Princess Health and Kenton County's approval of a needle exchange inches Northern Kentucky, hit the hardest by heroin, toward getting one. Princessiccia

Princess Health and Kenton County's approval of a needle exchange inches Northern Kentucky, hit the hardest by heroin, toward getting one. Princessiccia

county government county health boards county health departments health departments hepatitis c heroin HIV legislation local government needle exchanges public health

Gusty 16:40 Add Comment

The Kenton County Fiscal Court unanimously approved a mobile needle exchange program March 29, which moves the City of Covington's needle exchange program one step closer to fruition, Terry DeMio reports for the Cincinnati Enquirer.

The Fiscal Court's approval was one of several conditions required by the City of Covington to allow its exchange to move forward. Covington's plan also requires two other counties in the Northern Kentucky Health District to adopt exchanges (only Grant County has); limits access to only resident's of the district's four counties; and would move the exchange to St. Elizabeth Healthcare hospital.

In addition, it requires a one-for-one needle exchange and a mandate that all participants must be tested for hepatitis C, hepatitis B, HIV, and, where applicable, pregnancy. This condition is likely not legal and is being investigated by the Northern Kentucky's Health Board's legal counsel, DeMio reports.

Kenton County's plan differs from Covington's in that it mandates only the offering of these tests, DeMio reports.

Both plans will require the Kenton County Board of Health's approval.

Needle-exchange programs were authorized by the state anti-heroin law passed in 2015, and require both local approval and funding. They are meant to slow the spread of HIV and hepatitis C, which are commonly spread by the sharing of needles among intravenous drug users. Northern Kentucky has been hit the hardest in the state by heroin and its hepatitis C rates have been reported at 19 times the national rate.

The needle exchange would be funded by $250,000 from the R.C. Durr Foundation, and the health department would use its staff and already available testing to further pay for the exchange, DeMio reports.

The Fiscal Court also approved exploring the idea of building a community-wide addiction treatment center on the county jail grounds; putting $25,000 toward a heroin helpline; and approved a resolution to encourage the Northern Kentucky Board of Health to create a high-quality prevention and education program for the community.

The Northern Kentucky Area Development District has already put out proposals for the heroin helpline, DeMio notes. And County Judge-Executive Kris Knochelmann told him that Boone and Campbell counties were willing to consider putting $25,000 each toward it, and that St. Elizabeth had promised $75,000 toward its operation.

The other needle exchanges in the state that are either operating or have been approved are in Louisville and Lexington and in the counties of Pendleton, Carter, Elliott, Franklin, Grant and Jessamine.

Princess Health and Louisville opens first needle exchange in state; officials predict rural counties will be slow to follow.Princessiccia

Princess Health and Louisville opens first needle exchange in state; officials predict rural counties will be slow to follow.Princessiccia

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Gusty 11:34 Add Comment

Photo by Scott Utterback, The Courier-Journal

Louisville Metro Public Health & Wellness opened its mobile needle-exchange program Wednesday, June 10, making Louisville the first place in Kentucky to implement such a program.

Lexington and Northern Kentucky are expected to follow soon, but officials say that establishing needle exchanges in much of Kentucky will be "more politically complex," Mike Wynn reports for The Courier-Journal.

"We're going to see some parts of our state where this is available and others where it is not," Scott Lockard, president of the Kentucky Health Departments Association, told Wynn. "Rural areas are opting for a slow and deliberate approach, heavy on education and dialogue," he said, and some communities won't even consider a exchange because of "seemingly endless hoops to jump through."

Bullitt County, south of Louisville, is a prime example. There, officials told Wynn that they plan to do a needs assessment and host a community forum with input from law enforcement and mental health experts.

"It's a work in progress," Public Health Director Andrea Renfrow told Wynn. "We are not able to go as quickly as Louisville Metro."

One critic, Magistrate Joe Laswell, told Wynn that he had talked to many voters who are against the exchanges and want to know why police wouldn't arrest addicts when they show up to swap out dirty needles. "I believe in charging and incarcerating," he said, apparently unaware that the addicts would need to have drugs in their possession to be charged.

Lockard, who heads the Clark County Health Department, told Wynn that he won't ask his board to take a vote until August and that he can't predict the political outcome when it goes to city and county officials.

In three other Bluegrass counties, Scott, Harrison and Nicholas, the board of the Wedco District Health Department wants to start a needle exchange, reports The Cynthiana Democrat, but can't proceed in any of the counties without approval of the fiscal court.

So, despite the two-year debate that just ended in Frankfort over the law, it's not really over.

Democratic state Rep. John Tilley of Hopkinsville, the legislature's biggest proponent for needle exchanges, told Wynn that giving city councils and fiscal courts final authority over the programs was necessary to sooth critics and pass a comprehensive heroin bill this year.

Opponents of the law say the exchanges promote drug use, while proponents cite evidence that doesn't support those claims, but instead "help prevent the spread of deadly and expensive diseases and pull addicts into treatment programs while keeping dirty needles out of parks and off the streets," Wynn writes.

A Lexington Herald-Leader editorial wrote about needle exchanges: "Congressional critics rely on a gut feeling that providing needles endorses drug use, but 20 years of research argues otherwise." Listing that where there are syringe exchange programs:

• Participants are five times more likely to get treatment.
• HIV and hepatitis C declines among drug users.
• Participants can get referrals to substance abuse treatment, disease prevention education, vaccinations, condoms, counseling and testing for communicable diseases.
• Costs are more than recaptured. A 2011 European study found that $1 spent on needle-exchange programs yielded $27 in health-care cost savings, prompting an international report to call needle exchanges "one of the most cost-effective public health interventions ever funded."

The federal Centers for Disease Control and Prevention recently reported that new cases of hepatitis C more than tripled in Kentucky, Tennessee, Virginia and West Virginia between 2006 and 2012, mainly from the use of dirty needles. Officials fear an outbreak of HIV and AIDS will follow.

Princess Health and Princess Health andTobacco heritage blocks smoking bans in rural Kentucky.Princessiccia

Princess Health and Princess Health andTobacco heritage blocks smoking bans in rural Kentucky.Princessiccia

cigarettes county health departments local government smoking smoking ban smoking bans smoking ordinances tobacco

Gusty 07:24 Add Comment

"A mural showing a tobacco harvest has been on display high in
the second-floor rotunda of the Bourbon County Courthouse for
than 100 years," Mary Meehan writes. (Herald-Leader photo) 

Bourbon County's strong tobacco heritage is the main obstacle for proponents of a local smoking ban, and similar feelings exist in many Kentucky counties, Mary Meehan reports for the Lexington Herald-Leader in the second of a series of stories about tobacco use in Kentucky.

"At an April political forum at Bourbon County High School, cigarette butts lined the walkway to the auditorium, although the campus is designated smoke-free," Meehan writes. "Onstage, candidates for city council and magistrate were asked whether they would support a smoking ban. Some said they had fathers or sisters who were longtime smokers who had cancer, most said they didn't smoke, and a few said they weren't sure smoking was really a health risk. Of 18 candidates, only one said he would support a smoking ban. He didn't win in last week's primary election."

The forum was organized by Students Making a Change in Our Communities, a youth group advocating a smoking ban. They have helped rejuvenate efforts begun three years ago by the Coalition for a Smoke-Free Bourbon County and Cyndi Steele, health coordinator for the Bourbon County Health Department.

"Twelve of Kentucky's 120 counties and 26 cities have enacted some type of smoke-free ordinance," Meehan notes. "In Kentucky, 34 percent of the population is protected by smoke-free laws. Almost all Kentucky cities with bans are county seats, leaving most of rural Kentucky without smoking regulations. Efforts to enact a statewide ordinance have failed in the legislature.

"Across the country, about half the population lives in places with smoke-free rules, said Cynthia Hallett, executive director of the nonprofit Americans for Nonsmokers' Rights. She said the science on the dangers of smoking and exposure to secondhand smoke was clear, as were the benefits of smoke-free laws. Kids who grow up where smoking is banned in public places are less likely to smoke, she said. People tend to quit when towns go smoke-free." (Read more)

Read more here: http://www.kentucky.com/2014/05/25/3259432/bourbon-countys-tobacco-heritage.html?sp=/99/322/&ihp=1#storylink=cpy

Read more here:

Princess Health and Princess Health and'Stars are aligned' for making Ky. healthier, and let's start with schools, health commissioner tells County Health Rankings event.Princessiccia

Princess Health and Princess Health and'Stars are aligned' for making Ky. healthier, and let's start with schools, health commissioner tells County Health Rankings event.Princessiccia

county health county health departments farmers' markets health rankings health reform nutrition public health smoking state government tobacco tobacco prevention

Gusty 15:42 Add Comment

Kentucky is poised to make itself healthier, and one key push needs to be making schools smoke-free, the two top officials in charge of the effort told a gathering of state and local health leaders and activists in Frankfort on Wednesday.

Mayfield

"We know our health statistics are bad, but the stars are aligned for Kentucky, and the time to get healthy is now," Dr. Stephanie Mayfield, the state commissioner of public health, said at a gathering held to highlight "Signs of Progress" in conjunction with the national release of the fifth annual County Health Rankings.

"We're seeing changes that we haven't seen in a generation or multiple generations," Mayfield said, such as the expansion of Medicaid under federal health reform; the enrollment of almost 400,000 Kentuckians in the program or private coverage through the state insurance exchange, Kynect; and a coordinated effort by state agencies to make specific improvements in Kentucky's health statistics.

"I can't stop smiling about this," Mayfield said of the effort, called Kyhealthnow. "This is public health at its best," using accountable strategies to reach measurable goals. "These are strategies we need to implement across our state," she said, "but we need to do it in a  way that's not condemning to people and helps them make healthy choices."

Mayfield is co-chair of the effort, headed by Lt. Gov. Jerry Abramson under appointment from Gov. Steve Beshear. Both of them said it must include a stringer effort to ban smoking on school grounds.

Abramson (cn|2 image)

"Only 33 of our 173 school districts have tobacco-free policies," Abramson said with a touch of incredulity, repeating the line for impact. "We have areas where the government has stepped up [with a smoking ban] and the school districts haven't; we have areas where the school districts have stepped up and the governments haven't; and unfortunately, we have lots of areas throughout the commonwealth of Kentucky where neither has occurred"

Mayfield said, "It is disgraceful that all of our schools are not smoke-free. . . . We need to target our children," because the tobacco companies are.

In a national County Health Rankings video, Grant County School Supt. Sally Skinner said, "We have for some time realized the connection between healthy students and strong academic results." Grant County was recognized nationally for focusing on its health ranking as a motive for improvement, and for raising it from 89th to 60th out of 120 counties.

The program also featured videos of three other counties (Floyd, Franklin and Todd) that have used the rankings and associated data to motivate their efforts. The counties are representative of many others "that are doing something" to improve community health, said Dr. Connie White, clinical director for the state Department of Public Health.

Floyd County was recognized for its work against diabetes; Franklin County was noted for its creation of smoke-free environments; and Todd County was recognized for starting a farmers' market to make more fresh produce available.

"There are so many exciting efforts under way in Kentucky," said Katie Wehr of the Robert Wood Johnson Foundation, which funds the County Health Rankings and Roadmaps. She praised the three health departments that have won national accreditation: Franklin County, Three Rivers and Northern Kentucky. "You are demonstrating to the rest of the nation what's possible."

The foundation held similar events in Rockingham County, North Carolina, and Amherst, N.Y., a Buffalo suburb, to mark the fifth anniversary of the rankings and the importance of the roadmaps, which give communities guidance on campaigns to improve community health.

"The rankings are the starting point for the conversation," said Kitty Jerome, director of the Roadmaps to Health Action Center at the University of Wisconsin. "The number is not as important as the people in this room."

Abramson said it's unfortunate that so many Kentucky counties are chronically at or near the bottom of the rankings. "Many areas simply aren't getting the message," he said, "and anything we can do to spread that message and beat that drum is very important. . . . "We've got to do something in a coordinated, collaborative way to bring about an enhanced environment of health for our citizens."

"We are all on the same page," said Jane Chiles, chair of the Friedell Committee for Health System Transformation, which co-sponsored the event and is working with other groups on a statewide, county-by-county campaign to improve the state's health. "It is a winning collaboration going forward that will result in a healthier Kentucky."

Former University of Kentucky president Lee Todd, who emceed the event, said the state needs to declare war on what he calls "Kentucky's uglies" to get citizens and communities motivated to improve their health. He acknowledged that the term "war" is "a little tough-sounding, but I think it's time we get mad enough about some of the statistics. . . . If we had one one-hundredth the interest in moving our health rankings as we do our basketball rankings, we would be a top-ten state."

Princess Health and Knox County converting ambulance tax, taking 3/8 of health tax and asking library for same in order to save hospital.Princessiccia

Princess Health and Knox County converting ambulance tax, taking 3/8 of health tax and asking library for same in order to save hospital.Princessiccia

county health departments critical access hospitals health departments hospitals rural health taxes

Gusty 13:55 Add Comment

The Knox County Fiscal Court and the Knox County Board of Health reached a deal Monday to aid its debt-laden county hospital's recovery from bankruptcy by diverting, at least temporarily, 37.5 percent of local health tax revenue to the hospital, asking the local library to do likewise and converting an ambulance tax into a hospital tax.

The proposed agreement is "revenue neutral" and would not create any additional tax for Knox County residents while allowing the Knox County Hospital in Barbourville to stay open, writes Jeff Noble of The Times-Tribune in Corbin.

To save the hospital, the hospital board needs a tax of about 8 cents per $100 worth of property, County Judge-Executive J.M. Hall said. The deal would convert a 5-cent ambulance tax to a hospital tax, and the county health board has agreed to shift 1.5 cents of its 4-cent tax to the hospital. The library board is considering similar action, which would make up the total 8 cents, Hall told Noble.

Health Department Director Susan Liford said the two-year deal with the health board will begin in January 2014 and will be re-evaluated at the end of that period. The health department will be diverting $300,000 to $400,000 a year to the hospital, Noble reports.

"The board felt like we needed to help the hospital, and they were very adamant they did not want to put the health department in jeopardy and have no one here lose their jobs," Liford told Noble. "I think it�s the moral thing to do. And we need our hospital."

The hospital has a debt estimated at $23 million, though the Knox County Fiscal Court purchased it out of bankruptcy by in 2004 for just $7.2 million, according to documents analyzed by the Barbourville Mountain Advocate, Knox County's weekly newspaper. Last July, the fiscal court took over hospital operations of the hospital, borrowing $6 million to fund them, after the former owners filed Chapter 11 bankruptcy. (Mountain Advocate graphic; click on it for larger version)

Princess Health and Health departments raise, or try to raise, tax rates to offset state cuts, higher benefit costs and Medicaid payment problems.Princessiccia

Princess Health and Health departments raise, or try to raise, tax rates to offset state cuts, higher benefit costs and Medicaid payment problems.Princessiccia

county health departments health departments local government public health taxes

Gusty 11:06 Add Comment

Some county health departments are trying, and others may try, to increase property-tax rates to make up for Medicaid shortfalls, program cuts and the rising costs of employee benefits so they can continue providing essential public health services for their communities.

Anderson County Health Department Director Tim Wright has proposed a 33 percent rate increase from 3 cents per $100 of assessed property value to 4 cents per $100. The increase would add an estimated $150,000, which Wright says he would use to end employee furloughs and make up for $200,000 that has not been paid by the Kentucky Spirit managed-care company, reports Editor Ben Carlson of The Anderson News.

Many departments have already cut positions and implemented furloughs to compensate for Medicaid shortfalls, state program cuts and employee benefit costs, said Scott Lockard, past president of the Kentucky Public Health Association and director of the Clark County Health Department. Most departments have done everything possible to increase efficiency of the departments' resources, he said.

A recent tax increase in Boyle County will make property owners pay a little more to help fund the county health department. The fiscal court recently voted to raise the county's health tax from 2.4 cents per $100 to 2.5 cents.

As funding streams have changed, departments need additional revenue sources, said Brent Blevins, director of the Boyle County Health Department. Blevins said without the rate increase, the already short-staffed department would have to cut services.

Declining property values during the recession have decreased tax revenue, said Marcia Hodge, director of the Garrard County Health Department. It proposed a tax rate increase from 4 cents to 4.25 cents in September that was estimated to bring in about $21,000, but the fiscal court did not approve it, she said.

Another problem that health departments face, Hodge said, is that they are required to participate in the state's insurance and retirement system. Over the 12 years she has been at the department, retirement contributions have increased from 4 percent to 25 percent, while costs of fringe benefits have more than doubled while salaries have only increased 10 percent, she said.

The Floyd County Health Department increased its tax rate last September for the first time in 20 years, primarily because of increased costs of employee benefits and department funding cuts, said Thursa Sloan, director of the department.

Sloan said she anticipates a big change in the services that health departments provide over the next 10 years.  Primary care will take a much more preventive approach, she said, and health departments will have to pull back in such services and go back to the basics.

Princess Health and Health departments in N. Ky. and Franklin County are among the first 11 in the nation to be accredited, a milestone in public health .Princessiccia

Princess Health and Health departments in N. Ky. and Franklin County are among the first 11 in the nation to be accredited, a milestone in public health .Princessiccia

county health departments health care health departments public health

Gusty 16:06 Add Comment

Three Kentucky departments are among the first 11 in the nation to receive accreditation from the national Public Health Accreditation Board, which announced the achievements Thursday.

The Franklin County Health Department, the Three Rivers District Health Department in Carroll, Gallatin, Owen and Pendleton counties, and the Northern Kentucky Independent District Health Department, in Boone, Grant, Kenton and Campbell counties received five-year accreditation.

"I am proud of the departments achieving this public health milestone of national accreditation," said board Chair Dr. Douglas Scutchfield, professor of health services research and policy at the University of Kentucky College of Public Health. "Before now, there has not been a national system for health departments to demonstrate accountability and quality to their community."

Scutchfield said accreditation means a department is providing a "high quality of public health service, leadership and accountability to its constituents," and is a clear indication of the departments' "passion and dedication to improving and protecting the health" of the community.

The board, funded by the federal Centers for Disease Control and Prevention and the Robert Wood Johnson Foundation, has received 128 total applications for accreditation: 112 from local health departments, 15 from state departments; and one tribal department.

In addition to the three Kentucky departments that have received accreditation, other Kentucky departments have applied and are awaiting site visits. Those are the Lexington-Fayette County, Barren River District, Madison County and Christian County health departments, said Jill Midkiff, chief spokesperson for the Cabinet for Health and Family Services.

Although accreditation is completely voluntary, it is being encouraged for local health departments by the state Department for Public Health, which is in the process of applying for its own accreditation in 2014. Midkiff said the department just completed its state health assessment, which is now being reviewed, and is beginning to assemble partners to write a state health improvement plan, which should take about a year. (Click here to learn more about accreditation)

Princess Health and Three Kentucky health departments in first group up for national accreditation; requires local health assessment, improvement plan.Princessiccia

Princess Health and Three Kentucky health departments in first group up for national accreditation; requires local health assessment, improvement plan.Princessiccia

Cabinet for Health and Family Services county health boards county health departments health departments health policy public health

Gusty 14:41 Add Comment

By Molly Burchett
Kentucky Health News

Three Kentucky health departments are among the first in the nation to be considered for national accreditation, a process that could help improve patient care and put the agencies in closer touch with their communities' needs.

The national Public Health Accreditation Board will make its first accreditation decisions next week. Among the first group being considered are the Franklin County Health Department, the Three Rivers District Health Department in Carroll, Gallatin, Owen and Pendleton counties, and the Northern Kentucky Independent District Health Department, in Boone, Grant, Kenton and Campbell counties.

The decision will be a historic one, and this is an exciting time for the board and Kentucky, said board Chair Dr. Douglas Scutchfield, professor of health services research and policy at the University of Kentucky College of Public Health.

The accreditation program was launched in September 2011 after a seven-year development process aimed at advancing quality and performance and value in the departments, and their accountability to stakeholders, Scutchfield said.

Departments are assessed by rigorous standards tested in 30 diverse health departments across the country to ensure essential public health services are provided in the community, according to the board's website. Two of the 12 "domains" of the standards deal with administration and governance. In Kentucky, state law makes county health boards responsible for the health of the county. Counties served by district health departments still have county boards.

Accreditation can help a board and department identify opportunities to improve performance and management, and to improve relationships with the community, since the process requires a community health assessment, a community improvement plan and a strategic plan to address the need of the community, said Scutchfield.

The process, often called "Mobilizing for Action through Planning and Partnerships," can help boards and departments be better prepared to proactively respond to emerging and re-emerging health challenges. For a PDF of Franklin County's MAPP document, click here.

The accrediting board has received 108 applications from health departments around the nation: 13 state health departments, 94 local health departments and one tribal agency. In addition to the three Kentucky agencies being considered in the first group, the other Kentucky departments that have applied for accreditation and are awaiting site visits are Lexington-Fayette County, Barren River District, Madison County and Christian County, Jill Midkiff, chief spokesperson for the Cabinet for Health and Family Services, said in an email.

The accreditation process encourages departments to move away from the "silo" model to collaborate with community programs. In Christian County, it has changed the way department employees view their jobs, because they have to continuously reflect on their methods and brainstorm for ways to improve, Health Department Director Mark Pyle told Nick Tabor of the Kentucky New Era.

"Accreditation will likely open new revenue streams," Tabor writes. "But in a way, the process matters more than the status designation."

Midkiff said, "In addition to benefiting from the process itself, our federal and state resources in public health are increasingly shrinking, we are being asked to do more with less. And there is a need for transparency within agencies."

Midkiff said accreditation "may make the agency more competitive for grants in the future. We are actually seeing quality improvement and performance management requirements being written in many federal grants now, so it is being expected at the national level."

Although accreditation is completely voluntary, it is being encouraged for local health departments by the state Department for Public Health, which is in the process of applying for its own accreditation in 2014. Midkiff said the department just completed its state health assessment, which is now being reviewed, and is beginning to assemble partners to write a state health improvement plan, which should take about a year.

Kentucky Health News is an independent service of the Institute for Rural Journalism and Community Issues at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.

Princess Health and Some Christian Co. health board members balk at director's idea of using $100,000 of $2.4 million reserve for recreational trail.Princessiccia

Princess Health and Some Christian Co. health board members balk at director's idea of using $100,000 of $2.4 million reserve for recreational trail.Princessiccia

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Gusty 09:20 Add Comment

The director of the Christian County Health Department urged its board to give $100,000 from reserves to fund a rail-to-trail project to provide residents with new opportunities for exercise.

Coverting old railroad beds to recreation trails could help improve Christian County's infrastructure to promote healthy living, which is needed because a study last year ranked Christian County 116th out of Kentucky's 120 counties in this area, said Health Department Director Mark Pyle.

The department has $2.4 million in reserve, but several board members opposed the idea, citing a budget shortfall this fiscal year, financial troubles with the school-nurse program and delays in Medicaid reimbursements, reports Nick Tabor of the Kentucky New Era.

The City of Hopkinsville hopes to raise $400,000 for the first phase of the trail project. A recreational trail would initiate a culture change and residents should have public resources equal to those of other regions, Mayor Dan Kemp told Taylor.

Pyle told Tabor the trail would help the health department accomplish its goal of advancing public health, and the reserve money isn't there for sitting on. He said he believes the board will agree to using the money for the project at its next meeting, April 22, after considering funding priorities.

The New Era endorsed the health department's contribution as a good investment in local health, which by law is the health board's responsibility. For a PDF of the editorial and the news story, click here.

Princess Health and Health departments prepare for challenges posed by health-care reform law.Princessiccia

Princess Health and Health departments prepare for challenges posed by health-care reform law.Princessiccia

Affordable Care Act county health departments grants health care law health care reform health departments health insurance

Gusty 07:14 Add Comment

No one really has a clue what changes from the health-care reform law will mean to Kentuckians and public health departments are preparing for the uncertainty, reports Kristy Cox of Business Lexington.

"The Affordable Care Act will have an impact on health departments.  It is going to put a whole lot more people out there on the street on health insurance" of one kind or another, Dr. Rice Leach, head of the Lexington-Fayette County Health Department, told Cox.

"I think how health departments are impacted is going to look a little different depending on what part of the state they're in," Rice said. "The United States has passed a law that creates an entitlement for 30 or 40 million people, and here in Lexington, for 10,000 or 20,000 more people to have health insurance. Now, who is going to take care of them?"

If the private sector can't handle the increased patient load, Leach said, the stress goes onto the health departments, meaning they may be expected to provide a broad "continuum" of care for acute medical needs, including doctors and laboratory services. Leach said he hopes other systems will step up to provide care so health departments can continue to focus on preventative services.

Many factors determine what health departments can and can't do as well as their ability to generate dollars. Leach called  the services mandates by state and federal governments as "mission critical activities," which include preventive health, communicable disease control, public health education, emergency response, sanitary code and restaurant inspection and public health policy, writes Cox. 

Despite the challenging economic environment created by budget cuts and managed-care non-payment issues, Kentucky health departments are trying to stay focused on their big-picture mission.  Some departments are writing grants and others, like the Lincoln Trail District Health Department, has sent nurses into school systems in attempt to increase revenue through expanded clinical services, Cox reports.

Princess Health and School nurses start getting scarcer, due to Medicaid problems.Princessiccia

Princess Health and School nurses start getting scarcer, due to Medicaid problems.Princessiccia

children's health county health departments health departments managed care Medicaid nurses school nurses schools

Gusty 11:36 Add Comment

By Molly Burchett
Kentucky Health News

Students in many Kentucky counties will find it harder to see a school nurse due to changes in the state Medicaid program and lack of payment from managed-care companies.

Takirah Sleet, 7, and school nurse Michelle Marra looked at Takirah's
lunch tray to calculate her insulin dosage at Lansdowne Elementary
in Lexington. (Lexington Herald-Leader photo by Pablo Alcala)

In Crittenden County schools, budget woes have forced the Pennyrile District Health Department to request additional money from the school district to keep its school health clinics fully-staffed and open, reports Jason Travis of The Crittenden Press. Allison Beshear, director of the health department, told Travis one reason from the budget crunch is a lack of payment from Kentucky Spirit, which owes the health department $266,000.

Without additional money from the school district, Beshear says, the health department cannot maintain the current level of service at school clinics through the end of the school year.  Proposals have been made to offer services to the district that entail reducing clerical staff without reducing the number of nurses; but in order to do so, trained school staff would have to handle daily medication distribution and help to answer the phones for the clinic.

"Kentucky Spirit has filed two appeals with the Cabinet of Health Services and the Finance Cabinet in which it claims to not be financially responsible for healthcare given in school clinics," reports Drew Adams of WKMS-FM in Murray reports in a story about similar problems in Hopkins County.

Other school districts facing similar problems include those of Bell, Clark and Pike counties. Eleven school health clinics in Bell County could be shut down by the end of this school year, reports WBIR-TV of Knoxville. In Clark County, a lawsuit between the state and Kentucky Spirit has put a halt to reimbursement for health services provided in county schools, reports Rachel Gilliam of The Winchester Sun.

Last month, the Pike County Board of Health filed a lawsuit against Kentucky Spirit because the managed-care firm has stopped reimbursing the Board of Health for school-nurse programs, reports Jordan Vilines of WYMT-TV in Hazard. The money has to be reimbursed in order to provide school nurses.

�I think having someone in the school to ensure that our children are healthy is imperative for the quality of life of our kids, especially in a very rural area," Pike Judge-Executive Wayne T. Rutherford told Vilines.  He said that without reimbursement, school nurses could lose their jobs, which would leave hundreds of kids without immediate medical care.

Kentucky Health News is an independent service of the Institute for Rural Journalism and Community Issues at the University of Kentucky, with support from the Foundation for a Health Kentucky.

Princess Health and How to take local action to improve health at the local level is outlined at Frankfort conference.Princessiccia

Princess Health and How to take local action to improve health at the local level is outlined at Frankfort conference.Princessiccia

county health county health boards county health departments health departments health rankings local government

Gusty 14:51 Add Comment

By Tara Kaprowy
Kentucky Health News

A recipe for how to improve health at the local level in Kentucky was the capstone of a day-long seminar in Frankfort Monday, with experts stressing that partnerships are key and funding will remain tight.

Communities must mobilize, prioritize, "effectivize" their actions, publicize and evaluate, measure and report performance, Trudi Matthews, director of policy and public relations at HealthBridge, summed up at the end of the Kentucky Health Quality Collaborative Conference.

The gathering was hosted by Kentucky Voices for Health in partnership with the Friedell Committee for Health System Transformation. "No single actor or set of stakeholders can solve what's wrong," Matthews said. "We really need to think across silos. We really have to collaborate."

When it comes to funding, governments "have made it very clear they will not increase the number of dollars that will be put into health care," said keynote speaker Dr. Robert Graham, national program director for Aligning Forces for Quality. "We're in a perfect storm," agreed Sue Thomas-Cox, branch manager for chronic disease prevention at the Kentucky Department for Public Health. "Federal, state and local governments don't have enough money . . . so we must work together."

Luckily, health care happens at the local level, Graham said, with hospitals and clinics unique to communities, health insurance agents locally based and consumers grounded in their communities. While there is "no particular model for how to get (change) started," Graham said, the first step is getting all stakeholders � purchasers, insurance agents, providers, consumers, faith-based organizations � around the same table. "You've got to make sure there is a balance of interests," he said. 

Also key are local boards of health and health departments, whose members and staff are charged with safeguarding the health of the people of a county, under state law, and have the advantage of being "relatively untainted by the illness-for-dollars disease," pointed out Dr. Forrest Calico, a rural health consultant and longtime worker in the field.

Health departments must ensure they don't spread themselves too thin, said Dr. Steve Davis, acting commissioner for the Department for Public Health. "One of the biggest reasons why we have not moved the health needle in Kentucky is we need to be an inch wide and a mile deep," he said. Communities need to "come up with five or six things and let's hammer, hammer, hammer it," he said. Of those priorities, Davis pointed out the importance of tackling chronic disease: "That's what's killing our brethren and eating our financial lunch." For adults, he would like to see an increase in breast, cervical, colon and lung cancer screening, as well an increase in immunization rates especially for flu and pneumonia.

For children, Davis has six priorities: reduce preterm and low-birthrate babies; improve injury-prevention programs; decrease tobacco use; reduce obesity; increase immunization rates; and improve oral health.

To get more accomplished, health departments need to team up with local organizations to avoid duplication of services, which Davis said accounts for $300 billion in unnecessary spending nationwide. He added the goal is to make "1 plus 1 equal 3," with health departments needing to adopt a "do or assure" philosophy.

But there are challenges in health departments, with some local health board members failing to "roll up their sleeves," Davis said. "You can go in with nothing in your head and leave with nothing in your head," agreed Henry Bertram, chair of the Pendleton County and Three Rivers District Board of Health.

A survey of health departments showed just 46 percent of local boards of health have a vision for the next three years to improve the health status of their community and just 44 percent say they are tracking compliance for the 10 essential services they are charged with providing. And the real numbers might be worse, because the survey was voluntary.

While about half of the state's health departments are committed to working toward achieving national accreditation, only three departments � Franklin, Northern Kentucky and Three Rivers District � have actually applied for it. 

Also crucial for communities is using data to identify priorities, take action and measure performance, whether using county-specific numbers at www.kentuckyhealthfacts.org or using national data.

"We don't want to get stuck in analysis paralysis," but communities can use the data as "a story you can use as leverage," said Jan O'Neill, community engagement specialist for County Health Rankings & Roadmaps. The County Health Rankings evaluate the morbidity and mortality rates for nearly every county in the country and rank them within a state.  The rankings can act as a motivator for counties interested in effecting health changes, but "We have to be aware of their limitations" given their margins of error, especially for small counties, pointed out Al Cross, director of the Institute for Rural Journalism and Community Issues. 

O'Neill spoke of San Bernadino County in California, which used its low ranking to spur change. The county focused on its built environment, pressing hard for Walk or Wheel to School programs, community gardens and a kids community health center. O'Neill pointed out the changes are about more than infrastructure. "It's the relationships," she said. "It's the human capital ... It's many not all doing it all, but bringing what you do best. That's what mobilizing looks like."

Jodi Mitchell, executive director for Kentucky Voices for Health, said she is "starting to see a tide of change" already in Kentucky. What's important is to keep momentum building and, equally vital, ensure people are willing to participate. "If you're not at the table," she said, "you're on the menu."

Kentucky Health News is a service of the Institute for Rural Journalism and Community Issues, based in the School of Journalism and Telecommunications at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.

Princess Health and Floyd County woman is Kentucky's smoke-free advocate of year.Princessiccia

Princess Health and Floyd County woman is Kentucky's smoke-free advocate of year.Princessiccia

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Gusty 08:01 Add Comment

For her work spreading the word about second-hand smoke and founding the coalition that ultimately helped Prestonsburg pass a smoke-free ordinance in 2009, Floyd County's Jean V. Rosenberg was named 2012 advocate of the year at the annual Smoke-Free Policy Conference hosted by the University of Kentucky's Kentucky Center for Smoke-Free Policy. She stands with center Director Dr. Ellen Hahn, left, and Dr. Melissa Walton-Shirley, right, the Glasgow cardiologist who won in 2011.

Rosenberg started her work in 2005 when she began working for the Floyd County Health Department as a program specialist to increase awareness about the dangers of second-hand smoke, reports Ann Blackford reports in a university press release. During that time, she founded the Breathe Easy Floyd County Coalition, which educated people about second-hand smoke and supported local smoke-free initiatives.

On Nov. 1, 2009, the City of Prestonsburg implemented a 100 percent smoke-free ordinance in all workplaces and enclosed public places, with Rosenberg at the helm to propel the effort forward. (Read more)