As discussed in Part One, some of the programs that the Archuleta County Public Health Transitional Advisory Committee have recommended — after seven months of research and debate — are required by state law, to be provided by a public health department. In some cases — such as vaccinations for children — the state can also provide the funding for those programs.
Other programs recommended by the Committee are not statutorily required, but may have funding available from state or federal agencies, as well as possible community benefits. The WIC (Women, Infants and Children) program is one example of a non-required public health program. This USDA program provides vouchers for the purchase of nutritional foods — dairy, grains, eggs, fresh fruits and vegetables — to low-income families that include pregnant or breastfeeding mothers, infants, and children up to age 5.
Nationally, WIC serves only about half of the families who are potentially qualified for assistance based on income. I have no idea how effective the programs has been at reaching Archulta County families in recent years, while it was managed by San Juan Basin Public Health.
In Part One, we looked at the Communicable Disease Prevention, Investigation and Control programs, and the Maternal, Child, Adolescent and Family Health programs.
Technically, the schedule of program and the annual budget request must be approved by the Archuleta County Board of Health. But that Board does not yet exist.
Here are some additional programs recommended by the Transitional Advisory Committee.
Chronic Disease, Injury Prevention and Behavioral Health Promotion
The focus of this foundational service is to address the root causes of chronic health conditions, injury prevention and behavioral health problems through community prevention education and strategies, and health promotion programs based on local and statewide data.
Although not statutorily required, the following programs are recommended to support community health.
A. Oral Health Program (regional collaboration): Includes a school based oral health program, educational prevention programs, and dental navigation/referral. The Oral Health program funding through Delta Dental should support a majority of the program.
B. Tobacco Education and Prevention Program: Education and intervention will help community members in two important ways: 1) never start using tobacco products, and 2) to provide support to stop using tobacco products in order to stop using tobacco products in order to improve long term health outcomes.
C. Substance Abuse Support: Education and referral to support community members in getting help with substance abuse issues.
Access to and Linkage w/Healthcare
Although not statutorily required, the following programs are recommended to support community health. Some of the services can be billed to Medicaid or other insurance, but a majority of these programs do not currently have methods of funding. Fee for service, for those without health insurance or Medicaid, can be considered.
A. Health insurance navigation: The role of ACPHD is to support individuals in applying for Medicaid when applicable and to assist others by educating them about insurance options and how to apply for insurance through the health exchange.
B. Support of medically fragile children on Medicaid: Work with families on finding and accessing appropriate care through help with resources and referrals.
C. Referral and support to find local health care providers: Ensure community members can access appropriate care and understand the options for care in our community.
Environmental Public Health
ACPHD will investigate and respond to community environmental health concerns that
impact food safety, surface and groundwater, sanitation of institutional facilities (based on jurisdictional authority), and air quality; and identify and mitigate zoonotic (animal-borne diseases) and other threats related to environmental hazards. Management of solid and hazardous waste also falls under this umbrella. Some programs will be managed through the County Planning Department.
A. Restaurant/school/temporary food vendor/other institutional inspections: Staff will inspect facilities according to state established criteria. Staff will respond to complaints, investigate outbreaks and conduct re-inspections if necessary. Education and assistance in meeting food safety regulations will be important. Fees will partially offset the cost for this program.
B. Water testing/monitoring: This will be provided through the Water Quality Department.
C. Air quality/Radon: Limited services will be provided through the Water Quality Department.
D. Onsite Water Treatment (Septic) Systems: Management of septic system planning, permitting and inspecting will be provided through the Water Quality Department.
E. Zoonotic: Surveillance and response/tracing of outbreaks is mentioned in Communicable Disease category above but will be a partial function of the Environmental Health Specialist job description.
Contract Positions
In addition to the proposed programming and staffing recommendations, some contract positions are required or recommended.
A. A Medical Director will need to be under contract, per state statute, to provide expert advice to the Board of Health as well as to provide oversight to clinic staff for the purpose of clinic services.
B. WIC supervisor/high risk counselor will have to be contracted to fulfill program requirements. This person may be from another county or will be a contractor in the community who fulfills the needed requirements.
In addition to contracted positions, the Committee recommends that the Board of Health continue to explore shared contracts for services to provide cost effective services that are beyond the scope and availability in Archuleta County.
Based on those recommendations (and the ones mentioned in Part One) the Archuleta County Public Health Department would look something like this chart (which does not include the Environmental Public Health positions hosted by the Planning Department.)
With these recommendations in mind, the Transitional Advisory Committee developed a recommended 2024 budget… which we will look at tomorrow.