delaware county public health services annual 2015...director of public health healthy people living...

2015

Bonnie Hamilton (January-April)

Amanda Walsh

Director of Public Health

Healthy people living in healthy and thriving communities

ANNUAL

REPORT

Delaware County Public

Health Services

HEALTH SERVICES ADVISORY BOARD Licensed Home Care Service Agency & Public Health Programs

Christina Gardner Dr. Rohan Jayasena Nicole Blanchard Audrey Lewis Dr. Riaz Lone Tina Molé Dana Scuderi-Hunter Wayne Shepard Amanda Walsh Bonnie Hamiliton R. Eugene Pigford Arthur Merrill Wayne Marshfield Charles Gregory

Committee Members 2015

COMMUNITY HEALTH

Tina Molé, Chairman Charles Gregory R. Eugene Pigford Arthur Merrill Wayne Marshfield MEDICAL DIRECTOR Dr. Riaz Lone MEDICAL ADVISOR Dr. Rohan Jayasena

>> i DELAWARE COUNTY PUBLIC HEALTH ANNUAL REPORT 2015

99 Main Street Delhi NY, 13753 607-832-5200

www.delawarecountypublichealth.com

VISION: *HEALTHY PEOPLE LIVING IN HEALTHY AND THRIVING COMMUNITIES

MISSION:

*PROTECT, PROMOTE AND IMPROVE THE HEALTH AND WELL-BEING OF PEOPLE OF ALL GENERATIONS AND CREATE HEALTHY PLACES TO LIVE, LEARN, WORK AND PLAY.

PUBLIC HEALTH Prevents epidemics and the spread of disease Protects against environmental hazards Prevents injuries Promotes and encourages healthy behaviors Responds to disasters and assists communities in recovery Assures the quality and accessibility of health services CORE VALUES Collaboration: Working in partnership with individuals, the community and organizations

to strengthen our resources and achieve a common goal. Equity: Fostering policies and programs that promote fairness, social justice, equality and

cultural competence. Excellence: Sustaining a knowledgeable and competent Public Health workforce providing

high quality services to the community. Innovation: Applying technology, knowledge and research to implement creative and

progressive interventions. Integrity: Adhering to high ethical and professional standards in the workplace to ensure

transparent and accountable performance. Respect: Embracing the dignity and diversity of individuals, groups and communities. Science: Supporting and promoting best practice in any discipline based on sound research

and professional judgment.

>> ii DELAWARE COUNTY PUBLIC HEALTH ANNUAL REPORT 2015

>> Table Of Contents

>> iii

Organization Chart .................................................................................................... 1

Chronic Disease Prevention ...................................................................................... 2-3

Complete Streets and Prescription Trails ............................................................ 2

Breastfeeding in the Workplace ........................................................................... 3

Promote Mental Health ........................................................................................... 4

Communicable Disease Control ............................................................................... 5-10

Communicable Disease Report ........................................................................... 5-7

Immunization ....................................................................................................... 8

Rabies Program .................................................................................................... 9-10

Emergency Preparedness & Response ..................................................................... 11

Public Health Preparedness ……………………………………………………………………………11

Environmental Health & Injury Control ................................................................... 12-15

Lead poisoning Prevention .................................................................................. 12-13

Child Passenger Seat Program ............................................................................. 13

Matter of Balance ................................................................................................ 14

Mortality and Morbidity Data …………………………………………………………………………15

Family Health ............................................................................................................ 16-17

Children with Special Health Care Needs ............................................................ 16

Maternal Child Health Program........................................................................... 16-17

Early Intervention Program ...................................................................................... 18-19

Preschool Special Education Program ...................................................................... 20-23

Administration .......................................................................................................... 24

Records Management …………………………………………………………………………………….24

Corporate Compliance Program ……………………………………………………………………..24

2015 Net Costs to Delaware County ........................................................................ 25-26

Agency Summary ...................................................................................................... 27-28

DELAWARE COUNTY PUBLIC HEALTH ANNUAL REPORT 2015

>> 1 DELAWARE COUNTY PUBLIC HEALTH ANNUAL REPORT 2015


Chronic Disease Prevention Delaware County Priorities and Goals

Focus Area: Reduce Obesity in Children and adults

Goal: Create Community environments that promote and support healthy beverage choices and physical activity.

Objective: By December 31, 2017, at least 1 municipality will have passed a complete streets pol-icy.

Focus Area: Expand the role of public and private employers in obesity prevention

Goal: Increase breastfeeding exclusivity for the first 6 months of life, and continued breastfeed-ing duration for the first 12 months of life.

Objective: By 12/31/17 increase the 1% of employers with supports for breastfeeding at the worksite by 10%.

Complete Streets and Prescription Trails SUNY Delhi endorsed Complete Streets becoming the first SUNY campus to endorse complete streets. The town of Colchester and the Village of Walton each passed a Complete Streets poli-cy in 2015. The general public, local officials, planning board members and elected officials of villages, and towns were invited to meet Mark Fenton, a national public health, planning and transportation consultant and a former host of the “America’s Walking” series on PBS. Mark provided presen-tations on healthy community design and how it can be achieved to provide safe routes to schools, development of trails and walking/biking routes in communities. Mr. Fenton dis-cussed the economic, environmental and public health benefits of designing healthier neigh-borhoods and how communities can get started planning. On Wednesday, October 14th, Fen-ton spoke to the County Board of Supervisors and he presented Healthy Communities By De-sign: Economic, Environmental and Public Health at Farrell Student and Community Center Hall, on the SUNY Delhi Campus. On Thursday, October 15th, Building Healthy Communities Fenton hosted an open forum at Okun Theater, Farrell Student and Community Center, SUNY Delhi Campus. Mark Fenton conducted three walk audits with community members while he was in Delaware Count; the village of Delhi, the town of Colchester and SUNY Delhi Campus. An audit is an un-biased examination/evaluation of the walking and biking environment. The purpose of an au-dit is to identify concerns for pedestrians and bicyclists related to the safety, access, comfort, and convenience of the environment. The audits generated discussion and suggestions for walkability at each locality.


Chronic Disease Prevention

Breastfeeding in the Workplace

Outreach has been conducted to local businesses and to educate them on breastfeeding friendly poli-cies in the workplace. Meetings were held with local employers to educate them on the benefits of breastfeeding for mother and child and employer. Informational packets were created to assist em-ployers in learning how to support nursing mothers at work. Employers were educated on the NYS Nursing Mothers in the Workplace Act and provided guidance for developing policies and a designat-ed location for pumping. The majority of Delaware County businesses are supportive of their em-ployees who breastfeed. According to Delaware County birth certificate data, the breastfeeding rate for 2015 was 62.2%. While breastfeeding initiation rates are high during hospital stay, the rates decline post hospital dis-charge. Nursing mothers are utilizing lactation support counselors affiliated with the hospital. In an effort to increase local, ongoing, support, members of the Breastfeeding Coalition in October be-came Certified Lactation Counselors (CLC’s) Two of the members certified were Public Health staff.

Breastfeeding Coalition

Delaware County Breastfeeding Coalition meets bi-monthly. An important project and large under-taking was providing breastfeeding education to healthcare providers within Delaware County. A fly-er was created and hand delivered to providers throughout the county. A Resource magnet and tear poster, providing breastfeeding support resources in the county was cre-ated and distributed to agencies and providers that serve women. The Coalition participated in the World Breastfeeding Week WALK in Delhi, NY sponsored by Dela-ware County WIC. Social Media and local radio messages were disseminated during World breastfeeding Week August 1 -7, 2015.


Promote Mental Health

Delaware County Suicide Prevention Network is a committee comprised of individuals and community stake holders who are dedicated to reducing the high rate of suicide in Delaware County. Meetings are held on a monthly basis to review Delaware County da-ta on suicidal ideations/attempts and related deaths which is obtained from area hospi-tals. Members utilize the available data to develop strategies and plan educational train-ings to promote suicide prevention throughout the County.

Network members provided community based educational trainings on suicide prevention and postvention top-ics. The following evidenced based suicide first aid community trainings were provided:

Safe Talk workshops were held on May 19, with eighteen (18) participants and June 24, with twenty-six participants

ASSIST (2day) workshop was held on October 26 & 27, with sixteen (16) participants.

Members identified the need for a suicide prevention first aid training which was shorter in length to better ac-commodate community resident’s needs. Question Persuade and Refer (QPR) a one and half hour (1 ½ hr) evi-dence based program was selected. Currently there is one QPR facilitator in the county. Agencies and commu-nity groups who have expressed interest and or may benefit from being QPR trained include: DSS staff, law en-forcement, first responders (EMS, Fire Departments), veterans and senior citizens. QPR workshops were re-quested by Franklin, Charlotte Valley and Delhi school districts, SUNY Delhi College and Delaware County Proba-tion for 2016.

A suicide prevention display was created by network members and featured for the week at the Delaware Coun-ty Fair held August 15-20. On Wednesday a Sources of Strength presentation was given by South Kortright stu-dents and South Kortright counselor Terri Korba. Sources of Strength is an evidence based school program which teaches resiliency in children. A Sources of Strength display was provided at the Office of Aging Picnic.

On September 21, “Let’s Talk About It”, a free educational community forum on mental wellness was held at SUNY Delhi and in Sidney. A resource fair, presentation and panel discussion on the importance of mental well-ness was presented to community residents. A nationally renowned mental health speaker was the keynote speaker; panelists included representatives from law enforcement, mental health providers, clergy and suicide survivors. The event was funded with a grant awarded by the Constitution Pipeline. Sidney received 65 attendees and SUNY Delhi received 45 attendees.

On September 27, the Suicide Prevention Network participated in the American Foundation for Suicide Preven-tion (AFSP) Suicide Prevention Awareness WALK held in collaboration with SUNY Delhi’s KSE fraternity at the SUNY Delhi.


Communicable Disease Control

Communicable Disease Report A total of 1336 investigations and 495 cases were completed.

Gastrointestinal Illness

Campylobacter, Cryptosporidiosis, Giardiasis, Salmonellosis and Listeria were seen in Delaware County.

Hepatitis

There were 40 newly identified Hepatitis C cases and 5 new cases of Hepatitis B. The agency’s role is to determine possible source(s) of infections, provide patient and community education and col-lect data for New York State and the Centers for Disease Control (CDC).

Influenza

A total of 145 Laboratory confirmed cases of influenza were reported to DCPH.

Sexually Transmitted Diseases (STD)

Delaware County Public Health provides anonymous HIV and other STD testing and treatment at to cost to Delaware County residents. This is a contracted testing service provided by Family Planning of South Central New York. Clinic sites are located in Oneonta, Sidney and Walton.

HIV & STD Clinic Testing 2013 2014 2015

Test Positive Test Positive Test Positive

HIV Test 43 0 39 0 69 0

Chlamydia Test 39 5 43 1 179 9

Gonorrhea Test 39 0 43 0 179 0

Syphilis Test 16 0 23 0 11 0



Communicable Disease Report

In 2015, the Hepatitis C virus (HCV) reports continued to increase with note of both acute and chronic cases throughout the county. The mean population of HCV cases is 41.6 years of age. Of 39 new Hepatitis C reports (acute and chronic), 17 cases fell into the CDC defined high risk “Baby Boomer” population (born 1945 – 1965). There is no outbreak associated with the 2015 HCV re-ports. Chlamydia continued to show high numbers with 157 new reports; a mean age of 22.8 years is reported. There is no outbreak associated with the Chlamydia reporting however 52 of the reports are associated with the SUNY Delhi population. Lyme reports remain high throughout the entire county with 65 cases meeting NYSDOH case definition. The number of 2015 reports remain relatively consistent with previous years.

One case of Latent Tuberculosis (LTBI) was tracked in 2015. This was of a 21 year old, immigrant who received 9 months of medication.

A Pertussis outbreak in October was present in a local school system which involved a total of 11 individuals (2 adults, 7 high school students, and 2 elementary students). A total of 472 individu-als were identified as potential contacts and were notified by the DCPH staff.

A respiratory outbreak was identified in an adult assisted facility. A total of 34 residents and 6 staff members displayed various combinations of symptoms including: cough, sore throat, head-ache, and malaise. Flu swabs and Legionellosis testing were completed on 4 of the symptomatic residents however they came back negative. DCPH staff worked with NYSDOH to assist in pre-ventative measures for the facility to reduce the spread of illness.

Legionellosis became a concern in 2015 throughout New York state as there were increased re-ports of severe illness throughout the largely urban areas of the state. Delaware County encoun-tered 3 cases of Legionellosis. Two of the Legionellosis cases consisted of a married couple who had recently traveled outside of the state and did stay in a hotel. Of these individuals, 1 reported hospitalization for severe illnesses, however multiple comorbidities existed which exasperated the severity. Interviews by DCPH communicable disease staff determined that the hotel stay was not associated with the reported illness because the timeframe did not fall into the incubation period seen between the 2 cases. Potential sources within their home were identified through the interview process however, no confirmed source was ever identified. New York State De-partment of Heath Oneonta District office continued the investigation beyond the Delaware County Public Health efforts, a source of exposure was not identified through their department either.



Count of Reports and Cases by Illness

Total 2014 Total 2015

DISEASES REPORTS CASES REPORTS CASES

Anaplasmosis 4 3 6 0

Anthrax 2 0 0 0

Babesiosis 5 2 6 2

Burkholderia 0 0 0 0

Campylobacteriosis 17 13 45 28

Chlamydia 109 94 183 156

Cryptosporidiosis 8 6 9 4

E Coli 6 1 1 0

Ehrlichiosis 1 0 7 2

Encephalitis 1 0 14 1

Enterovirus D-68 6 1 0 0

Giardiasis 13 11 9 3

Gonorrhea 5 3 6 6

H1N1 1 1 0 0

Haemophilus Influenza 2 1 5 1

Hepatitis A 5 2 11 0

Hepatitis B 22 4 26 5

Perinatal Hepatitis B 4 0 2 0

Hepatitis C 300 *41 439 40

Influenza 78 74 171 145

Legionellosis 2 0 6 3

Lyme Disease 142 **34 166 64

Measles 0 0 5 0

Meningitis 2 2 1 0

Mumps 2 0 0 0

Pertussis 1 0 15 12

Q Fever 3 0 1 0

Rocky Mountain Spotted Fever 1 0 4 3

Rubella 0 0 0 0

Salmonellosis 16 9 13 4

Shigatoxin-Producing Infection 0 0 0 0

Strep, Invasive or Resistant 19 12 17 6

Syphilis 29 0 39 0

Tuberculosis 9 0 35 0

West Nile Virus 2 0 10 0

Varicella 1 0 0 0

Other 39 0 75 10

TOTALS 857 314 1336 495

** Numbers reflect Lyme Disease cases reported to NYSDOH that meet CDC Case Criteria only. Not all clinically

diagnosed Lyme Disease reports meet CDC Case Criteria. Hep C cases represent newly identified chronic cases.


Immunization Clinic Vaccinations

Age Group

Total Participants in Age Group

Number of Vaccinations Given

2014 2015 2014 2015

0-18 11 3 31 3

19-30 1 0 1 0

31-64 3 8 3 11

65+ 3 3 4 3

Total 18 14 39 17


Immunization

Each year the Center for Disease Control promotes national vaccine observances. Statewide, local health departments coordinate efforts to support CDC’s activities. This year the agency participated in the fol-lowing national events: National Infant Immunization Week, National Immunization Awareness Month, and National Influenza Vaccination Week. Public Health is grateful to the numerous community partners who assisted with outreach efforts. The CDC grant continues to fund efforts to improve vaccination rates by vaccinating insured and underin-sured children and adults and promoting the importance of vaccinations. The grant also focuses on reduc-ing perinatal hepatitis B transmission. New York State Public Health Law requires all mothers be tested for hepatitis B during pregnancy. Infants who are born to mothers who have not been tested or mothers who are infected with hepatitis B are at greater risk of acquiring infection during birth. Delaware County over-sees and provides coordination as necessary to assure at risk infants have received appropriate preventa-tive treatment, vaccination, and testing to reduce their risks from exposure. In compliance with the New York State Department of Health (NYSDOH) Immunization Action Plan Grant Delaware County Public Health visited four medical providers. Provider specific immunization statistics were gathered from the New York State Immunization Information System (NYSIIS) and presented. Suc-cesses were highlighted and areas for improvement were identified with the goal of maintaining and/or improving immunization practices, accurate NYSIIS data entry, and therefore improved vaccination rates. Delaware County Public Health continues to participate in the NYSDOH Vaccine for Children program. The Adult Hepatitis Vaccination Program was recently replaced with the NYSDOH Vaccine for Adults program expanding the number of adult vaccines available for administration under program guidelines. Free or low cost vaccination services are available for uninsured or underinsured children and adults who qualify.

Vaccine must be stored at specific tempera-tures. The agency maintains 24/7 data logging digital thermometers. To monitor vaccine storage and maintain its viability and effec-tiveness. Vaccine that is not stored properly must be discarded and replaced. In 2015, there was a large power outage, where vac-cine was successfully moved offsite to a stor-age location with a generator. There was no loss in vaccine.


Communicable Disease Control Rabies Program All animal bites and exposure reports are investigated as part of the rabies prevention program. A total of 268 bite reports were received, an increase of 25 from 2014. There were 23 animal to animal bite reports and 245 animal to human bite reports. Animal specimens are sent for rabies testing when indicated and all individuals requiring rabies post exposure treatment are followed through the completion of treatment. A total of 25 animals were sent for rabies testing and of these three were positive for rabies.

In 2015, a total of 1465 dogs, cats and ferrets received rabies vaccinations at free public clinics; a decrease of 439 from the previous year.

Animals Vaccinated at Free Public Health Rabies Clinics

2012 2013 2014 2015

1465

1872

1716

1904

1200

1400

1800

1600

An

ima

ls V

accin

ate

d

Number of Animals Tested for Rabies 2015

Specimens Positive Negative Total Untestable

Bat 0 7 7 0

Cat 1 4 5 0

Dog 0 2 2 0

Raccoon 1 2 3 0

Cow 0 2 2 0

Other 1 5 6 0

Total 3 22 25 0

1000



Rabies Program Continued:

Animal to Human Bite Reports by Town in 2015

Town Bat Cat Dog Other

Andes 0 1 4 0

Bovina 4 1 1 0

Colchester 0 2 4 0

Davenport 0 4 4 2

Delhi 7 9 8 8

Deposit 0 2 3 0

Franklin 2 5 11 0

Hamden 0 0 3 1

Hancock 0 1 6 0

Harpersfield 0 0 1 0

Kortright 0 4 1 1

Masonville 0 0 1 0

Meredith 0 3 10 1

Middletown 4 12 12 1

Out of County 1 1 13 3

Roxbury 0 2 3 0

Sidney 7 6 22 1

Stamford 0 4 2 0

Tompkins 1 0 0 0

Walton 9 8 13 1

*Out of Town 0 1 4 2

Total 35 62 127 21

*Note: Bites occurred out of county but residents lived in Delaware Co., therefore Dela-ware County case follow-up was required. Other may include: fox, raccoon, skunk, cow. Report does not include the # animal to animal bites


Emergency Preparedness & Response Public Health Preparedness Ebola preparedness continued throughout 2015. Staff training occurred monthly to build skills in safe Ebola response measures and use of appropriate personal protec-tive equipment. Additionally, local healthcare partners (hospitals, EMS, Emergency Management) collaborated with Delaware County Public Health (DCPH) to develop county wide procedures and training in response to the presentation of a local Ebola patient. DCPH was able to participate in a New York State Department of Health (NYSDOH) Tabletop exercise which involved parties from all healthcare and public health sectors on the local and state levels. Staff training included National Incident Management System (NIMS) training, HSEEP, disease control and surveillance, communication management, outbreak manage-ment, volunteer management, and mass vaccination point of distribution training. A Medical Countermeasures Dispensing drill was conducted May 2015. The drill called, Silent Strike, tested the county health department capabilities to distribute medical countermeasures to the population as a response to the release of a harmful biological agent in the area. The success of the drill was accomplished through part-nerships and participation of: Delaware County Emergency Management, Delaware County Information Technology, Otsego County Public Health, the Bassett Health Care network, Chenango Area Hospice Association, and the American Red Cross, SUNY Delhi, Delaware County staff as patient volunteers, and the Delhi American Legion. A variety of communication drills were also held throughout the year with local coun-ty partners, volunteers and NYSDOH to test the capabilities of DCPH to distribute im-portant health information in a timely and effective manner. Public Health disaster plans were reviewed as well as new plans developed in regards to disaster response procedures, and specimen shipping. In addition, the Delaware County Comprehensive Emergency Management Plan (CEMP) was updated with in-put from the DCPH.

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Environmental Health & Injury Control

Child Lead Poisoning Prevention

The Lead Poisoning Prevention Program goal is to reduce the risk of lead exposure to children and pregnant women and prevent, reduce or mitigate childhood lead poisoning. This is accomplished through outreach and education activities and case management services. Lead poisoning prevention activities include family based outreach and education. A birth packet was mailed to parents of new-borns which included information on lead poisoning prevention. Public Health nurses provided infor-mation about lead poisoning and risk reduction to families during maternal child health home visits and at WIC sites. A written risk assessment tool was used to help families assess their risk for expo-sure to lead.

Community based education included billboards, print media and radio messaging. Health care pro-viders were given information via site visits, mailings and informational meetings.

Case management services were provided to families of children with elevated blood lead levels. Services include monitoring lead levels, providing education and assisting parents with appointments for follow up testing. Home visits are made with the NYS District Office to determine location and type of environmental factors impacting lead levels. Information on mitigating sources of lead expo-sure is provided by to families by the District Office staff person.

Intervention Strategy by Blood Lead Level

Lead Level Intervention

5-9 ug/dl Information letter and educational material on lead exposure reduction sent for 1 year olds

10-14 ug/dl Telephone call and follow up information letter and educational material on lead exposure reduction. Case management to ensure blood levels decrease.

15-19 ug/dl Home visit by DCPH and Environmental Health staff to perform assessment and to educate parents on lead exposure reduction, identify source of lead, and pro-vide information on effective abatement strategies. Case management to ensure blood levels decrease. 20-44 ug/dl

45-60 ug/dl

In addition to intervention for 20-44 ug/dl level, notify Department of Health, con-duct home visit within 24 hrs of notification of elevated level and follow-up blood test within 48 hrs.

Lead Testing Rates (% of children tested)

Age Group 2014 2015

One Year Old 60.9% 61.7%

Two Year Old 52.1% 59.6%

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Environmental Health & Injury Control Child Lead Poisoning Prevention Child Passenger Safety Program The Child Passenger Safety Program coordinated by The New York State Governor’s Traffic Safety Committee provides grant funding for Certified Child Passenger Safety Technicians to train the pub-lic on correct installation and use of their child’s safety seat or booster seat. Seats are checked for proper fit for the size of the child; and to determine whether the seat had been recalled, or exceed-ed its viable lifetime. If car seat technicians are unable to safely install a car seat owned by a family, a new car seat is provided at no cost to families. Public Health also contracts with Delaware Oppor-tunities to provide car seats to low income families and to provide monthly fitting stations at their office in Hamden NY. Public Health has five certified technicians on staff. 317 car seats were distrib-uted in 2015.

2015 Car Seat Fitting events:

Children's Festival at Delaware Opportunities - June 24th 2015 - 35 seats checked, 14 seats replaced

Delaware National Bank of Delhi - July 17th 2015 - 6 seats checked, 2 seats replaced

Sidney McDonalds (With Sidney Village Police) - August 1st 2015 - 5 seats checked, 1 seat replaced

DC4 Childcare Center - September 17th 2015 - 8 seats checked, 4 seats replaced

Number of Children Newly Identified With Elevated Blood Lead Levels

Lead level 2010 2011 2012 2013 2014 2015

10-14 ug/dl 6 0 7 3 3 10

15-19 ug/dl 1 1 2 3 2 0

20-44 ug/dl 2 2 0 0 2 0

45-60 ug/dl 0 0 0 0 0 0

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Environmental Health & Injury Control A Matter of Balance

Public Health collaborates with Office for the Aging to offer the Matter of Balance Program to Delaware County Seniors. Matter of Balance is an evi-denced based fall prevention program. In 2015, a total of 4 Matter of Bal-ance sessions were offered serving 45 unduplicated senior residents of Delaware County. The first series was implemented at Delaware Valley Hospital; the class ran from April 6th to June 1st, with 8 people in attendance. A 4 week session held 2x per week was held in Meredith with 10 people attending from May 4th- June 4th. In Downsville, two Matter of Balance classes were held due to a large in-terest in the program. The first series was held June 6th-August 10th, 14 people attending. The second class was held in the fall starting October 5th and ending November 23rd, with 13 people were in attendance. Office for the Aging and Public Health anticipate recruiting more volunteer coaches and plan to conduct another coach training in 2016.

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Environmental Health & Injury Control

Mortality and Morbidity Data

CAUSE OF DEATH 2012 2013 2014 2015

Accidents 16 12 14 8

AIDS Related Illness 1 1 0 0

Alzheimer’s 1 0 0 0

Cancer 106 109 105 105

Chronic Obstructive Pulmonary Disease (COPD) 36 31 40 42

Cirrhosis of the Liver 5 4 5 5

Congenital Anomalies 0 0 1 3

Dementia 27 21 36 26

Diabetes Mellitus 0 1 1 4

Drug Overdose 2 0 2 5

Gastritis, Enteritis, Colitis, Diverticulitis 0 1 1 2

Heart & Circulatory Diseases 200 213 155 135

Homicide & Legal Intervention 1 1 0 0

Multiple Organ Failure 10 3 5 5

Neurologic Disease 8 1 3 6

Pending Investigation (Sent for Autopsy) 7 3 1 4

Pneumonia/Diseases Pulmonary Circulation 47 42 41 67

Renal Failure 12 15 18 18

Septicemia 13 16 19 8

Suicide 10 9 9 5

Tuberculosis 1 0 0 0

All Other Causes 14 11 13 10

TOTAL DEATHS *Deaths are reported to the county in which a person resides.

517 494 469 459

TOBACCO LISTED AS A CONTRIBUTING

FACTOR TO DEATH

Year Yes Probably Total Deaths

2015 58 49 459

2014 59 45 469

2013 59 54 494


Family Health

Children with Special Health Care Needs

The Children with Special Health Care Needs (CSHCN) and Physically Handicapped Children’s (PHCP) program is funded by the New York State Department of Health. The program assists families with children from birth to 21 years of age with special health care or educational needs. The program provides resources to address their identified needs, and referrals to appropriate agencies. The PHCP program provides financial assistance for medical care and support services and care coor-dination to services to families in this program. Three families received care coordination this year. Care coordinators helped families access both medical follow up and educational evaluations. Referrals were made so that families could access programs that would help pay for needed services. On May 21 at SUNY Delhi a training for families and professionals was sponsored by CSHCN grant. Occupational Therapist, Lindsey Biel presented on focusing on sensory needs of children and how providers and caregivers can work with them. One hundred and four people attended, 24 were fam-ilies of children with special needs. Resources for families were distributed. This conference re-ceived positive reviews from attendees. Outreach was provided at: Advisory Board for Delaware Opportunities, Child Passenger Safety Events, Hancock Children’s Center, and School Based Health Center Clinics.

Maternal Child Health Program

Nurses in the Maternal Child Health Program provide home visits to pregnant women, new mothers and newborn infants. Referrals are accepted from hospitals, health care providers, community agen-cies and clients or their families. The nurse provides health guidance to promote the physical, emo-tional, mental and social well-being of mothers, babies and their families. Education on pregnancy, nutrition, labor and delivery, family planning, infant care, breast-feeding and parenting is provided. The frequency and number of home visits is based on the needs of the family. The agency also serves as a resource to direct clients to other community services.

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Family Health Maternal Child Health Program

Births by Hospital HOSPITAL 2012 2013 2014 2015

Albany 23 19 16 17

Bassett 103 104 130 109

Catskill Regional Medical 5 4 5 6

Chenango Memorial 16 19 22 13

Crouse Hospital 0 4 3 1

Fox 148 113 110 95

Home 4 13 6 7

Kingston Hospital 10 6 2 2

Lourdes 23 28 18 25

Northern Dutchess 7 6 12 13

Wilson—UHS 69 49 56 53

Other 15 1 18 8

TOTALS 423 366 398 349

Births By Town

Town 2013 2014 2015

Andes 3 6 9

Bovina 1 3 3

Colchester 9 6 11

Davenport 28 37 30

Delhi 41 42 20

Deposit 10 14 11

Franklin 9 15 16

Hamden 14 13 5

Hancock 17 27 20

Harpersfield 2 4 5

Kortright 19 11 9

Masonville 8 6 11

Meredith 11 10 12

Middletown 19 30 17

Roxbury 14 22 12

Sidney 71 64 73

Stamford 21 36 23

Tompkins 13 3 6

Walton 56 48 56

Unknown 0 1 0

TOTALS 366 398 349

Percentage of Mothers Who Reported

Smoking During Pregnancy in 2015

Smoked

During

Pregnancy

29%

Did Not Smoke

During Pregnancy

71%

The percent of Delaware County women who smoke during

pregnancy is above both the New York State and national

average smoking percentage rates.

Early Intervention The Early Intervention Program is a statewide program that provides services to children under age 3

with developmental delays or children who are at high risk for developmental delays and their families.

Services include case management, evaluation, transportation, therapies, counseling and special

education. Services are provided in any setting in which the child typically lives and plays.

There were 141 children who were actively enrolled and received services this year. There are no Early

Intervention evaluator agencies physically located in Delaware County. There is a shortage of available

evaluation services to service Delaware County. Some evaluators will travel closer to Delaware County to

allow parents to access their services. The closest evaluator is Springbrook, Inc., Oneonta, NY.

Springbrook Provides evaluation services to more than one county.

The Local Early Intervention Coordinating Council (LEICC) met in March and September. The LEICC

members help identify gaps in service and offer support and possible resolutions. Speech therapy

continues to be the most needed service in the county. There continues to be a shortage of occupational

therapy, physical therapy and nutritional services. The agency continues to try to look for ways to expand

services and work with New York State Department of Health to address barriers that contribute to the

therapy shortage and lack of evaluation agencies. The Speech

Pathologist position within the agency was filled from April to

October.


School District #

Children

Andes 2

Charlotte Valley 9

Delhi 21

Deposit 5

Downsville 10

Franklin 4

Hancock 2

Margaretville 2

Oneonta 7

Roxbury 3

Sidney 28

South Kortright 5

Stamford 11

Unadilla 3

Walton 29

Total 141 0

50

100

150

200

250

300

2010 2011 2012 2013 2014 20152010 2011 2012 2013 2014

276

242

105

170 154

# o

f C

hil

dre

n

0

100

200

Number of Children in EI and Child Find

300

141

2015

Early Intervention


Total Referrals = 120

0 5 10 15 20 25 30

ANDES

CHARLOTTE VALLEY

DELHI

DEPOSIT

DOWNSVILLE

FRANKLIN

HANCOCK

MARGARETVILLE

ONEONTA

ROXBURY

SIDNEY

SOUTH KORTRIGHT

STAMFORD

WALTON

EI/Child Find Referrals by School District in 2015

0 5 10 15 20 25 30

Andes

Charlotte Valley

Delhi

Deposit

Downsville

Franklin

Hancock

Margaretville

Oneonta

Roxbury

Sidney

Walton

South Kortright

Stamford

2

7

22

27

2

5

3

4

2

8

4

4

9

21

0

Preschool Special Education Program

The Preschool Special Education Program provides educational services to children ages 3-5 years old, who have a disability that affects the way they learn. Eligibility for services is determined by the child’s individual school district’s Committee on Preschool Special Education (CPSE) . The CPSE’s decision of eligible services for each child is determined by the committee following part 200 of the New York State regulations of the Commissioner of Education. The CPSE creates an Individualized Education Program (IEP) for the child. Parents have a choice of 7 evaluators to complete educational evaluations for their preschool child. These evaluators are approved through New York State Education Department. Delaware County contracts with individual providers for related services, as well as 7 school districts where children attend Universal Preschool or the district’s own preschool program. Professionals include: Speech and Language Pathologists Occupational Therapist Speech Therapist Physical Therapist Special Education Teachers Teacher of the Visually Impaired Teacher Of Deaf In addition Delaware county contracts with 6 integrated preschool programs: Carousel Children’s Services (a program of the ARC of Delaware County) located in Delhi, New York Center for Spectrum Services located in Kingston, New York Family Enrichment Network located in Norwich and Johnson City, New York Handicapped Children’s Association located in Johnson City, New York Kids Unlimited (a program of Springbrook, Inc) located in Oneonta, NY Whispering Pines located in Cobleskill and Delanson New York Carousel Children’s Services continues to be the only in-county evaluator and integrated preschool program. Delaware County has been contracting with a transportation consulting group, VMC, Inc., (Value Management Consultants) to help defray the cost of preschool transportation for the county. VMC’s function is to keep the preschool transportation costs down by providing routing functionality and to field transportation questions and concerns from the county, integrated preschool programs, and transporters regarding the transportation of preschool children. VMC also assisted in the transportation bidding process in the summer of 2014. The VMC’s new ideas to the bidding process and routing strategies have begun to positively impact transportation costs.




# C

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ices

Number of Preschool Children Receiving

Services in Delaware County 2010-2015

Related

Services

Center

Based

2010 2011 2012 2013 2014 2015

116 111 129 118 123 121

54 55 60 48 40 46



2015 Preschool Students by School District

Nu

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of

Stu

den

ts

Nu

mb

er o

f S

tud

ents

2015 Preschool Evaluations by School District

0

5

10

15

20

25

30

CB

RS

Related Services Center Based Services

Children found eligible for services Children found not eligible for services

0

2

4

6

8

10

12

14

16

18



2015 Preschool Related Services by Type

Speech Therapy

Physical Therapy

Occupational Therapy

Parent Training

Brookside

Carousel

2015 Preschool Center Based Enrollment

Handicapped Children's Association

Springbrook

Child Development Council

Whispering Pines

30%

5% 12%

53%

2%

72%

7%

7%

6%

6%

>> 24

Administration

Records Management

All records for Public Health are retained according to the Records Retention and Disposition Schedule (CO-2), a published reference tool from State government records services that lists how long specific records must be retained and when they can be disposed of legally. The records are stored in appropriate boxes with labels that list what the contents are as well as the retention period and disposition date. The boxes are stored on marked shelving units in a locked room. Public Health contracts with a shredding company who comes quarterly to shred records on site. In 2015, a total of 55 boxes of records had exceeded the retention period and were destroyed.

Corporate Compliance Program

The Public Health corporate compliance program was developed to ensure standards of care, ethical behavior and compliance with all applicable federal, state and local laws and regulations governing the agency. Compliance Program policies and procedures are in place to identify and report fraud, waste, and abuse of public resources. The Public Health Director annually certifies to the NYS Office of the Medicaid Inspector General (OMIG) that the agency compliance program satisfactorily meets requirements of NYS Social Services Law ("SSL") Section 363-d and 18 NYCRR Part 521. The compliance committee uses a team approach to ensure the identification, investigation and correction of compliance problems and met four times in 2015 to discuss any potential compliance risks.

Accomplishments for 2015:

- Compliance Policies and Procedures were reviewed and updated

- A process was implemented to ensure completion of the Yearly Financial Index for EI clients

- The committee identified that numerous self-evaluation activities are conducted to ensure early detection of fraud and abuse. A tool was developed to document any issues identified and the results of these activities will be included in the Quarterly QA report.

- It was identified that one preschool service provider’s session notes did not meet Medicaid standards. DCPH staff worked closely with the provider on needed documentation. Medicaid was not billed for these services until documentation met Medicaid standards.

- ICD-10 was successfully implemented.


2015 Net Costs to Delaware County


Delaware County Public Health Services provides 6 Core Public Health functions; Chronic Disease Prevention, Communicable Disease Control, Family Health, Environmental Health, Emergency Pre-paredness and Response, and Community Health Assessment. These 6 core functions are funded by New York State Aid Article 6 funding. Article 6 funding reimburses net expenses (expenses-revenue) excluding fringe benefits and mal-practice insurance at 100% up to our cap of $500,000 and then reimbursement drops to 36% for the remainder of eligible expenses. Early Intervention and Preschool Special Education are two federally mandated programs which are ineligible for New York State Aid Article 6 funding. These programs are partially funded via the EI Administration grant, Private Insurance, Medicaid, New York State Department of Education and New York State Department of Health. Delaware County Public Health Services continues to receive the following grants: A Lead Poisoning Prevention grant which provides $27,379 to increase awareness of lead poi-

soning, identify high-risk populations, increase lead testing/screening and provide follow-up to children with elevated lead levels.

A Children with Special Health Care Needs grant which provides $17,553 to reduce or elimi-nate gaps and barriers which prevent families of children with special needs from obtaining insurance, health services, and community resources and assist them with navigating the healthcare system.

A Rabies grant which provides $14,545 for human post exposure treatment, specimen ship-ment and testing, and pet vaccination clinics.

An Immunization Action Plan which provides $30,000 to increase immunization rates, improve immunization records, and promote immunizations through education and training.

A Public Health Preparedness grant which provides $52,096 for planning, training and exercis-es in preparation for a public health emergency.

An Early Intervention Administration grant which provides $21,313 for administration of the Early Intervention program including, Child Find, Outreach and Education, and ensuring ser-vices are available.

A Child Passenger Safety grants which provides $23,500 to increase the proper use and instal-lation of child safety seats through a distribution program, fitting station and car seat check events.

In 2015 Delaware County Public Health was awarded an additional grant of $38,000 to acceler-ate preparedness planning and operational readiness for responding to Ebola Virus Disease (EVD).




Administration

Chronic Disease Prevention

Community Health Assessment

Family Health

Environmental Health


Emergency Preparedness & Response

Early Intervention

Preschool

$1,115,822 (69%)

$230,263 (14%)

$64,740 (4%)

$33,020 (2%) $4,241 (<1%) $33,346 (2%)

$21,783 (1%)

$74,214 (5%)

$36,038 (2%)

Agency Evaluation Summary

The Health Services Advisory Board (HSAB) met on the following dates: 1/23/15; 4/23/15; 5/28/15;

7/30/15; 9/24/15; and 11/19/15. The advisory board includes the Community Health Committee

of the Board of Supervisors. The HSAB is responsible for approving new and revised policies and

procedures and provides quality assurance functions including review of quarterly QA reports,

patient complaints and any other issues/concerns that may arise. The HSAB provides administrative

oversight to the agency. The Medical Director attends and participates in the meetings and also

signs non patient specific orders for the Article 28 immunization clinic. The Medical Director is

available on a 24/7 basis and the Medical Advisor is also available to the agency as needed.

2015 was a year of transition and new roles. A new program coordinator position was filled in

January to coordinate some of the detailed projects required by the Agency’s Community Health

Improvement Program. The Speech Language Pathologist position was filled in April, allowing

more children in both Early Intervention and Preschool programs to receive speech therapy. Bonnie

Hamilton, Public Health Director retired as of April 17, 2015 after 25 years of service in Public

Health. The transition of Public Health Directors left the Epidemiologist position vacant until June.

In October the Speech Language Pathologist position became vacant once again.

The Community Health Improvement second year activities were implemented in 2015.

The two major priority areas are preventing chronic disease; and promoting mental health and

preventing substance abuse. Complete Streets second year project activities included SUNY Delhi

College adopting a Complete Street campus, continued engagement of municipalities to sign

policies and national speaker, Mark Fenton presenting to SUNY Delhi and the Delaware County

Board of Supervisors. Businesses were engaged to assess breastfeeding support for mothers

returning to work. The Suicide Prevention Network continued strengthen in attendance and

priorities were established to direct the group where to where to focus its efforts.


Agency Evaluation Summary Continued:

Public Health has been very actively involved in New York State’s healthcare transformation

initiative. New York State has created a healthcare alignment model with the goal of improving

population health, transforming healthcare delivery and eliminating health disparities. This

includes the State Health Innovation Plan (SHIP), the Population Health Improvement Plan (PHIP),

Delivery System Reform Incentive Payment Program (DSRIP) and the Prevention Agenda. The

State Health Innovation Plan (SHIP)-New York’s State Health Innovation Plan is our roadmap to

achieve the “Triple Aim” for all New Yorkers: improved health, better health care quality and

consumer experience, and lower costs. The Population Health Improvement Program includes

supporting the SHIP, Prevention Agenda and DSRIP via identifying strategies to improve health.

Delaware County belongs to the Southern Tier PHIP, 1 of 11 in NYS (Chenango, Delaware, Broome,

Tioga, and Tompkins). DSRIP is a Medicaid led initiative to reduce avoidable hospital use by 25%

over 5 years through transforming NYS health Care system into a financially viable high performing

system. The DSRIP model includes Performance Provider Systems (PPS). There are three that

include Delaware County-Care Compass (Southern Tier; UHS and Lourdes), Leatherstocking

(Bassett), and Westchester Medical Center. DSRIP principles include patient centered,

transparent, collaborative, accountable and value driven.

Chlamydia is a sexually transmitted infection that continues to be on the rise. Supporting STD

data and education was provided to a student and parent group at Delaware Academy and

Central School District to assist them in asking the school board to allow STD testing and

treatment within its the school based health center. Delaware Academy and Central School

District board of education voted yes to STD testing and treatment services in the fall of 2015.

Hepatitis C cases continue to increase and pertussis was persistent in one of the local school

districts.

Staff trained monthly with Ebola PPE per New York State Ebola preparedness protocols.

The agency continues to have a collaborative relationship with the NYSDOH District Office located

in Oneonta, NY. The District Office and our agency worked together on the legionella cases and

source identification and cooling tower and surveillance related to the New York State legionella

outbreak.


Agency Evaluation Summary Continued:

Early Intervention and Preschool Special Education programs are required services that are not

included as part of core services and therefore not eligible for Article 6 state aid reimbursement.

Preschool Special Education expenses continue to be the largest portion of the budget. The

number of children in preschool children remained steady. The number of EI children has

decreased, slightly. Delaware County continues to contracted with VMC consulting group to assist

in the coordination of routing with the goal of saving dollars in the transportation budget.

Springbrook integrated preschool in Oneonta, NY increased from 2 to 2 classrooms to

accommodate the increase in children requiring integrated center based services.

The Community Improvement Plan strategies and activities will continue to be implemented over

the next 2 years. Healthcare transformation will continue, the rise in drug use, need for

emergency preparedness, disease surveillance and chronic disease prevention and continued

collaboration with our partners will remain priorities in 2016.


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