SENATE BILL 969

THE TALHO INSIDERChild Care Center Nutrition & Physical Activity Education Pilot Project

The 2011 Biosurveillance Conference

County Health Rankings Stimulates Discussions about the Public Health System Improvement

Tech Tip

and more...

PresidentCelestino GarciaMidland Health Department

President-ElectEduardo OlivarezHidalgo County Health and Human Sercives

Vice-PresidentLou FranklinWichita Falls-Wichita County Public Health District

Past PresidentBing BurtonDenton County Health Department

Secretary / TreasurerMatt RichardsonAmarillo Department of Public Health

Executive DirectorLee A. Lane

Members-At-LargeStephen L. WilliamsHouston Department of Health and Human Services

Michael HillCity of El Paso Department ofPublic Health

Volume III, Issue II

September 2011

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MESSAGE FROM THE EXECUTIVE DIRECTORHaving come to a close, the Texas 81st Legislature is behind us. TALHO participation was greater than the past sessions. Although there were many cuts in public health programs there was one piece of legislation passed that we believe is one of the most important pieces of legislation in more than two decades. Senate Bill 969, filed by Senator Jane Nelson and sponsored by Representative Lois Kolkhorst and signed by Governor Perry, will create a standing Public Health Funding and Policy Committee. The Committee is made up of five local health departments’ representatives, two regional health directors, and two faculty from schools of public health.

Local health officials often learn about funding for public health priorities only weeks or days before funding is allocated, and funding allocation decisions are frequently made without regard to the specific public health needs of the communities. Local

health officials are the “boots on the ground” in dealing with public health issues. They should be involved in setting policy priorities. Now they have an established means to communicate their concerns and suggestions to the Department of State

Health Services. The Committee will meet to define core public health functions for state health departments, evaluate public health in the state and identify areas that need improvement, funding available to perform these functions, and establish policy priorities for the Department of State Health Services to use in allocating money available for core public health services.

The committee’s policy priorities must be in accordance with prevailing epidemiological evidence, variations in geographic and population needs. The priorities must also be in accordance with state and federal law and federal funding requirements.

At least semiannually the committee must make formal recommendations to the Department of State Health Services on the use of funds available exclusively to local health departments to perform core public health functions and on the allocation of the available funds throughout the state. The Committee must also produce an annual report on the implementation of their duties. The bill requires that the Committee provide opportunities for public testimony at least twice a year and that the Department of State Health Services create a plan to transition from a contractual relationship to a cooperative agreement relationship with local health departments. It also requires the Department of State Health Services to file an annual report with the Governor, Lt. Governor and Speaker on the implementation of the Committee’s funding and policy recommendations and explanations on why they did not implement any of the recommendations.

The bill takes effect on September 1, 2011 and the committee must be formed no later than October 1, 2011. The Committee shall have its first meeting no more than 30 days after it is formed. This bill is not subject to sunset prior to 2023.

Thanks go to the TALHO Board of Directors, the TALHO Membership, the TALHO Lobby Firm, the TALHO staff and others that assisted in seeing the bill created, introduced, heard in committees by both the Senate and the House and finally passed and signed into law.

Lee Lane

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MESSAGE FROM TALHO PRESIDENTWOW!! What a year with the passing of SB 969 and challenges forth coming in Public Health. I want to give thanks to Lee Lane and Nancy Fisher for all that they do, and as well to TALHO staff and membership. We know that our members want to know how we are doing as an association. Our passion and focus on performance, membership and the citizens that we serve continue to propel TALHO forward. This passion is what drives us to always improve for our membership, and our communities. We strive to be much more than an association, our determination is what makes a positive difference. TALHO is being looked to by locals, non-profit partners and public health associations to lead and provide guidance in determining community needs.

As a leadership organization comes great responsibilities. We continue to demonstrate courage and tenacity to lead. We must hold on to our principles.

It’s never easy to lead. THE TEAM IS STRONG AS THE MEMBERSHIP STANDS TOGETHER.

Sal Garcia

Enhance Public Health Opportunities for Members

Identify and promote best practices, funding and new relationships

Maintain updated member directory information

Identify and engage new partnerships to enhance local public

health

Advance Development of Voluntary Public Health Accreditation

Maintain a working relationship with the Public Health Accreditation Board (PHAB)

Maintain monthly meetings of the Public Health Accreditation Council of Texas

Engage TALHO Membership in PHACT

activities

Represent the Collective Interest of Local Public Health

Identify the potential for hiring a lobbyist

Identify priority issues

for a Legislative Agenda

Maintain a lobbyist for

TALHO

Enhance the Use of Technology Services

Enhance the use of technology by members

Identify outside technology opportunities that will generate revenue for

TALHO

Enhance TALHO’s Relationship with Partners

Enhance communications with partners

Identify mutually agreed upon priorities and actions with

partners

TALHO Strategic Map 2010 - 2012

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ADVOCACYJanet Emerson Public Health Servant Award

TALHO’s Highest Accolade For Local Public Health Servants2011 RecipientLee A Lane, Executive Director, TALHO

Lee Lane has served as the only TALHO Executive Director since 2000. Prior to that in a span of over 25 years Lee carved out a name for himself as a public health advocate. He participated in many workforce committees and task groups and positioned himself as a voice for Public Health and particularly Local Public Health. He participated on the Governor’s Task Force and subsequent passage of the Primary Health Care Services Act in 1985 (HB1844); assistance with passage of the Child Passenger Safety Seat System in 1984 (SB 3); assistance in legislation enabling the establishment of the first rural health clinic in Texas to receive cost-based reimbursement under the Federal Rural Health Clinic Act; and participating in a trip across the Texas-Mexico border in search of Mexican markets and herbalist selling raw products for the tea-gordolobos for the treatment of tuberculosis. It was later proven to have a toxic substance that caused serious side effects, and in one case death, in Texas tuberculosis patients that were taking both TB drugs and the tea-gordolobos. This led to a change in the interviewing of tuberculosis patients including taking an herb medical history. Two years prior to the September 11, 2001, terrorist attack, TALHO recognized bioterrorism as a viable threat. Many local health departments did not have telecommunications technology. Under Lee’s leadership, and with assistance from the Texas Telecommunications Infrastructure Board and the Centers for Disease Control & Prevention, TALHO accepted the challenge of building a new communications network. This was the beginning of the statewide Health Alert Network (HAN) system and is now part of a broader initiative known as the Public Health Information Network (PHIN). Of particular note, Lee oversaw the passage of two pieces of legislation that greatly impacts local public health:

• Senate Bill 9 in the 79th Legislative Session requires that the state health department include TALHO, TACHC and TORCH in the Texas Health Alert Network to the extent federal funds for bioterrorism preparedness are available for that purpose.• Senate Bill 969 in the recent 82nd Legislative Session that creates the Public Health Funding and Policy Committee, requiring five of the nine representatives on the committee are from local public health entities.

These pieces of legislation ensure that local public health has a presence and voice in the development of policies, implementation of

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ADVOCACYprograms, and allocation of funding directed specifically to local health departments.

The Janet Emerson Public Health Servant Award is presented annually to an outstanding public health employee who has demonstrated extraordinary performance with an exemplary commitment to local public health. As TALHO’s highest honor, this award is a means of expressing gratitude, recognition and encouragement of professional accomplishment in public health at the local level.

This award serves as a living memorial to Janet Emerson, who served her community as Chief Executive Director of the Waco-McLennan County Public Health District from 1983 until medical retirement in August, 2004. During her tenure, Janet successfully responded to many public health issues with her strength of will, affection, judgment, idealism, and achievement that will last a lifetime.

Development and Passing of Senate Bill 969

An update on the passage of Senate Bill 969 creating the Public Health Funding and Policy Committee was provided in the Executive Director message. Creating and passing the bill required time, persistence, communication skills and knowing your audience. Here is a timeline from idea to reality and the type of work involved by the TALHO Staff and Members:

Concept Development March 2010 – August 2010Beginning in March, TALHO began work on determining how to increase the ability of LHDs to plan and deliver local public health services outlined in the Texas Health and Safety Code, Chapter 121, Local Public Health Reorganization Act. A review of in-state and out of state processes determined that the development of a committee with representation from local public health might assist the Department of State Health Services in reviewing policy development and funding allocation to local health departments. The TALHO Board began development of a White Paper on Public Health Infrastructure. Discussions were held on developing a Texas bill on public health policy and funding.

Drafting the Bill September 2010 – January 2011 TALHO began internal and external meetings to determine the process and content of drafting a bill to develop a public health funding and policy advisory committee. By November of 2010 a first

Stages of the BillStage 1: Bill filed by Nelson on 2/25/2011.

Stage 2: Bill reported out of Senate committee on Health & Human Services with vote of 9 Ayes, 0 Nays, 0 Present Not Voting, 0 Absent. 3/28/2011

Stage 3: Bill passed the Senate. 4/7/2011

Stage 4: Bill reported out of House committee on Public Health with vote of 10 Ayes, 0 Nays, 0 Present Not Voting, 1 Absent. 5/18/2011

Stage 5: Bill passed the House. 5/27/2011

Stage 6: Bill signed by the Governor. 6/17/2011

Stage 7: Bill becomes law. Effective on 9/1/11.

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draft of a legislative bill was created to develop a Public Health Policy and Funding Advisory Committee, whose charge would be to review the use of federal funds to implement public health services at the local level. Meetings were held with Senator Jane Nelson’s office on the development of the bill. By the end of December the White paper was completed. TALHO, with partners, sponsored a Legislative Breakfast on Local Public Health on January 12 at the Capitol. The White Paper was disseminated and TALHO members met with their local legislators to educate them on the functions and activities of local public health departments.

Filing the Bill February 2011 After months of work by TALHO staff, members and partners, Senate Bill 969 was filed creating the Public Health Policy and Funding Committee. Meetings continued with partners and legislators to discuss the bill and its intent. (See the box on page 5 for the stages of the bill)

Following the Bill March 2011 - May 2011After a bill is filed it awaits appointment to a committee to be heard and receive public comments. Senate Bill 969 was referred in March to the Senate Health and Human Services Committee. A public hearing was held that month, allowing TALHO staff and members to provide oral and written testimony on the work conducted by LHDs. Other partners registered their support for the bill. The bill passed favorably out of committee with no opposition. A second Legislative Breakfast was held at the Capitol on March 29. Representative Lois Kolkhorst, Chair, Committee on Public Health, attended and spoke at the Breakfast, voicing appreciation and support for work by LHDs. The Senate Bill 969 was laid before the Senate in April and passed with no amendments. It was engrossed and referred to House to begin the process all over again. In May, the bill was referred to the House Committee on Public Health, testimony was heard from TALHO members and the bill was reported out favorably. Again, other partners registered their support for the bill.

Final Passing of the Bill May 2011In the final leg of the journey, the bill was heard on May 25 and was passed by the House. A report was enrolled and signed in the Senate. The bill was on its way to the Governor for signature.

Signing of the Bill and Effective Date June 2011 Governor Rick Perry signed the bill on June 17. A long and sometimes nail-biting process was completed. However the next step is still to come. On September 1, 2011 the bill goes into effect. Between now and then, DSHS will receive nominations for the nine positions on the committee and by November 1, 2011 the committee will begin its work

As mentioned in previous messages, thanks goes to all TALHO staff, members and partners who put their time and voice to creating a committee that will positively impact the delivery of local public health services in the future!

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Policy Analyst Jordan Head(right) received plaque (on behalf of Senator Jane Nelson) from Executive Director Lee Lane commemorating the passing of SB 969.

Front row left to right: Nancy Fisher, Eddie Olivarez, Jordan Head, Lee Lane, Lou FranklinBack row left to right: Dr. Bing Burton, Stephen L. Williams, Sal Garcia, Dr. Matt Richardson, Mike Hill

ADVOCACY

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PUBLIC HEALTH PROGRAMS Child Care Center Nutrition & Physical Activity Education Pilot Project

TALHO developed a nutrition and physical activity education program targeting child care centers, and in particular, children ages 3-5, staff and parents. This program was partially funded by a grant from the Texas Department of Agriculture between September 2010 and August 2011.

The program impact is to improve awareness, knowledge and behavior toward good nutrition and increased physical activity. TALHO worked with a Certified Nutrition Specialist to develop the following tools: 1) Pre and Post Assessments for Children; 2) Center Nutrition & Physical Activity Policy and Environmental Change Scan Assessment; 3) 18 week curriculum; 4) Parent Handout Book and 5) Hydroponic Garden Grow and Go System.

The scope of work included assessing the center’s policies and supports for promoting good nutrition and physical activity. Teachers were trained to implement the pre/post assessments and weekly curriculum. The curriculum coincides with planting seeds and growing produce in a hydroponic garden system in the child care center. Staff was trained on the Garden System and were able to take responsibility for future maintenance. Produce was picked by staff and children for use as part of the lesson plans for children to learn where produce comes from.Pre - assessments were conducted in January 2011 and completed again in June 2011.

Results included:

Environmental Scan - Changes in the food preparation and menu options were made, as well as, the development of a written physical activity policy.

Pre and post assessments - Resulted in the children’s improved ability to correctly identify healthier foods and physical activity options over the less healthy options. Staff, children and parents all enjoyed the lessons, planting, growing, harvesting and eating the produce. Staff intends to continue using the Grow and Go System as an alternative to outdoor gardening. This allows year round access to the produce.

TALHO Health Promotion Discussion Group Calls

Since August 2010, TALHO began holding monthly calls for local health department (LHD) staff interested in networking with each other to identify, discuss and implement best practice programs in their community. Regular email notices are sent about upcoming events, tools and resources. LHD staff presented on topics including obesity prevention, tobacco cessation, cancer prevention, heart disease and stroke awareness, nutrition education, community gardens, food procurement policies, physical activity and social media. Calls have also included speakers from CDC, the Cancer Prevention and Research Institute of Texas and DSHS.

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PUBLIC HEALTH PROGRAMSHealth Promotion Calls August 2010 - June 2011:August 2010 • “Federal and State Obesity Prevention Grants Working at the Local Level” Kathy Shields, Chronic Disease Prevention, San Antonio Metropolitan Health District. • Dr. Patsy Cano, Health Promotion Bureau Chief, Houston Department of Health and Human Services. September 2010 • “City of El Paso Department of Public Health Presentation on Services” Sue Beatty, Health Education & Training Manager, City of El Paso Department of Public Health. • “Denton County Health Department Cardiovascular Health Summit: Building Healthy Communities” Bing Burton, Director, Denton County Health Department. October 2010 • “Beaumont Public Health Department Stroke Awareness Project” Sherry Ulmer, Nurse Manager, Assistant Health Director, Beaumont Public Health Department.November 2010 • “Public Health Cancer Prevention Interventions in Laredo” Waldo Lopez, City of Laredo Health Department• “Live a More Colorful Life” Campaign in Tarrant County” Glenda Redeemer, MSN, APRN, Division Manager, Chronic Disease Prevention, Tarrant County Public Health.December 2010 • “Austin/Travis County Obesity Prevention Strategic Plan” Kristy Hansen, MEd, CHES, Program Coordinator, Chronic Disease Prevention and Control , Austin/Travis County Health and Human Services DepartmentJanuary 2011 • “Using Social Media to Promote Health Messages and Programs” Sue Beatty, Health Promotion Director, El Paso Department of Public Health and David Peralta-Torres, HIV Prevention Specialist, El Paso DPH and Stephanie Taylor, PIO, Northeast Texas Public Health District.February 2011 • “Stroke Awareness Campaign in Angelina County” Ann Watson, RN, Cardiovascular and Stroke Educator, Angelina County & Cities Health District.• “Make the Call” Office of Women’s Health National Heart Attack Awareness in Women Campaign” Jennifer Smith, Chief Public Health Officer, TALHO and Brenda Salazar, Health Educator, Hidalgo County Health and Human Services.April 2011 • “Implementing Food Procurement Policy: Lessons Learned from the County of Los Angeles” Lauren Gase, MPH, CHES, Centers for Disease Control and Prevention, Office of the Associate Director for Policy.• “Texas DSHS CVD and Stroke Program – Sodium Reduction Collaborative” Jane Osmond, MA, Program Coordinator, DSHS CVD and Stroke Prevention Program.June 2011 • “Cancer Prevention and Research Institute of Texas” Dr. Rebecca Garcia, Chief Prevention OfficerRamona Magid, Prevention Program Director.

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Heart Attack Recognition Teams (HART) in Women Funded Project

In December 2010, TALHO worked with DSHS and the Hidalgo County Health and Human Services(HCHHS) to answer a request for applications from the National Office of Women’s Health. The project targets women over 50, their supporters, and others to increase awareness of the risk factors for heart attacks in women and encourage action to call 911. TALHO was funded to facilitate the US Department of Health and Human Services National Campaign “Make the Call” materials in a market area of over 500,000 people.

Working with HCHHS and the DSHS, the campaign materials were promoted to all TALHO members to encourage use of the radio, TV and print media materials in their outlets. HCHHS has conducted specific outreach to 500 health care providers, in the HCHHS health clinics reaching over 500 people, conducted general public outreach to over 2400 people and media interviews reaching over 1.2 million residents. A training was provided through the South Texas Promotora Association, TALHO, HCHHS and DSHS educating 100 promotoras on the Community Health Worker Handbook on Heart Disease and Stroke Prevention. These promotoras provided outreach to over 1000 persons in the community. TALHO and DSHS worked with the Texas Council on Cardiovascular Disease and Stroke to offer a DSHS Grand Rounds on Heart Disease to 178 health care professionals across Texas. The media materials are still available and can be downloaded at www.womenshealth.gov.

County Health Rankings Stimulates Discussions about the Public Health System Improvement

On March 30, the University of Wisconsin (UOW) published the County Health Rankings (CHRs) report for Texas. The Robert Wood Johnson Foundation (RWJF)-funded CHRs, the most comprehensive report of its kind, ranks the overall health of nearly every county in all 50 states by using a standard way to measure how healthy people are and how long they live.

To coordinate and assist the release and dissemination of the CHRs in Texas, the UoW’s Population Health Institute and the RWJF sought the assistance of the TALHO, Texas Health Institute (THI) and the DSHS, who serve as co-leaders of the Texas CHRs Team. TALHO and THI received funding to promote the release of the CHRs and to convene and educate stakeholders about the CHRs. This is intended to spur action by state and local groups to use the CHRs to improve the health of their respective constituents.

The Texas CHRTeam hosted a meeting on June 16 to bring a multi-stakeholder group together to review

PUBLIC HEALTH PROGRAMS

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the CHRs, discuss the pros and cons of the rankings, determine if there are next steps to be done, gather commitment from group members to continue forward and identify 3-5 action steps for the group after the meeting.

During the Texas CHR meeting, the Team provided an overview of the CHRs process and methods, framed a dialogue about the Texas rankings, and provided the space for strategic discussion on the need to improve systems and capacity to inform local and regional program and policy development to ultimately affect social determinants of health and health equity. Klaus Madsen, Director, Special Projects at THI facilitated a “fireside chat” between David L. Lakey, M.D., Commissioner of the Department of State Health Services and Bing Burton, Ph.D., TALHO Immediate Past President, Director, Denton County Health Department. Dr. Lakey and Dr. Burton were asked to share their perspectives on the CHRs. Commissioner Lakey demonstrated the correlations between health outcomes (mortality and morbidity) and socio-economic factors such as household income, high school graduation rates and educational attainment. Dr. Burton shared how affecting health behaviors requires a higher level of awareness of public health among both local and state elected officials and encouraged his fellow local public health officials to engage policymakers in their community. Examining the major change drivers affecting public health in the short term (loss of funding from the federal and state government and Healthcare Reform), Dr. Lakey expressed that we need to look at areas where the system can be improved: strengthening the collaboration between mental health and public health, prioritizing the prevention of substance abuse and preventing children from entering the juvenile justice system. Making changes in these areas requires strong partnerships with public and private sector partners outside of health and healthcare.

Other participants shared their opinions about the CHRs. Dr. Ron Anderson, President & CEO of Parkland Health and Hospital System and member of the THI Executive Committee, recommended that you look at data below the county level to understand health disparities and the causes behind them; but also take a regional look to explore health improvement efforts that extend beyond local jurisdictions. “Disease does not recognize county boundaries”, stated Dr. Anderson.

Dr. Paul McGaha, Regional Director in DSHS HSRs 4 and 5 North, where 17 of the lowest ranking counties are located, said that the CHRs validate the issues around education, economic factors and cultural behaviors. The Hispanic paradox of the Texas border population having better health status in spite of poverty is related to the sense of belonging and connectedness in Hispanic families and communities. This milieu is less common in other parts of the state, including East Texas, where there frequently exist an estrangement and distrust of the governmental system and a feeling of disconnectedness. In spite of this, local elected officials like county judges are able to rally community leaders around health challenges.

Mike Messenger, System Improvement Specialist with DSHS and Jennifer Smith with TALHO, facilitated a rich group discussion to identify potential next steps and involvement of the participating organizations. There was a great enthusiasm in the group to continue to work together through the following next steps:

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PUBLIC HEALTH PROGRAMS1. Convene a diverse group of stakeholders in the next three months.

2. Work to establish statewide goals that are achievable and targeted.

3. Craft State and Local Level Action Steps based on the goals.

4. Provide Group recommendations to put resources where the problems are.

Participants at the meeting included:East Texas Area Health Education CenterMary Wainwright, MS, RN, Director, Rural & Regional Programs

Texas A&M School of Rural Public HealthBarbara J. Quiram, PhD, Director, Office of Special Programs Professor, Health Policy & Management

Texas AgriLife Extension Service Judith L. Warren, Ph.D., Professor, Special Initiatives Coordinator, 4-H, Youth Development and Human Sciences Texas Association of Local Health OfficialsLee Lane, Executive DirectorDr. Bing Burton, TALHO Immediate Past President, Dir. - Denton County Health Dept. Dr. Matt Richardson, Dir. - City of Amarillo Department of Public HealthLarry Johnson, Dir. - Abilene City and County Health District Patsy Gaines, TALHO Immediate Past Sec./Treas. Milam County Health Dept. Sal Garcia, TALHO President, Dir., Midland Health DepartmentTexas Health Institute George Roberts, Jr – THI Immediate Past President,

CEO – Northeast Texas Public Health DistrictRon J. Anderson, MD – THI Exec. Committee, President & CEO/CEO – Parkland Health and Hospital SystemHardy Loe, Jr., MD – THI Trustee Emeritus, Hardy Loe & AssociatesDonna Meyer, PhD, THI Trustee and Director, Community Health Strategies

Texas Department of State Health ServicesDr. David Lakey, CommissionerDr. James Morgan, Asst. Comm. RLHSDr. Paul McGaha, Regional Director, PHR 4/5N

University of Texas - Houston - School of Public HealthLinda Lloyd, Ph.D., Management, Policy & Community Health, Associate Professor of Community Health and Associate Dean for Public Health Practice, Houston

Unable to attend, but part of the group, is:University of North Texas - School of Public HealthDr. Richard Kurz, Dean

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ACCREDITATIONTexas Public Health Accreditation Conference

TALHO worked with numerous partners in 2008 to help create the Public Health Accreditation Council of Texas (PHACT). PHACT’s purpose is to stay abreast of national accreditation efforts and in particular the development of the voluntary national public health accreditation program by the Public Health Accreditation Board (PHAB). PHACT consists of 13 voting members, 6 of which are local health departments and one representative from the TALHO administrative office. PHACT website is www.phactx.org.

In June of 2010 PHACT worked with PHAB to review the Beta Test materials for accreditation, providing input and recommendations for improvements. PHACT determined there was a need for staff in LHDs to become more aware of the national accreditation program. TALHO conducted a survey of the membership to gauge interest and needs in preparing for accreditation. A one and a half day conference is scheduled for October in Austin. The conference will increase awareness, knowledge and skills of LHD staff concerning the national voluntary accreditation program and generate interest in preparing and applying for accreditation.

National speakers confirmed to participate are from the PHAB, NACCHO, CDC, and the Robert Wood Johnson Foundation. LHDs from other states who participated in the Beta Test experience have been confirmed to join our own Texas LHDs who have begun developing the three required documents for accreditation: The Community Health Assessment, Community Health Improvement Plan and Agency Strategic Plan. The conference will bring real world experience and tools to LHDs who are starting to create their own processes for seeking accreditation. More information on registration is available on the TALHO website. You can download the new accreditation materials at www.phaboard.org

SAVE THE DATEThe 2011 Texas Public Health Accreditation Conference

WhenTuesday, October 11, 2011 8:00 AM - Wednesday, October 12, 2011 12:30 PMCentral America Time

WhereThe Commons Learning Center, University of TexasJ.J. Pickle Research Campus10100 Burnet Road, Bldg. 137(between U.S. 183 and Braker Lane)Austin, TX 78758 USA

Fees $85.00

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TECHNOLOGY A Gathering of Great Minds on the Topic of Biosurveillance

The 2011 Biosurveillance Conference was a two day event June 13 and June 14 at The University of Texas Commons Learning Center on the J.J. Pickle Research Campus in Austin, Texas. Biosurveillance describes the process of active data-gathering with appropriate analysis and interpretation of biosphere data that might relate to disease activity and threats to human or animal health -- whether infectious, toxic, metabolic, or otherwise, and regardless of intentional or natural origin -- in order to achieve early warning of health threats, early detection of health events, and overall situational awareness of disease activity.

This conference provided public health professionals in the state of Texas with a look at recent technological advancements, best practices, and community collaborations in the areas of both biosurveillance and syndromic surveillance.

The topics and speakers were:A National Strategy to Enhance Local Biosurveillance Capacity Aaron T Fleischauer, PhD, MSPH Commander, US Public Health ServiceCareer Epidemiology Field Officer Centers for Disease Control and Prevention

Detection, Diagnosis, and Community Impact of Disease Outbreaks in Animal Populations Roger W. Parker, DVM, PhD Deputy DirectorTexas Veterinary Medical Diagnostic LaboratoryTexas A&M University

Anti-Terrorism Operations: Detection, Response, and Why They Hate Colonel Andrew Joseph Jurchenko Sr.United States Army (Retired)Dean of The American Board for Certification in Homeland Security, A Unit of The American College for Forensic Examiners International

End-to-end Information Support for Disease Surveillance and Control Dr. Michael M. WagnerAssociated Professor of Medicine and Intelligent SystemsCenter for Biomedical InformaticsUniversity of Pittsburgh

Future Directions in Biosurveillance Dean LampmanRegional Surveillance CoordinatorTarrant County Public HealthSouthwest Center for Advanced Public Health Practice

Data Analysis and Outbreak Detection for Syndromic Surveillance: The BioPortal ExperienceDr. Hsinchun ChenMcClelland Professor of Management Information Systems and Director, Artificial Intelligence Lab at the University of Arizona

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TECHNOLOGYEnvironmental Sampling in Response to Hurricanes Katrina and RitaDonald WilliamsDeputy Associate DirectorRemedial Branch, Superfund DivisionUS Environmental Protection Agency

Rollcall: The Collaboration and Development of an Electronic School Surveillance System in the Houston Independent School District.• Byron Oujesy, MSEpidemiologist, Acute Pathogen and Biosurveillance UnitHouston Department of Health and Human Services• Ethan WaldoDirector of Software DevelopmentTexas Association of Local Health Officials.

Tech Tip:E-mail SignaturesA signature is a declaration of identity and intent. E-mail signatures are no different. They set the tone of a message, contain contact details, and are professional like a letterhead. This article provides some tips on creating e-mail signatures.

The first thing to keep in mind is being concise. E-mails are not about the signature. Be sure to include your name, the company being represented, your position, and your contact information. Even though there might be many ways to be contacted, less is more here. Don’t include links to your personal social network pages or instant messenger names. Keep it professional; avoid including home phone numbers, personal websites, home addresses, or a random quote at the bottom.

Use images with caution. Don’t use animated gifs of cats playing keyboards. Keep it simple. Make sure it fits with the text and the tone being presented. 50x50 pixels should work. If your entire signature is an image, people will be unable to copy and paste your contact information. Make sure, if the logo doesn’t load, the signature still looks nice and contains all the same information.

Avoid HTML. Different e-mail services approach HTML in e-mails differently. there’s no way to know your HTML will run the same in every e-mail client. Try to stick to common web fonts.

Adding a signature to your Gmail account:1. Sign in to Gmail. 2. Click Settings at the top of any Gmail page.3. Enter your new signature text in the box at the bottom of the page next to the Signature option. As you type, the radio button will shift from No Signature to the text box. 4. Click Save Changes.

Adding a signature to Outlook:1. After opening a new message window, click the Signature button under the message tab and select “Signatures…”. 2. Click the new button.3. Type the name for the signature and click Ok.4. Edit your signatures in the box provided using the toolbar to format the text and insert an image.5. When you finish editing, click Ok.6. Click the Signature button under the message tab again. 7. Select the name you chose for your signature and it will appear in your message.

Adding a signature in Yahoo:1. Under the Options drop down menu select Mail Options.2. Go to the Signature category.3. Select “Show a signature on all outgoing messages.”4. Edit your signature in the box provided.5. Click the Save Changes button.

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TALHO Telecommunications Service Priority (TSP) Program

We are proud to announce that on July 22, 2011, TALHO qualified as a Level 3 responder in the Telecommunications Service Priority Program (TSP) through the United States Department of Homeland Security. TALHO’s TSP qualification extends service priority to all members on the Health Alert Network (HAN). This includes TALHO-managed local public health department T1s as well as the DS3 circuit at the State of Texas Disaster Recovery Center (DROC).

The Telecommunications Service Priority (TSP) is a program that authorizes national security and emergency preparedness (NS/EP) organizations to receive priority treatment for vital voice and data circuits or other telecommunications services. As a result of hurricanes, floods, earthquakes, and other natural or man-made disasters, telecommunications service vendors frequently experience a surge in requests for new services and requirements to restore existing services. The TSP Program provides service vendors a Federal Communications Commission (FCC) mandate to prioritize and expedite service requests by identifying those services critical to NS/EP.

This service priority applies to all voice and data circuits managed and maintained by TALHO in service of the HAN over the HAN telecommunications network. This service repair priority is extremely important to ensure that all emergency preparedness operations in Texas continue to operate when data or voice service is needed.There are five essential service criteria for TSP eligibility. The essential service criteria categories are as follows:

A. National Security Leadership (Restoration/Provisioning Levels 1-5) a. This category is strictly limited to only those telecommunication services essential to national survival if nuclear attack threatens or occurs.B. National Security Posture & U.S. Population Attack Warning (Levels 2-5) a. This category covers those minimum additional telecommunication services essential to maintaining an optimum defense, diplomatic, or continuity-of-government posture before, during, and after crisis situations.C. Public Health, Safety, & Maintenance of Law & Order (Levels 3-5) a. This category covers the minimum number of telecommunication services necessary for giving civil alert to the U.S. population and maintaining law and order and the health and safety of the U.S. population in times of any national, regional, or serious local emergency.D. Public Welfare & Maintenance of the National Economic Posture (Levels 4-5) a. This category covers the minimum number of telecommunication services necessary for maintaining the public welfare and national economic posture during any national or regional emergency.E. Emergency Criteria (Emergency Provisioning Only - Level E) a. This category is limited to those services so critical to the protection of life and property or to NS/EP that they must be provisioned immediately, without regard to cost to the user.

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As referenced above, TALHO receives priority just below key national political and military operations and has received the highest priority level within the category local public health is eligible for. This eligibility is directly related to the key role TALHO plays in its construction of the HAN through TXPhin (https://www.txphin.org) and the management of the HAN telecommunications network where TALHO guarantees users’ connectivity to the HAN system. TALHO IT staff will continue to work closely with your local public health department IT staff to ensure HAN connectivity is operational. This is a critical function to ensure CDC Emergency Preparedness money continues to be received in Texas.

TALHO is proud of achievements like Level 3 certification in the Telecommunications Service Priority program. We believe this achievement is critical in ensuring preparedness infrastructure, activities and staff, are operational during emergency situations. There are additional programs TALHO will be reviewing for its membership in the coming months that will continue to ensure key local public health emergency preparedness personnel in Texas receive national priority during times of local, state, or national crisis or attack.

TECHNOLOGY

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Local Public Health News Austin/Travis County Health and Human Services Receives Grant to Focus on Community Health ImprovementFunding will help demonstration site prepare for public health accreditation process

The National Association of County and City Health Officials (NACCHO) has announced its selection of 12 local health departments, including the Austin/Travis County Health and Human Services Department, to receive grant funding to initiate and complete a robust community health improvement process in preparation for the new, voluntary, national accreditation process for public health departments due to launch in September. With support from the Robert Wood Johnson Foundation (RWJF), each local health department received $35,000 to develop a community health assessment (CHA) and a community health improvement plan (CHIP), two of the three prerequisites that every health department must complete before applying for accreditation.

“On behalf of our community, it is an honor to be selected for this prestigious grant award,

representing one of twelve health departments in the nation and the only one in Texas,” said Shannon Jones, Acting Director of Austin/Travis County HHSD. “Engaging the community’s residents, organizations, businesses, and governments in a quality and evidence-based comprehensive community health improvement process illustrates Austin/Travis County as a leader prioritizing our community’s health and social service needs so we may advance equity, together.”

In addition to working on issues affecting their communities, the demonstration sites also will investigate why some groups of people might not be as healthy as others, and develop a plan to address these health inequities. For example, if a community health improvement plan identifies high rates of death from heart disease and low rates of physical activity in a community, the grantee might also consider the social and economic factors contributing to the statistic, such as a lack of safe sidewalks and grocery stores selling fresh fruits and vegetables. This additional information would allow a community to consider the full range of issues that impact its health and health improvement strategies to make it easier for people to be healthy.

NACCHO received a total of 127 applications for the 12 demonstration project grants. For more information about this project, visit http://www.naccho.org/chachip.

Tarrant County Spreading The Word About Women’s Health and Healthy Babies

The Tarrant County Public Health WIC program was funded by the Department of State Health Services to conduct a pilot program to provide basic women’s health education and outreach to potential WIC clients. The high infant mortality rate in Tarrant County caught the attention of Mike Montgomery, the Texas WIC Director, who asked, “What can WIC do to help address infant mortality in Tarrant County?” The answer was four community health workers, trained in basic health education, who can get the word out about the importance of a mother’s health to the health of her baby. The workers use a curriculum that includes information on healthy weight, chronic disease prevention, breastfeeding, stress management, prevention of sexually transmitted

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Local Public Health Newsdiseases and other infections. The workers also answer questions regarding the WIC program and provide referral information regarding health care, job training and parenting information. This all is accomplished as the community health workers travel the county providing education and outreach in churches, community meetings and events, schools and WIC clinics.

Texas LHDs Involved in Action Communities for Health, Innovations, and Environmental ChangE (ACHIEVE)Williamson County and Cities Health District (WCCHD) and Harris County Public Health and Environmental Services (HCPHES) are part of the national ACHIEVE program, funded through the National Association of Chronic Disease Directors and the Centers for Disease Control and Prevention. ACHIEVE communities develop a plan of action to implement policy and environmental changes to reduce chronic disease and related risk factors in their communities.

WCCHD worked through their Healthy Hearts Coalition to focus

actions on developing physical activity, nutrition and tobacco policies in their county. The Coalition achieved the following results:

• Commissioners Count banned smoking on all county government property.• The coalition leveraged $27,000 to be used for smoking cessation classes for governmental employees.• Three clinics, two private medical offices and a federally-qualified health center provide exercise prescriptions for their patients with diabetes.• Funding was leveraged from the United Way to provide personal training to residents receiving exercise prescriptions.• ¡Por Vida! is being launched in Georgetown restaurants to help adults and children make healthier food choices.• A worksite wellness toolkit and workshop brings local businesses onboard to promote employee wellness and chronic disease prevention.

Dr. Chip Riggins, Executive Director and Health Authority for WCCHD says “Leaders from across this community are committed to an ongoing process that has great potential to make and keep our cities and county as healthy as they can be.”

ContactMelissa Cammack or Cynthia GuerreroWilliamson Cities and County Health District512-943-3667mcammack@wcchd.org

HCPHES worked with the Aldine-Greenspoint YMCAs, an ACHIEVE community, to develop a Community Health Action and Response Team (CHART) that includes leaders from all sectors of the community. The CHART Team made the following results:• Created the ACHIEVE Fitness Zone, an outdoor gym, with the backing of a Precinct Commissioner.• Harris County modified their Parks Master Plan based on stated needs of residents.• Created three community gardens at schools and 5 neighborhood locations in Harris County.• Improved tobacco cessation services delivered at Harris County PHES clinics.

ContactsLinda E. ForysHarris County Public Health & Environmental Services713-439-6291lforys@hcphes.org

For more detailed information on all ACHIEVE projects, go to http://www.chronicdisease.org/

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Local Public Health News Employee Focuses on Reducing ObesitySue Beatty

Sue Beatty began her career in 1988 with the City of El Paso Department of Public Health (DPH) as a Nutritionist with the WIC Program, counseling parents about proper nutrition for their children. She is currently the Health Education & Training Manager in charge of curricula development and implementation. She is regarded as an expert in the areas of Nutrition, Eating Disorders, and Weight Management. In this and other areas, Sue strives to ensure nutrition related presentations to the community are taught factually and with fidelity. Sue’s efforts assist the DPH fulfill its mission “to work in partnership with people in our community to promote and protect the health of the borderland”

Sue has been instrumental in leading efforts that have led to significant and long-lasting contributions to the DPH and the health of the community in general including the passage of the Smoke Free Ordinance by El Paso City Council in 2001 and Socorro City Council in 2006.

Currently, Sue plays a leadership role in community efforts addressing childhood obesity and nutrition. She serves as Co-facilitator of the Healthy Eating Active Living (HEAL) Coalition with the Paso del Norte Health Foundation. The Coalition strives to encourage change at the policy level to positively affect the health of the community. One of the most significant contributions of the HEAL Coalition thus far is the passage of resolutions leading to the initiation of an Obesity Prevention Plan for the cities of El Paso and Socorro and at the Ysleta del Sur Pueblo Tribe.

The Obesity Resolution of the City of El Paso makes obesity prevention a priority, commits to developing programs geared to improve nutrition and increase physical activity, makes policy recommendations toward obesity prevention, and directs the City

Manager to implement the five-year Obesity Prevention Action Plan and report progress annually to the city Council. The Action Plan addresses the following:

1. Built Environment2. Access to Healthy Food3. Employee Wellness Program and Policies4. Community Involvement for Improved Nutrition and Physical Activity5. Implementation

Through the implementation of this plan, the City of El Paso expects to make an impact in the health of future generations of El Pasoans.

An additional project Sue is leading involves working with the El Paso Zoo where she will coordinate an Obesity Prevention Project called Wild about Health. Funded by the Department of State Health Services (DSHS), the project will encourage zoo visitors to eat healthy and be physically active and will make food policy changes at the zoo cafes to include an analysis of foods served, pricing equity among all foods and menu labeling.

Additional accomplishments includes education to youth and parents throughout El Paso County; member of the Texas School Health

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Local Public Health NewsAdvisory Council; collaboration with school districts and the Paso del Norte hHealth Foundation to establish the first ever Regional School Health Advisory Council (SHAC) Conference in the fall of 2011, and implementation of an HIV Prevention Program funded by DSHS.

Sue is the recipient of the 2006 Department of Public Health Leadership Award.

New Director of Public Health for the San Antonio Metropolitan Health District

Dr. Thomas L. Schlenker joined the City of San Antonio in June 2011. As the new Director of Public Health for the San Antonio Metropolitan Health District, Thomas L. Schlenker, M.D., M.P.H. oversees a department responsible for carrying out a variety of duties and responsibilities associated with protecting the overall public health of the community through an array of services.

Prior to his appointment with the City, Dr. Schlenker was the Public Health Director for Madison and Dane County, Wisconsin from 2006-2011. Previous to that he led health departments in Milwaukee, Wisconsin, Salt Lake City, Utah, served as Chief Medical Officer for the Children’s Hospital of Wisconsin-Kenosha and was a Senior Fullbright Fellow at the National Institute of Public Health in Cuernavaca, Mexico.

Dr. Schlenker is a board certified pediatrician who has cared for patients, conducted public health research and managed organizations in the United States and Latin American.

Dr. Schlenker has been recognized for merging local health agencies, for his research in infant mortality, childhood lead poisoning, and the epidemiology of measles and for effectively connecting the practice of local public health to community clinicians and health care systems.

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LOCAL PUBLIC HEALTH NEWS

RetirementsKathy MooreDirector Texarkana-Bowie County Family Health Center

Michelle SkyrmeExecutive Administrative Assistant & HAN Administra-torGregg County Health Department

Fernando A Guerra, MD, MPHDirector of HealthSan Antonio Metropolitan Health District

David LurieDirectorAustin-Travis County Health & Human Services De-partment

Jean Galloway, MDDirector-Health & Human ServicesFort Bend County Health & Human Services

New DirectorsCathy Sbrusch, RN, BSN, CICDirector of Public Health ServicesBrazoria County Health Department

John TeelDirectorGrayson County Health Department

Danny BrackinDirectorJasper-Newton County Public Health District

Thomas Schlenker, MDDirector of HealthSan Antonio Metropolitan Health District

Carlos RiveraDirectorAustin-Travis County Health & Human Services De-partment

New Director Hired For Austin/Travis County-Carlos RiveraCarlos Rivera has 20 years experience in health and human services currently serving as the Director of Health and Human Services for the City of Hartford, Connecticut. The department has 320 employees and an $18 million budget. The department provides services in Disease Prevention and Health Promotion, Environmental Health, Maternal and Child Health, Recreation and Arts and Culture. Carlos served as Chair of the Mayor’s Task Force on Hartford’s Uninsured which resulted in the Healthy Hartford Campaign, a citywide health and wellness education initiative which received the 2008 U.S. Surgeon General’s Champion Award. His department also issues Hartford Critical Health Indicators, an analysis of secondary data related to the health of Hartford’s residents. Mr. Rivera previously served as the Director of Ambulatory Services for Saint Francis Hospital and Medical Center in Hartford from 2002-2004 and Director of Behavioral Health and Intermediate Sanctions for Community Solutions, Inc. from 1999-2002. He has ten years experience as a psychiatric social worker, Juvenile Parole Officer and Child Support Investigator.

Mr. Rivera is a LCSW, has a Bachelor’s Degree in Political Science from University of Connecticut as well as Master’s Degrees from the University of Connecticut, one in Social Work and another in Public Health. Mr. Rivera also has an MBA from Rensselaer Polytechnic Institute. His professional affiliations include the American Public Health Association, the Connecticut Association of Directors of Health and the National Association of County and City Health Officials.

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August 10: PHACT Meeting, TALHO Board Meeting

August 11: TALHO Membership Meeting

September 14: PHACT Meeting

September 28: TPHA/TAMSRPH Health Disparities Conference

October 11: Texas Public Health Accreditation Conference

October 12: Texas Public Health Accreditation Conference, TALHO Board Meeting

October 13: TALHO Membership Meeting

November 9: PHACT Meeting

November 17: Texas Viral Hepatitis Summit

December 8: PHACT Meeting, TALHO Board Meeting

December 9: TALHO Membership Meeting

UP COMING EVENTS

The views expressed in the resources mentioned within do not necessarily reflect those of TALHO or the sponsors. Please direct comments or questions about The TALHO Insider to Jennifer Smith, MSHP

Chief Public Health Officer, at jennifer.smith@talho.org or 512-814-2546 ext. 1102. For a complete list of staff contacts, please visit www.TALHO.org

GOLD STANDARD FRIENDS OF LOCAL PUBLIC HEALTH SPONSORS

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