2022 Annual Report

Progress – A Foreword by Joan Raulston

What is the definition of progress? The definition of progress is to move forward: proceed: to develop to a higher, better, or more advanced stage.  This definition is the true essence of the Dent County Health Center in 2023. The running joke when I started at the health center in October 1996 was that no one knew where we were located. I must admit, I was one of those residents.  My father-in-law (Wayne Raulston) was on the Board and told me about the job opening but I was reluctant to apply due to my lack of knowledge of the services offered at the health center. Wayne was stepping off the board and said to at least try due to my previous work experience. From that brief conversation, my journey started under Administrator Peggy Musgraves and continues today.

When I walk into the office today, I see a very different office and I feel proud knowing that in some small way I am a part of an organization that is creating a name for itself like I would have never imagined. No one must ask where we are located, and other health departments that we have looked up to are asking to come visit our facility to observe our daily operations and follow our example in their communities. 

One health department visited our organization and was surprised at the number of appointments we had the day they observed.  This large health department had given three covid shots the day before their visit and we were giving approximately 25 covid vaccinations the day of the visit.  I spoke with another county that told me they had approximately 3 labs a week and we had appointments for 10 the day we spoke. Back in 2018, both of these health departments were exceeding our total revenue by double and triple amounts.

THE BEGINNING

When I joined the DCHC staff we had five full-time employees and that included the administrator.  We had three part-time employees that worked two days or less.  We offered WIC, immunizations (two days a week), health inspections, blood pressure checks (one day a week) & family planning (one day a month).  The office had three computers and printers and four of those were supplied by the state.  We had five phones and we paged overhead if you were needed for a phone call.  We were a small health department that had three main contracts; WIC, MCH and CORE. The office was chaotic during busy WIC clinics but for the most part it was a quiet working atmosphere.

CURRENT

Let’s jump ahead to our current operations. Currently the health center has 12 full employees, 2 part time employees and a project manager for a specific contract.  We still offer WIC, Immunizations, etc. but we also offer labs, rapid testing (covid, flu, strep etc.), Urine drug screenings, Safe Cribs, Car Seat Installations and instruction, CPR training, Childcare assistance, mobile visits, acute illness visits, STI testing with follow up healthcare and the list continues. 

We have an electronic health record that is a scheduler and biller for all appointments, a new modern internet-based phone system and computer system for every employee. We currently are billing 10 different contracts with one pending on the State to send final paperwork.  We have services that are available to all ages in the community.

The employees attend a weekly staff meeting and at the top of the agenda it reads, “why are you here?”  I’m here to support my family, obviously, but I am also here to be a part of an organization that is making a difference.  I have a girlfriend that always tells me how lucky I am to work somewhere that helps people.  I couldn’t agree more.

Mission Statement

The Mission of the Dent County Health Center is to promote and protect the health of the citizens of Dent County through education, disease and injury prevention, regulation and delivery of public health services in order that all residents may achieve optimum health. We believe that Public Health Makes Life Better.

What is Public Health?

The Institute of Medicine has defined public health as “an organized community effort aimed at the prevention of disease and promotion of health.”  Unlike our health care system which provides medical services to individuals, our public health system focuses on the health of our city/population as a whole.

Public health affects us all, all of the time.  Public health efforts have increased our life span by nearly 30 years in the past century.  Simple actions we take for granted today such as drinking clean water and breathing clean air, eating fresh fruits and vegetables, wearing seatbelts and bike helmets, and using pedestrian cross-walks, are benefits that we owe to the efforts of a system that is dedicated to making good health available to every citizen. 

Our public health system involves many players.  The Health Department has legal responsibility for ensuring public health and employs professionals, such as disease investigators, environmental inspectors, social workers, and nurses.  The Health Department also relies on medical professions in public and private practice to perform public health functions and help patients practice prevention.  Police and fire departments play a crucial role in sustaining public safety and well-being, and even architects, housing developers, city planners and parks and recreation staff contribute through their everyday work to the safety and health of our community. 

Neighborhood and nonprofit organizations are also part of the public health system. Our department has active partnerships with the American Red Cross, area health departments, the Salem Memorial District Hospital, Pathways Community Behavioral Healthcare, local pharmacies, physicians and veterinarians, the Division of Family Services, Dent County Fire Department, local law enforcement, and the Council for a Healthy Dent County.

The Main Functions of a Public Health System:

1. Preventing diseases and decreasing transmission of existing diseases
2. Protecting against environmental hazards
3. Preventing injuries
4. Promoting and encouraging healthy behaviors
5. Responding to disasters and assisting communities in recovery
6. Ensuring the quality and accessibility of health services
7. Ensuring every child has a healthy start

Public health is a vital function that requires broad public concern and support in order to fulfill society’s interest in assuring the conditions in which people can be healthy.  History teaches us that organized community effort to prevent disease and promote health is both valuable and effective.  It is this philosophy of assuring a healthy environment, promoting healthy behaviors, and preventing disease that the staff of the Dent County Health Center is committed to practicing now and in the future.

The People Who Make Public Health Work

2022 Board of Trustees

2022 Medical Staff and Volunteers

2022 Employees

COVID-19 Pandemic

The COVID-19 Pandemic, which was officially declared by the WHO in March of 2020, continued throughout 2021 and 2022. The State of Missouri declared COVID-19 as “endemic” in April of 2022, though some enhanced reporting requirements and special authorizations continued. In response the pandemic, Dent County Health Center maintained new services developed in 2021 while continuing to add new services.

Vaccines

The Health Center continued offering Pfizer and Moderna vaccines throughout the year. When the children’s versions were authorized, those were administered as well. The Health Center offered the updated (Omicron) booster once it became available in September.

Testing

The Health Center remained the first and only place in the county to offer COVID-19 testing without a doctor’s order. The Health Center tested 1538 people for COVID-19 in 2022. Additional testing resources were added in 2022, including the purchase of an IDNow analyzer, capable of testing for influenza, RSV, streptococcus, and COVID-19. A Biofire RP-EZ was purchased as well, which tests for 19 different pathogens, including both viruses and bacteria.

Treatment

In 2022, COVID-19 cases were highest in January and tapered off and remained at a low level throughout the rest of the year in comparison to 2020 and 2021. DCHC offered treatment in the form of monoclonal antibodies when they were available. When Paxlovid was authorized for pharmacists to order, it was dispensed through consultation with DCHC’s pharmacist and administrator. Treatment access improved when April Greener, Family Nurse Practitioner, was hired. Patients could make an appointment with her and receive necessary treatment for COVID-19 or whatever illness they had, aided by the diagnostic power of the Biofire RP-EZ.

Case Investigation

Detailed case investigations ceased in April of 2022. Basic information on positive cases continued to be collected throughout the year. Cases were reportable at an individual level throughout 2022. Health Center staff recorded 1392 COVID-19 cases in 2022. Dashboards were published on a monthly rather than weekly basis in 2022.

Effect on Other Services

For better or worse, 2022 was characterized as the year we made COVID-19 a part of our everyday lives. All service-lines were restored in 2022 to pre-pandemic capacity. For some periods, employee masking was discontinued during times of very-low transmission. Food inspections resumed and in-person conferences came back. Influenza and RSV returned to circulation as well, resulting in a so-call “tri-demic” of COVID, Flu, and RSV over the 2022 holiday season.

Clinical Services

Nurse Practitioner Hired

In June of 2022, April Greener, FNP, joined the Dent County Health Center under collaboration with Dr. Jessica King from Texas County Memorial Hospital. Dr. King would later become the Health Center’s medical director after the resignation of long-serving Dr. Yvonne Prince.

April was instrumental in the success of the Health Center in the second half of 2022. In August through September of 2022, during a wave of staff resignations, April helped with blood draws, immunizations, and COVID tests.

She quickly became well-liked by patients. Patients comment on her positive bedside manner and her caring nature, and many patients wish to come back and see her more frequently.

With April on the team, DCHC was able to offer acute illness visits, on-demand visits for Show-Me Healthy Women, well-child visits, and more for the first time. The positive community feedback on these services has been overwhelming.

Communicable Disease Surveillance, Investigation, and Prevention

The purpose of communicable disease investigations are to identify the causes of the disease and decrease the incidence of new people becoming sick. Communicable diseases are those diseases that are a concern to public health.  They are reported and tracked by the state or federal government.  All states must collect information on the federally reportable list.  In addition, they may choose to mandate the reporting of other diseases of interest to the state officials.  Public health officials at state health departments and CDC continue to collaborate in determining which diseases should be nationally notifiable.  A disease may be added to the list as a new pathogen emerges, or a disease may be deleted as its incidence declines.

As part of its activities in keeping the community informed, the Communicable Disease Prevention Program is responsible for the maintenance and operation of the Dent County node of the Missouri Department of Health’s Health Alert Network (HAN).  This notification system targets physicians, hospitals, local health departments, veterinarians, ambulance services and other first responder agencies.  Disease alerts, warnings, recommendations and other information can be transmitted through this system to all or selected recipients. The communicable disease department is critical in emergency planning for our community to identify and contain disease outbreaks.

The reporting of communicable diseases to the health department assists in identifying how many people are affected and who else is at risk. Another critical component is to protect those at risk. Individuals may qualify to receive confidential testing and treatment for a communicable disease by contacting our office.

HIV and Sexually Transmitted Infection Services

1. Pregnancy Counseling, Testing and Referral
2. Sexually Transmitted Disease Testing and Counseling
3. Counseling and referrals provided as needed.

Changes in CD in 2022

A new CD nurse, Trisha O’Neil, RN, was hired and trained in September 2022. Several changes were brought to the program with her guidance, including free chlamydia and gonorrhea testing.

The blood lead investigation and screening program was moved to the CD department in 2022 as well. In December of 2022, the Lead program was improved with the purchase of a LeadCare II analyzer, which requires capillary blood (a fingerstick) instead of a venous sample (regular blood draw).

A large backlog of Lead cases due to the COVID-19 pandemic was in the process of being cleared out at the end of 2022.

Statistics

ENVIRONMENTAL PUBLIC HEALTH SERVICES

Examples of Services Provided:

1. Enforcement of state ordinances governing food service, retail food sales and on-site wastewater disposal.  Services provided for Dent County.
2. Inspection of food service establishments, retail food stores, schools, licensed daycares, lodging establishments, public swimming pools.
3. Construction permits issued for on-site sewage disposal systems through Department of Health and Senior Services.
4. Sampling of private water supplies.
5. Investigation of environmental complaints.
6. Investigation of all incidents involving distressed foods including vehicular accidents, fires, floods, etc.
7. Involved in emergency response planning in Dent County.

Food Protection

Food protection is a responsibility of the Environmental Public Health Program.  The program handles inspections for all food establishments in Dent County.

Food protection is also responsible for the investigation of any and all truck wrecks (trucks carrying food, drugs or cosmetics) that occur in Dent County for proper disposal of damaged or contaminated products.  Food protection responds 24 hours a day, seven days a week to all fire investigations and natural disasters that involve any food establishment.

Lodging Inspections

The Environmental Public Health Program partners with the Bureau of Environmental Health Services at the Missouri Department of Health and Senior Services to inspect all lodging establishments within Dent County.

The licensing year is from October 1^st through September 30^th.  Licenses may be obtained by completing an application that is mailed to each establishment on August 1^st by the Bureau of Environmental Health Services.  Establishments must include an approved inspection for the current year and payment of the appropriate licensing fee with their completed applications.

Inspections are unannounced and can take place anytime throughout the year.  Establishments that meet the sanitation and safety standards outlined in the lodging rule, 19 CSR 20-3.050, will receive an approved inspection report.  Re-inspections are conducted as needed on non-compliant establishments, and no license will be issued until the violations are corrected.

Child Care Inspections

The Health Center works with the Department of Health and Senior Services staff to assure that annual sanitation inspections are conducted in all licensed child care facilities.  Inspections are conducted to protect children in and out of home care from environmental hazards such as exposure to disease, harmful chemicals, lead hazards, building safety and food safety hazards. 

Online Reports

At the end of 2022, food and lodging inspection reports were posted on our website.

Statistics

Public Health Emergency Preparedness

Background

Any number of public health emergencies could occur in Dent County ranging from disease outbreaks, to food, environmental and health needs after a natural disaster.

The Health Center plans for and responds to such events. It is not enough to write plans to address public health concerns. The staff works with volunteers and community partners to develop and exercise these response capabilities.

In the event of a serious occurrence of a communicable disease, the counties must be prepared to execute functions not normally required during events normally planned for by other disciplines such as law enforcement and fire service. These include disease surveillance and investigation, mass prophylaxis, isolation and quarantine, mass patient care and even mass fatalities.

Over the last several years, the health department staff have deployed in response to prolonged power outages due to ice storms or tornados. We also assist the EMD and the American Red Cross by inspecting emergency shelters and/or mass feeding sites and providing food safety guidance to volunteers.

Shelters were opened by the staff as requested by EMD and the City of Salem during the power outage of 2005, the ice storm of 2007, the derecho winds of Spring 2009, and the straight-line winds Memorial Day Weekend 2017. The staff has made onsite visits to merchants during emergencies and disasters to assist them in the mitigation of product losses and provide education and assistance as to product viability.

Our Role

It is important to remember that many disciplines will have a role in events as serious as a natural disaster and that it may not be contained within the county limits of Dent County; nor will any communicable disease outbreak.

Dent County staff maintains ongoing working relationships with public health agencies in neighboring jurisdictions and other government agencies. They participate in several committees and subcommittees that meet to plan and coordinate responses to public health emergencies. The department has a Memorandum of Understanding with the American Red Cross to offer support for functional need clients in emergency shelters. The Dent County Health Center is actively involved in a regional partnership with Region I State Emergency Management and meets regularly to improve our ability to respond to various emergency events.

Community Partnerships

The Dent County Health Center partners with the Phelps County Medical Reserve Corps which works to recruit citizens to join the Health Departments to serve as volunteers.  They are taught how to keep themselves safe and healthy and to impart this same information to people in their circle of influence, such as their family, friends, co-workers, neighbors and faith family. This effort supports the goal to keep the communities informed and engaged in the prevention of the development of chronic disease as well as responding appropriately to public health emergencies.  These citizens will perform a critical role during public health outbreaks and crisis, as well as during health information campaigns designed to keep the community healthy.

Through these and countless other activities, the program strives to ensure the health and safety of the citizens and visitors of the counties. Plans evolve to meet the increasing challenges of these changing times. Medical Reserve Corps maintain a trained, background checked list of volunteers to allow a surge of public health services in case of an emergency or disease outbreak

Maternal/Child Health Initiatives

The Maternal/Child Health Program works to improve the health of women, children and families over their lifespan through community engagement, partnerships, education and advocacy. Our most recent focus in Dent County has been on substance use prevention and injury prevention. These programs have achieved positive, measurable outcomes with a strong community partnership with Healthy Dent County and the local school.

For the upcoming contract year, the Dent County Health Center will be working with several community partners in conjunction with Healthy Dent County Prevention Coalition to focus our efforts on Child and Adolescent Intentional and Unintentional Injuries, with an emphasis on Substance Abuse awareness and prevention. 

Child Abuse and Injury Prevention

The health works closely with new mothers to promote and educate parents on safe crib standards and infant bedding to prevent accidental suffocation and SIDS deaths. A Children’s Trust Fund grant support personnel to provide education and safe cribs to program clients.

Childcare Health Consultation

We have health professionals that are prepared to offer consultation and education to providers, parents and children in daycare settings.  The consultation and education services provide credit hours to childcare providers to qualify for licensure.  The education provided focuses on child safety, CPR, communicable disease prevention and emergency response.

Care Coordination for Prenatals

Care Coordination is a program funded by Medicaid for pregnant women that have been identified as having high-risk pregnancies. This program’s goal is to reduce the incidence of premature births and adverse events due to lack of prenatal care and health prevention during pregnancy. Registered Nurses counsel program participants monthly and provide education and guidance regarding pregnancy, healthcare, labor and delivery, and infant care education.

In 2022, there was only one Medicaid plan that covered care coordination, and no local providers accepted this plan. As a result, care coordination visits dropped to zero. Alternative funding mechanisms are under investigation to ensure delivery of this important service.

Show-Me Healthy Women and WISEWOMAN

The Show-Me Healthy Women program offers free breast and cervical cancer screenings to women ages 35-64, or older if they do not receive Medicare part B. To qualify, women must have a household income at or below 200 percent of the Federal poverty level and have no insurance to cover the services or be unable to pay the deductible for the insurance. The Health Center partners with Salem Memorial District Hospital to offer mammogram screenings and sends a healthcare provider to facilitate the program.  

The WISEWoman program is a companion to Show-Me Healthy Women. It provides free blood pressure, cholesterol, and diabetes screenings for women who qualify.

Statistics

Immunizations

We provide all immunizations for children and adults. Off-site clinics at SMDH, area schools, and places of employment are offered regularly and can be scheduled by request.

Immunizations are available by appointment, Monday thru Friday, 8:00 a.m. to 4:30 p.m.

We offer free vaccines for those who qualify. Vaccines for Children are always free.  

Statistics

Laboratory Services

Outpatient lab services are provided at greatly reduced rate to clients with an order from a medical provider. We offer any test currently conducted by Labcorp. In addition, we have a variety of rapid testing available for results in an hour or less.

Lab testing volume increased in 2022 after a facility remodel doubled the lab-draw stations and improved the facility workflow and space utilization. Three full-time staff members are assigned to manage the pharmacy and lab area, which includes routine blood draws, rapid tests, and immunizations.

Statistics

WIC (Women, Infants, and Children)

What is WIC?

WIC is a supplemental nutrition program for women, infants and children. WIC helps to prevent health problems and improve the health status of participants through good nutrition. The WIC Program supplements the diets of qualified participants with nutritious food items by issuing a food “prescription.” WIC promotes breastfeeding as the optimal feeding for infants and provides education and support.

Who qualifies for WIC?

1. Women who are pregnant, breastfeeding (nursing a baby up to one year old), and postpartum (up to 6 months after a pregnancy has ended)
2. Infants (a child under one year old)
3. Children (from 1 year old up to age 5)

All women, infants, and children must meet income guidelines and medical criteria to qualify for WIC.

WIC will not provide all of the foods needed. WIC foods are intended to supplement the diet. The food packages approved for use in the Missouri WIC program are designed to help meet infants’ developmental needs and current pediatric feeding recommendations, and to complement the eating patterns of preschool children. WIC foods also supplement the special requirements of pregnant and breastfeeding women and help to re-supply the nutrient stores women use during pregnancy.

Statistics

Vital Records

Our registrar and deputy registrars can print birth records for the State of Missouri from 1920 to present and death certificates from 1980 to present.

Statistics

Health Education and Promotion

In response to the growing obesity epidemic, the Health Center works with other community partners on a number of healthy eating and active living initiatives.  These include The Salem Fitness Center, health fairs, and community gardens, walking programs, workplace health planning and support for healthy foods in schools.

Community Engagement

Public Health Information is provided to the community in the Your World Today, local newspaper, local radio, and the Health Center Facebook page as well as the website, www.dentcountyhealthcenter.org. 

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