Board of Health - October 14, 2022 Minutes

Regular Meeting: October 14, 2022

Opening: Noon, 225 4th St N, Chelsey Matter called the meeting to order
Present: Chelsey Matter-Chair, Lyn Telford MSN, RN, CPHQ, Arlette Preston, Nyamal Dei, Duane Breitling, Amy LaValla DNP, PMHNP-BC, APRN, PHN, Bernie Dardis, Kayla Nelson DNP, APRN, FNP-C, Charlene Nelson
Others Present: Desi Fleming, Robyn Litke Sall, Melissa Perala, Tracie Newman, MD, MPH, FAAP, Justin Bohrer, Tim Mahoney, Jan Eliassen, Lori Sall
Announcements: Meeting minutes from August 19, 2022: motion to approve by Ms. Matter, move to approve Lyn Telford, seconded by Kayla Nelson. All members present voted aye and the motion was declared carried.
Department Updates: Ms. Fleming presented department updates:
Restarted all staff meetings. Program numbers are rebounding. Flu season is starting, seasonal flu vaccine and bivalent Covid-19-19 immunizations are available. Home test kits: we have distributed 132,000 test kits to the public. Ms. Matter mentioned that it is “Socktober” and to challenge the board members to contribute socks to the Gladys Ray Shelter.
Board of Health Bylaws: We have gotten clarification that many of the changes that were being proposed were under the authority of the Fargo City Commission. The changes are going to the Fargo City Commission to be reviewed and acted upon. Ms. Fleming confirmed that the city attorney gave the opinion that the Board of Health’s membership, mission, and responsibilities etc. are under the authority of the Fargo City Commission. Ms. Fleming confirmed that the Board of Health is a city group, and it is up to the City Administration to set anything that is linked to ordinance such as bylaws. The proposed bylaws that were presented in the last meeting are public record, but they are not being presented to the City Commission as a formal recommendation. Ms. Preston mentioned that the city attorney was recommending some changes and that they would be discussed on Monday night’s City Commission meeting and that the consent agenda is available online for viewing.
Health Officer Update: Tracie Newman, MD, reported that monkey pox cases are decreasing, 22% decline in cases. Total of 23 deaths internationally. We have the highest rates, but our cases have decreased nationwide. In ND there were 6 total cases. Majority in the eastern part of the state and 1 in western part of the state. Cases are still involving predominantly young adult men. Many public health are downgrading classification of the disease (due to access to vaccines/treatments), so Monkeypox will now considered a Hazard Group 3 organism (others are HIV, Hep B and Hep C) and it is managed at the community level. Flu season is here, and we are set up for a potentially severe season because all the COVID-19-19 precautions have been lifted and we may have a lower population immunity. Australia is experiencing the worst flu season in the last 5 years. We usually peak about February and there has already been a flu outbreak resulting in school absences along with pediatric RSV, rhinovirus and enteroviruses showing up early. It takes two weeks to establish protection after immunization for flu.
Bivalent boosters (original SARS CoV 2 strain + BA.4/5) currently available for ages 12 and older. ACIP (CDC’s advisory committee meets October 19-20. The Pfizer (ages 5 – 11 years) and Moderna (6 - 17 years) EUA’s were just approved for younger age groups. Presented ND Covid-19-19 Vaccine Rates. We are at about 55% of adults for one dose, pediatric rates 6.6% of kids 5 and under having one Covid-19 immunization. Side effects from getting the booster for the younger age group include a sore arm maybe some fatigue. Ms. Fleming reminded the board that it is difficult to get a true picture of COVID-19-19 cases because may who are positive are staying at home and doing testing at home, so those numbers do not get reported. Ms. Matter pointed out that the flu is the same with people not reporting the illness.
Budget Update: Ms. Perala reviewed the expenditures and revenues highlighting that salaries are on track except for the temporary seasonal staff was more expensive because of all the hiring due to COVID-19 and we still have some of them employed with us. We received a substantial amendment to our $80,000 Ryan White budget; this money goes to assist those living with HIV/AIDS in the area. The marketing expense is covered by COVID-19 funds. Other services budget is quite high due to the Harm Reduction program and mostly taxi rides. Custodial is up mainly because of the downtown engagement center costs. Expenses are mostly covered by grant funds. Revenue side is way off. Budget adjustments didn’t come in and we have had some changes in finance. Revenue is coming in well and there should be no issue meeting our budget. Medicaid expansion revenue has now been moved to our Medicaid line item and no longer under third party insurance.
Strategic Planning: Ms. Fleming spoke regarding that we have not done any strategic planning with the last 15-20 years. She took over in 2018 and we started to work on it and then Covid-19 happened, and everything changed. Strategic planning will help provide a roadmap of where we to go as an agency, setting our priorities and goals and then we want activities that will support these goals. It helps us a group to have a common goal. The last three years have been difficult with a lot of burnout and hopelessness, it has not been easy with public negativity and scrutiny. We are trying to reframe our role and recover. We are talking in meetings with all our staff about accountability and the roles we all play in making this a success. Each person may be performing well, but this will assure that we are all aligned and flowing in the same direction and our divisional plans will feed into our agency goals. We hired a public health consultant and started meetings in March of 2022. We used tools to assess like SOAR documents, window in our world meetings, and staff input. We had an all-day meeting to get feedback from staff and leadership team. Consultants took staff comments and formulated themes for FCPH values: communication, trust, accountability, and empathy/compassion. Then strategic area were named as communication, collaboration, workforce, policy, and infrastructure. Our strategic areas are set up to address agency internal needs first then external. We need to support our staff and help with resiliency for them. We are looking for staff feedback and actionable items to fill in gaps. We are having a January 1st implementation to start those internal activities. Mr. Bohrer will speak regarding the strategic plans interfacing into existing plans, as he oversees all the plans for FCPH except for public emergency plans. Mr. Bohrer explained that we can build on some processes that already exist as well as create new ones. FCPH is going to start with internal plans and then move externally. We are planning to have more things out on our website to be more transparent. Some of these plans will be new for us and a learning process. The five goals foundation will be what we will be building out on to help us move forward into the next few years. It has been difficult in the past to get the public information because it has been overrepresented by higher education, higher income Caucasian females so we know we are missing populations that we serve. We will strive to gather information from these other populations. Mr. Bohrer has set forth a data request from the state for BRFSS (Behavioral Risk Factor Surveillance System) data. We want to see the stratified data so we can develop micro and macro plans. The state is working on a dashboard so it would be more up to date and responsive then a one-time report. We are going to publish our strategic plan and then be able to start building on collaboration, infrastructure, and policy. We need more feedback and collaboration during our health assessment process. Ms. Dei wants to know how we will diversify. Mr. Bohrer mentioned our health equity grant and discussed how 2020 and the COVID-19 years has meant a lot of turnover so it has been quite an undertaking to figure out our contact list for stake holders. We are working on identifying partnerships and finding out who is left out. We have a listening session on October 22 with new Americans (regarding Covid-19-19 vaccine). We will be trying to focus on the groups we have been missing because we have lost touch with some organizations because we have been stretched thin that past few years (new Americans, African Americans, Native People). Mr. Dardis wants to know when do these plans move from internal to external. Ms. Fleming responded that we still have been doing external meetings and we are working on establishing new partnerships and potentially we would need six months to work on the internal plans and get them established. Ms. Fleming mentioned that Harm Reduction is our most challenging division to keep staffed. Our Mobile Outreach Program has been very successful, so the community wants more, which is great, but it is difficult work and there is logistics around funding, hiring, training, and finding the right people to work it. Same thing applies for our nursing department. Right now, we are covering what we need to, our numbers are coming back and that adds some strain, and the State has asked if we can take the Covid-19 test site back. From a staff perspective we can’t take that responsibility back. Ms. Telford commented that beginning January 1, CMS will require participating organizations to assess and address health related social needs this would open another pool of data. We need to look at our electronic system and assess who is coming in and who are we missing. Mr. Bohrer responded that we get our data for health assessment through surveys, and we use county health rankings.
Substance Use Coordinator Update: Ms. Litke Sall must skip the first part of her presentation due to time constraints, but Ms. Matter has requested that she return at a later date and present. Ms. Litke Sall discussed the State Opioid Response grant which ran from October 2021 until September 2022. The program areas that were covered by this grant were: Parents Lead Program Promotion, Speak Volumes Campaign, Access to Prescription Opioids, Opioid Overdose Prevention, Reducing Barriers to Treatment, Anti-Stigma Campaign, Syringe Services Program, and ONE Program. To promote the Parents Lead Program we did 121 social media posts (20,525 individuals reached), 2 booths and one news conference, 1,079 promotional materials distributed. This program is for parents to model healthy behaviors and encourage participation in health activities with positive peers. The Speak Volumes campaign ran from January 22 to September 2022 and they had 72 social media posts and reached 26,978 individuals. This plan is for adult binge drinking really homing in on drink size. Access to Prescription Opioids is for reducing the availability of Opioids in the community. We had 67 social media posts and reached 12,520, they participated in two booths and distributed 710 Deterra (safe medication disposal bags) bags that can be used if a person doesn’t go to a “Take Back” location. For the Opioid Overdose Program, we had a mural painted for the International Awareness Day 2021 and each butterfly on the mural has the name/initial of a person who died. There were 52 names on the mural. They did 130 social media posts, 55,635 reached, 13 news stories, and a City of Fargo video. For the Opioid Overdose Response there were 63 trainings conducted, 743 individuals trained, 3,797 Naloxone kits distributed, 1,076 doses administered, 553 reported reversals (life saved with Narcan distributed from FCPH) and 770 fentanyl testing strips distributed (June-Sept).
Narcan leave behind program is where one dose of Narcan is left behind on overdose calls. Fargo (started August 5th) and West Fargo (started July 22nd) Fire Departments have been participating. Syringe Services program is a disease prevention program located at 510 5th St N in Fargo. There have been 136 social media posts for them that have reached 35,244 people, nine presentations to 233 individuals, 976 individuals served, and 368 new enrollees. They have also been awarded a $100,000 AIDS United Covid-19 grant. Transportation to Treatment program is to reduce the barriers for individuals to get to treatment for substance use disorder, from October of 2021 to September 2022 we have provided 81 individuals transportation. Anti-stigma campaign has had 58 social media posts with 13,809 reached. This campaign is for reducing the stigma around substance use and addiction that may prevent these individuals from getting help. ONE program (Opioid & Naloxone Education) had FCPH home health nurses screen patients with an opioid prescription and provide education, resources, and support to ensure safe use (April through September). We reached 180 clients, provided 16 lock boxes, 36 Deterra bags. Six patients received education and Narcan for overdose prevention.
Ms. Preston announced that Ms. Fleming was awarded the Friend to Medicine award from ND Medical Health Association.
No public comment
Meeting Adjourned
Next Meeting: December 16, 2022