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!