50.000 --> 00:12:61.000 So the public health department is this green bar over here and then the rest is behavior health and developmental disabilities. 00:13:01.000 --> 00:13:05.000 And then we have some operational and business services people. 00:13:05.000 --> 00:13:13.000 The public health department is much smaller than the behavioral health's department. 00:13:13.000 --> 00:13:18.000 We all report to our health services director. Her name is Noelle Carroll. 00:13:18.000 --> 00:13:30.000 And most counties have a county administrator and that person is the liaison between the county commissioners and the department directors for the county. 00:13:30.000 --> 00:13:34.000 And they're pretty much the boss of everyone. 00:13:34.000 --> 00:13:41.000 Our three county commissioners are Mike Ainsworth, Craig Pope, and Jennifer Wheeler. 00:13:41.000 --> 00:13:48.000 Mike Ainsworth and Craig Pope are both up for reelection so if your resident and voting member of Polk County 00:13:48.000 --> 00:13:56.000 then I definitely encourage you to vote and read through your voters pamphlet. 00:13:56.000 --> 00:13:67.000 I'll have to admit before I got this position I didn't really care much about the local politics but after working for Polk County for the past four years 00:14:07.000 --> 00:14:22.000 I mean local politics has the most impact in our community so it's really important to me now that I make sure I educate myself and others on our county elections. 00:14:22.000 --> 00:14:28.000 So I wrote down our various programs that was in that green bar on our ORG chart. 00:14:28.000 --> 00:14:34.000 So we have the WIC program. Is anyone familiar with the WIC program? Yeah, okay. 00:14:34.000 --> 00:14:40.000 Thats the women, infants and children program. We serve pregnant and postpartum women. 00:14:40.000 --> 00:14:48.000 And children ages zero through five. It's a supplemental nutrition education program. 00:14:48.000 --> 00:14:58.000 So people who are WIC recipients receive food benefits and nutrition education. 00:14:58.000 --> 00:14:66.000 Public health emergency preparedness, have you talked about emergency preparedness at all in any of your courses? 00:15:06.000 --> 00:15:13.000 I'll talk a little bit about it. I didn't get much education in public health emergency preparedness. 00:15:13.000 --> 00:15:18.000 And I'm now our public health emergency preparedness coordinator. 00:15:18.000 --> 00:15:24.000 And it's probably one of the most fun things about my job so I'll talk about that a little bit later. 00:15:24.000 --> 00:15:31.000 We do communicable disease control which includes STD and tuberculosis. 00:15:31.000 --> 00:15:36.000 Reproductive health, we have a nurse practitioner that works one day per week. 00:15:36.000 --> 00:15:44.000 And we are able to see men and women for STI issues or birth control. 00:15:44.000 --> 00:15:52.000 And we have a limited amount of birth control pills, IUD's, the depo shot. 00:15:52.000 --> 00:15:58.000 We do see a lot of people. A lot of people come to us because of our expertise in reproductive health. 00:15:58.000 --> 00:15:64.000 I just completed a survey in our reproductive health clinic and a lot of people 00:16:04.000 --> 00:16:11.000 said that they like to come to us rather then their primary care provider because we are nice 00:16:11.000 --> 00:16:16.000 and friendly, we're easy to get into. You can get an appointment quickly which is 00:16:16.000 --> 00:16:21.000 huge especially in women's health when it can take months to get an appointment. 00:16:21.000 --> 00:16:32.000 We do immunization. Most of our clients are kids zero through 18 and most of the kids that we see do have Oregon Health Plan insurance. 00:16:32.000 --> 00:16:37.000 We also just started the Oregon Mothers Care program which is 00:16:37.000 --> 00:16:48.000 a program that helps pregnant women get their first prenatal care visit and establish health insurance with either Oregon Health Plan or CAWEM Plus 00:16:48.000 --> 00:16:54.000 CAWEM Plus is, I don't remember the acronym, but its basically health insurance 00:16:54.000 --> 00:16:60.000 for women who are undocumented and not eligible for other publicly available health insurances 00:17:00.000 --> 00:17:06.000 So that program's really critical because we looked at our coordinated care organization 00:17:06.000 --> 00:17:13.000 incentive measure data and one of the areas that their really struggling with is getting women into care early. 00:17:13.000 --> 00:17:19.000 So we started this program in January of last year 00:17:19.000 --> 00:17:27.000 and our goal for the first year was to see nine clients and we've seen probably 25 so far. 00:17:27.000 --> 00:17:32.000 Which is great and it tell's me that theres a real need in our community. 00:17:32.000 --> 00:17:36.000 We have the home visiting program. 00:17:36.000 --> 00:17:44.000 Home visiting is with a nurse and a community health worker. She's our outreach specialist, she does several of these programs up here. 00:17:44.000 --> 00:17:52.000 And that program is for pregnant women and children ages zero through five 00:17:52.000 --> 00:17:58.000 and then we also have the cocoon home visiting program which is for kids with special needs. 00:17:58.000 --> 00:17:63.000 I just hired a tobacco prevention coordinator on February first. 00:18:03.000 --> 00:18:15.000 And that tobacco prevention program is present in just about every county in Oregon and they are responsible for enforcing the indoor clean air act for 00:18:15.000 --> 00:18:24.000 expanding the definition of basically the indoor clean air act and getting more smoke fee places. 00:18:24.000 --> 00:18:36.000 We do all the vital records. So if theres a death that occurs in Polk County then we will be the ones processing that death certificate and 00:18:36.000 --> 00:18:40.000 this is a fee revenue generating program for us. 00:18:40.000 --> 00:18:51.000 Not many counties do jail health but we staff our jails medical program with LPN's and one RN. 00:18:51.000 --> 00:18:60.000 And then we also have the Ryan White program which is a HIV case management program and that helps people who 00:19:00.000 --> 00:19:05.000 are newly diagnosed or have had HIV for a while get reestablished with care 00:19:05.000 --> 00:19:11.000 if they've fallen out of care and it helps them with other medical needs like getting glasses 00:19:11.000 --> 00:19:20.000 or getting their rent paid for for the month. So that's an overview of public health so far. 00:19:20.000 --> 00:19:28.000 So one of the questions your professor asked me was in what ways do you collaborate with other agencies and individuals. 00:19:28.000 --> 00:19:36.000 So I'm going to talk about three things. Our lead testing event, the community health assessment and public health modernization. 00:19:36.000 --> 00:19:44.000 I'm not sure if any body saw this in the news last year but there was a building in west Salem that 00:19:44.000 --> 00:19:53.000 was a battery manufacturing facility and was repurposed for retail use. 00:19:53.000 --> 00:19:63.000 Recently there was some dust wipe samples taken and the dust wipe samples tested really really high for lead. 00:20:03.000 --> 00:20:12.000 And there were six different businesses in this facility and one of them was a cross-fit center with a 00:20:12.000 --> 00:20:17.000 it wasn't a licensed child care but you know when you go to the gym you can bring your kid 00:20:17.000 --> 00:20:25.000 and they can play with toys while you exercise and someone watches them. Well its not a license child care facility so its not 00:20:25.000 --> 00:20:29.000 licensed by, or inspected I mean. 00:20:29.000 --> 00:20:38.000 And so there's kids in this building, theres batting cages, theres a restaurant, Little Lois Caffe 00:20:38.000 --> 00:20:46.000 and a roller skating club and a couple others. I think theres a storage facility. 00:20:46.000 --> 00:20:57.000 So you can imagine our shock and anxiety when we hear that theres this super high levels of lead and children present. 00:20:57.000 --> 00:20:68.000 And potentially people eating this lead dust. So that was back in April 2017, almost a year ago. 00:21:08.000 --> 00:21:19.000 Oh I'm sorry it was February, March. And I got a call from the Oregon health authority preparedness program 00:21:19.000 --> 00:21:28.000 on my cell phone while I was pumping because I had just had my daughter at a meeting and I 00:21:28.000 --> 00:21:35.000 I was shocked. This was kind of the first response that I've ever had to 00:21:35.000 --> 00:21:41.000 deal with as the health department administrator and also the emergency preparedness coordinator. 00:21:41.000 --> 00:21:51.000 And then they asked me how did they get this permit to repurpose the building for retail use and I just though well wait a second 00:21:51.000 --> 00:21:60.000 the county, our jurisdiction is not in city limits so we don't issue permits for anything thats within city limits and this building is. 00:22:00.000 --> 00:22:06.000 So I kind of had to step back and think about it for a while. I raced back from my meeting 00:22:06.000 --> 00:22:13.000 to Polk County and got on the phone with our environmental health and community development director. 00:22:13.000 --> 00:22:21.000 And we were just talking things through. Okay are we liable, did we issue this permit? No we didn't. Okay so what's the next step? 00:22:21.000 --> 00:22:27.000 We worked with the DEQ and Oregon OSHA 00:22:27.000 --> 00:22:36.000 and the Oregon health authority to basically clean up the place and get it functioning again for commercial use. 00:22:36.000 --> 00:22:50.000 And we also offered blood lead testing to any kid or pregnant or breast feeding women who visited the facility in the previous I think 30 days. 00:22:50.000 --> 00:22:56.000 So that was in March of last year, we tested 60 people in a 00:22:56.000 --> 00:22:66.000 two and a half hour period and we did not find any elevated blood lead levels which was significant. 00:23:06.000 --> 00:23:10.000 There were several news stories about it so 00:23:10.000 --> 00:23:19.000 Some of the ways that I partnered with other agencies for example the Oregon health authority I worked with their communications manager 00:23:19.000 --> 00:23:24.000 to make sure we're on the same page with whats getting released to the news paper 00:23:24.000 --> 00:23:32.000 what are we allowed to say and how to we want this story to be perceived by the public. 00:23:32.000 --> 00:23:37.000 And you'll see one of our partners up here is the West Salem Neighborhood Association. 00:23:37.000 --> 00:23:44.000 And that was probably the best thing I could do was to partner with a local 00:23:44.000 --> 00:23:49.000 neighborhood association because they really had the relationship with the 00:23:49.000 --> 00:23:56.000 local residence and they're very politically active. 00:23:56.000 --> 00:23:63.000 There is a commissioner that goes to those meetings but also representative Paul Evens goes to those meetings. 00:24:03.000 --> 00:24:10.000 And working with them to make sure this was a locally driven 00:24:10.000 --> 00:24:19.000 process from start to finish. Through the clean up through the testing and communication to the public was really important. 00:24:19.000 --> 00:24:25.000 I wrote down a couple of things I wanted to share with you. 00:24:25.000 --> 00:24:27.000 I'm just gonna pull them up real quick. 00:24:27.000 --> 00:24:32.000 And I'm just going to read them to you. I think these notes might be on moodle I'm not sure. 00:24:32.000 --> 00:24:37.000 So earn and maintain the trust of community residents and engage them at the grass roots 00:24:37.000 --> 00:24:41.000 by working toward common goals and ensuring mutual benefits are achieved. 00:24:41.000 --> 00:24:45.000 That's a core system function of public health. 00:24:45.000 --> 00:24:54.000 So working with our neighborhood association was integral in getting trust within our community and it really helped 00:24:54.000 --> 00:24:59.000 with the state agencies as well. I mean I have a little anxiety working with the 00:24:59.000 --> 00:24:64.000 state agencies because you know often times they are perceived as coming in and taking over 00:25:04.000 --> 00:25:13.000 and thats not what we are trying to do here. We really want this to be a community driven process. 00:25:13.000 --> 00:25:19.000 The next core system function, work with relevant, federal, state tribal, regional, and local 00:25:19.000 --> 00:25:25.000 governmental agencies such as departments of transportation, aging, mental health 00:25:25.000 --> 00:25:36.000 or planning to promote health prevent disease and protect individual and community. So thats another core system function that you can see that we 00:25:36.000 --> 00:25:46.000 did throughout the process of the lead testing event and the high lead levels. 00:25:46.000 --> 00:25:53.000 And then one last one that I'll read to you is the emergency preparedness capability. 00:25:53.000 --> 00:25:61.000 It's to respond to emergencies, provide efficient and appropriate situation assessment, determine objectives for the health needs of those effected, 00:26:01.000 --> 00:26:07.000 allocate resources to address those needs and return to routine operations. 00:26:07.000 --> 00:26:17.000 So I mentioned public health emergency preparedness a little bit earlier. The capabilities you lean through 00:26:17.000 --> 00:26:23.000 FEMA and the public health preparedness program through the CDC 00:26:23.000 --> 00:26:33.000 really teaches you these core public health duties and we treated this event as an emergency preparedness response activity so 00:26:33.000 --> 00:26:38.000 I was able to call in partners from Marion County, from the state, from Multnomah County. 00:26:38.000 --> 00:26:43.000 We all had our vests on and we all had a job. 00:26:43.000 --> 00:26:50.000 We had people in incident command, we had flow monitors, we had the blood testers 00:26:50.000 --> 00:26:62.000 and screeners, people providing patient education at the end and someone checking people in to make sure 00:27:02.000 --> 00:27:12.000 we didn't just want to test someone because they were worried that they had eaten at the Little Lois Cafe 00:27:12.000 --> 00:27:21.000 Which I had. Little Lois Cafe was in this building and I was currently breastfeeding my daughter and so I had her blood level tested. 00:27:21.000 --> 00:27:28.000 Luckily she was fine but you know theres those worried well people including myself and 00:27:28.000 --> 00:27:34.000 so it was really important to have someone screen people out and this lady was so good. 00:27:34.000 --> 00:27:41.000 She was from Marion County so she didn't really know everyone in Polk County but she was really used to responding to these emergency events and she 00:27:41.000 --> 00:27:48.000 screened out my boss. So that was kind of a funny thing that happened. And if you'll go to the next slide. 00:27:48.000 --> 00:27:52.000 We issued an alert on our website 00:27:52.000 --> 00:27:60.000 in conjunction with Marion County because it is in West Salem, we share the city of Salem and many people who live in Marion County 00:28:00.000 --> 00:28:07.000 probably went to this building so that was really important to get them on board, get their communicable disease team 00:28:07.000 --> 00:28:16.000 in the know. Their health officer and I crafted this alert together and posted it to our website and then there was an article in the Oregonian about this. 00:28:16.000 --> 00:28:19.000 This is another example of how health can be so political. 00:28:19.000 --> 00:28:28.000 There was a change in how building permits were issued and 00:28:28.000 --> 00:28:35.000 no testing was completed when these retail commercial businesses 00:28:35.000 --> 00:28:43.000 began, when they open and so how does a battery manufacturing site get repurposed 00:28:43.000 --> 00:28:49.000 and kids and food is prepared in this building. So there were some regulatory gaps 00:28:49.000 --> 00:28:57.000 that the Oregon health authority had to report to the governor and they're still dealing with those at this point. 00:28:57.000 --> 00:28:70.000 So I think this is a really good example to show you many different capabilities of a local health department and how we respond to events like this. 00:29:10.000 --> 00:29:16.000 So I want to jump to our community health assessment. Theres a web link to our current community heath assessment. 00:29:16.000 --> 00:29:21.000 We update our community health assessment with new data every two years. 00:29:21.000 --> 00:29:28.000 And then we engage in a full MAPP process every five years. 00:29:28.000 --> 00:29:34.000 And so we just started our new MAPP process this year and 00:29:34.000 --> 00:29:44.000 Megan is on our steering comity which is great. The steering comity is made up of partners from Marion and Polk Counties 00:29:44.000 --> 00:29:54.000 and we get together and oversee the four different MAPP phases 00:29:54.000 --> 00:29:59.000 And MAPP stand for mobilizing for action through partnerships and planing 00:29:59.000 --> 00:29:67.000 and it is a national framework that is recommended for when you engage in a community health assessment. 00:30:07.000 --> 00:30:14.000 So right now we're on the visioning phase. Our steering comity at the next meeting will focus on visioning. 00:30:14.000 --> 00:30:19.000 We're still negotiating what that'll look like. And then well go into our four MAPP assessments. 00:30:19.000 --> 00:30:25.000 We're still negotiating what that'll look like. And then well go into our four MAPP assessments. 00:30:25.000 --> 00:30:35.000 That is community themes and strengths, our local public health system assessments, the community health status assessment and forces of change. 00:30:35.000 --> 00:30:40.000 So community health assessment isn't just getting data off the internet 00:30:40.000 --> 00:30:47.000 or the Oregon health authority vitals statistics webpage. It's about engaging your community 00:30:47.000 --> 00:30:53.000 and asking them what they're seeing and what health issues they're experiencing. 00:30:53.000 --> 00:30:61.000 And then after you've gone through this year long process, to do a good health assessment it takes about a year 00:31:01.000 --> 00:31:08.000 When we're finished with our health assessment then we'll figure out which priorities we're going to focus on. 00:31:08.000 --> 00:31:15.000 And those are prioritized using a tool that we're going to identify 00:31:15.000 --> 00:31:22.000 and it takes into consideration the resources that you have in your health department and your community. 00:31:22.000 --> 00:31:27.000 So jumping to the next issue is public health modernization. 00:31:27.000 --> 00:31:33.000 This is new legislation for how governmental public health services are delivered. 00:31:33.000 --> 00:31:38.000 And the state legislature has said that, 00:31:38.000 --> 00:31:47.000 we need to have four foundational programs and everyone in Oregon should have access to a health department that has these capabilities. 00:31:47.000 --> 00:31:55.000 And those programs are communicable disease control, health promotion, disease and injury prevention, 00:31:55.000 --> 00:31:60.000 environmental health and equitable access to health services. 00:32:00.000 --> 00:32:10.000 And then the capabilities are around the circle here so policy and planing, community partnership development, 00:32:10.000 --> 00:32:16.000 leadership and organizational competencies, assessment and epidemiology, 00:32:16.000 --> 00:32:22.000 health equity and cultural responsiveness, emergency preparedness and response, 00:32:22.000 --> 00:32:29.000 and communications. I also wanted to show you a video. 00:32:29.000 --> 00:32:37.000 Step three in the CLHO public health modernization road map is implement select foundations programs and capabilities. 00:32:37.000 --> 00:32:44.000 In this video we'll hear public health leaders describe effective implementation models and partnerships. 00:32:44.000 --> 00:32:50.000 There's not just a systemic modernization thats going on theres also the programs that are modernizing. 00:32:50.000 --> 00:32:58.000 I expect my communicable disease programs to be thinking about every possible partner and stakeholder in the community 00:32:58.000 --> 00:32:63.000 and inviting them into their work plans, inviting them into their processes 00:33:03.000 --> 00:33:11.000 and asking the hard question about who's the right person to do the work? Can we leverage each other in a new unique way? 00:33:11.000 --> 00:33:17.000 Can we take a risk and innovate and then evaluate that and see if its a good investment for Oregon? 00:33:17.000 --> 00:33:28.000 So Marion County is neighbors to Polk County and we share a city, Salem, which is where the bulk of the population is for both counties. 00:33:28.000 --> 00:33:32.000 So we have lots of opportunities to be at the same table. 00:33:32.000 --> 00:33:40.000 And we've have a history of having informal cross jurisdictional sharing activities for example 00:33:40.000 --> 00:33:47.000 We've co-applied for grants. When Marion County's had training opportunities we've invited their staff over. 00:33:47.000 --> 00:33:54.000 We've provided search capacity to them when they had a recent event involving lead. 00:33:54.000 --> 00:33:62.000 We have coalitions that we both participate on so we're trying to get a two county approach. 00:34:02.000 --> 00:34:11.000 Marion and Polk counties have engaged in some informal cross jurisdictional sharing specifically through our community health assesment. 00:34:11.000 --> 00:34:21.000 Through sharing in the community health assessment process Polk County has access to these survey tools that have been reviewed by their epidemiologist. 00:34:21.000 --> 00:34:32.000 We have access to an epidemiologist and just a more formal process for engaging in community health assessment activities. 00:34:32.000 --> 00:34:39.000 Marion county is also an accredited county where as Polk County is not so by 00:34:39.000 --> 00:34:46.000 partnering with them were able to ensure a high quality assessment and standard. 00:34:46.000 --> 00:34:55.000 The first and foremost objective right now is to really make a new 500,000 dollar grant that we've been awarded work for Polk and Marion County 00:34:55.000 --> 00:34:60.000 and we have a comity that's been put together 00:35:00.000 --> 00:35:09.000 so that we can analyze the progress of our grant application and find ways to fortify that and make it work better. 00:35:09.000 --> 00:35:18.000 And also take us to a place where we have more ability to work with our coordinated care organization our CCO. 00:35:18.000 --> 00:35:25.000 So that we can expand this opportunity going forward because we believe that the CCO holds some keys 00:35:25.000 --> 00:35:32.000 to helping us improve our funding stream and our efficiencies in public health in the future. 00:35:32.000 --> 00:35:46.000 So that was kind of a quick overview of our partnership with Marion County. Marion County is four and a half times larger in population size than Polk County 00:35:46.000 --> 00:35:49.000 And so naturally their health department is a little bigger too. 00:35:49.000 --> 00:35:63.000 And they just hired their third epidemiologist and they are just fantastic people to work with because the are the ones that really understand the data. 00:36:03.000 --> 00:36:16.000 you should of seen out health assessment back from 2012 it was not nearly as robust as the one thats on our website which I really encourage you to look at. 00:36:16.000 --> 00:36:25.000 And you saw commissioner Pope talk about a comity that we formed between Marion and Polk county leadership 00:36:25.000 --> 00:36:32.000 to talk about ways that we can work cross county more effectively. You'd think its kind of easy were just right there 00:36:32.000 --> 00:36:39.000 were in Dallas, their in Salem but theirs actually quite a bit of autonomy 00:36:39.000 --> 00:36:50.000 and jurisdiction issues that we need to consider before we start doing some formal sharing and what I mean by formal sharing is staff. 00:36:50.000 --> 00:36:60.000 So we just hired a public health worker and actually she's a graduate of Western Oregon University a recent graduate, Martha Camacho. 00:37:00.000 --> 00:37:11.000 And so shell be working with us on this new grant that commissioner Pope was talking about on communicable disease control 00:37:11.000 --> 00:37:24.000 and we are trying to figure out how can we share staff cross county if there is a vacation or vacancy in Marion County can our staff go across and work 00:37:24.000 --> 00:37:32.000 in Marion County and theres actually quite a number of legal issues associated with that so were staring to work through some of those 00:37:32.000 --> 00:37:43.000 legal and risk liability issues with our commissioners and legal council and our health department leadership which is really exciting. 00:37:43.000 --> 00:37:48.000 Another thing I was asked to talk about is challenges and rewards of my position. 00:37:48.000 --> 00:37:57.000 I have mentioned several times the political nature of public health. The political climate is one I struggle with 00:37:57.000 --> 00:37:67.000 working in a small rural county where I each April I go to our county commissioners and I have to justify our budget for the year 00:38:07.000 --> 00:38:20.000 Not all of our state grants cover the staff we currently have and so we have to, we receive county general fund dollars to support reproductive health, immunizations, 00:38:20.000 --> 00:38:29.000 and basically all of our programs are supported by county general fund and county general fund means our property tax dollars. 00:38:29.000 --> 00:38:35.000 So the property taxes that people pay who live in Polk County go toward supporting these 00:38:35.000 --> 00:38:42.000 public health programs and its about 13 to 15 percent of our overall budget so its not a huge number 00:38:42.000 --> 00:38:50.000 but its still significant that we have some level of buy in and financial support from our commissioners. 00:38:50.000 --> 00:38:57.000 I mentioned limited funding. A lot of the grants that we apply for are competitive with other counties. 00:38:57.000 --> 00:38:64.000 Sometimes the smaller counties are limited in grant writing staff and time and so it 00:39:04.000 --> 00:39:12.000 kind of can create a further divide between smaller more under resourced communities then larger counties 00:39:12.000 --> 00:39:25.000 And rising rates of communicable diseases. In Oregon in the past six years we've seen I believe its like a 400 percent increase in syphilis 00:39:25.000 --> 00:39:36.000 and in Marion County between 2017 and 2016 theres been a 40 percent increase in gonorrhea so 00:39:36.000 --> 00:39:46.000 we have shrinking budgets and rising communicable diseases which is on of the challenges I deal with on a daily basis. 00:39:46.000 --> 00:39:52.000 But I absolutely love my job. I love what I do. Its different everyday 00:39:52.000 --> 00:39:59.000 And I think working with the community and our state and local partners, 00:39:59.000 --> 00:39:70.000 I love working with them to achieve a common goal especially. Working with the lead issue, yeah it was really stressful and complicated 00:40:10.000 --> 00:40:19.000 but you really get a whole new sense and appreciation for the people that you work with everyday 00:40:19.000 --> 00:40:28.000 And a lot of our programs are very reactive so we get a report of a communicable disease and then we go and investigate. 00:40:28.000 --> 00:40:37.000 We're not doing much upstream public heath and prevention which may sound a little shocking but we're not funded to do that work right now. 00:40:37.000 --> 00:40:47.000 As you can imagine staff who are not funded to be doing upstream public health work don't really get the opportunity to do so very often 00:40:47.000 --> 00:40:52.000 One of the rewarding things for me to do is to give staff that opportunity 00:40:52.000 --> 00:40:61.000 and the tools to work with our community partners and engage in some upstream public health activities and I'll give you an example of one of those 00:41:01.000 --> 00:41:11.000 is our communicable disease nurse is working with long term care facilities to increase flu vaccinations among health care workers. 00:41:11.000 --> 00:41:17.000 There's a regulatory gap that does not include staff who work in long term care facilities 00:41:17.000 --> 00:41:30.000 to be required flu vaccination but studies show that the staff are the ones bringing the flu into these congregate settings and long term care facilities. 00:41:30.000 --> 00:41:40.000 He worked with a couple, or he tried to work with a couple of long term care facilities and not a single one took him up on his offer 00:41:40.000 --> 00:41:47.000 and then flu season hit and norovirus came along with flu season 00:41:47.000 --> 00:41:55.000 and now we have a couple community partners who have agreed to let us come in and provide this education next flu season. 00:41:55.000 --> 00:41:61.000 You know its also rewarding to let people take this project and kind of fumble 00:42:01.000 --> 00:42:14.000 or you know not be 100 percent successful because you're not always going to achieve the results that you want when you are engaging in these types of activities. 00:42:14.000 --> 00:42:20.000 I'm happy that we have a couple of long term care facilities on board for next flue season. 00:42:20.000 --> 00:42:27.000 Okay and some recommendations. I always recommend informational interviews with 00:42:27.000 --> 00:42:36.000 peers in the field. I have done them for many students here at Western Oregon and so have a lot of my staff. 00:42:36.000 --> 00:42:49.000 And I think its really helpful just to get a sense of kind of figure out what you want to do. I didn't really know what I wanted to do 00:42:49.000 --> 00:42:55.000 and I didn't really engage in any informational interviews but the people who have 00:42:55.000 --> 00:42:64.000 asked me for an informational interview I know who they are still, their name pops up, were connected on linkedin 00:43:04.000 --> 00:43:10.000 and I've helped identified a couple other people for them to talk to in their desired field. 00:43:10.000 --> 00:43:19.000 And I think thats a really good way to figure out if you're not really sure what direction you want to take. 00:43:19.000 --> 00:43:28.000 Learning opportunities outside of the classroom can be just as valuable. And get to know your community. I think if this is a community that 00:43:28.000 --> 00:43:39.000 you want to work in or live in you know volunteer, get to know some community based organizations and engage in some learning outside of the classroom. 00:43:39.000 --> 00:43:46.000 I had the opportunity to travel to Washington D.C. and do some lobbying while I was an undergraduate student and 00:43:46.000 --> 00:43:54.000 that was probably one of the most powerful experiences of my education and really kind of shaped my trajectory. 00:43:54.000 --> 00:43:61.000 Refine your elevator speech and network which is something I have a hard time doing. I feel like I'm more of an introvert myself 00:44:01.000 --> 00:44:08.000 and so networking is kind of difficult. So I'll make a challenge to myself okay I'm gonna talk to one person I don't know today. 00:44:08.000 --> 00:44:16.000 I'm gonna talk to two people I don't know today and It can be a little nerve racking but in the long run I think it's really 00:44:16.000 --> 00:44:22.000 beneficial to just talk to other people and get to know them and their experiences. 00:44:22.000 --> 00:44:31.000 Health equity I mentioned earlier that were engaging in a health equity self assessment for our health department 00:44:31.000 --> 00:44:36.000 and one of the small changes we've already made was to start asking about it on interviews. 00:44:36.000 --> 00:44:41.000 When I'm interviewing new staff in any position they will be asked at least one question about 00:44:41.000 --> 00:44:46.000 health equity relating to how do challenge stereotypes and promote inclusion? 00:44:46.000 --> 00:44:56.000 How do you recognize your own implicit bias and what do you do when you've made a mistake? How do you hold yourself accountable? 00:44:56.000 --> 00:44:61.000 That's really important and I think a lot of health departments are moving in that direction if they haven't already. 00:45:01.000 --> 00:45:12.000 I think that your education is really, really important and when I'm interviewing people I also look to see if they can be a good player. 00:45:12.000 --> 00:45:19.000 If they will you know be able to jump in and work in another program that day because we have staff out. 00:45:19.000 --> 00:45:25.000 If they can be open to constructive criticism and feedback. 00:45:25.000 --> 00:45:35.000 And so I just want to let you know those are kinds of things I look for in when I hire new staff and just kind of start thinking about those. 00:45:35.000 --> 00:45:44.000 Yes and internships. So I offer about one to two per year. I can only have one intern at a time because of 00:45:44.000 --> 00:45:50.000 staffing and its kind of an administrative burden to onboard a new intern 00:45:50.000 --> 00:45:55.000 They go through background checks and you know you have your county 00:45:55.000 --> 00:45:61.000 email address and theres all these rules associated with working for a governmental agency. 00:46:01.000 --> 00:46:08.000 So sometimes when things are getting a little crazy I'll put the breaks on any new internship but 00:46:08.000 --> 00:46:20.000 I mentioned were just starting over our every five year health assessment and so I'm looking for an intern to begin next quarter 00:46:20.000 --> 00:46:25.000 to help me with our community health assessment which I think is a really valuable experience. 00:46:25.000 --> 00:46:40.000 I've had students work on our health assessment updates in the past and for all of my interns I offer you know I'll be a reference for them 00:46:40.000 --> 00:46:45.000 forever and write a letter of recommendation as well. 00:46:45.000 --> 00:46:55.000 I also wanted to just mention that I don't really do short duration volunteer just because it takes a long time to get a volunteer onboarded 00:46:55.000 --> 00:46:62.000 but I do have like longer term volunteer and practicum and internship opportunities. Thank you. 00:47:02.000 --> 00:47:07.000 Applause