A Successful Regional Health Department in Colorado

Richard L. Vogt, M.D.Executive Director

CCI Conference, June 10, 2009

Composition

• Tri-County Health Department (TCHD) serves Adams, Arapahoe and Douglas Counties

• We serve 1¼ million residents, ¼ of Colorado’s population

• Our Board of Health has three appointed representatives from each county, for a total of nine members

History

• TCHD was formed in 1948 to include Adams, Arapahoe and Jefferson Counties

History

• In 1958, Jefferson County formed its own Health Department, so TCHD served only two counties until 1966

• In 1966, Douglas County decided to join TCHD after they received mutual

aid in response to the

South Platte River floods

Approach as a Regional Health Department

• Delicate balance functioning as one health department serving the needs of three diverse counties

• TCHD needs to keep consistent approaches for all of our three counties

• However, each county has special needs and interests that also need to be addressed

Regional Health Department

• Provide core services to all three of our counties

• Provide some individualized services for each of our counties

Core Services Offered to Each County

• Nursing– Adult and child immunizations– Family planning– Women’s cancer screenings– Maternal child health programs– Access to care programs– HIV/AIDS, sexually-transmitted disease

and TB outreach programs– Chronic disease prevention

Core Services

• Environmental Health

– Restaurant inspection program

– Child care inspection program

– Pool/spa inspection program

– Onsite-wastewater program

– Hazardous chemicals in schools

– Land use reviews

– Vector control

Core Services

• Nutrition

– WIC program

– Community nutrition

– Early childhood obesity and prevention

– Dietetic internship

– Breast-feeding support program

Core Services

• Epidemiology, Planning and Communication

– Infectious disease investigation

– Outbreak control

– Public information

– Tobacco prevention

– Statewide older adult fall prevention program

– Health planning– Geographic Information Systems (GIS)

Core Services

• Emergency Preparedness– Developed emergency

response plans in coordination with external and internal partners

– Coordinated agency responses to public health emergencies

– Coordinated the strategic national stockpile and mass prophylaxis

– Developed agency continuing operation plans (COOP)

Core Support Services

• Administration

– Purchasing

– Payroll

– Human resources

– Information technology

– Facility management

Individual County Interests and Programs

Adams County• Major interest in protective

measures with oversight

of landfills and the Rocky

Mountain Arsenal cleanup project

• Developed an innovative mutual agreement with Adams County Human Services to provide selected nursing services for human service clients using Temporary Assistance for Needy Families (TANF) funds

• Household hazardous waste disposal

Arapahoe County

• Largest populated county in our jurisdiction

• We have special funding to help provide dental services for Arapahoe County senior citizens

• Developing a similar program with social services again using TANF funds

• Arapahoe County has shown a special interest in outbreaks of illness that require planning– West Nile Virus– H1N1 influenza infections

Douglas County

• Has a special interest in water– Quantity– Quality

• TCHD conducted a special study of the quality of well water in homes that have septic systems, finding little contamination in households with submitted samples

• Household hazardous waste disposal

Three-County Agreement

• In 1988, all three sets of County Commissioners entered into an agreement to provide the same level of county per capita funding

• The advantage is that there is a common contribution for all of the three counties

• A disadvantage is that we are funded at a level that the most financially challenged county can afford each year

• We also have individual contracts for county-specific activities

Benefits of Regional Health Department

• Provide more uniform services across counties

• Provide enough depth to shift resources depending upon the public health need

• Can provide a significant nursing workforce for public health activities in the area

• Able to undertake large campaigns– In 1992, administered IG to 15,000 residents– In 1993, coordinated activities for the Pope’s visit – In 2009, administered 1,300 doses of IG and hepatitis

A vaccine

Benefits

• Receive financial support from three counties which enables us to have professionals and programs that would otherwise be unavailable

• We have economies of scale with one office of administrative services for three counties

Challenges

• A presence in each of our three counties

• Staff liaison in an office located in each county

• Attendance at each of the many county functions– Volunteer appreciation receptions– Ground-breaking and dedication ceremonies– Presentations of our proposed budget to each

county

Challenges

• Campaign with Commissioners over the years with the theme that “TCHD is your local health department”

• Lack of recognition as a “department” similar to those housed within the county structure

• Lack of awareness by county residents that TCHD is their county health department

Challenges

• Some difficulty in managing 11 offices in our jurisdiction– Four full service offices– Two partial service offices– Four WIC offices– One administrative office

• Currently have an “office director” for each office

Challenges

• Arrange for courier services between offices

• Negotiate multiple leases for properties not supported by counties

• Strive to be “equal and fair” to employees in 11 different offices

• Strive to provide uniform services between the different offices

Space Challenge

• At present, each county provides at least one office for TCHD free-of-charge

• However, one county has provided all of our office space at no charge

• TCHD contracted with a consulting firm to evaluate the current county space support

• The results will be presented to our three sets of County Commissioners

Douglas County Study

• In 2003, Douglas County formed a committee to review the possibility of forming their own LHD

• At that time, Colorado Statutes allowed this to happen, giving 12 months notice to the LHD

• TCHD convinced Douglas County of the worth of our agency to provide services to residents

• In the end, Douglas County decided to stay with TCHD because of “economies of scale” and demonstration of vision and strong leadership

Activities

• Undertaken a campaign to be included in all written county reports that list county departments

• Attempted to attend all county functions recognizing county departments

• Attempted to send a TCHD staff representative for regular county management meetings

Summary

• There are many advantages to establishing a regional health department

• However, the process is not without challenges

• At present, each of our three counties feel that we are providing cost-effective, high- quality public health services to our residents and are attentive to individual county needs

Thank you!