Page 1 of 18...Comparative analysis to identify health disparities in the community, c. Analysis of...

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A B C D E F G H I J K L MReceived? A 1-4 B 1-4 C 1-2 / D 1-3 G1 G2 G3 / G4 G5 G6 Total % of 8 areas

ADAMS X 1 1 1 3 38%ASOTIN X 1 1 2 25%BENTON-FRANKLIN X 1 1 1 1 4 50%CHELAN-DOUGLAS X 1 1 13%CLALLAM X 1 1 2 25%CLARK X 1 1 1 1 1 1 6 75%COLUMBIA X 1 1 1 1 1 1 1 7 88%COWLITZ X 1 1 13%GARFIELD X 1 1 1 1 1 1 1 1 8 100%GRANT X 1 1 2 25%GRAYS HARBOR X 1 1 1 3 38%ISLAND X 1 1 1 1 4 50%JEFFERSON X 1 1 1 3 38%KITSAP X 1 1 1 3 38%KITTITAS X 1 1 1 1 4 50%KLICKITAT 0 0%LEWIS X 1 1 1 1 4 50%LINCOLN X 1 1 1 1 4 50%MASON X 1 1 1 1 1 5 63%NE TRI X 1 1 1 1 4 50%OKANOGAN X 1 1 13%PACIFIC X 1 1 2 25%PUBLIC HEALTH SEATTLE-KING COUNTY X 1 1 1 3 38%SAN JUAN X 1 1 13%SKAGIT X 1 1 2 25%SKAMANIA X 1 1 1 1 4 50%SNOHOMISH X 1 1 1 1 4 50%SPOKANE X 1 1 2 25%TACOMA-PIERCE X 1 1 1 1 4 50%THURSTON X 1 1 1 1 4 50%WAHKIAKUM X 1 1 1 1 4 50%WALLA WALLA X 1 1 1 1 1 1 1 1 8 100%WHATCOM X 1 1 1 3 38%WHITMAN X 1 1 1 1 1 1 6 75%YAKIMA X 1 1 1 1 1 5 63%

0 0%Total 34 10 5 18 11 15 27 23 14 0

29% 14% 51% 31% 43% 77% 66% 40% 0%

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A 1-4* Assessment (Surveillance and Epidemiology)BARS Code: 562.80 Assessment ActivitiesMeasure: Abbrev (All)

Row LabelsSum of Count

ADAMS - Pay for and allocate .25 FTE (80 hours/month staff time) to lead community health coalition effort of conducting Community Health Needs Assessment to guide development of Community Health Improvement Plan 1ASOTIN - Pay for and allocate approximately 13 hours of staff members’ time weekly to participate in community health assessment activities in Asotin County. 1BENTON-FRANKLIN - 1. Fund the creation of an Epidemiologist/Assessment Analyst position to compile, assess and evaluate communicable disease and reportable condition data. This position would expand BFHD’s capabilities to focus on response and intervention efforts by: a. Identifying trends, b. Comparative analysis to identify health disparities in the community, c. Analysis of the effectiveness of response and intervention strategies, d. Identify gaps in data collection, e. Inform the community to provide focused review of available data, identify gaps, review trends and identify focus areas for intervention and response. 2. Provide funds for technology improvements in the area of statistical analysis and data collection. 1CHELAN-DOUGLAS - 0CLALLAM - 0CLARK - 0COLUMBIA - .20 FTE Assessment and Communications-Contract with Walla Walla Community of Health to assist in CHA, CHIP, CD Surveillance. Participate in ACH region continuing efforts towards efficiency and sharing of services. 1COWLITZ - 0GARFIELD - Seek assessment training for staff (cost unknown) to enhance collected data and information and reports shared locally with groups and the public. 1GRANT - 0GRAYS HARBOR - 0ISLAND - 0JEFFERSON - 0KITSAP - 0KITTITAS - 0KLICKITAT - 0LEWIS - 0LINCOLN - provide approximately .25 FTE to conduct a collaborative Community Health Assessment for Lincoln County. Our goal is to complete the assessment by December 31, 2018. This work will be done in collaboration with Lincoln and Odessa Hospital Districts, along with Behavioral Health Agencies to evaluate the current health trends and priorities to guide our work into the future. LCHD will use cross jurisdictional sharing through a contract with the Spokane Regional Health District Data Center to provide data analysis and interpretation services in support of our Assessment. 1MASON - 0NE TRI - NETCHD will appropriate approximately $10,000 conduct a collaborative Community Health Assessment for counties within our jurisdiction. Our goal is to complete the assessment by December 31, 2018. NETCHD will use cross jurisdictional sharing through a contract with the Spokane Regional Health District Data Center to provide data analysis and interpretation services in support of our assessment. 1OKANOGAN - 0PACIFIC - 0PUBLIC HEALTH SEATTLE-KING COUNTY - 0SAN JUAN - 0SKAGIT - 0SKAMANIA - 0SNOHOMISH - 0SPOKANE - 0TACOMA-PIERCE - 0THURSTON - 0WAHKIAKUM - Plan to contract with an epidemiologist to do an assessment of our community. IT has been 10+ years since any assessment has been done in Wahkiakum County. 1WALLA WALLA - 0.5 FTE Assessment and Communication Coordinator – CHA, CHIP, CD surveillance, overdose surveillance with Coroner, etc. 1

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WHATCOM - 0WHITMAN - pay for and allocate 6 hours per week of a staff members time to train, collaborate and conduct surveillance with county and regional public health partners 1YAKIMA - 0(blank)Grand Total 10

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B 1-4* Emergency Preparedness (All Hazards)BARS Code: 562.88 Emergency Preparedness and ResponseMeasure: Abbrev (All)


ADAMS - 0ASOTIN - 0BENTON-FRANKLIN - 0CHELAN-DOUGLAS - 0CLALLAM - 0CLARK - 0COLUMBIA - .15 FTE Education, communication with providers, and activities regarding Highly Infectious diseases. 1COWLITZ - 0GARFIELD - Pay staff 10 hr/wk for education for improvement in CD related emergency preparedness activities and meetings. 1GRANT - 0GRAYS HARBOR - 0ISLAND - Ensure local and regional capacity to respond to emergencies of public health significance. 1JEFFERSON - 0KITSAP - 0KITTITAS - 0KLICKITAT - 0LEWIS - 0LINCOLN - 0MASON - 0NE TRI - 0OKANOGAN - 0PACIFIC - 0PUBLIC HEALTH SEATTLE-KING COUNTY - 0SAN JUAN - 0SKAGIT - 0SKAMANIA - 0SNOHOMISH - 0SPOKANE - 0TACOMA-PIERCE - 0THURSTON - B3 Allocate up to 10% toward training and update of current Department policy specific to emergency preparedness for infectious disease outbreaks. 1WAHKIAKUM - 0WALLA WALLA - Is covered through Bioterrorism dollars 1WHATCOM - 0WHITMAN - 0YAKIMA - 0(blank)Grand Total 5

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C 1-2 CommunicationsD 1-3 Policy Development E 1-2 Community Partnership DevelopmentF 1-8 Business Competencies (Leadership, Accountability, Quality Assurance, Quality Improvement, Information Technology, Human Resources, Facilities and Operations, Legal and Analysis)BARS Code: 562.11 Communications, 562.12 Policy Development; 562.13 Community Partnership Development; 526.14 Business Competencies; 562.15 Information TechnologyMeasure:Abbrev (All)


ADAMS - Pay for and allocate 8 hours/month of a staff member’s time to develop and maintain community partnerships through participation in local coalitions and collaborative efforts with community partners to research and promote effective policies and communication strategies. 1ASOTIN - 1. Pay for and allocate approximately 27 hours of staff time to meet with individuals and agencies to develop partnerships, to attend meetings and participate in local and/or regional coalitions or groups, and community efforts, research and promote effective public health policies. 2. Purchase new technology and equipment to possibly include two computer tablets or laptops to be able to be able to conduct field work and assessments and sync to agency-wide database to improve efficiencies.

1BENTON-FRANKLIN - 0CHELAN-DOUGLAS - 0CLALLAM - 0CLARK - Develop and pilot a competency based onboarding and annual training program for staff within the communicable disease / tuberculosis program to foster ongoing staff development and skill transfer. 1

COLUMBIA - .20 FTE Communications: Oversee external communications regarding public health practices and Foundational Public Health Services. Communicating communicable disease information with participating providers and Health Officer. 1COWLITZ - 0GARFIELD - 1. Pay staff 28 hr/wk to participate in 2 local coalitions, 1. Community Health and Prevention Advisory Board- CHAPAB and 2. Pomeroy Advocates for Community Empowerment- PACE for monthly meetings and daily work to support community efforts. 2. Update technology to support staff work with FPHS work and improve communication options (1 laptop, 1 desktop, 1 copier/fax/scanner, related needed software for the computers). 3. Update communication plan. 4. Update needed public health office policies. 1

GRANT - GCHD will purchase and implement a performance management system to track GCHD quality improvement measures. 1GRAYS HARBOR - 0ISLAND - 0JEFFERSON - 1. Pay for staff training and competency in using the new notifiable conditions tracking and reporting technology, WDRS, once it is available. The number of staff hours will be determined by the actual training requirements. 2. The FPHS funds will pay for 11-13 hours of staff time split between the three selected Bars expenditure areas. 1KITSAP - 0KITTITAS - 1. Pay for and allocate 15 hours of the Community Health Supervisor’s time to develop a tuberculosis policy and protocol for the department. 2. Pay for and allocate 25 hours of the Assessment Coordinator’s time, 10 hours of the Community Health Supervisor’s time, and 10 hours of the Public Health Nurse’s time for the development of performance measures for the communicable disease program. 1KLICKITAT - 0

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LEWIS - C1: pay for and allocate 2 hours per week, .05 FTE, of the Deputy Director’s time to meet with individuals to develop partnerships, attend community meetings and develop, review, and update communication plan/strategy and content. Individual will also participate in training for public health communications including the ability to write a press release, conduct a press conference and use electric communication tools. F1-3: pay for an allocate 3 hours per week, .075 FTE, of the Deputy Director’s time to develop/enhance leadership skills, learn accountability methods for public health programs, and coach the CD and TB staff members on quality improvement and assurance, including review of policies and procedures for all programs with CD and TB. F3: pay for training requirements associated with implementation of the Washington disease Reporting System (WDRS). Training costs may include some travel and staff time. Currently the CD PHN uses a surface pro so we may need to purchase a laptop since WDRS is not yet ready to be used with a tablet. 1LINCOLN - utilize approximately $10,000 to upgrade critical infrastructure to support foundational public health activities. This will include a conversion of our antiquated phone system to a new Voice Over IP (VOIP) system to serve the agency. The upgraded phone system will save costs for the health department as well as provide a sustainable more user friendly phone system. We will also purchase a new computer with assessment, social media and graphics capabilities. This computer will support our assessment activities as well as development of informational brochures to support immunization outreach and communicable disease prevention. 1

MASON - Pay for transition to Office 365 in order to allow communication with critical partners such as DOH and to develop internal communications through SharePoint that will allow cross disciple communication on communicable disease investigation. 1NE TRI - NETCHD will utilize FPHS appropriations to develop community partnerships with local medical providers and school districts to increase immunization rates. Staff at NETCHD will work with interested partner agencies to organize and implement immunization opportunities at schools and other venues where children can receive needed vaccinations. 1

OKANOGAN - 1. Pay for and allocate 40 hours per week of a staff time to prepare job descriptions, advertise, and train new and essential staff, update policies and procedures which provide fiscal monitoring, BARS reporting, contract billing, and program contract oversight with upcoming retirement of key public health personnel in Environmental Health and Fiscal positions..2. OCPH will continue to meet with individuals to develop partnerships, to attend meetings and participate in coalitions or community efforts, research and promote effective policies, develop a communication plan and communication content / materials, so that we can ensure timely reporting. 3. OCPH will upgrade current systems/server and purchase new technology and train staff on how to use it; which enables staff to complete their work including ensuring policies and procedures are updated and relevant. 1PACIFIC - 1. Use portion of funds to assist department in the purchase of an electronic health record system. The LHJ having an electronic record system will increase our ability to communicate between offices and other CD nurses in our health department related to follow-up of communicable disease reports, assure proper treatment, and follow up on treatment. 2. Pay for 0.2 FTE of a staff person to work on the implementation of the electronic health records system. The use of an E H R will also save time when entering immunizations, as they will be uploaded to the WAIIS system and not have to be entered twice. This ability with assist with data collection in a timely manner 1PUBLIC HEALTH SEATTLE-KING COUNTY - 0SAN JUAN - 0SKAGIT - 0SKAMANIA - 0SNOHOMISH - 0SPOKANE - 0TACOMA-PIERCE - 0THURSTON - C 2 Allocate up to 5% of funds to pay for Community Engagement Evidence and Partnerships staff time to develop community partnerships and education/communication content for educational and outreach activities around sexually transmitted illnesses, Hepatitis C, and other Communicable Diseases with a youth focus.

F 4 Allocate up to 10% of funds to provide technical training and purchase of new technology to meet WDRS implementation requirements and other needed hardware, software, equipment, and training needed for Investigation and Control of Disease staff.

1WAHKIAKUM - 0WALLA WALLA - Communications -0.5 FTE Assessment and Communication Coordinator: oversee external communications, communication strategy and planning efforts and share the value of public health; will also hire a consultant to help develop communication plan and materials which will be shared with DOH

1

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WHATCOM - pay for and allocate 3 hours per week of a staff members time to meet with individuals, groups and agencies to develop partnerships, to attend meetings and participate in coalitions or community efforts, research and promote effective policies 1WHITMAN - 0YAKIMA - Investment in and implementation of computer systems (virtual desktop infrastructure) that allow staff to access their computers using cloud-based technology. This will allow real-time data transfer, remote access regardless of location, and networked data back-up. This will reduce complexity in normal business operations and provide critical business continuity in the event of disaster. 1(blank)Grand Total 18

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G1 Provide timely, statewide, locally relevant and accurate information statewide and to communities on communicable disease and other notifiable conditions and their control.BARS Code: 562.79 EpidemiologyMeasure:Abbrev (All)


ADAMS - 0ASOTIN - 0BENTON-FRANKLIN - 0CHELAN-DOUGLAS - 0CLALLAM - 0CLARK - Strengthen epidemiologic capacity to review and interpret data, develop disease specific data products, and develop an information dissemination plan to share with community partners. 1COLUMBIA - .15 FTE Continuous surveillance of CD and notifiable condition database and information on outbreaks. 1COWLITZ - 0GARFIELD - Pay staff 28 hr/wk to work in the epidemiology program locally and within the State, and attend training to enhance RN skills in notifiable conditions. 1GRANT - 0GRAYS HARBOR - 0

ISLAND - Respond to local and regional cases of communicable disease and ensure community notification when appropriate. 1JEFFERSON - 0KITSAP - 0KITTITAS - 0KLICKITAT - 0LEWIS - pay for and allocate 2 hours per week of the Communicable Disease (CD) Public Health Nurse (PHN) time to review and interpret data, share with partners and communicate with public as needed. 1LINCOLN - 0MASON - Pay for and allocate resources to investigate fecal coliform reports and respond to Noro virus outbreaks in shellfish beds throughout Mason County marine areas and to provide communication to the public on water protection to prevent communicable disease. 1

NE TRI - NETCHD will utilize FPHS appropriations to work with school and healthcare providers to review data to develop community based strategies to improve vaccination rates throughout our three-county area. This will also include working with providers who need information and strategies to improve vaccine acceptance and vaccine rates among their patients. 1OKANOGAN - 0PACIFIC - 0PUBLIC HEALTH SEATTLE-KING COUNTY - 0SAN JUAN - 0SKAGIT - 0SKAMANIA - 0SNOHOMISH - 0SPOKANE - 0

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TACOMA-PIERCE - 1. Hire a 1.0 FTE Communicable Disease Epidemiologist to improve disease surveillance, investigation and response. Through improved data, this work will improve the efficiency and effectiveness of various areas of communicable disease control work including ensuring testing and treatment for hepatitis and STDs and promotion of immunizations. Work will include:a. Data collection, management and analysis related to the surveillance, detection and prevention of the notifiable communicable diseases, TB, STD and HIV; analysis of program and county-wide immunization data. b. Assist investigative teams in developing recommended evidence-based interventions and disease control measures. c. Work with community partners to support epidemiologic investigations. d. Provide staff training to improve data collection, management and analysis skills. 2. Pay for and allocate .25 FTE Communicable Disease Nurse Epidemiologist to strengthen capacity to ensure timely and complete investigation of notifiable conditions and to detect and respond to outbreaks of communicable disease. 3. Pay for and allocate .25FTE Public Health Nurse Consultant to support communications with medical providers. Work will include updating on-line provider resource website, visiting provider offices, promoting evidence based interventions to control communicable diseases and supporting notifiable condition reporting.

1THURSTON - 0WAHKIAKUM - 0

WALLA WALLA - Continuous surveillance of CD and notifiable condition database, information on outbreaks/cluster will be assimilated and distributed as needed. 1 hour per week Assessment and Communication Coordinator. 2 hours per week CD Nurse 1WHATCOM - 0WHITMAN - pay for and allocate 8 hours per week of a staff members time to review and interpret data, share with partners, communicate to the public, etc. as needed; train staff in data systems, analysis, interpretation; etc. 1YAKIMA - Strengthen the transfer of necessary real-time medical data and best practices to the medical, social-service and education communities. The resulting information technology and communication structures will allow timely and relevant information to reach the target audience in normal business operations as well as disaster response events. 1(blank)Grand Total 11

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G2 Promote immunization through evidence based strategies and collaboration with schools, health care providers and other community partners to increase immunization rates.BARS Code: 562.32 ImmunizationsMeasure: Abbrev (All)


ADAMS - 0ASOTIN - 0BENTON-FRANKLIN - 0CHELAN-DOUGLAS - 0CLALLAM - 0CLARK - Develop and pilot a training targeting medical assistants on immunization best practices including reading and interpreting the ACIP recommended childhood vaccination schedule, storage and handling requirements, and strategies for improving clinic level coverage rates. This training is being developed in response to a request from our community partners based on identify gaps. 2. Conduct annual back to school educational sessions to our school nurse partners reviewing immunization requirements, updates, local epidemiology of vaccine preventable diseases, vaccine coverage rates, and available resources. 1COLUMBIA - 0COWLITZ - 0GARFIELD - Pay staff 28 hr/wk to promote immunizations, work with Pomeroy School District (review IIS student vaccination requirements, educate school and parents about vaccines, interact with parents and refer students for needed vaccinations. Review data from IIS to identify and target efforts to providers with the lowest rates; share data with these providers; strategize on how to help them improve rates. 1GRANT - 0GRAYS HARBOR - 0ISLAND - 0JEFFERSON - 1. Jefferson County’s historically low immunization was identified as a priority area through the Jefferson County Health Assessment. This is one of the four priority areas in the Community Health Improvement Plan. FPHS funds will pay for staff time to work on our CHIP strategies to increase our immunization rates. These strategies include working with the schools and health care providers. As a part of this work, we plan to review data from IIS to identify and target efforts to providers with the lowest rates; share data with these providers; strategize on how to help them improve rates; implement. 2. FPHS funds will pay for 11-13 hours of staff time split between the three selected Bars expenditure areas. 1KITSAP - Pay for and allocate 0.3 FTE to: · Develop outreach strategy plan to improve rates among prioritized populations based on age-specific immunization and provider immunization rates, · Provide targeted provider education on compliance to minimal vaccine intervals for optimal immunity, Implement the outreach plan 1KITTITAS - Pay for and allocate 200 hours of the Public Health Nurse’s time to review and analyze school and childcare immunization records, encourage and support school nurses to use the new school module of the WAIIS, and make contact with parents to update immunizations for children and address barriers. 1KLICKITAT - 0LEWIS - 0LINCOLN - allocate .1 FTE to work with school nurses and healthcare providers in Lincoln County to review data from IIS to develop community based strategies to improve vaccination rates in Lincoln County. This will also include working with providers who need strategies to improve rates among their patients. 1MASON - 0NE TRI - 0OKANOGAN - 0PACIFIC - 0PUBLIC HEALTH SEATTLE-KING COUNTY - 0SAN JUAN - Pay for approximately 12 hours per week of a staff member’s time to: 1. review data from IIS and other data sources to identify and target efforts to all providers in the county, 2. share data with these providers, 3. strategize with providers on how to improve rates, 4. provide technical assistance to school districts to implement the IIS school based module, 5. review school district immunization rates with each district, and strategize with schools on how to improve rates and enforce school exclusion policies 1

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SKAGIT - Pay for and allocate 20 hours per week of a Public Health Nurse position. G.2 activities will be combined with G.3 activities to create a 30 hours per week position. In the case that it is more effective to contract for such services, the county will do so. The Public Health Nurse position will promote evidenced based immunization (IZ) services in Skagit County. Education will be provided to and ongoing partnerships formed with health care providers in order to effectively engage vaccine-hesitant parents and patients. Additionally, the staff member will coordinate with the Washington Immunization Information System (ISS) to obtain data in order to review current and historical immunization rates. A plan will be drafted based on this data. The plan will include outreach to health care providers. Some providers may not be entering all patients into the IZ registry and the staff member will provide education and support to increase IZ data entry and accuracy. The Public Health staff member will complete a community inventory of current childhood IZ activities. Plans will be developed to increase IZ rates. Key partners in this effort will include Skagit’s seven school districts and the four tribes within the county. Plans will feature the creation of messaging/communication campaign. Subsequent to this plan, the campaign will be launched to engage the community at large. 1SKAMANIA - Support PH Nurse with working with school nurse to review school immunization requirements, updates and current coverage rates in the County. 1

SNOHOMISH - Allocate staff to review DOH school immunization data to identify and target efforts with a minimum of 1 school district on increasing immunization rates; present immunization data and vaccine requirements to school superintendents, Participate in a minimum of 2 local health fairs to promote childhood and adult immunizations, Review data from IIS to identify and target areas for improvement with providers/clinics; strategize how to help them improve rates and implement strategies. 1

SPOKANE - 1 FTE staff to conduct immunization records review with large childcare centers and WIC clients to identify gaps in documentation/immunizations given, implement data completion efforts and clinic access strategies; target healthcare provider groups who serve these children and share immunization coverage rates with those providers to identify best-practice strategies to improve rates; network with healthcare insurers to create synergy around activities that are mutually beneficial. 1TACOMA-PIERCE - Pay for and allocate .5FTE Public Health Nurse Consultant to engage the medical provider community to offer childhood immunizations in after-hours and alternate venues, such as schools, and work with providers to offer quality improvement practice guidelines to increase immunization coverage in their practices. Work with the Pierce County Medical Reserve Corps to provide school based flu shots in targeted districts and work with school districts to review and update records to identify and address gaps in immunization coverage. 1THURSTON - 0

WAHKIAKUM - Allocate funding for coordination of the HPV immunizations, targeting teens, using our community health workers. 1WALLA WALLA - Quarterly review of Clinic Immunization Rates - Assessment and Communication Coordinator to review IIS data with CD Coordinator and Clinic Services Division Manager and form messages to providers, 5 hours per quarter Assessment/Comm. Coordinator5 hours per quarter CD Nurse1 hour per Clinic Services Division ManagerGoals: to review data from IIS to identify and target efforts to providers with the lowest rates; share data with these providers; strategize on how to help them improve rates; implement. 1WHATCOM - 0

WHITMAN - pay for and allocate 4 hours per week of a staff members time to review data from IIS to identify and target efforts to providers with the lowest rates; keep up to date (train) on best practices in promoting immunization participation, share data with providers, community groups and partner agencies; strategize on how to improve vaccination rates; implement. 1YAKIMA - 0(blank)Grand Total 15

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0

G4 Ability to receive laboratory reports and other identifiable data; conduct disease investigations, including contact notification; and recognize, identify, and respond to cases and outbreaks/clusters of communicable diseases and other notifiable conditions in accordance with national, state, and local mandates and guidelines.BARS Code: 562.39 Other Communicable DiseaseMeasure: Abbrev (All)


ADAMS - Pay for .25 FTE (80 hours/month staff time) for staff training and policy development, increasing ability to monitor, respond to, and evaluate communicable disease reports, laboratory reports, and other data related to notifiable conditions. This will increase capacity to conduct disease investigations and response to cases or outbreaks of communicable diseases in a timely manner. 1ASOTIN - 0

BENTON-FRANKLIN - 1. Provide additional staffing to the review and respond to communicable disease reports. 2. Provide training for new and existing staff in the use and management of communicable disease and reportable conditions in WDRS. BFHD has identified a need to develop additional staff capabilities and depth, in the receipt, review and response to communicable disease and notifiable condition reports. Education efforts in this area will include: a. Disease and condition reporting requirements, b. Investigation and interviewing techniques, c. Review of specific disease reporting forms, d. Review of reporting and data sources.

1CHELAN-DOUGLAS - Support a sufficient portion of a Public Health Nurse position to receive laboratory reports and conduct disease investigations according to applicable guidelines. 1CLALLAM - 1. Community Health Nurses review and share data with partners, work with partners including tribes, the accountability community of health, health care system and providers, restaurants, and others to develop the prioritized plan. 2. Community Health Nurses will conduct disease investigations. 1CLARK - Develop a strategic plan for the Infectious Disease program mapping community assets, partnership building opportunities and prioritizes control interventions for communicable disease. 1

COLUMBIA - .25 FTE Workforce training for nursing staff to be competent in laboratory reports, conducting disease investigations, and respond to cases and outbreaks in accordance with local, state, and national mandates and guidelines. 1COWLITZ - 1. Develop and implement, in partnership with Cowlitz County school districts and daycare/childcare centers, an Outbreak Response Toolkit and Response Plan for a notifiable vaccine-preventable illness, such as Measles or Mumps. 2. Work with community partners including tribes, health care system and providers, child care centers, and others to engage in a partner tabletop exercise around Measles or Mumps. 3. Identify further needs including training and other gaps in order to improve and implement an efficient, coordinated response that minimizes the communicability of the illness in the childcare and school community. 4. Develop a plan to address the needs including training and other gaps. Work to identify a sustainable source of revenue to ensure annual review and training with LHJ, childcare centers, schools and community partners. 5. FPHS funding will provide for approximately 18 hours per week or 950 hours per contract cycle (12 months) to develop, in partnership with Cowlitz County school districts and daycare/childcare centers an Outbreak Response Toolkit and Response plan to a notifiable vaccine-preventable illness, such as Measles or Mumps. 1GARFIELD - 1. Pay staff 20 hr/wk to work with local providers and clinics to provide current, appropriate information on notifiable conditions. 2. Seek ongoing training with a focus on Hepatitis C and Tuberculosis for RNs/disease investigators to enhance skills in disease investigations and education; and improve knowledge base for disease investigations. 1

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GRANT - 1. 0.1 FTE will facilitate a community task force of partners and stakeholders to develop, implement and evaluate a comprehensive needle service program to control the spread of communicable diseases. These programs have been associated with reduced risk for infection with hepatitis C and HIV viruses. 2. Staff time to prepare for the technology upgrades and staff preparation for WDRS (Washington Disease Reporting System) roll out. 3. 0.3 FTE will be dedicated to conducting timely disease investigations for notifiable conditions in accordance with national, state, and local mandates and guidelines.

1GRAYS HARBOR - Pay for and allocate at least .2 FTE of a staff member’s time to dedicate towards conducting disease investigations in accordance with national, state, and local mandates, guidelines and procedures. 1ISLAND - 0JEFFERSON - 1. Pay for staff time dedicated to conducting disease investigations in accordance with national, state, and local mandates, guidelines, and procedures. 2. FPHS funds will pay for 11-13 hours of staff time split between the three selected Bars expenditure areas. 1KITSAP - 1. Pay for and allocate 6 hours per week of a staff members time to review and share data with partners, work with partners including tribes, the accountability community of health, health care system and providers, and others to develop the prioritized plan. 2. Hire a 0.5 FTE to conduct disease investigations according to a prioritized plan. 1KITTITAS - Pay for and allocate 50 hours of Assessment Coordinator time and 85 hours of Community Health Supervisor time for conducting an assessment of health care provider practices regarding STD screening and working with providers to increase screening. 1KLICKITAT - 0

LEWIS - 1. Pay for and allocate 3 hours per week of the Communicable Disease (CD) Public Health Nurse (PHN) time to work with partners and providers to develop and implement a prioritized control plan addressing communicable diseases and other notifiable conditions, specifically to include hepatitis c and influenza. 2. Pay for and allocate 3 hours per week of the Communicable Disease (CD) Public Health Nurse (PHN) time to conduct disease investigations according to the prioritized plan. 1

LINCOLN - allocate a .1 FTE to review our communicable disease policies and procedures and update as appropriate and train CD staff. We will also improve our communicable disease skills and knowledge through additional training opportunities. This work may also include a formalized agreement with Spokane Regional Health District through cross jurisdictional sharing for their staff to provide technical assistance and training to Lincoln County Communicable Disease staff. 1MASON - Epidemiology: Pay for and investigate Noro virus outbreaks and reports of fecal coliform contamination in waters not currently funded for investigation. Investigate disease outbreaks in marine areas that support shellfish harvest and beachfront areas that support recreational swimming and waterfront activities. 2. Purchase needed electronic tablets to interface with data collection for field investigations of communicable disease 1NE TRI - NETCHD will continue to review our communicable disease policies and procedures, update as appropriate, and train CD staff. We will also improve our communicable disease skills and knowledge through additional training opportunities. This work may also include a formalized agreement with Spokane Regional Health District through cross jurisdictional sharing for their staff to provide technical assistance and training to NETCHD staff. 1. This work strategy will also include training staff on the WDRS system and any software or computer upgrades that are required to utilize the system. 2. In addition, CD staff at NETCHD will continue to develop an improved approach to Hepatitis C reports, where active and chronic cases can more easily be identified and followed up on appropriately.

1OKANOGAN - 0PACIFIC - 0PUBLIC HEALTH SEATTLE-KING COUNTY - Hire 1 FTE to strengthen our infection control capacity and enhance coordination with acute care facilities for preventing the spread and responding to healthcare-associated/acquired infections (HAIs). PHSKC Communicable Disease Section will have a dedicated FTE to conduct our own HAI investigations and to collaborate with and bolster efforts to respond to HAIs by infection control, risk management, employee health, and communications staff at acute care hospitals around King County. 1SAN JUAN - 0SKAGIT - 0

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SKAMANIA - Support PH Nurse with reviewing and responding to communicable disease reports and outbreaks according to set State guidelines. Support PH Nurse with receiving and reviewing laboratory reports and conducting communicable disease investigations.

1

SNOHOMISH - 1. Allocate staff to identify local and statewide community assets for the control of notifiable conditions, including the statewide interjurisdictional agreement resources. 2. Allocate staff (or contract with external resources) to develop and implement a prioritized control plan for CD response; share with local, regional, and state partners 3. Allocate staff to receive notifiable conditions reports and investigation cases and contact investigations according to WA DOH guidelines and the priority response plan; maintain 24/7 response capabilities; monitor cases for possible outbreaks/clusters, using DOH definition guidelines; notifiable conditions will be documented in PHIMS/WDRS and reported to DOH according to DOH guidelines 1SPOKANE - 0TACOMA-PIERCE - Pay for and allocate 20 hours per staff time week to implement recommended state and federal hepatitis control plans,investigate cases of acute hepatitis and improve access to care and treatment, and work with medical providers to increase screening. 1THURSTON - Pay for and allocate .5 FTE of staff time to increase capacity to provide intervention and prevention activities, investigation, response, and follow up for Hepatitis C and other communicable diseases and notifiable conditions.

Pay for necessary staff training and educational materials1

WAHKIAKUM - 1. Contract with epidemiologist to coordinate the local community assets for control of communicable diseases, and to initiate a plan for Hep C. 2. Pay for additional hours for Environmental Health staff to support communicable diseases. 1WALLA WALLA - Annual Review of Communicable Disease Manuel, with mandated CD/notifiable condition reporting, update as needed; 20 hours per year Assessment Coordinator 20 hours per year CD Nurse 1WHATCOM - Pay for and allocate 20 hours per week of a Public Health Nurse position to conduct disease investigations according to a prioritized plan. This is a new position. 1

WHITMAN - 1. pay for and allocate 2 hours per week of a staff members time to review and share data with partners, work with partners, the accountability community of health, health care system and providers, restaurants, and others to develop the prioritized plan. 2. pay for and allocate 8 hours per week of a staff members time to conduct disease investigations. 1

YAKIMA - Implementation of statewide Washington Disease Reporting System (WDRS) initiative. Communicable Disease and Nursing staff will be trained in the use of 1. WDRS and cross-trained in all applicable applications. 2. Investigate and manage all notifiable conditions, that occur in Yakima County or involve Yakima County residents, in accordance with national, state, and local mandates and guidelines. Recognize, identify, and respond to outbreaks/clusters that are communicable diseases.

1(blank)Grand Total 27

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G5 Assure the availability of partner notification services for newly diagnosed cases of syphilis, gonorrhea, and HIV according to Centers for Disease Control and Prevention (CDC) guidelines.BARS Code: 562.33 Sexually Transmitted Disease (STD)Measure: Abbrev (All)


ADAMS - 0ASOTIN - 0BENTON-FRANKLIN - Provide additional staffing resources to enable a more detailed response to all communicable disease reports including syphilis, gonorrhea, HIV and other sexually transmitted infections. 1CHELAN-DOUGLAS - 0CLALLAM - Community Health Nurses to f/u on all new cases of syphilis, gonorrhea and HIV. 1CLARK - Conduct partner notification services for all newly diagnosed cases of syphilis, gonorrhea, and HIV according to internal disease control plan and national and state guidelines. 1COLUMBIA - .15 FTE Communicable disease Public Health nurse to receive training needed and assure availability of partner notification services for newly diagnosed cases. 1COWLITZ - 0GARFIELD - Staff hrs. in G4. Make sure all clients are contacted and partner notification is offered. 1GRANT - 0GRAYS HARBOR - Pay for and allocate .1 FTE of a staff member’s time dedicated towards providing partner notification services for newly diagnosed cases of syphilis, gonorrhea, and HIV according to CDC guidelines. Will also refer cases of syphilis and HIV among MSM to DOH. 1ISLAND - Assign staff on both Camano and Whidbey Islands to respond to disease reports from laboratories, physicians and other sources and conduct disease investigations according to a prioritized plan. 1JEFFERSON - 0KITSAP - reports or no case reports for patients diagnosed with syphilis, gonorrhea, and HIV, · Contact all new cases of syphilis, gonorrhea and HIV cases to verify knowledge of partner notification services, · Contact all identified partners regarding expedited partner therapy, · Investigate reasons for missing lab reports in PHIMS, Investigate barriers to testing among high risk populations 1KITTITAS - 1. Pay for and allocate 20 hours of Public Health Nurse and 20 hours of Community Health Supervisor time to received training on conducting STD interviews. 2. Pay for one night hotel for each person and per diem. 1KLICKITAT - 0

LEWIS - pay for and allocate 2 hours per week of the Communicable Disease (CD Public Health Nurse (PHN) time to start partner notification services for newly diagnosed cases of syphilis and gonorrhea according to Centers for Disease Control and Prevention (CDC) guidelines. Partner notification of these diseases was previously stopped during the economic downturn. 1LINCOLN - 0MASON - Provide staff for outreach to providers to ensure understanding of the requirements of disease reporting, identifying and reducing barriers to timely and complete reporting from health care facilities experiencing turnover, and cross training staff due to changes in staff assignments. 1NE TRI - 0OKANOGAN - 0PACIFIC - 0PUBLIC HEALTH SEATTLE-KING COUNTY - Hire 1 FTE to respond to King County’s ongoing increase in syphilis cases and address the need for surveillance and partner services, to assure screening and treatment of sexual partners of confirmed syphilis patients. We will increase the percentage of syphilis patients who receive a partner services interview and increase the numbers of sexual partners identified by the partner services interview, resulting in more people tested and appropriately treated and a reduction in transmission. 1SAN JUAN - 0

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SKAGIT - Pay for and allocate 10 hours per week of a Public Health Nurse position. G.5 activities will be combined with G.2 activities to create a total 30 hours per week position. In the case that it is more effective to contract for such services, the county will do so. The Public Health Nurse position will analyze Skagit’s STD burden. This staff member will disseminate up-to-date disease trends and clinical preventative resources to health care providers. The position will encourage providers to take routine sexual histories, as well as test, rapidly diagnose and treat patients and partners. In addition, community outreach will be expanded in partnerships with an array of community stakeholders including Skagit’s seven school districts, Skagit Valley College, Skagit/Stanwood PFLAG and a wide array of community health fairs. The staff member will seek broader platforms to reach targeted populations. These platforms may range from social media to distributed educational materials. 1SKAMANIA - Support the PH Nurse with partner notification and treatment according to CDC guidelines. 1SNOHOMISH - Allocate staff to provide partner notification for all newly-diagnosed cases of syphilis, gonorrhea, and HIV; complete quarterly DOH reports, documenting partner index; develop an STD Action Plan, based on the 2017 STD briefing paper addressing the high disease rates in Snohomish County 1SPOKANE - 1 FTE staff to perform disease investigation for syphilis and prioritized gonorrhea high risk cases in Spokane County to improve case and partner services interview rates and treatment follow-through. This position will assist with HIV Field Interview Records (FIRS) and will be available to provide surge backup for HIV cases as needed. 1

TACOMA-PIERCE - Pay for and allocate .5FTE Disease Intervention Specialist to increase the percentage of partners of cases of gonorrhea and syphilis that receive timely treatment. Work will include case and contact interview and assuring treatment. 1THURSTON - Pay for and allocate .5 FTE of staff time to increase capacity to provide sexually transmitted illness investigation, follow-up, and partner notification services.

Pay for necessary staff training and educational materials1

WAHKIAKUM - Train staff in data collection and software for the tracking of communicable diseases. Purchase computers that will be able to work with the new data system. 1WALLA WALLA - .15 FTE CD Nurse to f/u on all new cases of syphilis, gonorrhea and HIV. 1WHATCOM - Pay for and allocate 20 hours per week of a Public Health Nurse position to f/u on all new cases of syphilis, gonorrhea and HIV. This is a new position. 1

WHITMAN - pay for and allocate 4 hours per week of a staff members time to follow up on new cases of syphilis and gonorrhea. 1YAKIMA - Increase the number of STD case investigations and partner notification follow-ups and service provision. Strengthen clinical partnerships that share public health protocols and best practices with medical partners in hospitals, federally qualified health centers (FQHCs) and private practice. Increase partnerships and programs to educate youth and at-risk populations to decrease the number of STD cases.

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G6 Assure the appropriate treatment of individuals who have active tuberculosis, including the provision of directly-observed therapy according to CDC guidelines.BARS Code: 562.34 TuberculosisMeasure: Abbrev (All)


ADAMS - 0ASOTIN - 0BENTON-FRANKLIN - Increase technology resources to allow for telehealth services to support the treatment of active tuberculosis in remote areas of the county. 1CHELAN-DOUGLAS - 0CLALLAM - 0

CLARK - Funding will be used to support the work of our TB Program including treatment for all active TB cases, providing DOT, assisting providers with technical questions, and developing protocols to ensure high quality case management services. 1COLUMBIA - .15 FTE Communicable disease nursing staff to oversee investigation and treatment of active TB cases according to CDC guidelines. Workforce training for nurses to be competent in TB related activities. 1COWLITZ - 0GARFIELD - Add 5 hr/wk staff time for any needed treatment needs for clients that might have active tuberculosis, staff education, and policy revisions and/or protocols for community partners. 1GRANT - 0GRAYS HARBOR - Pay for and allocate .1 FTE to oversee the treatment for all active TB cases, including DOT, and measure/monitor the % of active cases that complete treatment. 1

ISLAND - Respond to new active cases of tuberculosis and provide directly observed therapy under the guidance of a physician. 1JEFFERSON - 0KITSAP - 0KITTITAS - 0KLICKITAT - 0LEWIS - 0LINCOLN - 0MASON - Currently covered as a required county responsibility. 1NE TRI - 0OKANOGAN - 0

PACIFIC - Pay for 0.2 FTE of a staff person to work, along with our Health Officer to consult with local providers regarding proper diagnosis and treatment of both Latent and Active TB patients. Train staff on current diagnosis and treatment methods so they can discuss and consult with local providers to assure the patients are receiving the most up to date information. 1PUBLIC HEALTH SEATTLE-KING COUNTY - Use funding to help fill the gap between state foundational revenues and the cost of maintaining our current capacity for this work. This funding will support the current work of Public Health Nurses, Health Outreach Aids, and Disease Research & Intervention Specialists. Activities include disease investigation; overseeing the treatment for all active pulmonary TB cases; recruiting, training and developing protocols for community providers (or across multiple jurisdictions and health officers); assuring/providing DOT; and measuring/monitoring the percentage of active cases that complete treatment 1SAN JUAN - 0SKAGIT - 0SKAMANIA - Support the PH Nurse with investigation, DOT treatment as well as coordination and support with medical providers according to CDC guidelines. 1SNOHOMISH - Allocate staff to oversee treatment and case management services for all active TB cases; TB Control Officer to provide oversight and medical management of TB treatment and coordination with community providers; provide directly-observed therapy; provide annual data to include % of active cases that complete treatment. 1SPOKANE - 0TACOMA-PIERCE - 0THURSTON - 0

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WAHKIAKUM - 0WALLA WALLA - .15 FTE CD Nurse to oversee treatment for all active TB cases, including recruiting, training and developing protocols for community providers (or across multiple jurisdictions and health officers), assuring/providing DOT; measure/monitor % of active cases that complete treatment. 1WHATCOM - 0WHITMAN - pay for and allocate 1 hour per week of a staff members time to oversee treatment for all active TB cases, including keeping up to date on recent treatments and challenges 1YAKIMA - Develop and implement a procedure to administer electronic directly-observed therapy to promote the adherence of tuberculosis treatment. 1(blank)Grand Total 14

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