2012 State of the County Health Report

10 Return on Investment Return on Investment Return on Investment Impacting the Health Impacting the Health Impacting the Health Impacting the Health Impacting the Health Impacting the Health of Johnston County of Johnston County of Johnston County of Johnston County of Johnston County of Johnston County 2011 – 2012 Annual Report 2011 – 2012 Annual Report 2011 - 2012 Annual Report Page 1PageDirector’s Message wwwjohnston nccom health The Johnston County Board of Health and the staff of the Johnston County Health Department are pleased to provide you with our annual report for fiscal year 2011 - 2012 The Johnston County Health Department works hard to accomplish our mission — provide quality healthcare , promote a safe environment , and partner with Johnstonians to foster healthy lifestyles This report was developed to inform Johnston County residents and officials of the progress made by their Public Health Department to meet this mission The demand for our many services has increased over the past year due to the changes in the economy We have added new classes such as the Living Healthy Chronic Disease Self - Management program and launched a partnership with the Rex Mobile Unit for screening mammograms for low income women We worked as a team with our many community partners to focus on the areas identified in our Community Health Assessment while continuing to provide much needed safety net services to Johnston County residents In 2013 , we integrated behavioral health into our services I am proud of the many programs provided by our staff and the diligence with which they work to improve the health of Johnston County For additional information , please visit our website at wwwjohnstonnccom health Thank you for taking the time to review our annual report Marilyn Pearson , MD Health Director 2013 – 2014 Board of Health 2013 – 2014 Board of Health Dr William Smith Veterinarian & Chairman Dr William Smith Veterinarian & Chairman Dr Connie Barnes Pharmacist & Vice - Chair Dr Connie Barnes Pharmacist & Vice - Chair Mr Tony Braswell County Commissioner Mr Tony Braswell County Commissioner Dr James Oldham Dentist Dr James Oldham Dentist Mr Brian Leonard Engineer Mr Brian Leonard Engineer Dr Michael Haines Optometrist Dr Michael Haines Optometrist Vacant Physician Vacant Physician Dr Oliver Johnson Public Member Dr Oliver Johnson Public Member Dr Pamela Edwards Public Member Dr Pamela Edwards Public Member Mr Hank Daniels Public Member Mr Hank Daniels Public Member Mrs Lori Anderson Register Nurse Mrs Lori Anderson Register Nurse 2011 - 2012 Annual Report Page 2PageBy The Numbers 2011 Johnston County Demographics Estimated Population is 172,595 2011 Johnston County Race Non - Hispanic Estimate Percent Population by Age White 136,527 7910 Black or African American 27,112 1570 Age Estimate American Indian or Alaska 304 020 Native Population 0 - 19 53,098 Asian 328 020 Native Hawaiian or Other Pacific 0 0 Population 20 - 34 31,875 Islander Other Race 4,602 270 Population 35 - 54 58,431 Two or more races 3,722 220 Ethnicity Estimate Percent Population 60 and over 29,191 Hispanic any race 22,424 1300 2011 – 2012 Revenues Total Budget 7,591,724 2011 - 2012 Annual Report Page 3PagePromoting Health Students for 2011 - 12 at JCPHD Community Outreach Johnston County Public Health Department Johnston County Public Health Department Physicians , Physician Extenders , Nurses , Lab strives to provide quality health care to the Staff , and Social Workers precept students community through outreach and services from local Universities and Colleges and provided by our public health team The incorporate them into our clinic to enhance their Public Health knowledge It is our goal to public health team has an integral role in train and develop leaders that will enhance the disseminating important health messages Public Health workforce in the future and to the community at various events such assure a competent and thriving Public Health as the Smithfield Ham and Yam , Selma Model Railroad Days , Benson Mule Days , Clayton Harvest Festival , health fairs , and employer In 2011 - 12 we were able to precept students offered programs Our interpreters expand from the following schools Campbell , Duke , our ability to reach diverse populations to ECU , JCC , NC State , and UNC decrease barriers to accessing healthcare Disciplines Social Workers , Physician Assistants , Nurse Practitioner , Nurses , Phlebotomy & Health Ed Students Providers The JCPHD employs Board Certified Physicians , Nurse Practitioners and Physician Assistants Extended role nurses also provide expanded services to clients in our clinics The physicians of the Health Department are affiliate staff of Johnston Medical Center and provide on call coverage for established patients of JCPHD 2011 - 2012 Annual Report Page 4PagePage pageNumber5Case Management Pregnancy Care Management Services PCM focuses on improving the health of our NC mothers and babies It is provided to NC Medicaid participants and a qualified number of uninsured women who have risk factors Our registered nurses and social workers work closely with pregnancy medical homes and local health departments to help coordinate services on behalf of the participants This participant - centered program , implemented in March 2011 , also focuses on the coordination of community resources to help the participants meet the medical goal of a healthy pregnancy During the 2011 - 2012 year , 1107 encounters were completed Care Coordination for Children & Parents As Teachers Programs CC4C is a statewide , population - based care management program , serving children under 5 years of age who meet eligibility criteria CC4C , in collaboration with families and Medical Homes , strives to improve health care outcomes for participating children Care management services are provided by social workers and registered nurses who are qualified and experienced in working with families and children Services include assessments to help identify needs , referrals to needed services and resources , and frequent follow up with the family and child’s doctor regarding progress at meeting needs PAT is an early childhood parent education program , serving children from birth up to age 5 Funding for the program comes from the Johnston County Partnership for Children PAT supports parents in their role as their child’s first and most important teacher Services are provided by trained parent educators who are certified by the Parents As Teachers National Center , Inc Services include monthly home visits to share developmental information and parenting support , parent - child group meetings , health and developmental screenings , and referrals to community services and resources as needed Stats for July 2011 - June 2012 ? PAT 461 home visits completed ? CC4C 387 unique clients 2011 - 2012 Annual Report Page 5PagePage pageNumber6Child Health Johnston Countys Public Health Department clinic offers health care for children , ranging from treatment to education Our preventive health care for children includes immunizations , check - ups , physical exams , and health care for sick children Physicals include vision hearing screens , fluoride applications ages 6 months - 3 ½ years , developmental assessments , asthma education and specialty referrals as needed Asthma education and follow up is key to helping children and their families understand asthma symptoms and how to manage their care Every 3 – 6 months the clinic routinely evaluates a childs asthma symptoms and medication regimen The Johnston County Health Department Child Health Clinic partners with Community Care of Wake and Johnston Counties to provide educational outreach to families Routine follow - up care , home visits , and community resources are key ways to enhance the quality of care for our patients Stats for July 2011 - June 2012 ? Health Check Preventive Physicals 1,515 ? Sick Visits Follow - up visits 2,155 ? Immunization visits 2,837 ? Sickle Cell screening visits 482 Dental Health Johnston County has approximately 30 Dental Offices and most of them have more than one Dentist There are two Pediatric Dentists in Clayton that specializes in treating small children Fourteen of these dental offices see patients with Medicaid and N C Health Choice The only sliding fee scale clinics available to adults and children in Johnston County is CommWell Health Dental Centers 2 sites There are 43 Schools in Johnston County All of the Elementary schools in Johnston County are in fluoridated areas except for Pine - Level and Micro Johnston County has one Public Health Dental Hygienist employed by The N C Oral Health Section Her priority activities include Public School Dental Assessments and referrals for the following groups Pre - K , K - 5 , and Exceptional Children in Johnston County Schools Dental education and parent information is provided to about 7,000 school children a year , and a Fluoride Mouth Rinse Program funded by N C Dept of Public Health is in five targeted Johnston County Schools According to the 2009 - 2010 School Level Oral Health Status Data , untreated tooth decay in Kindergarten students in Johnston County Schools was at 12 This is below the state average of 15 Finding a Dental Home for parents & children is a priority and our Public Health Dental Hygienist is a constant resource for the community 2011 - 2012 Annual Report Page 6PagePage pageNumber7Environmental Health The Environmental Health Department offers the following services Food and Lodging Inspections , On Site Well Program , Children’s Lead Poisoning Prevention and Investigations , Meth Lab Decontamination Consultation , and investigations of restaurant smoking complaints Food and Lodging The state adopted a new set of rules regarding food handling in September 2012 The results of the new rules created a learning curve for both the regulators and the food industry’s staff Two workshops for regulator’s and the food industry had over 300 attendees We also hosted a Hispanic food code workshop in October 2012 Our staff met our regulatory obligations in completing the inspection frequencies prescribed by the state There were twenty - three 23 Temporary Food Establishment TFE food events in 2012 Sixty - eight TFE food permits and 25 exemptions were issued Two “ petting ” zoos were also visited as part of these events On Site Well Program A Septic Installer’s Workshop was hosted in September to assist septic contractors in obtaining required educational credits at no cost Over 60 attendees participated in that workshop As one of the fasting growing counties and one of the most active for on - site activities , over 6,000 visits or inspections were performed in 2012 Other Programs As part of our duties , we follow - up on complaints filed regarding smoking in restaurants We responded to four smoking complaints in 2012 One lead case was investigated and we responded to 8 meth lab reports in 2012 The Environmental Health Office is currently disseminating information in an electronic format through our website at wwwjohnstonncenvironmentalhealthorg We are implementing an in - house program to link our old septic well permits to the current physical address to assist the public and staff with permit retrieval Our website had almost 5,000 visits in 2012 Stats for 2012 ? Total Applications for Service 2,026 Evaluation , Permits , Reviews ? Total Inspections and Site Visits 12,289 ? Total Office Consultative Contacts Septic Well 6,681 ? Total Office Consultative Contacts Food Lodging 3,360 2011 - 2012 Annual Report Page 7PagePage pageNumber8Epidemiology Its a goal of the Epidemiology department that Johnston County Community members be protected against communicable diseases The Epidemiology clinic provides opportunities for education , vaccination , screening and treatment One of the most important parts of disease prevention is vaccination Throughout the year , there are scheduled vaccination clinics serving all ages One of the largest vaccination efforts by the health department is the Annual Influenza Campaign A few of the targeted clinics include influenza vaccinations at long term care facilities , vaccination for foreign travel , immunizations to meet college vaccination requirements , and vaccinations for county employees The dates for special clinics are announced in local papers and on the County website The Epidemiology clinic contains a Sexually Transmitted Infection STI screening clinic offering daily appointments that are free of charge These appointments are available for anyone , regardless of their insurance status or county of residence The staff feels it is important to offer these services to everyone because STIs know no boundaries Anyone can be affected by these diseases and screening is the gateway to education , treatment and prevention Many STI’s are treated without charge through the clinics In addition , Epidemiology staff provides education to citizens and community agencies about communicable diseases upon request The health department serves as an information center for many students , private offices , and community organizations As we are regularly in contact with the State Communicable Disease Branch , updates and educational materials are often disseminated via email , website and fax to local medical providers Extra attention is given to investigating outbreaks and preventing transmission of communicable diseases Stats for July 2011 - June 2012 • Immunizations 2,062 • HIV Tests 1,387 • TB related visits 2,858 • Other Encounters 359 2011 - 2012 Annual Report Page 8PagePage pageNumber9Laboratory Our goal is to support the clinics of the Johnston County Health Department by providing accurate laboratory test results in a timely manner in order to aid in the monitoring of healthy patients and in the diagnosis and treatment of the unhealthy We operate under a CLIA Clinical Laboratory Improvement Amendments number provided by the NC State Lab of Public Health CLIA provides guidelines that all laboratories performing testing on humans must abide by All of our records are reviewed periodically by a consultant provided by the State Lab A CLIA representative can inspect our records at any time In our laboratory , we perform a variety of testing including glucose , hemoglobin , hemoglobin A1c , fecal occult blood , urinalysis , urine pregnancy tests , rapid strep , rapid influenza , gonorrhea cultures and gram stains tests for syphilis , urinary tract infections , and vaginal infections In 2012 , we performed over 20,000 tests in our laboratory Many tests are sent to reference laboratories Our laboratory is staffed with 3 full - time techs All techs are required to prove competency and participate in continuing education activities each year We constantly evaluate our processes to look for ways to improve Primary Care Clinic Johnston County Health Department has been providing Adult Primary Care Services for over 15 years to adults ages 18 and older Primary Care Clinics mission is to work together with the Community to deliver comprehensive and quality health care to citizens of Johnston County The clinic serves as a safety net provider for the county and accepts Medicare , Medicaid and uninsured patients based on a sliding fee scale The services provided in Primary Care are ? Acute and Chronic Care ? Mammograms ? Breast and Cervical Cancer Program ? Medication Assistant Program ? Diabetes Education and Resource Program ? Rex Mobile Mammography Bus ? Laboratory services Stats for July 2011 - June 2012 ? Primary Care 5,157 ? BCCCP 243 ? Diabetes Program 126 2011 - 2012 Annual Report Page 9Page0Women , Infants and Children - WIC WIC is the Special Supplemental Nutrition Program for Women , Infants , and Children funded by the United States Department of Agriculture The WIC program serves pregnant , post - partum women , infants , and children up to 5 years of age The WIC program provides vouchers for nutritious foods • Milk • Eggs • Whole grain breads and cereals • 100 juice • Beans and or peanut butter • Fruits and vegetables • Vouchers for infant cereal • Fruits and vegetables infants six months of age In addition to healthy foods , WIC provides services such as breastfeeding support , nutrition education , and referrals to other programs such as Medicaid , SNAP food stamps , medical and dental care , and immunization Breastfeeding promotion and support is an integral part of the WIC Program WIC strives to increase the initiation , duration and exclusivity of breastfeeding among women enrolled in the Program All WIC agencies have trained personnel ready to assist mothers in making informed decisions about their infant feeding choice WIC also instructs mothers in the basics of breastfeeding Johnston County WIC program has a breastfeeding peer counselor support program that provide mother - to - mother counseling In addition , all local WIC agencies provide breastfeeding aids such as manual and electric breast pumps WIC offers a food package for women who exclusively breastfeed their babies This food package provides tuna or salmon , as well as additional amounts of whole grains , cereal , milk , cheese , juice , peanut butter , beans , peas and lentils While breastfeeding is highly encouraged , infant formulas are available for non - breastfeeding mothers Over 3 million dollars was spent in our county using WIC food instruments Stats for July 1 , 2011 – June 30 , 2012 ? Total WIC encounters 47,724 2011 - 2012 Annual Report Page 10Page1Women’s Health Clinic Women’s Health provides prenatal care to low income pregnant women and birth control education and methods for women who choose to plan their pregnancies Family Planning provides access to multiple methods of contraception on a sliding fee scale Our patients receive a physical exam , a class on available options , limited lab work , and are provided a method of birth control We also have after school hours available for teens Maternal Health clinic provides prenatal care that includes lab work , educational classes group and individual and evaluations by a mid - level provider or physician We contract with Johnston OB - Gyn to provide consultative service for our OB patients Recently , we began offering 17P injections for our patients who are at risk for preterm delivery As a Pregnancy Medical Home , we provide OB case management services for patients who qualify for the program After their delivery , we visit our patients at Johnston Health to offer postpartum follow - up and pediatric care appointments for their infant The Women’s Health Clinic at the Johnston County Health Department strives to provide our patients with quality care in a patient friendly atmosphere Our caring staff offer professional health care and personalized education concerning women’s health issues Stats for July 2011 - June 2012 ? WH Visits 6,041 2011 - 2012 Annual Report Page 11Page2Community Transformation Grant Project Communities Transforming for a Healthier North Carolina In 2011 , the North Carolina Division of Public Health was awarded a five - year grant to help communities make healthy living easier for North Carolinians Funded by the Centers for Disease Control and Prevention , the Community Transformation Grant Project CTG Project in North Carolina is working to prevent chronic disease , promote healthier lifestyles , reduce health disparities , and control health care spending 10 multi - county regions across the state have received funding to forge new collaborations and develop new strengths as they implement CTG Project goals We are Transforming Health Together , the eight - county regional partnership in Central North Carolina Franklin , Granville , Halifax , Johnson , Nash , Vance , Warren , and Wilson Transforming Health Together is working community by community to accomplish goals in the three CTG strategic areas – Active Living and Healthy Eating , Tobacco Free Living , and High Impact Clinical and Preventive Services Regional staff and local leads are Transforming Health Together in Region 7 with area residents and stakeholders so healthy living can be easier for all in Central North Carolina North Carolina Region 7 Primary Strategic Directions Strategic Direction 1 Tobacco Free Living Increase smoke - free regulations in local government buildings and indoor public places Strategic Direction 2 Active Living and Healthy Eating Increase the number of community organizations that promote joint - use community use of facilities Increase the number of communities that support farmers markets , mobile markets , and farm stands Strategic Direction 3 High Impact Evidence - Based Clinical and Other Preventative Services Increase the number of health care providers who screen patients for high blood pressure , high cholesterol , weight management , and tobacco cessation , and refer them to programs that support chronic disease self - management , weight management , or tobacco cessation For More Information Johnston County Public Health Department - 919 - 989 - 5200 Visit us online at wwwtransforminghealthNCorg Like Transforming Health NC on Facebook Follow us on Twitter @ TransformNC 2011 - 2012 Annual Report Page 12Page3Collaboration with Community Partners Johnston County Public Health continues to develop new partnerships throughout Johnston County Public Health has identified five priority areas for our county obesity , diabetes , access to healthcare , cancer and injury prevention By collaborating with community partners we are able to address priority areas utilizing interdisciplinary teams In addition to our existing partnerships , we have also developed new partnerships Just recently the Johnston County Local Management Entity LME has joined Alliance Behavioral Health Care As a result , the Johnston County Public Health Department has assumed the safety net provider functions of the LME in 2013 In addition , a Kate B Reynolds grant provides co - located behavioral health services at the health department Although many of our partnerships are located in Johnston County , we recently established regional partnerships through the Community Transformation Project Grant CTPG The CTPG is a 5 year regional grant that focuses on environmental and policy changes that support tobacco free living , active living , healthy eating and evidence based clinical and preventative services The regional collaboration consists of Health Director’s Region 7 which incorporates Johnston , Franklin , Granville - Vance , Halifax , Nash , Warren and Wilson counties Quality Improvement Workforce development and Quality Improvement QI are the foundations for continuing growth in quality care of the residents served at Johnston County Public Health Department Our Quality Assurance Team is representative of all disciplines in our Health Department Ideas and goals developed by this team strive to assure best practices and good customer service Quality Improvement Projects • As a part of the American Recovery and Reinvestment Act ARRA , an Electronic Health Record EHR Incentive program was implemented The goal of the program is to encourage providers to adopt and implement EHR technology and demonstrate meaningful use of that technology Meaningful use has improved standardized medical documentation across all clinics JCPHD implemented the electronic medical record over twelve years ago and it has improved documentation and access to the patient record • Clinical staff frequently assesses clinic flow to develop strategies to reduce lead time for patients and to deliver service in a more customer friendly manner • The Diabetic Education program writes a Plan Do Study Act PDSA each month to help assess what works with the program and what needs improvement • A semi - annual audit for each clinic is performed to evaluate clinical charts for documentation , ordered tests studies and billing Corrective Action plans are written as needed Our continued focus is on improving customer service and the immunization inventory process 2011 - 2012 Annual Report Page 13Page4Innovation Integrating Behavioral Health In January 2013 , the Health Department integrated Behavioral Health Services into public health Johnston County Health Department is one of the first health departments in recent history to fully unify these services The Behavioral Health Division provides Outpatient Services Psychiatric Care Case management Group Therapy Patient Medication Assistance Program Inpatient Services Psychiatric Consultations Psychiatric and Case Management coverage of the 20 Bed Inpatient Units Emergency Crisis Services Consultation and Coverage of the 4 Bed Emergency Department Units Over 3,200 clients received services in 2011 2011 - 2012 Annual Report Page 14Page