local health department staffing and services summary ...staffing and services summary fiscal year...

North Carolina Department of Health and Human Services

Division of Public Health State Center for Health Statistics

November 2017

Local Health Department Staffing and Services Summary

Fiscal Year 2017

Cover photo — blood pressure examination, (ID 13473) Amanda Mills, photographer, http://phil.cdc.gov/phil/home.aspCover photo — child being given immunization, (ID 9368) James Gathany, photographer, http://phil.cdc.gov/phil/home.aspCover photo — nutritionist talks with client, (ID 13721) Amanda Mills, photographer, http://phil.cdc.gov/phil/home.aspCover photo — form with ink pen topped with a happy face nurse, MGDboston, photographer, www.morguefile.comCover photo — stonewall, Maryhere, photographer, www.morguefile.com

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Local Health Department Staffing and Services Summary

Fiscal Year 2016–2017

N.C. Department of Health and Human Services Division of Public Health

State Center for Health Statistics

1908 Mail Service Center Raleigh, North Carolina 27699-1900

(919) 733-4728 www.schs.state.nc.us

www.schs.state.nc.us/SCHS

State of North CarolinaRoy Cooper, Governor

www.ncgov.com

Department of Health and Human ServicesMandy K. Cohen, MD, MPH, Secretary

www.ncdhhs.gov

Elizabeth Cuervo Tilson, MD, MPH State Health Director

Division of Public HealthDaniel Staley, Division Director

www.publichealth.nc.gov

State Center for Health StatisticsEleanor Howell, MS, Director

www.schs.state.nc.us

AuthorsKathleen Jones-Vessey

Farnaz Chowdhury April Duval

November 2017

The Department of Health and Human Services does not discriminate on the basis of race, color, national origin, sex, religion, age

or disability in employment or the provision of services.

www.ncdhhs.gov

www.schs.state.nc.us/SCHS

Local Health Department Survey — FY2016–2017 iii

Division of Public Health N.C. Department of Health and Human Services State Center for Health Statistics

Table of Contents

Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Changes to the Survey Instrument . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Staffing (Section A) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Local Health Department Occupations and FTEs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Total FTEs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 RecruitingDifficulties. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 TrendsinFTEsforSpecificOccupationalGroups . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Occupational Composition of LHDs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Trends in FTEs by County . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Public Health Services (Section B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Health Support Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Environmental Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Personal Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

Bilingual Health Initiatives (Section C) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 Non-English Information and Education Material in LHDs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 BilingualStaffingandServices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

Other Topics (Section D) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 Cultural Diversity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 Internet Access . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

Governing Body . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

Local Health Department Survey — FY2016–2017 1


Introduction

This survey is the latest in a series of surveys of North Carolina health departments which, since 1984, have provided a count of health department employees by occupational groups, a summary

of essential public health services, and assessments of other topics, such as bilingual health initiatives and the use of information technology in health departments. All surveys have been oriented to the state’sfiscalyear:beginningJuly1andendingJune30ofthesubsequentyear.Thecurrentsurveywasadministeredinthespringof2017,andcoversthe2016–2017fiscalyear(FY2017).

All of North Carolina’s 100 counties are represented in this survey. A total of 85 surveys were returned, consisting of 79 single-county health department respondents and six multi-county district healthdepartmentrespondents.Thedistricthealthdepartmentsincludedare:(1)Alleghany,AsheandWatauga counties (Appalachian District); (2) Granville and Vance counties; (3) Martin, Tyrrell and Washingtoncounties;(4)Rutherford,PolkandMcDowellcounties;(5)Avery,MitchellandYanceycounties (Toe River Health District); and (6) Albemarle Regional Health District (consisting of Bertie, Camden,Chowan,Currituck,Gates,PasquotankandPerquimanscounties).

Inthisreport,wesummarizethedatafromtheFY2017survey,andwepresentcomparisonswithprioryearsofthesurveywherepossible.Forthesectionofthesurveyonstaffing,weusethesamedefinitionsthathavebeenusedinthepasttocalculatethenumberoffulltimeequivalent(FTE)employees in order to ensure consistency across reports. Throughout this report, health department respondents are referred to as health departments, health departments/health districts or LHDs (Local Health Departments).

Changes to the Survey InstrumentTheInformationTechnology(IT)sectionofthesurveywaseliminatedforFY2017.Minoradditionstothesurveyweremadetoreflectcurrenthealthservicescategoriesandoccupationalcategories.



Table 1. Health Department Staffing for FY2017: Full-time Positions, Part-time Hours, Annual Contract Hours and FTEs

by Occupational Category

Occupational Category:

Total Funded

Full-time Positions

Total Weekly Hours Worked

by Part-time Staff

Annual Contract

Staff Hours Worked

Total FTE (Not

Including Contract)

Total FTE (Including Contract)

% LHDs with

Difficulty Recruiting

Health Director 82 78 4,598 84 86 10.6%Administrative/Management Support Staff 1,867 2,092 39,325 1,919 1,939 4.7%LAN/PC Support 45 30 5,439 46 48 1.2%Physician 28 668 32,911 45 61 17.6%Physician Assistant 56 776 2,655 75 77 12.9%Dentist 42 90 12,537 44 51 16.5%Dental Assistant 95 129 4,544 98 100 8.2%Dental Hygienist 47 445 0 58 58 9.4%RN (Clinical) 1,334 4,723 10,217 1,452 1,457 35.3%RN (Enhanced Role) 284 310 1,950 292 293 24.7%RN (Home Health) 152 230 3,342 158 159 15.3%LPN (Clinical) 80 84 800 82 83 4.7%LPN (Home Health) 8 0 1,942 8 9 1.2%Occupational Health Nurse 2 0 0 2 2 1.2%Nurse Practitioner 116 484 19,848 128 138 42.4%Certified Nurse Midwife 16 107 4,069 19 21 4.7%Pharmacist 18 108 10,653 21 26 3.5%Nutritionist 390 734 5,613 408 411 25.9%Therapist 68 0 5,001 68 71 3.5%Social Worker 422 584 12,426 437 443 8.2%Environmental Health Specialist 715 726 6,185 733 736 34.1%Environmental Health Technician 11 0 15 11 11 2.4%Public Health Investigator 10 0 0 10 10 2.4%Lab Technician 180 122 6,003 183 186 9.4%X-Ray Technician 3 0 0 3 3 1.2%Health Educator 283 300 22,773 291 302 11.8%Interpreter, Spoken Language 207 315 22,349 215 226 4.7%Aides (all types) 159 232 34 165 165 1.2%Landfill Operators/Workers 32 954 29 56 56 1.2%Animal Control Officers 79 1,007 0 104 104 4.7%Epidemiologist/Statistician 11 0 587 11 11 2.4%Community Health/Outreach Worker 78 132 2,639 81 83 4.7%Preparedness Staff 46 100 4,571 49 51 7.1%Public Information Officer 21 8 0 21 21 4.7%Other 894 1,523 17,186 932 941 3.5%

TOTAL 7,881 17,091 260,241 8,308 8,438

* Note: Part-time hours per week were converted to FTEs by dividing by 40; annual contract staff hours were converted to FTEs by dividing by 2000. Full time and FTE figures are rounded to the nearest whole number.



Staffing (Section A)

Local Health Department Occupations and FTEsTable 1presentsdataregardingHealthDepartmentstaffingforFY2017.Dataarepresentedforeachoccupational group, and include the total number of full-time positions, the total hours worked by part-time staff per average week, the annual number of contract staff hours worked, as well as the total FTEs—both including and excluding contract staff. FTEs excluding contract were calculated as the number of full-time funded positions, plus the number of part-time hours divided by 40 (one work week). FTEs including contract were calculated as the number of FTEs (as calculated above) plus the number of annual contract hours reported divided by 2000.

Total FTEsInFY2017,therewere8,308full-timeequivalentemployeesincountyhealthdepartments(notincludingcontractpersonnel),whichisbelowtheFY2013FTEtotalby353employees(Figure 1). The number of FTEs employed in North Carolina health departments has decreased 14 percent since reachingapeakinFY2007.

Figure 1Full-time Equivalent Employees, FY1989–FY2017

(Not Including Contract Personnel)

9,5678,769 8,661 8,308

9,676

8,705

5,8396,336

7,026

8,179 8,236 8,5959,480

0

2,000

4,000

6,000

8,000

10,000

12,000

1989 1990 1993 1995 1997 1999 2003 2005 2007 2009 2011 2013 2017* Note: 2003, 2007, 2009, 2011, 2013 and 2017 were the only years with a

100 percent survey response rate. Survey was not administered in 2015.



Recruiting DifficultiesTheFY2017surveyalsoaskedifhealthdepartments/districtshadexperienceddifficultiesrecruitingforspecificoccupationalgroups,aspresentedinTable 1. The occupational groups that health departmentsreportedhavingthemostdifficultiesrecruitingforincludedNursePractitioners(42%),ClinicalRNs(35%),EnvironmentalHealthpositions(34%),EnhancedRoleRNs(25%)andNutritionists(26%).

Trends in FTEs for Specific Occupational GroupsIn Figure 2,trendsfromFY1989–FY2017areshownforthreeofthelargestprofessionalgroupsworkinginNorthCarolinahealthdepartments:nurses(LPNsandRNs),managementsupportstaff and environmental health specialists. Within the nursing profession, the total number of FTE nursesincreasedby10percentfromFY1989toFY2017(194FTEs).Thenumberofenvironmentalhealth specialist positions increased by 20 percent (120 FTEs) during this time period. In addition, administration/managementsupportstaffpositionsalsoincreasedbyatotalof245positions(15%)fromFY1989toFY2017.FromFY2013toFY2017,nursingandadministrativestaffbothdecreased,whilethenumberofenvironmentalhealthspecialistFTEsincreasedslightly(3%).

Figure 2Trends in Staffing for Specific Occupational Categories, FY1989-FY2017

(Not Including Contract Personnel)

0

250

500

750

1,000

1,250

1,500

1,750

2,000

2,250

2,500

2,750

3,000

1989 1990 1993 1995 1997 1999 2003 2005 2007 2009 2011 2013 2017

Fiscal Year

FTE Employees

Total Nursing Administration/Management Support Staff Environmental Health Specialist



Occupational Composition of LHDsFigure 3 shows the distribution of all public health occupations in North Carolina health departments forFY2017.Thenursingprofessionmadeupthelargestpercentageofpersonnelwith28percent,followed closely by administrative and management support staff with 26 percent. The remaining specifiedoccupations—aides,environmentalhealthspecialists,socialworkers,nutritionistsandhealth educators—accounted for approximately 26 percent of all health department personnel. Other occupationalcategoriescomprisedanadditional20percentofhealthdepartmentstaff.TheFY2017occupationaldistributionissimilartotheresultsreportedintheFY2013healthdepartmentsurvey,with nurses representing 28 percent and support staff representing 26 percent of the health department personnel.

Trends in FTEs by CountyTable 2showsthechangeinthenumberofFTEsandpercentagechangefromFY2013toFY2017.Overall,56of85healthdepartments/healthdistricts(66%)reportedthattheylost FTE positions since the last survey was conducted. Another 28 percent (n=24) health departments reported that they gainedFTEpositionsduringthistimeperiod.BetweenFY2013andFY2017,therewasnochangeinthereportednumberofFTEsforfivehealthdepartments(theylostorgainedoneorfewerpositionsduring this time period).

Figure 3FTE Employees by Occupation, FY2017

( Not Including Contract Employees )

Health Educators3.4%

Other20.2% Nurses

27.8%

Admin/Mgmt Support

25.8%Aides4.1%

E.H. Specialists/Techs8.4%

Social Workers5.1%

Nutritionists5.2%



Table 2. Health Department Staffing: Change in Number of FTEs FY2013–FY2017, Number and Percent Change by Health Department

2013FTEs

2017FTEs

Percent Change

2013FTEs

2017FTEs

Percent Change

Alamance 100 92 -8.0% Jackson* 50 57 14.0%Albermarle District 351 210 -40.2% Johnston 135 146 8.1%Alexander* 34 29 -14.7% Jones 21 19 -9.5%Anson 19 19 0.0% Lee 38 42 10.5%Appalachian District 91 79 -13.2% Lenoir 60 50 -16.7%Beaufort 43 43 0.0% Lincoln 75 67 -10.7%Bladen 67 56 -16.4% Macon 61 64 4.9%Brunswick 79 60 -24.1% Madison 31 38 22.6%Buncombe 136 110 -19.1% Martin/Tyrrell/Washington 94 74 -21.3%Burke 50 45 -10.0% Mecklenburg 611 825 35.0%Cabarrus 178 205 15.2% Montgomery 28 30 7.1%Caldwell 81 78 -3.7% Moore 50 46 -8.0%Carteret 61 61 0.0% Nash 115 113 -1.7%Caswell 39 42 7.7% New Hanover 177 160 -9.6%Catawba 157 99 -36.9% Northampton 58 48 -17.2%Chatham 79 72 -8.9% Onslow 112 108 -3.6%Cherokee 32 29 -9.4% Orange 113 102 -9.7%Clay 25 29 16.0% Pamlico 16 15 -6.3%Cleveland 210 229 9.0% Pender 55 65 18.2%Columbus 55 50 -9.1% Person 52 48 -7.7%Craven* 143 150 4.9% Pitt 122 133 9.0%Cumberland 244 279 14.3% Randolph 78 80 2.6%Dare 95 87 -8.4% Richmond* 69 59 -14.5%Davidson 102 98 -3.9% Robeson 144 138 -4.2%Davie 49 56 14.3% Rockingham 76 73 -3.9%Duplin 55 41 -25.5% Rowan 77 69 -10.4%Durham 207 224 8.2% Rutherford/ Polk/McDowell 99 67 -32.3%Edgecombe* 103 76 -26.2% Sampson 41 46 12.2%Forsyth 281 236 -16.0% Scotland 40 35 -12.5%Franklin 56 47 -16.1% Stanly 62 65 4.8%Gaston 201 190 -5.5% Stokes 42 32 -23.8%Graham 24 21 -12.5% Surry 132 115 -12.9%Granville/Vance 73 74 1.4% Swain 53 29 -45.3%Greene 27 26 -3.7% Toe River District 156 60 -61.5%Guilford 409 385 -5.9% Transylvania 27 28 3.7%Halifax 92 80 -13.0% Union 121 87 -28.1%Harnett 87 68 -21.8% Wake* 648 614 -5.2%Haywood 64 52 -18.8% Warren 41 44 7.3%Henderson 89 95 6.7% Wayne 136 123 -9.6%Hertford 50 40 -20.0% Wilkes 63 63 0.0%Hoke 36 26 -27.8% Wilson 123 110 -10.6%Hyde 20 14 -30.0% Yadkin 18 18 0.0%Iredell 110 106 -3.6%

Note: FTE figures do not include contract staff. Sum of health department FTEs may not add up to total statewide FTEs due to rounding.

* Where large discrepancies existed between reported figures for FY2013 and FY2017 exist, reported FTEs from FY2011 were used for comparisons.



— text continued on page 12

Public Health Services (Section B)

AccordingtoNorthCarolinalaws:“The Public Health Laws of North Carolina establish categories of essential public health services that are to be made available and accessible to all

citizens of the State [G.S. 130A-1.1(b)].” Table 3 presents essential services established by this law as well as other services deemed to be essential to the public health of North Carolina citizens. For each service, counties were asked to indicate if the service was provided in their health department or healthdistrict.ThistablealsopresentsacomparisonofresultsfromtheFY2013andFY2017healthdepartment surveys, to provide a picture of how things have changed during this time period.

Health Support ServicesThe majority of health departments/health districts in North Carolina reported that they provide registrationofvitalevents(89%).Vitalrecordsandstatisticsaremaintainedin91percentofallhealth departments (n=77). Nearly all health departments indicated that they conduct communicable diseasesurveillance(98%),offerlaboratoryservices(98%)andperformhealthassessmentsforreportablediseases(97%).Inaddition,mosthealthdepartmentsreportedthattheyareengagedincommunityhealtheducation(95%),emergencypreparednessresponseplanning(94%)andperformcomprehensivecommunityhealthassessment(89%).However,significantlyfewerreportedthattheirhealthdepartment/districtengagedinchronicdiseasesurveillance(61%),healthplanning(66%),orhealthcodedevelopmentandenforcement(59%).While72percent(n=61)healthdepartmentsreportedofferingpublichealthnursepharmacydispensing,lessthanhalf(35%)reportedofferingother pharmacy services. Nearly half of health departments indicated that they provided school nursingservices(47%).Thehealthsupportserviceprovidedleastfrequentlywaspesticidepoisoninginvestigation, with only 14 percent of health departments reporting that they offered this service.

ThehealthsupportserviceswiththelargestdeclinesfromFY2013toFY2017wereinpesticidepoisoning(-25%)andbehavioralriskassessment(-22%).Additionally,thereweredeclinesinhealthdepartmentsreportingthattheyofferedotherpharmacyservices(-17%).Thehealthsupportservicecategorieswithsubstantialincreaseswerehealtheducation(+36%),prenatalcare(+34%),childhealth(+24%)andpublichealthnursepharmacydispensing(+11%).

Environmental HealthNearly all county health departments report offering water sanitation and safety for public swimming pools(98%)andprivatewatersupply(95%).Mosthealthdepartmentsalsoofferrestaurantandlodginginspections(97%)andon-sitesewageandwastewaterdisposalservices(94%).Leadabatement services are provided by 72 percent (n=61) of the health districts surveyed. Regarding pestmanagement,25healthdepartments(29%)reportthattheyprovidemosquitocontrolandninehealthdepartments(11%)providerodentcontrol.Tickcontrolisprovidedby6percentofallhealthdepartments(n=5)andbeddingcontrolisofferedin14healthdepartments(17%).



Table 3. Public Health Services Provided by Health Departments/Districts, FY2017 (100 Percent of Health Departments/Districts Reporting)

Services Offered

Number of Health

DepartmentsFY2017

Percent of Health

DepartmentsOffering Service

Percentage Change

from FY2013

to FY2017HEALTH SUPPORTRegistration of Vital Events 76 89.4% -6.2%Assessment of Health Status, Health Needs and Environmental Risks to Health Epidemic Investigations ● Risk Assessment 60 70.6% -6.3% ● Pesticide Poisoning 12 14.1% -25.0%Health Assessment ● Comprehensive Community Health Assessment 76 89.4% -2.6% ● Behavioral Risk Assessment 28 32.9% -22.2% ● Reportable Disease 82 96.5% 1.2% ● Vital Records and Statistics 77 90.6% -3.8% ● Chronic Disease Surveillance 52 61.2% -8.8% ● Communicable Disease Surveillance 83 97.6% 1.2% ● Emergency Preparedness Response Planning & Assessment 80 94.1% -3.6%Policy Development Functions/Services ● Health Code Development and Enforcement 50 58.8% -5.7% ● Health Planning 56 65.9% -8.2% Health Assurance ● Health Education 68 80.0% 36.0% ● Child Health 68 80.0% 23.6% ● Prenatal Care 71 83.5% 34.0% Community Health Education 81 95.3% 6.6% Laboratory Services 83 97.6% 0.0% Public Health Nurse Pharmacy Dispensing 61 71.8% 10.9% Other Pharmacy Services 30 35.3% -16.7% School Nursing Services 40 47.1% -4.8%

ENVIRONMENTAL HEALTHRestaurant/Lodging/Institutions Sanitation and Inspections 82 96.5% -3.5%On-Site Sewage and Wastewater Disposal 80 94.1% -4.8%Water Sanitation and Safety ● Private Water Supply 81 95.3% 0.0% ● Milk Sanitation 4 4.7% -20.0% ● Shellfish Sanitation 8 9.4% 0.0% ● Public Swimming Pool 83 97.6% 0.0%Bedding Control 14 16.5% -26.3%Pest Management ● Mosquito 25 29.4% -3.8% ● Rodent 9 10.6% -55.0% ● Ticks 5 5.9% -54.5%Lead Abatement 61 71.8% -3.2%




Services Offered

Number of Health

DepartmentsFY2017

Percent of Health


Percentage Change

from FY2013

to FY2017PERSONAL HEALTHPrimary Care ● Adult 38 44.7% 0.0% ● Pediatric 41 48.2% -6.8%Maternal Health ● Prenatal and Postpartum Care 67 78.8% -2.9% ● Pregnancy Medical Home 59 69.4% 5.4% ● Pregnancy Care Management 82 96.5% 2.5% ● Postnatal Home Visits 58 68.2% -13.4% ● SIDS Counseling 75 88.2% 0.0% ● WIC Services—Mother 85 100.0% 7.6%Family Planning ● Preconceptional Counseling 83 97.6% 3.8% ● Contraceptive Care 84 98.8% -1.2% ● Fertility Services 41 48.2% 28.1% ● Pregnancy Prevention—Adolescent 81 95.3% 0.0%Child Health ● Immunizations 85 100.0% 0.0% ● Care Coordination for Children (CC4C) 82 96.5% 1.2% ● WIC Services—Children 85 100.0% 4.9% ● Lead Poisoning Services 72 84.7% -10.0% ● Well-Child Services 69 81.2% -1.4% ● Adolescent Health Services 61 71.8% 3.4% ● Newborn Home Visiting Services 56 65.9% -17.6% ● School Health Services 36 42.4% -18.2% ● Services to Developmentally Disabled Children 27 31.8% 22.7% ● Children with Special Health Care Needs Services 24 28.2% -14.3% ● Genetic Services 14 16.5% -12.5%Chronic Disease Control Early Detection and Referral ● Kidney Disease 24 28.2% 9.1% ● Hypertension 55 64.7% -9.8% ● Cancer 56 65.9% -15.2% ● Diabetes 63 74.1% -4.5% ● Cholesterol 43 50.6% -20.4% ● Arthritis 17 20.0% -15.0% Patient Education ● Kidney Disease 35 41.2% 25.0% ● Hypertension 65 76.5% -9.7% ● Cancer 63 74.1% -6.0% ● Diabetes 71 83.5% -4.1% ● Cholesterol 55 64.7% -17.9% ● Arthritis 28 32.9% 0.0%




Services Offered

Number of Health

DepartmentsFY2017

Percent of Health


Percentage Change

from FY2013

to FY2017PERSONAL HEALTH (continued)Chronic Disease Monitoring & Treatment 30 35.3% -18.9%Home Health Services 17 20.0% -39.3%Behavioral Health Services ● Child Behavioral Services 14 16.5% -6.7% ● Adult Behavioral Services 12 14.1% 500.0% ● Health Behavior Intervention 12 14.1% n/aHealth Promotion and Risk Reduction ● Nutrition Counseling 73 85.9% 0.0% ● Injury Control 41 48.2% 2.5% ● Tobacco Cessation 75 88.2% 2.7%Communicable Disease Control ● 24/7 day Communicable Disease Response 83 97.6% -1.2% ● CD Reporting Information for Health Care Providers 83 97.6% 1.2%Acute Communicable Disease Control ● Surveillance 84 98.8% 0.0% ● Case investigation 85 100.0% 2.4% ● Post-exposure prophylaxis 81 95.3% 0.0% ● Implementation of control measures 82 96.5% -1.2% ● Outbreak investigations 85 100.0% 1.2%Tuberculosis Control ● Surveillance 85 100.0% 0.0% ● Case and contact investigation 85 100.0% 0.0% ● Directly and observed therapy 84 98.8% -1.2% ● Treatment of contacts 85 100.0% 0.0% ● Isolation and other control measures 84 98.8% -1.2%STD Community Level Surveillance, Investigation, Prevention and Control ● Examination and testing of at risk individuals for STDs within one workday of request

84 98.8% 5.0%

● Examination, Testing, Treatment, Counseling and Referral 85 100.0% 0.0% ● Partner notification 81 95.3% 9.5% ● Investigation of Disease Control Measure Violations 80 94.1% -1.2% ● Counseling/education—community outreach 79 92.9% 5.3% ● Counseling/education—individual 85 100.0% 0.0%AIDS/HIV Community Level Surveillance, Investigation, Prevention and Control ● HIV/Syphilis Partner Notification Services 51 60.0% 6.3% ● Case Management 26 30.6% 8.3% ● Investigation of Disease Control Measure Violations 63 74.1% -8.7% ● Opt-Out Testing in clinics 52 61.2% -18.8% ● Community-based testing in partnership with CBOs 36 42.4% 20.0% ● HIV seropositive counseling, follow-up and referral 55 64.7% -11.3%Hepatitis A and B Immunizations 82 96.5% 0.0%




Services Offered

Number of Health

DepartmentsFY2017

Percent of Health


Percentage Change

from FY2013

to FY2017PERSONAL HEALTH (continued)Rabies Control: Provide a full range of services when people are bitten by dogs or cats ● Identify and confine the biting animal for observation or submitting animal for rabies testing

49 57.6% -7.5%

● Receive reports from physicians of persons bitten by animals capable of transmitting rabies

81 95.3% 3.8%

● Provide rabies exposure risk assessments 76 89.4% 5.6% ● Coordinate administration of rabies post exposure prophylaxis if necessary

76 89.4% 2.7%

Rabies Control: Provide services when people are exposed to rabies vector species (bats, terrestrial carnivores) ● Identify (if possible) the biting animal and submit for rabies testing 48 56.5% -11.1% ● Receive reports from physicians of persons bitten by animals capable of transmitting rabies

78 91.8% 2.6%

● Provide rabies exposure risk assessments 77 90.6% 10.0% ● Coordinate administration of rabies post exposure prophylaxis if necessary

74 87.1% 2.8%

Rabies Control: Provide services for domestic animals that are reasonably suspected of being exposed to rabies ● Identify (if possible) the biting animal and submit for rabies testing 47 55.3% -14.5% ● Order rabies booster, quarantine or euthanasia of the exposed animal

55 64.7% -9.8%

Coordinate at least one annual rabies vaccination clinic in the county for dogs, cats and ferrets

46 54.1% -8.0%

Canvas the county to search for unvaccinated dogs/cats/ferrets and appropriately administer all animal sheltering functions

23 27.1% 9.5%

Administer the voluntary Certified Rabies Vaccinator Program in the county if one exists

38 44.7% 35.7%

Dental Health ● Dental Health Education 54 63.5% -5.3% ● Topical Fluoride Application 51 60.0% -5.6% ● Sealant Application 47 55.3% -2.1% ● Dental Screening and Referral 54 63.5% -6.9% ● Dental Treatment 39 45.9% -9.3% ● Community Fluoridation 11 12.9% -45.0% ● “Into the Mouths of Babes” Dental Preventative Services 27 31.8% 0.0% ● Mobile Dental Health Services 17 20.0%Other Personal Health ● Migrant Health 11 12.9% -38.9% ● Refugee Health 22 25.9% -8.3% ● Hospice 3 3.5% n/a



FromFY2013toFY2017,NorthCarolinahealthdepartmentsreportthatnoenvironmentalhealthservice categories increased. The largest declines in environmental health services were in rodent control(-55%)andtickcontrol(-55%).Beddingcontrolandmilksanitationservicesalsodeclinedbymore than 20 percent during this time period.

Personal HealthPersonal health services comprise the largest category of services provided at local health departments.Nearlyhalfofallhealthdepartments(48%)reportedofferingpediatricprimarycareandadultprimarycareservices(45%).WhilethenumberofhealthdepartmentsofferingadultprimarycareservicesremainedthesamefromFY2013toFY2017,thenumberofferingpediatricservicesdeclinedslightly(-7%)duringthistimeperiod.

Under the sub-category of Maternal Health services, over 90 percent of all health departments reportedofferingpregnancycaremanagement(97%)and100percentoffermaternalWICservices.SIDScounselingwasofferedby75healthdepartments(88%)and79percentofhealthdepartmentsreported that they provided prenatal and postpartum care (n=67). Approximately two-thirds of health departments(69%)reportedthattheyprovidepregnancymedicalhomeservicesand58healthdepartmentsreportedofferingpostnatalhomevisits(68%).NoneofthematernalhealthcategoriesexperiencedsubstantialincreasesinreportedservicesfromFY2013toFY2017.Postnatalhomevisitsdeclined 13 percent during this time period.

Within Family Planning services, nearly all health departments reported offering contraceptive care (99%)andpreconceptioncounselingservices(98%).Inaddition,themajorityofhealthdepartmentsalsoprovideadolescentpregnancyprevention(95%).Fertilityserviceswerelesslikelytobeoffered,withfewerthanhalfofhealthdepartments(48%)reportingthattheyofferedthisservice.However,within family planning services, the fertility services category experienced the largest increase from FY2013toFY2017(+28%).

Examining Child Health services, immunizations and child WIC services were provided by all health departments(100%).Mosthealthdepartmentsalsoreportedofferingcarecoordinationforchildren(97%).Wellchildservicesandleadpoisoningserviceswereprovidedbyatleast80percentofhealthdepartments. Adolescent health services (n=61) and newborn home visiting services (n=56) were provided by more than half of all health departments. Child health services which were offered less frequentlyincludedschoolhealthservices(42%),servicestodevelopmentallydisabledchildren(32%),servicesforchildrenwithspecialhealthcareneeds(28%)andgeneticservices(17%).FromFY2013toFY2017,thecategoriesofservicewithlargedeclinesincludedschoolhealthservices(-18%)andnewbornhomehealthservices(-18%).ServicestoDevelopmentallyDisabledChildrenwas the only child health category of service with a noteworthy percentage increase during this time period(+23%).

For services related to Chronic Disease Control, early detection and referral services were most frequentlyprovidedfordiabetes(74%),cancer(66%),hypertension(65%)andcholesterol(51%).Less than 30 percent of health departments offered early detection and referral for kidney disease (28%)andarthritis(20%).FromFY2013toFY2017,mostchronicdiseaseearlydetectionandreferral



categories experienced decreases. Kidney disease was the only category with a reported increase in services(+9.1%).Thenumberofhealthdepartmentsreportingthattheyofferedearlydetectionandreferral for cancer, arthritis and cholesterol all decreased by more than 10 percent. For every disease category, the provision of Patient Education services for these same chronic diseases was higher thanthatofearlydetectionandreferral.Fewerthanhalf(35%)ofhealthdepartmentsreportedthattheyofferchronicdiseasemonitoringandtreatmentservicesinFY2017—thisislowerthanfiguresreportedinFY2013(-19%).

Provision of Behavioral Health services was not commonly reported by health departments in FY2017.Only14healthdepartmentsreportedofferingbehavioralhealthservicesforchildren(17%)and12healthdepartmentsofferedbehavioralhealthservicestoadults(14.1%).Healthbehaviorinterventionwasreportedby14percentofhealthdepartments(n=12).FromFY2013toFY2017,childbehavioralhealthservicesdecreasedslightly(-7%).Incontrast,adultbehavioralhealthservicesincreasedsubstantially—fromtwohealthdepartmentsofferingthisserviceinFY2013to12healthdepartmentsinFY2017.

Regarding Health Promotion efforts, the majority of health departments reported that they provide tobaccocessationcounseling(88%)andnutritioncounseling(86%).However,slightlylessthanhalf(48%)reportedhealthpromotioneffortsaimedatinjurycontrol.TherewasvirtuallynochangeinanyofthehealthpromotionandriskreductionservicecategoriesfromFY2013toFY2017.

Under services for Communicable Disease,nearlyallhealthdepartments(98%)reportthattheyoffer24/7 communicable disease response and communicable disease reporting information for health care providers. All health departments reported offering case investigation and outbreak investigation services(100%).Nearlyallhealthdepartmentsreportedthattheyofferacutecommunicablediseasecontrolsurveillance(99%),implementationofcontrolmeasures(97%)andpost-exposureprophylaxis(95%).AlloftheFY2017acutecommunicablediseasecontrolcategoriesarecomparabletofiguresreportedintheFY2013survey.

With regard to Tuberculosis Control, allhealthdepartments(100%)reportofferingsurveillance,case and contact investigation, and treatment of contacts. Nearly all also report offering direct and observedtherapyandisolationandothercontrolmeasures(99%).TherewerenosubstantivechangesintuberculosiscontrolservicesreportingfromFY2013toFY2017.

Under the STDsection,allhealthdepartments(100%)reportofferingexamination,testing,treatment,counseling, and referral as well as individual counseling. Nearly all health departments report providingexaminationandtestingofatriskindividualsforSTDswithinoneworkdayofrequest(99%).Mosthealthdepartmentsalsoreportthattheyprovidepartnernotification(95%),investigatediseasecontrolmeasureviolations(94%)andconductcommunityoutreachcounseling/education(93%).Increaseswerereportedforthreecategories,includingpartnernotification(+10%),communityoutreach(+5.3%)andexaminationandtestingofatriskindividuals(+5%).

With regard to AIDS/HIV, most health departments report offering investigation of disease control measureviolations(74%).OverhalfalsoreportprovidingHIVseropositivecounseling,follow-upandreferral(65%),opt-outtestinginclinics(61%)andHIV/syphilispartnernotificationservices



(60%).Lessthanhalfofhealthdepartmentsreportprovidingcommunity-basedtestinginpartnershipwithCommunityBasedOrganizations(42%)and31percentreportedprovidingcasemanagement.InFY2017,sixadditionalhealthdepartmentsreportedofferingcommunity-basedtestinginpartnershipwith Community Based Organizations, which represented a 20 percent increase from the number reportedinFY2013.Thenumberofhealthdepartmentsreportingthattheyprovideopt-outtestingdeclinedby19percentfromFY2013toFY2017.Nearlyallhealthdepartments(97%)reportedofferingHepatitisAandBimmunizationsinFY2017whichwascomparabletoFY2013figures.

Under Rabies Control services, most health departments indicate that they received reports from physiciansofpersonsbittenbyorexposedtoanimalscapableoftransmittingrabies(95%).Mosthealth departments also report that they coordinate administration of rabies post-exposure prophylaxis ifnecessaryforthosebitten(89%)orexposed(87%).Overhalfofhealthdepartmentsreportedthatthey identify the biting animal and submit it for rabies testing and coordinate at least one annual rabies clinic in the county for dogs, cats and ferrets. However, only 23 health departments report that they canvas the county to search for unvaccinated dogs, cats or ferrets, and appropriately administer all animalshelteringfunctions(27%),andonly38reportedthattheyadministerthevoluntary“CertifiedRabiesVaccinator”Program(45%).FromFY2013toFY2017,thenumberofhealthdepartmentsreportingthattheyadministerthe“CertifiedRabiesVaccinator”Programincreasedby36percent.

Under Dental Health services, more than 60 percent of health departments reported offering dental healtheducation(64%),dentalscreeningandreferral(64%),topicalfluorideapplication(60%)andsealantapplication(55%).However,slightlylessthanhalf(46%)ofallhealthdepartmentsindicatethattheyofferdentaltreatment.Nearlyoneinthree(32%)ofhealthdepartmentsreportedthattheyparticipateinthe“IntotheMouthsofBabes”dentalpreventativeservicesprogram.Only17healthdepartments(20%)indicatedthattheyoffermobiledentalhealthservicesandonly13percentprovidecommunityfluoridation.Thenumberofhealthdepartmentsreportingcommunityfluoridationhasdeclined45percentfromFY2013toFY2017.

With regard to Other Personal Health services,11healthdepartments(13%)reportedthattheyoffermigranthealthservicesand22healthdepartments(26%)indicatedthattheyproviderefugeehealthservices.BothofthesecategoriesdecreasedfromFY2013toFY2017.OnlythreehealthdepartmentsreportthattheyofferedhospiceservicesinFY2017.



Bilingual Health Initiatives (Section C)

Non-English Information and Education Material in LHDsAll health departments reported that they provide educational and informational materials in other languages, with all reporting that they offer materials in Spanish (n=85). In addition to Spanish, a small number of health departments also report that they provide educational material in other languages such as Arabic, Hmong and Mandarin.

Table 4 presents the number and percentage of health departments that report needing non-English material by health department service area. Over half of health departments report using and not needinganyadditionalnon-EnglishmaterialforFamilyPlanning(64%),MaternalHealth(58%),CommunicableDisease(55%)andChildHealth(53%)services.Inaddition,nearlyhalfofhealthdepartmentsstatethattheyusenon-EnglishmaterialforPatientEducation(49%)andHealthPromotion(47%).SlightlymorethanathirdofhealthdepartmentsreportthattheyuseanddonotneedmaterialsforChronicDiseaseControl(39%)andDentalHealth(37%).Examiningtheneedfornon-English education/information across all service types, 32 to 42 percent of all health departments indicated that they use and need or have a need for bilingual materials.

Bilingual Staffing and ServicesSeventy-sixhealthdepartments(89%)reportedhavingbilingualstaffandninehealthdepartments(11%)reportedthattheydidnothavebilingualstaff.Spanishwasthemostfrequentlanguageprovided by bilingual staff; with a few health departments also reporting staff speaking Hmong, Mandarin,Arabicandotherlanguages.Nearlyhalfofhealthdepartments(48%)reporttheirservicepopulationisbecomingmorenon-Englishspeaking.Halfofhealthdepartments(50%)reportedthattheirdepartmenthasspecificoutreacheffortstargetingnon-Englishspeakingpopulations.



Table 4. FY2017 Health Department Use of Non-English Educational/ Informational Material

Service

Use and Does

Not Need Additional

Use and Needs

Additional Materials Need

Do Not Need

Not Applicable

Missing / Unknown

# % # % # % # % # % # %

Maternal Health 49 57.6 26 30.6 2 2.4 2 2.4 4 4.7 2 2.4

Family Planning 54 63.5 28 32.9 1 1.2 2 2.4 0 0.0 0 0.0

Child Health 45 52.9 27 31.8 4 4.7 3 3.5 3 3.5 3 3.5

Chronic Disease Control 33 38.8 24 28.2 5 5.9 5 5.9 9 10.6 9 10.6

Patient Education 42 49.4 30 35.3 3 3.5 4 4.7 1 1.2 5 5.9

Health Promotion and Risk Reduction 40 47.1 31 36.5 4 4.7 3 3.5 0 0.0 7 8.2

Communicable Disease Control 47 55.3 31 36.5 5 5.9 1 1.2 0 0.0 1 1.2

Dental Health 31 36.5 20 23.5 7 8.2 4 4.7 11 12.9 12 14.1



Other Topics (Section D)

Cultural DiversityAll 85 health departments report that their staff has undergone cultural diversity training. Nearly halfofhealthdepartments(47%)indicatethattheirdepartmentutilizestheNationalStandardsforCulturally and Linguistically Appropriate Services in Health and Health Care (CLAS Standards); with 58 percent of health departments noting that they would like to know more about CLAS Standards.

Internet AccessAllbutonehealthdepartmentreportedthattheirstaffhasinternetaccessatwork(99%).

Governing BodyAs shown in Figure 4, nearlythree-quartersofhealthdepartments(72%)reportthataBoardofHealth is the governing body over their health department. Consolidated Human Services Board (12%)oraBoardofCommissioners(12%)wereindicatedforalmostaquarterofhealthdepartments(n=20). A small number of health departments reported multiple governing bodies (n=3).

Health Board72%

Board of County Commissioners

12%

Consolidated Human Services Board

12%

Multiple Governing Bodies Reported

3%Missing/Not Reported

1%

Figure 4: Governing Body Over Health Department, SFY2017 Local Health Department Survey

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local health department staffing and services summary ...staffing and services summary fiscal year...

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