Budget Committee on Human Services Testimony

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1 Budget Committee on Human Services Testimony Bismarck ~ March 9, 2006 Alana Knudson, PhD Center for Rural Health, Medical School of Medicine and Health Sciences, UND Good morning Chairman Dever and members of the Committee. My name is Alana Knudson, and I am the Associate Director for Research at the Center for Rural Health at the University of North Dakota School of Medicine and Health Sciences. I am here today on behalf of Dr. H. David Wilson, Dean of the School of Medicine and Health Sciences, who along with his administrative team, is meeting with the Liaison Committee on Medical Education (LCME). The LCME is recognized by the US Department of Education for accrediting education programs leading to the Medical Doctor (MD) degree. This accreditation is a prerequisite for eligibility of graduates to obtain medical licensure in most states, for students to sit for U.S. medical licensure examinations, and to obtain federal student loans. The LCME conducts site visits every eight years. Thank you for the opportunity to provide comments on the School of Medicine and Health Sciences role and involvement with public health units in North Dakota. The School of Medicine and Health Sciences (Medical School) plays an integral role in preparing physicians and health professionals, such as clinical laboratorians, for their work in public health. The majority of our collaborative activities are with the North Dakota Department of Health and, through these efforts, local public health units receive benefits. However, today s presentation will focus on your request for the Medical School s role and involvement with local public health units. My presentation today will encompass the three primary areas of collaborative efforts between the Medical School and local public health units which relate to some of the 10 essential public health services. These three areas include: 1. Technical Assistance and Research; 2. Educational Support; and, 3. Information Dissemination. Technical Assistance and Research There are many ways that the Medical School provides technical assistance and research to local public health units. The essential public health function that relates to this area is: to mobilize public and private sector collaboration and action to identify and solve health problems. The Center for Rural Health, located in the Medical School, is the focal point for rural health and is closely linked to rural communities across the state. Center for Rural Health The State Office of Rural Health, located in the Center for Rural Health (CRH), connects the Medical School and the university to rural communities and their health institutions to facilitate the development and maintenance of rural health delivery systems. The State Office administers the Blue Cross Blue Shield of North Dakota Rural Health Grant Awards, and local public health units have partnered with their local health providers to enhance services to their communities. Participants in this program include: Steel County Public Health, Southwestern District Health 1

2 Unit, and Rolette County Public Health District. The Automated External Defibrillators (AEDs) Program also has provided AEDs to local public health units including: Steele County Public Health, Dickey County Health District, Ransom County Public Health Department, Cavalier County Health District, Towner County Public Health, Central Valley Health Unit, and Ransom County Public Health. AED applications have been received from Ransom County Public Health, Nelson-Griggs District Health Unit, and Rolette County Public Health. The State Office also provides assistance to local public health units through the federal Outreach Grant Program. The Office of Rural Health Policy's Outreach Grant Program is designed to encourage the development of new and innovative health care delivery systems in rural communities that lack essential health care services. The emphasis of this grant program is on service delivery through creative strategies that require the grantee to form a network with at least two additional partners. A number of North Dakota s local public health units have been included as partners in these grants such as: Southwestern District Health Unit, City-County Health Department (Valley City), McIntosh District Health Unit, Kidder County Health District, and Dickey County Health District. The State Office also facilitates and sponsors the annual Dakota Conference on Rural and Public Health, which is March in Fargo. As a co-sponsor, the North Dakota Public Health Association members participate on the steering committee and assist in the selection of presentations. Approximately 300 health professionals, many of whom are from local public health units, annually attend this conference. Lastly, the State Office coordinates grant writing and strategic planning seminars for rural health care providers who often include their public health partners. In addition to these seminars, the Center staff reviews grants, provide letters of support, and assist in conducting evaluations of projects. A second program at the CRH that links to the local public health units is the Medicare Rural Hospital Flexibility (Flex) Program. The Flex Program was established as part of the Balanced Budget Act of 1997 (Public Law ) to support and preserve the nation's smallest and most vulnerable rural hospitals. Flex grants have been awarded to North Dakota Critical Access Hospitals who have identified as partners the Wells County District Health, Emmons County Public Health, and City County Health Department (Valley City). A third program at the CRH, North Dakota Family to Family Network, serves North Dakota families raising children with special needs through the family matching process. The design of the project, which connects families by phone, places great emphasis on reaching rural families who may not otherwise have the emotional and informational support systems available to them. Collaboration between the Family to Family Network and the local public health units is ongoing, which is illustrated by the Grand Forks Public Health Department providing meeting space. Another example of how the CRH contributes to local public health is through research activities. Research for new insights and innovative solutions to health problems is one of the 10 essential public health services. One challenge that public health faces in North Dakota and in 2

3 the U.S. relates to workforce shortages. The CRH staff has been conducting the Nursing Needs Study since This research project includes gathering information from each of the local public health units. Overall findings from the 2005 survey indicate there is an 11 percent vacancy rate for registered nurses (RNs). Likewise, dentistry is another workforce shortage issue facing North Dakota. For the past several years, the CRH has worked closely with the Grand Forks Public Health Department and other community agencies to develop a dental clinic that would better serve the underserved populations in the Greater Grand Forks area. During the past three years, the CRH has conducted 16 Rural Health Dialogues across North Dakota. These dialogues in rural communities provided the CRH a chance to share what services we provide to rural communities and for CRH staff to hear what issues impact rural communities. This information has helped to shape our work at the CRH and to inform local, state, and national policy makers. Many local public health units were represented at the dialogues. In particular, some local public health professionals expressed the concern about potential cuts in federal programs that would directly impact their work at the community level. Center for Health Promotion and Prevention Research The Center for Health Promotion and Prevention Research (CHPPR) staff has worked with all of the state s local public health units through the evaluation of the state-wide Community Health Grant Program, which provides funding to all local public health units tobacco control and prevention activities (reports available on request). In addition, CHPPR staff has prepared a comprehensive report for the Grand Forks Public Health Department (GFPH) on tobacco prevention and control activities in Grand Forks County, and also assisted the GFPH in their efforts to pass a clean air ordinance by providing scientific and policy data on the effects of second-hand smoke and business impact in states/cities with clear air ordinances (report available on request). Lastly, the CHPPR staff co-sponsored with a public health unit (including cost sharing) a tobacco prevention curricula training for teachers entitled Life Skills Training. Community Medicine The Department of Community Medicine provided 16 CME presentations on the North Dakota Tobacco Quitline project to local public health units during Drs. Eric Johnson and Donna Anel presented findings from the project and provided additional information about the program. Products 7 SORH Outreach grants to enhance community health networks with local public health partners 3 FLEX grants to improve community health through wellness with local public health partners 4 BCBSND grants to improve rural health care with local public health partners 9 AEDs provided to local public health units, 3 AED awards pending Community Health Grant Program Evaluation Report to the Grand Forks Public Health Department on Tobacco Prevention and Control Activities 16 CME presentations on the North Dakota Tobacco Quitline Program 3

4 Educational Support The essential public health service that relates to educational support is: assure a competent public health workforce. The Medical School provides opportunities to educate public health professionals through courses, degree programs, and continuing education. Local public health professionals have participated in these educational opportunities on-campus and through our distance learning programs. Pathology and Office of Continuing Medical Education Many of the local medical officers serving their local public health units are UND graduates. In addition, many other professionals working in local public health have participated in UND School of Medicine and Health Sciences educational programs and continuing medical education (CME) opportunities. One program, in particular, that benefits local public health is the Clinical Laboratory Science program. It is the largest training program in the state and one of the largest in the country. Through this program, students may earn BS and MS degrees. Many of the local and state public health laboratorians have received their educations at UND. In addition, the Office of Continuing Medical Education and Outreach, in collaboration with the North Dakota State Department of Health, sponsors Laboratory Science Seminars for laboratorians to earn continuing education credit. Laboratorians at First District Health Unit and Fargo Cass Public Health have participated in these seminars. Dr. Mary Ann Sens, Chair of Pathology, serves as the Grand Forks country coroner and also participates in many of the public health and emergency preparedness exercises. Community Medicine Don Shields, Director of the Grand Forks Public Health Department, holds an appointment as a clinical faculty in the Department of Community Medicine. Mr. Shields and Dr. James Hargreaves, an infectious disease specialist at Altru Health System, presented the February 13, 2006, Dean s Hour entitled, If it comes, will we be prepared? This presentation focused on a possible avian flu pandemic and is available for viewing on the Medical School's web page at Local Public Health Professionals Teach Medical Students Educational support goes both ways. Public health also provides educational opportunities for UND students and residents. For example, third year medical students in Fargo go to the Fargo Cass Public Health Family Planning Program as part of their obstetrics/gynecology rotation. Second year medical students learn how to perform a clinical breast exam at the Grand Forks Public Health unit. Bismarck medical students attend the Tobacco Free Coalition in Bismarck through the Bismarck-Burleigh Public Health unit. The students are also exposed to public health issues through the schools, geriatric centers, and the detention center. Medical residents also interface with local public health. The Minot family practice residents learn about the myriad of public health programs through a month-long rotation on public health at the First District Health Unit. Family Practice residents in Bismarck provide examinations for the Custer Health Unit s Family Planning Program as part of their community medicine and behavioral health rotation. In addition, they also learn about health care reimbursement issues and receive training on medications. 4

5 Products Laboratory Science Seminars Dean s Hour presentation by Community Medicine Clinical Faculty Member, Don Shields, Director of the Grand Forks Public Health Department Information Dissemination The essential public health service that relates directly to information dissemination is: to inform, educate, and empower individuals about health issues. The dissemination of information is key to public health professionals abilities to translate research into practice. For example, the economic impact of asthma on school-age children, families, and society is immense, and more public health efforts to better control asthma in children are needed. We also have learned that depression plays an important role in the etiology, course, and outcomes associated with chronic disease. As we learn more about what works to improve people s health, it is important that the information gets shared so it can be put into practice at the local level. The Medical School uses a number of different ways to share information with local public health units. Center for Rural Health The Rural Assistance Center (RAC), located in the CRH was established in 2002 by the Department of Health and Human Services as the rural health and human services information portal to help rural communities and other rural stakeholders access the full range of available programs, funding, and research that can enable them to provide quality health and human services to rural residents. RAC offers many services to help inform decisions affecting rural health and human services including: funding opportunities, information guides, maps, customized searches, and success stories. All services are provided free of charge. Local public health units have accessed the Rural Assistance Center web page at CRH publications, including the Rural Health Update, EMS Update, Tribal Health Update, and the Focus on Rural Health are electronically disseminated to all local public health units. The CRH and the CHPPR co-sponsored a conference with the Grand Forks Public Health Department that focused on training and motivating public health professionals to use media and effective communication strategies for developing public health initiatives and priorities. Products ND public health unit staffs are RAC clients ND public health unit staffs receive CRH publications Training Conference for Public Health Professionals 5

6 Summary The School of Medicine and Health Sciences is involved in many different ways with local public health units. Are there opportunities to be more involved with local public health? Absolutely! With additional resources, we could better address the public health challenges our state faces such as: binge drinking, obesity, diabetes, tobacco use, substance abuse, etc. We would like to provide more opportunities for our students and residents to interface with the 28 local public health units that contribute to our state s population health. There also are Medical School faculty who have expertise in areas such as conducting assessments and program evaluations that may be helpful to local public health units. We look forward to a continued collaboration between the Medical School and the local public health units to improve the health of North Dakotans. Thank you for the opportunity to provide this information to the committee. I d be pleased to answer any questions today or whenever convenient to you. Please contact me at or by at 6

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