STORY COUNTY BOARD of HEALTH TENTATIVE AGENDA TUESDAY, April 2, 2019 2:00 PM

STORY COUNTY BOARD OF HEALTH TENTATIVE AGENDA TUESDAY, April 2, 2019 2:00 PM

Public Meeting Room* - Story County Administration (900 6th Street) – Nevada, Iowa

1. CALL TO ORDER

2. APPROVAL OF AGENDA

3. APPROVAL OF MINUTES

Documents:

MINUTES 020519.PDF

4. CONSENT AGENDA All items listed under the consent agenda will be enacted by one motion. There will be no separate discussion of these items unless a request is made prior to the time the Board votes on the motion.

4.I. Consideration Of Contract Between Iowa Department Of Natural Resources And Story County Board Of Health

Documents:

AMENDED CONTRACT.PDF

5. PUBLIC FORUM This is the time for members of the public to offer comments concerning matters not scheduled to be heard before the Board of Health.

6. ADDITIONAL ITEMS

6.I. Discussion And Consideration Of Local Public Health Services FY20 Application - Les White

Documents:

FY20 LOCAL PUBLIC HEALTH SERVICES APPLICATION.PDF

6.II. Discussion Of Health Impact Assessments - Leanne Lawrie Harter

Documents:

HEALTH IMPACT ASSESSMENTS.PDF

6.III. Discussion Of Story County Swimming Pool Ordinance - Matt Cory

6.IV. Discussion And Consideration Of Watershed Assessment Implementation Matrix And Working Group Program And Recommendation To The Board Of Supervisors - Leanne Harter IMPLEMENTATION MATRIX

7. AGENCY AND DEPARTMENTAL REPORTS

7.I. Story County Public Health; Treasa Ferrari, Patsy Beese

7.II. YSS; Denise Denton

Documents:

FEBRUARY 19 YSS REPORT.PDF THE MARIJUANA REPORT MARCH 6, 2019.PDF POTENT CANNABIS HEIGHTENS PSYCHOSIS RISK.PDF CANCER PATIENTS AND MJ USE.PDF NEVADA COMMUNITY CONVERSATION ON SUBSTANCE ABUSE FLYER.PDF

7.III. Story County Environmental Health; Margaret Jaynes

Documents:

BOH 04 02 19 EH PRESENTATION.PDF

8. COMMENTS Staff Board

9. ADJOURNMENT

Story County strives to ensure that its programs and activities do not discriminate on the basis of race, color, national origin, sex, age or disability. Persons requiring assistance, auxiliary aids or services, or accommodation because of a disability may contact the county's ADA coordinator at (515)382-7204. STORY COUNTY BOARD OF HEALTH TENTATIVE AGENDA TUESDAY, April 2, 2019 2:00 PM

Public Meeting Room* - Story County Administration (900 6th Street) – Nevada, Iowa

1. CALL TO ORDER

2. APPROVAL OF AGENDA

3. APPROVAL OF MINUTES

Documents:

MINUTES 020519.PDF

4.I. Consideration Of Contract Between Iowa Department Of Natural Resources And Story County Board Of Health

Documents:

AMENDED CONTRACT.PDF

5. PUBLIC FORUM This is the time for members of the public to offer comments concerning matters not scheduled to be heard before the Board of Health.

6. ADDITIONAL ITEMS

6.I. Discussion And Consideration Of Local Public Health Services FY20 Application - Les White

Documents:

FY20 LOCAL PUBLIC HEALTH SERVICES APPLICATION.PDF

6.II. Discussion Of Health Impact Assessments - Leanne Lawrie Harter

Documents:

HEALTH IMPACT ASSESSMENTS.PDF

6.III. Discussion Of Story County Swimming Pool Ordinance - Matt Cory

6.IV. Discussion And Consideration Of Watershed Assessment Implementation Matrix And Working Group Program And Recommendation To The Board Of Supervisors - Leanne Harter IMPLEMENTATION MATRIX

7. AGENCY AND DEPARTMENTAL REPORTS

7.I. Story County Public Health; Treasa Ferrari, Patsy Beese

7.II. YSS; Denise Denton

Documents:

7.III. Story County Environmental Health; Margaret Jaynes

Documents:

BOH 04 02 19 EH PRESENTATION.PDF

8. COMMENTS Staff Board

9. ADJOURNMENT

STORY COUNTY BOARD OF HEALTH STORY COUNTY ADMINISTRATION 900 6TH STREET NEVADA, IOWA 50201

Minutes

AN AUDIO RECORDING OF THE FULL MEETING MAY BE FOUND IN THE ENVIRONMENTAL HEALTH DEPARTMENT, OR BY VISITING WWW.STORYCOUNTYIOWA.GOV

DATE: February 5, 2019 Dr. John Paschen, Chair Mark Speck, Vice-Chair CALL TO ORDER: 2:00 p.m. Dr. John Kluge (arrived at 2:08) Mark Speck PLACE: Administration Building, 2nd Floor Louisa Tabatabai Lauris Olson (Ex-officio) *Absent

STAFF PRESENT: Margaret Jaynes, Environmental Health Director; Cathy Bazylinski, Environmental Specialist; Matt Cory, Environmental Specialist, Stephanie Jones, Recording Secretary

OTHER PEOPLE PRESENT:

1. CALL TO ORDER Dr. John Paschen called the meeting to order at 2:00 p.m.

2. APPROVAL OF AGENDA Health Impact Assessments was moved to April 2, 2019 meeting.

3. APPROVAL OF OCTOBER 2, 2018 MINUTES Motion by Speck, Second by Kluge MCU

4. APPROVAL OF CONSENT AGENDA No Consent Agenda

5. PUBLIC FORUM None

6. ADDITIONAL ITEMS

Election of Officers Motion by Speck, Second by Tabatabai for Paschen to continue as Chair and Speck as Vice-Chair. MCU

Board of Health Member Appointments Procedure Paschen welcomed the two new board members, Louisa Tabatabai and Lauris Olson. Paschen stated that the application process is being re-opened for the opening on the Board of Health that was created after the Board of Supervisor member changed to an ex-officio member. Paschen asked if the BOH can see the applications and have input. Olson stated that the Board of Supervisors voted that all three supervisors could interview the applicant’s one-on-one if they chose and provide input, and will send the applications to the Board of Health chair. Paschen stated that he would like to welcome the applicants to attend the April 2, 2019 Board of Health meeting. Discussion took place about Board of Health members attending an interview. Olson stated that there could not Page 1 of 3

STORY COUNTY BOARD OF HEALTH STORY COUNTY ADMINISTRATION 900 6TH STREET NEVADA, IOWA 50201 be a quorum, but that one or two Board of Health members could attend the interviews. Olson also stated that gender equity balance is important for boards as well.

Encourage The 2019 Iowa Legislature To Pass The 3/8 Cent Sales Tax To Fund Iowa’s Natural Resources And Outdoor Recreation Trust

Margaret Jaynes was speaking about this item on behalf of Mike Cox and provided an overview of funding through sales tax that would go towards recreational and water quality improvements. Jaynes asked if the board would like to send a letter to the state legislators showing that the Story County Board of Health supports this and asking the legislators to pass the 3/8 cent sales tax to fund the Iowa Natural Resources and Outdoor Recreation Trust. Motion by Kluge, Second by Speck for approval to submit the letter to the Legislature. MCU

Requiring Septic System Site Review/Soils Analysis Performed By A Licensed Engineer/Soils Professional

Margaret Jaynes gave an overview of this item and stated that during the budget review she had proposed the purchase of a gator and probe equipment for soil testing which was not approved. The suggestion was made during the budget review for a soil professional or civil engineer do the soil analysis. Jaynes stated that the Board of Health would need to approve the change and also a lower the septic permit fee since she would no longer be doing the soils work. Discussion took place about the process and Jaynes stated that she would prefer to still be on site when the soil work is completed. Motion by Paschen, Second by Speck for a civil engineer or soils professional to perform the soil site evaluation. MCU

7. AGENCY AND DEPARTMENTAL REPORTS

Story County Public Health

Les White stated that there is a new Chief Nursing Officer, Cory Geffre. White shared that their office has been going through a remodel to better accommodate immunization clinics. Treasa Ferrari gave a vaccination report update and spoke about a reminder program to let people know they are due for immunizations. Reportable diseases for the county have been slow the last three months. Influenza has now increased in Iowa and is now considered wide spread throughout the state, but still is not as bad as it was last year. Paschen asked about the match for vaccine vs influenza strains. Ferrari stated that she has been told the vaccine is a good match this year.

Mid-Iowa Community Action Gloria Symons gave an update about the types of services provided by MICA in Story County and provided updates of the government shutdown affecting programs. Sierra Stevens provided an update on enrollment in programs and stated that they were fortunate that WIC was not immediately affected by the government shutdown and that they would like people to know they are still open. Symons stated that the Story County Dental Clinic is now fully staffed and that approximately 200-250 patients per month are seen.

YSS Denise Denton provided an update about school programs and stated that the Opioid Task Force continues to meet each month. Denton gave an update on the Nevada Task Force and shared that there will be a town hall meeting in March and she will send out information about that meeting when available. Denton stated that YSS did not receive the grant from the Iowa Department of Public Health, which means a funding loss of over $150,000.00. Denton stated that in Story County the subsidies prevention would be business as usual. Olson asked if there would be duplicated services in the county since Community Resources received the grant money.

Page 2 of 3

STORY COUNTY BOARD OF HEALTH STORY COUNTY ADMINISTRATION 900 6TH STREET NEVADA, IOWA 50201 Denton stated that she feels there will be plenty of work to go around, but there could be some redundancy. Denton stated that a letter was recently sent to the Iowa Department of Public Health regarding the position on CBD products in Iowa. Olson asked if the law has been challenged and Denton said not that she is aware. Paschen stated that a letter to law enforcement stating that the Board of Health would like enforcement on businesses that are selling CBD products. Denton stated that she feels it is not being enforced because no one has complained. Tabatabai asked if the level of THC is tested in CBD oil and Denton stated it is tested if it is sold from one of the manufactures in the state, but not if it is sold over the counter or on the internet. Olson stated that she felt this issue should be taken to the county attorney for an opinion. Jessica Reynolds came in to the board room for another meeting while the discussion was taking place. Paschen provided an overview. Reynolds stated that she would be happy to provide a written opinion to the Board of Health prior to their next meeting. Paschen stated that he feels a recommendation from the Board of Health that they feel the law should be enforced and that CBD oil can only be sold at one of the five dispensaries throughout the state.

Story County Environmental Health Margaret Jaynes provided an update on well permits, well plugging, cisterns, well rehabs, water samples, TOT inspections, and septic permits issued. Jaynes stated that $9,000 remains for Grants to Counties. Jaynes stated that January is National Radon Awareness Month and information was posted to the public and free radon test kits were given away throughout the month. Jaynes provided an update on nine conceptual reviews completed and other items going on which included working on well ordinances, watershed group, budget and the LongView Pork CAFO. Discussion took place about the steps of the appeal process.

COMMENTS Staff: None Board: Kluge asked about dredging of Hickory Grove and wondered if any septic systems are going into the lake. Jaynes stated the biggest issue is the Story County Lagoon needing work. Paschen asked if the master matrix meeting will be rescheduled. Jaynes stated that a date is being worked out for rescheduling. Paschen stated that he hopes that the Board of Health will continue to make recommendations using the board’s expertise to the Board of Supervisors.

ADJOURNMENT 3:27 p.m.

______Approval of Minutes

______Title and Date

Page 3 of 3

DNR Updated 7/2017

IOWA DEPARTMENT OF NATURAL RESOURCES

Amendment Number 1 to CONTRACT NUMBER 17ESDWQBTGROT0001-85

Between

Iowa Department of Natural Resources And Story County Board Of Health

IN WITNESS THEREOF, the parties hereto have executed this Contract Amendment on the day and year last specified below.

DEPARTMENT OF NATURAL RESOURCES

By: Date: Eric Wiklund, Supervisor, NPDES Section

CONTRACTOR By: Date: Story County Board of Health

This Contract Amendment shall not begin until it has been either (1) signed by both parties or (2) the Contract Amendment start date has occurred, whichever is later.

For DNR use only: 1. Retain a signed copy of the Contract in the project file and send a hardcopy with 1st invoice to Budget & Finance. 2. Please do one of the following: a. Email scanned copy to [email protected] (please name subject your Contract #); b. Fax copy to 515-725-8201 (Attn: Christina Iiams); OR c. Mail a copy of the contract to IOWA DNR, ATTN: Christina Iiams, 502 E 9th St, Des Moines IA 50319

17ESDWQTGROT0001-85, Amendment #1 – Page 1 DNR Updated 7/2017

IOWA DEPARTMENT OF NATURAL RESOURCES

Amendment Number 1 to CONTRACT NUMBER 17ESDWQBTGROT0001-85

Between

Iowa Department of Natural Resources And Story County Board Of Health

IN WITNESS THEREOF, the parties hereto have executed this Contract Amendment on the day and year last specified below.

DEPARTMENT OF NATURAL RESOURCES

By: Date: Eric Wiklund, Supervisor, NPDES Section

CONTRACTOR By: Date: Story County Board of Health

This Contract Amendment shall not begin until it has been either (1) signed by both parties or (2) the Contract Amendment start date has occurred, whichever is later.

For DNR use only: 3. Retain a signed copy of the Contract in the project file and send a hardcopy with 1st invoice to Budget & Finance. 4. Please do one of the following: d. Email scanned copy to [email protected] (please name subject your Contract #); e. Fax copy to 515-725-8201 (Attn: Christina Iiams); OR f. Mail a copy of the contract to IOWA DNR, ATTN: Christina Iiams, 502 E 9th St, Des Moines IA 50319

17ESDWQTGROT0001-85, Amendment #1 – Page 2 DNR Updated 7/2017

This Contract Amendment is entered is between the Iowa Department of Natural Resources (DNR) and Story County Board of Health (Contractor). The parties agree as follows:

Section 1 STATEMENT OF PURPOSE 1.1 Purpose. The purpose of the Contract Amendment is to continue the annual tasks identified in the Original Contract for two additional years for commensurate compensation accordingly.

Section 2 DURATION OF CONTRACT AMENDMENT 2.1 Term of Contract Amendment. The term of this Contract Amendment shall be from May 31, 2019 through May 31, 2021 unless terminated earlier in accordance with the Termination section of the Original Contract. However, this Contract Amendment shall not begin until it has been signed by both parties. DNR shall have the sole option to amend this Contract to add up to no more than six years total from the beginning date of the Original Contract.

2.2 Approval of Contract Amendment. If the amount of compensation to be paid by DNR according to the terms of the Original Contract together with this Contract Amendment is greater than $25,000.00 and the Contract was never approved by the commission; or if this Contract Amendment increases the value of the Contract by $25,000 or by more than 10% of the previous Contract approved by the commission, whichever is greater, then performance shall not commence unless by May 31, 2019 this Contract Amendment has been approved by the Environmental Protection Commission.

Section 3 CONTRACT AMENDMENT STATEMENT OF WORK 3.1 Statement of Work. As part of this Contract Amendment, Contractor shall perform the following Tasks by the Task Milestone Dates set out below.

Obligation Task Milestone Date Amendment Task 1: Annual records reviews 2020-2021 Description: The Contractor shall annually (once during the period August 1, 2019 to May 31, 2020, and once during August 1, 2020 to May 31, 2021) conduct a records review of the current license application and waste management plan for each septic tank cleaner (licensee) located within its contracted area. The review shall check for accuracy and verify the information The Contractor’s obligations provided by the licensee. Particular attention shall be paid to where the shall remain throughout the septage is collected and where it is disposed. The Contractor shall verify that term of the Contract and the septage collected is disposed of in the method described by the licensee. shall be completed no later than: Publicly owned treatment works (POTW) designated as disposal sites shall be contacted to ensure they allow deposition of septage from the licensee. If the First Year; May 31, 2020 licensee does not report any land application, the Contractor shall confirm they Second Year: May 31, 2021 have no record of land application sites used by the licensee. If the licensee reports land application sites, the Contractor shall confirm that the licensee has ownership of the sites, or has permission to land apply septage on the sites.

The Contractor shall verify that the licensee has accurately reported the correct number of vehicles used in the collection and disposal of septage.

17ESDWQTGROT0001-85, Amendment #1 – Page 3 DNR Updated 7/2017

Amendment Task 2: Equipment inspections Description: The Contractor shall annually (once during the period August 1, 2019 to May 31, 2020, and once during August 1, 2020 to May 31, 2021) inspect each vehicle used by a septic tank cleaner (licensee) within its contracted area for the pumping, transport or land application of septage for compliance with 567 IAC chapter 68 requirements.

The Contractor’s inspection shall do all of the following: The Contractor’s obligations 1. Ensure that the connections on the vehicle are sound and not leaking. shall remain throughout the 2. Ensure that the vehicle has the ability to agitate and properly remove all of term of the Contract and the septage in a septic tank. shall be completed no later 3. Ensure that the vehicle is properly identified with 3” lettering as described than: in 567 IAC chapter 68. 4. Verify that the vehicle identification and licensing information matches the First Year: May 31, 2020 information provided on the license. Second Year: May 31, 2021 5. Ensure that each vehicle has the appropriate license in the vehicle. 6. Ensure any storage facilities for septage are watertight and are used for septage only. 7. Otherwise verify compliance with the applicable parts of 567 IAC 68.9.

The Contractor shall annually provide the DNR Project Manager with a report that identifies the commercial septic tank cleaners inspected and the date inspected. Amendment Task 3: Land application site inspections Description: The Contractor shall annually (once during the period August 1, 2019 to May 31, 2020, and once during August 1, 2020 to May 31, 2021) inspect each land application site used by a septic tank cleaner (licensee) within its contracted area to ensure compliance with 567 IAC chapter 68 requirements.

The Contractor’s inspection shall do all of the following: 1. Ensure that the maximum application rate of 30,000 gallons per acre per year is not exceeded. The Contractor’s obligations 2. Ensure that a crop is grown on the site at a minimum of every three years shall remain throughout the or after the application of the maximum allowable amount. term of the Contract and 3. Ensure that all applicable separation distances are met as described in 567 shall be completed no later IAC chapter 68. than: 4. Ensure that the maximum slope of the application site does not exceed 9% First Year: May 31, 2020 (5% for frozen ground at a rate of 2500gallons/day). 5. Ensure the tank cleaner has the ability to properly mix lime with the Second Year: May 31, 2021 septage to raise the pH to 12 and the ability to measure pH. 6. If lime stabilization is not used, the Contractor shall ensure that the licensee has the equipment available to properly inject or incorporate the septage in the time allotted in 567 IAC chapter 68. 7. Otherwise verify compliance with 567 IAC 68.10. 8. The Contractor shall annually provide the DNR Project Manager a report that identifies the commercial septic tank cleaner, the land application site(s) and the date inspected.

Section 4 COMPENSATION 4.1 Source of Funding. The source of funding for this Contract Amendment is as follows: fund number 0947, annual license and license renewal fees collected pursuant to Iowa Code section 455B.172.

17ESDWQTGROT0001-85, Amendment #1 – Page 4 DNR Updated 7/2017

4.2 Not-to-exceed total amount of contract. Payment for work performed by the Contractor according to the terms of this Contract Amendment, shall not exceed $10,000 annually. Payment shall be for satisfactory completion of the statement of work outlined in this Contract Amendment, provided that Contractor has complied with the terms of the Original Contract and this Contract Amendment.

Task Amount of compensation in Amount of compensation Grand Total Original Contract CURRENT CONTRACT AMENDMENT Task 1, 2, and 3: $250 for the first vehicle of $250 for the first vehicle of $250 for the first vehicle of Annual inspection of each licensee, $150 for each each licensee, $150 for each each licensee, $150 for each equipment, records subsequent vehicle of each subsequent vehicle of each subsequent vehicle of each and land application licensee, licensee, licensee, site(s) (if applicable) $7 per 1000 gallons septage $7 per 1000 gallons septage $7 per 1000 gallons septage land applied at each site. land applied at each site. land applied at each site Total Not to exceed funds Not to exceed $10,000.00 Not to exceed $10,000.00 available from the collection annually dependent on annually dependent on of commercial septic tank funds available from the funds available from the cleaner license fees collection of commercial collection of commercial described in Section 2.1. septic tank cleaner license septic tank cleaner license fees as described in Original fees as described in Original Contract Section 2.1 Contract Section 2.1

An original invoice shall be submitted to DNR in accordance with the table below. All other provisions of Section 7.5 “Submission of Invoices” of the Original Contract shall remain in full force. Task Milestone Date Amount Due Invoice Due Not to Exceed $10,000 Annually No Later Than Task 1, 2, 3: Annual inspection $250 for the first vehicle of each licensee, $150 for No later than: of equipment, records and land each subsequent vehicle of each licensee, $7 per First Year May 31, 2020 application site(s) (if applicable) 1000 gallons septage land applied at each site. Second Year May 31, 2021

Section 5 OTHER AMENDMENT PROVISIONS RESERVED

Section 6 EFFECT OF AMENDMENT ON ORIGINAL AGREEMENT PROVISIONS All provisions of the Original Contract shall remain in full force and effect unless specifically changed by this Contract Amendment.

17ESDWQTGROT0001-85, Amendment #1 – Page 5 IowaGrants Page 1 of 9

Application Details Go to Application Forms 299042 - FY20 Local Public Health Services Application Guidance 302771 - LOCAL PUBLIC HEALTH SERVICES FY20 Local Public Health Services

Status: Editing Submitted Date:

Applicant Information Project Officer Organization Information AnA User Id TRISHA.MACDONALD@IOWAID Organization Story County Board of Health First Name* Trisha Ann Macdonald Name:* Organization First Name Middle Name Last Name County Government Title: Type:* DUNS: Email:* [email protected] Organization Address:* 918 Linn St Website: Address: 900 6th Street

City* Story City Iowa 50248 City State/Province Postal Code/Zip Phone:* Nevada Iowa 50201 515-733-6035 City State/Province Postal Code/Zip Phone Ext. Phone: Program Area of Interest* Local Public Health Services Ext. Fax: Fax:

Cover Sheet-General Information

Authorized Official Name* John Paschen Title* Chair Organization* Story County Board of Health If you are an individual, please provide your First and Last Name. Address* 900 6th Street

City/State/Zip* Nevada Iowa 50201

City State Zip

Telephone Number* 515-382-7202

E-Mail*

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[email protected]

Fiscal Officer/Agent

Please enter the "Fiscal Officer' for your Organization.

If you are an individual, please provide your First and Last Name. Name* Trisha Macdonald Title Program Assistant Organization Mary Greeley Medical Center Address 1114 Duff Avenue

City/State/Zip Ames Iowa 50010

City State Zip

Telephone Number 515-233-7501 E-Mail [email protected]

County(ies) Participating, Involved, or Affected by this Proposal* Story County Congressional District(s) Involved or Affected by this 4th - Rep Steve King (R) Proposal* Congressional Map Iowa Senate District(s) Involved or Affected by this 23, 24, 25 Proposal* District Map Iowa House District(s) Involved or Affected by this 45, 46, 49 Proposal* District Map

Business Organization Form - Contact Information

Provide the legal name of the eligible applicant. (examples include: XYZ County DBA XYZ County Board of Health, XYZ Community Action Organization, etc.) Please contact the fiscal officer of the applicant organization if you are unsure of the legal name registered with the Federal Internal Revenue Services (IRS). Legal Name of Eligible Applicant:* Story County Board of Health

Provide the legal address of the eligible applicant. This is the address associated with the Federal Tax ID Number. Applicant Legal Address:* 900 6th Street Applicant City:* Nevada Applicant State:* Iowa Applicant Zip Code:* 50201 Applicant's Last 4 digits of Federal Tax ID Number:* 5024 Enter only the last 4 digits of your Federal Tax ID Number Applicant's Phone Number:* 515-382-7202

Applicant's Fax Number:

Include the name of the Executive Director or Chief Executive Officer of the Applicant Organization. If the Applicant is a Board of Health/Board of Supervisors, include the name of the Board's authorized signatory. Executive Director/CEO Name:* John Paschen

Select Title. Title:* Board Authorized Signatory

Alternate Mailing Address for Warrant/Payment, as applicable

This section is optional and will be used by IDPH if the applicant is awarded a contract. As applicable, applicant may enter an alternate address (if different from legal address above) for IDPH to mail warrants/payments for provision of services.

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Attention to: Mary Greeley Home Health Services Insert alternate address, as applicable: 1114 Duff Avenue Street or PO Box City: Ames State: Iowa Zip Code: 50010

Business Organization Form - Business Structure

Identify the legal structure of the applicant. If the applicant is not a governmental organization, the applicant must be registered with the Iowa Secretary of State's office to do business in Iowa or agrees to register if awarded a contract. Legal Business Structure of Applicant:* Government- County

Identify the state of incorporation or registration of the applicant. State of Incorporation:* Iowa

Business Organization Form - Organization History

Provide a brief history of the agency. History:*  

This field is limited to 20,000 characters.

Include the agency’s mission statement. Mission Statement:*  

This field is limited to 500 characters.

Include the agency’s vision statement. Vision Statement:*  

This field is limited to 500 characters.

Business Organization Form - Table of Organization

Attach a current table of organization. Table of Organization:* Organizational Chart.pdf

Business Organization Form - Disclosure of Litigation

Answer “no” or “yes” as to whether the applicant has any pending or threatened litigation, administrative or regulatory proceedings or similar matters which could affect the applicant’s ability to perform required services.

Is there any litigation, administrative, or regulatory proceedings pending or threatened against your No agency or subcontractor?*

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If “yes”, list and summarize any pending or threatened litigation, administrative, or regulatory proceedings or similar matters which could affect the applicant’s ability to perform required services.

Business Organization Form - Disclosure of Contract Default

Has your agency or a subcontractor defaulted on a contract? Contract or subcontract Contact person Telephone Brief description of incident No

Business Organization Form - Disclosure of Terminated Contract

Has your agency or subcontractor terminated a contract? Identify if it was contract or subcontract Contact person Telephone Number of Contact Person Email Address of Contact Person Brief description of incident No

Business Organization Form - Disclosure of Contract Termination

Has your agency or a subcontractor had a contract terminated? Identify if it was a contract or subcontract Contact Person Telephone Number of Contact Email Address of Contact Person Brief Description of Incident No

Business Organization Form - Audited financial statement

Business Organization Form - Audited Financial Statement Attachment

Business Organization Form - Disclosure of Financial Accountability

Have any irregularities of financial records been discovered to the applicant's accounts? Identify each irregularity Date of finding Corrective action Current status of resolution No

Business Organization Form - Disclosure of Financial Accountability Contact Information

Contact Person: LesLa White Telephone Number of Contact: 515-233-7571 Email Address of Contact Person: [email protected]

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Application Certification and Conditions

The information contained in the Application Forms is accurate, to the best of my knowledge. * Yes

Under no circumstances will any personnel, employee or independent contractor of the contractor, be paid by the programs applied for in this grant application or by any other programs administered by the contractor to an extent that would translate to a full-time equivalency of greater than 1.0. Furthermore, no time will be "double-charged". * Yes

The organization has the resources to meet the goals and objectives included in this application for the amount of funds applied for. * Yes

If a contract is awarded, based on my authority, the organization is committed to fulfilling the contract conditions from the Iowa Department of Public Health. * Yes

If a contract is awarded, it is the contractor's sole responsibility to ensure appropriate individual(s) have registered within IowaGrants.gov and are granted access to the Grant Tracking site at www.IowaGrants.gov. The contractor acknowledges that all assigned individuals will have full rights (add, modify, and delete) for all Grant Tracking components including contractual forms, reporting forms, and claims submission. * Yes

If a contract is awarded, I designate the following individual as the Grantee Contact with full responsibility for assignment of appropriate individuals to this grant in IowaGrants.gov * John Paschen

I certify that my agency is not suspended or debarred or otherwise excluded from participating in provision of services in the event application is approved. * Yes

I have read and understood the applicable Scope of Work for this Funding Opportunity. * Yes

The BOH or BOS Authorized Signatory must complete this form and sign it by typing in their name. Signature* John Paschen

Select your title. Title of Signatory* Board Authorized Signatory

Insert the date the Board Authorized Signatory completed and signed this form. Click 'Save' at the top of the page.

Date form completed and signed*

Optional: This area is provided for the uploading of Transmittal Letter or other communication to IDPH as applicable to this application. IDPH reserves the right to make the determination of the applicability of the communications at its sole discretion.

Attachment

Project Director Identification

Insert first and last name for the person that will be identified as the project director. Project Director First and Last Name* Les White Project Director Title* Director

Identify the agency in which the project director is employed. Project Director Agency* Mary Greeley Medical Center Home Health Services Project Director Phone Number* 515-233-7571 Project Director Email Address* mailto:white%[email protected] Project Director Mailing Address (street or P.O. Box)* 1114 Duff Avenue

Project Director City, State, Zip* Ames Iowa 50010

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Activity

Row Cost Report Method Start Date of Data End Date of Data Agency Cost Agency Charge Reimburse Rate Line Item Number Collaborative Relationships (Billing Unit: Hour) Alternative Cost Report 07/01/2017 06/30/2018 $53.93 $0.00 $53.93 Community Health Assessment (Billing Unit: Hour) $0.00 $0.00 $0.00 Community Utility (Resource Referral) (Billing Unit: Hour) $0.00 $0.00 $0.00 Disease Outbreak Investigation, Reportable Disease Follow-up, Surveillance (Billing Unit: Hour) Alternative Cost Report 07/01/2017 06/30/2018 $56.34 $0.00 $56.34 Family Support Home Visiting (Billing Unit: Visit) $0.00 $0.00 $0.00 Foot Care Clinics (Billing Unit: Person) $0.00 $0.00 $0.00 Health Education (Billing Unit: Hour) $0.00 $0.00 $0.00 Health Hazard Investigation (Billing Unit: Hour) $0.00 $0.00 $0.00 Health Promotion (Billing Unit: Visit) CMS Cost Report 07/01/2017 06/30/2018 $173.23 $0.00 $173.23 Home Care Aide (Homemaker) (Billing Unit: Hour) CMS Cost Report 07/01/2017 06/30/2018 $42.70 $37.00 $37.00 Home Care Aide (Personal Care) (Billing Unit: Hour) CMS Cost Report 07/01/2017 06/30/2018 $62.65 $42.00 $42.00 Immunizations (Billing Unit: Person) $0.00 $0.00 $0.00 Injury Prevention & Follow-up (Billing Unit: Hour) $0.00 $0.00 $0.00 Local Board of Health Support (Billing Unit: Hour) $0.00 $0.00 $0.00 Nursing (Skilled) (Billing Unit: Visit) CMS Cost Report 07/01/2017 06/30/2018 $301.25 $285.00 $285.00 Nursing (Health Maintenance) (Billing Unit: Visit) $0.00 $0.00 $0.00 Public Health System Development (Billing Unit: Hour) $0.00 $0.00 $0.00 Resource Navigation (Care Coordination) (Billing Unit: Hour) $0.00 $0.00 $0.00 Screening and Assessment (Billing Unit: Person) $0.00 $0.00 $0.00

Additional Rate

Row Activity Name Billing Unit Cost Report Method Start Date of Data End Date of Data Agency Cost Agency Charge Reimburse Rate Line Item Number Activity 1 $0.00 $0.00 $0.00 Activity 2 $0.00 $0.00 $0.00 Activity 3 $0.00 $0.00 $0.00 Activity 4 $0.00 $0.00 $0.00 Activity 5 $0.00 $0.00 $0.00 Activity 6 $0.00 $0.00 $0.00

Alternative Activities

Authorized Agencies

Legal Legal Governing Authorized Authorized Authorized Authorized Authorized Authorized Authorized Authorized Authorized Agency Service Is a Draft Subcontract

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name of Structure Board for Agency Agency Agency Agency Agency Agency Agency Agency Administrator Email Area the subcontract Authorized of Authorized Street Address: Address- Address- Phone Administrator Administrator- Administrator Address Authorized between the Agency Authorized Agency Address City, State, State. Zip. Number First Name Last Name Phone Agency Board of Agency Zip Code Number will serve Health and this Authorized Agency anticipated? Mary Greeley Medical Non-Profit Board of 1114 Duff 515-239- Story Center Ames Iowa 50010 Les White 515-233-7571 [email protected] Yes Corporation Directors Avenue 6730 County MGMCCountyBOHFY20.docx Home Health Services

Authorized Agency Key Personnel

Authorized Agency Authorized Agency Key Personnel-Full Name (First and Last) Authorized Agency Key Personnel Title Authorized Agency Key Personnel Email Address Mary Greeley Medical Center Home Health Services Les White Director [email protected] Mary Greeley Medical Center Home Health Services Treasa Ferrari Public Health Nurse [email protected] Mary Greeley Medical Center Home Health Services Trisha Macdonald Program Assistant [email protected] Mary Greeley Medical Center Home Health Services Sherry Zook Public Health Nurse [email protected]

Alternative Plan Details

Alternative Plan Details 1 Are there any Alternative Plans listed in the LPHS Budget form?* No Authorized Agency Activity Amount $0.00 How will the activity increase capacity for the agency to provide services in your community? Identify essential public health services to be delivered (all that apply) Describe the activity to be delivered Identify target populations to be served (all that apply) Identify the outcome measure used to evaluate use of the Alternative Plan.

Subcontracts Proposed

Are Subcontracts proposed for work and services of this project?* Yes

Subcontract Plan

Subcontract Plan 1 Subcontractor Identified?* Yes Scope of Work to be performed through a subcontract*  

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Anticipated Dollar Amount for each subcontract* $204,030.00 Name of subcontractor Mary Greeley Home Health Services Subcontractor Street Address 1114 Duff Avenue Subcontractor Address: City, State, Zip Code Ames Subcontractor Address-State. Iowa Subcontractor Address-Zip. 50010 Subcontractor qualifications   Service Area the Subcontractor will serve Story County

Minority Impact Statement

Question # 1

1. The proposed grant programs or policies could have a disproportionate or unique POSITIVE IMPACT No on minority persons. *

If YES, describe the positive impact expected from this project

Indicate the group(s) positively impacted.

Question # 2

2. The proposed grant project programs or policies could have a disproportionate or unique NEGATIVE No IMPACT on minority persons. *

If YES, describe the negative impact expected from this project.

If YES, present the rationale for the existence of the proposed program or policy.

If YES, provide evidence of consultation with representatives of the minority groups impacted.

Indicate the group(s) negatively impacted.

Question # 3

3. The proposed grant project programs or policies are NOT EXPECTED TO HAVE A DISPROPORTIONATE OR UNIQUE IMPACT on Yes minority persons. *

If YES, present the rationale for determining no impact.  

Certification

I hereby certify that the information on this form is complete and accurate, to the best of my Yes knowledge.* Name of Person Submitting Certification. * LesLa White Title of Person Submitting Certification* Director MGMC Home Health Services

County Information

County # 85 County Name Story County

Provide the name of the person who is responsible for submitting the minutes. This does not have to be Stephanie L. Jones, Administrative Assistant II

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a LBOH member.

Member Information

Date Select one: Full Name Title (if Address City State Zip Code New Term Exp. Phone LBOH Medical E-Mail Revised applicable) Member Date Physician License # John J. McFarland Clinic, PC PO Box 50010- 515-239- 03/21/2019 CHAIRPERSON Ames Iowa No 12/31/2020 Yes 26890 [email protected] Paschen 3014 3014 4404 515-233- 03/21/2019 VICE CHAIR Mark Speck 5620 Hickory Hills Dr Ames Iowa 50014 No 12/31/2021 No [email protected] 3680 Louisa 515-291- 03/21/2019 MEMBER 1530 Northwestern Ames Iowa 50010 Yes 12/31/2021 No Tabatabai 4977 515-663- 03/21/2019 MEMBER John P. Kluge 2320 Timberland Rd Ames Iowa 50014 No 12/31/2020 No [email protected] 7804

Iowa.gov – The Official Website of the State of Iowa. Dulles Technology Partners Inc.

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HIA AIMS TO MAKE THE HEALTH IMPACTS OF PUBLIC DECISIONS EXPLICIT.

Source: Human Impact Partners. A Health Impact Assessment Toolkit: A Handbook to Conducting HIA, 3rd Edition. Oakland, CA: Human Impact Partners. February 2011. C2C PLAN – HOUSING GOAL 3 STRATEGY: IN ORDER TO UNDERSTAND AND ADDRESS PUBLIC HEALTH IMPLICATIONS OF HOUSING STRATEGIES AND PROJECTS, CONSIDER CONDUCTING HEALTH IMPACT ASSESSMENTS WHEN APPROVING NEW OR UNDERTAKING POLICY MAKING WITH REGARD TO PUBLIC INFRASTRUCTURE AND DEVELOPMENT. C2C PLAN – IMPLEMENTATION MATRIX DETERMINE VIABILITY OF USING HEALTH IMPACT ASSESSMENTS PRESENTATION OVERVIEW • WHAT IS HEALTH IMPACT ASSESSMENT • THE WHY (HIA) • THE HOW • GOALS OF HIA IN PUBLIC DECISION- • HIA PROCESS MAKING • RELATIONSHIP TO OTHER EFFORTS • FOUR BASIC TYPES • NACO’S HEALTHIEST CITIES AND • THE WHO COUNTIES CHALLENGE TOOLKIT • THE WHAT • NEXT STEPS • THE WHEN • RESOURCES • THE WHERE • QUESTIONS ONE TOOL PLANNERS CAN USE TO INFORM COMMUNITY DECISIONS ABOUT THE HEALTH IMPLICATIONS OF DEVELOPMENT POLICIES OR PROPOSALS IS THE HEALTH IMPACT ASSESSMENT (HIA). THE GOAL OF HIA IS TO APPLY AVAILABLE RESEARCH ABOUT HEALTH IMPACTS TO SPECIFIC LAND-USE QUESTIONS TO DEVELOP EVIDENCE- BASED RECOMMENDATIONS TO INFORM DECISION-MAKING.

Source: The Effective Use of Health Impact Assessment (HIA) in Land-Use Decision Making – Salkin and Ko (October 2011) WHAT IS HEALTH IMPACT ASSESSMENT?

• HIA BRINGS TOGETHER SCIENTIFIC DATA, HEALTH EXPERTISE, AND STAKEHOLDER INPUT TO IDENTIFY THE POTENTIAL AND OFTEN OVERLOOKED POSITIVE AND NEGATIVE EFFECTS ON PUBLIC HEALTH OF PROPOSED LAWS, REGULATIONS, PROJECTS, POLICIES, AND PROGRAMS. • PROVIDE PRAGMATIC, EVIDENCE-BASED RECOMMENDATIONS ABOUT HOW TO REDUCE RISKS, PROMOTE BENEFITS, AND MONITOR THE HEALTH EFFECTS OF THE IMPLEMENTED DECISION.6 THESE ASSESSMENTS HAVE BEEN USED TO INFORM DECISION-MAKING IN A RANGE OF SECTORS, INCLUDING PLANNING, AGRICULTURE, CRIMINAL JUSTICE, ECONOMIC POLICY, TRANSPORTATION, AND HOUSING.

Source: Health Impact Assessment Can Inform Planning to Promote Public Health – A Brief from the Health Impact Project and the American Planning Association (August 2016) GOALS OF HIA IN PUBLIC DECISION- MAKING • IDENTIFYING HARMS AND BENEFITS BEFORE DECISIONS ARE MADE. • IDENTIFYING EVIDENCE-BASED STRATEGIES AND RECOMMENDATIONS TO PROMOTE HEALTH AND PREVENT DISEASE. • INCREASING TRANSPARENCY IN THE POLICY DECISION-MAKING PROCESS. • SUPPORTING INCLUSIVE AND DEMOCRATIC DECISION-MAKING. • SUPPORTING COMMUNITY ENGAGEMENT IN THE DECISION-MAKING PROCESSES. • ADVANCING EQUITY AND JUSTICE. • SHIFTING DECISION-MAKING FROM AN ECONOMIC TO A QUALITY OF LIFE FRAMEWORK. • INFORMING A DISCUSSION OF THE TRADE-OFFS INVOLVED WITH A PROJECT OR POLICY. • FACILITATING DECISIONS AND THEIR IMPLEMENTATION.

Source: Human Impact Partners. A Health Impact Assessment Toolkit: A Handbook to Conducting HIA, 3rd Edition. Oakland, CA: Human Impact Partners. February 2011. FOUR BASIC TYPES (NATIONAL RESEARCH COUNCIL 2011)

• RAPID: AN HIA THAT CAN BE COMPLETED IN A SHORT TIME FRAME (WEEKS OR MONTHS), OFTEN FOCUSED ON LESS COMPLEX DECISIONS. THESE HIAS GENERALLY INVOLVE LITERATURE REVIEWS AND SECONDARY DATA ANALYSIS, BUT CAN STILL RETAIN AN EMPHASIS ON STAKEHOLDER ENGAGEMENT. • DESKTOP: A RAPID HIA THAT ENTAILS LITTLE OR NO STAKEHOLDER ENGAGEMENT. • INTERMEDIATE: AN HIA THAT INVOLVES MORE TIME AND RESOURCES (SOMETIMES SEVERAL MONTHS) AND A MORE COMPLEX SCOPE THAN RAPID HIAS, USING MORE DETAILED ANALYSIS AND MORE STAKEHOLDER ENGAGEMENT THAN A RAPID HIA. THESE HIAS TYPICALLY DO NOT INVOLVE COLLECTING NEW DATA. • COMPREHENSIVE: AN HIA THAT REQUIRES THE COLLECTION OF NEW, PRIMARY DATA AND INVOLVES A COMPLEX SCOPE AND EXTENSIVE STAKEHOLDER ENGAGEMENT. THESE HIAS CAN TAKE LONGER THAN A YEAR TO COMPLETE.

Source: The State of Health Impact Assessment in Planning | American Planning Association (July 2016) THE WHO

• RANGE OF STAKEHOLDERS, SUCH AS DECISION-MAKERS, ELECTED AND APPOINTED OFFICIALS, PLANNERS, PUBLIC HEALTH PRACTITIONERS, BUSINESS OWNERS, RESIDENTS, AND COMMUNITY MEMBERS, AS ACTIVE PARTICIPANTS IN THE PROCESS.

Source: Health Impact Assessment Can Inform Planning to Promote Public Health – A Brief from the Health Impact Project and the American Planning Association (August 2016) THE WHAT HIAS TAKE INTO ACCOUNT ENVIRONMENTAL, SOCIAL, AND ECONOMIC FACTORS RELATED TO HEALTH AND EVALUATE THE POTENTIAL IMPACTS OF A PROPOSED PROJECT, PLAN, PROGRAM, OR POLICY ON THE HEALTH OF THE COMMUNITY.

Source: Health Impact Assessment Can Inform Planning to Promote Public Health – A Brief from the Health Impact Project and the American Planning Association (August 2016) THE WHEN

HIAS ARE A METHOD OF PROACTIVELY INFORMING A DECISION UNDER CONSIDERATION AND CAN BE USED TO INFLUENCE ANY STAGE OF THE PLANNING PROCESS, INCLUDING VISIONING, GOAL-SETTING, AND THE CREATION AND IMPLEMENTATION OF PLANS, POLICIES, AND PROJECTS, AS LONG AS THE ASSESSMENT IS COMPLETED IN ADVANCE OF THE DECISION IT SEEKS TO INFORM.

Source: Health Impact Assessment Can Inform Planning to Promote Public Health – A Brief from the Health Impact Project and the American Planning Association (August 2016) THE WHERE PLANNING HIAS CAN ASSESS HEALTH IMPACTS OF PROJECTS, PLANS, AND POLICIES AT THE BUILDING, STREET, NEIGHBORHOOD, LOCAL, OR REGIONAL SCALE.

Source: Health Impact Assessment Can Inform Planning to Promote Public Health – A Brief from the Health Impact Project and the American Planning Association (August 2016) THE WHY HIAS CAN HELP PLANNING EFFORTS PROTECT AND PROMOTE THE HEALTH AND WELL-BEING OF THE COMMUNITY AND HELP ENSURE THAT HEALTH BENEFITS AND RISKS FROM DECISIONS ARE EQUITABLY DISTRIBUTED.

Source: Health Impact Assessment Can Inform Planning to Promote Public Health – A Brief from the Health Impact Project and the American Planning Association (August 2016) THE HOW

HIAS EMPLOY A VARIETY OF DATA SOURCES, SUCH AS DEMOGRAPHIC AND HEALTH INFORMATION AND INPUT FROM STAKEHOLDERS, TO IDENTIFY THE POTENTIAL HEALTH EFFECTS OF PLANNING DECISIONS, WITH SPECIAL ATTENTION PAID TO CERTAIN TARGET POPULATIONS SUCH AS SENIORS, CHILDREN, AND LOW-INCOME COMMUNITIES. HIAS CAN BE FAIRLY QUICK, USING A “RAPID” OR “DESKTOP” MODEL OVER A FEW WEEKS OR MONTHS, OR THEY CAN USE A LONGER, MORE COMPREHENSIVE APPROACH, TAKING SEVERAL MONTHS TO MORE THAN A YEAR TO COMPLETE.

Source: Health Impact Assessment Can Inform Planning to Promote Public Health – A Brief from the Health Impact Project and the American Planning Association (August 2016) HIA PROCESS

IN GENERAL, HIAS FOLLOW SIX STEPS—SCREENING, SCOPING, ASSESSMENT, RECOMMENDATIONS, REPORTING, AND MONITORING/EVALUATION.

Source: The State of Health Impact Assessment in Planning | American Planning Association (July 2016) AS THE U.S. FACES INCREASINGLY COMPLEX AND INTERRELATED CHRONIC AND INFECTIOUS HEALTH CONDITIONS, HIA IS A TOOL TO INSTIGATE INTERDISCIPLINARY CONVERSATIONS LEADING TO SOLUTIONS THAT IMPROVE HEALTH.

Source: The State of Health Impact Assessment in Planning | American Planning Association (July 2016) RELATIONSHIP TO OTHER EFFORTS • COMMUNITY HEALTH NEEDS ASSESSMENTS • STORY COUNTY COMMUNITY HEALTH ASSESSMENT 2015 STORY COUNTY PUBLIC HEALTH AND STORY COUNTY QUALITY OF LIFE ALLIANCE • THE MISSION OF THE STORY COUNTY QUALITY OF LIFE ALLIANCE (SCQLA) IS TO PROMOTE HEALTH AND QUALITY OF LIFE ACROSS STORY COUNTY THROUGH ASSESSMENT AND COLLABORATION. THE PURPOSE OF SCQLA IS TO ENSURE THE REGULAR ASSESSMENT OF THE HEALTH NEEDS IN OUR COMMUNITY THROUGH DATA COLLECTION/AGGREGATION, AND PERPETUATE THIS KNOWLEDGE THROUGH ORGANIZED AND SYSTEMATIC SHARING WITH COMMUNITY INSTITUTIONS AT-LARGE. • REQUIRED OF THE LOCAL PUBLIC HEALTH DEPARTMENTS IN IOWA, THROUGH THE IOWA DEPARTMENT OF PUBLIC HEALTH (IDPH). THESE ASSESSMENTS ARE TO BE PERFORMED EVERY 5 YEARS, AND REPORTED BACK TO IDPH. NACO’S HEALTHIEST CITIES AND COUNTIES CHALLENGE TOOLKIT • THIS TOOLKIT IS DESIGNED TO SUPPORT CITIES AND COUNTIES IN THE CONSIDERATION OF OPPORTUNITIES AND CHALLENGES IMPACTING THE COLLECTIVE HEALTH OUTCOMES OF THEIR COMMUNITIES. • THE EVIDENCE-BASED PRACTICES AND EXAMPLES IN THIS TOOLKIT EQUIP CITIES AND COUNTIES TO IMPROVE THE HEALTH OF RESIDENTS THROUGH MODULES THAT OUTLINE PLANNING, IMPLEMENTATION AND EVALUATION CONSIDERATIONS OF COMMUNITY HEALTH INITIATIVES. • TOOLKIT ONLINE NEXT STEPS DETERMINE VIABILITY OF USING HEALTH IMPACT ASSESSMENTS • DISCUSSION ON LEVEL OF INTEREST • DO YOU MAKE DECISIONS/ADDRESS ISSUES THAT COULD BE BETTER INFORMED USING HIA? • ARE THERE GOALS THAT COULD BE SET AT THIS TIME FOR HIA? • HOW WOULD HIA BE USED? • IDENTIFY WHO SHOULD BE INVOLVED • WHO ARE THE DECISION MAKERS? • WHO ARE THE STAKEHOLDERS? RESOURCES

• HEALTH IMPACT ASSESSMENT CAN INFORM PLANNING TO PROMOTE PUBLIC HEALTH – A BRIEF FROM THE HEALTH IMPACT PROJECT AND THE AMERICAN PLANNING ASSOCIATION (AUGUST 2016) • THE STATE OF HEALTH IMPACT ASSESSMENT IN PLANNING • THE EFFECTIVE USE OF HEALTH IMPACT ASSESSMENT (HIA) IN LAND-USE DECISION MAKING – SALKIN AND KO (OCTOBER 2011) • HEALTH IMPACT ASSESSMENT (HIA) PRELIMINARY CHECKLIST BY DESIGN FOR HEALTH • HUMAN IMPACT PARTNERS. A HEALTH IMPACT ASSESSMENT TOOLKIT: A HANDBOOK TO CONDUCTING HIA, 3RD EDITION. OAKLAND, CA: HUMAN IMPACT PARTNERS. FEBRUARY 2011. • MINNESOTA HIA ACTION GUIDE – ADVANCING CAPACITY AND UNDERSTANDING FOR HEALTH IMPACT ASSESSMENT IN MINNESOTA (DECEMBER 2016) QUESTIONS

Source: Minnesota HIA Action Guide – Advancing Capacity and Understanding for Health Impact Assessment in Minnesota (December 2016) Board of Health Report February 2019 YSS Prevention Services

Child Abuse Prevention: YSS staff completed Talking About Touching began programming to Roland Story first grade students and Colo NESCO Kindergarten, First and Second Grades. Prevention staff are also involved in the work of the Children’s Well Being Collaboration. The collaboration explores mental health resources for youth. Exploring prevention programming available for mental health prevention. Also exploring stigma associated with mental health issues.

Youth Development and Community Outreach: Ames Mayors Youth Committee (MYC) met in February. Members presented a bullying activity for 8th grade Health at AMS in February. Committee members also participated in the February 28 Day on the Hill. Members met with local legislators to explore the impact that substance abuse has in the community. Great events!

Ames Middle School Builders Club met once in February. Members participated in an informational presentation on ISTEP Chapters, to focus on youth led tobacco prevention efforts. Members also participated in the February 28 Day on the Hill. Members met with local legislators to explore the impact that substance abuse has in their home community. Members also participated in a press conference to talk about vaping and drug trends.

Collins Maxwell ChaMps did not meet in February due to weather.

Substance Abuse Efforts: Too Good For Drugs (elementary substance abuse curricula) programming was started in Colo NESCO and Collins Maxwell Schools in February.

Project ALERT (middle school substance abuse curricula) programming occurred in Ballard and Collins Maxwell Schools.

Staff participated in the following Substance Abuse Prevention outreach activities:  Staff participated in the February 14 AC4C Capacity Workgroup. Exploring ways to partner with local coalitions and share resources. Next step is to reach out to Community Health Consultants for the Community Partnership Tobacco Grants to gauge interest.  Staff also participated in the February 18 AC4C Executive Council meeting. Explored sustainability of AC4C and prevention efforts across the state.  Staff participated in the February 14 meeting to explore agency policy on CBD Oil.  Staff presented to two sections of ISU Health Studies 275 classes on February 18 and discussed substance abuse programs and resources available to school staff. There were 63 students in attendance.  Staff participated in the February 21 Collegiate Recovery Training in Des Moines. Explored prevention efforts for those in recovery at the university.  Staff presented an overview of Prevention Services offered across the county at the February 27 Eastern Story County Circles of Champions. Approximately 20 people were in attendance.  Staff began a series of 3 session drug education in February with 18 students.  Staff provided two separate presentations to three sections of ISU 110 Health Classes. Topic was alcohol abuse, marijuana and prescription drug misuse. 133 students were in attendance.  Staff provided two separate presentation to six sections of Ames High Health classes. Topic was ATOD. 136 students participated.  ISU Health Promotion Club met on Feb 5 & 19. Club activities including work to promote a state wide vaping law and local CBD ordinance.  Staff provided assistance to an ISU Fraternity in planning for and carrying out wellness activities for the fraternity Corporate Board meeting to discuss advising responsibilities. Met Feb 8, 24 and 19.  Staff participated in the Feb 11 Opioid Task Force. Continued discussion of the last community conversation and goals moving forward.  Staff participated in the Feb 11 Nevada Task Force on Substance Abuse meeting. Planning continues for the Community Conversation scheduled for March.

Community Partnership Tobacco Grant:  The following tobacco presentation were made: o Staff presented to the Nevada Early Morning Kiwanis Club on February 5. 26 club members were present. Conversation around Tobacco and Electronic Smoking Devices (ESDs) was paramount to discussion. Brought paraphernalia to show differences in tobacco products including ESDs. o Staff made a presentation to Roland Story High School Students from 2/19-2/21. 310 students participated. YSS staff presented to all PE/Health class high school students at Roland Story High School over a period of three days. Content covered tobacco history and the similar paths vaping industry is currently taking. Also talked about health concerns of both tobacco and ENDS.  The following are outreach efforts made by YSS staff to increase the number of Tobacco and Nicotine Free DHS Licensed Preschool Centers in Story County: o YSS staff followed up on previous email sent out to ACPC in regards to a nicotine free policy for on site. No reply has been had yet. o YSS staff reached out to Prairie Flower Childrens Center to promote nicotine free policy. YSS staff explained the benefits to health, the objectives to the community, and explained the language requirements for free signage provided by IDPH. Waiting on reply, will reach back out in subsequent month. o Staff reached out to Ames Play and Learn advocating for a nicotine free policy to be adopted by care center. Staff explained the heath objectives and benefits of adopting such a policy. Staff explained language requirements for free signage. Will continue to follow up. o Staff reached out to St. Paul Preschool to promote nicotine free policy. Staff explained the benefits of such a policy, as well as the health objectives by IDPH. Will continue to be in contact. o YSS staff followed up with email to a previous call made to The 2000 Day Learning Experience concerning the nicotine free policy. All information was restated in the email. Will continue to follow up until contact is made.  The following is outreach made by staff to increase the number of Workplaces Adopting Tobacco Free/Nicotine Free Policy in Story County: o Followed up with email to Anytime Fitness in Boone to see where potential policy adoption may be at. Email restated all previous information. Will continue to follow up. o Reached out to Adams Cycle to advocate for nicotine free policy. YSS staff explained via email the benefits, objectives and free signage language requirements spelled out by IDPH. o Reached out to Hunziker Properties housing complex to advocate both workforce policy and smokefree homes policy. Will continue to follow up. o Reached out to First Property Management housing complete to advocate for smokefree policy for both complex and workplace. Have scheduled a meeting to explain further processes required. Meeting set for next month.  The following are outreach efforts made by YSS staff to increase the number of Diabetes Treatment/Education Programs who adopt the Quitline Iowa 2As and R and fax referral system: o Staff spoke to Kindred Health employee about 2As and R process and Quitline Iowa. Employee (who is an occupational therapist) has been trying to implement use into practice. o Reached back out to Da Vita, restated purpose of call. No response by whom it concerned, will continue to follow up.  The following are additional outreach efforts made by the YSS for Tobacco Control efforts: o Staff participated in the St. Cecilia Ministry Fair and gave out 30 brochures and 50 Quitline Iowa Cards.

BREAKING . . .

Grey matter volume differences associated with extremely low levels of cannabis use in adolescence

A study published in the Journal of Neuroscience today “presents evidence suggesting structural brain and cognitive effects of just one or two instances of cannabis use in adolescence.” The researchers note that nearly 35 percent of 10th graders report using marijuana. Read study abstract here.

Teens and vaping marijuana: Understanding the dangers of “dabbing”

Dabbing among 8th, 10th, and 12th graders is on the rise, according to the Monitoring the Future Survey. Dr. Ruben Baler, a health scientist at the National Institute on Drug abuse, which funds the survey, estimates that of the 3 million teens now vaping e-cigarettes, 30 to 40 percent are vaping marijuana.

The term vaping generally applies to heating capsules of nicotine in an e- cigarette and inhaling the fumes, while dabbing refers to inhaling fumes from a heated capsule of THC in a vape pen. And those THC capsules contain concentrates with 60 to 90 percent THC compared to about 12 percent THC in today’s marijuana that is smoked. Americans were getting high less than 5 percent THC in the 60s, 70s, 80s, and 90s.

“This is a very dangerous trend,” Dr. Baler says. E-cigarettes and vape pens “are very easy to hide. They’re odorless, and they’re marketed very aggressively for kids, whether they have flavorings or high concentrations of nicotine or marijuana.”

He warns that an adolescent brain is still in development and “should be completely clean” of any “drug that can derail that trajectory of development.”

Police: Vape shop owner, employees charged with selling marijuana to minors

Police arrested the owner and four employees at a vape shop called Kloudy Visionz in Taunton, Massachusetts after finding a stash of marijuana behind the counter, which allegedly was sold to teenagers.

Even though marijuana is legal in Massachusetts for adults, Kloudy Visionz does not have a license to sell it to anyone, let alone someone under age 21. An investigation had revealed teenagers leaving through a side entrance with marijuana.

The store had been opened for only about a year, but its license to sell tobacco had expired.

Thousands of people in DC area seek treatment for marijuana dependency each year

Several thousand people in the area surrounding Washington DC have sought treatment for the drug that “isn’t addictive” (marijuana) as many legalization proponents claim.

An investigation by the NBC Washington News4 I-Team found that Virginia health agencies admitted approximately 4,000 residents each year for the past four years to treat marijuana dependency. While the majority were men, more recent records show an uptick in women ages 31 to 40 seeking treatment.

In 2016, experts testifying before the US Senate Judiciary Committee told members that 8 percent to 9 percent of adults and 17 percent of adolescents who try marijuana become addicted. The experts estimated that some 2.7 million Americans were dependent on the drug.

Those seeking treatment are encouraged to call the Substance Abuse and Mental Health Services Administration’s free, confidential hotline at 1-800-662- HELP (4357).

Read NBC Washington story and see video here.

Marijuana use and driving in Washington State: Risk perceptions and behaviors before and after implementation of retail sales

This roadside study surveyed drivers in Washington State the month before marijuana retail sales began, 5 to 6 months later, and 1 year later. Some 2,355 drivers completed the survey.

They were asked about their past and current marijuana use and whether they believed driving after use increased their risk for having an accident. They also were drug tested for the presence of THC in oral fluids or blood.

The proportion of daytime THC-positive drivers increased from 8 percent before retail sales to 23 percent 6 months after sales began. No such change occurred among nighttime drivers. The odds of being THC positive were 40 percent lower among drivers who believe marijuana can impair driving.

Further research should continue to monitor marijuana and driving and to develop a way to determine impairment.

Read Insurance Institute for Highway Safety study here.

The Marijuana Report is a weekly e-newsletter published by National Families in Action in partnership with SAM (Smart Approaches to Marijuana).

Visit National Families in Action's website, The Marijuana Report.Org, to learn more about the marijuana story unfolding across the nation.

Subscribe to The Marijuana Report e-newsletter.

The Marijuana Report Staff Executive Editor Sue Rusche Editor Nicole Carter IT Consultant Lee Clontz Social Media Coordinator Margarita Eberline

We are grateful to our Board of Directors and Senior Adviser for their support of National Families in Action, which produces The Marijuana Report website and e-newsletter.

National Families in Action Board of Directors William F. Carter, Chairman of the Board Realtor Berkshire Hathaway HomeServices – Georgia Properties, Atlanta.

Sue Rusche, President and CEO, Atlanta.

Richard L. Brown, Secretary Attorney (Ret.), Lakewood Ranch, Florida Founder & Chairman, Sudden Cardiac Arrest Association

Jeannine F. Adams, Director President and CEO, J. Addams & Partners, Atlanta.

Jack L. Arbiser, MD, PhD, Director Thomas J. Lawley Professor of Dermatology Winship Cancer Institute, Emory University, Atlanta

William H. Avery, Director Partner (Ret.), Alston & Bird, LLP, Atlanta.

Margarita Eberline, Director Strategy Director, 360 Marketing Plus, Atlanta.

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Potent Cannabis Heightens Psychosis Risk -Daily use of cannabis, especially high-potency cannabis, tied to excess cases of psychotic disorders by Zeena Nackerdien, CME Writer, MedPage TodayMarch 28, 2019 CME INFORMATIONCME Author: Zeena Nackerdien

Study Authors: Marta Di Forti, Diego Quattrone, et al.; Suzanne Gage

The goals were to identify patterns of cannabis use with the strongest effects on odds of psychotic disorder across separate locations and to explore whether differences in such patterns contribute to variations in the incidence rates of psychotic disorder.

Questions Addressed:

 Could differences in patterns of cannabis use be described across sites?  Did differences in patterns of cannabis use contribute to variations in the incidence of psychotic disorder across sites?

Synopsis and Perspective:

There is an excess of cases of psychotic disorders in areas where daily use and use of high-potency cannabis are more prevalent in the general population, according to a study led by Marta Di Forti, PhD, of the Institute of Psychiatry, Psychology, and Neuroscience at King's College London, and colleagues, that was recently published in Lancet Psychiatry.

Some short-term, experimental intoxication studies suggested that ratios of Δ -tetrahydrocannabinol (THC) to cannabidiol could have an impact on risk of psychotic-like experiences, with one study suggesting that cannabidiol might be anti-psychotic. Additionally, several studies have shown an association between heavy cannabis use and the risk of psychosis. However, while cannabis use has increased in some populations, the corresponding level of psychosis incidence has not – an oft-mentioned paradox.

Di Forti and colleagues examined this anomaly more closely by looking at detailed measures of cannabis use from 901 patients (ages 18 to 64) with first-episode psychosis and 1,237 controls at a mental health facility across 11 sites in Europe and Brazil. People with first-episode psychosis tended to be younger, male, an ethnic minority, and less educated than controls. Some 65% of cases reported any lifetime use of cannabis compared with 46% of controls. "We asked people if they used cannabis, when did they start using it and what kind of cannabis," explained Di Forti in a statement. The researchers used the Cannabis Experience Questionnaire as part of their investigation. Cannabis use was stratified based on THC content into low-potency (THC <10%) and high-potency (THC ≥10%) categories. While this approach does not account for variations in the THC content of individual samples, the authors considered it to be a conservative cutoff. Participants named the types of cannabis they were using (e.g., Nederhasj and Nederwiet in the Netherlands and skunk-like cannabis in London). Researchers were able to develop a potency variable based on self-reported type of cannabis use combined with Europe-wide data published by the European Monitoring Center for Drugs and Drug Addiction on the concentration of THC in cannabis found across the 11 sites.

Compared with never-users, daily cannabis use was associated with a 3.2-fold higher likelihood of psychotic disorder, rising to nearly five times increased odds for daily use of high-potency types of cannabis. Calculated population attributable fractions indicated that, if high-potency cannabis was no longer available, then 12.2% of cases of first- episode psychosis could be prevented across the 11 sites, rising to 30.3% in London and 50.3% in Amsterdam. Adjusted incident rates for psychotic disorder were positively correlated with the prevalence in controls across the 11 sites of use of high-potency cannabis (r = 0.7; P=0.0286) and daily use (r = 0.8; P=0.0109). Additionally, those who spent at least €20 per week (around $23) on cannabis also had higher odds of psychosis (aOR 2.5, 95% CI 1.6-3.8, P<0.0001), as well as those who first used cannabis before they were age 16 years (aOR 1.6, 95% CI 1.1-2.1, P=0.01).

Results have to be appraised within the context of study limitations outlined by the authors. Contemporaneous analysis of urine, blood, or hair samples was not performed to confirm cannabis use. However, the authors stated that such biological measures would not have captured a historical pattern of use. Moreover, prior correlational studies showed that cannabis users reliably reported the type and frequency of cannabis consumption. Other study limitations included an underestimation of the effect of potency on the odds ratios for psychotic disorder and the fact that the potency variable did not include the proportion of another important cannabinoid, cannabidiol.

Source Reference: Lancet Psychiatry, March 19, 2019; DOI: 10.1016/S2215-0366(19)30048-3

Study Highlights: Explanation of Findings

Daily use of cannabis and use of high-potency cannabis were the strongest independent predictors among the measures of cannabis use tested in the study population. "The odds of psychotic disorder among daily cannabis users were 3.2 times higher than for never users," the authors wrote. Prevalence of daily cannabis use in the controls, or prevalence of high potency cannabis use correlated with the incidence rates for psychosis for almost every site assessed in the study, although cannabis use sample sizes were very small. Use of cannabis by the age of 15 years modestly increased the odds of psychotic disorder, but not independently of frequency of use or of the potency of the cannabis used, according to Di Forti and colleagues.

Herbal types of cannabis (THC <10%) were prevalent in countries like Italy, France, and Spain, while the THC content of cannabis available in the Netherlands and London ranged from 22% to 94%. "Use of high-potency cannabis was a strong predictor of psychotic disorder in Amsterdam, London, and Paris where high-potency cannabis was widely available," noted the authors. Current findings were consistent with evidence from the literature suggesting that the use of cannabis with a high concentration of THC has more harmful effects on mental health than does the use of weaker forms.

Despite the researchers "assuming causality" many times throughout their study, "does this mean we can now be sure that (daily and high potency) cannabis use causes psychosis? Unfortunately, not all the evidence utilizing different methods is consistent about causality," said Suzanne Gage, PhD, of the University of Liverpool in England, in an accompanying commentary. "Di Forti and colleagues' study asks participants about their cannabis use prior to their first episode psychosis diagnosis, but it is possible that subclinical symptoms might have existed prior to cannabis initiation, meaning that associations in the opposite direction cannot be ruled out," she wrote. It is "perfectly possible" the relationship is bidirectional, Gage added, "as suggested by other work using genetic variables as proxies for the exposures of interest in a Mendelian randomization design.

But Gage also conceded that the bulk of evidence to date indicates "that for some individuals there is an increased risk of psychosis resulting from daily use of high potency cannabis," which the current study supports. Indeed, a longitudinal study reported last year found that psychotic episodes more often followed cannabis initiation than the other way around.

Both the authors and the editorialist agreed that education was needed to inform the public about the mental health hazards of regular use of high-potency cannabis, especially since the products are becoming increasingly available worldwide.

While the findings should generate interest among cannabis users, it is worth noting that there may be many risk factors for psychotic disorders. Those other causes that may include genetics and that may accumulate to enhance or disrupt a young person's life trajectory are currently being explored in The Adolescent Brain Cognitive Development Study.

Reviewed by Henry A. Solomon, MD, FACP, FACC Clinical Associate Professor, Weill Cornell Medical College and Heidi Wynn Maloni, PhD, ANP-BC, CNRN, MSCN, Nurse Planner

Primary Source The Lancet Psychiatry Source Reference: Di Forti M, et al "The contribution of cannabis use to variation in the incidence of psychotic disorder across Europe (EU- GEI): a multicentre case-control study" Lancet Psychiatry 2019; DOI:10.1016/S2215-0366(19)30048-3.

Secondary Source The Lancet Psychiatry Source Reference: Gage SH "Cannabis and psychosis: triangulating the evidence" Lancet Psychiatry 2019; DOI:10.1016/S2215- 0366(19)30086-0.

Additional Source MedPage Today Source Reference: Monaco K "Cannabis and Psychosis: Getting Harder to Argue Against Causation" 2019.