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County Board of Health Planning Process CITY OF DUBUQUE, IOWA MEMORANDUM December 15, 1999 TO: The Honorable Mayor and City Council Members FROM: Michael C. Van Milligen, City Manager SUBJECT: County Board of Health Planning Process Public Health Specialist Mary Rose Corrigan has provided information on the planning process that will be used for the transition of public health services with the dissolution of the City Board of Health. l!1Jl(tJ,~/L MCVM/j Attachment cc: Barry Lindahl, Corporation Counsel Tim Moerman, Assistant City Manager Mary Rose Corrigan, Public Health Specialist Paul Buss, Director, Dubuque County Health Department Mary Rose Corrigan, Public Health Specialist, City of Dubuque Mary Pat Breitfelder, Director of Community Health Services, Hillcrest Family Services Barbara Moran, Director, Visiting Nurse Association Rod Tokheim, Vice-President Marketing and Planning Art Roche, Director of Planning, both from Mercy Medical Center The County Board of Supervisors also approved this process at their December 6, 1999 meeting. will keep you informed as we proceed. . ' To: Dubuque County Board of Public Health & Dubuque County Board of Supervisors From: Rod Tokheim, Mercy Medical Center - Dubuque Re: Planning Process Recommendations BACKGROUND At the joint meeting of the Dubuque County Board of Supervisors, Dubuque County Board of Health and representatives of the City of Dubuque on Tuesday, November 16, I volunteered to develop a process that the Board of Health and the Supervisors might use to help establish next year's county public health funding priorities. To help me in this effort, I convened a task force made up of a subgroup of the Healthy Dubuque Steering Committee. The task force met on Friday, November 19 to brainstorm with the resulting ideas contained in this memo. It is the task force's desire that I distribute a written summary of our ideas regarding a possible county public health planning process to members of the County Board of Health and Supervisors prior to their next meeting on December 8. Members of the task force will be present at the December meeting to answer any questions. ADVISORY TASK FORCE The following are members of the task force: Julie McMahon - Bureau Chief, Iowa Department of Public Health Paul Buss - Director, Dubuque County Health Department Mary Rose Corrigan - Public Health Specialist, City of Dubuque Mary Pat Breitfelder, Director of Community Health Services, Hillcrest Family Services Barb Moran, Director, Visiting Nursing Association Rod Tokheim, Vice President Marketing and Planning, Mercy Medical Center Art Roche, Director of Planning, Mercy Medical Center. In addition to providing recommendations regarding a process, members of the task force have expressed willingness to volunteer their time to help support the proposed process. Specific task force member assignments are listed below. While many of the members are happy to playa role, it is anticipated that Paul Buss will serve as staff to this process and coordinate proposed activities. RECOMMENDATIONS Both short term and long range recommendations are listed below. However, given rapidly approaching deadlines for budget development and the completion of the Iowa Department of Public Health (IDPH) community assessment, the task force focused its initial attention on these issues first. In addition the task force felt strongly that the County Board of Health and the Supervisors should pursue public health planning and budgeting on a joint basis this year. The primary rationale for this recommendation is to avoid duplication of effort and to facilitate consensus. (See figure #1 for a flow chart of these two processes.) PROPOSED PROCESS FOR PUBLIC HEALTH BUDGETING AND STATE REPORTING (figure # I) IDPH COMMUNITY AsSESSMENT - BUDGETING PROCESS I Board of Health & Supervisors review & approve process / " - Staff & task force develop educational program ! Staff distributes IDPH reporting form for comment ! Board of Health & Supervisors education session Staff & Healthy DubuQue data assess- ment sub-committee complete rough draft of IDPH reporting form Public forum held to review first draft of IDPH communi~ assessment Board of Health & Supervisors first pri- ori~ setting meeting ., Board of Health & - ~ Supervisors second priori~ setting meeting & public hearing Edit IDPH communiry assessment form in light of counry prioriry setting process Staff complete final public health budget .... Submit IDPH communi~ assessment report - Counry Board of Health and Healthy DubUQue Screening committee work to determine role and goal statements for their respective organizations. Establish planning and budgeting calendar for the next fiscal year. 1. Budgeting - Our group identified the following steps related to the development of a county public health budget: general education regarding public health responsibilities and expenditures; a mechanism for gathering input from impacted groups or organizations; and a formal process of setting priorities for county expenditures in public health. It should be noted that when we speak of the county health public budget we are referring to the entire Board of Health budget and all other health related community service dollars expended by the county. This second group would include a number of programs funded by various IDPH grants that channeled through the county board of Supervisors and not the Board of Health. Education - Based on comments by members of the County Board of Health and Supervisors during their November meeting, the subcommittee assumed that both groups were interested in an educational session before proceeding. The task force tentatively identified the Board of Health's January 18 meeting as a possible date for such an educational session. listed below are the tentative topics for this session. Additional topics may be covered. However, in order to provide appropriate preparation time, these topics should be shared with the task force at your December 8 meeting. · A review of county responsibilities relative to the provision of core public health functions as identified in Chapter 137 of the Iowa Code and Chapter 77 of the Iowa Administrative Code. While it is the task force's understanding that such an education program has already occurred, a brief review is still seen as appropriate. Mary Pat Breitfelder has agreed to develop this presentation for the joint educational session. · A review of how Dubuque County compares to the state of Iowa on a number of traditionally measured public health dimensions. Paul Buss and Mary Rose Corrigan will be responsible for organizing and presenting this portion of the session. · A high level review of the source and use of public health funds in Dubuque County by core public health functions/ essential public health services. This information will be prepared by Julie McMahon. · A three year analysis of Dubuque County public health statistics including but not limited to information on the number of clients served and dollars expended. While it is intended that Barb Moran will present this topic, others including Paul Buss, Mary Rose Corrigan, Julie McMahon, Jan Hess and Rod Tokheim will help prepare this information. · A profile of public health service providers in Dubuque County including: specific services provided, clients served, total expenditures by service and corresponding unit costs by service. Again Barb Moran will present, and Paul Buss, Mary Rose Corrigan, Julie McMahon, Jan Hess and Rod Tokheim will help prepare the information. · A comparison of how other urban Iowa counties organize and fund their public health functions. This information has already been compiled, and Jan Hess is in the process of obtaining a copy of the information. Presentation of information will probably be made by Jan Hess with one or more of the Directors of Public Health from either Scott, Lynn or Blackhawk available to answer questions. No confirmation of the latter group is yet available. Another educational opportunity for the County Board of Health and Supervisors is the results of the Community Assessment of Human Needs recently completed by Mercy Medical Center. This study was commissioned by Mercy's Institutional Ethics Committee to help direct where the hospital's future charitable efforts should be focused. The study was conducted by Art Roche, Mercy's director of planning. The study involved interviews with approximately 50 community leaders, members of social service agencies, school faculty and selected members of the actual poor residing in our community. The purpose of the study was to develop a profile of what these individuals consider to be the most important social needs in the Tri-State area. Art Roche would be glad to share the actual written study and make a presentation on it just before the first priority setting session. The final recommendation regarding education involves community education and the role of media in the process. It is the recommendation of the task force that local media be invited to attend any and all meetings and that press releases be prepared in advance of these meetings to highlight and explain key points of the process. Paul Buss, Mary Rose Corrigan and the City Public Information Officer would be responsible for preparing these releases. Input - The task force feels the County Board of Health and Supervisors should seek additional input this year into their state reporting / annual planning and budgeting processes. This extra effort is seen as particularly important in light of possible funding short falls and changing public health priorities. The first way that the task force recommends additional input be sought is by having the county sponsor a public forum to gather feedback on information collected as a part of the state reporting / annual planning process. (More will be written about this in the section on state reporting and annual planning.) While task force members are willing to lead this meeting, it is hoped that County Board of Health and Supervisors will attend in order to directly hear community comment. Paul Buss and Jan Hess would be responsible for 4 setting up the meeting. Paul Buss and Mary Rose Corrigan would facilitate it, and prepare possible pre-meeting materials and media release. A second way additional input might be sought is through a public hearing that is part of the second priority setting meeting. At his meeting Paul Buss will highlight which public health initiatives he recommends funding in light of available dollars and the priorities established by the County Board of Health and Supervisors at their last joint meeting. Affected groups should be invited to this meeting and given an opportunity to make comment on the director's recommendations before the County Board and Supervisors approve the final priority list. Priority Setting - Priority setting could be handled during the Board of Health's regularly scheduled meetings in February and March. Representatives of the media and groups or organizations which may be affected by a reprioritization of county funding should be encouraged to participate in the priority setting sessions . The length of the February meeting may need to be extended to accommodate all the issues to be covered. The first meeting would take place in late February with the following proposed agenda: · Review core public health functions and essential public health services · Review input from public forum and state reporting priorities identified by public health staff · Review list of programs presently funded by the county · Brainstorm additional public health needs not presently served · Rank order existing programs and newly identified needs. Mary Rose Corrigan, Paul Buss and Rod Tokheim will facilitate this first meeting. Once the County Board of Health and Supervisors have rank ordered programs, Paul Buss and Jan Hess will meet to identify projected costs for the prioritized programs. Paul Buss and Jan Hess will then create a list that identifies which rank ordered programs can be funded given the county public health budget submitted in January. This list should also include unfunded prioritized programs as well. The March priority setting meeting will then involve the review and approval of the list of programs to be funded as identified by staff. The task force recommends that representatives of affected organizations and media be invited to this meeting. Once the final list of projects has been approved, Paul Buss should provide formal notification to both funded and unfunded organizations. A previously prepared media release developed by Paul Buss and Mary Rose Corrigan should be distributed that 5 night to members of the media who are present. Those not present should be faxed a copy of the release the next morning. Once the prioritization process has been completed Paul Buss will complete a formal public health budget. 2. IDPH Community Assessment - The importance of completing this process can not be understated. Results of the Dubuque County assessment will be used in conjunction by our local Empowerment Board and the State of Iowa as it makes decisions regarding Dubuque area requests for funding. In future years the task force recommends that the IDPH Community Assessment be completed in advance of the budgeting process. However, this year the task force sees these two processes running concurrently rather than sequentially. Integration of the two processes will take place at the time of the open public forum discussed earlier. The task force identified the following steps as necessary for the successful completion of the IDPH Community Assessment. First, Paul Buss and Mary Rose Corrigan will take the form that the county needs to complete as a part of this process and distribute sections of the form to the organizations that are responsible for the issues covered by that particular section Paul Buss and Mary Rose Corrigan will meet with Art Roche to determine what information he and/or the Data Assessment Sub Committee of Healthy Dubuque might be able to provide them to complete the Community Assessment. Paul Buss, Mary Rose Corrigan and Art Roche will collect and synthesize input and information from the various organizations that were solicited in order to complete the state report. Paul Buss and Mary Rose Corrigan will make a presentation to County Board of Health and Supervisors regarding results outlined in IDPH Community Assessment. Art Roche will present findings of Community Assessment of Human Needs study commissioned by Mercy. The study includes the results of interviews with over 50 area human service providers and actual program recipients. Focus of the study was identification of what various groups identified as the most critical human services issues facing the Dubuque area at this time. Paul Buss and Mary Rose Corrigan will present results of IDPH Community Assessment at open public forum. Paul Buss will integrate results of open public forum and county prioritization process into the IDPH Community Assessment and submit on April 1. 6 3. Long Range Planning and Organizational Issues - Once the more pressing budgeting and state reporting/annual planning issues have been resolved, the task force and the rest of the Healthy Dubuque Steering Committee would like to work with the County Board of Health to clarify our respective roles. The Healthy Dubuque Steering Committee has enjoyed a productive relationship with the County Board of Health over the years. As a result of changing public health demands and increasingly limited dollars for direct care and planning, members of the Healthy Dubuque Steering Committee have come to feel that the time is right for the committee to review its role and annual activities or goals. However, as we have attempted to do this, it has become clear that we can not accomplish this without a better understanding of the County Board of Health's needs. That is why we would like to work jointly with the County Board of Health to define both our purposes and goals. The benefit to the county is that if we are successful the Healthy Dubuque Steering Committee can continue to serve as a cost effective resource to the county. Another expected outcome of such an effort would be development of a new job description for the County Director of Public Health that clearly defines how this individual will support and work with both groups. Outlined below our the task force's ideas on how our two groups might engage in such a joint visioning process. Paul Buss collect mission statements and director job descriptions from county health department around the State of Iowa. Rod Tokheim and Paul Buss draft Role and Goals statement for the County Board of Health. New statement to be presented at their May meeting. County Board of Health review, edit and approve role and goal statement. County Board of health appoint a subcommittee to be chaired by Jan Hess, Dubuque County Personnel Director, to 1) develop a new job description for the County Director of Public Health and 2) develop a new state reporting/annual planning and budgeting calendar for the next fiscal year. Rod Tokheim will work with the Healthy Dubuque Steering Committee to develop a new role and goal statement for the committee. Healthy Dubuque Steering Committee will then establish new activity calendar for the next fiscal year. 7 DUBUQUE COUNTY PUBLIC HEALTH PLANNING & BUDGETING PROCESS CALENDAR Activity Person Responsible Date 1. Distribute planning process outline to Rod Tokheim 11-30-99 members of the County Board of Health and Supervisors 2. Draft sample media release Mary Rose Corrigan 12-3-99 3. Review proposed process and make County Board of Health 12-8-99 recommendation on future directions Supervisors 4. If approved, distribute release to Paul Buss 12-8-99 media Mary Rose Corrigan 5. Finalize Planning & Budgeting Paul Buss 12-15-99 Calendar Jan Hess 6. If approved, edit proposal based on Rod Tokheim 12-17-99 Board of Health and Supervisor input 7. Distribute sections of IDPH Paul Buss 12-17-99 Community Assessment reporting form Mary Rose Corrigan to key constituent organizations and solicit input from them for inclusion in final report 8. Reserve space for community forum Paul Buss 12-17-99 to take place in early February 9. Invite Directors from other eastern Paul Buss 12-17-99 Iowa Public Health Departments to attend County Board of Health and Supervisor January education session 10. File status quo initial budget Paul Buss 1 -1 -00 estimates for county public health expenditures 8 11 . Complete materials for Board of 1 - 7 -00 Health and Supervisor education session * County Responsibilities Mary Pat Brietfelder * Public Health Measures Mary Rose Corrigan & Paul Buss * Source & Use of Funds Julie McMahon * Dubuque County Activity statistics Barb Moran Paul Buss Mary Rose Corrigan Jan Hess Rod T okheim Julie McMahon * Dubuque County Provider Profile Barb Moran Paul Buss Mary Rose Corrigan Jan Hess Rod Tokheim Julie McMahn * Comparison with other urban county Jan Hess public health functions 12. Distribute Joint Education Session Paul Buss 1 -1 2 -00 materials Jan Hess 13. Draft news release regarding joint Mary Rose Corrigan 1-1 2-99 educational session Paul Buss 14. Joint Educational Session County Brd of Health 1 -1 9-00 and Supervisors 15. If approved, distribute news release Paul Buss 1 -1 9-00 to media if approved Mary Rose Corrigan 9 16. Collect input from key constituent Paul Buss Mid to late organizations and for IDPH Community Mary Rose Corrigan January Assessment Art Roche (Mercy) 17. Invite participants to Community Paul Buss Late Forum Mary Rose Corrigan January * Mail invitations to key organizations * Develop and distribute media release inviting general public to forum 18. Community forum Rod Tokheim Early Mary Rose Corrigan February * Provide input into IDPH Community Paul Buss Assessment priorities 19. Conduct first priority setting meeting Paul Buss Late Rod Tokheim February 20. Draft and distribute media release on Mary Rose Corrigan Day after outcome of prioritization meeting Paul Buss prioritizatio n meeting 21. Develop estimated costs for Paul Buss March prioritized list of public health priorities Jan Hess 22. Contact organizations affected by Paul Buss March new prioritization and invite to second priority setting meeting / public hearing 23. Conduct second priority setting Paul Buss March meeting and public hearing Jan Hess 24. Complete and file IDPH Community Paul Buss 4-1 -00 Assessment report Mary Rose Corrigan 25. Draft Board of Health role and goal Paul Buss April statement Rod Tokheim 10 26. Board of Health meets to review and Paul Buss May comment on role and goal statement. Rod Tokheim Board appoints subcommittee to work on Jan Hess new job description for Director of Public Health consistent with new role and goal statement 27. Board of Health of Health reviews Jan Hess June and comments on new job description County Brd. of Health for director Subcommittee 28. Healthy Dubuque Steering Rod Tokheim June Committee meets to discuss their role in light of new Board of Health role and goal statement 29. Complete final budget * Draft Paul Buss ?????? * Community Board of Health Approval Community Board of ?????? Health * Supervisors Approval Supervisors ?????? 11 MEDIARElEASE City of Dubuque Health Services Department · City Hall Annex, 1300 Main St. · Dubuque, IA 52001-4732 · (319) 589-4181 For Immediate Release Date: Contact: Phone: December 9, 1999 Mary Rose Corrigan (319) 589-4181 OR Paul Buss (319) 557-7396 The Dubuque County Board of Health approved a public health planning process at their December 8, 1999 meeting. The process will incorporate a transition from having a City and County Board of Health to one County Board of Health, and will also facilitate a community health assessment prioritization process, followed by appropriate public health budgeting for the County Board of Supervisors. Members of the County Board of Health appointed task force who will work on this process include: Dr. John Viner, MD, Chair, County Board of Health Julie McMahon, Bureau Chief, Iowa Department of Public Health Paul Buss, Director, Dubuque County Health Department Mary Rose Corrigan, Public Health Specialist, City of Dubuque Mary Pat Breitfelder, Director of Community Health Services, Hillcrest Family Services Barbara Moran, Director, Visiting Nurse Association Rod Tokheim, Vice-President Marketing and Planning, Mercy Medical Center Art Roche, Director of Planning, Mercy Medical Center The process is anticipated to be completed in April 2000 with the culmination of a final public health budget for the County and the submission of a community health assessment report to the Iowa Department of Public Health. Additional duties will include long range planning and organizational issues for the County Board of Health, including the role of the Healthy Dubuque Steering Committee. ###