Annual Report 2015 - Bollinger County Health Center - … · 2016-07-19 · Annual Report 2015 Josephine Dunbar hair ... MO 63764 Phone: 573-238-2817 Fax: ... Health enter provides

Juanita Welker, Administrator

Veronica Dodds BSN, RN

Dianne Holzum, RN

Annual Report 2015

Josephine Dunbar Chair

Jo Burford Vice-Chair

Carole Abernathy Secretary

Mildred Shell Member

Elizabeth Leadbetter Member

Board of Trustees

Health Center Personnel

County Commissioners

Juanita Welker Administrator

Charity Collier Administrative Office Support Assistant

Betsy VanGennip Office Support Assistant

Stephanie Wall Office Support Assistant

Dianne Holzum Senior Public Health Nurse

Veronica Dodds Public Health Nurse

Amber Mock __________Public Health Nurse

Melissa Allen Nutritionist, Health Educator

Amanda Koch _________Nutritionist

Amy Umfleet Breastfeeding Peer Counselor

Linda Doerge Regional Public Health Emergency Planner

Steve Yates Environmental Sanitarian

Travis Elfrink Presiding Commissioner

James Null Southern Commissioner

Steven Jordan Northern Commisioner

Contact Us Bollinger County Health Center PO Box 409

Marble Hill, MO 63764

Phone: 573-238-2817

Fax: 573-238-3085

www.bollingercountyhealth.org

Melissa Allen BS, CLC

Amanda Koch RD, LD

Amy Umfleet, BFPC

Stephanie Wall, OSA

Betsy Vangennip, OSA

Charity Collier, AOSA

Amber Mock, BSN, RN, CLC

Bollinger County Health Center Page 2 2015 Annual Report Page 15

From the Administrator... On behalf of the Bollinger County Health Center Board of Trustees and staff, I am pleased to present the 2015 Annual Report. This report describes the various programs and services the Health Center provides in striving to improve the health of the county. This report also summarizes key activities undertaken within those programs. While funding declined in some areas, programs to encourage healthy lifestyles continue. As reported in the following sections, staff members encourage individuals to eat healthy, stop smoking, exercise on a regular basis, and manage chronic diseases. The accomplishments of 2015 are truly a team effort and requires collaboration among our board and staff, as well as our numerous community partners. We thank you for your support, as we continue working to prevent, promote and protect the health of our residents.

Respectfully submitted,

Juanita Welker Administrator

Annual Financial Report

Charity Collier, Administrative Office Support Assistant 1/27/2016

In an effort to better serve the people who reside and work in Bollinger County, the Health Center is expanding its vaccina-tion program. Beginning in 2014 the Health Center will use the VaxCare pro-gram to vaccinate children who have insurance or would like to pay out-of-pocket. All required childhood immun-izations will be offered.

2015 Annual Report Page 3 Bollinger County Health Center Page 14

Vaxcare

WILL YOUR

INSURANCE PAY FOR

VACCINATIONS?

Call your insurance company and ask the following questions: 1. Does my insurance cover

the cost of immunizations at 100%?

2. What is the date of eligibility for the person receiving immunization?

3. Am I required to pay a co-pay?

4. Do I have to meet my de-ductible before it will pay for immunizations?

Health Highlights for Bollinger County

County Health Rankings Bollinger County is ranked 56 out of 114 coun-ties on health outcomes. Bollinger County resi-dents are less likely to die of premature death as compared to other counties in the state (ranked 57 out of 114), and babies are less likely to have a low birth weight. However, residents are more likely to have poor physical health days. Eighteen percent of Bollinger residents are uninsured, compared to 16% of Missouri residents. Bollinger County was ranked 93 out of 114 counties for health behaviors. Bollinger County has a higher than average adult rate of obesity (37%), physical inactivity (33%) and smoking (25%). The county also has a high teen pregnan-cy rate (50 per 1,000 female residents age 15-19). The percentage of children in Bollinger County living in poverty is 29% compared to the state rate of 22%. However, there are fewer children living in single parent households in Bollinger County (24% in Bollinger, 34% in Missouri). Vio-lent crime is also lower than the state average.

www.countyhealthrankings.com

*Provider list and benefits subject to change

County Health Outcome Ranking

Accepted Insurances mn1

AARP Secure Horizons Healthlink

Aetna (do not accept HMO Plans)

Humana

Anthem BCBS (do not accept Medicare Advantage)

Mail Handlers (do not accept HMO POS or Medicare Ad-vantage Plans)

BCBS Federal Medicare B (influenza & pneumonia vaccinations only)

BCBS Kansas City Medicare Railroad (influenza & pneumonia vaccinations

CIGNA Multiplan

Coventry (do not accept HMO POS or Medicare Ad-vantage Plans)

Three Rivers Preferred

First Health (do not accept HMO POS or Medicare Ad-vantage Plans)

Tricare

Golden Rule UMR

Great West- CIGNA United Healthcare

The Health Center began using the VaxCare program in 2014, to provide vaccinations for children and adults who have insurance or would like to pay out-of-pocket. Vaxcare provides vaccine

and billing services to the Health Center which provides immun-izations for clients with private insurance. Vaxcare has allowed the Health Center to expand services and be

able to offer immunizations to meet the needs of county resi-dents.


Health Education Services

PHYSICAL ACTIVITY: In 2015, 14 people were enrolled in the Arthritis Foundation Exercise Classes. The Arthritis Classes are ongoing and are offered on Mondays-Wednesdays-Fridays at the Senior Nutrition Center.

Youth Tobacco Prevention: In 2015, students from Meadow Heights and Woodland School Districts attended both local and regional trainings hosted by the Tobacco Free Missouri Youth Advisory Board. Their mission is to promote healthy lifestyles by advocating for a tobacco free Missouri, edu-cating youth about the risks of tobacco use, and empowering future generations to be tobac-co free. The Health Center re-ceived a Youth Leadership in Tobacco Prevention contract through DHSS to provide fund-ing for resources and expenses as well as technical support for activities related to the Tobac-co Free Missouri Youth pro-gram. The Youth Leadership in Tobacco Prevention contract

also provides funding for the Teen Outreach Program (TOP). TOP is currently being offered at Woodland High School. TOP is an evidence based program that builds leadership skills through classroom and community ser-vice learning activities.

NUTRITION/ HEALTH EDUCA-TION: Nutrition and health edu-cation services are provided as requested. Materials are pro-vided for the annual Bollinger County Resource Fair, Bollinger County Fair, and various other events as requested. Represen-tation is provided for school health boards and various area coalitions. Regular presenta-tions are made for Woodland’s

8th Grade Health Class and for Community Counseling Center’s Psycho-Social-Rehab. AMERICAN LUNG ASSOCIA-TION: Through a partnership with the American Lung Associa-tion (ALA) pregnant women can

have their carbon monoxide (CO) levels tested. A participant’s CO levels along with the dangers of smoking and second-hand smoke during pregnancy are discussed with participants. Women who are smoking but wish to quit are offered cessation help through SCRIPT, a cessation booklet de-signed specifically for pregnant women. Those who have quit smoking are invited to enroll in a free texting program that offers support for participants to re-main smoke-free. The ALA pro-vides incentive items to partici-pants who are smoke free at 1, 2, and 3 months post partum. In 2015, 82 women were screened and 21 enrolled in the texting program.

The Vaccines for Children Pro-gram (VFC) is funded by CDC and provides free vaccines to children who qualify. Children must be under the age of 19 years and meet one of the following requirements:

Medicaid Eligible

No Insurance Coverage

American Indian or Alaskan Native

Underinsured

In 2015, Bollinger County Health Center nurses administered 1,284 vaccines through the Vac-cines for Children Program.

Vaccines for Children Program

Immunizations are given at the Health Center on Wednesdays from 8 am to 3:30 pm and other days by appointment. Public Health Nurses visited the local schools to administer flu vaccinations to school em-ployees and students. Open clinics were held every Wednesday to administer flu

vaccinations to the general pub-lic. A total of 1,214 flu vaccina-tions were given in 2015. Tdap clinics were also held in

the county schools to meet the

8th grade entry requirement .

Tdap is given to provide protec-

tion against pertussis, also known

as the whopping cough, and teta-

nus. Tdap vaccinations were giv-

en to 148 people in 2015.

Vaccine Preventable Disease

The Environmental Public Health Specialist inspects school cafeterias, restaurants, taverns, retail grocery, food complaints, daycares, lodging establishments, and sewage systems. Onsite sewage permits are provided upon request when required for all new or re-placement sewage systems and are inspected via site vis-its. Sewage complaints are also investigated with viola-tions issued. All violations are required to be corrected un-der current law.

Approximately 42 food establish-ments are routinely inspected based on their risk assessment to prevent food-related illnesses. There are 11 Daycares inspected annually for safety and sanitary issues. Hotels/motels, if licensed, are inspected annually to ensure public safety. Based on the viola-tions and findings, some under-go multiple rounds of re-inspections until they conform to safety guidelines. The Environmental Specialist also provides technical infor-mation and advice to residents about other environmental is-sues and private drinking water.

EPH services are provided through a contract with Wayne County. For more information contact Steve Yates at the Wayne County Health Center, (573) 224-3218.

Environmental Public Health


Women, Infants, and Children (WIC)

Number of Participants

Breastfeeding Peer Counselor Program

HEAL: In 2015, the Health Center continued with its Healthy Eating, Active Living (HEAL) grant. The purpose of the HEAL grant is to create healthy communities that ensure residents have access to affordable, healthy foods and where active lifestyles are encouraged and supported.

Since October 2014, this grant has provided funding and technical support for worksites to become desig-nated as a Missouri Breastfeeding Friendly Worksite. In 2014, there was only 1 Breastfeeding Friendly Worksite in Bollinger County. Through efforts made with the HEAL grant, that number has increased to 13 in 2015. Funding and technical support for the Breastfeeding Friendly Worksite Award will continue to be offered in 2016.

The grant also provides funding and technical support for Child-care Centers to become a desig-nated Missouri MOve Smart Childcare Facility. The Missouri MOve Smart Guidelines, devel-oped by MO DHSS, are designed to boost the physical activity practices and improve the health and wellness of children ages 2-5. The MOve Smart pro-gram is voluntary and open to all licensed-exempt child care facilities throughout Missouri. The program recognizes inter-mediate and advanced levels. Each level requires increasingly higher physical activity stand-ards. The guidelines include recommendations for total amounts of structured and un-structured physical activity, in-door physical activity, learning integrated physical activity, screen time, staff participation in physical activity, and staff role modeling of an active life-style. Before receiving the grant, there were no MOve Smart childcare facilities in

Bollinger County, but during the 2015 year, 5 facilities became MOve Smart.

CDSMP: Through a partnership with Mississippi County Health Department, St. Francois Coun-ty Health Center, and the Re-gional Arthritis Foundation, the Health Center has 3 staff mem-bers who are certified to teach a Chronic Disease Self Manage-ment Program (CDSMP). This is a 6 week workshop that helps participants learn to better manage their chronic disease through diet, exercise, working with their healthcare team, and pain management. Twenty-seven people completed the workshop in 2015.

Health Education Services Cont. WIC is a supplemental nutrition education program that helps mothers and young children eat well and stay healthy. Women, Infants and Children who meet income guidelines may go to any WIC provider in the State of Missouri to apply for WIC bene-fits. Income guidelines are es-tablished by the Unites States Department of Agriculture. WIC

provides breastfeeding educa-tion and support; nutrition and health education; referrals and health screenings; and funds to buy nutritious foods. The WIC program is very active in our county, with 4,736 client contacts in 2015. Eight clinic days are set aside each month to serve WIC clients. Seven of

those days are in the Marble Hill Office, and a satellite clinic is held in Patton one day per month.

The Breastfeeding Peer Counse-lor Program provides breastfeeding education and support to WIC participants. The Breastfeeding Peer Counse-lor (BFPC) teaches breastfeed-ing classes monthly, as well as host a quarterly support group. The BFPC also provides one-on-one counseling to moms. The Breastfeeding Peer Counse-lor Program loans both manual and electric breast pumps. The Breastfeeding Peer Counse-lor made 373 contacts to prena-tal and breastfeeding WIC par-ticipants in 2015. Breastfeeding initiation rates for FY 2015 were 73.1% which was above the State average of 69.2%. Breastfeeding duration rates at 6 months were 8.9% and 9.3% at 12 months. The Bollinger

County WIC Program also re-ceived recognition as “Breastfeeding Friendly WIC Clinic” for the fifth year in a row, and was recognized as a

Missouri Breastfeeding Friendly Worksite. The Breastfeeding Peer Counselor Program is coor-dinated by the WIC Nutritionist.

Women 1102

Infants 1050

Children 2584

73.1%

61.0% 59.0%55.1% 52.8% 50.2%

BollingerCounty

MadisonCounty

WayneCounty

CapeGirardeau

County

Perry County StoddardCounty

Breastfeeding Rates 7/1/14- 6/30/15


Case Management services are available for any eligible preg-nant woman that may be at risk for a poor pregnancy out-come. These services are in-tended to encourage adequate

prenatal care, to help reduce the incidence of infant mortality, and low birth weight. Prenatal cli-ents, that wish to participate, are seen by Public Health Nurses during office visits for assess-

ment, teaching, referral, and support. The number of Case Management clients has in-creased from 23 clients in 2014, to 30 in 2015.

Children, 9 months through 5 years of age, are assessed for lead risk factors during routine visits to the Health Center. Capillary lead testing is availa-ble to any child in this age

range. Children that have elevat-ed blood lead levels are followed by a Public Health Nurse for Case Management until levels return to a normal limit. 151 lead tests were completed in 2015. There

were 101 Prenatal clients who were also given a verbal assess-ment for lead poisoning. If risk factors are noted, they are pro-vided a copy of the results for follow up with their OB/GYN.

Lead Assessment/Testing

The services of a Public Health Nurse, trained in child care consultation, are offered to all licensed, license exempt, and non-regulated child care pro-viders within Bollinger County. We have served 1 Head Start program, 1 licensed preschool, 2 license-exempt facilities, 1

licensed group home, and 7 li-censed family-home providers this past year. Also, 39 Children Health Promotion Presentations, 1½ hours on-site provider consul-tations, 2 technical consults, and 10.5 hours of group trainings have been completed. A total

number of 233 children have been impacted by these services.

Child Care Health Consultation

Prenatal Case Management/Risk Appraisal

Surveillance The Health Center receives weekly reports from daycares, schools, a Long Term Care Facility, and a medical provider on the number of illness/disease seen in attendees, residents or clients. The communicable disease nurse reviews this information to monitor the illnesses reported. The agency also receives reports on reportable conditions in Missouri. Investigations are done by the nurses with interventions as necessary to promote the health of Bollinger County Residents. For 2015, the agency had a higher than usual report of pertussis (whooping cough), Rocky Mountain Spotted fever, tick borne illnesses, and salmonella (a bacterial enteric disease). Investigations of these cases and interventions are completed to prevent future spreading of the diseases. Though we had a higher than usual number of these diseases, we had no outbreaks in 2015.

Sexually Transmitted Disease Public Health Nurses can provide screenings for chlamydia, gonorrhea, HIV and Syphilis. Treatment is provided on site for chlamydia and gonorrhea. Follow-up of HIV and Syphilis are generally handled by Missouri

Department of Health staff. In addition to these screenings, the Health Center now does Hepatitis C screenings through the Hepatitis C Alliance.

Rabies In 2015, Rabies was found in a bat, and also a domestic animal, a dog. Due to rabies being found in a domestic animal, Bollinger County was under a rabies alert. Domestic animals with rabies were also found throughout the state. Please see the state map of the counties and species. Bats and skunks were the species in the wildlife population most found to be rabid. Rabies in humans is most always fatal. Pet vaccination against rabies by a

licensed veterinarian, is the best prevention of potential human exposure to rabies.

Tuberculosis The Health Center also does investigations and follow-up of all positive tuberculin skin test done at the Health Center or those reported to us by another agency. Public Health Nurses provide case management services for Latent TB Infection (not contagious) and TB Disease (contagious). We offer TB screening test on Wednesday and other days by appointment. This test is placed on one day and read 48—72 hours later.

Communicable Disease

Show Me Healthy Women (SMHW) is a free breast and cervical cancer screening pro-gram funded by the state of Missouri. To qualify for a free breast and/or cervical cancer screening, women must meet certain age, income, and in-surance guidelines. The Bol-linger County Health Center currently provides annual

SMHW services to 25 partici-pants. WISEWOMAN (Well-Integrated Screening and Evaluation for Women Across the Nation) is offered in conjunction with SMHW services. WiseWoman includes screenings that meas-ure blood pressure, total choles-terol, HDL, Blood glucose, and

height and weight for calcu-lating body mass index (BMI). WISEWOMAN education helps each woman make changes she is ready to make, helps her set realistic goals, and provides re-sources and tools to help her make these changes.

Show Me Healthy Women and WiseWoman


In December of 2014, the Health Center was awarded the Immunization Awareness and Access Initiative. The four year grant will cover immunizations for children and adults who do not have a payment source, provide education to the public on immunizations, and sponsor a yearly regional nurse’s workshop including topics about immunizations. A combination of community

based interventions will be used to increase the demand for vaccinations in Bollinger County, improving vaccination rates and awareness of immunization rec-ommendations. Public health nurses in the region will be offered educational opportuni-ties to expand knowledge of immunization protocols and improve the efficacy of immunization programs. The first training in April, 2015 was attended by 79 public health professionals**

Immunization Awareness and Access Initiative

The Safe Cribs of Missouri pro-gram has continued at the Health Center under the direc-tion of the Missouri Depart-ment of Health & Senior Ser-vices. Funding for this pro-gram through the State has been limited, but portable cribs have been made availa-ble to clients if they do not have a crib and if they meet

the financial eligibility require-ments set by the State. Require-ments also include clients being at least 35 weeks gestation or having an infant less than 3 months old at the time of the crib application. During 2015, there were 11 referrals and 8 cribs were delivered to new par-ents, with office and home visits by Public Health Nurses that in-

cluded teaching on child safety and safe sleep.

Safe Cribs for Missouri

Vital Records

The Bollinger County Health Center provides certified cop-ies of Birth and Death Certifi-cates. This service is available through the Missouri Depart-

ment of Health, Bureau of Vital Records. Birth certificates are $15 per copy for births after 1920. Death certificates, for deaths occurring after 1980, are

$13.00 per copy. The Health Center fulfilled 1,087 certified copy requests in 2015.

Bollinger County is better pre-pared today to respond to a disaster than at any time in the past. The Health Center con-tinues to update response

plans for disasters due to weath-er, illnesses and manmade inci-dents. Funding for Ebola Public Health Emergency Preparedness was received in 2015. Linda Do-

erge is the Regional Emergency Planner and assists in coordinating emergency plans and response for Bollinger County.

Emergency Response

Walk-in Services

Wednesday Clinics 50 STD 176

Outside Clinics 36 Vision and Hearing 20

Blood Pressures 768 Other Injections 106

Blood Sugar 42 Show Me Healthy Women 114

Hemoglobin 38 Pregnancy Test 82

Cholesterol 30 PPD 225

Lead Screening 385 Health Ed Services 918

Walk-in services are provided to residents of Bollinger County on Wednesdays or by appointment.

The mission of the MRC is to

engage volunteers to

strengthen public health,

emergency response and com-

munity resiliency. Bollinger

County has had a Medical Re-

serve Corps since 2/15/2007.

Its primary reason for estab-

lishment was to assist the Lo-

cal Public Health Agency with

the implementation of mass

treatment for the National

Strategic Stockpile and to ad-

minister Influenza vaccina-

tions to residents. CPR/First

Aid classes, available through

the MRC, were completed by 19

individuals in 2015. CERT

(Community Emergency Re-

sponse Team) Training is availa-

ble through the MRC when re-

quested. The 20-hour training

covers: disaster preparedness,

terrorism and CERT, disaster fire

suppression, light search and

rescue operations, disaster

medical operations, disaster

simulation, and disaster

psychology and team

organization.

Medical Reserve Corps (MRC)

**Funding for this project was provided by The Missouri Foundation for Health. The Missouri Foundation for Health is a philanthropic organization whose vision is to improve the health of the people in the communities it serves


“Prevent Tick Bites” posters were placed in every park in Marble Hill

Ebola Preparedness and Re-

sponse Activities funding was

provided to directly engage in

preparedness activities at the

community, county, and

regional levels. Bollinger

County Health Center part-

nered with 13 counties in the

Southeast Missouri Region to

apply for funding.

Upon receipt of funding, the

partners began planning for a

table top exercise for Ebola, as

well as other infectious diseases.

Equally important, the funding

provides Personal Protective

Equipment (PPE) training for

Health Care, Emergency Ser-

vices, Fire Departments, 911,

Emergency Management Direc-

tors and law enforcement

agencies.

Ebola Preparedness

Billing for Immunization Services

In August of 2015, the Bol-linger County Health Center received a grant through the Missouri Department of Health and Senior Services. The Billing for Immunization Services in Local Public Health

Agencies grant has allowed the Health Center to pursue direct contracts with insurance compa-nies that allows the Health Cen-ter to provide vaccinations to clients with commercial insur-ance. Through this grant the

Health Center has started the process of obtaining commercial insurance contracts, and billing the insurance companies for services rendered.

Influenza Immunization Through School Clinics funding was provided through the Mis-souri Department of Health and Senior Services, to support

mass influenza immunization clinics. Through this grant, the Health Center nurses were able to go to all four schools in the

county and administer 555 flu shots to county students.

Influenza Immunization Through School Clinics Project

Breastfeeding Support Group

Outreach to Patton HOPS Child Care Consultation

Breastfeeding Brandi

Bollinger County Resource Fair

Annual Report 2015 - Bollinger County Health Center - … · 2016-07-19 · Annual Report 2015 Josephine Dunbar hair ... MO 63764 Phone: 573-238-2817 Fax: ... Health enter provides

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