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Lake County General Health District

2010 Annual Report

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TABLE OF CONTENTS

Board of Health .......................................................................................................... 3 Administrative Personnel ....................................................................................................... 4

Vital Statistics Staff ............................................................................................................... 4

Community Health Services Staff ..................................................................................... 5-6

Environmental Health Program Staff ..................................................................................... 7

Seasonal Employees Hired In Calendar Year 2009 ............................................................... 8

Advisory Committees to the Board of Health ........................................................................ 8

Child Health Services Advisory Council ............................................................................... 8

Health District Licensing Council ......................................................................................... 8

Contracting Individuals/Agencies/Consultants ...................................................................... 9

Fiscal Agent – Lake County Family and Children First Council........................................... 9

1.0 REPORT OF THE HEALTH COMMISSIONER ........................................ 10-18 1.01 Introduction ....................................................................................................... 10-12

1.02 Board of Health ................................................................................................. 12-13

1.03 Financial Overview ........................................................................................... 14-16

1.04 Vital Statistics ................................................................................................... 17-18

2.0 REPORT OF THE DIRECTOR

ENVIRONMENTAL HEALTH PROGRAMS .............................................. 19-33 Administration ..................................................................................................................... 19

Potable Water Supply .......................................................................................................... 19

Bioterrorism/Disaster Response ........................................................................................... 19

Liquid Waste Treatment and Disposal ................................................................................. 19

Stormwater ........................................................................................................................... 20

Solid Waste Program ........................................................................................................... 20

Radiological Health Program ............................................................................................... 20

Recreation Areas .................................................................................................................. 20

Schools ................................................................................................................................ 20

Food Protection .................................................................................................................... 20

Public Health Nuisances ...................................................................................................... 21

Rabies Control Program ....................................................................................................... 21

Mosquito Control Program ............................................................................................ 22-22

Air Pollution Program .......................................................................................................... 22

Plumbing Program ............................................................................................................... 22

Miscellaneous ...................................................................................................................... 22

Charts and Graphs .......................................................................................................... 23-33


COMMUNITY HEALTH SERVICES ........................................................... 34-60 3.01 Administrative Review ..................................................................................... 34-37

3.01.01 Grant Review ................................................................................... 37-38

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TABLE OF CONTENTS (cont.) 3.02 Clinical Services ............................................................................................... 39-47

3.02.01 Well Child Clinic ................................................................................ 40

3.02.02 Lead Testing ........................................................................................ 40

3.02.03 Childhood Immunizations ............................................................. 41-42

3.02.04 Adult Immunizations ........................................................................... 42

3.02.05 Bureau of Children with Medical Handicaps ...................................... 43

3.02.06 Newborn Home Visit Program ............................................................ 43

3.02.07 Communicable Disease ................................................................. 43-45

3.02.08 Rabies Vaccine ................................................................................... 45

3.02.09 Tuberculosis .................................................................................. 45-46

3.02.10 Flu Clinics ........................................................................................... 46

3.02.11 Other Public Health Clinical Activities ......................................... 46-47

3.03 Help Me Grow .................................................................................................. 47-49

3.04 WIC .................................................................................................................. 49-51

3.05 Health Promotion and Planning ................................................................... 51-60

3.05.01 Unit Supervisor’s Report ................................................................. 51-52

3.05.02 Preparedness Specialist ................................................................... 52-53

3.05.03 Health Educator .............................................................................. 53-54

3.05.04 Health Educator/Preparedness Specialist ........................................ 54-57

3.05.05 HIV Case Management and Prevention .......................................... 57-59

3.05.06 Drug Assistance Program ............................................................... 59-60

3.05.07 Breathe Well, Breathe Free Program .................................................... 60

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BOARD OF HEALTH LAKE COUNTY GENERAL HEALTH DISTRICT

Roger Anderson

2306 River Road

Willoughby Hills, OH 44094

Timothy Brennan

102 River Street

Grand River, OH 44045

Alvin Brown, VMD

9853 Johnnycake Ridge

Mentor, OH 44060

William Catania

8994 Elm Street

Kirtland, OH 44094

Edward A. Currier,

President Pro-Tem

9381 Baldwin Road

Kirtland Hills, OH 44060

Patricia Fowler

28730 Ridge Road

Wickliffe, OH 44092

Marcus Garland

5436 Pinehill Drive

Mentor-on-the-Lake, OH 44060

Juan Michael Hernandez, MD

122 Pinehurst Boulevard

Eastlake, OH 44095

Brian Katz

Willoughby Parks & Recreation

Two Public Square

Willoughby, OH 44094

Randy Owoc

1722 Benjamin Road

Madison, OH 44057

James Pegoraro

8585 East Avenue

Mentor, OH 44060

Lynn A. Smith, MD,

Board President

150 Mentor Avenue

Painesville, OH 44077

Anthony Vitolo

31500 Daniel Drive

Willowick, OH 44095

Gloria Wright4

6840 Olde Meadow Court

Mentor, OH 44060

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HEALTH DISTRICT ADMINISTRATIVE PERSONNEL

Frank Kellogg, RS, MPH

Health Commissioner

Carla Baster, DO

Child Health Physician

Robert Curran, MD

Medical Director

Vicki D. Estep

Registrar/Administrative Secretary

FINANCE/HUMAN RESOURCES

Jeffrey Campbell, CPA

Senior Manager

Cynthia Bolt

Administrative Clerical Specialist

Timothy L. Snell, BS, AB, MCSE

Data/Office Manager

Jami Stout

Administrative Clerical Specialist

VITAL STATISTICS

Vicki Estep, Registrar

Joanne Bryan

Jacqueline Filipek1

Deputy Registrar Clerical Specialist III

Billie Portera4

Clerical Specialist III

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COMMUNITY HEALTH SERVICES

Ron Graham, MPH, RD, LD, Director

Sandra Allison, LSW, BA, Help Me Grow Supervisor

Kathleen Durchik, RN, BA, MPH, Nursing Administrator/Director of Nursing

Judy Dwyer, RN, BS, Emergency Preparedness Coordinator4

Kathy Milo, BS, MEd, Health Promotion and Planning Supervisor3

Lauren Henderson, RD, LD, WIC Supervisor

Judi Waite, Clinical Services Clerical Supervisor

Ann Donley, Help Me Grow Clerical Supervisor

Laura Nygord, WIC Clerical Supervisor

Loree Albright, LD, RD, BS

WIC Nutritionist

Nancy Arnold, LD, RD, BS

WIC Nutritionist

Lisa Beebe


Linda Burkholder, RNC

Public Health Nurse II/TB Coordinator

Danielle Burns, BA

Help Me Grow Service Coordinator

Julie Caine

WIC Clerical Specialist III

Dawn Candow, BS, LSW


Luann Carano-Anderson, LD, RD, BS

WIC Nutritionist

Loretta Carsey, RN

Public Health Nurse II

Nancy Chavez

Clerical Specialist III/Translator

Dawn Cole, BS

Emergency Preparedness Specialist

Patricia Collins-Reed


Sonja Early


Jennifer Fabian


Carolyn Fedele

WIC Breastfeeding Peer Consultant

April Fraiser, BS


Julie Gembus, BS, LSW


Rhonda Hoon, BS, MA


Denise Jones


Terry Keener


Rachel Klco, LSW

Social Worker

Mary Ludwig, LSW, BS


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Victoria Luyster, BS, CHES

Health Educator

Kathleen Mackey, RN, BSN, MA5

Epidemiologist/CD Coordinator

Mitzi Madej1


Christine Margalis, MEd, CHES1

Health Educator

Michele Melnick, LSW

Social Worker

Kathy Milo, BS, Med3

Health Educator

Dawn Moran


Dawn Nickerson, BS, MEd

Health Educator

Maureen O’Hearn, RN, BA

Public Health Nurse II

Shauna Rich, BS1,4

Health Educator

Jennifer Richmond, RD, LD 1

Registered Dietician

Maria Ruffner1,4


Ellyn Ross, MS, LD, RD

WIC Nutritionist

Karen Sarosy


Cherise Stabler, RN, BSN9

Communicable Disease Coordinator

Cynthia Stoerkel


Carol Tackett, RN

Public Health Nurse II, BCMH

Jennifer Tallion, BS, LSW


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ENVIRONMENTAL HEALTH PROGRAM

Nancy Niehus, MS, RS, Director, Environmental Health Programs

Laura K. Kuns, BS, RS, Supervisor, Water, Solid & Liquid Waste Programs

Bert Mechenbier, BA, RS, Supervisor, Air Pollution Control Programs

Marianne Rusnak, Clerical Supervisor

Terry Kent, RS, Supervisor Mosquito and Special Projects

Christy Armstrong, BS, RS

Public Health Sanitarian II

Michael Bartlett, BS, RS


Susan Bell, MS, RS


Tim Cox, BS, RS


Kristen Fink, BS, RS


Barbara Friel


Camala Godfrey


Paul Kasden, BS, RS


Rose Ann Kundtz


Dan Lark, BS, RS

Public Health Sanitarian Specialist

Chris Loxterman, BS, RS

Public Health Sanitarian Specialist

Dan Marn, BS, RS


Doug Mehls, BS, RS


Daniel Nicholson

Plumbing Inspector

Davene Sarrocco-Smith, BS, RS


Dan Sinclair, BS, RS


Paul Stromp, BS, RS


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SEASONAL EMPLOYEES HIRED IN CALENDAR YEAR 2010

Michelle Comstock

Lisa Diemer

Holly Dudas

Susan Kain

Thomas Kaperak

Michaela Klco

Martin Kuns

Shirley Lange

Tim Lynch

Brenda Mitchell

Dale Mullen

Tony Passerallo

John Pitts

Susan Slagel

Leigh Smith

Kyle Sukys

Diane Tagliaferri

Consuela Willis

ADVISORY COMMITTEES TO THE BOARD OF HEALTH

CHILD HEALTH SERVICES ADVISORY COUNCIL

Avril Albaugh

Sandra Allison

Barbara Davis, MD

Linda DeRosa

Alison Doherty

Kathy Durchik, RN

Johanna Flenz

Ron Graham, MPH

Lauren Henderson

Christine Kettunen

Denise Mackura

Peggy Meros

Barb Moran

Dawn Nickerson

Jerry Ranally

Stacy Rihaly, RN, Chair

Colleen Weaver

Mary Wynne-Peaspanen

Joyce Zadd

Juan M. Hernandez, MD, Liaison, Board of Health

HEALTH DISTRICT LICENSING COUNCIL

Tim Brennan, Vice-Chairman

James Falvey, Chairman

Ralph Harrison, Secretary

Phil Haskell

Chris Hodges

Bob Rideout

Randy Owoc, Board of Health Liaison

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CONTRACTING INDIVIDUALS/AGENCIES/CONSULTANTS

Advance Audiology

Around the Clock Home Care, Inc.

Ashtabula County Health District

Board of Cuyahoga County Commissioners

Family Planning Association of NE Ohio

Lake County Board of Commissioners

Lake Co. Family & Children First Council

Lake County Jobs & Family Services

Lakeland Community College

Language Line, Inc.

Lee Specialists, Inc.

Madison Village

Mary Anne’s Family Hearing

Mentor City

Mooney, Valarie – Plumbing Inspector

Neighboring – Consumer Choice

Ohio Dept of Health - BCMH

Ohio Dept of Health – Lead Prevention

PM & Family Investment, LCC

Portsmouth City Health Department,

HIV/STD Division

Stehlik, Donovan – Plumbing Inspector

Stephens, Christopher – Plumbing Inspector

Willoughby City

Willowick City

FISCAL AGENT FOR THE FOLLOWING:

Lake County Family and Children First Council

Mary Ellen Condon4

Pat Kohut1, 4

Denise Mackura1

1 Employed 2009 2 Appointed 2009 3 Promoted 2009

4 Resigned 2009 5 Retired 2009 6 Laid Off 2009

7 Terminated 2009 8 Title Change 2009 9 Lateral Transfer 2009

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1.0 REPORT OF THE HEALTH COMMISSIONER

1.01 Introduction

As noted in my introductory remarks, “prevention” of illness and injury very well summarizes

the business of public health and the LCGHD along with “promotion” and “protection”. There

are highlights during 2010 that demonstrate our work as follows:

1) Lake County was ranked as the 13th healthiest County in the State based on Health

Outcomes and 17th in the State based on Health Factors by the Robert Woods Johnson

Foundation.

2) Initiated a “Just Run” program designed to assist schools and other youth organizations in

the promotion of fitness and healthy lifestyle choices while combating childhood obesity

and its related illnesses.

3) Initiated a Pharmaceutical Drug Disposal program for all Lake County residents to reduce

pollution and drug abuse.

4) Obtained the LCGHD’s first dental sealant grant for participating schools and families

5) The Health Commissioner was appointed to the Assoc. of Ohio Health Commissioners

(AOHC) Public Affairs Committee, AOHC Board of Directors, the Ohio EMA CBRNE

Detection Working Group, the ODH Environmental Health Bureau Review Committee

and the Lake County Opiate Task Force.

6) The ODH approved the LCGHD as a provider of Level One Certification in Food

Protection Training.

7) LCGHD Supervisory staff met with Mentor City leadership to introduce the LCGHD

staff and to familiarize them with the services that the LCGHD offers to the City.

8) Completed 2009 State audit. No deficiencies, material weaknesses, material

misstatements, or instances of GAS non-compliance were found.

9) Obtained a wheelchair for handicapped LCGHD visitors.

10) LCGHD Medical Director Robert Curran M.D. was presented the Ohio Charles B Payne

Memorial Award by the Ohio Tuberculosis Coalition and the American Lung Association

to recognize his outstanding leadership and 30 years of service toward the elimination of

tuberculosis in Ohio.

11) With the assistance of Lake County GIS Chief Dick Kotapish, the LCGHD staff and

ACHIEVE committee unveiled an ACHIEVE web site which includes links to dozens of

local websites that address combating chronic disease through physical activity and

nutritious eating.

12) The LCGHD ordered the remediation of a motel based meth lab in Wickliffe.

13) Purchased billboard space to promote seasonal flu vaccination.

14) Passed all phases of a PNPP FEMA graded exercise.

15) CPHS Ron Graham Appointed as United Way campaign Government Division Co-Chair

16) EH Sanitarian Dan Lark was appointed to the ODH Sewage Technical Advisory

Committee.

17) Staff supervisor Laura Kramer Kuns, RS, was appointed to State Board of Sanitarian

Registration.

18) LCGHD became a Beta Test Site and obtained certification to participate in Statewide

issuance of birth certificates.

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19) Mentor Fire Chief Mr. Richard Harvey was selected for the Medical Reserve Corp Spring

Deployment Training in Washington D.C.; only 35 individuals were selected from the

280 applicants across the US for their role in the H1N1 response.

20) Performed a community health assessment receiving over 2,500 completed surveys.

21) Environmental Health Director Nancy Niehus was invited to join the “Neighboring” IRIS

Project to better serve Lake County’s older citizens and their caregivers who are in need

of interventions due to their mental health and behavioral issues.

22) Staff Sanitarian Davene Sarroco-Smith was invited to serve or attend the National

Conference for Food Protection, the FDA 2010 “50-State” Workshop, the Food

Protection Manager Certification Committee and the FDA’s Partnership for Food

Protection (PFP) Coordinating Committee.

23) The original State Sewage Law (ORC 3718 aka HB 231) was reinstated in June via the

passage of SB 110 with the assistance Senators Grendell and Niehaus.

24) Held Spanish classes for LCGHD staff to better communicate with our Hispanic speaking

population.

25) Staff participated with the Lake County Free Clinic to establish a Medical and First Aid

tent at the Northeast Ohio Convoy of Hope at the Lake County Fairgrounds on June 26,

2010.

26) The LCGHD convened a meeting of Lake County marinas to improve plumbing, waste

disposal and food protection issues.

27) Director of Nursing Kathy Durchik presented during the poster showcase at the National

NACCHO Conference to highlight the LCGHD’s partnership with the safety force during

the H1N1 campaign.

28) In part, as a result of LCGHD lobbying efforts, the Ohio EPA secured funding and

conducted soil and water sampling at the Mentor Salt Fill.

29) Passed WIC, CRI, HIV/AIDS, Vital Stats and Solid Waste programmatic surveys.

30) For the first time ever 4 LCGHD submitted ticks were identified by the ODH as black

legged ticks (aka deer tick), previously labeled as rare in Ohio, and never before

originating in Lake County, the vector of Lyme disease in Ohio.

This following section of “highlights” notes many of the routine activities of the LCGHD noted

elsewhere in this report including:

1) Distribution of over 38,880 Oral Rabies Vaccine (ORV) baits by hand throughout the

county

2) With USDA cooperation, vaccination of 2,390 central Lake County raccoons against

rabies

3) Held 24 Well Child clinics serving 166 clients

4) Tested 156 children for blood lead levels

5) Gave 4,271 childhood and 1,012 adult vaccinations

6) Gave 2,332 H1N1 vaccinations

7) Managed an active case load of 199 Lake County children in the BCMH treatment

program

8) Made 117 newborn home visits

9) Tracked and investigated 1,016 reports of Class A communicable disease

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10) Performed 951 TB tests

11) Administered 1,740 does of seasonal flu vaccine

12) Gave services to 840 families enrolled in our Help Me Grow Program

13) Gave nutrition services to an average caseload of 4,222 WIC clients

14) Assisted 218 parents in obtaining child safety seats

15) Administered 600 HIV tests

16) Gave assistance to 123 underinsured or uninsured residents in lowering their prescription

medication costs

17) Investigated 509 animal bites and 743 nuisance complaints

18) Trapped, identified and tested over 9.607 mosquitoes, catalogued and mapped 66 dead

bird calls and had no human cases of WNV

19) Lake County experienced 17 ozone action and 12 small particulate matter advisory days

in 2010.

20) Made inspections of 148 Smoke Free Workplace complaints

21) Tested two bathing beaches on 103 summer days

22) 3 Rabid Skunks and 1 Rabid Bat was found in Lake County

23) Inspected 7,117 plumbing fixtures

24) Conducted 4,048 inspections of 1,230 food operations

25) Conducted 278 inspections of 109 public swimming pools

26) Distributed an additional 18, 592 KI pills to the public thru local pharmacies

27) 17 Police Departments and over 200 students participated in the Traffic Safety Expo

All of the above was performed with significantly less staff than in previous years. The Health

District has made tireless efforts to reduce staff and become increasingly more efficient (but

remain effective) due to the economic downturn and to keep pace with declining revenues.

Besides previous staffing changes, financial savings were made in numerous small items such as

cancelling Westlaw account ($5,000), reducing vehicle oil change frequency ($1,100), bidding

custodial services ($10,800), auctioning 7 vehicles ($29,700), cutting PNPP FMT expenses

($1,000), and recouping unemployment claims ($1,000).

1.02 Board of Health

The Board of Health (BOH) of the Lake County General Health District (LCGHD) holds its

regularly scheduled meetings on the third Monday of each month. The Board is under the

leadership of Dr. Lynn Smith (Painesville) who was re-elected as Board President and also

serves the community as Lake County Coroner. Mr. Jim Pegoraro (Mentor) was elected as

President Pro-tem. Three members of the BOH were reappointed by their respective appointing

authorities (Anthony Vitolo-Willowick, Marc Garland-MOL, and Dr. Alvin Brown-District

Advisory Council). Mrs. Gloria Wright (Mentor) resigned from the Board in October after four

years of service. BOH President Dr. Lynn Smith and BOH member Juan Hernandez were

appointed to the ADAMHS Board, Lake County Opiate Task Force.

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The fourteen members of the Board represent all twenty-three political subdivisions within Lake

County and those licensed by the LCGHD. Their primary purpose is to establish public health

policy for the Health District. The Board’s authority includes the ability to a) establish a budget,

b) refer violators of public health laws for prosecution, c) accept grant funds, d) establish

contracts with certain individuals/agencies, e) hire certain positions, f) make public health policy,

g) adopt local regulations and h) approve certain purchases.

The overall attendance at the twelve regularly scheduled monthly meetings was over 88%. Six

members, Roger Anderson, Pattie Fowler, Anthony Vitolo, Marc Garland, Jim Pegoraro and Dr.,

Lynn Smith had 100% attendance and six additional members missed two or less meetings.

There were sixteen committee meetings held during the year.

In 2010, Board of Health actions included:

1) Approval of a resolution of appreciation for H1N1 volunteers

2) Appointment of a Deputy Health Commissioner

3) Approval of an online car auction that netted $27,900 in the sale of LCGHD autos

4) Added 3 part time WIC positions and a contract for a Home Visitor position

5) Approved over $118,000 in reimbursements to area police, fire and political subdivisions

for H1N1 clinic assistance

6) Adoption of administrative client fees for the Drug Repository Program

7) Authorized replacement of the LCGHD email (exchange) server

8) Adoption of a logo for the LCGHD that incorporates the national public health symbol

9) Authorized the purchase of mosquito truck GPS tracking and flow monitoring equipment,

mosquito adulticide, MARC’s radios, and one copier.

10) Authorized consulting contracts for POD planning,

11) Authorized bids for community health assessment survey and analysis, web site

modification, and auto purchases

12) Approval of contracts for Help Me Grow auditory and developmental assessments

13) Approval of maternity license applications for Lake West, TriPoint and Hannah’s Home

14) Ratified a contract with AFSCME union staff

15) Adopted a policy for management staff concerning automobile use

16) Referred to the Prosecutor 8 cases for failure to connect to accessible sewers (4), solid

waste violations (2), tattoo violations (1) and housing violations (1). The BOH also gave

six time extensions for sewer connections.

17) Approved a 2011 Budget

18) Heard eleven staff presentations concerning various program areas

19) Approved one, 18-lot subdivision for home sewage treatment systems

20) Tabled 1 variance request concerning a semipublic sewage system

21) Approved the purchase of seasonal influenza vaccine for $33,780

22) Accepted $2.0 million in various grant funds

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1.03 FINANCIAL OVERVIEW

A. Public Health Disbursements

Public Health Disbursements totaled $6,299,738 in 2010. A breakdown of

these disbursements is shown in figure 2. Salary, Fringe benefits, and

contract services account for nearly 74% of all disbursements. Included in

the contract services line item is the cost of contractual services of social

workers, and other public health care service providers.

B. Public Health Receipts

Health District receipts come from a variety of sources including taxes,

fees for service, grants and State subsidies. For 2010 receipts other than

tax dollars totaled $4,182,853 which represents 64% of the dollars

received. A breakdown of the major sources of receipts is shown in figure

1.

C. Tax Support

The primary reason that tax dollars are needed is that the State has

mandated local health departments to conduct certain public health

programs without any means of reimbursement. Examples of such

programs include rabies control, vector borne disease program, and school

inspections. Tax dollars received in 2010 totaled $2,333,865.

D. Cost Analysis

In order to protect public tax dollars and to insure the proper fee is being

charged for Health District services, a detailed cost analysis is prepared by

the Health District staff. This detailed report is presented each year to the

Board's Policy Review Committee which examines the issues surrounding

the cost of providing services, including salaries, fringe benefits, and

productivity.

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Lake County General Health District

Receipts and Disbursements

Receipts 2010 Actual

2011

Approved

2012

Projected

Receipts other than Tax Dollars 4,182,853$ 3,540,132$ 3,546,088$

Public Health Support - Tax Dollars 2,333,865$ 2,218,484$ 2,175,629$

Previous Year End Cash Balance 45,344$ -$

Obligated Funds from Previous Year 1,931,003$ -$ -$

Total Cash Receipts 8,493,064$ 5,758,616$ 5,721,717$

Disbursements

Total Disbursements 6,299,738$ 5,758,616$ 5,721,717$

Ending Year Balance 64,396$

Obligations carried forward 2,128,931$

Total Disbursements and Obligations 8,493,064$ 5,758,616$ 5,721,717$

Balance -$ -$ -$

DISBURSEMENTS BY LINE ITEM

Salaries 3,074,277$ 3,205,854$ 3,179,027$

Fringe Benefits 1,080,016$ 1,243,088$ 1,306,075$

Contract Services 502,836$ 238,616$ 273,778$

Board of Health 12,080$ 16,000$ -$

Program Supplies, Marketing, Health Ed. 279,102$ 255,912$ 166,450$

Office Supplies and Postage 93,980$ 105,890$ 93,610$

Transportation and Travel 93,283$ 90,531$ 88,835$

Building Expense 199,293$ 228,330$ 201,619$

Equipment 109,680$ 19,575$ 37,515$

Returns 138,081$ 3,000$ 3,000$

Operating Expenses 316,837$ 300,525$ 343,561$

Contingency -$ 51,295$ 28,247$

SUB TOTAL $ 5,899,467 $ 5,758,616 $ 5,721,717

Obligations from previous year 400,272$ -$ -$

TOTAL 6,299,738$ 5,758,616$ 5,721,717$

RECEIPTS BY LINE ITEM

Environmental Health Services 865,940$ 836,202$ 843,836$

Community Health Services 128,420$ 162,878$ 108,181$

Federal Grants 1,803,521$ 1,357,973$ 1,386,777$

State Grants 659,889$ 627,188$ 548,461$

Local Grants and Contracts 172,091$ 45,579$ 125,227$

Vital Statistics 288,327$ 275,000$ 300,000$

Family & Children First 145,980$ 151,955$ 151,955$

Miscellaneous 118,685$ 83,357$ 81,650$

TOTAL 4,182,853$ 3,540,132$ 3,546,088$

-16-

Public Health Service

Disbursements

Figure 22010 Disbursements - $6,299,738

Wages49%

Fringe Benefits17%

Services8%

Supplies6%

Operating Expense14%

Obligations6%

Public Health Service Receipts

Figure 12010 Receipts - $6,516,718

Env Health13%

Vital Statistics4%

Grants41%

Community Health2%

Tax Dollars36%

Family First2% Miscellaneous

2%

-17-

1.04 Vital Statistics

What are vital records?

Birth Records

Adoptions

Death Records

Marriage Records

Divorce

Health Districts issue only birth and death certificates (and burial permits). Probate Courts

maintain copies of marriage and divorce records. Ohio VS maintains birth, adoption, death,

marriage and divorce records in its vault in Columbus.

How Birth Records Originate -

Woman in labor goes to the hospital

After the child is born the mother completes a “Mother’s Worksheet” and the hospital

completes a “Facility Worksheet”. If a mother is married, then the husband is presumed

to be the father. If the mother refuses to provide husband’s information, then the

certificate is placed on hold.

Information from the worksheets is entered into the State IPHIS program by the hospital

support staff.

When the record is complete a hard copy is printed and hand delivered to the Health

District, along with a log of all birth certificates being submitted for filing.

Health District staff review the birth records electronically through IPHIS, one by one,

before marking them “filed”.

Copies of the birth certificates are made and the original documents are sent to ODH VS

weekly to be registered.

All electronic records marked “filed” in IPHIS are imported from the State data base and

downloaded into our local HDIS data base, from which our birth abstracts are issued.

Vital Statistics Sales and Services Rendered –

2010 2009 2008 2007 2006 2005

Birth Certificates Issued 4855 5627 5776 5581 5210 5112

Out of County Birth Certs Issued 20

Death Certificates Issued 8434 9556 10092 8882 9194 9470

Fetal Death Certificates Issued 1 3 4 - - -

Burial Permits Issued 717 773 894 848 546 531

Birth Certificates Filed 1949 1951 2069 2023 1909 1999

Death Certificates Filed 1704 1772 1804 1636 1715 1737

Free Veterans’ Copies 344 393 335 - - -

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In looking at the above table, statistics for the number of certificates filed was slightly down and

the number sold was moderately down from 2009. The 1949 birth certificates filed in 2009 were

in county births only; a percentage of Lake County residents deliver their babies out of county.

The 1704 death certificates filed in Lake County are the total death certificates filed. Death

certificates can only be filed and/or issued with the county in which the death occurred.

For Vital Statistics, the majority of 2010 was spent preparing for the roll out of statewide

issuance by the Ohio Department of Health, Bureau of Vital Statistics. Statewide issuance is the

ability of certified local offices to issue Ohio birth certificates regardless of where the event

occurred. The birth no longer has to occur within Lake County. The State and local

representatives have been working toward this impressive and seemingly impossible goal for

approximately 18 years.

All offices had the ability to complete training and gain statewide access by December, 2010,

when they:

Completed competencies, (passed office site visit and individual training/testing).

Updated account “administrator” and assigned individual passwords.

Offices that failed to pass competencies have access to their own birth records only in IPHIS, not

other jurisdiction's records. That is still a benefit. As of 12.31.2010, 98 out of 121 local

registration offices have been certified to issue state wide.

Fee Distribution:

$ 8.00 retained by the Lake County General Health District for issuing the certified copy

$ 9.00 to the Ohio Department of Health (ODH)

$ 1.50 to the Ohio Family Violence Prevention Fund, Ohio Department of Public Safety

$ 3.00 to the Ohio Children’s Trust Fund, Ohio Department of Job and Family Services

$21.50

The Lake County General Health District receives only 37% of the monies collected for each

certificate issued.

Fee Comparisons with Surrounding Counties

Lake County $21.50 Cuyahoga County $25.00

Geauga County $23.00

Ashtabula County $24.00

Ashtabula City $25.00

Conneaut City $25.00

Medina County $22.00

Portage County $22.00

Summit County $22.00

Trumbull County $23.00

Fairfield County $30.00

-19-


ENVIRONMENTAL HEALTH

2010 ENVIRONMENTAL HEALTH SIGNIFICANT ACCOMPLISHMENTS

Administration

Continued efficient operation at reduced staffing levels

Staff was cross-trained and share program responsibilities

Supervisors handled 57 after-hours calls*

Performed 46,861 field and office activities *

Staff demonstrated availability for “call-down” drill

Participated in bargaining staff contract negotiations

Supervisor appointed to Sanitarian Registration Board of Ohio

Potable Water Supply

Participated in ODH conference calls and regional meetings

Reviewed and commented on Private Water System state rule review

Conducted follow up on water quantity and quality issues resulting from Chapel Road

sanitary sewer installation

Bioterrorism/Disaster Response

Several staff members attended upper level Incident Command training

Director and EH PIO attended Crisis Communication workshop

Antiviral medication stockpile continued to be stored and monitored

Staff member attended Public Information Officer (PIO) training and participated in

regional drill

Obtained 15 radios (at no local expense) to comply with Lake County 800 MHz radio

system

Liquid Waste Treatment & Disposal

Staff member appointed to Ohio Sewage Technical Advisory Committee

Participated on Sewage Treatment Rules committee

Staff recommended BOH extensions to six homeowners for sanitary sewer connections

Attended Marsh Area Regional Coalition (MARCS) meetings

Supervisor Kuns was awarded Northeast Ohio OEHA Outstanding Sanitarian Award

Facilitated Mentor Lagoons Marina storm water project

Referred two unresolved sewer connection issues to Prosecutor

Worked with Planning Commission to submit an application to participate in a household

sewage treatment system repair or replacement loan forgiveness program

Supervisor appointed to Lake County Department of Utilities Appeals Board

Held meetings for contractors to review changes to sewage law

-20-

Stormwater

Participated in Lake County stormwater audit by Ohio EPA

Set up educational displays at Lake County Fair and community events

Solid Waste

Continued to participate in OEPA’s verified complaint of Mentor Salt Fill

Hosted informational meeting for residents residing in Mentor Salt Fill neighborhood

Participated on Diamond Shamrock Community Relations Team

Passed OEPA solid waste survey

Referred two unresolved solid waste cases for prosecution

Radiological Health

The field monitoring team (FMT) continued to train to be ready to respond in the event of

a nuclear emergency

The FMT participated in a dry run and FEMA graded exercise with no deficiencies noted

Inventoried and distributed potassium iodide (KI) tablets to pharmacies, residents and

businesses

Recreation Areas

Assisted licensed pools and spas with Virginia Graeme Baker Act compliance issues

Obtained and implemented beach monitoring grant, with 390 samples in 130 day

sampling season*

Worked with USGS to upgrade beach data collection to work toward water quality

forecasting

Provided input on new pool, spa and special use pool rules

Schools

Provided guidance and continued inspections to school districts

Continued to assist schools in eliminating mercury and mercury-containing devices

Food Protection

Person in Charge (PIC) and ServSafe food protection courses were presented to 234 and

30 participants, respectively

PIC was approved by ODH for Level One Certification in Food Protection training

Training was conducted for school food service personnel in several districts

Significant food recalls were prominently placed on our web page

Staff members attended epidemiology, farmer’s market, and foodborne investigation

trainings

Staff participated in Northeast Ohio Food Protection Roundtable

A sanitarian served on the Conference for Food Protection committee, Food Protection

Manager Certification committee, and FDA 50-State Workshop

Mailed quarterly issues of “Food Talk” for food safety information and timely updates

-21-

Public Health Nuisances

Investigated three cases of illegal tattooing

Responded to 743 citizen complaints

Assisted three communities with large-scale neighborhood rat surveys and follow-up

Staff attended numerous educational programs on the up and coming bedbug problem

Investigated a growing number of hoarding complaints in residential homes

Attended hoarding conference with nationally-recognized speakers

Director invited to participate in Iris Project, a multi-agency consortium to address clients

with difficult situations, often involving housing

Referred one housing case to Prosecutor for failure to provide heat

Rabies Control

Investigated 509 instances of animal bites and/or potential rabies exposures

Obtained rabies surveillance grant from ODH and collected 124 specimens for testing,

resulting in three rabid skunks*

One rabid bat detected from 18 sample submissions

Director appointed OEHA Rabies Technical committee chair and spoke at Dog Warden

conference

Conducted fall ORV baiting distributing over 40,000 baits in 243 man-hours while

driving nearly1800 miles

Served as a regional storage and staging area for ORV bait

ODNR Wild Ohio TV program rabies segment aired focusing on northeast Ohio rabies

Provided support for USDA supplemental TVR efforts in Painesville area

Provided written rabies update for municipalities, veterinarians, parks, trappers, and staff

Consulted with ODH veterinary staff regarding domestic animal rabies vaccination

clinics

Lobbied for continued rabies funding in ODH and USDA budgets

Gave guidance to 12 people who elected to seek post exposure rabies prophylaxis, mostly

for bat exposures

Provided consultation regarding new rabies post-exposure prophylaxis protocol

Mosquito Control

Trapped 9,607 and tested 8,806 mosquitoes resulting in three positive WNV mosquito

pools*

Responded to environmental concerns from state and local Sierra Club members

Trained several new drivers prior to spraying season

Followed developments in federal and Ohio NPDES permit requirements for applying

pesticide near or over water

Received 66 dead bird calls

Sprayed 85 routes in 22 nights

Hosted vector control workshop and equipment calibration rodeo

Passed ODA pesticide division inspection

Continued to operate at lower staffing levels and at reduced budget

Limited product purchase by utilizing products on hand

-22-

Posted spray schedule on web site and provided telephone notification of spraying to

interested parties

Lake County’s first-ever black-legged (deer) ticks identified

Air Pollution Control

Assisted OEPA in ongoing legal proceedings for asbestos violations

Attended bi-monthly LEPC meetings

Attended asbestos refresher course

Staff renewed certification at smoke school

Participated in monthly OLAPCOA (local air authority) meetings

Attended NOACA air pollution meetings

Responded to and assisted OEPA with mercury spills

Northeast Ohio continues to be in attainment for current ozone standards

Collected 30 pounds of mercury from homeowners, businesses and schools for recycling

Monitored former Harvey High School and Lake East hospital asbestos abatement and

demolition projects

Plumbing

Utilized contract plumbing inspector on as-needed basis rather than hiring additional staff

Inspector spoke to staff and other area plumbing inspectors on the topic of food service-

related plumbing issues

Assisted staff with marina operators presentation on backflow device requirement

Consulted with several area marina owners for compliance guidance

Attended training at Department of Commerce and Ohio Association of Plumbing

Inspectors

Participated in numerous construction conferences for large projects, including Madison

School District and Waite Hill village hall

Active in the Plumber Association of Northeast Ohio

Miscellaneous

Facilitated environmental health program orientation to interested student interns

Continuing education classes were offered onsite to reduce staff travel, including “On

Target” Spanish lessons tailored to Health District needs

Several presentations were given by staff on various topics including careers in public

health, water and sewage fundamentals, rabies and housing

Staff received Excel training at Auburn Career Center

Set up displays for Earth Day at Lake Metroparks and Painesville City

Produced Health District resource guide with Healthy Families committee

Celebrated Public Health Week

Worked with community health nursing staff to investigate disease outbreaks

Staff was trained in bloodborne pathogens, CPR and fire safety

Assisted at seasonal flu clinics as needed

Conducted 83 smoke-free inspections

*indicates graphics follow narrative

-23-

2010 Environmental Health Numbers of Places & Activities 2010 # ACTIVITIES

ITEM # PLACES OFFICE FIELD TOTAL

Air Pollution 2921 1548 4469

Animal Bites 509 934 90 1024

Asbestos 502 143 645

Bathing Beaches 385 232 617

Bioterrorism Planning 9 4 13

CD Investigation 28 1 29

Closed Landfills 10 146 37 183

Plumbing Permits/Fixtures/Contactors 365/7117/126 2315 1560 3875

Compost Sites 14 89 37 126

Day Camps 8 17 11 28

Disaster Response 42 14 56

Env. Assessments 96 0 96

Existing Home Sewage Evaluations 52 255 176 431

Existing Residential Water Samples 27 47 54 101

Food Operations Commercial/Non-Commercial 1035/195 3590 4048 7638

Food Plan Reviews 41 303 67 370

H1N1 Response 19 13 32

Home Sewage & SF New or Replacement Permits 53 368 203 571

Home Sewage Repair Permits 34 138 73 211

Housing 2047 734 2781

Infectious Waste Generators (Non-Primary) 67 0 0 0

Infectious Waste Generators (Primary) 13 41 13 54

Infectious Waste Transporter Trucks 5 0 0 0

KI Pills 2 0 2

Lot Split Reviews 3 6 0 6

Manufactured Home Parks/Lots 24/2160 140 57 197

Marinas/Boats 23 222 40 262

Mercury 7 1 8

Mobile Food Operations 93 205 397 602

Mosquitoes/Ticks 826 562 1388

Open Burning Permits 68 93 169 262

Open Landfills 1 94 23 117

Other EH & Comprehensive 5828 510 6338

Other Food 697 126 823

Other Liquid Wastes 404 37 441

Other Nuisances 853 240 1093

Other Recreation 12 2 14

Other Sewage 2159 445 2604

Other Solid Wastes 1141 438 1579

Other Water 253 26 279

Phase II Storm Water 1667 352 2019

Pools/Spa 109 338 278 616

Private Water System Alteration Permits 2 9 2 11

Private Water System New Permits 21 111 28 139

Private Water System Sealing Permits 24 49 4 53

Radiation 339 362 701

Rec Vehicle Camps/Temp Camps 2/9 30 24 54

Registered Sewage Installers 21 29 0 29

Registered Sewage Service Providers 13 3 0 3

Schools 82 364 203 567

Semi Public Sewage Systems 293 348 308 656

Semi Public Water Samples 5 1 1 2

Septage (Septic Tank) Haulers/Trucks 36/20 10 2 12

Sewer Connections 558 19 577

Sewage (NPDES) Samples 50

Sewage Operation Permits 15 70 129 199

Site Evaluations 35 708 83 791

Solid Waste Haulers/Trucks 0 0 0 0

Subdivision Approvals/Lots 1/18 16 0 16

Tattoo Only/Tattoo & Piercing Establishments/TL 10/12/1 72 44 116

Temporary Food Operations 181 536 223 759

Vendors/Locations 10/155 74 97 171

Water Haulers 6 2 3 5

TOTAL 32568 14293 46861

-24-

POTASSIUM IODIDE (KI) DISTRIBUTION 2009 - 2010

Distribution Locations Distributed

pills 4 tablet baggies

Distributed to EPZ Businesses (bagged) 42,240 10,560

Distributed to Day Cares, Schools (bagged) 68,320 17,080

Distributed to Walk Ins @ LCGHD (bagged) 8,000 2000

Distributed to public by Pharmacies Dec 2009 (bagged) 10,588 2,647 Distributed to public by Pharmacies Sept 2010 (bagged) 18,592 4,648

Distribution Total 147,740 36,935

-26-

Lake County Bathing Beach Summary

2003-2010

# Exceedences>235 E. coli/100ml

June thru # # Standard Exceedences

Year August Samples Fairport Headlands Headlands

Precip (inches) Harbor West East

2003 8.7 62 15 7 4

2004 10.4 57 7 4 4

2005 9.6 56 8 8 8

2006 23.1 57 5 13 14

2007 10.3 106 18 8 10

2008 16.8 105 23 13 10

2009 9.44 111 15 7 9

2010 10.56 103 11 17 16

-28-

COUNTY/YEAR 2006 2005 2004 TOTAL

Species Raccoon Skunk Other Total RaccoonSkunk Other Total Raccoon Skunk Other Total Raccoon Skunk Total Total Total Total Total

Ashtabula 1 1

Cuyahoga 1 1 1 4 1 7

Geauga 4 16 22 42

Lake 3 3 3 3 4 3 7 9 9 18 6 15 22 74

Mahoning 1 1 1 1 2

Trumbull 1 1 1 1 2 1 4

TOTAL 2 3 0 5 0 3 0 3 5 3 1 9 11 9 20 11 37 45 130

2010 2009

# RACCOON STRAIN RABID ANIMALS

2008 2007

-30-

Year # States* # States* # US # US # Ohio # Ohio # Lake C # Lake C

Affected With Human Human Human Human Human Human Human

with WNV WNV Cases Fatalities Cases Fatalities Cases Fatalities

1999 4 1 62 7 0 0 0 0

2000 12 3 21 2 0 0 0 0

2001 27 10 66 9 0 0 0 0

2002 44 40 4,156 284 441 31 7 0

2003 47 46 9,862 264 108 8 1 0

2004 45 41 2,539 100 12 2 0 0

2005 49 42 3,000 119 61 2 0 0

2006 49 42 4,269 177 48 4 2 0

2007 49 43 3,598 121 23 3 0 0

2008 48 42 1,356 44 15 1 0 0

2009 48 34 663 30 2 0 0 0

Total 29,592 1157 710 51 10 0

US, Ohio and Lake County Human WNV Cases

-31-

# WNV + %

Year # Dead Bird # Birds Positive Positive

Calls Tested Birds Birds

2001 109 109 13 11.93%

2002 78 78 21 26.92%

2003 774 61 5 8.20%

2004 641 118 1 0.85%

2005 358 56 4 7.14%

2006 580 144 29 20.14%

2007 243 15 0 0.00%

2008 144 6 1 16.67%

2009 84 0 0 N/A

2010 66 0 N/A

Lake County Dead Bird Calls/Testing

-32-

Lake % of # Lake % Lake Ohio # Ohio % Ohio # Counties % Counties

County Ohio County County ODH Lab Positives Positives Reporting Reporting

Type Samples Samples Positives Positives Samples Positives Positives

Dead Birds 0 N/A 0 N/A 0 0 N/A 0 0%

Live Birds 0 0.0% 0 0.00% 0 0 N/A 0 0%

Mosquito Pools 225 2.5% 3 1.33% 8,843 260 2.9% 12 14%

# Mosquitoes 8,806 2.8% 3 0.03% 316,623 260 0.082% 12 14%

Horses 0 0.0% 0 N/A 25 1 4.0% 1 1%

0 WN Fever 1 WN Fever

0 WN Neuroinvasive 4 WN Neuroinvasive

(0 fatal) 0 Other

(incl 0 fatal)

N/A N/A 4 5%

OHIO AND LAKE COUNTY WNV SURVEILLANCE STATISTICS 2010

Lake County Ohio

Humans 0 N/A

-34-


COMMUNITY HEALTH SERVICES

The Division of Community Health Services demobilized the H1N1 influenza response in

early 2010; an event that was new to most of the staff at the Lake County General Health

District. The county-wide response was successful due to the effective partnership that

exists with the local fire departments, the Lake County Emergency Management Agency,

and the Lake County school nurses. Mass clinics and school based clinics lead to rapid,

efficient, and effective response that resulted in a low incidence of disease during the

response. Vaccinations by clinic type may be seen in Table 1.

Table 1: 2009-2010 H1N1 Vaccination Administered by the Lake County General

Health District by Site.

Clinic Site Date # Vaccinated # Out of County % Out of County Hrs of Operation

Willoughby HS 11/15/09 2,339 104 4.4% 9:30 AM-7:30 PM

Mentor HS 11/22/09 4,658 351 7.5% 9:30 AM-7:30 PM

Wickliffe HS 12/6/09 1,199 170 14.2% 10:00 AM-3:00 PM

Riverside HS 12/13/09 2,653 120 4.5% 10:00 AM-3:00 PM

Schools & Closed Clinics 10/14/09-03/05/10 18,662 N/A N/A N/A

Total To Date 29,511

Table 2 represents the age of individuals receiving vaccinations during the 2009-2010

H1N1 responses by all providers. Providers included the Lake County General Health

District, physicians, and hospitals.

Table 2: Lake County Residents Receiving Vaccination by Age

-35-

Table 3: Lake County Residents Receiving H1N1 Vaccination by Zip Code

3.01 ADMINISTRATIVE REVIEW

3.01.01

Community Health Services Program Goals for 2011

1.) Implementation of the Ohio Department of Health Dental Sealant Program for

Lake and Ashtabula County.

2.) Development of a Dental Task Force and the Obesity Task Force to address

resource and program gaps.

3.) Expansion of the Healthy Families Resource Center to provide both professional

and public education classes including but not limited to parents, medical

professionals, community agencies, and other target groups.

4.) Provide training to ensure all management staff possesses the skills necessary for

grant management and compliance as part of the continuity of operations plan.

5.) Complete a 2010 Community Health Assessment and the associated Community

Health Improvement Plan.

6.) Conduct an internal assessment of the Lake County General Health District

operations in order to prepare for National Public Health Accreditation in fall of

2011.

7.) Diversify grant revenue sources to expand and pilot programs in the area of

chronic disease prevention.

3.01.02

JUST RUN: Youth Physical Activity

The Lake County General Health District became the fourth JUST RUN Satellite Licensed

Site in the Nation. The JUST RUN program is a school based initiative that provides a

structured program to assist youth in adopting running as a lifelong physical activity. The

license agreement allows the Health District to use the materials provided by Big Sur

Marathon, the creators of the JUST RUN program, with greater autonomy and

accountability. The Health District will soon be awarded its own webpage within the

-36-

JUST RUN website and will have access to participant registration. The ultimate goal of

the program would be to partner with another community group to host the first JUST

RUN 5K event to be held specifically for the school-based JUST RUN youth participants.

3.01.03

Medical Reserve Corps

The National Association of City and County Health Officials awarded the Lake County

General Health District a capacity building award in the amount of $5,000.00. The Lake

County Medical Reserve Corps (MRC) proved to be very valuable in the H1N1 response

and was the quickest way the Health District was able to bring in additional medical

professionals for support staffing during an emergency. The benefit would have been

even greater if the event was under a tighter response and time frame. Ms. Victoria

Luyster has made great efforts to engage Lake County medical professionals into the

MRC. Due to the H1N1 public health emergency, and the wide recruitment of temporary

staff, it served to increase the awareness of the MRC and resulted in additional MRC

participants.

3.01.04

Action Communities for Health, Innovation and EnVironmental ChangE

On Tuesday, April 27, 2010, the Lake County General Health District released the Action

Communities for Health, Innovation and EnVironmental ChangE (ACHIEVE) website.

The website includes links to dozens of websites that address combating chronic disease

through physical activity and nutritious eating. A Comprehensive Recreation Areas

Inventory was prepared and is now accessible through the web mapping portion of the

new ACHIEVE website. All recreation facilities across Lake County are layered on top of

an interactive digital map of Lake County. Clicking on the facility opens up a link to that

facility’s website where one can investigate all of its activities, programs and other

information. Access is also provided to meeting agendas, minutes, working documents,

and plans of the workgroup implementing ACHIEVE.

ACHIEVE hopes to bring local leaders and stakeholders together to build a healthy

community by developing and implementing policy and environmental change strategies

that focus on physical activity, nutrition, chronic disease management, and leadership.

Two key components of ACHIEVE are policy development and environmental change.

Policy development focuses on implementing laws, rules, procedures, or regulations that

guide and positively influence health habits within our schools, workplaces and public

spaces. Environmental change alters the physical, social and/or economic environments to

encourage a healthier lifestyle. When sidewalks, bike paths and connections to parks,

green space, crosswalks, and other environmental considerations are consciously built into

communities, it is more conducive to active transportation and promotes use of these

considerations for all. ACHIEVE will continue to promote policy, environmental change,

and long‐term planning that support healthy living. Some of these initiatives include

healthy vending and meal offerings at our schools; access to parks, bike trails and

sidewalks; and worksite wellness improvements. The website may be viewed at

www.lakecountyohio.gov/achieve.

http://www.lakecountyohio.gov/achieve

- 37 -

3.01.05

Strategic Planning

The Community Health Services Division Managers were assigned by the Director of

Community Health Services the task of beginning a strategic planning process. Managers of the

four units will work with their respective staff and programs to submit draft goals and objectives

that address major program improvements and to newly identified programs that will benefit the

residents of Lake County. These goals will then be reviewed by the Director and finalized when

the results of the 2010 Community Health Assessment data can be evaluated. Goals and

objectives are to address cost containment, productivity, quality improvement, revenue

diversification, and innovative/sustainable programs identified by health data collection. It is the

intent to prepare a program ranking project supported by the strategic planning document and

which addresses the needs identified in the community health assessment.

3.01.06

Perry Nuclear Power Plant Graded Exercise

A big congratulations to Ms. Kathy Durchik (Nursing Director), Ms. Kathy Milo (Health

Promotion and Planning Supervisor), Ms. Dawn Cole (Public Information Officer/Health

Educator), and Ms. Carol Tackett (Public Health Nurse) for their stellar job of setting up and

operating the Care Center at Kirtland High School on Monday, September 27, 2010 and their

role in the September 28, 2010 emergency exercise where Ms. Cole received the highest of

accolades for her work as the Public Information Officer at the Joint Information Center. Health

District staff walked through the critical Incident Command System documents with Mr. Ron

Graham acting as the on-site Incident Commander.

3.02 GRANT REVENUE REVIEW

The Division of Community Health Services directed their efforts to include aggressive grant

acquisitions during the 2010 year and it is an effort that will continue. In 2009 the Division was

awarded $1,961,057.00 in grant funding compared to the $2,487,795.00 in 2010.

Table 4 provides a summary of grant awards for the 2010 fiscal year.

Table 4: 2010 Grant Award Summary

Program Granting Agency Grant Award

Western Reserve Junior Service

League-Child Passenger Seats

Western Reserve Junior

Service League $500.00

Action for Healthy Kids Columbiana $1,000.00

United Way-Matter Of Balance United Way $3,000.00

United Way-Drug Repository Program United Way $4,000.00

Medical Reserve Corps National Association of City

and County Health Officials $5,000.00

- 38 -

Program Granting Agency Grant Award

Community Development Block Grant:

Lake County Commissioners

Car Seat Program $6,000.00

Newborn Home Visiting $17,000.00

Care Source Foundation-

Asthma/Obesity Care Source $7,500.00

Great Gains Lake County Jobs and

Family Services $10,000.00

HIV Nutrition Cuyahoga County

Commissioners $10,000.00

City Readiness Initiative Cuyahoga County

Commissioners $27,000.00

HIV Testing Ohio Department of Health $28,000.00

PHER-Epidemiology Ohio Department of Health $31,253.00

Safe Communities Ohio Department of Public

Safety $32,400.00

Ryan White Case Management Portsmouth Health District $60,000.00

Child and Family Health Services Ohio Department of Health $73,700.00

Help Me Grow American Recovery

and Reinvestment Act Funds Ohio Department of Health $75,249.00

Immunization Action Plan Ohio Department of Health $79,110.00

Help Me Grow Federal Part C Ohio Department of Health $99,562.00

Medicaid Administrative Claim Ohio Department of Health $100,000.00

Public Health Infrastructure (Public

Health Emergency Preparedness) Ohio Department of Health $173,770.00

Public Health Emergency Response

(PHER)Planning Ohio Department of Health $240,010.00

Help Me Grow

Ohio General Revenue Ohio Department of Health $324,533.00

PHER-Implementation Ohio Department of Health $473,208.00

Women, Infants, and Children's

Nutrition (WIC) Program Ohio Department of Health $606,000.00

Total $2,487,795.00

- 39 -

3.02 CLINICAL SERVICES PROGRAMS - 2010

The programs and projects of the Clinical Services area are funded by grants, subsidies, fees and

Board of Health monies. The emphasis of Clinical Services is to protect, prevent illness and

promote a healthy community. Programs are implemented by a Nursing Director and five Public

Health Nurses. Services include: adult and child immunizations; lead screening; health

assessments; service coordination; newborn home visits; well-child physicals; community

awareness and collaboration. Nurses also conduct communicable disease surveillance,

investigation, prevention education and tuberculosis control for the county.

Clinical Services Goals:

Empower and educate individuals to make healthy choices and build a resilient

community.

Strengthen capacity to detect, control and prevent infectious diseases and to effectively

respond to outbreaks.

All staff participated in ongoing training to maintain their unique expertise and deliver up to date

health programs. Staff nurses are active members of local, regional and statewide committees.

Additionally, this unit continues as a training site for area schools of nursing.

Public Health Nurses implemented the Community Education Program. They presented eleven

childcare provider courses in CPR, Communicable Disease and Pediatric First Aid. Seven health

information seminars were conducted at Lake County workplaces, community agencies, schools

and through the media. A staff nurse provided all health district employees an opportunity to

renew their CPR certification.

A Family Literacy project was established through the distribution of new books to children at

immunization clinics. The children’s books “Saturday Shots” and “Lions Aren’t Afraid of

Shots” were used as an incentive for parents and children to complete their immunizations on

time. Additionally, books donated by a local bookstore are provided in our clinic waiting room.

This project promotes immunizations, literacy at an early age and interaction between parents

and children through reading activities.

In March, Medical Director, Robert Curran, M.D. was presented by the Ohio Tuberculosis

Coalition and the American Lung Association the Charles B. Payne Memorial Award. This award

recognizes his outstanding leadership and efforts toward the elimination of tuberculosis in Ohio.

In July, Director of Nursing, Kathleen Durchik R.N., M.P.H. attended and presented a poster at

the National Association of County and City Health Officials (NACCHO) conference in Memphis

Tennessee. The poster depicted the collaboration of local public health nurses and Fire/EMS

during the H1N1 Event response.

The Health District Children’s Immunization Program worked with the Ohio Department of

Health on the American Recovery and Reinvestment Act (ARRA) funded Billables Project. This

project focuses on improving reimbursement for vaccines in the public sector. Between June and

September 2010, college interns surveyed 119 individuals at various Health District children’s

clinics. Results indicated 60.5% had private insurance, 15.1% had Medicaid and 24.4% were

- 40 -

uninsured. Major private insurers included Medical Mutual (65.3%), Anthem (12.5%), United

Healthcare (6.9%), and Aetna (5.6%). When clients were asked why they utilized our clinics the

top three reasons included: cost (74.8%), location (31.1%) and clinic hours (17.7%). Lake

County client responses were similar to regional and state-wide results. In 2011, the Ohio

Department of Health will explore a process for local health departments to bill third party health

insurers for vaccine administered to their patients.

3.02.01

Well Child Clinic

This program provides a comprehensive well child physical exam, nutritional assessment,

hearing testing, developmental screening, and immunizations for children and adolescents.

Screenings are age appropriate and completed by a team that includes a physician, several

nurses, a social worker, and a dietitian. Sports and work physicals, pre-school and school

physicals, well baby checkups are completed. Well Child Clinic remains partially funded by the

Children and Families Health Services Grant. Fees are based on a sliding fee scale set by the

Ohio Department of Health. Medicaid is also accepted.

A total of 24 Well Child Clinics were held in the 2010. There were 166 clients

served.

A Spanish-speaking Interpreter was available for all Well Child Clinics. Language

Line Interpreter Service was available for other non-English speaking clients.

Child and Family Health Services Advisory Council met quarterly to review the

program goals and to discuss maternal/child needs of the community. The

Community Health Services Director, Nursing Director, WIC Supervisor and Help

Me Grow Supervisor all serve on this Advisory Council.

3.02.02

Lead Testing

Information on Lead Testing, children at risk and side effects of lead poisoning is offered

routinely to clients in the Well Child Clinic and Lead Clinic. Information on proper paint

removal, water testing, etc. is given to clients upon request. Children with elevated lead levels

were followed with additional screenings and/or were referred to physicians and Health District

Environmental Health according to Center for Disease Control (CDC) standards.

All households with children with elevated lead levels receive a home visit by a public health

nurse for in-depth screenings and education. All children with elevated lead levels will be

referred to the Help Me Grow Program as appropriate.

YEAR NUMBER

TESTED

LEVEL 10

UG/dL

% Above

Normal Limits

2010 156 0 0%

2009 74 0 0%

2008 98 0 0%

- 41 -

3.02.03

Childhood Immunizations

This program provides protection against vaccine-preventable childhood diseases through the

administration of the appropriate vaccines to children 2 months to 18 years of age, as well as,

providing parental education.

Clinics were held six times per month, at various locations and times, in an effort to

fully serve clients throughout the county. Spanish-speaking interpreters were utilized

at the Painesville morning and afternoon clinics.

In 2010, the following vaccines were added to our inventory: Prevnar 13

(Pneumococcal disease), Hiberex (4th

dose Haemophilus Influenza), FluMist

(Influenza), Kinrix (combination Polio and Dtap), and Menveo (Meningitis).

The Health District continues to partner with community businesses, local service

organizations, libraries and the pharmaceutical companies to provide incentives and

information literature to the community to improve immunization awareness.

The Immunization Action Plan Grant funds outreach activities for the community and

medical providers. Fairs, events and presentations are utilized to increase awareness

of the need for childhood immunizations.

The Maximize Office-Based Immunization Program (MOBI) or Assessment

Feedback Incentives Exchange (AFIX) reports and assessments are offered to local

medical providers to assess immunization activity in their practice. Six physician

practices participated in this program. This year, the Cleveland Clinic Foundation-

Willoughby Hills and Lake Health Pediatrics-Willoughby were recognized by the

Ohio Department of Health for obtaining high immunization rates.

Lake County General Health District continues as a site for area nurse/provider

training programs provided through Center for Disease Control (CDC) and Ohio

Department of Health (ODH). Immunization staff attends these programs to acquire

training on vaccine information and schedules. Nurses receive continuing education

credits for this training.

The Medical Director and Director of Nursing approved all new policies and

procedural changes that were recommended by the Clinical Services Policy and

Procedure Review Committee. This Policy Committee performs an important role in

maintaining the quality standards of the Immunization Program. Staff nurses meet

monthly and review current trends, address changes needed in practice standards and

assure that the Immunization Practice Standards Protocol for the agency are up-to-

date. Immunization program quality is monitored through medical chart audits and

client satisfaction surveys.

Influenza vaccine was recommended for all children age 6 months and older.

Influenza vaccine was offered at regular Child Immunization Clinics to children and

parents. Additional Children’s Flu Clinics were held in October, November and

December 2010.

- 42 -

Childhood Immunizations Given by Health District

YEAR #Given #Attended Dtap Td Tdap Polio MMR HIB Pediarix Pentacel

2010 4271 1788 224 17 323 118 227 267 70 177

2009 4349 1896 277 22 174 175 294 118 30 287

2008 4636 1919 417 26 189 284 370 279 192 0

YEAR Hep B Varicella Hep A Prevnar Flu Meningitis Proquad HPV Rotavirus

2010 203 364 402 485 434 264 42 225 206

2009 275 411 558 438 396 225 0 171 208

2008 147 499 672 433 373 303 21 115 0

3.02.04

Adult Immunizations

This program provides appropriate vaccines to the adult population for vaccine-preventable

communicable diseases. The vaccine fees are established by the Board of Health.

Twenty-three (23) clinics were held in 2010.

Staff promoted adult immunization awareness and the need for vaccine protection at

various fairs, presentations and events throughout the year. Adult vaccine

information is provided to parents on newborn home visits.

To address the nationwide increase in pertussis, eligible caregivers of young children

were offered a tetanus-diphtheria and pertussis (Tdap) booster at all children’s and

adult clinics.

Zostavax, a vaccine to protect individuals over 60 years of age against Shingles, has

had limited availability due to manufacturing problems.

Adult Immunizations Given by Health District

Year Given #Attended TD Tdap MMR Hep B Pneumonia

2010 1012 848 174 90 27 490 11

2009 996 799 135 71 23 477 9

2008 1058 853 116 49 34 508 11

Year Hep A Varicella Flu Rabies Meningitis Shingles

2010 102 21 1306 14 20 58

2009 134 21 2181 18 25 79

2008 206 22 1637 7 49 54

- 43 -

3.02.05

Bureau for Children with Medical Handicaps (BCMH)

This program targets families of children ages 0-21 years of age who have a medical handicap

condition and whose families need financial assistance for uninsured medical expenses related

to the child’s ongoing medical care. Families must meet income eligibility requirements.

Two hundred and ninety-seven (297) Lake County children are currently enrolled in

BCMH. This includes diagnostic, treatment and service coordination (PHN)

programs. Approximately, 199 Lake County children are active on the BCMH

Treatment Program.

The BCMH Public Health Nurse initiated diagnostic coverage on 36 children

(newly identified clients).

Forty (40) home visits were made to clients on the BCMH Program.

BCMH Public Health Nurse (PHN) assesses the medical needs of the Help Me

Grow (HMG) clients. HMG/PHN referrals were reviewed resulting in 35 home

visits to clients.

3.02.06

Newborn Home Visit Program

The Newborn Home Visit program targets first time parents, teen-parents, and their newborn

infants. Public Health Nurses make a one-time home visit in the first few weeks after the baby is

born to provide an assessment of mother and child, answer questions, link families to services

and resources within our community and provide information to keep babies healthy and safe.

A total of 192 newborn referrals were received from various hospitals in 2010.

Public Health Nurses made 117 newborn home visits for 2010.

A $17,000 Lake County Community Block Grant was awarded to support this project

from October 2010 through August 2011.

3.02.07

Communicable Disease Program

This program identifies and controls communicable disease outbreaks in Lake County in order to

protect the public from illness, disability and/or death. The Communicable Disease Team

maintains a system of surveillance, analysis, recording and forwarding reports of communicable

disease to the Ohio Department of Health (ODH) with an emphasis on outbreak recognition,

investigation, containment, and education.

One thousand and sixteen (1016) Class A diseases were directly reported to the Lake

County General Health District by laboratories, physicians, hospital and other health

professionals for 2010. All required investigations were completed on cases reported

to the Health District. One hundred and forty-nine (149) cases were reported and

transferred to other jurisdictions. An additional 61 investigations did not meet the

ODH case definition.

Two vaccine preventable outbreak investigations were conducted: Hepatitis A in a

- 44 -

workplace and Mumps in a tradition-observant Jewish community.

Nurses supported the Environmental Health Division in investigating

vomiting/diarrhea illness outbreaks associated with Norovirus.

Nurses utilize the Epi-Center Surveillance System to monitor regional hospital

emergency department registrations. This community health surveillance program

observes for surges in respiratory, gastrointestinal and neurologic conditions. This

year, 66 Epi-center investigations were conducted.

Influenza surveillance is conducted with the local laboratories, urgent cares, physician

offices reporting positive influenza rapid tests on a weekly basis.

Communicable Disease Surveillance Report Disease Reported 2010 2009 Botulism – Infant 1 0

Camplylobacter 28 29

Chlamydia 533 438

Coccidioidomycocsis 0 1

Creutzfeldt Jakob Disease 1 0

Cryptosporidiosis 0 3

E. Coli 0157:H7 4 1

E. Coli not 0157:H7 1 0

Giardia 9 15

Gonorrhea 123 64

Haemophilus Influenza 5 5

Hepatitis A 7 0

Hepatitis B 18 26

Hepatitis C 130 138

Herpes Congenital 0 1

Influenza-Hospitalized 2 51

Legionella (Legionnaires Disease) 0 1

Listeriosis 3 1

Lyme Disease 3 2

Measles 0 1

Meningitis, Aseptic 10 7

Meningtitis, Bacterial – not Nisseria 1 0

Meningitis, Bacterial, Nisseria 0 1

Mumps 3 2

Mycobacterium, Avium 4 2

Mycobacterium, Gordonae 8 3

Mycobacterium Mais Complex 2 0

Mycobacterium, Tuberculosis (Case) 2 3

Mycobacterium, Tuberculosis (Suspect) 0 1

Mycobacterium, Other than TB 4 0

Pertussis 24 7

Pneumococcal Disease Streptococcal 20 20

Salmonella 34 33

Shigella 3 5

Streptococcal, Group A 2 1

Streptococcal, Group B, newborn 0 3

Syphilis 16 17

Varicella 15 24

Yersinia 0 2

TOTALS 1016 908

- 45 -

Top 6 Reportable Diseases by Age Range in 2010.

Disease 0-15 yrs 16-18 yrs 19-25 yrs 26-35 yrs 36-45 yrs 45 yrs + Total

Chlamydia 18 114 289 95 10 7 533

Hepatitis C 0 5 15 21 17 72 130

Gonorrhea 2 19 65 34 1 2 123

Salmonella 6 1 4 5 4 14 34

Campylobacter 3 3 4 2 1 15 28

Pertussis 5 2 1 6 3 7 24

3.02.08

Rabies Vaccine Program

This program targets residents of Lake County who had or may have a potential exposure to

Rabies. Communicable Disease Nurses are responsible for providing information on how to

obtain Rabies vaccine for use in post-exposure therapy. Technical information on Rabies disease

and Rabies vaccine is provided to local physicians upon request. An information packet about

Rabies and Rabies vaccine is available to clients/families in need of post-exposure vaccine.

Pre-exposure rabies vaccine (3 dose series) is available to individuals in high risk occupations.

Pre-Exposure Rabies Vaccine Administered to:

2010 2009 2008

5 clients 6 clients 2 clients

3.02.09

Tuberculosis Control Program

Communicable Disease Nurses receive reports of suspect and confirmed cases of active

Tuberculosis (TB) for contact identification and follow-up. Prevention efforts include medication

therapy for positive reactors and cases and providing TB Testing Clinics and client education.

Fees for TB Testing are determined annually by the Board of Health.

A total of 34 TB Skin Testing Clinics were held between the Painesville and

Willoughby Clinics. Additional skin testing was conducted at assisted living

facilities, various local schools and workplaces.

Two TB cases and one suspect TB case were reported in Lake County for 2010.

TB Risk Assessment was conducted under CDC guidelines. The Lake County

General Health District is a medium risk facility for TB disease.

A total of 951 TB skins tests were administered by the Health District. Of the total

tested, only 9% were foreign born with 43% of the foreign born from Mexico.

A total of 16 clients TB tested through the Health District had a positive reaction.

- 46 -

Health District TB Program Review: 2010 2009 2008

# TB Tests Performed 951 1166 1574

# Positive Reactors from TB testing 16 32 47

Percentage of Positives 1.6 2.7 2.9

Other TB Statistics 2010 2009 2008

Number of Verified TB Cases Reported from all sources 2 3 3

Number of Clients Receiving TB Medication through the Health District 28 56 71

3.02.10

Flu Clinics

Annual vaccination against influenza is recommended for anyone over 6 months of age who

wants to reduce the risk for becoming ill with influenza or transmitting it to others. Fees are

established annually by the Board of Health.

In 2010, 2,332 H1N1 vaccinations were given from January through May 2010.

One thousand three hundred and six (1,306) adult doses were administered from

October through December 2010. The immunization clinics were conducted at Senior

Centers, Lakeland Community College, various adult care facilities and at the Lake

County General Health District. The Clinical Services Public Health Nursing staff

made home visits to those unable to attend a clinic.

Four hundred and thirty four (434) child doses of flu have been administered from

September through December 2010. Flu vaccine continues to be administered for the

first few months in 2011.

ADULT FLU ADMINISTERED 2010 2009 2008

TOTALS 1306 2181 1631

CHILD FLU ADMINISTERED 2010 2009 2008

TOTALS 434 396 306

3.02.11

Other Public Health Clinical Activities

1. Genetic Newborn Screening. This is a mandatory screening of all newborns in

accordance with Ohio Administrative Code 3701.45. The Health District would provide

this screening if there was a home-birth with no physician or midwife in attendance or

when a physician is unable to locate a baby who needs a second test or retest. In 2010,

the Health District received one referral.

- 47 -

2. Universal Newborn Hearing Screening. This is a mandatory notification to

parents/guardian of the availability of Ohio’s Newborn Hearing Screening program in

accordance with Ohio Administrative Code 3701-40-10. In 2010, the Health District

assisted four families obtain hearing screenings for their infants.

3. Health Assessments. This is a service that Clinical Services provides to perform initial

health screenings as needed for placement of foster/custody children. There were two (2)

health assessments completed by Public Health Nurses in 2010 for the Lake County

Department of Job and Family Services.

3.03 HELP ME GROW

Children 0-3 years of age with a developmental delay and/or medical diagnosis and first-time or

teen mothers in poverty with risk factors qualify for this program.

Children with a diagnosed medical condition or have been found to have a delay through our

evaluations are considered “Part C” children. Help Me Grow (HMG), also works with “At Risk”

families who have risk factors, such as, poverty, chronic disturbed interactions, parental

substance abuse or mental illness and/or chronic medical conditions that may affect the

development of their child without preventative measures.

Help Me Grow has grown into two distinct programs for children prenatal to three years of age.

1. Part C Program for children with disabilities.

2. Home Visitation Program for first time mother’s in poverty, families with

substantiated abuse and military families.

3.03.01

Program Accomplishments

Help Me Grow received another 100% compliance year in all five procedural areas.

In 2010, a total of 840 families were served through Help Me Grow Programs.

This Ohio Department of Health (ODH) State family survey indicated that 100% of families

surveyed felt they were treated with respect and were overall satisfied with Lake County HMG

services. Family attendance rates in the developmental skills play group and support groups was

90-100%.

2010 Totals Number Served

Part C 461

New At Risk 154

Referrals

20 % increase of family referrals for 2 years 673

Developmental Evaluations 257

Community Developmental Screenings 72

- 48 -

Great Gains services expanded to meet the needs of 55 more families this year who were unable

to access any other service. The participants receive comprehensive parenting through the

Parents as Teachers curriculum for multiple risk factors, such as, safety, bonding, supporting

their child’s development, and accessing community resources for family needs.

3.03.02

Future Changes

The planning process for the Center for Early Childhood Development (CECD) created a policy

and operational road map to advance and strengthen the administration of early childhood

services and supports for families and their children. (http://www.build-ohio.org/cecd.html).

The CECD established the design for the Early Childhood Development System to include a

comprehensive, “whole-child” approach. Included in the design is an emphasis on:

comprehensive health (physical and behavioral health and wellness); early care & education;

family supports; and special needs/early intervention.

Proposals were made for the re-design of Ohio’s HMG home visiting program by developing

statewide standards grounded in research, evidence-based practices and improved outcomes. The

design of an extensive evaluation plan is underway. Due to the increased General Revenue Funds

provided in Ohio House Bill 1, this higher quality, more intensive program for pregnant women

and first time mothers is slated to become a Medicaid eligible service early in State Fiscal Year

(SFY) 2012.

The Early Childhood Cabinet made proposal of a “core team” or “trans-disciplinary approach”

for the delivery of early intervention services for children, under the age of three, with a delay

and/or disability. This approach will build networks of professionals to support families, within

their natural environments, to enhance and support their child’s development. Resources (in SFY

11) have been made available to provide training for dozens of teams to deliver these evidence-

based services.

Services in the Lake County Healthy Families Division will continue with the Autism

Connections, community parenting groups, serving families in need that do not qualify for HMG

and strengthening community partnerships.

The Ohio Department of Health (ODH) Family Surveys for Lake County HMG indicated

families require more information on the system complaint procedures and an increase in family

support opportunities, which is being addressed for this coming year.

ODH has provided Lake County with population estimates, taken from the census and vital

statistics data, for families who qualify for home visitation services. They identified 486 families

that could engage in home visiting services in Lake County. HMG staff are completing the home

visitation certifications and training to meet these future needs.

- 49 -

A typical HMG family with risk factors usually will have involvement in other systems such as

drug and alcohol, courts, mental health and the Department of Job and Family Services. Most of

these families are living in poverty and are coping with single parenting of newborns and infants.

Research shows that early experiences determine the foundation for future learning, behavior and

health that will ultimately impact our society without services to support healthy development.

This fully indicates the need for research-based, comprehensive early childhood programs and

supports.* *Letterman, A. (2010) Accomplishments in Early Childhood development Policy and initiatives Strickland

Administration. (Neurons to Neighborhoods (2006), Phillips.)

3.04 WIC (Women, Infants and Children) Program

The WIC program serves: pregnant and post-partum women, breastfeeding women, infants and

children up to five years old who have qualifying income and medical/nutritional health risks.

WIC provides nutrition and breastfeeding education, counseling and support.

WIC is a supplemental food program offering nutritious foods in accordance with

the 2005 dietary guidelines including, but not limited to: fresh fruits and

vegetables, whole grains, low fat dairy products and high protein sources.

WIC is a referral agency working closely with other community health care

services.

WIC participants receive nutritional care through a collaboration of health

professionals including, registered and licensed dietitians, registered nurses, nurse

practitioners and physicians. Nutrition assessments take place on an individual

basis performing anthropometric measurements, group sessions, one-on-one

counseling sessions, health history forms, self-education, breastfeeding peer

support groups, and high risk counseling sessions.

WIC has been proven to decrease rates of pregnancy weight gain less than or

greater than ideal, decrease the rate of anemia in the 3rd

trimester, decrease the

rates of smoking during the last three months of pregnancy and decrease the rates

of low birth weight and high birth weight. WIC has also been proven to increase

the rate of breastfed infants.

WIC offers electric and manual breast pumps for qualifying participants.

WIC allows for individualized breastfeeding support and promotion through a

new peer program mandated in the State of Ohio.

Funding is provided through the Ohio Department of Health WIC Grant. The Grant year begins

in October and ends in September.

- 50 -

3200

3400

3600

3800

4000

4200

4400

2009 2010 2011

3946

41784222

3603

3780

4321

CA

SE

LO

AD

YEAR

Assigned Caseload

AVERAGE

ASSIGNED

300,000

400,000

500,000

600,000

700,000

2008 2009 2010 2011

526,761551,450

606,975

698,190

FUN

DIN

G

YEAR

GRANT FUNDING

The Lake County WIC Program has three clinics in the county. 1. Painesville, which acts as a central location, located in the Lake County General

Health District, which makes up 52% of our caseload.

2. Willoughby (west), which acts as an outside clinic, located on Euclid Avenue,

which makes up 37% of our caseload.

3. Madison (east), which acts as an outside clinic, located at Stratton Place, which

makes up 11% of our caseload.

- 51 -

The Lake County WIC program offers Farmer’s Market vouchers for individuals on the program.

WIC participants receive $15.00 worth of Farmer’s Market vouchers. Six hundred and fifty (650)

of these vouchers were distributed in 2010 which has the potential to bring in the equivalent of

$9,750.00 revenue for local farmers.

Total Number of Vouchers Distributed by Client Category

Pregnant Post-Partum Breastfeeding Children TOTAL

Painesville 43 32 24 253 352

Willoughby 20 11 12 133 176

Madison 13 5 9 95 122

TOTAL 76 48 45 481 650

3.05 HEALTH PROMOTION AND PLANNING

3.05.01

Unit Supervisor's Report

This has been a transitional year with becoming the Supervisor and hiring a new Health

Educator. The Unit Supervisor provided programming/supervision for the Health Educator

position for nine months. Then oriented a new Health Educator for the remaining months in

2010. The Unit Supervisor continued to orient with Health Promotion and Planning

programs/grant requirements. Current grants and budgets were reviewed on a monthly basis

along with some budget revisions: Medical Reserve Corps, Smokefree Work Sites, Action

Communities for Health Innovation and Environmental Change, Safe Communities, Breathe

Well, Breathe Free, Drug Assistance Program, HIV Case Management and HIV Prevention

Grants.

The Unit Supervisor was trained by Ohio Department of Health as the Ohio Public Health

Communications System (OPHCS) Administrator for Lake County. Monthly tests will start in

2011. Unit Supervisor completed Incident Command System (ICS) 200, 800, 300 and 400 to

become National Incident Managements System (NIMS) compliant.

The Unit Supervisor completed requirements to maintain Child Passenger Safety certification

and completed HIPAA training.

The Unit Supervisor represented the Health District in two tobacco enforcement administrative

reviews.

Emergency Preparedness exercises attended/facilitated by Unit Supervisor in 2010 included:

Public Health Dispensing Drill.

Call Down Drills.

MARCS Regional and State Drills.

Shadowed Preparedness Specialist in the Perry Nuclear Power Plant Exercise

graded by the Federal Emergency Management Agency.

Shadowed Preparedness Specialist as Evaluator - Geauga County Bomb Threat

- 52 -

Exercise.

Planning Chief in the Octoberthrax, Northeast Ohio Regional Public Health

Exercise.

Greeter at the Potassium Iodide (KI) Care Center at Kirtland High School.

The Unit Supervisor provided assistance with the Community Health Assessment process by

scheduling and contracting agencies to administer the survey for six weeks at various locations.

The results of the survey will be used to identify community needs in Lake County.

3.05.02

Preparedness Specialist

3.05.02.01

Emergency Preparedness

The Preparedness Specialist participated in the following exercises:

Public Information Officer (PIO) - H1N1 Clinic sponsored by the Northeast Ohio

Regional Public Health Partnership at the International Exposition (IX) Center in

Cleveland, Ohio. The clinic was also used as regional drill to fulfill Cities

Readiness Initiative (CRI) requirements.

Evaluator - Geauga County Bomb Threat Exercise.

Public Health Information Officer - Perry Nuclear Power Plant Exercise graded

by the Federal Emergency Management Agency.

Design Team Member, Controller/Evaluator – Octoberthrax, Northeast Ohio

Regional Public Health Exercise.

The Preparedness Specialist coordinated the activities related to the Cities Readiness Initiative

(CRI) assessment performed by Ohio Department of Health (ODH), including preparation of

documented evidence of compliance with the CRI.

The Preparedness Specialist successfully completed the Basic PIO Course G290 sponsored by

the Ohio Emergency Management. This course is the beginning of a series of PIO courses

recommended by the National Emergency Management Association and qualifies the

Preparedness Specialist to be called by State and Federal Emergency Management Agencies to

serve in a Joint Information Center during a disaster.

The Preparedness Specialist coordinated the distribution of potassium iodide (KI) at seven

pharmacies within the Perry Nuclear Power Plant Emergency Planning Zone (EPZ) in

cooperation with First Energy’s push to get KI into the homes of Lake County’s EPZ residents.

The Preparedness Specialist created and executed public information and communication

campaigns for seasonal influenza, the Lake County Community Health Assessment, Lake

County Pharmaceutical Drug Collection and Disposal Program, and central issuance of birth

certificates that involved three or more of the following methods: the utilization of billboard

advertising, Lake County General Health District website, printed advertisements, radio

interviews, social media, press conferences and television interviews.

- 53 -

While there are currently no monies available for tobacco-related activities in Lake County, Lake

County General Health District is still the Chair organization of the Lake Geauga Ashtabula

Tobacco Prevention Coalition (LGATPC) which works as a clearing house for tobacco education

and speaker’s bureau. The Preparedness Specialist created a Twitter site for LGATPC, located at

twitter.com/#!/LGATPC.

Data Reports

New and Updated Plans and Documents 2010

Total YTD 55

Agencies/Individuals Served/Total Documents/Items 2010

Total YTD 1968

New Fact Sheets 2010

Total YTD 2

News Releases 2010

Total YTD 74

3.05.03

Health Educator

3.05.03.01

Safe Communities

Two Health Educators obtained their Child Passenger Safety Seat Technician certification

through National Highway Traffic Safety Association. The Child Passenger Safety Program

continued through a change of employees throughout the year. In 2010, 218 seats were

distributed in Lake County.

The Lake County Safe Communities Coalition held the 7th Annual Traffic Safety Expo with

another terrific turnout. This event pulls all high school juniors and seniors together to show

them they can have a good time without alcohol. This event is held before prom and graduation

season and covers all aspects of traffic safety (texting while driving, impaired driving, and seat

belt use).

Seat Distribution 2010 HI Back Boosters Convertible Seats Backless Boosters

Total YTD 44 53 121

Child Passenger Seat Participant Demographics – City 2010

Painesville Eastlake Madison Mentor Willowick Concord WH Other Total

YTD 72 8 3 18 2 4 1 25 133

- 54 -

Child Passenger Seat Participant Demographics – Race 2010

Caucasian African-American Hispanic Total

YTD 77 10 46 133

Child Passenger Seat Participant Demographics - Referred By 2010

Friend/ Relative

WIC Help Me Grow

Birth Right

Family Planning

Hannah's House

GRADS

CHS Clinic

211 Other Total

YTD 14 49 6 14 3 1 4 11 4 27 133

The Health Educator coordinated the Lake County Child Fatality Review Board. This Board

reviews the death of any child that resides in Lake County that occurred in 2010.

The Health Educator maintained a database for all age suicides that occurred in Lake County for

the Lake County Suicide Prevention Coalition. There were 28 suicides in Lake County.

The Health Educator participates on the following Coalitions: Lake County Crime Prevention

Task Force, Lake County Safe Routes to School (Painesville Twp.), Action for Healthy Kids,

Lake County Child Fatality Review Committee, Lake County Suicide Prevention Coalition and

the Greater Cleveland Safe Kids Coalition.

3.05.04

Health Educator/Preparedness Specialist

3.05.04.01

Lake County Medical Reserve Corps

Thirty-seven volunteers joined the program in 2010. Twenty-two of the thirty-seven joined after

they helped with clinics during H1N1. As of December 31, 2010, the Lake County Medical

Reserve Corps (MRC) is made up of ninety-one volunteers. Volunteers participated in training,

test alerts, and other events throughout the year. New volunteers had the opportunity to take

MRC 101, a 4-hour lecture based training, on April 15 and October 4. A total of thirty-one

volunteers were trained. Volunteers received and participated in four Ohio Responds

notification test alerts this year. An average of 63% of volunteers responded to the alert within

24 hours of receiving the call. Additionally, 15 volunteers participated in a tour of the Lake

County Emergency Management Agency (EMA) in May, one volunteer attended the MRC

Federal Deployment Training in Washington, D.C. in June, four volunteers helped at seasonal flu

clinics in September and October, and six volunteers helped with a press conference in

December 2010.

- 55 -

Lake County Medical Reserve Corps Volunteers – December 2010

Volunteers by Profession Number

Registered

Total Number of

Registered Volunteers

Total

Percentage

Nurses (RN, LPN) 51 91 56%

Mental Health Professionals 7 91 7%

Physician Assistants 0 91 0%

Nurse Practitioners 1 91 1%

EMS Professionals 4 91 4%

Physicians 5 91 6%

Pharmacists 9 91 10%

Veterinarians 4 91 4%

Dentists 0 91 0%

Respiratory Therapists 1 91 1%

Other Public Health/Medical 5 91 6%

Non-Public Health/Non-Medical 4 91 4%

TRAINED VOLUNTEERS 91 91 76%

3.05.04.02

Matter of Balance

Five classes were held between April and October this year. The following sites hosted a class;

Breckenridge, Willoughby Senior Center, Mentor Way Nursing Facility and Eastlake Senior

Center. A total of 48 seniors successfully completed the 8-session course over this 6-month

period. The average age of class participants in Lake County is 78 with 80% being female.

3.05.04.03

Action Communities in Health, Innovation, and Environmental Change (ACHIEVE)

During 2010, several trainings and conferences were attended. Strategic Research Group, a

consultant of the Ohio Department of Health, met with the coaches of ACHIEVE Lake County to

conduct an assessment and write up a case study on the initiative. The following conferences

related to ACHIEVE were attended; Chronic Disease Academy hosted by the National

Association of Chronic Disease Directors, Active Transportation Conference hosted by Ohio

Department of Transportation, National Society for Public Health Education Mid-year

Conference, Ohio Action for Healthy Kids Zone 4 Conference, and the Learning Institute hosted

by Y-USA. The Health Educator/Preparedness Specialist presented at two of the conferences.

Matter of Balance Program – 2010

Month/Year

Number of

Classes

Held

Location of Class Number of

Participants

April 1 Breckenridge 11

May 1 Willoughby Senior Center 10

July 2 Mentor Way & Eastlake 16

November 1 Willoughby Senior Center 10

YTD 5 4 47

- 56 -

During 2010, four ACHIEVE sub-committees continued to work on wellness in the following

sectors of the community, Community-at-Large (CAL), Community Institution/Organization

(CIO), School, and Worksite. The CAL committee developed the local website for ACHIEVE

Lake County and has continued to update the information on the site. The site includes an

interactive recreational map that includes all facilities and means to obtain physical activity in

Lake County, such as, bowling alleys, golf courses, trails, and parks. A meeting with city

officials was held in April as part of the launch of the website.

The CIO committee offered food and nutrition classes from April to October and provided the

participants of the class with Painesville Farmers' Market vouchers. A total of 85 vouchers were

distributed and 40 were redeemed at the market. The group met in October with representatives

from City of Painesville to discuss how to provide vouchers that will be good at any market in

Lake County for the 2011 year. Lake County Central YMCA hosted two diabetes prevention

and maintenance classes, as part of the ACHIEVE initiative, this year. Each class worked with

15 participants over a ten week period on proper nutrition and physical activity in order to make

health improvements.

The School committee met in April with Superintendants of Lake County public schools to

introduce the ACHIEVE initiative. The committee provided ten $1,000 mini grants to schools in

October and December. The following schools received one or more grants to make changes in

terms of policy and/or environment that directly improves physical activity or nutrition for

students; Chestnut Elementary, North High School, Elm Street Elementary, Longfellow

Elementary, Ridge Middle School, Leroy Elementary School, Kirtland Middle School, and

Madison Avenue Elementary. The schools were funded for initiatives, such as, virtual hike

across the United States, exposure to healthy food tasting, exposure to one mile marked

indoor/outdoor walk/run course, staff and student involvement with bike to school days, salad

shakers served at lunch, recess before lunch, healthy cooking labs, school greenhouse, school

gardens, and a marathon club. The School committee was able to request Veggie U kits for

fourth grade classrooms through a grant obtained by the Ohio Department of Health. Between

July and September, 13 kits were requested by ACHIEVE for various 4th

grade teachers in Lake

County.

The Worksite committee signed Memorandum of Understanding (MOU) to provide funding over

a 12-month period to six businesses in Lake County for policy and/or environmental changes that

must address wellness. The MOUs were signed between July and September 2010. The

following businesses signed the MOU; Avery Dennison, Fredon Corporation, Lincoln Electric,

Stafast, Neighboring Mental Health Services, and Transfer Express, Inc. Several of the

businesses have completed or plan to complete a health screening for employees where they are

able to receive results, such as, glucose level, blood pressure, cholesterol and body mass index.

ACHIEVE has provided each of these businesses with the opportunity to access walking path

maps (both indoor and outdoor) for their employees, as well as, wellness posters that contain

messages related to physical activity and nutrition. A brief phone interview was completed with

each of the businesses’ vending company to provide ACHIEVE and the business with more

information about their vendor and what they are willing to put in their machines. As part of this

- 57 -

initiative, the Lake County General Health District, installed a bike rack, offered fresh fruit for

employees, and made healthy changes to their vending machine options this year.

3.05.04.04

Smoke Free Workplace Law

Enforcement Data in Lake County - 2010 # of

investigations

# of letters of

warning issued

# of Fine 1

letters issued

# of Fine 2

letters issued

# of Fine 3

letters issued

January 11 0 0 0 0

February 0 2 0 1 0

March 6 0 0 0 0

April 10 1 0 0 0

May 5 0 0 0 0

June 4 2 0 0 0

July 9 1 0 0 0

August 3 0 0 0 0

September 7 0 0 0 0

October 7 0 1 0 0

November 10 2 0 0 0

December 8 1 0 0 0

YTD 80 9 1 1 0

3.05.05

HIV Case Management and Prevention

Total HIV Positives Reported

YTD

2008 1

2009 0

2010 0

Three Year Period HIV Test Site Participants Lake and Ashtabula

Sites

Year 2008 2009 2010

Total Tested 374 417 600

Client Utilization by all Clinic Sites 2010 No Response 3

Ashtabula 181

Cuyahoga 61

Geauga 21

Lake 327

Other 7

Total YTD 600

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The Health Educator along with a Health District Social Worker tested over 600 clients and has

exceeded the goal for 2010. The HIV staff opened a new test site in Conneaut at the Lake Erie

Correctional Facility. The HIV staff tested 112 inmates and 28 men received HIV education.

Response to testing at the facility was very well received. Testing and education will continue in

2011.

Seventy-five people were tested at Lakeland Community College on December 1, 2010 for

World AIDS Day. A free HIV test site was available to all students, staff, and the general public.

In 2011, another free HIV test site is scheduled for April 13, 2011. An educational booth was in

the student center to answer questions and to refer the public to the test site. Peers from the

"HIV Peer to Peer" program volunteered and provided assistance and education.

The Lake County Health District provides medical case management services and support to

HIV positive individuals and their families. Currently, approximately 90 individuals are served

in Lake, Geauga, and Ashtabula counties. Client contacts per month average 115. This does not

include collateral contacts with physicians, therapists, nurses, dieticians, pharmacists, family

members, etc. Case Managers continued to collaborate with Ashtabula City Health Department

in utilization of a private meeting room to schedule client visits once per week. Clients work

with Case Managers to update information in their files a minimum of twice yearly. This update

includes obtaining medical information on the client, discussing treatment outcomes, and

increasing the client's understanding of transmission and risk factors.

The primary focus of case management continues to be establishing adequate medical care for

clients, ensuring medication adherence, and preventing HIV transmission. HIV case managers

also provide access to the Ohio Drug Assistance Program. Due to recent HIV program cuts, a

main concern is now helping clients who are on the wait list find alternate methods of getting

their medications filled and paid for each month. Direction to clients is given to apply for

appropriate benefits including social security, disability, energy assistance programs, food

stamps, housing, mental health, substance abuse, etc. The Health District has also welcomed a

Ryan White funded dietitian to the staff to serve clientele closer to their homes. Case

management staff also provides to clients access to Ryan White emergency assistance funds,

HUD's Housing Opportunities for People with AIDS funds. This year funds were cut from this

program that historically provided clients with transportation and food support services. Funding

cuts, such as these, increase the need for the transportation assistance case management grant

provides clients with as well as our food pantry referrals and newly developing Lake County

General Health District mini pantry project. Case managers attend Ryan White Planning council

meetings (Part A - County and Part B -State) monthly; serve on the Housing Opportunities for

People living With AIDS Committee, and attend monthly network meetings.

3.05.05.01

Risk Reduction / Education

The Lake County General Health District facilitates a client support group which provides not

only on-going support, but has added an education component to assist clients with

understanding and better managing their health with grant funding. 2010 saw the educational

and risk reduction group come to life to promote this monthly educational program. In 2010

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there were 12 groups held. During these sessions, collaboration for educational speakers was

made with community agencies such as Catholic Charities, Nutrition Counseling, Bristol-Meyers

Squibb Pharmaceutical, University Hospitals and Dominion East Ohio Gas. Group attendance

varied from five to twenty plus in attendance. The purpose of these sessions is to empower

clients through education to live stronger, healthier lives, both physically, mentally and

financially. “Give a man a fish and you feed him for a day. Teach a man to fish and you feed him

for a lifetime.”- Chinese Proverb

3.05.05.02

Peer to Peer / Outreach

Lake County General Health District was approved for grant funding in 2010 to initiate an

outreach program called “Peer to Peer” This program is designed to help train and facilitate the

utilization of grounded and healthy HIV+ individuals as a mentor to an out of care, erratically in

care newly diagnosed HIV+ person. Case Managers met with pre-determined eligible mentor

clients and assisted in the education and enrollment process to become a peer mentor. Clients in

need of a peer mentor must sign a release of information before being linked with a peer mentor

and can refuse mentoring services at anytime. This year approximately eight peer mentors were

trained and linked with individual peer clients for mentoring. Program focus is on

confidentiality, respect, education for the peer on HIV management, medication and adherence

support, and linkage with community services applicable to the peers individualized needs.

Recent improvements include a Health District designated cubicle space for mentors to use to

document their interactions, research community supports, or meet with their case worker for

problem solving. Meetings are held monthly between the mentors and case managers to assure

boundaries and policies are being kept, as well as, to explore new ideas, problem-solve difficult

cases, and share program updates. Annual satisfaction surveys completed by both the peer

mentors and the peers showed average to above average satisfaction with this pilot program. We

look forward to expanding this program in the future.

3.05.06

Drug Assistance Program

The Lake County Drug Assistance Program helps uninsured or underinsured individuals to

obtain medications at a lower cost. The program has served 123 clients this year. Articles in the

News Herald were instrumental in increasing the number of clients served.

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3.05.07

Breathe Well, Breathe Free Program

This program identifies low-income children/families experiencing the chronic diseases of

asthma and obesity in an effort to prevent, reduce the severity of, or eliminate these diseases. A

very comprehensive assessment is completed for each family consisting of: home health

assessment, increasing awareness of the risk factors, offer nutrition counseling, and to provide a

referral and advocacy system for children. The program started in April 2010 and at the end of

December 16 families and 22 children throughout Lake County were enrolled.

Painesville City Schools adopted an administrative guideline stating that a student that has

asthma may carry his/her inhaler throughout the school day. The Health Educator was

instrumental in helping a Breathe Well, Breathe Free family institute the administrative

guideline. The goal for 2011 is to educate other school districts and have each school district

revise their administrative guidelines pertaining to inhaler possession during the school day.

Drug Assistance Program Count by City 2010

Concord 3

Concord Twp 2

Eastlake 15

Euclid 1

Highland Heights 1

Kirtland 4

Lake Line 1

Madison 15

Mentor 21

Mentor Headlands 1

Mentor on the Lake 2

Painesville 28

Painesville Twp 1

Perry 2

Wickliffe 7

Willoughby 11

Willowick 8

TOTALS 123

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Lake County General Health District 33 Mill Street

Painesville, OH 44077

Telephone: (440) 350-2543 Fax: (440) 350-2548

www.lcghd.org

http://www.lcghd.org/