ࡱ> BD?@A#` `|bjbj ^ >>>^D0 0 0 D L_L_L_8_`D t```JaJac:d\:e0$hprǫ0 p`c@cppǫJaJaܫ:^u^u^up8Ja0 Ja^up^u^u2ͧ 0 IJa` 0}8(RL_rBa.~s6\I0 IXje i^ukmjejejeǫǫu^jejejeppppD D D -6d(D D D 6D D D  State of fb88 Governors Office of Health Policy and Finance 15 State House Station Augusta, fb88 04333-0078 JOHN E. BALDACCI TRISH RILEY GOVERNOR DIRECTOR TO: Sen. Joseph C. Brannigan, Chair Rep. Anne C. Perry, Chair Members of the Joint Standing Committee on Health and Human Services Sen. Elizabeth M. Schneider, Chair Rep. Christopher R. Barstow, Chair Members of the Joint Standing Committee on State and Local Government Sen. Bill Diamond, Chair Rep. Stan Gerzofsky, Chair Members of the Joint Standing Committee on Criminal Justice and Public Safety FROM: Trish Riley, Director Governors Office of Health Policy and Finance DATE: January 4, 2008 I am very pleased to forward for your review the final report of The Public Health Work Group, Current Plans and Recommendations for Statewide Public Health Infrastructure to Be Developed within Existing Resources Over the Next Five Years. The Public Health Work Group was established through the State Health Plan to assure all the stakeholders in public health worked together to develop a more effective and efficient public health system in fb88 that would achieve our goal of making fb88 the healthiest state. L.D. 1812, Resolve, Regarding the Role of Local Regions in fb88's Emerging Public Health Infrastructure, stipulated the membership of the Public Health Work Group and limited its membership to 40 and required the Public Health Work Group to report on its infrastructure proposal to the Jt. Standing Committee on Health and Human Services and the Jt. Standing Committee on State and Local Government. In addition, L.D. 676, An Act To Implement the Recommendations of the Task Force To Study fb88's Homeland Security Needs", asked the DHHS ME CDC to develop a proposal regarding Local Health Officers with input from the Public Health Work Group. That report needs to be submitted to both the Jt. Standing Committee on Health and Human Services and the Jt. Standing Committee on Criminal Justice and Public Safety. Because the Local Health Officer function is critical to the broader public health system, we have included both in this one report. I hope you concur that the Public Health Work Group has developed a proposal that will lead fb88 forward with a more effective and efficient public health system that can operate within existing resources and streamline how public health services are delivered. The Public Health Work Group has worked long and hard to develop this important set of recommendations. Our office, working collaboratively with the ME CDC in the Dept. of Health and Human Services, has been pleased to spearhead this work and would welcome an opportunity to meet with you to further discuss the plans and recommendations included herein. cc: Dora Mills Members, The Public Health Work Group THE PUBLIC HEALTH WORK GROUP REPORT Current Plans and Recommendations for a Statewide Public Health Infrastructure to Be Developed within Existing Resources over the Next 5 Years to the fb88 Legislatures Joint Standing Committee on Health and Human Services Joint Standing Committee on State and Local Government Joint Standing Committee on Criminal Justice and Public Safety December 31, 2007 Goal of the fb88 State Health Plan: Making fb88 the Healthiest State Public Health Work Group Current Plans and Recommendations for a Statewide Public Health Infrastructure to Be Developed within Existing Resources over the Next 5 Years Report to the fb88 Legislature: Joint Standing Committee on Health and Human Services Joint Standing Committee on State and Local Government Joint Standing Committee on Criminal Justice and Public Safety 12.31.07 fb88s health care spending is the second highest in the nation, fueled in part by high rates of chronic illness. Nearly half of health care cost increases are attributable to five often preventable diseases: cardiovascular disease, diabetes, cancer, chronic lung diseases, and depression. Our public health system has an enviable track record of community partners, fb88 CDC, and other statewide entities working together successfully to address such health problems as high teen pregnancy, infant mortality, and youth smoking rates. This system holds a unique and important role in preventing disease and promoting good health. However, because of the fragmented funding and patchwork quilt of agencies it has built, there is a need for improved coordination and streamlining in order for the system to most effectively and efficiently address current and future health problems. Often driven by Federal requirements, community-based funding has been administered through a wide array of entities with over 500 different grants addressing some aspect of public health. The 2005 State Health Plan charged the Public Health Work Group (PHWG) to implement a statewide community based public health infrastructure that works hand in hand with the personal heath care system. In 2006 the Legislature enacted a resolve, LD 1614, charging the PHWG with developing core competencies, functions, and performance standards for comprehensive community health coalitions. In 2007 the Legislature, through LD 1812, again called on the PHWG to streamline administration, strengthen local community capacity, and assure a more coordinated system of public health. That legislation set forth requirements for membership on the Public Health Work Group to assure broad representation while limiting membership to forty people, who worked tirelessly over several years to make this plan a reality. A membership list is included in Appendix A to this report. In 2007 the Legislature also enacted LD 676, seeking a plan from fb88 CDC, with input from the PHWG, to modernize the Local Health Officer system. This report addresses the Legislatures charges and describes the public health infrastructure, administered through eight districts, that includes Local Health Officers, Comprehensive Community Health Coalitions, district offices of fb88 CDC, District Coordinating Councils, and a Statewide Coordinating Council. The system, for the first time, links and coordinates local, sub-state, and state public health activities using existing resources more efficiently. This system also includes representation from and links to the state and county emergency preparedness system. An effective and efficient statewide public health system is critical to achieve the goal of the State Health plan - making fb88 the Healthiest State. This requires coordinated planning and calls for certain other functions within the 10 Essential Public Health Services to be carried out at the local, district and state level over the next five years and within existing resources. fb88s Statewide Public Health System to Be Developed within Existing Resources over the Next 5 Years fb88s public health infrastructure is designed to: Strengthen the statewide consistent delivery of Essential Public Health services to all fb88 people. Achieve greater effectiveness and efficiency through coordination, collaborative planning, and leveraging of fb88s public health and private assets. Assure health disparities for vulnerable populations are being addressed. Assure Local and District Health Improvement Plans inform and are informed by the State Health Plan. Coordinate assessment of local public health needs and the development, implementation, and evaluation of Local and District Health Improvement Plans. Assure accountability to local communities for fairness and transparency in the public health system. Assure accountability in the use of State resources for achieving the goals of the State Health Plan. Recognize, link with, and strengthen both governmental and non-governmental roles as part of the public health system at local, county, and state levels. Comprehensive Community Health Coalitions A major step in streamlining and assuring a more coordinated public health system was put in place in 2007 by integrating Healthy fb88 Partnerships and Community Health Coalitions into one system of Comprehensive Community Health Coalitions that strengthen local public health capacity statewide. This streamlining resulted in over 100 state grants and contracts to health coalitions being bundled to 28 contracts. Overview of Local Health Officer Proposed Changes The Local Health Officer (LHO) system provides a linkage between state public health and every local municipality. It is a system that has been in place for over 100 years. The Legislature charged fb88 CDC/DHHS with proposing revisions to assure the laws governing LHOs are appropriate for the 21st Century. An Act to Modernize the Local Health Officer Statutes (see Appendix B) has been endorsed by the PHWG and is presented as part of this report for consideration for introduction in the 2008 session of the fb88 Legislature. The pending Act streamlines a myriad of statutory duties and removes redundancies, while strengthening and focusing the system on the local governmental functions related to controlling and reporting local public health nuisances and communicable disease threats. Process The Director of the fb88 CDC conducted two surveys of LHOs in June and August of 2006. These surveys, previously reported on to the Criminal Justice and Public Safety Committee, gave us a snapshot of the backgrounds, scope of work, and employment situations of over 200 LHOs statewide. A subsequent meeting with 18 LHOs in Augusta in November, 2006 was helpful in defining a process for further discussions. In June, 2007 over 70 LHOs met in Augusta to review the recently-enacted statute setting forth requirements for education, training, and experience for LHOs. Subsequently, Dr. Dora A. Mills, Chris Lyman from the fb88 CDC, and Trish Riley (or another representative from the Governors Office of Health Policy and Finance), hosted eight meetings with LHOs and related stakeholders, one in each of the fb88 CDC/DHHS districts. These stakeholders included municipal elected and management officials, county government officials (including county commissioners and emergency management officials), hospital and health center staff, Comprehensive Community Health Coalition staff, and representatives from the two municipal health departments in fb88 (Bangor and Portland). These meetings all occurred in the latter half of October 2007 and were held in Waterville, Ellsworth, Bangor, Caribou, Wells, Portland, Rockland, and Auburn. A total of over 100 LHOs attended these eight meetings. Between the over 200 LHOs who responded to the surveys, the 90 who attended Augusta-based meetings, and the over 100 who attended one of the eight district meetings, we received a great deal of valuable input from LHOs and related stakeholders. Outcomes The following is proposed: Local Health Officers need to remain municipal-based employees who provide: reporting to fb88 CDC/DHHS of perceived local public health threats; linking of town residents to fb88 CDC/DHHS resources; and mitigation of some types of unsanitary conditions (such as a tenant living in an unsanitary rental unit). b) Some redundant LHO statutes should be eliminated such as: those that allow LHOs to provide immunization clinics (there is nothing in state law that says they cannot do so, even without this statute); those that give LHOs the authority to address wolf hybrid issues (this is redundant with the animal control officer statutes); and those that give LHOs the authority to deal with public health issues related to jails (the fb88 CDC provides that, and the consensus among LHOs is that they are not qualified to do this). c) During a declared public health emergency, the LHOs will report to and assist the fb88 CDC on issues related to the public health emergency. The statutory duties of LHOs should be re-formatted to make them easier to read and understand. fb88 CDC Public Health Units within each DHHS district have been formed and consist of co-located Public Health Nurses, District Nurse Epidemiologists, Health Inspectors, Drinking Water Engineers, and District Public Health Liaisons. These Public Health Units may perform certain public health functions that are more efficiently and effectively provided by them, such as some district or county-level functions and some public health emergency functions (see page 7 of this report). In the case of public health emergencies, the District Public Health Liaisons will serve in the county emergency operations centers (EOC) as liaisons between state and local public health entities. In those districts that consist of multiple counties, the District Nurse Epidemiologist and/or Public Health Nurses may also serve as EOC liaisons as well as back-up to the District Liaison. Additionally, the fb88 CDC is promulgating major substantive rules to comply with Public Law, Chapter 462, to set the requirements for training, education, and experience of LHOs. Those should be ready for the Legislatures review by mid-January, 2008. A copy of the proposed statutory language to modernize the statutes governing local health officers is attached as Appendix C to this report, Appendix D is an agenda for the October 2007 LHO forums held in each of the eight CDC/DHHS districts, and Appendix E is the form used to obtain feedback from LHOs. Statewide Coordinating Council (SCC) A Statewide Coordinating Council (SCC) will build on the work of the PHWG to implement a statewide public health infrastructure that streamlines administration, strengthens local community capacity, and assures a more coordinated system for delivery of essential public health services. The SCC will be the representative body for review and guidance to the fb88 CDC on strategicstate levelpolicies related to thealignedsystemof Local Health Officers, Comprehensive Community Health Coalitions, District Coordinating Councils, and on other policy issues directly related to public health infrastructure, roles and responsibilities, system assessment and performance, and national accreditation. The Statewide Coordinating Council will be appointed and convened by the fb88 CDC and Governors Office of Health Policy and Finance and will include a member from each District Coordinating Council. The SCC will meet at least quarterly and will report annually on the status of fb88s public health infrastructure to the Governors Advisory Council on Health Systems Development and the Legislatures Health and Human Services Committee. District fb88 CDC/DHHS Units An effective and efficient statewide public health system requires coordinated planning and calls for certain other functions to be carried out at the district level. To improve the administration of state programs and policy and to assure state policy reflects the different needs in each of the eight DHHS districts, fb88 CDC will out-station worker and co-locate existing district workers, and establish District fb88 CDC/DHHS units. These will be linked to District Coordinating Councils. The fb88 CDC/DHHS Units are to include: Public Health Nurses: who provide personal care and population health services including maternal/child health home visits, and vaccination clinics, who participate in addressing disaster preparedness or local infectious disease outbreaks, and who participate in identifying needs and gaps in access to care in the community. District Field Epidemiologists: who provide local surveillance and investigation of infectious disease outbreaks. Health Inspectors: who inspect and license a variety of facilities such as eating establishments, lodging facilities, swimming pools, and youth camps, who work closely with municipal code enforcement officers, and who assist in investigating outbreaks. e) Local Public Health Liaisons: who provide a direct link with the public health district, representing the fb88 CDC and providing public health leadership, who help coordinate state public health functions at the district level, provide technical assistance and consultation to districts in public health planning efforts, and who provide public health assistance to Local Health Officers, County Emergency Management, and other entities. District Coordinating Councils (DCC) As part of fb88s public health infrastructure, District Coordinating Councils (DCCs) will be designated by the fb88 CDC based on recommendations from each of the eight districts and with review and comment by the Statewide Coordinating Council. DCCs will: Be the district-wide representative body for collaborative planning and decision-making for functions that are more efficiently and effectively accomplished at the district level. Perform, through its members, some of the specific functions within the 10 Essential Public Health Services at the district level. Mobilize working partnerships in which efforts and resources are combined within the district in order to produce results than no one community, organization or sector could achieve effectively or efficiently alone. Include members from or representing: fb88 CDC/DHHS County Governments Municipal Governments City Health Departments Hospitals Emergency Management Agencies Emergency Medical Services Tribes Comprehensive Community Health Coalitions/Healthy fb88 Partnerships School Districts Local Health Officers Institutions of Higher Education Health Care Providers Clinics and Community Health Centers Voluntary Health Organizations Family Planning Organizations Area Agencies on Aging Mental Health Services Substance Abuse Services Community-Based Organizations, Issue-Specific Coalitions, and Civic Groups Others 5. Have governance and leadership competency including: Agreed upon operating principles and transparent decision-making. A small volunteer Steering Committee charged with convening, agendas, and overseeing communications. Linkage with the fb88 CDC/DHHS Local Public Health Liaison. 6. Through its members, have competency in: District-wide convening, fostering collaboration, and mobilizing across communities, organizations, and sectors. Leveraging local assets and securing external resources such as contracts, grants, and in-kind goods or services. Interpretation and use of health assessment data. District-level and issue-specific planning. Evaluation design, analysis, and use of evaluation findings. Use of the Internet and other skills and channels for effective communications. Working with fiscal agents capable of accepting and administering funds on behalf of the district as a whole. District Functions within the Ten Essential Public Health Services Note: Responsibility for each function at the district level is assigned to the District DHHS Unit, to the DCC, or is identified as a shared DHHS/DCC responsibility. EPHS #1: Monitor health status to identify community health problems. 1.1 Assure district-wide coordination and consistency for community health status monitoring, local health assessments, and in the development of Community Health Profiles including the identification of disparities in population health status within and between districts. Responsible: DHHS 1.2 Promote the alignment and linkage of local, district, and state data systems. Responsible: DHHS/DCC 1.3 Promote broad-based participation in community health status assessments and collaborate with all relevant entities to collect, analyze, and disseminate data. Responsible: DCC 1.4 Coordinate the development of a District Health Profile based on key indicators identified in the State Health Plan. Responsible: DHHS/DCC EPHS #2: Diagnose and investigate health problems and health hazards in the community. Carry out surveillance and investigation of outbreaks as per delegation of authority by the state. Responsible: DHHS Participate in emergency and all hazards preparedness planning and carry out roles in partnership with officially recognized federal, state, and local authorities. Responsible: DHHS/DCC EPHS #3: Inform, educate, and empower people about health issues. Ensure that culturally and linguistically appropriate public health information, public health programs, and health promotion activities include vulnerable populations and are effectively and efficiently distributed district-wide through collaborative networks with all relevant entities. Responsible: DHHS/DCC EPHS #4: Mobilize community partnerships to identify and solve health problems. Convene and facilitate partnerships among all relevant entities for district programs and initiatives. Responsible: DCC Organize and facilitate a communications system among all relevant entities within and across districts. Responsible: DHHS/DCC Mobilize partnerships to leverage new and existing resources. Responsible: DCC EPHS #5: Develop policies and plans that support individual and community health efforts. Develop a District Health Improvement Plan integrating the District Health Profile, District Public Health System Assessment, State Health Plan and local Community Health Improvement Plans and priorities. Responsible: DHHS/DCC Facilitate district input to and communication about the State Health Plan. Responsible: DCC Facilitate development and coordination of plans and policies, laws, regulations, ordinances, and codes within and across districts. Responsible: DHHS/DCC EPHS #6: Enforce laws and regulations that protect health and ensure safety. Carry out health inspection and licensing activities as per delegation of authority by the state. Responsible: DHHS Provide communities with technical assistance on issues related to public health law. Responsible: DHHS 6.3 Identify, recommend and advocate for improvements in enforcement of state public health policies, laws, and regulations across the district. Responsible: DHHS/DCC EPHS #7: Link people to needed personal health services and assure the provision of health care when otherwise unavailable. Develop and support strategies within and across districts to close gaps in access to personal health services as specifically identified within the District Health Improvement Plan. Responsible: DCC EPHS #8: Assure a competent public health and personal health care workforce. Coordinate and provide for district-wide training, and technical assistance on public health and personal health care evidence-based practices as specifically identified within the District Health Improvement Plan. Responsible: DHHS/DCC Develop and support recruitment, education, training and retention strategies as specifically identified within the District Health Improvement Plan. Responsible: DHHS/DCC EPHS #9: Evaluate effectiveness, accessibility, and quality of personal and population-based health services. Assure coordination and consistency for district public health system assessments within and between districts. Responsible: DHHS Promote broad-based participation in district public health system assessments and collaborate with all relevant entities to collect, analyze, and disseminate data. Responsible: DCC Coordinate and build capacity for high-quality program, organizational, and system evaluation within the district. Responsible: DHHS/DCC Provide input to evaluation design and promote district-wide participation in evaluation activities. Responsible: DCC 9.5 Promote use of evaluation findings in development and revision of District Health Improvement Plans. Responsible: DHHS/DCC EPHS #10: Research for new insights and innovative solutions to health problems. Promote district-wide participation in research as specifically identified within the District Health Improvement Plan or the State Health Plan and in other research initiatives as appropriate. Responsible: DCC Promote use of research and promising practices to modify and develop public health policies, initiatives, and programs. Responsible: DHHS/DCC  LD 1614:  HYPERLINK "http://www.maine.gov/dhhs/boh/phwg/C_LD1614.doc" http://www.maine.gov/dhhs/boh/phwg/C_LD1614.doc  LD 1812:  HYPERLINK "http://www.maine.gov/dhhs/boh/phwg/T_LD1812.doc" http://www.maine.gov/dhhs/boh/phwg/T_LD1812.doc  LD 676:  HYPERLINK "http://janus.state.me.us/legis/LawMakerWeb/externalsiteframe.asp?ID=280023188&LD =676&Type=1&SessionID=7" http://janus.state.me.us/legis/LawMakerWeb/externalsiteframe.asp?ID=280023188&LD =676&Type=1&SessionID=7  fb88 DHHS Districts:  HYPERLINK "http://www.maine.gov/dhhs/boh/phwg/S_HHSDs_Offices3.pdf" http://www.maine.gov/dhhs/boh/phwg/S_HHSDs_Offices3.pdf  Public Health Functions Project, 1994  HYPERLINK "http://www.health.gov/phfunctions/public.htm" http://www.health.gov/phfunctions/public.htm  Health Disparities: differences in the incidence, prevalence, mortality, and burden of diseases and other adverse health conditions that exist among specific population groups. (National Institutes of Health, 2000.) The Office of Minority Health and Health Disparities (OMHD) aims to accelerate CDCs health impact in the U.S population and to eliminate health disparities for vulnerable populations as defined by race/ethnicity, socio-economic status, geography, gender, age, disability status, risk status related to sex and gender, and among other populations identified to be at-risk for health disparities. (US Centers for Disease Control and Prevention, 2007.)  Consensus Recommendations for Comprehensive Community Health Coalitions:  HYPERLINK "http://www.maine.gov/dhhs/boh/phwg/I_CCHC.Definition.Functions.Competencies.PerfStandards.Consensus.070108.pdf" http://www.maine.gov/dhhs/boh/phwg/I_CCHC.Definition.Functions.Competencies.PerfStandards.Consensus.070108.pdf  Local Public Health Liaison position description:  HYPERLINK "http://www.maine.gov/dhhs/jobs/psc2.htm" http://www.maine.gov/dhhs/jobs/psc2.htm The fb88 CDC will designate workers as point persons in each district until such time as Liaison positions are filled.  Assurance: One of the core functions of public health, assurance refers to the process of determining that services necessary to achieve agreed upon goals are provided, either by encouraging actions by other entities (public or private sector), by requiring such action through regulation, or by providing services directly. (Institute of Medicine Committee for the Study of the Future of Public Health. The Future of Public Health. Washington, DC: National Academy Press; 1988.)  Local health assessments: Per National Association of County and City Health Officials (NACCHOs) Mobilizing for Action through Planning and Partnerships (MAPP) Tool: Community Themes and Strengths Assessment Local Public Health System Assessment Community Health Status Assessment Forces of Change Assessment  Community health profile (CHP): A comprehensive compilation of measures representing multiple categories, or domains, that contributes to a description of health status at a community level and the resources available to address health needs. Measures within each domain may be tracked over time to determine trends, to evaluate health interventions or policy decisions, to compare community data with peer, state, national or benchmark measures, and to establish priorities through an informed community process. (NPHPSP: National Public Health Performance Standards Program Glossary)  Community partnerships: A continuum of relationships between and among the local public health system and its constituents that foster the sharing of resources, responsibility, and accountability in community health improvement and undertaking advocacy for capacity development and the delivery of community health services and improving community health. Partnerships are formed to assure the comprehensive, broad-based improvement of health status in the community. (NPHPSP)  State Health Improvement Plan: A state health improvement process is a collaborative effort to identify, analyze, and address health problems in a state; assess applicable data; develop measurable health objectives and indicators; inventory statewide health assets and resources; develop and implement coordinated strategies; identify accountable entities; and cultivate state public health system ownership of the entire process. The results of the state health improvement process are contained in a written document, the State Health Improvement Plan. (NPHPSP)  Community Health Improvement Plan: A long-term, systematic effort to address health problems on the basis of the results of assessment activities and the community health improvement process. This plan is used by health and other governmental education and human service agencies, in collaboration with community partners, to set priorities and coordinate and target resources. A health improvement plan is critical for developing policies and defining actions to target efforts that promote health. It should define the vision for the health of the community inclusively and should be done in a timely way. (Adapted from: United States Department of Health and Human Services. Healthy People 2010. Washington, DC: US Department of Health and Human Services; 2000.) See also Community health improvement process.  Evaluation: Systematic approaches to determine whether stated objectives are being met. 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