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DICKINSON COUNTY

PUBLIC HEALTH

2019 ANNUAL REPORT

TABLE OF

CONTENTS

02

LETTER FROM DIRECTOR

03

PUBLIC HEALTH SNAPSHOT

05

STAFFING

06

IMPROVE PATIENT EXPERIENCE

09

IMPROVE POPULATION HEALTH

13

REDUCE HEALTHCARE COSTS

15

FUNDING

LETTER FROM

DIRECTOR

2019 was a busy year for Dickinson County Public Health. A new community health needsassessment and health improvement plan were completed, vaccinations again increased10% from 2018, and a new partnership with Community Health Partners in Sioux County toincrease community education efforts. Vaccinations keep the public safe and are one of the greatest contributions to PublicHealth. Through the team's diligent work in 2019, vaccination rates rose for 2 year olds,adolescents and influenza. Total immunizations given were also increased by 10%compared to 2018. This continues to shed good light on the quality improvement andcollaborative work the team at Public Health completes. As Public Health is largely funded through federal, state and local sources, advocacybecomes increasingly important to maintain funding. In 2019 efforts were made to improvethe health of the residents throughout the Lakes Area through the promotion of tobaccofree / nicotine free public spaces policies. The cities of Spirit Lake and Wahpeton bothsigned update community ordinances restricting the use of tobacco and nicotine products. The Board of Health signed a letter of support 2020 will also be an active year withadvocacy. Water fluoridation, tobacco free / nicotine free, and strong immunizationpolicies will be the main focuses. We are happy to serve a community that is engaged and is consistently aiming to improveitself.

2019 Annual Report 02

Thank you, Brandon RohrigDirector of Population and Public Health

2019 experienced multiple changes withinPublic Health and highlighting thesewere: nomination for the healthiestcommunity award, planting fourcommunity edible orchards, the additionof a tobacco educator, and strengtheningthe community Hunger Coalition(www.dickinsoncountyhunger.com).

To maintain public funding and encouragehealth improving policies, Public Health actively communicates with a variety ofstakeholders. Public Health was active inadvocating against multiple vaccinehesitancy bills in the Iowa legislature in2019. 2020 focuses will be waterfluoridation, tobacco free / nicotine free andimmunization policies.

DICKINSON COUNTY PUBLIC

HEALTH SNAPSHOT


16HEALTHIEST COUNTY

IN IOWA

RWJF COUNTY HEALTH RANKINGS

106HEALTHIEST COUNTY

IN UNITED STATES

USNEWS HEALTH RANKINGS

17, 258

RESIDENTS

2016 2017 2018 2019

75

50

25

0

SPEAKING ENGAGEMENTSThrough speaking engagements,immunizations and other services,Public Health directly interacted withover 5,000 community residents in2019.

2019 Annual Report

COMPREHENSIVE CHILD HEALTHSERVICESComprehensive child health services arenow offered in Public Health throughregularly scheduled Tuesday clinics as wellas by appointment. Public Health offersdevelopmental screenings with the ages andstages questionnaire (ASQ), dentalscreenings, fluoride varnishes, and selectnursing visits. In 2019, over 300 childrenwere impacted by these services.

IMMUNIZATIONSImmunization coverage continuesto be one of the highest in the stateat 64%, 89%, and 91% and 2019experienced an overall increase inthe coverage rates from 2018.Public Health continues to innovatein 2020 and looks to continue thisimprovement

72 speaking engagements in 2019


STAFFING

V I C E P R E S I D E N T O F Q U A L I T YA N C I L L A R Y & C O M M U N I T YS E R V I C E S : C O N N I E L A N G E

Chai r : Dr . Zachary Borus

Vice Cha i r : Connie B jornstad

Caro l DeSchepper

T im O 'Hagan

Secretary : Sandy G i f f row

Beth Wi l l

Publ ic Hea l th Nurse :Mi l ly T i l lo tson

Publ ic Hea l th Nurse :Ju l ie K l ieg l

Publ ic Hea l th Nurse :Jordan Battern

Publ ic Hea l th Nurse :D iane Zempel

B O A R D O F H E A L T HD I R E C T O R O F P O P U L A T I O N

A N D P U B L I C H E A L T H :B R A N D O N R O H R I G

Kit t ie Webster

Dr . Miche l leSchwartz -Webb

Publ ic Hea l th Nurse :Car ly Janssen

Publ ic Hea l th A ide :G ina DeMoss

Publ ic Hea l th Educator :Katy Burke

Secretary : L inda Arndt

IMPROVE

PATIENT

EXPERIENCE


BABYSITTER TRAINING

Babysitter Training is offered through apartnership between Dickinson CountyPublic Health and Iowa State UniversityExtension & Outreach. The trainingprovides a fun, interactive opportunity foryouth ages 11-15 to learn how to be atrustworthy, responsible, caring,competent and capable babysitter.Instruction is provided on how to care forinfants and children up to 10 years of age,how to keep children and the babysittersafe, how to make playtime fun with age-appropriate activities, and how to handle awide variety of emergencies.

HEALTHY KIDS DAY

The local YMCA held their second annual healthy kids day in April 2019. Public Healthwas present, staffing a booth that had general nutrition information as well as car seatsafety information/checks. Nutrition information was focused around the 5-2-1-0campaign in Iowa. Car seat safety provided handouts and a car seat technician to answerany parent questions.



The CHNA is meant to act as a compass to guide hospitals and Public Health in theoptimal direction to best serve the public’s needs. Primary and secondary data arecollected directly from the public as well as a variety of published sources. The HIP isthe working document of the CHNA. The HIP takes the data from the CHNA and putsit into an actionable plan for improving the areas identified as a need. The top 3 issuesidentified were: resources, behavioral health, and chronic disease. More information and the full CHNA and HIP are located at: CHNA: https://www.avera.org/app/files/public/75070/2019-chna-lakes-regional.pdf HIP: https://www.avera.org/app/files/public/75824/2019-chna-lakes-implementation-plan.pdf

Q

FRESH CONVERSATIONS

Fresh Conversations is a program that isoffered through a partnership betweenDickinson County Public Health and TheElderbridge Agency on Aging to hostnutrition discussions on a monthly basis atarea senior centers. The topics vary frommonth to month and the sessions include anexercise, educational component,nutrition discussion, call to action and afood sampling. Public Health hosts classesat the Spirit Lake and Lake Park Senior Mealsites every month. Classes range from 15-25people each month with an averageattendance of 16 in 2019.

COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA)

AND HEALTH IMPROVEMENT PLAN (HIP)



TOBACCO PREVENTION & CESSATION

As sub-contractors of the Tobacco Prevention &Cessation grant, Dickinson County Public Healthpartnered with the surrounding counties of Clay,Emmet, and Palo Alto to provide greater awarenessof the health risks associated with tobacco andnicotine use, as well as access to interventiontechniques, policy change templates, and cessationresources, such as Quitline Iowa and My Life MyQuit. Due to the national Teen Vaping Epidemic and risein EVALI cases, our primary focus was sharinginformation about e-cigarette adverse healtheffects. In 2019, we spoke at 23 community eventsacross the 4 counties reaching approximately 541people, including 9 presentations held withinDickinson county, providing the opportunity toconnect with 163 local residents.

CHILD SAFETY SEAT CHECK

Car Seat Safety events are providedyearly by Dickinson County PublicHealth. Certified Technicians providecar seat checks from infants to school-age children free of charge. Caregiversare educated on how to properlyinstall their infant/child’s car seat aswell as how to properly use the carseat. Car seat checks can also bescheduled by contacting DickinsonCounty Public Health.

IMPROVE

POPULATION

HEALTH

Public Health administers the majority of child and adult immunizationsfor Dickinson County. This is a unique situation as the Public Healthdepartment in other counties generally do not provide vaccinations forchildren with private insurance. Because of this, Public Health has theopportunity to greatly effect immunization rates and coverage throughquality improvement projects, innovation, and collaboration. In 2019, 7653 immunizations were administered, 2162 patients receivedthe influenza immunization, 2920 total patients were immunized, 64%of adolescents received human papillomavirus immunization, 91% ofadolescents received their recommended immunizations and 89% of2 year olds received their recommended immunizations.

2,708

S C H O O L S :

263

D A Y C A R E S :


2,162

I N F L U E N Z A V A C C I N A T I O N S :

2,920

P A T I E N T S I M M U N I Z E D :

IMMUNIZATIONSIMMUNIZATIONS

AUDITS

Every child in daycare, preschool, and grade school must have animmunization record on file and depending on their age and grade level,have certain immunizations in order to attend. The Iowa Department ofPublic Health tasks each county to audit the records of local daycares,preschools and schools to ensure children have the appropriateimmunizations required by law.

IMMUNIZATION AUDITS



Public Health goes into three Dickinson County school districts to administerinfluenza vaccines to children. This reduces the barrier of travel and time forparents that would otherwise be unable to make it to the public health office.

6TH AND 11TH GRADE CLINICS

SCHOOL FLU SHOTS

Before entering 7th grade, students are required to have one dose of Meningococcal(MCV4) and Tdap, and before entering 12th grade, students are required to have twodoses of meningococcal conjugate (MC) vaccine. Public Health uses these clinics toreach out to students and immunize them at the school where it is convenient for thefamilies and also reduces the number of patients that need immunizations in the lastfew weeks before school. 2019 saw a drop in adolescent clinic immunizations due to achange in tracking metrics. In previous years flu shots were included in the clinictotals and in 2019, this was removed.

2 0 1 9

F LU

SHOT S :

5 1 3 K I D S

2 0 1 9

ADO LE SCENT

C L I N I C S :

2 5 5 K I D S



In summer 2019, the Public Health intern worked with the community to complete acomprehensive community food assessment. The full assessment can be accessedbelow. Highlights included more resource communication, increased education aboutcooking, and increased access to food pantries.

Q

ADVOCACY EFFORTS

Public Health is active in local, state, andfederal legislative efforts. In 2019, localPublic Health successfully advocated formultiple communities and businesses inDickinson County to adapt tobacco freepolicies. Public Health helped disrupt sevendifferent vaccine hesitancy bills introducedat the state level. Lastly, Public Health metwith federal legislators to speak aboutPublic Health concerns for 2019.

COMMUNITY FOOD ASSESSMENT

https://bit.ly/3c12oji

https://bit.ly/3c12oji

0 5 10 15 20 25

2016

2017

2018

2019

Since in 2002, Public Health has received funds from the government to make sure the communityis prepared for disaster. Funds can be used for various projects and are aimed to help thecommunity at large. 2019 was the second year with which funds were dispersed through the northwest Iowa regionrather than directly to the county. In 2019, a full scale active shooter event was completed atCamp Foster and a table top exercise was completed at a Lakes Regional Healthcare leadershipmeeting. Funded projects included a new coalition radio, first aid kits, stair chairs, and new PAPRhoods and parts.

Public Health is tasked with investigatingcertain diseases as they arise to assist stateepidemiologists. The diseases investigatedare highly contagious and pose varyinglevels of threats to the health of thecommunity. Investigations include a phoneinterview with the patient and dependingon the disease, further specimen collection.

2019 Annual Report

Dickinson County Public Health partners with Webster County Public Health to offerMaternal and Child and Adolescent Health (MCAH) grant services to DickinsonCounty. Services include: Maternal and Prenatal Health Support and Education, ChildHealth Nursing Visits (CHNV), Lead and Hemoglobin testing, Dental Screenings andpreventive Fluoride Varnish applications, Developmental Screenings (ASQ), andresource information for families with newly eligible Medicaid children birth to 21years of age.



BCBB is a home visitation program serving pregnant women and new parentswith infants up to 12 months of age. Home visits are done with a nurseand provide one-on-one time with parents to increase knowledge of theirinfant’s health and development. BCBB also connects families to resources thatmatch their unique needs.

BEST CARE FOR BETTER BABIES (BCBB)

MATERNAL CHILD AND ADOLESCENT HEALTH (MCAH)

For patients that are home bound and stable, Public Health receives funding to ensurepatients can maintain their independence and their health. Public Health is able toassist with nurses through health maintenance (HM) and home care aides (HCA) tomaintain patient independence. Per state reporting, data is organized in the grant fiscalyear instead of calendar year.



PUBLIC HEALTH HOME VISITING

Staff87.4%

Grant Expenses6.1%

Supplies5.1%

County34.9%

Professional32.6%

State23.8%

Federal7.1%

Other1.6%

FY 15 FY 16 FY 17 FY 18 FY 19

1,000,000

750,000

500,000

250,000

0

2019 Annual Report

Federal, state, and other grants were reduced by 7% from 2017. Professional servicesand MCAH services increased 16% and 14% respectively from 2018. Much of theincrease has come from increased services offered in the Public Health clinic andcollaboration with family medicine providers. County funding has remained the samefor the past 6 years.

8n=8 =w8sg 1s · services comprehensive child health services are now offered in public health...

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