Clinton County Health Department

Clinton County Health Department Health Care Services Division Annual Report

Clinton County Health Department Vision Clinton County Healthy People in a Healthy Community Mission Our mission is to improve and protect the health, well-being, and environment of the people of Clinton County Core Values Advocacy, Collaboration, Excellence, Innovation, Integrity, Service Health Care Services Division Overview The Health Care Services Division targets the part of the Department s mission addressing prevention. Services include primary and secondary prevention interventions to impact population measures by serving those individuals and families who are at risk for adverse health outcomes. Table of contents Executive Overview... 2 Program Highlights... 3-22 Immunization Services... 3-6 Sexually Transmissible Infections Clinic... 6-7 HIV Testing... 7-8 Communicable Disease... 9-12 Tuberculosis Program... 12 Lead Screening Program... 13 Improved Pregnancy Outcome (IPO)... 14-16 Newborn / Postpartum... 16-17 Family Services / Children with Special Health Care Needs (CSHCN)... 18-19 Developmental Services... 20-22 Division Presentations, Trainings, and Other Community Engagement... 23-24 List of Acronyms... 25 Division Contacts... 26-29 2 0 1 4 A n n u a l R e p o r t H e a l t h C a r e S e r v i c e s D i v i s i o n Page 1

Executive Overview The Health Care Services Division provides health services in the community. It is diverse as it operates under four different Articles and two State Departments Department of Health, Articles 25, 28 & 36 and the Department of Education, Article 89. Key staff changes were anticipated and planned starting in and continuing into 2015. The Article 36 (LHCSA) home visiting SPHN, Pam LeFebvre retired in August,. The return of former homecare SPHN Nichole Louis was welcomed with several years of homecare clinical, supervisory and management experience. The Children s Service Coordinator (CSC), Vicki Driscoll, retired in December. Ms. Driscoll directed the Early Intervention (DOH Article 25) and Preschool (SED Article 89) programs. This is a pivotal position that oversees two very highly regulated, State controlled programs. A new CSC Dr. Wanda McQueen began January 2, 2015. The Article 28 programs (Immunizations, Communicable Disease Management and Surveillance Programs) remained stable during. Cross-training of personnel to at least one secondary program continues. The HCS division held four quarterly Quality Assurance Meetings (QAC) and four quarterly Professional Advisory Committee (PAC) meetings. The PAC is comprised of 21 community and county representatives. During each meeting, efforts and updates pertaining to the HCS Division are reported and discussed. The meeting agenda has expanded to learn about and discuss community programs, challenges and efforts. The Health, Planning and Promotion (HPP) Director is now a member of the committee. This committee provides a forum to bring forth to the community key topics such as CHIP, CHHA, grant and CCHD initiatives. The QAC is comprised of 12 in-house and community representatives including the Medical Director. The QAC provides a forum to discuss and facilitate quality assurance issues such as best practices, policy & procedure approval, utilization review, ongoing professional education, HIPAA and Corporate Compliance Regulations and compliance efforts, root cause analysis of complaints and incidents, and patient satisfaction surveys and their needed follow-up. Ongoing employee education in clinical areas continues. The staff receives this education through local and state conferences, seminars, webinars and in-house presentations. All in all, as the health care industry in the nation continues to change, HCS must also change. The provision of gap services to our County residents is critical in our community. Internally, the process of a program evaluation including a needs analysis starting with the IPO Program has begun. This will continue into 2015 and beyond. Our mission continues to address prevention by serving those individuals and families who are at risk for adverse health outcomes. 2 0 1 4 A n n u a l R e p o r t H e a l t h C a r e S e r v i c e s D i v i s i o n Page 2

Program Highlights Immunization Services CCHD offers regularly scheduled Immunization Clinics as part of the ongoing effort to make Clinton County s environment safe and its residents healthy. The HCS Division publicizes Immunization Clinic dates and locations through the CCHD website at www.clintonhealth.org and print media. Individuals who may have limited access to services through providers and pharmacies may choose to attend a health department clinic. Highlights CCHD received additional public vaccines to serve the underinsured or uninsured adult population. This included MMR (Measles, Mumps and Rubella), Tdap (Tetanus, diphtheria and acellular pertussis), HPV (Human Papilloma Virus) and Zostavax vaccines. CCHD staff offered no-cost Tdap and influenza vaccines to adult relatives and caregivers of newborn babies in an effort to protect new born babies by cocooning. The vaccines were offered at CVPH in the lactation room just steps away from the newborn postpartum unit. This program began in January and was completed in May when the supply of free Tdap was exhausted. A total of 147 Tdap vaccines were administered. NYSDOH required all public vaccine programs to maintain inventory, vaccine ordering and refrigerator/freezer temps in the New York State Immunization Information System (NYSIIS). This was initiated to aide in the monitoring of VFC/public vaccine usage, and to discourage fraud and abuse of the system. CCHD has been complying with this system since early. Decreases have been observed in vaccines (except Tdap/ Hepatitis vaccines) distribution by CCHD. This is related to guideline changes in the Vaccine for Children Program (VFC) that became effective in 2012. These guidelines prohibit local health departments from vaccinating anyone under the age of 19 who has medical insurance. This encourages the populace to receive vaccine from their primary care provider. In addition, many pharmacies provide adults with flu, Pneumococcal 23, Prevnar 13 and Zostavax vaccines. They are able to bill insurances including supplemental Medicare insurances when necessary. We continue to direct adult and childhood vaccine recipients to providers who are equipped to provide the vaccines needed at the most cost effective manner. During HCS purchased three new Data Logger temperature monitoring systems to consistently and accurately document refrigerator and freezer temperatures. The information is downloaded from each Data Logger into a computer program. This maintains accurate records of vaccine temperatures as required by NYSDOH Vaccine programs. The HPV Initiative is a partnership between a pilot pediatric provider, HPP and HCS. The goal is to increase HPV vaccination rates in females aged 13 to 17 through provider education. A chart audit was completed at the provider s office to determine baseline data. On-going data collection from more providers will allow for modification of goals as needed. 2 0 1 4 A n n u a l R e p o r t H e a l t h C a r e S e r v i c e s D i v i s i o n Page 3

Request for Hepatitis A or A/B vaccine has increased to meet the numbers of those diagnosed with Hepatitis C. Diagnosis is made through primary providers meeting the recommendation to test all baby boomers or through drug rehabilitation or jail services. The use of Hepatitis A vaccine as a single antigen is used with the population that have a history of receiving Hepatitis B vaccine as a requirement for school or work. Those with no history of Hepatitis B vaccine receive Hepatitis A/B with both antigens. Program Analysis: CCHD continues to meet the needs of the public to fill the gap service for immunizations when not available at other venues. Primary Care Providers may offer limited or no vaccines to their patients and use CCHD to fill the role for their patient vaccine needs. Additionally, individuals may not have primary care or lack insurance or funds for the vaccines they need. Doses Given: Selected Vaccines 2012 2013 Hepatitis A 48 38 49 Hepatitis B 78 70 37 Hepatitis A/B Combo 74 70 101 HPV 51 18 7 Meningitis 52 37 21 MMR 124 93 96 Pneumococcal Poly 54 46 35 Tdap 219 380 408* Zostavax(shingles) 170 44 22 Varicella 67 51 32 Rabies 69 57 Goals: 2015 *Doses from Adult Public supplies and VFC Supplies included Denotes number of vaccines (not persons) actually given since the rabies vaccine is given as a series. Continue to outreach to uninsured and underserved populations, including adults and other unimmunized segments of the community, with emphasis on HPV and Tdap vaccination. Continue development and implementation of new VFC/NYSIIS regulations and billing procedures with emphasis on further development of our Med Services computer software program, sharing appropriate data with the NYSIIS system, to assist with inventory monitoring. Evaluate and implement cost effective initiatives for private billing of immunizations to maximize revenue available to CCHD from numerous insurances including Medicare Part B. Assess the availability and access to adult vaccines in the community and develop plans for outreach for this population. 2 0 1 4 A n n u a l R e p o r t H e a l t h C a r e S e r v i c e s D i v i s i o n Page 4

Rabies Vaccination Program The rabies program is a shared program between the Environmental Health and Safety and Health Care Services Divisions within the agency to meet the terms of Title IV of New York State Health Law: rabies section 2140-2145. This includes the identification and control of animal rabies and the suppression of human rabies. In, fifty-seven doses of post-exposure rabies vaccine were administered to twenty-two individuals. There were no shortages of vaccine over the calendar year as has been in the past. In December, a Rabies Program Quality Improvement project between EHS and HCS was begun. Goals of the project include: Improving the performance of public health response to human potential rabies exposures. Improving rate of compliance with accuracy of HRIG administration targeted training. Increasing rate of compliance for timely reporting of all animal bites and exposures from providers. Increasing efficiency of communication and documentation by adopting use of the rabies CDESS database. Influenza/Pneumococcal Clinic Program Highlights September 2013 to May Influenza season: CCHD continued its influenza immunization program with clinics throughout the county offered to high risk individuals. Clinics were offered at senior housing venues, Advocacy and Resource Center, Alzheimer s Program, Behavioral Health Services and Clinton County Mental Health for a total of 14 clinics. CCHD continues to offer flu and pneumococcal vaccine at regularly scheduled clinics. The influenza activity level during the final weeks of into 2015 was categorized as widespread to epidemic across 43 states including New York. Due to drift in the Influenza A H3N2 virus, the flu vaccine this year is expected to be less effective. Vaccine Doses Administered Vaccine 2012 2013 Influenza 1098 657 721 Pneumococcal 62 51 43* * Includes vaccinations given at immunization and flu clinics including Pneumococcal 23 and Prevnar 13. 2 0 1 4 A n n u a l R e p o r t H e a l t h C a r e S e r v i c e s D i v i s i o n Page 5

Goals: 2015 Continue serving as the safety net for the community, providing influenza vaccine to high risk populations who find it difficult to access vaccine in the private sector. Continue to offer high dose influenza vaccine to those in the community 65 years and older (pharmacies may not offer high dose influenza vaccine). Sexually Transmissible Infections Clinic Public Health Law 2308 requires that local health departments provide adequate facilities for the free diagnosis and treatment of persons living within its jurisdiction who are suspected of being infected or are infected with an STD. Clinton County meets this mandate by contracting with Planned Parenthood of the North Country for the service of testing and treating clients with STI s / STD s. Highlights In September of 2013, Public Health Law 2308 was amended to allow for use of personal health insurance to cover the cost for testing and treating of sexually transmitted infections. The local health department is billed only for individuals without health insurance. marked the first full year with the change in effect. Statistics show a significant decrease in requested reimbursement with a cost savings to CCHD of 73% as compared to 2012 and services. See table below: Year CCHD cost Breakdown of costs 2012 $128,250.00 CCHD paid 100% of cost. 2013 $88,400.00 CCHD paid 8 months of full cost and 4 months only for those individuals with no insurance to cover the cost of testing and treatment. $34,440.00 CCHD paid only for those with no insurance to cover the cost of testing and treatment. In, due to the change in reimbursement, STI clinic attendance was decreased. 2 0 1 4 A n n u a l R e p o r t H e a l t h C a r e S e r v i c e s D i v i s i o n Page 6

breakdown of 139 cases: Requested screening for sexually transmitted infections: 103 attendees requested screening for an STI but were asymptomatic, with 12% of the 103 testing positive for a reportable STI. Symptomatic persons: 36 attendees requested STI testing due to symptoms of an STI. Forty-four percent of the 36 attendees tested positive for a reportable STI. Program Analysis: Due to the changes in NYS Law the financial responsibilities of CCHD have decreased significantly. The system is still structured to allow testing and treatment for any county resident with a suspected sexually transmitted disease without a primary care provider or insurance to cover the cost. Goals: 2015 CCHD will continue member participation with the Clinton County Partners for Awareness & Service Group, to promote identification, treatment and prevention of sexually transmitted infections. HIV Testing Highlights HIV testing is available through CCHD by two different venues. The first is through CCHD s contract with Planned Parenthood of the North Country. The majority of individuals requesting HIV testing obtain services from that venue while attending an STI clinic for screening or treatment of an STI. 2 0 1 4 A n n u a l R e p o r t H e a l t h C a r e S e r v i c e s D i v i s i o n Page 7

The second venue is at the monthly HIV clinic offered at Health Care Services. Participants may choose anonymous (no identifying information is collected) or confidential (information is collected but kept confidential) testing. CCHD is the only place in the county where a person can receive anonymous testing. All other testing options within the community to include private providers, student health centers and the Alliance for Positive Health (formerly the AIDS Institute) can only provide confidential testing. Health Care Services is a participant in the Clinton County Partners for Awareness & Service Organization. Member agencies include the Alliance for Positive Health, Planned Parenthood of the North Country, Plattsburgh State University, Clinton Community College and The University of Vermont- CVPH. The organization organizes educational and testing events to encourage prevention and early detection and treatment of sexually transmitted infections. Defendant HIV Testing HIV Test Site 2012 2013 PPNCNY-CCHD Clinic contract 529 288 109 Chest Clinic 8 6 1 CCHD-anonymous 4 0 4 Confidential 7 0 4 Total 548 294 118 Under New York State law, a defendant accused of rape or sexual assault can be court ordered to participate in HIV testing. When court ordered the LHD is required to complete the testing, either by HIV antibody test and/or an HIV viral load depending on the time frame of the assault. There were no court orders in requesting HIV testing. Program Analysis We continue to see a reduction in HIV testing at HCS associated with a change in legislation in 2013, allowing tests to be billed to third party insurers (those statistics are not reported to the LHD). Additionally, HIV testing is now a normalized part of routine medical requirement that states that HIV testing is offered to all persons between the ages of 13 and 64 receiving hospital or primary care services. Goals: 2015 Provide educational resources and outreach to primary care providers to assist in their compliance with the adopted regulations to offer testing, technical assistance and other resources. Continue monthly CCHD HIV testing clinics to assure access to anonymous and confidential testing at no cost in Clinton County. 2 0 1 4 A n n u a l R e p o r t H e a l t h C a r e S e r v i c e s D i v i s i o n Page 8

Communicable Disease Communicable Disease BOLD FACE = Vaccine Preventable Disease 2012 2013 Anaplasmosis 0 0 1 Campylobacter 6 13 8 Chlamydia 284 252 328 Coccidioides- Valley Fever 0 1 0 Cryptosporidiosis 1 0 1 Dengue Fever 1 0 0 E. coli 0157/not subtyped 0 2 1 Encephalitis 0 0 1(Arbo) Giardiasis 5 7 6 Gonorrhea 33 17 27 H. influenza (invasive) 3 0 1 Hepatitis A 0 0 0 Hepatitis B - Acute 0 3 0 Chronic 3 4 1 Chronic inmate 4 2 5 Perinatal Hep B 1* 0 0 Hepatitis C Acute 1 6 2 Chronic 71 111 94 Chronic inmate 61 63 81 Influenza confirmed Lab 46 28 82 Legionellosis 1 3 5 Lyme Disease 21 49 25 Meningitis - Aseptic 3 1 4 Herpes 0 0 0 Meningococcal 0 0 0 Bacterial 0 1 0 Pneumococcal 0 0 0 Pertussis 36 49 40 Rabies Exposure- lab test (+) 2 2 2 Rocky Mt. Spotted Fever 0 1 0 Salmonellosis 14 9 7 Shigella Staphylococcus Aureus - NB 0 0 0 0 0 0 Streptococcal - 2 3 7 Group A (invasive) Group B 5 7 7 Streptococcal pneumonia 8 10 8 Syphilis Prenatal syphilis exposure 7 0 9 1 4 0 Tuberculosis Active disease 1 1 0 TOTALS cases 620 654 660 All three years of cases were reconciled with NYSDOH stats for (+) case definitions only since they may vary depending on lab testing. 2 0 1 4 A n n u a l R e p o r t H e a l t h C a r e S e r v i c e s D i v i s i o n Page 9

The Communicable Disease Program monitors and investigates exposure of communicable disease to individuals and the public in an effort to detect, treat and prevent further transmission. There are many tools used by the program to evaluate and determine the status of communicable disease within the community. Surveillance gathering is aided by community partners to include medical and dental providers, Alliance for Positive Health, University of Vermont Health Network at CVPH and Planned Parenthood of the North County New York (PPNCNY). Additionally, Plattsburgh State University (PSU), Clinton Community College (CCC), long-term care facilities, veterinary offices, pharmacies, the public school systems and MD offices assist in the surveillance process. This collaboration is vital in active surveillance. Partner agencies call with questions, comments and possible trends which aid in the surveillance process. Highlights The Communicable Disease team received the NYS Communicable Disease Performance Improvement Award with a final achievement score of 99.04 during the monitored performance period for the first six months of. The award criteria looked at timeliness and completeness of case reporting. One case of Ebola symptom compatible illness was identified in a traveler to Africa as reported by a primary care provider. The individual had not traveled to any of the Ebola impacted countries and was quickly ruled out as a suspect case by NYSDOH and the CDC. The provider had quickly followed the reporting requirement to notify the LHD. Chlamydia cases show a 10% increase over previous year. Sexually transmitted infections (STIs) account for the majority of communicable disease cases throughout the year. Some provider offices including Pediatric providers have reported that they are screening sexually active individuals at a higher rate than in the past, which may account for a certain proportion in the increase in cases. Syphilis was still detected within the community, although fewer cases were reported in. Confirmed influenza cases were reported in higher than usual numbers with only viral cultures or PCR testing considered as positive influenza cases by NYSDOH. Rapid testing performed in medical offices falls under Influenza like illness (ILI) and is not reported. Early in the 2013- Flu season, cases were reported as mainly influenza A (H1N1) as the most prevalent virus circulating. A second wave of positive flu cases occurred later in the season with influenza B becoming the more prevalent virus over the entire state. Although not a reportable illness, Enterovirus D-68 (EV-D68) was detected across the country in higher than usual numbers. Training and webinars were provided by NYSDOH and this information was then shared with providers by Public Health Connection newsletter, Partner Nurse and direct faxes. It was important to differentiate EV-D68 disease from other circulating respiratory illnesses. Positive test results for two individuals resulting in two laboratory-confirmed cases in Clinton County. Both children were hospitalized and have since recovered. Lyme disease reports remained steady throughout the year. NYSDOH provided signage for community parks and other outdoor recreational facilities to alert people to the presence of ticks and prevention of Lyme Disease. Public education outreach included radio segments to encourage tick prevention and action to take for a possible exposure. One person was diagnosed with two tick-borne illnesses (Ehrilichiosis and Babesiois) that are not known to be endemic in Clinton County. Exposure was presumed to be elsewhere since the individual had travelled to an endemic area. 2 0 1 4 A n n u a l R e p o r t H e a l t h C a r e S e r v i c e s D i v i s i o n Page 10

The mosquito-borne illness known as Saint Louis Encephalitis was confirmed in an elderly person with no travel history. Saint Louis Encephalitis is not known to be endemic in Clinton County. Increased surveillance will monitor for further in-county disease. Tularemia was confirmed in one child with travel to a tularemia endemic area and history of an insect bite. A sibling was also tested, treated and counted as a suspect case. Sources of tularemia disease are usually rabbits, ticks or deer flies. Significant reports of norovirus within the community coincided with NYSDOH reports across the state. Many community nursing homes and adult care facilities were impacted with both patients and staff affected. An increase in the invasive streptococcal pneumonia reports corresponded to high levels of strep throat reported by the local schools and primary care providers through community surveillance. The beginning of the school year brought an increase in pertussis cases as many of those ill were affiliated with a school sports team. Only investigations meeting the NYSDOH pertussis case definition were counted as actual cases in the final tally. Pertussis education was provided to the community via WIRY s Health Program within on-air discussion between public health nurses and WIRY staff. HCS nurses also network closely with school nurses and pediatric office management staff. Hepatitis C infections continue to be investigated with similar numbers of cases seen each year. Investigations reveal needle and drug paraphernalia sharing among this population. The Alliance for Positive Health Program (formerly AIDS Council) has been accepted as a needle exchange provider. Needle exchange programs is an evidence-based intervention to decrease disease rates. The Alliance will capture statistics to assess for program effectiveness over the next few years. Additionally, the NYSDOH law requires primary care providers to offer hepatitis testing to all persons born between 1942 and 1965. One case of hepatitis C co-infection with HIV was also newly diagnosed. Staff continues to use on-line webinar opportunities to keep current on emerging disease topics. This includes the topics of Lyme disease, pertussis, tuberculosis, EV-D68, influenza, and Chikungunya. Public Health nurses also attended conferences on community public health concerns which included training at the Global Tuberculosis Institute. Program Analysis Chlamydia, Hepatitis C and Pertussis cases continue to be elevated. Pertussis disease has been increasing nation-wide since the early 1980 s. Identified causes include increased awareness, improved diagnostic tests and waning immunity. With waning immunity, the acellular pertussis vaccine (DTaP) now used may not protect the individual as long as the whole cell vaccine (DTP) did. International travel continues to bring diseases such as Ebola and Chickungunya from other endemic areas around the country and world. Travel history is a very important portion of illness investigation and allows for early identification and treatment of these diseases. 2 0 1 4 A n n u a l R e p o r t H e a l t h C a r e S e r v i c e s D i v i s i o n Page 11

Goals: 2015 Provide staff training in EXCEL computer program to assure competence with disease line listing creation. Continue to educate individuals, agencies and providers in Public Health recommendations through media venues including Facebook, the CCHD website and outreach activities. Tuberculosis Clinic Program New York State Law requires local health departments to provide TB surveillance, identification and treatment of active cases and their close contacts who reside in the county. The mission of the CCHD-Health Care Services Chest Clinic is to identify and treat latent TB infections and active TB disease to prevent the spread of TB. Targeted tuberculosis (TB) testing is used to focus program activities, provider practices, and financial resources to groups at the highest risk for latent tuberculosis infection (LTBI). Highlights There were several staff changes. The former alternate Public Health Nurse became the Chest Clinic charge nurse and a second Public Health Nurse became an alternate. Both nurses have completed extensive training at the Global Tuberculosis Institute in New Jersey. CCHD TB Program Statistics 2011-2013 2011 2012 2013 Active TB 0 1 1 0 Total Chest Clinic Visits 38 41 57 21 Tuberculin Skin Tests (TST) 151 122 201 107 Program Analysis Chest Clinic continues to adhere to CDC guidelines for targeted testing and treatment of those who have an increased likelihood of exposure to persons with TB disease and those with clinical conditions that increase the risk of progression from LTBI to TB disease. CDC discourages use of diagnostic tests for LTBI among individuals and populations at low risk for infection and may be responsible for decreased requests for testing. Goals: 2015 Education and training for primary care providers on CDC recommended practices for placing and reading tuberculin skin testing and Chest Clinic referral requirements through Partner Nurse packet information and the 2015 Primary Provider Workshop. 2 0 1 4 A n n u a l R e p o r t H e a l t h C a r e S e r v i c e s D i v i s i o n Page 12

Lead Screening Program Control of Lead Poisoning NYS Public Health Law, Title 10 of Article 13, guides local health departments in the development and implementation of plans, policies and services for the prevention and elimination of childhood lead poisoning. Included in the law is the identification and management of children with lead poisoning, and strategies to detect and reduce lead hazards in the environment. The Clinton County Health Department (CCHD) offers lead poisoning prevention education and capillary lead tests as part of the Lead Screening Program. Capillary blood tests are available at a monthly lead clinic and as needed for outreach activities. Payment for this service is based on a sliding fee scale and third party insurance. Highlights The lead program is administered through two divisions of CCHD including Health Care Services(HCS) and Environmental Health and Safety (EHS). Due to staff changes in EHS, a new sanitarian was certified by NYS as a lead inspector. EHS lead inspectors deal with the physical environment, while HCS nurses deal with the individuals involved. The lead program assists community agencies such as Head Start to assure that new students have up-to-date lead levels on file with participation in their Fall into Head Start Program. Additionally, staff provided daycare provider training at Child Care Resource Center- Family Connections Program. Lead resource materials for parents and children are disseminated at all HCS outreach opportunities. Number of elevated Lead Cases 2012 2012 2013 Total CCHD Children Screened 16 1* 4* 10 14 mcg/dl 0 2 1 15 19 mcg/dl 3 0 2 >20 mcg/dl 0 0 1 TOTAL NEW ELEVATED CASES 3 2 4 *Total screened reflects patients receiving screening through the Health Department. Decreasing numbers reflect children receiving testing by their primary provider. Program Analysis All Clinton County pediatric providers continue in-office testing for capillary lead levels. This has increased the amount of children being tested allowing for early detection and elimination of lead hazards. Goals: 2015 Revision of the shared lead policy including the use of components of NYSDOH Lead Web System. The Lead Web Program can electronically create referrals between the EHS and HCS divisions. Quarterly meetings between the two divisions will assure high performance in case management. 2 0 1 4 A n n u a l R e p o r t H e a l t h C a r e S e r v i c e s D i v i s i o n Page 13

Improved Pregnancy Program (IPO) The goal of the IPO program is to improve pregnancy outcomes by ongoing prenatal care. The goal is for the mom to stay well during pregnancy and to be prepared for parenting. This increases the likelihood of having healthy, full-term babies. The IPO program is a voluntary, prenatal home visiting program for women who want additional support and are determined to be at high risk during their pregnancies. The nurses provide information on nutrition, immunizations, exercise, healthy lifestyle choices, emergency preparedness, and community resources relating to pregnancy and parenting. The registered nurses who partner with the mothers monitor the growth and development of both mother and baby. They help the mothers manage pregnancy symptoms and complications. Highlights New breastfeeding initiatives were started as a result of the successful completion of the International Board Certified Lactation Consultant (IBCLC) examination by two of our staff nurses. The information packets provided at enrollment, 28 weeks and postpartum now have new lactation handouts for those who are choosing to breastfeed. The nurses were invited to attend the visit of Dr Nils Bergman of South Africa at CVPH, an expert in the Infant/Parent bonding and the creator of Skin to Skin techniques. They attended a private demonstration and CVPH grand rounds. Two IPO program nurses were interviewed on Plattsburgh s local radio station, WIRY, about the program. IPO was featured at the multiple agency community baby shower. This annual event provides education and support services for pregnant women and young families in our community. A new partner nurse committee was formed including IPO nurses to increase communication with medical practices and other providers. Up to date information on health, immunizations and emergency preparedness at regular quarterly intervals is provided. The use of the PHQ-2 Mental Health screen was initiated in March for use at enrollment and postpartum. Pregnant women are screened for depression and referred to supporting agencies during and after the birth of the baby as part of a larger community effort to improve mental, emotional and behavioral services provision. The volunteer partnerships with Dr. Prondecki and Dr. Steinfeld, two local dentists, were ended. This was, in part, due to the high incidence of missed appointments by IPO clients who were referred to the dental offices. 2 0 1 4 A n n u a l R e p o r t H e a l t h C a r e S e r v i c e s D i v i s i o n Page 14

Selected Statistics for IPO Participants 2013-2104 2013 * Total Referrals 83 102 Total Enrolled 55 41 Total Discharged 59** 24** Referred Woman Enrolled 66% 40% Enrolled Women <19 yrs. 16% 17% Enrolled Women >35 yrs. 2% 8% Obesity BMI >29 40% 33% Preterm Infants <37 wks. 21% 12.5% IPO Infants <5 lb. 8oz. 11.5% 8% IPO Infants >9 lbs. 3.8% 4% Socio-Economic Concerns 76% 92% Community Referrals (made by RNs) 92% 96% ***Breastfeeding choice at enrollment N/A 37% Formula feeding choice at enrollment N/A 8% Breastfeeding and formula feeding N/A 4% Undecided feeding choice at N/A 54% enrollment Breastfeeding choice postpartum (PP) N/A 37.5% Formula feeding PP N/A 17% Breastfeeding and Formula feeding PP N/A 12% Choice of feeding not given N/A 29% Tdap Antepartum N/A 29% Tdap Postpartum N/A 8% Unknown Tdap N/A 62% MEB concerns N/A 54% Data based on statistics gathered at discharge (*) Statistics reported only for the clients in who were retained to postpartum (**) includes patients enrolled during 2012 or 2013 respectively (***) stats shown for only 5 months of data for Program Analysis The statistical data report was expanded mid-year to include tracking on the following data: feeding choices, pertussis immunization, extent of smoking, alcohol and drug use, medical issues or diagnosis, Mental- Emotional-Behavioral (MEB) concerns and retention to postpartum of clients who had been enrolled in the program. The data being collected includes pregnant women with medical diagnosis due to pregnancy (pregnancy induced hypertension, gestational diabetes, and anemia) and any other medical diagnosis during their pregnancy (hypertension, sexually transmitted infections and communicable disease). MEB concerns that are being tracked are women with depression, anxiety and persistent mental health behavioral illnesses. These additions will help to develop the IPO program further to better address issues affecting participants during the antepartum and postpartum periods. 2 0 1 4 A n n u a l R e p o r t H e a l t h C a r e S e r v i c e s D i v i s i o n Page 15

The number of clients reported in for statistical purposes included only those that completed the program, as defined by enrollment and retention through to a postpartum visit. The number of clients for 2013 included all clients enrolled but not necessarily completing the program. Goals: 2015 Continue to gather data on pregnant mothers with the additional tracking elements to expand the criteria for enrollment, identify target populations and to identify additional outreach and educational opportunities to increase referral sources. The outcomes being collected will be analyzed and evaluated to develop program guidelines for best practice to improve maternal and newborn health within the IPO program. As part of the CCHD plan, initiatives to strengthen and expand breastfeeding initiation and duration within the community infrastructure, IPO is an opportunity to provide education to the pregnant women and their families about breast feeding and importance of overall health. Recommendations from the CDC have guided the practice of third trimester Tdap immunization in an effort to pass on immunity to the neonate. IPO nurses will continue to assess, instruct importance of receiving this immunization. Tracking of this information will continue to assess the outcome of the recommendation within the population. Influenza vaccine is also recommended during pregnancy. The patients are being referred to CCHD clinics and primary care providers to receive their immunizations. The IPO program has a high percentage of mothers with psycho-social concerns and in need of community based services. With this data establishing a collaboration and/or partnership with community counseling services in the community to better serve this population. Newborn/Post-partum Program: Health Care Services offers health promotion programs for newborns and their families residing in Clinton County. The newborn-postpartum visit is an opportunity to provide a positive outcome during the neonatal period, aiding in the prevention or early detection of growth and developmental problems. Services are directed toward providing the following: assessment and provision of information regarding the emotional, social, and physical care of the newborn and parents, with emphasis on immunization, nutrition, safety, healthy lifestyles choices, and growth and development. Information on community resources is provided and assistance with referrals is offered when indicated. Other topics addressed include maternal health promotion and prevention, postpartum depression, family planning, and pre-conception health. Highlights Referrals from local hospitals generate a phone call contact to all families with newborns residing in Clinton County offering a home visit. The focus on higher priority criteria for home visits include: first time parents, high risk multipara, early follow-ups, and breastfeeding families. All families that declined the home visit service received a mailed newborn information packet. A continued focus on adult Tdap vaccination information was shared with participants at newborn rounds, postpartum home visits, and in packets mailed to the families. The importance of Tdap vaccination is critical to protecting babies by surrounding the baby with caregivers that are immunized against pertussis, providing a cocooning effect. 2 0 1 4 A n n u a l R e p o r t H e a l t h C a r e S e r v i c e s D i v i s i o n Page 16

Newborn rounds at UVM Medical Center-CVPH are conducted Monday through Friday by HCS nurses. Postpartum packets were updated and standardized with up to date brochures and materials. A new SPHN was appointed to the MCH program and has revised and updated the intake process and developed a spreadsheet to more accurately record referrals and home visiting data. A priority to assign first time breastfeeding mothers to one of HCS s two Certified Lactation Consultants increases patient continuity of care. *Every family is offered a home visit **In 2011 and 2012 MOMS participants were targeted for visits Program Analysis The total number of newborn referrals in Clinton County was 694.The number of referrals received in increased from 683 to 694. All Clinton county newborn referrals were offered services via direct contact during newborn rounds, a telephone call, or a mailed newborn packet. Families specifically targeted for a home visit included first time mothers, infants born to active IPO participants, medical concerns for mother or baby regardless of parity and all breastfeeding mothers. The number of referrals targeted for a visit was 694 with 184 families accepting services in.the percentage of families that accepted services in decreased by 18 % from 2013. This decrease may be explained by the transition from the MOMS program to the IPO program over the last three years. Without the ability to facilitate insurance enrollment, the participation in the IPO program has significantly decreased thus decreasing the number of families participating in the newborn program. Goals: 2015 Newborn / Postpartum Visits 2011 2012 2013 No. Newborns Referred* 718 683 653 694 No. Referred Targeted for Visit ** 506 683 653 694 Numbers & Percentage Targeted with Completed Home Visit 343 68% 432 63% 291 45% 184 27% Improve the newborn and postpartum information packets and mailings with the use of consolidated up to date brochures and educational materials with a particular focus on breastfeeding. Increase education and support for breastfeeding families with the availability of two staff certified Lactation Consultants. Continue staff education on promoting and supporting breastfeeding families. Encourage Tdap vaccine to partners and all caregivers with direct newborn contact via newborn rounds. Encourage the distribution and return of client satisfaction survey postcards for feedback regarding home visits for improved program feedback. 2 0 1 4 A n n u a l R e p o r t H e a l t h C a r e S e r v i c e s D i v i s i o n Page 17

Family Services/CSHCN The Children with Special Health Care Needs Program (CSHCN) is a statewide public health grant that provides case management services for information and referral services for health and related areas for families of eligible children. To be eligible for the services the child needs to be between 0-21 years of age who has or is suspected of having a serious or chronic physical, developmental, behavioral or emotional condition and who also require health and related services of a type or amount beyond that required by children generally. The Family Services Program provides case management nursing assessment, education, and guidance in the areas of breastfeeding and nutrition, development, safety, immunization, bereavement for pregnancy loss, still born and newborn deaths, and chronic disease prevention to families in Clinton County. As part of the Family Services Program, HCS nurses also make referrals to programs within CCHD such as the Early Intervention Program, Lead Program, WIC, and Healthy Neighborhoods, as well as, other community agencies. Highlights (CSHCN) There were 21 referrals to CSHCN program in. Each family was provided with the Resource Directory for Children and Young Adults with Special Health Care Needs, Children with Special Health Care Needs brochure, CCHD s Immunization Services brochure, 10 Things To Do To Prevent Infectious Disease handout, Steps to Healthy Lifestyle brochure, Health Care Services Telephone Listings Of Local Agencies and Services, CCHD Family Services brochure and Plan 9 handout. All 21 children that were referred were 4 years-old and under. The health care needs identified for referral were most often infant prematurity, including the complications and conditions associated with prematurity. Others included failure to thrive, metabolic abnormalities, cardiac defects, respiratory diseases, and congenital abnormalities. All families received information on CSHCN, information on their specific diagnoses, and other community resources available to them based on the specific needs of the patient and family. Referral sources: CCHD, Crimes Victims advocacy, Primary Care Providers, Local Hospitals and parents of children with special health care needs. A HCS registered nurse and supervising public health nurse presented an overview of the CSHCN program to the Clinton County Board of Health on November 17,. Quarterly outreach continued throughout. Brochures and posters were sent to pediatricians, primary care physicians and obstetricians at The University of Vermont Health Care Network in Plattsburgh and Burlington Vermont (Formally known as CVPH Medical Center and Fletcher Allen Health Care, respectively). The Health Care Services division also provided CSHCN information to school nurses and counselors and other community based programs within Clinton County that focus efforts on families and children. Highlights (Family Services) There were 21 referrals/transitions to the Family Services Program in. Referral sources include other home visiting programs at CCHD, such as Newborn/Postpartum, CSHCN and IPO Programs, and other community agencies including the Clinton County Department of Social Services, primary care providers and self-referrals from families directly. Three of the referred cases did not receive any services due to lack of connection with the family after the referral was received. There are a variety of reasons for referrals to the Family Services Program including newborn assessment after 6 weeks of life, postpartum depression, potential failure to thrive, lack of insurance 2 0 1 4 A n n u a l R e p o r t H e a l t h C a r e S e r v i c e s D i v i s i o n Page 18

coverage, child behavioral issues. parenting education needs, wellness check, lice education, breastfeeding consultation and medical assessments. In HCS has an expanded role in the overall CCHD / Community initiatives to strengthen and expand breastfeeding initiation and duration within the community. HCS participates in collaboration with WIC, University of Vermont Health Care-CVPH, HPP, and local providers in a Breastfeeding Coalition that is focusing on increasing initiation of breastfeeding among postpartum women by 10% and increasing duration of breastfeeding by 5%. Referrals Program 2010 2011 2012 2013 Family Service 11 14 16 22 21 CSHCN 16 23 5 7 21 Total 27 37 21 29 42 Program Analysis: The CSHCN had a three times increase in referral and participation from 2013 to. The increase is due to several factors including broadening outreach efforts to extend into all community based services, reviewing intake information for eligibility criteria and guiding referral sources specific to the program. Efforts are continuing for collaboration with referring hospitals with neonatal intensive care units for those children born prematurely or for other diagnoses that prolongs hospitalization after birth. The Family Services Program remains consistent with referral numbers in. This program has expanded by adding additional breastfeeding support to mothers in need of lactation consultants. Goals: 2015 CCHD HCS Division will continue to track participants within the NYSDOH Health Commerce System and reporting of the grant as outlined. A new system has been implemented which will improve care through quality measures. The system will be gathering information for planning future outreach efforts, case management services and community collaborations to continue to improve the system of care for children and families within our community. The CSHCN brochure was reviewed and a new version will be published in 2015 to encompass all visiting programs that are offered by CCHD. All infants and children referred to health department programs will be screened and evaluated for needs and will be offered case management services in the CSHCN program if they meet eligibility. HCS will continue to participate in the Breastfeeding Coalition with community partners with the goal to improve the overall health of the community by improving breastfeeding rates and duration. 2 0 1 4 A n n u a l R e p o r t H e a l t h C a r e S e r v i c e s D i v i s i o n Page 19

Developmental Services The mission of the Developmental Services Team is to identify, evaluate and coordinate services for children ages birth to 5 years whose development is compromised and to provide appropriate intervention for improving child and family development. It is comprised of two programs: the Early Intervention program, designed for children under the age of three and the Preschool Program, providing services to children ages 3 to 5. It operates under two NYS laws: Article 25 Section 69-4, (Early Intervention Services) and Article 89 of the State Education Law Section 4410, (Preschool Special Education Services). Both programs are designed to facilitate the identification of, evaluation of and the provision of therapeutic and/or educational services to children with developmental delays. Highlights Early Intervention and Preschool Early Intervention served 335 children this year Preschool served 388 children this year End of year staffing levels: Early Intervention- four full time Service Coordinators, two staff with part time hours allotted to Early Intervention; Preschool- full time Children s Services Program Specialist and the part time, seasonal Preschool Program Assistant; Children Services Coordinator position vacant due to retirement and new staff starting 1/2/2015. New Service Coordinator completed training, interim Children s Services Program Specialist trained and new Children Services Coordinator (CSC) hired. Preparations for other pending staff retirements in 2015 began, including budgeting for retiring CSC to continue as a contractor to support new staff. Staff attended numerous trainings offered by local provider agencies, CCHD, all-county webinars and conference calls, Center for Disease Control (CDC), Champlain Valley Physician s Hospital (CVPH) and the EI Learning Network Program policies and procedures were reviewed, revised and/or rewritten Staff reviewed program forms to ensure they were in compliance with regulations; forms were revised as needed. On-going quality assurance efforts continue internally and for community providers. Parent satisfaction surveys are completed regularly for both EI and Preschool. Preschool program was selected for a Medicaid Audit. The final report has not yet been published but notice was received that the agency successfully met the criteria established. Continued active involvement at the regional and statewide level advocating for major regulatory changes within the Preschool Program. Manual for the Preschool Program operations was completed. Most EI and Preschool templates have been consolidated and organized in the computer network. A system was developed for ongoing organization. Local Early Intervention Coordinating Council (LEICC) met in the spring and the fall. CCHD EI Program co-hosted with two neighboring counties and NYSDOH an EI training on Natural Environments in October for the community. Local agencies were provided with vendor tables from which they shared their program information with attendees. EI and Preschool staff met with each of the local service agencies to discuss relevant issues. Staff participated in local committees such as the Child Care Coordinating Council of the North Country, THRIVE, Ready-Set-Grow, JCEO Health Advisory Committee, Healthy Families New York, Head Start Selection Committee, Preschool Steering Committee, County Early Intervention and Preschool Administrators Committee (CEIPAC) Continued collaboration with and delegation of duties between Finance and Preschool staff to improve efficiency, timeliness and regulatory compliance 2 0 1 4 A n n u a l R e p o r t H e a l t h C a r e S e r v i c e s D i v i s i o n Page 20

NYSDOH conducted a successful one day monitoring review of one of our local provider agencies. NYS-BEI Conflict of Interest regulations implemented in 2013 were put on hold by the courts and final disposition is still pending. Children s Services Coordinator gave a presentation to the Early Childhood Education class at PSU regarding the operation, components and mandates of the Early Intervention Program Children s Services Coordinator attended the New York State Association of Counties (NYSAC) spring and fall meetings as a member of the Children with Special Needs Standing Committee. Governor Cuomo signed legislation mandating new Preschool rate setting methodology to start in 2015. Program Analysis: brought many challenges to both the Early Intervention and Preschool Programs. There were staff and supervisory changes, a Medicaid Audit of the Preschool Program, major Policy and Procedure reviews, new and ongoing training requirements, and preparation for pending staff retirements. The staff pulled together and addressed these challenges in a manner that has strengthened and enhanced the quality of both programs. The team will focus on improving the EI and Preschool programs image in the community and strengthen the team approach to services, concentrating on empowering families. The group looks forward to the opportunities and challenges to come in 2015! Goals: 2015 Developmental Services 2011 2012 2013 Early Intervention Program (EIP) Number of referrals 196 219 202 234 Unduplicated count of children 298 326 321 335 Total number of discharges 200 202 195 205 Reasons for closure: Children delay/condition resolved 27 24 25 24 EI Evaluation found child not eligible -- 46 41 49 Family refused -- 43 35 45 Unable to locate family / moved -- 12 9 13 Transitioned to 3-5 program -- 54 73 56 Age-out, not eligible for 3-5 program -- 21 12 16 Other Reasons: Duplicate record for child -- 2 -- -- Preschool Special Education Program Number of referrals 179 250 219 235 Unduplicated count of children on June 1 st 309 254 253 279 Number of Preschool meetings 702 708 684 737 Continue to collaborate with providers on the changes in EIP and any issues of mutual interest. Facilitate meetings with County and EI providers to promote interdisciplinary collaboration on a regular basis. Update initial contact materials for families with a focus on team approach and the roles of team members. Develop a consistent communication message for all Initial Service Coordinators regarding available EI services. 2 0 1 4 A n n u a l R e p o r t H e a l t h C a r e S e r v i c e s D i v i s i o n Page 21

In-house training for EI staff to share effective communication strategies for working with families and service providers. Focus will be on empowering families and helping them to identify what is needed to meet the needs of their child. Complete required training and orientation of a new EI Service Coordinator, Children s Service Program Specialist and Children Services Coordinator. Conduct outreach to local medical providers and agencies serving young children to provide current Early Intervention Program information. Children Services Coordinator will be a member of the Plattsburgh Public Library focus group (Early Literacy Community Asset Analysis) to identify services available for Clinton County children. 2 0 1 4 A n n u a l R e p o r t H e a l t h C a r e S e r v i c e s D i v i s i o n Page 22

Division Presentations, Training Offered and Other Community Engagement Activities: The HCS Division is service-directed. One of the most important services HCS delivers is prevention outreach and education to our community. Our focus is through 5 Strands of Public Health: Immunization, Nutrition, Life Style Choices, Safety and Preparedness and Development. This outreach is achieved through presentations, written resources (brochures, pamphlets, handouts, etc.), social media and other media sources. The following is a listing of outreach activities by HCS personnel: January: * WIRY radio interview on Influenza. * Presentation to the BOH on STDs in Clinton County. * Presentation to the Northern Adirondack Medical Home and CVPH personnel on HCS programs. March: April: * WIRY radio on What Happens During a Newborn Home Visit. * Presentation to PSUC Introduction to Social Work class of 36 students and their Professor Dr. Yough on the 5 Strands of Public Health. * EHS & HCS personnel manned a CCHD Information Table at BHSN s Wellness Day. Many brochures and other educational materials were made available to the participants. The staff had a chance to ask questions of our personnel. * Interview on WPTZ TV concerning Tdap, cocooning, and our efforts at CVPH to immunize newborn caregivers and family members. * Participation in the PSUC Get Yourself Tested event in collaboration with the Clinton County Partners for Awareness and Service Committee for STI awareness. * Presentation to the Parenting Class sponsored by DSS on Immunizations and HCS services. May: * WIRY radio interview on Lyme Disease Things That Bite. June: * Community Baby Shower. Two CCHD representatives manned a table at this community event. The staff had many teachable moments for pregnant and post-partum moms and their children. July: August: * Presentation to the EHS PAC meeting on Lyme Disease/West Nile Virus. * Participation by IBCLC s in The Big Latch a community-wide event at CVPH. * Presentation to the HCS QAC on CSHCN program. * Presentation for Family Connections daycare workers How To Tell if Your Child is Sick. 2 0 1 4 A n n u a l R e p o r t H e a l t h C a r e S e r v i c e s D i v i s i o n Page 23

September: * HCS sponsored its Annual School Health Professional Workshop. The Workshop was attended by 35 health professionals representing most of the school districts and included the following presentations: Mental Health in the adolescent population by a Clinton County Mental Health LCSW. Dental Care in the school setting by a RDH from High Peaks Dental. Large-scale POD planning by a CCHD PHN II. Immunization and Norovirus updates by HCS SPHN. October: * WIRY radio interview with both the EHS Director and HCS PHN on tattoos including pending legislation. * CCHD EI Program co-hosted with two neighboring counties and NYSDOH, an EI training on Natural Environments for the community. Local agencies were provided with vendor tables from which they shared their program information with attendees. * Presentation to the CCHD BOH on our -2015 HPV Initiative. *Presentation to the Plattsburgh Noon Kiwanis on preventing infection and discussion on Communicable Disease, specifically Ebola. November: *WIRY radio interview on the -2015 Flu Season. *Participated in a Get Yourself Tested event in collaboration with the CC Partners for Awareness and Service Committee. *Presentation to the CCHD BOH an overview of the CSHCN program. *Presentation to District 8 nurses about HCV and the proposed Needle Exchange Program with Aids Council. December: *Pertussis and Flu interview with the local newspaper (Press-Republican). *Interview on WPTZ TV on Pertussis. *Interview on FOX TV on Pertussis. *Presentation to the Clinton County Nurses Association on Scabies. Partner-Nurse Program The Partner-Nurse Program was revitalized in the Fall of. The HCS nurses partnered with several health providers and agencies in the area. Nurses meet with each partner at least quarterly. Information is delivered on specific Public Health topics within the scope of the 5 Strands of Public Health. Partners are urged to call with specific needs or requests. Partner nurses also collaborated to disseminate information on Ebola in October. Providers were contacted, met in person, left written specific information and made follow-up calls. This program will be continued in a more formal, organized manner in 2015. 2 0 1 4 A n n u a l R e p o r t H e a l t h C a r e S e r v i c e s D i v i s i o n Page 24

List of Acronyms ACNENY AIDS Council of Northeastern New York CCHD Clinton County Health Department CCMAC Clinton County Multi-Agency Coordination group CSC Children s Services Coordinator CSHCN Children with Special Health Care Needs (grant) CSPS Children s Services Program Specialist DPH Director of Public Health EHS Environmental Health and Safety Division EI Early Intervention HCS Health Care Services Division HPP Health Planning and Promotion Division IBCLC International Board of Certified Lactation Consultants IPO Improved Pregnancy Outcome LHD Local Health Department LTBI Latent Tuberculosis Bacteria Infection MCT Medical Clerk Typist NENY- Northeastern New York NYSDOH New York State Department of Health PHN Public Health Nurse PPNCNY Planned Parenthood of the North Country New York RN Registered Nurse SED State Education Department SPHN Supervising Public Health Nurse Sr. Typ Senior Typist STD Sexually Transmissible Disease STI Sexually Transmissible Infection TDAP Tetanus, Diphtheria, Acellular Pertussis Typ - Typist VFC Vaccine for Children 2 0 1 4 A n n u a l R e p o r t H e a l t h C a r e S e r v i c e s D i v i s i o n Page 25

Division Staff Jackie Allan, RN - PT Gloria Garami, PHN Ruth Lucas, PHN Joanne Swiesz, DPS Carrie Barcomb, MCT Laurel Glode, PHN Karen Merrill, PHN Bobbie Szczypien, RN - PT Elizabeth Casey, Sr. Typ Eeva Jiménez, RN - PT Mary Paul, PHN Laurie Taylor, RN - PT Vicki Driscoll, CSC Shelley Lee, PHN Darlene Pavone, RN Lillie Thompson, MCT - PT Darwyna Facteau, SPHN Pam LeFebvre, SPHN + Theresa Plimpton, RN-PT Janice Tobin, PHN Michelle Fortin, Typ Nichole Louis, SPHN + Karen Plotas-McGrath, Noreen Wolansky, RN - PT PHN Includes all employed in HCS during. Does not include contractual staff. PT = part-time + = partial year Contractors Linda Keysor, RN, BSN Quality Assurance Coordinator Wanda Flynn, RN, BSN, MSN Quality Assurance Coordinator Debbie Everett Preschool Program Assistant Vince Pagano, Registered Pharmacist Consultant Kevin McCullum, MD David Beguin, MD Administration Board of Health Lynn Howard, RN, BSN, President Jerie Reid, Director of Public Health, Secretary Victor Ludewig, MD Kathleen Camelo, MD Ed Garrow Heidi Moore, MD, Vice President Jonathan Beach, DO, Legislative Liaison Kathleen Kasprzak, RN, PhD Virginia Hay, RN Thomas Everett 2 0 1 4 A n n u a l R e p o r t H e a l t h C a r e S e r v i c e s D i v i s i o n Page 26

Joanne Swiesz, RN, BSN Director of Patient Services - HCS Darwyna Facteau, RN, BSN, SPHN - HCS Quality Assurance Committee Margaret Searing, RN, BSN, Quality Coordinator - CCHD Ellen LaMora, RN, BSN Consumer Community Member BOCES LPN Adj. Prof. Laurie Williams, Director of HPP + Pamela LeFebvre, RN, BSN, MS, SPHN HCS + Vicki Driscoll, CSC - HCS Judy Baksi, RN, BSN, MA, Adj. Prof SUNY Plattsburgh Nursing & MRC Volunteer Kevin McCullum, MD Medical Consultant Wanda Flynn, RN, BSN, MSN QA Contractor Elizabeth Casey, Senior Typist (Recorder) + Partial year Linda Keysor, RN, BSN, Retired SPHN, QA Contractor, MRC Volunteer Nichole Louis, RN, BSN, SPHN + Professional Advisory Committee Diana Aguglia, Director Aids Council NENY Jamie Basiliere, Director No. Co. Child Care Coordinating Council David Beguin, MD Assist. Medical Consultant CCHD Donald Biggs, Esq Legal Advisor - CCHD Anne Bongiorno, PHD Prof. SUNY @ Plattsburgh Nursing Department Karen Case, CNM Planned Parenthood Anthony Ching, MD Plattsburgh Pediatrics Joanne Swiesz, Director of Patient Services HCS, CCHD + Partial year Anna D Angelo, FNP SUNY Plattsburgh Kevin Defayette, Director Residential Resources Vicki Driscoll, CSC HCS - CCHD Darwyna Facteau, RN, BSN, SPHN HCS - CCHD Rich Holcomb, Deputy Commissioner - LDSS Pam LeFebvre, RN, BSN, MA, SPHN CCHD + Nichole Louis, RN, BSN, SPHN CCHD + Laurie Williams, Director HPP - CCHD Kevin McCullum, MD Medical Consultant - CCHD Vincent Pagano, RPh Pharmacology Consultant HCS CCHD Esther Piper, Director Healthy Families NY, BHSN Judy Ross, Sr. Public Health Sanitarian, EHS CCHD Margaret Searing, RN, BSN, Quality Coordinator, CCHD Darcy Sunderland, Supervisor, CPS - LDSS Lillie Thompson, MCT Recorder, HCS, CCHD 2 0 1 4 A n n u a l R e p o r t H e a l t h C a r e S e r v i c e s D i v i s i o n Page 27

Community Organizations with HCS Representation Action for Health Breastfeeding Initiative STI/STD Community Partnership CCMAC Planning Group & RRC CEIPAC County Early Intervention/Preschool Administration Committee Clinton Community College Nursing Advisory Board Child Care Coordinating Council-Board Community Services Board Domestic Violence Task Force Environmental Health PAC EXPLORE Steering Committee EXPLORE Pain Conference Committee EXPLORE Psychiatric Conference Committee HPV Initiative Head Start Selection Committee Healthy Families NY Hospice of the North Country Board & QA Committee JCEO Health Advisory Committee NYSAC Preschool / EI Subcommittee Preschool Steering Committee SUNY @ Plattsburgh Nursing Advisory Board Suicide Prevention Committee THRIVE Ready, Set, Grow Tri-County Immunization Consortium Residential Resources Board & QA Committee Eastern Adirondack Health Care Network (EAHCN) LEICC-Local Early Intervention Coordination Council Baby Friendly Initiative Women and Children Service Line 2 0 1 4 A n n u a l R e p o r t H e a l t h C a r e S e r v i c e s D i v i s i o n Page 28

Division Contacts Phone: 565-4848 Fax: 565-4509 www.clintonhealth.org Director of Patient Services Joanne Swiesz Supervising Public Health Nurse Darwyna Facteau Supervising Public Health Nurse Nichole Louis Children s Services Coordinator Wanda McQueen Principal Clerk Typist Elizabeth Casey 2 0 1 4 A n n u a l R e p o r t H e a l t h C a r e S e r v i c e s D i v i s i o n Page 29