2016 ANNUAL REPORT

Lewis County Public Health 7785 North State Street, Suite 2 Lowville, New York 13367 315-376-5453 www.lewiscountypublichealth.com

Director of Public Health Early Intervention Official

Penny A. Ingham, MPH

Medical Director

Daniel Root, MD

Supervising Public Health Nurse

Marcia Ashline, RN, BSN

Children with Special Needs Program Coordinator Early Intervention Official Designee Preschool Municipality Representative

Laurie Simmons, BS

Corporate Compliance Officer Emergency Preparedness Coordinator

Ashley Waite, RN, BSN

Fiscal Manager

Paula Kaufmann, AAS, Cert.

Lewis County Rabies Control Officer

Jennifer Nightingale, DVM

Governing Board - Lewis County Board of Legislators Chairman Michael Tabolt Public Health Committee Members Rocky Fawcett Philip Hathway Andrea Moroughan, Chair

2016 Annual Summary LCPH continues to provide services as a Diagnostic and Treatment Center, a Licensed Home Care Services Agency, Partial CLIA Laboratory and as an Early Intervention Services Agency. These designations allow Public Health to provide the services required under New York State Law. LCPH as an agency and its individual programs accomplished several goals and continued to provide high quality services to our county residents. The Community Health Survey for Adults as well as the Community Health Assessment was completed during this year in conjunction with our community partners. The findings have been published and are available on our website. The culmination of this work is the prioritization of health needs based on many factors. With the assistance of many community partners the Community Health Improvement Plan, to be implemented over the next three years, was developed. The Improvement Plan is a community health plan – requiring the commitment and work of agencies, schools and our communities in order to see the outcomes achieved. Good health is more than “health services”. It is the interplay of all aspects of our lives including where we live, work and play. Quality Improvement was a major initiative during this year. The plan was developed and implementation will be ongoing. In addition, our agency received CDC’s GOLD STAR Status for the Diabetes Prevention Program! And, the Early Intervention Program met all performance standards, a difficult outcome to achieve. Overall priorities for 2016 included:    

Adopt Public Health’s Quality Improvement Plan framework and implement the QIP 2016 objectives Continue full updates to Public Health policies Develop Strategic Plan for 2017-2020 (continuing development in 2017) Develop timeline and continue efforts toward Public Health Accreditation

For the Public Health Staff, the Health Services Advisory Committee and our various and numerous Community Partners, the health and wellness of the Citizens of Lewis County continues to be our guide as we deliver services of the highest quality with compassion, dedication, and integrity. We continue our readiness to prevent disease, promote life-long health and prepare and protect the citizens of Lewis County. Penny A. Ingham, MPH Director

Core Public Health Services Lewis County Public Health provides a variety of services and programs to protect and promote the health of the community it serves. Following State Article Six Guidelines for General Public Health Work, LCPH offers core Public Health services that include: Emergency Preparedness and Response, Community Health Assessment, Chronic Disease Prevention, Family Health, Communicable Disease Control, and Environmental Health. The Preventive Health Services Programs are designed to promote healthy lifestyles, prevent disease and reduce the impact of disease in county residents. Our programs include: Communicable Disease Surveillance and Control, Rabies Prevention, Arthropod-Associated Disease Prevention, Immunizations for Children and Adults, including Travel Vaccination Clinics, Chronic Disease Prevention and Self-Management Programs, Tobacco Cessation Programs, Cancer Screening Services, Maternal Child (MCH) Home Visiting Program, Childhood Lead Poisoning Prevention Program, Dental Health Education, Emergency Preparedness and Response, Health Education, Child Health Consultant, and Population Health Initiatives. Our goal is to provide evidence-based programming to ensure practices are based on best available scientific evidence. Both the Diabetes Prevention and Diabetes Self-Management Programs remained very popular and successful, receiving referrals from both healthcare providers and previous participants. In early 2016, we joined a state-wide initiative to implement oral health preventive services within the medical home for children aged 0-5 years. The year-long implementation process involved monthly webinars and conference calls under the leadership of the New York State Association of County Health Officials (NYSACHO) and Dr. Melinda Clark who is a pediatrician and driving force behind the initiative. Public Health was provided the materials necessary to train local providers on the application of fluoride varnish to children during Well Child visits. Our Health Educator visited several area providers to educate and promote this valuable intervention and will continue the effort into the coming year.

COMMUNICABLE DISEASE/STD/TB Disease Campylobacter Chlamydia Cryptosporidiosis Dengue Fever e Coli Giardia Gonorrhea Hepatitis A Hepatitis B, Chronic Hepatitis C, Chronic Influenza A Influenza B Influenza unknown strains Legionellosis

Number Reported 29 36 17 1 11 15 4 2 23 87 154 101 1 1

Disease Lyme Disease Perinatal Hepatitis B Pertussis Meningitis, Bacterial Meningitis, Viral / Encephalitis Salmonella Strep, Group B Syphilis Tuberculosis, Latent Tuberculosis, Active Yersiniosis Zika Virus Non State-Reportable Diseases Total Investigations (less Influenza reported only, no investigation)

Number Reported 41 4 7 2 11 10 8 4 4 1 1 4 55 378

Under CLIA we screened 40 individuals for Hepatitis C (HCV), HIV, Lead and Hemoglobin. All individuals who receive HCV or HIV testing also receive pre- and post-test counseling. We continued to conduct HIV and Hepatitis C testing of inmates at the Lewis County Jail for inmates who request testing. Tuberculin skin testing was provided to 272 people including health care workers and the public through immunization clinics and office visits. This test determines if a person has had exposure to Tuberculosis.

RABIES Exposure reports were addressed for 195 cases during 2016. The Communicable Disease Nurse and the Public Health Animal Control Officer investigated each report, providing education and follow up as needed. Two positive specimens included 1 skunk and 1 raccoon. LCPH and the County Rabies Control Officer addressed the human and animal needs related to these outcomes. Rabies Post Exposure Prophylaxis (PEP) was administered to 13 people due to exposures to bats and rabid, or suspected rabid, animals. In collaboration with Countryside Veterinary Clinic, LCPH offered nine rabies vaccination clinics throughout the year: one in January, seven during the month of May at various fire halls and town barns throughout the county, and one in September. Through these free (donation friendly) clinics, 1,000 pets were successfully vaccinated. Through a cooperative effort among the U.S. Department of Agriculture’s Wildlife Services, Cornell University, USDA, and the New York State Department of Health, an aerial rabies bait drop occurred over most of Lewis County in August, 2016. Restoration of vaccination efforts along the Black River Valley in Lewis County, supported entirely with NYS funding except for the western portion of Diana, will serve to vaccinate wildlife in a vulnerable rabies corridor and enhance protection for residents and domestic animals.

ARTHROPOD BORNE DISEASE PROGRAM (Ticks and Mosquitoes) Active surveillance was conducted with local veterinary clinics, physician practices and the emergency room for any meningitis or encephalitis type illnesses that occurred throughout the mosquito season. Lyme disease is indigenous to Lewis County, and all ticks are considered vectors of Lyme disease. investigated 41 reports of suspected and/or confirmed Lyme Disease throughout the year.

Staff

Zika virus became a public health priority in the spring of 2016. LCPH was responsible for authorizing Zika testing for individuals who traveled to affected countries who either were pregnant or had developed symptoms of Zika virus. We assisted the local hospital laboratory in becoming eligible to collect specimens for testing which were then sent to the NYSDOH laboratory in Albany for analysis.

IMMUNIZATION PROGRAM Throughout the year we vaccinated 726 individuals who attended either our weekly, travel, walk-in, and employer-sponsored immunization clinics. We continued the practice of billing several insurance plans for privately funded vaccines and for administrative costs associated with state-funded vaccines. Through both the Migrant and Vaccines for Adults programs (State-funded vaccine for individuals who are uninsured or underinsured) 24 individuals received 40 free vaccinations. Flu vaccinations were provided to 351 adults and 93 children. Due to widespread availability of flu vaccine within the community, LCPH again did not hold public flu clinics in 2016. Instead, seven private flu clinics were held at various businesses throughout the county, immunizing a total of 271 individuals.

LCPH provided travel counseling and vaccines to 29 individuals through the International Travel Immunization Clinic.

CHRONIC DISEASE LCPH provides the Chronic Disease Self-Management Program in partnership with community agencies to provide the program throughout Lewis County, stretching LCPH’s reach to various age groups and populations. The Northern Regional Center for Independent Living and Lewis County Office for the Aging offer classes throughout the year. Five workshops were held by the three agencies reaching 22 people.

CHRONIC DISEASE -- ARTHRITIS Lewis County Office for the Aging in collaboration with LCPH began offering an evidence-based Tai Chi for Arthritis program for community members. Tai Chi for Arthritis is an 8-week program, meeting two days a week for one hour. Research studies have shown that Tai Chi for Arthritis relieves pain and improves the quality of life for people living with arthritis. The program also helps improve muscular strength, balance, relaxation, posture and immunity. Ten participants completed the first workshop.

CHRONIC DISEASE -- DIABETES Public Health achieved GOLD STAR Status from the CDC for the Diabetes Prevention Program, one of only 18 in the state to receive this recognition. LCPH continued to offer the DPP, a year-long evidence-based program designed to teach people with pre-diabetes how to improve food choices, increase physical activity, and maintain a healthy lifestyle. The 16-week (core) sessions are followed up with four bi-weekly sessions, and 6 monthly post-core sessions, requiring a full year of participant commitment to the program. Four groups, with a total of 32 individuals, were conducted in 2016, with an average weight loss of 10 pounds per participant. The Diabetes Self-Management Program (DSMP) is an evidence-based program developed by Stanford University and is designed to help people gain self-confidence in their ability to control their symptoms and how diabetes affects their lives. This workshop teaches the skills needed in the day-to-day management of diabetes in order to maintain and/or increase an active and fulfilling lifestyle. Four workshops were held in 2016 with 31 participants completing the 6-week program. Public Health offered a monthly diabetes support group from March through November. The average attendance was 7 people. In an effort to ensure this program provides quality and proven health maintenance strategies, the group will be restructured to an evidence-based format when it reconvenes in the spring of 2017.

CHRONIC DISEASE PREVENTION -- CANCER SERVICES PROGRAM (CSP) Although there was a decrease in screenings for 2016 due in large part to more people having insurance, the Cancer Services Program (CSP) still saw 32 new participants referred by various partners. This year, the CSP participated in: Community Health Awareness Day at LCGH and Super Science Saturday at JCC promoting colorectal screening, both county fairs where we displayed the inflatable colon, lobby outreach events at the LCGH in October and March, JRC employee benefit fair, Salmon Run Mall Health Fair, ACS Making Strides, Pink and Pearls Brunch, the Ta-Ta Run, wellness fairs at area schools, and literacy classes at BOCES promoting cervical cancer and HPV testing. Targeted efforts were focused around a variety of advertising avenues for March and October awareness campaigns, including social media, billboards, placemats, radio, television, buses, newspapers, movie theaters, free media in newsletters, and promotional items.

County

# Individuals Screened

# Needed Diagnostic Testing

80

Breast - 18 Cervical – 1 Colonoscopies – 3

Jefferson Fit Kit Sent – 48 Fit Kit Returned - 27 46

Breast - 5 Cervical – 0 Colonoscopies – 1

Lewis Fit Kit Sent - 32 Fit Kit Returned - 24

Cancer Diagnosis Breast – 2 invasive Cervical – 1 CIN 1, Mild Dysplasia Colon – 0 Hyperplastic Polyps 1 Adenomatous polyp no high grade dysplasia Breast – 1 invasive Cervical – 0 Colon – 1 Hyperplastic Polyp 0 Adenomatous polyps no high grade dysplasia

We continue to refer participants to the NYS of Health Plan Marketplace to become insured. We have established a reciprocal referral process with area Navigators. Research at the State level found there are still a number of people who are uninsured in NYS – showing continued need for the Cancer Services Program.

CHRONIC DISEASE PREVENTION -- TOBACCO CESSATION Three women participated in the “Baby and Me, Tobacco Free” program. Women who remain smoke-free during their pregnancy and during the first year after their babies are born receive monthly coupons for free diapers. We continued to have five staff members trained to provide cessation counseling to anyone in the community. One staff person was trained in the 5As to become eligible to conduct “Baby and Me, Tobacco Free” counseling. No nicotine replacement therapy (NRT) products were available for distribution in 2016. We remained involved with the Tobacco Health Systems through St. Joseph’s Hospital Health Center.

CHRONIC DISEASE PREVENTION – CARDIOVASCULAR DISEASE LCPH continued working with the North Country Initiative and Central New York Care Collaborative under DSRIP to assist individuals in preventing or managing cardiovascular disease through our blood pressure screening program. Clinical staff participated in training through the Million Hearts Campaign to ensure protocol is followed during each screening, ensuring accurate results and continuity of care. Clinical staff is available to conduct blood pressure screenings on a walk-in basis.

PRENATAL CARE AND INFANT MORTALITY The Maternal-Child Home Visiting Program offers nursing visits by a registered nurse to high-risk pregnant women, new mothers and newborn infants. The nurse provides information on pregnancy, nutrition, labor and delivery, family planning, infant care, breast-feeding and parenting. The agency also serves as a resource to direct clients to other community services. Public Health staff assists with Presumptive Eligibility for Medicaid for Pregnant Women. This enables entry into Medicaid starting with their first prenatal visit.

Antepartal Health Guidance Postpartum Health Guidance Newborn Health Guidance

Referrals 13 9 36

Admissions 0 7 22

Average Monthly Caseload 0 1 2

LEAD POISONING AND PREVENTION PROGRAM Lead Poisoning is a serious health problem, especially for children, as it can cause learning difficulties, kidney damage, hearing loss, growth problems, anemia, and behavior problems. Therefore, medical providers are required, by law, to test all one and two year old children for the presence of lead. Public Health offers free, onsite lead screening to all one through four year old children via a fingerstick, with results obtained within three minutes. We also provide hemoglobin testing in conjunction with lead testing in an attempt to increase the number of children who are tested for lead. A total of 21 children were tested in our clinic in 2016. Overall County Rate of Lead Testing 2016 – 52% of one year olds 64% of two year olds Number of children tested One Year olds Two year olds

2015 – 56% of one year olds 50% of two year olds <10mcg/dl 165 203

10-14 mcg/dl 5 2

2014 – 48% of one year olds 44% of two year olds 15-19 mcg/dl 0 1

20 -44mcg/dl 0 1

DENTAL HEALTH Dental caries is the most common chronic disease of childhood. As many as 11% of 2-year-old children are affected by dental caries, and prevalence increases rapidly to 44% in 5-year-olds. The consequences of early childhood dental caries includes: pain, tooth loss, impaired chewing and nutrition, below average weight gain, infection, difficulty sleeping, increased caries in permanent teeth, school absences, and future dental work. Fluoride varnish is a proven intervention that strengthens teeth and reduces decay. According to research, children who received > 4 fluoride varnish applications realized a 17% reduction in dental carries-related treatments as opposed to those children who received no fluoride. Very few children under the age of five visit the dentist, and children are 2.5 times more likely to lack dental than medical coverage. For these reasons, LCPH participated in an initiative to implement fluoride varnish in the primary care setting. Public Health detailing to medical providers occurred in the latter half of 2016 to provide education on this promising practice.

INJURY PREVENTION LCPH participates in the Lewis County Traffic Safety Coalition, a group of individuals from area agencies representing law enforcement, emergency management, highway, schools, trails, and health/human service agencies, with the primary goal of reducing pedestrian and traffic injuries. Outcomes of coalition activities have included road signage, speed zone changes, and car seat distribution programs. LCPH continues to refer clients in need of car seats to nearby agencies who participate in the car seat program administered through the NYS Governor’s Traffic Safety Committee.

HEALTH EDUCATION One of the Ten Essential Public Health Functions is to “inform, educate, and empower people about health issues.” Lewis County Public Health participated in three large health related events this year: 

On April 16th Cancer Services staff participated in the annual Lewis County General Hospital’s Community Health Awareness Day. This event is well received by area residents and offers a variety of health education

and health screenings. Our agency was present to offer information on cancer screening, early detection, and chronic disease prevention. 

In July, LCPH participated in the Lewis County Fair with an informational booth, focusing on specific topics each day. Although all program information was made available throughout the week, special emphasis was placed on Immunizations, Lead Poisoning Prevention, Cancer Services, and the Chronic Disease SelfManagement and Diabetes Prevention Programs. LCPH sponsored the Baby Room and Early Intervention programs were highlighted there.

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The Family Fit N’ Fun Faire was held on August 20th and sponsored by the Lead Poisoning Prevention Program. The goal of the fair was to provide not only health information, but highly interactive opportunities for children to learn. Twenty-three different community service providers manned booths at the Lewis County Fair Grounds. Activities included: lead poisoning prevention education, hand washing demos, nutrition and physical activities, school bus safety, gross motor activities, healthy snacks and other fun activities. Approximately 210 people attended, down slightly from the previous year. This was the 10th and final year of this successful collaborative effort between community agencies.

Additional Education Activities: 

In March staff observed Colon Cancer Awareness Day with an inflatable colon and a screening/ education display in the lobby of Lewis County General Hospital.

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Also in March, LCPH participated in the South Lewis Central School’s College Fair and provided education to students and parents on immunizations for college as well as STD prevention.

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National Public Health Week was celebrated the first week of April. LCPH provided information on all our programs through a display in the hospital and a display/open house in our lobby.

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On May 25th our Health Educator provided education on poison control to 326 fifth-graders at the Lewis County Fairgrounds during Ag Safety Day.

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In July and August, our Health Educator attended the DSS PINS (Persons in Need of Supervision) program and provided education to youth on healthy choices and adolescent vaccines.

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National Night Out was held in September and LCPH provided information on emergency preparedness.

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In October staff attended the Head Start Health Fair and provided information to parents of young children on immunizations, lead poisoning prevention, and early childhood services.

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Five licensed and family daycares received education from our Daycare Consultant (Health Educator) on a variety of topics including home and environmental safety, medications, immunizations, and infection control.

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In addition, LCPH staff offered presentations to school districts, parent groups, businesses, libraries, and senior citizens groups on a variety of subjects such as: hand washing, infection control, tobacco cessation, nutrition, poison control, chronic disease prevention, STDs, head lice, lead poisoning prevention and immunizations.

COMMUNITY HEALTH ASSESSMENT AND IMPROVEMENT PLAN, 2016-2018 In 2016, LCPH worked with the Fort Drum Regional Health Planning Organization (FDRHPO) and other local health departments in the Tug Hill Seaway Region to develop a community health assessment. Community health assessments are one of five core activities funded under the Article 6 program, which occurs on a three-year cycle. The 2016 Tug Hill Seaway Regional Community Health Survey, which was conducted by the Center for Community Studies at Jefferson Community College was utilized in the assessment, along with several secondary data sources. The purpose of a community health assessment is to review the health status of a population for the purpose of (1) understanding the general health of the community, (2) assessing the causes and risk factors underlying the community’s health status, (3) evaluating the effectiveness of programs and policies intended to improve or maintain health, and (4) planning the allocation of resources and efforts to address health needs.

Summary of Prevention Agenda Indicators for Lewis County (as of 2016 Community Health Assessment) Indicators most relevant to priorities selected in 2013 are underlined. Better

Fair

Worse

Cigarette smoking

Adult obesity Child obesity Colorectal cancer screening Heart attack hospitalizations

Chronic disease

Asthma ED visits Asthma ED visits (aged 0-4) Diabetes hospitalizations (adults)

Mental health & substance abuse

Adults with poor mental health Binge drinking

Environment

Fall hospitalizations (elderly)

Fall ED visits (children 1-4) Low-income access to supermarkets

Occupational injuries (adolescents) Climate Smart Communities pledge Alternate modes of transportation Optimally fluoridated water

Women, infants, & children

Preterm births Infant breastfeeding Infant breastfeeding disparity (Medicaid)

Well-child visits (0-15 months) Children with health insurance Unintended pregnancies Women with health insurance

Premature births disparity (Medicaid) Well-child visits (3-6 years) Well-child visits (12-21 years) Unintended pregnancies disparity (Medicaid) Births within 24 months of a previous pregnancy

Infectious disease

Flu immunizations Gonorrhea case rate (women) Gonorrhea case rate (men) Chlamydia case rate (women) Syphilis case rate (women)

Early child immunizations

HPV immunizations (female adolescents)

Overall health & disparities

Premature deaths Preventable hospitalizations

Adults with health insurance Adults with a PCP

Suicide death rate

Stakeholders reviewed strategies and activities outlined in the New York State Prevention Agenda 2013-2018 Action Plan to determine interventions appropriate for the Lewis County Community Health Improvement Plan. Several factors were taken into account, including demographics, economics, geography and socioeconomic factors of the county. The Health Impact Pyramid was also referenced in coalition meetings in order to select the most impactful strategies. Research was conducted to identify evidence-based strategies to reach performance indicators. Briefly, the following are selected strategies for each of the priorities, which are also indicated on the pyramid (see below): 1. Prevent Chronic Disease: Reduce Obesity in Adults a. Start or expand farm-to-institution programs in hospitals, workplaces, and other institutions b. Start or expand farmers’ markets in all settings c. Support and promote community and home gardens d. Promote worksite wellness programs

e. Promote access to physical activity opportunities (community wide campaigns) f. Engage healthcare providers in prevention and awareness activities 2. Prevent Chronic Disease: Reduce Obesity in Children a. Establish policies to incorporate fruit and vegetable activities into schools as a way to increase consumption b. Encourage school districts to implement Comprehensive School Physical Activity Programs (CSPAP) 3.

Promote Mental Health and Prevent Substance Abuse: Prevent Substance Abuse and Other Mental, Emotional, and Behavioral Disorders a. Collaborate through prevention partnerships to integrate, implement and coordinate suicide prevention initiatives

EMERGENCY PREPAREDNESS AND RESPONSE In March, the New York State Commissioner of Health declared Zika virus an imminent threat to public health. This made Zika virus a new priority. A Zika Action Plan was developed and adopted in April. This included traveler and public education, Zika virus testing authorizations, and human disease monitoring. In April, the Preparedness Coordinator and Fiscal Manager attended the National Preparedness Summit. This was a five day conference in Texas. The theme of the conference was “Planning Today for Rebuilding Tomorrow. Resiliency and Recovery in the 21st Century.” Topics covered included utilizing technology and social media to be better prepared, communication during disasters, disaster mental health, caring for at risk populations during disasters, utilizing volunteers, establishing partnerships, among others. Information gained from the Summit is being utilized by LCPH. Also in April, the Preparedness Coordinator began The Roadmap to Ready Program. This program paired her with a mentor to guide her on how to be a better preparedness coordinator as well as a team of new Preparedness Coordinators to network with and discuss struggles. In December, she completed this program and has been empowered in her role as Preparedness Coordinator. Planning was a big focus this year. The Isolation and Quarantine, Strategic National Stockpile, and Medical Countermeasure Clinical Operation plans were all revised and updated. In December an Operational Readiness Review was conducted. This Assessment looked at both the planning and operational side of Public Health Preparedness. Overall the assessment was very good, some areas for improvement were noted, but this was to be expected. The Preparedness Coordinator will continue to work on Operational Readiness.

Children with Special Needs Programs CHILD FIND (birth to 3) The goal of Child Find is to ensure that all children have a primary care provider who is doing developmental screenings at all well child visits. Qualified staff members work with families, physicians, and community agencies to offer information and support to families with children, birth to age three, who reside in Lewis County. Referrals are received from various sources including primary care physicians, parents, social services, and hospitals. At-Risk Conditions include foster care placement, indicated reports of child abuse or neglect, prematurity and low birth weight, and a parent’s perceived concern about their child’s development, among others. Child Find & Referral outreach efforts include participation in Head Start meetings, local school districts, and collaboration with local physicians and other community programs to ensure Child Find is being offered to families. LCPH staff also work with Lewis County Social Services on Child Abuse Prevention and Treatment Act referrals.

EARLY INTERVENTION PROGRAM (birth to 3) The Early Intervention Program is designed to meet the very special needs of disabled or developmentally delayed children, age birth to three and their families. Early Intervention services include but are not limited to: medical services for diagnosis or evaluation purposes, early identification, screening and assessment, therapy services, family training, counseling, home visits, parent support groups, respite, transportation reimbursement and service coordination. Referrals are received from various sources including primary care physicians, parents, social services, Head Start and hospitals. Early Intervention staff promotes the EI Services through participating in the Head Start Health Services Advisory Committee Meetings, Lewis County Mental Health & Developmental Disabilities Subcommittees to the CSB, JeffLewis Child Care Training Advisory Council, among others.

Family Fit ‘N Fun Faire, Lewis County Fair (Baby Changing & Feeding Area/Information Booth), Baby Show & various other LCPH events including Public Health Awareness Week were used to inform the community about the EI program and its services. The Local Early Intervention Coordinating Council met twice this year. These meetings were well attended by our community partners and agencies. The Council has identified barriers/gaps in services such as transportation, bilingual services/evaluations, behavioral and social work services, waitlist for Special Education Itinerant Teacher Services and “after-EI/PK” services-advocacy, program supports, financial barriers. We continue to invite parents to join the Council.

PRESCHOOL SPECIAL EDUCATION PROGRAM (3-5 years) The Preschool Special Education Program is for 3 to 5 year olds who are determined by the resident school district as being eligible for services that address their educational needs until they are Kindergarten eligible. Within the evaluation process, specific developmental needs are assessed such as: gross and fine motor skills, speech and language skills, vision and hearing concerns and educational and social development. LCPH administers the program on behalf of the County. Referrals are made directly to the school district by parents and families, as well as by local agencies involved with children, such as Head Start and Department of Social Services, upon consent of a parent. Services are provided through contracts between LCPH and agencies approved by State Education to provide preschool special education services and evaluations. Local School Districts include Lowville, South Lewis, Beaver River, Copenhagen, Harrisville, Carthage, Adirondack, Camden and South Jefferson.

CHILDREN WITH SPECIAL HEALTH CARE NEEDS PROGRAM The Children with Special HealthCare Needs Programs are available to children birth to age 21 who have or are suspected of having a serious or chronic physical, developmental, behavior or emotional condition and who require health and related services of a type or amount beyond that required by children generally. The programs consist of: Resource & Referral includes assisting families to access services from various agencies, organizations and medical facilities who can assist with the needs of the child. Some examples include, SSI, Ronald McDonald Houses, Children’s Miracle Network, Exceptional Family Members Program, Committee on Special Education, and Independent Living Centers. Services may include medical travel and accommodations, assistance with insurance issues, SSI applications, mediation, etc. Families can call the CSHCN Program directly or community agencies and physicians can refer a family. There is no financial component associated with this portion of the program.

Physically Handicapped Children’s Program (PHCP) provides financial assistance for medical & dental needs through a pre-approval process when there is no other payer source for the medical services (other eligibility criteria must also be met). More than 150 medically disabling conditions qualify including certain dental procedures. The dental component offers assistance to children with severe dental conditions, such as cleft palate and severe malocclusions. Referral is required from the local dentist.

47 children received services in 2016. 46 were for orthodontia needs. In total, 67 services were authorized in 2016. Unduplicated Count of Children Authorized under the Treatment Program by Age Total

Age < 1

1<3

3<5

5 < 13

13 < 19

>19

47

0

0

0

17

29

1

Administrative Initiatives QUALITY IMPROVEMENT In the spring, the Public Health Planner began writing a new Quality Improvement Plan. This was complete and approved in July. The project chosen for 2016-2017 is increasing evidenced based programs and interventions provided by LCPH. The initial phase of the project was conducting research to find evidence for the programs we currently offer and conducting program review meetings to discuss findings. Once all programs have been reviewed, any program that is not evidenced based will then be reevaluated to see if it can be made evidenced based. Our goal for this project is to have 75% of the programs and interventions provided by public health be evidenced based. We are on track for meeting this goal and are looking at other projects to take on for 2017-2018.

PUBLIC HEALTH ACCREDITATION In 2015, we conducted preliminary research on becoming an accredited health department. The Director and Public Health Planner completed the Public Health Accreditation Board’s Online Orientation. This gave us a good idea of what is required to become an accredited health department. In 2016, a timeline was established for meeting our goal of becoming an accredited health department. Several plans and documents must be in place before a health department can even apply for accreditation. These documents include a Community Health Assessment, Community Health Improvement Plan, Strategic Plan, Workforce Development Plan, and a Quality Improvement Plan. The Community Health Assessment, Community Health Improvement Plan, and the Quality Improvement Plan were complete in 2016. The Strategic Plan and Workforce Development Plan are priority for 2017.

The 10 Essential Public Health Services Monitor Health Status Diagnose and Investigate Inform…Educate…Empower Mobilize Community Partnerships Develop Policies and Plans Enforce Laws and Regulations Link People to Needed Health Services Assure a Competent Workforce Evaluate Effectiveness, Accessibility and Quality Conduct Research

Health Services Advisory Committee Daniel Root, MD Shereen Palmer, MD Steve Fuller Sue Gydesen, CSW Jennifer Jones Robert MacKenzie, AEMT-P Andrea Moroughan, Legislator Jennifer Nightingale, DVM Tammy Suiter, RN Marcia Ashline, RN, BSN Penny Ingham, MPH Megan Kraeger Kathy Sochia Laurie Stoffel Ashley Waite, RN, BSN

Lewis County Public Health Agency 7785 North State Street, Suite 2 Lowville, New York 13367 Telephone (315) 376-5453 Fax (315) 376-7013 www.lewiscountypublichealth.com Like us on Facebook!

Mission: prepare and educate the people of Lewis County to ensure their health and safety