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Hertford County Public Health Authority Board of Health Meeting April 25, 2016

Members Present Members absent Staff/Visitors Rebecca Greene Howard Hunter III Ramona Bowser Westelle Cherry Mitchell McLean Dr. Terry Hall Rita Boone Susan Brinkley Iulia Vann Rhonda Harrington Dr. Jamie Udwadia Charles Reynolds Katina Eley-Hardy

Call To Order- Dr. Terry Hall, called the meeting to order at 6:32 PM. He welcomed Board members, staff, and visitors to the meeting.

Invocation-The invocation was given by Mrs. Westelle Cherry

Roll Call-Mrs. Rita Boone, called the roll. A quorum was established.

Conflict of Interest–The Board of Health reviewed the agenda and no conflicts were identified.

Approve Agenda- Mrs. Westelle Cherry made a motion to approve the agenda. The motion was seconded by Mr. Charles Reynolds and approved by the Board.

Approve Minutes- Ms. Rhonda Harrington made a motion to approve the March 28, 2016 Board of Health Meeting minutes. The motion was seconded by Dr. Jamie Udwadia and approved by the Board.

Approve Closed Minutes- Mr. Charles Reynolds made a motion to approve the March 28, 2016 Board of Health Closed Meeting minutes. The motion was seconded by Mrs. Westelle Cherry and approved by the board.

Approve Absences- Mrs. Westelle Cherry made a motion to approve the absence of Mr. Howard Hunter III. The motion was seconded by Mrs. Rebecca Greene and approved by the board.

Recognition of New Employees – None #3

Public Comment- None

Agency Update- Mrs. Ramona Bowser updated the board on the following: QA Indicator Report Review- Mrs. Ramona Bowser asked if there were any questions. Assure access to mandated and essential public health services that includes expansion of services- Iulia reports that the Healthy Beginnings application was submitted on March 11 and now we are waiting for a decision to be made if we are going to be funded for the program. The Infant Mortality Reduction program budget has been approved, the Job Description completed and it will be advertised at the beginning of April. The Vidant Community Benefit Grant for the Breast and Cervical Screening Program has been completed and submitted for review. I am working with the HIV department staff to complete the grant application for the “Capacity building Initiative for substance abuse and HIV prevention services for at-risk racial/ethnic minority youth and young adults” grant. The application is due April 11. Fully utilize and integrate EMR into all agency services – Iulia states that the Toshiba copy machines are having problems with their scanning capabilities which didn’t allow us to scan anything in the EMR in the last few weeks. IT department is working on the issues. The IT department will also create the appropriate accounts for staff to be allowed to enter the Patagonia Scans server. Patagonia is still working on adding the new forms needed in the ID clinic in the EMR. On March 31st a Patagonia representative came for a day of training. The training will be focusing on the ID clinic aspect and the staff that operates the ID clinic will be the priority. In the after-noon there was a refresher session for the rest of the staff and questions from staff were answered. Maintain fiscal management of agency, including Home Health – Shamieka reports, Home Health revenue for March 2016 = $143,099.23. Revenues exceeded expenses for February by $41,331.82. Home Health is still advertising for a 2 Full-time and Part-time Nurse Case Manager. The additional RN positions are due to the resignation of Deneen Robbins, RN (last date with agency 3/28/16) and Emily Jordan, RN (last date with agency 4/12/16). Crystal Hoggard and I will marketing our vacancies to the RNs at Roanoke-Chowan Comm. College that are graduating in the spring on April 21st at 11:30. On March 28th Renita Smallwood, RN returned to the agency part-time; April 8th was Melinda Flythe’s last day with the agency. On May 20th, we will also attend a Job Fair in Gates County. We are exploring the possibility of utilizing companies that contract nurses and well as job placement companies in an effort to fill these vacancies as quickly as possible. We are utilizing McBee to review start of care paperwork to avoid a lapse in time claims timely. We will continue to market our services by communicating with discharge planners as well as doctors’ offices to offer our services to the community and residence of Hertford, Bertie, Gates and Northampton. The 2% withholding applies to all Medicare providers in #3 accordance with the Value Based program that Palmetto has implemented. This not a penalty being imposed upon our agency. As long as we maintain positive outcome measures in accordance with the STAR rating system and Oasis questionnaire we’ll be able to generate the same revenues. Thus far the 2% withholding still has not negatively impacted our ability to generate revenue. In the process of trying to become a participating provider with Human. Our patient census is currently at 235. Ramona states that the agency currently has a $70,000 operating surplus and home health is now operating in the black. A request has been submitted to DMA to have our 2015 cost settlement expedited as funds are desperately needed in this fiscal year. All programs are on restricted spending for the remainder of the year. All 16-17 agreement addenda (AA) have been reviewed and ready to be sent back to the state with the exception of family planning and child health. These two AAs were revised this year by the state and require much more information for completion. Unfortunately, the agency’s application for the Healthy Beginnings funding was not successful. However, we will receive a recurring $35,000 for infant mortality work in 2016-17. We intend to hire an additional nurse using these funds who will also work in the clinics. The county funding request is due April 15th and the agency will be requesting a 19% increase in funding amounting to $56,209. The agency hasn’t received an increase in county appropriation in 2 years. Currently, county funding is 7% of our total budget. Prevent the spread of communicable diseases by monitoring disease and syndromic reporting to detect trends and implement control measures – Iulia repots the Monthly report of Communicable Disease: The Epi team met on March 18th to discuss the new trends in communicable disease. Update reports were presented by both Mrs. Esther and I. We also watched the CDC webinar regarding the Zika virus. On March 3rd Mrs. Esther participated in a Quarantine Training in Greenville. On March 3rd and on March 23rd I have attended webinars that presented the trends in the prevention and transmission of the Zika Virus and that offered information about successful way to eliminate mosquitos. Coordinate preparedness exercises in accordance with contract addendum- Ed states that the Preparedness coordinator attended the Isolation and Quarantine workshop. This workshop was based on procedures and protocols in an Isolation and Quarantine instance. It went over who has authority in what situations. Hertford County will be working on updating the I&Q Plan. On April 1st HCPHA’s After Action report was due for the Full Scale Exercise that took place in January. Accompanying that After Action Report was a report that was associated with the staff training. The Preparedness Coordinator is currently working on the MYTEP (Multi Year Training and Exercise Plan). CSE Maintain Region 9 HIV/AIDS Network of Care- Iulia reports: IT is still working to set the two computers that were ordered for the HIV department. At this point, all staff that need access to CareWare are able to enter it from their desks. The outreach even scheduled for March 31st in Elizabeth City was canceled by the #3

University and will be rescheduled sometime during the summer (July- August). Mrs. Cherri was scheduled to be out of the office starting March 23rd due to medical issues, and we are expecting her to return on April 18th. Jail testing is running smoothly and Candace is going out frequently and performs testing. Tommy is our full-time Patient Navigator at this time and throughout the month of March he has performed outreach trips in the entire Region 9 Network of care, connecting with Health Departments, Doctors’ Offices and Hospitals to promote the services that we offer through our HIV Specialty Clinic and educate the staff in other agencies about the referral process. He created a package that he dropped off at all locations with brochures and information about our agency and our services. At this point no staff has showed interest in becoming a provider for our clinic. A plan B for the ID clinic is still being developed. Advocate to implement policy and environmental changes related to physical activity, nutrition and tobacco and collaborate on related programs in the county- Crystal D. reports: CHANGE Project Activities March 2 – Home visit and recruitment of churches in Ahoskie and Murfreesboro (New Ahoskie Baptist Church, Nebo Baptist Church and First Baptist Murfreesboro). March 3 – Signed up a family of three (mother and two daughters) March 4 – Ipad training in Chapel Hill March 7 – home visit (Harrellsville and Cofield) March 9 – recruitment visited 2 salons and 2 barber shop. They gave me permission to post information about the program but didn’t have my flyer approve yet by Audrina (A cut Above, Divine Touch, and Salon 21). March 11 – visit the Senior Center again to see if anyone was interest in joining the program. March 14 – recruitment attempt again in the community (Dr. Kohury, Calvary Baptist.) March 15 – change meeting at RCCHC March 17 – home visit to clients (Ahoskie, Harrellsville) March 22 – home visit to clients Murfreesboro March 28-29 – recruitment to local church (Presbyterian Church in Ahoskie, Revisited New Ahoskie) March 31 – meeting with Dr. Beauchamp in Ahoskie and later signed up my first smoking cessation client.  Total of 20 clients are enrolled in the program.

 Completed and submitted the Healthy Communities Qtr 3 report and the draft 2016-2017 action plan.  Attended the planning meeting via conference call regarding the 2nd Annual Live Together Screen Together event. The program is scheduled for April 30th at the Shrine. #3

Address adolescent risk behaviors- Crystal D. reports: Kick Butts day event did not take place at the middle school. The counselor reported that the student’s behavior were disruptive so the principal would not allow they event to take place. Counselor stated that she will schedule a date for me to come back out to do education with the staff and students regarding e- cigarettes. Implement and market Medical Nutrition Therapy services- Jessica saw 3 clients this month for MNT (target is 5 clients) and the services will be reimbursable since they all had health insurance (Medicaid). Monitor and refine quality assurance/CQI (Continuous Quality Improvement) /program evaluation methods – Iulia reports: Senior Management and Expanded Management continue to report data in the QA metrics as it relates to their programs. Maintain the process for managing revisions of admin policies and procedures – Crystal D. continues to review policies monthly with management team. Policies are reviewed and submitted to Crystal Hoggard to be updated. Integrate community health strategic planning and priorities and budgeting process through existing program budgets when possible- Ramona reposts: Strategic planning was delayed due to our inability to find a facilitator. We will be looking at dates early in April. Beyond budgeting for a 2% COLA and bracing for any insurance rate increases, there will be no new or additional program funding requests in the 2016-17 budget. However, depending upon what priorities are identified during the strategic planning process, the agency may seek additional revenue from funding sources outside of the agency. Educate the staff and community about the responsibilities and services of public health – Jessica planned and conducted a nutritional outreach/educational event starting March 11th through March 18th in 3 schools in the county (Ahoskie Elementary, Riverview and Bearfield) in order to celebrate Nutrition Month. Tommy has performed outreach trips in the entire Region 9 Network of care, connecting with Health Departments, Doctors’ Offices and Hospitals to promote the services that we offer through our HIV Specialty Clinic and educate the staff in other agencies about the referral process. Support and grow community collaborations/partnerships – Iulia states that the Agency has reviewed and Mrs. Bowser has signed the new MOA that we have with Hertford County Public Schools for 2016 - 2017 and we are waiting for the Superintendent to sign it as well if everything is approved. Local doctor in Ahoskie, Dr. Beauchamp is very interested in speaking to me about our programs for maternal health and others that would pertain to his patients. He's very concerned for the health of Hertford County residents that have limited access to healthcare due to income and other factors. I will make contact with him in the next couple of days and try to plan for a meeting with him. Maternal and Child Health Community Advisory Board has been created for the Healthy Beginnings and it includes DSS, Pregnancy Care of Ahoskie, New Ahoskie Baptist. Crystal D. continues to work with the CHANGE project (UNC). Also continue to meet with HHMA on monthly bases #3

(Health Promotion Subcommittee). Continue to work with the PICH project regarding tobacco prevention. Continue to work with the JCPC collaborative regarding adolescent risk behaviors. Collaborating with the hospital and other agencies in the community regarding Project Lazarus. Continue to work with Office on Aging Re: Fall Prevention. Continue to work wiith Vidant Pitt/RC Hospital Re: Community Health Assessment. Continue to work with the Winton Farmers Market. Maintain and enhance a comprehensive emerging disease, health threat and emergency preparedness plan- Ed reports: The Responder Health and Safety Plan has been released to counties in the Eastern Region. This will be an appendix in our All Hazards Plan. The Preparedness Coordinator will tailor this plan to fit Hertford County’s needs. CSE The funds that were being utilized for Ebola are now being utilized for Zika Preparation. (Newspaper Article, Tip-n-Toss information, and Educational material) CSE Secure a maintenance contract for agency owned buildings- Develop a plan to consolidate Winton offices with office in Ahoskie- Ramona reports: still waiting for the promised walk thru and proposal for maintenance contract.

OTHER ACTIVITIES NOT INCLUDED IN STRATEGIC PLAN- Crystal D. reports: Continue to work with Vidant hospital regarding the community health assessment. There were a total of 3 focus groups completely for this month. The focus groups were conducted at Senior Site in Ahoskie, Murfreesboro Professional Women’s Group, and Menola Church Group. Attending the HHMA Executive Board meeting where we discussed and planned the agenda for the full board meeting scheduled for April 11th.

ISSUES AND CONCERNS - Staff retention is a major concern in home health. Currently looking for additional nurses including contract nurses through a professional staffing agency. While the sign-on bonus has been reinstated, there may be cause to temporarily compensate the remaining home health nurses for assuming additional duties due to the sudden resignation of two nurses.

Potential Grant Opportunities – Mrs. Bowser stated that the RFA for Region 9 Network is due in June. We did not receive the Healthy Beginnings Grant.

BOH Executive Committee Report- Mrs. Ramona Bowser went over the Health Director Job Description and asked if there was anything that needed to be changed.

Mrs. Westelle Cherry made a motion to approve the Health Director Job Description. The motion was seconded by Mrs. Rebecca Greene and approved by the Board. #3

BOH Finance Committee Report- Mrs. Ramona Bowser stated that the finance committee did not meet and presented the financial reports.

PHA Balance Sheet- March 2016 – Mrs. Ramona Bowser reported that cash in deposit for assets was $582,356.78. Accounts receivable-general was $20,240.22 and accounts receivable for Home Health was $124,803.54. Total assets were $778,393.62. Total liabilities were $61,808.75 and total fund balance was $716,584.87.

Financial Summary Report- March 2016 – Mrs. Ramona Bowser reported the year to date revenues were 67.58% of the budget and year to date expenses were 65.79% of the budget. Accounts Receivable with allowance for bad debts totaled $176,834. Home Health had a profit of $41,332 for March 2016, and without transfers had a profit of $41,332. Year to Date Home Health has a profit of $37,403 and without transfers a profit of $37,403. Home Health cash balance is negative $126,636 for March 2016.

Quarterly Fiscal Monitoring Report- Mrs. Ramona Bowser presented the quarterly fiscal monitoring report for the period ending March 31, 2016. The report shows a year to date profit of $77,508. The current unrestricted fund balance is 13,79%, above the required 8%.

Capital Expenditure Plan- Mrs. Ramona Bowser presented the Home Health Capital Expenditure Plan. The Plan states there are no intended expenditures greater than $600,000.00/yr during the next (3) years.

Mrs. Westelle Cherry made a motion to approve the Finance Committee Reports and the Audit Capital Expenditure Plan. The motion was seconded by Mr. Charles Reynolds and approved by Board.

BOH Personnel Committee Report- Dr. Terry Hall stated that the personnel committee did not meet.

Hertford County Public Health Authority Personnel Action Request

Current Classification: New Position

Requested Classification: Public Health Nurse II

Working Title: Infant Mortality Reduction Program Care Manager #3

Number of Positions: 1

Grade: 17

Salary Range: $40,571-60,404

Mid Range: $49,503

Effective Date: March 1, 2016

Justification for position:

Research has shown that the use of 17P (alpha hydroxyl progesterone) with women who are at risk and have a history of preterm birth reduces the likelihood of a repeat preterm birth. The position will identify, refer and support these women through education and resource referral and once identified, assist in coordination of services and encourage compliance to treatment plans. Evidence-based strategies such as motivational interviewing and coordination of care can be used to promote maximized success and self-sufficiency. Coordinate all medical aspect of client care by devising an appropriate plan of action and coordinating the services required with other team members to execute the plan. Reviews client record, confers with team members to gain a complete grasp for the patient’s needs to ensure at risk pregnant women, residing Hertford County, have improved medical outcomes and quality of life resulting in preventing preterm births, unnecessary hospitalizations and reducing infant mortality while making more efficient use of resources. The Infant Mortality Reduction Program Care Manager is primarily responsible for recruiting and assisting prenatal clients in accessing appropriate health and social care systems in order to promote the highest degree of pregnancy outcome possible. This position is also responsible to administer the 17P injections at the clients’ location of choice (home visits or in the clinic). Position will work closely with other resources like DSS.

Position will be funded 50% by Infant Mortality Reduction Grant funds and 50% from Clinical Nursing Program Funds.

Health Director Merit Recommendation – one-time bonus of 3% to be paid in FY16.

COLA – move forward with the 2% COLA in FY17 proposed budget.

Performance Evaluation Policy - Each and every employee will receive annual performance evaluations, due in October with the exception of the Health Director. The Health Director shall receive performance evaluations annually in the month the Health Director was appointed to the position.

Ms. Susan Brinkley made a motion to approve the New Position - Infant Mortality Reduction Program Care Manager, Health Director - Merit Recommendation, FY17 COLA Recommendation and the Performance Evaluation Policy. The motion was second by Ms. Rhonda Harrington and approved by the board. #3

BOH Policy & Program Committee Report – Mr. Charles Reynolds stated no report.

Old Business-none

New Business- NALBOH Conference 2016 – Mrs. Bowser stated that she would need to know no later than June 30, 2016, who would be attending the Conference.

Next meetings- Personnel, Thursday, May 12, 2:00 pm, Ahoskie Policy, Thursday, May 5, 2:30 pm, Ahoskie Executive, Tuesday, May 10, 2:30 pm, Ahoskie Finance, Monday, May 23, 6:00 pm, Winton Full BOH Mtg., Monday, May 23, 6:30 pm, Winton

Adjourn- Mrs. Westelle Cherry made a motion to adjourn the meeting at 7:16pm. The motion was seconded by Mr. Charles Reynolds and approved by the Board.